The Knowledge Hub

Immunization with PCV reduces pneumonia cases and saves lives, easing economic burden on families and health systems

A surveillance study over a 10-year period in the Gambia found that routine introduction of PCV led to a 33% reduction in the incidence of radiological pneumonia and a 27% decline in pneumonia hospitalizations in children. Reducing the rate of pneumococcal disease will not only save lives but will also reduce the substantial economic burden placed on families and health systems.

Mackenzie GA, Hill PC, Jeffries DJ et al.. 2021. Impact of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease and pneumonia in The Gambia: 10 years of population-based surveillance. The Lancet Infectious Diseases. 21(9).

Malnourished children are at a greater risk of death from vaccine-preventable diseases

Findings of a systematic review evaluating the relationship between pneumonia and malnourishment found that severely malnourished children in developing countries had 2.5 to 15 times the risk of death. For children with moderate malnutrition, the risk of death ranged from 1.2 to 36.

Chisti, M.J., Tebruegge, M., La Vincente, S., et al.. 2009. Pneumonia in severely malnourished children in developing countries – mortality risk, aetiology and validity of WHO clinical signs: a systematic review. Tropical Medicine and International Health. 14(10).

Treatment of vaccine-preventable pneumococcal disease carries a heavy financial toll for health systems and families

In a study in The Gambia – a setting where healthcare is free of charge to patients – pneumococcal disease nonetheless placed a heavy financial burden on families seeking treatment before arrival at the hospital, with families paying for transportation costs, drugs, diagnostic tests and even burial in the case of death. 50-80% of the cost of treating an episode of pneumococcal disease was born by the health system, which still left families to cover a cost up to 10 times their average daily household budget. In addition the estimated treatment cost for inpatient pneumonia of US$109 is nearly 4 times the annual per capita expenditure for health in The Gambia.

Usuf, E., Mackenzie, G., Sambou, S., et al. 2016. The economic burden of childhood pneumococcal diseases in The Gambia. Effectiveness and Resource Allocation. 14(4).

Diarrhea is associated with pneumonia in undernourished children

In a recent review of data from developing countries, researchers found that episodes of diarrhea may predispose undernourished children to pneumonia.

Schlaudecker, E.P., Steinhoff, M.C. and Moore, S.R.. 2011. Interactions of diarrhea, pneumonia, and malnutrition in childhood: recent evidence from developing countries. Current Opinion in Infectious Diseases. 24(5).

Undernourished children have a higher likelihood for diarrhea and pneumonia but immunization can improve infant growth

Multiple studies show that

1. Diarrhea and pneumonia impair children’s growth and that underlying malnutrition is a major risk factor for these conditions.
2. “Episodes of diarrhea may predispose to pneumonia in undernourished children” and
3. Immunization against influenza (in mothers) and Streptococcus pneumoniae may improve infant growth. In addition, new studies from Bangladesh, Colombia, Ghana, and Israel further support the paradigm that malnutrition is a key risk factor for diarrhea and pneumonia.

Schlaudecker, E.P., Steinhoff, M.C. and Moore, S.R.. 2011. Interactions of diarrhea, pneumonia, and malnutrition in childhood: recent evidence from developing countries. Current Opinion in Infectious Diseases. 24(5).

Pediatric pneumococcal or Hib meningitis surviviors had a higher likelihood for neuropsychological deficits

In a systematic literature review of studies in Africa, it was found that 25% of children who survived pneumococcal or Hib meningitis had neuropsychological deficits.

Ramakrishnan, M., Ulland, A.J., Steinhardt, L.C., et al. 2009. Sequelae due to bacterial meningitis among African children: a systematic literature review. BMC Medicine. 7(47).

Bacterial meningitis is associated with long-term neurophysiological impacts

A systematic literature review analyzing data from 21 African countries revealed that bacterial meningitis is associated with high case fatality and frequent neurophysiological sequelae. Pneumococcal and Hib meningitis contribute to one third of disease related mortality. They also cause clinically evident sequalae in 25% of survivors prior to hospital discharge. The three main causes of bacterial meningitis- Haemophilus influenzae type B; Streptococcus pneumoniae (pneumococcus) and Neisseria meningitidis (meningococcus) are vaccine preventable, routine use of conjugate vaccines have potential for significant health and economic benefits.

Neuropsychological sequelae includes hearing loss, vision loss, cognitive delay, speech/language disorder, behavioural problems, motor delays/impairment, and seizures.

Ramakrishnan, M., Ulland, A.J., Steinhardt, L.C., et al. 2009. Sequelae due to bacterial meningitis among African children: a systematic literature review. BMC Medicine. 7(47).

Vaccine-preventable diarrhea is linked to poor growth

A prospective case-control study conducted in several developing countries found that children with moderate-to-severe diarrhea grew significantly less in length in the two months following their episode compared to age- and gender-matched controls.

Kotloff, K.L., Nataro, J.P., Blackwelder, W.C., et al. 2013. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet. 382(9888).

Implementing pneumonia vaccination programs can significantly reduce hospitalizations

Assuming 90% coverage, a program in The Gambia using a 9-valent PCV (PCV9) would prevent approximately 630 hospitalizations, 40 deaths, and 1000 DALYs over the first 5 years of life of a birth cohort. The estimated cost would be $670 per DALY averted in The Gambia.

Kim, S., Lee, G. and Goldie, S.. 2010. Economic evaluation of pneumococcal conjugate vaccination in The Gambia. BMC Infectious Diseases. 10(260).

Immunization can prevent severe long-term impacts of infections, including seizures and hearing loss

In The Gambia, 58% of children who survived pneumococcal meningitis had long lasting negative health outcomes. Half had major disabilities such as mental retardation, hearing loss, motor abnormalities, and seizures.

Goetghebuer, T., West, T.E., Wermenbol, V., et al. 2000. Outcome of meningitis caused by Streptococcus pneumoniae and Haemophilus influenzae type b in children in The Gambia. Tropical Medicine and International Health. 5(3).