Autor/a:
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Sigaúque, Betuel; Verani, Jennifer R.; Massora, Sérgio; Vubil, Delfino; Quintó, Llorenç; Acácio, Sozinho; Mandomando, Inácio; Bassat Orellana, Quique; Nhampossa, Tacilta; Pimenta, Fabiana; Sacoor, Charfudin; Carvalho, Maria da Gloria; Macete, Eusébio; Alonso, Pedro
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Abstract:
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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 Manhica 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. |