The Fiji Pneumococcal Project that has been funded by NIH has been designed to provide all the information necessary to facilitate the early introduction of infant pneumococcal immunization into Fiji, a small developing country in the Pacific. The project has evaluated the burden of pneumonia, otitis media and pneumococcal meningitis in Fijian infants. This information, along with the results of a new study of the outcome of pneumococcal meningitis that is included with this application, will be used to build the economic argument for pneumococcal immunization. The vaccine trial will evaluate the impact of one, two or three doses of pneumococcal conjugate vaccine in infancy followed by a dose of pneumococcal polysaccharide vaccine at six or nine months of age on pneumococcal immunity, nasopharyngeal carriage of pneumococci and responses to a small dose of pneumococcal polysaccharide at 15 months of age. The trial has been delayed due to lack of availability of Prevenar, and additional costs incurred by this delay and improvements that have been made in the study design are included in this application. The results of this trial will guide pneumococcal immunization in the developing world. Since this trial was funded, similar studies have been commissioned by WHO but neither have yet commenced. In preparation for a future effectiveness study, involving the whole of Fiji, using the regimen determined to be most appropriate based oh the current study, and evaluating both the direct effectiveness of immunization (on vaccine recipients), and the indirect effectiveness or herd immunity effect (on older children and adults), a study of the etiology and epidemiology of pneumonia in all age groups in Fiji is also proposed. The results of this study will form the basis of an effectiveness evaluation following the pilot introduction of pneumococcal immunization into Fiji in 3-5 years time. ? ?
