Abstract
Background: Pneumococcal conjugate vaccines (PCVs) have prevented deaths due to pneumonia among children. The effect may differ between higher- and lower-income populations due to various factors, such as differences in the distribution of pneumococcal serotypes, healthcare access, and PCV uptake. This study aims to evaluate an association between increasing PCV coverage and population-level declines in death due to pneumonia and its variation by socioeconomic status of subnational regions. Methods: We analyzed municipality-level mortality data from 2005 and 2015 for children aged 2-23 months in Brazil, Colombia, and Peru. We fit Poisson regression models to estimate the relationship between changes in PCV uptake and deaths due to all-cause pneumonia among subnational regions with different income levels. We controlled for changes unrelated to PCV by using data on non-respiratory deaths over time. Results: Uptake of the third dose of PCV varied across subnational regions and was higher in high-income regions. Higher uptake of PCV was associated with larger declines in pneumonia mortality. This association did not differ by income level of the region in Brazil and Colombia. In Peru, low-income regions observed larger declines in pneumonia deaths, but there was large uncertainty in the difference between the low- and high-income regions. We estimated that, with 90% coverage, there would be 4-38% declines in all-cause pneumonia mortality across income levels and countries. Conclusions: Regions with higher PCV coverage experienced larger declines in pneumonia deaths, regardless of the income level. Having more reliable data on mortality records and vaccine uptake would improve the reliability of vaccine impact estimates.
Highlights
Vaccination programs targeting pneumococcus are established globally
Declines in all-cause pneumonia mortality by pneumococcal conjugate vaccine (PCV) uptake and income level All-cause pneumonia mortality declined over time across income levels and countries, and these declines started before the introduction of PCV (Figure 1A)
Higher uptake of the third dose of PCV was associated with additional declines in pneumonia deaths in most of the regions in all three countries (Figure 3)
Summary
Vaccination programs targeting pneumococcus are established globally. Pneumococcal conjugate vaccines (PCVs) have effectively reduced the burden of disease and death due to pneumonia and other severe pneumococcal infections (e.g., septicemia, meningitis)[1,2,3,4,5,6,7]. The impact of PCVs on preventing deaths due to pneumonia could differ between higher- and lower-income populations. Variations in vaccine uptake can influence the overall reduction It may seem obvious, the authors should introduce what is already known and why differences in pneumonia deaths related to socioeconomic status between and within countries may be expected. The effect may differ between higher- and lower-income populations due to various factors, such as differences in the distribution of pneumococcal serotypes, healthcare access, and PCV uptake. This study aims to evaluate an association between increasing PCV coverage and population-level declines in death due to pneumonia and its variation by socioeconomic status of subnational regions. Higher uptake of PCV was associated with larger declines in pneumonia mortality This association did not differ by income level of the region in Brazil and Colombia. In Peru, low-income regions observed larger declines in Invited Reviewers version 1
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