Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates.
Lancet. 2009 Sep 12; 374(9693):893-902.Lct

Abstract

BACKGROUND

Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, and sepsis in children worldwide. However, many countries lack national estimates of disease burden. Effective interventions are available, including pneumococcal conjugate vaccine and case management. To support local and global policy decisions on pneumococcal disease prevention and treatment, we estimated country-specific incidence of serious cases and deaths in children younger than 5 years.

METHODS

We measured the burden of pneumococcal pneumonia by applying the proportion of pneumonia cases caused by S pneumoniae derived from efficacy estimates from vaccine trials to WHO country-specific estimates of all-cause pneumonia cases and deaths. We also estimated burden of meningitis and non-pneumonia, non-meningitis invasive disease using disease incidence and case-fatality data from a systematic literature review. When high-quality data were available from a country, these were used for national estimates. Otherwise, estimates were based on data from neighbouring countries with similar child mortality. Estimates were adjusted for HIV prevalence and access to care and, when applicable, use of vaccine against Haemophilus influenzae type b.

FINDINGS

In 2000, about 14.5 million episodes of serious pneumococcal disease (uncertainty range 11.1-18.0 million) were estimated to occur. Pneumococcal disease caused about 826,000 deaths (582,000-926,000) in children aged 1-59 months, of which 91,000 (63,000-102,000) were in HIV-positive and 735,000 (519,000-825,000) in HIV-negative children. Of the deaths in HIV-negative children, over 61% (449,000 [316,000-501,000]) occurred in ten African and Asian countries.

INTERPRETATION

S pneumoniae causes around 11% (8-12%) of all deaths in children aged 1-59 months (excluding pneumococcal deaths in HIV-positive children). Achievement of the UN Millennium Development Goal 4 for child mortality reduction can be accelerated by prevention and treatment of pneumococcal disease, especially in regions of the world with the greatest burden.

FUNDING

GAVI Alliance and the Vaccine Fund.

Links

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Authors+Show Affiliations

O'Brien KL
GAVI's PneumoADIP, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. klobrien@jhsph.edu
Wolfson LJ
No affiliation info available
Watt JP
No affiliation info available
Henkle E
No affiliation info available
Deloria-Knoll M
No affiliation info available
McCall N
No affiliation info available
Lee E
No affiliation info available
Mulholland K
No affiliation info available
Levine OS
No affiliation info available
Cherian T
No affiliation info available
Hib and Pneumococcal Global Burden of Disease Study Team
No affiliation info available

MeSH

Age DistributionCause of DeathChild MortalityChild WelfareChild, PreschoolCost of IllnessGlobal HealthHIV InfectionsHIV SeroprevalenceHealth Services AccessibilityHealth Services Needs and DemandHumansIncidenceInfantMeningitis, PneumococcalPneumococcal VaccinesPneumonia, PneumococcalPopulation SurveillanceSepsisStreptococcus pneumoniaeVaccination

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

19748398