4th Regional Pneumococcal Symposium_Downloadable

8/7/2019 4th Regional Pneumococcal Symposium_Downloadable

1/64

1


2/64


3/64

acknowledgements

PneumoadiP

glaxosmithkline

the kenya Paediatric association

Pneumococcal awareness council of exPerts (Pace)

Pfizer (formerly known as wyeth)

sabin Vaccine institute

the south african Paediatric association

uniVersity of the witwatersrand

us centers for disease control and PreVention

world health organization

table of contents

foreword

introduction

executiVe summary

session i: g P d ep 1

session ii: P ep r 4

session iii: ip P c V d i e 19

session iV: i c V V dvp up 28

session V: g i P V 34

regional and country PersPectiVes 38

session Vi: V av ip i 49

sPeakers 53

attendees 54


4/64


5/64


6/64

Proceedings from the 4 regional Pneumo coccal symPosium >>

Dp my dv, wv, m l d d d . t l p-

, ll dl d, d D. o Lv PmaDiP. implm, vll, d

l ym dlv v ll l, d w dlv , w d mm wll y

y d . W wll d w v y d d, vy mply,

w wll d pll wll.

bld d pll wll q m d l, d ympm lly

, pl l wk, d, v dvlp d m, ld dy, d ply mk

, m pml d pv j pl l , ml ply.

executiVe summaryDp dv v dvlpm, pml d ll l d l

dvlp wld, plly m ld. c m p d ll m pml d 820,000

wldwd y, w m l a. My mll m m pm, mddl ,

ld p, d m.

o 14 mll l pml d wldwd, 4 mll a, v --

v mly m d. t f rl Pml sympm, ld J, s a,

23 M 2009, d d pml d a d d wld, lk

wy pv d dd d m wld p ld.

M 180 ppl m 38 , ld 23 a , dd f rl Pml symp-

m J, s a. D ympm, pp d p d dd p

m pml pdmly y ppv v d d d vll.

fllw l ymp Mx cy, Mx, 2004; s Pl, bzl, 2006; d il, tky, 2008;

m w zd y s V i d PmaDiP pp w Wld hl oz

(Who), s a Pd a, u.s. c D cl d Pv (cDc), Ky Pd- a, d uvy Wwd. s ympm 2004, mj dv v md

qy d pm, w d mmz pm, d dvlp

d d v mlv.

a am d cl a, ympm pd w d l p mp

pml d -s a, ld -mdy w d ly pvl a,

hiV d kl ll d, d vwd l ld m v l . a l

ymp, p d pp l d wldwd pv d

mmz pm, d w v dvlpm d dd , l, d m

ll d w v p p wld.

hlp kk m, s a Dpy M hl D. Ml sl dd mp p-

ml d s a d pk y d 7-vl pml j

v (PcV7). sl mmz pm v ld d d d pvl d

lk pl d mpl d d lk mllpx, D. sl d. W lv d

pml v wll d mly m ld d ldly.


7/64


8/64

Proceedings from the 4 regional Pneumo coccal symPosium >> v

PcV pvd l y d y 20 p

PcV pv 9 m m pm hiV-d ld -hiV d ld

t f V

i dd lk mp v d pl , p d ppdd p w v dvlpm, wll v ld m d PcV

w . Pml dy pv pd l m v

dvlpm d p, ld pd ll l d l. glxsmKl (gsK) ly vd

mk z cd 10-vl pml -ypl hmpl z p D j

v (PhD-cV) d xp ly v l m ep Md ay (eMea). Wy md

13-vl v dd (PcV13) l w eMea, cl, d bzl, d vd d k

usa d s a. b gsK d Wy v pl pply Who pql pv

v. i dd, pv m Path d bzl fiocruZ dd z l dv v

d dvlpm wd.

s l ymp w vd, pml v v dd m a, w my

vll l ld. cy pv m s a d gm ddly d pv xpw v d, ld m dl m PcV d . ad

pk, m ll m dly d v l pl, dvlp

d py ly d pply dl v, pll wll mplm PcV mm-

z pm, d dvlp dd mmz mp. i dd a y ppv, Jm

D, mm b Plm, pk wk v- all-Py Plmy gp

Pml d l d .

c-v l ky , dv k xpd PcV mmz ddl . Lk

pl v m m d mmy mmz, d dd plz

l m w ll, p d PcV -v d m lly

l v. t pd v w p d p, d D. a

s, nw Jy Mdl sl. t v mjy d [ PcV7 d ] v d v -v.

c aWpp p ympm, l w d mv wd d dv

pv pml d. o Lv, - ympm, dd m ll

. a mm z mm, fd W Ky Pd a, pmpd ll

wk d mp [ PcV d ] m l.

Wl d pm mp p k , ll m. s a. Md,

c-D rpy d Ml P r u uvy Wwd, d, t l-

l w v x v y ly plm dv v

p a w d v .

D. c d Qd mmd p ympm: a d , pp dd.


9/64

1


10/64

Proceedings from the 4 regional Pneumococcal symPosium >> 2

i y gm l l w pld, Wld hl oz d vd

ply mmd d PcV ll . i z d pml d d

y d y PcV, d pml pv py, plly w

d ld mly.

c-evt pml j v (PcV) pv l mdy d mly, d m ly

-v p $5 p d l lm vy gaVi y. D. a s pld pp teLance fy 2007 xmd -v PcV pv ld mly, d d

ly v w $1 d $5 p d, p d ld pk PcV wld p

pjd lly d ldd mly d ly -v.

V ot 7-vl pml j v (PcV7) mv wd m wdpd d. t v ,

v, d v x dl. t m, Wy, wll mmdly pply d

p gaVi-ll , ld rwd d gm. t x pml j v, 10-vl

pml hmpl z p D j ml (PhD-cV), ly ld cd d

xpd ld lw. i 2010, 13-vl ml (PcV13) xpd pl PcV7. t lk

pply d yp v dd mxmz ld vvl mp v.

t ud s, al, nw Zld, d -m W ep pvd v

ld ly, d x p d v lw-m w k p-

ml d. a ly m w v xpd gaVi d v.

figure 1 | tl Mly r m srepococcu pneumonae cld ud 5 y 2000


11/64

3


12/64


session ii: P ep rco-chairs: Mm sm d ol akyj

t d pdmly d d pml d w vv pm-

l d d pm a. D. tm c, cd expdd Pm immz

Wld hl oz (Who) Dpm immz, V d bll pd w vvw

d pml vv d a d ld mdl d m d

m d d.

