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Clin Infect Dis. Author manuscript; available in PMC 2019 September 23.
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Published in final edited form as:

Clin Infect Dis. 2019 September 05; 69(Suppl 2): S66–S71. doi:10.1093/cid/ciz457.

Impact of 13-Valent Pneumococcal Conjugate Vaccine on

Meningitis and Pneumonia Hospitalizations in Children aged <5
Years in Senegal, 2010–2016
Papa M. Faye1, Mouhamadou A. Sonko1, Amadou Diop1, Aliou Thiongane1, Idrissa D. Ba1,
Michael Spiller2, Ousmane Ndiaye1, Baidy Dieye1, Jason M. Mwenda3, Ahmed I. Sow4, Boly
Diop4, Aliou Diallo5, Jennifer L. Farrar2, African Paediatric Bacterial Meningitis
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Surveillance Network
1Albert Royer Children’s Hospital, Dakar, Senegal
2Divisionof Bacterial Diseases, National Center for Immunization and Respiratory Diseases,
Centers for Disease Control and Prevention, Atlanta, Georgia
3World Health Organization, Regional office for Africa, Republic of Congo, Brazzaville
4Ministry of Health, Dakar, Senegal
5World Health Organization, Senegal

Abstract
Background.—Senegal introduced a 13-valent pneumococcal conjugate vaccine (PCV13) in
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October 2013, given at 6, 10, and 14 weeks of age. We document trends of meningitis and
pneumonia after the PCV13 introduction.

Methods.—From October 2010–October 2016, hospitalization data for clinical meningitis and
pneumonia in children aged <5 years were collected from logbooks at a large, tertiary, pediatric
hospital in Dakar. We used a set of predetermined keywords to define hospitalizations for
extraction from hospital registers. We conducted a time-series analysis and compared
hospitalizations before and after the PCV13 introduction, accounting for seasonality. The initial
PCV13 uptake period (October 2013–September 2014) was considered to be transitional and was
excluded.
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Correspondence: J. L. Farrar, Division of Bacterial Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road MS
H24-6, Atlanta, Georgia 30329 (ihi4@cdc.gov).
Disclaimer. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of
the Centers for Disease Control and Prevention or the World Health Organization.
Supplement sponsorship. This supplement was supported with funds from Gavi, the Vaccine Alliance through The World Health
Organization and the CDC Foundation, and The Medical Research Council Unit The Gambia at the London School of Hygiene and
Tropical Medicine.
SUPPLEMENTARY DATA
Supplementary materials are available at Clinical Infectious Diseases online. Consisting of data provided by the authors to benefit the
reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be
addressed to the corresponding author.
Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for
Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been
disclosed.
 Faye et al. Page 2

Results.—Over the 7-year period, 1836 and 889 hospitalizations with a discharge diagnosis of
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pneumonia and meningitis, respectively, occurred in children aged <5 years. In children aged <12
months, a small, significant reduction in pneumonia was observed post-PCV13 (−3.8%, 95%
confidence interval [CI] −1.5 to −5.9%). No decline was observed among children aged 12–59
months (−0.7%, 95% CI −0.8 to 2.2%). Meningitis hospitalizations remained stable for children
aged <12 months (1.8%, 95% CI −0.9 to 4.4%) and 12–59 months (−0.5%, 95% CI −3.6 to 2.6%).

Conclusions.—We used data from 1 hospital to detect a small, significant reduction in all-cause
pneumonia hospitalizations 2 years post-PCV13 introduction in infants; the same trend was not
measurable in children aged 12–59 months or in meningitis cases. There is a need for continued
surveillance to assess the long-term impact of sustained PCV13 use and to monitor how
pneumococcus is causing disease in the meningitis belt.

