Pneumonia is leading infection among children afflicted with HIV

Recently, Uganda launched the new 10-valent pneumococcal vaccine (PCV 10) that is expected to protect 1.5m children below one year against pneumonia infections by end of the year. I interviewed Seth Berkley, the Global Alliance for Vaccine Initiative (GAVI) CEO about the new vaccine. GAVI is channelling over 5m doses of the new vaccine to Uganda. 

Below are the excerpts of the interview.

What are pneumococcal diseases and what is their impact?

Pneumococcal disease (PD) is caused by the bacterium Streptococcus pneumoniae, also known as pneumococcus, and is the number one vaccine preventable cause of death in children under 5 years of age globally. Pneumococcus is the most common cause of fatal pneumonia in children. In Uganda, it is estimated that pneumonia is responsible of 17% of the deaths in children under 5.

What are the symptoms of pneumococcal disease?

Pneumococcus is the most common cause of fatal pneumonia in children. Other life-threatening pneumococcal infections include meningitis and sepsis.

What complications arise from pneumococcal disease?

The pneumococcus is the most common cause of invasive (serious) bacterial infections in children, including meningitis, bacteremia (infection of the blood), and pneumonia (infection of the lungs). The pneumococcus is also the most common bacterial cause of acute middle ear infections in children

How is pneumococcal disease transmitted?

The bacterium spreads from person-to-person via respiratory droplets - if the infected person coughs or sneezes in close proximity to other people, the other people may become infected.

Why is pneumococcal disease a health problem in Uganda and the world?

It is one of the major causes of under-5 children’s deaths. Of children under five with suspected pneumonia in Uganda, only 73% are taken to an appropriate health care provider, and 47% receive antibiotics. About 60% of infants less than 6 months are exclusively breastfed.

Who is at risk of acquiring pneumococcal disease?

While persons of any age can acquire pneumococcal disease, young children, particularly infants, are most vulnerable. Immunity-weakening conditions such as malnutrition, HIV/ AIDS, low birth weight, and non-exclusive breastfeeding put children at greater risk for pneumococcal disease.

How can pneumococcal disease be prevented?

The Global Action Plan for Prevention and Control of Pneumonia (GAPP), issued by WHO and UNICEF, recommends a three-pronged approach to address child pneumonia that includes protection (exclusive breastfeeding and improved nutrition), prevention efforts (including routine use of measles, Hepatitis B and pneumococcal vaccines), and treatment (appropriate antibiotics). GAPP estimates that scaling up coverage of these key interventions to 90% could help prevent more than two-thirds of childhood pneumonia deaths worldwide.

What pneumococcal vaccines has GAVI made available to Uganda and other countries?

Pneumococcus comes in 90 varieties or “serotypes.” Three existing pneumococcal conjugate vaccines (PCVs) protect against 7, 10, and 13 of the most common serotypes. The 10- and 13-valent pneumococcal vaccines cover more than 70% of the invasive pneumococcal disease (IPD) causing serotypes afflicting African children. Uganda introduced the 10-valent pneumococcal vaccine (PCV 10).

Which new vaccines are currently in development and why are new vaccines needed?

New vaccines are needed to protect against additional serotypes of pneumococcus to better protect children. Also, efforts are been made to find less expensive vaccines.

Are there people who should not be vaccinated? If yes, why?

PCV are considered safe in all target groups for vaccination, including immuno-compromised individuals.

How and when should the PCV be administered?

The PCV-10 should be given in three doses. The minimum age at first dose is 6 weeks, with a minimum interval of four weeks between the subsequent doses - e.g., 6, 10 and 14 weeks. Ideally, PCV-10 should be given simultaneously with other childhood vaccinations: DTP (for Diphtheria), Hib (Hepatitis B) and Oral Polio Vaccine administration.

Should HIV positive individuals receive the PCV?

Yes, pneumococcal vaccination is recommended in HIV infection to help reduce invasive pneumococcal disease. Studies have shown that children with HIV/AIDS are 9-40 times more likely to contract pneumococcal disease than HIV-negative children, and may also be more likely to contract antibiotic-resistant strains of the disease. In fact, pneumonia is the most common infection leading to hospitalization among HIV-infected children. In Uganda, there are an estimated 1.4 million people currently living with HIV/AIDS, about 190,000 of whom are children under age of 15.

 Do adults need the PCV?  How often, if at all?

The GAVI supports immunization in children, because most complications arise in young children. PCVs for immunization of older populations and the potential use of such vaccines for immunization in pregnancy to protect new born babies are currently not considered sufficient by the World Health Organization (WHO) to make policy recommendations.

Does the PCV have any side effects, mild or otherwise?  Which ones?

The safety of pneumococcal conjugate vaccines for children has been well demonstrated in clinical trials and confirmed after the distribution of more than 198 million doses worldwide. Post-licensure surveillance has found that the use of childhood pneumococcal vaccine also protects unvaccinated children and adults by reducing transmission.

What impact has the PCV had in countries where it has been introduced?

Immunization with PCV7 in the United States, the first country that introduced broadly the vaccination, has led to profound reductions in the disease burden among adults in the first 7 years of the program. The impact of PCV in GAVI eligible countries is being carefully monitored as part of routine sentinel surveillance.