{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:01:40Z","timestamp":1791309700208,"version":"4.3.1"},"reference-count":56,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,1,22]],"date-time":"2020-01-22T00:00:00Z","timestamp":1579651200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: Invasive and non-invasive pneumococcal diseases are significant health and economic burdens, especially in children and the elderly. Italy included the 7-valent (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) in the National Immunization Program in 2007 and 2010, respectively, allowing a dramatic reduction in the burden of pneumococcal disease. In the era of budget constraints, decision-makers may consider switching from the higher-valent, more costly PCV13, to the lower-cost PCV10. This study estimated the potential public health and economic impact of changing vaccine programs from PCV13 to PCV10 in Italy. Methods: A decision-analytic forecasting model estimated the impact of PCV programs. Real-world surveillance data were used to forecast serotype distribution and disease incidence among children and the elderly over a specified 5-year time horizon. Costs and outcomes included estimates of cases and deaths avoided, quality-adjusted life years (QALYs) gained, and total costs from a payer perspective, discounted at an assumed rate of 3.0%, and robustness validated through several scenarios and sensitivity analyses. Results: A switch from PCV13 to PCV10 would increase invasive pneumococcal disease (IPD) cases by 59.3% (4317 cases) over a 5-year horizon, primarily due to serotypes 3 and 19A. Pneumonia increased by 8.3% and acute otitis media (AOM) by 96.1%. Maintaining a PCV13 program would prevent a total incremental 531,435 disease cases (1.02M over a 10-year time horizon) and 641 deaths due to invasive pneumococcal disease (IPD), with \u20ac23,642 per QALY gained over 5 years versus PCV10. One-way and probabilistic sensitivity analyses showed that a PCV13-based program remained cost-effective in 99.7% of the simulations in Italy as parameters varied within their plausible range; percent vaccinated had the most impact. Conclusions: Maintaining the PCV13 strategy would provide substantial public health and economic benefits in Italy and is cost-effective. Switching from PCV13 to PCV10 would increase the incidence of pneumococcal disease primarily linked to re-emergence of serotypes 3 and 19A.<\/jats:p>","DOI":"10.3390\/pathogens9020076","type":"journal-article","created":{"date-parts":[[2020,1,22]],"date-time":"2020-01-22T11:17:57Z","timestamp":1579691877000},"page":"76","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Estimating the Clinical and Economic Impact of Switching from the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) to the 10-Valent Pneumococcal Conjugate Vaccine (PCV10) in Italy"],"prefix":"10.3390","volume":"9","author":[{"given":"Filippo","family":"Ansaldi","sequence":"first","affiliation":[{"name":"Department of Health Sciences, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS San Martino University Hospital, 16132 Genoa, Italy"},{"name":"Liguria Health Authority, A.Li.Sa., 16121 Genoa, Italy"},{"name":"CIRI-IT, Centre of Influenza and other Respiratory Infections, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4347-2561","authenticated-orcid":false,"given":"Sarah","family":"Pugh","sequence":"additional","affiliation":[{"name":"Pfizer, Collegeville, PA 19426, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9707-5214","authenticated-orcid":false,"given":"Daniela","family":"Amicizia","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS San Martino University Hospital, 16132 Genoa, Italy"},{"name":"Liguria Health Authority, A.Li.Sa., 16121 Genoa, Italy"},{"name":"CIRI-IT, Centre of Influenza and other Respiratory Infections, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Di Virgilio","sequence":"additional","affiliation":[{"name":"Pfizer, 00188 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4633-202X","authenticated-orcid":false,"given":"Cecilia","family":"Trucchi","sequence":"additional","affiliation":[{"name":"IRCCS San Martino University Hospital, 16132 Genoa, Italy"},{"name":"Liguria Health Authority, A.Li.Sa., 