Volume 95, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Pneumonia is a public health problem in the tropics, and the 7-valent pneumococcal conjugative vaccine (PCV-7) has been introduced in an effort to prevent the disease and therefore reduce childhood mortality. In Rwanda, PCV-7 was introduced in 2009, and we aimed to determine its impact on the rate of child hospitalization/mortality due to pneumonia. A retrospective survey was conducted on hospitalization rates and pediatric deaths between two periods, that is, before the introduction of PCV-7 (2007–2009) and after the introduction of PCV-7 (2010–2013) in Kabutare District Hospital. There was a 53% reduction in hospitalization, with a significant decline in in-hospital deaths between the two periods. There was also a significant correlation between vaccination coverage and decline in hospitalization rates between 2009 and 2013. We conclude that PCV-7 vaccine is associated with significant reduction in the rate of child hospitalization and mortality but more mechanistic studies are warranted to determine the immunological impact, especially in the context of coinfections and malnutrition.


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  1. Lodha R, Kabra SK, Pandey RM, , 2013. Antibiotics for community-acquired pneumonia in children. Cochrane Database Syst Rev 6: CD004874. [Google Scholar]
  2. Fischer Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O'Brien KL, Campbell H, Black RE, , 2013. Global burden of childhood pneumonia and diarrhoea. Lancet 381: 14051416.[Crossref] [Google Scholar]
  3. Oishi K, Tamura K, Akeda Y, , 2014. Global control of pneumococcal infections by pneumococcal vaccines. Trop Med Health 42: 8386.[Crossref] [Google Scholar]
  4. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR, , 2011. Viral pneumonia. Lancet 377: 12641275.[Crossref] [Google Scholar]
  5. Scott JAG, Brooks WA, Peiris JSM, Holtzman D, Mulholland EK, , 2008. Pneumonia research to reduce childhood mortality in the developing world. J Clin Invest 118: 12911300.[Crossref] [Google Scholar]
  6. Grijalva CG, Nuorti JP, Arbogast PG, Martin SW, Edwards KM, Griffin MR, , 2007. Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis. Lancet 369: 11791186.[Crossref] [Google Scholar]
  7. Pírez MC, Algorta G, Cedrés A, Sobrero H, Varela A, Giachetto G, Montano A, , 2011. Impact of universal pneumococcal vaccination on hospitalizations for pneumonia and meningitis in children in Montevideo, Uruguay. Pediatr Infect Dis J 30: 669674.[Crossref] [Google Scholar]
  8. Ministry of Health of Rwanda, National Institute of Statistics of Rwanda, Kigali, Rwanda and ICF Macro, Calverton, Maryland, USA, 2009. Rwanda DHS, 2007-2008 - Rwanda Interim Demographic and Health Survey, FR215. Available at: http://dhsprogram.com/publications/index.cfm. [Google Scholar]
  9. MOH, 2011. Expanded program on immunization, Comprehensive multi-year plan 2011–2015. Available at: http://www.gavi.org/country/rwanda/documents/#cmyp. [Google Scholar]
  10. Patrzalek M, Gorynski P, Albrecht P, , 2012. Indirect population impact of universal PCV7 vaccination of children in a 2 + 1 schedule on the incidence of pneumonia morbidity in Kielce, Poland. Eur J Clin Microbiol Infect Dis 31: 30233028.[Crossref] [Google Scholar]
  11. Gray D, Zar HJ, , 2009. Management of community-acquired pneumonia in HIV-infected children. Expert Rev Anti Infect Ther 7: 437451.[Crossref] [Google Scholar]
  12. Gray DM, Zar HJ, , 2010. Community-acquired pneumonia in HIV-infected children: a global perspective. Curr Opin Pulm Med 16: 208216. [Google Scholar]
  13. Zar HJ, , 2004. Pneumonia in HIV-infected and HIV-uninfected children in developing countries: epidemiology, clinical features, and management. Curr Opin Pulm Med 10: 176182.[Crossref] [Google Scholar]
  14. Victora CG, Kirkwood BR, Ashworth A, Black RE, Rogers S, Sazawal S, Campbell H, Gove S, , 1999. Potential interventions for the prevention of childhood pneumonia in developing countries: improving nutrition. Am J Clin Nutr 70: 309320. [Google Scholar]
  15. WHO/UNICEF, 2014. Rwanda: WHO and UNICEF Estimates of Immunization Coverage: 2014 Revision, 123. Available at: http://data.unicef.org/child-health/immunization.html. [Google Scholar]
  16. Cohen C, von Mollendorf C, de Gouveia L, Naidoo N, Meiring S, Quan V, Nokeri V, Fortuin-de Smit M, Malope-Kgokong B, Moore D, Reubenson G, Moshe M, Madhi SA, Eley B, Hallbauer U, Kularatne R, Conklin L, O'Brien KL, Zell ER, Klugman K, Whitney CG, von Gottberg A, for the South African Invasive Pneumococcal Disease Case-Control Study Group, , 2014. Effectiveness of seven-valent pneumococcal conjugate vaccine (PCV-7) against invasive pneumococcal disease in HIV-infected and -uninfected children in South Africa: a matched case-control study. Clin Infect Dis 59: 808818.[Crossref] [Google Scholar]
  17. Binagwaho A, Pegurri E, Drobac PC, Mugwaneza P, Stulac SN, Wagner CM, Karema C, Tsague L, , 2013. Prevention of mother-to-child transmission of HIV: cost-effectiveness of antiretroviral regimens and feeding options in Rwanda. PLoS One 8: e54180.[Crossref] [Google Scholar]
  18. Tornheim JA, Manya AS, Oyando N, Kabaka S, Breiman RF, Feikin DR, , 2007. The epidemiology of hospitalized pneumonia in rural Kenya: the potential of surveillance data in setting public health priorities. Int J Infect Dis 11: 536543.[Crossref] [Google Scholar]
  19. Thanee C, Pancharoen C, Likitnukul S, Luangwedchakarn V, Umrod P, Phasomsap C, Apornpong T, Chuanchareon T, Butterworth O, Puthanakit T, , 2011. The immunogenicity and safety of pneumococcal conjugate vaccine in human immunodeficiency virus-infected Thai children. Vaccine 29: 58865891.[Crossref] [Google Scholar]
  20. Abzug MJ, Pelton SI, Song LY, Fenton T, Levin MJ, Nachman SA, Borkowsky W, Rosenblatt HM, Marcinak JF, Dieudonne A, Abrams EJ, Pathak I, Pediatric AIDS Clinical Trials Group P1024 Protocol Team, , 2006. Immunogenicity, safety, and predictors of response after a pneumococcal conjugate and pneumococcal polysaccharide vaccine series in human immunodeficiency virus-infected children receiving highly active antiretroviral therapy. Pediatr Infect Dis J 25: 920929.[Crossref] [Google Scholar]

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  • Received : 25 Dec 2015
  • Accepted : 19 May 2016
  • Published online : 07 Sep 2016

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