The Knowledge Hub

The introduction of PCV13 vaccine in Tennessee reduced racial disparities in pneumococcal disease

Population-based surveillance data collected in the state of Tennessee from 1998 – 2016 found that the introduction of PCV13 was associated with reductions in socioeconomic and racial disparities in PCV13-serotype invasive pneumococcal disease (IPD). PCV13 introduction was associated with the prevention of IPD in the overall population as well as substantial decreases in racial disparities in IPD over time between Black and White populations. Before PCV13 was introduced, Black people in the study had an IPD incidence 1.5 times higher than White people – 24.7 and 16.4, respectively. After PCV13 introduction, Black people had an IPD incidence 1.15 times the incidence among Whites: 15 and 13.1, respectively.

Raman R, Brennan J, Ndi D et al.. 2021. Marked Reduction of Socioeconomic and Racial Disparities in Invasive Pneumococcal Disease Associated With Conjugate Pneumococcal Vaccines. The Journal of Infectious Diseases. 223(7).

Immunization programs have saved millions of lives, especially among children, and will continue to do so in the future

Increases in vaccine coverage and the introduction of new vaccines into LMICs have had a major impact in reducing mortality. Vaccination programs for ten selected pathogens will have averted an estimated 69 million deaths in 98 low- and middle-income countries between 2000 and 2030. Most of this impact has been concentrated in a reduction in mortality among children younger than 5 years (57% reduction), most notably from measles. These public health gains are predicted to increase in coming decades if progress in increasing vaccine coverage is sustained.

Li X, Mukandavire C, Cucunubá ZM et al.. 2021. Estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030: a modelling study. The Lancet. 397(10272).

Globally, immunization has a high return on investment saving billions of dollars by preventing disability, health costs, and premature deaths

By preventing illness, disability, premature death, lost wages, and other costs, this modeling study found that vaccines against ten pathogens averted $828.5 billion of economic burden in 94 low- and middle-income countries between 2021 and 2030. Immunization programs provided a high return on investment (ROI), with projections for net benefits of vaccine programs estimated at $1,445.3 billion (using a cost-of-illness approach) and $3,371.5 billion (using a value-of-a-statistical-life approach) from 2011 to 2030. For every $1 invested in immunization, there was a return on investment of $20 using cost-of-illness and $52 using a value-of-a-statistical-life approach.

Sim SY, Watts E, Constenla D et al.. 2020. Return On Investment From Immunization Against 10 Pathogens In 94 Low- And Middle-Income Countries, 2011–30. Health Affairs. 39(8).

Introducing the PCV vaccine in India will save millions of dollars in healthcare costs, especially for the poorest households

An analysis of the potential impact of pneumococcal conjugate vaccine (PCV) in India found that introducing PCV vaccine will protect the population from potentially catastrophic health expenditures due to treatment and hospitalizations for pneumococcal disease – saving an estimated $49-63 million in out-of-pocket expenditures each year, depending on the assumed vaccination coverage rate. Financial protection will be greatest for the poorest households, with the poorest quintile is estimated to have the greatest savings in out-of-pocket expenditures of all wealth quintiles.

Megiddo I, Klein E, Laxminarayan R. 2018. Potential impact of introducing the pneumococcal conjugate vaccine into national immunisation programmes: an economic epidemiological analysis using data from India. BMJ Global Health. 3(3).

Immunizing with pneumococcal conjugate vaccine in India can greatly reduce deaths, especially among the poor

A modeled analysis of the potential impact of pneumococcal conjugate vaccine (PCV) in India estimated that the greatest reductions in deaths due to PCV vaccination would be among the poorest segments of the population. Assuming a vaccination coverage rate of 77% (the current DTP3 coverage rate), PCV would prevent nearly 2.5 times as many deaths per 100,000 children under five in the 2 poorest income quintiles than in the 2 wealthiest groups (313 vs. 134), and nearly 3 times as many deaths per 100,000 if coverage reaches 90% (446 vs. 167).

