Pneumonia a Major Killer in Children; Prevention Possible with Safe and Effective Vaccines
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Haemophilus influenza and Streptococcus pneumonia are the main causes of bacterial pneumonia and estimated to be the causative organisms for more than 50% of all childhood pneumonias. In addition some diseases, like measles and pertussis (whooping cough) can lead to pneumonia as a complication.
It has been shown through various studies that mortality due to pneumonias could be decreased by interventions like prevention of pneumonia through immunization, early diagnosis and optimal case management, exclusive breastfeeding for six months, reducing indoor air pollution, preventive antibiotic treatment in HIV infected children and zinc supplementation.
Prevention of pneumonia through immunization
In India, pneumonia is responsible for an estimated 410,000 deaths in children under five and a substantial proportion of these deaths are due to pneumococcal pneumonia. While treatment with antibiotics reduces mortality, lack of access to care and delay in provision of antibiotics, especially among the poor and most vulnerable children result in high case fatality from pneumonia. Studies have shown that up to 19% of children hospitalized with pneumonia die in India. Another consideration is the rising resistance to commonly used antibiotics worldwide associated with increasing rates of treatment failures. Hence, prevention of Pneumonia through immunization is an effective way to decrease the incidence and prevent mortality and morbidity in children. Among immunizations, introduction of Haemophilus influenza (Hib) and Pneumococcal vaccines (PCV) and improving immunization coverage of Measles and Pertussis vaccine have been shown to decrease the incidence of Pneumonia in children under 5 years of age.
Taking into consideration all the evidence presented, the National Technical Advisory Group (NTAGI) on Immunization recommended the national roll out of Hib vaccine by 2012 as a multi-dose liquid pentavalent vaccine (DPT-Hep B-Hib). Concerning pneumococcal vaccine, the NTAGI recognizing the need for its introduction, recommended a vaccine impact study on the 7 valent Pneumococcal vaccine (PCV 7) in one high mortality state be initiated as early as possible.
Hib and Pneumococcal vaccines are safe and cost-effective vaccines and are instrumental in preventing serious and fatal pneumonia in young children under 5 years of age. WHO recommends prioritizing the use of vaccines, as millions of children, specially the poor, remain at high risk of dying from pneumonia. The WHO recommendations were made after a thorough review of all available data on the disease and potential vaccine impact by expert committees and the WHO Strategic Advisory Group of Experts (SAGE). Introduction of Hib and Pneumococcal conjugate vaccines into the childhood immunization programmes, especially in developing countries, will contribute effectively to achieving the Millennium Development Goal of globally reducing childhood deaths by two-thirds by 2015.
The pneumococcal conjugate vaccines also prevent meningitis caused by pneumococcus, one of the common causes of bacterial meningitis, which is associated with high fatality rate (over 30% in India) and long term disabilities like deafness, seizures, paralysis and learning disorders among survivors. Prevention of severe pneumonia and invasive pneumococcal diseases through vaccination is therefore an important advance in public health.
Due to some recent concerns on the safety of Pneumococcal vaccines, a comprehensive review of all the safety data related to this vaccine was conducted by the WHO Global Advisory Committee of Vaccine Safety which concluded that “the evidence did not identify any major safety problems with PCV7 or any other pneumococcal conjugate vaccine, with the possible exception of reactive airway disease (wheezing), which may bear further scrutiny as additional data become available.” The advisory committee concluded that the risk-benefit ratio for the vaccine strongly supports the use of the vaccine in routine immunization programmes.
PCV is currently being used in the national immunization programmes of over 25 industrialized countries with no evidence of increase in the occurrence of wheezing. A post-marketing surveillance review in the U.S.A. estimated a less than 1 case report of asthma per 1 million doses of PCV distributed. However, like with any vaccine, ongoing safety evaluations will further monitor this issue and overall safety of these vaccines.
Regarding the cost of Hib and Pneumococcal vaccines, it is recognized that the price in the private market and in industrialized countries is relatively high at present, but past experience, for example with the hepatitis B vaccines, shows that the cost of vaccines do decline drastically when introduced on a large scale. At the projected public sector prices in developing countries, these vaccines are considered highly cost-effective and a worthy allocation even if a country were to self-finance the procurement of the vaccine. The above pattern of ultimate reduction in vaccine cost is also true for the cost of life-saving treatments such as for AIDS, and which have substantially declined over time.