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CHERG - Child Epidemiology Reference Group
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Haemophilus influenzae type b and Pneumococcal Conjugate Vaccines

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More Intervention Effect Estimate Summaries

Reference
Theodoratou E, Johnson S, Jhasss A, Madhi SA, Clark A, Boschi-Pinto C, Bhopal S, Rudan I, and Campbell H. The effect of Haemophilus influenzae type b and pneumococcal conjugate vaccines on childhood pneumonia incidence, severe morbidity and mortality.  International Journal of Epidemiology 2010 April; 39 (Suppl 1): i72-i85.

Background

  • According to a UNICEF-WHO report from 2006, over two million children die from pneumonia each year, accounting for almost one in five under-5 deaths worldwide. (1)
  • WHO recommends routine immunization programs including measles, pertussis, Haemophilus influenzae type b (Hib) conjugate and pneumococcal (PC) conjugate vaccines, in order to prevent pneumonia.
  • The majority of Global Alliance for Vaccines and Immunization (GAVI Alliance) eligible countries have now introduced Hib vaccine (http://www.hibaction.org), but the coverage of the PC vaccine is still very limited in the areas where it is needed most (2).

Intervention Effects

Hib Conjugate Vaccine on Pneumonia Morbidity 

  • Pneumonia and all-cause mortality outcomes were dropped because initial quality of evidence was very low
  • 4% (95% CI: 3, 6%) reduction in clinical pneumonia
  • 6% (95% CI: 1, 11%) reduction in clinical severe pneumonia
  • 18% (RR: 0.82, 95% CI: 0.67-1.02) reduction in radiologically confirmed pneumonia - Estimated by combining one RCT, two cRCTs and one case-control study that used systematic vaccine allocation.

Pneumococcal Conjugate Vaccines (all valent) on Pneumonia Morbidity

  • Pneumonia and all-cause mortality outcomes were dropped because initial quality of evidence was very low
  • 7% (95% CI: -2, 15%) reduction in clinical pneumonia
  • 7% (95% CI: -1, 14%) reduction in clinical severe pneumonia
  • 26% (RR:  0.74, 95% CI: 0.63-0.88) reduction in radiologically confirmed pneumonia

Intervention Recommendation

  • Findings of this review indicated that the summary effect of Hib and PC conjugate vaccines on radiologically confirmed pneumonia was 18% and26% respectively.  These estimates will be used as a severe morbidity proxy for pneumonia mortality in the LiST model.
  • Estimates of the direct effect of the vaccine should ideally be adjusted to account for the proportion of circulating pneumococci that are vaccine type; however, data on serotype distribution are currently incomplete. 
  • While one study showed a 13% reduction in radiologically confirmed pneumonia (95% CI: -7, 29%) among HIV+ children, more evidence is required to model the differential impact in HIV-affected regions.
  • Positive indirect vaccine effects are important; however, the dynamics of S. pneumonia in developing countries needs further study to delineate their potential impact.

References from Theodoratou Paper Cited Here

  1. UNICEF, World Health Organization. Pneumonia; the forgotten killer of children.  2008. http://www.unicef.org/publications/index_35626.html
  2. Rudan I, El AS, Black RE, Campbell H. Childhood pneumonia and diarrhea: setting our priorities right. Lancet Infect Dis 2007; 7: 56-61.

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