Incidence of pneumonia is not reduced by pneumococcal conjugate vaccine.

Madhi et al. write that the pneumococcal conjugate vaccine (PCV) is an effective instrument for pneumonia prevention in children. This is not strictly true. WHO data suggest that there are 450 million cases of pneumonia each year and that it causes 3.9 million deaths. In the sub-Saharan region of Africa, 1 022 000 die and 702 000 die in south Asia. The pneumonia referred to is “clinical pneumonia” – a diagnostic syndrome within the Integrated Management of Childhood Illness – WHO and United Nations Children’s Fund (UNICEF) system for triage and clinical management in developing countries. The Cochrane database states that PCV does not reduce the incidence of clinical pneumonia, although it has been shown to reduce vaccine-serotype bacteraemic pneumonia and radiological pneumonia. The benefit of reducing bacteraemic pneumonia and radiological pneumonia is so minimal that it has no effect on “clinical pneumonia”. Poor nations will need to assess its cost utility carefully.