COLOMBO, Sri Lanka -- The need for an urgent and sustained effort to document the burden of pneumococcal disease formed the core of discussions amongst leading scientists attending a WHO meeting today. With pneumococcal disease estimated to be responsible for up to one million child deaths each year local efforts to measure the scale of the problem in Asia are essential in preventing unnecessary child deaths from Streptococcus pneumoniae, a bacterium that causes pneumonia and meningitis.
Serious pneumococcal infections occur throughout life, but young children (especially those under 2 years old) and the elderly are at the highest risk for severe pneumococcal disease. Furthermore, more than 90 percent of pneumococcal pneumonia deaths in children occur in developing countries, and pneumococcal meningitis kills or disables over 40 percent of the children who get the disease.
"Effective surveillance of pneumococcal disease and its serotypes is needed to accurately map the magnitude of the problem and help evaluate the impact of available vaccines", commented Dr Thomas Cherian, co-ordinator a.i., EPI+, Vaccines and Biologicals at WHO.
Pneumococcal disease is a major global health problem, and of concern in Asia. For example, at the Lady Ridgeway Hospital (LRH) for Children in Colombo, Sri Lanka -- one of the largest Children's hospitals in the region -- 794 pneumonia cases (32 deaths) and 295 meningitis cases (9 deaths) were reported in 2003. Pneumococcal surveillance, initiated in 2005, indicates that a sizable proportion of these cases could be due to infections by Streptococcus pneumoniae.
Â Â Â Dr. Nihal Abeysinghe, the Chief Epidemiologist of the Ministry of Health,
is pleased that Sri Lanka is a part of the South Asian Pneumococcal Alliance
(SAPNA) and that pneumococcal surveillance conducted in Sri Lanka is based on
sound methodology with high standards of quality control. He also emphasised
the value and the importance of technical and financial assistance by WHO and
GAVI's PneumoADIP in supporting and sustaining effective pneumococcal
surveillance activities in Sri Lanka.
Dr. Sarath de Silva, the consultant pediatrician at the LRH said that the improved microbiology laboratory support now provides clinicians with the opportunity to identify pneumococci as a leading cause of meningitis and pneumonia in children. In 2005, Streptococcus pneumoniae were isolated from specimens from three meningitis patients and nine pneumonia patients.
Dr. Kumudu Karunarathne, the consultant microbiologist, also at the LRH, commented that a high level of resistant pneumococci to commonly used antibiotics was a very significant finding in 2005. The fact that over 90 percent of the Streptococcus pneumoniae isolates are resistant to penicillin is of greatest concern, and all clinicians in the country should be aware of this fact.
Fortunately, new vaccines to prevent deadly pneumococcal infections are now available and widely used in many countries in North America and Europe. As Dr. Katharine O'Brien, deputy director for surveillance and research at GAVI's PneumoADIP explained: "with systematic surveillance in place and a coordinated effort to introduce pneumococcal vaccines we could save millions of children's lives and make a significant move towards meeting a key U.N. Millennium Development Goal of reducing child mortality by two-thirds by 2015.
The Pneumococcal Surveillance Investigators meeting was sponsored by the World Health Organization and GAVI's PneumoADIP and brought together experts from a number of Asian countries including Bangladesh, India, Indonesia, Republic of Korea, Mongolia, Nepal, Sri Lanka, Thailand and Vietnam.
The importance placed on this meeting reflects the global community's increasing focus on pneumococcal disease, and the urgent need for a global solution. Only last week BBC World aired the second in a landmark series of programs looking at pneumococcal disease and life-saving vaccines. The documentary took a close look at the burden of pneumococcal disease in India and Nepal, and the effort required to introduce a vaccine in developing countries.
 World Health Organization. Pneumococcal vaccines. The Weekly
Epidemiol Record 2003;14:110-9
Â Â Â  Annual Health Bulletin, LRH, 2003
Â Â Â  Pneumococcal Vaccines Accelerated Development and Introduction Plan
(PneumoADIP) based at Johns Hopkins Bloomberg School of Public Health
Source: Global Alliance for Vaccines and Immunization