Pneumococcal disease: Closing the gap

• Main Author: Ashfaq Hasan
• Format: Article
• Language: English
• Published: Deccan College of Medical Sciences 2015-01-01
• Series: Journal of Medical and Allied Sciences
• Subjects: pneumococcus; epidemic
• Online Access: http://jmas.in/Vol5Issue1/Pneumococcal%20disease%20Closing%20the%20gap.pdf
• ISSN: 2231-1696; 2231-170X

oday, India is home to 99 million elderly people. By 2050, the number of elderly in this country will have gone up to 300 million1. With an increase in life expectancy from 32 years at the time of independence to 67.14 years in 20121, 10% of the population finds itself labeled as ‘senior citizen’. Inevitably, age brings with it comorbidities, immune senescence and pneumococcal disease. Pneumonia, in deference to its considerable morbidity and mortality, was exalted by Sir William Osler to its dubious pedestal of “Captain of all these Men of Death”. Unsurprisingly, immune debility and in several regions of the planet increasing antibiotic resistance, have ensured that pneumococcal pneumonia continues to take a large toll of senior citizens. Death rates have hardly budged over the last three decades. In India, pneumonia accounts for 25-30% deaths in the elderly3, a fatality rate almost unrivalled by most other terminal diseases. Among 15 high-burden countries, India has the dubious distinction of ranking third from last in the Global Action Plan for Pneumonia and Diarrhea (GAPPD)4. During the World Immunization Week 2015 (April 24th to 30th), the ‘Close the Immunization Gap’ campaign gains crucial importance. Immunization, long vaunted as one of the most successful and cost-effective health interventions there is, prevent 2 to 3 million deaths every year, and saves enor-mous hospitalization costs and prevents loss of productivity. The recently published CAPiTA study (Community Acquired Pneumonia Immunization Trial in Adults), evaluated the efficacy of a novel 13-valent conju-gate vaccine for Pneumococcal pneumonia a vac-cine proven for its efficacy in children for the first time in older adults over 85,000 of them. Childhood vaccination with ‘PCV-13’, of course, was instrumental in reducing nasopharyngeal carriage of Strep pneumonia and decreasing the prevalence of Pneumococcal disease in the community at large. Altogether, the idea was not novel at all. Polysaccharide vaccines for Meningococci and Hemophilus influenza b have logically evolved into conjugate vaccines. Based on the outcomes of the CAPiTA study, the Advisory Committee on Immunization Practices called forth an extraordinary meeting to appraise the evidence and suggest the incorporation of PCV-13 into extant vaccination guidelines5. The high burden of pneumococcal disease in India makes the CAPiTA trial particularly relevant3. In a country of relatively limited resources and a popu-lation of well above a billion, any preventive public health program presents a massive challenge. With traditional surveillance systems for most diseases below par, India needs to rapidly perfect its epidemiologic skills—without which any effort in preventive healthcare may become an exercise in futility.