Pneumonia Incidence with Immunization - Essay Example

Pneumonia incidence with immunization Introduction Pneumonia is a fatal disease affecting people of all age groups with varying pathogenesis and outcomes. In children, the majority of deaths occur in the newborn period, with over two million deaths a year worldwide. The World Health Organization estimates that one in three newborn infant deaths are due to pneumonia and WHO also estimates that up to 1 million of these (vaccine preventable) deaths are caused by the bacteria Streptococcus pneumoniae, and 90% of these deaths take place in developing countries(World Health Organisation[WHO], 1999) Mortality from pneumonia generally decreases with age until late adulthood. Elderly individuals, however, are at particular risk for pneumonia and associated mortality.Its incidence is much higher in the developing nation where medical care isn't always available in the best quality and the standard of living is low. Even in a developed country like UK, the annual incidence of pneumonia is approximately 6 cases for every 1000 people for the 18-39 age groups. For those over 75 years of age, this rises to 75 cases for every 1000 people. Roughly 20-40% of individuals who contract pneumonia require hospital admission of which between 5-10% are admitted to a critical care unit. There is a pressing need to find solutions outside the box for bringing down the incidence of pneumonia because of its high incidence to alleviate human suffering. Purpose This paper aims at closely scrutinizing the role of pneumococcal polysaccharide vaccine (PPV) and pneumococcal conjugate vaccine (PCV) in bringing down the incidence of pneumonia. With the emergence of antibiotic resistance especially for micro organisms like Streptococcus pneumoniae it would be a great boon to have PPV and PCV reduce cases of pneumonia thereby avoiding the expenses of antibiotics and complications that accompany pneumonia. Herd immunity is another concept that seems to play a considerable role in protecting the community at large by the concept of vaccination is very well applicable to these vaccines. In some places, the HiB vaccine for influenza is given considerable importance in bringing down the cases of pneumonia caused by Hemophilus influenzae which comes next to Streptococcus pneumoniae in the list of organisms causing pneumonia. There have been studies indicating that results showing decrease in incidence of pneumonia with vaccination as fluke because there is a belief that there are other factors independent of vaccination which indicate the prognosis of a particular case of pneumonia. In fact some people who get the vaccination for pneumonia may consider themselves totally immune to the disease thereby putting their health at risk. In that scenario, it would be highly undesirable for the government and NGO's to put their money and resources in vaccination programs for pneumonia which can instead be in fluxed into tried and tested methods of treatment for pneumonia by providing better antibiotics, improving standards of living and reaching out to the masses. Considering the limited resources available in most parts of the world this question assumes a great significance where final decision is based on which method would succeed in saving more lives and reducing suffering. Hygiene and proper methods of administration also play a significant role in ensuring the success of any immunization program. Literature Review Much has been published and discussed regarding various vaccines used for treatment of pneumonia so there is a need to analyse all the major available data from the right perspective. "Madhi et al. writes that the pneumococcal conjugate vaccine (PCV) is an effective instrument for pneumonia prevention in children. This is not strictly true. WHO data suggest that there are 450 million cases of pneumonia each year and that it causes 3.9 million deaths. In the sub-Saharan region of Africa, 1 022 000 die and 702 000 die in south Asia.1 The pneumonia referred to is "clinical pneumonia" - a diagnostic syndrome within the Integrated Management of Childhood Illness - WHO and United Nations Children's Fund (UNICEF) system for triage and clinical management in developing countries. The Cochrane database states that PCV does not reduce the incidence of clinical pneumonia, although it has been shown to reduce vaccine-serotype bacteraemic pneumonia and radiological pneumonia. The benefit of reducing bacteraemic pneumonia and radiological pneumonia is so minimal that it has no effect on "clinical pneumonia". Poor nations will need to assess its cost utility carefully. Findings concluded that only 3.6 children per 1,000 vaccinated acquire immunity against the pneumonia, whereas the risk of asthma is doubled by the vaccination." (Chowdhary & Puliyel, 2008 ). On the contrary promising studies like by Felicity Cutts (Medical Research Council, UK and WHO) and colleagues who recruited children aged 6-51 weeks in The Gambia from August 2000 to February 2003. Children were randomly assigned to receive either, three doses of diphtheria-tetanus-pertussis-Haemophilus influenzae serotype b vaccine as a control (8719), or three doses of this tetravalent vaccine mixed with a nine-valent pneumococcal conjugate vaccine (8718), with intervals of at least 25 days between doses. 333 of the 8189 children given the pneumococcal vaccine had an episode of pneumonia confirmed by chest x-ray compared with 513 of 8151 in the control group. The vaccine reduced the first episode of pneumonia diagnosed by chest x-ray by 37% and reduced admissions to hospital by 15%. Disease caused by the types of pneumococcus bacteria in the vaccine was lowered by 77% and overall child mortality by 16%. The vaccine also had a good safety profile.( Cutts et al., 2005) In a study concentrating on impact of PCV vaccine on infants, the findings suggested that there was a clear population level impact, with a flattening of the curve for IPD reports since the programme started in 2006 - even for 6B serotype, where there was evidence that PCV confers less protection than the other 6 serotypes. From an epidemiological perspective, the lower immunity to the 6B serotype will likely have no impact as together with herd immunity and the booster dose at 13 months, there will be good population protection.