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Original article
Effectiveness of pneumococcal conjugate vaccine against presumed bacterial pneumonia hospitalisation in HIV-uninfected South African children: a case–control study
  1. Shabir A Madhi1,2,3,
  2. Michelle J Groome1,2,
  3. Heather J Zar4,
  4. Constant N Kapongo5,
  5. Christine Mulligan4,
  6. Susan Nzenze1,2,
  7. David P Moore1,2,
  8. Elizabeth R Zell6,
  9. Cynthia G Whitney6,
  10. Jennifer R Verani6
  1. 1Medical Research Council: Respiratory & Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
  2. 2Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
  3. 3National Institute for Communicable Diseases, Division of National Health Laboratory Service, Center for Vaccines and Immunology, Johannesburg, South Africa
  4. 4Department of Paediatrics and Child Health, Red Cross War Memorial Hospital, University of Cape Town, Cape Town, South Africa
  5. 5Ngwelezane Hospital, University of KwaZulu-Natal, KwaZulu Natal, South Africa
  6. 6Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Professor Shabir A Madhi, National Institute for Communicable Diseases 1 Modderfontein Road, Sandringham, Gauteng 2131, South Africa; shabirm{at}


Introduction We evaluated pneumococcal conjugate vaccine (PCV) effectiveness against hospitalisation for presumed bacterial pneumonia (PBP) in HIV-uninfected South African children. 7-valent PCV was introduced in April 2009 using a 2+1 schedule (doses at age 6, 14 and 39 weeks), superseded with 13-valent PCV in May 2011.

Methods A matched case–control study was conducted at three public hospitals (Soweto, Cape Town and KwaZulu-Natal) between April 2009 and August 2012. PBP cases had either WHO defined radiographically confirmed pneumonia or ‘other infiltrate’ on chest radiograph with C-reactive protein ≥40 mg/L. Hospitalised controls were children admitted with a disease unlikely to be pneumococcal and matched for case age, site and HIV infection status. Age-matched community controls were enrolled from Soweto. Adjusted vaccine effectiveness (aVE) was estimated using conditional logistic regression.

Results Of 1444 HIV-uninfected enrolled PBP cases, 1326 had ≥1 hospital controls (n=2075). Overall, aVE of an up-to-date PCV schedule was 20.1% (95% CI −9.3% to 41.6%) in children aged ≥8 weeks and 39.2% (95% CI 8.46% to 59.6%) among children 16–103 weeks of age. There were 889 PBP cases in Soweto with hospital controls and ≥1 community control (n=2628). The aVE using community controls was similar compared with hospital controls in Soweto, including 32.1% (95% CI 4.6% to 51.6%) and 38.4% (95% CI 7.7% to 58.8%), respectively, in age group ≥8 weeks and 52.7% (95% CI 25.7% to 69.9%) and 53.8% (95% CI 19.5% to 73.5%), respectively, in age group 16–103 weeks.

Conclusions PCV implemented using a 2+1 schedule in the routine infant immunisation programme was effective at preventing PBP in HIV-uninfected children. Effectiveness estimates were similar to efficacy measured by earlier randomised controlled trials using different vaccination schedules.

  • Pneumonia
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