Global Pneumococcal Disease and Vaccine
Streptococcus pneumoniae (pneumococcus) can cause serious infections such as pneumonia, meningitis, and bloodstream infection. Based on available data, the World Health Organization (WHO) estimates that S. pneumoniae kills close to half a million children under 5 years old worldwide every year, with most of these deaths occurring in developing countries.
Respiratory infections, especially pneumonia, are a leading cause of childhood mortality worldwide. S. pneumoniae is the leading cause of pneumonia mortality globally, and accounted for more deaths than all other causes (etiologies) combined in 2016.1 Most of these deaths occur in countries in Africa and Asia.
The U.S. Food and Drug Administration first licensed pneumococcal conjugate vaccine (PCV) for infant use in the United States in 2000. In 2007, WHO published a position paperCdc-pdfExternal recommending all countries include PCV as part of the routine infant immunization schedule. There are currently two formulations of PCV in the market: 10-valent PCV and 13-valent PCV. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization recommends both formulations.
Countries that introduced PCV have observed large reductions in severe (invasive) pneumococcal disease and pneumonia. As of March 2018, 142 countries out of 194 WHO member states have introduced PCV into their National Immunization Program either nationally or sub-nationally. High-income countries were the early adopters of PCV. With the support from Gavi, The Vaccine AllianceExternal, many low-income countries have been able to introduce PCV into their national immunization program. Despite this progress, 53% (approximately 71 million) of the global infant population are still not receiving PCV.2
1 GBD 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016External. Lancet Infect Dis. 2018 Sep 19. pii: S1473-3099(18)30310-4. doi: 10.1016/S1473-3099(18)30310-4.
2 Johns Hopkins Bloomberg School of Public Health International Vaccine Access Center (IVAC). View-hub report: Global vaccine introduction and Implementation, March 2018Cdc-pdfExternal.
In collaboration with WHO, Ministries of Health, and other international partners, CDC helps to strengthen surveillance and laboratory capacity to describe disease burden and monitor emergence of non-vaccine serotypes. Additional efforts include conducting PCV impact evaluations to inform and sustain the use of PCV globally.
- CDC Traveler’s Health: Pneumococcal Disease
- Integrated Global Action Plan for Prevention and Control of Pneumonia and DiarrheaExternal: Ending Preventable Child Deaths from Pneumonia and Diarrhea by 2025
- WHO Position Paper on Pneumococcal Conjugate Vaccines in Young ChildrenCdc-pdfExternal
- The Strategic Advisory Group of Experts (SAGE) on ImmunizationExternal, WHO
- View-Hub Report: Global Vaccine Introduction and Implementation, March 2018Cdc-pdfExternal.
- GAVI, the Vaccine AllianceExternal, is a partnership that combines public and private sector resources to bring the benefits of immunization to children in greatest need.
- Advance Market CommitmentExternal. In 2009, governments from five developed countries and the Bill & Melinda Gates Foundation launched an innovative pilot funding program to incentivize vaccine manufacturers to produce effective and affordable vaccines that would be available to all children worldwide. The pilot is expected to save more than 1.5 million lives by 2020.
- Pneumococcal Meningitis Outbreaks in sub-Saharan AfricaExternal. Pneumococcal meningitis outbreaks have been reported in countries in the African Meningitis Belt after pneumococcal conjugate vaccine introduction. WHO published a fact sheet in June 2016 on the diagnosis and treatment of pneumococcal meningitis.
- GBD 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016External. Lancet Infect Dis. 2018 Sep 19. pii: S1473-3099(18)30310-4. doi: 10.1016/S1473-3099(18)30310-4.
- Wahl B, O’Brien KL, Greenbaum A, Majumder A, Liu L, Chu Y, et al. Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: Global, regional, and national estimates for 2000-15External. Lancet Glob Health. 2018;6(7):e744–57.
- 2017 Pneumonia & Diarrhea Progress Report: Driving Progress Through Equitable Investment and ActionCdc-pdfExternal.
- Sigaúque B, Moiane B, Massora S, Pimenta F, Verani JR, Mucavele H, et al. Early declines in vaccine type pneumococcal carriage in children less than 5 years old after introduction of 10-valent pneumococcal conjugate vaccine in MozambiqueExternal. Pediatr Infect Dis J. 2018;37(10):1054–60.
- Bozio CH, Abdul-Karim A, Abenyeri J, Abubakari B, Ofosu W, Zoya J, et al. Continued occurrence of serotype 1 pneumococcal meningitis in two regions located in the meningitis belt in Ghana five years after introduction of 13-valent pneumococcal conjugate vaccineExternal. PLoS One. 2018;13(9):e0203205.
- Tomczyk S, Lessa FC, Sánchez J, Peña C, Fernández J, Gloria Carvalho M, at al. Effectiveness of 13-pneumococcal conjugate vaccine (PCV13) against invasive pneumococcal disease in children in the Dominican RepublicExternal. BMC Infect Dis. 2018;18(1):152.
- Whitney CG. Examining duration of protection: Should a booster dose be part of all infant pneumococcal conjugate vaccine programs?External Clin Infect Dis. 2018;67(3):375–7.
- Kambiré D, Soeters HM, Ouédraogo-Traoré R, Medah I, Sangaré L, Yaméogo I, et al. Early impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis-Burkina Faso, 2014–2015External. J Infect. 2018;76(3):270–
- Loo JD, Conklin L, Fleming-Dutra KE, at al. Systematic review of the indirect effect of pneumococcal conjugate vaccine dosing schedules on pneumococcal disease and colonizationExternal. Pediatr Infect Dis 2014; 33 Suppl 2:S161-71.
- Fleming-Dutra KE, Conklin L, Loo JD, et al. Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on vaccine-type nasopharyngeal carriageExternal. Pediatr Infect Dis J. 2014;33 Suppl 2:S152-60.
- Loo JD, Conklin L, Fleming-Dutra KE, et al. Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on prevention of pneumoniaExternal. Pediatr Infect Dis J. 2014;33 Suppl 2:S140-51.
- Deloria Knoll M, Park DE, Johnson TS, et al. Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on immunogenicityExternal. Pediatr Infect Dis J. 2014;33 Suppl 2:S119-29.
- Conklin L, Loo JD, Kirk J, Fleming-Dutra KE, Deloria Knoll M, Park DE, Goldblatt D, O’Brien KL, Whitney CG. Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on vaccine-type invasive pneumococcal disease among young childrenExternal. Pediatr Infect Dis J. 2014;33 Suppl 2:S109-18.
- Park DE, Johnson TS, Nonyane BA, et al. The differential impact of coadministered vaccines, geographic region, vaccine product and other covariates on pneumococcal conjugate vaccine immunogenicityExternal. Pediatr Infect Dis. 2014;33 Suppl 2:S130-9.