High residual carriage of vaccine-serotype Streptococcus pneumoniae after introduction of pneumococcal conjugate vaccine in Malawi

Todd D. Swarthout (), Claudio Fronterre, José Lourenço, Uri Obolski, Andrea Gori, Naor Bar-Zeev, Dean Everett, Arox W. Kamng’ona, Thandie S. Mwalukomo, Andrew A. Mataya, Charles Mwansambo, Marjory Banda, Sunetra Gupta, Peter Diggle, Neil French and Robert S. Heyderman
Additional contact information
Todd D. Swarthout: Malawi-Liverpool-Wellcome Trust Clinical Research Programme
Claudio Fronterre: CHICAS, Lancaster Medical School, Lancaster University
José Lourenço: Department of Zoology, University of Oxford
Uri Obolski: Tel Aviv University
Andrea Gori: University College London
Naor Bar-Zeev: Malawi-Liverpool-Wellcome Trust Clinical Research Programme
Dean Everett: Malawi-Liverpool-Wellcome Trust Clinical Research Programme
Arox W. Kamng’ona: University of Malawi
Thandie S. Mwalukomo: University of Malawi
Andrew A. Mataya: Malawi-Liverpool-Wellcome Trust Clinical Research Programme
Charles Mwansambo: Ministry of Health
Marjory Banda: Ministry of Education
Sunetra Gupta: Department of Zoology, University of Oxford
Peter Diggle: CHICAS, Lancaster Medical School, Lancaster University
Neil French: Malawi-Liverpool-Wellcome Trust Clinical Research Programme
Robert S. Heyderman: Malawi-Liverpool-Wellcome Trust Clinical Research Programme

Nature Communications, 2020, vol. 11, issue 1, 1-12

Abstract: Abstract There are concerns that pneumococcal conjugate vaccines (PCVs) in sub-Saharan Africa sub-optimally interrupt Streptococcus pneumoniae vaccine-serotype (VT) carriage and transmission. Here we assess PCV carriage using rolling, prospective nasopharyngeal carriage surveys between 2015 and 2018, 3.6–7.1 years after Malawi’s 2011 PCV13 introduction. Carriage decay rate is analysed using non-linear regression. Despite evidence of reduction in VT carriage over the study period, there is high persistent residual carriage. This includes among PCV-vaccinated children 3–5-year-old (16.1% relative reduction from 19.9% to 16.7%); PCV-unvaccinated children 6–8-year-old (40.5% reduction from 26.4% to 15.7%); HIV-infected adults 18-40-years-old on antiretroviral therapy (41.4% reduction from 15.2% to 8.9%). VT carriage prevalence half-life is similar among PCV-vaccinated and PCV-unvaccinated children (3.26 and 3.34 years, respectively). Compared with high-income settings, there is high residual VT carriage 3.6–7.1 years after PCV introduction. Rigorous evaluation of strategies to augment vaccine-induced control of carriage, including alternative schedules and catch-up campaigns, is required.

Date: 2020
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DOI: 10.1038/s41467-020-15786-9

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