Morgan Congdon1, Hwanhee Hong2,3, Rebecca R Young4, Coleen K Cunningham4, Leslie A Enane5, Tonya Arscott-Mills1,6,7, Francis M Banda6,7, Mamiki Chise8, Keneilwe Motlhatlhedi9, Kristen Feemster10, Sweta M Patel11, Sefelani Boiditswe6, Tiroyaone Leburu6, Samir S Shah12, Andrew P Steenhoff7,10, Matthew S Kelly4. 1. Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 2. Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA. 3. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA. 4. Division of Pediatric Infectious Diseases, Duke University, Durham, North Carolina, USA. 5. The Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA. 6. Botswana-UPenn Partnership, Gaborone, Botswana. 7. Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana. 8. Ministry of Health, Gaborone, Botswana. 9. Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana. 10. Division of Pediatric Infectious Diseases and Global Health Center, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 11. Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, North Carolina, USA. 12. Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA.
Abstract
BACKGROUND: Globally, pneumonia is the leading cause of death among children. Few data exist regarding the effect of Haemophilus influenzae type b (Hib) vaccine and 13-valent pneumococcal conjugate vaccine (PCV-13) on the burden of childhood pneumonia in African settings. METHODS: We collected data on children aged 1 to 59 months at 3 hospitals in Botswana. Hib vaccine and PCV-13 were introduced in Botswana in November 2010 and July 2012, respectively. We compared pneumonia hospitalizations and deaths prevaccine (January 2009 to October 2010) with postvaccine (January 2013 to December 2017) using seasonally adjusted, interrupted time-series analyses. RESULTS: We identified 6943 pneumonia hospitalizations and 201 pneumonia deaths. In the prevaccine period, pneumonia hospitalizations and deaths increased by 24% (rate, 1.24; 95% CI, .94-1.64) and 59% (rate, 1.59; 95% CI, .87-2.90) per year, respectively. Vaccine introduction was associated with a 48% (95% CI, 29-62%) decrease in the number of pneumonia hospitalizations and a 50% (95% CI, 1-75%) decrease in the number of pneumonia deaths between the end of the prevaccine period (October 2010) and the beginning of the postvaccine period (January 2013). During the postvaccine period, pneumonia hospitalizations and deaths declined by 6% (rate, .94; 95% CI, .89-.99) and 22% (rate, .78; 95% CI, .67-.92) per year, respectively. CONCLUSIONS: Pneumonia hospitalizations and deaths among children declined sharply following introduction of Hib vaccine and PCV-13 in Botswana. This effect was sustained for more than 5 years after vaccine introduction, supporting the long-term effectiveness of these vaccines in preventing childhood pneumonia in Botswana.
BACKGROUND: Globally, pneumonia is the leading cause of death among children. Few data exist regarding the effect of Haemophilus influenzae type b (Hib) vaccine and 13-valent pneumococcal conjugate vaccine (PCV-13) on the burden of childhood pneumonia in African settings. METHODS: We collected data on children aged 1 to 59 months at 3 hospitals in Botswana. Hib vaccine and PCV-13 were introduced in Botswana in November 2010 and July 2012, respectively. We compared pneumonia hospitalizations and deaths prevaccine (January 2009 to October 2010) with postvaccine (January 2013 to December 2017) using seasonally adjusted, interrupted time-series analyses. RESULTS: We identified 6943 pneumonia hospitalizations and 201 pneumonia deaths. In the prevaccine period, pneumonia hospitalizations and deaths increased by 24% (rate, 1.24; 95% CI, .94-1.64) and 59% (rate, 1.59; 95% CI, .87-2.90) per year, respectively. Vaccine introduction was associated with a 48% (95% CI, 29-62%) decrease in the number of pneumonia hospitalizations and a 50% (95% CI, 1-75%) decrease in the number of pneumonia deaths between the end of the prevaccine period (October 2010) and the beginning of the postvaccine period (January 2013). During the postvaccine period, pneumonia hospitalizations and deaths declined by 6% (rate, .94; 95% CI, .89-.99) and 22% (rate, .78; 95% CI, .67-.92) per year, respectively. CONCLUSIONS:Pneumonia hospitalizations and deaths among children declined sharply following introduction of Hib vaccine and PCV-13 in Botswana. This effect was sustained for more than 5 years after vaccine introduction, supporting the long-term effectiveness of these vaccines in preventing childhood pneumonia in Botswana.
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