title: The burden of pneumococcal disease among Latin American and Caribbean children: review of the evidence.
abstract: OBJECTIVE
  To conduct a comprehensive review of data on pneumococcal disease incidence in Latin America and the Caribbean and project the annual number of pneumococcal disease episodes and deaths among children < 5 years of age in the region.
  
  
  METHODS
  We carried out a systematic review (1990 to 2006) on the burden of pneumococcal disease in children < 5 years of age in the region. We summarized annual incidence rates and case fatality ratios using medians and interquartile ranges for invasive pneumococcal disease (IPD) (including all-IPD and separately abstracting pneumococcal meningitis, pneumonia, bacteremia, and sepsis data), pneumonia (all cause and radiologically confirmed), and acute otitis media by age group: < 1 year, < 2 years, and < 5 years. We modeled age-specific cumulative incidence of disease obtained from standard Kaplan-Meier analysis and projected data to obtain regional estimates of disease burden. We adjusted burden estimates by serotype coverage, vaccination coverage, and vaccine efficacy to estimate the number of cases and deaths averted.
  
  
  RESULTS
  Of 5 998 citations identified, 26 papers from 10 countries were included. The estimated annual burden of pneumonia, meningitis, and acute otitis media caused by pneumococcus in children < 5 years of age ranged from 980 000 to 1 500 000, 2 600 to 6 800, and 980 000 to 1 500 000, respectively. An estimated 12 000 to 28 000 deaths due to pneumococcal disease occur in the region annually. Pneumococcal conjugate vaccine could save 1 life per 1 100 and prevent 1 case per 13 children vaccinated.
  
  
  CONCLUSIONS
  A substantial burden of pneumococcal disease in the region is potentially preventable with pneumococcal conjugate vaccines and should be considered in regional vaccine decision making. Results are limited by the very few studies, conducted in selected settings, included in this review.
authors.affiliation: Universidad de los Andes, Salud Pública y Epidemiología, San Carlos de Apoquindo, Santiago, Chile. mtvalenzuela@uandes.cl
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Valenzuela
authors.forename: Rosalyn
authors.initials: R
authors.lastname: O'Loughlin
authors.forename: Fernando
authors.initials: F
authors.lastname: De La Hoz
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gomez
authors.forename: Dagna
authors.initials: D
authors.lastname: Constenla
authors.forename: Anushua
authors.initials: A
authors.lastname: Sinha
authors.forename: Juan Esteban
authors.initials: JE
authors.lastname: Valencia
authors.forename: Brendan
authors.initials: B
authors.lastname: Flannery
authors.forename: Ciro A
authors.initials: CA
authors.lastname: De Quadros
mesh_terms: D017691:Caribbean Region / Q000453:epidemiology; D002675:Child, Preschool; D017281:Cost of Illness; D006801:Humans; D007223:Infant; D007843:Latin America / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000517:prevention & control