A Comment from the Coordinator, Announcements, Deep Breaths blog post by Dr. Eric McCollum, Upcoming events, and PIN Member and Partner Updates for May 2018.
A Comment from the Coordinator
BIG NEWS: Published in The New England Journal of Medicine, April 26, 2018: Can four twice-yearly mass distributions of oral azithromycin administration have an effect on child mortality? MORDOR study researchers have shown through a cluster-randomized trial in communities in Malawi, Niger, and Tanzania that “among post-neonatal, preschool children in sub-Saharan Africa, childhood mortality is lower in communities randomly assigned to mass distribution of azithromycin than in those assigned to placebo.” The implications of these results showing a significant reduction in child death via routine antibiotic administration could be groundbreaking. This is a big deal. Access the article here!
UNITAID has announced a call for proposals on Better tools for integrated management of childhood fever! The deadline for proposal submission is August 17, 2018 at 12:00 noon CET. View the press release here.
Deep Breaths: Blogs from Network Members
The missing fifth vital sign
by Eric D. McCollum, MD
The medical axiom “vital signs are vital” infers that vital signs are the foundation for delivering high quality pediatric clinical care. And they are. Vital signs traditionally include the four measurements of body temperature, heart rate, respiratory rate, and blood pressure. However, over the past several decades a fifth vital sign has emerged, oxygen saturation.
Oxygen is an essential molecule for the body and when abnormally low in the bloodstream it is called hypoxemia. Hypoxemia is a serious and life threatening condition for children. A portable device called a pulse oximeter can quickly and non-invasively estimate the proportion of hemoglobin within arterial red blood cells saturated with oxygen, the most common method for oxygen transportation throughout the body. Pulse oximeters typically include three parts, a microprocessor, a probe that fits on the finger or toe, and a cable to connect the two. Pulse oximeters work by utilizing complex software and rapidly cycling light-emitting diodes and detectors within the probe that altogether, usually within a few seconds, calculate the ratio of unabsorbed light during normal blood flow. This ratio in turn estimates the relative proportion of hemoglobin with and without oxygen, the oxygen saturation.
In children the oxygen saturation is most often low when ill with advanced respiratory diseases, like pneumonia. While in low-income settings pneumonia is a leading cause of pediatric mortality, and is responsible for the vast majority of children with hypoxemia, pulse oximeters are infrequently available despite decades of routine use in high-income settings. More recently the World Health Organization reclassified oxygen, the standard life-saving treatment for hypoxemia, as an essential medicine. Pulse oximeters are also well accepted to be more accurate than clinical signs for detecting hypoxemia. So why are pulse oximeters not in routine use during pediatric care in low-income settings?
In short, the answer is due to a lack of high quality, durable, reusable, low-cost pulse oximeters suitable for pediatric use in low-income settings. While measuring an oxygen saturation with a pulse oximeter usually takes less than one minute, children can pose unique measurement challenges. Children are often anxious and moving during measurements, and this can create movement artifact. They can also be cold or dehydrated and therefore have poor peripheral blood flow in their fingers, hands, toes, and feet. Furthermore, children, and especially infants, are physically smaller such that reusable pulse oximeter probes do not fit properly on all children, necessitating the use of multiple, usually costly, specialty pediatric probes targeting different sizes and ages of children. All of these scenarios can decrease the accuracy of the oxygen saturation measurement and/or increase the amount of time required to obtain the value. Along with high costs, a lack of device durability in demanding clinical environments, and insufficient training and supervisory support, these challenges have created barriers to routine pediatric pulse oximetry use in low-income settings.
Lifebox Foundation, a non-profit organization based in the United Kingdom, has been working since 2011 to distribute quality, affordable pulse oximeters to resource-limited hospitals in an effort to improve surgical safety. To date Lifebox has disseminated more than 16,000 pulse oximeters throughout low-income settings globally. In a recent project sponsored by the Bill and Melinda Gates Foundation, Lifebox stepped forward to address the pediatric pulse oximeter gap in low-income settings by designing an innovative, low-cost, robust, reusable, universally fitting pulse oximeter probe for children of all ages. The device is nearly ready for implementation.
