Journal Article

The Impact of a 9-Valent Pneumococcal Conjugate Vaccine on the Public Health Burden of Pneumonia in HIV-Infected and -Uninfected Children

Shabir A. Madhi, Locadiah Kuwanda, Clare Cutland and Keith P. Klugman

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 40, issue 10, pages 1511-1518
Published in print May 2005 | ISSN: 1058-4838
Published online May 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/429828
The Impact of a 9-Valent Pneumococcal Conjugate Vaccine on the Public Health Burden of Pneumonia in HIV-Infected and -Uninfected Children

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Introduction

Pneumococcal conjugate vaccine (PnCV) may be used as a probe to define the burden of pneumococcal disease and better characterize the clinical presentation of pneumococcal pneumonia.

Methods

This study used a 9-valent PnCV to define different end points of vaccine efficacy and the preventable burden of pneumococcal pneumonia in 39,836 children who were randomized in a double-blind, placebo-controlled trial in South Africa.

Results

Whereas the point-estimate of vaccine efficacy was greatest when measured against the outcome of vaccine-serotype specific pneumococcal bacteremic pneumonia (61%; P = .01), the sensitivity of blood culture to measure the burden of pneumococcal pneumonia prevented by vaccination was only 2.6% in human immunodeficiency virus (HIV)-uninfected children and 18.8% in HIV-infected children. Only 37.8% of cases of pneumococcal pneumonia prevented by PnCV were detected by means of chest radiographs showing alveolar consolidation. A clinical diagnosis of pneumonia provided the best estimate of the burden of pneumococcal pneumonia prevented through vaccination in HIV-uninfected children (267 cases prevented per 100,000 child-years) and HIV-infected children (2573 cases prevented per 100,000 child-years).

Conclusion

Although outcome measures with high specificity, such as bacteremic pneumococcal pneumonia, provide a better estimate as to vaccine efficacy, the burden of disease prevented by vaccination is best evaluated using outcome measures with high sensitivity, such as a clinical diagnosis of pneumonia.

Journal Article.  4844 words. 

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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