Introduction Pneumococcal conjugate vaccines (PCVs) prevent disease through both direct protection of vaccinated individuals and indirect protection of unvaccinated individuals by reducing nasopharyngeal (NP) carriage and transmission of vaccine-type (VT) pneumococci. While the indirect effects of PCV vaccination are well described, the PCV coverage required to achieve the indirect effects is unknown. We will investigate the relationship between PCV coverage and VT carriage among undervaccinated children using hospital-based NP pneumococcal carriage surveillance at three sites in Asia and the Pacific.
Methods and analysis We are recruiting cases, defined as children aged 2–59 months admitted to participating hospitals with acute respiratory infection in Lao People’s Democratic Republic, Mongolia and Papua New Guinea. Thirteen-valent PCV status is obtained from written records. NP swabs are collected according to standard methods, screened using lytA qPCR and serotyped by microarray. Village-level vaccination coverage, for the resident communities of the recruited cases, is determined using administrative data or community survey. Our analysis will investigate the relationship between VT carriage among undervaccinated cases (indirect effects) and vaccine coverage using generalised estimating equations.
Ethics and dissemination Ethical approval has been obtained from the relevant ethics committees at participating sites. The results are intended for publication in open-access peer-reviewed journals and will demonstrate methods suitable for low- and middle-income countries to monitor vaccine impact and inform vaccine policy makers about the PCV coverage required to achieve indirect protection.
- public health
- respiratory infections
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Contributors FMR conceived the idea and designed the study. JYRL, SD, KF, PNN, RL, RP, AX, DABD and FMR supported the development of country-specific protocols and study implementation in Lao PDR. CCB, RF, DL, WP and FMR supported the development of country-specific protocols and study implementation in PNG. TM, SLV, CvM, KM, JC and FR supported the development of country-specific protocols and study implementation in Mongolia. CS, EMD and JH devised the microbiological approach and laboratory protocols. JC, CDN, RA and FR devised the analysis plan. JC and FR drafted the manuscript. All authors provided feedback to the draft manuscript and have read and approved the final version.
Funding This work is supported by the Bill & Melinda Gates Foundation grant number (OPP1115490). JC is completing a PhD at The University of Melbourne, funded by an Australian Government Research Training Program scholarship.
Competing interests None declared.
Patient consent Guardian consent obtained.
Ethics approval The study is being conducted according to protocols approved by the following ethics committees: Lao PDR Ministry of Health National Ethics Committee for Health Research (057/2013 NECHR), Oxford Tropical Research Ethics Committee (1050-13), Mongolian National Ethics Committee for Health Research, the WHO Regional Office for the Western Pacific (WPRO) Ethics Review Committee (2013.30.LAO.2.EPI, Mongolia), PNG IMR Institutional Review Board (1510), Government of PNG Medical Research Advisory Committee (15.18) and the Royal Children’s Hospital/MCRI Human Research Ethics Committee (33177B and 33203E).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement We have an agreement with Bill & Melinda Gates Foundation to share datasets that are requested by non-profit institutions and/or scientific researchers for a particular purpose, such as a meta-analysis or systematic review. We would make them available after ensuring appropriate ethical considerations. Proposals should be directed to Associate Professor Fiona Russell (email@example.com).
Collaborators The PneuCAPTIVE protocol development group includes the authors of the paper listed in the byline and the following: Dashtseren Luvsantseren (NCCD, Ulaanbaatar, Mongolia), Bujinlkham Suuri (NCCD, Ulaanbaatar, Mongolia), Mukhchuluun Ulziibayar (NCCD, Ulaanbaatar, Mongolia), Dashpagam Otgonbayer (NCCD, Ulaanbaatar, Mongolia), Audrey Dubot-Pérès (LOMHWRU, Vientiane, Lao PDR), Keodomphone Vilavong (LOMHWRU, Vientiane, Lao PDR), Anisone Chanthongthip (LOMHWRU, Vientiane, Lao PDR), Syladeth Chanthaphone (LOMHWRU, Vientiane, Lao PDR), Joycelyn Sapura (PNG IMR, Goroka, PNG), John Kave (PNG IMR, Goroka, PNG), Tonny Kumani (PNG IMR, Goroka, PNG) and Wendy Kirarock (PNG IMR, Goroka, PNG).
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