PneumoADIP's New Website Launched Today

The new PneumoADIP website, enhanced to provide easy access to comprehensive resources on pneumococcal disease and vaccines, was launched today. Changes to the site ensure that resources such as the Pneumococcal Disease And Preventionslide set and the video “Childhood Pneumococcal Disease. Serious. Common. Preventable Now.” (subtitled in French, Spanish and English) are more easily accessible. The site also now incorporates an in-site Google search engine to make finding information even easier.

Please visit the new site and participate in the weekly online polls on key pneumonia issues, at www.preventpneumo.org.

Special Feature: Countdown to 2015 Evaluates Global Progress Towards Millennium Development Goal for Child Mortality

The Countdown to 2015 Initiative is a group of experts worldwide who monitor global progress towards Millennium Development Goals 4 and 5 (reduction of child and maternal mortality, respectively). In the April 12th edition of the Lancet, the group highlights important findings from their recent report, released at a meeting in CapeTown, South Africa earlier this month.

Since the Initiative’s first report in 2005, when only 7 of the 68 priority countries were on track to meet MDG 4 (which aims to reduce mortality in children under 5 years of age by two-thirds by 2015), 9 more countries have joined them on track to MDG4. Overall, 24% of priority countries are currently on target to meet this goal, thanks to broad coverage of important interventions such malaria prevention, immunization, prevention of mother to child transmission of HIV and available treatment for diarrhea and pneumonia. However, progress in the majority of countries has been inadequate and some countries, like Botswana and Congo, are actually headed in the opposite direction – that is, average annual childhood mortality increased between 1990 and 2006.

Regional and intra-country inequities have persisted, according to the report. All ten countries with the least reduction in childhood mortality were in sub-Saharan Africa. In another of the Lancet series papers, the Countdown group has shown that among priority countries, the gap between maximum and actual coverage with a set of important interventions varied from 54% for the poorest fifth of the population to 29% for the wealthiest fifth, on average. The mean overall gap in the 54 countries studied was 43%, lead by Ethiopia with a staggering 70% gap between maximum and actual coverage. The largest declines in coverage gaps were seen as a result of immunization services (which accounted for 33% of declines on average), but overall, the authors note that coverage inequities are slow to diminish and have persisted despite good progress in a few countries.

Two other papers in the Lancet series have evaluated the contribution of donors and the importance of the policy environment for reaching MDGs 4 and 5. Donor funds for child health increased 63% between 2003 and 2006 to 7$US per child per year up from 4$US. Although some needy countries experienced a decrease in funds, overall, the Countdown group found that funds were being appropriately disbursed in proportion to the burden of child mortality across 68 countries. Of funds dedicated to maternal, newborn and child health (MNCH) projects, immunization services accounted for the largest annual share of spending between 2003 (46%) and 2006 (28%).

The Countdown Working Group on Health Policy and Health Systems evaluated 13 indicators of the policy environment in five separate categories: evidence and information, leadership and governance, service delivery, financing, and health workforce. The group found that “strong global and national commitment, adequate financial resources and intensive technical support” were the most important determinants of successful policy change and implementation.

Individual country reports, findings and the full report can be found on the Countdown website, www.countdown2015mnch.org/reports.

Research News

1. HIV Infection Contributes to Increased Pneumococcal Colonization in Zambian Women.

A recent study based on a longitudinal cohort in Ndola, Zambia supports a causal relationship between HIV infection and increased colonization with S. pneumoniae. The study suggests that HIV infection significantly increases the risk of pneumococcal colonization and repeat colonization, and may also reduce the time to new colonization. Pediatric serogroups 6, 19 and 23 accounted for excess colonization among HIV-positive mothers compared to HIV-negative women, indicating the potential role for pneumococcal conjugate vaccines – which target all these serogroups – in HIV-infected adult populations. Increasing pediatric vaccination coverage to augment herd protection of adults or vaccination of adults themselves may be important for reducing the burden of pneumococcal disease in HIV-infected populations. These data may, in part, explain the higher rates of invasive pneumococcal disease (IPD) in HIV/AIDS patients.

