Focus on What You Think - Special Section

IVAC administered a set of 4 surveys at the 7th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD) in Tel Aviv, Israel, in March 2010, covering issues including: serotype replacement; vaccine efficacy, schedule, and affordability; pneumonia beliefs and programs; and vaccine introductions. Most of the 257 respondents came from European or American regions (WHO regions), though a substantial number came from the Western Pacific, South-East Asian, and African Regions. We present some of the key findings of these surveys here.

Vaccine efficacy, schedule, and affordability: PCV booster shots in the second year of life were rated as important or very important by more than 90% of those surveyed. Half of the respondents believed the booster to be equally important in high- and low-incidence countries, while 38% believed that the booster was more important in high-incidence countries.

Serotype replacement: The survey revealed a lack of consensus in the scientific community over the definition of serotype replacement, the severity of the problem, and the scope and likelihood of serotype replacement. Respondents were split between whether serotype replacement was “a big problem” (30/65, 42%) or “a concern but not a big problem” (n= 30/65, 42%). The serotype of greatest concern to respondents as a potential cause of non-vaccine type replacement disease was 19A.

Disease perceptions: Nearly 80% of respondents identified pneumonia as the leading killer of children worldwide over malaria, rotavirus, HIV, and other diseases. However, nearly half reported that pneumonia is not considered a common or important cause of child death in their countries. The presence of other important public misconceptions was reported by a substantial number of respondents.

Pneumonia Control Strategies: Half of those surveyed believed that Hib and PCV introduction were the most promising and feasible solutions for global pneumonia control, while most of the remaining respondents indicated that comprehensive policies encompassing multiple interventions were necessary. Similarly, a majority of respondents expressed a desire for programs and advocates that combine pneumonia control efforts with systems to address diarrhea and other diseases, highlighting the importance of collaborative efforts to address the disease through all proven means.

Full results from this survey will be available at www.preventpneumo.org shortly.

Media

1.Donors urged to recommit to saving lives through child vaccinations
In Geneva, the GAVI Alliance Board met on June 15 and 16 to discuss next steps in expanding vaccine access in low-income countries. The board prepared to move forward with 15 applications as well as to open a new round of applications. Plans to continue immunization programs and introduce pneumococcal and rotavirus vaccines will cost an estimated $4.3 billion across the next five years—$2.6 billion of which still needs to be raised. If sufficient funds are made available, GAVI projects that the program will vaccinate 240 million children and save four million additional lives by 2015. GAVI Board Chair Mary Robinson said, “Children have a right to health and we have it in our power to set them on a path to healthy and productive lives. There comes a time to stop talking and start doing. I sincerely hope that we will see donors put their money on the table. Without this funding for immunization, the world will not reach Millennium Development Goal 4 to reduce under-five mortality by two-thirds by 2015.”

2.Gates Foundation to spend $1.5B to improve maternal and child health
This month, Melinda Gates announced the Foundation’s plan to spend $1.5 billion across the next five years to improve maternal and child health internationally. Speaking at the Women Deliver Conference in Washington DC on June 7, Gates emphasized the importance of a holistic approach to health that includes family planning, pre- and post-natal care, safer delivery practices, and vaccinations. U.N. Secretary-General Ban Ki-moon also spoke on the need for increased funding and attention for maternal and child health from countries of all income levels.

3.Day of the African Child observance emphasizes need for greater investment in child health
June 16 marked the Day of the African Child, a memorial event which honors the South African children killed in a 1976 protest march. On this historic day, local and international organizations reflected on gains made in child health and development as well as the significant challenges that remain. With over four million African children dying each year—many from preventable causes such as pneumonia and diarrhea—organizers in Cameroon, Liberia, Somalia, Kenya, and many other countries called for increases in national health sector spending.

