Disparities in Effectiveness of Pneumococcal Vaccine in Industrialized and Developing Countries: Is Vaccination Closing the Gap?

Backgrounds Streptococcus pneumoniae cause serious disease including pneumonia, meningitis and bacteremia and mortality is seen most in developing countries. The aim of the study was to determine if the reduction in IPD and pneumonia rates were similar in developed and developing countries after the introduction of the pneumococcal conjugated vaccine and to determine changes in the disparities of these diseases rates in these countries. Methods. Literature searches were conducted by using the PubMed database and Google scholar. The main criterion for selection was that the studies compare incidence of IPD or pneumonia in children pre and post PCV7, PCV10, or PCV13 vaccine introduction. Only published articles that described the incidence rate of IPD or pneumonia with quantitative data were fully reviewed in detail. Results. A total of 22 articles were full-text original publications and one was a review article. Within 3 years of PCV introduction in the United States, all-cause IPD dropped from 98.7/100,000 to 20/100,000 children <5 years of age and similar such reductions were also documented in Europe, Canada, Australia and Israel. In South Africa, rate of IPD incidence among children younger than 2 years of age declined from 54.8 to 21.7 cases per 100,000 from the baseline to 2011 and the further decreased to 17.0 cases per 100,000 person in 2012 (total reduction of 69%. The incidence rates of pneumonia in children <5 years were estimated to be 0.29 episodes per child-year in developing and 0.05 episodes per child-year in developed countries. After PCV7 introduction the rates of pneumonia hospitalizations in <5 years old decreased in the US from 1,274/100,000 to 723/100,000 in UK, from 1,340/100,000 children to 1,079/per 100,000 children. In Nicaragua reduction of rate ration of 0.67 (95% CI: 0.59-0.75) among infants and 0.74 (95% CI: 0.67-0.81) among 1 year olds and Uruguay from 1,542/100,000 to 1,227/100,000 and in South Africa, from ~96/1,000 in 2008-2009 to 69.3/1,000 (27.8%). Conclusions. PCVs are effective in both industrialized and developing countries in reducing IPD and pneumonia. Although developing countries are behind in PCV introduction, there is hope that if PCV is introduced in national immunization programs, IPD can perhaps be reduced to that of levels in industrialized countries, also resulting in reduced levels of pneumonia incidences. More surveillance studies are needed in all countries, but especially in developing countries that have introduced PCV to more accurately determine IPD and pneumonia reduction as a result of vaccination.

пневмококковые вакцины, дети, пневмония, инвазивная пневмококковая инфекция, заболеваемость

1. Organization W.H. Estimated Hib and pneumococcal deaths for children under 5 years of age. 2008.

2. Organization W.H. Pneumococcal Vaccines: WHO position paper. Weekly Epidemiol Record 2003; 14: 110-119.

3. Goetghebuer T. et al. Outcome of meningitis caused by Streptococcus pneumoniae and Haemophilus influenzae type b in children in The Gambia. Trop Med Intern Health 2000; 5: 3: 207-213.

4. Jain, S. et al. Community-acquired pneumonia requiring hospitalization among US children. New England J Med 2015; 372: 9: 835-845.

5. Centers for Disease, C. and Prevention. Direct and indirect effects of routine vaccination of children with 7-valent pneumococcal conjugate vaccine on incidence of invasive pneumococcal disease in United States, 1998-2003. MMWR. Morbid Mortal Weekly Report. 2005; 54 36: 893.

6. American Academy of Pediatrics, Committee on Infections, D., Recommendations for the prevention of Streptococcus pneumoniae infections in infants and children: use of 13-valent pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23). Pediatrics 2010; 126: 1: 186.

7. Van Beneden C.A. et al. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbid Mortal Weekly Report: Recommendations and Reports 2000; 1-35.

8. Centers for Disease, C., Prevention, and P. Advisory Committee on Immunization, Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP) for use of 7-valent pneumococcal conjugate vaccine (PCV7) in children aged 24-59 months who are not completely vaccinated. MMWR. Morbid Mortal Weekly Report, 2008; 57: 13: 343.

9. De Carvalho G.H. et al. Use of seven-valent pneumococcal conjugate vaccine (PCV7) in Europe, 2001-2007. Euro surveillance: bulletin Europeen sur les maladies transmissibles= European communicable disease bulletin, 2009; 14: 12: 334-338.

10. Torres A. et al. Pneumococcal vaccination: what have we learnt so far and what can we expect in the future? Eur J Clin Microbiol Infecti Dis 2015; 34: 1: 19-31.

11. Publication W.H.O. Pneumococcal vaccines WHO position paper-2012-recommendations. Vaccine 2012; 30: 32: 4717-4718.

12. Centers for Disease C. and Prevention, Progress in introduction of pneumococcal conjugate vaccine-worldwide, 2000-2012. MMWR. Morbid Mortal Weekly Report, 2013; 62: 16: 308.

13. Division U.S. Pneumococcal Conjugate Vaccine: Current Supply & Demand Outlook. 2013.

14. O'Brien K.L. et al. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. The Lancet 2009; 374: 9693: 893-902.

15. Isaacman D.J., McIntosh E.D., Reinert R.R. Burden of invasive pneumococcal disease and serotype distribution among Streptococcus pneumoniae isolates in young children in Europe: impact of the 7-valent pneumococcal conjugate vaccine and considerations for future conjugate vaccines. Internat J Infect Dis 2010. 14(3): p. e197-e209.

16. Black S. et al. Pneumococcal conjugate vaccine and pneumococcal common protein vaccines. Vaccines. 5th ed. Philadelphia, PA: WB Saunders Company, 2008; 531-568.

17. Roca A. et al. Invasive pneumococcal disease in children< 5 years of age in rural Mozambique. Trop Med Internat Health 2006; 11: 9: 1422-1431.

18. Karstaedt A.S., Khoosal M., Crewe-Brown H.H. Pneumococcal bacteremia during a decade in children in Soweto, South Africa. Pediatr Infect Dis J 2000; 19: 5: 454-457.

19. Cutts F.T. et al. Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in the Gambia: randomised, double-blind, placebo-controlled trial. Lancet 2005; 365: 9465: 1139-1146.

20. Rudan I. et al. Epidemiology and etiology of childhood pneumonia. Bulletin of the World Health Organization 2008; 86: 5: 408-416B.

21. Wong W.Y., Overturf G.D., Powars D.R. Infection caused by Streptococcus pneumoniae in children with sickle cell disease: epidemiology, immunologic mechanisms, prophylaxis, and vaccination. Clin Infect Dis 1992; 14: 5: 1124-1136.

22. Reed C. et al. Development of the respiratory index of severity in children (RISC) score among young children with respiratory infections in South Africa. PloS one 2012; 7: 1: e27793.

23. Pilishvili T. et al. Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis 2010; 201: 1: 32-41.

24. Myint T.T. et al. The impact of 7-valent pneumococcal conjugate vaccine on invasive pneumococcal disease: a literature review. Adv Ther 2013; 30: 2: 127-151.

25. Ben-Shimol S. et al. Early impact of sequential introduction of 7-valent and 13-valent pneumococcal conjugate vaccine on IPD in Israeli children №5 years: an active prospective nationwide surveillance. Vaccine 2014; 32: 27: 3452-3459.

26. Guevara M. et al. Reduced incidence of invasive pneumococcal disease after introduction of the 13-valent conjugate vaccine in Navarre, Spain, 2001-2013. Vaccine 2014; 32: 22: 2553-2562.

27. Steens A. et al. Prompt effect of replacing the 7-valent pneumococcal conjugate vaccine with the 13-valent vaccine on the epidemiology of invasive pneumococcal disease in Norway. Vaccine 2013; 31: 52: 6232-6238.

28. Waight P.A. et al. Effect of the 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in England and Wales 4 years after its introduction: an observational cohort study. Lancet Infect Dis 2015; 15: 5: 535-543.

