1. Pneumococcal Meningitis Rates Before Vaccine Introduction

A retrospective study conducted by the Health Protection Agency Centre for Infections, London assessed the incidence of pneumococcal meningitis, associated deaths and serotypes of causative pneumococci in England prior to the inclusion of the 7-valent conjugated pneumococcal vaccine in the routine childhood immunization programme in 2006. The annual incidence of pneumococcal meningitis was about 1 case per 100, 000 population between 1998 and 2005 with the highest incidence of 34 cases per 100,000 occurring in 2 to 11 month olds in 2004.

While still quite serious, these UK rates are much lower than those observed in many parts of the developing world. A study in 2002-2003 in Burkina Faso found an overall pneumococcal meningitis incidence in all ages of 17 cases per 100,000 people per year and a shocking 95 cases per year per 100,000 infants less than 12 months of age. A pneumococcal vaccine is not yet available in Burkina Faso.

In the UK, PCV7 has been available since 2001 and affords 72% serotype coverage for patients under 2 years of age. Although initially recommended only for use in children under 5 years of age who were unusually vulnerable to infection, since September 2006, the new vaccine has been included within the standard childhood immunization schedule with doses administered at 2 and 4 months and a booster dose at 13-15 months of age. This study is important as it provides baseline information on the epidemiology of pneumococcal meningitis prior to the start of the immunization programme and is essential for prospective evaluation of the effectiveness and public health impact of the newly introduced PCV7 vaccine to England, as well as other countries such as Ireland and New Zealand which have introduced the vaccine this year. Johnson et al. J. Infect. Nov 2007; 55: 394-399.

2. Prime Boost Immunization Strategy Shows Promise in HIV Infected Adults

Results from a randomized, open-labeled phase II trial in France suggested that in HIV-infected adults, a prime-boost strategy consisting of PCV followed by PPV (23-valent pneumococcal polysaccharide vaccine) boost led to a higher rate of immunological responders as compared to the administration of a single injection of the currently recommended PPV. The prime-boost strategy using PPV + PCV resulted in a higher level of serotype-specific IgG against all but one of the seven polysaccharides shared by the two vaccines compared to patients receiving PPV alone. Nearly 20% more patients in the prime-boost group responded to 5 to 7 serotypes common to both vaccines compared to PPV-only vaccinated individuals, an effect which was maintained over time. Overall, the prime-boost strategy led to the higher frequency, breadth, magnitude and sustainability of antibody responses compared to the PPV-only immunized group. HIV-infected patients are at higher risk for invasive pneumococcal disease and studies such as these are important to developing improved immunization strategies aimed at protecting this vulnerable population. Lesprit et al. AIDS. Nov 2007; 21: 2425-2434.

3. Intercell Reveals Promising Preliminary Data on Pneumococcal Vaccine Candidates

The Austrian vaccine company, Intercell AG, has published pre-clinical data on its vaccine programme for Pneumococcus in the latest edition of the Journal of Experimental Medicine. The article reports the two lead candidates forming the basis of Intercell’s subunit pneumococcal vaccine, which were found to be exceptionally conserved among clinical isolates and that play important non-redundant roles in bacterial multiplication. These data are promising for the development of novel pneumococcal protein vaccines. According to Intercell’s website (www.intercell.com), the first phase I trial of this vaccine candidate will be conducted this year.

4. UNICEF Reports Highlight Pneumonia Morbidity & Mortality

The UNICEF reports, Progress For Children and The State of the World’s Children 2008, Child Survival, published in December 2007, emphasized reducing the deaths due to acute respiratory infections by one third as being an important target. Both reports highlighted that while more than half of under-fives with suspected pneumonia in the developing world are taken to appropriate health providers, this proportion has increased little since 2000. The prevention of childhood pneumonia was emphasized as being critical in order to achieve the Millenium Development target of reducing childhood mortality. Worldwide availability and distribution of PCV7 is likely to play a key role in achieving this goal, in addition to factors such as adequate nutrition (including exclusive breastfeeding, vitamin A supplementation and zinc intake), reduced indoor air pollution and increased immunization rates with vaccines that help prevent children from developing infections such as Haemophilus influenza type b (Hib), measles and pertussis.

5. Even Celebrities Are Vulnerable to Pneumonia

Christian Brando, the eldest son of Marlon Brando, has died this week of pneumonia at age 49. It was also reported that 28-year old actor Heath Ledger was sick with pneumonia at the time of his death on January 22nd. Famous people, young and old, have been claimed by the disease including actor Charles Bronson, jazz great Miles Davis and very recently, Japanese makeup mogul, Shu Uemura. American rap star Eminem and British television presenter Jeremy Beadle are currently recovering from bouts of pneumonia. Celebrities and other healthy adults are at risk of pneumonia, the bacterial form of which can be prevented by immunization. In the January 24th edition of Time Magazine, US Assistant Surgeon General, Anne Schuchat was quoted as saying “Vaccines are for everybody”, although in a recent survey sponsored by the Centers for Disease Control it was revealed that many people don’t know adult vaccines exist. This lack of awareness helps to explain why adult immunization rates in the US fall so short of national targets, leaving many people at risk for pneumonia and other serious conditions. The tragic loss of these notable personalities should remind us all that pneumonia can strike anyone.

