Effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control study
Summary: Background: The 13-valent pneumococcal conjugate vaccine (PCV13) was designed to include disease-causing serotypes that are important in low-income and middle-income countries. Vaccine effectiveness estimates are scarce in these settings. South Africa replaced PCV7 with PCV13 in 2011 using...
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Elsevier
2017-03-01
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Series: | The Lancet Global Health |
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English |
format |
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DOAJ |
author |
Cheryl Cohen, DrPhD Claire von Mollendorf, MD Linda de Gouveia, NDMedTech Sarona Lengana, MD Susan Meiring, MD Vanessa Quan, MD Arthermon Nguweneza, MSc David P Moore, MD Gary Reubenson, MD Mamokgethi Moshe, MD Shabir A Madhi, ProfPhD Brian Eley, ProfMD Ute Hallbauer, MD Heather Finlayson, MD Sheeba Varughese, MD Katherine L O'Brien, ProfMD Elizabeth R Zell, MSc Keith P Klugman, ProfPhD Cynthia G Whitney, MD Anne von Gottberg, PhD |
spellingShingle |
Cheryl Cohen, DrPhD Claire von Mollendorf, MD Linda de Gouveia, NDMedTech Sarona Lengana, MD Susan Meiring, MD Vanessa Quan, MD Arthermon Nguweneza, MSc David P Moore, MD Gary Reubenson, MD Mamokgethi Moshe, MD Shabir A Madhi, ProfPhD Brian Eley, ProfMD Ute Hallbauer, MD Heather Finlayson, MD Sheeba Varughese, MD Katherine L O'Brien, ProfMD Elizabeth R Zell, MSc Keith P Klugman, ProfPhD Cynthia G Whitney, MD Anne von Gottberg, PhD Effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control study The Lancet Global Health |
author_facet |
Cheryl Cohen, DrPhD Claire von Mollendorf, MD Linda de Gouveia, NDMedTech Sarona Lengana, MD Susan Meiring, MD Vanessa Quan, MD Arthermon Nguweneza, MSc David P Moore, MD Gary Reubenson, MD Mamokgethi Moshe, MD Shabir A Madhi, ProfPhD Brian Eley, ProfMD Ute Hallbauer, MD Heather Finlayson, MD Sheeba Varughese, MD Katherine L O'Brien, ProfMD Elizabeth R Zell, MSc Keith P Klugman, ProfPhD Cynthia G Whitney, MD Anne von Gottberg, PhD |
author_sort |
Cheryl Cohen, DrPhD |
title |
Effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control study |
title_short |
Effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control study |
title_full |
Effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control study |
title_fullStr |
Effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control study |
title_full_unstemmed |
Effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control study |
title_sort |
effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in south african children: a case-control study |
publisher |
Elsevier |
series |
The Lancet Global Health |
issn |
2214-109X |
publishDate |
2017-03-01 |
description |
Summary: Background: The 13-valent pneumococcal conjugate vaccine (PCV13) was designed to include disease-causing serotypes that are important in low-income and middle-income countries. Vaccine effectiveness estimates are scarce in these settings. South Africa replaced PCV7 with PCV13 in 2011 using a 2 + 1 schedule. We aimed to assess the effectiveness of two or more doses of PCV13 against invasive pneumococcal disease in children with HIV infection and in those not infected with HIV. Methods: Cases of invasive pneumococcal disease in children aged 5 years or younger were identified through national laboratory-based surveillance. Isolates were serotyped with the Quellung reaction or PCR. We sought in-hospital controls for every case, matched for age, HIV status, and study site. We aimed to enrol four controls for every case not infected with HIV and six controls for every case with HIV infection (case-control sets). With conditional logistic regression, we calculated vaccine effectiveness as a percentage, with the equation 1 – [adjusted odds ratio for vaccination] × 100. We included data from an earlier investigation of PCV7 to assess vaccine effectiveness in children exposed to but not infected with HIV and in malnourished children not infected with HIV. Findings: Between January, 2012, and December, 2014, we enrolled children aged 16 weeks or older to our study: 240 were cases not infected with HIV, 75 were cases with HIV infection, 1118 were controls not infected with HIV, and 283 were controls with HIV infection. The effectiveness of two or more doses of PCV13 against PCV13-serotype invasive pneumococcal disease was 85% (95% CI 37 to 96) among 11 case-control sets of children not infected with HIV and 91% (−35 to 100) among three case-control sets of children with HIV infection. PCV13 effectiveness among 26 case-control sets of children not infected with HIV was 52% (95% CI −12 to 79) against all-serotype invasive pneumococcal disease and 94% (44 to 100) for serotype 19A. Vaccine effectiveness against PCV7-serotype invasive pneumococcal disease was 87% (95% CI 38 to 97) in children exposed to HIV but uninfected and 90% (53 to 98) in malnourished children not infected with HIV. Interpretation: Our results indicate that PCV13 in a 2 + 1 schedule is effective for preventing vaccine-type pneumococcal infections in young children not infected with HIV, including those who are malnourished or who have been exposed to HIV. Although the point estimate for PCV13 vaccine effectiveness in children infected with HIV was high, it did not reach significance, possibly because of the small sample size. These findings support recommendations for widespread use of pneumococcal conjugate vaccine in low-income and middle-income countries. Funding: Gavi, The Vaccine Alliance. |
