Table 1.

Characteristics of included studies regarding incidence of IPD and/or pneumococcal pneumonia among children <5 years of age, Africa, 2000–2012

Study	Study period, PCV status	Country, location(s)	Design	No. of enrolled cases <5y	Diagnostic method	Syndrome	Age group (months)	Incidence (cases per 100,000/person-year) 95% CI
Western and Central Africa

Cutts et al. 2005¹⁵	8/2000 – 4/2004, pre-PCV	Upper and Central River Division, The Gambia	Randomized, placebo-controlled, double-blind PCV trial	17,437 (Vaccine group: 8,718; placebo group: 8,719)	Radiography, culture	Nonbacteremic pneumonia^a	3–11 12–23 24–29	PCV group: 3,440 (2,880–4,100) 2,580 (2,230–2,990) 1,270 (880–1,840)	Placebo group: 5,300 (4,590–6,110) 4,170 (3,710–4,680) 1,870 (1,370–2,540)
Cutts et al. 2005¹⁵	8/2000 – 4/2004, pre-PCV	Upper and Central River Division, The Gambia	Randomized, placebo-controlled, double-blind PCV trial	17,437 (Vaccine group: 8,718; placebo group: 8,719)	Radiography, culture	IPD	3–11 12–23 24–29	30 (4–190) 79 (30–170) 130 (40–410)	390 (230–660) 280 (180–440) 180 (70–480)

Campbell et al. 2004¹⁴	6/2002–5/2003, pre-PCV	Bamako, Mali	Prospective surveillance	2,049	Culture, confirmed by molecular diagnostics; latex agglutination	Meningitis	0–11 12–48	26.1 (10.2–48.4) 9.1 (0.2–41.3)
						Bacteremic pneumonia^b	0–11 12–48	10.5 (1.3–33.1) 30.0 (11.0–54.3)
						IPD	0–11 12–48	22.9 (12.0–37.3) 21.6 (9.8–38.2)

Parent du Chatelet et al. 2005¹⁸	4/2002 – 4/2003, pre-PCV	Burkina Faso	Prospective surveillance, some retrospectively identified	281	Culture, PCR testing for all cases	Meningitis	<12 <60	95(65–125) 41 (31–51)

Mueller et al. 2012¹⁶	3/2007 – 12/2009, pre-PCV	Bobo Dioulasso, Burkina Faso and surrounding urban and rural zones	Hospital-based surveillance	263,848	Culture, multiplex PCR, latex agglutination	Meningitis	0–5 6–11 12–48	57.5 (35.1–88.8) 43.1 (22.3–75.3) 5.0 (2.4–9.1)

Nielsen et al. 2012¹⁷	9/2007 – 7/2009, pre-PCV	Asante region, Ghana	Prospective survey	1,351	Culture	Bacteremia	<60	430 (250–610)

Eastern Africa

Sigauque et al. 2008²⁰	5/2001 – 4/2006, 1. 6% received PCV in 2003 as part of clinical trial	Manhiça, Mozambique	Prospective surveillance	15,962	Culture	Bacteremia	<12 12–<60	403 (307–529) 187 (151–232)

Roca et al. 2009¹⁹	1/2006 – 1/2007, PCV not part of routine immunization schedule	Manhiça, Mozambique	Surveillance	3,507	Culture	Meningitis	<2 2–11 12–48	0 108 (35–337) 18 (4–70)

Thriemer et al. 2012²¹	3/2009 – 12/2010, pre-PCV	Pemba Island, Zanzibar, Tanzania	Surveillance	637	Culture	Bacteremia	≤60	2 (0.4–6); Adjusted: 42 (32–54)

Southern Africa

von Gottberg et al. 2013²³	2003–2008, pre-PCV	South Africa	Surveillance	8,673 (70% HIV-infected)	Culture	IPD	<12 12–48	HIV-uninfected: 48 (35–63) 6 (5–7)	HIV-infected: 1,022 (923–1,123) 198 (178–220)

Tempia et al. 2015²²	2/2009 – 12/2012, post-PCV	Soweto, South Africa	Prospective surveillance	8,050	PCR	Bacteremic pneumonia^c	<24	2009: 436 6 (375.9–504.2) 2011: 86.9 (62.1–118.3) 2012: 157.1 (123.2–197.6)
Tempia et al. 2015²²	2/2009 – 12/2012, post-PCV	Soweto, South Africa	Prospective surveillance	8,050	Culture	IPD		2009: 129.8 (97.8–168.9) 2011: 58.6 (38.7–85.3) 2012: 43.1 (26.3–66.5)

HAART, highly active antiretroviral therapy; IPD, invasive pneumococcal disease; PCV, pneumococcal conjugate vaccine; PCR, polymerase chain reaction

Radiological pneumonia.

Growth in S. pneumoniae in blood of children admitted with clinically diagnosed pneumonia.

Cough/difficulty breathing and any of the following symptoms/signs: unable to drink/breastfeed, vomits everything, convulsions, lethargic or unconscious, stridor when calm and lower chest wall indrawing, O₂ saturation <90%.