6. WHO Statement on Antibiotic Treatment of Pneumonia

According to a WHO statement on January 4, 2008, treatment of children suffering from severe pneumonia with antibiotics at home, in lieu of sending them to the hospital, could significantly reduce pneumonia-associated mortality in developing countries. Under current WHO guidelines, children with mild pneumonia are administered oral antibiotics, typically amoxicillin, and severe cases are referred to hospitals for treatment with injectible antibiotics. However, a study conducted by the Boston University School of Public Health suggests that oral antibiotics administered at home were as effective as injectible antibiotics against pneumonia. Furthermore since children with pneumonia have weakened immunity, treatment at home is likely to reduce the risk of acquiring nosocomial infections that may result from crowded hospital settings.

7. Imminent Meningitis Epidemic to Hit Africa

The WHO has confirmed outbreaks of meningitis bacterium in three West African countries, marking the start of what experts have warned could be the worst meningitis epidemic to hit Africa in a decade. The International Federation of Red Cross and Red Crescent Societies is launching meningitis prevention activities in 14 countries, namely, Burkina Faso, Benin, Chad, Democratic Republic of Congo, Ethiopia, Ghana, Ivory Coast, Kenya, Mali, Niger, Nigeria, Sudan, Togo and Uganda. It has initiated the training of 25, 000 volunteers across the region and is educating people on how to recognize meningitis and the associated dangers. These efforts might help to curb the spread of the disease and may result in a more rapid and prepared response. It is estimated that roughly 80 million of the 350 million inhabitants in the region will need to be vaccinated and thus supply of the vaccine to this region will be critical.

Announcements

Job Positions at the University of Pittsburgh Graduate School of Public Health - The Department of Epidemiology of the University of Pittsburgh Graduate School of Public Health (GSPH) is recruiting a tenure track faculty at the Assistant and Associate Professor levels with expertise in clinical/epidemiologic research, as well as a faculty at the Assistant Professor level with expertise in biostatistics, relevant to vaccine preventable, drug resistant, or foodborne bacterial diseases, as well as tuberculosis. Candidates should have a doctoral degree and at least 3 years post-doctoral experience with a demonstrated record of recent research accomplishments and sufficient evidence to establish salary support after 3 years. For more information please email: lharriso@edc.pitt.edu

Senior Medical Epidemiologist post with AMP, hosted by the Pasteur Institute - AMP is a non-profit organization based at the Pasteur Institute in Paris, France and is involved in research activities and training – primarily in the area of vaccinology – throughout the developing world, although mainly in Africa. AMP is the lead implementer of a major grant from the Gates Foundation to establish Technical Vaccine Advisory Committees in developing countries in Asia and Africa. The current grant will provide funding to establish these committees in developing countries so that these countries can make rational decisions regarding implementation and schedules for new and impending vaccines such as Hib, pneumococcal and meningococcal conjugate vaccines and vaccines against rotavirus, human papillomavirus, dengue, rubella, malaria, hepatitis B, and others. The incumbent will take charge of all roles and responsibilities related to implementation of this project, under the supervision of the Scientific Director at AMP. The project will involve extensive travel to Africa and occasionally to Asia, Europe, and potentially the United States. Grant management will not be part of this position. For more information, please contact Bradford GESSNER, MD 106617.3011@compuserve.com or Dr. Alfred da SILVA, MD : ads@aamp.org

Upcoming Events

February 13-14, 2008 –The 3rd Regional Pneumococcal Symposium will take place in Istanbul, Turkey and is cosponsored by the Sabin Institute and GAVI’s PneumoADIP. Registration is available online at www.pneumo2008.com

February 19-21, 2008 –In collaboration with UNICEF and the GAVI Secretariat, WHO is organizing the third Global Immunization Meeting to be held in Geneva, from 19-21 February 2008. Structured around the four strategic areas of GIVS, the meeting will provide a forum for technical updates and feedback between WHO and UNICEF global, regional and country staff as well as immunization partners. The focus will be on programmatic issues related to global immunization efforts; monitoring progress of GIVS and global immunization efforts; and sharing policy decisions from SAGE and recommendations from the Global Advisory Group on Vaccine Safety.

March 9-14, 2008 –The Biology of Acute Respiratory Infections Conference will take place in Ventura, CA. All applications for the conference should be submitted by February 17, 2008. For more information please visit: http://www.grc.org/programs.aspx?year=2008&program=acuteresp

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 –The 13th International Congress on Infectious Diseases will be held in Kuala Lumpur, Malaysia. The deadline for abstract submission is February 13th, 2008. For more information please visit: www.isid.org/13th_icid