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. 2019 Oct 31;220(220 Suppl 4):S253-S262.
doi: 10.1093/infdis/jiz301.

Impact of 13-Valent Pneumococcal Conjugate Vaccine on Pneumococcal Meningitis, Burkina Faso, 2016-2017

Heidi M Soeters  1 , Dinanibè Kambiré  2 , Guetawendé Sawadogo  3 , Rasmata Ouédraogo-Traoré  2 , Brice Bicaba  4 , Isaïe Medah  4 , Lassana Sangaré  5 , Abdoul-Salam Ouédraogo  6 , Soumeya Ouangraoua  7 , Issaka Yaméogo  4 , Malika Congo-Ouédraogo  5 , Absatou Ky Ba  8 , Flavien Aké  3 , Velusamy Srinivasan  1 , Ryan T Novak  1 , Lesley McGee  1 , Cynthia G Whitney  1 , Chris Van Beneden  1
Affiliations

Impact of 13-Valent Pneumococcal Conjugate Vaccine on Pneumococcal Meningitis, Burkina Faso, 2016-2017

Heidi M Soeters et al. J Infect Dis. .

Abstract

Background: In 2013, Burkina Faso introduced 13-valent pneumococcal conjugate vaccine (PCV13) into the routine childhood immunization program, to be administered to children at 8, 12, and 16 weeks of age. We evaluated the impact of PCV13 on pneumococcal meningitis.

Methods: Using nationwide surveillance, we gathered demographic/clinical information and cerebrospinal fluid (CSF) results for meningitis cases. Pneumococcal cases were confirmed by culture, polymerase chain reaction (PCR), or latex agglutination; strains were serotyped using PCR. We compared annual incidence (cases per 100 000) 4 years after PCV13's introduction (2017) to average pre-PCV13 incidence (2011-2013). We adjusted incidence for age and proportion of cases with CSF tested at national laboratories.

Results: In 2017, pneumococcal meningitis incidence was 2.7 overall and 10.5 (<1 year), 3.8 (1-4 years), 3.5 (5-14 years), and 1.4 (≥15 years) by age group. Compared to 2011-2013, PCV13-serotype incidence was significantly lower among all age groups, with the greatest decline among children aged <1 year (77%; 95% confidence interval [CI], 65%-84%). Among all ages, the drop in incidence was larger for PCV13 serotypes excluding serotype 1 (79%; 95% CI, 72%-84%) than for serotype 1 (52%; 95% CI, 44%-59%); incidence of non-PCV13 serotypes also declined (53%; 95% CI, 37%-65%). In 2017, 45% of serotyped cases among all ages were serotype 1 and 12% were other PCV13 serotypes.

Conclusions: In Burkina Faso, meningitis caused by PCV13 serotypes continues to decrease, especially among young children. However, the concurrent decline in non-PCV13 serotypes and short pre-PCV13 observation period complicate evaluation of PCV13's impact. Efforts to improve control of serotype 1, such as switching from a 3 + 0 schedule to a 2 + 1 schedule, may improve overall control of pneumococcal meningitis in this setting.

Keywords: Burkina Faso; pneumococcal conjugate vaccine; pneumococcal meningitis; vaccine impact.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Figures

Figure 1.
Figure 1.
Epidemic curve of confirmed pneumococcal meningitis cases, serotyped cases, 13-valent pneumococcal conjugate vaccine (PCV13) serotypes, serotype 1, and PCV13 serotypes excluding serotype 1 among children aged <1 year, by month, Burkina Faso, 2011–2017. Streptococcus pneumoniae isolated from cerebrospinal fluid (CSF) by culture or detected in CSF by real-time polymerase chain reaction or latex agglutination.
Figure 2.
Figure 2.
Annual incidence of pneumococcal meningitis caused by 13-valent pneumococcal conjugate vaccine (PCV13) serotypes, by patient age group, Burkina Faso, 2011–2017.
Figure 3.
Figure 3.
Annual incidence of serotype 1 pneumococcal meningitis, by patient age group, Burkina Faso, 2011–2017. PCV13, 13-valent pneumococcal conjugate vaccine.
Figure 4.
Figure 4.
Annual incidence of pneumococcal meningitis among children aged <5 years, by serotype category, Burkina Faso, 2011–2017. PCV13, 13-valent pneumococcal conjugate vaccine.
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