PCV Impact in Pakistan
Asad Ali, MBBS, MPH
On behalf of
Pneumococcus Research team
Aga Khan University
Pakistan is first South Asian country to
launch vaccine against childhood
pneumonia
Millions of infants to receive the life-saving pneumococcal vaccine
Islamabad, 9 October 2012 — Mir Hazar Khan
Bijrani, Minister, Inter Provincial Coordination
(IPC) has announced today the introduction of
a new vaccine to protect Pakistani children
from pneumonia – a disease that takes the
lives of approximately 1.3 million children
globally before their fifth birthday.
With this launch, Pakistan is the first country in
South Asia to introduce the pneumococcal
vaccine.
Incidence rates of childhood meningitis in Hyderabad, Pakistan.
Zaidi A K M et al. Clin Infect Dis. 2009;48:S129-S135
© 2009 by the Infectious Diseases Society of America
Pneumococcal Serotypes and Serogroups Causing
Invasive Disease in Pakistan, 2005-2013
Sadia Shakoor, Furqan Kabir, Asif R Khowaja, Shahida M Qureshi, Fyezah Jehan, Farah Qamar, Cynthia G
Whitney, and Anita KM Zaidi.
111 pneumococci isolated from
• Sterile body fluids from both adults and children in clinical lab
• Meningitis surveillance project through the GAVI Alliance’s Hib Initiative to
study
• Pneumococcal bloodstream isolates from various ongoing pneumonia
surveillance studies.
Age group and
Source
Number of cases
Serotypes (n)
syndrome
Proportion of
Proportion of
serotypes included
serotypes included
in PCV-10* (%)
in PCV-13 (%)
47/72 (65.3%)
48/72 (66.7%)
9/12 (75%)
10/12 (83.3%)
56/84 (66.7%)
58/84 (69%)
0-59 months
Meningitis
CSF
72
18A/B/C/F (13), 14 (7),
19F (6), 23B (6),
12F/A/44/46 (6), 5 (4),
9V/A (3), 1(2), 11A/D (2),
15B/C (2), 10A (2),
6A/B/C (2), 4 (2), 23F(2),
22A/F (1), 19A (1), 17 (1),
8 (1), 9N/L (1), 24A/B/F
(1), 33F/A/37 (1), 35B (1),
NT† (5)
Sepsis
Blood
12
5 (3), 1 (2), 23A (2), 23F
(1), 3 (1), 14 (1),
10F/C/33C (1), 35B (1)
Subtotal
84
*Includes Vaccine -related (VR) serotypes
Age group and
Source
Number of cases
Serotypes (n)
Proportion of serotypes Proportion of serotypes
included in PCV-10* (%) included in PCV-13 (%)
syndrome
5-15 years
Meningitis
CSF
4
7A/F (1), 11A/D (1),
Sepsis
Blood
3
18A/B/C/F (1), 1 (1),
Empyema
Pleural fluid
2
19F (2)
Subtotal
24A//B/F (1), NT (1)
19F (1)
9
*Includes Vaccine -related (VR) serotypes
0/4 (0%)
0/4 (0%)
3/3 (100%)
3/3 (100%)
2/2 (100%)
2/2 (100%)
5/9 (55.6%)
5/9 (55.6%)
Age group and
Source
Number of cases
Serotypes (n)
syndrome
Proportion of
Proportion of
serotypes included
serotypes included
in PCV-10* (%)
in PCV-13 (%)
2/5 (40%)
2/5 (40%)
4/8 (50%)
4/8 (50%)
5/5 (100%)
5/5 (100%)
11/18 (61.1%)
11/18 (61.1%)
Adults (18-70 years)
Meningitis
CSF
5
5 (1), 13 (1), 19F (1),
Sepsis
Blood
8
1 (2), 23F (2), 13 (1),
22A/F (1), NT (1)
15B/C (1),
38/25F/25A (1)
Other**
Subtotal
See below
5
18
*Includes Vaccine -related (VR) serotypes
** Ascitic fluid (n=3), synovial fluid (n=1),
unknown sterile body fluid (n=1)
19F (3), 1 (1), 14 (1)
S.pneumoniae carriage serotypes among children aged 3months to 5 years in
lower Sindh, Pakistan – determination by real-time PCR
Sadia Shakoor, Sahrish Muneer , Velusamy Srinivasan , Fyezah Jehan , Imran Nisar , Aneeta Hotwani ,
Shahida Qureshi, Bernard Beall , Cynthia G Whitney, and Anita KM Zaidi
• 696 nasopharyngeal swabs were collected from children aged 3 months to 5
years in January 2013 (before PCV-10 introduction) from two districts of
Sindh (Karachi and Matiari) .
• 553 (79.5%) of the specimens yielded pneumococci.
• A sampling of 100 isolates, representing 100 different swabs, were shipped
to the CDC, Atlanta GA, for serotyping using sequential real time triplex
sequential real time PCR reactions
Poster board no is: P-149
Abstract number ISPPD-0202
Carriage pneumococcal serotypes by Quellung in children from lower Sindh,
Pakistan
Others: 1 each of serotypes 4, 29, 31, 39, 48, 10F, 12F, 15A, 16F, 17F, 18F, 24F, 28A, 33B, 33D, 33F, 35B,
35C, 35F, 7C, 9V, and one non-typeable strain
PCV10 coverage of carriage serotypes in lower Sindh- n=100
Cases of Hib and Pneumococcal meningitis in children < 5 years of age detected on
sentinel surveillance: Pre-and-post Pentavalent vaccine & PCV-10 introduction in
Pakistan
Introduced Hib vaccine in
national EPI in Jan 2009
Introduced PCV-10 in
national EPI in Apr 2013
Note: 1 case of Hib meningitis recruited in 2013 was aged 5 months; unvaccinated; and resident of Sohrab Goth Karachi;
1 case of Hib meningitis recruited in 2014 was aged 6 months; unvaccinated; and resident of Thatta.
Impact of PCV-10 Introduction in
Sindh
GAVI sponsored project
Objectives
1. To demonstrate the impact of introduction of
PCV-10 on
– invasive pneumococcal disease (IPD) in children
(bacteremic pneumonia and meningitis)
– Pneumococcal carriage in the nasopharynx of
children
2. To determine coverage in selected districts
3. To improve coverage in selected districts and
show what worked
Impact of PCV-10 introduction in
Sindh
Study Districts:
1. Karachi (Bin Qasim town)
2. Hyderabad
3. Matiari
4. Thatta
5. Tando-Allahyar
6. Tando Muhammad Khan
7. Jamshoro
Impact of PCV-10 introduction in Sindh
Study Districts
Participating Hospitals
Karachi
National Institute of Child Health, Civil Hospital,
Abbasi Shaheed Hospital, AKU Kharadar, AKU
Garden, Kharadar General Hospital
Hyderabad
Civil Hospital, Aga Khan Maternal and Child care
centre
Matiari
Taluka Head Quarter Matiari & Hala
Jamshoro
Liaquat University Hospital
Thatta
District Head Quarter Thatta
Summary and Next Steps
• Data suggests substantial burden of IPD in Pakistan
• Pakistan is the first country in South Asia to have
introduced PCV in its EPI program
• Rigorous studies to monitor the impact of PCV
introduction are ongoing- Data expected in 12-18
months
Thank you
Questions: [email protected]