Using pneumococcal and rotavirus surveillance in vaccine decision-making: A series of case studies in Bangladesh, Armenia and the Gambia

Abstract

Pneumonia and diarrhea are the leading causes of child morbidity and mortality globally and are vaccine preventable. The WHO-coordinated Global Rotavirus and Invasive Bacterial Vaccine-Preventable Disease Surveillance Networks support surveillance systems across WHO regions to provide burden of disease data for countries to make evidence-based decisions about introducing vaccines and to demonstrate the impact of vaccines on disease burden. These surveillance networks help fill the gaps in data in low and middle-income countries where disease burden and risk are high but support to sustain surveillance activities and generate data is low. Through a series of country case studies, this paper reviews the successful use of surveillance data for disease caused by pneumococcus and rotavirus in informing national vaccine policy in Bangladesh, Armenia and The Gambia. The case studies delve into ways in which countries are leveraging and building capacity in existing surveillance infrastructure to monitor other diseases of concern in the country. Local institutions have been identified to play a critical role in making surveillance data available to policymakers. We recommend that countries review local or regional surveillance data in making vaccine policy decisions. Documenting use of surveillance activities can be used as advocacy tools to convince governments and external funders to invest in surveillance and make it a priority immunization activity.

Barriers in Bangladesh

“…As with the CDC, our experience suggests that this is feasible. The WHO runs Invasive Bacterial Vaccine Preventable Disease (IB-VPD) surveillance studies in 58 countries, where they have already set up offices that can facilitate the delivery of relevant supplies to supported laboratories ( Hasan et al, 2018 ); the current process, however, often moves at a glacial pace and is highly bureaucratic. Donors could leverage the systems and relationships already established by the WHO to help research laboratories acquire supplies for their own projects.…”

Unbiased Metagenomic Sequencing for Pediatric Meningitis in Bangladesh Reveals Neuroinvasive Chikungunya Virus Outbreak and Other Unrealized Pathogens

“…More than 100 bacterial and viral pathogens are known to cause meningitis, but most microbiology laboratories in resource-poor settings test primarily for bacterial pathogens, namely, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, and group B S treptococcus , using culture, directed PCR, and/or serology (5, 7). In a World Health Organization (WHO)-supported meningitis surveillance study in Dhaka, Bangladesh (8), we collected 23,140 cerebrospinal fluid (CSF) samples from patients with suspected meningitis between 2004 and 2016, 8,125 of which contained ≥10 white blood cells (WBC)/μl. We were able to detect a bacterial etiology in only 1,585 (20%) of these cases despite the use of multiple diagnostic tools, including culture, antigen, and pathogen-specific qPCR assays.…”

Comparison of Culture, Antigen Test, and Polymerase Chain Reaction for Pneumococcal Detection in Cerebrospinal Fluid of Children

“…All CSF samples used in this study were collected as part of the Invasive Bacterial Vaccine Preventable Disease surveillance study supported by the World Health Organization (WHO) conducted at the Dhaka Shishu Hospital (DSH) [ 14 ]. DSH, the largest pediatric hospital in Bangladesh, provides primary to tertiary care to children aged 0–18 years.…”