MEDIA

1.  Global child mortality decline continues, falling below 9 million under-five deaths in 2008

For the first time on record, the number of annual under-five deaths fell below 9 million, with an estimated 8.8 million deaths in 2008.    Experts attribute this progress to the increased use of immunizations, insecticide-treated bednets, and Vitamin A supplementation, among other interventions.  The global under-five mortality rate of 65 deaths per 1,000 live births in 2008 is a 28% decline since 1990.  The Millennium Development Goal is to decrease under-five mortality by two-thirds between 1990 and 2015.  At the current rate of progress, the world will not meet this goal. "Compared to 1990, 10,000 fewer children are dying every day," said UNICEF Executive Director Ann M. Veneman. "While progress is being made, it is unacceptable that each year 8.8 million children die before their fifth birthday."  Pneumonia and diarrhea are the top causes of under-five mortality, yet remain relatively neglected.  The expanded use of the pneumococcal and rotavirus vaccines may help to accelerate progress in child health and survival. 

2.  Pneumococcal vaccine roll-out begins in The Gambia

On August 19, The Gambia became the second country in Africa to introduce the pneumococcal conjugate vaccine (PCV) through support from the GAVI Alliance.  The vaccine will be incorporated into the country’s routine immunization schedule and will be provided at no cost to families. This news comes just four months after Rwanda began a similar vaccine program.  "We are committed to saving the lives and improving the health of our children and families, and we are proud to set an example for our West African neighbors to follow.  With the introduction of this vaccine, the goal of significantly reducing childhood death in our country will now be within reach," said Gambian Minister of Health Dr. Mariatou Jallow.  According to WHO estimates, one out of every six childhood deaths in The Gambia is due to pneumonia.  The vaccine launch is the result of a successful partnership that includes the Gambia government, the GAVI Alliance, WHO, USAID, UNICEF and Wyeth Pharmaceuticals.

3.  Hib vaccine introduced in Bhutan

The country of Bhutan recently introduced the Hib-containing pentavalent vaccine  into their national immunization program.  Health Minister Lyonpo Zangley Dukpa announced, "With our commitment to reduce childhood mortality by 40 percent, we strongly feel that we're moving in the right direction by making this vaccine available for our children."  Tshewang Tamang, the program officer of Bhutan’s vaccine-preventable disease program, estimated that the introduction of the vaccine would reduce incident Hib pneumonia and meningitis cases by 50% in the next five years.  Support from the GAVI Alliance will ensure that the vaccines will available at a discounted rate of US$ 0.23 (compared to the market rate of US$3.60) for the first five years of vaccine coverage.

4.  Call to strengthen U.S. support for Advanced Market Commitments

In a recent blog in The Huffington Post, Drs. Seth Berkley and Orin Levine advocated for increased U.S.-based leadership and financial support for Advanced Market Commitments (AMCs).  An AMC is a market-based financing mechanism that accelerates the delivery of life-saving vaccines for children worldwide.  The pneumococcal AMC has already helped to deliver the pneumococcal vaccine to children in The Gambia and Rwanda.  It is funded by the governments of Italy, the United Kingdom, Canada, Russia and Norway and the Bill & Melinda Gates Foundation, which have contributed a total of $1.5 billion.  The authors note that the U.S. is absent from this list, and state, "President Obama and our Congress can move the United States from the sidelines to the frontlines of this issue by calling for new AMCs to tackle infectious diseases, and then backing those calls with financial support. In the process, they can support medical innovation using a cost-effective approach to foreign aid, save millions of lives and re-establish U.S. leadership in driving innovative, results-based solutions."

RESEARCH

5.  Special issue in the journal Vaccine devoted to pneumococcal disease

The journal Vaccine recently devoted a special issue to pneumococcal disease.  In it, Ron Dagan reviews of the history of PCV7, highlighting its clinical benefits and the concomitant decline in antibiotic-resistant pneumococcus.  He also discusses the concept of serotype replacement, noting that the increased incidence of IPD caused by non-vaccine serotypes since the introduction of PCV7 has primarily occurred among the elderly, HIV-positive and children with underlying medical conditions.  He concludes that the increase of IPD caused by serotype 19A is primarily related to antibiotic resistance, and is concerning in both vaccinated and unvaccinated populations. 