Keywords
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meningitis; pneumonia; pneumococcal conjugate vaccine; vaccine impact; hospitalization data

Pneumonia and meningitis, most of which are caused by Streptococcus pneumoniae, are
leading infectious causes of morbidity and mortality in children aged <5 years worldwide [1,
2]. Globally, pneumococcus is responsible for 294 000 deaths in human immunodeficiency
virus (HlV)-uninfected children aged <5 years annually; nearly 50% of these deaths occur in
Africa and 81% occur in children who present with pneumonia [1]. In Africa, over 2.3
million pneumococcal pneumonia cases occur annually in children aged <5 years, resulting
in over 137 000 deaths [1]. A previous study conducted at the study hospital—Albert Royer
National Children’s Hospital (Centre Hospitalier National d’Enfants Albert Royer
[CHNEAR]) in Dakar, Senegal—found that invasive pneumococcal infections accounted for
0.8% of all admissions, with 61% categorized as meningitis and 29% as pneumonia [3].
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Pneumococcal conjugate vaccines (PCV) are effective interventions in preventing

pneumonia and meningitis caused by S. pneumoniae and are recommended for use in all
countries by the World Health Organization [4]. Studies on PCV effectiveness have shown
20–35% reductions in all-cause pneumonia and >90% reductions in invasive pneumococcal
disease (including meningitis) after PCV introductions [5, 6]. Furthermore, serotype
distribution differs by region, and its effectiveness on serotype-specific diseases may differ
by vaccine product. However, the majority of data derive from middle- and high-income
settings; data from low-income settings are sparse.

Although PCV effectiveness data on meningitis and clinical pneumonia endpoints are
emerging from Africa concurrent with the increased uptake of PCV into routine
immunization programs over the last decade, more data on the impact in West Africa and the
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meningitis belt (a region in sub-Saharan Africa with high incidences of meningitis) are
needed. In this region, pneumococcal meningitis outbreaks due to vaccine serotypes,
particularly serotype 1, have occurred despite PCV introductions [7–9]. Senegal, a low-
income country in West Africa, introduced the 13-valent pneumococcal conjugate vaccine
(PCV13), which protects against disease due to 13 serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14,
18C, 19A, 19F, and 23F), in October 2013. The routine immunization schedule includes 3
primary doses (3 + 0) at 6, 10, and 14 weeks of age with no booster dose; there was no

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catch-up campaign. National coverage for 3 doses of PCV13 was 81% in 2014 and increased
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to 93% in 2016 [10]. Coverage rates for the Dakar region, where the study hospital is
located, ranged between 75% (2015) and 79% (2016; unpublished data). A Haemophilus
influenzae type B conjugate vaccine, which prevents meningitis and pneumonia caused by
Haemophilus influenzae type B, was introduced into the routine immunization program in
2005, and coverage has remained relatively stable through the study period (range 89–93%
from 2014–2016) [11]. A 10-day campaign for MenAfrivac (a vaccine against
meningococcal A meningitis) occurred in November 2012, which targeted 1- to 29-year-olds
in 35 districts in 8 regions and reached 95% of a targeted cohort of 3.9 million people [12].
The HIV prevalence rate in the general population is 0.5 (95% confidence interval [CI] 0.3–
0.6) [13]. Seasonal peaks for respiratory syncytial virus and influenza occur similarly to
peaks for pneumonia.

We utilized hospital administrative data, which is readily available and routinely collected
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for all hospitalizations, from a large pediatric hospital in Dakar to understand the impact of
PCV13 on clinical meningitis and pneumonia in children aged <5 years in Senegal.

METHODS
Hospitalization data for clinical meningitis and pneumonia in children aged <5 years were
collected at CHNEAR, a large national and subregional tertiary pediatric hospital in Dakar,
Senegal. CHNEAR has 120 beds for neonatal, surgical, and pediatric patients and averages
5000 admissions annually.

Trained study staff reviewed the logbooks of 4 pediatric wards to collect the number of
admissions for children aged <5 years who were admitted for pneumonia or meningitis from
October 2010–October 2016. Admissions for clinical pneumonia and meningitis were based
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on discharge diagnoses using a set of predetermined keywords (abbreviations were

included); no additional laboratory or medical record information were used to determine
hospitalizations (Supplementary Appendix). Furthermore, as the data source was admission
logbooks, vaccination history was not available and we were unable to determine whether
meningitis cases received the PCV13. We excluded hospitalizations with discharge
diagnoses of bronchiolitis. Where a discharge diagnosis was missing, an admission
diagnosis was used to define the primary clinical syndrome requiring hospitalization. A
logbook from March to November 2010 was missing from 1 ward; data from individual
medical charts were collected for this period. We stratified data by 2 age groups: 0–11
months and 12–59 months.

