PneumoADIP’s final Small Grants deadline is February 15, 2005. Please remember that this is the very last cycle of Small Grants funding. You can learn about projects we have already funded in this issue of PneumoFOCUS. And for more information about the program and how to apply visit us online at www.preventpneumo.org.

GAVI’s PneumoADIP is pleased to sponsor an episode of the upcoming BBC World documentary series, “Kill or Cure.” This particular episode will focus on pneumococcal disease in developing countries, giving a human face to those suffering from it and looking at what is being done to prevent it. Filming took place in October in Suweto, South Africa and in Kilifi, Kenya with cooperation from Drs. Shabir Madhi and Keith Klugman in Suweto and Drs. Anthony Scott, Mike English and Wamae Maranga as well as Ms. Beverly Watila of NetSPEAR in East Africa. The first episode of the series will air on 6th January 2005. Please stay tuned for more information on this exciting project and click here to see BBC World’s description of the project .

GAVI’s PneumoADIP is pleased to announce the first recipients of our Small Grants Program awards. All submitted applications were reviewed first internally and then externally for scientific merit, methodological soundness and agreement with PneumoADIP’s mission, which is to improve child survival and health by accelerating the evaluation of and access to new, lifesaving pneumococcal vaccines for the world's children. Congratulations to the successful candidates. We look forward to reviewing many future applications.

Bobo-Dioulasso, Burkina Faso. Starting on 1 November 2004, Association pour l’aide a la Médecine Préventive (AMC) will begin to establish sentinel surveillance sites to monitor pneumococcal meningitis in the region. As the program evolves, surveillance will expand to include two districts in Togo and at least one district in each of Benin, Mali and Northern Burkina Faso. These sites will provide important tools in measuring the population-based impact of any potential pneumococcal vaccine introduction program. Researchers will look at the pneumococcal meningitis case fatality rate and the resulting burden of sequelae, and will estimate the proportion of clinical and purulent meningitis due to S. pneumoniae. The project will continue for 12 months, through November 2005.

Viti Levu, Fiji. In December 2004, the Fiji Pneumococcal Project (FiPP) – a collaboration between the Fiji Ministry of Health (MOH), Fiji School of Medicine (FSM) and University of Melbourne – will begin a two-year project to develop a simple, reproducible system for estimating the outcome of pneumococcal meningitis in a developing country. They will try to determine the probability that – in this region where Hib vaccination is universal and Meningicoccal meningitis is rare – culture-negative purulent meningitis is due to S. pneumoniae. Researchers will also be looking at short- and long-term child morbidity and mortality due to pneumococcal meningitis and antibiotic susceptibility and serotype distribution. Finally, FiPP will document how bacterial meningitis is clinically managed in Fiji and the cost involved. This project will continue through May 2006.

Ibadan, Nigeria. Researchers at University College Hospital here will begin a project here on January 2005 to improve their laboratory’s capability to isolate and identify S. pneumoniae and other fastidious bacterial pathogens from samples of blood from children who show symptoms of pneumonia or meningitis. The team will also collect information on antibiotic resistance and serotype distribution of isolated pneumococci. This project will serve to strengthen bacterial disease surveillance in this rural African setting. The project will continue for 15 months and will end March 2006.

Alexandria Governorate, Egypt. In January 2005, researchers at El-Shatby University Pediatric Hospital and Alexandria Fever Hospital here will be gathering information on the number and serotype distribution of pneumococcal isolates collected. They will also be looking at antibiotic resistance patterns. Both of these hospitals already have well-established microbiology laboratories. This project will contribute to an understanding of the role of the pneumococcus in severe pneumonia and meningitis and to increased global momentum for the development and financing of appropriate vaccines and other interventions. The project will continue through the end of April 2006.

West Java, Indonesia. Starting in January 2005, researchers from three universities - Padjadjaran University in Bandung, Indonesia, University of Colorado Health Sciences Center in Denver, Colorado, USA and Ben-Gurion University of the Negev in Beer-Sheva, Israel – will assess serotype distribution and antimicrobial resistance patterns of pneumococcal infections among children in the region. By increasing public awareness of pneumococcal serotype distribution in this rural and peri-urban community, this project will also help to increase global momentum for the development and financing of appropriate vaccines and other interventions.

Mexico City, Mexico, 2-4 November 2004 – The Pan American Health Organization EPI managers and Technical Advisory Group gathered here for their annual meeting. They had pneumococcal disease prevention high on their agenda, dedicating a full day to the topic. The chief of PAHO’s immunization unit, Dr. Jon K. Andrus, organized the meeting, and Dr. Orin Levine of GAVI’s PneumoADIP acted as chair.

Representatives from participating countries presented excellent examples of their disease burden data collection efforts and of how a picture of pneumococcal disease is emerging via information available as a result of the SEREVA network cooperation. Participants identified several possible ways that PneumoADIP might support PAHO’s pneumococcal disease-related initiatives. We are working together to identify the best option.

