MAJOR CHILDHOOD KILLER "ALMOST NEUTRALISED" IN KENYA

9 August 2006

H. influenzae type b is one of the developing world's major childhood killers, responsible for half a million deaths and 3 million episodes of serious disease a year among children. Now, researchers at the Kenya Medical Research Institute–Wellcome Trust Research Programme (KEMRI-WT) in Kenya have proven that vaccination programmes can be much more effective than previously thought, and are working with the Ministry of Health in Kenya to tackle the disease. The research is presented today in JAMA, the Journal of the American Medical Association.

The disease, known as Hib, causes meningitis and pneumonia in infants and young children and is responsible for 5 per cent of hospital deaths in Kilifi, Kenya. However, difficulties in diagnosing the disease, coupled with the cost of vaccination programmes, have meant that most governments in Africa have been reluctant to fund vaccination programmes. Hib is detectable only by blood culture or CSF culture (cerebrospinal fluid, the clear fluid that circulates in the space surrounding the spinal cord), and such investigations are not routinely carried out in hospital laboratories in Africa.

Despite these difficulties, the Ministry of Health in Kenya introduced Hib vaccine into the routine childhood immunisation programme in 2001. Researchers in Kilifi have shown that this has reduced the incidence of Hib by 88 per cent among children under five. As a result, the Ministry of Health in Kenya has decided to sustain the vaccination programme originally funded by the Global Alliance for Vaccines and Immunization.

The research was led by the University of Oxford's Dr Anthony Scott, funded by a Wellcome Trust Research Career Development Fellowship in Clinical Tropical Medicine.

"The results of the vaccination programme have been highly successful and Hib has been almost neutralised in Kilifi," says Dr Scott. "This is one of those studies where the policy implications of the results are clear and unambiguous, and Kenya's Ministry of Health has made an important and decisive policy decision on the basis of this research and associated cost-effectiveness calculations."

"It is very clear from the study at the Kenya Medical Research Institute that an infant vaccination programme against Hib will help us tackle a very serious childhood killer," says Dr Shahnaaz Sharif, Deputy Director of Medical Services in Kenya. "The Kenyan Ministry of Health fully supports such a programme and will ensure its implementation across the country."

The study took place over six years in Kilifi following Hib infections before and after introduction of the vaccine in 2001. The Global Alliance for Vaccines and Immunization provided the vaccine free to Kenya and 11 other African countries for five years. From next year, countries are being asked by the Alliance to contribute to vaccine costs.

"Because of the inherent problems surrounding diagnosis of Hib and the fact that hospitals do not routinely screen for the disease, most governments in Africa are sceptical about the burden of the disease and are lukewarm about sustaining the vaccine programme," says Dr Scott. "We sincerely hope that Kenya's decision to sustain the vaccine programme will carry other nations in the region in the same direction."

KEMRI-WT is one of the Wellcome Trust's Major Overseas Programmes, carrying out vital research on diseases that cause high levels of mortality in the tropics. Over the past five years, the Trust has spent approximately 10 per cent of its funds supporting research and capacity building in developing and restructuring countries, and in 2005 spent £50 million on directly funded international grants.

"The response of the Ministry of Health in Kenya to the study by Dr Scott and his team is very important," says Dr Mark Walport, Director of the Wellcome Trust. "The study offers huge potential in tackling one of Africa's less well known but still very serious childhood killers. I hope Kenya's decision to implement the findings will encourage other governments in the region to make the financial commitment to continue with their vaccination programmes."

Contact

Craig Brierley
Media Officer
Wellcome Trust
T +44 (0)20 7611 7329
E c.brierley@wellcome.ac.uk

Notes for editors

1. The Wellcome Trust is the most diverse biomedical research charity in the world, spending about £450 million every year both in the UK and internationally to support and promote research that will improve the health of humans and animals. The Trust was established under the will of Sir Henry Wellcome, and is funded from a private endowment, which is managed with long-term stability and growth in mind.

2. The Hib Initiative – last year the Global Alliance for Vaccines and Immunization launched a US$37 million programme called the Hib Initiative, which comprises infectious disease experts from Johns Hopkins Bloomberg School of Public Health, the London School of Hygiene and Tropical Medicine, the US Centers for Disease Control and Prevention (CDC), and the World Health Organization. An estimated 3.1 million cases of Hib disease occur each year in children under the age of five, resulting in approximately 400 000 deaths.

3. JAMA, published continuously since 1883, is an international peer-reviewed general medical journal published 48 times per year. It is the most widely circulated medical journal in the world, and is published in multiple international editions and languages.

4. The KEMRI-Wellcome Trust Research Programme – based at two sites –in Kilifi on the Kenyan coast, north of Mombassa, and in the grounds of Kenyatta Hospital in Nairobi –the Programme is part of the Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Research, Coast.

Research studies in Kilifi focus on clinical, basic and epidemiological aspects of malaria and other diseases of childhood, while work in Nairobi targets the pharmacology and therapeutics of anti-malarial drugs, as well as malaria epidemiology, control and health policy.

The Programme is a base for training clinical and basic scientists with a commitment to health research in Kenya and the East African region.

The Programme works in collaboration with KEMRI, and is part of KEMRI's Centre for Geographic Medicine Research, Coast, headed by Dr Norbert Peshu. It also collaborates and works closely with the Kenyan Ministry of Health. The Programme's researchers interact extensively with regional and international networks of researchers on malaria and other diseases endemic in Kenya.

The Programme has direct collaborative links with the University of Oxford, the Institute of Child Health (London), Liverpool University and School of Tropical Medicine, and London School of Hygiene and Tropical Medicine.