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Johns Hopkins Bloomberg School of Public Health

Vaccine Impact: The Gambia

Life-Saving Potential in Rural Settings

Two studies testing the efficacy of the 9-valent pneumococcal conjugate vaccine (PCV) in The Gambia and South Africa demonstrate that multi-valent pneumococcal conjugate vaccines are safe and effective even for HIV-positive children. Multi-valent pneumococcal vaccines have the potential to make a major health impact especially in rural settings where access to treatment is limited.

Study investigators, led by Felicity Cutts of the British Medical Research Council, concluded that the 9-valent pneumococcal conjugate vaccine has a high efficacy against radiological pneumonia and invasive pneumococcal disease in a rural African setting. They found that the vaccine can substantially reduce hospital admissions and improve child survival. They recommended that pneumococcal conjugate vaccines should be made available to African infants.

This was the first, major, randomized, controlled, vaccine, clinical trial in nearly 20 years to show significant reduction in child mortality.

The trial results were:

  • There was an overall reduction of childhood mortality by 16% in children vaccinated with the 9-valent PCV.
  • For every 1000 children that were vaccinated, 7 deaths were prevented.
  • The 9-valent PCV was 77% effective in preventing pneumococcal infections caused by the vaccine serotypes.
  • 37% fewer hospital cases of pneumonia occurred in the children who received the vaccine compared with children who received the control vaccine. This is indicative not only of an increase in health for the children but also of substantial decreases in medical and opportunity costs.

A previous study showed that this vaccine was effective in reducing the number of pneumococcal infections in children in urban South Africa. But many of the children suffering from pneumococcal disease in Africa live in rural areas with high infant mortality rates, significant rates of malaria transmission, and very limited access to healthcare. The Gambia is representative of these areas and the results of the study suggest that the deaths caused by pneumococcal infections in rural Africa are preventable.