Life Saving Shots For Killer Pneumonia

Each year, millions of children succumb to diseases like pneumonia which are preventable with readily available vaccines. Pneumonia is the leading killer of children under 5 claiming 1.5 million young lives every year. Despite being the cause of almost 20% of all under 5 deaths, the disease attracts less than 5% of the global health funding. Vaccines against two of the main causes of life-threatening pneumonia— pneumococcal (Streptococcus pneumoniae) and Hib (Haemophilus influenzae Type b) have been developed and are currently being used in the developed countries. But coverage in third world countries like India (which accounts for almost 40% of the worldwide childhood pneumonia cases) is low, particularly of pneumococcal vaccines. If developing countries had these vaccines, the lives of almost 1 million children under age 5 could be saved every year.

Immunization protects children from pneumonia, which is a debilitating disease that can often lead to complications like chronic respiratory conditions and septicaemia or the likelihood of a fatal outcome. All children have the right to this protection. The WHO immunization schedule for infants recommends that children receive Hib and Pneumococcal conjugate vaccine (PCV) in 3 doses over a period of the first 6 months. However whereas vaccination with Hib is included in the immunization programme of many countries, the PCV is presently available only in some countries.
Pneumococcal Vaccines Accelerated Development and Introduction Plan (PneumoADIP) is a project funded by Global Alliance for Vaccines and Immunisations (GAVI) to accelerate the introduction of pneumococcal vaccinations into low-income countries through partnerships between countries, donors, academia, international organizations and industry. With action now, a projected 5.4 million child deaths can be prevented by 2030.

Haemophilus influenzae type B vaccine (Hib janan or PRP vaccine) is a conjugate vaccine developed for the prevention of fatal invasive pneumonia. Due to routine use of the Hib vaccine in the U.S. from 1980 to 1990, the incidence of invasive Hib disease decreased from 40-100 per 100,000 children down to 1.3 per 100,000. GAVI offers substantial subsidization of Hib vaccine for developing countries. In addition, GAVI has created the Hib Initiative to catalyze uptake of the vaccine. The CDC and WHO currently recommend that all infants be vaccinated using a polysaccharide-protein conjugate Hib vaccine, starting after the age of 6 weeks.
 Dr. S. K. Sehta, a Consultant Paediatrician and Neonatologist of Lucknow hopes that, “Although these vaccines are very expensive presently, the Government of India is planning along with the W.H.O. to make the Hib vaccine available in developing countries like ours. However, these have a very low affordability in the masses. Other vaccines that are a part of the W.H.O. recommendations, for example measles, are very important as measles increases susceptibility to pneumonia.”

Similarly, Dr. Neelam Singh, Consultant Paediatrician and Gynaecologist and Chief Functionary of Vatsalya Resource Centre on Health, says, “The BCG vaccine against tuberculosis is very important. Many respiratory diseases and infections in children are caused due to tuberculosis. Secondly, we have the DPT vaccine for diphtheria, pertusis and tetanus, out of which the first two are infections of the upper respiratory tract. Thirdly, measles vaccine given at nine months is very important. Although the measles vaccine does not directly prevent pneumonia but indirectly it does, because a child suffering from measles becomes prone to the super added infection of pneumonia.  So this vaccination programme should be followed regularly from birth to twelve years of child’s age. Recently the Hib vaccine has been introduced. Three doses of this vaccine are given along with DPT. It is available in our country. Urban people who can afford it as it is an expensive vaccine get their children immunized.”

The aforementioned vaccines prevent fatal pneumonia caused by highly virulent strains of the most common pathogens. However, a child vaccinated is not cent percent safe from pneumonia. This fact needs to be understood by parents and caretakers. Immunization is not fool proof. Proper hygiene along with good nutrition is also a vital component of the pneumonia prevention strategy. In this context Dr. S. N. Rastogi, Paediatrician and Child Cardiologist, running a private clinic in Lucknow adds, “Pneumonia can be caused by various pathogens like- Streptococcus pneumoniae or Haemophilus influnzae or Mycoplasma. Parents think that if once they have got their child vaccinated she/he won’t be affected by pneumonia. But pneumonia can occur as secondary infection also.”

Due to lack of public awareness and the high cost of these life-saving vaccines, several children in India are not able to avail of their benefits. One of them is Atharva, a 3 years old child, who was battling for his life in the Paediatric Intensive Care Unit of Chattrapati Sahuji Maharaj Medical University, when I visited him in the first week of October, 2011. His mother, Mrs. Renu Bala Sharma, lamented, “We had heard that pneumonia is a common disease of children and children do get infected with it often but we had never thought it would get so serious. We got him vaccinated against every disease. We went by the vaccination card. We did not know whether it had pneumonia vaccine also in it. Had we known about the vaccine we would have got him immunized. Money isn’t more precious than our child. We have already spent lakhs of rupees on his treatment. We were driven from one nursing home to another, and had almost given up on him, till we reached this hospital. Now there is some hope of his recovery. ”

The pneumonia vaccines are not yet a part of the immunization programme in India and many other developing nations. Ironically these are the nations where the prevalence of pneumonia is very high. Of course, well educated mothers of the upper strata of Indian society make sure that their child is immunized against every life threatening disease. Mrs. Alpana Singh, who gave birth to her second child on the 1st October at the private City Hospital, Lucknow, says, “I have heard that pneumonia is one of the most dangerous diseases. I cannot recall the name of the vaccine, but my doctor told me about it and I got my first child, who is three years old now, vaccinated against it as a precautionary measure. But the vaccine was not mentioned on the regular vaccination chart.”

The WHO actively works towards mobilizing parents and other caregivers about why immunization is important, the recommended immunization schedule, and where their children can be immunized.  There is an imminent need for Research and Development initiatives in the development of pneumonia vaccines. With support and funds from international organizations, these vaccines should be made available, at affordable costs, in developing countries at the earliest.

Somya Arora - CNS
(The author is doing her post-graduation in microbiology from Lucknow University and writes on social justice issues for CNS: