Invasive pneumococcal diseases among hospitalized children in Lima, Peru

Ochoa, Theresa J.; Egoavil, Martha; Castillo, María E.; Reyes, Isabel; Chaparro, Eduardo; Silva, Wilda; Campos, Francisco; Saenz, A.

doi:10.1590/s1020-49892010000800008

Cited by 30 publications

(50 citation statements)

References 24 publications

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“…The estimated distributions were concordant to the findings of a report from several hospitals in Lima [41]. Table 3 shows the estimated impact of each of the vaccination alternatives by clinical syndrome, relative efficacy and serotype coverage for the base case.…”

Section: Vaccine Serotype Coveragesupporting

confidence: 79%

Cost-effectiveness analysis of 10- and 13-valent pneumococcal conjugate vaccines in Peru

Mezones‐Holguín

Canelo‐Aybar

Clark

et al. 2015

Vaccine

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a b s t r a c tObjective: To evaluate the cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine (PCV10) versus the 13-valent PCV (PCV13) to the National Immunization Schedule in Peru for prevention of pneumococcal disease (PD) in children <5 years of age. Methods: The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (version 2.0) was applied from the perspective of the Government of Peru. Twenty successive cohorts of children from birth to 5 years were evaluated. Clinical outcomes were pneumococcal pneumonia (PP), pneumococcal meningitis (PM), pneumococcal sepsis (PS) and acute otitis media from any causes (AOM). Measures included prevention of cases, neurological sequelae (NS), auditory sequelae (AS), deaths and disability adjusted life years (DALYs). A sensitivity analyses was also performed. Findings: For the 20 cohorts, net costs with PCV10 and PCV13 were US$ 363.26 million and US$ 408.26 million, respectively. PCV10 prevented 570,273 AOM; 79,937 PP; 2217 PM; 3049 PS; 282 NS; 173 AS; and 7512 deaths. PCV13 prevented 419,815 AOM; 112,331 PN; 3116 PM; 4285 PS; 404 NS; 248 AS;and 10,386 deaths. Avoided DALYs were 226,370 with PCV10 and 313,119 with PCV13. Saved treatment costs were US$ 37.39 million with PCV10 and US$ 47.22 million with PCV13. Costs per DALY averted were US$ 1605 for PCV10, and US$ 1304 for PCV13. Sensitivity analyses showed similar results. PCV13 has an extended dominance over PCV10. Conclusion: Both pneumococcal vaccines are cost effective in the Peruvian context. Although the net cost of vaccination with PCV10 is lower, PCV13 prevented more deaths, pneumococcal complications and sequelae. Costs per each prevented DALY were lower with PCV13. Thus, PCV13 would be the preferred policy; PCV10 would also be reasonable (and cost-saving relative to the status quo) if for some reason 13-valent were not feasible.

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Section: Vaccine Serotype Coveragesupporting

confidence: 79%

Cost-effectiveness analysis of 10- and 13-valent pneumococcal conjugate vaccines in Peru

Mezones‐Holguín

Canelo‐Aybar

Clark

et al. 2015

Vaccine

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“…This study is of utmost importance, especially to countries such as Peru with estimated IPD rates in children under 24 months of age in Lima of 18.4 cases/100,000 [4] and where pneumonia is the major problem related to child mortality [54]. Also, EEs are an important tool for making decisions in public health interventions because of their budgetary impact; furthermore, because vaccination programs are provided by the public sector, vaccination programs are among the most frequently studied public health interventions [29,55,56].…”

Section: Discussionmentioning

confidence: 99%

“…S. pneumoniae causes invasive pneumococcal diseases (IPDs) (e.g., meningitis and bacteremia) and non-invasive pneumococcal diseases (e.g., community-acquired pneumonia [CAP] and acute otitis media [AOM]) [1][2][3][4]. Prevention is complex because there are 94 serotypes.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children

Mezones‐Holguín

Bolaños-Díaz

Fiestas

et al. 2014

J Infect Dev Ctries

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Introduction: Pneumococcal pneumonia (PP) has a high burden of morbimortality in children. Use of pneumococcal conjugate vaccines (PCVs) is an effective preventive measure. After PCV 7-valent (PCV7) withdrawal, PCV 10-valent (PCV10) and PCV 13-valent (PCV13) are the alternatives in Peru. This study aimed to evaluate cost effectiveness of these vaccines in preventing PP in Peruvian children <5 yearsold. Methodology: A cost-effectiveness analysis was developed in three phases: a systematic evidence search for calculating effectiveness; a cost analysis for vaccine strategies and outcome management; and an economic model based on decision tree analysis, including deterministic and probabilistic sensitivity analysis using acceptability curves, tornado diagram, and Monte Carlo simulation. A hypothetic 100 vaccinated children/vaccine cohort was built. An incremental cost-effectiveness ratio (ICER) was calculated. Results: The isolation probability for all serotypes in each vaccine was estimated: 38% for PCV7, 41% PCV10, and 17% PCV13. Avoided hospitalization was found to be the best effectiveness model measure. Estimated costs for PCV7, PCV10, and PCV13 cohorts were USD13,761, 11,895, and 12,499, respectively. Costs per avoided hospitalization were USD718 for PCV7, USD333 for PCV10, andUSD 162 for PCV13. At ICER, PCV7 was dominated by the other PCVs. Eliminating PCV7, PCV13 was more cost effective than PCV10 (confirmed in sensitivity analysis). Conclusions: PCV10 and PCV13 are more cost effective than PCV7 in prevention of pneumonia in children <5 years-old in Peru. PCV13 prevents more hospitalizations and is more cost-effective than PCV10. These results should be considered when making decisions about the Peruvian National Inmunizations Schedule.

