4th regional pneumococcal symposium_downloadable
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acknowledgements
PneumoadiP
glaxosmithkline
the kenya Paediatric association
Pneumococcal awareness council of exPerts (Pace)
Pfizer (formerly known as wyeth)
sabin Vaccine institute
the south african Paediatric association
uniVersity of the witwatersrand
us centers for disease control and PreVention
world health organization
table of contents
foreword
introduction
executiVe summary
session i: g P d ep 1
session ii: P ep r 4
session iii: ip P c V d i e 19
session iV: i c V V dvp up 28
session V: g i P V 34
regional and country PersPectiVes 38
session Vi: V av ip i 49
sPeakers 53
attendees 54
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Proceedings from the 4 regional Pneumo coccal symPosium >>
Dp my dv, wv, m l d d d . t l p-
, ll dl d, d D. o Lv PmaDiP. implm, vll, d
l ym dlv v ll l, d w dlv , w d mm wll y
y d . W wll d w v y d d, vy mply,
w wll d pll wll.
bld d pll wll q m d l, d ympm lly
, pl l wk, d, v dvlp d m, ld dy, d ply mk
, m pml d pv j pl l , ml ply.
executiVe summaryDp dv v dvlpm, pml d ll l d l
dvlp wld, plly m ld. c m p d ll m pml d 820,000
wldwd y, w m l a. My mll m m pm, mddl ,
ld p, d m.
o 14 mll l pml d wldwd, 4 mll a, v --
v mly m d. t f rl Pml sympm, ld J, s a,
23 M 2009, d d pml d a d d wld, lk
wy pv d dd d m wld p ld.
M 180 ppl m 38 , ld 23 a , dd f rl Pml symp-
m J, s a. D ympm, pp d p d dd p
m pml pdmly y ppv v d d d vll.
fllw l ymp Mx cy, Mx, 2004; s Pl, bzl, 2006; d il, tky, 2008;
m w zd y s V i d PmaDiP pp w Wld hl oz
(Who), s a Pd a, u.s. c D cl d Pv (cDc), Ky Pd- a, d uvy Wwd. s ympm 2004, mj dv v md
qy d pm, w d mmz pm, d dvlp
d d v mlv.
a am d cl a, ympm pd w d l p mp
pml d -s a, ld -mdy w d ly pvl a,
hiV d kl ll d, d vwd l ld m v l . a l
ymp, p d pp l d wldwd pv d
mmz pm, d w v dvlpm d dd , l, d m
ll d w v p p wld.
hlp kk m, s a Dpy M hl D. Ml sl dd mp p-
ml d s a d pk y d 7-vl pml j
v (PcV7). sl mmz pm v ld d d d pvl d
lk pl d mpl d d lk mllpx, D. sl d. W lv d
pml v wll d mly m ld d ldly.
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Proceedings from the 4 regional Pneumo coccal symPosium >> v
PcV pvd l y d y 20 p
PcV pv 9 m m pm hiV-d ld -hiV d ld
t f V
i dd lk mp v d pl , p d ppdd p w v dvlpm, wll v ld m d PcV
w . Pml dy pv pd l m v
dvlpm d p, ld pd ll l d l. glxsmKl (gsK) ly vd
mk z cd 10-vl pml -ypl hmpl z p D j
v (PhD-cV) d xp ly v l m ep Md ay (eMea). Wy md
13-vl v dd (PcV13) l w eMea, cl, d bzl, d vd d k
usa d s a. b gsK d Wy v pl pply Who pql pv
v. i dd, pv m Path d bzl fiocruZ dd z l dv v
d dvlpm wd.
s l ymp w vd, pml v v dd m a, w my
vll l ld. cy pv m s a d gm ddly d pv xpw v d, ld m dl m PcV d . ad
pk, m ll m dly d v l pl, dvlp
d py ly d pply dl v, pll wll mplm PcV mm-
z pm, d dvlp dd mmz mp. i dd a y ppv, Jm
D, mm b Plm, pk wk v- all-Py Plmy gp
Pml d l d .
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pl v m m d mmy mmz, d dd plz
l m w ll, p d PcV -v d m lly
l v. t pd v w p d p, d D. a
s, nw Jy Mdl sl. t v mjy d [ PcV7 d ] v d v -v.
c aWpp p ympm, l w d mv wd d dv
pv pml d. o Lv, - ympm, dd m ll
. a mm z mm, fd W Ky Pd a, pmpd ll
wk d mp [ PcV d ] m l.
Wl d pm mp p k , ll m. s a. Md,
c-D rpy d Ml P r u uvy Wwd, d, t l-
l w v x v y ly plm dv v
p a w d v .
D. c d Qd mmd p ympm: a d , pp dd.
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i y gm l l w pld, Wld hl oz d vd
ply mmd d PcV ll . i z d pml d d
y d y PcV, d pml pv py, plly w
d ld mly.
c-evt pml j v (PcV) pv l mdy d mly, d m ly
-v p $5 p d l lm vy gaVi y. D. a s pld pp teLance fy 2007 xmd -v PcV pv ld mly, d d
ly v w $1 d $5 p d, p d ld pk PcV wld p
pjd lly d ldd mly d ly -v.
