Burden of invasive pneumococcal disease among children in rural Mozambique: 2001-2012

PLoS One. 2018 Jan 5;13(1):e0190687. doi: 10.1371/journal.pone.0190687. eCollection 2018.

Abstract

Background: Invasive pneumococcal disease (IPD) is a major cause of illness and death among children worldwide. 10-valent pneumococcal conjugate vaccine (PCV10) was introduced as part of the Mozambican routine immunization program in April 2013. We characterized the IPD burden in a rural area of Mozambique before PCV introduction and estimated the potential impact of this intervention.

Methods: We conducted population-based surveillance for IPD, defined as S. pneumoniae isolated from blood or cerebrospinal fluid, among children <5 years old admitted to Manhiça District Hospital, a referral hospital in a rural area with high prevalence of human immunodiciency virus infection. S. pneumoniae was identified using standard microbiologic methods and serotyped using sequential multiplex PCR or Quellung. IPD incidence was calculated among cases from a defined catchment area.

Results: From January 2001 through December 2012, we isolated 768 cases of IPD, 498 (65%) of which were bacteraemic pneumonia episodes. A total of 391 (51%) were from the catchment area, yielding IPD incidence rates of 479, 390 and 107 episodes per 100,000 children-years at risk among children <12, 12-23 and 24-<60 months old, respectively. The overall IPD incidence fluctuated and showed a downward trend over time. In these same age groups, in-hospital death occurred in 48 (17%), 26 (12%), and 21 (13%) of all IPD cases, respectively. Overall 90% (543/603) of IPD isolates were available for serotyping; of those, 65% were covered by PCV10 and 83% by PCV13. Among 77 hospital deaths associated with serotyped IPD, 49% and 69% were caused by isolates included in the PCV10 and PCV13, respectively.

Conclusions: We describe very high rates of IPD among children in rural Mozambique that were declining before PCV introduction. Children <1 year old have the greatest incidence and case fatality; although the rates remain high among older groups as well. Most IPD episodes and many deaths among children <5 years old will likely be prevented through PCV10 introduction in Mozambique.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child, Preschool
  • Female
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Mozambique / epidemiology
  • Pneumococcal Infections / epidemiology*
  • Rural Population
  • Streptococcus pneumoniae / immunology
  • Streptococcus pneumoniae / pathogenicity

Grants and funding

This project was supported with Bacterial Disease Surveillance funds from; the Program for Appropriate Technology in Health (PATH) through to the pneumonia and Pneumococcus surveillance study (GAT.770-790-01350-LPS), Bill and Melinda Gates Foundation through Center for Vaccine Development, University of Maryland, School of Medicine (Grant: S00957) and from the U.S. Agency for International Development (Fixed Obligation Grant: AID-656-f-12-00001, TFA-656-12-000003) through to the Surveillance for Paediatric Pneumonia and Invasive Pneumococcal Disease in Mozambique. The study was also supported by CISM core funding provided by the Spanish Agency for International Cooperation (Ministry of Foreign Affairs, Spain). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.