Commentary: The pneumococcal vaccine is bolstering child health in Nepal
By Rose Weeks
New evidence shows fewer children hospitalized with bacterial pneumonia, but countries must be vigilant to avoid a drop in vaccine coverage during COVID-19
In a parallel, pandemic-free universe, thousands of researchers will gather this week in Toronto, Canada at the 12th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD) to discuss new findings related to the diagnosis, prevention, and treatment of this serious bacterial disease. In reality, ISPPD has been postponed to June 2021, but the conference organizers are sharing new data this week, including 21 abstracts from the PneumoNepal study. This evidence shows progress in the fight against Streptococcus pneumoniae (pneumococcus), a major cause of disease, disability, and death worldwide that is vaccine preventable.
Nepali scientists, with allied institutions, have been measuring the health, programmatic, and economic impact of pneumococcal conjugate vaccine in Nepal for six years.
Nepali scientists and global collaborators studying the impact of PCV10 on childhood pneumonia, meningitis and sepsis
The PCV10 vaccine, which includes 10 pneumococcal serotypes or disease strains, was introduced around Nepal’s devastating April 2015 earthquake and has since been administered, through great effort, to over 2 million children across the mountainous country’s seven provinces.
The over 40 researchers authoring analyses for ISPPD include scientists at Kathmandu’s Patan Academy of Health Sciences. They are now persevering at this time of acute disruption of global health systems to collect and analyze invasive bacterial surveillance data—the core of the PneumoNepal (PnP) team’s approach to assessing vaccine impact (see graphic and map).
Here are 6 signs the pneumococcal vaccine has reduced the burden of pneumococcal disease in Nepali children, extracted from research that was to be presented at ISPPD. All abstracts can be found on PneumoNepal.org, a resource sharing data on ongoing pneumococcal vaccine impact assessment through interactive graphics.
- Bacterial pneumonia dropped by one-third
An analysis led by Dr. Shrijana Shrestha found that the proportion of pneumonia cases determined through x-rays to be likely bacterial in nature was 34% lower four years after the vaccine was introduced. In an era of increasing antibiotic resistance, this reduction will be critical to maintain.
Bacterial meningitis also declined three years after PCV10 was introduced in Nepal, according to an analysis by Bhishma Pokhrel and colleagues.
2. Transmission of disease strains covered by PCV10 has dropped
Children under 2 years of age hospitalized with pneumonia at Patan Hospital, Nepal, were 78% less likely to have vaccine-type bacteria in their nose following the introduction of PCV10 compared to before vaccine was used. And children of all ages hospitalized for pneumonia, including those who were unimmunized, were less likely to test positive for the presence of vaccine-type pneumococcal disease in the back of their nose. Vaccine-type carriage decreased significantly from about 15% before the vaccine to 6% in 2018.
3. The vaccine will avert catastrophic health spending
Cristina Garcia, Arun Sharma, and colleagues showed that PCV10 can significantly reduce catastrophic spending from caring for children with pneumococcal disease, averting more than half of all incidents of catastrophic health spending from pneumococcal pneumonia, meningitis, and sepsis.
After their home was destroyed by the 2015 earthquake, Samjhana Khadga and family saved for years to build a new home. They were unable to finish the construction after spending to save their child, Jasmina, who was hospitalized with severe pneumonia. (Photo: Amanda Mustard)
4. Invasive Bacterial Disease (IBD) is less likely to be caused by vaccine-type bacteria
Now running for over 15 years, Patan’s Invasive Bacterial Disease (IBD) surveillance system is at the core of measuring vaccine impact. Promising data show that children are less likely to be sickened with the vaccine-type invasive pneumococcal disease after vaccination.
5. While impact has been significant, results hint at possible benefits of switching pneumococcal vaccine product to further reduce disease
Following the introduction of PCV10, young children hospitalized with pneumonia were more likely to test positive for having pneumococcal serotypes not covered by this vaccine. Healthy children swabbed in the carriage studies were also often found to have pneumococcal serotypes such as 19A, a strain covered by PCV13.
6. Nepali families say preventing severe pneumonia is critical to avoid financial disaster
Storytelling provides a lens to better understand the impact of pneumonia, supplementing quantitative evidence to understand the economic and emotional toll of pneumonia on families with a child hospitalized with severe disease.
One story featuring a young Nepali pneumonia survivor named Niruta was featured in a film previewed at the Global Forum on Childhood Pneumonia this past January in Barcelona, Spain.
Keeping vaccine coverage up during the pandemic—and catching up on missed doses—will be critical
From January 2016 to November 2019, disease strains covered by PCV10 were detected in unvaccinated children hospitalized with invasive bacterial disease, according to an analysis by Krishna Prajapati. This means while pneumococcal strains prevented by the vaccine are declining, they are still around and could surge back if the vaccine program is interrupted.
With the pandemic putting enormous strains on health systems in Nepal as elsewhere in the world, it will be important for governments to implement effective catchup campaigns following lockdowns to ensure the continued diminishment of the deadly pneumococcal bacterium and many other vaccine-preventable germs.
Rose Weeks is IVAC’s Director of Communications. She was fortunate to meet the incredible Patan Academy of Health Sciences team in Kathmandu last year. You can take a virtual tour of the renowned hospital in pre-pandemic times through photos by Amanda Mustard on our Flickr album.
 WUENIC estimates for 2015-2019. VIEW-hub.org/viz