4.G-8 and G-20 meetings present opportunity to accelerate progress towards MDG4
On June 25 and 26, world leaders will meet at the G-8 and G-20 meetings in Canada. In advance of the meeting, Save the Children urged G-8 members to commit to increased spending in maternal and child health, ONE hosted a panel discussion on historic G-8 spending performance, and the Make Poverty History coalition reported on host country Canada’s foreign aid practices. Leaders are expected to discuss a recommitment to international maternal and child health in order to meet MDG goals.
The Global Coalition against Child Pneumonia and a group of Dean’s of Schools of Public Health, including Dean Mike Klag of Johns Hopkins Bloomberg School, have addressed letters to G8 leaders calling on them to take urgent action to address the major killers of children including pneumonia, diarrhea and malaria. G8 countries are urged to honor and increase committed funding to proven interventions for child survival including bednets, prevention of mother to child transmission of HIV, immunization generally and, for pneumonia, to additionally empower the global community to implement the Global Action Plan for the Prevention and Control of Pneumonia and increase awareness of this the world’s biggest killer of children.

5.13-valent pneumococcal vaccine available in the Philippines
This month in the Philippines, Pfizer introduced Prevnar 13 for the prevention of child pneumonia, meningitis, and sepsis. As one of the top 15 high-burden countries for pneumonia, in 2000, the Philippines was estimated to have over 13,500 deaths due to pneumonia each year among children under five, excluding neonates (O’Brien et al, Lancet 2009). Pfizer announced plans to donate Prevenar 13 doses to be delivered by World Vision.

6.AAP replaces PCV7 with PCV13 in vaccination guidelines; urges better doctor-patient communication
The American Academy of Pediatrics announced updated recommendations for pneumococcal vaccinations following the recent approval of Prevnar 13. The new guidelines replace PCV 7 with PCV 13 and maintain the same vaccination schedule with doses at 2, 4, 6, and a booster at 12-15 months. The guidelines also recommend that children with incomplete courses of PCV 7 also switch to PCV 13 to complete their course. In related news, the AAP released updated guidelines in response to new research reflecting suboptimal immunization rates among children and adolescents in the US. The guidelines encourage better doctor-patient communication, public-private partnerships for manufacturing and distribution, and proactive public health campaigns to address vaccine misconceptions.

Research

7.PCV introduction leads to reductions in racial disparities
This month In Pediatrics, Pilishvili et al. showed that introduction of PCV7 eliminated race and child care attendance as risk factors for vaccine-type IPD among children aged 3 to 59 months in the U.S. The study examined a wide range of risk factors for disease, including underlying medical conditions, among 782 cases and 2512 control subjects from 2001 to 2004. Among vaccinated children, there was no significant difference in the risk of vaccine-type IPD (OR 0.6, 95% CI: 0.2-1.9) for black children compared to white children, while among unvaccinated children, three times the risk of vaccine-type IPD was found for black children compared to white children (OR 3.5, 95% CI: 1.9-6.6). Additionally, researchers found that group child care attendance did not significantly increase the odds of IPD (OR 1.1, 95% CI: 0.6-2.2) among vaccinated children, but resulted in twice the risk of VT-IPD (OR 2.0, 95% CI: 1.3-3.0) among unvaccinated children. However, disparities remained among children with non-vaccine type IPD, especially for black children attending group child care (adjusted OR 4.0, 95% CI: 2.3–7.0) as compared to white children. Researchers concluded that as higher-valency vaccines are introduced, racial disparities are expected to continue to decrease with vaccine usage.

8.Kenyan study examines the etiology of viral pneumonia
In JAMA, Berkley et al. from the Kenya Medical Research Institute reported on the etiology of viral pneumonia cases at the Kilifi District Hospital in 2007. Of the 759 patients under age 12 years admitted for severe or very severe pneumonia for whom a sample was collected, at least one respiratory virus was detected in 56% of cases (95% CI: 52%-60%). Respiratory syncytial virus (RSV) was the most common virus and was detected in 34% of cases (95% CI: 31%-38%). Other viruses included Human coronavirus 229E (6.7%), influenza type A (5.8%), Parainfluenza type 3 (3.8%), Human adenovirus (3.8%), and Human metapneumovirus (3.0%). Researchers also compared nasal washes of inpatient pneumonia cases with those of children presenting with mild upper respiratory tract infections and those of well children presenting for routine immunizations. The case-control comparison showed that presence of RSV was associated with severe diseases (adjusted OR 6.11, 95% CI: 1.65-22.6) while the presence of other respiratory viruses was not significantly associated with severe disease (adjusted OR 1.27, 95% CI: 0.64-2.52).