D. hp J m PmaDiP pd l m Pml gll syp Pj. D. s Md

uvy Wwd dd mp xm pml d d hiV , p-

lly m ld d v d dl d 2444. D. fd W m Ky Pd a dd

d pml m d ql a, d lld d ll p ml d

v d ld. flly, D. M rmk pd d w l vw

ld d m a l p w kl ll d, w p vv p-ml d.

figure 3 | Pml cj V hly c-ev

Finland

Incidence,

cases/10

0,0

00pop

Chile

USA,

multisite

Kenya

Gambia

45.3

1000

100

10

1

49.1

166.9213

458

Not only is the disease incidence higher in Africa, the severity and case fatality from these diseases is also higher

s: r Ka JaMa 2001; Dvd M JiD 1994; oDmpy tJ PiDJ 1996; Lv MM PiDJ 1998; ekl J JaMa 1992; bkly neJM 2005


13/64

5


14/64


Model 1i m mdl, d-d pp w d m p y y mlply

ppl k (d v w v p) y d v d h,

, pm. t ll d, mlpld m dvd m pv

ml w ly ( dmd y l vw) pml m ldd v y .

i w dd v d pl y, wld w dvdd d

Wld bk d d y d v mly lw, mdm, , d vy . t

md d pdmly d d w ml w p d w y

mly . s, w -, ll m mly wld v

ml d pdmly d d.

Model 2i d mdl, -pm, -m vv d d w dmd y k

m -pm d -m . t w pld vl d m-

ly pd m -m vv d. t m yw mlpld w m -pm, -m . a ml p w

d w ly m p w m d.

Model 3u d m v ll l, md w 14 mll pm-

l d d wld, w 4 mll a; w 800,000 pml d,

w 90,000 w m ppl w w hiV-pv; d w 440,000 pml d a

plly, w d 49 p ll d. M d w d y pm, w

ly mll pp d m d vv d.

D v dld s a, W a d cl a

ly . i my a , d d v 300 p 100,000 ld d v

d 10 w d p, v a.

figure 4 | Pml gll D bd, 2000 (ld d 5)

Who em 2008

~14 million cases(UR: ~1119 M)afr: 4 mll (28% ll )

~820,000 deaths(UR: ~560950 K)~90K m hiV (+) ld (ur: 60100K)

afr: 440,000 d (49% ll d)


15/64

7


16/64


t x p w y ly dm w yp d vd y , d l wd

d d m m y ld. t ly d wd m y

ld z 23 m, yp 14 dmd. am 24- 59-m-ld, yp 14 w l m mm

yp, l pp d d y yp 14 dd w w p. i

y ld w w kd , yp 1 w kd d.

nx, md pl mp v v ml pml d. rl

vv pml d w pd y yp d d v ml, d wd

v yp ldd PcV7 ppxmly 50 p l vv pml d

ld d v ll . t 70 p d wld q yp ldd

10- 13-vl v.

t m mp v v ml wld v pml d, d pm-

l d d d m Who Pml gll bd D (gbD) pj. t d d -

d pml d d v yp a d a ll v pd.

Lk ll pml d y v yp w yp ldd PcV7 ld lp pv

ppxmly 400,000 pml d ld y; v yp ppxmly dd-l 170,000 d PcV10, d 200,000 PcV13.

D Lmt pj, d pld l lm ly d -

p yp d. i m , mpl d dvdl yp pd, d

ly p d pd pld y yp PcV ml my dvdl yp

lmpd . t l d dl p m d. W yp w pd,

w l w w:

) d ;

) d d d;) d d / pd l.

sm w l d-v ppl d lmd d ly, yp d w vl-

l m . a l m l lld v xdd pd m qd v

y lvl m, d ddl d w yp d m ,

lkly ddl yp d wll lvl m ly, l my

-l .

hiV P di , D. s Md uvy Wwd dd mp xm pml

d d hiV , xpl d vv pml d s

a ld d d d v y , wll dl w 24 d 44y

p v pd w dd. i m d d, m v ly pld wl pv-

l hiV mmy l d. i s a, v ml m pl l

ppv, v d wk hiV-d dvdl, d pvl hiV y,

wll d k vv pml d w hiV-d ppl.


17/64

9


18/64


uly, ll m y m 65 p v yp w y llw-p,

dw 39 p v y llw-p. i d v, m l p-

, w w q w s a m d dl.

t pml j v l dd hiV-d dl, d d d w ly

pv d m mmy v d qv d qlv p, d mp

m vl ld w t-ll dpd mm p.

ely plmy d pd y nl f w vy pv m, w hiV-d dl

pvly d vv pml d dmzd v d pl, w 75 p d

v yp vv pml d. hwv, mpd dvy yp vvpml d hiV-d dl, d 28 p d vv pml d.

t d pml j v hiV-d dl wll ply k pl l v 10

y m w. t lkld v d vv pml d hiV-d dl l

pl d p v mmzd mm. i ud s, d d p

w 65 p d llw d pml v y ld.

f dl ud s, 62 p d vv pml d m hiV-d dl d

v yp. uly, 44 p vv pml d d -v -

yp hiV-d dvdl, m w m x m -hiV d ppl.

t w 20 p d ll vv pml d, l l d d

lwd 100800 p 100,000. i w vl d

p, y wld xp l d d pvd, v w 20 p d,

m .

a pl y V al w 40 p d vv pml d d vv p-

m m hiV-d dl. hwv, hiV-d dl w ll-lw aiDs, vv

figure 5 | PcV Pv 9 tm M Pm hiV id cld

2500

1000

1500

2000

500

0

267

2302

HIV- ChildrenHIV+ Children

Casesclinicalpneumoniaprevented

per100,0

00child-yr

s

Vaccine preventable disease

s: Md sa, l. ciD 2005;40(10):1511-8.


