WORLD PNEUMONIA DAY

1. WHO and UNICEF Release Global Action Plan for Pneumonia

The Global Action Plan for the Prevention and Control of Pneumonia (GAPP), released today by WHO and UNICEF, outlines a six-year plan for the worldwide scale-up of a comprehensive set of interventions to control the disease. Countries are urged to implement a three-pronged pneumonia control strategy that:

• protectschildren by promoting exclusive breastfeeding and ensuring adequate nutrition and good hygiene;

• preventsthe disease by vaccinating them against common causes of pneumonia such as Streptococcus pneumoniae(pneumococcal disease) and Haemophilus influenzaetype b (Hib); and

• treatschildren at the community level and in clinics and hospitals through effective case management and with an appropriate course of antibiotics.

The GAPP estimates the cost of scaling up exclusive breastfeeding, vaccinations and case management in the world's 68 high child mortality countries. Together, these countries account for 98% pneumonia deaths worldwide. With this investment, the GAPP projects that by 2015, the scale-up of existing interventions can decrease child pneumonia mortality substantially.

2. Former US Senator Bill Frist and Rwandan Minister of Health, Richard Sezibera, call for "renewed global action on pneumonia" in The Lancet

In a commentary which appeared in the Oct. 31st edition of The Lancet, former US Senator and Save the Children Board Member, Bill Frist teamed up with Rwandan Minister of Health, Richard Sezibera, to call for increased resources and political will to fight childhood pneumonia. The GAPP report (see story 1 above) was highlighted and praised as turning point in the fight, setting out a roadmap to address the deadly scourge worldwide. "We live in a world with infinite possibilities. Hearts are transplanted, DNA is decoded, and new medical discoveries are made every day. Yet we continue to be stymied by how best to reach those in resource-poor settings with the most basic care and medicines that we take for granted" the authors say. "Resources and political will are standing between children and their futures. With the right tools, we should not fail the next generation of leaders and doctors."

To read the full commentary, register for free at The Lancet online.

3. Interview with Dr. David Marsh, Save the Children

The PneumoFOCUS recently interviewed Dr. David Marsh from Save the Children regarding his views on worldwide pneumonia control and the role of community case management (CCM).

Dr. Marsh is the Senior Child Survival Advisor and Global Team Leader for CCM at Save the Children. He is a pediatrician and international public health physician. As the Global Team Leader of Save the Children's CCM Initiative, he oversees work in 15 countries. As part of the Global Action Plan for Pneumonia Control, he led a review of developing countries' CCM programs, policies and plans for the Bulletin of the World Health Organization ('08). He is a member of two global CCM oversight bodies, the CCM Task Force (with UNICEF, WHO, USAID, and IRC) and the CCM Operations Research Task Force (with UNICEF, WHO/TDR, Karolinska Institute, and Boston University). His advocacy for pneumonia control at a March '09 malaria meeting sparked interest in creating a World Pneumonia Day.

What were some of your early experiences in childhood pneumonia, and how do they relate to your current work?

I am a pediatrician by training, and I recall one incident from when I was working on a Navaho reservation in the late 1970s. A baby was hospitalized with a fever and, day after day, he stayed in the hospital undergoing many expensive tests and generating a huge bill. It turned out the baby had a horrific case of pneumonia, and ultimately he was fine. But, if we had been trained as well as today's community health workers are in integrated management of childhood illnesses (IMCI), the baby could have been treated as an outpatient much more comfortably and at a much lower cost.

I'm now thrilled to preach the gospel of case management, along with the protection and prevention of pneumonia through better nutrition and vaccinations. For years, Save the Children has been championing this strategy in over 20 countries around the world. A multi-country evaluation of IMCI a few years back revealed that the system works well if children reach the appropriate health facilities, but many caregivers don't seek care in time. This is commonly because many families live far from the facilities. It can also be due to lack of knowledge, money, or faith in the local health facility among other factors. In partnership with UNICEF, WHO, and many other international groups, we've developed a range of tools to help countries implement effective CCM. There will always be kids that are sick with pneumonia and, by implementing effective CCM, we can equip community health workers to bring a science-based approach to caring for children.

