ArticlesBurden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates
Introduction
Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, and sepsis in children. Recent estimates of child deaths caused by S pneumoniae range from 700 000 to 1 million every year worldwide.1, 2, 3
Since resources for child survival are increasing, estimates of pneumococcal disease burden based on comprehensive, clear, and rigorous methods are needed. Although global estimates are valuable for international institutions and global initiatives, they have limited use for national policy makers. Progress in pneumonia case and death prevention will be facilitated by cause-specific estimates that help local and regional policy makers to prioritise interventions, such as vaccines or antibiotic treatments, specific for particular pneumonia causes.
We estimated the burden of serious pneumococcal cases and deaths in children younger than 5 years for the year 2000 at global, regional, sub-regional, and country levels by systematic, transparent methods (webappendix), including a comprehensive literature review.4
Section snippets
Methods
We used distinct methods to estimate pneumococcal disease burden from three serious clinical syndromes: meningitis, pneumonia, and non-pneumonia, non-meningitis invasive disease (defined as isolation of S pneumoniae from a normally sterile body fluid). Methods are described in detail in the webappendix pp 3–9; however, here we provide a concise description of the main components.
To obtain data for the models of meningitis and non-pneumonia, non-meningitis invasive disease, we did a
Results
The comprehensive literature review4 yielded 156 studies with data for the meningitis or the non-pneumonia, non-meningitis disease models after application of the inclusion, exclusion, and quality criteria (webappendix pp 30–37). All regions, except southeast Asia, had at least some data for pneumococcal meningitis incidence. All regions, except eastern Mediterranean, had data for pneumococcal meningitis case-fatality ratio (table 1). Overall, 15% of countries had pneumococcal meningitis
Discussion
735 000 pneumococcal deaths (519 000–825 000) in HIV-negative children account for 11% (8–12%) of 6·6 million total deaths in children aged 1–59 months19, 21 and for 7% (5–8%) of 10·6 million deaths in children younger than 5 years including neonatal deaths.19 Although these numbers represent the most rigorous estimate of child deaths caused by S pneumoniae, they are probably an underestimate. Surveillance in high-mortality developing countries usually under-detects bacterial meningitis and
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