Impact of 10-Valent Pneumococcal Conjugate Vaccine on Bacterial Meningitis in Madagascar

Abstract

Background: The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Madagascar in 2012. The objective of this study was to determine the impact of PCV10 on bacterial meningitis in hospitalized children <5 years of age.

Methods: During 2010-2017, data from the hospital admission logbook were recorded for bacterial meningitis and pneumonia hospitalizations in children <5 years of age. Between April 2011 and December 2017, 3312 cerebrospinal fluid (CSF) samples collected from children who fulfilled the World Health Organization case definition of suspected bacterial meningitis were analyzed at the sentinel site laboratory (SSL) by microscopy, culture, and antigen detection tests. A total of 2065 CSF samples were referred to the regional reference laboratory for real-time polymerase chain reaction (RT-PCR) analysis. 2010-2011 was defined as the prevaccine period, 2012 as vaccine introduction year, and 2013-2017 the postvaccine period. The number of cases, causative agent, and pneumonia hospitalizations were compared before and after PCV10 introduction.

Results: In the prevaccine period, bacterial meningitis and pneumonia hospitalizations accounted for 4.5% and 24.5% of all hospitalizations while there were 2.6% and 19%, respectively, in the postvaccine period (P < .001). In samples tested at the SSL, 154 were positive with 80% Streptococcus pneumoniae and 20% other bacteria. Pneumococcal meningitis diagnosed by RT-PCR declined from 14% in 2012 to 3% in 2017. Also, 14% of children with pneumococcal meningitis died.

Conclusions: Following PCV10 introduction, pneumococcal meningitis, bacterial meningitis, and pneumonia hospitalizations declined. Surveillance should continue to monitor the impact of PCV10.

Keywords: Streptococcus pneumoniae; PCV; acute bacterial meningitis; pneumococcal conjugate vaccine.

Figure 1.

Percentage of total hospitalizations due to meningitis and pneumonia, 2010–2017, Madagascar. Abbreviation: PCV10, 10-valent pneumococcal conjugate vaccine.

Figure 2.

Bacteria identified from cerebrospinal fluid samples tested between 2011 and 2017 at sentinel site laboratory (SSL) Centre Hospitalier Universitaire Mère Enfant Tsaralalàna (CHUMET) and at the regional reference laboratory (RRL) by polymerase chain reaction (source: laboratory data register, CHUMET and RRL South Africa).