TY - JOUR
T1 - Effect of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease in The Gambia
T2 - a population-based surveillance study
AU - Mackenzie, Grant A.
AU - Hill, Philip C.
AU - Jeffries, David J.
AU - Hossain, Ilias
AU - Uchendu, Uchendu
AU - Ameh, David
AU - Ndiaye, Malick
AU - Adeyemi, Oyedeji
AU - Pathirana, Jayani
AU - Olatunji, Yekini
AU - Abatan, Bade
AU - Muhammad, Bilquees S.
AU - Fombah, Augustin E.
AU - Saha, Debasish
AU - Plumb, Ian
AU - Akano, Aliu
AU - Ebruke, Bernard
AU - Ideh, Readon C.
AU - Kuti, Bankole
AU - Githua, Peter
AU - Olutunde, Emmanuel
AU - Ofordile, Ogochukwu
AU - Green, Edward
AU - Usuf, Effua
AU - Badji, Henry
AU - Ikumapayi, Usman N.A.
AU - Manjang, Ahmad
AU - Salaudeen, Rasheed
AU - Nsekpong, E. David
AU - Jarju, Sheikh
AU - Antonio, Martin
AU - Sambou, Sana
AU - Ceesay, Lamin
AU - Lowe-Jallow, Yamundow
AU - Jasseh, Momodou
AU - Mulholland, Kim
AU - Knoll, Maria
AU - Levine, Orin S.
AU - Howie, Stephen R.
AU - Adegbola, Richard A.
AU - Greenwood, Brian M.
AU - Corrah, Tumani
N1 - Funding Information:
RAA is currently employed by GlaxoSmithKline Vaccines and has received grant awards from WHO , GAVI Alliance , and the Bill & Melinda Gates Foundation while employed at Medical Research Council Gambia. MK, SRH, and BMG have received grants from the Bill & Melinda Gates Foundation . MK has received grants from the GAVI Alliance , Merck , and Pfizer , and personal fees from Pfizer . All other authors declare no competing interests.
Funding Information:
The study was funded by GAVI's Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA), the Bill & Melinda Gates Foundation ( OPP 1020372 ), and the UK Medical Research Council (MRC) . The Gambia Government, Upper River Region, Regional Health Team delivered the pneumococcal conjugate vaccine; and surveillance was done at the The Basse Major Health Centre and government health facilities in Gambissara, Demba Kunda, Fatoto, Garawol, and Koina. We thank all staff at the MRC Basse Field Station and the residents of the Basse Health and Demographic Surveillance System for supporting the study.
Funding Information:
The study was funded by GAVI's Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP) , the Bill & Melinda Gates Foundation , and the UK Medical Research Council . None of the funding sources had any role in collection, analysis, or interpretation of the data. The corresponding author had full access to all the data and was responsible for the final decision to submit for publication.
Publisher Copyright:
© 2016 Mackenzie et al. Open Access article distributed under the terms of CC BY
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background Little information is available about the effect of pneumococcal conjugate vaccines (PCVs) in low-income countries. We measured the effect of these vaccines on invasive pneumococcal disease in The Gambia where the 7-valent vaccine (PCV7) was introduced in August, 2009, followed by the 13-valent vaccine (PCV13) in May, 2011. Methods We conducted population-based surveillance for invasive pneumococcal disease in individuals aged 2 months and older who were residents of the Basse Health and Demographic Surveillance System (BHDSS) in the Upper River Region, The Gambia, using standardised criteria to identify and investigate patients. Surveillance was done between May, 2008, and December, 2014. We compared the incidence of invasive pneumococcal disease between baseline (May 12, 2008–May 11, 2010) and after the introduction of PCV13 (Jan 1, 2013–Dec 31, 2014), adjusting for changes in case ascertainment over time. Findings We investigated 14 650 patients, in whom we identified 320 cases of invasive pneumococcal disease. Compared with baseline, after the introduction of the PCV programme, the incidence of invasive pneumococcal disease decreased by 55% (95% CI 30–71) in the 2–23 months age group, from 253 to 113 per 100 000 population. This decrease was due to an 82% (95% CI 64–91) reduction in serotypes covered by the PCV13 vaccine. In the 2–4 years age group, the incidence of invasive pneumococcal disease decreased by 56% (95% CI 25–75), from 113 to 49 cases per 100 000, with a 68% (95% CI 39–83) reduction in PCV13 serotypes. The incidence of non-PCV13 serotypes in children aged 2–59 months increased by 47% (−21 to 275) from 28 to 41 per 100 000, with a broad range of serotypes. The incidence of non-pneumococcal bacteraemia varied little over time. Interpretation The Gambian PCV programme reduced the incidence of invasive pneumococcal disease in children aged 2–59 months by around 55%. Further surveillance is needed to ascertain the maximum effect of the vaccine in the 2–4 years and older age groups, and to monitor serotype replacement. Low-income and middle-income countries that introduce PCV13 can expect substantial reductions in invasive pneumococcal disease. Funding GAVI's Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP), Bill & Melinda Gates Foundation, and the UK Medical Research Council.
AB - Background Little information is available about the effect of pneumococcal conjugate vaccines (PCVs) in low-income countries. We measured the effect of these vaccines on invasive pneumococcal disease in The Gambia where the 7-valent vaccine (PCV7) was introduced in August, 2009, followed by the 13-valent vaccine (PCV13) in May, 2011. Methods We conducted population-based surveillance for invasive pneumococcal disease in individuals aged 2 months and older who were residents of the Basse Health and Demographic Surveillance System (BHDSS) in the Upper River Region, The Gambia, using standardised criteria to identify and investigate patients. Surveillance was done between May, 2008, and December, 2014. We compared the incidence of invasive pneumococcal disease between baseline (May 12, 2008–May 11, 2010) and after the introduction of PCV13 (Jan 1, 2013–Dec 31, 2014), adjusting for changes in case ascertainment over time. Findings We investigated 14 650 patients, in whom we identified 320 cases of invasive pneumococcal disease. Compared with baseline, after the introduction of the PCV programme, the incidence of invasive pneumococcal disease decreased by 55% (95% CI 30–71) in the 2–23 months age group, from 253 to 113 per 100 000 population. This decrease was due to an 82% (95% CI 64–91) reduction in serotypes covered by the PCV13 vaccine. In the 2–4 years age group, the incidence of invasive pneumococcal disease decreased by 56% (95% CI 25–75), from 113 to 49 cases per 100 000, with a 68% (95% CI 39–83) reduction in PCV13 serotypes. The incidence of non-PCV13 serotypes in children aged 2–59 months increased by 47% (−21 to 275) from 28 to 41 per 100 000, with a broad range of serotypes. The incidence of non-pneumococcal bacteraemia varied little over time. Interpretation The Gambian PCV programme reduced the incidence of invasive pneumococcal disease in children aged 2–59 months by around 55%. Further surveillance is needed to ascertain the maximum effect of the vaccine in the 2–4 years and older age groups, and to monitor serotype replacement. Low-income and middle-income countries that introduce PCV13 can expect substantial reductions in invasive pneumococcal disease. Funding GAVI's Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP), Bill & Melinda Gates Foundation, and the UK Medical Research Council.
UR - http://www.scopus.com/inward/record.url?scp=84958576893&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84958576893&partnerID=8YFLogxK
U2 - 10.1016/S1473-3099(16)00054-2
DO - 10.1016/S1473-3099(16)00054-2
M3 - Article
C2 - 26897105
AN - SCOPUS:84958576893
SN - 1473-3099
VL - 16
SP - 703
EP - 711
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 6
ER -