Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates

Lancet. 2009 Sep 12;374(9693):893-902. doi: 10.1016/S0140-6736(09)61204-6.


Background: Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, and sepsis in children worldwide. However, many countries lack national estimates of disease burden. Effective interventions are available, including pneumococcal conjugate vaccine and case management. To support local and global policy decisions on pneumococcal disease prevention and treatment, we estimated country-specific incidence of serious cases and deaths in children younger than 5 years.

Methods: We measured the burden of pneumococcal pneumonia by applying the proportion of pneumonia cases caused by S pneumoniae derived from efficacy estimates from vaccine trials to WHO country-specific estimates of all-cause pneumonia cases and deaths. We also estimated burden of meningitis and non-pneumonia, non-meningitis invasive disease using disease incidence and case-fatality data from a systematic literature review. When high-quality data were available from a country, these were used for national estimates. Otherwise, estimates were based on data from neighbouring countries with similar child mortality. Estimates were adjusted for HIV prevalence and access to care and, when applicable, use of vaccine against Haemophilus influenzae type b.

Findings: In 2000, about 14.5 million episodes of serious pneumococcal disease (uncertainty range 11.1-18.0 million) were estimated to occur. Pneumococcal disease caused about 826,000 deaths (582,000-926,000) in children aged 1-59 months, of which 91,000 (63,000-102,000) were in HIV-positive and 735,000 (519,000-825,000) in HIV-negative children. Of the deaths in HIV-negative children, over 61% (449,000 [316,000-501,000]) occurred in ten African and Asian countries.

Interpretation: S pneumoniae causes around 11% (8-12%) of all deaths in children aged 1-59 months (excluding pneumococcal deaths in HIV-positive children). Achievement of the UN Millennium Development Goal 4 for child mortality reduction can be accelerated by prevention and treatment of pneumococcal disease, especially in regions of the world with the greatest burden.

Funding: GAVI Alliance and the Vaccine Fund.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Age Distribution
  • Cause of Death
  • Child Mortality
  • Child Welfare / statistics & numerical data*
  • Child, Preschool
  • Cost of Illness*
  • Global Health*
  • HIV Infections / epidemiology
  • HIV Seroprevalence
  • Health Services Accessibility
  • Health Services Needs and Demand
  • Humans
  • Incidence
  • Infant
  • Meningitis, Pneumococcal / economics
  • Meningitis, Pneumococcal / epidemiology*
  • Meningitis, Pneumococcal / prevention & control
  • Pneumococcal Vaccines
  • Pneumonia, Pneumococcal / economics
  • Pneumonia, Pneumococcal / epidemiology*
  • Pneumonia, Pneumococcal / prevention & control
  • Population Surveillance
  • Sepsis / economics
  • Sepsis / epidemiology*
  • Sepsis / prevention & control
  • Streptococcus pneumoniae
  • Vaccination


  • Pneumococcal Vaccines