Research News

1. IPD Declines in All Ages Following Vaccine Introduction, Report Finds

A recent report published this month in Morbidity & Mortality Weekly highlights the impact of PCV in reducing the burden of invasive pneumococcal disease (IPD) in children, five years after introduction of the vaccine to the United States. Overall IPD rates in 2005 were lower for children aged <5 years compared with average rates in 1998-1999 and remain below the Healthy People objective for 2010. “This vaccine is continuing to provide a very substantial public health impact 6 years after its introduction,” says Matthew Moore of the CDC, a lead researcher on the study. The researchers found a significant decline in IPD rates for all age groups (-78%, under 5 years; -38%, 5-17 years; -39%, 18-49 years; -14%, 50-64 years; -32%, 65-79 years; and –42%, 80 years and older) with even greater declines in IPD caused by those strains included in the PCV7 vaccine. “Disease caused by non-PCV7 serotypes, especially 19A, is emerging and accounts for nearly all IPD,” Moore states, underlying the need to expand the number of serotypes included in the conjugate vaccine formulations in the future, while expanding the use of all vaccines now.

2. Treatment for Childhood Tuberculosis Increases Risk of Antibiotic-Resistant Pneumococcal Pneumonia

A study from South Africa, where both tuberculosis and pneumococcal disease are major problems, found that the use of fluoroquinolones to treat multi-drug resistant tuberculosis (MDRTB) increased the risk of developing levofloxacin-resistant pneumococcal pneumonia. The study, published in the March 20th online edition of The Lancet, was focused on pneumococcal pneumonia in children but was conducted using surveillance that detects invasive bacterial disease in South Africans of all ages. In the study, 89% of children with levofloxacin non-susceptible pneumococcal infections had a history of TB treatment, compared to only 18% of those infected with levofloxacin-susceptible pneumococcal pneumonia.

This study illustrates several important points. First, it shows how high-quality surveillance for invasive bacterial disease can help to monitor changes in antibiotic susceptibility patterns that are important for clinical management and national drug policies. Second, it illustrates the importance of preventing HIV, which drives both increases in the occurrence of TB and pneumococcal disease. Lastly, it is the latest example of a situation where drug treatment for one illness can directly impact increasing drug resistance in pneumococcal infections. Other well-known examples of drug treatments that lead to striking increases in pneumococcal resistance are the use of azithromycin for trachoma elimination and the use of Fansidar for malaria treatment which can drive increases in co-trimoxazole resistance.

3. South Korea 19A Incidence Increased Pre-Vaccine Introduction

A recent report from South Korea (in the journal Emerging Infectious Diseases) provides an interesting example of increases in the prevalence of 19A invasive disease that began before substantial use of PCV7. To understand the dynamics of 19A prevalence prior to and following PCV7 introduction in South Korea in November 2003, 593 pediatric pneumococcal isolates were serotyped from 1991-2006. The 7-valent pneumococcal conjugate vaccine includes serotypes 4, 6B, 9V, 14, 18C, 19F and 23F. It does not include serotype 19A, and the 19F conjugate does not appear to provide cross-protection vs. 19A invasive disease.

The proportion of non-vaccine serotype 19A isolates increased in children less than 5 years of age during the period before introduction of PCV7, while serotype 19F decreased. Multidrug-resistant ST320 isolates containing mef/erm determinants were responsible for the expansion of serotype 19A before PCV7 use in the South Korean population. Contrary to data from the US, the increase in serotype 19A in South Korea was observed prior to PCV7 introduction and remained stable following implementation of the vaccine. These data underline the importance of surveillance to better characterize trends in IPD and long-term PCV7 efficacy, and the potential for antibiotic use (and resistance) to drive changes in serotype-specific disease rates.

4. Baseline Data from The Gambia on S. pneumoniaeCarriage Prior to Conjugate Vaccine Introduction

In order to gather baseline data on the epidemiology of pneumococcal disease prior to national introduction of PCV7 in The Gambia, a longitudinal study was conducted to measure the prevalence of S. pneumoniaecolonization in infants. Nasopharyngeal swabs were collected from 236 infants from 21 villages throughout the country, who were followed from birth to 12 months of age. All infants were found to carryS. pneumoniaeat some time point, with the mean age of primary acquisition being 33 days. There was no significant difference in the time to acquisition according to whether the serotypes were included in the 7-valent vaccine (ie, PCV7 serotypes) or not in the vaccine (ie, “non-vaccine serotypes”). There were however differences in the two groups of serotypes, with non-vaccine serotypes generally acquired earlier and carried for shorter periods in comparison to vaccine serotypes. These data will prove valuable for evaluating the overall impact of PCV7 and other pneumococcal conjugate vaccines in this population.

