Fighting pneumonia in Nepal: making numbers count

This video shows how disease burden and impact studies at Patan have guided the national introduction of Haemophilus influenzae type b and pneumococcal vaccines, which protect children against the two main causes of pneumonia.

QUANTIFYING BURDEN OF DISEASE

“Some countries are unaware of the burden of Hib and pneumococcal disease in young children,” says Dr Andrew J Pollard, Professor of Paediatric Infection and Immunity, University of Oxford, which partners with Gavi to support Patan’s vaccine impact studies. “Generating data which shows there is a burden, is essential to provide the key evidence governments need to drive the introduction of immunisation programmes that prevent the causes of pneumonia in young children.”

CHANGING IMMUNISATION POLICY

When Nepal introduced pneumococcal vaccine in 2015, it became the first Gavi-supported country to use a 2+1 vaccination schedule – two primary doses plus a booster dose – as opposed to the more standard 3+0 schedule – three primary doses – that is administered in most countries. The decision was based on data generated at Patan hospital showing that immunity in the second year of a child’s life was better with a 2+1 schedule than with a 3+0.

“Our study definitely helped the government make the final decision to use a 2+1 schedule for pneumococcal vaccination,” says Professor Shrijana Shrestha, Dean of the Academy of Health Science at Patan hospital. “Our experience could be very useful to our neighbouring countries as well.”

PROVING IMPACT ON PNEUMONIA

Patan’s Chief Paediatrican, Dr Imran Ansari, estimates that prior to the addition of Haemophilus influenzae type b (Hib) vaccine into Nepal’s routine immunisation schedule, over a quarter of the 1,500–2,000 children admitted to his ward each year had pneumonia. “Even though the impact studies have not been published yet, it is my general impression that after the introduction of the Hib vaccine, the incidence of pneumonia has gone down,” says Dr Ansari.

SHOWING THE ECONOMIC IMPACT

In addition to studying the effectiveness of the pneumococcal vaccine in reducing disease, Patan’s study is also assessing the long-term economic impact of preventing pneumonia, both for families and the government. “We’re looking at health economics,” says Dr Pollard, “By preventing disease, how have we changed the health of the population? What impact does that have economically, both for families who may no longer have to look after a sick child, and for the healthcare system?”

Q&A

What vaccine impact studies does Gavi support?

The Vaccine Alliance is funding a series of studies around the world to help demonstrate the impact of pneumococcal and rotavirus vaccines in Gavi-supported countries. These vaccines protect children against the main vaccine-preventable causes of pneumonia and diarrhoea – currently the world’s biggest child killers.

What is the objective?

The studies help us learn more about the two vaccines and their impact on health – there is currently a lack of pneumococcal and rotavirus vaccine impact data in low- income countries, especially from Asia. Secondly, we hope that the studies will give policy-makers, both nationally and regionally, concrete evidence of how routine use of both these vaccines can impact health. These data will be especially important in the case of rotavirus because, to date, few Asian countries have introduced the vaccine.

Where are the studies taking place?

Ten targeted impact assessments are in progress across Africa and Asia. In addition, Gavi supports surveillance of invasive pneumococcal disease and rotavirus disease as well as vaccine safety monitoring at numerous sites across Gavi countries.

What are the main areas of focus of the pneumococcal vaccine impact studies?

The studies are evaluating two types of pneumococcal vaccine: PCV10 and PCV13, which protect against 10 and 13 strains of pneumococcal disease, respectively. Studies look at:

• the effectiveness of the vaccine;
• changes in the number of children hospitalised for pneumonia, meningitis and sepsis before and after the introduction of the vaccine; • overall pneumococcal vaccine coverage rates;
• the impact on the local economy of healthier children and adults; and
• the wider health impact of immunisation on local communities (if enough infants are immunised against pneumococcal disease, it becomes difficult for the disease to gain a foothold in the community – this offers some protection to those who are unable to receive vaccinations, known as herd immunity).

What about the rotavirus vaccine?

We hope that rotavirus impact studies across Africa, as well as in Haiti and Uzbekistan, will show the real-world impact of the vaccine on the number of hospitalisations for diarrhoea. The work will also measure the vaccine’s effectiveness when delivered through the routine immunisation schedule^a.