Dr Gaurav Gupta,         Pediatrician,   Member AAP, IAP,Charak Clinics, Mohali             Feb 2012
   Brief intro about Pneumococcal Disease   India – Scope of IPD – morbidity &    mortality   Latest data (including AS...
   Brief intro about Pneumococcal Disease   India – Scope of IPD – morbidity &    mortality   Latest data (including AS...
Pneumococcal Disease S. pneumoniae first isolated by  Pasteur in 1881 90 known serotypes First U.S. vaccine in 1977 (14...
DISEASES CAUSED BY STREPTOCOCCUSPNEUMONIAE                   PNEUMOCOCCAL INFECTION  Non-invasive disease       Invasive d...
Strep Pneumoniae in developing countries                    1000 X                     AOM                     100 X      ...
   Brief intro about Pneumococcal Disease   India – Scope of IPD – morbidity &    mortality   Latest data (including AS...
Each Dot = 5,000 child deathsChild DEATHS We are No. 1      Black RE. The Lancet 2003; 361: 2226-2234
Pneumococcal Disease Burden    in India   Meningitis and Sepsis –     Among Top 10 causes of mortality      in India    ...
PNEUMOCOCCAL DISEASE BURDENCountries with the greatest number of pneumococcal       deaths among children under 5 years   ...
PNEUMONIA AND INDIA Pneumonia remains the leading killer of children1 410,000 children < 5 die of pneumonia every year1,2 ...
We are missing the target     (Millennium Development Goal 4)                                  Under-five mortality ratio ...
   Brief intro about Pneumococcal Disease   India – Scope of IPD – morbidity &    mortality   Latest data (including AS...
A limited number of serotypes     cause IPD in young Children                      ~ 10 Serotypes causes                  ...
PCV 7 - CoverageReferences: 1. Johnson et al. Plos Medicine 2010
PCV 10 - Coverage
PCV 13 - Coverage
Pneumococcal Polysaccharide and Non- Typable Haemophilus influenza                               (NTHi)                Pro...
Epidemiology of Pneumococcal Serotypes in India in Children under 5yrs :An overview of available data       1999 : IBIS s...
PNEUMONET KIMS study… (1 year data)•Study done at 3 hospitals in                                                          ...
Pressing Need For RobustIndian Data ……   Very limited data available from India regarding    Pneumococcal disease causing...
CMC                    CNBC              Inclusion                                       Study Centres   CriteriaLudhian  ...
ASIP: Distribution of Serogroup/typePreliminary Results (n=35), 2011    Serogroup /     No. of     Serotype      isolates ...
Summary : Prevalence of    Pneumococcal Serotypes in    India   Available data since 1999 to 2011 suggest that in    chil...
   Brief intro about Pneumococcal Disease   India – Scope of IPD – morbidity &    mortality   Latest data (including AS...
Spectrum of disease caused by 2bacteria   H. influenzae                                                        S. pneumoni...
NTHi is one of the leading pathogen in Otitis Media            40.0%                                    36.7%            3...
Indian data on NP carriage of NTHi in     children under 2yrs of age
Review of contribution of NTHi (non typable Haemophilus influenzae) and                    S pneumonia in children Acute o...
Conclusion: NTHi (Non Typable Haemophilus influenzae) and S.pneumonia and are the major causative organism forAOM among u...
Pneumococcal Otitis Efficacy Trial (POET)                                                                                 ...
Summary : Importance of NTHiand dual pathogen protection   NTHi along with S. Pneumoniae causes non    invasive disease l...
   Brief intro about Pneumococcal Disease   India – Scope of IPD – morbidity &    mortality   Latest data (including AS...
Description of PCV vaccines Prevenar     4, 6B, 9V, 14, 18C, 19F, 23F             CRM197 Diphtheria carrier proteinSynflor...
Design of Synflorix                Why use a carrier protein derived from H. influenzae?   Synflorix designed to potential...
Summary : What about Serotype 3, 6A and 19A?Is there any difference between these 2 Vaccines? Serotype 3 (not a common ped...
