Indirect Effects of 10-Valent Pneumococcal Conjugate Vaccine against Adult Pneumococcal Pneumonia in Rural Western Kenya

Godfrey M. Bigogo, Allan Audi, Joshua Auko, George O. Aol, Benjamin J. Ochieng, Herine Odiembo, Arthur Odoyo, Marc Alain Widdowson, Clayton Onyango, Martien W. Borgdorff, Daniel R. Feikin, Maria Da Gloria Carvalho, Cynthia G. Whitney, Jennifer R. Verani

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2177-2184
Number of pages8
JournalClinical Infectious Diseases
Volume69
Issue number12
DOIs
StatePublished - Nov 27 2019

Fingerprint

Pneumococcal Pneumonia
Kenya
Conjugate Vaccines
Pneumococcal Vaccines
Respiratory Tract Infections
Incidence
Confidence Intervals
HIV
Urine
Streptococcus pneumoniae
Antigens
Observation
10-valent pneumococcal conjugate vaccine
Chest Pain
Cough
Respiration
Vaccines

Keywords

  • adult
  • herd immunity
  • Kenya
  • pneumococcal vaccines
  • pneumonia

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Bigogo, G. M., Audi, A., Auko, J., Aol, G. O., Ochieng, B. J., Odiembo, H., ... Verani, J. R. (2019). Indirect Effects of 10-Valent Pneumococcal Conjugate Vaccine against Adult Pneumococcal Pneumonia in Rural Western Kenya. Clinical Infectious Diseases, 69(12), 2177-2184. https://doi.org/10.1093/cid/ciz139

Indirect Effects of 10-Valent Pneumococcal Conjugate Vaccine against Adult Pneumococcal Pneumonia in Rural Western Kenya. / Bigogo, Godfrey M.; Audi, Allan; Auko, Joshua; Aol, George O.; Ochieng, Benjamin J.; Odiembo, Herine; Odoyo, Arthur; Widdowson, Marc Alain; Onyango, Clayton; Borgdorff, Martien W.; Feikin, Daniel R.; Carvalho, Maria Da Gloria; Whitney, Cynthia G.; Verani, Jennifer R.

In: Clinical Infectious Diseases, Vol. 69, No. 12, 27.11.2019, p. 2177-2184.

Research output: Contribution to journalArticle

Bigogo, GM, Audi, A, Auko, J, Aol, GO, Ochieng, BJ, Odiembo, H, Odoyo, A, Widdowson, MA, Onyango, C, Borgdorff, MW, Feikin, DR, Carvalho, MDG, Whitney, CG & Verani, JR 2019, 'Indirect Effects of 10-Valent Pneumococcal Conjugate Vaccine against Adult Pneumococcal Pneumonia in Rural Western Kenya', Clinical Infectious Diseases, vol. 69, no. 12, pp. 2177-2184. https://doi.org/10.1093/cid/ciz139
Bigogo, Godfrey M. ; Audi, Allan ; Auko, Joshua ; Aol, George O. ; Ochieng, Benjamin J. ; Odiembo, Herine ; Odoyo, Arthur ; Widdowson, Marc Alain ; Onyango, Clayton ; Borgdorff, Martien W. ; Feikin, Daniel R. ; Carvalho, Maria Da Gloria ; Whitney, Cynthia G. ; Verani, Jennifer R. / Indirect Effects of 10-Valent Pneumococcal Conjugate Vaccine against Adult Pneumococcal Pneumonia in Rural Western Kenya. In: Clinical Infectious Diseases. 2019 ; Vol. 69, No. 12. pp. 2177-2184.
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abstract = "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.",
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AU - Auko, Joshua

AU - Aol, George O.

AU - Ochieng, Benjamin J.

AU - Odiembo, Herine

AU - Odoyo, Arthur

AU - Widdowson, Marc Alain

AU - Onyango, Clayton

AU - Borgdorff, Martien W.

AU - Feikin, Daniel R.

AU - Carvalho, Maria Da Gloria

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AU - Verani, Jennifer R.

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N2 - 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.

AB - 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.

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