V ot 7-vl pml j v (PcV7) mv wd m wdpd d. t v ,
v, d v x dl. t m, Wy, wll mmdly pply d
p gaVi-ll , ld rwd d gm. t x pml j v, 10-vl
pml hmpl z p D j ml (PhD-cV), ly ld cd d
xpd ld lw. i 2010, 13-vl ml (PcV13) xpd pl PcV7. t lk
pply d yp v dd mxmz ld vvl mp v.
t ud s, al, nw Zld, d -m W ep pvd v
ld ly, d x p d v lw-m w k p-
ml d. a ly m w v xpd gaVi d v.
figure 1 | tl Mly r m srepococcu pneumonae cld ud 5 y 2000
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session ii: P ep rco-chairs: Mm sm d ol akyj
t d pdmly d d pml d w vv pm-
l d d pm a. D. tm c, cd expdd Pm immz
Wld hl oz (Who) Dpm immz, V d bll pd w vvw
d pml vv d a d ld mdl d m d
m d d.
D. hp J m PmaDiP pd l m Pml gll syp Pj. D. s Md
uvy Wwd dd mp xm pml d d hiV , p-
lly m ld d v d dl d 2444. D. fd W m Ky Pd a dd
d pml m d ql a, d lld d ll p ml d
v d ld. flly, D. M rmk pd d w l vw
ld d m a l p w kl ll d, w p vv p-ml d.
figure 3 | Pml cj V hly c-ev
Finland
Incidence,
cases/10
0,0
00pop
Chile
USA,
multisite
Kenya
Gambia
45.3
1000
100
10
1
49.1
166.9213
458
Not only is the disease incidence higher in Africa, the severity and case fatality from these diseases is also higher
s: r Ka JaMa 2001; Dvd M JiD 1994; oDmpy tJ PiDJ 1996; Lv MM PiDJ 1998; ekl J JaMa 1992; bkly neJM 2005
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Model 1i m mdl, d-d pp w d m p y y mlply
ppl k (d v w v p) y d v d h,
, pm. t ll d, mlpld m dvd m pv
ml w ly ( dmd y l vw) pml m ldd v y .
i w dd v d pl y, wld w dvdd d
Wld bk d d y d v mly lw, mdm, , d vy . t
md d pdmly d d w ml w p d w y
mly . s, w -, ll m mly wld v
ml d pdmly d d.
Model 2i d mdl, -pm, -m vv d d w dmd y k
m -pm d -m . t w pld vl d m-
ly pd m -m vv d. t m yw mlpld w m -pm, -m . a ml p w
d w ly m p w m d.
Model 3u d m v ll l, md w 14 mll pm-
l d d wld, w 4 mll a; w 800,000 pml d,
w 90,000 w m ppl w w hiV-pv; d w 440,000 pml d a
plly, w d 49 p ll d. M d w d y pm, w
ly mll pp d m d vv d.
D v dld s a, W a d cl a
ly . i my a , d d v 300 p 100,000 ld d v
d 10 w d p, v a.
figure 4 | Pml gll D bd, 2000 (ld d 5)
Who em 2008
~14 million cases(UR: ~1119 M)afr: 4 mll (28% ll )
~820,000 deaths(UR: ~560950 K)~90K m hiV (+) ld (ur: 60100K)
afr: 440,000 d (49% ll d)
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t x p w y ly dm w yp d vd y , d l wd
d d m m y ld. t ly d wd m y
ld z 23 m, yp 14 dmd. am 24- 59-m-ld, yp 14 w l m mm
yp, l pp d d y yp 14 dd w w p. i
y ld w w kd , yp 1 w kd d.
nx, md pl mp v v ml pml d. rl
vv pml d w pd y yp d d v ml, d wd
v yp ldd PcV7 ppxmly 50 p l vv pml d
ld d v ll . t 70 p d wld q yp ldd
10- 13-vl v.
t m mp v v ml wld v pml d, d pm-
l d d d m Who Pml gll bd D (gbD) pj. t d d -
d pml d d v yp a d a ll v pd.
Lk ll pml d y v yp w yp ldd PcV7 ld lp pv
ppxmly 400,000 pml d ld y; v yp ppxmly dd-l 170,000 d PcV10, d 200,000 PcV13.
D Lmt pj, d pld l lm ly d -
p yp d. i m , mpl d dvdl yp pd, d
ly p d pd pld y yp PcV ml my dvdl yp
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) d ;
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sm w l d-v ppl d lmd d ly, yp d w vl-
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lkly ddl yp d wll lvl m ly, l my
-l .
hiV P di , D. s Md uvy Wwd dd mp xm pml
d d hiV , xpl d vv pml d s
a ld d d d v y , wll dl w 24 d 44y
p v pd w dd. i m d d, m v ly pld wl pv-
l hiV mmy l d. i s a, v ml m pl l
ppv, v d wk hiV-d dvdl, d pvl hiV y,
wll d k vv pml d w hiV-d ppl.
