Evolution of Pneumococcal Vaccine introduction in Childhood and Older Adult National Immunization Programs in Latin America and the Caribbean

Abstract

Background: In Latin America and the Caribbean (LAC), Streptococcus pneumoniae is associated with an important burden of disease and mortality. The highest incidence of invasive disease and fatality occur at the extremes of life (the first 12 months of life and 65 years or older). In 2007, WHO recommended that all countries should include pneumococcal conjugate vaccine (PCV) as part of their childhood national immunization program (NIP). Since then, PCV uptake globally has occurred rapidly. In 2015, PAHO launched the 2015-2020 Regional Immunization Action Plan which promotes universal and equitable access to immunization services throughout the life cycle. The objective of this review is to describe the evolution of the incorporation of publicly funded pneumococcal immunization in childhood and older adults in LAC NIPs since their recommendation by WHO or PAHO. Methods & Materials: A comprehensive search was done of official national government websites and the country profiles in the WHO immunization monitoring system. Results: Currently, 36 LAC countries/territories have introduced PCV10 or PCV13 in their routine childhood NIP representing 98% of the region's birth cohort (10.8 million). The majority of the countries/territories use PCV13, with the exception of Brazil, Colombia and Ecuador, which use PCV10. All NIPs have a 3-dose schedule (either 2+1 or 3+0). A total of 8 countries have a universal funded program for older adults for 60 or 65 years and older, representing 30% of the region's cohort population (22 and 15 million, respectively). Six countries have pneumococcal polysaccharide vaccine (PPV23) (Chile, Costa Rica, Mexico, Nicaragua, Paraguay, and Uruguay) and two countries fund a sequential regimen with PCV13+PPV23 (Argentina and Panamá). Some countries have implemented or extended funding of pneumococcal immunization to high risk patients. Conclusion: Fast and efficient PCV introduction in infants has occurred since 2007 following WHO/PAHO recommendations. Unlike the introduction of pneumococcal vaccine in childhood in LAC NIPs, only a few countries in LAC have introduced a universal pneumococcal vaccination program for older adults in their NIPs. Infant and older adult cohorts that could potentially benefit from a publicly funded pneumococcal vaccination NIP represent around 98% and 30% of the referenced populations, respectively.