Clinical Otitis Media and         Pneumonia Study (COMPAS)• Multicentre, double-                                        Pa...
Synflorix : Only new generation PCV withProven Efficacy Against ClinicalPneumonia                          Synflorix™     ...
Synflorix IPD Effectiveness II:  Pneumococcal Meningitis in Brazil, in <2 yr olds  1998-2011Cumulative number of Pneumococ...
Synflorix in Various Countries NIPs  National Immunization Programs                Regional      High Risk                ...
   Brief intro about Pneumococcal Disease   India – Scope of IPD – morbidity &    mortality   Latest data (including AS...
Q 1. Why should I use Synflorix when prophylactic useof Paracetamol is not recommended as the immuneresponse may be lowered?
Q 2. Synflorix co-administration with IPV caused areduced immune response to IPV 2. Can I still useSynflorix with IPV?Answ...
Summary             Pneumococcal disease is the #1 vaccine-preventable cause              of death worldwide in children ...
Synflorix   what’s new in preventing pneumococcal disease (feb 2012)
Synflorix   what’s new in preventing pneumococcal disease (feb 2012)
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Synflorix what’s new in preventing pneumococcal disease (feb 2012)

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  • Key PointsAs per the O’Brien report in Lancet 2009, India tops the countries with the greatest number of pneumococcal deaths in children under 5 years, ahead of China which has a higher population.
  • Key PointsThe Millennium Development Goal 4 aims to reduce mortality in children younger than 5 years by two-thirds between 1990 and 2015. However looking at this graph for 60 priority countries (including India), it seems we are still far away from that goal.
  • Although 91 serotypes have been isolated only a few of these serotypes are responsible for invasive pneumococcal disease. According to Johnson et al published in 2010, only 10 serotypes cause 75% of IPD in children under 5 years of age.
  • Key PointsOverall, positive culture growth was obtained in 432 (8.2%) of the 5,249 enrolled subjects. Percentages of total growth were as follows: Salmonella sp. 60 (13.9%); Streptococcus pneumonia 27 (6.3%); Staphylococcbus hominis 41(9.5%); Micrococcus sp. 32 (7.4%); Staphylococcus epidermidis 24 (5.6%); Staphylococcus aureus 19 (4.4%).SP was detected and serotype information obtained in 17 subjects (n=18 serotypes). In 1 subject isolates grown from CSF and blood were of 2 different serotypes (CSF=6A and blood=3).Distribution of the serotypes isolated is shown in Table 3; 6A and 5 were seen most frequently.The serotype coverage offered by PCV7, PCV10, and PCV13 was 27.77%, 55.55%, and 100%, respectively.Four of the 18 isolates were resistant to trimethoprim/sulfamethoxazole, 3 to erythromycin, and 1 to ceftriaxone. Antibiotic resistance was observed for serotypes 6A, 14, 1, 3, and 19A.
  • Based on a compilation paper written by Murphy et al in 2009, NTHi is one of the leading othopathogens and is responsible more than 30% AOM cases in children under 5 years of age.
  • Speakers notesBecause of the broad impact and the management difficulties of AOM, prevention of otitis media by vaccination is an appealing prospect. Over the past decade, evidence has emerged that this is indeed a viable option. AOM can be a vaccine preventable disease.First evidence were obtained with the PCV-7 vaccine. In studies conducted in Finland and the USA, efficacy was demonstrated against AOM following infant vaccination. This slide reports the results observed in the Finnish study. The vaccine efficacy against all-cause AOM was shown to be limited (~6%) in the FinOM study, even though efficacy against pneumococcal vaccine serotypes was 57%.This interesting but modest results may be explained by evidence of significant replacement with non-vaccine serotypes (-33% = an increase in episodes due to non-vaccine serotypes) and otopathogen replacement with H.influenzae (-11%).PCV-7 shows no evidence of efficacy against Hi AOM, which together with Strep pneumoniae is the second biggest cause of bacterial AOM
  • To summarize on these 3 serotypes – Serotype 3 is not commonly isolated in children under 5 yrs of age. It is an atypical serotype and there is inconsistent immune boosting by any of the pneumococcal vaccines. Even the FDA has questioned the effectiveness of ST 3 in Prevenar 13.Serotype 6B-6A cross-protection is now a globally accepted fact and the WHO/GAVI organizations accept that any PCV with ST 6B will provide cross-protection to 6A.Serotype 19A as shown in the earlier slides is not a rising problem across the globe. And 19F-19A cross-reactivity is possible.To conclude – both vaccines have only a marginal difference in their coverage and for India, based on Dr. Nitin Shah’s article, both vaccines offer &gt;70% IPD coverage.
