Impact of 13-valent pneumococcal conjugate vaccine on the incidence of hospitalizations for all-cause pneumonia among children aged less than 5 years in Burkina Faso: An interrupted time-series analysis.

BACKGROUND: Pneumococcal disease is a major public health concern globally and particularly in Burkina Faso, where the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced nationwide into the routine immunization schedule in 2013. The aim of this study was to evaluate vaccine impact on all-cause pneumonia hospitalizations among children <5 years of age. METHODS: Hospitalization data covering a 10-year period (January 1, 2009-December 31, 2018) were collected retrospectively in four rural district hospitals, using medical records to extract data on relevant variables. Using an interrupted time-series design and segmented regression, the effectiveness and impact of PCV13 on the rates of pneumonia hospitalization were estimated. Severe acute malnutrition and unintentional injury were used as control conditions. RESULTS: Vaccine effectiveness was found to be 34% (95% confidence interval (CI) 16-49%, p=0.001), 24% (95% CI 2-41%, p=0.032), and 50% (95% CI 30-64%, p<0.001) against all-cause pneumonia among children <5 years, <2 years, and 2-4 years of age, respectively. By October 2018, PCV13 introduction had led to an absolute reduction in the pneumonia hospitalization rate of 348 cases per 100000 person-years among children <5 years of age. No decline was observed for the control conditions. CONCLUSIONS: These estimates point to a substantial public health impact of PCV13 against pneumonia hospitalization among children aged <5 years in Burkina Faso.

Quality and reliability of vaccination documentation in the routine childhood immunization program in Burkina Faso: Results from a cross-sectional survey.

INTRODUCTION: Accurate and timely vaccination data are important to the Expanded Program on Immunization (EPI) to assess individual vaccination status and to monitor performance and vaccine coverage (VC). Since 2013, Burkina Faso introduced several new vaccines into the routine childhood immunization schedule. However, sustained efforts for a timely update and alignment of immunization home-based (HBRs) and health facility-based records (FBRs) with the evolving schedule were not implemented. METHODS: In 2016-17, we conducted a 6-week cross-sectional survey in 30 health facilities (HFs) across 10 health districts (HDs), targeting children aged < 24 months and their caregivers. Data collected included sociodemographics, availability of vaccination recording fields in HBRs, and vaccination dates. We evaluated the characteristics, completion patterns, and concordance of HBRs and FBRs to determine their reliability as data sources in estimating VC. A standard HBR was defined as one that had recording fields for all recommended 17 vaccine doses of the schedule, and discordance between HBR and FBR as having different vaccination dates recorded, or vaccination information missing in one of the records. We computed proportions and concordance statistics, and used logistic regression to explore predictors of discordance. RESULTS: We recruited 619 children, including 74% (n = 458) aged 0-11 months. Half (50.6%) of HBRs were non-standard. About two-thirds (64.6%) of children were concerned with discordant information. Compared to HBRs, FBRs were generally associated with low negative predictive values (median: 0.41; IQR: 0.16-0.70). Multivariate logistic regression model showed that standard HBR was protectively associated with discordant information (OR = 0.46, 95% CI: 0.26-0.81, p = 0.010). CONCLUSION: We documented a lack of standardization of HBRs and frequent information discordance with FBRs. There is a pressing need to update and standardize vaccination recording tools and ensure their continuous availability in HFs to improve data quality in Burkina Faso.