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uly, ll m y m 65 p v yp w y llw-p,
dw 39 p v y llw-p. i d v, m l p-
, w w q w s a m d dl.
t pml j v l dd hiV-d dl, d d d w ly
pv d m mmy v d qv d qlv p, d mp
m vl ld w t-ll dpd mm p.
ely plmy d pd y nl f w vy pv m, w hiV-d dl
pvly d vv pml d dmzd v d pl, w 75 p d
v yp vv pml d. hwv, mpd dvy yp vvpml d hiV-d dl, d 28 p d vv pml d.
t d pml j v hiV-d dl wll ply k pl l v 10
y m w. t lkld v d vv pml d hiV-d dl l
pl d p v mmzd mm. i ud s, d d p
w 65 p d llw d pml v y ld.
f dl ud s, 62 p d vv pml d m hiV-d dl d
v yp. uly, 44 p vv pml d d -v -
yp hiV-d dvdl, m w m x m -hiV d ppl.
t w 20 p d ll vv pml d, l l d d
lwd 100800 p 100,000. i w vl d
p, y wld xp l d d pvd, v w 20 p d,
m .
a pl y V al w 40 p d vv pml d d vv p-
m m hiV-d dl. hwv, hiV-d dl w ll-lw aiDs, vv
figure 5 | PcV Pv 9 tm M Pm hiV id cld
2500
1000
1500
2000
500
0
267
2302
HIV- ChildrenHIV+ Children
Casesclinicalpneumoniaprevented
per100,0
00child-yr
s
Vaccine preventable disease
s: Md sa, l. ciD 2005;40(10):1511-8.
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i l, w lm vll d, s. pneumonaed m pp d a w vy
mly d ll ql. t l vv ld w ql m d
lkly pmlly m y lly d ppl. fm, ld l m l lkly
lv dld.
b i P s c dD. M rmk pd d w l vw d d m a l -
p w kl ll d, w p vv pml d.
a p , -s
a p , ,
, p - v pp.
meena ramakrishnan
t vd k pm, m, d m a w kl ll d mpd
w kl ll. a d ml dd, w lm 250,000
y w kl ll m. t lm w-d ll l ll d y v ml
dd lly.
o v, md 18 p a ppl ml v m-
l s, c, lm. t a m d eql w ml dm.
t ppl v kl ll m, d 12 p ll mzy
ml s.
figure 6 | P-D Mly d sp sql
N Meningitis (%)
0
1
0
2
0
H Influenza B (%)
11
12
14
21
2
S Pneumonia (%)
13
26
20
37
14
OUTCOME
Mortality
Physical Defects
Cognitive Defects
Hearing Loss
Visual Loss
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m d ly l q mplyd p csf ld pm. oly x 32 d
d y dl pd ly l mdly. o x d, l q dd m
pml dy d l pm. oly dy md w kd ld pl w d, d
dy, w xpd m ld, w dl d pm.
t w l vy ll d vll p m dy j w, pl, my mm kl ll p w q mpl. oly l ddd
p-pl . i d, pvl p-pl d m 1548 p
j.
t qly w m d dd v l p, -kl ll p p
w l d. al d my l l ly d, y w
w p l w l p, d l ll lv k m .
t mjy dd l d mdll lm md dl k w kl ll
d d vv l d. t m lm w lk l p, w m mp
l my pk p d m pm v w p. W d
w dd k , d d wd d dd kl ll d ypm d mpd pvl kl ll d d l ppl.
t m ddl lm d pl w . t l , m d
d w dd pl y pl , w wd p w
lvly , w d d ly m mpl, d m , w w l
py d d m.
t l pl m , kl ll d my v d dm m
m ll l , m ppv wy, w l v p p p d
kl ll m.
rlt l d l w vd dy d d mdly, ddzd qly
m w dd d x :
1) lv l dy q() jv vw;
2) d lly dd pp l md;
3) dd pp m kl ll d (scD) d m l
m pp;
4) l l p (j w l w scD);
5) xpl l dy l, ppp; d
6) vll mp dy.
t w x l m qly d w dd wy xpld w m-
l d k vv l d. all x l d l p ppl.
f d w m Dm rpl c m Z, dy w m n, d
m sl.
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Proceedings from the 4 regional Pneumo coccal symPosium >> 16
wld q l mdl. s dd y lkd l vl,
w ld v xmd m d w l d v l m pd.
RESPONSE: r D m il ddd w ly yp dd, yplly z d
y y , , w d k dw y d y yp d, d . h
mmly pd yp 1 d. al, lly pd pll p-m ld kd d y dl d m w yp mmly d vy y .
tk ll d, D d l m -ly ld dd
m w rmk dd y dy p d d -ly yp. cly,
d y w yp pvd w w v. t wll ld plly
w wll d v mld d yp.
QUESTION: rd adl w Mdl r cl gm dd q fd W
mly pd n md. adl d q m pdm, plly
w wk d d pdm, mly k lly 20 p. Kw , d
k 4 p mly pd m v mld d ppl mp- d?
RESPONSE: fd W pdd l m mld, w d pvd w.
t ly l pd mly m w m n a, d , m ply
lwy my pdm.
QUESTION: P Pd m Wy dd q s Md d d p l
v yp v w m yp hiV-pv ld d dl. Pd d m
p Md wd ud s m, m w yp v,
plly 19a. h kd Md m yp ppl l d v l v y.
sdly, kd m mm mp d ply d ppl y.