2. Acute Bacterial Meningitis Etiology in the Central African Republic.

Data from a prospective study conducted from October 2004 to September 2005, at the Complexe Pediatrique de Bangui, Central African Republic (CAR) revealed that S. pneumoniaewas the most common cause of meningitis children with suspected meningitis, from 1 day to 16 years of age. Of 417 study participants, 130 were proven acute bacterial meningitis and 37 probable bacterial meningitis. 94% and 96% of S. pneumoniae strains tested remained susceptible to benzylpenicilline and chloramphenicol, respectively. The mortality rate was 47% for infections caused by S. pneumoniaecompared to 35% overall for bacterial meningitis. These data are critical for understanding the etiology of acute bacterial meningitis in CAR and underline the need for pneumococcal vaccine introduction into the region.

3. Resistant S. pneumoniaecommonly found in HIV-positive children.

In a prospective study of HIV-positive children 8 weeks of age and older in South Africa with varying exposure to trimethoprim-sulfamethoxazole (TMP-SMX), more than 80% of bacterial isolates (with the exception of one organism) from nasopharyngeal swab were found to be resistant to one or more antibiotics. S. pneumoniae was the most commonly isolated organism and accounted for 22% of the 181 pathogens found in 167 children. Other important organisms with high rates of antibiotic resistance were S. aureus, H. influenzae and Enterobacteriacae. The authors suggest that further study into the spectrum and extent of antibiotic resistant co-infections in HIV positive children in poor settings should be a priority.

Media News

4. The Lancet Launches its Global Health Network.

The Lancet launched its Global Health Network, an initiative to improve global access to information as means to improve global health. The network will search and archive evidence, commission new analyses, devise programmatic recommendations, formulate proposals and campaign for action in critical areas of international health and development. Its publications will include disease and country reports, focused mainly on health in low- and middle- income countries. Richard Horton, Editor of The Lancet, described the network as a “virtual policy institute in global health, drawing together the best scientists to work on neglected but vitally important aspects of human health”.

5. Health Systems 20/20 Launches Web-Based Database Tool.

A new public access Health Systems Database has been launched by Health Systems 20/20. This web-based tool compiles and analyzes country data from multiple sources, and allows users to generate charts and fact sheets for the assessment of country level health system performance. Data contributors to the tool include WHO, the World Bank, UNICEF, as well as in-country data.

6. Newark Star-Ledger Spotlights Pneumococcal Vaccination and PneumoADIP.

A recent interview with Orin Levine, Executive Director, PneumoADIP, in the Star-Ledger, highlights the urgency for pneumococcal vaccination and distribution worldwide, as well as the economic and financial issues surrounding distribution and supply of the vaccine in the global market.

7. Child Pneumonia Prevention Asia Regional Advocacy Workshop a Success.

GAVI’s PneumoADIP and the Hib Initiative hosted their first Child Pneumonia Prevention Asia Regional Advocacy Workshop in Bali, Indonesia, April 22-24. Twenty prominent child health experts from eight Asian countries including Bangladesh, Cambodia, China, Indonesia, Nepal, Pakistan, Phillipines and Vietnam, took part in the event.

Participants included pediatricians, child health researchers, and representatives from Ministries of Health. The three-day workshop was designed by the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP) and is the second of its kind. An African workshop was conducted in Tanzania in November, 2007. The workshop was designed so that participants can improve advocacy skills and are given tools to help engage key audiences, raise awareness and promote action to prevent childhood pneumonia.

Policy News

8. Implications of Pneumococcal Childhood Vaccine Introduction into Developing Countries.

In this month’s issue of PLoS Medicine, Anthony Scott and Mike English discuss the implications of pneumococcal and Hib vaccine introduction in developing countries with respect to disease epidemiology, policy, treatment and diagnosis of childhood pneumonia. The authors state that with the introduction of new vaccines against pneumococcus and H. influenzae type b, the global burden of severe pneumonia should be reduced by about one-half. They point out that the reduction in Hib and pneumococcal disease will impact on the diagnosis, classification, prevention and management of pneumonia because the most common bacterial causes of pneumonia will be largely gone. The authors argue that a new body of pneumonia research is essential to shape future policy in developing countries and keep pace with changing disease trends and that such research must begin now to be ready by the time it is needed for policy-making in the post-vaccine introduction period.

