Abstract
BackgroundPneumococcal 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.MethodsWe 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.ResultsStudy 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.ConclusionThese 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.
Highlights
Pneumonia remains the leading cause of infectious mortality in children under 5King C, et al BMJ Global Health 2020;5:e002669. doi:10.1136/bmjgh-2020-002669BMJ Global HealthWhat do the new findings imply? ►► PCV13 introduction, as part of a well-established extended programme of immunisation (EPI) programme in a low-income, high-burden setting alongside rotavirus vaccine (RV) introduction, is associated with significant reductions in infant mortality. ►► This strengthens the growing evidence that investment in Pneumococcal conjugate vaccine (PCV) and rotavirus vaccines (RVs) scale-up to prevent infant deaths should be prioritised
13-v alent PCV, with subsequent RV introduction, on population infant mortality in Malawi. ►► We demonstrate significant reductions in all non- traumatic infant mortality among three-dose age- eligible infants following PCV13 introduction in Malawi, in two different locations. ►► The reductions in mortality were associated with vaccine coverage
What do the new findings imply? ►► PCV13 introduction, as part of a well-established EPI programme in a low-income, high-burden setting alongside RV introduction, is associated with significant reductions in infant mortality. ►► This strengthens the growing evidence that investment in PCV and RV scale-up to prevent infant deaths should be prioritised
Summary
Pneumonia remains the leading cause of infectious mortality in children under 5BMJ Global HealthWhat do the new findings imply? ►► PCV13 introduction, as part of a well-established EPI programme in a low-income, high-burden setting alongside RV introduction, is associated with significant reductions in infant mortality. ►► This strengthens the growing evidence that investment in PCV and RV scale-up to prevent infant deaths should be prioritised. We evaluated mortality impact and vaccine effectiveness (VE) of PCV13 introduced in November 2011, with subsequent RV1 roll-o ut in October 2012, in Malawi. In the absence of preintroduction data, individual three-d ose versus zero-d ose 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. Infant mortality decreased from 17 to 10/1000 live births during the study period. 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-b urden settings
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