  • BIO-SYN-0023-11Primary objective is met. Efficacy for other CAP endpoints was shown with LL&gt;0 irrespective of type of analysis*High consitency between per protocol (ATP) and Intent-to-treat (ITT or TVC -total vaccinated cohort)
  • Synflorix what’s new in preventing pneumococcal disease (feb 2012)

    1. 1. Dr Gaurav Gupta, Pediatrician, Member AAP, IAP,Charak Clinics, Mohali Feb 2012
    2. 2.  Brief intro about Pneumococcal Disease India – Scope of IPD – morbidity & mortality Latest data (including ASIP) regarding Pneumococcal strains prevalent in Asia/ India What about NTHi ? Information about the latest dual pathogen vaccine against S. Pneumoniae and NTHi Common Questions regarding using PCV 10
    3. 3.  Brief intro about Pneumococcal Disease India – Scope of IPD – morbidity & mortality Latest data (including ASIP) regarding Pneumococcal strains prevalent in Asia/ India What about NTHi ? Information about the latest dual pathogen vaccine against S. Pneumoniae and NTHi Common Questions regarding using PCV 10
    4. 4. Pneumococcal Disease S. pneumoniae first isolated by Pasteur in 1881 90 known serotypes First U.S. vaccine in 1977 (14 valent PPV) PCV 7 launched in 2000 Type-specific antibody is protective
    5. 5. DISEASES CAUSED BY STREPTOCOCCUSPNEUMONIAE PNEUMOCOCCAL INFECTION Non-invasive disease Invasive disease • Sinusitis • Bacteraemia (blood) • Otitis media • Pneumonia • Meningitis (CNS) • Endocarditis (heart) • Peritonitis (body cavity) • Septic arthritis (bones and joints) • Others (appendicitis, salpingitis, soft-tissue infections) Musher, in Principles and Practice of Infectious Diseases, 1995
    6. 6. Strep Pneumoniae in developing countries 1000 X AOM 100 X Non Invasive pneumoneia 10 X Bacteremia Meningitis
    7. 7.  Brief intro about Pneumococcal Disease India – Scope of IPD – morbidity & mortality Latest data (including ASIP) regarding Pneumococcal strains prevalent in Asia/ India What about NTHi ? Information about the latest dual pathogen vaccine against S. Pneumoniae and NTHi Common Questions regarding using PCV 10
    8. 8. Each Dot = 5,000 child deathsChild DEATHS We are No. 1 Black RE. The Lancet 2003; 361: 2226-2234
    9. 9. Pneumococcal Disease Burden in India Meningitis and Sepsis –  Among Top 10 causes of mortality in India Meningitis  causing 1.53 lakh deaths in children under 5 yrs Sepsis Pneumonia –  No. 1 Killer of children in India  Causing 4 lakh deaths in children Pneumonia under 5yrs Acute Otitis Media (AOM) – Non-invasive diseases  Most frequent disease of (Otitis media) Non-invasive diseases childhood (Otitis media)  Leading cause of physician visits and antibiotic therapy Black RE et al. Lancet 2010; 375: 1969-1987 Pneumonia: The Forgotten killer; WHO September 2008 Rudan et al. Bull World Health org 2008; 86: 408 Gehrard grevers, IJPO Vol 74 Issue 6, June 2010, Pages 572- 577
    10. 10. PNEUMOCOCCAL DISEASE BURDENCountries with the greatest number of pneumococcal deaths among children under 5 years TOP TENO,Brien K, et al. Lancet. 2009;374:893-902.
