It has been an eventful few months in the pneumococcal vaccine field. Between November 2006 and February 2007, GAVI and its donors pledged >$1.7 billion for the purchase of pneumococcal vaccines on behalf of GAVI countries. In March, WHO published its position paper on pneumococcal conjugate vaccines, endorsed by the Strategic Advisory Group of Experts (SAGE) on immunization, in which WHO recommended introduction of pneumococcal conjugate vaccine for all countries, especially those with a high burden of pneumonia mortality.  By the end of May, WHO is expected to provide estimates of pneumococcal disease burden to all countries.

Political will for prevention of pneumonia and pneumococcal disease also continues to increase.  In the United Kingdom, an All-Party Parliamentary Group (APPG) on Pneumococcal Disease Prevention in the Developing World was launched on March 14th.  On May 10th, in the United States, the Global Health Council (GHC) is sponsoring a briefing in the US Capitol building for members of the US Congress, sponsored by Rep. Visclosky (D-Indiana), and on May 7th, the Sabin Vaccine Institute will launch, Pneumococcal Awareness Council of Experts (PACE), a group of leading experts dedicated to building awareness of pneumococcal disease and pneumonia as health problems and the value of prevention.

The 4th annual surveillance investigators meeting took place in Bangkok, Thailand. Our thanks go to our excellent hosts and also to everyone who participated in making this meeting a great success. What made this years meeting different from previous years was the abundance of data that is becoming available, reflecting the investment made by PneumoADIP, HibInitiative, WHO and their partners across the globe. A one year extension of PneumoADIP will bring us together once more in 2008. In the meantime, the research team at PneumoADIP aims to send out copies of all of the presentations to participants by June 15, 2007.

To read more about the meeting, read the latest issue of The Hib Focus by The Hib Initiative.

In April, 2007, the GAVI Alliance issued letters to GAVI-eligible countries in order to solicit which countries are interested in introducing pneumococcal vaccines, beginning in 2008.  Responses from countries for pneumococcal vaccine introduction are due by May 25th, 2007.  Expressions of interest are non-binding commitments, but the responses are important because these indications will help GAVI to determine which countries should be priority for vaccine use, and will help GAVI’s PneumoADIP to determine which countries are priorities for new investments in disease surveillance.

The April 25, 2007, edition of JAMA contains an important article by Rosalyn Singleton and colleagues reporting the experience with a 7-valent pneumococcal conjugate vaccine in Alaska and particularly in the Alaska Native populations who have a high incidence of invasive pneumococcal disease.  The authors report that the incidence of invasive pneumococcal disease due to serotypes not included in the 7-valent vaccine increased significantly among Alaska Natives following widespread use of the 7-valent vaccine, a phenomenon known as replacement disease.  

Since 2000 when 7-valent vaccine was introduced into the US immunization schedule, a small amount of replacement disease has already been observed in the general US population.  The degree of replacement disease in the general US population as well as non-native Alaska residents has been small relative to the reductions in vaccine type disease. Among Alaska Native children less than 2 years of age, the degree of replacement disease, especially with serotype 19A, has been more significant than that seen in the general US population and therefore overall vaccine impact has been reduced.  

Click here to read more of the PneumoADIP comment

Click here to read the article abstract Singleton et al. JAMA Apr 2007; 297: 1784-1792.

Read Interview with Tom Hennessy, Director, CDC’s Arctic Investigations Program

Two publications in April highlight the health impact of pneumococcal vaccination in the US population. Grijalva et al used the largest inpatient database available in the US, namely the Nationwide Inpatient Sample, to show that between 1997 and 2004 there has been a dramatic decline of 39% in all-cause pneumonia admission rates in children less than 2 years of age attributable to PCV7 introduction. The size of this effect was larger than would have been expected and extend the observations on the value of pneumococcal vaccination in the USA. Grijalva et al. Lancet Apr 2007; 369: 1179-86. In Science, Klugman and Madhi discussed the importance of pneumococcal vaccines in reducing influenza-associated morbidity in the US. Immunization of infants against pneumococcal disease also has shown to have beneficial outcomes in the adult population due to herd immunity effects. Together these reports underline the beneficial effects of pneumococcal vaccines in both infants and adults populations, as well as their protective effects in the prevention of targeted pneumococcal bacteremias as well as untargeted viral infections, such as influenza. Klugman et al. Science Apr 2007; 36: 49-50.

Remembering Dr. Robert Austrian. Dr. Robert Austrian, a clinician and pioneer in vaccine research who helped to develop the first multivalent vaccine against the pneumococcal disease, died on March 25th, 2007 due to a stroke. Born in Baltimore on April 12, 1916, Dr. Austrian earned his college and medical degrees from Johns Hopkins University, where he also trained as a specialist in internal medicine and developed an interest in pneumococcal infections. Dr. Austrian did much of the early research that led to the development of two pneumococcal polysaccharide vaccines licensed in 1977 and 1983. He identified several lethal pneumococcal serotypes, supervised clinical trials and published studies proving the safety and effectiveness of novel pneumococcal vaccines developed by drug companies. Dr. Austrian will be remembered and revered for his work, the impact of which can be seen in the number of lives saved worldwide due to pneumococcal vaccination.

For more immunization news and events, read GIN (Global Immunization News) available at:
http://www.gavialliance.org/Resources_Documents/gavi_updates/index.php
http://www.who.int/immunization/en/

May 7, 2007 – PACE launch at the National Press Club, Washington, D.C.
http://www.sabin.org

May 6-9, 2007 – Boston.
http://www.bio2007.org

May 10, 2007 – GHC congressional briefing at DC.
http://www.globalhealth.org/news/article/8698

May 29, 2007 – CGD Demand Forecast report launch event.
http://www.globalhealth.org/conference/view_top.php3?id=700

June 16, 2007 - Kenya Child Survival Run event at Nairobi.

June 18-19, 2007 - GAVI Global Advocacy Group meeting at Dublin.

September 28, 2007 - GAVI country applications deadline for pneumococcal vaccine.