Federal Government urged to focus on Pneumonia eradication

…As Pfizer launches Prevenar 13 pneumococcal vaccine

Alexander Chiejina

There is no gain saying that Nigeria is the economic powerhouse of West Africa. However, despite been one of the wealthiest countries on the African continent, its health indices is a course of major concern to health experts in the country giving the fact that about a million children under the age of 5 die every year from preventable childhood illnesses.

Only recently, the World Health Organisation (WHO) revealed that pneumonia is the single largest cause of death in children globally with an estimated that 1.8 million children under the age of five years dying from the disease and another 155 million cases of childhood pneumonia reported annually.

Driving this matter home, the burden of pneumococcal diseases in the world has placed Nigeria first in Africa and second in the world after India on the list of 15 countries, with an estimated 700, 000 infants affected by the disease thus recording three-quarters of childhood pneumonia cases in the world. Also, Nigeria lies in the Pneumococcal Meningitis belt of Africa where mortality in children and adults has remained high since the seventies despite availability of antibiotics for treatment.

Giving this worrisome indices, experts at a program organised by Pfizer Inc. to launch its pneumococcal polysaccharide conjugate vaccine Prevanar 13 in Lagos have tasked the Federal Government to increase vaccination of children with a view of nipping this disease in the bud.

Explaining the aetiology, Christy Okoromah, Consultant Cardiology/Infection Disease Unit, Department of Paediatrics, Lagos University Teaching Hospital (LUTH), Idi Araba, said that Pneumonia is a form of acute respiratory infection which affects the lungs.

Okoromah disclosed that the most common cause of this life threatening childhood pneumonia is caused by the bacterium Streptococcus pneumoniae; Haemophilus influenzae type b (Hib) – the second most common cause of bacterial pneumonia; and in infants infected with HIV, Pneumocystis jiroveci which is responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.

According to her; “the normal inhabitant of S. pneumonia is in the nasopharnyx of humans. It can be spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. The symptoms of pneumonia include rapid or difficult breathing, cough, fever, chills and wheezing (more common in viral infections).
When pneumonia becomes severe, children may experience lower chest wall indrawing, where their chests move in or retract during inhalation (in a healthy person, the chest expands during inhalation). Infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.”

For Adegoke Falade, Consultant Paediatrician, University College Hospital, UCH, Ibadan, while most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. Falade stated that pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.

In his words “the bacterium S. Pneumonia is invasive, invisible and has got many deadly serotypes in the country that are resistant to antibiotics. However, drivers that predisposes to antibiotic resistance include the prescription of most antibiotics for the treatment of pneumonia which is not necessary. Another major concern is the low dose and long duration of illness when antibiotic is used for treatment. It is noteworthy to state that indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung), overcrowding can increase a child's susceptibility to pneumonia.”

Even as Nigeria continues in its quest to attain the Millellium Development Goals (MDGs) by2015, there is the need to prevent pneumonia in children which is an essential component of a strategy to reduce child mortality. Hence, immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.

For Enrico Liggeri, country Manager, Pfizer Nigeria and the African region, since pneumococcal disease is the number 1 vaccine preventable cause in children under the age of 5 years globally, the launch of the New Prevenar 13 vaccine which is already in use in over 50 countries will go a long way in preventing babies dying in their thousands from preventable infection when immunized by the vaccine.

“Prevenar 13, which is a pneumococcal conjugate vaccine, helps to protect against the disease caused by 13 of the most prevalent pneumococcal serotypes globally (1,3,4,5,6A, 6B,7F, 9V, 14, 18C, 19A,19F and 23F which causes invasive pneumococcal disease including sepsis, meningitis, bacteria in blood, bacteria)etc. Hence, as many pathogens other than pneumococcal serotypes represented in the vaccine may contribute to pneumonia burden in children, protection against all clinical pneumonia is expected to be lower than for invasive pneumococcal disease (IPD)”, Amgad Gamil, Regional Medical Director, Vaccines, Pfizer Dubai revealed.

In addition, adequate nutrition is key to improving children's natural defences starting with exclusive breastfeeding for the first six months of life. This is also effective in preventing pneumonia and reducing the length of the illness. Also, addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.

There is the need for the Ministry of Health to collaborate with the National Primary Health Care Development Agency (NPHCDA) to ensure that pneumonia vaccines are included in 2011 strategy plans in the country’s routine immunisation process.
More importantly, the Federal, State and Local Governments should ensure through appropriate intervention, that the mortality and morbidity of this ‘forgotten killer’ (Streptococcus pneumonia) be curtailed at all levels, bearing in mind the resolution of the World Health Assembly in May 2010. However, the inauguration of a National Advisory Committee on Vaccination and Immunisation as found in developed countries such as the United States of America and Germany is recommended.

With this in place, understudying and understanding the pattern of infectious diseases in Nigeria whether periodic or seasonal and use evidence - based research epidemiology and surveillance will guide the nation.