MEDIA

1.  PATH and the FDA collaborate to evaluate pneumococcal vaccine conjugation technology

This month the FDA announced a new, two-year collaboration with the international NGO PATH to speed the development of conjugation technology for pneumococcal vaccines. Under the Cooperative Research and Development Agreement (CRADA) program, PATH will direct $480,000 in funding, which primarily stems from the Bill and Melinda Gates Foundation, to the FDA's Center for Biologics Evaluation and Research (CBER). The major goal of the initiative is to evaluate the center's conjugation technology, which links bacterial surface coatings to carrier proteins in the development of vaccines. The collaboration also permits the technology to be shared with the China National Biotec Group's Chengdu Institute of Biological Products, which produces the majority of China's vaccines.

2.  Gates Foundation committed to pneumonia

Voice of America interviewed IVAC's Dr. Orin Levine regarding the recent commitment by the Bill and Melinda Gates Foundation of $10-billion across 10 years for vaccines which included a strong focus on pneumonia vaccines. The funding is expected to save millions of children's lives through better vaccine development as well as improved vaccine deployment to low- and middle-income countries worldwide. Dr. Levine discussed the progress that has been made in prioritizing pneumonia in national health policy agendas, especially in countries such as Rwanda and The Gambia where pneumococcal vaccines have already been introduced. He also reviewed the challenges that remain to reducing child pneumonia deaths and called for continued commitment from major donor countries, vaccine manufacturers, and countries planning vaccine introductions. You can listen to the full interview here.

3.  Preliminary details of the Presidential Global Health Initiative released

The Obama Administration released a consultation document detailing the vision and priorities of the Global Health Initiative. The plan represents a $63 billion commitment over six years and encompasses PEPFAR activities as well as TB, malaria, and other international health efforts. Among other priorities, the initiative outlined support for multilateral partnerships, specifically identifying the GAVI Alliance as a target for increased U.S. government support. The program also pledges to support proven, cost-effective interventions for child health improvement including pneumonia and rotavirus vaccination, oral rehydration therapy for diarrhea, and antibiotic treatment of pneumonia.


4.  Dr. Thomas Cherian receives PACE Global Leadership Award for accelerating access to pneumonia vaccines

At the WHO Global Immunization Meeting in Geneva this month, the Pneumococcal Awareness Council of Experts (PACE) recognized the accomplishments of Dr. Thomas Cherian by presenting him with the third-annual PACE Global Leadership Award. Dr. Cherian is currently the coordinator of the Expanded Program on Immunization (EPI) at WHO. His work has been critical in understanding the global burden of pneumococcal and Hib disease, speeding vaccine development, evaluating vaccine efficacy, and establishing sound recommendations for policymakers. WHO Assistant Director-General Daisy Mafubelu noted, "Dr. Cherian has dedicated his life to advancing prevention for the world's children, and we are proud to have him leading WHO's efforts to ensure that life-saving vaccines reach those most in need." Past recipients of the award include the Rwandan and Costa Rican ministers of health for their accomplishments in vaccine introduction.

5.  Efforts to introduce Hib-containing pentavalent vaccine in India encounter hurdles

Health ministers report that the plan to incorporate Hib vaccines into India's Universal Immunization Program is temporarily on hold pending a decision from the Delhi High Court. In accordance with recent recommendations from the National Technical Advisory Group on Immunization, the Hib-containing pentavalent vaccine was scheduled to be introduced initially in 10 states with a national expansion to follow. The GAVI Alliance has pledged $165 million to support vaccine introduction in India in light of the high burden of disease. Recent estimates rank India as having the highest number of annual cases and deaths due to Hib in children under 5 years of age anywhere in the world, with nearly 2.4 million cases and over 70,000 deaths attributed annually to Hib pneumonia, meningitis, and other infections.

6.  Tanzania reallocates health funding according to disease burden, improves child survival

Reflecting on a decade of child health gains in Tanzania, Don de Savigny from the University of Ghana Public Health School explored the impact of integrated strategies to reduce child mortality. Drawing from his experience in the health ministry, de Savigny expanded on the use of district-level health accounts as one of the tools leveraged to improve the efficient use of scarce resources. The accounts matched disease-specific health funding to actual population disease burden. Initial calculations revealed that IMCI-preventable diseases such as pneumonia and diarrhea comprised over 30% of the overall disease burden, yet garnered as little as 8% of district budgets. Based on these findings, reallocations led to improved funding for IMCI and, ultimately, contributed to reductions in child mortality.