9.ALRI incidence examined among Australian Northern Territory indigenous infants
O’Grady et al. from Charles Darwin University in Australia presented results from a five-year cohort study in Medical Journal of Australia this month examining incidence of acute lower respiratory infections among Northern Territory indigenous infants. Among 9295 infants studied, ALRI incidence was found to be 426.7 cases per 1000 child-years (95% CI: 416.2–437.2), with infants from Central Australia experiencing ALRIs at twice the rate of those from the Top End (relative risk: 2.12; 95% CI: 1.98–2.27). Pneumonia comprised 33% of the ALRI disease burden overall (1216 cases, rate 143 per 1000 child-years), 38% among Central Australians (630 cases, rate 252 per 1000 child-years), and 30% among Top End residents (586 cases, rate 97.6 per 1000 child-years).

10.Current usage and future research needs reviewed for CRM₁₉₇ in pediatric conjugate vaccines
In the June 17 issue of Vaccine, Shinefield examined the development and use of CRM₁₉₇ as a carrier protein in pediatric conjugate vaccines. The review includes an overview of the history of CRM₁₉₇ effectiveness against Hib, S. pneumoniae, and other pathogens as well as an exploration of areas requiring further study including conjugate interference, expansion of serotype coverage, and effectiveness in special populations such as the indigenous and immuno-compromised.

11.Randomized clinical trial shows no therapeutic effect of zinc supplementation on pneumonia
In this month’s American Journal of Clinical Nutrition, Valentiner-Branth et al. from the Statens Serums Institute in Denmark presented the results of a randomized controlled trial of zinc supplementation therapy among Nepalese children with pneumonia. While zinc supplementation has been shown to reduce the risk of ALRIs and pneumonia, previous studies on its therapeutic effect have been inconsistent. Researchers completed a double-blind, placebo-controlled trial among children 2 to 35 months with severe (149 subjects) or non-severe pneumonia (2479 subjects). The intervention group received zinc supplementation (10-20mg) for two weeks in addition to antibiotic treatment. The odds ratio for treatment failure among those receiving zinc compared to those receiving a placebo was found to not be significantly different for non-severe cases (OR-0.95, 95% CI: 0.78-1.2) or for severe pneumonias (OR-0.97, 95% CI: 0.42-2.2) for severe pneumonia. No significant difference in time to recovery was observed among non-severe pneumonia patients. Researchers identified the need for further research on the effect of zinc on severe pneumonia cases and other bacterial infections due to the small portion of subjects with severe pneumonia in this study.

12.Household survey in Guinea Bissau reflects low parental knowledge about pneumonia
This month in BMC Public Health, King, Mann, and Boone presented results from a cross-sectional household survey in rural Guinea Bissau on maternal and child health. Men and women from 310 households were interviewed on knowledge and practices related to indicators affecting child survival in a high-mortality setting. 12% of women and 29% of men had heard of pneumonia, but only one participant of 620 correctly identified the signs of pneumonia and none identified antibiotics as the appropriate treatment for pneumonia. Similarly low levels of health knowledge were reflected with regard to diarrhea, HIV, and other relevant diseases. 65.8% of children older than 14 weeks had received DTP3 vaccines and 76.8% of children older than 9 months had received measles vaccines. Women reported most commonly seeking help from another parent (50.3%) and/or a clinic (27.1%) when a child was ill, while men reported seeking help at the clinic (58.1%) and/or from a relative (21.9%). Men and women reported normally purchasing medicine at a clinic (>50%) and/or pharmacy (>35%), while slightly less than 20% reported purchasing medicine from a local person. Researchers are using the results from this study to measure the progress of the Enabling Parents to Increase Child Survival (EPICS) trial underway in Guinea Bissau.

