Defining the burden of pneumonia in children preventable by vaccination against Haemophilus influenzae type b
Defining the burden of pneumonia in children preventable by vaccination against Haemophilus influenzae type b
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DOI：
10.1097/00006454-199912000-00006
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发表时间：
1999-12-01
影响因子：
3.6
通讯作者：
Levine, MM
中科院分区：
文献类型：
--
作者：
Levine, OS;Lagos, R;Levine, MM
目标。确定通过b型流感嗜血杆菌（Hib）疫苗接种可预防的婴幼儿肺炎住院负担。设计：随机选择智利圣地亚哥的疫苗接种中心，接种PRP-T、Hib结合疫苗、白喉-破伤风-百日咳（DTP）联合疫苗或单独接种DTP疫苗。接受大于或等于2剂百白破或百白破和Hib结合疫苗联合接种的婴儿，主要结果测量。肺炎发作导致住院，并伴有可能的细菌感染指标，包括肺泡实变或胸腔积液的放射学证据，红细胞沉降率升高（大于或等于40 mm/h）或听诊支气管呼吸音。结果，在4至23个月的参与者中，PRP-T将肺泡实变或胸腔积液相关肺炎的发生率降低了22%(95%置信区间，-7至43)，每1000名儿童每年发作5.0至3.9次。当肺炎病例定义包括以下任何一项时，肺泡实变，胸腔积液，红细胞沉降率大于或等于40mm /h或支气管呼吸音，PRP-T提供26%的保护（95%置信区间，7至44），每年每1000名儿童预防2.5次发作，结论。Hib疫苗对非菌源性肺炎提供实质性保护，特别是那些有肺泡实变、胸腔积液或其他可能的细菌感染迹象的病例。Hib疫苗预防的婴儿非菌源性肺炎病例是脑膜炎病例的5倍，这表明Hib疫苗接种的大部分效果可能无法通过常规培养方法检测到。
Objectives. To determine the burden of pneumonia requiring hospitalization in infants and young children preventable by vaccination against Haemophilus influenzae type b (Hib).Design, Vaccination centers in Santiago, Chile, were randomly selected to administer PRP-T, an Hib conjugate vaccine, combined with diphtheria-tetanus toxoids-pertussis (DTP) vaccine or DTP alone.Subjects. Infants who received greater than or equal to 2 doses of DTP or DTP and Hib conjugate vaccine combined,Main outcome measures. Pneumonia episodes leading to hospitalization accompanied by indicators of likely bacterial infection including radiologic evidence of alveolar consolidation or pleural effusion, an elevated erythrocyte sedimentation rate (greater than or equal to 40 mm/h) or bronchial breath sounds on auscultation,Results, In participants age 4 to 23 months, PRP-T reduced the incidence of pneumonia associated with alveolar consolidation or pleural effusion by 22% (95% confidence interval, -7 to 43) from 5.0 to 3.9 episodes per 1000 children per year. When the pneumonia case definition included any of the following, alveolar consolidation, pleural effusion, erythrocyte sedimentation rate greater than or equal to 40 mm/h or bronchial breath sounds, PRP-T provided 26% protection (95% confidence interval, 7 to 44) and prevented 2.5 episodes per 1000 children per year,Conclusions. Hib vaccine provides substantial protection against nonbacteremic pneumonia, particularly those cases with alveolar consolidation, pleural effusion or other signs of likely bacterial infection. Hib vaccination prevented similar to 5 times as many nonbacteremic pneumonia cases in infants as meningitis cases, thus indicating that the largest part of the effect of Hib vaccination might be undetectable by routine culture methods.