01 Aug Five Insights from ISPPD for Advocates
July 31, 2016
Reported by the International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health
Writer: Salma Warshanna-Sparklin
Contributors: Maria Knoll, PhD, Lois Privor-Dumm, IMBA, and Stephanie Cascio, PhD, MPH
Scientific experts from around the world came together for the International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD) in Glasgow, Scotland on June 26th – 30th. Out of their scholarly plenaries and meetings came five insights about pneumococcal pneumonia that advocates should know.
Credit: Warren Media
Insight #1: Pneumococcal conjugate vaccines are making an impact in all parts of the world, but next generation pneumonia vaccines are still needed.
Currently, there are two available pneumococcal conjugate vaccines (PCVs): PCV-13 (PrevenarÒ) and PCV-10 (SynflorixÒ). By covering the deadliest strains that cause pneumonia and meningitis, they have had a huge impact on burden and mortality worldwide. However, there is still disease caused by other strains not contained in the vaccines, called non-vaccine serotypes. After the vaccine evicts the serotypes that used to live naturally in the nose and throat (nasopharynx) of children, the non-vaccine serotypes can set up camp. Even though carriage of these strains rarely cause disease, researchers are striving to develop new vaccines that extend coverage to additional serotypes—or even all of them—in order to meet the overarching goal: reducing all preventable disease. More funding for research and development may allow researchers to discover a next-generation pneumococcal vaccine sooner rather than later, to counter the risk of non-vaccine serotypes.
Insight #2: Maternal influenza immunization may help reduce the burden of pneumonia and help reduce the deadly impact of pneumococcus.
Children who are too young to receive the pneumococcal vaccine or who have received only one dose are still at risk of deadly pneumonia. What’s more, children who have contracted influenza are at an even higher risk of contracting secondary pneumococcal infections and experiencing a more severe form of pneumonia. The good news: influenza vaccine reduces severe bacterial pneumonia. However, neonates are too young to receive the flu shot, given at six months of age. An alternative is to immunize the mother with flu vaccine during pregnancy. Her antibodies get passed on to the newly-born child and help protect her baby from severe pneumonia. The maternal flu vaccine can protect the child via breastfeeding until the child is old enough—around two months of age—to receive the PCV immunization. It’s important for policy makers to understand the dynamics of co-infection and synergistic interventions.
Insight #3: Increasing access to antibiotics in India has paid off—but it’s not enough.
Of the top 5 countries with the highest burden of child pneumonia, India is the only one that has seen a significant decline. Between 2000 and 2013, there has been an almost 60% reduction in pneumonia mortality in India. This success is partially due to increasing antibiotic access, especially among their poorest communities. At the same time, India remains the #1 high-burden country in the world, which indicates that providing treatment has not been enough. Prevention is necessary for even more dramatic change, of which vaccines are an important component. Advocacy work is needed to help ensure India introduces PCV vaccine as is planned in the coming year.
Insight #4: Malnutrition is an underlying risk factor of pneumonia deaths that needs more attention.
Despite the existence of safe and effective vaccines, kids are still dying from pneumonia. One of the major risk factors for pneumonia in children is malnutrition, which must be addressed where disease burden is still high and access to care is insufficient. A malnourished child has a weakened immune system. When a child is faced with an infectious threat, their system is poorly equipped to respond and defend the body, thereby increasing the severity of the infection. A vicious cycle commences of a vulnerable immune system and severe illness—increasing the risk of mortality.
Insight #5: Adults need their own comprehensive approach to preventing pneumonia.
While pneumococcal pneumonia is the leading cause of vaccine-preventable deaths among children under-5 globally, it is also a major killer of adults. Childhood immunization programs have contributed to significant declines in adult pneumonia in high-income countries, but this indirect strategy may be insufficient to protect adults in low-income countries where pneumonia is a common cause of hospitalization. Researchers aren’t seeing the same indirect impact in low-income countries, particularly among adults who have comorbidities such as chronic obstructive pulmonary disease (COPD), tuberculosis, and HIV. These factors make adults more susceptible and predisposed to developing pneumonia. Since adults are impacted by risk factors to different degrees than children, a comprehensive and strategic approach to prevention in adults is a gap that needs to be addressed.