Indonesian baby (infant) hospitalized for treatment of severe pneumonia receives supplemental oxygen at General Sardjito Hospital, Yogyakarta, Indonesia, 2005.

The objectives of the Respiratory Pathogen Vaccines Program are:

• To generate and disseminate evidence needed by policymakers for the rational introduction of licensed conjugate Haemophilus influenzae type b (Hib), pneumococcal and influenza vaccines by measuring disease burden; assessing vaccine effectiveness; cost effectiveness and acceptability; and analyzing policy strategies for vaccine introduction.
• To develop consensus at the national level on the use of Hib, pneumococcal conjugate and influenza vaccines in selected Asian countries. The availability of international financing for introduction of Hib vaccines creates great opportunities for national leaders as well as challenges for sustaining vaccine financing once international support for new vaccine introduction has ended.

Projects

• In 2006, the IVI, in collaboration with Wyeth Vaccines, Quest Laboratories, Quintiles International and others began work on a multi-national study of invasive pneumococcal disease (IPD) in six countries in the Asia-Pacific region, called PneumoNet. This project is conducting prospective surveillance at hospitals using standardized screening, enrollment and data collection procedures. The IVI is providing expertise in epidemiologic procedures, including assessment of catchment areas served by study hospitals and providing support to study teams in conducting quality assurance and quality control procedures during the enrollment of study participants.
• In 2005, with funding from GAVI, the IVI and collaborating scientists in Vietnam initiated a prospective hospital-based study of invasive pneumococcal disease in Nha Trang in Southest Vietnam. This study was focused on identifying IPD among children < 5 years of age using standardized screening criteria and enrollment procedures. This disease burden study is the first to demonstrate that Hib and pneumococcus are causes of invasive bacterial meningitis in Khanh Hoa Province, Vietnam.
• In 2005, the IVI completed a retrospective study of childhood empyema (infection of the lining of the lungs) in seven countries in the Asia-Pacific region (China, Vietnam, Thailand, Indonesia, Australia, Taiwan and Korea). This study sought to identify serotypes of pneumococcus in children under 15 years hospitalized for pneumonia with the complications of pleural effusions or empyema(Survey of childhood empyema in Asia). To supplement the retrospective data, prospective surveillance studies of childhood empyema will be conducted in Australia, Korea, Taiwan and Thailand in collaboration with investigators at Sydney Children's Hospital of Australia.
• The IVI collaborated with Vietnamese scientists from the National Institute of Hygiene and Epidemiology (NIHE) to evaluate the impact of bacterial meningitis in children less than 5 years of age and to provide estimates of the Hib meningitis disease burden(see paper in The American Journal of Tropical Medicine and Hygiene). A follow-up analysis of Hib disease burden in all of Vietnam, based on hospital data, yielded an annual incidence of 18/100,000 in children under five and helped lead to a government decision to introduce Hib conjugate vaccine into the national immunization program with GAVI support.
• In the area of influenza research, the Respiratory Pathogen Vaccine Program completed studies on influenza outpatient visits and hospitalizations in a community hospital in Seoul, Korea. This study has become the basis for analyses now underway in collaboration with the Korean National Health Insurance Research Center. This large-scale administrative database analyses is one of the largest analyses conducted in Asia using national health insurance data. These data will be provided to national policymakers in the region to help them understand the value of routine vaccination against influenza. The program is also conducting a prospective study of influenza in children in Kampong Cham Province of Cambodia, in collaboration with the U.S. CDC Influenza Division, staff of the Pediatric Dengue Vaccine Initiative at IVI and the Pasteur Institute of Cambodia.

Despite more than 15 years of experience in providing conjugate Hib vaccines to infants and children in developed countries, Hib vaccines have not reached the majority of vulnerable children in less developed countries who are at risk for severe Hib meningitis, pneumonia and sepsis. Delayed introduction of Hib vaccines for children may be attributed to several factors including the lack of information about the disease and the effectiveness of the vaccine in developing countries, as well as challenges in securing sustained financing for purchase of these relatively more expensive vaccines.(The Lancet) IVI's research activities now support conduct of disease burden and economic analyses to estimate the national burden of Hib disease as well as studies that measure vaccine impact following introduction of Hib vaccines into national immunization programs.

Dr. Mary Slack (Respiratory and Systemic Infection Laboratory, Health Protection Agency, Centre for Infections, London), Consultant to the PneumoADIP-supported study of invasive pneumococcal disease watches as a Vietnamese child undergoes evaluation in the Department of Pediatrics, Khanh Hoa General Hospital, Nha Trang, Vietnam, 2006.

• In December 2007, the IVI co-hosted the first Symposium on Pneumococcal Vaccination in the Asia-Pacific Region, in collaboration with the GAVI Alliance, the PneumoADIP and the Sabin Foundation. The meeting, attended by more than 150 policymakers from Asian countries, respiratory disease experts, and representatives from international agencies, donor organizations and vaccine producers, conducted with a call to action to accelerate the introductdion of pneumoccocal conjugate vaccines in the Asia-Pacific region (See link: The International Symposium for Pneumococcus and Pneumococcal Disease, 2008)

Last Updated : June 2008