{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:42:15Z","timestamp":1791384135582,"version":"4.3.3"},"update-to":[{"DOI":"10.1371\/journal.pmed.1003537","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T00:00:00Z","timestamp":1614643200000}}],"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T00:00:00Z","timestamp":1613433600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Data on the national-level impact of pneumococcal conjugate vaccine (PCV) introduction on mortality are lacking from Africa. PCV was introduced in South Africa in 2009. We estimated the impact of PCV introduction on all-cause pneumonia mortality in South Africa, while controlling for changes in mortality due to other interventions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>We used national death registration data in South Africa from 1999 to 2016 to assess the impact of PCV introduction on all-cause pneumonia mortality in all ages, with the exclusion of infants aged &lt;1 month. We created a composite (synthetic) control using Bayesian variable selection of nondiarrheal, nonpneumonia, and nonpneumococcal deaths to estimate the number of expected all-cause pneumonia deaths in the absence of PCV introduction post 2009. We compared all-cause pneumonia deaths from the death registry to the expected deaths in 2012 to 2016. We also estimated the number of prevented deaths during 2009 to 2016. Of the 9,324,638 deaths reported in South Africa from 1999 to 2016, 12\u00b76% were pneumonia-related.<\/jats:p>\n<jats:p>Compared to number of deaths expected, we estimated a 33% (95% credible interval (CrI) 26% to 43%), 23% (95%CrI 17% to 29%), 25% (95%CrI 19% to 32%), and 23% (95%CrI 11% to 32%) reduction in pneumonia mortality in children aged 1 to 11 months, 1 to 4 years, 5 to 7 years, and 8 to 18 years in 2012 to 2016, respectively. In total, an estimated 18,422 (95%CrI 12,388 to 26,978) pneumonia-related deaths were prevented from 2009 to 2016 in children aged &lt;19 years. No declines were estimated observed among adults following PCV introduction. This study was mainly limited by coding errors in original data that could have led to a lower impact estimate, and unmeasured factors could also have confounded estimates.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study found that the introduction of PCV was associated with substantial reduction in all-cause pneumonia deaths in children aged 1 month to &lt;19 years. The model predicted an effect of PCV in age groups who were eligible for vaccination (1 months to 4 years), and an indirect effect in those too old (8 to 18 years) to be vaccinated. These findings support sustaining pneumococcal vaccination to reduce pneumonia-related mortality in children.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1003537","type":"journal-article","created":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T22:23:42Z","timestamp":1613514222000},"page":"e1003537","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":32,"title":["Estimated impact of the pneumococcal conjugate vaccine on pneumonia mortality in South Africa, 1999 through 2016: An ecological modelling study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7081-6273","authenticated-orcid":true,"given":"Jackie","family":"Kleynhans","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4395-347X","authenticated-orcid":true,"given":"Stefano","family":"Tempia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8057-8448","authenticated-orcid":true,"given":"Kayoko","family":"Shioda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0243-7455","authenticated-orcid":true,"given":"Anne","family":"von Gottberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Weinberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,16]]},"reference":[{"issue":"11","key":"pmed.1003537.ref001","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1016\/S1473-3099(17)30396-1","article-title":"Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015","volume":"17","author":"GBD 2015 LRI Collaborators.","year":"2017","journal-title":"Lancet Infect Dis"},{"issue":"9875","key":"pmed.1003537.ref002","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/S0140-6736(13)60222-6","article-title":"Global burden of childhood pneumonia and diarrhoea","volume":"381","author":"CLF Walker","year":"2013","journal-title":"Lancet"},{"key":"pmed.1003537.ref003","doi-asserted-by":"crossref","first-page":"e6085","DOI":"10.7717\/peerj.6085","article-title":"The impact of pneumococcal vaccination on pneumonia mortality among the elderly in Japan: a difference-in-difference study","volume":"6","author":"SM Jung","year":"2018","journal-title":"PeerJ"},{"issue":"2","key":"pmed.1003537.ref004","doi-asserted-by":"crossref","first-page":"e249","DOI":"10.1016\/S2214-109X(18)30455-8","article-title":"Effect of pneumococcal conjugate vaccine introduction on childhood pneumonia mortality in Brazil: a retrospective observational study","volume":"7","author":"C Schuck-Paim","year":"2019","journal-title":"Lancet Glob Health"},{"key":"pmed.1003537.ref005","author":"LHd Oliveira","year":"2019","journal-title":"Declines in Pneumonia Mortality Following the Introduction of Pneumococcal Conjugate Vaccines in Latin American and Caribbean Countries"},{"issue":"8","key":"pmed.1003537.ref006","doi-asserted-by":"crossref","first-page":"e0183348","DOI":"10.1371\/journal.pone.0183348","article-title":"Changes in the incidence of pneumonia, bacterial meningitis, and infant mortality 5 years following introduction of the 13-valent pneumococcal conjugate vaccine in a \"3+0\" schedule","volume":"12","author":"S Becker-Dreps","year":"2017","journal-title":"PLoS ONE"},{"key":"pmed.1003537.ref007","unstructured":"World Health Organization. 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