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Declines in pneumonia mortality following the introduction of pneumococcal conjugate vaccines in Latin American and Caribbean countries.

Abstract

Pneumococcal conjugate vaccines (PCVs) are recommended for use in pediatric immunization programs worldwide. Few data are available on their effect against mortality. We present a multi-country evaluation of the population-level impact of PCVs against death due to pneumonia in children <5 years.

The estimated declines in pneumonia mortality following the introduction of PCVs ranged from 11% to 35% among children aged 2-59 months in five countries: Colombia (24%, 95% credible interval: 3-35%), Ecuador (25%, 4-41%), Mexico (11%, 3-18%), Nicaragua (19%, 0-34%), and Peru (35%, 20-47%). In Argentina, Brazil, and the Dominican Republic, the declines were not detected in the aggregated age group but were detected in certain age strata. In Guyana and Honduras, the estimates had large uncertainty, and no declines were detected. Across the ten countries, most of which have low to moderate incidence of pneumonia mortality, PCVs have prevented nearly 4500 all-cause pneumonia deaths in children 2-59 months since introduction.

Although the data quality was variable between countries, and the patterns varied across countries and age groups, the balance of evidence suggests that mortality due to all-cause pneumonia in children declined after PCV introduction. The impact could be greater in populations with a higher pre-vaccine burden of pneumonia.

We obtained national-level mortality data between 2000-2016 from ten Latin American and Caribbean countries, using the standardized protocol. Time series models were used to evaluate the decline in all-cause pneumonia deaths during the post-vaccination period while controlling for unrelated temporal trends using control causes of death.

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