Conjugate vaccines for preventing Haemophilus influenzae type B infections.
ABSTRACT Haemophilus influenzae (H. influenzae) is an important cause of meningitis and pneumonia in children. Vaccine cost is a significant barrier to use in low income countries. Determining the size of the effects of the vaccine will enable cost-effectiveness comparisons with competing priorities in low income countries.
1. To determine the effects of conjugate Hib vaccine in preventing Hib disease or death in children under five years of age.2. To determine any variation in effect with type of vaccine, number of doses, age at first dose, in children with known HIV infection, or in high and low income countries.3. To determine any serious adverse outcomes.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2006); MEDLINE (January 1966 to December 2006); EMBASE (1990 to June 2006) and scanned reference lists and contacting of authors of trial reports. Reports in all languages were considered.
All randomised controlled trials (RCTs) or quasi-RCTs of conjugate H. influenzae type b vaccines compared with placebo or no treatment in children who were followed until at least two years of age.
Two review authors independently selected eligible studies and extracted data.
Six studies were included in the review, and four in the meta-analyses. The overall quality of the trials was good. The relative risk for invasive Hib disease was 0.20 (95% confidence interval (CI) 0.07 to 0.54; random-effects model), but there was statistically significant unexplained variation (heterogeneity) in the effects of the four trials in the meta-analysis (P = 0.002). The size of the effects did not appear to differ consistently with different vaccine types, the number of vaccine doses, age at first vaccination or use in high income versus low income countries, but the CIs for the effect estimates were wide. Hib-related mortality data showed a non-significant trend towards benefit (relative risk was 0.29; 95% CI 0.07 to 1.20; random-effects model). The relative risk for all cause mortality in the two trials from which data were available were 1.01 (95% CI 0.38 to 2.67, random-effects model) and 0.97. No serious adverse effects were reported in any of the trials.
Hib vaccine is safe and effective. In resource-poor settings, decisions to use the vaccine will depend on its cost, the local burden of Hib disease and competing priorities.
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ABSTRACT: This study estimates household costs for treatment of pneumonia, severe pneumonia and very severe febrile disease. Combined with reported costs from the health care provider perspective, an estimate of the overall financial burden of these diseases has been developed for the Northern Areas of Pakistan. Data on the duration and economic implications of the illnesses for households were collected from caretakers of children under 3 years of age enrolled in a surveillance study who sought care at a health facility. Trained study physicians and health workers identified children with pneumonia, severe pneumonia and very severe febrile disease--as defined by protocols for the Integrated Management of Childhood Illness (IMCI). From January to December 2002, 141 health facility visits for pneumonia (n = 41, 29%), severe pneumonia (n = 65, 46%) and very severe febrile disease (n = 35, 25%) were recorded for 112 children who sought care at various levels of health facilities in the Northern Areas of Pakistan. The total societal average cost per episode was US$22.62 for pneumonia, US$142.90 for severe pneumonia and US$62.48 for very severe febrile disease. For household expenditures, medicines constituted the highest proportion (40.54%) of costs incurred during a visit to the health facility, followed by meals (23.68%), hospitalization (13.23%) and transportation (12.19%). Pneumonia is one of the leading killers of children in Pakistan with a correspondingly high economic burden to society. The results of this study suggest that there is a strong economic justification for expanding the availability of existing interventions to fight pneumonia, and for introducing measures such as vaccines to prevent pneumonia episodes.Health Policy and Planning 09/2008; 23(6):438-42. DOI:10.1093/heapol/czn033 · 3.00 Impact Factor
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ABSTRACT: We investigated the efficacy of 2 formulations of Augmentin on experimental pneumonia due to Haemophilus influenzae (HI) in rabbits. Two strains were used (H128 and 401285) with amoxicillin/clavulanic acid MICs of 1/0.5 mg/l and 4/2 mg/l. Pneumonia was induced in immunocompetent rabbits by inoculation of 10 log(10) CFU HI. The treatments were infused by using computer controlled pumps in order to mimic the human pharmacokinetic (PK) profile of either conventional Augmentin treatment (875/125 mg twice daily) or the sustained release formulation (SR: 2000/125 mg twice daily). After 2 d of treatment, the bacterial concentrations in the lungs were similar for both strains and both treatments: isolate H128, conventional Augmentin reduced bacterial numbers to 3.8+/-2.1 log(10) CFU/g and Augmentin SR to 3.1+/-2.4 log(10) CFU/g; isolate 401285, conventional Augmentin to 3.5+/-2. Thus, both treatments demonstrated similar efficacy against H. influenzae pneumonia in this model, even when induced by a strain with an amoxicillin/clavulanic acid MIC of 4/2 mg/l. These results support current breakpoints for conventional Augmentin against H. influenzae and suggest that Augmentin SR is at least as effective against these isolates.Scandinavian Journal of Infectious Diseases 02/2007; 39(2):115-21. DOI:10.1080/00365540600951200 · 1.64 Impact Factor
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ABSTRACT: Vaccine preventable pneumonias account for 5% of all the years of potential life lost (YPLL) attributable to racial and ethnic health disparities. Eliminating disparities in influenza and pneumococcal vaccination rates could eliminate many of these pneumonia deaths and hospitalizations among at-risk individuals. This represents one of the most focused and achievable targets within the broader agenda of eliminating racial and ethnic health disparities, which is one of two major health goals for the nation outlined in Healthy People 2010. A broad, three-dimensional conceptual framework guiding a strong public health/primary care partnership will be required to achieve this goal.Ethnicity & disease 02/2005; 15(2 Suppl 3):S3-1-S3-3. · 0.92 Impact Factor