19/64

11


20/64

Proceedings from the 4 regional Pneumo coccal symPosium >> 12

i l, w lm vll d, s. pneumonaed m pp d a w vy

mly d ll ql. t l vv ld w ql m d

lkly pmlly m y lly d ppl. fm, ld l m l lkly

lv dld.

b i P s c dD. M rmk pd d w l vw d d m a l -

p w kl ll d, w p vv pml d.

a p , -s

a p , ,

, p - v pp.

meena ramakrishnan

t vd k pm, m, d m a w kl ll d mpd

w kl ll. a d ml dd, w lm 250,000

y w kl ll m. t lm w-d ll l ll d y v ml

dd lly.

o v, md 18 p a ppl ml v m-

l s, c, lm. t a m d eql w ml dm.

t ppl v kl ll m, d 12 p ll mzy

ml s.

figure 6 | P-D Mly d sp sql

N Meningitis (%)

0

1

0

2

0

H Influenza B (%)

11

12

14

21

2

S Pneumonia (%)

13

26

20

37

14

OUTCOME

Mortality

Physical Defects

Cognitive Defects

Hearing Loss

Visual Loss


21/64

13


22/64


m d ly l q mplyd p csf ld pm. oly x 32 d

d y dl pd ly l mdly. o x d, l q dd m

pml dy d l pm. oly dy md w kd ld pl w d, d

dy, w xpd m ld, w dl d pm.

t w l vy ll d vll p m dy j w, pl, my mm kl ll p w q mpl. oly l ddd

p-pl . i d, pvl p-pl d m 1548 p

j.

t qly w m d dd v l p, -kl ll p p

w l d. al d my l l ly d, y w

w p l w l p, d l ll lv k m .

t mjy dd l d mdll lm md dl k w kl ll

d d vv l d. t m lm w lk l p, w m mp

l my pk p d m pm v w p. W d

w dd k , d d wd d dd kl ll d ypm d mpd pvl kl ll d d l ppl.

t m ddl lm d pl w . t l , m d

d w dd pl y pl , w wd p w

lvly , w d d ly m mpl, d m , w w l

py d d m.

t l pl m , kl ll d my v d dm m

m ll l , m ppv wy, w l v p p p d

kl ll m.

rlt l d l w vd dy d d mdly, ddzd qly

m w dd d x :

1) lv l dy q() jv vw;

2) d lly dd pp l md;

3) dd pp m kl ll d (scD) d m l

m pp;

4) l l p (j w l w scD);

5) xpl l dy l, ppp; d

6) vll mp dy.

t w x l m qly d w dd wy xpld w m-

l d k vv l d. all x l d l p ppl.

f d w m Dm rpl c m Z, dy w m n, d

m sl.


23/64

15


24/64


wld q l mdl. s dd y lkd l vl,

w ld v xmd m d w l d v l m pd.

RESPONSE: r D m il ddd w ly yp dd, yplly z d

y y , , w d k dw y d y yp d, d . h

mmly pd yp 1 d. al, lly pd pll p-m ld kd d y dl d m w yp mmly d vy y .

tk ll d, D d l m -ly ld dd

m w rmk dd y dy p d d -ly yp. cly,

d y w yp pvd w w v. t wll ld plly

w wll d v mld d yp.

QUESTION: rd adl w Mdl r cl gm dd q fd W

mly pd n md. adl d q m pdm, plly

w wk d d pdm, mly k lly 20 p. Kw , d

k 4 p mly pd m v mld d ppl mp- d?

RESPONSE: fd W pdd l m mld, w d pvd w.

t ly l pd mly m w m n a, d , m ply

lwy my pdm.

QUESTION: P Pd m Wy dd q s Md d d p l

v yp v w m yp hiV-pv ld d dl. Pd d m

p Md wd ud s m, m w yp v,

plly 19a. h kd Md m yp ppl l d v l v y.

sdly, kd m mm mp d ply d ppl y.

RESPONSE: Md d m yp , l ly w dd d 2005, d w w

l w w m w yp hiV-d dl. Pd yp, yp

ldd PcV7, m m dm hiV-d dl, plly m m. t p

s a 70 p ld l mly ld, w m d ld

m w d ld. t xpl dm dlly pd -

yp hiV-d dvdl. t m m , xmpl, yp 19a. t k

d m 2005, l my m m vll d m d.

i m w d d v, Md d md m

p w v y pmy , hiV-d ld d m p d

d v mpd hiV-d ld w dd v v d y. f s

a, pm 2+1 w d d pvdd m mplmd. s wll x

wk d 14 wk dl w d d m, w ld xd p, w dd

w l p l.


25/64

17


26/64


QUESTION: cy Wy m u.s. cDc kd pl xpd mpl d kl ll

d d hiV. sld dl -p mp d d m pl dl d-

hiV Md md? D m pply kl ll? sld m -p

mp dd, y l? W pl mpl?

RESPONSE: M rmk mmd wld d ppl kl ll p d

m d y v vll d d a, wll y v y l, lp

. t lm vll d ly d pm w md l, d

wld mp d kl ll p, lk hiV p, pl ppl w v l. ev

w p d, rmk ddd, i k w d v d d m ly -m

m c d w y v kl ll p.

i m dl, rmk d d w p d p m ePi

dl d w wld dlvy l v. i l, wld wy pp

ll d d d pv mpl kl ll p w d d

d v lk v. t m pvv pp wld lp l m qly p w

v vll -m kl ll p c, w l xpy 4050 y .t ly m a ppl ll d l xpy, lly l

20 y kl ll j.

RESPONSE: Md ddd q pl mp, m vl lld ,

hiV-d ld wll vv m l pd m. al, d wd, l ud s,

kd vv pml d ld l l ppl

ll l . Md ddd y m v mplm d w -p

mp. i , v ld x d 14 wk, d ld w

wll v m . t pl -p mp ym , dd

w pl d -p mp w hiV-d ld.