Other articles in this issue provide insight into a wide range of topics related to pneumococcal disease.  Carlos Grijalva reviews three studies showing substantial declines in pneumonia-related hospitalizations among children under age two years following the introduction of routine PCV7 immunization in the United States in 2000.  Klugman, Chien & Madhi discuss the relationship between pneumococcal pneumonia and influenza, focusing on the health consequences of co-infection.  They note the important role of PCV in pandemic influenza preparedness.  Peter Paradiso discusses the essential criteria for evaluating the effectiveness of a new PCV.  He focuses on the use of WHO-recommended antibody concentrations to evaluate the immunologic non-inferiority of new vaccines compared to PCV7.

Several articles focus on pneumococcal disease in Latin America.  De Quadros provides an overview of the burden of pneumococcal disease in Latin America, emphasizing the disproportionate burden among low-income groups.  Valenzuela and de Quadros review concerning data on the rise of antibiotic resistance of Streptococcus pneumoniae in Latin America.  They call for expanded vaccination with PCV and strengthened surveillance systems to detect changes in resistance patterns and serotypes causing disease. 
Soley & Arguedas focus on the link between pneumococcal serotypes and invasive disease in Latin America .  They stress the need for enhanced vaccine coverage of pneumococcal serotypes 1,5,3,7F and 19A, as well as ongoing serotype surveillance after the introduction of new vaccines.

6.  Study shows African children with sickle cell anemia at high risk for pneumococcal, Hib and other bacterial infections

Williams and colleagues recently published the results of a retrospective cohort and case-control study of bacterial sepsis among Kenyan children with sickle-cell anemia.  Investigators conducted blood cultures on all children under 14 years of age from a defined study area admitted to the Kilifi District Hospital in rural Kenya from August 1, 1998 to March 31, 2008.  Cases were children with bacteremia and controls were children from the same area recruited for studies during 1998 to 2005, and children born in the area between 2006 and 2008.  They detected 2,157 (6%) cases of bacteremia among the 38,441 children admitted.  They then tested for sickle-cell anemia and identified the disease among 108 cases (6%), compared to 89 controls (1%). The age-adjusted odds ratio for all-cause bacteremia in children with sickle-cell anemia was 26.3.  Streptococcus pneumoniae was the organism most commonly isolated from children with sickle-cell anemia (41%).  Approximately 75% of all pneumococcal isolates were serotypes covered by ten-valent pneumococcal conjugate vaccine.  Pneumococcus was followed by non-typhi Salmonella species (18%) and Haemophilus influenzae type b (12%).  These organisms are the same as those that are most likely to cause bacteremia among children with sickle-cell anemia living in developed countries.  This study suggests that expanded access to the pneumococcal and Hib vaccines in Africa would be of particular benefit to children living with sickle-cell anemia. 

ANNOUNCEMENTS

Clinician survey on pulse oximetry and oxygen supplementation
Across the world, pulse oximetry and oxygen supplementation are variously used to diagnose and manage childhood pneumonia. PATH is conducting a web-based survey to learn about clinicians’ experiences with these tools, including assessments of such aspects as usefulness, accessibility, and reliability.  Click here to participate in the survey. 

Medical Research Council in The Gambia announce job openings
The Medical Research Council in The Gambia is currently drafting an exciting new research agenda organized under three themes.  They are seeking 1) a paediatrician/clinical scientist to lead the Child Survival theme, 2) a public health specialist/epidemiologist to lead the Disease Control & Elimination theme and 3) a vaccinologist/vaccine epidemiologist to lead the Vaccination theme.  Post holders will be expected to lead their own areas of research as well as to provide guidance and support to a team engaged in a broad, cross-cutting spectrum of research. They will also be expected to develop, generate and encourage a wide range of external funding opportunities and collaborations.

UPCOMING EVENTS

The 3rd International Conference on Modern Vaccine Adjuvants and Delivery Systems will be held in Vienna, Austria October 28-30, 2009.  For more information on the conference, including registration, please visit http://www.meetingsmanagement.com/mvads_2009/index.htm

The 6th World Congress of the World Society for Pediatric Infectious Diseases will 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

From November 30 to December 2, 2009, Children's Rights at a Cross-Roads: A Global Conference on Child Rights and Research will take place in Addis Ababa, Ethiopia.  Additional information is available at http://www.childwatch.uio.no/projects/global-conferences/un-child-rights-convention-anniversary-conference-2009/

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

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.