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Emerging Vaccines for Pneumococcal Pneumonia

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Reference
Webster J, Theodoratou E, Nair H, Seong AC, Zgaga L, Huda T, Johnson HL, Madh S, Rubens C, Zhang JSF, El Arifeen S, Krause R, Jacobs TA, Brooks AW, Campbell H, and Rudan I.  An evaluation of emerging vaccines for childhood pneumococcal pneumonia.  BMC Public Health 2011 11 (Suppl 3):S26.

Background

  • Pneumonia is the leading cause of child mortality worldwide. (1)  Streptococcus pneumonia (SP) or pneumococcus is estimated to cause 821,000 child deaths each year. (2)
  • SP has at least 92 serotypes.  The most frequently used vaccine is the seven valent, protein conjugate vaccine (3) which protects against the serotypes that account for only approximately 39% of the invasive disease-causing serotypes in Africa, 48% in Asia and 53.4% in Latin America and the Caribbean. (4-6)
  • To further reduce the burden from SP pneumonia, a vaccine is required that could protect children from a greater diversity of serotypes. There are currently two main vaccine strategies under development: 1) a serotype-based pneumococcal conjugate vaccine covering as high a proportion as possible of all disease-causing serotypes; and 2) a pan-serotype protective vaccine using conserved common pneumococcal protein antigens.
  • Webster et al. summarized findings from a modified Child Health and Nutrition Research Initiative (CHNRI) process whereby a systematic literature review related to emerging SP vaccines was conducted, and the findings were presented to a group of 20 experts who then rated their degree of optimism (0-100%) on several criterion.

CHNRI Criterion

Answerability: production of an effective novel vaccine that can be fitted into the routine Expanded Programme of Immunization (EPI) schedule within 10 years.

  • Pneumococcal Conjugate Vaccine (PCV) - very high level of optimism (> 95%)
  • Common Protein Vaccine (PPV) – moderate level of optimism (72%)

Efficacy: the impact of the vaccines under ideal conditions

  • PCV - high level of optimism (> 80%)
  • PPV - high level of optimism (> 80%)

Cost of Development and Implementation

  • PCV - optimistic about the development of a low cost PCV (80%)
  • PPV - expressed concern over the ability to develop a PPV with similarly low development costs (50%)

Deliverability

  • PCV - high level of optimism (> 80%)
  • PPV - high level of optimism (> 80%)

Disease Burden Reduction (median potential effectiveness)

  • PCV - 25% reduction (IQR: 20-38%, min 15%, max 45%) in overall pneumonia mortality
  • PPV - 30% reduction (IQR: 26-40%, min 20%, max 45%) in overall pneumonia mortality

Acceptability: among end-users and health workers 

  • PCV - high level of optimism (> 90%)
  • PPV - high level of optimism (> 90%)

Equity: impact on decreasing child health inequity

  • PCV - high level of optimism (> 90%)
  • PPV - high level of optimism (> 90%)

Intervention Recommendation

  • There is a very high level of optimism (> 80%) that low-cost polysaccharide conjugate SP vaccines would satisfy all of the relevant criteria.  The potential effectiveness in reducing pneumonia mortality was predicted to be 25%
  • For low-cost, cross-protective common protein vaccines for SP, the experts expressed concern over answerability (72%) and the level of development costs (50%), while the scores for all other criteria were over 80%.  The potential effectiveness in reducing pneumonia mortality was predicted to be 30%.
  • While it is not only important that investments are made in researching new vaccines, adequate emphasis must be made and resources allocated for proper distribution of the vaccine.

References from Webster Paper Cited Here

  1. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010; 375(9730):1969–1987. 
  2. O'Brien KL, Wolfson LJ, Watt JP, Henkle E, Deloria-Knoll M, McCall N, Lee E, Mulholland K, Levine OS, Cherian T. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet. 2009; 374:893–902. 
  3. Improving Global Health by Preventing Pneumococcal Disease. Report from the All-Party Parliamentary Group on Pneumococcal Disease Prevention in the Developing World. 2008. 
  4. Lucero MG, Dulalia VE, Parreno RN, Lim-Quianzon DM, Nohynek H, Makela H, Williams G. Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and pneumonia with consolidation on x-ray in children under two years of age. Cochrane Database Syst Rev. 2004. p. CD004977.
  5. Lucero MG, Dulalia VE, Nillos LT, Williams G, Parreno RA, Nohynek H, Riley ID, Makela H. Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age. Cochrane Database Syst Rev. 2009. p. CD004977. 
  6. GAVI's PneumoADIP. Pneumococcal Regional Serotype Distribution for Pneumococcal AMC TPP. 2008.

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