October 27, 2008

By John Reichard,
CQ HealthBeat Editor

Experts on pneumococcal disease, a bacterial infection that causes pneumonia, meningitis, sepsis and other diseases, are making headway in their efforts to promote vaccination to prevent the life-threatening conditions — but they have a long way to go.

A U.S. federal advisory panel voted last week to recommend wider use of pneumococcal vaccination in adults, while global health activists urged far wider pneumococcal vaccination of children and adults around the world.

“Pneumococcal disease takes the lives of 1.6 million people each year — including more than 800,000 children under age 5 — making it a leading infectious killer worldwide, said Ciro A. de Quadros, executive vice president of the Sabin Vaccine Institute. “These deaths are unacceptable and unnecessary because effective vaccines are currently available,” said de Quadros, who co-chairs an organization sponsored by the Sabin Vaccine Institute called the Pneumococcal Awareness Council of Experts. The mission of the Washington, D.C.- based institute is to promote global access to vaccines to reduce infectious disease.

Developed countries including the United States have made strong gains against pneumococcal disease in children through national vaccination programs. In the United States, efforts also are underway to widen adult vaccination beyond the elderly, who are eligible for the pneumococcal shot through their Medicare benefits, to include certain adults of ages 19 to 64 who are at increased risk of the condition.

The Advisory Committee on Immunization Practices (ACIP), a federal panel whose advice normally becomes standard vaccination policy in the United States, voted Oct. 22 to recommend that adults who smoke, aged 19 through 64, receive the vaccination. The recommendation follows one by the panel at its meeting in June that pneumococcal vaccination be given to adults below the age of 65 who have asthma.

An estimated one-fifth of the U.S. adult population are smokers, according to the Centers for Disease Control and Prevention (although many smokers may already have other indications for vaccination such as chronic disease, asthma, or other lung disease, the agency noted).

The vote last week “is the first time the ACIP has recommended a vaccine specifically for people who smoke,” Merck, the maker of the Pneumovax 23 pneumococcal vaccine said in a news release Oct. 23. “This recommendation is based on data that showed smokers are approximately four times more at risk for pneumococcal disease than non-smokers.”

The ACIP also recommended that smokers who receive the vaccine undergo counseling to quit their use of tobacco.

CDC also released a study last week showing that as of August 2008, 26 countries offered a pneumococcus vaccination known as PCV7 through national immunization programs. “However, none of these countries is a low-income or lower-middle income country,” the study noted. “Overcoming the challenges to global introduction remains an urgent public health priority.” The agency added that global use of pneumococcal vaccine would prevent 5.4 million to 7.7 million deaths among children by 2030.

Analysts at the Sabin Vaccine Institute commented that “24 of the 26 countries that routinely protect their children with pneumococcal vaccines are high-income countries that represent less than one percent of the worldwide burden of this devastating disease.” Although cost has been an obstacle to wider use, “global immunization funding could be as much as $8 billion for new vaccines and immunization systems during the next ten years,” it noted.

“We must take action,” said Orin Levine, the other co-chairman of the Pneumococcal Awareness Council of Experts. “We have the vaccines, the technology, the financing and the demand to prevent this disease.”