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. 2019 Sep 5;69(Suppl 2):S72-S80.
doi: 10.1093/cid/ciz462.

Pneumococcal Conjugate Vaccine Impact on Meningitis and Pneumonia Among Children Aged <5 Years-Zimbabwe, 2010-2016

Vongai Dondo  1   2 , Hilda Mujuru  1   2 , Kusum Nathoo  1   2 , Vengai Jacha  2 , Ottias Tapfumanei  3 , Priscilla Chirisa  3 , Portia Manangazira  3 , John Macharaga  2 , Linda de Gouveia  4 , Jason M Mwenda  5 , Regis Katsande  5 , Goitom Weldegebriel  6 , Tracy Pondo  7 , Almea Matanock  7 , Fernanda C Lessa  7
Affiliations

Pneumococcal Conjugate Vaccine Impact on Meningitis and Pneumonia Among Children Aged <5 Years-Zimbabwe, 2010-2016

Vongai Dondo et al. Clin Infect Dis. .

Abstract

Background: Streptococcus pneumoniae is a leading cause of pneumonia and meningitis in children aged <5 years. Zimbabwe introduced 13-valent pneumococcal conjugate vaccine (PCV13) in 2012 using a 3-dose infant schedule with no booster dose or catch-up campaign. We evaluated the impact of PCV13 on pediatric pneumonia and meningitis.

Methods: We examined annual changes in the proportion of hospitalizations due to pneumonia and meningitis among children aged <5 years at Harare Central Hospital (HCH) pre-PCV13 (January 2010-June 2012) and post-PCV13 (July 2013-December 2016) using a negative binomial regression model, adjusting for seasonality. We also evaluated post-PCV13 changes in serotype distribution among children with confirmed pneumococcal meningitis at HCH and acute respiratory infection (ARI) trends using Ministry of Health outpatient data.

Results: Pneumonia hospitalizations among children aged <5 years steadily declined pre-PCV13; no significant change in annual decline was observed post-PCV13. Post-PCV13 introduction, meningitis hospitalization decreased 30% annually (95% confidence interval [CI], -42, -14) among children aged 12-59 months, and no change was observed among children aged 0-11 months. Pneumococcal meningitis caused by PCV13 serotypes decreased from 100% in 2011 to 50% in 2016. Annual severe and moderate outpatient ARI decreased by 30% (95% CI, -33, -26) and 7% (95% CI, -11, -2), respectively, post-PCV13 introduction.

Conclusions: We observed declines in pediatric meningitis hospitalizations, PCV13-type pneumococcal meningitis, and severe and moderate ARI outpatient visits post-PCV13 introduction. Low specificity of discharge codes, changes in referral patterns, and improvements in human immunodeficiency virus care may have contributed to the lack of additional declines in pneumonia hospitalizations post-PCV13 introduction.

Keywords: Zimbabwe; children; meningitis; pneumococcal vaccines; pneumonia.

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Figures

Figure 1.
Figure 1.
Harare Central Hospital admissions by syndrome and age group, 2010–2016. Abbreviations: CI, confidence interval; PCV13, 13-valent pneumococcal conjugate vaccine.
Figure 1.
Figure 1.
Harare Central Hospital admissions by syndrome and age group, 2010–2016. Abbreviations: CI, confidence interval; PCV13, 13-valent pneumococcal conjugate vaccine.
Figure 1.
Figure 1.
Harare Central Hospital admissions by syndrome and age group, 2010–2016. Abbreviations: CI, confidence interval; PCV13, 13-valent pneumococcal conjugate vaccine.
Figure 2.
Figure 2.
Streptococcus pneumoniae–positive CSF samples by serotype group among children aged <5 years admitted to Harare Central Hospital, 2011–2016. Abbreviations: CSF; cerebrospinal fluid; PCV13, 13-valent pneumococcal conjugate vaccine. *Calculated as the percent of PCV13-type among positive pneumococcal CSF specimens serotyped.
Figure 3.
Figure 3.
Nationwide ARI outpatient department visits among children aged <5 years, 2012–2016. Abbreviations: ARI, acute respiratory infection; PCV13, 13-valent pneumococcal conjugate vaccine.
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