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.

Keywords: Zambia; meningitis; pneumococcal conjugate vaccine; pneumococcus; pneumonia.

Figure 1.

Modeled and observed pneumonia hospitalization counts by age and month/year of discharge using MOH and UTH data, Zambia, 2010–2016. Abbreviations: MOH, Ministry of Health; PCV10, 10-valent pneumococcal conjugate vaccine; UTH, University Teaching Hospital.

Figure 2.

Estimated reductions in in-hospital pneumonia and meningitis deaths among hospitalized children aged <5 years post-PCV10 using MOH and UTH data, Zambia, 2010–2016. A, Pneumonia hospitalization deaths. B, Meningitis hospitalization deaths. Abbreviations: MOH, Ministry of Health; PCV10, 10-valent pneumococcal conjugate vaccine; UTH, University Teaching Hospital.

Figure 3.

Modeled and observed meningitis hospitalization counts by age and month/year of discharge using MOH and UTH data, Zambia, 2010–2016. Impact on pneumonia hospitalizations post-PCV10: (A) −72.1% (95% CI −79.0 to −63.2%); (B) −61.6% (95% CI −70.8 to −50.4%); (C) −11.5% (95% CI −24.0 to 37.3%); and (D) −39.3% (95% CI −57.5 to −16.2%). Abbreviations: CI, confidence interval; MOH, Ministry of Health; PCV10, 10-valent pneumococcal conjugate vaccine; UTH, University Teaching Hospital.