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Infectious Disease Mortality in Rich vs' Poor Countries World Health Report, 2003

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International Vaccine Institute. Founded on the belief that vaccine science is a key ... If a vaccine can induce herd immunity, it will confer protection to non ... – PowerPoint PPT presentation

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Title: Infectious Disease Mortality in Rich vs' Poor Countries World Health Report, 2003


1
Infectious Disease Mortality in Rich vs. Poor
Countries (World Health Report, 2003)
Rich Countries 10
  • Poor Countries 90

2
The Value of Vaccines
Ali Maouw Maalin, was the last case of
smallpox in the world Somalia,1977
Vaccines are the most cost-effective tools for
preventing death and disability
in developing countries
Luis Fermín Tenorio, was the last polio case in
the Americas Perú, 1991
3
International Vaccine Institute
  • Founded on the belief that vaccine science is a
    key tool for closing the gap in health between
    rich and poor
  • The worlds only international organization
    dedicated exclusively to research on new vaccines
    for developing countries

4
Mission of the Institute
  • To promote the health of people in
    developing countries by the development,
    introduction and use of new and improved
    vaccines
  • through a dynamic interaction among science,
    public health and business
  • - From The Preamble to the Constitution of IVI
    (1996)

5
Background and Governance
  • The Institute began as a seed project of UNDP
  • Korea won an international competition to serve
    as the host country
  • In 1997 the IVI became an International
    Organization under the Vienna Convention
  • The Institute is autonomous and independent
  • The Institute is governed by a Board of Trustees
    - a majority of whom are chosen in their
    individual capacity

6
Signatories to Establishment Agreement(As of
May, 2005)
  • Bangladesh Kazakhstan Netherlands Slovakia
  • Bhutan Kuwait Oman Sri Lanka
  • Brazil Kyrgyzstan Pakistan Sweden
  • China Rep. Korea Panama Tajikistan
  • Ecuador Lebanon PNG Thailand
  • Egypt Malta Peru Turkey
  • Indonesia Mongolia Philippines Uzbekistan
  • Israel Myanmar Romania Vietnam
  • Jamaica Nepal Senegal WHO

7
Closing the Gap Global Challenges
  • To develop new vaccines against diseases
    causing millions of deaths every year in the
    developing world
  • To deploy available new generation vaccines in
    developing countries at affordable prices

8
IVIs Translational Research to Accelerate the
Rational Introduction of New Vaccines
Countries need information
How to introduce the vaccine?
Which disease?
Vaccine safety impact?
Assessment of disease burden and other
epidemiological studies
Economic, socio-behavioral, policy studies
Vaccine trials and demonstration projects
9
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10
IVIs Translational Research Priorities
  • 1. Vaccines against enteric infections 3 million
    dths/yr
  • ETEC
  • Shigella
  • Cholera
  • Typhoid
  • Rotavirus
  • 2. Vaccines against respiratory infections 1.5
    million dths/yr
  • Hib
  • Pneumococcus
  • Meningococcus
  • 3. Vaccines against flavivirus infections 50
    thousand deaths/yr
  • JE
  • Dengue

11
Cholera
  • Severe diarrhea, caused by Vibrio cholerae
  • Causes rapid dehydration that can kill within a
    matter of hours

12
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13
Cholera
  • Occurs in endemic and epidemic forms
  • Settings afflicted by natural disasters, war, and
    refugee crises are at particular risk for
    epidemics

14
  • Cholera Outbreak in Zaire in 1994

15
Global Burden of Cholera
  • WHO estimates that there are 5.5 million cases
    and about 120,000 deaths each year
  • Most of the morbidity and mortality occurs in the
    poorest countries of Asia and Africa

16
Vaccines against Cholera
  • Older generation, injectable vaccines proved
    ineffective
  • Newer generation, orally administered vaccines
    were pioneered by Prof. Jan Holmgren (U. of
    Goteborg and Vice-Chairman, IVI Board of
    Trustees)
  • The Holmgren vaccine (Dukoral SBL Vaccin AB,
    Sweden) consists of cholera toxin B subunit (BS)
    together with killed cholera cells (WC), and is
    given in two doses
  • IVI scientists recently reported that this
    vaccine was safe and highly protective against
    cholera in a population in Mozambique with a high
    prevalence of HIV/AIDS (New England Journal of
    Medicine 352 757-67, 2005)