url |
http://www.sciencedirect.com/science/article/pii/S2214109X17300438 |
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doaj-84a3737168cb4c099c51ecc3aaa357fc2020-11-25T01:49:19ZengElsevierThe Lancet Global Health2214-109X2017-03-0153e359e369Effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control studyCheryl Cohen, DrPhD0Claire von Mollendorf, MD1Linda de Gouveia, NDMedTech2Sarona Lengana, MD3Susan Meiring, MD4Vanessa Quan, MD5Arthermon Nguweneza, MSc6David P Moore, MD7Gary Reubenson, MD8Mamokgethi Moshe, MD9Shabir A Madhi, ProfPhD10Brian Eley, ProfMD11Ute Hallbauer, MD12Heather Finlayson, MD13Sheeba Varughese, MD14Katherine L O'Brien, ProfMD15Elizabeth R Zell, MSc16Keith P Klugman, ProfPhD17Cynthia G Whitney, MD18Anne von Gottberg, PhD19Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Correspondence to: Dr Cheryl Cohen, Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Sandringham 2131, South AfricaCentre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaCentre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South AfricaCentre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South AfricaDivision of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South AfricaDivision of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South AfricaCentre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South AfricaDepartment of Paediatrics, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaRahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaDr George Mukhari Hospital, Paediatrics Department, Medunsa University, Johannesburg, South AfricaCentre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South AfricaRed Cross War Memorial Children's Hospital, and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South AfricaUniversitas and Pelonomi Hospitals, Department of Paediatrics and Child Health, University of the Free State, Bloemfontein, South AfricaTygerberg Hospital, and the Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South AfricaCharlotte Maxeke Johannesburg Academic Hospital, Paediatrics Department, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaJohns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USANational Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USADepartment of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South AfricaNational Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USACentre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, University of the Witwatersrand, Johannesberg, South Africa; Hubert Department of Global Health, Rollins School of Public Health, and Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, USASummary: Background: The 13-valent pneumococcal conjugate vaccine (PCV13) was designed to include disease-causing serotypes that are important in low-income and middle-income countries. Vaccine effectiveness estimates are scarce in these settings. South Africa replaced PCV7 with PCV13 in 2011 using a 2 + 1 schedule. We aimed to assess the effectiveness of two or more doses of PCV13 against invasive pneumococcal disease in children with HIV infection and in those not infected with HIV. Methods: Cases of invasive pneumococcal disease in children aged 5 years or younger were identified through national laboratory-based surveillance. Isolates were serotyped with the Quellung reaction or PCR. We sought in-hospital controls for every case, matched for age, HIV status, and study site. We aimed to enrol four controls for every case not infected with HIV and six controls for every case with HIV infection (case-control sets). With conditional logistic regression, we calculated vaccine effectiveness as a percentage, with the equation 1 – [adjusted odds ratio for vaccination] × 100. We included data from an earlier investigation of PCV7 to assess vaccine effectiveness in children exposed to but not infected with HIV and in malnourished children not infected with HIV. Findings: Between January, 2012, and December, 2014, we enrolled children aged 16 weeks or older to our study: 240 were cases not infected with HIV, 75 were cases with HIV infection, 1118 were controls not infected with HIV, and 283 were controls with HIV infection. The effectiveness of two or more doses of PCV13 against PCV13-serotype invasive pneumococcal disease was 85% (95% CI 37 to 96) among 11 case-control sets of children not infected with HIV and 91% (−35 to 100) among three case-control sets of children with HIV infection. PCV13 effectiveness among 26 case-control sets of children not infected with HIV was 52% (95% CI −12 to 79) against all-serotype invasive pneumococcal disease and 94% (44 to 100) for serotype 19A. Vaccine effectiveness against PCV7-serotype invasive pneumococcal disease was 87% (95% CI 38 to 97) in children exposed to HIV but uninfected and 90% (53 to 98) in malnourished children not infected with HIV. Interpretation: Our results indicate that PCV13 in a 2 + 1 schedule is effective for preventing vaccine-type pneumococcal infections in young children not infected with HIV, including those who are malnourished or who have been exposed to HIV. Although the point estimate for PCV13 vaccine effectiveness in children infected with HIV was high, it did not reach significance, possibly because of the small sample size. These findings support recommendations for widespread use of pneumococcal conjugate vaccine in low-income and middle-income countries. Funding: Gavi, The Vaccine Alliance.http://www.sciencedirect.com/science/article/pii/S2214109X17300438 |