What has been the most promising development in combating childhood pneumonia in the past few years?

I believe there are two kinds of public health science: discovery science—which includes trials and breakthroughs in the lab to discover new interventions—and delivery science, which in comparison is in its infancy. Delivery science explores how to get interventions to the people who need them most; we know what to do, the question is how to do it. I have been very gratified to see momentum growing in this area. Specifically, there has been a realization that pneumonia remains the biggest killer of children and, without case management as well as protection and prevention, countries won't reach their Millennium Development 4 Goals to reduce child mortality.

Your 2008 article in the WHO Bulletin pointed out the wide range of CCM policies and progress throughout the world. In your view, what are the drivers of success in implementing CCM?

The answer is complicated, but one best practice has been to build upon existing cadres of health workers. These groups are already deployed to provide health preventative and promotion messages, and they just need their skill sets rounded out to include the curative piece. A second part of the equation is the people involved. When a country has effective champions of case management, the sky is the limit. I've recently spent time in Uganda where a critical group of champions, including representatives from Ministry of Health, NGOs, UNICEF and others, has served as excellent drivers of change. They not only have the right strategy and the right vision, but also the strong will to patiently hammer out the details.

Why do you think most people (in industrialized countries) still aren't aware that childhood pneumonia is a problem, and how can this perception be changed?

I think there is still a perception that pneumonia is a disease of the past, and it is still viewed as "the old man's friend" as Sir William Osler once said. People don't realize the impact of pneumonia around the world, and when you look at the dollars spent on pneumonia compared to its disease burden, the numbers just don't match up. It's critical to find people who are interested in and who have been affected by pneumonia, and to give them a voice.

Visit Save The Children online, learn more about Survive to Five and see how they are supporting World Pneumonia Day.

4. Interview with First Lady of Nigeria's Delta State

The PneumoFOCUS recently had the privilege of interviewing the First Lady of Nigeria's Delta State, Her Excellency, Mrs. Roli Uduaghan. She has been very involved in women's issues and maternal and child health in Delta State and throughout Nigeria. In addition, she founded the MasterCare Foundation dedicated to the health of Nigeria's women and children.

You have been a champion of pneumonia's prevention and proper treatment. Why is this issue important to you?

I have been a passionate advocate for the reduction of child and maternal mortality and have executed several projects to improve the health of women and children in Delta State. In the course of my work, I came across several children suffering from different ailments, most of which are preventable and treatable, but I discovered that most times the parents make the wrong diagnosis due to ignorance and poverty. Pneumonia is one of the most misdiagnosed ailments thus leading to death of children. This is very sad because pneumonia is actually a preventable disease and can be well managed through prevention, proper diagnosis and right treatment. This is why we are championing the cause of preventing pneumonia and taking the message to all the nooks and crannies of Delta State.

The need to sensitize the Government and populace on prevention and proper treatment of pneumonia is driven by my commitment to improving the wellbeing of women and children in Delta State. These are the two most vulnerable groups of people in most developing countries like Nigeria. It is also why I established the Master Care Foundation for the wellbeing of women and children.

I have also recognized the need to arrest this plague, by first educating people on prevention of Pneumonia and advocating for the Delta State Government to offer free pneumonia vaccines in public health centres and hospitals. You know that in Nigeria especially amongst the low income group most older children take care of their younger siblings, so we are taking the message to schools, churches, local community centres, village meetings etc.

Most importantly when we are faced with statistics which show that in Nigeria, 6 million children suffer from pneumonia with a whopping 200,000 of them dying from the ailment, then we must fight to reduce this scourge . These deaths occur because less than 35% of them have access to proper medical care, we must therefore rise up and fight to reduce and possibly eradicate over time death of more children from pneumonia.

Have you met families that have dealt with the devastation of pneumonia?

Yes, it was an experience that gave me a lot of concern. In one of our visitations to rural areas, one of the women brought a child who kept sneezing and coughing , the boy was so restless throughout the event. I asked her if she has seen a doctor and she told me it is okay, that she is treating him with some herbs and has kept him warm. I noticed that the boy had some difficulty breathing and insisted that she should go to a hospital. I took her to the Hospital and the child was diagnosed with pneumonia. Fortunately, the disease was still at a manageable state, so the child was treated and the mother was very relieved that she took my advice of taking the child to the hospital. After paying for the treatment, we had to give the mother some money and grinding machine to start a small business.