Md pmd wll yp dm dl w vv pml d ud s mlz s a l y. h

l pl hiV-d ld w wll m vd, d m k vv

d. i m pl, v mj lm pmz mmd

ld d y v hiV-d ld.


27/64

19


28/64


epdmly gm cldD 1980, b gwd ld m ld m d m ld. t d

dmd m vl ld mly gm ldd pml d, haemoplu

nuenzaeyp b (h), lmll, pm d ml. o , pm mly d y pml d

klld lly m ld ml, d 86 p ld w dd w d w y . fm

d ml l pvdd y gwd m, adl d pml-ld d ly ld l mpz, xpld, mp k pvv p ly ld w y.

adl d m d dd y gwd m l pmy pv-

ldd d gm. t gm v d m v mmz pm

1980 d 1990. splly, v y expdd Pm immz (ePi) gm

ll a, w v d ppxmly 82 p . add-

lly, mplm v pm gm h lm ly wpd d. ovll,

dm d l- d m ld gm. Y, pml d

m p .

ey Pml cj VW d m PmaDiP, Pml svll Pj w ld xm p d

yp d lyz l v gm. a pm, pml

d gm w 10- 20- ld ud s d ep. a pdmll dy wd

v, w p 546 pml d p 100,000 ld d y ld d

250 d p 100,000 ld l v y . adl wd vd -

ld y y l Pml svll Pj w ml, v .

a mmy-d d w ld gm k dy mmy d

y v pml j v. W d w pv l v w ,

y dd mm p d y dd w ePi v dmzd, lld y l

PcV9 w ld. bw 2001 d 2004, PcV9 w pvdd 17,437 ld w, d m . t

l mmzd ld w md 30 m llw l mmz.

t dy ld PcV9 w , v d dd w d v gm. sp-

lly, v wd 37 p y dll pm d, m mply, wd 16 p

d vll mly, 15 p d vll pl dm d 7 p d ll

pm. adl pd PcV9 dply ppxmly 80 p v l a, w

m ldd ll lw. t dy w 20 y w mp mly. W

l, adl xpld pvl d d m d dd p

d mmy wld v v, lw wld.

W W M g gm a Lv Vadl mpzd PcV9 lv d l d vll lvl ld mly. u-

ly, PcV9 pdd. id, PcV7 wll dd gm J, w pp m gaVi all.

W pml yp d v m pm gm, PcV7 w d ld p-

yp 1 p . i PcV9, PcV7 ly wd 50 p y gm.


29/64

21


30/64


PcV v p ,

, p p p.

keith klugman

t lp w pml d d z xmly mp p pl l. Klmd d d m 1918 pdm d m d w d pml-

d z. Pdm z m l mkd. W d pp l-

p, Klm d d dvm v ld pv wdpd mly d pdm

ml 1918 z k.

W ll pm d pvdd pml j v mm d s a,

Klm lld p p wd mpvm v. sml gm, PcV7,

w pdd, m l v w s a ppl PcV9. impvm v

s a ld m ly lwd lvl pml d, lwd lvl vv d

d ld l pv pdm vv d k.

P V usa epD. cy Wy dd d PcV7 ud s d d vll

pml d w u.s. by 2007 pml mmz am ld w ml

mmz mj ldd v. D d m, av bl c

svll, w v v d k mp w u.s. M mply pv v-

PcV7 u.s., Wy wd u.s. uanedlw pml d m

v y.

figure 8 | r ivv Pml D am cld


31/64

23


32/64


figure 9 | id e adlivv Pml D r abc, 19982007

70

60

50

40

30

20

10

0

2007 vs.baseline

2003 2004 2005 2006 200720022001200019991998

Cases/100,0

00

population

65+ years

40-64 years

18-39 years

PCV7

-37%

-23%

-49%

YearLx l. JaMa 2004 d pld d

figure 10 | ivv Pml D r alk nv cld < 2 Y old

350

300

250

200

150

100

50

0

2003 2004 2005 2006 2007200220011995-2000

Rates

per100,0

00

PCV7 Introduced

Year

PCV7 typenon-PCV7 type

sld cy aiP


33/64

25


34/64


npyl rplmPcV vy l l d wld. D, wv, kwldd yp pl-

m ld p l v mp.

Wl pml d m md y ld d mly ld, l vy

mp dd w plm yp dl. h yp plm dvdl w mmmpmd, ldly ppl w hiV-pv. t vd

plm hiV-v dl w 18 d 64 y , lkly dvdl

d ly.

impv rd ovll ivv D rlWl vll pml d w d dl, p, dvdl pml-ld

d l dl. splly, D dd PcV dl pml m,

pm d py , d md. f xmpl, w d m sp m

v y d, m pml m d. addlly, py

, pml pm, dd 20 p d md lw lvl. flly, d v

ld md dd y 40 p. t md l plly mp w ,w md p ld d w y v d.

figure 12 | % P m nP hly cld W Vt, V-rld n-Vt, by Q

(20002003)

35%

30%

25%

20%

15%

10%

5%

0%

4 5 6 7 8 9 10 11 12321

vaccination Total

Non-VT

VT

VT-related

%P

nc

Quarter (20002003)

Pl l, Pedar infec D J, 23:1015-22, 2004


35/64

27


36/64


s iV: i c V Vdvp upchair: D. K Klm

t d p dd dvlpm x- pml v

d ll dvlpm. P Pd m Wy V d Wllm hd m glxsmKl bl-

l dd p v pp l. Mk ald, m Pml V Pj

Path, llwd w d p Path k pp dvlpm x--

pml v vl pp. o l Dvlp c V M

nwk, ak hmm b-M/fz ddd ll d w pd pm-

l v, d . splly, hmm d pd d d

mddl-m .

w: dvp n- c VD. P Pd y kwld w pdmly l v dvlpm. W pvl d

yp vy m d ppl, pdmly plly mp pml v

dvlpm. f xmpl, -v yp 19a plly vl m alk , wl -v

yp 1 dpply pwl a. W md, Wy dvlpd x- pml

j v (PcV) dd pv d y yp ldd 7-vl pml j

v (PcV7). t v 13-vl pml j v, Pv 13 (PcV13).

