According to the International Union Against Tuberculosis and Lung Disease (The Union), child pneumonia remains a major threat to children under 5 years of age despite the great potential of the pneumococcal vaccine. “Pneumococcal vaccine is an important intervention that is already in use and highly effective in resource-rich settings – and it has great potential in high child-mortality settings too. However, tackling childhood pneumonia is a complex issue that requires a more comprehensive approach than a single vaccine”, said Dr Steve Graham of The Union’s Child Lung Health Division.
The main reason for this is the fact that while pneumonia is caused by a wide range of pathogens the pneumococcal vaccine provides protection against Streptococcus pneumonia bacterium only. So while it has the potential to successfully reduce cases of child pneumonia and even protect populations who do not have easy access to effective health care, it alone cannot prevent pneumonia-related deaths in infants and children, including those due to non-vaccine pneumococcal serotypes, other common bacteria and viruses. In low- and middle-income countries, where 99% of the 1.5 million deaths from child pneumonia occur each year, factors like lack of access to health care; lack of standard case management, irrational use of antibiotics; malnutrition and HIV infection also contribute to high fatality rates.
In the opinion of Professor (Dr) Gourdas Choudhuri, Vice-Chairman, Institute of Digestive and Hepato-biliary Sciences, Medanta Medicity, Gurgaon and a noted public health expert, “Although the role of vaccines in preventing the disease cannot be overlooked, a vaccine may work well against some of the germs causing pneumonia but not all. So it is difficult to have a complete vaccine for full protection. The pneumococcal vaccine is a good vaccine. But the issue is whether the strains causing the disease, which are present in the community, are the same as those present in the vaccine, otherwise the vaccine will not work. Pneumococcus has many strains. So a routine immunization with one vaccine may not work.”
Hence for a more comprehensive approach on child pneumonia in all settings, The Union recommends other preventive strategies, as well as vaccine: nutrition and breastfeeding, reduction in indoor air pollution, hand washing and improved case management. Curative interventions include addressing the rising rates of bacterial resistance; models of community care; the role of zinc; focus on the needs of high-risk patients, such as those who are malnourished or HIV-infected and infants; as well as wider availability of oxygen therapy and other methods of respiratory support.
A case in point is The Union’s l Child Lung Health Project in Malawi, based on standard case management, which dramatically lowered the case fatality rate for severe pneumonia between 2000 and 2005 by 66% since the 2000 baseline. Pilot projects using this same approach have also been carried out in Benin, China and Sudan.
“Understanding the social and health system determinants of pneumonia causation and death is also crucial to developing comprehensive approaches”, says Dr Graham. “Incorporating comprehensive approaches in national plans for child survival is the way to proceed in reducing the threat of pneumonia.”
Let us hope that experts at the forthcoming 43rd Union World Conference on Lung Health in Kuala Lumpur, Malaysia will impress upon stakeholders, civil society members and government officials the importance of a comprehensive strategy to prevent innocent children from succumbing to pneumonia and other lung health related diseases.
Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is currently providing on-site news coverage from 43rd Union World Conference on Lung Health, with kind support from the Lilly MDR TB Partnership and Global Alliance for TB Drug Development (TB Alliance). She is a J2J Fellow of National Press Foundation (NPF) USA. She received her editing training in Singapore, has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also authored a book on childhood TB (2012), co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" and a report on Hepatitis C and HIV treatment access issues in 2011. Email: firstname.lastname@example.org, website: http://www.citizen-news.org)