This is because we identified that if the mother had the means she would have taken her child to the hospital. We therefore decided that we should improve the woman's economic fortunes so she can properly take care of her children. At least with the money from her trade she can give her children proper nutrition and care. This is the strategy we adopt at Master Care Foundation, empower the women with knowledge and economic means to support their husbands in taking good care of their families.

What is the MasterCare Foundation doing in Delta State to address this issue?

MasterCare Foundation has been involved in projects channeled at improving the lives of women, these projects are funded through donations from private individuals and donor agencies such as the John Hopkins University. Such projects include the free eye-care programme where more than five thousand women had free eye surgeries as well as the provision of glasses to another twelve hundred. This passion has extended to advocating for the prevention and treatment of pneumonia considering the low level of awareness for the devastating effect of the ailment amongst the populace. That is why we have lined up several activities and developed a sustainable programme to ensure that within the next 5years we can reduce the incidence of pneumonia in Delta State to zero level and ensure that every child has access to free pneumonia vaccines.

World Pneumonia Day is approaching on November 2nd. How will Delta State participate and why is WPD important?

In Nigeria we lose about 200,000 children annually to pneumonia that is a staggering statistic which needs to be reversed. This is especially when you consider that pneumonia is a preventable disease which has a vaccine. MasterCare Foundation is going to embark on a sensitization campaign in Delta State through the use of Radio, Television, print medium and other one-on-one conversations to educate people on the prevention and treatment of pneumonia. More importantly we intend to engage the Ministry of Health through the Commissioner and persuade them to start offering pneumonia vaccines to children free of charge and at a subsidized rate for adults.

How will Delta State continue to address childhood pneumonia after World Pneumonia Day?

We are going to continue in our effort to lobby both the executive and legislative arm of Government and influence the formulation of a policy that makes pneumonia vaccine available to children free of charge in the state. We will also continue our mass media, schools and hospitals campaign in all the 25 Local Government areas of the state to ensure they fully understand what pneumonia is and educate them on how to prevent and seek treatment for it when it occurs… We also want to see government embark on a comprehensive educational programme on the prevention and care of pneumonia. If you conduct a straw poll on knowledge of pneumonia, you will be surprised to see that over 70% of the population thinks Pneumonia is all about cold, they know it occurs mostly during the rainy season but do not understand the dynamics. We need to let people know that keeping warm is not enough to prevent pneumonia.

We have been involved in health campaigns for reducing child and maternal mortality, we are involved in immunization, de-worming, malaria prevention, breast and cervical cancer and HIV/AIDS amongst others. Delta State Government currently offers free medical treatment to children and pregnant women, so there is already a platform on which we can operate to ensure the success of eradicating pneumonia as a killer disease in Delta State.

Another dimension is the environmental pollution issue, we will lend our voices to that of other environmental activists who are clamoring for less pollution of the atmosphere caused by smoking, commercial activities and oil exploration. This is an ongoing programme that will not stop until we totally eradicate pneumonia as a killer disease in Delta State and hopefully be a catalyst for spreading the message all over Nigeria.

5. Events and Highlights

Global Pneumonia Summit on World Pneumonia Day – New York
A summit of health experts, NGOs, government officials and many others is being held today, November 2nd, in New York. The summit, moderated by Dr. Richard Besser, Sr. Health and Medical Editor for ABC News, will include speakers such as Dr. Jeffrey Sachs, Director of the Earth Institute, special advisor to UN Secretary General, and singer-songwriter and UNICEF Goodwill Ambassador Angelique Kidjo, as well as experts from the CDC, Johns Hopkins University, the World Health Organization, Save the Children and others. You can watch the Summit on live webcast at www.worldpneumoniaday.org beginning at 9am EST, 2pm GMT.

