District burden and costs of severe pneumonia before and after introduction of pneumococcal vaccine in Malawi

malawi
Duration

October 2011 - August 2014

Funder

Bill and Melinda Gates Foundation

Partner

Parent and Child Health Initiative (PACHI)

PI

Anthony Costello

IGH Staff Involved
Contact

Mary Caspillo-Brewer

The purpose is to study the pattern and severity of childhood pneumonias before and after the introduction of the pneumococcal vaccine, evaluate the vaccine status of children with severe illnesses, and analyze the cost effectiveness of the pneumococcal vaccine in two districts of Malawi.

Acute respiratory infections are one of the leading causes of childhood illness and responsible for ~2 million deaths every year among children under 5. A conjugate vaccine against Streptococcus pneumoniae, targeting the most important disease pathogens, represents a major opportunity to improve global child health. Malawi will be among the first countries in Africa to introduce pneumococcal conjugate vaccine starting at the end of 2011. Pneumonia is the commonest admission diagnosis for many children’s wards at hospitals in Malawi and at primary care health centres.

It is not clear how the vaccine will affect the severity of pneumonia and the burden of disease falling upon primary and secondary health facilities in Malawi, nor the costs that might be saved as a result of vaccine roll-out.

Acute respiratory infections are one of the leading causes of childhood illness and death worldwide, being responsible for ~2 million deaths every year among children under 5 years of age [1]. Streptococcus pneumoniae is a major cause of pneumonia, blood stream infection and meningitis.

The imminent availability of a conjugate vaccine against Streptococcus pneumoniae, targeting the most important disease pathogens, represents a major opportunity to improve global child health [2,3]. Given its regional leadership in childhood immunization programmes (eg, the Haemophilus influenzae type b (Hib) vaccine has approximately 90% national coverage dating to 2002) and track record of research of vaccines, Malawi will be among the first countries in Africa to introduce pneumococcal conjugate vaccine with a target roll-out date of November 2011. The pneumococcal vaccination programme will target infants younger than one year of age, with a goal national coverage rate of 50% after year one, 95% national coverage rate after year two, and increasing to a 98% coverage rate after year 5. Infants will be vaccinated at 6, 10, and 14 weeks of age. There is no plan for catch-up vaccinations in older child populations.

Two health care workers at each health facility will be trained with respect to administering the vaccine 3 months prior to the target roll-out date. To accommodate the need for an increase in cold chain capacity, Malawi has procured one 60m3 cold room and approximately 370 refrigerators. Since high coverage will take time to achieve, it is likely that a large cohort of children under five will remain non-immune for the first two years after introduction.