November, 2006 – London. Momentum continues to build for the launch of the innovative Advance Market Commitment in 2006. After a year of efforts to launch through the G8 process, a core group of countries including Italy, the UK, and Canada are leading an effort, along with GAVI and the World Bank, to launch an AMC for pneumococcal vaccines. In an effort to broaden awareness of the burden of disease and the value of an AMC for pneumococcal vaccines, finance officials from key donor countries will convene November 9th in London. An expert panel, including PneumoADIP Executive Director, Dr. Orin Levine, will present to the AMC Technical Working Group about the pilot proposal of AMCs for pneumococcal vaccines. “This meeting is an indication of the momentum built by the lead countries, Italy, UK, Canada, and the World Bank and GAVI, for the launch of an AMC this year.” said Dr. Levine, “If successful, an AMC for pneumococcal vaccine will help prevent 5.3 million child deaths by 2030 and pave the way for other AMCs to fight AIDS, TB, malaria, and other diseases.”

For previous AMC updates, read the July PneumoFOCUS.

October 12, 2006 – Paris. The International Finance Facility for Immunization, the World Bank, Deutsche Bank and Goldman Sachs have embarked on a campaign in five European cities with the aim of meeting potential investors. IFFIm is a new international development institution designed to accelerate the availability of funds for health and immunization programs through the GAVI Alliance.
Julian Lob-Levyt, Executive Secretary of the GAVI Alliance, stated “The creation of IFFIm provides investors with an opportunity to participate in the scaling up of a highly successful public-private collaboration that is focused on saving and improving the lives of the world’s youngest and most vulnerable citizens.”

For more information please visit www.iff-immunisation.org

October, 2006 – London. How many times have you been asked to provide an estimate of the burden of pneumococcal or Hib disease? If you’re like many working in this field, it happens quite a lot. Well, soon you can expect to have official WHO approved estimates for these diseases. On October 24 and 25, a WHO expert panel reviewed global disease burden estimates for pneumococcal and Hib disease based on rigorous, systematic methods. This WHO effort to estimate the burden of disease has been a comprehensive effort requiring more than 2 years of work on the part of WHO, GAVI’s PneumoADIP and the Hib Initiative. The team screened more than 14,000 publications, abstracted over 1000 using a 14 page data abstraction form, and then built estimates using advanced modeling and meta-analytic methods.

The provisional estimates now go through an official WHO process for clearance and a country consultation process. At the end, there will be country, regional, and global estimates of pneumococcal pneumonia, meningitis, and non-pneumonia, non-meningitis cases and deaths. Official estimates are expected in mid 2007.

Pneumonia is the leading infectious cause of death worldwide, and yet most policy-makers don’t recognize it as a major global health problem. So when UNICEF and WHO recently issued their report on pneumonia: Pneumonia, The Forgotten Killer of Children, the GAVI Alliance, GAVI’s PneumoADIP, The Hib Initiative and PATH joined forces to promote the publication through media outreach.

On the 18th of September UNICEF, the Government of Norway and The Lancet co-hosted a “Child Survival Symposium” at UNICEF’s headquarters in New York. A range of activities were scheduled at the symposium including: the publication of a special issue of The Lancet devoted to child survival, panel debates with high profile speakers, the publication of opinion editorials on child survival and the launch of the UNICEF/WHO report on pneumonia.

The timing of the release of the report offered an opportunity to highlight the fact that achieving the Millennium Development Goal for Child Survival (MDG 4) will require urgent action to reduce childhood pneumonia deaths, which at present account for more than 19 per cent of all under-five deaths. The following key fact was highlighted in all materials by UNICEF/WHO and partners that day; pneumonia is the world’s biggest child killer; bigger than malaria, AIDS and measles combined.

The key outcomes of the GAVI-PneumoADIP-Hib Initiative-PATH joint outreach are:
• Media outreach in 10 countries (including UK, US, Italy, Germany) has, to date, produced 70 articles focusing on the pneumonia report
• An illustrated email teaser was sent to over 2,000 stakeholders of the partnering organizations, linking back to the website
• On the date of the email being sent/official report launch, the daily website visits to www.preventpneumo.org were the highest in September, with 816 visits. Visitors came from over 80 countries between 17 September and 6 October 2006.