The Lifebox probe has a novel extended clip sensor with its optics, which produce and measure unabsorbed light wavelengths, located near the probe hinge rather than the traditional position at the distal end of the sensor. This design allows stable fitting of the probe on the child’s big toe and moves the cable away from the patient so it doesn’t obstruct the probe fit. The inclusion of soft, comfortable silicone pads on the probe allow it to grasp the foot while placing the optics over the toe, all of which minimizes movement artifact. The soft pads also enhance comfort and allow placement of the probe across the smaller foot of newborns and older neonates. The design is consistent enough to a conventional finger sensor that it can be used on fingers also. Thus, the probe comfortably and securely fits children of all ages. The device has achieved CE marking and successfully undergone extensive usability testing in Malawi, Bangladesh, and the United Kingdom on more than 1,300 pediatric measurements. The results of which have been presented at the 11th International Symposium on Pneumococci and Pneumococcal Diseases in Melbourne, Australia and are expected to be published mid-2018. Lifebox intends to make the probe available, together with an upgraded oximeter box and microprocessor, later in 2018. The price of the device is planned to be less than $250 USD, which includes shipping anywhere in the world.
Other ongoing innovative projects by Phillips and Masimo are also aiming to address the lack of appropriate pediatric pulse oximeters in low-income settings. Taken together the future for routine oxygen saturation measurements, the missing fifth vital sign in low-income settings, is looking far brighter for children throughout the world in 2018 and beyond. Vital signs are vital, and this includes measuring the oxygen saturation in children no matter where they live.
Please visit the following link for a video on the new Lifebox probe: https://vimeo.com/237773270.
Dr. Eric McCollum is an Assistant Professor at Johns Hopkins School of Medicine, Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, Baltimore, United States. He has a joint appointment at Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, United States and he is the Director of Johns Hopkins University Global Program in Pediatric Respiratory Sciences in Maseru, Lesotho.
World Immunization Week, APRIL 24 – 30, 2018.
World Immunization Week aims to highlight the collective action needed to ensure that every person is protected from vaccine-preventable diseases. This year’s theme: “Protected Together, #VaccinesWork”, encourages people at every level – from donors to the general public – to go further in their efforts to increase immunization coverage for the greater good.
Find out more at: http://www.who.int/campaigns/immunization-week/2018/en/
36th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID).
Malmö, Sweden. May 28 – June 2, 2018.
Building on the success and innovation of previous meetings, ESPID 2018 will feature a wide range of sessions and learning opportunities showcasing the latest research and developments in the field hosted by leading international experts.
Register to attend here.
Pneumonia Innovations Network Member and Partner Updates
University of Southampton releases R&D spending analysis
Michael Head and team from the University of Southampton took the opportunity at the Commonwealth Heads of Government Meeting to launch the first analysis of pneumonia R&D spending. Please read the analysis, “Sizing Up Pneumonia Investment.” It finds that pneumonia attracts just 3% of all infectious disease R&D with the entire field being held up by one donor. Michael Head explains:
"These findings from the Research Investments in Global Health study, funded by the Bill & Melinda Gates Foundation, summarizes public and philanthropic investment for pneumonia-related research by the G20 countries between 2000 and 2015. It provides analysis of investment trends over time, the geography of pneumonia research funding, and levels of investment in specific priority areas such as paediatric, antimicrobial resistance and vaccine-focused research.
Overall, $3 billion of pneumonia-related research investment is described here, covering over 2000 studies from dozens of funders. Despite the very high mortality (almost 1 million deaths per year, mostly in children aged under 5 in resource-poor settings), the volume of research into pneumonia is low, and the ‘Big Three’ of HIV, malaria and tuberculosis all receive greater levels of funding compared to their respective burden of disease. There was also little investment specifically targeted at high-burden nations in sub-Saharan Africa and Asia.
Pneumonia has been historically neglected by the global health community, and that needs to change. Our analyses inform the evidence base around resource allocation and provide a platform for further multi-disciplinary stakeholder discussions including policymakers, funders, researchers and clinicians.”
PIN at ISPPD
PIN members presented their work in various symposia and posters at the 11th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD 2018)!
WHO AFRO and The Access Challenge create toolkit to stress importance of vaccines in Africa
African Vaccination Week is this week! WHO AFRO, with support from The Access Challenge, has created a series of materials and a media toolkit in order to call to stress the importance of vaccines throughout Africa.
Children in Chad are especially vulnerable to early death (especially from pneumonia) due to lack of action from all actors. Chad is one of the few sub-Saharan African countries that has not introduced pneumococcal vaccine. The Access Challenge, with the First Lady of Chad, has created videos to spotlight Chad’s vaccination work. Feel free to share these videos for World Immunization Week!