Media Briefing – Delhi, India
The Indian Academy of Paediatrics (IAP)and the Public Health Foundation of India (PHFI), in collaboration with Johns Hopkins University, WHO, UNICEF, USAID, MCH-STAR and the Indian Clinical Epidemiology Network (IndiaCLEN), are organizing a media briefing including child health professionals and champions to mark the first World Pneumonia Day on 2 November.

National experts will share information on the scale of the problem, medical, social and financial burden on the country and information on prevention and treatment targeted at individuals and families. This will be followed by a Q&A and a "Meet the Press" session wherein individual experts will talk to the press. Speakers expected at the event include Dr Panna Choudhury (IAP), Prof Srinath Reddy (PHFI), Dr Rajesh Mehta (WHO/India), Dr NK Arora (IndiaCLEN), Dr Rajiv Tandon (USAID) and Dr Henri Van Den Hombergh (UNICEF/India). The Health Minister of Delhi government has been invited as the guest of honour.

National Press Conference – Dhaka, Bangladesh
Child health experts in Bangladesh are planning a series of events for World Pneumonia Day to underscore the need for pneumonia prevention in the region. Events began with a press conference on November 1, 2009 and will be followed by a rally and symposium on November 2, 2009 to urge action to fight pneumonia. Longtime PneumoADIP collaborators and PACE members, Dr. Samir Saha and Dr. Zulfiqar Bhutta, have been a driving force in the observance of World Pneumonia Day in Bangladesh.

Walk for Pneumonia – Abuja, Nigeria
World Pneumonia Day advocacy in Nigeria focuses on building partnerships locally and internationally by involving a range of stakeholders in the governmental, non-governmental and private sectors. Child health advocates plan to conduct seminars, brief political officials, run programs geared towards capturing the voices of children. A Walk for Pneumonia is being planned in the capital city of Abuja on November 2, 2009.

Launching New Treatment Policy – Kampala, Uganda
The Uganda Paediatric Association is spearheading the commemoration of World Pneumonia Day with a Pneumonia Awareness Walk to the Parliament of Uganda to present a petition and thereafter a public dialogue on pneumonia. The day's theme "Know Pneumonia, No Pneumonia" will focus on educating Ugandans on the magnitude of pneumonia and the best way to combat it. The UPA is petitioning Parliament and the Ministry of Health for the introduction of the vaccine on the regular immunisation schedule. UPA partners include the Antibiotic Consensus Society of Uganda and the Pneumonia Advocacy and Working Group of Uganda.

Together as One Against Pneumonia –Kinshasa, Democratic Republic of the Congo
There will be a televised football match between National TV and University Hospital, with the key message "Together as One Against Pneumonia" and a televised roundtable discussion where parents can call-in and ask health-related questions on Nov. 2.

Film Screening and Symposium – Baltimore, United States
On November 2, 2009, students and public heath leaders in Baltimore, Maryland will host a film screening and symposium at Johns Hopkins University to commemorate World Pneumonia Day. Students are planning activities throughout the week including "Pneumonia Activism with David Rubenstein" on Thursday, Nov 4th. David Rubenstein is the founder of Save Darfur Coalition and Best Shot Foundation.

CDC Documentary Viewing– Atlanta, United States
The U.S. Centers for Disease Control and Prevention will host a documentary viewing in honor of World Pneumonia Day. CDC experts will be available for a panel Q&A session.

Run for Child Survival – Nairobi, Kenya
The annual Run for Child Survival in Kenya on November 21 will bring together health experts, athletes, families, and others to raise awareness about child survival in Kenya. The theme of this year's run is World Pneumonia Day.

Pnock Out Pneumonia Tournament – Nationwide, United States
Students on college campuses across the United States will be playing dodgeball this winter to help in the fight against pneumonia. Funds raised during the Pnock Out Pneumonia dodgeball tournament, organized by the Best Shot Foundation, will be used to provide children in developing countries with the critical health care they need to prevent and cure pneumonia. Students will be having fun while helping to save lives. Winners from the regional games will be flown to Las Vegas to play in the national finals. For more information go to Best-Shot.org.