7.  UNICEF and partners draft communication framework for pneumonia and diarrhea control


In December 2009, UNICEF hosted a consultation with communication and program experts representing leading NGOs, bilateral and multilateral institutions, and public health partnerships. The purpose of the consultation was to develop a shared vision of how to both support countries in the development of coordinated communication strategies for new vaccine introduction, and to re-energize efforts to prevent and control pneumonia and diarrhea. Participants agreed that a coordinated approach to fighting pneumonia and diarrhea is critical, and subsequently drafted a framework to guide countries in developing effective communication strategies to encourage healthy actions to prevent and control these diseases. Once the framework is finalized, it will be pre-tested in a select number of countries. Potential partners are encouraged to join in supporting these efforts. The report is available here.

RESEARCH

8.  Effect of PCV-7 on disease incidence and serotype distribution in the U.S. examined


Researchers examined IPD cases from 1998 to 2007 from eight sites across the U.S. to estimate the impact of the PCV-7 introduction which began in 2000. The results, published in the Journal of Infectious Diseases, showed that all-age IPD incidence rates decreased by 45% (from 24.4 to 13.5 per 100,000 population, p<.01) while vaccine-type incidence decreased 94% (from 15.5 to 1.0 cases per 100,000 population, p<.01). Among children under five, all-type incidence decreased 76% (from 98.7 to 23.6 per 100,000, p<.01) and vaccine-type incidence decreased 99.5% (from 81.9 to 0.4 per 100,000, p<.01). Researchers found an increase in the incidence of non-vaccine serotypes including 19A (from 6.1 to 7.9 per 100,000 across all ages and 6.8 to 10.3 per 100,000 in children under five, p<.05). However, authors note that the impact of these increases on overall disease burden was substantially outpaced by the accompanying reductions in vaccine-type IPD. The introduction of the PCV-7 resulted in an estimated 211,000 fewer cases and 13,000 fewer deaths between 2000 and 2007.

9.  Researchers conduct review of pneumococcal meningitis epidemiology in the African meningitis belt

In a recent issue of BMC Infectious Diseases, Gessner and colleagues conducted a systematic review of literature published from 1970 to 2005 on population-based pneumococcal meningitis in Africa. They used the resulting data, which included four countries in the African meningitis belt (Burkina Faso, Ghana, Nigeria, Senegal) to model the risk for pneumococcal meningitis throughout life. They found that, like meningococcal meningitis, pneumococcal meningitis is more common in the dry season. The model yielded the following estimated incidence rates per 100,000 persons: 98 for persons <1 year; 7.8-14 for age 1-19; and 5.8-12 for age 20-99. Case fatality ratios for pneumococcal meningitis were high among all age groups (36-66%), and mortality incidences were 2-12 times higher than for meningococcal meningitis. Infants under age 1 showed the highest incidence of pneumococcal meningitis disease and death, and experienced 17% of total cases and 16% of deaths. In comparison, cumulative risk was highest among the 5-59 age group, who experienced 59% of cases and 57% of deaths. Serotype 1 caused more than 60% of pneumococcal meningitis cases among people over age five. Based on this data, the authors stress the importance of an effective vaccine against serotype 1 pneumococcus, and call on policymakers to consider vaccine use among older children and adults, in addition to infants.

10.  Researchers assess the etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines


In a study published in the European Journal of Pediatrics, researchers sought to determine the etiologic agents of community-acquired pneumonia (CAP), as defined by WHO clinical guidelines, among hospitalized children. The study population was 99 patients age 2 months to 5 years admitted to the children's unit of the university hospitals in Lausanne and Geneva, Switzerland with WHO-defined CAP. Researchers performed several diagnostic tests, including microbiologic, serologic, and biochemical assays. Of the 86% of cases in which researchers identified a potential causative agent, an estimated 46% were cases of Streptococcus pneumoniae. Overall, viral agents were found in 67% of infections, most commonly rhinovirus or human metapneumovirus, 53% of the samples contained bacteria, and 33% were mixed. The only clinical sign associated with bacterial pneumonia was dehydration, and the laboratory markers C-reactive protein and procalcitonin were higher in children with bacterial pneumonia, regardless of co-existing viral infection. These results highlight the importance of childhood pneumococcal vaccination. The authors also call for additional research to determine more precisely which children with CAP require antibiotic therapy.

