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Meta-Analysis
. 2016 Dec 12;11(12):e0166736.
doi: 10.1371/journal.pone.0166736. eCollection 2016.

Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review

Lucia Helena de Oliveira  1 , Luiz Antonio B Camacho  2 , Evandro S F Coutinho  2 , Martha S Martinez-Silveira  3 , Ana Flavia Carvalho  4 , Cuauhtemoc Ruiz-Matus  1 , Cristiana M Toscano  5
Affiliations
Meta-Analysis

Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review

Lucia Helena de Oliveira et al. PLoS One. .

Abstract

Background: Several Latin American and Caribbean (LAC) countries have introduced pneumococcal conjugate vaccine (PCV-10 or PCV-13) in their routine national immunization programs.

Objectives: We aimed to summarize the evidence of PCV impact and effectiveness in children under 5 years old in the LAC Region.

Methods: We conducted a systematic review of the literature on impact or effectiveness of PCVs on deaths or hospitalizations due to invasive pneumococcal disease (IPD), pneumonia, meningitis and sepsis. We searched Medline, WoS, Lilacs, Scopus, Central and gray literature published in any language from 2009 to January 2016. We included studies addressing the outcomes of interest in children in the target age group, and with the following designs: randomized trials, cohort or case-control, interrupted time series with at least three data points before and after the intervention, and before-after studies. Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Descriptive analysis of the effectiveness measurements and sensitivity analysis were conducted. Effectiveness is reported as 1-OR or 1-RR for case control or cohort/clinical trials, and as percent change of disease incidence rates for before-after studies.

Results: We identified 1,085 citations, 892 from databases and 193 from other sources. Of these, 22 were further analyzed. Studies were from Brazil, Chile, Uruguay, Argentina, Peru and Nicaragua. Effectiveness ranged from 8.8-37.8% for hospitalizations due to X-ray confirmed pneumonia, 7.4-20.6% for clinical pneumonia, and 13.3-87.7% for meningitis hospitalizations, and 56-83.3% for IPD hospitalization, varying by age, outcome definition, type of vaccine and study design.

Conclusions: Available evidence to date indicates significant impact of both PCV-10 and PCV-13 in the outcomes studied, with no evidence of the superiority of one vaccine over the other on pneumonia, IPD or meningitis hospitalization reduction in children under 5 years old.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart: process of study selection.
Fig 2
Fig 2. Vaccine effectiveness (%, 95% confidence interval*) against pneumonias clinical and X-Ray/consolidated, by vaccine, group of age, and hospitalization or death.
* Effectiveness estimates and 95%CI are presented in black for studies assessing hospitalized pneumonia, and in light gray for studies assessing combined pneumonia inpatient and outpatients as endpoints. Two studies with no available confidence intervals were not plotted: Hortal et al.[17]; Scotta et al.[27] Countries: ARG (Argentina); BRA (Brazil); CHI (Chile); NIC (Nicaragua); PER (Peru); URU (Uruguay).
Fig 3
Fig 3. Vaccine effectiveness* against meningitis, by vaccine, group of age, vaccine serotypes and all serotypes, and hospitalization or death.
* 95% confidence intervals were not reported by several of the studies and were not plotted. Country: BRA (Brazil).
Fig 4
Fig 4. Vaccine effectiveness (%, 95% confidence interval*) against invasive bacterial disease, by vaccine, group of age, vaccine serotypes and all serotypes, and hospitalization or death.
*Study by Valenzuela et al. [45] did not report confidence interval and was not plotted. Countries: BRA (Brazil); URU (Uruguay).
See this image and copyright information in PMC

References

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