Wy PcV13 ld p pvdd y l PcV7. i dd p ll v yp

d PcV7, pd mm p x ddl pml yp, ld , ,

v, x a, v f d 19a. ovll, d w l mmz dl w PcV13 vk dy

p mpl PcV7 v. Wl PcV13 mmy l w mm lly

figure 13 | PcV13 syp d c P cmp

4 6B 9V 14 18C 19F 23F 1 6A 7F 19A3 5PCV13

4 6B 9V 14 18C 19F 23FPrevenar

PCV13 contains the same carrier protein CRM 197


37/64

29


38/64


hd wd vll mpv mmy p PhD-cV. Wl vll y w , mm-

y l yp 1 w lw gsK d pd. hd ypzd lw-y l

yp 1 ld ld yp ppy, d d ld mpv -

y l yp 1. fm, wd w PhD-cV w dmd ld

mmz. i , hd d d PhD-cV lly d mm p PrP

(h). h dd w, wv, -pl yp w p v vd ll w dmd w PhD-cV, l d w w .

b l, hd d w mp dv v w p m d p.

f, hd xpld mmz k mm w -dmd v. fm,

d y mpz mp ddl p v wld pvd d y

d p.

t l Who d ep rly a, gsK d dy mp w ld

v, PcV7. PhD-cV ld y d vd pv p m ep

rly ay. t ll 10-yp pml j v w hmpl p d

pml v m Who pl.

Path: ep Ppt Pml V Pj (PVP) Path dd l dvlpm x- pm-

l v yd j v d dy. D. Mk ald pd l Path, -

l, p z l, llly-lv l, l mm wldwd

k ld yl p l.

t m l PVP l dvlpm , v d dl v srepococcu

pneumonae ld a d lw-m wld. f wk x m jv d

wk w v p mpl jv, Path pp m v.

figure 15 | Pml V Pd Ppl

RegulatoryPhase 3Phase 2Phase I

Proteinsubunit

(Universityof Glasgow)

Proteinsubunit

(Universityof Adelaide)

Killedwhole cell(CHB/Butantan Institute)

Conjugatevaccine

(Partner 2)

Proteinsubunit(Mucosis)

Antigendiscover

(Genocea)

SynflorizPCV 10(GSK)

Prevnar-7(Wyeth)

Prevnar-13(Wyeth)

Proteinvaccine

Proteinvaccine

IC47protein

(Intercell)

Conjugatevaccine

(Partner 1)

Antigendiscover(Genocea)

Pre-clinical

= PATH-supported

= not PATH-supported

= under PATH consideration


39/64

31


40/64


dQuestion: K Klm qd md w v wll pm-

l yp 1, plly vl s a.

Response: P Pd pdd y m w v yp 1. h

d pv l dmd p, d y mpz d

v w pl d dy p yp 1. t l p l dy w ld d d y l. al v yp 1

p, Pd pvdd p ld .

Response: Wllm hd wd w pp Pd pmm v y yp 1. h

w d mmy d p yp 1 d y Wy d gsK v.

b v v w pm d. gsK pp yp 1 d dl

w d wlv m , d.

Comment: Pd d mpz mp lyz v y p yp y

m l dy p l d ly d l dy. Pd xpld

m d m dl kll d y d d yp.

Question: J f m Dm rpl kd Pd d hd w l

pl dm 7-, 10- 13-vl v pl pmy v d dvdl v

dl.

figure 17 | tdy Mk s

Market

305

98

Low Income

$7 (?)

135

45

SolvedGAVIAMC

IFFim

PushMechanisms

DCVMN

SOLVEDPneumo ADIP

Middle Income

$20 (?)

130

43

High Income

$60

40

10

Vaccine

Price/Dose(average est.)

Vaccine Market(Mi doses)

Population(Mi)

Clear Role for DCVMN in production of Pneumococcalconjugated vaccines for middle income countries


41/64

33


42/64


s V: g i P Vco-chairs: fd W d r D

c-v Vc-v ly w pml j v (PcV) -v d

x, -v v. i , D. a s nw Jy Mdl sl (uMDnJ) d

-ld q pml d: , PcV v? sd, PcV -v ?

ad lly, w l d m ly m y d d PcV?

i i, -v ,

PcV -v -v.

anusha sinha

i PcV -v?bd vwd ly d , md PcV wld v m 262,000 470,000 lv p

y, w l vy lmd d p . t ly 72 gaVi ll w

-v m $22 p dly-djd l y (DaLY) vd $100 p DaLY vd.

fm , s d v mjy d [ 7-vl pml j v (PcV7) d

] ll w Wld hl oz mk ly -v v.

figure 18 | gaVi-ell c: Pld rl

LivesSaved(100k)

Hosp.Averted(100k)

Disease CostsSaved

($, mill)

DALYsAverted

(mill)

$ Per DALYAvertedScenario

Deaths3 to 29 months

+ Non-fatal disease3 to 29 months

+ Extendedprotection to59 months

+ Herd immunity fornon-immunizedtarget popn

262

262

369

470

262

1,158

2,458

3,074

44

218

453

558

8.3

8.3*

11.7

15.0

100

80

37

22

s l 2007


43/64

35


44/64


r immz Pm d cll implmi 2002, Who, unicef d p a dvd r evy D (reD) pp mpv

mmz v lw-pm . reD d lvl v ky lm l

mmz pm: 1) pl d mm ; 2) l ; 3) ppv pv; 4)

lk w mm d l v; d 5) v m. fm 20022006, mplm w m

44 1,067 d (80 p). nmm ldd wdpd reD pp ld v v.

a 2007 vl wd pm l. sly, ll d, v

mp reD pp w mplmd, d reD y w ppld vl-

d. hwv, w ll my lvd. hl d w m

mmy. ey p l d y d d p m l m,

p dk w ly pvdd l l . al, l m w mmy w ld

w-d l , y w d mm d d dd mpvd.

cll mplm reD m. t ld wk l dlvy d mmz ym, dq l

d m mplm reD pp my , d ll w m

mmz v wl d w v d l-m lly d d mm w v d d vm.

t dd ll reD mplm, reD dl w vd. t w reD fld gd wd

ll ppl d lk w mm. i l ldd ym d

ly ym m mmz d d pm d d lvl. cy

dp l w ddd ll d d l d pp v py ld d lvl.

