Reply to Anderson and Caniza.
Reply to Anderson and Caniza.
复制标题
回复安德森和卡尼萨。
DOI：
10.1093/cid/ciaa1628
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Kelly,MatthewS
中科院分区：
文献类型：
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作者：
Congdon,Morgan;Arscott-Mills,Tonya;Kelly,MatthewS
致编辑：我们感谢Anderson和Caniza的来信，感谢他们对我们关于b型流感嗜血杆菌和13价肺炎球菌结合疫苗对博茨瓦纳儿童肺炎住院和死亡的影响的文章感兴趣。他们强调，在我们的研究中，尽管引入了这些疫苗，但感染人类免疫缺陷病毒（HIV）的母亲的孩子肺炎死亡率仍然很高。作者还对2019年冠状病毒病（COVID-19）大流行对免疫和其他儿童健康规划的影响表示关切，并指出这些服务的中断可能对感染艾滋病毒母亲的子女的健康尤其有害。作为致力于改善博茨瓦纳和其他低收入和中等收入国家儿童健康的儿科医生，我们也有这些关切，并同意有必要采取协调一致的行动，以防止这些国家最近在健康方面取得的进展出现逆转。感染艾滋病毒的儿童和艾滋病毒暴露、未感染（HEU）儿童的感染发病率和死亡率都高于未感染艾滋病毒（未暴露）母亲的儿童。特别是，先前的研究表明，这种超额死亡率大部分是由肺炎引起的[3-6]。尽管许多因素导致了他们的高感染风险，但HIV儿童和HEU儿童对几种常见的儿童病原体（包括乙型流感嗜血杆菌和肺炎链球菌）的母体抗体水平较低[7,8]。然而，在常规疫苗接种后，感染艾滋病毒的儿童和高浓血症儿童对这些病原体产生了强大的抗体反应，这说明了在博茨瓦纳和其他艾滋病毒高流行地区优先为这些弱势群体提供疫苗接种服务的重要性。COVID-19大流行对世界卫生组织（世卫组织）、联合国儿童基金会和全球疫苗和免疫联盟产生了重大影响，据估计，在大流行期间，8000多万1岁以下儿童的常规免疫服务可能会中断。在许多低收入和中等收入国家，由于将工作人员和资源重新分配给COVID-19的防范和应对工作，儿童健康项目长期资金不足的问题已经加剧[9-11]。国家边境的关闭中断了疫苗供应链，个人防护设备的短缺阻碍了提供常规疫苗接种服务的能力。在博茨瓦纳，公共诊所制定了额外的安全预防措施，并提供疫苗和其他必要的儿童保健服务
To the Editor—We thank Anderson and Caniza for their letter and interest in our article on the impact of Haemophilus influenzae type b and 13-valent pneumococcal conjugate vaccines on child pneumonia hospitalizations and deaths in Botswana [1]. They highlight the continued high pneumonia mortality among children of mothers with human immunodeficiency virus (HIV) in our study despite introduction of these vaccines. The authors also express concern about the effect of the coronavirus disease 2019 (COVID-19) pandemic on immunization and other child health programs, noting that disruptions of these services may be particularly detrimental to the health of children of mothers with HIV. As pediatricians working to improve the health of children in Botswana and other low-and middle-income countries (LMICs), we share these concerns and agree that concerted action is necessary to prevent a reversal of the recent health gains experienced in these countries. Both children with HIV and HIV-exposed, uninfected (HEU) children have higher infectious morbidity and mortality than the children of mothers without HIV (unexposed)[2]. In particular, prior studies suggest that much of this excess mortality results from pneumonia [3–6]. Although a number of factors contribute to their high infection risk, children with HIV and HEU children acquire lower levels of maternal antibodies to several common childhood pathogens, including H. influenzae type B and Streptococcus pneumonia [7, 8]. However, children with HIV and HEU children generate robust antibody responses to these pathogens following routine vaccination, illustrating the importance of prioritizing these vulnerable groups for vaccination services in Botswana and other settings with high HIV prevalence. The COVID-19 pandemic has a substantial impact on the World Health Organization (WHO), the United Nations Children’s Fund, and the Global Alliance for Vaccines and Immunizations estimate that routine immunization services could be disrupted for more than 80 million children aged< 1 year during the pandemic [9]. In many LMICs, chronic underfunding of child health programs has been exacerbated as staff and resources have been reallocated to COVID-19 preparedness and response efforts [9–11]. Closures of country borders have interrupted vaccine supply chains, and personal protective equipment shortages have hindered the ability to offer routine vaccination services [11]. In Botswana, public clinics instituted additional safety precautions and provided vaccines and other essential child health