Universidad Peruana de Ciencias Aplicadas, Lima, Peru
Universidad Norbert Wiener, Lima, Peru.
BMJ Glob Health. 2023 Aug;8(8). doi: 10.1136/bmjgh-2023-012752.
Pneumonia due to (pneumococcus) is a major cause of mortality in infants (children under 1 year of age), and pneumococcal conjugate vaccines (PCVs), delivered during the first year of life, are available since the year 2000. Given those two premises, the conclusion follows logically that favourable impact reported for PCVs in preventing pneumococcal disease should be reflected in the infant mortality rates (IMRs) from all causes. Using publicly available datasets, country-level IMR estimates from UNICEF and PCV introduction status from WHO, country-specific time series analysed the temporal relationship between annual IMRs and the introduction of PCVs, providing a unique context into the long-term secular trends of IMRs in countries that included and countries that did not include PCVs in their national immunisation programmes. PCV status was available for 194 countries during the period 1950-2020: 150 (77.3%) of these countries achieved nationwide PCV coverage at some point after the year 2000, 13 (6.7%) achieved only partial or temporary PCV coverage, and 31 (15.9%) never introduced PCVs to their population. One hundred and thirty-nine (92.7%) of countries that reported a decreasing (negative) trend in IMR, also reported a strong correlation with decreasing maternal mortality rates (MMRs), suggesting an improvement in overall child/mother healthcare. Conversely, all but one of the countries that never introduced PCVs in their national immunisation programme also reported a decreasing trend in IMR that strongly correlates with MMRs. IMRs have been decreasing for decades all over the world, but this latest decrease may not be related to PCVs.
由肺炎链球菌引起的肺炎是婴儿（1 岁以下儿童）死亡的主要原因，自 2000 年以来，已可提供用于预防肺炎球菌疾病的肺炎球菌结合疫苗 (PCV)。基于这两个前提，可以得出合乎逻辑的结论，即 PCV 预防肺炎球菌疾病的有利影响应该反映在所有原因导致的婴儿死亡率 (IMR) 中。使用公开可用的数据集、联合国儿童基金会提供的国家一级 IMR 估计数和世卫组织提供的 PCV 引入状况，对各国的特定时间序列进行了分析，以研究年度 IMR 与 PCV 引入之间的时间关系，从而在包括和不包括 PCV 纳入国家免疫规划的国家中，为 IMR 的长期长期趋势提供了独特的背景。1950-2020 年间，PCV 状况可用于 194 个国家：150 个国家（77.3%）在 2000 年后的某个时间点实现了全国范围内的 PCV 覆盖率，13 个国家（6.7%）仅实现了部分或临时的 PCV 覆盖率，31 个国家（15.9%）从未向其人口引入过 PCV。139 个报告 IMR 呈下降（负）趋势的国家（92.7%）也报告了与下降的孕产妇死亡率 (MMR) 之间存在很强的相关性，这表明整体儿童/母亲医疗保健状况得到了改善。相反，所有未将 PCV 纳入国家免疫规划的国家（除一个国家外）也报告了 IMR 呈下降趋势，且与 MMR 之间存在很强的相关性。全世界的 IMR 已经下降了几十年，但最近的下降可能与 PCV 无关。
