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LCQ6: Pneumococcal diseases
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    Following is a question by the Hon Audrey Eu and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (January 30):

Question:

     It has been learnt that children aged below two and elderly people aged above 65 are highly susceptible to invasive pneumococcal diseases (PD). On average, about 20 people suffering from various serious complications caused by Streptococcus pneumoniae were taken to public hospitals each year between 2000 and 2004, and nine children aged below five even died of the diseases. In this connection, will the Government inform this Council:

(a)  as a medical research has pointed out that the inclusion of pneumococcal vaccines in the local childhood immunisation programme (CIP) will bring about herd immunity, which can effectively reduce the risk of family members and other people who have not been vaccinated contracting PD, and the Department of Health is conducting, in collaboration with the Hospital Authority and the Li Ka Shing Faculty of Medicine of the University of Hong Kong, a study on the effectiveness of the vaccine in preventing elderly people from contracting such pneumonia, whether the study has considered the effect of herd immunity; if not, of the reasons for that;

(b)  since a local university was commissioned in early 2006 to carry out a study on the possibility of incorporating pneumococcal vaccines in the local CIP, when the study is expected to be completed and the Government's subsequent specific work plans; and

(c)  given that quite a number of international health care organisations are increasingly concerned about PD, for instance, the World Health Organisation released in March last year the global position paper suggesting that priority be accorded to including pneumococcal conjugate vaccines in national immunisation programmes, whether the Government will include the vaccine in the local CIP to address the international community's expectation; if it will, when it will be implemented; if not, the reasons for that?

Reply:

Madam President,

     According to data from the findings of Streptococcus pneumoniae isolation conducted by laboratories in all public hospitals under the Hospital Authority (HA) in Hong Kong between 2000 and 2004 on blood, cerebrospinal fluid and samples from other sterile body sites, average incidence rate of invasive pneumococcal diseases among children aged below two and elderly aged above 65 is 7.7 per 100 000 population per year. In the same period, a total of nine children aged below five were recorded to have died from complications caused by Streptococcus pneumoniae.

     Currently, two pneumococcal vaccines are available on the market, namely the 7-valent polysaccharide-protein conjugate vaccine (PCV-7) and the 23-valent pneumococcal polysaccharide vaccine (23vPPV). PCV-7 is recommended for use by infants aged six weeks to children aged five years. 23vPPV is not suitable for use by children aged below two, and is generally recommended for older children and adults.

     The Department of Health (DH) is currently conducting two studies on pneumococcal vaccines. One is the study mentioned in part (a) of the question conducted in collaboration with HA and the Li Ka Shing Faculty of Medicine of the University of Hong Kong, which evaluates the efficacy of 23vPPV. As mentioned in part (b) of the question, DH has commissioned a local university to conduct another study on the cost-effectiveness of incorporating PCV-7 into the Child Immunisation Programme.

     I will now respond to each part of the question.

(a)  Overseas studies point out that the vaccination of children with PCV-7 will provide indirect protection to people who have not been vaccinated (e.g. the elderly), i.e. the effect of herd immunity. The objective of the study being conducted by DH in collaboration with HA and the Li Ka Shing Faculty of Medicine of the University of Hong Kong focuses on the comparison of the incidence and mortality rates between elderly aged over 65 with chronic illness who have received 23vPPV vaccination and those who have not. Therefore, the effect of herd immunity brought about by children vaccinated with PCV-7 is not within the scope of the study.

(b)  The study on the cost-effectiveness of incorporating pneumococcal vaccines in the Childhood Immunisation Programme is expected to complete in the first quarter of this year, and the findings will be submitted to the Secretariat of the Research Fund for the Control of Infectious Diseases. The Scientific Committee on Vaccine Preventable Diseases (the Committee) under the Centre for Health Protection (CHP) of DH will study the findings and make recommendations to DH's CHP regarding the pneumococcal vaccines. The Government will make a decision having regard to the recommendations of the Committee and various factors.

(c)  We note the World Health Organisation (WHO) position paper issued in March 2007 on pneumococcal vaccines. In view of the global situation of pneumococcal infections and having considered the safety and efficacy of PVC-7 for children, WHO considers that countries where over 50 children die before the age of five per 1 000 live births should make the introduction of pneumococcal vaccine a high priority for their childhood immunisation programmes. According to the data of DH, between 2000 and 2004, about 3.4 children died before the age of five per 1 000 live births in Hong Kong. Furthermore, WHO considers that countries with more than 50 000 deaths annually among children aged under five should also make the introduction of pneumococcal vaccine a high priority for their childhood immunisation programmes. Between 2000 and 2004, the number of children died before the age of five in Hong Kong ranges from about 140 to 210 every year. During the same period, only one to four children in Hong Kong died from complications caused by Streptococcus pneumoniae every year.

     In considering whether to include a new vaccine in the Childhood Immunisation Programme, DH needs to take into account a number of scientific factors, including epidemiology (such as incidence and mortality rates); disease burden; the safety, efficacy, side effects, cost-effectiveness and adequacy of supply of the vaccine, etc. The acceptance of the vaccine by the public, the availability of other preventive measures and the administrative arrangements for vaccination are also key factors for consideration. The Government will take the above factors into account objectively in considering whether to include the pneumococcal vaccines in the local Childhood Immunisation Programme.

Ends/Wednesday, January 30, 2008
Issued at HKT 15:12

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