Lly, reD m l w d pplml d w l ldd w reD fld gd.

Lk ad: nw V idnw v dd a w pp gaVi all. V d md dwy w

96 p a v dd hp b v d 80 p dm h v fy 2009. nmm mmd w vy dl w ppvl m d mpzd

mp dvy d w v.

a ppl d mplm j m a v ppvd y gaVi all, w

m M hl v md mmm mplm. i dd m a v, hPV d ml

v l ly dvlpm.

V svllfm d lld w 2005 d 2008, h imp d dd v b, bk f, g,

Ml, rwd, sl d ud wd h vy d v d v pv mp. i dd,

vll dd pml v w np.

rv vll 2006 d w dd y Who d l m. Plmy (2 y) d d

42 p d plz d v. t l d lv, m m-

ld vll d vll l y.


45/64

37


46/64


r & c Ppvchairs: tm c d hmpy Lw

s aD. a v g rpy d Ml P r u (rMPru), nl i cmm-

l D (nicD) nl hl Ly sv (nhLs) pd s a ppv w y

d d d w v, d w y pp m ll y .

s a d l vll, mm w ll pl l, pv d mly l-

, wll l w m ppl. addlly, d vll w dd 23

y ddl ll d. t d d wd dm d l

pl w mjy d vll w dd.

t vy v l p, pk w l d dk d d

llw-p v md. t vy l v pl d l w l dl l l.

f pp vll , ly w ldd w dd m mlly l

pm. a y 21 dy w ld y pm w 21 dy w d .

syp mdly d dl w d p ml ply .

o lm d lld vv d ly m mll p pml d d,

d ly p w v dmd pl d v d pm k md. al, m d

d ly k ld l pm , wl k m m p pm.

t l m p pm y v d p l pv . a p,

ply ll m my lly md. a qly d pvd l dw ll dd v pd y dd s a pl l ly

ym mpv vll. i md 7080 p pm dd l

pd.

t vll pvd m -p d , d d m 2006 w ld l

y k pml d, w y mddl-d dl p

hiV-d -k wll. a -d pd ld qld pd m.

alm w-d m d v mjy pm d m d 10-20

p m w .

i ld l v y , yp 14 d m vv d w 2003 d 2007. syp

19a d w 2003 d 2005 d lzd v x w y. syp 1 w d dd

v y. syp 5 d 2004 d v x y.

i ld l v y , pl d v m pd w s a, m mp

yp yp 14 llwd y 6b, 6a d 23f. i w ld, yp 1 m mp

yp s a ppl 19a ll ld d ppl.


47/64

39


48/64


a d pml v, s a wld m v ld l d

w d vv d. r pl s a, vl d my plm

v d ld, ld vl, ld . i wll lkly k m p d

dm v w pl m. fly, ldy v vll

m ll p, w my l w d dl.

i s a p

abc sv u s.

anne Von gottberg

i l, yp 1 d mp ll ld s a, ly 3 p d

. i ld ld, mly d w hiV-v ld. sv p d ld l

w y d yp 19a, d p, m 50 p l wll -

pl pll. i s a, vv pml d d w 75 p pvl

hiV -, d lly p hiV - w pm, w lm dpl

. hwv, w l d, s a ld l m v d.

mD. Mmmd ik pvdd vvw pml M w pl mp vv

, m d m d ml .

M mll ld w ly l ppl 1.2 mll. ad Wld bk, l

m p p j v $5,000 usD, mk ll gaVi d. t My hl l

v ppl, d w 10 d 20 p ppl pdmly pv l l.

bly v m ll vm l d m m pv l pd

cl hl Ly. i 2008, ly pd 645 cpl d (csf) pm d ly 11,000

ld l.

M wll-ld mmz pm, l w v mplmd ly

ll v ll clm-g (bcg) v w wk l d dp, , p

(DtP), pl, h, d p b v x, 10, d 14 wk. V v vy d d 2007, 87.3 p

ll vd d d DtP vm l . ild w v v-

d pv p l v mw w 90-95 p. t h v w dd

pv p 1995, d d , w dd mmz dl l M 2006.

t ly 16,000 lv y M, pml j v (PcV) w

dd $30 p d (w l l p) d -d dl w d, wld

$1.4 mll usD. t v d $0.7 mll usD.

t m d d ppv d ll a 1997, d w l

csf pm h, m d pm . t d ld l-pv d -p-

v . t m d dy ply l d pv vw l l.


49/64

41


50/64


ov l 10 y, m l pm m csf d ld l d. i

csf, m pm d y m, m pml m. t m

ld l pd d v-ld l 12 y, l pp ld l

l ply d d m pm pd.

u w lm, l d pml m ll p wld 0.8p 100,000 20072008 d lm 19 p 100,000 ld d 1. tk ld l l d

csf l d xld dpl l m w d pm ld ld l d csf

2007-2008, vv pml d d ppl wld 34.7 p 100,000.

i m w v k , w w p ydm, p y

plmy, y llm hiV m v d .

t pll -ply ld l l, w -ply dd y Mic 0.12 ,

d m 8.3 p m 50 p. eymy d yl l d

m 24 l 2002 2030 p 20072008. am csf l,

d v 40 p. M pll -pl m d Mic w 0.12-1, w

ly w l w Mic 2 .

t d p lm, mly yp d vv l m, d d d

d pml pm. i m d m, my p, plly ld, d

v dm pl, l l v csf d ld l pm.

t d pk p m plly-d m y lx l , my d

v w plym (Pcr) mmmp k wld v pkd p v

m . t d ld pm pd pv l; wv, wld v d

y m 10 p.

i l, pm ld l m M, ply d d

h v mmz dl. hwv, l m . am-l mkdly d p 10 y vv d -vv pm l. a

y, M wll d v d d pml d -

d PcV. hwv, vlly ll yp d vv l wld l mk d.

d rp c (drc)i y ppv, D. Ml nymw expdd Pm immz (ePi) pm Drc v

vvw x Drc d l-l mmz pm. h l dd mmz-

v d wy pml v ld dd c, w yp pml j-

v wll dd d w Drc pl d v.

t Drc a d l y, w ppl md 69 mll ppl w 70 p m

lv l . nw 4 p ppl. L xpy lvly 45 y

ld d pvl hiV md dy 4.2 p. Drc w mly

ld d v y ld md 148 ld 1000 d dy.