    11. 11. PNEUMONIA AND INDIA Pneumonia remains the leading killer of children1 410,000 children < 5 die of pneumonia every year1,2 25% of all child deaths are due to pneumonia3 Meta-analysis of 4 CTs suggest 30-40% of all severe pneumonia in children is pneumococcal. In Indian context, around 123,000 to 164,000 children <5 years die annually from pneumococcal pneumonia11. Levine OS et al Indian Pediatrics 2007; 44:491-4962. Pneumonia – The forgotten killer of children, WHO, UNICEF, 20063. Thacker N. IPD burden - An Indian Perspective. Pediatrics Today 2006; 9(4): 208-213
    12. 12. We are missing the target (Millennium Development Goal 4) Under-five mortality ratio (U5MR) projections 60 priority countries U5MR in 2015 85 at current AAR 38 MDG Target U5MR in 2015 AAR =average annual rate of reduction MDG=millennium development goalSource: UN Population Division World Population Prospects, 2004. 12
    13. 13.  Brief intro about Pneumococcal Disease India – Scope of IPD – morbidity & mortality Latest data (including ASIP) regarding Pneumococcal strains prevalent in Asia/ India What about NTHi ? Information about the latest dual pathogen vaccine against S. Pneumoniae and NTHi Common Questions regarding using PCV 10
    14. 14. A limited number of serotypes cause IPD in young Children ~ 10 Serotypes causes 75% of IPD in children under 5 years of ageJohnson et al PLOS Medicine 2010
    15. 15. PCV 7 - CoverageReferences: 1. Johnson et al. Plos Medicine 2010
    16. 16. PCV 10 - Coverage
    17. 17. PCV 13 - Coverage
    18. 18. Pneumococcal Polysaccharide and Non- Typable Haemophilus influenza (NTHi) Protein D conjugate vaccine, adsorbed Europe Asia North America Africa Latin America oceaniaReferences: 1. Johnson et al. Plos Medicine 2010 2.Nitin k. shah et al. summary of invasive pneumococcal disease burden among children in Asia-Pacific region. Vaccine 28(2010) 7589-7605
    19. 19. Epidemiology of Pneumococcal Serotypes in India in Children under 5yrs :An overview of available data  1999 : IBIS study (Invasive Bacterial Infection Surveillance)  2006-07 :SAPNA network (South Asia Pneumococcal Alliance)  2008 : Asian Network for Surveillance Of Resistant Pathogens ( ANSORP 2008 )  1992-07 : S. Pneumoniae Surveillance for Serotype distribution in Bangladesh:  2008 : KIMS Study (PneumoNET)  2009 :Pneumo ADIP (Pneumococcal vaccine Accelerated Development and Introduction Plan )  2011 : Alliance for Surveillance of Invasive Pneumococci (ASIP) : (Jan – Nov ) 19
    20. 20. PNEUMONET KIMS study… (1 year data)•Study done at 3 hospitals in Table 3: Serotype DistributionBangalore South Zone(Kempegowda Institute of Medical Serotype NSciences Hospital, Vanivilas 6A 5Hospital, and Indira Gandhi 5 3Institute of Child Health) 1 2 3 2•Limited no. of serotype and onlyfrom part of a city of a region 14 2hence can not represent a Sub 9V 1continent like India 19F 1 18C 1• No indication of high prevalenceof serotype 19 A 19A 1 a – In 1 subject 2 different serotypes were obtained from blood and CSF (6A in CSF and 3 in blood) 20
    21. 21. Pressing Need For RobustIndian Data …… Very limited data available from India regarding Pneumococcal disease causing  Serotypes  Prevalence  Distribution Robust data from PAN India will help in Suitability and choice of PCV in India ASIP : ALLIANCE FOR SURVEILLANCE OF INVASIVE PNEUMOCOCCI IN INDIA can really help in understanding the prevalence of S. Pneumonie and serotype