17
Remaining Question about Killed Oral Cholera
Vaccines
  • Can use of the vaccine induce herd immunity?
  • If a vaccine can induce herd immunity, it will
    confer protection to non-vaccinated neighbors of
    vaccinated persons as well as enhanced protection
    of vaccinated persons when a population is
    vaccinated
  • Occurs because vaccination interrupts the
    transmission of the pathogen (eg cholera) in a
    population
  • Very important because in routine public health
    practice, only a proportion of a population will
    usually be vaccinated

18
1985 Efficacy Trial of Orally-Administered,
Killed Whole Cell-Based Cholera Vaccines
  • Site Matlab, Bangladesh
  • Eligibility Children aged 2-15 yrs Non-pregnant
    women older than 15
  • Subjects were randomized to oral BS-WC vaccine
    (Dukoral) oral WC vaccine or oral E.coli K12
    placebo
  • Enrollment89,596 (62,285 received complete
    regimens)
  • After dosing, subjects were followed to assess
    whether they experienced cholera

19
1985 Efficacy Trial of Orally-Administered,
Killed Whole Cell-Based Cholera Vaccines
Analyses of Vaccine Protection
  • At one year of follow-up, vaccine protection by
    each vaccine against cholera was about 60

20
Re-analysis of the Bangladesh trial to assess
herd immunity (Todays Lancet)
  • The Matlab field site consists of numerous
    geographically distinct clusters of households
  • Vaccine coverage varied considerably in the
    6,423 residential clusters

21
Levels of vaccine coverage, Matlab, 1985
22
Re-analysis of the Bangladesh trial to assess
herd immunity (Todays Lancet)
  • Basic strategy Analyzed the risk of cholera in
    different residential clusters according to level
    of vaccine coverage
  • Herd protection of non-vaccinated neighbors risk
    of cholera in placebo recipients should be
    inversely related to level of vaccine coverage
  • Herd protection of vaccinees (enhancement of
    direct vaccine protection) risk of cholera in
    vaccinees should be inversely related to level of
    vaccine coverage

23
Re-analysis of the Bangladesh trial to assess
herd immunity findings (Todays Lancet)
  • Herd protection of non-vaccinated neighbors
  • There was a strong inverse relationship
    between the risk of cholera in non-vaccinees and
    the level of vaccine coverage of their
    residential clusters
  • In clusters in which vaccine coverage was
    lt28, incidence of cholera was 7.0 cases/1000
  • In clusters in which vaccine coverage was
    gt50, the incidence of cholera was reduced to 1.4
    cases/1000.
  • This indicates that even moderate levels of
    vaccine coverage of residential clusters
    conferred 70 protection to non-vaccinated
    neighbors

24
Re-analysis of the Bangladesh trial to assess
herd immunity findings (Todays Lancet)
  • Herd protection of vaccinated persons
  • There was a suggestive inverse relationship
    between the risk of cholera in vaccinees and the
    level of vaccine coverage of their residential
    clusters
  • In clusters in which vaccine coverage was
    lt28, incidence of cholera was 2.7 cases/1000
  • In clusters in which vaccine coverage was
    gt50, the incidence of cholera was reduced to 1.3
    cases/1000.
  • This suggests that even moderate levels of
    vaccine coverage may enhance vaccine protection
    of vaccinees by 50

25
Implications of Todays Article in Lancet
  • In addition to protecting persons who are
    vaccinated, killed oral cholera vaccines can
    confer a high degree of herd protection when they
    are administered to populations
  • This is the first demonstration that vaccination
    against cholera can confer herd immunity
  • Taken together with IVIs recent findings about
    killed oral cholera vaccine in Mozambique, these
    data suggest that killed oral cholera vaccines
    should be considered for the control of endemic
    cholera and for use in populations at high risk
    for cholera epidemics following disasters, such
    as the recent Tsunami

26
Acknowledgements
  • IVI, Republic of Korea ICDDR,B, Bangladesh
  • Mohammad Ali, Ph.D.
    David Sack, M.D.
  • Lorenz von Seidlein, M.D., Ph.D. Mohammad Yunus,
    M.D.
  • John D. Clemens, M.D.
  • U. of Goteborg, Sweden
  • Jan Holmgren, M.D., Ph.D.
  • Columbia U., U.S.
  • Michael Emch, Ph.D.

27
Vaccines to PreventDiseases of the Most
Impoverished
  • The DOMI Program
  • A program to accelerate the development and begin
    the introduction of new vaccines against cholera,
    shigellosis, and typhoid fever, supported by the
    Bill and Melinda Gates Foundation
  • International Vaccine Institute
  • Seoul, Korea
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