Pneumococcal Disease: Global Disease Prevention Strategies with a Focus on the Challenges in Iraq

Figures & data

Table 1 Pneumococcal Vaccines

S. No	Name of Vaccine (Brand Name, Company)	Carrier Protein	Target Serotypes	Year of FDA Licensing	Reference
Pneumococcal Polysaccharide Vaccines
1.	PPSV14	–	1, 2, 3, 4, 6A, 7F, 8, 9N, 12F, 14, 18C, 19F, 23F, and 25	1977	[17]
2.	PPSV23 (Pneumovax^® 23, MSD)	–	1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, and 33F	1983	[18]
Pneumococcal Conjugate Vaccines
3.	PCV7 (Prevnar^®, Pfizer)	CRM197	4, 6B, 9V, 14, 18C, 19F, and 23F	2000	[19]
4.	PCV10 (Synflorix^®. GlaxoSmithKline)	NTHi Protein D, tetanus toxoid, diphtheria toxoid	1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F	WHO prequalified in 2009; Licensed in Canada, Australia, Europe between 2008 and 2009	[20]
5.	PCV10 (Pneumosil^®, Serum Institute of India)	CRM197	1, 5, 6A, 6B, 7F, 9V, 14, 19A, 19F, and 23F	WHO prequalified in 2019; Licensed in India in 2020	[21]
6.	PCV13 (Prevnar 13^®, Pfizer)	CRM197	1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F	2010	[22]
7.	PCV15 (Vaxneuvance^®, MSD)	CRM197	1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, 33F	2021	[23]
8.	PCV20 (Prevnar 20^®, Pfizer)	CRM197	1, 3, 4, 5, 6A, 6B, 7F,8, 9V,10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, 33F	2021	[24]

Abbreviations: FDA, Food and Drug Administration; PPSV, Pneumococcal polysaccharide vaccines; PCV, Pneumococcal conjugate vaccines; WHO, World Health Organization; NTHi, non-typeable Haemophilus influenzae; CRM197, cross-reacting material 197 (a nontoxic variant of diphtheria toxin).

Table 2 Overview of Pneumococcal Vaccine Introduction, Vaccine Coverage and Disease Burden in Different Countries of the World

