{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T02:06:49Z","timestamp":1780538809725,"version":"3.54.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","license":[{"start":{"date-parts":[[2019,9,5]],"date-time":"2019-09-05T00:00:00Z","timestamp":1567641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CDC Foundation","award":["971-17"],"award-info":[{"award-number":["971-17"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Streptococcus pneumoniae is a leading cause of pneumonia and meningitis in children aged &lt;5 years. Zimbabwe introduced 13-valent pneumococcal conjugate vaccine (PCV13) in 2012 using a 3-dose infant schedule with no booster dose or catch-up campaign. We evaluated the impact of PCV13 on pediatric pneumonia and meningitis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We examined annual changes in the proportion of hospitalizations due to pneumonia and meningitis among children aged &lt;5 years at Harare Central Hospital (HCH) pre-PCV13 (January 2010\u2013June 2012) and post-PCV13 (July 2013\u2013December 2016) using a negative binomial regression model, adjusting for seasonality. We also evaluated post-PCV13 changes in serotype distribution among children with confirmed pneumococcal meningitis at HCH and acute respiratory infection (ARI) trends using Ministry of Health outpatient data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Pneumonia hospitalizations among children aged &lt;5 years steadily declined pre-PCV13; no significant change in annual decline was observed post-PCV13. Post-PCV13 introduction, meningitis hospitalization decreased 30% annually (95% confidence interval [CI], \u201342, \u201314) among children aged 12\u201359 months, and no change was observed among children aged 0\u201311 months. Pneumococcal meningitis caused by PCV13 serotypes decreased from 100% in 2011 to 50% in 2016. Annual severe and moderate outpatient ARI decreased by 30% (95% CI, \u201333, \u201326) and 7% (95% CI, \u201311, \u20132), respectively, post-PCV13 introduction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We observed declines in pediatric meningitis hospitalizations, PCV13-type pneumococcal meningitis, and severe and moderate ARI outpatient visits post-PCV13 introduction. Low specificity of discharge codes, changes in referral patterns, and improvements in human immunodeficiency virus care may have contributed to the lack of additional declines in pneumonia hospitalizations post-PCV13 introduction.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciz462","type":"journal-article","created":{"date-parts":[[2019,6,5]],"date-time":"2019-06-05T23:19:15Z","timestamp":1559776755000},"page":"S72-S80","source":"Crossref","is-referenced-by-count":14,"title":["Pneumococcal Conjugate Vaccine Impact on Meningitis and Pneumonia Among Children Aged &lt;5 Years\u2014Zimbabwe, 2010\u20132016"],"prefix":"10.1093","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5908-4785","authenticated-orcid":false,"given":"Vongai","family":"Dondo","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe"},{"name":"Harare Central Hospital, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilda","family":"Mujuru","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe"},{"name":"Harare Central Hospital, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kusum","family":"Nathoo","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe"},{"name":"Harare Central Hospital, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vengai","family":"Jacha","sequence":"additional","affiliation":[{"name":"Harare Central Hospital, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ottias","family":"Tapfumanei","sequence":"additional","affiliation":[{"name":"Epidemiology and Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla","family":"Chirisa","sequence":"additional","affiliation":[{"name":"Epidemiology and Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Portia","family":"Manangazira","sequence":"additional","affiliation":[{"name":"Epidemiology and Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Macharaga","sequence":"additional","affiliation":[{"name":"Harare Central Hospital, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"de Gouveia","sequence":"additional","affiliation":[{"name":"Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason M","family":"Mwenda","sequence":"additional","affiliation":[{"name":"World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regis","family":"Katsande","sequence":"additional","affiliation":[{"name":"World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goitom","family":"Weldegebriel","sequence":"additional","affiliation":[{"name":"World Health Organization, Intercountry Support Team, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy","family":"Pondo","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, 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