Effectiveness of PCV-10 to reduce severe viral acute lower respiratory infection in Bangladesh
Megan Reller, MD, PhD, MPH, DTM&H
BACKGROUND: Pneumonia and other acute lower respiratory infections (ALRI) are the leading cause of death in children worldwide (1.5 million per year in resource-limited countries) and viruses, with or without bacterial co-infection, cause at least 50% of these infections. A 10-valent pneumococcal conjugate vaccine (PCV-10) will soon be introduced into the national infant immunization program in Bangladesh with catch-up (for those <23 months residing in the study areas).
GAP: PCV-10 may decrease mortality by reducing severe disease related to respiratory virus-Streptococcus pneumoniae co-infections; in a trial in South Africa, a 9-valent PCV significantly reduced viral ALRI: influenza A (45%), parainfluenza 1-3 (44%), respiratory syncytial virus (22%), and human metapneumovirus (45%). The effectiveness of 10-valent PCV-10 on severe viral ALRI in children 2-23 months of age is unstudied.
HYPOTHESIS: We hypothesize that PCV-10 will effectively decrease severe viral ALRI in children 2-23 months of age in Bangladesh.
METHODS: We will study children under surveillance for invasive pneumococcal disease (IPD) in a well-established rural field site (Sylhet-district, population ~770,000) in Bangladesh.
We will evaluate PCV-10’s impact by assessing any PCV-10 vaccine vs. none among cases (patients with laboratory-confirmed severe viral ALRI) vs. controls (2 hospital-based, age- and sex-matched without ALRI).
IMPACT: The stronger the evidence for the beneficial impact of PCV-10 on reducing ALRI and IPD, the more likely resource-poor countries are to invest limited resources in this intervention; further, this work has other potential implications for prevention and treatment, such as routine vaccination for influenza and/or use of anti-viral medications in patients with severe ALRI who are at greatest risk for death.