Changes in the incidence of pneumonia, bacterial meningitis, and infant mortality 5 years following introduction of the 13-valent pneumococcal conjugate vaccine in a "3+0" schedule

Becker‐Dreps, Sylvia; Blette, Bryan; Briceño, Rafaela; Alemán, Jorge; Hudgens, Michael G.; Moreno, Gilberto; Ordoñez, Ana Manuela; Rocha, Julio; Weber, David J.; Amaya, Erick

doi:10.1371/journal.pone.0183348

Cited by 15 publications

(15 citation statements)

References 23 publications

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“…Our index elaborated on the individual vaccine coverage trends by demonstrating an overall commitment across emerging economies towards increasing vaccine access. Our findings indicating a broader public health value of vaccine commitment are supported by previous studies reporting decreased infant mortality after PCV13, influenza, meningococcal, and rotavirus vaccines; [21][22][23][24] however, the relationship between individual vaccination policies and life expectancy has been investigated to a lesser extent. In addition, the broader value of vaccine commitment was also demonstrated in a recent study suggesting an increase in GDP per dollar invested in vaccines, likely due in part to the impact of vaccines on disease prevention and infant survival, enabling a more productive work force.…”

Section: Discussionsupporting

confidence: 86%

Trends in vaccine investment in middle income countries

Onishchenko

Hill

Wasserman

et al. 2019

Human Vaccines & Immunotherapeutics

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Although a proven and effective preventive health measure, childhood immunization programs remain vulnerable to budgetary pressures. Sustainable financing of immunization programs is an important issue that presents a challenge for middle-income countries (MIC) in particular, in part due to technological advances meaning more vaccines are available. This study aimed to analyse trends in immunization program investment across 15 MIC selected based on availability of data, income level classification, and regional representativeness. We assessed investment trends in relation to vaccine coverage, vaccine access, and broader health indicators. Immunization and expenditure data were obtained from the World Health Organisation (WHO) database and the WHO UNICEF Joint Reporting Form and WHO Vaccine Product, Price and Procurement from 2006–2016. We calculated a weighted average index of vaccine commitment (WAIVC) based on vaccine coverage, vaccine scope, and weighted by vaccine innovation measured by approximating vaccine expenditure. Correlation analyses were conducted between immunization expenditure per-capita and each WAIVC, infant mortality and life expectancy. Correlation analyses at a global and individual country level indicate an improvement in immunization access, vaccination commitment measured by WAIVC, and scope of available vaccines in countries with sustained increases in vaccination funding. Increases in national immunization expenditure were correlated with reduced infant mortality and increased life expectancy. Vaccine expenditure comprises a small proportion (less than 2%) of total healthcare spending and has not uniformly increased in accordance with the scope of available vaccines. The present analysis supports the premise that countries with consistent increases in vaccine expenditure have increased vaccine coverage and commitment measured by WAIVC and improved broader health outcomes, indicating the value of sustained investment in vaccination for improved population health. The benefits of vaccine expenditure in this holistic fashion are critical to inform policy decisions on national budget allocation for vaccine funding.

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Section: Discussionsupporting

confidence: 86%

Trends in vaccine investment in middle income countries

Onishchenko

Hill

Wasserman

et al. 2019

Human Vaccines & Immunotherapeutics

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“…The pneumococcal conjugate vaccine (PCV) has potential to greatly reduce childhood mortality. Most assessments of PCV impact on all-cause pneumonia mortality were performed in Latin American and Caribbean countries, with results ranging from no reduction in children <5 years in Brazil, to a 44% reduction in children <1 year in Peru for all-cause pneumonia mortality [ 3 – 6 ]. Data are lacking from Africa, including South Africa.…”

Section: Introductionmentioning

confidence: 99%

Estimated impact of the pneumococcal conjugate vaccine on pneumonia mortality in South Africa, 1999 through 2016: An ecological modelling study

et al. 2021

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Background Data on the national-level impact of pneumococcal conjugate vaccine (PCV) introduction on mortality are lacking from Africa. PCV was introduced in South Africa in 2009. We estimated the impact of PCV introduction on all-cause pneumonia mortality in South Africa, while controlling for changes in mortality due to other interventions. Methods and findings We used national death registration data in South Africa from 1999 to 2016 to assess the impact of PCV introduction on all-cause pneumonia mortality in all ages, with the exclusion of infants aged <1 month. We created a composite (synthetic) control using Bayesian variable selection of nondiarrheal, nonpneumonia, and nonpneumococcal deaths to estimate the number of expected all-cause pneumonia deaths in the absence of PCV introduction post 2009. We compared all-cause pneumonia deaths from the death registry to the expected deaths in 2012 to 2016. We also estimated the number of prevented deaths during 2009 to 2016. Of the 9,324,638 deaths reported in South Africa from 1999 to 2016, 12·6% were pneumonia-related. Compared to number of deaths expected, we estimated a 33% (95% credible interval (CrI) 26% to 43%), 23% (95%CrI 17% to 29%), 25% (95%CrI 19% to 32%), and 23% (95%CrI 11% to 32%) reduction in pneumonia mortality in children aged 1 to 11 months, 1 to 4 years, 5 to 7 years, and 8 to 18 years in 2012 to 2016, respectively. In total, an estimated 18,422 (95%CrI 12,388 to 26,978) pneumonia-related deaths were prevented from 2009 to 2016 in children aged <19 years. No declines were estimated observed among adults following PCV introduction. This study was mainly limited by coding errors in original data that could have led to a lower impact estimate, and unmeasured factors could also have confounded estimates. Conclusions This study found that the introduction of PCV was associated with substantial reduction in all-cause pneumonia deaths in children aged 1 month to <19 years. The model predicted an effect of PCV in age groups who were eligible for vaccination (1 months to 4 years), and an indirect effect in those too old (8 to 18 years) to be vaccinated. These findings support sustaining pneumococcal vaccination to reduce pneumonia-related mortality in children.

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“…Studies in Nicaragua reported declines of 33% (20-43%) (27) in all-cause mortality in infants 1-11 months two years after vaccine introduction. A similar study conducted in Nicaragua four years after PCV introduction found an even higher all-cause mortality decline among 1-11 month olds, of 44% (23-59%) (28). However, LRI mortality was estimated to represent less than a third of total deaths in that age group (11).…”

Section: Discussionmentioning

confidence: 94%