RESPONSE: Md d m yp , l ly w dd d 2005, d w w
l w w m w yp hiV-d dl. Pd yp, yp
ldd PcV7, m m dm hiV-d dl, plly m m. t p
s a 70 p ld l mly ld, w m d ld
m w d ld. t xpl dm dlly pd -
yp hiV-d dvdl. t m m , xmpl, yp 19a. t k
d m 2005, l my m m vll d m d.
i m w d d v, Md d md m
p w v y pmy , hiV-d ld d m p d
d v mpd hiV-d ld w dd v v d y. f s
a, pm 2+1 w d d pvdd m mplmd. s wll x
wk d 14 wk dl w d d m, w ld xd p, w dd
w l p l.
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Proceedings from the 4 regional Pneumo coccal symPosium >> 18
QUESTION: cy Wy m u.s. cDc kd pl xpd mpl d kl ll
d d hiV. sld dl -p mp d d m pl dl d-
hiV Md md? D m pply kl ll? sld m -p
mp dd, y l? W pl mpl?
RESPONSE: M rmk mmd wld d ppl kl ll p d
m d y v vll d d a, wll y v y l, lp
. t lm vll d ly d pm w md l, d
wld mp d kl ll p, lk hiV p, pl ppl w v l. ev
w p d, rmk ddd, i k w d v d d m ly -m
m c d w y v kl ll p.
i m dl, rmk d d w p d p m ePi
dl d w wld dlvy l v. i l, wld wy pp
ll d d d pv mpl kl ll p w d d
d v lk v. t m pvv pp wld lp l m qly p w
v vll -m kl ll p c, w l xpy 4050 y .t ly m a ppl ll d l xpy, lly l
20 y kl ll j.
RESPONSE: Md ddd q pl mp, m vl lld ,
hiV-d ld wll vv m l pd m. al, d wd, l ud s,
kd vv pml d ld l l ppl
ll l . Md ddd y m v mplm d w -p
mp. i , v ld x d 14 wk, d ld w
wll v m . t pl -p mp ym , dd
w pl d -p mp w hiV-d ld.
Md pmd wll yp dm dl w vv pml d ud s mlz s a l y. h
l pl hiV-d ld w wll m vd, d m k vv
d. i m pl, v mj lm pmz mmd
ld d y v hiV-d ld.
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epdmly gm cldD 1980, b gwd ld m ld m d m ld. t d
dmd m vl ld mly gm ldd pml d, haemoplu
nuenzaeyp b (h), lmll, pm d ml. o , pm mly d y pml d
klld lly m ld ml, d 86 p ld w dd w d w y . fm
d ml l pvdd y gwd m, adl d pml-ld d ly ld l mpz, xpld, mp k pvv p ly ld w y.
adl d m d dd y gwd m l pmy pv-
ldd d gm. t gm v d m v mmz pm
1980 d 1990. splly, v y expdd Pm immz (ePi) gm
ll a, w v d ppxmly 82 p . add-
lly, mplm v pm gm h lm ly wpd d. ovll,
dm d l- d m ld gm. Y, pml d
m p .
ey Pml cj VW d m PmaDiP, Pml svll Pj w ld xm p d
yp d lyz l v gm. a pm, pml
d gm w 10- 20- ld ud s d ep. a pdmll dy wd
v, w p 546 pml d p 100,000 ld d y ld d
250 d p 100,000 ld l v y . adl wd vd -
ld y y l Pml svll Pj w ml, v .
a mmy-d d w ld gm k dy mmy d
y v pml j v. W d w pv l v w ,
y dd mm p d y dd w ePi v dmzd, lld y l
PcV9 w ld. bw 2001 d 2004, PcV9 w pvdd 17,437 ld w, d m . t
l mmzd ld w md 30 m llw l mmz.
t dy ld PcV9 w , v d dd w d v gm. sp-
lly, v wd 37 p y dll pm d, m mply, wd 16 p
d vll mly, 15 p d vll pl dm d 7 p d ll
pm. adl pd PcV9 dply ppxmly 80 p v l a, w
m ldd ll lw. t dy w 20 y w mp mly. W
l, adl xpld pvl d d m d dd p
d mmy wld v v, lw wld.
W W M g gm a Lv Vadl mpzd PcV9 lv d l d vll lvl ld mly. u-
ly, PcV9 pdd. id, PcV7 wll dd gm J, w pp m gaVi all.
W pml yp d v m pm gm, PcV7 w d ld p-
yp 1 p . i PcV9, PcV7 ly wd 50 p y gm.
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PcV v p ,
, p p p.
keith klugman
t lp w pml d d z xmly mp p pl l. Klmd d d m 1918 pdm d m d w d pml-
d z. Pdm z m l mkd. W d pp l-
p, Klm d d dvm v ld pv wdpd mly d pdm
ml 1918 z k.
W ll pm d pvdd pml j v mm d s a,
Klm lld p p wd mpvm v. sml gm, PcV7,
w pdd, m l v w s a ppl PcV9. impvm v
s a ld m ly lwd lvl pml d, lwd lvl vv d
d ld l pv pdm vv d k.
