Infant Immunization to Reduce Pneumonia in HIV +ve women

婴儿免疫接种可减少艾滋病毒 ve 妇女的肺炎

• 批准号: 6778684
• 负责人: JAMES W. CURRAN
• 金额: $ 30.7万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6778684
• 关键词: Infant; Immunization; Reduce; Pneumonia; HIV

DESCRIPTION (provided by applicant): Pneumonia is the leading cause of hospitalization of HIV-positive adults in Soweto, South Africa, where 30% of the population is HIV-positive. Streptococcus pneumoniae is implicated in the etiology of up to 46% of pneumonia episodes in HIV-positive adults in Africa, and the 23-valent pneumococcal vaccine appears ineffective and possibly deleterious to the health of African HIV-positive adults not receiving antiretroviral therapy. Data from a recently completed prospective randomized trial of a conjugate pneumococcal vaccine among 39,836 children in Soweto has demonstrated a 72% efficacy of this vaccine in preventing vaccine type invasive pneumococcal disease (IPD) and a 17% reduction in all pneumonia in these children. A similar vaccine, given to children in the United States, has recently been demonstrated to reduce IPD in adults by means of a herd immunity effect. The vaccine is thought to interrupt transmission of vaccine serotypes (pediatric serotypes) from children to adults. The effectiveness of this approach to prevent IPD (and possibly non-bacteremic pneumococcal pneumonia) depends on the fraction of pediatric serotypes causing invasive disease in adults. The research team has demonstrated that conjugate pneumococcal vaccines interrupt transmission of pediatric serotypes in children in Soweto. It has also shown there to be a significantly increased risk of pediatric serotypes causing IPD in HIV-positive adults (and particularly in women) in Soweto. This proposal's objective is to determine whether pneumococcal conjugate vaccination of infants will reduce the burden of pneumococcal disease in HIV-positive women. This objective will be met by first (Specific Aim 1) investigating retrospectively whether IPD and pneumonia were reduced in the mothers of 19,922 children vaccinated compared to 19,914 controls enrolled in the previous pediatric vaccine trial. The extent of herd immunity induced by that trial may, however, be expected to be limited. A prospective study (Specific Aim 2) will ascertain the vaccine preventable burden of IPD and pneumonia in 2,000 adults in the community prior to the routine introduction of pneumococcal conjugate vaccination in infants in order to assess the impact of that intervention on IPD and pneumonia in HIV-positive women.

描述（由申请人提供）：肺炎是南非索维托的HIV阳性成年人住院的主要原因，那里有30％的人口为HIV阳性。肺炎链球菌与非洲的HIV阳性成年人中多达46％的肺炎发作有关，而23名价值的肺炎球菌疫苗似乎无效，并且可能对非洲HIV阳性成人的健康疾病无效，这可能是无效的。来自Soweto的39,836名儿童中结合肺炎球菌疫苗的最近完成的前瞻性随机试验的数据表明，该疫苗在预防疫苗类型的疫苗类型肺炎球菌疾病（IPD）方面具有72％的疗效，这些儿童的所有疫苗降低了17％。最近已证明一种类似的疫苗是给美国儿童的，可以通过群豁免效应来减少成人的IPD。人们认为该疫苗会中断疫苗血清型（小儿血清型）从儿童到成人的传播。这种方法可预防IPD（以及可能非细菌性肺炎球菌肺炎）的有效性取决于儿科血清型的比例，从而导致成人侵入性疾病。 研究小组已经证明，索韦托儿童儿童血清型的共轭肺炎球菌疫苗中断。它还表明，索韦托的HIV阳性成年人（尤其是女性）的小儿血清型风险显着增加。该提议的目标是确定婴儿的肺炎球菌结合疫苗接种是否会减轻HIV阳性妇女肺炎球菌疾病的负担。首先（特定目标1）将回顾性地研究IPD和肺炎在19,922名儿童接种疫苗的母亲中，而在先前的儿科疫苗试验中招募的19,914例对照组中，将实现这一目标。然而，该试验引起的群豁免的程度可能会受到限制。一项前瞻性研究（特定目标2）将确定在社区中有2,000名成年人的IPD和肺炎的疫苗可预防的负担，然后在常规引入婴儿中肺炎球菌结合疫苗接种疫苗，以评估该干预措施对HIV阳性妇女中IPD和肺炎的影响。