Economic burden of pneumococcal infections in children under 5 years of age

Ceyhan, Mehmet; Ozsurekci, Yasemin; Aykac, Kubra; Hacibedel, Basak; Ozbilgili, Egemen

Pneumonia, meningitis, and acute otitis media (AOM) are substantial pediatric public health problems worldwide. 1 In this group of diseases, Streptococcus pneumoniae (pneumococcus) is the major global etiological cause of pneumonia and accounts for 36% of overall childhood pneumonia. 2 As invasive Haemophilus influenzae type b infections decrease, pneumococcus has become the leading cause of bacterial meningitis among children aged 5 years or below and is also isolated in 28%-55% of middle ear aspirates from AOM cases. 3 According to the World Health Organization (WHO) estimates, approximately 1.6 million people die of pneumococcal diseases each year 4 and 0.7-1 million of these deaths occur in children under the age of 5 years. 2 Although case fatality rate due to pneumococcal infections is substantially high in developing countries, it is also considerable in developed countries. While case fatality rate of pneumococcal meningitis was reported as 48% in hospitalized children in Gambia, 5 this rate has been reported as high as 20% in developed countries. 6 According to the results of a study evaluating the global disease burden of pneumonia in children under the age of 5 years, pneumococcal diseases accounted for approximately 11% of overall deaths. 1 Further analyses of the same study revealed that the mortality rate was 119 (87-130) per 100,000 and the case-fatality rate was 5% (4%-9%) for pneumococcal pneumonia; however, for pneumococcal meningitis, the case-fatality rate was as high as 59% (27%-80%) despite the mortality rate of 10 (4-13) per 100,000. Within the European region (including Turkey) identified by WHO, the mortality rate was 25 (18-28) per 100,000 and the case-fatality rate was 5% (4%-9%) for pneumococcal pneumonia, whereas these rates were 3 (2-4) per 100,000 and 38% (32%-58%), respectively, for pneumococcal meningitis. The differences in quality and accessibility of healthcare services may create differences between countries.