News from the Second Regional Pneumococcal Symposium São Paulo, Brazil
Pneumococcal Disease in Latin America Kills Two Children Every Hour, Causes 1.6 Million Cases of Childhood Disease Every Year, New Study Finds
Vaccination Saves One Life for Every Thousand Children Vaccinated; Prevents One Case of Disease for Every 80 Children Vaccinated
São Paulo, Brazil, 13 December 2006 (PAHO)—Global health experts today released the most comprehensive study ever conducted on the impact of pneumococcal disease in South America and the Caribbean, and revealed potential health and economic benefits of a vaccine already routinely given to children in the United States. The study was released at the Second Regional Pneumococcal Symposium, attended by some 325 public health experts, doctors, scientists, and leading policy makers from across the region.
"The report indicates that pneumococcal disease has a huge impact on child health and survival in our region," said lead author Maria Teresa Valenzuela, an epidemiologist at the University of the Andes in Chile. "It kills 18,000 children every year – two children an hour. It is responsible for not one, but four major types of illness: ear infections, pneumonia, sepsis and meningitis—three of which can be deadly."
The report found that every year, children under five years old in Latin America suffer from pnuemococcal illnesses that include an estimated:
- 1.3 million cases of acute middle ear infections that can lead to deafness;
- 330,000 cases of pneumonia;
- 1,200 cases of sepsis (blood infection);
- 3,900 cases of meningitis (inflammation of the brain).
The report specifically analyzes the impact of the bacteria Streptococcus pneumoniae, responsible for the deaths of up to one million children around the world every year—ninety percent in developing countries. Until now, however, there has been no comprehensive estimate of the burden of pneumococcus in Latin America. But despite its systematic approach, researchers say that even this study represents a minimal estimate of disease, as surveillance for pneumococcal disease is technically difficult and only exists in a few countries.
Search for Solutions
Reviewing the potential impact of the existing vaccine, the report found that widespread vaccination of children in Latin America would prevent over half of all pneumococcal illnesses and deaths regionally—saving a child's life every hour. Vaccination would save one life for every thousand children vaccinated and avert one case of illness for every 80 children vaccinated. Extended vaccines that are expected to become available in 2-3 years will raise the level of protection even further.
"As new vaccines and other health technologies become available, inequities are growing between those who have access and those who do not," said Ciro de Quadros, President of the Albert B. Sabin Vaccine Institute. "That's why these meetings are so important. All the stakeholders can hear the evidence of the disease burden and the solutions. It's a question of finding a sustainable way of introducing these vaccines; we can only do this with alliances of national governments, donor organizations, and the vaccine industry."
In Latin America, annual routine pneumococcal vaccination covering 92% of children would save the lives of 9,478 children every year. It would prevent 678,000 cases of ear infection; 176,000 cases of pneumonia; 2,100 cases of sepsis; and 660 cases of meningitis.
In addition to the current vaccine, which contains seven strains of the pneumococcal bacteria, the report considers the potential impact of other pneumococcal vaccines now in development, including a 10-strain formulation and a 13-strain formulation. It found that the current 7-strain formulation would cover up to 64% of pneumococcal disease in children in Latin America, and that the 10-strain and 13-strain formulations would cover up to 87% and 92% of disease, respectively.
"The current vaccine may not be a silver bullet, but widespread immunization will clearly translate into thousands of lives saved, as well as better health for children. This will also benefit large number of adults and elderly who catch the disease from children every year," said Jon Andrus of the Pan American Health Organization (PAHO).
A multi-national team of researchers associated with the Albert B. Sabin Vaccine Institute wrote the report, working in collaboration with PAHO, GAVI's PneumoADIP at Johns Hopkins and the U.S. Centers for Disease Control and Prevention. The team conducted a comprehensive literature review that covered the period 1990-2006. The final report analyzed 143 peer-reviewed papers. In addition, the authors contacted 46 pneumococcal researchers in 13 countries, conducted a survey of health care providers and contacted national Ministries of Health to obtain any other relevant data.
Costs and Benefits
The researchers conducted a separate but similar search for all articles describing costs associated with pneumococcal disease and vaccines in Latin America. They analyzed the economic burden of disease as well as the health outcomes and costs associated with use of the currently available vaccine in children up to age five. Not included, however, is the impact of "herd immunity"—the reduction in disease among non-immunized people that results from the reduction in transmission. Therefore, the study represents a minimum of actual cost savings from vaccination, the authors report.
They found a high economic burden of pneumococcal disease: direct medical costs born by the health care systems in Latin America amount to US$293 million per year, with at least another US$40 million in costs born by families.
"These findings will allow national policymakers to make evidence-informed decisions regarding the introduction of a pneumococcal vaccine in their countries," said Orin Levine, Executive Director of GAVI's PneumoADIP. "The challenges ahead include assuring sustained financing, predictable supply, and affordable pricing so that all children, every where can be protected against pneumococcal disease."