Burden of pneumococcal disease in children in Cuba before the introduction of a novel pneumococcal conjugate vaccine

Abstract

# Background The Cuban heptavalent conjugate pneumococcal vaccine will be introduced for children beginning in 2020. We estimated the burden of pneumococcal cases and deaths in children 1-59 months in 2015. # Methods Mortality and morbidity attributable to pneumococcus were estimated for each of the three primary syndromes commonly associated with pneumococcus: pneumonia, meningitis, and invasive non-pneumonia, non-meningitis (NPNM). Vaccine randomized clinical trial data were used to estimate the proportion of pneumonia deaths attributable to pneumococcus. Data from Cuba were obtained from two domestic sources: National Bacterial Meningitis Surveillance System and the laboratory register from the National Reference Laboratory. Syndrome-specific pneumococcal mortality proportions were applied to all-cause pneumonia and meningitis death estimates prepared by the World Health Organization Maternal Child Epidemiology Estimation (WHO/MCEE) collaboration. The proportion of pneumonia cases attributable to pneumococcus was applied to estimates of all-cause clinical and severe pneumonia also prepared by the WHO/MCEE collaboration. Pneumococcal NPNM morbidity and mortality estimates were prepared using the ratio pneumococcal meningitis to pneumococcal invasive disease. Estimates were adjusted for HIV prevalence and access to health care. # Results In 2015, pneumococcus was estimated to cause 970 severe cases (uncertainty range, UR=692-1209) and 39 deaths (UR=23-59) among children 1-59 months. The estimated incidence rate of severe pneumonia was 149 (UR=112-170) per 100,000 children 1-59 months. The estimated case fatality ratio (CFR) was 2% (UR=1-2%). Over a period of one year, 22 deaths were attributed to pneumococcal pneumonia (UR=16-23), 9 (UR=14-19) to pneumococcal meningitis, and 8 (UR=3-17) to pneumococcal bacteremia. The CFR due pneumococcal meningitis was 18% (UR= 8-37%) in 2015. # Conclusions Reduced morbidity and mortality due to pneumococcal disease in Cuba could be achieved with the accelerated introduction of a novel PCV product in children.