Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review

Abstract

BackgroundSeveral Latin American and Caribbean (LAC) countries have introduced pneumococcal conjugate vaccine (PCV-10 or PCV-13) in their routine national immunization programs.ObjectivesWe aimed to summarize the evidence of PCV impact and effectiveness in children under 5 years old in the LAC Region.MethodsWe conducted a systematic review of the literature on impact or effectiveness of PCVs on deaths or hospitalizations due to invasive pneumococcal disease (IPD), pneumonia, meningitis and sepsis. We searched Medline, WoS, Lilacs, Scopus, Central and gray literature published in any language from 2009 to January 2016. We included studies addressing the outcomes of interest in children in the target age group, and with the following designs: randomized trials, cohort or case-control, interrupted time series with at least three data points before and after the intervention, and before-after studies. Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Descriptive analysis of the effectiveness measurements and sensitivity analysis were conducted. Effectiveness is reported as 1-OR or 1-RR for case control or cohort/clinical trials, and as percent change of disease incidence rates for before-after studies.ResultsWe identified 1,085 citations, 892 from databases and 193 from other sources. Of these, 22 were further analyzed. Studies were from Brazil, Chile, Uruguay, Argentina, Peru and Nicaragua. Effectiveness ranged from 8.8–37.8% for hospitalizations due to X-ray confirmed pneumonia, 7.4–20.6% for clinical pneumonia, and 13.3–87.7% for meningitis hospitalizations, and 56–83.3% for IPD hospitalization, varying by age, outcome definition, type of vaccine and study design.ConclusionsAvailable evidence to date indicates significant impact of both PCV-10 and PCV-13 in the outcomes studied, with no evidence of the superiority of one vaccine over the other on pneumonia, IPD or meningitis hospitalization reduction in children under 5 years old.

Sustained reductions of invasive infectious disease following general infant Haemophilus influenzae type b and pneumococcal vaccination in a Swedish Arctic region

“…This is higher than previously documented in the Arctic, where reductions by 35.1–52.5% were noted following general pneumococcal vaccination with the seven‐valent vaccine , and an additional reduction by 58.3% occurred when the seven‐valent vaccine later was replaced by the 13‐valent vaccine . Reductions of IPD noted in our study were similar or even higher than those reported in temperate settings, with reductions by 37–80% occurring in countries using seven‐valent vaccines and by 56–83% in countries using 10‐ or 13‐valent vaccines without previous use of seven‐valent vaccines . Such a high reduction as noted in our study in an Arctic region is promising.…”

Impact of 10-valent pneumococcal conjugate vaccine on invasive pneumococcal disease and nasopharyngeal carriage in Kenya

“…[18][19][20][21] In Latin American countries using PCV10 or PCV13, effectiveness against VT-IPD has been estimated at 56% to 84%. 22 Contributing to the observed reduction in IPD in Kilifi were an 85% reduction in bacteraemic pneumococcal pneumonia incidence and a 69% reduction in pneumococcal meningitis incidence in children <5 years. PCV impact on these important clinical outcomes has been documented elsewhere.…”

Public health impact of pneumococcal conjugate vaccine infant immunization programs: assessment of invasive pneumococcal disease burden and serotype distribution

“…We cannot exclude that a differential effect of these two vaccines exists but that this may have been overruled by other, more impactful, differences between countries or may become apparent upon analysis of a higher number of datasets. A recent review on the impact and effectiveness of PHiD-CV and PCV13 in children younger than 5 years of age in Latin American countries showed no evidence of one higher valent PCV being superior over the other in terms of impact on hospitalizations for pneumonia, IPD, or meningitis [81]. A population-based cohort study in Sweden directly compared the impact of PCV13 and PHiD-CV on IPD and found no difference between the vaccines in their effect on overall IPD [82].…”