BACKGROUND 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. METHODS 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. FINDINGS 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. INTERPRETATION 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. FUNDING Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

中文翻译：

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重新评估 112 个低收入和中等收入国家 5 岁以下儿童引入肺炎球菌结合疫苗的影响和成本效益：一项模型研究。


背景 据估计，2015 年肺炎链球菌导致 9·18 百万例肺炎球菌肺炎、脑膜炎和侵袭性非肺炎非脑膜炎疾病，并导致 318 000 例 5 岁以下儿童死亡。我们估计了潜在影响和成本效益肺炎球菌结合疫苗（PCV）的介绍。方法 我们更新了现有的伪动力学模型，通过将我们之前发布的伪动力学模型与关于疫苗覆盖率、负担和接种后的新的国家特定证据进行调整，来估计 13 价 PCV (PCV13) 对 112 个低收入和中等收入国家的影响。 - 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和全球负担研究对引入疫苗的影响。对 2000 年至 2030 年间出生的 5 岁以下儿童的死亡、伤残调整生命年 (DALY) 和避免的病例进行了估计。我们使用了每个国家的具体 PCV 覆盖范围和假设情景，其中覆盖范围增加到白喉-破伤风-百日咳 (DTP) 水平。我们进行了概率不确定性分析。结果 根据各国的具体疫苗覆盖情况，我们估计 PCV13 可以预防 697 000 例（95% 可信区间 359 000-1 040 000 例）死亡、46·0 (24·0-68·9) 百万伤残调整生命年和 131 例 (89· 2000 年至 2030 年间，112 个国家发生了 0-172) 百万病例。据估计，2000-30 年间，PCV 可预防 5·3% 的 5 岁以下儿童死于肺炎球菌。每避免 DALY，疫苗接种的增量成本将为 851 美元 (510-1530)。如果 2020 年 PCV 覆盖范围增加到 DTP 覆盖范围，PCV13 可以额外避免 146 000 人（75 500-219 000 人）死亡。 解释 纳入来自低收入环境的现实世界证据表明，全球 PCV 推广的延迟和 PCV 覆盖率低导致许多人丧生。疫苗引进延迟或疫苗覆盖率低的国家发生了许多 PCV 可预防的死亡。这些发现强调了快速扩大 PCV 以实现高覆盖率和最大化疫苗影响的重要性。资助比尔及梅琳达·盖茨基金会和全球疫苗免疫联盟。