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, Grant A;
Hill, Philip C;
Jeffries, David J;
Ndiaye, Malick;
Sahito, Shah M;
Hossain, Ilias;
Uchendu, Uchendu;
Ameh, David;
Adeyemi, Oyedeji;
+40 more...Pathirana, Jayani;
Olatunji, Yekini;
Abatan, Baderinwa;
Muhammad, Bilquees S;
Ahameefula, Ebirim;
Fombah, Augustin E;
Adeshola, Banjo;
Lobga, Babila G;
Saha, Debasish;
Mackenzie, Roslyn;
Odutola, Aderonke;
Plumb, Ian D;
Akano, Aliu;
Ebruke, Bernard E;
Ideh, Readon C;
Kuti, Bankole;
Githua, Peter;
Olutunde, Emmanuel;
Ofordile, Ogochukwu;
Green, Edward;
Usuf, Effua;
Badji, Henry;
Ikumapayi, Usman Na;
Manjang, Ahmed;
Salaudeen, Rasheed;
Nsekpong, E David;
Jarju, Sheikh;
Antonio, Martin;
Sambou, Sana;
Ceesay, Lamin;
Lowe-Jallow, Yamundow;
Fofana, Sidat;
Jasseh, Momodou;
Mulholland, Kim;
Knoll, Maria;
Levine, Orin S;
Howie, Stephen R;
Adegbola, Richard A;
Greenwood, Brian M;
Corrah, Tumani;
(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: https://doi.org/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.
