Population impact and effectiveness of sequential 13-valent pneumococcal conjugate and monovalent rotavirus vaccine introduction on infant mortality: prospective birth cohort studies from Malawi. Issue 9 (9th September 2020)

• Record Type: Journal Article
• Authors: King, Carina; Bar-Zeev, Naor; Phiri, Tambosi; Beard, James; Mvula, Hazzie; Crampin, Amelia; Heinsbroek, Ellen; Hungerford, Dan; Lewckya, Sonia; Verani, Jennifer; Whitney, Cynthia; Costello, Anthony; Mwansambo, Charles; Cunliffe, Nigel; Heyderman, Rob; French, Neil
• Other Names: author non-byline.; Nakagomi Osamu author non-byline.; Tate Jacqueline E author non-byline.; Parashar Umesh D author non-byline.
• Is Part Of: BMJ global health. Volume 5:Issue 9(2020)
• Publication Date: 2020-09-09
• Subjects: pneumococcal disease -- vaccines -- child health; World health -- Periodicals; 362.105
• DOI: 10.1136/bmjgh-2020-002669
• Languages: English
• ISSNs: 2059-7908

Abstract

Abstract : Background: Pneumococcal conjugate vaccine (PCV) and rotavirus vaccine (RV) are key tools for reducing common causes of infant mortality. However, measurement of population-level mortality impact is lacking from sub-Saharan Africa. We evaluated mortality impact and vaccine effectiveness (VE) of PCV13 introduced in November 2011, with subsequent RV1 roll-out in October 2012, in Malawi. Methods: We conducted two independent community-based birth cohort studies. Study 1, in northern Malawi (40000population), evaluated population impact using change-point analysis and negative-binomial regression of non-traumatic 14–51-week infant mortality preintroduction (1 January 2004 to 31 September 2011) and postintroduction (1 October 2011 to 1 July 2019), and against three-dose coverage. Study 2, in central Malawi (465 000 population), was recruited from 24 November 2011 to 1 June 2015. In the absence of preintroduction data, individual three-dose versus zero-dose VE was estimated using individual-level Cox survival models. In both cohorts, infants were followed with household visits to ascertain vaccination, socioeconomic and survival status. Verbal autopsies were conducted for deaths. Results: Study 1 included 20 291 live births and 216 infant deaths. Mortality decreased by 28.6% (95% CI: 15.3 to 39.8) post-PCV13 introduction. A change point was identified in November 2012. Study 2 registered 50 731 live births, with 454 deaths. Infant mortality decreased from 17 to 10/1000 live births during the study period. Adjusted VE was 44.6% overall (95% CI: 23.0 to 59.1) and 48.3% (95% CI: −5.9 to 74.1) against combined acute respiratory infection, meningitis and sepsis-associated mortality. Conclusion: These data provide population-level evidence of infant mortality reduction following sequential PCV13 and RV1 introduction into an established immunisation programme in Malawi. These data support increasing coverage of vaccine programmes in high-burden settings.