PNEUMOCOCCAL VACCINE IN NEPAL
9 YEARS OF PLANNING
Prof Dr Shrijana Shrestha
Paediatric Research Unit, Patan Hospital
Dean School of Medicine
Patan Academy of Health Sciences
1
History
• GAVI Alliance (formerly Global Alliance for Vaccines and
Immunization)
• SAPNA (South Asian Pneumococcal Network Alliance)
2005 -2006 at Kanti Hospital and Patan Hospital
• 2007 Funded by PneumoADIP directly
• 2009 WHO SEARO
• On-going collaboration with Canterbury Health
Laboratories in Christchurch, New Zealand and the
Department of Pediatrics at the University of Oxford, UK
At present, Patan Hospital is the only sentinel site for this
surveillance in Nepal
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Surveillance in Nepal – generating data on disease burden and
serotype distribution to inform policy decisions from 2005
IPD dominated by serotype 1
Pneumococcal serotype distribution at Patan Hospital Kathmandu 2005-2012
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Serotype 1: 97.4% of cases over 9 months
Serotype 5: 75% of cases over 9 months
Serotype 14: 100% of cases over 9 months
Number of isolates
N=83
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We need a schedule that provides protection through early childhood
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10
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0
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5
1
2
5
6B
8
9V
10A
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12A
14
15
15A
16
18C
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19A
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19C
19F
S. pneumoniae serotypes
Non-meningitis, n=60
Meningitis (Blood/CSF), n=23
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23B
23F
24B
25F
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PCV: pneumococcal conjugate vaccine
33F
48
NT
We evaluated a schedule that would
provide high antibody levels through
the second year of life without
compromising early protection
3+0
Patan
PCV10 study
6
18 weeks
10 14 weeks
2+1
10 months
9 months
2-4 years
PCV10 – similar protection
after 2 or 3 doses in EPI measured at 18 weeks
Using 2+1 gives better protection after 9 months of age for
the leading serotypes (measured at 2-4 years of age)
b
b
2+1 = 6, 14 weeks and 9 months
3+0 = 6,10, 14 weeks
b
Carriage studies-In Healthy Children
Serotype Distribution
• Impact assessment by observing disappearance of PCV serotypes after vaccine introduction
• Serotype 1 and 5 causes most disease but not often found in carriage
• May be more common in carriage in pneumonia cases
We have developed experience in rural and urban settings to collect data
Pneumococcal vaccine Nepal Impact
Assessment study (PneumoNIA)
funded by GAVI
1. Impact of PCV introduction on carriage of
pneumococci in children under 2 years of age
in Kathmandu
2. Impact of PCV introduction on carriage of
pneumococci in children with pneumonia
3. Enhanced surveillance of pneumonia and IPD
at Patan Hospital
4. Impact on meningitis and pneumonia
hospitalisations using hospital records
Acknowledgements
• GAVI impact assessment team
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Shyam Raj Upreti
Neelam, Adhikari
David Murdoch
Kate O’Brien
Stephen Thorson
Meeru Gurung
Dominic Kelly
Andrew Pollard
Jennifer Moisi
Brad Gessner