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“…Estudios previos en niños portadores sanos de Lima reportaron 5% de cepas resistentes a la penicilina en 1997 (20) ; 15% en el 2000 y 2001 (12,13) ; 36 y 37% en el 2003 y 2004, respectivamente (12,23) ; y 47% en el 2008 (24) . En estudios en pacientes con enfermedad neumococcica invasiva en el Perú se reportó 3% de resistencia a la penicilina en adultos en 1994 (25) ; 27% en niños en el 2000 (14) ; y 23% en el 2008 (5) . Este incremento también se ha evidenciado en otros países de Latinoamérica (Brasil, Argentina, Chile y Colombia) (21,26) en estudios realizados antes de la introducción de la vacuna conjugada contra el neumococo en los programas nacionales de inmunizaciones.…”

Section: Discussionunclassified

“…En el año 2000, a nivel mundial se estimó un aproximado de 14,5 millones de episodios por año de enfermedad neumocócica invasiva en niños (4) . En el Perú, S. pneumoniae es uno de los patógenos más importantes asociados con neumonía y meningoencefalitis en niños (5) . Sin embargo, puede también ocasionar enfermedades no invasivas como otitis media aguda y sinusitis (6) .…”

Section: Introductionunclassified

Resistencia antibiótica de Streptococcus pneumoniae en portadores nasofaríngeos sanos de siete regiones del Perú

Velásquez

Mercado

Egoavil

et al. 2014

Rev Peru Med Exp Salud Publica

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Objetivos. Determinar el patrón de susceptibilidad antibiótica de cepas de Streptococcus pneumoniae aisladas de portadores nasofaríngeos sanos menores de 2 años de siete regiones del Perú. Materiales y métodos. Entre el 2007 y 2009 se tomaron muestras de hisopado nasofaríngeo a 2123 niños sanos entre 2 y 24 meses de edad en los consultorios de crecimiento y desarrollo (CRED) y vacunación de hospitales y centros de salud de Lima, Piura, Cusco, Abancay, Arequipa, Huancayo, e Iquitos. Se determinó la resistencia a diez antibióticos mediante la prueba de disco-difusión de las cepas de neumococo aisladas. Resultados. Se aislaron 572 cepas. Se encontró altas tasas de resistencia a cotrimoxazol (58%); penicilina (52,2% no-sensibles); tetraciclina (29,1%); azitromicina (28,9%), y eritromicina (26,3%). La resistencia a cloranfenicol fue baja (8,8%). Se encontró 29,5% de multirresistencia. La resistencia a la azitromicina y a la penicilina fue diferente en las siete regiones (p<0,05), hallándose el mayor porcentaje de cepas no-sensibles a penicilina en Arequipa (63,6%), mientras que el menor fue en Cusco (23,4%). Conclusiones. Los elevados niveles de resistencia encontrados para penicilina, cotrimoxazol y macrólidos en cepas de neumococo aisladas de portadores sanos en todas las regiones estudiadas, y su asociación con uso previo de antibióticos, representan un importante problema de salud pública en nuestro país. Esto resalta la necesidad de implementar, a nivel nacional, estrategias para disminuir el uso irracional de antibióticos, sobre todo en la población pediátrica. Es necesario complementar los datos de resistencia a penicilina con la determinación de la concentración mínima inhibitoria para hacer las recomendaciones terapéuticas respectivas. Palabras clave: Streptococcus pneumoniae; Farmacorresistencia microbiana; Portador sano; Lactante (fuente DeCS BIREME). ANTIBIOTIC RESISTANCE OF Streptococcus pneumoniae AMONG HEALTHY NASOPHARYNGEAL CARRIERS IN SEVEN REGIONS OF PERU ABSTRACTObjectives. To determine the pattern of antibiotic susceptibility of isolated Streptococcus pneumoniae strains of healthy nasopharyngeal carriers younger than 2 years in seven regions of Peru. Materials and methods. Between 2007 and 2009, nasopharyngeal swab samples were collected among 2123 healthy children aged 2-24 months in growth and development medical practices (CRED) and vaccination offices of hospitals and health centers in Lima, Piura, Cusco, Abancay, Arequipa, Huancayo, and Iquitos. The resistance to ten antibiotics through disk diffusion sensitivity testing of isolated pneumococcus strains was determined. Results. 572 strains were isolated. High rates of resistance to co-trimoxazole (58%), penicillin (52.2% non-sensitive); tetracycline (29,1%); azithromycin (28,9%), and erythromycin (26,3%). Resistance to chloramphenicol was low (8.8%). Multiresistance was found at 29.5%. Resistance to azithromycin and penicillin was different in all seven regions (p<0,05), the highest percentage of non-sensitive strains being found in Arequipa ...

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Invasive pneumococcal diseases among hospitalized children in Lima, Peru

Abstract: IPD in hospitalized children in Lima is associated with high antimicrobial resistance levels and elevated case fatality rate, especially in young children. This baseline data will be useful for evaluating the effects of vaccine introduction.

Cited by 30 publications

References 24 publications

Cost-effectiveness analysis of 10- and 13-valent pneumococcal conjugate vaccines in Peru

Cost-effectiveness analysis of 10- and 13-valent pneumococcal conjugate vaccines in Peru

Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children

Resistencia antibiótica de Streptococcus pneumoniae en portadores nasofaríngeos sanos de siete regiones del Perú

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