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Pneumococcal

Every year, up to one million under-fives die from pneumococcal diseases. GAVI funds are encouraging developing countries introduce the life-saving pneumococcal vaccine.

What are pneumococcal diseases?

Pneumonia, meningitis and sepsis are all diseases caused by the pathogen streptococcus pneumoniae, or pneumococcus, making it the number one vaccine-preventable killer in the world:

  • Pneumonia: a severe acute respiratory infection in the lungs, which become filled with pus and fluid, making the absorption of oxygen difficult. Symptoms include high fever, chills, shortness of breath, a phelgm-producing cough and chest pain. Severe pneumonia can result in death.
  • Meningitis: a serious infection that causes inflammation of the lining surrounding the brain and spinal cord. High fever, headache and a stiff neck are common symptoms of meningitis, as are nausea, vomiting, an aversion to bright lights, sleepiness, confusion or seizures. Meningitis can result in hearing loss, brain damage, or learning disabilities in 10 to 20 percent of survivors; bacterial meningitis can result in death.
  • Sepsis: a very serious infection, that can progress rapidly to septic shock and multi-organ failure due to a lack of oxygen reaching important organs in the body. Symptoms include fever or abnormally low body temperature, chills, fast heart rate, low blood pressure, lethargy, confusion, or irritability, skin rash, inability to eat or drink, and/or decreased urine output.

Pneumococcal diseases are spread person to person through kissing, coughing on someone, sharing utensils or drinking cups, or touching contaminated surfaces. Antibiotics are currently used for pneumonia; however, streptococcus pneumoniae is growing increasingly resistant to commonly used antibiotics and vaccination is the only prevention.

Who is at risk?

WHO estimates that 800,000 to one million children under five die each year from serious pneumococcal diseases.

However, in contrast with other diseases affecting the developing world, there has been low awareness of these diseases' impact, not just among the public, but also among developed and developing world politicians, stakeholders and decision makers.Until recently pneumococcal diseases were not regarded as a major killer nor vaccine-preventable.

Where?

Pneumo map new

Pneumococcal diseases are a major public health problem all over the world with at least one child dying of penumococcal disease every minute, according to WHO. However, 90 percent of child deaths from serious pneumococcal diseases occur in developing countries.

Ten countries in Asia and sub-Saharan Africa account for more than 60% of pneumococcal diseases worldwide. Among Indian children, pnuemonia causes a quarter of all deaths.

The vaccine

There are many strains (or serotypes) of streptococcus pneumoniae and two types of vaccine currently available which contain differing numbers of serotypes.

  • 7-valent conjugate vaccine, known as Prevnar: approved for use in children under two years of age, and containing the seven serotypes that cause 38 – 86 percent of pediatric pneumococcal disease. The 7-valent is widely used in developed countries, where it has proved highly effective in reducing pneumococcal disease.
  • 23-valent unconjugated polysaccharide vaccine: approved for use in children who are more than two years of age, and containing the 23 serotypes that cause 88 percent of invasive pneumococcal disease.

WHO recommends that countries should prioritise introducing the 7-valent vaccine, when mortality among children under five is more than 50 per 1000 live births or more than 50,000 children die annually. WHO also recommends that countries with a high prevalence of HIV, or other conditions which increase the risk of pneumococcal disease, should vaccinate with 7-valent. The most effective vaccination strategy is a three dose schedule for infants.

When countries introduce the vaccine into their national programmes, a single catch-up dose of 7-valent may be given to unvaccinated children aged 12–24 months and to two to five year-olds who are considered most at high risk.

In developing countries, pneumococcal diseases are often caused by additional serotypes of streptococcus pneumoniae. As a result, 10 and 13-valent vaccines, which provide broader coverage, are needed and are currently in advanced stages of development.

WHO recommends that countries should consider switching from the 7-valent vaccines to these broader serotype conjugated vaccines as they become available, if pneumococcal disease in the affected population is caused by additional serotypes.

GAVI’s response

Countries can apply to GAVI for funding to introduce the 7-valent pneumococcal vaccine, Prevnar, into their national immunisation programmes. Eleven countries have had their applications approved since GAVI initiated this funding in 2007.

In 2007, GAVI pioneered a novel funding mechanism called an Advance Market Commitment (AMC), designed to stimulate the development and manufacture of pneumococcal vaccines for developing countries.

The AMC is based on the concept of putting money aside to guarantee the purchase of vaccines, such as pneumococcal vaccines, once they are developed, providing that they meet stringent, pre-agreed criteria on effectiveness, cost, and availability, and that developing countries demand them. The aim is to stimulate investment in research, development, and the establishment of manufacturing facilities, while giving governments in developing countries control over which vaccines they need. By guaranteeing an affordable price for the pneumococcal vaccine, often referred to as the tail price, the AMC supports sustained use of the vaccine.

GAVI also has funded research into understanding the severity of pneumococcal disease and the need for immunisation, by financing the pneumoADIP research project. Based at the Johns' Hopkins University Bloomberg School of Public Health in USA, the pneumoADIP, or Accelerated Development and Introduction Plan, has gathered evidence to make the case for manufacturing pneumococcal vaccines for the developing world.

Developing new vaccine manufacturing capacity, even when modifying existing facilities, can cost US$ 200-300 million so pharmaceutical companies can be reluctant to make this kind of investment unless they are certain of demand.