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. 2022 Mar 16:22:100430.
doi: 10.1016/j.lanwpc.2022.100430. eCollection 2022 May.

National, regional, and provincial disease burden attributed to Streptococcus pneumoniae and Haemophilus influenzae type b in children in China: Modelled estimates for 2010-17

Xiaozhen Lai  1   2 , Brian Wahl  3   4   5 , Wenzhou Yu  6 , Tingting Xu  7 , Haijun Zhang  1   2 , Cristina Garcia  4   5 , Ying Qin  8 , Yan Guo  2 , Zundong Yin  6 , Maria Deloria Knoll  4   5 , Hai Fang  1   9   10
Affiliations

National, regional, and provincial disease burden attributed to Streptococcus pneumoniae and Haemophilus influenzae type b in children in China: Modelled estimates for 2010-17

Xiaozhen Lai et al. Lancet Reg Health West Pac. .

Abstract

Background: Vaccination against Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib) is not included in China's national immunization programme. To inform China's immunization polices, we estimated annual national, regional, and provincial childhood mortality and morbidity attributable to pneumococcus and Hib in 2010-17.

Methods: We estimated proportions of pneumonia and meningitis deaths and cases attributable to pneumococcus and Hib using evidence from vaccine clinical trials and surveillance studies of bacterial meningitis and pathogen-specific case fatality ratios (CFR). Then we applied the proportions to model provincial-level pneumonia cases and deaths, meningitis deaths and meningitis CFR in children aged 1-59 months, accounting for vaccine coverage. Non-pneumonia, non-meningitis (NPNM) invasive disease cases were derived by applying NPNM meningitis ratios to meningitis estimates.

Findings: In 2010-17, annual pneumococcal deaths fell by 49% from 15 600 (uncertainty range: 10 800-17 300) to 8 000 (5 500-8 900), and Hib deaths fell by 56% from 6 500 (4 500-8 800) to 2 900 (2 000-3 900). Severe pneumococcal and Hib cases decreased by 16% to 218 200 (161 500-252 200) in 2017 and 29% to 49 900 (29 000-99 100). Estimated 2017 national three-dose coverage in private market was 1·3% for PCV and 33·4% for Hib vaccine among children aged 1-59 months. Provinces in the west region had the highest disease burden.

Interpretation: Childhood mortality and morbidity attributable to pneumococcal and Hib has decreased in China, but still substantially varied by region and province. Higher vaccine coverage could further reduce disease burden.

Funding: Bill & Melinda Gates Foundation.

Keywords: China; Haemophilus influenzae type b; Immunization; Streptococcus pneumoniae.

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Conflict of interest statement

HF reports grants from the Bill & Melinda Gates Foundation and Sanofi Pasteur. BW reports grants from the Bill & Melinda Gates Foundation. MDK reports grants from the Bill & Melinda Gates Foundation, Pfizer and Gavi Alliance, and personal fees from Merck. CG reports grants from the Bill & Melinda Gates Foundation and Pfizer, and personal fees from Merck. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Pathogen-specific pneumonia, meningitis, and NPNM morbidity and mortality conceptual models. NPNM=non-pneumonia, non-meningitis. CFR=case-fatality ratio.
Figure 2
Figure 2
Estimated Streptococcus pneumoniae (A) and Haemophilus influenzae type b (B) deaths and mortality in 2017. Size of bubble indicates absolute number of pathogen-specific deaths.
Figure 3
Figure 3
Mortality rates for Streptococcus pneumoniae and Haemophilus influenzae type b for 2010–2017, by region.
See this image and copyright information in PMC

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