Effects and costs of pneumococcal conjugate vaccination of Belgian children

Pneumococcal vaccination of children i FOREWORDVaccinations are an extremely successful chapter in the history of medicine Since the first experiments performed by Jenner in the late 18 th century with cowpox, many serious infectious diseases have been combated through vaccinations.In 1980 the world could even be declared 'free from smallpox'.Part of this success was explained through a unique feature of vaccination as a technique, the fact that also non-vaccinated individuals are protected since the germ becomes less prevalent in the environment, the so-called ' herd immunity' .Vaccination used to be save, efficient and cheap and the number of infectious diseases for which vaccination became routine has grown in recent years.Consequently, questions about the advisability of the introduction of new vaccinations were seldom asked: if it did the job it needed to be done.Streptococcus pneumoniae (pneumococcus) are bacteria that are often present in the upper airways in children and adults and that do not necessarily lead to disease.They can, however, cause serious diseases such as pneumonia, meningitis or sepsis but more often they will lead to less serious disorders such as ear-or upper respiratory tract infections.But, the less frequent severe infections are potentially lethal and can occasionally lead to serious neurological damage.The incidence of pneumococcal disease is strongly age-dependent and at risk are mainly children up to the age of 5 and adults aged 65 and over.At the moment a pneumococcal vaccine for young children came to the market in Belgium, the question was raised whether this should be included into routine vaccination schedules.The vaccine might be efficient but is also expensive.At this moment the complete vaccination scheme with 4 injections costs over 250 € per child, a cost paid by the parents or partly reimbursed by the sick fund.To evaluate whether universal vaccination of newborns would be appropriate usage of available means, and how this vaccination should be implemented, the KCE was asked to conduct a health technology assessment (HTA).The outcome of this evaluation was uncertain: earlier economic evaluations disagreed, local determinant had to be included as was the effect of ' herd immunity', and to obtain reliable estimates for Belgium using local data was essential.This report is the result of an intensive cooperation of several partners and was conducted under important time constraints.These constraints, however, were not allowed to interfere with quality.Considering the anticipated arrival of several new vaccines in the near future this report might be a trendsetter.We hope this report will help policymakers to use available resources effectively, using a rational health economic approach.

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