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Objective: To compare the costs and benefits of pneumococcal conjugate vaccination compared with no vaccination from the perspectives of the health care system and society., Methods: Using data from established sources, we estimated the incidence and mortality due to invasive pneumococcal disease, pneumonia, and acute otitis media (AOM) for a hypothetical birth cohort of children from birth to 5 years., Results: A universal pneumococcal conjugate vaccination program was estimated capable of annually avoiding 1 047 cases of invasive disease, 58 226 cases of pneumonia, and 209 862 cases of AOM. When herd immunity effects were considered, the program prevented 1.3 million cases of pneumococcal disease and over 7 000 pneumococcal deaths. At a vaccination cost of R$ 51.12 (US$ 26.35) per dose, vaccination would cost annually R$ 4 289 (US$ 2,211) per disability-adjusted life years averted. This does not take into account herd immunity effects., Conclusions: At the current vaccine price, conjugate vaccination could be a cost-effective investment compared to other options to control childhood diseases. Further analysis is required to determine whether vaccination at the current price is affordable to Brazil.

One of the candidate proteins for a mucosal vaccine antigen against Streptococcus pneumoniae is PsaA (pneumococcal surface antigen A). Vaccines targeting mucosal immunity may raise concerns as to possible alterations in the normal microbiota, especially in the case of PsaA, which was shown to have homologs with elevated sequence identity in other viridans group streptococci. In this work, we demonstrate that intranasal immunization with a cholera toxin B subunit-PsaA fusion protein is able to protect mice against colonization with S. pneumoniae but does not significantly alter the natural oral or nasopharyngeal microbiota of mice.

The distribution of pneumococcal serotypes in Brazil was analyzed by age group and clinical diagnosis, using data obtained during 20 years of national surveillance. Serotypes 1 and 5 remained among the main serotypes in all age groups, increasing in frequency with age. Serotype 14 was prevalent among children, whereas serotypes 3 and 4 were most prevalent among the adult population. The potential impact of the 7- and 9-valent conjugate vaccines on children up to age 5 years with severe pneumococcal diseases was 58.2% and 73%, respectively; the highest coverage of the 7-valent vaccine for pneumonia was achieved for children aged 7 months to 2 years (70%), whereas, for meningitis, it was observed for children aged 7 months to 5 years (58.6%). The use of conjugate vaccine may be of potential benefit by reducing the childhood sequelae and mortality of pneumococcal infection in Brazil.