Combatting Childhood Pneumonia

Childhood pneumonia causes more deaths among children under age 5 than tuberculosis, HIV, and COVID-19 combined. The Indian government introduced the pneumococcal conjugate vaccine (PCV) into the national immunization schedule in a phased manner in 2017, beginning with the highest-burden regions of the country and then scaling up to a nationwide rollout by December 2021.  

The Pneumonia REsearch and VAccine Impact League (PREVAIL) study is a multicentre vaccine impact evaluation study across six tertiary care hospitals in five states in India – New Delhi, Uttar Pradesh, Rajasthan, Madhya Pradesh and West Bengal. From October 2020 through November 2022, 4,517 children aged 1-35 months hospitalized with pneumonia have been enrolled across the sites, along with 1,479 well children from community sites. Senior investigators from these sites and PREVAIL researchers–including laboratory personnel, clinical research officers, and data analysts–met in Greater Noida, UP, on 11-12 February 2023 to discuss the preliminary results of the study.  

Dr Vikas Manchanda, Professor of Microbiology at Maulana Azad Medical College, New Delhi and Co-Principal Investigator of PREVAIL, opened the meeting saying, “Bringing together the network of pediatricians, microbiologists, community health providers, epidemiologists and health economists is critical for ongoing knowledge gathering”. Dr Manchanda and his team presented innovative laboratory methods for identifying serotypes of Streptococcus pneumoniae, the primary bacterial pathogen that causes severe pneumonia in children. Investigators reviewed results of pneumococcal nasopharyngeal colonization amongst PCV-immunized and unimmunized children to assess vaccine impact, and the early results were encouraging. Mortality of children hospitalized for pneumonia was high across all sites and is expected to decrease as the nationwide PCV rollout continues to mature into high coverage. The PREVAIL teams examined antimicrobial susceptibility patterns among vaccine-type pneumococcal strains, adding evidence to the role of vaccines in curtailing antimicrobial resistance.  

PREVAIL study investigators also assessed the economic impact of pneumonia hospitalization, finding that many households suffered a heavy burden in covering the cost of treatment, including catastrophic health expenditures that have economic impacts lasting beyond the episode of illness. Dr Anita Shet, Director of Child Health at the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health and Principal Investigator of PREVAIL, concluded the meeting, saying, “We are working together to build a world where pneumonia is no longer the leading cause of death in young children, and where every child can not only survive, but thrive well.”  

Dissemination of final PREVAIL results is expected in the last quarter of 2023.