To assess PCV13 impact, we conducted an interrupted time-series analysis using Poisson

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regression to compare hospitalizations before and after the PCV introduction, accounting for
seasonality. Data were collected and tallied by age group and month of admission. We
calculated the proportions of hospitalizations with a discharge diagnosis of meningitis or
pneumonia by age group and year. We defined the pre-PCV period as October 2010–
September 2013 and the post-PCV period as October 2014–October 2016. Given that the
vaccine was introduced in October 2013, the initial PCV uptake period (October 2013–
September 2014) was considered a transitional year and was excluded from analyses. We

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attempted to use intoxications and ingestions to serve as control conditions, as an indication

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of the stability of hospitalization trends over time; however, data were too sparse and,
therefore, were not used in analyses. Data were analyzed using Microsoft Excel and SAS 9.4
(SAS Institute Inc., Cary, NC).

This protocol was reviewed in accordance with the Centers for Disease Control and
Prevention human research protection procedures and was determined to be a nonresearch
study.

RESULTS
From October 2010–October 2016, 1836 clinical pneumonia hospitalizations occurred in
children aged <5 years; 603 (32.8%) hospitalizations were in children aged 0–11 months and
1233 (67.2%) were in children aged 12–59 months (Table 1). Among children <12 months
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of age, pneumonia hospitalizations accounted for 7.9% (104 of 1335) of all-cause

hospitalizations pre-PCV introduction and 6.5% (93 of 1416) post-PCV introduction.
Among children 12–59 months of age, the percentage of pneumonia hospitalizations among
all-cause hospitalizations decreased from 17.7% (228 of 1295) before the PCV13
introduction to 14.6% (175 of 1235) after the PCV13 introduction. Figure 1 shows monthly
trends of pneumonia and all-cause hospitalizations by age from October 2010–October
2016.

Among children aged <5 years, 889 hospitalizations for meningitis occurred at CHNEAR
from October 2010–October 2016: 480 hospitalizations among 0–11 months and 351 among
12–59 months (Table 1). Among children aged <12 months, meningitis hospitalizations
accounted for 7.1% (95 of 1335) of all-cause hospitalizations before the PCV introduction
and 5.1% (72 of 1416) after the PCV introduction. In children aged 12–59 months,
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meningitis hospitalizations represented 6.4% (83 of 1295) of all-cause hospitalizations

before the PCV13 introduction and 4.2% (52 of 1235) of all-cause hospitalizations after the
PCV13 introduction. Figure 2 shows monthly trends for clinical meningitis and all-cause
hospitalizations by age group from October 2010 through October 2016.

Using a time-series analysis, a statistically significant reduction of 3.8% (95% CI 1.5–5.9%)

was observed in children aged <12 months who were hospitalized with clinical pneumonia
in the post-PCV13 period, compared to the pre-PCV13 period. In children aged 12–59
months, no significant decline was observed (−0.7%, 95% CI −0.8 to 2.2%). Meningitis
hospitalizations remained stable for children aged both <12 months (1.8%, 95% CI −0.9 to
4.4%) and 12–59 months (−0.5%, 95% CI −3.6 to 2.6%) when comparing changes post-
PCV versus pre-PCV.
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DISCUSSION
Using administrative data collected from 1 large tertiary-care center in Senegal, we showed
that pneumonia hospitalizations declined by 4% among children aged <12 months during the
2 years following the PCV13 introduction. No declines in pneumonia or meningitis
hospitalizations were observed among children aged 12–59 months. The finding for children
aged <12 months is consistent with other studies that observed declines in clinical