13.Increases in S. pneumoniae resistance found in Austrian study
In the International Journal of Antimicrobial Agents, Hoenigl et al. from the Medical University of Graz, Austria discussed results from a retrospective analysis of S. pneumoniae resistance patterns from 1997 to 2008. The evaluation of 1814 S. pneumoniae isolates from Southeast Austria showed low penicillin and quinolone resistance (0.2% across the study period), but increases in resistance to erythromycin (from 3.5% to 14.7%), clindamycin (from 1.8% to 10.6%) and tetracycline (from 1.8% to 11.0%). Researchers emphasized the need for regional surveillance systems in addition to international surveillance activities.

Announcements

World Pneumonia Day Photo Contest final deadline is June 30
Just a few days remain to submit your photos to the 2010 World Pneumonia Day Photoshare Contest. We are seeking photos that tell the story of pneumonia around the world; examples include photos that demonstrate risk factors, interventions, or stories of survival or impact. Winners will receive a new Nikon camera and have their work featured at a New York City premiere event this summer. Judges include Pulitzer-prize winning New York Times columnist Nicholas Kristof and NBC Today show anchor Ann Curry. Be sure to submit your photos before June 30.

Job opportunity: Technical Communications Specialist at IVAC
The International Vaccine Access Center at the Johns Hopkins School of Public Health in Baltimore is currently accepting applications for the position of Technical Communications Specialist. The technical communications specialist will work within the Alliances and Information (A&I) team of IVAC and have a background in epidemiology, vaccine science or related technical experience. The A&I team conducts a variety of strategic communications and advocacy activities and works closely across IVAC’s program areas - including Epidemiology, Economics & Finance and Monitoring & Evaluation - to develop evidence-based materials and strategies aimed at increasing vaccine access throughout the developing world. For more information and to apply, please visit: http://www.jhsph.edu/ivac/jobcommunication.html

NIAID International Research in Infectious Diseases and AIDS Request for Applications
Objective: To provide support for innovative research on high-priority, pressing, region-relevant infectious disease scientific questions proposed by international investigators in resource-poor countries. Description: This initiative will support small grants in eligible (resource constrained) foreign countries for infectious diseases research among investigators and institutions at international sites where NIAID has significant investment in research and/or infrastructure. Research should focus on infectious diseases, including AIDS, that are of particular interest to the local country. Collaborative projects involving investigators and institutions from international sites and the U.S. are particularly encouraged. Contact: Polly Sager

New WHO documents available

The Initiative for Vaccine Research Strategic Plan 2010-2010. Available on the WHO site.

The State of the Worlds Vaccines and Immunization, Third Edition. Now in French and Spanish.

Upcoming Events

On July 11 to 14, 2010, the International Conference on Emerging Infectious Diseases will be held in Atlanta, Georgia. Visit http://www.iceid.org/ for additional information about the conference.

From July 11 to 15, 2010 the Association for Professionals in Infection Control and Epidemiology will hold its annual conference in New Orleans, Louisiana. Dr. Atul Gawande will be the keynote speaker at the event. For more information and to register, visit http://conference.apic.org.

The 15th Ordinary Session of the Summit of the African Union will be held in Kampala Uganda from July 19 to 27, 2010. This year's theme is "Maternal, Infant and Child Health and Development in Africa." More information can be found at http://www.africa-union.org.

The 26th International Pediatric Association Congress of Pediatrics will be held in Johannesburg, South Africa from August 4 to 9, 2010. The session will include a focus on child survival and associated progress towards MDGs, health determinants, issues in neonatal health, and emerging infections. Registration instructions and more information can be found at: http://www2.kenes.com/ipa/pages/home.aspx

Smallpox Eradication after 30 years: Lessons, Legacies and Innovations will be held in Rio de Janeiro from 24-27 August 2010. For more details, visit: http://smallpox2010.org/