Background: Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, and sepsis in children worldwide. However, many countries lack national estimates of disease burden. Effective interventions are available, including pneumococcal conjugate vaccine and case management. To support local and global policy decisions on pneumococcal disease prevention and treatment, we estimated country-specific incidence of serious cases and deaths in children younger than 5 years. Methods: We measured the burden of pneumococcal pneumonia by applying the proportion of pneumonia cases caused by S pneumoniae derived from efficacy estimates from vaccine trials to WHO country-specific estimates of all-cause pneumonia cases and deaths. We also estimated burden of meningitis and non-pneumonia, non-meningitis invasive disease using disease incidence and case-fatality data from a systematic literature review. When high-quality data were available from a country, these were used for national estimates. Otherwise, estimates were based on data from neighbouring countries with similar child mortality. Estimates were adjusted for HIV prevalence and access to care and, when applicable, use of vaccine against Haemophilus influenzae type b. Findings: In 2000, about 14·5 million episodes of serious pneumococcal disease (uncertainty range 11·1-18·0 million) were estimated to occur. Pneumococcal disease caused about 826 000 deaths (582 000-926 000) in children aged 1-59 months, of which 91 000 (63 000-102 000) were in HIV-positive and 735 000 (519 000-825 000) in HIV-negative children. Of the deaths in HIV-negative children, over 61% (449 000 [316 000-501 000]) occurred in ten African and Asian countries. Interpretation: S pneumoniae causes around 11% (8-12%) of all deaths in children aged 1-59 months (excluding pneumococcal deaths in HIV-positive children). Achievement of the UN Millennium Development Goal 4 for child mortality reduction can be accelerated by prevention and treatment of pneumococcal disease, especially in regions of the world with the greatest burden. Funding: GAVI Alliance and the Vaccine Fund.
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