Impact of 10-valent pneumococcal conjugate vaccine on pneumococcal
               meningitis in children up to two years of age in Brazil

Grando, Indianara Maria; Moraes, Camile de; Flannery, Brendan; Ramalho, Walter Massa; Horta, Marco Aurélio P.; Pinho, Diana Lucia Moura; Nascimento, Gilmara Lima

doi:10.1590/0102-311X00169913

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Article • Cad. Saúde Pública 31 (2) • Feb 2015 • https://doi.org/10.1590/0102-311X00169913 linkcopy

Impact of 10-valent pneumococcal conjugate vaccine on pneumococcal meningitis in children up to two years of age in Brazil

Impacto de la vacuna neumocócica conjugada 10-valente en la meningitis neumocócica en niños de hasta dos años de edad en Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstracts

The objective of this study was to analyze the impact of vaccination against Streptococcus pneumoniae on the morbidity and mortality from pneumococcal meningitis in children ≤ 2 years in Brazil, from 2007 to 2012. This is a descriptive study and ecological analysis using data from the Information System on Notifiable Diseases. Pre-vaccination (2007-2009) and post-vaccination (2011-2012) periods were defined to compare incidence rates and mortality. A total of 1,311 cases and 430 deaths were reported during the study period. Incidence decreased from 3.70/100,000 in 2007 to 1.84/100,000 in 2012, and mortality decreased from 1.30/100,000 to 0.40/100,000, or 50% and 69% respectively, with the greatest impact in the 6-11 month age group. This decrease in Pneumococcal meningitis morbidity and mortality rates two years after introduction of the 10-valent pneumococcal conjugate vaccine suggests its effectiveness.

Streptococcus pneumoniae; Meningitis; Vaccines

Variables	2007		2008		2009		2011		2012
Variables	n	%	n	%	n	%	n	%	n	%
Gender
Male	222	61.7	200	62.7	177	61.5	106	55.2	80	52.6
Female	138	38.3	119	37.3	111	38.5	86	44.8	72	47.4
Age group
< 1 year
< 6 months	136	37.8	98	30.7	98	34.0	111	57.8	78	51.3
≥ 6 months	124	34.4	120	37.6	109	37.8	39	20.3	29	19.1
1 year	74	20.6	75	23.5	53	18.4	21	10.9	26	17.1
2 years	26	7.2	26	8.2	28	9.7	21	10.9	19	12.5
Signs and symptoms
Fever	336	93.3	314	98.4	266	92.4	174	90.6	136	89.5
Vomiting	235	65.3	227	71.2	180	62.5	116	60.4	89	58.6
Seizures	164	45.6	154	48.3	119	41.3	76	39.6	61	40.1
Neck stiffness	138	38.3	137	42.9	117	40.6	58	30.2	52	34.2
Bulging fontanelle	116	32.2	89	27.9	82	28.5	58	30.2	50	32.9
Confirmatory criterion
Culture	277	76.9	222	69.6	205	71.2	114	59.4	88	57.9
Latex	80	22.2	87	27.3	73	25.3	68	35.4	49	32.2
PCR	3	0.8	10	3.1	10	3.5	10	5.2	15	9.9
Evolution
Cure	204	56.7	175	54.9	166	57.6	112	58.3	97	63.8
Death	127	35.3	106	33.2	97	33.7	65	33.9	33	21.7

Region/State	2007		2008		2009		2011		2012
Region/State	IR	MR	IR	MR	IR	MR	IR	MR	IR	MR
Southeast	5.65	2.08	4.88	1.73	4.78	1.84	3.93	1.42	2.99	0.69
MG	3.74	1.66	3.70	1.59	2.91	1.18	2.99	1.04	1.29	0.52
ES	5.53	1.66	1.72	1.15	4.06	1.16	3.37	1.35	2.67	1.34
RJ	5.86	3.15	4.83	1.96	5.44	3.68	5.81	2.66	3.62	0.82
SP	6.55	1.94	5.83	1.78	5.62	1.61	3.73	1.16	3.58	0.67
South	5.00	1.52	4.93	1.16	4.55	0.93	2.33	0.65	2.59	0.37
PR	5.73	2.55	5.77	1.77	4.36	0.69	2.29	0.23	3.64	0.91
SC	5.72	1.14	4.81	0.40	4.56	2.07	2.01	0.80	1.99	0.00
RS	3.80	0.67	4.09	0.96	4.76	0.50	2.58	1.03	1.80	0.00
Brazil	3.70	1.30	3.38	1.12	3.12	1.06	2.29	0.79	1.80	0.39

Incidence/Age group	Pre-vaccination									Post-vaccination
	2007			2008			2009			2011			2012			Total
	n	%	IR	N	%	IR	n	%	IR	n	%	IR	n	%	IR	n
< 1 year
< 6 months	136	26.1	8.92	98	18.8	6.47	98	18.8	6.71	111	21.3	8.46	78	15.0	5.88	521
≥ 6 months	124	29.5	7.46	120	28.5	7.65	109	25.9	7.02	39	9.3	2.74	29	6.9	2.02	421
1 year	74	29.7	2.28	75	30.1	2.39	53	21.3	1.73	21	8.4	0.77	26	10.4	0.95	249
2 years	26	21.7	0.79	26	21.7	0.81	28	23.3	0.89	21	17.5	0.76	19	15.8	0.68	120
Total	360	27.5	3.70	319	24.3	3.38	288	22.0	3.12	192	14.6	2.34	152	11.6	1.84	1311
Mortality/Age group	Pre-vaccination									Post-vaccination
	2007			2008			2009			2011			2012			Total
	n	%	MR	N	%	MR	n	%	MR	n	%	MR	n	%	MR	n
< 1 year
< 6 months	40	16.5	2.62	111	45.7	1.31	36	14.8	2.46	39	16.0	2.97	17	7.0	1.28	243
≥ 6 months	54	35.1	3.25	39	25.3	0.36	42	27.3	2.71	12	7.8	0.84	7	4.5	0.49	154
1 year	25	33.3	0.77	21	28.0	0.32	14	18.7	0.46	9	12.0	0.33	6	8.0	0.22	75
2 years	8	18.2	0.24	21	47.7	0.94	6	13.6	0.19	6	13.6	0.22	3	6.8	0.11	44
Total	127	24.6	1.30	192	37.2	1.12	98	19.0	1.06	66	12.8	0.80	33	6.4	0.40	516

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Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
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[t01TFN01] Source: Information System on Notifiable Diseases (SINAN).