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pneumonia following PCV introductions. A study from Israel found a 7% significant decline
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in children less than 5 years of age 4 years post-PCV13 introduction, and another study from
Italy observed a 5% significant decline in children less than 2 years of age almost 3 years
after PCV13 introduction [14, 15]. In Africa, 5 studies found reductions in pneumonia
hospitalizations post-PCV introduction, although a statistically significant reduction was
observed in only 2 of these. A vaccine effectiveness study in Rwanda documented a
significant vaccine effectiveness, of 54%, against severe pneumonia, defined as
hospitalization with a clinical diagnosis of severe pneumonia or severe acute lower
respiratory infection or 1 or more of the following signs: chest indrawing, respiratory
distress, hypoxia, or cyanosis [16]. A time-series analysis in South Africa documented a
39% reduction in pneumonia hospitalizations in HIV-uninfected children aged <5 years
post-PCV13 introduction [17]. In Togo, investigators used the indirect cohort method to
evaluate the PCV13 impact on severe pneumonia and found a nonsignificant, 80% (95% CI
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−90 to 100%) reduction; however, the study was conducted 1 year post-PCV13 introduction
and included a small sample size [18]. An observational study in Malawi documented a 47%
reduction in clinical pneumonia in children aged <5 years; however, this decline was also not
significant [19]. Another observational study in Kenya did find a significant 24% reduction
in clinical pneumonia in children aged <12 months after PCV10 introduction [20].

We did not observe the same trend in pneumonia hospitalizations among children aged 12–
59 months. Instead, in the 3 years prior to the PCV13 introduction, we observed an annual
decline in pneumonia hospitalizations, which continued at a slower pace after the PCV13
introduction. However, full indirect effects may not have occurred yet due to the still-
increasing uptake in the population targeted for vaccination. We would expect to see further
reductions as a result of direct and indirect effects in populations as the PCV coverage
improves and there are additional cohorts of newborns vaccinated.
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Reductions in the number and percent of hospitalizations for clinical meningitis were not
observed in either age group. These findings are unlike other studies in Africa, from Rwanda
and the Gambia, evaluating the PCV impact on meningitis, which found significant and
large reductions after PCV introductions [16, 21]. However, these studies measured more
specific outcomes and were limited to hospitalized probable (eg, cerebrospinal fluid
specimen with turbid appearance, elevated white blood cell count) and laboratory-confirmed
meningitis cases, and evaluated the PCV impact specifically on pneumococcal meningitis,
not on all-cause bacterial meningitis. Our analysis included all hospitalized meningitis cases,
defined by predetermined keywords in the ward logbooks and not by laboratory diagnostics;
therefore, it is not surprising that the effect of PCV13 was lower in this study, even though
pneumococcus is the leading cause of pediatric bacterial meningitis. Furthermore, the
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number of hospitalizations for meningitis was relatively small and our study was limited to a
single hospital, making an assessment of any nationwide trends difficult.

Despite PCV introductions, pneumococcal meningitis outbreaks, especially due to vaccine

serotypes, continue to occur throughout countries in the meningitis belt [7–9, 22]. In
Senegal, the dominant pneumococcal serotypes causing pediatric meningitis prior to the
PCV13 introduction were serotypes 1, 6A, 14, 5, and 23F, all of which are protected against
by PCV13 [3]. A recent study conducted at CHNEAR found that post-PCV13 introduction,

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pneumococcus remained the dominant etiology of confirmed bacterial meningitis cases in

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children aged <5 years, with 55% of confirmed pneumococcal meningitis cases caused by
vaccine serotypes (unpublished data). This finding aligns with what we observed for
meningitis hospitalizations and suggests the need for more research to understand factors
around the persistence of pneumococcal meningitis in the meningitis belt after PCV
introductions.

Data also suggest that a 3 + 0 schedule, without a booster dose, may not provide adequate
indirect protection among nonvaccinated children and adults. During a recent pneumococcal
meningitis outbreak in Ghana, studies found that the majority of cases occurred in
unvaccinated individuals, with serotype 1 causing 50–80% of the pneumococcal meningitis
cases [7, 8]. A subsequent study 1 year later found that serotype 1 was still responsible for a
large proportion of pneumococcal meningitis cases among older children and adults [22].
Additionally, a study from Burkina Faso evaluated the PCV impact on meningitis and found
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declines in all PCV13 serotypes except serotype 1 [9]. However, studies from South Africa,
the only country in Africa currently using a 2 + 1 schedule (6 weeks, 14 weeks, 9 months),
have shown significant declines in vaccine-type invasive disease and, specifically, serotype 1
in all age groups post-PCV introduction [23, 24]. These studies suggest that further
evaluations could provide insight on whether a 2 + 1 schedule is a more effective dosing
schedule in settings with continued serotype 1 disease post-PCV introduction.

