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Impact and effectiveness of 13-valent pneumococcal conjugate vaccine on population incidence of vaccine and non-vaccine serotype invasive pneumococcal disease in Blantyre, Malawi, 2006-18: prospective observational time-series and case-control studies.
Bar-Zeev, Naor; Swarthout, Todd D; Everett, Dean B; Alaerts, Maaike; Msefula, Jacquline; Brown, Comfort; Bilima, Sithembile; Mallewa, Jane; King, Carina; von Gottberg, Anne; Verani, Jennifer R; Whitney, Cynthia G; Mwansambo, Charles; Gordon, Stephen B; Cunliffe, Nigel A; French, Neil; Heyderman, Robert S.
Afiliação
  • Bar-Zeev N; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Center for Global Vaccine Research, University of Liverpool, Liverpool, UK; International Vaccine Access Center, Department of International Health, Bloomberg School of Public He
  • Swarthout TD; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; NIHR Global Health Research Unit on Mucosal Pathogens, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK. Electronic add
  • Everett DB; The Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK.
  • Alaerts M; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Cardiogenetics Research Group, Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium.
  • Msefula J; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi.
  • Brown C; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi.
  • Bilima S; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi.
  • Mallewa J; College of Medicine, University of Malawi, Blantyre, Malawi.
  • King C; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
  • von Gottberg A; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
  • Verani JR; National Center for Immunization and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA.
  • Whitney CG; National Center for Immunization and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA.
  • Mwansambo C; Ministry of Health, Lilongwe, Malawi.
  • Gordon SB; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, UK.
  • Cunliffe NA; NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.
  • French N; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Center for Global Vaccine Research, University of Liverpool, Liverpool, UK.
  • Heyderman RS; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; NIHR Global Health Research Unit on Mucosal Pathogens, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK.
Lancet Glob Health ; 9(7): e989-e998, 2021 07.
Article em En | MEDLINE | ID: mdl-34143997
BACKGROUND: The population impact of pneumococcal conjugate vaccines (PCVs) depends on direct and indirect protection. Following Malawi's introduction of the 13-valent PCV (PCV13) in 2011, we examined its impact on vaccine and non-vaccine serotype invasive pneumococcal disease among vaccine-eligible-age and vaccine-ineligible-age children and adults. METHODS: We did a prospective observational time-series analysis and a case-control study. We used data from between Jan 1, 2006, and Dec 31, 2018, from laboratory-based surveillance at a government hospital in Malawi. This period included 6 years before and 7 years after introduction of PCV13. By use of negative-binomial regression, we evaluated secular trend-adjusted incidence rate ratio (IRR) in vaccine serotype and non-vaccine serotype invasive pneumococcal disease before and after introduction of PCV. We compared predicted counterfactual incidence in hypothetical absence of vaccine with empirically observed incidence following vaccine introduction. The case-control study assessed vaccine effectiveness, comparing PCV uptake among cases of vaccine-eligible-age invasive pneumococcal disease versus matched community controls. FINDINGS: Surveillance covered 10 281 476 person-years of observation, with 140 498 blood and 63 291 cerebrospinal fluid cultures. A reduction in total (vaccine serotype plus non-vaccine serotype) invasive pneumococcal disease incidence preceded introduction of PCV: 19% (IRR 0·81, 95% CI 0·74 to 0·88, p<0·0001) among infants (<1 year old), 14% (0·86, 0·80 to 0·93, p<0·0001) among children aged 1-4 years, and 8% (0·92, 0·83 to 1·01, p=0·084) among adolescents and adults (≥15 years old). Among children aged 5-14 years there was a 2% increase in total invasive pneumococcal disease (1·02, 0·93 to 1·11, p=0·72). Compared with the counterfactually predicted incidence, incidence of post-PCV13 vaccine serotype invasive pneumococcal disease was 74% (95% CI 70 to 78) lower among children aged 1-4 years and 79% (76 to 83) lower among children aged 5-14 years, but only 38% (37 to 40) lower among infants and 47% (44 to 51) lower among adolescents and adults. Although non-vaccine serotype invasive pneumococcal disease has increased in incidence since 2015, observed incidence remains low. The case-control study (19 cases and 76 controls) showed vaccine effectiveness against vaccine serotype invasive pneumococcal disease of 80·7% (-73·7 to 97·9). INTERPRETATION: In a high-mortality, high-HIV-prevalence setting in Africa, there were significant pre-vaccine reductions in the incidence of invasive pneumococcal disease. 7 years after PCV introduction, although vaccine-attributable impact among vaccine-eligible-age children was significant, indirect effects benefitting unvaccinated infants and adults were not. Policy decisions should consider multiple alternative strategies for reducing disease burden, including targeted vaccination outside infant Expanded Programme of Immunization to benefit vulnerable populations. FUNDING: Bill & Melinda Gates Foundation, Wellcome Trust, and National Institute for Health Research.
Assuntos

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 1_ASSA2030 / 2_ODS3 / 4_TD / 7_ODS3_muertes_prevenibles_nacidos_ninos Base de dados: MEDLINE Assunto principal: Infecções Pneumocócicas / Vacinas Pneumocócicas Tipo de estudo: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male País/Região como assunto: Africa Idioma: En Revista: Lancet Glob Health Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 1_ASSA2030 / 2_ODS3 / 4_TD / 7_ODS3_muertes_prevenibles_nacidos_ninos Base de dados: MEDLINE Assunto principal: Infecções Pneumocócicas / Vacinas Pneumocócicas Tipo de estudo: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male País/Região como assunto: Africa Idioma: En Revista: Lancet Glob Health Ano de publicação: 2021 Tipo de documento: Article