New Zealand’s Experience with PCV7 Introduction – An interview with Fiona Colbert from Meningitis Trust

Fiona Colbert’s vision for establishing the Meningitis Trust in New Zealand was to see a country free from infectious diseases that cause meningitis and septicemia. “These diseases”, Colbert states, “recognize no boundaries and randomly attack the vulnerable and equally strong for no apparent reason.” With her medical background as a nurse and midwife and her strong commitment to this compelling cause, Colbert has been instrumental in driving PCV7 introduction policy forward in New Zealand. She currently serves as General Manager to Meningitis Trust and in 2005, became the Secretary for the Confederation of Meningitis Organizations. PneumoADIP had the pleasure of discussing with her some aspects of the New Zealand experience with PCV7 introduction – obstacles that were encountered, successes that ensued, and prospects for the future.

What is the burden of pneumococcal disease in New Zealand? Are there subsets of the population that are at high risk for infection?

In New Zealand, pneumococcal disease is a major health care burden, particularly in Maori and Pacific Islanders. It is estimated that at least 500 cases of IPD occur annually in New Zealand, with approximately 150 of these cases reported in children under the age of 5 years. In a pending publication from the Institute of Environmental Science and Research (ESR) , the average national annual incidence of IPD in infants less than 2 years is estimated to be 100.8/100,000 (using IPD isolates captured over an 8 year period from 1998-2005).

Further data from an Auckland prospective surveillance study conducted during 2000 to 2001 estimated the rate of invasive disease in all children less than 2 years of age to be 191 per 100,000. In this study, the rate of disease was significantly higher for Maori children (217 per 100,000) and for Pacific Islander children (296 per 100,000) in this age group.

From February 2006, the New Zealand Government initiated a funded vaccination program to reduce the incidence of pneumococcal disease in specific populations that were considered to be at high-risk of developing invasive disease. Under the current program, Prevenar is only funded for use in the following high-risk individuals:

• Children of any age pre- or post-splenectomy or with functional asplenia
• Children under five years of age with the following medical risks:
• • on immunosuppressive therapy or radiation therapy, when there is expected to be sufficient immune response
  • with primary immune deficiencies
  • with HIV infection
  • with renal failure, or nephrotic syndrome
  • immune suppressed following organ transplantation
  • with cochlear implants or intracranial shunts
  • with chronic cerebrospinal fluid leaks
  • receiving corticosteroid therapy for > 2 weeks, who are on an equivalent daily dosage of prednisone of 2 mg/kg/day or greater, or children who weigh >10 kg on a total daily dosage of 20 mg or greater

Despite their high-risk of disease, Maori and Pacific Islander children are not eligible for funded vaccination through this targeted program.

Briefly tell us about the Meningitis Trust and its organizational structure and function. What was its role in facilitating the New Zealand Ministry of Health’s decision to introduce PCV7 nationwide?

The Meningitis Trust was formed in 2001 as a response to the demand for education and support due to the meningococcal B epidemic that had been ongoing since 1991. With financial and practical support from the Meningitis Trust in the UK, the NZ Meningitis Trust was immediately able to supply quality educational and support materials. Also very quickly we were able to ascertain relevant service to best support those affected by meningitis and meningococcal disease. With the introduction of the MeNZB™ vaccine in 2004 we have supported the Ministry of Health with this initiative to combat an insidious disease. In early 2006 with the evident success of the MeNZB™ vaccine campaign we decided that it was timely to campaign for the pneumococcal vaccine to also be included in the immunization schedule. We embarked on a meningitis campaign to raise awareness on pneumococcal meningitis. This was supported by a number of families and individuals whose lives have been tragically affected by pneumococcal meningitis.

What were some of the major obstacles surrounding PCV7 introduction in New Zealand?

Limited information about pneumococcal disease burden was perceived as an obstacle by decision-makers to justify universal funding of Prevenar. Furthermore general immunization rates of children in New Zealand are low. The latest figures from the National Immunisation Register suggest only 59% of 6-month old children have received their required vaccinations. There is also a strong anti-immunisation voice in New Zealand. Lastly barriers to vaccine access include the fact that changes to the National Immunisation Schedule are only considered every 2 years, there are logistical considerations to ensure equity of access to both rural and urban areas, as well as sensitivities associated with promoting the importance of routine vaccination to different cultural groups.

Potential solutions include collaboration with clinicians or stakeholders to establish baseline disease burden information, and coordinated activities to drive disease awareness and build support for universal funding.

Are there any policy issues following introduction that you think might be useful to other countries that may introduce the vaccine in the near future?

Following inclusion of Prevenar on the National Immunization Programme (NIP), it is important that measures are undertaken to ensure pneumococcal disease is recognized as a notifiable illness, and that an active surveillance program is established to monitor the changing epidemiology of IPD and the impact of routine vaccination on disease burden in both vaccinated and unvaccinated (adult) populations. Active surveillance of vaccination coverage is also critical to identify access issues and ensure all eligible individuals receive timely vaccination.

Ongoing programs need to be implemented to overcome barriers to immunization. These might include education of the target population on the value of vaccination to drive compliance, awareness campaigns to promote the availability of the vaccine, consideration of cultural diversity and ensure communication and education programs are appropriate to the sensitivities of all communities, and continued advocacy, social mobilization and program communication to generate and sustain support for the NIP.

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