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. 2017 Jun 12;12(6):e0177746.
doi: 10.1371/journal.pone.0177746. eCollection 2017.

Surveillance of impact of PCV-10 vaccine on pneumococcal meningitis in Mozambique, 2013 - 2015

Aquino Albino Nhantumbo  1 , Goitom Weldegebriel  2 , Reggis Katsande  2 , Linda de Gouveia  3 , Charlotte Elizabeth Comé  1 , Arlindo Zacarias Cuco  1 , Vlademir Vicente Cantarelli  4   5 , Cícero Dias  5 , Juliana Caierão  5 , Jason Mwenda Mathiu  2 , Eduardo Samo Gudo  6
Affiliations

Surveillance of impact of PCV-10 vaccine on pneumococcal meningitis in Mozambique, 2013 - 2015

Aquino Albino Nhantumbo et al. PLoS One. .

Abstract

Background: Vaccination using the 10-valent conjugate vaccine (PCV-10) was introduced into the Extended Program on Immunization in Mozambique in March 2013, however its impact on pediatric pneumococcal meningitis is unknown. In this study, we assessed for the first time the impact of PCV10 on the burden of pneumococcal meningitis in children less than 5 years of age at the three largest hospitals in Mozambique.

Method: Between March 2013 and December 2015, a total of 744 cerebrospinal fluid (CSF) samples were collected from eligible children, of which 160 (21.5%) were positive for S. pneumoniae. Of these, only 86 samples met the criteria for serotyping and were subsequently serotyped using sequential multiplex PCR (SM-PCR), but 17 samples were non-typable.

Results: The proportion of cases of pneumococcal meningitis decreased from 33.6% (124 of 369) in 2013 to 1.9% (3 of 160) in 2015 (p < 0.001). The relative frequency of PCV10 serotype cases also decreased from 84.2% (48 of 57) in 2013 to 0% (0 of 3) in 2015 (p = 0.006). Between 2013 and 2015, serotype coverage of PCV-10 and PCV13 vaccine formulations was 66.7% and 81.2%, respectively.

Conclusion: Altogether, our findings shows that introduction of PCV-10 immunization resulted in rapid decline of pneumococcal meningitis children less than 5 years old in Mozambique. This decline was accompanied by substantial changes in the pattern of circulating pneumococcal serotypes.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of sample collection and testing.
The flow chart depicts the number of CSF samples collected and tested between March 2013 and December 2015. CSF: Cerebrospinal fluid; HCM: Hospital Central de Maputo; HCB: Hospital Central da Beira; HCN: Hospital Central de Nampula; SM-PCR: sequential multiplex polymerase chain reaction; NMRL: National Reference Microbiology Laboratory.
Fig 2
Fig 2. Detection of S. pneumoniae by PCR from 2013–2015, Mozambique.
Figure depicts the annual variation of the relative frequency of S. pneumoniae causing pneumococcal meningitis and also the variation in the number of CSF samples collected from children <5 years. Frequency of S. pneumoniae was determined using polymerase chain reaction (PCR). CSF: cerebrospinal fluid.
Fig 3
Fig 3. Distribution of serotypes of S. pneumoniae and vaccine coverage rates for PCV-7, PCV-10 and PCV-13 vaccine formulations.
Each bar represents the relative frequency of each serotype of S. pneumoniae. The value in the arrows above the bars depicts the vaccine coverage rates for PCV-7, PCV-10 and PCV-13, respectively NV, serotypes not included in 13-valent pneumococcal conjugate vaccine. NV, nonvaccine serotypes (serotypes 12F/12A/12B/44/46, 8, 22F/22A and 15B/C).
Fig 4
Fig 4. Proportions of isolates causing pediatric pneumococcal meningitis stratified by pneumococcal serotype and age.
Each bar represents the relative frequency of each serotype of S. pneumoniae.
See this image and copyright information in PMC

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