Consideraciones epidemiológicas de la enfermedad neumocócica e impacto clínico y económico de la vacuna antineumocócica (PCV-10) en niños menores de 5 años en el Ecuador

Abstract

Background: Pneumococcal diseases are responsible for a high disease burden in children under the age of 5 and elderly people, generating high health costs which represent a major public health problem worldwide. The introduction of the PCV vaccine in different contexts has proven to be one of the most cost-effective interventions to treat this health problem. Aim: To evaluate the epidemiological considerations of the pneumococcal disease and the clinical and economic impact of the pneumococcal vaccine (PCV-10) in children under the age of 5 in Ecuador. Methodology: The established population for this study was children under the age of 5 in Ecuador. Several cross-sectional studies were conducted using national data sources and primary sources of patients treated at the primary care to determine morbidity and mortality from pneumococcal diseases, analyze the antibiotic prescription in upper respiratory infections, and estimate missed vaccination opportunities affecting immunization coverage. In order to estimate the clinical impact of the pneumococcal vaccine over the hospitalizations and mortality of children under the age of 5 and the indirect effect in adults, an ecological study was carried out with a time series analysis from a regression model and synthetic controls. Finally, an economic evaluation was carried out to estimate the direct costs generated by routine immunization in children under one year of age in Ecuador Results: In the period between 2005-2015, the burden of pneumococcal disease in children under the age of 5 in Ecuador was 162,481 cases of pneumonia (99.16%), 1327 cases of sepsis (0.82%) and 44 cases of meningitis (0.02%). Additionally, there were 4874 deaths due to these causes, with a declining trend of 48% in mortality. The most common circulating serotypes in the country were: 14, 19A ,1 and 6B. PCV-10 vaccination coverage has remained constant over the past years from 83% to 85%. The impact of immunization on the reduction in hospitalizations was estimated to be 27% in children under the age of 1 and 33% in children under the age of 5. The estimated impact of the PCV on pneumonia mortality was 14% in children under the age of 1 and 10% in children under the age of 5. This is the first study to evaluate the indirect effect of the vaccine in adults, finding a 22% reduction in mortality in patients from 50 to 64 years old. The costs associated with routine immunization of a child under the age of 1 in Ecuador were USD 106,19 per vaccinated child and the total cost of immunization for all children under the age of 1, considering the coverage of 74.6%, was $26.476.994,49. Conclusion: The disease burden caused by pneumococcal disease remains a major public health problem in Ecuador, especially in the infant population. With the introduction of the PCV vaccine in the routine immunization program in 2010, a significant decrease in hospitalizations and patient mortality has been achieved, justifying the cost of investment in the maintenance of this vaccine.