Newer Vaccines

Approximately 2.0 of the 10.6 million deaths that occur in young children each year are due to pneumonia (Wardlaw et al. 2006). About half of these deaths occur among children in sub-Saharan Africa and another 30% occur in the countries of south Asia (Bryce et al. 2005). In developing countries 11-20 million children with severe pneumonia are known to require hospital admission (Rudan et al. 2004). Streptococcus pneumoniae has been identified as a main bacterial cause of pneumonia (Shann 1986) and other pneumococcal diseases particularly in very young children where a polysaccharide vaccine is not very effective. Recent estimates from WHO indicate that pneumococcal infections are responsible for 1.6 million deaths each year, half of them in the age group under 5 and the highest risk is among the children less than 2 years old and in elderly person (WHO, 2007). Emergence of penicillin- and multiple drug-resistant pneumococci has compounded the problems of managing children with pneumococcal disease. Apart from preventing invasive infections like meningitis, bacteraemia and pneumonia due to S. pneumoniae, a conjugate pneumococcal vaccine was able to reduce at least more than a million of estimated 20 millions of episode of otitis media in the USA and thereby reducing both the medical and societal cost indicating that vaccination is much more cost-effective than antibiotic treatment (Black et al. 2000; Capra et al. 2000; Eskola et al. 2001; Ray et al. 2002). An effective infant vaccination programme can prevent 78% of the potential meningitis cases, 69% of the potential pneumonia cases and 8% of the potential otitis media episodes in a birth cohort and lower the total cost of pneumococcal disease by about $750 million in a year in the USA (Black et al. 2000). In countries where pneumococcal disease is caused by only few serotypes, a conjugate vaccine is highly efficacious and can reduce rates of hospital admission, thus reducing both the direct and indirect cost of treatment and should be considered to reduce the disease burden and contain antibiotic resistance (Adegbola et al. 2006; Cutts et al. 2005).

Proper vaccination strategy can reduce meningococcal disease substantially and can be an effective strategy to prevent an impending epidemic even in the less developed countries (Peltola 2000b). Routine immunization with meningo-coccal vaccine is within the cost-effective reach of the public health interventions especially in countries where the disease is endemic (Miller and Shahab 2005). A simulation of epidemics of meningococcal disease proved that a preventive vaccination strategy is more cost-effective in averting a possible adverse outcome (Parent du Chatelet et al. 2001).

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