Portal de Periódicos da CAPES

Time to focus on the prevention of childhood pneumonia

2009; Wiley; Volume: 39; Issue: 11 Linguagem: Inglês

10.1111/j.1445-5994.2009.02054.x

1445-5994

David R. Murdoch, Orin S. Levine,

Respiratory viral infections research

In July, the United Nations issued a clear warning: while significant progress has been made towards eradicating global poverty and hunger, there are signs that this progress is slowing due to the world economic crisis.1 With the 2015 deadline for the achievement of the Millennium Development Goals drawing near, it is a call to action for all of us to redouble our efforts in order to save the lives of millions and stabilize the health, the economies and the very future of the developing world. For those of us who have dedicated our lives to preventing and treating infectious diseases, achieving Millennium Development Goal 4, a two-thirds reduction in mortality among children under five, remains a clarion call. The number one killer of children in this age group is pneumonia. For every child that dies of pneumonia in a developed country, more than 2000 die in developing countries.2 In fact, more children die each year of pneumonia than of AIDS, malaria and measles combined.3 The reasons are simple. The children in these countries are more vulnerable due to under-nutrition, immunocompromising conditions or poor environmental conditions. Lack of medical care delays or prevents access to timely diagnosis and treatment, and without access to vaccines to prevent the primary causes of pneumonia, they lack preventive immunity. As doctors and scientists, we can start turning the tide against pneumonia by supporting global efforts to prioritize pneumonia prevention as part of the first annual World Pneumonia Day – 2 November 2009 (http://www.worldpneumoniaday.org). Safe, effective vaccines against the common bacterial causes of pneumonia – the pneumococcal conjugate vaccine and the Haemophilus influenzae type b (Hib) conjugate vaccine – have been used with great success to reduce the burden of child pneumonia in industrialized countries like New Zealand, Australia, the United States, France, Italy and elsewhere. Since its introduction into the routine childhood immunization programme in the United States in 2000, the seven-valent pneumococcal conjugate vaccine (PCV-7) has virtually eliminated invasive pneumococcal disease among American-born infants,4 and has been associated with a significant reduction in invasive pneumococcal disease among individuals who were not vaccinated, particularly those aged ≥65 years.5 Hib meningitis is now so rare in industrialized countries that a case in our hospitals would bring a dedicated response by clinicians and public health officials to determine the source of that single infection. In recent years, great progress has been made in increasing access to these vaccines for children in developing countries as well. The GAVI Alliance has helped low-income countries introduce Hib and pneumococcal vaccines within their public vaccination programmes. With GAVI financing, nearly every low income country is using or planning to introduce soon the Hib conjugate vaccine.6 A new financing mechanism known as the Advance Market Commitment (AMC) is helping make pneumococcal vaccines available to developing countries more than a decade ahead of schedule and at prices their governments can afford.7 In 2009, nine new countries, including Costa Rica, the Gambia, Israel, Oman, Portugal, Rwanda, Saudi Arabia, Sweden and Turkey, introduced pneumococcal vaccines into their National Immunization Programmes, bringing the total number of countries that have universally implemented the vaccine to 39. But progress must continue in order to ensure universal access to these life-saving interventions. Ninety-nine per cent of pneumonia deaths occur in the developing world.8 Yet of the 71 countries eligible for AMC funding, as of this writing, fewer than 20 have applied. On 2 November 2009, a broad coalition of child health organizations, including the Sabin Vaccine Institute's Pneumococcal Awareness Council of Experts (PACE) (http://www.sabin.org/PACE), will hold events around the world designed to raise awareness and spur countries to act. Through increased investment in prevention, countries throughout the developing world can tackle pneumonia, chip away at the cycle of poverty and save millions of children's lives. In order to make the great strides necessary to meet the Millennium Development Goals, there must be global support and action. Working together, we can achieve results, and as leaders in our field it is incumbent upon us to continue the fight. We must use evidence-based advocacy to encourage our country and world leaders to recognize the severity of pneumonia and implement the measures necessary to save lives. The time is now for prevention. The economic and health challenges facing the world today will only escalate if not acted upon with urgency and full commitment of resources, and the world's problems will only be exacerbated by a continued cycle of poverty, caused in part by widespread but preventable diseases. We have the vaccines, the technology, the financing mechanisms and the demand to prevent pneumonia. It is time for governments to take advantage of these innovations and bring them to the people who need them most.