Our study has several limitations. The definitions for clinical pneumonia and meningitis
hospitalizations were based on keywords identified in the ward logbooks. These keywords
were defined at the discretion of the clinicians in the hospital and had not been previously
validated for accuracy. Second, our use of keywords limited our evaluation to all-cause
meningitis hospitalizations: a less-specific outcome than probable/purulent or lab-confirmed
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meningitis. As a result, we were unable to differentiate meningitis hospitalizations by

etiology, likely underestimating the impact from PCV13 on pneumococcal meningitis
hospitalizations. Lastly, we evaluated the PCV13 impact just 2 years after the PCV13
introduction; this was perhaps too early to see a significant impact due to vaccination,
particularly when monitoring a nonspecific outcome. Though we have reported a small
reduction in pneumonia among children aged <12 months, we would expect to see greater
reductions in sub-sequent years with increased vaccine coverage.

CONCLUSIONS
We observed a small but significant reduction in clinical pneumonia 2 years after the PCV13
introduction. The lack of impact observed on hospitalizations for pneumonia or meningitis
among children aged 12–59 months suggests the need to evaluate the effectiveness of a 3 + 0
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schedule in achieving indirect effects or consider evaluating its impact at a time further after
the PCV introduction (ie, 3 to 4 years post-introduction). Although PCV impact data on
clinical pneumonia and meningitis are limited from Africa, our findings for pneumonia are
consistent with currently available data and demonstrate the potential of using this approach,
especially in settings with limited or no available surveillance data, to add to the body of
evidence for PCV impact. Our study highlights the need for continued surveillance for
meningitis and pneumonia to assess the long-term impact of sustained PCV use on African

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children, as well as to monitor the pneumococcal serotypes causing disease in the meningitis
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belt.

Supplementary Material
Refer to Web version on PubMed Central for supplementary material.

Acknowledgments.
The authors thank all hospital staff and parents of children who used Centre Hospitalier National d’Enfants Albert
Royer.

Financial support. This work was supported by funding from Gavi, the Vaccine Alliance, through the CDC
Foundation (grant number memo-randum of agreement# 971–17).

References
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1. Wahl B, O’Brien K, Greenbaum A, et al. Burden of Streptococcus pneumoniae and Haemophilus

influenzae type B disease in children in the era of conjugate vaccines: global, regional, and national
estimates for 2000–15. Lancet Glob Health 2018; 6:e744–e757. [PubMed: 29903376]
2. World Health Organization. Estimated Hib and pneumococcal deaths for children under 5 years of
age. Available at: http://www.who.int/immunization/monitoring_surveillance/burden/estimates/
Pneumo_hib/en/ Accessed 31 August 2018.
3. Ba I, Ba A, Faye P, et al. Pediatric invasive pneumococcal disease in Senegal. Med Mal Infect 2015;
45:464–469.
4. World Health Organization. Pneumococcal conjugate vaccine for pneumococcal conjugate vaccines
in infants and children under 5 years of age: WHO position paper – February 2019. Wkly Epidemiol
Rec 2019; 94(8):85–104.
5. Conklin L, Loo JD, Kirk J, et al. Systematic review of the effect of pneumococcal conjugate vaccine
dosing schedules on vaccine-type invasive pneumococcal disease among young children. Pediatr
Infect Dis J 2014; 33(Suppl 2):S109–18. [PubMed: 24336053]
Author Manuscript

