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Population impact and effectiveness of sequential 13-valent pneumococcal conjugate and monovalent rotavirus vaccine introduction on infant mortality: prospective birth cohort studies from Malawi
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- King, C (author)
- Karolinska Institutet
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Bar-Zeev, N (author)
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Phiri, T (author)
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Beard, J (author)
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Mvula, H (author)
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Crampin, A (author)
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Heinsbroek, E (author)
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Hungerford, D (author)
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Lewckya, S (author)
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Verani, J (author)
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Whitney, C (author)
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Costello, A (author)
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Mwansambo, C (author)
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Cunliffe, N (author)
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Heyderman, R (author)
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French, N (author)
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Nakagomi, O (author)
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(creator_code:org_t)
- 2020-09-09
- 2020
- English.
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In: BMJ global health. - : BMJ. - 2059-7908. ; 5:9
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https://gh.bmj.com/c...
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https://doi.org/10.1...
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Abstract
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- 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.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.
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- By the author/editor
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King, C
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Bar-Zeev, N
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Phiri, T
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Beard, J
-
Mvula, H
-
Crampin, A
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show more...
-
Heinsbroek, E
-
Hungerford, D
-
Lewckya, S
-
Verani, J
-
Whitney, C
-
Costello, A
-
Mwansambo, C
-
Cunliffe, N
-
Heyderman, R
-
French, N
-
Nakagomi, O
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show less...
- Articles in the publication
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BMJ global healt ...
- By the university
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Karolinska Institutet