Effectiveness of Pneumococcal Vaccines (PCV13) Against Mortality from Clinical Pneumonia and Meningitis in Children Under Five Years in Ghana After PCV13 Introduction Into the Routine Immunisation System

Background: Streptococcus pneumoniae is a major cause of mortality from pneumonia and meningitis among children under five in West Africa. A systematic review in 2018 showed that 81% of pneumonia deaths in Africa were caused by pneumococcus. The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced into Ghana’s routine immunisation programme (EPI) in 2012, using the 3+0 schedule. However, few studies have assessed the impact of PCV13 on pneumonia and meningitis outcomes in Ghana and Africa. This study assessed the effectiveness of PCV13 in lowering mortality from clinical pneumonia and meningitis among children under five in the Kassena Nankana districts of Ghana. Methods: This was a retrospective observational study using longitudinal mortality and vaccination data of children younger than 5 years from the Navrongo Health and Demographic Surveillance System (NHDSS) database. The NHDSS monitors the health and demographics of 160,000 individuals across two districts. Secondary data on mortality and vaccinations from 1 January 2007 to 31 December 2017 were extracted. Mortality (non-traumatic) from pneumonia and all-cause mortality in children under five years in the study were assessed through verbal autopsies using the WHO tool. Mortality rates (MR) were calculated as the number of deaths per 1,000 live births. Results: Mortality from pneumonia fell by 50% in both males and females after the introduction of PCV13 vaccination. All-cause mortality for both sexes was reduced by 60%. PCV13 vaccine coverage increased from 85.9% in 2014 to 95.7% by 2017. Furthermore, mortality rates from pneumonia and meningitis combined showed a marked reduction from approximately 15% to 8% in children under five years old. Conclusion: PCV13 has been effective in lowering mortality from clinical pneumonia and meningitis in this study population.