6. Loo JD, Conklin L, Fleming-Dutra KE, et al. Systematic review of the effect of pneumococcal
conjugate vaccine dosing schedules on prevention of pneumonia. Pediatr Infect Dis J 2014;
33(Suppl 2):S140–51. [PubMed: 24336056]
7. Kwambana-Adams B, Asiedu-Bekoe F, Sarkodie B, et al. An outbreak of pneumococcal meningitis
among older children (≥5 years) and adults after the implementation of an infant vaccination
programme with the 13-valent pneumococcal conjugate vaccine in Ghana. BMC Infect Dis 2016;
16:1–11. [PubMed: 26729246]
8. Aku F, Lessa F, Asiedu-Bekoe F, et al. Meningitis outbreak caused by vaccine-preventable bacterial
pathogens—Northern Ghana, 2016. MMWR Morb Mortal Wkly Rep 2017; 66:806–10. [PubMed:
28771457]
9. Kambire D, Soeters HM, Ouedraogo-Traore R, et al. Early impact of 13-valent pneumococcal
conjugate vaccine on pneumococcal meningitis-Burkina Faso, 2014–2015. J Infect 2018; 76:270–9.
[PubMed: 29253559]
10. World Health Organization. Pneumococcal conjugate (PCV3) immunization coverage estimates by
Author Manuscript

country. Available at: http://apps.who.int/gho/data/node.main.PCV3n?lang=en Accessed 31

August 2018.
11. World Health Organization. Hib (Hib3) immunization coverage estimates by country. Available at:
http://apps.who.int/gho/data/node.main.A829 Accessed 21 May 2019.
12. USAID Maternal and Child Health Integrated Program. MCHIP end of project report. Washington
DC: USAID, 2014.
13. United States Agency for International Development. Senegal - country quickstats. Available at:
https://dhsprogram.com/Where-We-Work/Country-Main.cfm?
ctry_id=36&c=Senegal&Country=Senegal&cn=&r=1 Accessed 21 May 2019.

Clin Infect Dis. Author manuscript; available in PMC 2019 September 23.
 Faye et al. Page 8

14. Baldo V, Cocchio S, Gallo T, et al. Impact of pneumococcal conjugate vaccination: a retrospective
study of hospitalization for pneumonia in North-East Italy. J Prev Med Hyg 2016; 57:E61–8.
Author Manuscript

[PubMed: 27582630]
15. Ben-Shimol S, Givon-Lavi N, Greenberg D, Dagan R. Cocontribution of rotavirus and
pneumococcal conjugate vaccines to the reduction of pediatric hospital visits in young children. J
Pediatr 2017; 182:253–9.e2. [PubMed: 27939127]
16. Gatera M, Uwimana J, Manzi E, et al. Use of administrative records to assess pneumococcal
conjugate vaccine impact on pediatric meningitis and pneumonia hospitalizations in Rwanda.
Vaccine 2016; 34:5321–8. [PubMed: 27639280]
17. Izu A, Solomon F, Nzenze SA, et al. Pneumococcal conjugate vaccines and hospitalization of
children for pneumonia: a time-series analysis, South Africa, 2006–2014. Bull World Health
Organ 2017; 95:618–28. [PubMed: 28867842]
18. Moïsi J, Alassani I, Tall H, et al. Using the indirect cohort approach to estimate PCV13
effectiveness against meningitis and pneumonia endpoints in Northern Togo In: Program and
abstracts of the 10th International Symposium on Pneumonia and Pneumococcal Diseases
(Glasgow, Scotland). Geneva, Switzerland: ISPPD, 2016; 181.
Author Manuscript

19. McCollum ED, Nambiar B, Deula R, et al. Impact of the 13-valent pneumococcal conjugate
vaccine on clinical and hypoxemic childhood pneumonia over three years in Central Malawi: an
observational study. PLOS One 2017; 12:e0168209.
20. Silaba M, Ooko M, Bottomley C, et al. The impact of 10-valent pneumococcal conjugate vaccine
(PCV10) on the incidence of radiologically confirmed pneumonia and on pneumonia
hospitalizations among children in Kilifi, Kenya. In: Program and abstracts of the 10th
International Symposium on Pneumonia and Pneumococcal Diseases (Glasgow, Scotland). 2016;
22.
21. Mackenzie GA, Hill PC, Jeffries DJ, et al. Effect of the introduction of pneumococcal conjugate
vaccination on invasive pneumococcal disease in the Gambia: a population-based surveillance
study. Lancet Infect Dis 2016; 16:703–11. [PubMed: 26897105]
22. Bozio C, Abdul-Karim A, Abenyeri J, et al. Continued occurrence of serotype 1 pneumococcal
meningitis in two regions located in the meningitis belt in Ghana five years after introduction of
13-valent pneumococcal conjugate vaccine. PLOS One 2018; 13(9): 1–10.
23. von Gottberg A, Kleynhans J, de Gouveia L, et al. Trends in invasive pneumococcal disease among
Author Manuscript