The model used was specific to the epidemiology, health system situation, and population characteristics of India.

Megiddo I, Klein E, Laxminarayan R. 2018. Potential impact of introducing the pneumococcal conjugate vaccine into national immunisation programmes: an economic epidemiological analysis using data from India. BMJ Global Health. 3(3).

Influenza vaccination during pregnancy reduces severe pneumonia rates in infants, especially during peak influenza circulation

An analysis of data from three studies showed that the rates of severe pneumonia in infants in their first six months of life was 20% lower overall in infants whose mothers received the influenza vaccination during pregnancy than in infants whose mothers had not, and the rates of severe pneumonia was 56% lower during periods when influenza circulation was highest. These findings correspond with evidence that influenza infection predisposes individuals to pneumococcal infection.

The incidence rate of severe pneumonia in the vaccine group compared to the control group was 43% lower in South Africa, 31% lower in Nepal, but not significantly different in Mali.

Omer SB, Clark DR, Aqil AR et al.. 2018. Maternal influenza immunization and prevention of severe clinical pneumonia in young infants: Analysis of randomized controlled trials conducted in Nepal, Mali and South Africa. Pediatric Infectious Disease Journal. 37(5).

Childhood vaccination with PCVs reduces the incidence of invasive pneumococcal disease and benefits the whole population

A large study in Norway found that the overall incidence of invasive pneumococcal disease (IPD) declined significantly in individuals on immunosuppressive drugs following the introduction of PCVs for infants — and most significantly in people undergoing chemotherapy. These findings underscore the benefits that childhood vaccination with PCVs affords the entire population.

Steens A, Winje BA, White RA et al.. 2019. Indirect effects of pneumococcal childhood vaccination in individuals treated with immunosuppressive drugs in ambulatory care: a case-cohort study. Clinical Infectious Diseases. 68(8).

Immunization reduces the risk of invasive pneumococcal disease, but those on immunosuppressants still have higher chances

Even though the incidence of invasive pneumococcal disease declined in all groups, including individuals on immunosuppressive drugs, following the introduction of pneumococcal conjugate vaccines for infants in Norway, people on chemotherapy were still 20 times more likely to get IPD than individuals not on any immunosuppressants, while individuals on long-term corticosteroids or other immunosuppressive drugs were around 6 times more likely to get the disease.

Steens A, Winje BA, White RA et al.. 2019. Indirect effects of pneumococcal childhood vaccination in individuals treated with immunosuppressive drugs in ambulatory care: a case-cohort study. Clinical Infectious Diseases. 68(8).

Continuing vaccination in Kenya will prevent thousands of deaths and be cost-effective

An analysis in Kenya found that, although the government will need to more than double its current vaccine budget to continue using PCV after GAVI support ends, continuing the vaccination will prevent more than 101,000 cases of invasive pneumoccocal disease and pneumonia, more than 14,000 deaths over an 11-year period, and would be cost-effective (cost per DALY of $153 by 2032), even at the full GAVI price of US $3.05 per dose.

Ojal J, Griffiths U, Hammitt LL et al.. 2019. Sustaining pneumococcal vaccination after transitioning from Gavi support: a modelling and cost-effectiveness study in Kenya. Lancet Global Health. 7(5).

Immunization with PCV7 and PCV13 vaccines reduced pneumonia hospitalizations in adults, including the elderly

According to some studies, hospitalizations from all causes of pneumonia declined in 18-39 year old adults in the U.S. by 26% 4 years after PCV7 vaccine was included in the infant vaccination schedule and by a further 12% with the first 2 years after PCV13 replaced PCV7. Though reductions in older age groups were not statistically significant, other U.S. studies showed significant reductions in pneumonia hospitalization rates in all adult age groups, including the elderly.

Wiese AD, Griffin MR, Grijalva CG. 2019. Impact of pneumococcal conjugate vaccines on hospitalizations for pneumonia in the United States. Expert Review of Vaccines. 18(4).