    22. 22. CMC CNBC Inclusion Study Centres CriteriaLudhian Delhi a • PAN India • Age: Safdar <5 years Network • JungClinically suspected case of pneumonia, meningitis Delhior bacteremia (as per modified WHO case Institutes • 12 definition) KEM • Without previous antibiotic therapyMumba KEM • After informed consent by parent • 48 Sentinel i Pune • Microbiology protocol as per modified WHO/CDC Pediatricians surveillance manual BVP SRMC Pune Chenn • 7 Sentinel MGIM ai local labs S Pushpag Wardh iri a TiruvallaLTMM CMumba Central i Monitoring Lab CMC, St. AIMS Vellore Johns Kochi Bengalu 19
    23. 23. ASIP: Distribution of Serogroup/typePreliminary Results (n=35), 2011 Serogroup / No. of Serotype isolates 1 01 4 01 19 A % : 1/35 ( 2.85 %) 19F % : 3/35 ( 8.57%) 5 02 ------------------------------------ 10 04 19 % : 4/35 (11.4%) 7F - • In line with previous studies and 9V - PneumoADIP- Asia: 2009 14 (F) 01 18C - • Others: includes serogroups with 1 isolates 19F 03 23F 02 No case of ST 3 in India, 3 - results in line with 6 03 Previous large multicentric trials 19A 01 Others 17 23
    24. 24. Summary : Prevalence of Pneumococcal Serotypes in India Available data since 1999 to 2011 suggest that in children < 5 yrs of age  Serotype 1,5 and 7 are major cause of IPD in India across all studies  In pan India serotype surveillance studies there was no evidence of ST 3 prevalence in India  No rise / uptrend seen in serotype 19 A prevalence in India or no data is available to assume the same
    25. 25.  Brief intro about Pneumococcal Disease India – Scope of IPD – morbidity & mortality Latest data (including ASIP) regarding Pneumococcal strains prevalent in Asia/ India What about NTHi ? Information about the latest dual pathogen vaccine against S. Pneumoniae and NTHi Common Questions regarding using PCV 10
    26. 26. Spectrum of disease caused by 2bacteria H. influenzae S. pneumoniae Meningitis Sepsis Incidence of invasive H. influenzae disease drastically reduced—but not eliminated--where Hib vaccination introduced Pneumonia Non-invasive diseases + NTHi (Otitis media) (non-invasive & invasive diseases) 26 26
    27. 27. NTHi is one of the leading pathogen in Otitis Media 40.0% 36.7% 35.0% 31.7% 30.0% 25.0% 20.0% 18.7% 15.0% 10.0% 5.0% 0.0% S. NTHi M. Pneumoniae CatarrhalisThe 3 predominant pathogens in otitis media: S. pneumoniae, NTHi and M. catarrhalis (from 8 different studies involvingtympanocentesis and culture of middle ear fluid from 1990–2007).9–16Murphy et al The Pediatric Infectious Disease Journal • Volume 28, Number 10, October 2009
    28. 28. Indian data on NP carriage of NTHi in children under 2yrs of age
    29. 29. Review of contribution of NTHi (non typable Haemophilus influenzae) and S pneumonia in children Acute otitis mediaStudy Journa Year Place Sampl Age group S. pneumoniae Non typable l e H. influenzaeAlexandr BMC 2011 Colombi 99 3-60 months 30/99 (30%) 31/99 (31%)a Sierra infect. aet al. DisParra M Vaccin 2011 Mexico 121 3-59 months 35/121 (29%) 41/121 (34%)Bacterial eet al.Shiping AJ of 2011 Taiwan 225 1-94months --------------- 189/225 (84%)He. et al med. Res.Barkai G. Ped. 2009 Israel 8145 < 60months 4339/8145(53% 4928/8145et al Infect. ) (60%) Dis JRef: Alexandra Sierra et al.,BMC infectious diesease,2011 Parra M Bacterial et al., Vaccine. 2011 (29) 5544– 5549 Shiping He. African Journal of Microbiology Research Vol. 5(17), pp. 2407-2412 Barkai G. Pediatr Infect Dis J.2009 Jun;28(6):466-71
    30. 30. Conclusion: NTHi (Non Typable Haemophilus influenzae) and S.pneumonia and are the major causative organism forAOM among under 5 children worldwide. NTHi and S. pneumoniae mixed episodes are morelikely to occur in AOM, & interaction between these twopathogens contribute to chronicity and complexity of AOM.
