Health threat to children may be underestimated

Mary Ann Benitez

South China Morning Post

Jul 13, 2008

The incidence of pneumococcal diseases - caused by bacterial infections that can maim and kill under-fives - could be higher in Asia than reports suggest, two international experts have said, possibly giving impetus to the drive in Hong Kong to immunise children against such infections.

Streptococcus pneumoniae, or pneumococcus, can cause pneumonia, meningitis, sepsis and other life-threatening ailments.

Globally, such infections kill 1.6 million children - including more than 800,000 under five - each year, according to a recent international symposium in Reykjavik, Iceland.

In Hong Kong, it has been reported that 10 children died from pneumococcus infections between 2000 and 2005. However, the city has been waiting since last year for the Health Department to decide whether to include a pneumococcal conjugate vaccine in the childhood immunisation programme.

A University of Hong Kong team has completed a study to investigate the cost benefit of incorporating pneumococcal, chickenpox, Haemophilus influenzae type b and hepatitis A vaccines into the immunisation programme. 

The study's findings, which are being evaluated by the research council of the Research Fund for the Control of Infectious Diseases, have yet to be released.

Meanwhile, a separate study at the symposium in Iceland could provide fresh ammunition to local calls for children to be protected against pneumococcal infections.

Orin Levine, an executive director of the Global Alliance for Vaccines and Immunisation and one of the researchers who presented a study at the Reykjavik symposium, said research using a new diagnostic tool had found that previous studies had underestimated the presence of pneumococcal meningitis, specifically in Asia.

"It is the worst kind of bacterial meningitis. It has the highest case fatality rate and morbidity rate among survivors. It's a particularly terrible disease," he said.

Thomas Cherian, co-ordinator of the World Health Organisation's Expanded Programme on Immunisation, said the same was true for pneumococcal pneumonia.

"I think it is more difficult to diagnose pneumonia disease for a variety of reasons in Asian countries. It is not up there [with high-profile diseases]," said Dr Cherian. "It is more an under-recognised disease in Asian populations rather than a disease that does not exist over there."

He said about 40 per cent of pneumonia cases worldwide are caused by pneumococcus.

The experts said countries that have adopted the WHO recommendation to vaccinate newborns against pneumococcus include the vaccination in their immunisation schedule for diphtheria, tetanus and pertussis.