{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T05:22:30Z","timestamp":1765948950638,"version":"3.48.0"},"reference-count":48,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"WHO","award":["2014405143-0"],"award-info":[{"award-number":["2014405143-0"]}]},{"name":"HIB & Surveillance System"},{"name":"Gavi, the Vaccine Alliance","award":["MOZ-HSS-2-INS"],"award-info":[{"award-number":["MOZ-HSS-2-INS"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Mozambique introduced the 10-valent pneumococcal conjugate vaccine (PCV10) in 2013 using a three-dose primary series with no booster dose (3p+0) and later switched to the PCV13 using a schedule of two primary doses with one booster (2p+1). We aimed to describe the burden and serotype distribution of pneumococcal meningitis in children under 5 years of age in Mozambique over an eleven-year period starting with the year of PCV10 introduction, and assess the impact of the PCV vaccine and schedule changes. Methods: We analysed meningitis surveillance data in Mozambique from March 2013 through to December 2023. Cerebrospinal fluid (CSF) samples were collected from eligible children in three referral hospitals (Maputo Central Hospital [south], Beira Central Hospital [central], and Nampula Central Hospital [north]). Culture and polymerase chain reaction assay (qPCR) were performed on each sample. S. pneumoniae-positive samples were subsequently serotyped using multiplex assay. We estimated annual incidence rates for pneumococcal meningitis in children under 5 years old following the PCVs\u2019 introduction (2013\u20132023). The impact of the product switch and schedule change from PCV10\/3p+0 to PCV13\/2p+1 on the burden and serotype distribution of pneumococcal meningitis was assessed. Results: Of the 4075 CSF samples tested, 7.4% (301\/4075) were positive for S. pneumoniae, 2.5% (103\/4075) for H. influenzae, and 1.0% (42\/4075) for N. meningitidis. Pneumococcal meningitis incidence in children under five reduced from 44.7 cases per 100,000 in 2013 to 4.6 cases per 100,000 in 2023, an 89.7% reduction. In the PCV13\/2p+1 period (2020\u20132023), pneumococcal meningitis incidence was 51.2% lower than the PCV10\/3p+0 period (2013\u20132017) (IRR 0.49, 95% CI 0.4\u20130.6; p &lt; 0.001). PCV10-serotype pneumococcal meningitis incidence among children under five decreased by 65.6% in the PCV13\/2p+1 period (IRR 0.34, 95% CI 0.2\u20130.6; p &lt; 0.001). We detected zero cases of pneumococcal meningitis due to the PCV13-serotype in 2020\u20132023, whereas non-PCV10\/13-serotypes increased by 76% (IRR 1.76, 95% CI 1.2\u20132.6; p = 0.004). The case\u2013fatality proportion decreased by 71.9% (95% CI 62.9\u201384.8%) in the PCV13\/2p+1 period. Conclusions: Since the introduction of PCVs in Mozambique, the burden of pneumococcal meningitis and deaths in children under 5 years of age has substantially decreased, as well as the prevalence of PCV13-serotypes. Higher valency PCVs are needed due to the increased prevalence of non-PCV10\/13-serotypes. Funding: Gavi, The Vaccine Alliance, reference number: MOZ-HSS-2-INS; WHO Reference: 2014405143-0, creation DFC to support HIB &amp; Surveillance System.<\/jats:p>","DOI":"10.3390\/vaccines13121246","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T09:36:39Z","timestamp":1765791399000},"page":"1246","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Impact of Pneumococcal Conjugate Vaccines on the Burden of Pneumococcal Meningitis in Mozambique, 2013\u20132023"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1244-0332","authenticated-orcid":false,"given":"Aquino Albino","family":"Nhantumbo","sequence":"first","affiliation":[{"name":"Instituto Nacional de Sa\u00fade, Marracuene 1120, Mozambique"},{"name":"National Institute for Quality Control in Health (INCQS), Funda\u00e7\u00e3o Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21040900, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0535-3484","authenticated-orcid":false,"given":"Goitom","family":"Weldegebriel","sequence":"additional","affiliation":[{"name":"World Health Organization African Regional Office, Harare 348, Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"de Gouveia","sequence":"additional","affiliation":[{"name":"National Health Laboratory Service (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg 2192, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reggis","family":"Katsande","sequence":"additional","affiliation":[{"name":"World Health Organization African Regional Office, Harare 348, Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte Elizabeth","family":"Com\u00e9","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade, Marracuene 1120, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alcides Moniz","family":"Munguambe","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade, Marracuene 1120, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vlademir","family":"Cantarelli","sequence":"additional","affiliation":[{"name":"Departamento de Ci\u00eancias B\u00e1sicas da Sa\u00fade, Universidade Federal de Ci\u00eancias de Sa\u00fade de Porto Alegre (UFCSPA), Porto Alegre 900050170, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8358-1183","authenticated-orcid":false,"given":"C\u00edcero","family":"Dias","sequence":"additional","affiliation":[{"name":"Departamento de Ci\u00eancias B\u00e1sicas da Sa\u00fade, Universidade Federal de Ci\u00eancias de Sa\u00fade de Porto Alegre (UFCSPA), Porto Alegre 900050170, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachid","family":"Muleia","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade, Marracuene 1120, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ezequias Fenias","family":"Sitoe","sequence":"additional","affiliation":[{"name":"Nampula Central Hospital, Ministry of Health, Nampula 3100, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eunice Veronica","family":"Zeca","sequence":"additional","affiliation":[{"name":"Nampula Central Hospital, Ministry of Health, Nampula 3100, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir","family":"Seni","sequence":"additional","affiliation":[{"name":"Beira Central Hospital, Ministry of Health, Sofala 2100, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Nicolau","family":"Tambo","sequence":"additional","affiliation":[{"name":"Beira Central Hospital, Ministry of Health, Sofala 2100, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Cristina de Faria Neves","family":"Mussagi","sequence":"additional","affiliation":[{"name":"Maputo Central Hospital, Ministry of Health, Maputo 1100, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4729-0952","authenticated-orcid":false,"given":"Pl\u00e1cida Iliany","family":"Maholela","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade, Marracuene 1120, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0610-8648","authenticated-orcid":false,"given":"Ivano","family":"de Filippis","sequence":"additional","affiliation":[{"name":"National Institute for Quality Control in Health (INCQS), Funda\u00e7\u00e3o Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21040900, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8686-7873","authenticated-orcid":false,"given":"Eduardo Samo","family":"Gudo","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade, Marracuene 1120, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e744","DOI":"10.1016\/S2214-109X(18)30247-X","article-title":"Articles Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: Global, regional, and national estimates for 2000\u201315","volume":"6","author":"Wahl","year":"2018","journal-title":"Lancet Glob. 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