Indirect Effects of 10-Valent Pneumococcal Conjugate Vaccine Against Adult Pneumococcal Pneumonia in Rural Western Kenya
| Autor: | Marc-Alain Widdowson, Joshua Auko, Daniel R. Feikin, Maria da Gloria Carvalho, Godfrey M. Bigogo, Allan Audi, Cynthia G. Whitney, George Aol, Benjamin J. Ochieng, Arthur Odoyo, Martien W. Borgdorff, Herine Odiembo, Jennifer R. Verani, Clayton Onyango |
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| Přispěvatelé: | Academic Medical Center, APH - Global Health |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Rural Population 0301 basic medicine Microbiology (medical) medicine.medical_specialty 030106 microbiology HIV Infections medicine.disease_cause Article Pneumococcal conjugate vaccine Herd immunity Pneumococcal Vaccines 03 medical and health sciences 0302 clinical medicine Internal medicine Streptococcus pneumoniae medicine Humans Public Health Surveillance Blood culture 030212 general & internal medicine Vaccines Conjugate medicine.diagnostic_test Coinfection business.industry Incidence Incidence (epidemiology) Respiratory infection Middle Aged Pneumonia Pneumococcal medicine.disease Kenya respiratory tract diseases Pneumonia Infectious Diseases Pneumococcal pneumonia Female business medicine.drug |
| Zdroj: | Clinical infectious diseases, 69(12), 2177-2184. Oxford University Press |
| ISSN: | 1537-6591 1058-4838 |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
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