Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Clinical and Hypoxemic Childhood Pneumonia over Three Years in Central Malawi: An Observational Study

• DOI: 10.1371/journal.pone.0168209
• Publication Date: 2017-01-09T15:49:04Z
• Authors: Eric D. McCollum; Bejoy Nambiar; Rashid Deula; Beatiwel Zadutsa; Austin Bondo; Carina King; James Beard; Harry Liyaya; Limangeni Mankhambo; Marzia Lazzerini; Charles Makwenda; Gibson Masache; Naor Bar-Zeev; Peter N. Kazembe; Charles Mwansambo; Norman Lufesi; Anthony Costello; Ben Armstrong; Tim Colbourn
• Keywords: Pneumococcal Conjugate Vaccine; Pulse Oximetry

Background The pneumococcal conjugate vaccine's (PCV) impact on childhood pneumonia during programmatic conditions in Africa is poorly understood. Following PCV13 introduction Malawi November 2011, we evaluated the case burden and rates of pneumonia. Methods Findings Between January 1, 2012-June 30, 2014 conducted active surveillance children <5 years at seven hospitals, 18 health centres, with 38 community workers two districts, central Malawi. Eligible had clinical per guidelines, defined as fast breathing only, chest indrawing +/- breathing, or, ≥1 danger sign. Since pulse oximetry was not oxygenation <90% hypoxemic pneumonia, a distinct category from We quantified ways. compared period immediately following vaccine (early) to >75% three-dose coverage (post). also used multivariable time-series regression, adjusting for autocorrelation exploring seasonal variation alternative model specifications sensitivity analyses. early versus post analysis showed an increase cases total, decrease sign mortality. At 76% coverage, 0%, non-significant total (+47%, 95% CI: -13%, +149%, p = 0.154); increased 135% (+39%, +297%, 0.001), however, hypoxemia fell 47% (-5%, -70%, 0.031) hospital deaths decreased 36% (-1%, -58%, 0.047) years. observed shift towards disease without signs, proportion signs by 65% (-46%, -77%, p<0.0001). These results were generally robust plausible specifications. Conclusions Thirty months after Malawi, system severest forms including death, have markedly decreased.