16121 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2433-9610","authenticated-orcid":false,"given":"Andrea","family":"Orsi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS San Martino University Hospital, 16132 Genoa, Italy"},{"name":"CIRI-IT, Centre of Influenza and other Respiratory Infections, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Zollo","sequence":"additional","affiliation":[{"name":"Pfizer, 00188 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8463-8487","authenticated-orcid":false,"given":"Giancarlo","family":"Icardi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS San Martino University Hospital, 16132 Genoa, Italy"},{"name":"CIRI-IT, Centre of Influenza and other Respiratory Infections, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,22]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2012). Pneumococcal vaccines WHO position paper\u20142012. Wkly. Epidemiol. Rec., 87, 129\u2013144."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S1473-3099(05)70083-9","article-title":"Epidemiological differences among pneumococcal serotypes","volume":"5","author":"Hausdorff","year":"2005","journal-title":"Lancet Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2897","DOI":"10.1016\/j.vaccine.2015.04.068","article-title":"The 23-valent pneumococcal polysaccharide vaccine is effective in elderly adults over 75 years old-Taiwan\u2019s PPV vaccination program","volume":"3","author":"Tsai","year":"2015","journal-title":"Vaccine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"6802","DOI":"10.1016\/j.vaccine.2012.09.019","article-title":"Impact and effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive pneumococcal disease in the elderly in England and Wales","volume":"30","author":"Andrews","year":"2012","journal-title":"Vaccine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1080\/21645515.2017.1409316","article-title":"Effectiveness and practical uses of 23-valent pneumococcal polysaccharide vaccine in healthy and special populations","volume":"14","author":"Wang","year":"2018","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Htar, M.T.T., Stuurman, A.L., Ferreira, G., Alicino, C., Bollaerts, K., Paganino, C., Reinert, R.R., Schmitt, H.J., Trucchi, C., and Vestraeten, T. (2017). Effectiveness of pneumococcal vaccines in preventing pneumonia in adults, a systematic review and meta-analyses of observational studies. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0177985"},{"key":"ref_7","unstructured":"Ministero della Salute (2010, June 03). DGPRV 0024720-P-27\/05\/2010. Indicazioni in merito alla somministrazione del vaccino antipneumococcico Prevenar 13 in et\u00e0 pediatrica, Available online: https:\/\/www.google.com.hk\/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwjJy_qyrtjnAhXizIsBHaumC8UQFjAAegQIBhAB&url=https%3A%2F%2Fwww.fimpcalabria.org%2Fpublic%2Fvaccinazioni%2Findicazioni%2520in%2520merito%2520alla%2520somministrazione%2520del%2520vaccino%2520antipneumococcico%2520prevenar%252013%2520in%2520et%25C3%25A0%2520pediatrica%2520(2).pdf&usg=AOvVaw3c-X61f4k77BZQmseiR3VL."},{"key":"ref_8","unstructured":"Centro Nazionale di Epidemiologia (2019, March 20). Dati e Evidenze Disponibili per L\u2019utilizzo dei Vaccini Anti-Pneumococcici nei Soggetti a Rischio di Qualsiasi et\u00e0 e per L\u2019eventuale Ampliamento Dell\u2019offerta ai Soggetti Anziani. Available online: http:\/\/www.epicentro.iss.it\/vaccini\/pdf\/Dati%20e%20evidenze%20vaccini%20antipneumococcici.pdf."},{"key":"ref_9","unstructured":"Epicentro: Il Portale Dell\u2019epidemiologia per la Sanit\u00e0 Pubblica (2019, April 01). Le Vaccinazioni in Italia. Copertura Vaccinale. Available online: http:\/\/www.epicentro.iss.it\/vaccini\/dati_ita."},{"key":"ref_10","unstructured":"Italian Minister of Health (2019, April 01). National Prevention Immunization Plan, Available online: www.salute.gov.it\/imgs\/C_17_pubblicazioni_2571_allegato.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1007\/s12325-014-0157-1","article-title":"Recommendations for pneumococcal immunization outside routine childhood immunization programs in Western Europe","volume":"31","author":"Castiglia","year":"2014","journal-title":"Adv. