The Pnc polysaccharide vaccine is recommended for use in risk groups, including children above 2 years of age in most rich countries (Fedson et al., 2004; Pebody et al., 2005). How well the target groups are being reached is unclear as most countries do not have adequately functioning vaccine registries which could be linked to disease specific registries to understand the association between PPV vaccine coverage and age-specific effectiveness of PPV.
Presently very few countries have introduced PCV universally into their national vaccination program. First was the United States in the year 2000. This decision was backed up by favorable cost-effectivess predictions (Lieu et al., 2000). The first European country to introduce PCV on universal basis was Luxembourg in year 2004 (Pebody et al., 2005). Most other rich countries have recommendations for the use of PCV in risk groups only, the cost of which is covered either by the state or insurance. The reason for this selective approach is both the high cost of the vaccine and the uncertainty of the disease burden which could be prevented as well as concern about the impact of serotype replacement. Accordingly, more dynamic cost-effectiveness models have been constructed to allow for sensitivity analyses which take these different predictions into consideration (Melegaro et al., 2004).
None of the resource poor countries have introduced PCV into their national programs to date. The Global Alliance of Vaccines and Immunizations is working together with WHO to establish new funding mechanisms to cover the high cost of PCV introduction.
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