New Data on the Global Burden of Pneumococcal and Hib Disease

Dear Colleagues,

I am pleased to tell you that after an exhaustive study undertaken through a collaboration of the WHO, the PneumoADIP and the Hib Initiative, new data on the global, regional and country-level burdens of pneumococcal and Hib diseases will be released in The Lancet tomorrow, September 12th. As you have probably seen in a PneumoALERT earlier this week, the Global Health Council will host a briefing on the new data today in Washington, DC. If you have not yet made plans to do so, we would welcome you to participate and you can RSVP to the GHC here.

We found that pneumococcal and Hib disease exact a high toll in several important Asian and African countries. Fortunately, Hib vaccine is now or will shortly be available in nearly every low-income country in the world. For pneumococcal disease, our data are proof of a disturbing disparity between the places where children die every day of this preventable disease, and those places where effective preventive measures, like conjugate vaccines, are available. These results, which are the first ever estimates at the country level, can provide key decision-making information for countries considering the introduction of new vaccines, particularly pneumococcal conjugate vaccine.

The studies were undertaken with funding from the WHO, the Vaccine Fund and the GAVI Alliance. A press release for this announcement follows below and more information including interactive maps can be found on our website today and on the site of the WHO.

Finally, I would like to take the opportunity to thank the many people who have contributed their valuable time and energy to the completion of this important project, especially Dr. James Watt, lead author of the Hib disease burden paper, Dr. Thomas Cherian and his colleagues at the WHO who worked tirelessly on this effort, Dr. Maria Deloria-Knoll at the PneumoADIP, Prof. Kim Mulholland and colleagues at the London School of Hygiene and Tropical Medicine, Dr. Rana Hajjeh at CDC , and the tens of data abstractors and research assistants. A special thank you to Emily Henkle, Dr. Hope Johnson and especially to Dr. Orin Levine, Executive Director of the PneumoADIP.

Very best wishes,

Kate O’Brien, MD, MPH
Associate Professor,
Deputy Director, Research
PneumoADIP
Johns Hopkins Bloomberg School of Public Health

New WHO Data Underscores Global Threat of the World’s Leading Child Killer

Prevention and treatment of pneumonia are critical to reducing child mortality, reaching Millenium Development Goal 4

WASHINGTON, DC – New World Health Organization data to be published in this week's edition of The Lancet will shed new light on two leading causes of pneumonia, the world’s leading killer of children under age 5, both globally and within specific countries. The results, which are the first ever available at the country level, are expected to serve as a clarion call to developing country governments to invest in pneumonia prevention programs.

According to the studies, Streptococcus pneumoniae and Haemophilus influenzae type b [Hib] infections take the lives of an estimated 1.2 million children under age 5 each year. Safe and effective vaccines exist to provide protection against both diseases. However, use of Hib vaccine has only recently expanded to low-income countries and pneumococcal vaccine is not yet included in national immunization programs in the developing world, where children bear the highest risk for pneumonia and where most pneumonia-related child deaths occur.

Streptococcus pneumoniae (Pneumococcal Disease)
Data from the study show that in 2000, there were an estimated 14.5 million cases of pneumococcal disease worldwide, and 826,000 children under 5 years of age died of the disease. Of the 14.5 million pneumococcal cases, 95% were attributable to pneumonia. While the majority of pneumococcal cases (51%) were found in Asia due to the high population, an estimated 54% of pneumococcal deaths occurred in Africa, where the lack of vaccines, a high prevalence of HIV infection and lack of access to medical care contributed to the death toll.

"Our findings underscore the urgent need for prevention efforts throughout the developing world," said Kate O'Brien, primary author of the pneumococcal study and Associate Professor of International Health at the Johns Hopkins Bloomberg School of Public Health. "The need for vaccination and improved treatment is particularly urgent in Africa and Asia, which together account for 95% of all pneumococcal deaths."

The ten countries with the greatest number and greatest proportion of global pneumococcal cases were in Asia and Africa, and taken together account for 66% of cases worldwide. These countries include India (27%), China (12%), Nigeria (5%), Pakistan (5%), Bangladesh (4%), Indonesia (3%), Ethiopia (3%), Democratic Republic of the Congo (3%), Kenya (2%) and the Philippines (2%).

"In areas of the world where access to quality care is limited, the use of pneumococcal vaccine is particularly necessary to limit disease and save lives," said Thomas Cherian, Coordinator of the WHO Expanded Programme on Immunization. "Implementing pneumococcal vaccine is critical if developing countries are to achieve United Nations Millennium Development Goal 4 for child mortality reduction."

In 2000, only the USA had initiated routine use of pneumococcal vaccine. By August 2008, this expanded to include 24 high and two upper-middle income countries but did not include any from Africa or Asia, the regions with the highest numbers of pneumococcal deaths and cases. According to the study, these 26 countries accounted for less than 0.2% of global childhood pneumococcal deaths in 2000 and the children in these countries, on average, had a 40-fold lower risk of pneumococcal death than the children in countries not yet using the vaccine.