An evaluation of emerging vaccines for childhood pneumococcal pneumonia

Julia Webster, Evropi Theodoratou, Harish Nair, Ang Choon Seong, Lina Zgaga, Tanvir Huda, Hope L. Johnson, Shabir Madhi, Craig Rubens, Jian Shayne F Zhang, Shams El Arifeen, Ryoko Krause, Troy A. Jacobs, W Abdullah Brooks, Harry Campbell, Igor Rudan

Research output: Contribution to journalArticle

Abstract

Background: Pneumonia is the leading cause of child mortality worldwide. Streptococcus pneumoniae (SP) or pneumococcus is estimated to cause 821,000 child deaths each year. It has over 90 serotypes, of which 7 to 13 serotypes are included in current formulations of pneumococcal conjugate vaccines that are efficacious in young children. To further reduce the burden from SP pneumonia, a vaccine is required that could protect children from a greater diversity of serotypes. Two different types of vaccines against pneumococcal pneumonia are currently at varying stages of development: a multivalent pneumococcal conjugate vaccine covering additional SP serotypes; and a conserved common pneumococcal protein antigen (PPA) vaccine offering protection for all serotypes. Methods. We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging SP vaccines relevant to several criteria of interest: answerability; efficacy and effectiveness; cost of development, production and implementation; deliverability, affordability and sustainability; maximum potential for disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to sensitive nature of their involvement in such exercises. They answered questions from CHNRI framework and their collective optimism towards each criterion was documented on a scale from 0 to 100%. Results: The experts expressed very high level of optimism (over 80%) that low-cost polysaccharide conjugate SP vaccines would satisfy each of the 9 relevant CHNRI criteria. The median potential effectiveness of conjugate SP vaccines in reduction of overall childhood pneumonia mortality was predicted to be about 25% (interquartile range 20-38%, min. 15%, max 45%). For low cost, cross-protective common protein vaccines for SP the experts expressed concerns over answerability (72%) and the level of development costs (50%), while the scores for all other criteria were over 80%. The median potential effectiveness of common protein vaccines in reduction of overall childhood pneumonia mortality was predicted to be about 30% (interquartile range 26-40%, min. 20%, max 45%). Conclusions: Improved SP vaccines are a very promising investment that could substantially contribute to reduction of child mortality world-wide.

Original languageEnglish (US)
Article numberS26
JournalBMC Public Health
Volume11
Issue numberSUPPL. 3
DOIs
StatePublished - 2011

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Pneumococcal Pneumonia
Streptococcus pneumoniae
Vaccines
Pneumonia
Costs and Cost Analysis
Child Mortality
Conjugate Vaccines
Pneumococcal Vaccines
Administrative Personnel
Exercise
Health Priorities
Proteins
Mortality
Expert Testimony
Polysaccharides
Industry
Public Health
Research Personnel
Serogroup
Antigens

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Webster, J., Theodoratou, E., Nair, H., Seong, A. C., Zgaga, L., Huda, T., ... Rudan, I. (2011). An evaluation of emerging vaccines for childhood pneumococcal pneumonia. BMC Public Health, 11(SUPPL. 3), [S26]. https://doi.org/10.1186/1471-2458-11-S3-S26

An evaluation of emerging vaccines for childhood pneumococcal pneumonia. / Webster, Julia; Theodoratou, Evropi; Nair, Harish; Seong, Ang Choon; Zgaga, Lina; Huda, Tanvir; Johnson, Hope L.; Madhi, Shabir; Rubens, Craig; Zhang, Jian Shayne F; El Arifeen, Shams; Krause, Ryoko; Jacobs, Troy A.; Brooks, W Abdullah; Campbell, Harry; Rudan, Igor.

In: BMC Public Health, Vol. 11, No. SUPPL. 3, S26, 2011.