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Orsi, A., Ansaldi, F., Trucchi, C., Rosselli, R., and Icardi, G. (2016). Pneumococcus and the elderly in Italy: A summary of available evidence regarding carriage, clinical burden of lower respiratory tract infections and on-field effectiveness of PCV13 vaccination. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17071140"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/S1473-3099(18)30346-3","article-title":"Switch in a childhood pneumococcal vaccination programme from PCV13 to PCV10: A defendable approach?","volume":"18","author":"Desmet","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/S1473-3099(18)30410-9","article-title":"Interpretation of the switch in a childhood pneumococcal vaccination programme from PCV13 to PCV10 in Belgium","volume":"18","author":"Izurieta","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4587","DOI":"10.1016\/j.vaccine.2017.07.010","article-title":"Impact of pneumococcal conjugate vaccine (PCV7 and PCV13) on pneumococcal invasive diseases in Italian children and insight into evolution of pneumococcal population structure","volume":"35","author":"Camilli","year":"2017","journal-title":"Vaccine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s40121-018-0206-1","article-title":"Clinical and economic impact of a potential switch from 13-valent to 10-valent pneumococcal conjugate infant vaccination in Canada","volume":"7","author":"Wilson","year":"2018","journal-title":"Infect. Dis. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1080\/21645515.2018.1516491","article-title":"Modeling the sustained use of the 13-valent pneumococcal conjugate vaccine compared to switching to the 10-valent vaccine in Mexico","volume":"15","author":"Wasserman","year":"2019","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5766","DOI":"10.1016\/j.vaccine.2018.07.078","article-title":"How cost effective is switching universal vaccination from PCV10 to PCV13? A case study from a developing country","volume":"36","year":"2018","journal-title":"Vaccine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1586\/17476348.2013.816572","article-title":"Advanvces in pneumococcal antibiotic resistence","volume":"7","author":"Song","year":"2013","journal-title":"Exp. Rev. Respir. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.15585\/mmwr.mm6846a5","article-title":"Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged \u226565 Years: Updated recommendations of the Advisory Committee on Immunization Practices","volume":"68","author":"Matanock","year":"2019","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1080\/21645515.2017.1343773","article-title":"Overall effectiveness of pneumococcal conjugate vaccines: An economic analysis of PHiD-CV and PCV-13 in the immunization of infants in Italy","volume":"13","author":"Castiglia","year":"2017","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_22","unstructured":"Pastor, L., Sings, H., Hilton, B., Kohli, M., Kruse, M., and Wasserman, M. (2017, January 23\u201327). A systematic review of pneumococcal conjugate vaccine (PCV) impact on acute otitis media (OM) and nasopharyngeal carriage (NP) due to nontypeable haemophilus influenza (NTHi). Proceedings of the 35th Annual Meeting of the European Society for Paediatric Infectious Diseases, Madrid, Spain."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1080\/14760584.2018.1409116","article-title":"Review of vaccine effectiveness assumptions used in economic evaluations of infant pneumococcal conjugate vaccine","volume":"17","author":"Wasserman","year":"2018","journal-title":"Expert Rev. Vaccines"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"614","DOI":"10.4161\/hv.23253","article-title":"Carriage of Streptoccoccus pneumoniae in healthy adults aged 60 years or over in a population with very high and long-lasting pneumococcal conjugate vaccine coverage in children: Rationale and perspectives for PCV13 implementation","volume":"9","author":"Ansaldi","year":"2013","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2288","DOI":"10.1016\/j.vaccine.2012.01.067","article-title":"Carriage of Streptoccoccus pneumoniae 7 years after implementation of vaccination program in a population with very high and long-lasting coverage, Italy","volume":"30","author":"Ansaldi","year":"2012","journal-title":"Vaccine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"12868","DOI":"10.1073\/pnas.1717157115","article-title":"Antimicrobial resistance and the role of vaccines","volume":"115","author":"Bloom","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"eaaj2345","DOI":"10.1126\/scitranslmed.aaj2345","article-title":"The broad socioeconomic benefits of vaccination","volume":"10","author":"Bloom","year":"2018","journal-title":"Sci. Transl. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1016\/j.vaccine.2018.03.001","article-title":"Long-term impact of 10-valent pneumococcal conjugate vaccination on invasive pneumococcal disease among children in Finland","volume":"36","author":"Palmu","year":"2018","journal-title":"Vaccine"},{"key":"ref_29","unstructured":"Epicentro (2019, June 01). Vaccinazioni Dell\u2019et\u00e0 Pediatrica e Dell\u2019adolescente\u2014Coperture Vaccinali, Available online: http:\/\/www.salute.gov.it\/portale\/documentazione\/p6_2_8_3_1.jsp?lingua=italiano&id=20."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"9521","DOI":"10.1016\/j.vaccine.2011.10.013","article-title":"Economic and clinical evaluation of a catch-up dose of 13-valent pneumococcal conjugate vaccine in children already immunized with three doses of the 7-valent vaccine in Italy","volume":"29","author":"Boccalini","year":"2011","journal-title":"Vaccine"},{"key":"ref_31","first-page":"134","article-title":"Invasive pneumococcal disease in children and adults in seven Italian regions after the introduction of the conjugate vaccine, 2008\u20132014","volume":"39","author":"Caporali","year":"2015","journal-title":"Epidemiol. Prev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4203","DOI":"10.1016\/j.vaccine.2004.05.003","article-title":"Cost-effectiveness analysis of pneumococcal conjugate vaccination in England and Wales","volume":"22","author":"Melegaro","year":"2004","journal-title":"Vaccine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1017\/S0950268813002744","article-title":"Incidence and clinical presentation of acute otitis media in children aged <6 years in European medical practices","volume":"142","author":"Liese","year":"2014","journal-title":"Epidemiol. Infect."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1177\/147323000803600612","article-title":"Decline in pneumonia and acute otitis media after the introduction of childhood pneumococcal vaccination in Liguria, Italy","volume":"6","author":"Ansaldi","year":"2008","journal-title":"J. Int. Med. Res."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Baldo, V., Cocchio, S., Baldovin, T., Buja, A., Furlan, P., Bertoncello, C., Russo, F., and Saia, M. (2014). A population-based study on the impact of hospitalization for pneumonia in different age groups. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-485"},{"key":"ref_36","first-page":"131","article-title":"Emergency department syndromic surveillance system for early detection of 5 syndromes: A pilot project in a reference teaching hospital in Genoa, Italy","volume":"49","author":"Ansaldi","year":"2008","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_37","first-page":"1349","article-title":"Keuhkokuumeen aiheuttama sairaalahoidon tarve nyt ja tulevaisuudessa","volume":"68","author":"Koskela","year":"2013","journal-title":"Suomen L\u00e4\u00e4k\u00e4rilehti"},{"key":"ref_38","unstructured":"Epicentro (2019, April 06). Malattie Batteriche Invasive (Sepsi e Meningiti). Available online: https:\/\/www.epicentro.iss.it\/meningite\/aggiornamenti."},{"key":"ref_39","unstructured":"WHO Commission on Macroeconomics and Health (2001). Macroeconomics and Health: Investing in Health for Economic Development. Report of the Commission on Macroeconomics and Health, World Health Organization."},{"key":"ref_40","unstructured":"(2019, April 06). Cost Effectiveness and Strategic Planning (WHO-CHOICE). Available online: https:\/\/www.who.int\/choice\/costs\/en\/."},{"key":"ref_41","unstructured":"(2019, April 06). Tariffe Dell\u2019assistenza Ospedaliera per Acuti, Published on Official Gazette No 23 dated 28 January 2013. Available online: https:\/\/www.gazzettaufficiale.it\/eli\/id\/2013\/01\/28\/13A00528\/sg."