51/64

43


52/64


nymw dld d pd mmz d wd. t y vy l

z w wll v ll m, d nymw. t d , y wll d py ,

j mmz w v, ld py pv v d

m ym. t ldy pl. W v pp p v; d

ly d ld, d nymw.

nymw ldd p y mpz Drc l mm d d l w

d dv. h d mp mk xpl d

mk d d pm d mp a ld vvl. h pmlly

dld p a y , W y m , w wll v a l--

d.

t gD. rd adl Mdl r c (uK) gm pvdd vvw gm pl -

d pml v J 2009, d mpl d ppvd m v

PcV7 w pd v lv, v ly 63 p l gm.

Pl gm d PcV7 mmz w dvd , w ll dld

J 2009. t pl l ldd PcV10 PcV13 y w ppvd d vll

gm. t dl wld ePi pm w d w, d m.

figure 22 | sdl implm Pmjd V

Vaccines

7-valent (Wyeth)

10-valent (GSK)

13-valent (Wyeth)

Multi-valent(emerging suppliers)

Vaccins nouvelletechnologie

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016-2020

Serotypes des vaccins:7-valent: 4, 6B, 9V, 14, 18C, 19F, 23F10-valent: 7-valent + 1, 5, 7F13-valent: 10-valent + 3, 6A, 19A

Remplace le 7-valent

Homologation (FDA, EMEA)

Disponibles pour les marchs des pays en dveloppement


53/64

45


54/64


t d lm z w m pl lm , mxd lm mddl d l d

pd dy m l . t l lvly lw hiV pvl. t d v

pl d ml j v ld gaVi d PcV.

a xv vll dy pml m 2002 bk f d t.

rl 20072008 wd l d w d v p 100,000 l 17 p 100,000 w pd m bk f d g l dd. i m l, d plly ld

ld d dl (w-d ld y v) d yp 1 ld yp. t

vy lm k m 125 d ly 3050 p.

D. Mll PcV7 ld pv 30 p pml m ld d v d

12 p p v v y . t p wld 50 p 75 p w yp1-

v. ad m, Mll d PcV7 d v l mp pml m

ppl, wl z lm pj. i m l, w lly lk yp-p

d m, pm d l . s ld d dd mp m

d d pl v . s mv wd, p v y my

y m l.

figure 24 | W V?

> 5 yrs

12%

76%

78%

< 5 yrs

32%

50%

57%

< 1 yrs

30%

52%

57%

PCV-7

PCV-10

PCV-13

% preventable among Sp meningitis cases in age group

spl bk f d t J. Mll

dQuestion: D. clm m Ld, uK mmd w d PcV, ppl wll xpd, d w y

xp y q mpvd . clm kd a s d k d

d l mdl.

Response: s wd ly d m p dmpy d pl dmd

xpd ppl q. s l pd dlly-w ppl w l m

pdv dl v y m pv y.


55/64

47


56/64


Comment: r D d il, y v m v v pl pl p-

m vd-d dvm. f , d d, tdy y pv 14 plz.

W dd y d dy? h kd fld w y wy k v lmd vll y d

m dvy.

Reponse: fld kd m d d md y ld xpl . fld vd mmm nl Pmy hl Dvlpm ay mm.

Comment: amd n, mmz n, mmd d wk ldy w

v v d. h md d d mp, y pd d pvl

d pml v q 2010.

Comment: sv blk mmd -v d. h md lv l m d

vm d dd -v v d v lv pl l m

v y dk. h d y d mmz ld v my, y pl l

v -v mpv qly lv d v lv, d l

v v d -v lly xp m pl l v.

Response: s pdd y p v vll p . r k tll

b p m dy , mmd pl m w

v wll dd w vm.


57/64

49


58/64


t gaVi a: av ipD. J Pm, d gaVi dvy d mplm .

t gaVi all m v lv d p ppl l y mmz p -

. gaVi ld y l: py l ym, l pk dd

d w v, pdly d ly d y dd v d vl pl/pv ll l pp.

Pml d d v v d v-

pvl d ld d v. t wll x

gaVi. Pm d wl yplly dly w

dvlpm d d v d d m-

m ppvl p, gaVi p v d

pml d v v gaVi ll

my ep v d .

nw v pml d d v p

md ppy pv ll, l dy lvl. M d

d v wll v MDg-4.

t gaVi all -y k d y. i 2008-

2009, gaVi pld p 100 mll d h

v l . Pm w pl mpl-

m pml v ld mv . b d , y wld d ppl, pl d

v pl. t ald V id (aVi) pd l m gaVi m wll

pl .

aVi: t PlaVi pl mk d d pml d v v, wl dvlp

plm d w v. t gaVi d 42 pml d

44 v v y d y 2015. t dld wk pl pl w k v y

l .

t wk pl k dw : d ppp v, d wll

d, lp md y d d p d v. W ll

vlp, l d vd. gaVi plm m

l d.