    31. 31. Pneumococcal Otitis Efficacy Trial (POET) Vaccine Efficacy Vaccine Efficacy Acute Otitis Media Endpoint (95% CI) (95% CI) POET [11Pn-PD] FinOM [PCV-7] Any (confirmed by presence of middle-ear % 33.6 %6 fluid) (20.8 to 44.3) (-4 to16) Vaccine pneumococcal serotypes % 57 % 57 (41.4 to 69.3) (44 to 67) Non-vaccine pneumococcal serotype %8 % -33 (-64.2 to 49) (-80 to 1) Haemophilus influenzae % 35.6* (-%11) (3.8 - 57.0) (-34 to 8) Recurrent AOM % 55 % 16 (-1.9 to 80.7) (-6 to 35) *Non-Typeable Haemophilus influenzae % 35.3 (1.8 to 57.4) Synflorix Only new generation PCV offer dualNote: Results cannot be quantitatively compared due to differences in study population, Pathogen Protection against S. Pneumoniae andepidemiology of AOM, case-ascertainment , etc. NTHi in AOM1.Eskola J, et al. N Engl J Med 2001; 344:403-409; FinOM: Finnish Otitis Media; 2. Prymula R, et al. Lancet 2006; 367:740–748 31
    32. 32. Summary : Importance of NTHiand dual pathogen protection NTHi along with S. Pneumoniae causes non invasive disease like AOM NTHi is one of the leading pathogen in OM Managing OM is difficult and challenging and every children by 3 years of age will have an episode of AOM In POET trial 11 v PNPD vaccine offered dual pathogen protection against S. Pneumoniae and NTHi All cause AOM was reduced by 33.6 %
    33. 33.  Brief intro about Pneumococcal Disease India – Scope of IPD – morbidity & mortality Latest data (including ASIP) regarding Pneumococcal strains prevalent in Asia/ India What about NTHi ? Information about the latest dual pathogen vaccine against S. Pneumoniae and NTHi Common Questions regarding using PCV 10
    34. 34. Description of PCV vaccines Prevenar 4, 6B, 9V, 14, 18C, 19F, 23F CRM197 Diphtheria carrier proteinSynflorix 4, 6B, 9V, 14, 23F, 18C, 19F 1, 5, 7F NTHi protein DPrevenar13 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F 3, 6A, 19A CRM197 Diphtheria carrier protein 34
    35. 35. Design of Synflorix Why use a carrier protein derived from H. influenzae? Synflorix designed to potentially: • protect against most prevelent 10 pneumococcal serotypes • minimize risk of interference with co-administered vaccines • provide protection against NTHi disease S.pneumoniae Non-Typeable H. influenzae protein D [carrier protein] Polysaccharides (10 serotypes*)* 2 polysaccharides conjugated on tetanus and diphtheria toxoid respectively 35
    36. 36. Summary : What about Serotype 3, 6A and 19A?Is there any difference between these 2 Vaccines? Serotype 3 (not a common pediatric serotype)  is an atypical serotype and non boostable  In large muticentric clinical studies, Serotype 3 has not been isolated in children < 5 years of age in India ( IBIS 1999 TO ASIP 2011) Serotype 6A (globally accepted 6B-6A cross-protection)  PCV 7 which included only ST 6B, reduced 90% of serotype 6A IPD cases as per CDC surveillance data Serotype 19A (not rising in India)  Data from pan India studies confirms that, there is no rise / upward trend observed in serotype 19 A IPD cases Both the vaccine in India will offer > 70% IPD coverage
    37. 37. Clinical Otitis Media and Pneumonia Study (COMPAS)• Multicentre, double- Panama: blind, randomised, 7 centres controlled trial N= 7.000 subjects• Sample Size = 24,000 Colombia: 3 centres• Synflorix™ vs. control N= 3.000 (Randomised 1:1) subjects• 3 Latin American countries Argentina: 17 centres• Urban Setting N=14.000• Good access to health subjects care system