P V usa epD. cy Wy dd d PcV7 ud s d d vll
pml d w u.s. by 2007 pml mmz am ld w ml
mmz mj ldd v. D d m, av bl c
svll, w v v d k mp w u.s. M mply pv v-
PcV7 u.s., Wy wd u.s. uanedlw pml d m
v y.
figure 8 | r ivv Pml D am cld
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figure 9 | id e adlivv Pml D r abc, 19982007
70
60
50
40
30
20
10
0
2007 vs.baseline
2003 2004 2005 2006 200720022001200019991998
Cases/100,0
00
population
65+ years
40-64 years
18-39 years
PCV7
-37%
-23%
-49%
YearLx l. JaMa 2004 d pld d
figure 10 | ivv Pml D r alk nv cld < 2 Y old
350
300
250
200
150
100
50
0
2003 2004 2005 2006 2007200220011995-2000
Rates
per100,0
00
PCV7 Introduced
Year
PCV7 typenon-PCV7 type
sld cy aiP
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npyl rplmPcV vy l l d wld. D, wv, kwldd yp pl-
m ld p l v mp.
Wl pml d m md y ld d mly ld, l vy
mp dd w plm yp dl. h yp plm dvdl w mmmpmd, ldly ppl w hiV-pv. t vd
plm hiV-v dl w 18 d 64 y , lkly dvdl
d ly.
impv rd ovll ivv D rlWl vll pml d w d dl, p, dvdl pml-ld
d l dl. splly, D dd PcV dl pml m,
pm d py , d md. f xmpl, w d m sp m
v y d, m pml m d. addlly, py
, pml pm, dd 20 p d md lw lvl. flly, d v
ld md dd y 40 p. t md l plly mp w ,w md p ld d w y v d.
figure 12 | % P m nP hly cld W Vt, V-rld n-Vt, by Q
(20002003)
35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12321
vaccination Total
Non-VT
VT
VT-related
%P
nc
Quarter (20002003)
Pl l, Pedar infec D J, 23:1015-22, 2004
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s iV: i c V Vdvp upchair: D. K Klm
t d p dd dvlpm x- pml v
d ll dvlpm. P Pd m Wy V d Wllm hd m glxsmKl bl-
l dd p v pp l. Mk ald, m Pml V Pj
Path, llwd w d p Path k pp dvlpm x--
pml v vl pp. o l Dvlp c V M
nwk, ak hmm b-M/fz ddd ll d w pd pm-
l v, d . splly, hmm d pd d d
mddl-m .
w: dvp n- c VD. P Pd y kwld w pdmly l v dvlpm. W pvl d
yp vy m d ppl, pdmly plly mp pml v
dvlpm. f xmpl, -v yp 19a plly vl m alk , wl -v
yp 1 dpply pwl a. W md, Wy dvlpd x- pml
j v (PcV) dd pv d y yp ldd 7-vl pml j
v (PcV7). t v 13-vl pml j v, Pv 13 (PcV13).
Wy PcV13 ld p pvdd y l PcV7. i dd p ll v yp
d PcV7, pd mm p x ddl pml yp, ld , ,
v, x a, v f d 19a. ovll, d w l mmz dl w PcV13 vk dy
p mpl PcV7 v. Wl PcV13 mmy l w mm lly
figure 13 | PcV13 syp d c P cmp
4 6B 9V 14 18C 19F 23F 1 6A 7F 19A3 5PCV13
4 6B 9V 14 18C 19F 23FPrevenar
PCV13 contains the same carrier protein CRM 197
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hd wd vll mpv mmy p PhD-cV. Wl vll y w , mm-
y l yp 1 w lw gsK d pd. hd ypzd lw-y l
yp 1 ld ld yp ppy, d d ld mpv -
y l yp 1. fm, wd w PhD-cV w dmd ld
mmz. i , hd d d PhD-cV lly d mm p PrP
(h). h dd w, wv, -pl yp w p v vd ll w dmd w PhD-cV, l d w w .
b l, hd d w mp dv v w p m d p.
f, hd xpld mmz k mm w -dmd v. fm,
d y mpz mp ddl p v wld pvd d y
d p.
t l Who d ep rly a, gsK d dy mp w ld
v, PcV7. PhD-cV ld y d vd pv p m ep
rly ay. t ll 10-yp pml j v w hmpl p d
pml v m Who pl.
Path: ep Ppt Pml V Pj (PVP) Path dd l dvlpm x- pm-
l v yd j v d dy. D. Mk ald pd l Path, -
l, p z l, llly-lv l, l mm wldwd
k ld yl p l.
t m l PVP l dvlpm , v d dl v srepococcu
pneumonae ld a d lw-m wld. f wk x m jv d
wk w v p mpl jv, Path pp m v.
figure 15 | Pml V Pd Ppl
RegulatoryPhase 3Phase 2Phase I
Proteinsubunit
(Universityof Glasgow)
Proteinsubunit
(Universityof Adelaide)
Killedwhole cell(CHB/Butantan Institute)
Conjugatevaccine
(Partner 2)
Proteinsubunit(Mucosis)
Antigendiscover
(Genocea)
SynflorizPCV 10(GSK)
Prevnar-7(Wyeth)
Prevnar-13(Wyeth)
Proteinvaccine
Proteinvaccine
IC47protein
(Intercell)
Conjugatevaccine
(Partner 1)
Antigendiscover(Genocea)
Pre-clinical
= PATH-supported
= not PATH-supported
= under PATH consideration
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dQuestion: K Klm qd md w v wll pm-
l yp 1, plly vl s a.
Response: P Pd pdd y m w v yp 1. h
d pv l dmd p, d y mpz d
v w pl d dy p yp 1. t l p l dy w ld d d y l. al v yp 1
p, Pd pvdd p ld .