5. DCVMN and its Critical Role in Providing Access to Vaccines in Developing Countries

Since its establishment six years ago, the Developing Countries Vaccines Manufacturers’ Network (DCVMN) has become the main representing body for vaccine manufacturers based in developing countries. A voluntary public health driven alliance of vaccine manufacturers, DCVMN is made up of industry from developing countries offering a consistent and sustainable supply of quality vaccines, while increasing affordability and access for low-income countries. A recent review published in the March issue of Vaccine outlines the evolution of the Network, and its progression from initial focus on local markets into a major supplier of the global vaccine market. The article points out that the main purpose of the network is to “provide a consistent and sustainable supply of quality vaccines at an affordable price to developing countries and also to the entire globe”. PneumoADIP, which is proud to be a resource member of the DCVMN, had the pleasure of interviewing Dr. Suresh Jadhav, President of DCVMN, on the formation and of the Network and some of its projected goals. The interview may be found on our website.

6. Updated ACIP Recommendations for PCV Schedule

The US Advisory Committee on Immunization Practices (ACIP) published its annual updated recommended immunization schedule for persons aged 0-18 years. Updated pneumococcal vaccine recommendations state that children aged 24-59 months of age with anyincomplete schedule should receive a dose of PCV. Children aged 2 years or older with an underlying medical condition are recommended to receive a dose of PPV.

7. PneumoADIP Scientific Advisors Meeting Update

Earlier this month, more than 25 experts on pneumonia and pneumococcal disease from around the world met as the scientific advisory group to the PneumoADIP for a three-day meeting in Rome. In-depth discussions around surveillance, serotype replacement, dosing schedules and vaccines will help to shape the future direction of the PneumoADIP and serve as a basis for evaluation of the program’s effectiveness thus far. PneumoADIP would like to express our most sincere thanks to everyone who contributed and participated, helping to make the session informative and successful.

Media News

8. AMC Mechanism Gets Lobby in U.S. Senate

Senator John Kerry (D-Mass) welcomed the inclusion of a provision in the PEPFAR package that passed the Foreign Relations Committee on March 13, and bolstered America’s commitment to life-saving vaccines for the developing world. The amendment promotes the U.S. government’s participation in negotiation on Advance Market Commitments (AMC) as a means to develop key vaccines as well as to strengthen efforts to provide technical assistance for the creation of vaccines in developing countries. The pilot AMC for pneumococcal vaccine has already been funded US $1.5 billion by the UK, Norway, Italy, Russia, Canada and the Gates Foundation, and exemplifies how the AMC mechanism can offer a powerful means to make new vaccines universally accessible to protect against diseases that currently kill millions in developing countries.

9. Hib Vaccine Usage in Uganda Leads to Elimination of Hib Meningitis

Introduction of the Hib vaccine to Uganda has resulted in the elimination of deadly Hib meningitis in children under five, according to an independent study published in The Bulletin of the World Health Organization. By monitoring occurrence of bacterial meningitis due to Hib between 2001 to 2006, the study’s authors saw a marked decline in the disease resulting from implementation of a new vaccination program. The incidence of Hib dropped by 85 percent within four years of vaccine introduction and fell to zero in the fifth year. The authors estimate that Hib vaccine in the Ugandan immunization programme now prevents almost 30, 000 cases of severe Hib disease and 5, 000 child deaths (under 5 years) annually. Uganda was one of the first GAVI-eligible countries to adopt Hib vaccine and their results in disease control are similar to those seen in Bangladesh, Kenya, Chile, the Gambia, the United Kingdom and the United States.

Award News

10. Kate O’Brien Receives Sabin Young Investigators Award

Katherine L. O’Brien, MD, MPH, Associate Director of Johns Hopkins Center for American Indian Health, Associate Professor of International Health and Epidemiology at the Johns Hopkins Bloomberg School of Public Health and PneumoADIP’s Deputy Director of Research, will be awarded the inaugural 2008 Sabin Young Investigator Award for her distinguished early career accomplishments in vaccine preventable deaths and infections of children worldwide. The Sabin award will be presented on May 6, 2008 in Baltimore, MD, at the 11th Annual Conference on Vaccine Research, sponsored by the National Foundation for Infectious Disease.

Brian Greenwood Awarded the Noguchi Prize

11. Dr. Brian Greenwood, MD, the Manson Professor of Clinical Tropical Medicine at the London School of Hygiene and Tropical Medicine, and member of the PneumoADIP Management Committee, has been awarded the prestigious Hideyo Noguchi Africa Prize for his pioneering work in childhood malaria, pneumonia and meningitis. Dr. Greenwood’s work has included effectiveness studies of insecticide treated bednets, key studies demonstrating the importance of chemotherapy for child survival for malaria, and major contributions to Hib, pneumococcal and meningococcal vaccines. He will receive the award at a ceremony in Japan this May.

