Interview with Angelica Floren from Fundacion Dominicana de Infectologia, Florida, U.S.A.

Dr. Angelica Floren is currently president of the Fundacion Dominicana de Infectologia of Florida, a non-profit, tax exempt organization dedicated to the economic support of the Department of Infectious Diseases of Robert Reid Children’s (RRC) Hospital. She has worked in the RRC pediatric and the newborn intensive care unit for 15 years and has also been Assistant Professor of Clinical Pediatrics in the division of Neonatology at the University of Miami in Miami, Florida since 1990. PneumoADIP had the pleasure of interviewing her on her experiences with the foundation and with pneumococcal disease in the Dominican Republic.

Briefly describe the burden of pneumococcal disease in the Dominican Republic?

The infant mortality rate in the Dominican Republic (D.R.) has decreased markedly because of the decrease in cases of acute gastroenteritis, dehydration and malnutrition, in addition to the decrease in diseases prevented by immunization such as measles and polio. Now the most important cause for infant morbidity and mortality are respiratory diseases, especially pneumonia. The most frequent pathogen we find in severe pneumonia complicated by pleural effusions and in meningitis is Streptococcus pneumoniae, but we think what we find is only the tip of the iceberg, because many purulent spinal fluids and pleural fluids fail to yield a bacteria. The Robert Reid Cabral Children’s Hospital treated 15,000 cases of pneumonias in 2006. It receives one severe case of pneumonia with pleural effusion every other day and studies between 30-40 specimens of spinal fluid every month for suspected meningitis. S. pneumoniae is the most commonly isolated organism from CSF specimens. We believe that many of the pneumonia cases are also caused by pneumococcus. We are currently finishing a study sponsored by PneumoADIP in which we will be able to establish the burden of severe pneumococcal disease in the capital city of Santo Domingo in children below 5 years of age.

Tell us about the formation and mission of Fundacion Dominicana de Infectologia?

The Fundacion Dominicana de Infectologia was created to give economical and educational support to the Department of Infectious Diseases of the Robert Reid Cabral Children’s Hospital. It was started with a group of parents and physicians that were sensitive to the needs of our children. Through fund raising, collection of equipment needed in the department has been possible, such as thoracic suction machines for the treatment of pleural effusions, diagnostic kits for the microbiologic diagnoses of diseases as respiratory syncitial virus (RSV), television sets for the children hospitalized, and subscription to medical information such as the RED Book of the AAP, and the Journal of Infectious Diseases for the residents and staff doctors.

What are some of the current projects ongoing at the foundation? What are some of the future projects or goals?

At the present time we are in the process of writing proposals to obtain funds to prevent what we consider the single most important health problem in our children, namely pneumococcal disease. We are trying to use new tools available for the detection of pneumococcal disease such as BINAX NOW and PCR, and hopefully will convince the authorities to consider the introduction of the pneumococcal vaccine. Many lessons have been learned from our involvement with the PneumoADIP project, the most important of which is that the perception of a problem must come first in order to find a solution. Perception must start in the community and must find a way to the authorities and decision-makers before a solution is sought. For this reason we are now engaged in education projects for the community.

Would you have any key message(s) to convey to policy-makers and governments regarding pneumococcal disease and vaccination?

I would like to say to policy makers and governments that if we try to find a solution to pneumococcal disease together we would be more effective in its control or eradication. As GAVI has set a fund for very poor underdeveloped countries, we could also establish one for the countries of the Americas with the help of the UNICEF or maybe the Pan American Health Organization (PAHO), through fundraising campaigns targeting the millions of Latin American immigrants to the USA, and thereby maybe create a vaccine fund for the Americas. By creating such a fund, in addition to what PAHO has, we could negotiate prices in bulk for the new vaccines and guarantee a steady demand to pharmaceutical companies so they may provide a more stable supply. Through this mechanism introduction of the new life-saving vaccines would be easier.

Thank you for the opportunity to express these ideas.

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