Wear Blue Jeans on World Pneumonia Day: Worldwide
Demonstrate that you care about the 2 million children under the age of five who will die in 2009 from pneumonia by wearing blue jeans to work or school or wherever you go on November 2nd. What could be easier?! Tell people you see that pneumonia kills more children than any other disease. Look good and feel good knowing you are helping to turn the tide on pneumonia.

Links and Key Information:

Visit the official World Pneumonia Day Website where you can watch the live webcast of the New York Summit for World Pneumonia Day, see more events happening around the world and read news coverage: www.worldpneumoniaday.org.

Read the official Coalition press release on Reuters

Find out more about pneumonia from the Centers from Disease Control where you can also download podcasts from health experts, read official guidelines and send e-cards to friends and family in support of World Pneumonia Day: http://www.cdc.gov/Features/Pneumonia/.

Donate to the fight:

Save the Children Survive to Five Campaign

GAVI Alliance Immunize Every Child

Play a fun online vocabulary game at GiveVaccines.org and for each word you get right, 0.01mL of vaccine will be provided to a child in the developing world through the GAVI Fund.

Read about World Pneumonia Day on the Blogs:

Huffington Post

One Campaign

Disruptive Women in Health

MEDIA

6. Aid for Pneumonia and Diarrhea lagging – New York Times

Last week, the New York Times compared foreign assistance to developing countries for AIDS to that provided to fight much more common causes of death in childhood like pneumonia and diarrhea. "Public health experts agree there is tremendous potential to lower child deaths from diarrhea and pneumonia substantially" writes author, Celia Dugger. The piece highlights the disconnect between lives lost to HIV/AIDS or to pneumonia and diarrhea in childhood, and the funding assistance set aside by the US government to address these scourges. To read the full article, please click here.

7. Report shows progress in global immunization, but millions of children still lack access to life-saving vaccines

According to a joint report by the World Health Organization (WHO), United Nations and World Bank, in 2008, a record 106 million infants under age one were vaccinated. Research into vaccines is growing, and 120 vaccines are now available. Further, between 2000 and 2007, vaccination against measles helped to decrease measles-related deaths by nearly 75%. Despite these signs of progress, 24 million infants – nearly 20% of infants worldwide - failed to receive potentially life-saving vaccines in 2008. Most of these infants live in poor countries in Africa and Asia. An additional investment estimated at $1 billion per year is needed to ensure that vaccines are available to all children. Margaret Chan, Director-General of WHO said, "The influenza pandemic draws attention to the promise and dynamism of vaccine development today. Yet it reminds us once again of the obstacles to bringing the benefits of science to people in the poorest nations. We must overcome the divide that separates rich from poor - between those who get life-saving vaccines, and those who don't." To read the full report, click here.

8. Save the Children estimates that dramatically reducing child mortality would cost much less than people think

According to a recent global survey conducted by Save the Children, nearly half of people polled in both developed and developing countries believe that it will cost at least $400 billion to dramatically reduce child mortality. However, the organization estimates that it would actually cost only about $40 billion per year to make substantial progress in preventing many of the 9 million child deaths each year from causes such as pneumonia and diarrhea. Encouragingly, more than two-thirds of respondents thought it was "possible" or "very possible" to significantly reduce preventable child deaths. The organization also recently released a report "The next revolution: giving every child the chance to survive" that highlighted disparities in child health and survival in India. "For many poor parents and their children [in India], seeking medical help is a luxury and health services are often too far away," said Shireen Miller, Save the Children's head of policy and advocacy in India. Two million children under age five die each year in India – more than in any country in the world.

RESEARCH

9.Cochrane review of effectiveness of pneumococcal conjugate vaccine updated

An updated Cochrane review of randomized controlled trials (RCTs) reaffirmed the effectiveness of the pneumococcal conjugate vaccine (PCV) in preventing vaccine-serotypes invasive pneumococcal disease (VT-IPD) as well as other types of pneumococcal disease, X-ray defined pneumonia and clinical pneumonia among both HIV-positive and HIV-negative children under age two years. The review included results from six RCTs in Africa, the US, the Philippines and Finland, and the study populations totaled over 100,000 individuals across the PCV and the placebo or vaccine control groups. The pneumococcal conjugate vaccine was found to have an 80% efficacy against (VT-IPD) [95% CI: 58% to 90%, P < 0.0001], 58% for all-serotype IPDs (95% CI 29% to 75%, P = 0.001), and 11% for all-cause mortality [95% CI -1% to 21%, P = 0.08].

