The first pneumococcal vaccine for infants was licensed in the year 2000. In this issue of PneumoFOCUS we illustrate the important role of surveillance in monitoring the impact of vaccination after its introduction. This is a timely issue as more and more countries introduce the vaccine and as we prepare for first introductions in GAVI countries. Currently, nearly 20 countries have introduced or will soon introduce PCV7 into the national immunization programs, with Costa Rica and New Zealand among the most recent. For the insight of one important stakeholder in a recent decision, this issue concludes with an interview with Fiona Colbert, from Meningitis Trust, who discusses the recent New Zealand experience with introduction, and highlights ongoing projects and strategic aspects that might be useful to other countries interested in PCV7 introduction to their national immunization programs in the future.

PneumoADIP, GAVI and its partners continue to make progress on accelerating pneumococcal vaccines for developing countries. On the Advance Market Commitment, the next few months are a busy time. By the end of this year, there is expected to be a Technical Product Profile specifying the minimum characteristics and criteria that vaccines must pass in order to qualify for AMC funding. Country decision making is getting a boost now that the WHO is sending out country-specific estimates of the burden of disease to all Ministries of Health. This step is timely because the first round of GAVI applications are due to GAVI by September 28th. And vaccine development continues to progress with GSK’s 10-valent and Wyeth’s 13-valent vaccine both in phase 3 testing at this time.

As the first country to introduce PCV7, the US PCV7 experience has provided valuable post-introduction findings such as herd immunity, cost effectiveness, replacement disease, and alternative scheduling that would serve other countries interested in introducing pneumococcal vaccines.

PCV7 Effectiveness – Changing IPD Characteristics in the US - PCV7 introduction into the United States in 2000 has led to a decline in vaccine-type invasive pneumococcal disease (IPD) among both immunized children and non-immunized adults. In order to fully assess the effectiveness of the vaccine, however, it is essential to better characterize temporal trends in IPD incidence, clinical syndromes, and underlying conditions. Using active laboratory- and population-based surveillance data from the Centers for Disease Control and Prevention between July 1997 and June 2004, changing characteristics of IPD in Metropolitan Atlanta, Georgia were examined. It was found that the decreasing incidence of IPD in Atlanta from 2000 to 2001 was associated with decreases in cases of pneumonia and meningitis in adult and pediatric subjects and in cases of primary bacteremia in children. The burden of serotype-replacement disease remained small relative to these declines. Adults with co-morbidities, specifically with HIV infection, represent a growing proportion of patients with IPD and an important target population for pneumococcal immunization. This report highlights the value of surveillance to monitor the dynamics of disease incidence following vaccine introduction. Albrich et al. Clin. Infect. Dis. Jun 2007; 44(12): 1569-76.

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. Click here to read her interview with PneumoADIP.

July 31, 2007 – New York City. UK Prime Minister, Gordon Brown, launched a new campaign to tackle ill health, poverty and poor education in developing countries that will operate through the United Nations, and will comprise a partnership between governments, the private sector, faith and pressure groups. In his speech, on health, Brown mentions pneumococcal pneumonia: “Before us is the dream that we can triumph over ancient scourges and for the first time in the history of the world we can conquer polio, TB, tetanus, measles and then – with further advances and initiatives – go on to eliminate pneumococcal pneumonia, malaria and eventually HIV/AIDS.”

Brown stated that world leaders had failed to live up to promises to solve the crisis in the poorest nations, and was supported by 12 other leaders, including President George Bush, as well as the heads of 20 global companies, including Microsoft, Goldman Sachs, Anglo American, Google, Wal-Mart Stores, Bechtel Corporation, GE, Vodafone, Pepsi Co, and Cisco Systems. Brown’s officials say it is not a lack of scientific, economic or development knowledge that is holding back progress, but largely a lack of political will.
To read his speech, click here.

For more immunization news and events, read GIN (Global Immunization News) available at:
http://www.gavialliance.org/Resources_Documents/gavi_updates/index.php
http://www.who.int/immunization/en/

September 28, 2007 – GAVI country applications deadline for pneumococcal vaccine.

November 7-8, 2007 – Meningitis Research Foundation International Conference:
Meningitis and Septicaemia in Children and Adults in London, UK

November 27-30, 2007 – Joint GAVI Alliance & Fund Board Meetings in Cape Town, South Africa

December 4-7, 2007 – AFRO Task Force on Immunization in Madagascar

June 8-12, 2008 – ISPPD6 (6th International Symposium on Pneumococci & Pneumococcal Diseases) in Reykjavik, Iceland