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12 : Conjugate Vaccines as Probes To Define the Burden of Pneumococcal and Type b Pneumonia as Well as the Role of Viruses in the Pathogenesis of Pneumonia

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Conjugate Vaccines as Probes To Define the Burden of Pneumococcal and Type b Pneumonia as Well as the Role of Viruses in the Pathogenesis of Pneumonia, Page 1 of 2

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Abstract:

The burden of pneumonia prevented by conjugate pneumococcal vaccine may be underestimated by consideration only of the vaccine impact against X-ray-confirmed pneumonia. An analyses of the South African data suggest that the burden of disease prevented, or vaccine-attributable reduction (VAR) in disease burden, is higher against clinically confirmed pneumonia than against X-ray-confirmed disease. The impact of type b (Hib) conjugate vaccine on pneumonia in HIV-infected children has not been established, although the vaccine has activity against invasive Hib disease in these children similar to that of pneumococcal conjugate. There is abundant evidence that conjugate pneumococcal vaccines reduce the carriage of vaccine serotypes and in that way reduce the burden of invasive disease in the elderly. By inference, therefore, the vaccine should prevent both bacteremic and nonbacteremic pneumococcal pneumonia by herd immunity. A consistent finding in studies of pediatric viral pneumonia has been evidence of bacterial coinfection. The mechanism of the interaction may be as varied as the synergy between the pneumococcus and the influenza virus on apoptosis of neutrophils; virus-induced interleukin-1 and tumor necrosis factor upregulation of the platelet-activating factor receptor, which mediates bacterial invasion; or the influenza virus strain neuraminidase activity, which degrades mucin and enhances secondary pneumococcal pneumonia in mice. The vaccine probe approach allows direct investigation of the concurrence of bacterial and viral pathogens in children with pneumonia. Children (and possibly adults) hospitalized with presumed viral pneumonia require antibiotics, even if the bacterial superinfection cannot be confirmed by culture.

Citation: Klugman K, Madhi S. 2007. Conjugate Vaccines as Probes To Define the Burden of Pneumococcal and Type b Pneumonia as Well as the Role of Viruses in the Pathogenesis of Pneumonia, p 215-224. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch12
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Tables

Generic image for table
Table 1.

Conjugate vaccine studies as probes of X-ray confirmed bacterial pneumonia etiology

Citation: Klugman K, Madhi S. 2007. Conjugate Vaccines as Probes To Define the Burden of Pneumococcal and Type b Pneumonia as Well as the Role of Viruses in the Pathogenesis of Pneumonia, p 215-224. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch12
Generic image for table
Table 2.

Data from a South African trial analyzed using procalcitonin and CRP

Citation: Klugman K, Madhi S. 2007. Conjugate Vaccines as Probes To Define the Burden of Pneumococcal and Type b Pneumonia as Well as the Role of Viruses in the Pathogenesis of Pneumonia, p 215-224. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch12
Generic image for table
Table 3.

Estimated efficacies of a nine-valent pneumococcal conjugate vaccine in preventing pneumococcal pneumonia in hospitalized HIV-infected and non-HIV-infected children, by analysis

Citation: Klugman K, Madhi S. 2007. Conjugate Vaccines as Probes To Define the Burden of Pneumococcal and Type b Pneumonia as Well as the Role of Viruses in the Pathogenesis of Pneumonia, p 215-224. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch12
Generic image for table
Table 4.

Percentage efficacies of pneumococcal conjugate vaccine by per-protocol analysis in fully immunized infants

Citation: Klugman K, Madhi S. 2007. Conjugate Vaccines as Probes To Define the Burden of Pneumococcal and Type b Pneumonia as Well as the Role of Viruses in the Pathogenesis of Pneumonia, p 215-224. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch12

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