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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The impact of a 9-valent pneumococcal conjugate vaccine on the public health burden of pneumonia in HIV-infected and -uninfected children
Clinical Infectious Diseases, Volume 40, No. 10, Year 2005
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Description
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. © 2005 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Madhi, Shabir A.
South Africa, Johannesburg
University of the Witwatersrand
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Kuwanda, Locadiah
South Africa, Johannesburg
University of the Witwatersrand
Cutland, Clare Louise
South Africa, Johannesburg
University of the Witwatersrand
Klugman, K. P.
South Africa, Johannesburg
University of the Witwatersrand
United States, Atlanta
Rollins School of Public Health
Statistics
Citations: 209
Authors: 4
Affiliations: 3
Identifiers
Doi:
10.1086/429828
ISSN:
10584838
Research Areas
Disability
Infectious Diseases
Maternal And Child Health
Study Locations
South Africa