Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Schaeffer Center for Health Policy and Economics, University of Southern California, CA, USA.
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
Lancet Glob Health. 2024 Sep;12(9):e1485-e1497. doi: 10.1016/S2214-109X(24)00232-8.
Streptococcus pneumoniae has been estimated to cause 9·18 million cases of pneumococcal pneumonia, meningitis, and invasive non-pneumonia non-meningitis disease and 318 000 deaths among children younger than 5 years in 2015. We estimated the potential impact and cost-effectiveness of pneumococcal conjugate vaccine (PCV) introduction.
We updated our existing pseudodynamic model to estimate the impact of 13-valent PCV (PCV13) in 112 low-income and middle-income countries by adapting our previously published pseudodynamic model with new country-specific evidence on vaccine coverage, burden, and post-introduction vaccine impact from WHO-UNICEF estimates of national immunisation coverage and a global burden study. Deaths, disability-adjusted life-years (DALYs), and cases averted were estimated for children younger than 5 years born between 2000 and 2030. We used specific PCV coverage in each country and a hypothetical scenario in which coverage increased to diphtheria-tetanus-pertussis (DTP) levels. We conducted probabilistic uncertainty analyses.
Using specific vaccine coverage in countries, we estimated that PCV13 could prevent 697 000 (95% credibility interval 359 000-1 040 000) deaths, 46·0 (24·0-68·9) million DALYs, and 131 (89·0-172) million cases in 112 countries between 2000 and 2030. PCV was estimated to prevent 5·3% of pneumococcal deaths in children younger than 5 years during 2000-30. The incremental cost of vaccination would be I$851 (510-1530) per DALY averted. If PCV coverage were increased to DTP coverage in 2020, PCV13 could prevent an additional 146 000 (75 500-219 000) deaths.
The inclusion of real-world evidence from lower-income settings revealed that delays in PCV roll-out globally and low PCV coverage have cost many lives. Countries with delays in vaccine introduction or low vaccine coverage have experienced many PCV-preventable deaths. These findings underscore the importance of rapidly scaling up PCV to achieve high coverage and maximise vaccine impact.
Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.
据估计，2015 年肺炎球菌导致 918 万例肺炎球菌性肺炎、脑膜炎和侵袭性非肺炎性非脑膜炎疾病，以及 5 岁以下儿童 31.8 万人死亡。我们评估了肺炎球菌结合疫苗（PCV）引入的潜在影响和成本效益。
我们更新了现有的拟动力学模型，通过采用我们之前发表的拟动力学模型，并结合世界卫生组织-联合国儿童基金会对国家免疫覆盖率的估计以及全球负担研究中关于疫苗覆盖率、负担和疫苗引入后影响的新的国家特定证据，来估计 112 个低收入和中等收入国家中 13 价肺炎球菌结合疫苗（PCV13）的影响。我们为 2000 年至 2030 年期间出生的 5 岁以下儿童估计了死亡、残疾调整生命年（DALY）和预防病例数。我们使用了每个国家的特定 PCV 覆盖率，并假设覆盖率增加到白喉-破伤风-百日咳（DTP）水平。我们进行了概率不确定性分析。
使用国家特定的疫苗覆盖率，我们估计在 112 个国家，PCV13 可以在 2000 年至 2030 年期间预防 69.7 万人（95%可信区间 35.9 万-104 万人）死亡、4600 万（2400 万-6890 万）残疾调整生命年和 1.31 亿（8900 万-1.72 亿）例疾病。PCV 估计可以预防 2000-30 年期间 5 岁以下儿童中 5.3%的肺炎球菌死亡。每预防 1 个 DALY 的增量成本为 851 美元（510-1530 美元）。如果 2020 年 PCV 覆盖率增加到 DTP 覆盖率，PCV13 可以额外预防 14.6 万人（7.55 万-21.9 万人）死亡。
纳入来自低收入国家的真实世界证据表明，全球 PCV 推出的延迟和低 PCV 覆盖率导致了许多生命的丧失。疫苗推出延迟或 PCV 覆盖率低的国家经历了许多可预防的 PCV 死亡。这些发现强调了迅速扩大 PCV 接种范围以实现高覆盖率并最大限度地发挥疫苗效果的重要性。
比尔和梅琳达·盖茨基金会和全球疫苗免疫联盟。
