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Complicated vaccines simply save lives

- Deborah Minors

Pneumonia is the number one infectious disease killer of children under five in the developing world.

Professor Keith Klugman delivered the second Phillip V. Tobias Plenary Lecture, entitled: Research to prevent pneumonia deaths in children at the Faculty of Health Sciences Research Day and Postgraduate Expo on 1 September 2016.

Klugman is Director of Pneumonia at the Bill and Melinda Gates Foundation (the Gates Foundation) in Seattle, USA. Klugman is also the Emeritus William H. Foege Chair of Global Health at the Hubert Department of Global Health, Emory University, Atlanta, Georgia. He is a Wits alumnus (PhD neurochemistry) and he is an Honorary Professor in the Respiratory and Meningeal Pathogens Research Unit at the University.

We can prevent and treat pneumonia

“Aids, TB and malaria are all very important killers in Africa and Asia, but the number one cause of death from infectious diseases – in fact in children and adults – is pneumonia. It’s the number one cause of any death of any cause in kids,” says Klugman.

The largest mortality from pneumonia is in Pakistan, India, the Democratic Republic of the Congo (DRC), Nigeria and Ethiopia. South Africa has the fourteenth most children not immunized against pneumonia.

“In 2016 there were 332 000 un-immunized children in South Africa out of a birth cohort of a million. That is completely unacceptable and a real problem for the children of this country. We can prevent and treat pneumonia,” says Klugman.

Klugman challenged researchers to consider working in this field. “Those of you who are going to make your research careers in South Africa – there’s still lots of problems with pneumonia in this country. It’s a tragedy and it’s unacceptable.”

“Access to healthcare is the biggest driver of infant mortality.”

The Global Vaccine Action Plan goal target is immunization of 90% of children.  Klugman points out that Austria – despite its developed status – is at high risk of pneumonia infection, due in part to misinformation about vaccines.

Klugman presented findings of studies in which India originally topped the list of deaths from pneumonia. Vaccination, however, enabled a 60% decline in the number of deaths between 2000 and 2013. Antibiotics are now also accessible in India.

“However, in the DRC and Angola, deaths from pneumonia are increasing and that’s because of impoverishment. In northern Nigeria, the influence of Boko Haram is frightening – here access to healthcare is only for those who can pay.”

Klugman explained that in South Africa HIV positive people whose lives are saved by antiretroviral (ARV) medicine will be at increased risk of pneumococcal disease as they age.

“This is a big gap and it’s going to be a challenge in this country,” he warned.

Herd protection and decolonizing the virus

Klugman presented findings of his research into the Pneumococcal Conjugate Vaccine (PCV), which had proven effective in preventing pneumococcal disease and led to interventions that saved millions of lives, especially in Africa. These studies showed that PVC directly affected the carriage of the virus.

“Adults got strains of the virus from children and these strains were reduced in adults too once the children were immunized. So if you immunize the kids, it prevents the virus from colonizing. It’s herd protection. Just immunize the kids to prevent the older people from contracting pneumonia,” says Klugman.

PCV can save children’s lives and prevent the virus in adults, says Klugman. Critically, it can mitigate against the increased risk of infection in older, particularly HIV positive people.

Five diseases that kill newborn babies

Klugman referenced five diseases that kill newborn babies, where vaccines could save lives:

  • Influenza, the solution to which is the immunization of pregnant women to protect their babies. Prof. Shabir A. Madhi, Executive Director of the National Institute for Communicable Diseases, whom Klugman mentored at Wits, has conducted groundbreaking research in this field
  • Respiratory Syncytial Virus (RSV), for which there was previously no vaccine, but clinical trials are now underway in South Africa
  • Pertussis (whooping cough) is a highly contagious respiratory disease that is “epidemic” in South Afric
  • Neonatal sepsis, a bacterial blood stream infection in newborn babies in the setting of fever, and
  • Group B Streptococcus (GBS) for which there is currently no vaccine although Dr Madhi is conducting research into stillbirths at Chris Hani Baragwanath Hospital. Klugman hinted at the possibility of a GBS vaccine in South Africa this year through the Gates Foundation.

 “The work we do is complicated,” says Klugman. “Why we do it is not.”