Research output: Contribution to journalArticle

Webster, J, Theodoratou, E, Nair, H, Seong, AC, Zgaga, L, Huda, T, Johnson, HL, Madhi, S, Rubens, C, Zhang, JSF, El Arifeen, S, Krause, R, Jacobs, TA, Brooks, WA, Campbell, H & Rudan, I 2011, 'An evaluation of emerging vaccines for childhood pneumococcal pneumonia', BMC Public Health, vol. 11, no. SUPPL. 3, S26. https://doi.org/10.1186/1471-2458-11-S3-S26
Webster J, Theodoratou E, Nair H, Seong AC, Zgaga L, Huda T et al. An evaluation of emerging vaccines for childhood pneumococcal pneumonia. BMC Public Health. 2011;11(SUPPL. 3). S26. https://doi.org/10.1186/1471-2458-11-S3-S26
Webster, Julia ; Theodoratou, Evropi ; Nair, Harish ; Seong, Ang Choon ; Zgaga, Lina ; Huda, Tanvir ; Johnson, Hope L. ; Madhi, Shabir ; Rubens, Craig ; Zhang, Jian Shayne F ; El Arifeen, Shams ; Krause, Ryoko ; Jacobs, Troy A. ; Brooks, W Abdullah ; Campbell, Harry ; Rudan, Igor. / An evaluation of emerging vaccines for childhood pneumococcal pneumonia. In: BMC Public Health. 2011 ; Vol. 11, No. SUPPL. 3.
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abstract = "Background: Pneumonia is the leading cause of child mortality worldwide. Streptococcus pneumoniae (SP) or pneumococcus is estimated to cause 821,000 child deaths each year. It has over 90 serotypes, of which 7 to 13 serotypes are included in current formulations of pneumococcal conjugate vaccines that are efficacious in young children. To further reduce the burden from SP pneumonia, a vaccine is required that could protect children from a greater diversity of serotypes. Two different types of vaccines against pneumococcal pneumonia are currently at varying stages of development: a multivalent pneumococcal conjugate vaccine covering additional SP serotypes; and a conserved common pneumococcal protein antigen (PPA) vaccine offering protection for all serotypes. Methods. We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging SP vaccines relevant to several criteria of interest: answerability; efficacy and effectiveness; cost of development, production and implementation; deliverability, affordability and sustainability; maximum potential for disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to sensitive nature of their involvement in such exercises. They answered questions from CHNRI framework and their collective optimism towards each criterion was documented on a scale from 0 to 100{\%}. Results: The experts expressed very high level of optimism (over 80{\%}) that low-cost polysaccharide conjugate SP vaccines would satisfy each of the 9 relevant CHNRI criteria. The median potential effectiveness of conjugate SP vaccines in reduction of overall childhood pneumonia mortality was predicted to be about 25{\%} (interquartile range 20-38{\%}, min. 15{\%}, max 45{\%}). For low cost, cross-protective common protein vaccines for SP the experts expressed concerns over answerability (72{\%}) and the level of development costs (50{\%}), while the scores for all other criteria were over 80{\%}. The median potential effectiveness of common protein vaccines in reduction of overall childhood pneumonia mortality was predicted to be about 30{\%} (interquartile range 26-40{\%}, min. 20{\%}, max 45{\%}). Conclusions: Improved SP vaccines are a very promising investment that could substantially contribute to reduction of child mortality world-wide.",
author = "Julia Webster and Evropi Theodoratou and Harish Nair and Seong, {Ang Choon} and Lina Zgaga and Tanvir Huda and Johnson, {Hope L.} and Shabir Madhi and Craig Rubens and Zhang, {Jian Shayne F} and {El Arifeen}, Shams and Ryoko Krause and Jacobs, {Troy A.} and Brooks, {W Abdullah} and Harry Campbell and Igor Rudan",
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AU - Huda, Tanvir

AU - Johnson, Hope L.

AU - Madhi, Shabir

AU - Rubens, Craig

AU - Zhang, Jian Shayne F

AU - El Arifeen, Shams

AU - Krause, Ryoko

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AU - Rudan, Igor

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N2 - Background: Pneumonia is the leading cause of child mortality worldwide. Streptococcus pneumoniae (SP) or pneumococcus is estimated to cause 821,000 child deaths each year. It has over 90 serotypes, of which 7 to 13 serotypes are included in current formulations of pneumococcal conjugate vaccines that are efficacious in young children. To further reduce the burden from SP pneumonia, a vaccine is required that could protect children from a greater diversity of serotypes. Two different types of vaccines against pneumococcal pneumonia are currently at varying stages of development: a multivalent pneumococcal conjugate vaccine covering additional SP serotypes; and a conserved common pneumococcal protein antigen (PPA) vaccine offering protection for all serotypes. Methods. We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging SP vaccines relevant to several criteria of interest: answerability; efficacy and effectiveness; cost of development, production and implementation; deliverability, affordability and sustainability; maximum potential for disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to sensitive nature of their involvement in such exercises. They answered questions from CHNRI framework and their collective optimism towards each criterion was documented on a scale from 0 to 100%. Results: The experts expressed very high level of optimism (over 80%) that low-cost polysaccharide conjugate SP vaccines would satisfy each of the 9 relevant CHNRI criteria. The median potential effectiveness of conjugate SP vaccines in reduction of overall childhood pneumonia mortality was predicted to be about 25% (interquartile range 20-38%, min. 15%, max 45%). For low cost, cross-protective common protein vaccines for SP the experts expressed concerns over answerability (72%) and the level of development costs (50%), while the scores for all other criteria were over 80%. The median potential effectiveness of common protein vaccines in reduction of overall childhood pneumonia mortality was predicted to be about 30% (interquartile range 26-40%, min. 20%, max 45%). Conclusions: Improved SP vaccines are a very promising investment that could substantially contribute to reduction of child mortality world-wide.

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