Bergen, Norway, 21 September 2004 – Internationally renowned researchers and policy makers today pressed international health authorities and national governments to look for new strategies to expedite the development and delivery of urgently needed vaccines against poverty-related diseases in developing countries. The call to action came as part of a two day seminar organized by the Global Alliance for Vaccines and Immunization (GAVI) and the Centre for International Health at the University of Bergen. The meeting’s organizers also praised Norwegian political leaders for their commitment to find long-term solutions for the provision of vaccines to children in developing countries. Norway has committed sums equivalent to US$ 388 million to the year 2010. At a cost of US$ 28 per child, this represents resources sufficient to vaccinate almost 14 million children in the developing world. Statistically, this means that every individual in Norway is paying for the vaccination of three children. Hilde F. Johnson, Minister of International Development of Norway, and member of the Norwegian Cabinet praised GAVI for its work. “Immunization in the third world is an issue that Norwegian people care about deeply. Thanks to GAVI’s efforts, established vaccines have reached over 9 million more children in more than 50 countries, which is a remarkable achievement. Yet there is still much for us all to do”, she said.

Jens Stoltenberg, leader of the largest Norwegian political party, the Norwegian Labour Party, and former prime minister, urged participants and donor countries to support the development of relevant research agendas for the effective delivery of current and new vaccines in developing countries. “It is our moral duty. But it is also a profitable investment in economic development. Healthy children are important to economic growth, and vaccinating them is one of the surest ways to produce results”, he said.

The consequences of failing to immunize children are dramatic. According to the World Health Organization (WHO), some 30 million children born each year in developing countries are not vaccinated against the most common childhood diseases. Each year an estimated 1.5 million children under five die from vaccine-preventable diseases, and over 1 million children under five die from meningitis, pneumococcal disease and rotavirus diarrhea – diseases for which vaccines are currently under development. Dr. Tore Godal, Executive Secretary of GAVI, spoke of what he termed ‘a world of contradictions’. “So many children die of common and serious diseases, yet these are the very diseases that we could prevent”, he said. “Norwegians recognize this cruel paradox and have faced the challenge head on”.

During the two-day seminar, GAVI highlighted two current projects to ‘fast track’ the development and introduction of two priority vaccines – a pneumococcal conjugate and a rotavirus vaccine. The routine use of these vaccines, in developing countries, could contribute to achieving the United Nations’ ambitious goal of reducing child mortality by two-thirds by 2015.

Dr Orin Levine, Executive Director of the pneumococcal vaccine project, PneumoADIP, explained that these efforts are part of a broader initiative led by GAVI and its partners to accelerate the introduction of important new vaccines in developing countries. “To introduce a new vaccine has taken decades in the past, largely because vaccines developed for use in the highly profitable drug markets of the United States and western Europe need to be adapted to fit local serotype distribution,” explained Dr Levine. “As a result it has never been financially lucrative for drug companies, and this is one of the reasons why, until now, it has taken years for vaccine prices to decrease significantly enough to permit effective vaccine programs in developing countries”, he said.

But GAVI’s novel approach, begun with two $30 million grants to two small teams at PATH and the Johns Hopkins Bloomberg School of Public Health, aims to change this pattern by putting vaccine development for poorer countries on a fast track.

Investigators Picture during standardization and Microbiology meeting at Christian Medical College, Vellore, India. Left to Right: Dr. Batuwanthudawe, Dr. Mark C. Steinhoff, Mr. Thappa Chandra, Dr. Kurien Thomas, Dr. N. Tuladhar, Dr. M.K. Lalitha, Dr. Malka Desnayake, Dr. Aparna Shah Singh, Mrs. C.H. Jeyasurya.

In September 2004 a consortium of Nepalese and Sri Lankan hospitals came together under the banner of the South Asian Pneumococcal Network Alliance (SAPNA), and with sponsorship from GAVI’s PneumoADIP are embarking on an ambitious disease surveillance project to better define the regional burden of pneumococcal disease. They will be basing their surveillance on a successful model already in use in India – the Invasive Bacterial Infections Surveillance (IBIS).

These hospitals are no strangers to the collection of CSF and blood samples – Clinicians at Lady Ridgeway Hospital for Children in Colombo, Sri Lanka alone collected nearly 1,000 CSF samples in 2003. But they will be working on improving existing lab facilities and techniques to increase pneumococci isolation rates.

Although S. pneumoniae is likely the cause of at least one-third of all severe pneumonia, prevention of pneumococcal disease is a not widely established public health priority in these countries. An increased understanding of the burden of pneumococcal disease will enable decision makers to weigh various options for making the best use of limited resources. The investigating team has made close links with health policy makers in the countries even at the designing phase of the SAPNA project so that the data generated will help to influence health policy.

The surveillance project began in November 2004 and is expected to run through June 2006. During that time, the investigators team, led by Drs. B.K.K.Batuwanthudawe, N..Thuladhar, Aparna Singh, Mark Steinhoff, M.K. Lalitha and Kurien Thomas expect to collect 4000 blood cultures and CSF specimens.