10. Researchers assess the current state of and future outlook for pneumonia diagnostics

This month in the Journal of Clinical Microbiology, researchers from the Johns Hopkins Pneumonia Etiology Research for Child Health (PERCH) project and colleagues outlined the current state of and future outlook for pneumonia diagnostics. Recent progress has been made in preventing pneumonia through vaccination, and treating it through the use of case management. However, there is a need to close the gap in knowledge about pneumonia diagnostics. The paper called for improvement of current technologies—such as microscopy, specimen and blood cultures, and antigen detection—while continuing to develop innovative approaches, including promising avenues such as nucleic acid detection tests and biomarker detection through breath analysis. Given the disproportionate burden of pneumonia in developing countries, the researchers also emphasized the need to balance development of rapid, inexpensive, and easy-to-use methods with more costly tests that can be useful in sentinel surveillance sites.

11. Post-vaccination administered acetaminophen may decrease immune response

Children who receive post-vaccination acetaminophen as fever prophylaxis are more likely to have decreased immune responses the vaccines compared to those children who do not receive acetaminophen, according to researchers led by Dr. Roman Prymula of the University of Defence in the Czech Republic . Among children age 3-5 months, those who received post-immunization acetaminophen had decreased immune response to the pneumococcus, Hib, diphtheria, tetanus, and pertussis vaccines. Similar results were found for booster vaccinations of pneumococcus, Hib and tetanus at age 12-15 months. The results were published in The Lancet. In an accompanying editorial, CDC's Robert Chen wrote "This point has implications, especially for Haemophilus influenzae and pneumococcus, for which higher and sustained antibody concentrations are needed to interrupt the carrier state and reduce transmission within the population."

12. A call for increased access to pulse oximeters in developing countries

In a recent issue of the Annals of Tropical Paediatrics, Duke and colleagues review the use of pulse oximetry to reduce child mortality in developing countries. They argue that the use of pulse oximetry in resource-poor countries can reduce mortality in children suffering from pneumonia, other acute respiratory infections, and neonatal illnesses. For example, evidence suggests that use of pulse oximetry and a reliable oxygen source in developing country hospitals can decrease pneumonia-related deaths rates by 35%. They call for global action to promote the availability and use of pulse oximetry, along with reliable oxygen sources, in health facilities providing care for seriously ill children. The authors emphasize that this is a cost-effective intervention, costing approximately $10 per week of use of an oximeter.

UPCOMING EVENTS

The 6th World Congress of the World Society for Pediatric Infectious Diseaseswill be held November 18-29, 2009 in Buenos Aires, Argentina. All symposia will have simultaneous translation into Spanish. For Congress details, visit http://www2.kenes.com/wspid/pages/home.aspx.

A Regional Symposium on New Vaccinesin Lima, Peru will be held December 1-2, 2009. The event is co-hosted by the Sabin Vaccine Institute and the Pan American Health Organization. For more information, visit
http://sabin.org/events/regional-symposium-new-vaccines.

EPIDEMICS², the Second International Conference on Infectious Diseases Dynamicswill be held December 2-4, 2009 in Athens Greece. Conference details are online at http://www.epidemics.elsevier.com/.

The 40th Union World Conference on Lung Healthwill take place from December 3-7 in Cancun, Mexico. The conference’s theme is the interaction of poverty and lung health. Additional information is available at http://www.worldlunghealth.org/Conf2009/website/.

The 15th Annual Maternal and Child Health Epidemiology Conferencewill be held December 9-11 in Tampa, Florida. Pre-conference data skills trainings are also being conducted on December 7-8. For more information, visit http://www.cdc.gov/Reproductivehealth/MCHEpi/2009/AboutConference.htm.

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 deadline for travel grant applications is October 14, 2009. The deadline for abstract submission is November 16, 2009. Visa applications for travel to Israel may be a lengthy process, so participants are advised to register and begin the Visa application process as early as possible.