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Introduction (ID 39)
O001 - MENINGITIS AND MORTALITY TRENDS AMONG HOSPITALISED UNDER-FIVES FOLLOWING THE INTRODUCTION OF PNEUMOCOCCAL CONJUGATE VACCINES: A TIME-SERIES ANALYSIS IN WEST AND CENTRAL AFRICA (ID 769)
Abstract
Background
Pneumococcal conjugate vaccines (PCVs) have been introduced into the infant immunization programmes across West and Central Africa. We modelled trends in numbers of meningitis cases and deaths among children before and after PCV introduction, using WHO-supported sentinel surveillance.
Methods
A total of 36,901 children under five years with suspected meningitis were enrolled at sentinel hospitals across ten West and Central African countries through the Paediatric Bacterial Meningitis (PBM) Surveillance Network between 2010 and 2016. Laboratory testing of cerebrospinal fluid (CSF) specimens was performed using standard microbiologic and molecular methods. To assess trends in disease and mortality case counts before and after 10- and 13-valent PCV introduction, we applied interrupted time-series models and random effects meta-analysis, accounting for seasonality and secular trends.
Results
Across the countries, there was a decline of 35% (95% CI 2-57%, p=0.04) in annual suspected meningitis cases and 26% (95% CI 3-44%, p=0.03) in laboratory confirmed meningitis in the post vs. pre-PCV period; there was a non-significant decrease in suspected meningitis deaths (23% decline, 95% CI -23-52%, p=0.27) post PCV introduction. There was considerable heterogeneity in post-PCV meningitis trends among the different countries; larger and more precise reductions were observed in countries with at least 2 years post-PCV introduction surveillance.
Conclusions
We observed overall declines in paediatric meningitis cases and deaths, but impact was most evident in countries with a longer duration of surveillance post-PCV-introduction. The heterogeneity in the trends across the countries following PCV implementation warrants continued monitoring and surveillance.
O002 - PATHOGEN-SPECIFIC CAUSES OF PNEUMONIA DEATHS IN CHILDREN 1-59 MONTHS DETERMINED USING MINIMALLY INVASIVE TISSUE SAMPLING (MITS): RESULTS FROM CHILD HEALTH AND MORTALITY PREVENTION SURVEILLANCE (CHAMPS). (ID 166)
Abstract
Background
Determining pneumonia etiology is difficult because samples from inside the lung are rarely available. We describe fatal pneumonia etiology, determined using MITS, to investigate cause of death (CoD) in children aged 1-59 months from seven countries in Africa and South Asia.
Methods
Deaths that occurred between December 2016 and February 2020 were investigated post-mortem using blood samples (tested by culture and PCR) and MITS per lung (histopathology, PCR for 44 organisms [all sites] and culture [South Africa only]). Expert panels reviewed clinical data, MITS and culture results, and verbal autopsy and assigned underlying, antecedent/comorbid and immediate (final event) CoD per WHO recommendations.
Results
Pneumonia was the underlying (n=54), antecedent (n=108) and/or immediate (n=128) CoD in 273/594 (46%) deaths; South Africa, Kenya, Mozambique, Sierra Leone, Mali, Ethiopia and Bangladesh contributed 113, 50, 47, 28, 24, 10 and 1 pneumonia-related deaths, respectively. Median age was 8.4 (IQR: 3.3-19.4) months. Pneumonia deaths had a median of 2 (IQR: 1-3) implicated pathogens. The 10 leading pathogens (including co-infections) were Streptococcus pneumoniae (31.9%), Klebsiella pneumoniae (31.5%), Cytomegalovirus (14.3%), Haemophilus influenzae (10.7%), Staphylococcus aureus (9.9%), Respiratory syncytial virus (7.0%), Pneumocystis jirovecii (8.1%), Acinetobacter baumanii (5.1%), and adenovirus (5.1%).
Conclusions
CHAMPS methods provide a new way of examining pathogen-specific causes of pneumonia death, highlighting those deaths often had multiple pathogens and Klebsiella pneumoniae may cause more pneumonia deaths than previously thought. Despite use of pneumococcal conjugate vaccines at all sites, pneumococcus still caused 32% of childhood pneumonia-related deaths.