S. No.	Country	Income Group (as per World Bank)	Year of Vaccine Introduction	Immunization Program Type	Vaccine and Dosing Schedule	WUENIC Coverage (Year)	Total Number of Pneumococcal Disease Cases (2015)	Total Number of Pneumococcal Deaths (2015)
WHO: African Region
1.	Gambia	LIC	2009	Universal	PCV13, 3p+0	87% (2019)	2894	128
2.	South Africa	UMIC	2009	Universal	PCV13, 2p+1	83% (2020)	57,352	1318
3.	Rwanda	LIC	2009	Universal	PCV13, 3p+0	91% (2020)	8386	327
4.	Kenya	LMIC	2011	Universal	PCV10, 3p+0	90% (2020)	75,947	1990
5.	Malawi	LIC	2011	Universal	PCV13, 3p+0	93% (2020)	32,117	1541
6.	Botswana	UMIC	2012	Universal	PCV13, 3p+0	90% (2020)	3739	71
WHO: Region of the Americas
7.	USA	HIC	2000	Universal	PCV13, 3p+1	82% (2020)	6273	89
8.	Canada	HIC	2002	Universal	PCV13, 2p+1 and 3p+1	84% (2020)	639	8
9.	Mexico	UMIC	2008	Universal	PCV13, 2p+1	75% (2020)	61,345	728
10.	Peru	UMIC	2009	Universal	PCV13, 2p+1	80% (2019)	11,721	183
11.	Nicaragua	LMIC	2010	Universal	PCV13, 3p+0	92% (2020)	3226	67
12.	Bolivia	LMIC	2014	Universal	PCV13, 3p+0	68% (2020)	9800	288
WHO: Eastern Mediterranean Region
13.	Qatar	HIC	2005	Universal	PCV13, 3p+1	70% (2020)	620	2
14.	Kuwait	HIC	2007	Universal	PCV13, 3p+1	91% (2020)	1594	13
15.	UAE	HIC	2007	Universal	PCV13, 3p+1	84% (2020)	2417	6
16.	Bahrain	HIC	2008	Universal	PCV13, 3p+1	99% (2020)	494	3
17.	Oman	HIC	2008	Universal	PCV13, 2p+1	99% (2019)	1803	14
18.	Saudi Arabia	HIC	2009	Universal	PCV13, 3p+1	95% (2020)	14,854	107
19.	Morocco	LMIC	2010	Universal	PCV10, 2p+1	98% (2019)	24,109	327
20.	Yemen	LIC	2011	Universal	PCV13, 3p+0	72% (2020)	32,873	784
21.	Pakistan	LMIC	2012	Universal	PCV10, 3p+0	80% (2020)	476,025	14,418
22.	Djibouti	LMIC	2012	Universal	PCV13, 3p+0	70% (2020)	1240	47
23.	Libya	UMIC	2013	Universal	PCV13, 2p+1	73% (2020)	8024	51
24.	Sudan	LIC	2013	Universal	PCV13, 3p+0	90% (2020)	67,232	3851
25.	Afghanistan	LIC	2013	Universal	PCV13, 3p+0	68% (2020)	179,075	5076
26.	Lebanon	UMIC	2015	Universal	PCV13, 2p+1	74% (2020)	6778	19
27.	Iraq	UMIC	2017	Universal	PCV13, 3p+0	37% (2019)	111,636	1954
28.	Tunisia	LMIC	2019	Universal	PCV10, no data	82% (2020)	14,436	85
WHO: European Region
27.	Italy	HIC	2005	Universal	PCV13, 2p+1	91% (2020)	959	4
28.	France	HIC	2006	Universal	PCV13, 2p+1	92% (2019)	1271	14
29.	Germany	HIC	2006	Universal	PCV10 and PCV13, 2p+1	84% (2019)	1063	7
30.	Turkey	UMIC	2008	Universal	PCV13, 3p+1	95% (2020)	12,072	221
31.	Bulgaria	UMIC	2010	Universal	PCV13, 3p+1	85% (2020)	381	15
32.	Uzbekistan	LMIC	2015	Universal	PCV13, 2p+1	93% (2020)	12,755	1626
WHO: Western Pacific Region
33.	Australia	HIC	2005	Universal	PCV13, 2p+1	97% (2020)	1293	7
34.	New Zealand	HIC	2008	Universal	PCV13, 3p+1	92% (2020)	318	4
35.	Philippines	LMIC	2013	Subnational	PCV10 and PCV13, 3p+1	66% (2020)	296,776	3855
36.	Papua New Guinea	LMIC	2013	Universal	PCV13, 3p+0	39% (2020)	20,713	762
37.	Malaysia	UMIC	2020	Universal	PCV10, 2p+1	No data	39,871	120
WHO: Southeast Asian Region
38.	Nepal	LMIC	2015	Universal	PCV10, 2p+1	80% (2020)	65,542	887
39.	Bangladesh	LMIC	2015	Universal	PCV10, 3p+0	99% (2020)	362,882	4866
40.	Myanmar	LMIC	2016	Universal	PCV13, 3p+0	86% (2020)	133,059	2835
41.	India	LMIC	2017	Universal	PCV10 (Pneumosil^®), 2p+1	21% (2020)	4,408,490	68,697

Notes: PCV10 is used to refer to Synflorix^®, except for the case of India, where Pneumosil^® is being used. Data source: View-Hub.⁵

Abbreviations: WHO, World Health Organization; WUENIC, WHO and UNICEF Estimates of National Immunization Coverage; LIC, Low-income country; UMIC, Upper middle-income country; LMIC, Lower middle-income country; HIC, High-income country; PCV, Pneumococcal conjugate vaccine.

Figure 1 World map highlighting the WUENIC coverage for PCV for the year 2019.

Notes: Map for vaccine coverage for the year 2019 has been shown, as there are no coverage data for Iraq for the year 2020. Data from International Vaccine Access Center [IVAC], Johns Hopkins Bloomberg School of Public Health. VIEW-hub. Accessed March 2022, https://view-hub.org/.⁵

Figure 2 Trends in IPD incidence among children and adults before and following introduction of pneumococcal conjugate vaccines in different countries.

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