Indirect Effects of 10-Valent Pneumococcal Conjugate Vaccine Against Adult Pneumococcal Pneumonia in Rural Western Kenya.
Adult
Coinfection
Female
HIV Infections
/ epidemiology
Humans
Incidence
Kenya
/ epidemiology
Male
Middle Aged
Pneumococcal Vaccines
/ administration & dosage
Pneumonia, Pneumococcal
/ epidemiology
Public Health Surveillance
Rural Population
Streptococcus pneumoniae
/ immunology
Vaccines, Conjugate
/ administration & dosage
Kenya
adult
herd immunity
pneumococcal vaccines
pneumonia
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
27 11 2019
27 11 2019
Historique:
received:
19
09
2018
accepted:
11
02
2019
pubmed:
21
2
2019
medline:
20
9
2020
entrez:
21
2
2019
Statut:
ppublish
Résumé
Data on pneumococcal conjugate vaccine (PCV) indirect effects in low-income countries with high human immunodeficiency virus (HIV) burden are limited. We examined adult pneumococcal pneumonia incidence before and after PCV introduction in Kenya in 2011. From 1 January 2008 to 31 December 2016, we conducted surveillance for acute respiratory infection (ARI) among ~12 000 adults (≥18 years) in western Kenya, where HIV prevalence is ~17%. ARI cases (cough or difficulty breathing or chest pain, plus temperature ≥38.0°C or oxygen saturation <90%) presenting to a clinic underwent blood culture and pneumococcal urine antigen testing (UAT). We calculated ARI incidence and adjusted for healthcare seeking. The proportion of ARI cases with pneumococcus detected among those with complete testing (blood culture and UAT) was multiplied by adjusted ARI incidence to estimate pneumococcal pneumonia incidence. Pre-PCV (2008-2010) crude and adjusted ARI incidences were 3.14 and 5.30/100 person-years-observation (pyo), respectively. Among ARI cases, 39.0% (340/872) had both blood culture and UAT; 21.2% (72/340) had pneumococcus detected, yielding a baseline pneumococcal pneumonia incidence of 1.12/100 pyo (95% confidence interval [CI]: 1.0-1.3). In each post-PCV year (2012-2016), the incidence was significantly lower than baseline; with incidence rate ratios (IRRs) of 0.53 (95% CI: 0.31-0.61) in 2012 and 0.13 (95% CI: 0.09-0.17) in 2016. Similar declines were observed in HIV-infected (IRR: 0.13; 95% CI: 0.08-0.22) and HIV-uninfected (IRR: 0.10; 95% CI: 0.05-0.20) adults. Adult pneumococcal pneumonia declined in western Kenya following PCV introduction, likely reflecting vaccine indirect effects. Evidence of herd protection is critical for guiding PCV policy decisions in resource-constrained areas.
Sections du résumé
BACKGROUND
Data on pneumococcal conjugate vaccine (PCV) indirect effects in low-income countries with high human immunodeficiency virus (HIV) burden are limited. We examined adult pneumococcal pneumonia incidence before and after PCV introduction in Kenya in 2011.
METHODS
From 1 January 2008 to 31 December 2016, we conducted surveillance for acute respiratory infection (ARI) among ~12 000 adults (≥18 years) in western Kenya, where HIV prevalence is ~17%. ARI cases (cough or difficulty breathing or chest pain, plus temperature ≥38.0°C or oxygen saturation <90%) presenting to a clinic underwent blood culture and pneumococcal urine antigen testing (UAT). We calculated ARI incidence and adjusted for healthcare seeking. The proportion of ARI cases with pneumococcus detected among those with complete testing (blood culture and UAT) was multiplied by adjusted ARI incidence to estimate pneumococcal pneumonia incidence.