O003 - STREPTOCOCCUS PNEUMONIAE ASSOCIATED CHILD MORTALITY IN THE PNEUMOCOCCAL CONJUGATE VACCINE ERA (ID 406)
Abstract
Background
The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to better understand child mortality causes through longitudinal surveillance and etiologic investigation of under-five deaths and stillbirths. Deaths enrolled in CHAMPS were examined to describe deaths attributed to pneumococcus by age group in seven surveillance sites all of which use pneumococcal conjugate vaccine (PCV).
Methods
The CHAMPS protocol includes postmortem minimally invasive tissue sampling (MITS) with molecular, microbiologic, and histopathologic testing, clinical record review, and verbal autopsy. Underlying, co-morbid, and immediate causes of death (causal chain) are ascribed according to ICD-10 guidelines by local panels reviewing all data on each case.
Results
Pneumococcal diagnoses were in the causal chain for 6.2% (124/2012) of deaths, ranging from 0.5% (3/560) for stillbirths, 1.4% (12/838) for neonates, and 18.0% (109/614) for deaths from infants and children <5 years. Of these 124 pneumococcal-associated deaths, 88% (109) were deaths that occurred in the community or within 72 hours of hospitalization. Conditions in the causal chain included lower respiratory infections (87.1%), meningitis (14.3%), and sepsis (47.1%); many deaths had multiple conditions.
Conclusions
These findings support focus on preventing pneumococcal disease and associated child mortality, including assessing proportion of deaths due to vaccine serotypes and factors for under-immunization with PCV.
O004 - PREVALENCE AND RISK FACTORS OF PNEUMONIA AND DIARRHOEA IN UNDER-5 CHILDREN IN DEVELOPING COUNTRIES (ID 665)
Abstract
Background
The integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) was implemented by WHO/UNICEF in 2013 to end preventable childhood deaths due to pneumonia and diarrhoea by 2025. Notwithstanding, these diseases are the leading cause of child mortality globally. Therefore, this study aims to estimate the prevalence of pneumonia and diarrhoea in under-five children and investigate their demographic and socioeconomic risk factors in developing countries.
Methods
This study analysed 566,811 surviving under five-year-old children pooled from the latest round of Demographic and Health Surveys conducted in 53 developing countries. Both the bivariate analysis and logistic regression have been employed to analyse the data.
Results
This study reveals that about 6% and 16% of children were suffered from pneumonia and diarrhoea, respectively and varied widely across the countries and major geographical regions. The higher acute respiratory infection (11%) and higher diarrhoea (19%) prevalence have been found in Latin-America and Caribbean-countries and Central-Asia/West-Asia and North-African countries, respectively than other regions. Logistic regressions reveal that several socio-demographic and economic factors are found to be significant factors for both diseases. Among them, the main risk factors are low child birth-weight, low maternal education, poverty, Latin-America and Caribbean-countries and lower-income countries, which are positively associated with both diseases.
Conclusions
GAPPD should target these identified risk factors to achieve target-2025. Further, country-specific studies are needed to determine the risk factors for country-level policy advocacy.
O005 - PNEUMOCOCCAL SEROTYPE DIFFERENCES IN INVASIVE DISEASE ISOLATES OBTAINED FROM CHILDREN LESS THAN 5 YEARS OF AGE IN GAVI AND NON-GAVI COUNTRIES (ID 127)
Abstract
Background
Serotypes causing invasive pneumococcal disease (IPD) in children may vary globally and over time.
Methods
In a follow-up to our previous literature review of publications from 2010 to 2018, we searched PubMed, Embase, and performed a backward citation search to identify relevant articles for serotypes causing IPD published between May 2018 and October 2021. Publications with at least 20 serotype isolates were included. We summarized the overall distribution of existing PCV and non-PCV serotypes and analyzed the difference in serotype distribution between Gavi and non-Gavi countries.
Results
Thirty-eight articles met our inclusion criteria and yielded 4,815 serotypes, collected between 2010 and 2019. The ten most common serotypes were 19A, 14, 19F, 6B, 23F, 1, 6A, 15, 24F, and 3—accounting for nearly 60 percent of all serotypes. The five most common non-PCV types were 15, 24F, 23A, 15A, and 12F. Sixty-four percent of isolates (n = 3,105) were from non-Gavi countries; most common serotypes were 19A, 14, 19F, 6B, 15, 24F, and 23F. Most common serotypes (n = 1,740) from Gavi countries were 14, 19F, 1, 6B, 19A, and 23F. Most differences between non-Gavi and Gavi countries were seen in non-PCV serotypes, with serotypes 15/15A, 24F, 23A, and 12F seen frequently in non-Gavi countries and serotypes 2, 35B, and 15B in Gavi countries.
