Introduction of the pneumococcal conjugate vaccine into the South African public immunisation programme: dawn of a new era?

Abstract

Streptococcus pneumoniae is a leading vaccine-preventable cause of childhood death with an estimated 716,000 deaths occurring annually. Recent advances have seen the development of vaccines targeted against S. pneumoniae that are immunogenic and effcacious in very young children. These pneumococcal conjugate vaccines have now been evaluated in developed and industrialising countries with consistent effcacy against invasive pneumococcal disease at least due to the serotypes included in the vaccine. The vaccine has also been effcacious in preventing radiographically confrmed pneumonia, but has had less effect on pneumococcal acute otitis media. The introduction of the vaccine into the USA has been greatly successful and exceeds its expectations based upon the vaccine effcacy trials. In addition to preventing a greater than expected burden of invasive disease and pneumonia than anticipated in vaccinated children, the vaccine has also been associated with marked reduction in pneumococcal disease among unvaccinated members of the population, referred to as 'indirect protection'. The introduction of the vaccine into the immunisation programme of industrialising countries, such as in South Africa, require robust surveillance to evaluate the effectiveness of the vaccine in such settings where the epidemiology of pneumococcal diseases differs to that in developed countries.