Last data update: May 13, 2024. (Total: 46773 publications since 2009)
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Query Trace: Aol GO[original query] |
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Indirect effects of 10-valent pneumococcal conjugate vaccine against adult pneumococcal pneumonia in rural western Kenya
Bigogo GM , Audi A , Auko J , Aol GO , Ochieng BJ , Odiembo H , Odoyo A , Widdowson MA , Onyango C , Borgdorff MW , Feikin DR , Carvalho MDG , Whitney CG , Verani JR . Clin Infect Dis 2019 69 (12) 2177-2184 BACKGROUND: Data on pneumococcal conjugate vaccine (PCV) indirect effects in low-income countries with high HIV burden are limited. We examined adult pneumococcal pneumonia incidence before and after 10-valent PCV introduction in Kenya in 2011. METHODS: From 1/1/2008 to 12/31/2016, we conducted surveillance for acute respiratory infection (ARI) among ~12,000 adults (>/=18 years) in western Kenya, where HIV prevalence ~17%. ARI cases (cough or difficulty breathing or chest pain, plus temperature >/=38.0 C or oxygen saturation <90%) presenting to a clinic underwent blood culture and pneumococcal urine antigen testing (UAT). We calculated ARI incidence and adjusted for healthcare seeking using data from household visits. The proportion of ARI cases with pneumococcus detected among those with complete testing (blood culture and UAT) was multiplied by adjusted ARI incidence to estimate pneumococcal pneumonia incidence. RESULTS: Pre-PCV (2008-2010), crude and adjusted ARI incidence were 3.14 and 5.30/100 person-years-observation (pyo), respectively. Among ARI cases, 39.0% (340/872) had both blood culture and UAT; 21.2% (72/340) had pneumococcus detected, yielding baseline pneumococcal pneumonia incidence of 1.12/100 pyo (95% confidence interval [CI] 1.0-1.3). In each post-PCV year (2012-2016), pneumococcal pneumonia incidence was significantly lower than baseline; with incidence rate ratios (IRR) of 0.53 (95%CI 0.31-0.61) in 2012 and 0.13 (95%CI 0.09-0.17) in 2016. Similar declines were observed in HIV-infected (IRR 0.13, 95%CI 0.08-0.22), and HIV-uninfected (IRR 0.10, 95%CI 0.05-0.20). CONCLUSIONS: Adult pneumococcal pneumonia declined in western Kenya following 10-valent PCV introduction, likely reflecting vaccine indirect effects. Evidence of herd protection is critical for guiding PCV policy decisions in resource-constrained areas. |
Epidemiology of respiratory syncytial virus infection in rural and urban Kenya
Bigogo GM , Breiman RF , Feikin DR , Audi AO , Aura B , Cosmas L , Njenga MK , Fields BS , Omballa V , Njuguna H , Ochieng PM , Mogeni DO , Aol GO , Olack B , Katz MA , Montgomery JM , Burton DC . J Infect Dis 2013 208 Suppl 3 S207-16 BACKGROUND: Information on the epidemiology of respiratory syncytial virus (RSV) infection in Africa is limited for crowded urban areas and for rural areas where the prevalence of malaria is high. METHODS: At referral facilities in rural western Kenya and a Nairobi slum, we collected nasopharyngeal/oropharyngeal (NP/OP) swab specimens from patients with influenza-like illness (ILI) or severe acute respiratory illness (SARI) and from asymptomatic controls. Polymerase chain reaction assays were used for detection of viral pathogens. We calculated age-specific ratios of the odds of RSV detection among patients versus the odds among controls. Incidence was expressed as the number of episodes per 1000 person-years of observation. RESULTS: Between March 2007 and February 2011, RSV was detected in 501 of 4012 NP/OP swab specimens (12.5%) from children and adults in the rural site and in 321 of 2744 NP/OP swab specimens (11.7%) from those in the urban site. Among children aged <5 years, RSV was detected more commonly among rural children with SARI (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2-3.3), urban children with SARI (OR, 8.5; 95% CI, 3.1-23.6), and urban children with ILI (OR, 3.4; 95% CI, 1.2-9.6), compared with controls. The incidence of RSV disease was highest among infants with SARI aged <1 year (86.9 and 62.8 episodes per 1000 person-years of observation in rural and urban sites, respectively). CONCLUSIONS: An effective RSV vaccine would likely substantially reduce the burden of respiratory illness among children in rural and urban areas in Africa. |
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