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Vaccine for pneumonia and meningitis essential in India: experts

Scientists and public health experts from around the world who met at Hyderabad last week agreed there were sufficient data to mull over introducing PCV, a vaccine for pneumonia and meningitis in India.

The vaccine, scientifically called pneumococcal conjugate vaccine was a crucial topic of discussion at the 9th International Symposium on Pneumococci and Pneumococcal Diseases, ISPPD from March 9th to 13th.

It can prevent infection by the bacterium Streptococcus pneumoniae (which also goes by pneumococcus). The bacterium is one of the leading causes of pneumonia and meningitis, a severe infection of the protective covering of the brain and spinal cord.

It is one of the leading causes of death globally, taking the lives of more than 1 million children less than five years of age annually. More than 20% of the deaths take place here in India. The number of cases of pneumonia that do not result in death, referred to as morbidity, is also cause for great concern.

In India and around the world 1 in 5 children who develop meningitis die and among those who survive, over 30% suffer permanent disabilities such as deafness, seizures, mental and developmental delays.

Based on recent estimates, more 65,000 Indian children died from pneumococcal disease in 2012. Many more were hospitalized. Additionally, the burden to families of children with pneumococcal disease is enormous. Hospitalisations alone have been estimated to cost Rs 2000-14000 for pneumonia and more than Rs 50,000 for meningitis. In addition, such illnesses cause an enormous economic burden to the families since they often have to miss work in order to provide care for these children.

In order to discuss the increasing disease burden caused by the bacterium specially in this part of the world and find solutions to the problem, the ISPPD was held in India. This was the first time that this global meeting focused on understanding pneumococcus and addressing pneumococcal disease was held in Asia.

It brought together around 1,000 experts from more than 70 countries. The meeting was unique in its focus on scientific research and emphasis on research collaborations.

The important genomic and epidemiologic findings that were discussed at the meeting could lead to improved pneumococcal disease interventions which could benefit not only India, but all countries in this region.

Some of the interesting topics that were discussed included host and environmental factors associated with pneumococcal disease susceptibility and severity, interactions between pneumococcus and other bacteria that colonise the upper respiratory tract, new microbiological and genetic techniques for determining serotypes of pneumococcus and progress in the development of newer generations of vaccines and the immunologic approaches that researchers are exploring.

For countries planning to introduce pneumococcal conjugate vaccine (PCV), two topics were particularly relevant. They were current data on serotype replacement and vaccine impact studies.

More than 100 countries have already introduced PCV. In South Asia, Pakistan and Afghanistan have introduced PCV into their national programmes. This year, Nepal and Bangladesh will also add PCV to their schedule and a number of other countries will introduce the vaccine by 2016. These experiences of introduction and consideration of evidence for decision-making were shared at the symposium. It was also discussed that vaccine impact studies post-introduction will provide continued evidence for evidence-informed decisions.

The meeting takes place every two years in different countries around the world in collaboration with a local partner organisation. This year, ISPPD was hosted by the INCLEN Trust, a consortium of epidemiologists, social scientists, and health care professionals based in Delhi working on a variety of pressing public health concerns.

It is particularly fitting that this historic and important meeting took place at Hyderabad since over one third of the pneumococcal disease burden comes from India or the neighboring countries.

Currently pneumococcal vaccines seem to be the best answer to the problem and this justifies its inclusion in the National Immunization Programme. However, the current cost of the vaccine is prohibitive, and hence we need to explore partnerships that can offer options for subsidizing it to reach the benefit to the marginalised community which need it the most.