Conclusions
IPD serotype data in children are limited, with most originating from non-Gavi countries. There are differences in serotype distribution between Gavi and non-Gavi countries that may be important to inform next generation vaccines.
O006 - PNEUMOCOCCAL COMPLICATED OTITIS MEDIA IN CHILDREN LESS THAN 60 MONTHS OF AGE, 2014-2019 (ID 260)
Abstract
Background
Pneumococcal acute otitis media (AOM) in children due to vaccine related serotypes (Sts) declined after pneumococcal conjugate vaccine (PCV) introduction. This study investigates features of complicated pneumococcal OM (cOM; e.g. OM with perforated tympanic membranes (PTM), or complications such as mastoiditis).
Methods
Patients <60 months of age with cOM and pneumococcal isolates available from 2014-2019 from the US Pediatric Multicenter Pneumococcal Surveillance Group were included (2020 cases were analyzed separately). Analyses included demographics, immunization status, antimicrobial susceptibility and St determination. Recurrent OM (rOM) infection was defined as episodes separated by 14 days.
Results
609 encounters of which 41 were mastoiditis were identified from 579 patients; 27 patients had rOM infections within the study period. Median age was 17.3 (range 0-59.7) months. Most isolates were from spontaneous PTM drainage (66.3%) or through PE tubes (28.2%). 31 Sts were identified with 35B representing 19.5% of all isolates. PCV13 vaccine Sts identified were 3 (6.7%), 19F (4.9%), 19A (4.6%), and 6A (0.2%). 71% of mastoiditis cases were associated with PCV13 Sts. All rOM infections were caused by non-PCV13 Sts; 12/27 patients had the same serotype on both encounters. Antibiotic non-susceptibility was most often associated with St 19A (Table, Figure 1). In 2020, the occurrence of cOM declined compared to previous years (Figure 2).
Conclusions
Non-PCV13 Sts caused the majority of pneumococcal cOM. rOM infections were commonly caused by different Sts. Further surveillance will determine if the decline of pneumococcal infections in 2020 was temporary and resulted in a shift in St prevalence.
O007 - IMPACT OF THE INTRODUCTION OF THE PNEUMOCOCCAL CONJUGATE VACCINE ON PAEDIATRIC PNEUMONIA CASES IN NEPAL (ID 511)
Abstract
Background
PCV10 was introduced into the infant immunisation programme in Nepal in 2015. We assessed the impact of PCV10 on the pneumococcal nasopharyngeal carriage in children with pneumonia.
Methods
All children with clinician diagnosed pneumonia aged 2 months to <14 years admitted to Patan Hospital, Nepal, between March 2014-2015 (pre-vaccine), and between 2018- 2019 (post-vaccine), were included in the study. Nasopharyngeal swabs collected after informed consent were transported in STGG medium, cultured and serotyped by the Quellung method.
Results
Pneumococcal carriage was 35.7 % among 423 pneumonia cases in the pre-vaccine and 41.3 % among 683 pnemonia cases in the post-vaccine period. PCV10 vaccine-type carriage decreased significantly, from 13.7% pre-vaccine to 6.7% post-vaccine (prevalence ratio=0.52, p=0.0005). Serotypes 14 (4.7%) and 1 (3.3%) were most prevalent pre-vaccine; post-vaccine, they decreased to 1.2% and 1.9%, respectively. In 2018-2019, serotypes exceeding 2% were 19A (3.22%) and 6A (2.93%).Cumulatively, the three additional PCV13-types significantly increased (3.8% pre-vaccine, 7.3% post vaccine; prevalence ratio=1.94, p=0.0158). Non-typeable pneumococcus was common in both periods (7.1% pre-vaccine vs. 6.4% in 2018-2019).
Conclusions
Nasopharyngeal carriage of PCV10 serotypes has declined in pneumonia cases after vaccine introduction. The PCV13 additional serotypes have increased but by less than 4%. This information is important when considering changing to vaccines with broader serotype coverage.