adults aged ≥25 years, South Africa, 2005–2016. In: Program and abstracts of the 11th
International Symposium on Pneumonia and Pneumococcal Diseases (Melbourne, Australia).
2018; 18.
24. von Mollendorf C, Cohen C, Tempia S, et al. Epidemiology of serotype 1 invasive pneumococcal
disease, South Africa, 2003–2013. Emerg Infect Dis 2016; 22:261–70. [PubMed: 26812214]
Author Manuscript

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Figure 1.
Proportion of pneumonia hospitalizations among all hospitalizations, children 0 to 59
months, by month. Data are from the Centre Hospitalier National d’Enfants Albert Royer,
October 2010-Qctober 2016. Abbreviation: PCV13, 13-valent pneumococcal conjugate
vaccine.
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Figure 2.
Proportion of meningitis hospitalizations among all hospitalizations, children 0 to 59
months, by month. Data are from the Centre Hospitalier National d’Enfants Albert Royer,
October 2010–October 2016. Abbreviation: PCV13, 13-valent pneumococcal conjugate
vaccine.
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Table 1.

Average Annual Hospitalizations for Pneumonia and Meningitis Among Children Aged <5 Years

Age Group 0 to 59 Months 0 to 11 Months 12 to 59 Months

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Oct Oct 2013– Oct Oct Oct Oct 2013– Oct 2013– Oct
Oct 2010– Oct 2011– 2012– Average Sept 2014 Oct Oct 2015– Average 2010– 2011– 2012– Average Sept 2014 Oct Oct Average Oct Oct 2012– Average Sept 2014 2014– Oct 2015– Average
Sept Sept Sept pre- (transition 2014–Sept Sept post- Sept Sept Sept pre- (transition 2014– 2015–Sept post- 2011– Oct 2010– Sept pre- (transition Sept Sept post-
2011, 2012, 2013, PCV13, year), 2015, 2016, PCV13, 2011, 2012, 2013, PCV13, year), Sept 2015, 2016, PCV13, Sept 2012, Sept 2011, 2013, PCV13, year), 2015, 2016, PCV13,
Analysis Period n = 2434 n = 2511 n = 2947 n = 2631 n = 2660 n = 2665 n = 2638 n = 2652 n = 1175 n = 1259 n = 1572 n = 1335 n = 1447 n = 1558 n = 1275 n = 1416 n = 1252 n = 1259 n = 1375 n = 1295 n = 1213 n = 1107 n = 1363 n = 1235

Pneumonia
hospitalizations (% total
all-cause hospitalizations) 384 (15.8) 303 (12.1) 308 (10.5) 332 (12.8) 305 (11.5) 318 (11.9) 218 (8.3) 268 (10.1) 112 (9.5) 92 (7.3) 108 (6.9) 104 (7.9) 105 (7.3) 114 (7.3) 72 (5.6) 93 (6.5) 272 (21.6) 211 (16.9) 200 (14.5) 228 (17.7) 200 (16.5) 204 (18.4) 146 (10.7) 175 (14.6)

Meningitis
hospitalizations (% total
all-cause hospitalizations) 131 (5.4) 249 (9.9) 154 (5.2) 178 (6.9) 108 (4.1) 133 (5.0) 114 (4.3) 124 (4.7) 76 (6.5) 132 (10.5) 77 (4.9) 95 (7.1) 51 (3.5) 88 (5.7) 56 (4.4) 72 (5.1) 55 (4.4) 117 (9.4) 77 (5.6) 83 (6.4) 57 (4.7) 45 (4.1) 58 (4.3) 52 (4.2)

Data are from Centre Hospitalier National d’Enfants Albert Royer, October 2010–October 2016.
Abbreviation: PCV13, 13-valent pneumococcal conjugate vaccine.

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