Progress in introduction of pneumococcal conjugate vaccine--worldwide, 2000-2008.

Pneumococcal disease is a leading cause of childhood morbidity and mortality globally, causing an estimated 0.7--1.0 million deaths annually among children aged <5 years. A pneumococcal conjugate vaccine (PCV) that includes seven pneumococcal serotypes (PCV7) first became available in 2000. Studies in the United States have demonstrated that introduction of universal vaccination with PCV7 resulted in a 77% decrease in invasive pneumococcal disease among children aged <5 years and a 39% decrease in hospital admissions for pneumonia among children aged <2 years. A similar vaccine with two additional serotypes was highly efficacious against pneumonia and invasive disease in clinical trials in Africa and, in one trial, reduced all-cause mortality among children by 16%. Low-income countries, which account for >97% of pneumonia cases in children aged <5 years, will benefit most from introduction of PCV. This report summarizes the progress made in introducing PCV7 worldwide. As of August 2008, 26 countries offered PCV7 to all children as part of national immunization programs or had PCV7 in widespread use (i.e., with estimated national coverage >50%); however, none of these countries is a low-income or lower-middle income country. The World Health Organization (WHO) and UNICEF have recognized the safety and effectiveness of PCVs and recommend that these vaccines for young children be included in national immunization programs. Overcoming the challenges to global introduction remains an urgent public health priority.