LCQ13:Pneumococcal Conjugate Vaccine

     Following is a question by the Hon Audrey Eu and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (November 24):


     It has been reported that the Government has been administering free 7-valent Pneumococcal Conjugate Vaccine (PCV7) to eligible children since September 2009, yet PCV7 cannot confer protection against 49% of the serotypes of bacteria infecting children, including 3, 6A, 19A, 7F, 1 and 5, and the 10-valent Pneumococcal Conjugate Vaccine (PCV10) introduced as replacement since October this year merely confers protection against three more serotypes of bacteria (including 1, 5 and 7F).  Given that there has been a five-fold surge in the number of cases of serotype 19A pneumococcal infections in the neighbouring regions such as Taiwan, will the Government inform this Council:

(a) of the types and doses of pneumococcal vaccines procured by the Government and the expenditure involved in the past three years;

(b) given that there have been comments that the monitoring of pneumococcal infectious diseases in Hong Kong mainly relies on voluntary reporting by family doctors, and it is difficult for the Government to monitor the situation of serotype 19A pneumococcal infections effectively, whether the Government will consider following the practice of Taiwan by classifying pneumococcal infections as notifiable infectious diseases and requiring various healthcare institutions to notify the Government of such cases; if so, of the details; if not, the reasons for that; and

(c) given that it has been reported that the PCV10 introduced by the Government this year cannot provide protection against all types of pneumococci effectively, especially against the more life-threatening serotype 19A pneumococcus, and that the Government has switched to PCV10 because it is cheaper than PCV7, whether the Government will consider making better use of public money by abandoning the use of PCV10, which is used in Canada only, and procuring the more immunogenic 13-valent Pneumococcal Conjugate Vaccine instead, which is extensively used in the United Kingdom, the United States, Australia and various countries in Europe, so as to make up for the inadequacy in the monitoring system; if it will, of the details; if not, the reasons for that?



     Pneumococcus may cause invasive pneumococcal diseases (IPD) such as bacteraemic pneumonia, meningitis and septicaemia.  Between 2007 and 2009, 116 to 137 cases of IPD were recorded each year in Hong Kong.  More than 90 serotypes of pneumococcus have been identified so far.  Three types of pneumococcal conjugate vaccine (PCV) are available on the market for infant vaccination which respectively confer protection against seven serotypes (7-valent PCV), 10 serotypes (10-valent PCV) and 13 serotypes (13-valent PCV) of pneumococcus.  Currently, neither the World Health Organisation nor the Scientific Committee on Vaccine Preventable Diseases (SCVPD) under the Centre for Health Protection (CHP) has made any recommendation on which PCV is to be used as a priority.

(a) The Department of Health (DH) has started to provide free vaccination of 7-valent PCV to newborns born on or after July 1, 2009 since September 2009.  At the same time, the Government has launched a one-off catch-up programme for children under the age of two and born between September 1, 2007 and June 30, 2009 to receive free pneumococcal vaccination.  DH procured a total of 287,000 doses of 7-valent PVC by the end of October 2010 with an estimated expenditure of some HK$127 million.  DH also intends to procure a total of 280,000 doses of 10-valent PCV between August 2010 and July 2011 at a total cost of about HK$54.6 million.  Between August 2010 and November 10, 2010, 23,970 doses of 10-valent PCV were already procured by DH at an expenditure of some HK$4.67 million.

(b) The Government needs to consider a number of factors in determining whether a particular infectious disease should become statutorily notifiable.  These factors include the prevalence and severity of the disease or condition, outbreak potential, existence of a reliable diagnostic method, availability of effective personal or public health intervention, existence of better alternative surveillance methods, World Health Organisation's reporting requirements, potential as a biological weapon, etc.  Since the above factors vary from place to place for a given disease, different regions prescribe different lists of statutorily notifiable diseases.

     At present, DH has set up a laboratory surveillance system targeted at IPD for comprehensive surveillance of the local trend of IPD and changes in serotype replacement and antibiotic resistance, etc.  This surveillance system covers all the microbiology laboratories in public and private hospitals in Hong Kong and therefore can provide comprehensive and detailed epidemiological data of IPD in Hong Kong.  Currently, we have no plan to make pneumococcal diseases a statutory notifiable disease.

(c) According to the data from the laboratory surveillance system of CHP under DH, the number of IPD cases caused by serotype 19A pneumococcus only accounted for less than 5% of the total number of IPD cases during the period from 2007 to 2009.  At present, there is no sign of a potential outbreak of serotype 19A pneumococcus in Hong Kong.  Antibiotic sensitivity tests also indicate that serotype 19A pneumococcus is sensitive to antibiotics such as Vancomycin.

     13-valent PCV was registered in Hong Kong after the commencement of this year's Government tender exercise to procure pneumococcal conjugate vaccines whereas 7-valent PCV and 10-valent PCV were registered in Hong Kong in 2002 and 2009 respectively.  Given that the SCVPD under CHP has not made any recommendation on which PCV is to be used as a priority, it was stated in the tender document that the vaccine to be supplied must be a multi-valent PCV suitable for administering to infants aged 6 weeks to 2 years and covering at least the pneumococcal serotypes that are contained in 7-valent PCV.

     DH has replaced 7-valent PCV by 10-valent PCV since October 2010 through the Government's established tendering procedures after taking into account the cost effectiveness and the need to provide better protection for the public.

     DH will continue to take account of the recommendations of the SCVPD and the cost effectiveness of PCV for procurement of a suitable vaccine to safeguard public health.

Ends/Wednesday, November 24, 2010
Issued at HKT 16:01