Response: Wllm hd wd w pp Pd pmm v y yp 1. h
w d mmy d p yp 1 d y Wy d gsK v.
b v v w pm d. gsK pp yp 1 d dl
w d wlv m , d.
Comment: Pd d mpz mp lyz v y p yp y
m l dy p l d ly d l dy. Pd xpld
m d m dl kll d y d d yp.
Question: J f m Dm rpl kd Pd d hd w l
pl dm 7-, 10- 13-vl v pl pmy v d dvdl v
dl.
figure 17 | tdy Mk s
Market
305
98
Low Income
$7 (?)
135
45
SolvedGAVIAMC
IFFim
PushMechanisms
DCVMN
SOLVEDPneumo ADIP
Middle Income
$20 (?)
130
43
High Income
$60
40
10
Vaccine
Price/Dose(average est.)
Vaccine Market(Mi doses)
Population(Mi)
Clear Role for DCVMN in production of Pneumococcalconjugated vaccines for middle income countries
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s V: g i P Vco-chairs: fd W d r D
c-v Vc-v ly w pml j v (PcV) -v d
x, -v v. i , D. a s nw Jy Mdl sl (uMDnJ) d
-ld q pml d: , PcV v? sd, PcV -v ?
ad lly, w l d m ly m y d d PcV?
i i, -v ,
PcV -v -v.
anusha sinha
i PcV -v?bd vwd ly d , md PcV wld v m 262,000 470,000 lv p
y, w l vy lmd d p . t ly 72 gaVi ll w
-v m $22 p dly-djd l y (DaLY) vd $100 p DaLY vd.
fm , s d v mjy d [ 7-vl pml j v (PcV7) d
] ll w Wld hl oz mk ly -v v.
figure 18 | gaVi-ell c: Pld rl
LivesSaved(100k)
Hosp.Averted(100k)
Disease CostsSaved
($, mill)
DALYsAverted
(mill)
$ Per DALYAvertedScenario
Deaths3 to 29 months
+ Non-fatal disease3 to 29 months
+ Extendedprotection to59 months
+ Herd immunity fornon-immunizedtarget popn
262
262
369
470
262
1,158
2,458
3,074
44
218
453
558
8.3
8.3*
11.7
15.0
100
80
37
22
s l 2007
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r immz Pm d cll implmi 2002, Who, unicef d p a dvd r evy D (reD) pp mpv
mmz v lw-pm . reD d lvl v ky lm l
mmz pm: 1) pl d mm ; 2) l ; 3) ppv pv; 4)
lk w mm d l v; d 5) v m. fm 20022006, mplm w m
44 1,067 d (80 p). nmm ldd wdpd reD pp ld v v.
a 2007 vl wd pm l. sly, ll d, v
mp reD pp w mplmd, d reD y w ppld vl-
d. hwv, w ll my lvd. hl d w m
mmy. ey p l d y d d p m l m,
p dk w ly pvdd l l . al, l m w mmy w ld
w-d l , y w d mm d d dd mpvd.
cll mplm reD m. t ld wk l dlvy d mmz ym, dq l
d m mplm reD pp my , d ll w m
mmz v wl d w v d l-m lly d d mm w v d d vm.
t dd ll reD mplm, reD dl w vd. t w reD fld gd wd
ll ppl d lk w mm. i l ldd ym d
ly ym m mmz d d pm d d lvl. cy
dp l w ddd ll d d l d pp v py ld d lvl.
Lly, reD m l w d pplml d w l ldd w reD fld gd.
Lk ad: nw V idnw v dd a w pp gaVi all. V d md dwy w
96 p a v dd hp b v d 80 p dm h v fy 2009. nmm mmd w vy dl w ppvl m d mpzd
mp dvy d w v.
a ppl d mplm j m a v ppvd y gaVi all, w
m M hl v md mmm mplm. i dd m a v, hPV d ml
v l ly dvlpm.
V svllfm d lld w 2005 d 2008, h imp d dd v b, bk f, g,
Ml, rwd, sl d ud wd h vy d v d v pv mp. i dd,
vll dd pml v w np.
rv vll 2006 d w dd y Who d l m. Plmy (2 y) d d
42 p d plz d v. t l d lv, m m-
ld vll d vll l y.
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r & c Ppvchairs: tm c d hmpy Lw
s aD. a v g rpy d Ml P r u (rMPru), nl i cmm-
l D (nicD) nl hl Ly sv (nhLs) pd s a ppv w y
d d d w v, d w y pp m ll y .
s a d l vll, mm w ll pl l, pv d mly l-
, wll l w m ppl. addlly, d vll w dd 23
y ddl ll d. t d d wd dm d l
pl w mjy d vll w dd.
t vy v l p, pk w l d dk d d
llw-p v md. t vy l v pl d l w l dl l l.
f pp vll , ly w ldd w dd m mlly l
pm. a y 21 dy w ld y pm w 21 dy w d .
syp mdly d dl w d p ml ply .
o lm d lld vv d ly m mll p pml d d,
d ly p w v dmd pl d v d pm k md. al, m d
d ly k ld l pm , wl k m m p pm.
t l m p pm y v d p l pv . a p,
ply ll m my lly md. a qly d pvd l dw ll dd v pd y dd s a pl l ly
ym mpv vll. i md 7080 p pm dd l
pd.
t vll pvd m -p d , d d m 2006 w ld l
y k pml d, w y mddl-d dl p
hiV-d -k wll. a -d pd ld qld pd m.
alm w-d m d v mjy pm d m d 10-20
p m w .
i ld l v y , yp 14 d m vv d w 2003 d 2007. syp
19a d w 2003 d 2005 d lzd v x w y. syp 1 w d dd
v y. syp 5 d 2004 d v x y.
i ld l v y , pl d v m pd w s a, m mp
yp yp 14 llwd y 6b, 6a d 23f. i w ld, yp 1 m mp
yp s a ppl 19a ll ld d ppl.