    38. 38. Synflorix : Only new generation PCV withProven Efficacy Against ClinicalPneumonia Synflorix™ C-CAP Alveolar consolidation on Vaccine efficacy (%) Chest X-ray analyzed acc to ,[95% CIs] , p-value WHO definition Per-protocol (ATP) 25.7 [8.4;39.6] Intent-to-treat (TVC) 23.4 [8.8;35.7] ^ p-value significant if lower than 0.0175 *first episodes of pneumonia by Data Lock Point 31Aug2010 Per-protocol : Vaccine Efficacy for time to first occurrence of CAP anytime from 2 weeks after the administration of dose III and part of the ATP cohort. Intent-to-treat: Vaccine Efficacy for time to first occurrence of likely bacterial CAP (B-CAP) anytime from the administration of dose I 1.Tregnaghi et al., XIV SLIPE, Punta Cana, May 2011; 2.Tregnaghi et al., 29th ESPID, The Hague, June 2011 3.10PN-PD-DIT-028; NCT00466947
    39. 39. Synflorix IPD Effectiveness II: Pneumococcal Meningitis in Brazil, in <2 yr olds 1998-2011Cumulative number of Pneumococcal meningitis cases in children <2 years of age by month of occurrence, Brazil,2007-10 Synflorix™ introduction March-June 2010. 2009 UMV, 3+1 schedule 2010 ~48% reduction any Pn. meningitis 2011 Jun11 vs Jun10 Brazil National Pneumococcal menigitis reporting. MoH - SAUDE : http://portal.saude.gov.br/portal/saude/profissional/visualizar_texto.cfm?idtxt=37811 accessed 21Nov2011
    40. 40. Synflorix in Various Countries NIPs National Immunization Programs Regional High Risk Imm. Population Programs s Finland Brazil New Zealand Sweden Bosnia & (5 regions) Herzegovina Iceland Chile Kenya Poland Netherlands Peru Ethiopia Croatia Czech Rep Ecuador Saudi Arabia Slovakia Mexico Oman Bulgaria Colombia Austria Caribbean: Aruba, Jamaica, Bermuda, Gran Cayman,Cyprus, Albania Trinidad & Tobago, Barbados
    41. 41.  Brief intro about Pneumococcal Disease India – Scope of IPD – morbidity & mortality Latest data (including ASIP) regarding Pneumococcal strains prevalent in Asia/ India What about NTHi ? Information about the latest dual pathogen vaccine against S. Pneumoniae and NTHi Common Questions regarding using PCV 10
    42. 42. Q 1. Why should I use Synflorix when prophylactic useof Paracetamol is not recommended as the immuneresponse may be lowered?
    43. 43. Q 2. Synflorix co-administration with IPV caused areduced immune response to IPV 2. Can I still useSynflorix with IPV?Answer: Synflorix can safely be co-administered with IPV and will not cause a reduced antibody response to the poliovirus antigens
    44. 44. Summary  Pneumococcal disease is the #1 vaccine-preventable cause of death worldwide in children aged <5 years1  Data from India clearly points to vaccine preventable serotypes being common cause of Pneumococcal Disease !  Convenient transition from PCV 7 to newer vaccines at any point in the vaccination schedule4  PCV 10 offers protection against AOM too – unique.  For high risk cases PCV/ PPSV can be given up to 18 years1. WHO. http://www.who.int/immunization_monitoring/data/GlobalImmunizationData.pdf. Accessed September 3, 2009.2. Dinleyici E, et al. Expert Rev Vaccines. 2009;8:977-986.3. GAVI Pneumococcal AMC TPP, Nov 2008. http://www.vaccineamc.org/files/TPP_codebook.pdf. Accessed September 3, 2009.4. Prevenar 13. Summary of Product Characteristics. Wyeth Pharmaceuticals.5. Data on file. Pfizer Inc, New York, NY. 45
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