},{"key":"ref_42","first-page":"S36","article-title":"Valutazione economica del vaccino coniugato 13-valente","volume":"7","author":"Mantovani","year":"2010","journal-title":"JPH"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"699","DOI":"10.4161\/hv.23268","article-title":"Cost-effectiveness of new adult pneumococcal vaccination strategies in Italy","volume":"9","author":"Boccalini","year":"2013","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_44","unstructured":"(2019, April 02). Italian Census. Available online: www.istat.it."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1080\/14737167.2017.1330152","article-title":"Recent amendments to NICE\u2019s value-based assessment of health technologies: Implicitly inequitable?","volume":"17","author":"Paulden","year":"2017","journal-title":"Expert Rev. Pharmacoecon. Outcomes Res."},{"key":"ref_46","unstructured":"WHO (2008). WHO Guide for Standardization of Economic Evaluations of Immunization Programmes, World Health Organization. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/69981."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1007\/s40273-018-0672-z","article-title":"Discounting in Economic Evaluations","volume":"3","author":"Attema","year":"2018","journal-title":"Pharmacoeconomics"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"5485","DOI":"10.1016\/j.vaccine.2010.05.058","article-title":"Pharmacoeconomic evaluation of 10- and 13-valent pneumococcal conjugate vaccines","volume":"28","author":"Chuck","year":"2010","journal-title":"Vaccine"},{"key":"ref_49","first-page":"43","article-title":"Parents\u2019 utilities for outcomes of occult bacteremia","volume":"154","author":"Bennett","year":"2000","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1001\/archotol.125.11.1214","article-title":"Cost-utility of the cochlear implant in adults: A meta-analysis","volume":"125","author":"Cheng","year":"1999","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/S0895-4356(02)00448-1","article-title":"The EQ-5D and the Health Utilities Index for permanent sequelae after meningitis: A head-to-head comparison","volume":"55","author":"Oostenbrink","year":"2002","journal-title":"J. Clin. Epidemiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1155\/2007\/713576","article-title":"The burden of pneumococcal disease in the Canadian population before routine use of the seven-valent pneumococcal conjugate vaccine","volume":"18","author":"Morrow","year":"2007","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"ref_53","unstructured":"(2019, May 16). The National Immunization Programme in the Netherlands: RIVM. LCI Guideline. Available online: https:\/\/lci.rivm.nl\/richtlijnen\/pneumokokkenziekte-invasief."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/S1473-3099(15)00549-6","article-title":"Prevention of early episodes of otitis media by pneumococcal vaccines might reduce progression to complex disease","volume":"16","author":"Dagan","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Tregnaghi, M.W., Saez-Llorens, X., L\u00f3pez, P., Abate, H., Smith, E., P\u00f3sleman, A., Calvo, A., Wong, D., Cortes-Barbosa, C., and Ceballos, A. (2014). Efficacy of Pneumococcal Nontypable Haemophilus influenzae Protein D Conjugate Vaccine (PHiD-CV) in Young Latin American Children: A Double-Blind Randomized Controlled Trial. PLoS Med., 11.","DOI":"10.1371\/journal.pmed.1001657"},{"key":"ref_56","first-page":"611","article-title":"Impact of widespread introduction of pneumococcal conjugate vaccines on pneumococcal and nonpneumococcal otitis media","volume":"6","author":"Leibovitz","year":"2016","journal-title":"Clin. Infect. Dis."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/9\/2\/76\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:44:26Z","timestamp":1760363066000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/9\/2\/76"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,22]]},"references-count":56,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,2]]}},"alternative-id":["pathogens9020076"],"URL":"https:\/\/doi.org\/10.3390\/pathogens9020076","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,22]]}}}