Impact of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease and pneumonia in The Gambia: 10 years of population-based surveillance.

Gambia Pneumococcal Surveillance Group; Mackenzie, GAORCID logo; Hill, PC; Jeffries, DJORCID logo; Ndiaye, M; Sahito, SM; Hossain, I; Uchendu, U; Ameh, D; Adeyemi, O; +40 more...Pathirana, J; Olatunji, Y; Abatan, B; Muhammad, BS; Ahameefula, E; Fombah, AE; Adeshola, B; Lobga, BG; Saha, D; Mackenzie, R; Odutola, A; Plumb, ID; Akano, A; Ebruke, BE; Ideh, RC; Kuti, B; Githua, P; Olutunde, E; Ofordile, O; Green, E; Usuf, EORCID logo; Badji, H; Ikumapayi, UNORCID logo; Manjang, A; Salaudeen, R; Nsekpong, ED; Jarju, S; Antonio, MORCID logo; Sambou, S; Ceesay, L; Lowe-Jallow, Y; Fofana, S; Jasseh, MORCID logo; Mulholland, K; Knoll, M; Levine, OS; Howie, SR; Adegbola, RA; Greenwood, BMORCID logo; Corrah, T and (2021) Impact of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease and pneumonia in The Gambia: 10 years of population-based surveillance. The Lancet. Infectious diseases, 21 (9). pp. 1293-1302. ISSN 1473-3099 DOI: 10.1016/S1473-3099(20)30880-X
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BACKGROUND: The Gambia introduced seven-valent pneumococcal conjugate vaccine (PCV7) in August 2009, followed by PCV13 in May, 2011, using a schedule of three primary doses without a booster dose or catch-up immunisation. We aimed to assess the long-term impact of PCV on disease incidence. METHODS: We did 10 years of population-based surveillance for invasive pneumococcal disease (IPD) and WHO defined radiological pneumonia with consolidation in rural Gambia. The surveillance population included all Basse Health and Demographic Surveillance System residents aged 2 months or older. Nurses screened all outpatients and inpatients at all health facilities using standardised criteria for referral. Clinicians then applied criteria for patient investigation. We defined IPD as a compatible illness with isolation of Streptococcus pneumoniae from a normally sterile site (cerebrospinal fluid, blood, or pleural fluid). We compared disease incidence between baseline (May 12, 2008-May 11, 2010) and post-vaccine years (2016-2017), in children aged 2 months to 14 years, adjusting for changes in case ascertainment over time. FINDINGS: We identified 22 728 patients for investigation and detected 342 cases of IPD and 2623 cases of radiological pneumonia. Among children aged 2-59 months, IPD incidence declined from 184 cases per 100 000 person-years to 38 cases per 100 000 person-years, an 80% reduction (95% CI 69-87). Non-pneumococcal bacteraemia incidence did not change significantly over time (incidence rate ratio 0·88; 95% CI, 0·64-1·21). We detected zero cases of vaccine-type IPD in the 2-11 month age group in 2016-17. Incidence of radiological pneumonia decreased by 33% (95% CI 24-40), from 10·5 to 7·0 per 1000 person-years in the 2-59 month age group, while pneumonia hospitalisations declined by 27% (95% CI 22-31). In the 5-14 year age group, IPD incidence declined by 69% (95% CI -28 to 91) and radiological pneumonia by 27% (95% CI -5 to 49). INTERPRETATION: Routine introduction of PCV13 substantially reduced the incidence of childhood IPD and pneumonia in rural Gambia, including elimination of vaccine-type IPD in infants. Other low-income countries can expect substantial impact from the introduction of PCV13 using a schedule of three primary doses. FUNDING: Gavi, The Vaccine Alliance; Bill & Melinda Gates Foundation; UK Medical Research Council; Pfizer Ltd.


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