( Health Protection Scotland [HPS), 2008) An international team of experts has published the first comprehensive review of evidence on pneumococcal conjugate vaccination (PCV) for children with HIV infection. The review shows that HIV increases the risk of pneumococcal infection by up to 40 fold, that the disease is usually due to serotypes in the PCV, and that the vaccine can protect HIV-infected infants. The authors conclude that PCV can improve the lives of HIV-infected children and should be considered a potentially valuable complement to existing treatment strategies for HIV-infected children(Bliss, O' Brien, Janoff, Cotton, Musoke, Coovadia & Levine, 2007). Comparing the rates in 2004 with those in the baseline period of 1997 to 1999 among children younger than 2 years, hospitalizations due to all-cause pneumonia declined from 11.5 to 5.5 per 1,000 children (52.4 percent decline) and ambulatory [outpatient] visits due to all-cause pneumonia declined from 99.3 to 58.5 per 1,000 children (41.1 percent decline). Rates of hospitalization due to pneumococcal pneumonia declined from 0.6 to 0.3 per 1,000 children (57.6 percent decline) and rates of ambulatory visits declined from 1.7 to 0.9 per 1,000 children (46.9 percent decline).These results add to the growing evidence base of benefits of PCV7 vaccination and suggest an important role for the vaccine in reducing the burden of pneumonia and associated medical costs.(Zhou, 2007) A study by Dr. Klugman shows a 50 percent reduction in incidence of pneumonia in children with HIV on taking the PCV along with the influenza vaccine. The study provides evidence to support the use of this vaccine to prevent invasive pneumococcal disease, reduce antibiotic resistance and diminish the incidence of pneumonia in children (Klugman, 2003) Alaska Native children are experiencing increased rates of serious infections caused by strains of pneumococcal bacteria that are not covered by the current childhood pneumococcal vaccine, indicating the importance of ongoing surveillance of vaccine effectiveness. (JAMA, 2007) The clear cut benefits of these vaccines are doubted by many people. "India plans to adopt a pneumonia vaccine that doesn't work and has ill side-effects. While it's imperative that children need to be protected against pneumonia, the choice of the vaccine is critical. If it does not even provide immunity, then why public money should be wasted on it'"( Dasgupta, 2008) Rationale It is clear from the extensive research done over the years that the actual occurrence of pneumonia in a patient is governed by many factors of which vaccination is one. Its efficacy is not fool proof which was the case in vaccines against small pox which actually managed to eradicate the disease from the face of our planet. Incidence of pneumonia definitely shows a sharp fall within a year after the vaccination in most cases. Studies presented have shown that vaccination plays a role in actually reducing the severity of the disease by bringing down the hospital admissions, which actually is a very big plus point for our health system that is overburdened by increasing patients. But in the long run, a patient with proper vaccination and other unfavourable factors like debilitation, lowered immune status, lack of proper nutrition etc may still fall prey to this disease. While on the other extreme there are sporadic studies indicating other complications like asthma in children who take the PPV or PCV vaccination. The cost effectiveness plays a huge role in developing countries which do not yet have the expertise and the technology to develop the vaccine indigenously, which means that lot of money is involved in making the vaccine available to the masses which are huge in number in most developing nations of the world. Physicians have their differing opinions on which stage of pneumonia vaccines really act at and its relative importance in context of the survival and well being of the patient. Reflection Though the effectiveness of vaccines against isn't fool proof and pneumonia shall still cause deaths and suffering till better alternatives are available, still in my opinion green flag should be given to aggressively promote these vaccines in all parts of the world and not just in few places where research rather than actual prevention forms the main back bone of the proceedings undertaken. As technology is further developed and the demand is increased more and more companies can find cheaper ways of marketing the drugs, which in the process would further hasten the demand. And satisfactory results have been shown in studies undertaken even in remote areas of Africa where health remains a major issue due to inhuman living conditions confirms its efficacy for people with degrees of health status. A study in India which strongly condemns the use of vaccines in light of its cost is also based mainly on clinical interpretation of disease which may vary from physician to physician. The report that there is an increase in incidence of bronchial asthma due to this vaccine has found no basis in any other studies undertaken and therefore, it can be overlooked till further light is thrown on this issue. The vaccine may not be effective against the newer strains of pneumococcus in a way regions but it's the same case with antibiotics, but they have been used successful with their obvious shortcomings. What is imperative that the governments work responsibly by managing the vaccination programs diligently in order to ensure proper utilisation of resources and funds, only then we will be able to satisfactory give these vaccines their due, or else their efficacy may be undermined by sceptical people, which may not be in the best interest of humanity at large. Reference Chaudhary, Puliyel (2008). Bulletin World Health Organisation.'vol.86'no.10'Genebra. Cutts et al.(2005),Vaccine Against Childhood Pneumonia Shows Promise, ScienceDaily. Dasgupta, Debarshi (2008, sept 8). India introduces controversial pneumonia vaccine.OUTLOOK, India, 38, 466-467. Health Protection Scotland (2007). Joint Committee on Vaccination and Immunisation. Health Journal. JAMA(2007, Apr 25).Pneumococcal Infections Are Increasing, And Not Covered By Childhood Vaccine. Science Daily pp. 1A, 2A. Klugman, Paul (2003, Oct 2).Pneumococcal Vaccine Significantly Reduces Disease In South African Children. ScienceDaily, 287(2), 12. O'Brien KL, Janoff EN, Cotton M, Musoke P, Coovadia H, Levine OS. The evidence for using conjugate vaccines to protect HIV-infected children against pneumococcal disease. Lancet Infect Dis 2007 WHO (1999). "Pneumococcal vaccines. WHO position paper". Wkly. Epidemiol. Rec. 74 (23): 177-83. Zhou, Fangjun(2007).Pediatric Adolescent Med.;161(12):1162-1168. Read More