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a d pml v, s a wld m v ld l d
w d vv d. r pl s a, vl d my plm
v d ld, ld vl, ld . i wll lkly k m p d
dm v w pl m. fly, ldy v vll
m ll p, w my l w d dl.
i s a p
abc sv u s.
anne Von gottberg
i l, yp 1 d mp ll ld s a, ly 3 p d
. i ld ld, mly d w hiV-v ld. sv p d ld l
w y d yp 19a, d p, m 50 p l wll -
pl pll. i s a, vv pml d d w 75 p pvl
hiV -, d lly p hiV - w pm, w lm dpl
. hwv, w l d, s a ld l m v d.
mD. Mmmd ik pvdd vvw pml M w pl mp vv
, m d m d ml .
M mll ld w ly l ppl 1.2 mll. ad Wld bk, l
m p p j v $5,000 usD, mk ll gaVi d. t My hl l
v ppl, d w 10 d 20 p ppl pdmly pv l l.
bly v m ll vm l d m m pv l pd
cl hl Ly. i 2008, ly pd 645 cpl d (csf) pm d ly 11,000
ld l.
M wll-ld mmz pm, l w v mplmd ly
ll v ll clm-g (bcg) v w wk l d dp, , p
(DtP), pl, h, d p b v x, 10, d 14 wk. V v vy d d 2007, 87.3 p
ll vd d d DtP vm l . ild w v v-
d pv p l v mw w 90-95 p. t h v w dd
pv p 1995, d d , w dd mmz dl l M 2006.
t ly 16,000 lv y M, pml j v (PcV) w
dd $30 p d (w l l p) d -d dl w d, wld
$1.4 mll usD. t v d $0.7 mll usD.
t m d d ppv d ll a 1997, d w l
csf pm h, m d pm . t d ld l-pv d -p-
v . t m d dy ply l d pv vw l l.
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ov l 10 y, m l pm m csf d ld l d. i
csf, m pm d y m, m pml m. t m
ld l pd d v-ld l 12 y, l pp ld l
l ply d d m pm pd.
u w lm, l d pml m ll p wld 0.8p 100,000 20072008 d lm 19 p 100,000 ld d 1. tk ld l l d
csf l d xld dpl l m w d pm ld ld l d csf
2007-2008, vv pml d d ppl wld 34.7 p 100,000.
i m w v k , w w p ydm, p y
plmy, y llm hiV m v d .
t pll -ply ld l l, w -ply dd y Mic 0.12 ,
d m 8.3 p m 50 p. eymy d yl l d
m 24 l 2002 2030 p 20072008. am csf l,
d v 40 p. M pll -pl m d Mic w 0.12-1, w
ly w l w Mic 2 .
t d p lm, mly yp d vv l m, d d d
d pml pm. i m d m, my p, plly ld, d
v dm pl, l l v csf d ld l pm.
t d pk p m plly-d m y lx l , my d
v w plym (Pcr) mmmp k wld v pkd p v
m . t d ld pm pd pv l; wv, wld v d
y m 10 p.
i l, pm ld l m M, ply d d
h v mmz dl. hwv, l m . am-l mkdly d p 10 y vv d -vv pm l. a
y, M wll d v d d pml d -
d PcV. hwv, vlly ll yp d vv l wld l mk d.
d rp c (drc)i y ppv, D. Ml nymw expdd Pm immz (ePi) pm Drc v
vvw x Drc d l-l mmz pm. h l dd mmz-
v d wy pml v ld dd c, w yp pml j-
v wll dd d w Drc pl d v.
t Drc a d l y, w ppl md 69 mll ppl w 70 p m
lv l . nw 4 p ppl. L xpy lvly 45 y
ld d pvl hiV md dy 4.2 p. Drc w mly
ld d v y ld md 148 ld 1000 d dy.
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nymw dld d pd mmz d wd. t y vy l
z w wll v ll m, d nymw. t d , y wll d py ,
j mmz w v, ld py pv v d
m ym. t ldy pl. W v pp p v; d
ly d ld, d nymw.
nymw ldd p y mpz Drc l mm d d l w
d dv. h d mp mk xpl d
mk d d pm d mp a ld vvl. h pmlly
dld p a y , W y m , w wll v a l--
d.
t gD. rd adl Mdl r c (uK) gm pvdd vvw gm pl -
d pml v J 2009, d mpl d ppvd m v
PcV7 w pd v lv, v ly 63 p l gm.
