School of Pathology (ETDs)

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Browsing School of Pathology (ETDs) by Author "Eme, Ifeanyi"

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    Effect of Pneumococcal Conjugate Vaccine on Invasive Pneumococcal Disease in Children Hospitalized at Chris Hani Baragwanath Hospital over a 13 Year Period
    (University of the Witwatersrand, 2024) Eme, Ifeanyi
    Globally, under-5 mortality rates remain high in Africa, particularly the sub–Saharan region, where roughly 700,000 child mortalities are caused by S. pneumoniae infections. The purpose of this research project was to evaluate effectiveness of the pneumococcal conjugate vaccine (PCV) on the prevalence of invasive pneumococcal disease (IPD) in hospitalized children at the Chris Hani Baragwanath Academic Hospital (CHBAH) over a 13-year period, before and after the advent of the PCV, and its subsequent incorporation into the South African Expanded Program on Immunization (EPI). Methods: We carried out a retrospective review of demographic, laboratory, and clinical information of S. pneumoniae cultured on blood and/or cerebrospinal fluid in children below the age of 14 that were hospitalized at CHBAH between January 2006 and December 2018. The investigation was stratified into pre-PCV (2006–2008), transitional-PCV (2009–2011) and post-PCV era (2012–2018). Results: Of 867 children hospitalised for IPD over the study period, 409 (47.2%) cases occurred in pre- PCV era, 231 (26.6%) during transitional-PCV, and 227 (26.2%) in the post-PCV era. The IPD incidence (per 100,000 persons) of IPD reduced from 41.1 in 2006 to 4.6 in 2018 (p<0.001). In infants <2 years, there was 79.3% reduction in IPD incidence when comparing the pre-PCV (130.9 per 100,000 persons) and post-PCV period (27.1 per 100,000 persons). We also noted a decrease in the proportion of IPD cases in both the HIV-infected and uninfected persons, comparing pre-PCV to post-PCV period. The most prevalent vaccine serotypes were 14 (16.9%), 1 (14.0%), 6A (11.4%), 19F (11.0%), 23F (10.8%) and 6B (10.0%), whereas the predominant non-vaccine serotypes included; 15B/C (9.8%), 12F (9.3%), 16F (7.5%), NEG38 (7.5%) 35B (5.1%), and 7C (4.2%). Using the minimum inhibitory concentration (MIC), PCV introduction resulted in increased susceptibility to penicillin and cefotaxime. For the zone sizes using the Kirby Bauer disc diffusion method, vancomycin resistance was not seen in any of the isolates. All the other antibiotics showed increase in susceptibility over the period, apart from Erythromycin which initially tended to be relatively stable, but however showed increase in susceptibility across the eras as time goes on. Conclusion: The rate of IPD among children hospitalized at CHBAH has decreased markedly following the incorporation of the PCV into South African EPI programme. The study indicates a need for continued surveillance to monitor the change in resistance patterns and emergence in non- vaccine serotypes causing disease, as this is crucial for mapping out strategic intervention policies in South Africa