https___pneumonepal.org_the-studies_invasive-disease-surveillance_.xml
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Surveillance for Invasive Pneumococcal Disease In this study Streptococcus pneumoniae bacteria (pneumococcus) is a major cause of disease and disability worldwide, and is vaccine-preventable. In 2015, the Ministry of Health of Nepal began providing a 10-valent pneumococcal conjugate vaccine to infants (PCV10) as the vaccine was introduced into its routine infant immunization schedule. Monitoring hospitalized cases of disease over time The long-term monitoring of disease, (disease surveillance), allows public health professionals to see trends over time. Surveillance of children admitted to Kathmandu’s Patan Hospital paediatric ward with presumed invasive bacterial disease or pneumonia has continued uninterrupted and with unchanged methods since 2005. These data are helping the Pneumo Nepal Project provide a holistic understanding of the burden and distribution of pneumococcal disease before and after vaccine introduction. More than 90 distinct pneumococcal serotypes have been identified throughout the world, however only a small number of these serotypes cause the majority of disease in infants. The two pneumococcal conjugate vaccines (PCVs) available on the market protect against ten (PCV10) and thirteen (PCV13) of the most common serotypes, respectively. Decisions about which product to introduce in Nepal were informed by the available evidence from Patan Hospital's surveillance. Based on specimens collected in the 10 years prior to vaccine introduction, the Pneumo Nepal study estimated that PCV10 would cover 75% of serotypes responsible for cases of invasive disease detected since 2005, and that the three additional serotypes included in the PCV13 product would only increase this coverage by 4%. The same data indicated that the majority of cases of invasive pneumococcal disease were caused by serotypes included in PCV10, suggesting that the vaccine could offer significant protection against pneumococcal disease in Nepal. Fig. 1 Before Nepal’s introduction of PCV10 (2005-2015), most cases of invasive pneumococcal disease were caused by vaccine-preventable types Since mid-2009 all admissions, of any cause, to the paediatric ward at Patan Hospital have been recorded daily. Among these children, those with suspected IBD are identified and a detailed case record form has been completed, including demographic information, clinical features and laboratory results. These data form the basis of the childhood IBD surveillance program at Patan Hospital. Fig. 1 Yearly participant enrolment totals since 2014 Surveillance Data results Using the surveillance data the distribution of pneumococcal serotypes in children with microbiologically confirmed invasive pneumococcal disease (IPD) before (2014-2015) and after(2016-2019) PCV10 introduction in Nepal in 2015. Results showed that Pre-introduction, 27.3% of IPD cases were age  4 years old). Among 44 IPD cases detected from blood, 36 (82%) were vaccine-type (n=29 were ST1), and 7 were non-vaccine-type (6C, 10A (n=2), 19A, 24F, 38, 41). In 2019, specifically, there were 17 cases of invasive pneumococcal disease recorded. Information on serotype was available for 15 cases which included 11 (73%) cases of serotype 1, and one each of serotypes 3, 5, 6B and 19A disease. Figure 3 displays the number of cases of invasive disease over time by categories according to vaccine-type. Fig. 1 Cases of invasive pneumococcal disease by year and vaccine type (IBD surveillance) Analysis of surveillance data as an indicator of vaccine impact is ongoing. For more information, contact our study coordinator.
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आक्रामक न्युमोकोकल रोगको निगरानी यस अध्ययनमा स्ट्रेप्टोकोकस निमोनिया जीवाणु (न्युमोकोकस) रोग तथा संसारभरको अपाङ्गताको एक प्रमुख कारण हो l यसलाई खोपद्वारा रोकथाम गर्न सकिन्छ l सन् २०१५ मा नेपालको स्वास्थ्य मन्त्रालयले शिशुहरुलाई १०-भ्यालेन्ट निमोनिया विरुद्धको खोप (PCV10) प्रदान गर्न थालनी गर्यो जुन खोप नियमित शिशु खोप तालिका अन्तर्गत दिन शुरुवात गरिएको थियो l कालान्तरमा अस्पताल आएका रोगका घट्नाहरुको अनुगमन रोगको दीर्घकालीन अनुगमन, (रोग निगरानी) ले जनस्वास्थ्यकर्मीहरुलाई समयसंगै परिवर्तित ट्रेन्डहरु हेर्न सहजता प्रदान गर्दछ l काठमाडौँको पाटन अस्पतालको बाल चिकित्सा वार्डमा भर्ना भएका गम्भीर क्रामक जीवाणुसहितका रोग अथवा निमोनिया भएका बालबालिकाहरुको निगरानी गर्ने पद्दति सन् २००५ देखि निर्बाध अपरिवर्तित छ, उस्तै नै छ l यी तथ्यांकहरुले न्युमो नेपाल प्रोजेक्टलाई खोप शुरु गर्नु अघि र पछी न्युमोकोकल रोगको बोझ तथा वितरणसम्बन्धी समग्र बुझाई प्रदान गर्न मद्दत गर्दैछन् l आ संसारभरमा ९० प्रकारका फरक न्युमोकोकल सेरोटाइपहरुको पहिचान भएको छ l तथापि शिशुहरुमा मूलत: यी मध्येका थोरै सेरोटाइपहरुले मात्र रोग निम्त्याउँछन् l बजारमा उपलब्ध दुइ निमोनिया बिरुद्धका खोपहरुले (PVC हरु) क्रमश: दस (PCV10) र तेह्र (PCV13) साधारण सेरोटाइपहरुबाट बचाउने गर्छन् l नेपालमा कुन प्रोडक्ट चलाउने भन्ने निर्णय पाटन अस्पतालको निगरानीबाट प्राप्त प्रमाणहरुद्वारा जानकारी गराईएको थियो l खोपको शुरुवात भन्दा १० बर्ष अगाडि संकलन गरिएका नमुनाहरुमा आधारित भएर न्युमो नेपालको अध्ययनले PCV10 ले २००५ देखि पत्ता लागेका आक्रामक रोगका घट्नाहरुको कारक ७५% सेरोटाइपहरु समेट्ने एवं PCV १३ मा रहेका तीन थप सेरोटाइपहरुले यस कभरेजलाई ४% वृद्धि गर्ने तथ्य आँकलन गर्यो l आक्रामक न्युमोकोकल रोगका अधिकांस घटनाहरु PCV 10 मा रहेका सेरोटाइपहरुले निम्त्याउने कुरा पनि सोही तथ्यांकले जनायो जसले खोपले नेपालमा न्युमोकोकल रोग बिरुद्ध उल्लेख्य रुपमा सुरक्षा प्रदान गर्ने तथ्य पनि सुझायो l तस्विर १ नेपालमा PCV 10 चलाउनु अघि (२००५-२०१५) आक्रामक न्युमोकोकल रोगका अधिकांस घटनाहरु खोपद्वारा रोकथाम गर्न सकिने किसिमका थिए खोपको प्रभावको सूचकको रुपमा तथ्यांक निगरानीको विश्लेषण जारि नै छ l विस्तृत जानकारीकालागि हाम्रा अध्ययन संयोजकसँग सम्पर्क गर्नुहोस् l