title: Childhood pneumococcal disease in Africa - A systematic review and meta-analysis of incidence, serotype distribution, and antimicrobial susceptibility.
abstract: Determining the incidence, disease-associated serotypes and antimicrobial susceptibility of invasive pneumococcal disease (IPD) among children in Africa is essential in order to monitor the impact of these infections prior to widespread introduction of the pneumococcal conjugate vaccine (PCV).
  
  
  
  To provide updated estimates of the incidence, serotype distribution, and antimicrobial susceptibility profile of Streptococcus pneumoniae causing disease in Africa, we performed a systematic review of articles published from 2000 to 2015 using Ovid Medline and Embase. We included prospective and surveillance studies that applied predefined diagnostic criteria. Meta-analysis for all pooled analyses was based on random-effects models.
  
  
  
  We included 38 studies consisting of 386,880 participants in 21 countries over a total of 350,613 person-years. The pooled incidence of IPD was 62.6 (95% CI 16.9, 226.5) per 100,000 person-years, including meningitis which had a pooled incidence of 24.7 (95% CI 11.9, 51.6) per 100,000 person-years. The pooled prevalence of penicillin susceptibility was 78.1% (95% CI 61.9, 89.2). Cumulatively, PCV10 and PCV13 included 66.9% (95% CI 55.9, 76.7) and 80.6% (95% CI 66.3, 90.5) of IPD serotypes, respectively.
  
  
  
  Our study provides an integrated and robust summary of incidence data, serotype distribution and antimicrobial susceptibility for S. pneumoniae in children ≤5years of age in Africa prior to widespread introduction of PCV on the continent. The heterogeneity of studies and wide range of incidence rates across the continent indicate that surveillance efforts should be intensified in all regions of Africa to improve the integrity of epidemiologic data, vaccine impact and cost benefit. Although the incidence of IPD in young children in Africa is substantial, currently available conjugate vaccines are estimated to cover the majority of invasive disease-causing pneumococcal serotypes. These data provide a reliable baseline from which to monitor the impact of the broad introduction of PCV.
authors.affiliation: University of Minnesota Medical School, Minneapolis, MN, USA; Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi. Electronic address: irohtam@mlw.mw.
authors.forename: Pui-Ying
authors.initials: PY
authors.lastname: Iroh Tam
authors.affiliation: University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Beth K
authors.initials: BK
authors.lastname: Thielen
authors.affiliation: University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Obaro
authors.affiliation: Clinical Translational Science Institute, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Brearley
authors.affiliation: Clinical Translational Science Institute, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Kaizer
authors.affiliation: Clinical Translational Science Institute, University of Minnesota, Minneapolis, MN, USA; Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA.
authors.forename: Haitao
authors.initials: H
authors.lastname: Chu
authors.affiliation: University of Colorado, Denver, CO, USA.
authors.forename: Edward N
authors.initials: EN
authors.lastname: Janoff
mesh_terms: D000349:Africa / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D015995:Prevalence; D065288:Serogroup; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification
keywords: Children; Incidence; Invasive pneumococcal disease; Meta-analysis; Penicillin susceptibility; Pneumonia; Serotype; Streptococcus pneumoniae; Systematic review