9. Increasing Policy Innovation to Improve Immunization in Latin American and The Caribbean.

A recent article in Health Affairs documents the important role of childhood immunization in the Latin American and Caribbean region in reducing childhood mortality and outlines the policy framework that will be required to achieve Millennium Development Goal number 4 – reducing under 5 mortality by two-thirds by 2015. Sustaining policy innovations, improving coverage in low-performing districts, and optimizing the introduction of new vaccines through the Revolving Fund (RF) of the Pan American Health Organization (PAHO) were recommended in order to help ensure affordability for rotavirus and pneumococcal vaccines, in particular. In addition, strengthening of surveillance, and efforts to reduce non-vaccine related neonatal mortality were highlighted as critical. The authors emphasize that immunization should be combined with other high-priority public health interventions in order to achieve the MDG4 target in this region.

Finance News

10. Sabin Institute Receives Gates Grant to Pursue Sustainable Immunization Financing.

The Sabin Vaccine Institute received a $9.2 million grant from the Bill & Melinda Gates Foundation for a global advocacy effort to help countries finance their national immunization systems. The Sabin Advocacy Project for Sustainable Immunization Financing will work closely with 15 developing countries and with the GAVI Alliance over the next six years to increase awareness and appreciation of the value of immunization. “Developing countries have made important strides in protecting children with vaccines, and securing sustainable funding for immunization will ensure that these benefits are maintained for future generations”, said Jaime Sepulveda, Director of the Integrated Health Solutions Development for the Gates Foundation.

Award News

11. Richard Adegbola Awarded Prestigious Lifelong Fellowship in RCP London

Head of The Gambia’s Bacterial Surveillance Programme, visiting professor at the University of Leicester and longtime PneumoADIP collaborator, Professor Richard Adegbola, has been awarded a lifetime fellowship at the Royal College of Physicians, London. Professor Adegbola has been instrumental in several important clinical and efficacy studies relating to vaccines against childhood pneumonia and meningitis, particulary Hib and S. pneumoniae. He has recently been appointed the vice-chair of the European and Developing Country Clinical Trial Partnership Board and serves as an advisor and committee member to WHO groups focusing on group A meningococcus and tuberculosis. Congratulations, Professor Adegbola!

Announcements

Post-doc position in human mucosal responses to pneumococcal antigens

A 3 year full time non-clinical post doctoral position in Bristol UK is now available. The successful candidate will lead a funded project investigating human mucosal T and B cell immune responses to various pneumococcal antigens and vaccine candidates. For more information, please contact Adam.Finn@bristol.ac.uk

Infectious Disease Epidemiologist

The Global Disease Detection and Response Program has an opening for an infectious disease epidemiologist to be based in Cairo, Egypt. Primary responsibilities for the post include:

1. Plan and conduct surveillance, research, training and outbreak investigations for the International Emerging Infections Program (75%). Projects will include establishing population based surveillance for pneumonia, diarrhea, and febrile illnesses at specific sites throughout Egypt and may include regional travel for outbreak investigations, training and surveillance activities.
2. Manage the healthcare worker surveillance project for severe acute respiratory infections for Influenza Epidemiology Unit (25%), and participate in outbreak investigations of avian influenza.
   Candidates holding an advanced degree are encouraged to apply and may contact Erica Dueger for more information. erica.dueger@med.navy.mil

Upcoming Events

May 2-6

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.

May 5-10

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

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.

May 27-31

Global Health Council 35th International Conference on Global Health - Washington, DC
On-site registration ends May 2nd for the 35th annual Conference on Global Health. This year’s theme is Community Health and featured speakers include Dr. Margaret Chan from WHO and Dr. Mirta Roses from PAHO. In addition, the GHC Lifetime Achievement Award in Global Health will be presented to Dr. Carl Taylor, Prof. Emeritus of International Health at Johns Hopkins University School of Public Health.

June 8-12

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.

June 19-22

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.

June 29 - July 2

WHO Global Vaccine Research Forum - Paris, France
This WHO sponsored event will include sessions on pandemic flu, tuberculosis vaccines, an update from GAVI, vaccine access issues and advocacy for science policy.