Burden of Clinical Syndromes Associated with Pneumococcal Disease in Ecuador: A 2019 Perspective

OBJECTIVES: The 10-valent pneumococcal conjugate vaccine (PCV10) has been available for infants in Ecuador’s National Immunization Program (NIP) with vaccination coverage (>70%) since 2011. Currently, routine pneumococcal vaccination for older adults is not available in the NIP. This study aimed to estimate the burden of clinical syndromes associated with pneumococcal disease (PD) in Ecuador in 2019.

METHODS: A secondary analysis was conducted using data from the National Institute of Statistics and Census (INEC) . Clinical syndromes associated with PD (pneumonia, bacteremia, and otitis media) were identified using ICD-10 codes. The study population encompassed all ages for pneumonia and bacteremia, and only children under 5 years (y) for otitis media. Incidence rates were expressed per 100,000 persons and stratified by age group.

RESULTS: In 2019, a total of 75,301 pneumonia cases (39,522 inpatients and 35,779 outpatients) cases and 3,203 bacteremia cases were reported across all age groups. For otitis media, 399 hospitalizations and 11,324 outpatient visits occurred in children under 5y. The age groups most affected by pneumonia and bacteremia were <5y and ≥65y. Among those aged ≥65y, 62.7% of pneumonia cases were inpatient; the highest incidence rates observed were for inpatient pneumonia (877.5/100,000), followed by outpatient pneumonia (522.5/100,000), and bacteremia (109.3/100,000). The in-hospital case-fatality rate was higher in individuals aged ≥65y (10.6% for pneumonia and 41.8% for bacteremia). In children aged <1y, inpatient pneumonia had the highest incidence rate (2,309/100,000), followed by outpatient pneumonia (2,136/100,000) and outpatient otitis media (661.3/100,000). Of concern, 49% of pneumonia hospitalizations were observed in children < 5y, while 74% of deaths occurred in adults ≥65y.

CONCLUSIONS: The burden of clinical syndromes associated with PD was high in Ecuador, affecting mainly children under 5y and adults ≥65y. Strengthening surveillance and immunization strategies by increasing vaccine coverage and expanding programs to older adults may reduce the burden of PD.