Pl gm d PcV7 mmz w dvd , w ll dld
J 2009. t pl l ldd PcV10 PcV13 y w ppvd d vll
gm. t dl wld ePi pm w d w, d m.
figure 22 | sdl implm Pmjd V
Vaccines
7-valent (Wyeth)
10-valent (GSK)
13-valent (Wyeth)
Multi-valent(emerging suppliers)
Vaccins nouvelletechnologie
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016-2020
Serotypes des vaccins:7-valent: 4, 6B, 9V, 14, 18C, 19F, 23F10-valent: 7-valent + 1, 5, 7F13-valent: 10-valent + 3, 6A, 19A
Remplace le 7-valent
Homologation (FDA, EMEA)
Disponibles pour les marchs des pays en dveloppement
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t d lm z w m pl lm , mxd lm mddl d l d
pd dy m l . t l lvly lw hiV pvl. t d v
pl d ml j v ld gaVi d PcV.
a xv vll dy pml m 2002 bk f d t.
rl 20072008 wd l d w d v p 100,000 l 17 p 100,000 w pd m bk f d g l dd. i m l, d plly ld
ld d dl (w-d ld y v) d yp 1 ld yp. t
vy lm k m 125 d ly 3050 p.
D. Mll PcV7 ld pv 30 p pml m ld d v d
12 p p v v y . t p wld 50 p 75 p w yp1-
v. ad m, Mll d PcV7 d v l mp pml m
ppl, wl z lm pj. i m l, w lly lk yp-p
d m, pm d l . s ld d dd mp m
d d pl v . s mv wd, p v y my
y m l.
figure 24 | W V?
> 5 yrs
12%
76%
78%
< 5 yrs
32%
50%
57%
< 1 yrs
30%
52%
57%
PCV-7
PCV-10
PCV-13
% preventable among Sp meningitis cases in age group
spl bk f d t J. Mll
dQuestion: D. clm m Ld, uK mmd w d PcV, ppl wll xpd, d w y
xp y q mpvd . clm kd a s d k d
d l mdl.
Response: s wd ly d m p dmpy d pl dmd
xpd ppl q. s l pd dlly-w ppl w l m
pdv dl v y m pv y.
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Comment: r D d il, y v m v v pl pl p-
m vd-d dvm. f , d d, tdy y pv 14 plz.
W dd y d dy? h kd fld w y wy k v lmd vll y d
m dvy.
Reponse: fld kd m d d md y ld xpl . fld vd mmm nl Pmy hl Dvlpm ay mm.
Comment: amd n, mmz n, mmd d wk ldy w
v v d. h md d d mp, y pd d pvl
d pml v q 2010.
Comment: sv blk mmd -v d. h md lv l m d
vm d dd -v v d v lv pl l m
v y dk. h d y d mmz ld v my, y pl l
v -v mpv qly lv d v lv, d l
v v d -v lly xp m pl l v.
Response: s pdd y p v vll p . r k tll
b p m dy , mmd pl m w
v wll dd w vm.
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t gaVi a: av ipD. J Pm, d gaVi dvy d mplm .
t gaVi all m v lv d p ppl l y mmz p -
. gaVi ld y l: py l ym, l pk dd
d w v, pdly d ly d y dd v d vl pl/pv ll l pp.
Pml d d v v d v-
pvl d ld d v. t wll x
gaVi. Pm d wl yplly dly w
dvlpm d d v d d m-
m ppvl p, gaVi p v d
pml d v v gaVi ll
my ep v d .
nw v pml d d v p
md ppy pv ll, l dy lvl. M d
d v wll v MDg-4.
t gaVi all -y k d y. i 2008-
2009, gaVi pld p 100 mll d h
v l . Pm w pl mpl-
m pml v ld mv . b d , y wld d ppl, pl d
v pl. t ald V id (aVi) pd l m gaVi m wll
pl .
aVi: t PlaVi pl mk d d pml d v v, wl dvlp
plm d w v. t gaVi d 42 pml d
44 v v y d y 2015. t dld wk pl pl w k v y
l .
t wk pl k dw : d ppp v, d wll
d, lp md y d d p d v. W ll
vlp, l d vd. gaVi plm m
l d.
P Ppvt b Plm ld all Py Plmy gp (aPPg) Pml D Pv
Dvlp Wld dl w pml d uK d wld. t hl Jm D
h cmm v ppv Plm pml d d vy w
wly-md aPPg Pml D Pv Dvlp Wld.
figure 26 | gaVi Wk-pl
Donorswilling to
fund
Sufficient &appropriate
vaccine
Countrywillingnessto produce
Informedcouuntrydecision
Sustainable
introduction
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t n a P c V:a c a rD. J-M okw-bl Who pd d l mplm pml j-
v (PcV) d pvdd ll .
h d d m p pml v d p v y. aw,pply d d ll ly mpvd. a l d PcV a d
ldy . s a w ld w pml v dld dd apl 2009. s a
w l y mk ld ml l v ld ml
mly d .
a p l PcV, okw-bl mpzd d yd l v X m
d v. h mpzd d lk l mplm pml v d
pd pml d d p l y d mly ld. h l d
mp d mk vll d v m, d d
vy pp m gaVi.
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Proceedings from the 4 regional Pneumo coccal symPosium >> 54
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J M, usa
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tlm M, usa
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r oym Mkw, KenYaDvd Md, neW ZeaLanD
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attendees
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