Abstract
The objective of this study was to assess the impact of 10-valent pneumococcal conjugate (PCV10) vaccination on the incidence and mortality of pneumococcal meningitis in children under 5 in Brazil. A descriptive ecological, population-based quantitative study of secondary data from SINAN records for 2003-2009 and 2011-2017 and on vaccine coverage for 2011-2017 was conducted. The study was approved under permit CAAE 23629719.6.0000.5181. After PCV10 vaccine introduction, a substantial consistent reduction in incidence of and mortality rates of pneumococcal meningitis (70.33% Northeast, 69.49% Southeast) was observed across all regions of Brazil. Although the Human Development Index (HDI) improved during the study period, lethality rates remained high (North = 34.45% pre versus 40.08% post-vaccination), with no clear pattern of reduction associated with improved HDI in Brazil. In the final years of the study, a concerning decline in vaccination coverage rates was evident. Only the South (96.52%) and Mid-West (96.17%) regions attained the ≥ 95% vaccine coverage recommended by the Ministry of Health. This situation highlights the need for urgent measures to restore coverage rates and prevent recrudescence in cases and deaths associated with potentially preventable diseases.
Highlights
Pneumococcal meningitis (PM) is associated with high morbidity and mortality in children worldwide, in developing countries (Barichello, et al, 2012; Oliveira, 2017)
The study was based on secondary data for information held on the Tabnet - Datasus system (Ministry of Health) from the Brazilian Disease Notification System (SINAN) on the incidence, lethality and mortality of pneumococcal meningitis in the population of under-5s, according to data catalogued by the Brazilian Institute of Geography and Statistics (IBGE) for the 2000 and 2010 census
Following the introduction of the PCV-10 vaccine, there was a steady decline in notified cases of PM, with the curve flattening from 2015 onwards. (Figure 1) Figure 1 – Distribution of PM case notifications recorded on the Brazilian Disease Notification System (SINAM) for Brazil and regions, by year (2003-2017)
Summary
Pneumococcal meningitis (PM) is associated with high morbidity and mortality in children worldwide, in developing countries (Barichello, et al, 2012; Oliveira, 2017). Invasive diseases caused by pneumococcus, including meningitis, sepsis, and bacterial pneumonia, are responsible for approximately 800,000 deaths annually among children aged under 5 years (Grando, et al, 2015). Pneumococcal meningitis continues to be a major public health burden, despite the dramatic impact of the introduction of the PCV10 vaccine in lowering the incidence rate of the disease. Studies by Grando et al (2015) and Vieira and Kuppek, (2016) showed a significant decrease in the incidence rates of PM after introduction of PCV-7 in Australia, Spain and the USA, among other countries. In the decade 2000-2010, Streptococcus pneumoniae (Spn) was the leading cause of bacterial meningitis in Paraguay, associated with high lethality rates of 20% to 40% (Lovera, et al, 2011; Moreira, et al, 2016). In Brazil, the lethality rate was high, reaching 30% for pneumococcal meningitis between 2003 and 2018 (Moraes, et al, 2019)
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