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

Abstract

Background Despite the availability of vaccines, invasive bacterial diseases remain a public health concern and cause childhood morbidity and mortality. We investigated the characteristics of etiological agents causing bacterial meningitis in children <5 years in the years pre- (2010–2012) and post- (2014–2019) 10-valent pneumococcal conjugate vaccine (PCV10) introduction in Zambia. Methods Streptococcus pneumoniae (Spn), Haemophilus influenzae (Hi), and Neisseria meningitidis (Nm) from cerebrospinal fluid (CSF) were identified by microbiological culture and/or real-time polymerase chain reaction. Results During the surveillance period, a total of 3811 children were admitted with suspected meningitis, 16% (598 of 3811) of which were probable cases. Bacterial meningitis was confirmed in 37% (221 of 598) of the probable cases. Spn pneumoniae, Hi, and Nm accounted for 67% (148 of 221), 14% (31 of 221), and 19% (42 of 221) of confirmed cases, respectively. Thirty-six percent of pneumococcal meningitis was caused by 10-valent pneumococcal conjugate vaccine (PCV10) serotypes, 16% 13-valent pneumococcal conjugate vaccine and 39% by nonvaccine serotype (NVS). There was an association between the introduction of PCV10 vaccination and a decrease in both Spn meningitis and the proportion of PVC10 serotypes in the postvaccination period. Antimicrobial susceptibility of 47 Spn isolates revealed 34% (16 of 47) penicillin resistance. The 31 serotyped Hi accounted for 74% type b (Hib) and 10% type a (Hia). All 42 serogrouped Nm belonged to serogroup W. Conclusions There was a decline in pneumococcal meningitis and proportion of PCV10 serotypes in the postvaccination period. However, the serotype replacement with non-PCV10 serotypes and penicillin resistance warrant continued surveillance to inform policy.

Assessment of antimicrobial resistance laboratory-based surveillance capacity of hospitals in Zambia: findings and implications for system strengthening

“…The absence of carbon dioxide incubators in all of the surveyed laboratories compromises the ability to isolate fastidious organisms of public health significance such as Streptococcus pneumoniae , Haemophilus influenzae and Neisseria meningitidis , thereby limiting the hospital's ability to correctly treat patients infected with these organisms and monitor the changing trends, data that can support country- and/or region-specific vaccine development [ 73 , 74 ]. Further, the lack of -60 °C and -80 °C freezers in these facilities hinders the long-term storage of bacterial isolates that can be used for future analysis and surveillance.…”

Serotype distribution of invasive pneumococcal disease from countries of the WHO Africa, Americas, Eastern Mediterranean, South-East Asia, and Western Pacific regions: a systematic literature review from 2010 to 2021

“…These publications were distributed by WHO region ( Figure 2 ) as follows: 26 publications from AMRO ( 13 , 17 – 42 ), 32 publications from AFRO ( 14 , 15 , 43 – 71 ), 17 publications from EMRO ( 16 , 72 – 87 ), 13 publications from SEARO ( 88 – 100 ), and 19 publications from WPRO ( 100 – 119 ).…”