11.  Evaluation of Accelerated Child Survival and Development programme in west Africa highlights importance of improved management of pneumonia

Bryce and colleagues conducted a retrospective evaluation of UNICEF's Accelerated Child Survival and Development (ACSD) program in Benin, Ghana and Mali. ACSD aimed to accelerate reductions in child mortality through the implementation of three proven "intervention packages," one of which focuses on the management of pneumonia, malaria and diarrhea (IMCI+). Investigators used health survey data to compare changes in coverage for 14 ACSD interventions, nutritional status and under-five mortality between ACSD focus districts and comparison areas. The results of the study, published in The Lancet, revealed that while under-five mortality decreased in focus districts in Benin by 13%, in Ghana by 20%, and in Mali by 24%, the decreases were not significantly greater than those seen in comparison areas for either Benin (p=-0.15) or Mali (p=0.30; data unavailable for Ghana). The coverage for correct treatment of childhood pneumonia, diarrhea, and malaria did not differ in ACSD areas before compared to after program implementation in Benin and Mali, and also did not differ for pneumonia in Ghana. Correct treatment actually decreased significantly in Ghana for malaria (from 78% to 53%, p<0.0001) and diarrhea (from 39% to 28%, p=0.05). Among the lessons learned from this study, the researchers emphasized that "active promotion of country policies supporting community case management for pneumonia and malaria and the incorporation of zinc into the management of diarrhea" would be beneficial for future child survival programs.

12.  Researchers analyze impact of vaccination and water supply on invasive pneumococcal disease among Alaska Native children

Wenger and colleagues used laboratory surveillance data from 1986 to 2007 to analyze invasive pneumococcal disease (IPD) among Alaska children under age five, and its relationship with PCV7 introduction, socioeconomic status, and water supply. Alaskan Native (AN) children, particularly those in the Yukon-Kushokwim region (YK-AN), have historically shown high rates of IPD. The results of the study, published in The Pediatric Infectious Disease Journal, showed that IPD case rates per 100,000 declined from 97 in the pre-vaccine period (1986-2000) to 41 in the early vaccine period (2001-2004), and then climbed to 64 in the late vaccine era (2005-2007) due to nonvaccine-serotype IPD. During 2005-2007, the IPD rate among AN children was 3-5 times higher than non-AN children, and 5-10 times higher among YK-AN children compared to non-YK-AN and non-AN children. The rate of IPD among YK-AN children living in villages where <10% of houses had in-home piped water was twice as high compared to villages where more than 80% of houses had in-home piped water (390 vs. 146 cases/100,000, p= 0.008). The authors speculated that the impact of in-home piped water on IPD is mediated through limitation in hand-washing and conclude that "addressing infrastructure disparities such as in-home water supply may be a key component for controlling IPD in Alaska and other areas where such risk factors for IPD exist."

ANNOUNCEMENTS

Immunological basis for immunization: pneumococcal vaccines

The main purpose of this document is to give vaccination professionals (e.g., EPI managers) a brief and easy-to-understand overview of the scientific basis of vaccination related to pneumococcal disease.
http://whqlibdoc.who.int/publications/2009/9789241598217_eng.pdf.

UPCOMING EVENTS



The 14th International Congress on Infectious Diseases will be held March 9-12, 2010 in Miami, Florida. Visit the conference website at http://www.isid.org/14th_icid/ for more information. 


The 7th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD-7) will take place in Tel Aviv, Israel March 14-18, 2010. Conference details are online at http://www2.kenes.com/isppd/pages/home.aspx.

The Geneva Forum Towards Global Access to Health will be held on April 19-21, 2010 in Geneva, Switzerland. Details are available at http://www.ghf10.org/.


The Global Health Council's 37th Annual International Conference on Global Health, Dateline 2010: Global Health Goals & Metrics, will take place in Washington D.C. June 10-14, 2010. Additional information on this conference, which will examine metrics, progress and challenges on global health goals, is available at http://www.globalhealth.org/conference_2010/.


July 11-14, 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. The general abstract submission deadline is March 1, 2010.