Eli Clifton
WASHINGTON, Sep 11 2009 (IPS) – New data released by the World Health Organisation (WHO) sheds light on the leading causes of pneumonia and provides the first country-level information about the effects of pneumonia, the world s leading killer of children under five.
The study, which will be published in this week s issue of The Lancet, finds that Streptococcus pneumoniae and Haemonophilus influenzae type b (Hib) infections kill approximately 1.2 million children under five each year.
Pneumonia s high death rate amongst children is an avoidable public health problem, according to medical experts.
The important part of the findings is this is the first time we ve provided country specific numbers, Dr. Kate O Brien, an associate professor of international health at the Johns Hopkins Bloomberg School of Public Health, told IPS.
This provides an opportunity for countries to use evidence to drive policy, said O Brien, the lead author of the pneumococcal study.
Vaccines exist which can provide protection against both Streptococcus pneumoniae and Hib, but their distribution in the developing world is not at the levels needed to prevent such high childhood fatality rates from pneumonia.
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Hib vaccine has only recently been made available in low-income countries and Pneumococcal vaccine is not currently part of the national immunisation programmes in much the developing world.
The WHO study found that in 2000 there were an estimated 14.5 million cases of pneumococcal disease worldwide, and 826,000 children under five years old died of the disease and 95 percent of those deaths were attributable to pneumonia.
Fifty-one-percent of pneumococcal cases were found in Asia largely due to the high population and limited use of the vaccines and 54 percent of deaths were in Africa where the lack of vaccines, a high rate of HIV infection, and lack of basic medical care contributed to the high death rates.
The highest proportions of global pneumococcal cases were in India (27 percent), China (12 percent), Nigeria (5 percent), Pakistan (5 percent), Bangladesh (4 percent), Indonesia (3 percent), Ethiopia (3 percent), Democratic Republic of the Congo (3 percent), Kenya (2 percent), and the Philippines (2 percent).
Cases in Africa and Asia contributed to 66 percent of the world s total.
Pneumococcal vaccination has only recently become standard in some of the world s high and upper-middle income countries, but no country in Africa or Asia currently conducts routine vaccination.
In August 2008, 24 high income countries and two upper-middle income countries routinely used the pneumococcal vaccine but these 26 countries only account for less than 0.2 percent of the global childhood pneumococcal deaths.
The trend in infant pneumococcal vaccination in the developing world might be changing as a result of the Global Alliance for Vaccines and Immunisation (GAVI), a global health partnership which benefits from funding by the Bill and Melinda Gates Foundation as well as various public and private donors, which offers low income countries pneumococcal vaccines for as little as 15 cents per dose.
Eleven countries, including eight in Africa and Asia, have received approval for GAVI support to introduce a pneumococcal vaccine.
If fully rolled out in GAVI-eligible countries, the pneumococcal vaccine could save the lives of more than 440,000 children by 2015, said Dr. Julian Lob-Levyt, CEO of the GAVI Alliance. We encourage all developing countries to apply for this support as an important first step to saving children s lives.
The WHO findings included data on Hib and found that Hib caused approximately 8.1 million serious illnesses worldwide and 371,000 child deaths in the year 2000.
Following a similar pattern to pneumococcal disease, the countries with the highest number of Hib deaths in 2000 were in Asia and Africa. They included: India (72,000), Nigeria (34,000), Ethiopia (24,000), Democratic Republic of the Congo (22,000), China (19,000), Afghanistan (14,000), Pakistan (13,000), Bangladesh (12,000), Angola (9,000) and Niger (8,000).
Safe Hib vaccines have been available for nearly 20 years and have effectively wiped out Hib disease in the countries in which they are used but substantial regional variability in vaccine use has led to greater levels of Hib deaths in Asia and Africa.
Prevention of pneumococcal and Hib cases and deaths is imminently achievable, but countries must demonstrate the political will to prioritize prevention, said Orin Levine, executive director of PneumoADIP at the Johns Hopkins Bloomberg School of Public Health.
Together with financial assistance now available through the GAVI Alliance, these findings give countries the information they need and should now provide a mandate for local and regional policymakers to prioritise investment in pneumonia prevention, Levine said.
These estimates provide the missing link for country policy makers seeking justification for investments in lifesaving vaccines, said Anne Schuchat, director of the National Centre for Immunisation and Respiratory Diseases at the U.S. Centres for Disease Control and Prevention.
One of the things that s really important to countries is that they understand what the disease burden is. We ve heard from countries that it really helps to have numbers we can show to them. This helps them follow a cost-effective approach to preventative health and conduct cost-effectiveness analyses, said O Brien.
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