RESULTS
Pre-PCV (2008-2010) crude and adjusted ARI incidences were 3.14 and 5.30/100 person-years-observation (pyo), respectively. Among ARI cases, 39.0% (340/872) had both blood culture and UAT; 21.2% (72/340) had pneumococcus detected, yielding a baseline pneumococcal pneumonia incidence of 1.12/100 pyo (95% confidence interval [CI]: 1.0-1.3). In each post-PCV year (2012-2016), the incidence was significantly lower than baseline; with incidence rate ratios (IRRs) of 0.53 (95% CI: 0.31-0.61) in 2012 and 0.13 (95% CI: 0.09-0.17) in 2016. Similar declines were observed in HIV-infected (IRR: 0.13; 95% CI: 0.08-0.22) and HIV-uninfected (IRR: 0.10; 95% CI: 0.05-0.20) adults.
CONCLUSIONS
Adult pneumococcal pneumonia declined in western Kenya following PCV introduction, likely reflecting vaccine indirect effects. Evidence of herd protection is critical for guiding PCV policy decisions in resource-constrained areas.
Identifiants
pubmed: 30785189
pii: 5346100
doi: 10.1093/cid/ciz139
pmc: PMC6861607
mid: NIHMS1041823
doi:
Substances chimiques
10-valent pneumococcal conjugate vaccine
0
Pneumococcal Vaccines
0
Vaccines, Conjugate
0
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
2177-2184Subventions
Organisme : Intramural CDC HHS
ID : CC999999
Pays : United States
Organisme : CGH CDC HHS
ID : U01 GH000048
Pays : United States
Organisme : NCPDCID CDC HHS
ID : U19 CI000323
Pays : United States
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Références
Clin Ther. 2008 Feb;30(2):341-57
pubmed: 18343273
Pediatr Infect Dis J. 2014 Jan;33 Suppl 2:S109-18
pubmed: 24336053
AIDS. 2011 Feb 20;25(4):453-62
pubmed: 21178754
BMC Infect Dis. 2011 Apr 27;11:108
pubmed: 21521533
PLoS One. 2015 Mar 23;10(3):e0120761
pubmed: 25798951
J Clin Microbiol. 2010 May;48(5):1611-8
pubmed: 20220175
Pediatr Infect Dis J. 2014 Jan;33 Suppl 2:S140-51
pubmed: 24336056
J Acquir Immune Defic Syndr. 2013 Feb 1;62(2):e47-54
pubmed: 23075916
Vaccine. 2017 May 19;35(22):2882-2891
pubmed: 28449971
BMC Infect Dis. 2010 Jun 23;10:186
pubmed: 20573224
PLoS One. 2012;7(8):e43656
pubmed: 22937071
PLoS One. 2011 Mar 15;6(3):e17765
pubmed: 21423577
Lancet. 2009 Sep 12;374(9693):893-902
pubmed: 19748398
Pediatr Infect Dis J. 2014 Jan;33 Suppl 2:S152-60
pubmed: 24336057
Lancet Glob Health. 2014 Jul;2(7):e397-405
pubmed: 25103393
J Clin Microbiol. 2006 Jan;44(1):124-31
pubmed: 16390959
BMC Infect Dis. 2014 Jul 08;14:376
pubmed: 25005353
Vaccine. 2013 Dec 17;32(1):133-45
pubmed: 23684824
PLoS One. 2016 Feb 10;11(2):e0149104
pubmed: 26863135
Am J Public Health. 2000 Feb;90(2):223-9
pubmed: 10667183
Open AIDS J. 2016 Apr 08;10:34-48
pubmed: 27347270
Pediatr Infect Dis J. 2012 May;31(5):501-8
pubmed: 22327872
Lancet Infect Dis. 2016 Jun;16(6):703-711
pubmed: 26897105
PLoS One. 2015 Jun 03;10(6):e0128738
pubmed: 26039077
Lancet HIV. 2018 May;5(5):e241-e249
pubmed: 29650451
PLoS One. 2013;8(4):e60273
pubmed: 23565216
Lancet Glob Health. 2017 Jan;5(1):e51-e59
pubmed: 27955789
BMC Med. 2017 Jun 7;15(1):113
pubmed: 28592303
PLoS One. 2011 Jan 18;6(1):e16085
pubmed: 21267459
Pediatr Infect Dis J. 2006 Jun;25(6):494-501
pubmed: 16732146
N Engl J Med. 2014 Nov 13;371(20):1889-99
pubmed: 25386897
Int J Epidemiol. 2012 Aug;41(4):977-87
pubmed: 22933646