2nd Global meeting on implementing new and under-utilized vaccines, 23-25 June 2008
Pneumococcal vaccines
Infection with pneumococcus is a major cause of morbidity and mortality worldwide. In 2005, WHO estimated that 1.6 million deaths were caused by pneumococcus annually; this estimate includes the deaths of 0.7–1 million children aged <5 years, most of whom live in resource-constrained countries. In March 2007, WHO published a position paper calling for the priority introduction of pneumococcal conjugate vaccines in national immunization programmes, particularly in countries with high child mortality. In November 2007, three of the poorest countries in the Americas and two in Africa were approved for support from the GAVI Alliance.
In its current presentation in a pre-filled glass syringe, the pneumococcal conjugate vaccine presents a number of logistical challenges in terms of cold chain capacity requirements and waste disposal. As further countries prepare for introduction of this presentation at the beginning of 2009, these issues need careful planning and monitoring. Moreover, social mobilization, training of health care workers, delivery options and surveillance and impact assessment of pneumococcus vaccination need to be planned for.
Participants discussed: the drafting and pilot testing of training materials on introduction of pneumococcal conjugate vaccines including a waste management checklist; the need to develop clear consistent messages on pneumococcal disease and its prevention through vaccination, while putting this in the larger context of pneumonia and meningitis control; the need to collaborate with other pneumonia prevention programmes on consistent, clear public messages on disease, prevention and treatment; disease surveillance and impact assessment; optimal schedules for pneumococcal conjugate vaccines, the need for more data from developing countries, and vaccine dosing schedules including a catch-up dose.
Recommendations
- Finalize and pilot test the training materials during early introduction in the five countries approved for GAVI support in November 2007.
- Establish a group to work on key messages on pneumococcal disease, with subsequent testing and adaptation of the messages at local levels.
- Draft a manual for disease impact assessment in line with the existing manual for Haemophilus influenzae type b (Hib) surveillance, including an annex with a generic protocol on case-control studies. Field-test in 1-2 countries.
- Review the current vaccine schedule in light of further evidence from ongoing developing country trials.