To read the UNICEF/WHO Pneumonia report, visit http://www.unicef.org/french/publications/index_35626.html

October 28, 2006 – The Lancet. Clinical trials are designed to show the efficacy of vaccines when given under optimum conditions. But often programmes require information on how the vaccines are expected to work under non-standard schedules. In the most recent issue of the Lancet, Cynthia Whitney and colleagues from the CDC report an assessment of the field effectiveness of PCV-7 when used with various non-standard schedules. One key finding of this report is that non-standard schedules that give fewer than 3 doses in the first year of life confer substantial protection. These alternative regimens may be particularly useful for implementation of pneumococcal conjugate vaccine programmes in developing countries. The article is accompanied by an editorial authored by PneumoADIP’s Katherine O’Brien and Orin Levine.
Whitney et al. Lancet 2006; 368: 1495-502.
O’Brien et al. Lancet 2006; 368: 1469-70.

Re-evaluating the public health value of conjugate pneumococcal vaccines. It is widely accepted that x-ray diagnosis of pneumonia misses many cases of true pneumococcal pneumonia. An exploratory study conducted in the context of the South African pneumococcal vaccine trial now gives an idea of how much the low sensitivity of “radiologically-confirmed pneumonia” (CXR-AC) underestimates the burden of pneumococcal pneumonia. Madhi et al. estimate that radiologically-confirmed pneumonia underestimates the incidence of pneumonia prevented by PCV by as much as 63%. The authors urge consideration for the use of complementary markers in addition to chest radiographs, such as C-reactive protein levels, for future vaccine efficacy trials and impact studies. Madhi et al. Vaccine. Sept. 2006. IN PRESS.

Responses to pneumococcal vaccines in children with impaired humoral immunity. Total and serotype-specific antibody responses were measured in children with a history of recurrent or severe bacterial infections in response to PCV7 vaccination. Following vaccination with two doses of PCV& and a dose of PPV-23, children mounted an exclusively IgG1 response, with IgG3 titers remaining low to negligible. This finding was in contrast to the response to natural infection or to pneumococcal polysaccharide vaccines, which are often of an IgG2 subclass. Serotype-specific responses demonstrated that although PCV-7 specific serotype responses increased significantly post-vaccination, specific IgG against two of the serotypes not covered by PCV7 but only PPV-23 remained low. Serotype-specific IgG were useful in determining the protection against specific pneumococcal strains, and showed that the PPV-23 did not broaden protection against non-PCV7 serotypes. Uddin et al. Vaccine. 2006; 24: 5637-5644.

Assessing novel diagnostic methods. The usefulness of the immunochromatography (ICT) technique for detecting urinary S. pneumoniae antigen in the etiologic diagnosis of community-acquired pneumonias (CAP) was evaluated. Samples were obtained from patients enrolled in a prospective study on in-patients with CAP in a tertiary hospital from October 2004-March 2004. Using this technique the percentage of diagnoses of pneumococcal pneumonias increased by 26%, while the overall etiologic diagnosis increased from 28 to 49%. The technique sensitivity was 81%; the specificity varied between 80% in CAP with nonpneumococcal etiology and 99% for patients with fractures without infections. Briones et al; Clin. Vacc. Imm. Oct 2006; 13 (10): 1092-1097.

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

November 9-11th – NetSPEAR Annual Meeting, Nairobi, Kenya. This is the fourth annual meeting of this surveillance network, supported by GAVI’s PneumoADIP and HibInitiative.

November 15th – BBC World rebroadcast. The “Kill or Cure? Pneumococcal Vaccine” documentary that was aired in February, 2006 is scheduled to be aired this fall.
Visit www.bbcworld.com for the most up-to-date schedule.
Wed November 15th 19:30GMT
Thurs November 16th 09:30GMT
Thurs November 16th 12:30GMT (Asia Pac)
Fri November 17th 15:30GMT (South Asia)
Sat November 18th 01:30GMT
Monday November 19th 07:30GMT

December 8-9th – DCVMN Annual Meeting, Bangkok. Angeline Nanni, PneumoADIP Director of Vaccine Supply and Financing, and Maria Knoll, Director of Vaccine Research, are scheduled to speak at the annual meeting of the Developing Country Vaccine Manufacturers Network.

Dec 13-16 – Sao Paolo, Brazil. This week will see the Second Regional Symposium on Pneumococcal Disease and Vaccines and the re-launch of PAHO’s pneumococcal surveillance network, SIREVA II.