An evaluation of the emerging vaccines and immunotherapy against staphylococcal pneumonia in children

• Published in: BMC public health 2011-04, Vol.11 Suppl 3 (S3), p.S27-S27, Article S27
• Main Authors: Huda, Tanvir, Nair, Harish, Theodoratou, Evropi, Zgaga, Lina, Fattom, Ali, El Arifeen, Shams, Rubens, Craig, Campbell, Harry, Rudan, Igor
• Format: Article
• Language: English
• Subjects: Bacteria; Child; Humans; Immunization; Immunotherapy; Medical research; Pneumonia, Staphylococcal - prevention & control; Pneumonia, Staphylococcal - therapy; Randomized Controlled Trials as Topic; Staphylococcal Vaccines - supply & distribution; Staphylococcus aureus - immunology; Staphylococcus infections; Streptococcus infections; Treatment Outcome; Vaccines
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/1471-2458-11-S3-S27

Staphylococcus aureus is a commensal of human skin and nares. It is also one of the leading nosocomial pathogens in both developed and developing countries and is responsible for a wide range of life threatening infections, especially in patients who are immunocompromised, post-surgery, undergoing haemodialysis and those who are treated with catheters and ventilators. Over the past two decades, the incidence of nosocomial staphylococcal infections has increased dramatically. Currently there are at least seven vaccine and immunotherapy candidates against S. aureus in the developmental phase targeting both active and passive immunization. We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging vaccines against Staphylococcus aureus relevant to several criteria of interest: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies) to participate. The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to sensitive nature of their involvement in such exercises. They answered questions from CHNRI framework and their "collective optimism" towards each criterion was documented on a scale from 0 to 100%. The panel of experts expressed low levels of optimism (score around or below 50%) on the criteria of answerability, efficacy, maximum disease burden reduction potential, low cost of production, low cost of implementation and affordability; moderate levels of optimism (scores around 60 to 80%) that these vaccines could be developed at a low cost, and thus on the deliverability, sustainability and impact on equity; and high levels of optimism (scores above 80%) regarding acceptable of such a product to both the end-users and health workers. While assessing the candidates for passive immunization against S.aureus, the experts were poorly optimistic regarding low production cost, low implementation cost, efficacy, deliverability, sustainability, affordabil