29. Demczuk W.H. et al. Serotype distribution of invasive Streptococcus pneumoniae in Canada after the introduction of the 13-valent pneumococcal conjugate vaccine, 2010-2012. Can J Microbiol 2013; 59: 12: 778-788.

30. Wang M.-C. et al. Impact of pneumococcal conjugate vaccine on pediatric tympanostomy tube insertion in partial immunized population. The Scientific World Journal, 2015. 2015.

31. Lai C.-C. et al. Decline in the incidence of invasive pneumococcal disease at a medical center in Taiwan, 2000-2012. BMC Infect Dis 2014; 14: 1: 76.

32. Ishiwada N. et al. The incidence of pediatric invasive Haemophilus influenzae and pneumococcal disease in Chiba prefecture, Japan before and after the introduction of conjugate vaccines. Vaccine 2014; 32: 42: 5425-5431.

33. von Gottberg A. et al. Effects of vaccination on invasive pneumococcal disease in South Africa. New Engl J Med 2014; 371: 20: 1889-1899.

34. Chacon-Cruz E., Rivas-Landeros R.M., Volker-Soberanes M.L. Early trends in invasive pneumococcal disease in children following the introduction of 13-valent pneumococcal conjugate vaccine: results from eight years of active surveillance in a Mexican hospital. Therapeut Advanc Vaccin 2014. 2051013614547199.

35. Griffin M.R. et al. US hospitalizations for pneumonia after a decade of pneumococcal vaccination. New Engl J Med 2013; 369: 2: 155-163.

36. Elemraid M.A. et al. Impact of the 7-valent pneumococcal conjugate vaccine on the incidence of childhood pneumonia. Epidemiol Infect 2013; 141: 08: 1697-1704.

37. Koshy E. et al. Impact of the seven-valent pneumococcal conjugate vaccination (PCV7) programme on childhood hospital admissions for bacterial pneumonia and empyema in England: national time-trends study, 19972008. Thorax 2010; 65: 9: 770-774.

38. Greenberg D. et al. Impact of PCV7/PCV13 introduction on community-acquired alveolar pneumonia in children №5 years. Vaccine 2015.

39. Patrzalek M., Albrecht P., Sobczynski M. Significant decline in pneumonia admission rate after the introduction of routine 2+1 dose schedule heptavalent pneumococcal conjugate vaccine (PCV7) in children under 5 years of age in Kielce, Poland. Eur J Clin Microbiol Infect Dis, 2010; 29: 7: 787-792.

40. Angoulvant F. et al. Early impact of 13-valent pneumococcal conjugate vaccine on community-acquired pneumonia in children. Clin Infect Dis 2014; 58: 7: 918-924.

41. Afonso E.T. et al. Effect of10-valent pneumococcal vaccine on pneumonia among children, Brazil. Emer Infect Dis 2013; 19: 4: 589.

42. Abrao W.M.O. et al. Impact of the antipneumococcal conjugate vaccine on the occurrence of infectious respiratory diseases and hospitalization rates in children. Revista da Sociedade Brasileira de Medicina Tropical 2015; 48: 1: 44-49.

43. Becker-Dreps S. et al. Changes in childhood pneumonia and infant mortality rates following introduction of the 13-valent pneumococcal conjugate vaccine in Nicaragua. Ped Infect Dis J 2014; 33: 6: 637-642.

44. Hortal M. et al. Impact of pneumococcal conjugate vaccines on the incidence of pneumonia in hospitalized children after five years of its introduction in Uruguay. 2014.

45. Perez M.C. et al. Changes in hospitalizations for pneumonia after universal vaccination with pneumococcal conjugate vaccines 7/13 valent and Haemophilus influenzae type b conjugate vaccine in a pediatric referral hospital in Uruguay. Ped Infect Dis J, 2014; 33: 7: 753-759.

46. Madhi S.A., Bamford L., Ngcobo N. Effectiveness of pneumococcal conjugate vaccine and rotavirus vaccine introduction into the South African public immunisation programme. SAMJ: South Afric Med J 2014. 104(3): p. 228-234.