Population-based surveillance for pneumonia, sepsis and meningitis in all ages in The Gambia: Implications for pneumococcal vaccine introduction and surveillance in Africa
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Abstract
Background: WHO recommends that introduction of pneumococcal conjugate vaccine is accompanied by disease surveillance. Surveillance for pneumonia, sepsis and meningitis has been established in rural Gambia and 7PCV was introduced in August 2009. Methods: In and outpatient surveillance among a population of 148,000 began May 2008 following pilot surveillance which began September 2007. 24/7 surveillance for suspected pneumonia, sepsis and meningitis involves those aged “2 months. Suspected cases are confirmed by clinicians followed by standard investigations. Pneumococcal isolates are serotyped using latex agglutination. Results: From May 2008 until March 2009, 1463 cases (1225 < 5 years, 238 ≥ 5 years) of suspected pneumonia, sepsis and meningitis were detected. Age-specific proportions of those <5 years with suspected disease were 43% (n = 530) 2-11 months, 32% (n = 387) 1 year, and 25% (n = 308) 2-4 years. Of those aged “5 years, 42% (n = 100) were <15 years and 58% (n = 138) were ≥15.7% (95/1385) of blood cultures grew pathogens; 38% (36/95) pneumococcus and 20% (19/95) Staphylococcus aureus. 80% (76/95) of invasive bacterial disease occurred <5 years of age. 86% (25/29) of IPD <5 years of age was associated with pneumonia and there were seven cases of bacterial meningitis. All cases of IPD “5 years of age were associated with pneumonia and there were two cases of bacterial meningitis. The estimated incidence of IPD per 100000 person years was 362 (2-11 months), 295 (1 year), 56 (2-4 years), 4 (5-14 years) and 9 (≥15 years). The serotype distribution of 90 IPD episodes since initiation of pilot surveillance was: serotype 1: (28), 6A: (11), 5: (9), 14: (9), 19A: (3), 4: (3), 23F (2), 6B (2), 7F (2), other (21). The proportions of IPD covered by different vaccines were: 7PCV 20%, 7PCV + 6A 32%, PHiD10CV 63%, PHiD10CV + 6A 76%, 13PCV 79%. Conclusion: The burden of childhood pneumococcal disease in rural West Africa is substantial. The relative burden among older children and adults is much less. Vaccines of greater valence than 7PCV will cover substantially greater proportions of IPD. Ongoing high quality surveillance is critical to document the effectiveness of vaccine introduction and to provide data to inform immunization programs in resource limited settings. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive
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