The burden of pneumococcal disease among Latin American and Caribbean children: Review of the evidence

Universidad de los Andes, Salud Pública y Epidemiología, San Carlos de Apoquindo, Santiago, Chile.
Revista Panamericana de Salud Pública (Impact Factor: 0.85). 04/2009; 25(3):270-9. DOI: 10.1590/S1020-49892009000300011
Source: PubMed


To conduct a comprehensive review of data on pneumococcal disease incidence in Latin America and the Caribbean and project the annual number of pneumococcal disease episodes and deaths among children < 5 years of age in the region.
We carried out a systematic review (1990 to 2006) on the burden of pneumococcal disease in children < 5 years of age in the region. We summarized annual incidence rates and case fatality ratios using medians and interquartile ranges for invasive pneumococcal disease (IPD) (including all-IPD and separately abstracting pneumococcal meningitis, pneumonia, bacteremia, and sepsis data), pneumonia (all cause and radiologically confirmed), and acute otitis media by age group: < 1 year, < 2 years, and < 5 years. We modeled age-specific cumulative incidence of disease obtained from standard Kaplan-Meier analysis and projected data to obtain regional estimates of disease burden. We adjusted burden estimates by serotype coverage, vaccination coverage, and vaccine efficacy to estimate the number of cases and deaths averted.
Of 5 998 citations identified, 26 papers from 10 countries were included. The estimated annual burden of pneumonia, meningitis, and acute otitis media caused by pneumococcus in children < 5 years of age ranged from 980 000 to 1 500 000, 2 600 to 6 800, and 980 000 to 1 500 000, respectively. An estimated 12 000 to 28 000 deaths due to pneumococcal disease occur in the region annually. Pneumococcal conjugate vaccine could save 1 life per 1 100 and prevent 1 case per 13 children vaccinated.
A substantial burden of pneumococcal disease in the region is potentially preventable with pneumococcal conjugate vaccines and should be considered in regional vaccine decision making. Results are limited by the very few studies, conducted in selected settings, included in this review.

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    • "In Latin America and the Caribbean, Spn is estimated to account for 18,000 pneumococcal deaths, 327,000 cases of pneumonia, 4,000 meningitis and 1,229 sepsis each year in children aged under five years [2]. In addition, around 10.5 million episodes of AOM occur in children under 5 years of age per annual birth cohort [2,4], 30% of which are caused by Spn [5] and 18% per H. influenza[5]. The overall burden of pneumococcal disease in the pediatric population in the region is estimated at 600,000 Disability Adjusted Life Years [2]. "
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    ABSTRACT: A recently developed 10-valent pneumococcal non-typeable H influenzae protein D-conjugate vaccine (PHiD-CV) is expected to afford protection against more than two thirds of isolates causing IPD in children in Latin America, and also against acute otitis media caused by both Spn and NTHi. The objective of this study is to assess the cost-effectiveness of PHiD-CV in comparison to non-vaccination in children under 10 years of age in Argentina, Brazil, Chile, Colombia, Mexico and Peru. We used a static, deterministic, compartmental simulation model. The dosing regimen considered included three vaccine doses (at 2 months, 4 months and 6 months) and a booster dose (at 13 months) (3 + 1 schedule). Model outcomes included number of cases prevented, deaths averted, quality-adjusted life-years (QALYs) gained and costs. Discount for costs and benefits of long term sequelae was done at 3.5%, and currency reported in 2008-2009 U$S varying between countries. The largest effect in case prevention was observed in pneumococcal meningitis (from 27% in Peru to 47% in Colombia), neurologic sequelae after meningitis (from 38% in Peru to 65% in Brazil) and bacteremia (from 42% in Argentina to 49% in Colombia). The proportion of predicted deaths averted annually ranged from 18% in Peru to 33% in Brazil. Overall, the health benefits achieved with PHiD-CV vaccination resulted in a lower QALY loss (from 15% lower in Peru to 26% in Brazil). At a cost of USD 20 per vaccine dose, vaccination was cost-effective in all countries, from being cost saving in Chile to a maximum Incremental Cost-effectiveness Ratio of 7,088 US$ Dollars per QALY gained. Results were robust in the sensitivity analysis, and scenarios with indirect costs affected results more than those with herd immunity. The incorporation of the 10-valent pneumococcal conjugate vaccine into routine infant immunization programs in Latin American countries could be a cost-effective strategy to improve infant population health in the region.
    Cost Effectiveness and Resource Allocation 08/2013; 11(1):21. DOI:10.1186/1478-7547-11-21 · 0.87 Impact Factor
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    • "annual incidence estimates as follows: 1174 episodes of all-cause radiologically confirmed pneumonia per 100,000, 11 episodes of pneumococcal meningitis per 100,000, and 32 episodes of other severe invasive pneumococcal disease per 100,000 [9]. "
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    ABSTRACT: New vaccines have been demonstrated to be effective in reducing morbidity and mortality, particularly in children, but come at increased costs to societies, governments, and their national immunization programs compared with other traditional childhood vaccines. Rational allocation of available resources requires systematic collection of the evidence base to decide whether to introduce a new vaccine, an important component of which is cost-effectiveness analysis. In this article, we develop in-depth case studies to examine the country experience of conducting cost-effectiveness analysis with the support of Pan American Health Organization ProVac Initiative and the implications of its process for decision making on new vaccine introduction in Latin America and the Caribbean. Key lessons regarding how cost-effectiveness analysis may be effectively used to inform evidence-based immunization policy are highlighted, drawing from the experience of Nicaragua and Paraguay. Based on the lessons identified, the vision going forward will focus on promoting the sustainability of multidisciplinary country teams while continuing to prioritize capacity development as an overarching guiding principle for preparing countries to face future new vaccine policy decisions.
    12/2012; 1(2):248–253. DOI:10.1016/j.vhri.2012.10.003
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    • "Characteristics of the 63 studies included in the analysis, SIREVA and non SIREVA [[2],[27]-[60],[62],[71]-[135]]. "
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    ABSTRACT: Pneumococcal conjugate vaccines (PCVs) are in the process of implementation in Latin America. Experience in developed countries has shown that they reduce the incidence of invasive and non-invasive disease. However, there is evidence that the introduction of PCVs in universal mass vaccination programs, combined with inappropriate and extensive use of antibiotics, could be associated to changes in non-PCV serotypes, including serotype 19A. We conducted a systematic review to determine the distribution of serotype 19A, burden of pneumococcal disease and antibiotic resistance in the region. We performed a systematic review of serotype 19A data from observational and randomized clinical studies in the region, conducted between 1990 and 2010, for children under 6 years. Pooled prevalence estimates from surveillance activities with confidence intervals were calculated. We included 100 studies in 22 countries and extracted data from 63. These data reported 19733 serotyped invasive pneumococcal isolates, 3.8% of which were serotype 19A. Serotype 19A isolates were responsible for 2.4% acute otitis media episodes, and accounted for 4.1% and 4.4% of 4,380 nasopharyngeal isolates from healthy children and in hospital-based/sick children, respectively. This serotype was stable over the twenty years of surveillance in the region. A total of 53.7% Spn19A isolates from meningitis cases and only 14% from non meningitis were resistant to penicillin. Before widespread PCV implementation in this region, serotype 19A was responsible for a relatively small number of pneumococcal disease cases. With increased use of PCVs and a greater number of serotypes included, monitoring S. pneumoniae serotype distribution will be essential for understanding the epidemiology of pneumococcal disease.
    BMC Infectious Diseases 05/2012; 12:124. DOI:10.1186/1471-2334-12-124 · 2.61 Impact Factor
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