Announcements

Gates Funding Available for Novel Approaches to Global Health Problems -The Bill & Melinda Gates Foundation is accepting grant proposals for the Grand Challenges Explorations, a new $100 million initiative to help scientists pursue innovative ideas for addressing major problems facing global health. The topics for the first funding round include creating new ways to protect against infectious diseases, creating drugs or delivery systems that limit the emergence of resistance, creating new ways to prevent or cure HIV infection and exploring the basis for latency in tuberculosis infection. Applications will be accepted online from March 31-May 30. Registration must be completed by May 15.

Job Announcement at the Global Immunization Division, NCIRD -The Global Immunization Division (GID, National Center for Immunization and Respiratory Diseases (NCIRD) is seeking qualified applicants for the position of Chief, Vaccine Preventable Disease Eradication and Elimination Branch. The incumbent is responsible for providing leadership in directing efforts to improve immunization services, vaccine preventable disease surveillance, and monitoring/evaluation of eradication/elimination activities. Applicants should be a Doctor of Medicine or a Scientist with a strong professional background in epidemiology and international public health programs, particularly immunization programs. To apply, please apply to announcement numbers HHS-CDC-D1-2008-0007(External) and HHS-CDC-T1-2008-0009 (Internal) by Friday, April 11. Please contact Brent Burkholder, Director/GID, if you have any questions (Email: btb0@cdc.gov or Phone: 404-639-6232).

Upcoming Events

April 11-13, 2008 – International Congress of Tropical Pediatrics - Manila, Philippines
The 8th annual ICTP will be held in Manila with the theme “Improving Child Survival: A Continuing Challenge” which underscores a firm resolve to “continuously improve the health of children in the tropics. Child’s rights and survival, emerging and re-emerging diseases, new and underutilized vaccines, new and appropriate procedures, skills and medical equipment and products” will all be part of the program for the Congress.

April 21-24, 2008 – World Vaccine Congress - Arlington, Virginia (USA)
The WVC, to be held in Washington, DC, is aimed at the vaccine industry and bills itself as "the definitive strategic meeting place for the vaccine industry in the United States, Canada, as well as Central and South America." Speakers from PAHO, GAVI, Wyeth, GSK and Indian Immunologicals, among others, are on the program.

May 2-6, 2008 – Pediatric Academic Societies and Asian Society for Pediatric Research Joint Meeting - Honolulu, Hawaii (USA)
The PAS 2008 Annual Meeting is a partnership of four primary pediatric organizations and an Asian organization: The American Pediatric Society, the Society for Pediatric Research, the Ambulatory Pediatric Association, the American Academy of Pediatrics and the Asian Society for Pediatric Research. The PAS Annual Meeting is the largest international meeting focusing on research in child health while providing a unique venue for interdisciplinary scientific interactions.

May 5-7, 2008 –The 11th National Foundation for Infectious Disease Conference on Vaccine Research will be held in Baltimore, Maryland, USA. The conference has become the largest scientific meeting devoted exclusively to research on vaccines and associated technologies for disease prevention and treatment through immunization. Early registration will be open up to March 31st and onsite registration at the conference. For more information please visit: www.nfid.org.

May 5-10, 2008 –International Advanced Course on Vaccinology in Asia-Pacific Regions - Seoul, Korea
The course aims to strengthen the capacity of countries in vaccinology by providing participants with a comprehensive overview of the vaccine continuum, from vaccine development, evaluation and regulatory principles, to production, post-licensure, introduction and policy issues.

May 19-24, 2008 –World Health Assembly - Geneva, Switzerland
The World Health Assembly is the supreme decision-making body of the World Health Organization. It meets in Geneva in May each year, and is attended by delegations from the 193 Member States. The main function of the Health Assembly is to determine the policies of the Organization.

June 8-12, 2008 –The 6th International Symposium on Pneumococci and Pneumococcal Diseases will be held in Reykjavik, Iceland. The deadline for submission of abstracts is February 1st and early registration must be completed by April 1. More information may be found at http://www.congress.is/ISPPD-6/

June 19-22, 2008 –International Conference on Infectious Disease - Kuala Lumpur, Malaysia
Convened by the International Society for Infectious Diseases, the 13th annual ICID will be hosted by the Malaysian Ministry of Health and will again welcome delegates from over 100 countries. The program will include plenary talks by world renowned experts in the science of infectious diseases and other important topics presented by international luminaries in the field.