Declines in Pneumonia and Meningitis Hospitalizations in Children Under 5 Years of Age After Introduction of 10-Valent Pneumococcal Conjugate Vaccine in Zambia, 2010–2016

Abstract

Background Pneumococcus is a leading cause of pneumonia and meningitis. Zambia introduced a 10-valent pneumococcal conjugate vaccine (PCV10) in July 2013 using a 3-dose primary series at ages 6, 10, and 14 weeks with no booster. We evaluated the impact of PCV10 on meningitis and pneumonia hospitalizations. Methods Using hospitalization data from first-level care hospitals, available at the Ministry of Health, and from the largest pediatric referral hospital in Lusaka, we identified children aged <5 years who were hospitalized with pneumonia or meningitis from January 2010–December 2016. We used time-series analyses to measure the effect of PCV10 on monthly case counts by outcome and age group (<1 year, 1–4 years), accounting for seasonality. We defined the pre- and post-PCV10 periods as January 2010–June 2013 and July 2014–December 2016, respectively. Results At first-level care hospitals, pneumonia and meningitis hospitalizations among children aged <5 years accounted for 108 884 and 1742 admissions in the 42 months pre-PCV10, respectively, and 44 715 and 646 admissions in the 30 months post-PCV10, respectively. Pneumonia hospitalizations declined by 37.8% (95% confidence interval [CI] 21.4–50.3%) and 28.8% (95% CI 17.7–38.7%) among children aged <1 year and 1–4 years, respectively, while meningitis hospitalizations declined by 72.1% (95% CI 63.2–79.0%) and 61.6% (95% CI 50.4–70.8%), respectively, in these age groups. In contrast, at the referral hospital, pneumonia hospitalizations remained stable and a smaller but significant decline in meningitis was observed among children aged 1–4 years (39.3%, 95% CI 16.2–57.5%). Conclusions PCV10 introduction was associated with declines in meningitis and pneumonia hospitalizations in Zambia, especially in first-level care hospitals.

The Burden of Invasive Bacterial Disease and the Impact of 10-Valent Pneumococcal Conjugate Vaccine in Children <5 years hospitalized for Meningitis in Lusaka, Zambia, 2010–2019

“…The decline in the frequency of probable bacterial and confirmed meningitis cases after PCV10 introduction is notable. The reduction of probable bacterial meningitis cases is consistent with findings by Mpabalwani et al [ 8 ], who observed substantial decline in meningitis and pneumonia hospitalizations among children aged <5 years in the first 3 years after PCV10 introduction in Zambia.…”

“…Pneumococcal disease remains a public health concern because it is associated with long-term sequelae and high case-fatality rates (CFRs), which worsen by the rise in resistance to commonly used and affordable antibiotics such as penicillin [ 7 , 8 ]. An estimated 1.6 million children under 5 years of age die every year as a result of pneumococcal disease, the highest burden being in sub-Saharan African countries with high human immunodeficiency virus (HIV) prevalence [ 8 , 9 ]. More than 95 pneumococcal serotypes have been identified, based on differences in the antigenic characteristics of their capsular polysaccharides.…”

“…The World Health Organization (WHO) recommended the inclusion of Hib and the PCV10 using a 3 primary-dose series at age 6, 10, and 14 weeks in childhood immunization programs [ 18 ]. The introduction of vaccines in countries within WHO African region, as part of their national childhood Expanded Programme on Immunisation, has resulted in a significant decline in invasive bacterial diseases (IBDs) caused by pneumococcus and Hib [ 6 , 8 , 19 ].…”

“…Zambia introduced Hib vaccine in January 2004 and PCV10 (3 + 0 schedule) [ 8 ] in July 2013. There is currently no meningococcal vaccine available in Zambia.…”

Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumonia hospital admissions in Fiji: a time-series analysis

“…Two studies from Brazil and one from Zambia found that changes in all-cause pneumonia hospital admissions among children younger than 5 years varied between a 2% increase and 38% decrease following the introduction of PCV10. 16,18,19 Mortality reduced by 39% among children aged 2-23 months who were admitted to CWMH with all-cause pneumonia, bronchiolitis, and asthma. Few studies have Data are the ratio of observed to expected cases (95% CI).…”