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EXECUTIVE
DIRECTOR'S NOTE |
After years of collaborative efforts in the global health and development community, momentum continues to build for pneumococcal disease and its prevention in a variety of ways and we highlight some breakthroughs in this issue. For the first time, our surveillance colleagues in Bangladesh received government funding for pneumococcal disease surveillance – which signals government recognition of pneumococcal disease as a public health priority; congratulations! Recognition of pneumococcal disease as a big, preventable global health problem and the value of pneumococcal vaccines in saving lives continue to build in mass media, including recent issues of Time Magazine, The New Yorker, World Economics, Newsweek. Congratulations to each and everyone for building this momentum and let’s continue to work together to save lives faster than ever before.
IN THIS ISSUE:
1. Interview: Dr. Steve Luby, project director of ADIP Pneumococcal Project at ICDDRB in Bangladesh spoke with PneumoADIP about acquiring funding from the government for pneumococcal disease surveillance.
2. PCV-7 herd immunity revisited: JAMA publication focuses on indirect benefits for the elderly.
3. Value of vaccinations: Recent economic study re-evaluates the broader societal and economic value of vaccinations.
4. Pneumococcal vaccines in the press: Time Magazine, The New Yorker, Newsweek.
5. Vaccine supply: Pneumococcal vaccines mentioned in European biotechnology conference.
6. Vaccine research: 3 scientific publication highlights.
7. Upcoming events: Please note that the deadline for ISPPD-5 abstracts has been extended to December 7, 2005.
Orin Levine
Executive Director |
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| NEWS FROM THE FIELD: BANGLADESH PNEUMO PROJECT RECIEVES GOVERNMENT FUNDING
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ICDDR,B – ADIP Pneumococcal Project, Bangladesh. Two years ago in Bangladesh, researchers from multiple institutions embarked on an ambitious pneumococcal surveillance network project to provide population-based data on pneumococcal disease for policy makers. Recently, the government of Bangladesh committed additional funding to this project. This commitment signals government recognition of the long neglected pneumococcal disease as a public health priority. Dr. Steve Luby, current project director, spoke with PneumoADIP about this exciting development.
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| VACCINE RESEARCH: PCV-7 HERD IMMUNITY REVISITED – INDIRECT BENEFITS FOR ELDERLY
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| October 25, 2005 – JAMA. This publication is based on the same surveillance data as the September CDC report about the phenomenal direct and indirect effects of routine child pneumococcal vaccination in the U.S. Authors here aimed to delineate pneumococcal disease dynamics in adults aged 50 years or older before and after pediatric pneumococcal conjugate vaccine licensure. Results from this data indicate a significant decline in invasive disease in older adults following PCV-7 licensure, likely due to a decrease in community transmission of vaccine-type pneumococci from young children who received PCV-7. The study emphasizes the benefits of pediatric PCV-7 immunization in older adults, a particularly vulnerable age group at high risk for serious disease and death from pneumococcal infection. While the observed herd immunity effect may not apply to all population subsets, particularly those with chronic infections such as diabetes and HIV, the data presented in this study highlight the cost-effectiveness of PCV-7 and strongly support its incorporation into routine infant immunization programs. Lexau et al., JAMA. 2005 Oct; 294(16): 2043-2051
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| VACCINE FINANCING: RECENT ECONOMIC STUDY DOCUMENTS BROADER SOCIETAL BENEFITS OF VACCINATIONS |
The Value of Vaccination: An Economic Perspective. Research has shown that previous methods of quantifying the outcomes of immunization have greatly undervalued its benefits by focusing primarily on health-related advantages, such as averted morbidity, mortality and medical costs. Investigators at the Harvard School of Public Health and at the UK-based knowledge consultancy, River Path Associates, have shown that immunization programs boost global economies with outcomes that transcend solely health-related benefits. The investigators valued vaccination in terms of individual development, with an emphasis on areas such as cognitive ability, education, savings, investment, labor productivity, and changes in demographic dividends. A case study examined the rate of return on GAVI’s program to extend the use of the traditional basic childhood vaccination package to increase coverage of the under-used Hib, hepatitis B and yellow fever vaccines, and to help finance the introduction of anticipated vaccines covering pneumococcal disease, rotavirus, and meningococcal A/C conjugate. Results revealed that the average percentage-increase in income for children (whose immunization coverage increases through the GAVI program) is estimated to rise from 0.78 percent in 2005 to 2.39 percent by 2020. The internal rate of return to the GAVI program amounts to 12.4 percent in 2005, rising to 18 percent in 2020 as vaccine costs decline. The authors conclude that while the obvious outcome of immunization is improvement in health status, immunization also elicits a long-term but highly underestimated impact on individual development and economic progress. More research is necessary to quantify these health-independent value effects, which may provide incentives to renew the global commitment to vaccination. Bloom et al, World Economics. 2005 Jul-Sep; 6(3): 1-25
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| PNEUMOCOCCAL VACCINES IN THE PRESS
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November 7, 2005 – Time Magazine. In the recent comprehensive and powerful special report of Time Magazine about global health issues and efforts, pneumococcal disease is mentioned in its headline, “Saving 1 life at a time. When the rich sneeze, the poor catch pneumonia. Why do we allow it? Good people all over the world are battling the diseases of poverty. You can too. ” Time. 2005 Nov 7; Vol. 166 No. 19
October 24, 2005 – The New Yorker. A recent review in The New Yorker outlines the overall impact of the Gates Foundation in addressing the critical issues surrounding under-funded diseases, mostly prevalent in developing nations. The article cites GAVI’s work towards the elimination of vaccine-preventable diseases, particularly its support of research on vaccines for effective control of pneumonia, stating that such vaccines have the potential to reduce the burden of mortality in Africa by fifteen per cent. “A Reporter at Large: What Money Can Buy. Millions of Africans die needlessly of disease each year. Can Bill Gates change that?” by Michael Specter, The New Yorker. 2005 Oct 24; 57-71
Summer, 2005 – Newsweek. In an article about childhood immunizations in making unprecedented global health impact in the past now and the future, pneumococcal disease is highlighted with dengue, malaria, HPV and TB as “the most promising targets” for the next generation of vaccines in preventing infectious diseases. “On the March to Eradicate Child Illness: Childhood immunization is the most cost-effective technology in public health, doctors say. That message is getting out around the world.” by Karen Springen and Sam Seibert. (posted online July 1, 2005 ).