P Ppvt b Plm ld all Py Plmy gp (aPPg) Pml D Pv

Dvlp Wld dl w pml d uK d wld. t hl Jm D

h cmm v ppv Plm pml d d vy w

wly-md aPPg Pml D Pv Dvlp Wld.

figure 26 | gaVi Wk-pl

Donorswilling to

fund

Sufficient &appropriate

vaccine

Countrywillingnessto produce

Informedcouuntrydecision

Sustainable

introduction


59/64

51


60/64


t n a P c V:a c a rD. J-M okw-bl Who pd d l mplm pml j-

v (PcV) d pvdd ll .

h d d m p pml v d p v y. aw,pply d d ll ly mpvd. a l d PcV a d

ldy . s a w ld w pml v dld dd apl 2009. s a

w l y mk ld ml l v ld ml

mly d .

a p l PcV, okw-bl mpzd d yd l v X m

d v. h mpzd d lk l mplm pml v d

pd pml d d p l y d mly ld. h l d

mp d mk vll d v m, d d

vy pp m gaVi.

okw-bl d w m pml d v, d ll ply m

pp d lp pl d dl

m v d-- ppl. h ld

d py pl lw-pm

d lz ll mp v, d

wld vly lm d.

okw-bl d d v d

d pm v l

mk mp d v lv. h dd d

ld y d pm mly d

lp MDg-4. h l d p d-mk p, lp p d, lp dv

mplm d w m.

D. c d Qd s V i ld y a dd mplm pm-

l v dmd y wk d mllpx d ly d ml mly. h

mmd md mp s a ml v, wll w pl pp .

h mpzd a d PcV w y v pp, mpl pd y m

mldw. h l d py m v x x m pl d, w l

w dv, wll m dl mplm l v.

cy Wy u.s. c D cl d Pv (cDc) pd qly p d

m. s mkd d v m w p d m md

d k plm l. s pk l cDc vy pd -p

m.

okw-bl d l ld m

ml mp. f, d

l qd, d -p

l d dvlpd y

. sd, pd

p d l p y

ky lz

l. td, my qd p

v. f, vlvm v-

m ky. ad lly, m ym

m pl w kw l

lvl w pp d mm v dly.


61/64

53


62/64


P V ad, south africa

olkm akyj, nigeria

gl aw, botsWana

h ad, usa

f fz aw i, caMeroon

Kwdw od aw-ay, ghana

ck ad, usaa e a, caMeroon

t av, south africa

adw bk, uganDa

D bkmy, burunDi

sp bly, uniteD KingDoM

L bl, south africa

sv blk, usa

Ly bdky, usa

ad a bl, ethioPia

g b, ghana

am b, Liberia

Ldy bm, south africa

Dl bd, south africa

L bl, uKraineJl b, usa

a cvl, usa

bm Ml clm, uniteD KingDoM

bdl ck, south africa

tm c, sWitZerLanD

cyl c, south africa

Mk c, south africa

Ldy c, usa

cl cld, south africa

M Dl Kll, usa

al Dll, senegaL

Zl D, south africa

nll Dlm, south africa

nl M D Pl, south africa

a h ek, caMeroon

D ev, MaLaWi

tl fkd, south africa

adk fld, nigeria

Dl fk, KenYa

J f, DoMinican rePubLic

fdk f, beLgiuM

h fly, south africa

nl f, MaLaWi

Dvd g, KenYa

M gm, uniteD KingDoM

Ll gd, usa

Ldy g, usaMll J gm, south africa

Wllm hd, beLgiuM

a M h rp, sWitZerLanD

r sm hydm, MaLaWi

al hll, south africa

Jy h, south africa

gy hy, south africa

Pk M J, south africa

hp J, usa

tlm K, usa

Plp Kl Mm, ZaMbia

cld W Km, sierra Leone

t Km nj, KenYa

Pl Ky, beLgiuM

n K, south africa

Mdl Kyl, south africaD Kw Kk, south africa

s a. K, beLgiuM

rdk rd K, tanZania

s Kk, uganDa

D Kzz, ud

a K, south africa

Pvl Kzv, cZech rePubLic

a L, KenYa

t Lw, south africa

Km L, south africa

b Ll, aLgeria

Klw Lklk, south africa

K L, usa

M L, south africaL Lpz, south africa

nm L, MaLaWi

Ml Ml ely, Dcr

bl Ml, south africa

g Mkz, the gaMbia

Md Mlw, south africa

f Mm, south africa

Yu hj Mkm, tanZania

M Mk, south africa

Mm Ml Mll, south africa

om M, usa

elz M, south africa

cl M, KenYa

sm Mm, usa

J Mw, caMeroon

Ml MQ, usa

b Ml, ethioPia

ewd Mm c, caMeroon

nm Mdlw, south africa

t M, south africa

ry Ml, south africa

J M, usa

Jl Mkl, south africa

tlm M, usa

Mp Mm, south africa

nk M, south africa

r oym Mkw, KenYaDvd Md, neW ZeaLanD

ew M L rz, france

Km Plp M, south africa

tm K n, Liberia

Pk M ndzv, south africa

nml n, south africa

a ndd, tunisia

M Dy n, south africa

adm n, nigeria

slwm o, ZaMbia

J ob, usa

f o, KenYa

olkl old, nigeria

J od, KenYa

gl P-bl, france

r Pwk, beLgiuMr P, south africa

L Pv-Dmm, usa

W Pp, south africa

M rmk, usa

n rmmy, south africa

M edwd rm, south africa

Jy rwld, sWitZerLanD

sm Km s, bangLaDesh

Mmd sd, coMoros

Py skl, uniteD KingDoM

adl sl, tanZania

e smp-Dk, uniteD KingDoM

Mmmd M. sk, Liberia

J i s, MeXicoMld sl, south africa

by s, south africa

bl M slld, south africa

Pll s, sWaZiLanD

ap s, nePaL

b sw, usa

s sppd, uniteD KingDoM

sv sw, tanZania

t sl, usa

al sm, ethioPia

amd s, south africa

s sdd, usa

D sl, usa

c rm t, PhiLiPPines

nd tl, egYPt

Pk tpp, south africa

J tl, KenYa

i tk, KenYa

elly rwz tmw, uganDa

Mdjm td twk, egYPt

a ulld, usa

e u, the gaMbia

fm Vl, angoLa

J V D hv, south africa

r V D gp, south africa

Ml V Dyk, beLgiuM

g V Zyl, south africaaly Ww, south africa

K Wj, beLgiuM

ty Wllm, usa

e Wdy, uganDa

olkd Y, botsWana

hyd Y, uniteD KingDoM

h Z, south africa

attendees


63/64


64/64

Documents

4th Regional Pneumococcal Symposium_Downloadable