Study Recommends Shift in Pneumonia

Vaccination Strategy

Pneumococcal vaccination programs should focus on children with the poorest access to
healthcare services, according to a study.
Science and Development Network | April 11, 2014 | Health
AsianScientist (Apr. 11, 2014) By Paul Icamina Immunization of infants against
pneumococcal diseases should target areas where the children are most likely to benefit if broad
nationwide vaccination is not possible and too costly to implement, according to a study.

The WHO recommends that pneumococcal conjugate vaccines (PCVs) be included in

immunization programs to protect young children against acute lower respiratory infections that
remain the largest cause of childhood mortality worldwide, accounting for nearly a fifth of the
deaths.
While PCVs are widely available in industrialized nations, the cost of these vaccines and the
strategy of universal vaccination hinder developing countries from adopting the WHOs goal,
according to a study that evaluated the efficacy of PCVs in 47 towns in Bohol province, in the
Philippines. The PCV, which costs US$46 per full vaccination of three doses per child, is not

included in the expanded immunization program of the Philippines Department of Health

(DOH).
According to the research team study led by Elisabeth Dowling Root, assistant professor
at the Department of Geography, University of Colorado Boulder, An alternative
strategy to universal vaccination is needed to reach remote areas and achieve the highest
efficacy that may reduce the overall costs of vaccination in developing countries.
Root said that they were able to show how spatial epidemiology can be used and how the
introduction of new vaccines might require new surveillance and delivery strategies.
The study examined records of childhood pneumonia cases between July 2000 and December
2004 to examine spatial variation in vaccine efficacy. It defined efficacy as the percent reduction
in the incidence rate of radiographic pneumonia (visible on an X-ray) in vaccinated children
compared to unvaccinated children or those given controlled placebo treatments in a local
neighborhood.
Researchers found that vaccine efficacy increased with distance from the main study hospital.
The study reported that parents of children who live near the hospital may be able to obtain
treatment before the children develop radiographic pneumonia, whereas travel difficulties may
prevent rural parents from seeking treatment for their children until late stages of pneumonia.
Our main finding suggests that areas with poor access to health care have the highest
vaccine efficacy. An alternative vaccination strategy could target vaccination to areas
where children are most likely to benefit, rather than focus on nationwide immunization,
the study authors said.
However, a Philippine health official disagreed.
Selective vaccination should not be the case, said Antonio Ligsay, chief of the
Research Development and Management Division of the Philippine Council for Health
Research and Development.
How would those who are not selected feel? he said, noting this move is not
appropriate for the Filipino culture. People may feel they have been left out, that they
are not important enough to be included in PCV vaccination.
Root, however, clarifies that we never suggested that children with good access to care should
not receive PCV."
In countries where universal coverage is possible, we absolutely believe that this should
be pursued, she said. But in countries that cannot achieve universal coverage, we
suggest that children with access problems could be targeted first if a PCV campaign
were to begin.

The article can be found at: Root et al. (2014) Distance to health services affects local-level
vaccine efficacy for pneumococcal conjugate vaccine (PCV) among rural Filipino children.
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DOH adds vaccine vs pneumonia to

immunization program

The Department of Health has added free anti-pneumonia vaccination to its immunization
program for children in the country's health centers.
DOH Secretary Enrique Ona said this is another historic milestone to the DOH's Expanded
Program on Immunization (EPI).
We are introducing the Pneumococcal Conjugate Vaccine (PCV) to the Philippine vaccination
program for infants, Ona said on the DOH's Facebook page.
This is part of our goal to achieve better health outcomes and meet our health-related
Millennium Development Goals by strengthening existing public health programs, such as

expanding immunization interventions, he added.

Ona said the vaccine would have cost P2,050 per child, including three doses of the PCV.
He added Filipinos may have to spend up to P23,500 for hospitalization, including professional
fee, consultation, laboratory tests and medication.
The DOH cited Philippine health statistics for 2010 showing pneumonia is the second leading
cause of infant mortality, accounting for 2,628 deaths.
ARMM, Caraga first beneficiaries
The DOH said the integration of the PCV will be done by phases, with Autonomous Region in
Muslim Mindanao and Caraga being the first beneficiaries of the program.
"Additional regions will be included every year for administration of pneumococcal vaccines
until 100 percent of the regions are covered," the DOH said.
It said Caraga was chosen for initial PCV implementation to complement the Rotavirus
vaccination that started in July 2012.
Also, Caraga was selected as the site for the impact study on the rotavirus vaccination which will
end in 2014.
The ARMM and Caraga were among the regions where a high number of pneumonia cases had
been recorded, the DOH said.
Under the program, the vaccine will be administered to 333,000 infants aged between six and 11
months, residing in the Caraga and ARMM areas.
The DOH said these infants represent 14 percent of the 2.4 million target infants nationwide.
Present vaccines in the DOH's Expanded Program on Immunization include BCG for childhood
tuberculosis, rotavirus vaccine, measles-mumps-rubella vaccines (MMR), polio vaccine, and
pentavalent vaccine, a combination of Diphtheria-Pertusis-Tetanus-Hepatitis B-Haemophilus
influenza vaccines. LBG, GMA News