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| VACCINE SUPPLY: PNEUMOCOCCAL VACCINES MENTIONED AT BIOTECHNOLOGY CONFERENCE
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Cordia Conference, London – October 11-13, 2005. There were three sessions of particular relevance to vaccines at this European biotechnology conference with a strong emphasis on making vaccines commercially viable:
•Vaccination: who should be vaccinated and who pays for it?
•Making vaccines a clinical and commercial success
•Vaccines: what’s the latest?
Pneumococcal disease was mentioned in all three of these sessions, with former GAVI director Tore Godal, Dr Alan Lamont of Acambis and Kim Mullholland of the London School of Hygiene and Tropical Medicine all mentioning the development of pneumococcal vaccines in their presentations.
The role of the Global Alliance for Vaccines and Immunization (GAVI) was highlighted by several speakers. Both Tore Godal and Kim Mullholland highlighted the beneficial impact of GAVI in helping to reverse the downward trend in vaccinations in the developing world that had been seen in the 1990s. Kim Mullholland also said that this process has been boosted recently by IFFIm. Dr Lamont also identified GAVI funding as a key driver in the vaccine market – which he said is predicted to be worth $15 billion by 2010.
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| VACCINE RESEARCH: 3 SCIENTIFIC PUBLICATION HIGHLIGHTS |
Advances in Diagnostics. The Binax NOW S. pneumoniae antigen test, previously validated for urine and cerebrospinal fluid (CSF) testing, has recently been shown to have excellent sensitivity and high specificity for the diagnosis of pneumococcal pneumonia from bronchoalveolar lavage (BAL). Bronchoscopy with BAL is used in the diagnosis of severe or nonresolving community-acquired pneumoniae (CAP), ventilator-associated pneumoniae (VAP), and pneumoniae in immunocompromised patients. Current standard microbiological and cytological analyses of S. pneumoniae are often impaired due to the effects of antibiotic treatment on Gram stain reaction, morphology and culture. The Binax NOW S. pneumoniae antigen test can be used as an adjunct to these standard methods, potentially increasing overall diagnostic validity. Furthermore the long shelf life of the antigen test (1 year for a package of 12 tests) and its stability at room temperature render it optimal for use in developing countries.
Jacobs et al, J. Clin. Microbiol. 2005 Aug; 43(8): 4037-40
Modeling Approaches to Vaccinology. Using incidence rates from CDC’s Active Bacterial Core surveillance and immunogenicity data from the Navajo/Apache trial of pneumococcal conjugate vaccine (PCV), mathematical modeling was used to predict the optimal age to administer a single dose of PCV. The mathematical model generated incorporated two critical factors used to predict optimal age of vaccination, namely, the age-specific incidence of pneumococcal disease and the ability of the immune system to respond to the vaccine. The study concluded that a single dose of PCV has the potential to prevent a significant amount of invasive pneumococcal disease in children. Based on the model, the optimal time to administer a single dose of PCV7 was 5-7 months if immunologic memory occurred, and 6-8 months in the absence of immunologic memory. While immunogenicity trials of a single dose of PCV are required to corroborate these findings, this work explores a more cost-effective strategy that could be employed as an alternative to the proposed multiple PCV dose regimens.
Barzilay et al, Vaccine. 2005 Sep 30 (in press)
Trends in Antibiotic Resistance. A recent review in The Lancet states that S. pneumoniae strains fully susceptible to penicillin, once universal, have declined to between one-half to two-thirds of strains in many countries, and to less than a quarter in others. Furthermore resistance to macrolides, cotrimoxazole, tetracycline and choloramphenicol has also been on the rise. HIV-infected patients, who are prescribed antibiotics as prophylaxis, are particularly vulnerable to resistant strains. Rising resistance to each drug has been accompanied by a growing percentage of strains resistant to many or all of them, and the emergence of resistance to fluoroquinolones.
Okeke et al., Lancet Infect. Dis. 2005 Sep; 5(9): 568-80
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