Bill & Melinda Gates Foundation

Aging Populations Face Old Foe in Pneumococcal Disease

March 15, 2013

When discussing public health campaigns and disease prevention, most people want to immediately jump to the solution – we want a vaccine, a cure, a narrative – so we can stop the cycle of disease and suffering. But we must remember to crawl before we walk, and this cliché could not ring more true than in the world of disease monitoring and surveillance, particularly for a disease like pneumococcal, a deadly bacterial infection that kills more than 1.6 million people annually, including half a million children. 

Pneumococcal disease can strike quickly, infecting adults and children alike. It is the leading cause of pneumonia, but can also develop into deadly forms of meningitis or sepsis. The good news is that thanks to robust childhood vaccination programs, we are beginning to see a significant reduction in pneumococcal infections among children. In the Latin America and Caribbean region, routine use of pneumococcal conjugate vaccines for children under the age of five began in 2003, and as more countries use the vaccine a major reduction in cases would be expected over the next few years.

As the threat of pneumococcal infection among young children declines in countries that have introduced the vaccine, the greatest burden of disease will fall on other at risk groups. In the United States, for example, 85 percent of pneumococcal disease cases now occur in adults.  Conservative estimates predict that among adults in Latin America, infection rates may be similarly high. As the population ages and lives longer, pneumococcal cases will further rise, causing many more hospitalizations and increasing medical costs.

So it surprises me that this deadly disease in adults is not given the proportionate attention it deserves. Great determination and collaboration among the international health community helped make global reductions in pediatric pneumococcal disease possible. It is time to transition this success to find solutions to prevent pneumococcal infections in older children and adults, especially those over 65.

Are we doing enough to prevent pneumococcal disease among adults using the currently recommended vaccines? Is there a more effective intervention? Right now, we don’t have enough information to answer these questions, but the solution is right at our finger tips—robust disease monitoring and surveillance programs are a necessary first step to determine the best way to tackle a deadly infection like pneumococcal disease.

As indicated in a recent study by the Sabin Vaccine Institute, the Pan American Health Organization, the U.S. Centers for Disease Control and Prevention and the International Vaccine Access Center at Johns Hopkins University, there is insufficient national data from Latin American countries to create an accurate picture of pneumococcal disease in adults. An investment is needed to determine not only the total burden and cost of pneumococcal infection, but whether expansion of currently available vaccines against the disease is feasible and effective. 

To address this rising problem, a group of public health experts from around the world gathered in Sao Paulo this week for the 5th Regional Pneumococcal Symposium. They called on regional policymakers to prioritize adult pneumococcal disease on their public health agendas, with an emphasis on making it easier for healthcare professionals to detect and report on disease occurrences. Without this crucial first step of pneumococcal monitoring and surveillance, we won’t be armed with the information necessary to prevent it.

A “life-course” approach must be taken in order to make modern advances in public health - like new and improved vaccines and technologies - available to all those at risk in every age group. This includes duly prioritizing critical health issues of the young, the old and everyone in between in the public health agenda, so that no one must suffer from vaccine preventable diseases.

 
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