Pneumococcal conjugate vaccine introduction in Latin America and the Caribbean: progress and lessons learned

Abstract

In Latin America and the Caribbean, pneumococcus has been estimated to cause 12,000-28,000 deaths, 182,000 hospitalizations, and 1.4 million clinic visits annually. Countries in the Americas have been among the first developing nations to introduce pneumococcal conjugate vaccines into their Expanded Programs on Immunization, with 34 countries and territories having introduced these vaccines as of September 2015. Lessons learned for successful vaccine introduction include the importance of coordination between political and technical decision makers, adjustments to the cold chain prior to vaccine introduction, and the need for detailed plans addressing the financial and technical sustainability of introduction. Though many questions on the Pneumococcal Conjugate Vaccine remain unanswered, the experience of the Americas suggests that the vaccines can be introduced quickly and effectively.

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

“…The studies selected in our review were carried out in countries using the vaccination schedule 2+1, except Brazil which used 3+1 and Nicaragua, 3+0[8]. Brazil has since switched to a 2+1 schedule, which is also currently used in all countries in the Region where PCV has been implemented, except for 4 countries which are supported by GAVI.…”

“…As of May 2016, 29 LAC countries and territories were using PCV-10 or PCV-13 with schedules consisting of vaccine doses given at ages 2, 4, and 6 months without a booster dose (3+0), or primary PCV doses administered at ages 2 and 4 months with a booster at age 12–18 months (2+1). Some countries also provided a single catch-up dose to children aged 12–23 months in the year of the vaccine introduction [8]. …”

“…Notwithstanding, since the introduction of PCV-10 and PCV-13 in LAC, preliminary evidence suggested that these vaccines were promising in reducing illness and deaths dues to S . pneumonia [8]. …”

Community-Acquired Pneumonia in Latin America

“…65 As of September 2015, 34 countries and territories have introduced these vaccines into their national immunization programs. 66 Evidence from high-income countries shows that vaccinating infants with pneumococcal conjugate vaccine (PCV) can prevent pneumococcal disease in adults through herd protection since vaccinated children are less likely to be colonized with and transmit S. pneumoniae. 67 However, it is unknown whether similar indirect protection will occur in low-and middle-income countries, given the greater force of transmission, poor underlying health status, and low vaccine coverage.…”

Efetividade da vacina pneumocócica 10-valente em crianças no Chile: estudo caso-controle aninhado usando dados nacionais de vigilância de Morbimortalidade

“…Apesar disso, há de se pensar que mesmo com a identificação de algum vírus respiratório, ainda assim pode haver co-infecção com o pneumococo, ou seja, pode haver casos de pneumonia pneumocócica mesmo entre as pneumonias codificadas com o CID-10 J12 77. No Chile, 70% das pneumonias pneumocócicas que ocorreram no período pré-Essa redução de cerca de um terço das morte infantis por todas as causas é um resultado tão importante que tem sido usado para promover a incorporação da vacina em outros países da América Latina e Caribe 110. Assim como no estudo nicaraguense, é concebível que a vacinação PCV seja responsável por essa larga redução na mortalidade de crianças chilenas quando se considera a importante carga de mortalidade da doença pneumocócica, representada não só pelos óbitos classificados como pneumonia, mas também por parte das meningites e sepses.…”