Effectiveness of abbreviated and delayed 7-valent pneumococcal conjugate vaccine dosing regimens.
ABSTRACT We estimated the effectiveness of abbreviated regimens of 7-valent pneumococcal conjugate vaccine (PCV7) based on serotyped cases of invasive pneumococcal disease (IPD) in children under 5 reported from 2001 to 2004 to two US surveillance programs. Vaccination regimens included in the analysis were 1 dose < 3 months old, 2 doses < 5 months old, 3 doses < 7 months old, full schedule (3 doses and a booster), 1 dose at 12-23 months, and 2 doses at 12-23 months. Vaccine effectiveness (VE) was calculated as (1-Mantel-Haenszel summary odds ratio in vaccinated children, as compared to unvaccinated children)x100% for each regimen, stratifying by year. Among 400 eligible cases, for vaccine-type IPD, VE was 90.5% for the full schedule, 76.6% for 3 doses < 7 months old, and 70.5% for 2 doses < 5 months old; 1 dose < 3 months provided no significant protection. No regimen provided significant protection against vaccine-related serotypes. Data for regimens begun at 12-23 months were inconclusive. These data support the use of the 2-dose and 3-dose infant PCV7 regimens when the full series cannot be delivered and detail the limitations of abbreviated dosing regimens.
- Oral Oncology 07/2011; 47. · 3.03 Impact Factor
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ABSTRACT: Febrile young children present frequently to the emergency department. While most febrile children recover uneventfully, certain subgroups are at higher risk of serious infection. Febrile neonates require extensive diagnostic testing, antibiotic therapy, and hospital admission. Diagnostic testing can be utilized in older patients to identify children at low risk and high risk for serious infection. This information may assist in determining the treatment and disposition of these febrile children.Emergency medicine clinics of North America 08/2013; 31(3):601-26. · 0.96 Impact Factor
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ABSTRACT: Pneumococcal conjugate vaccines (PCV) are being implemented globally using a variety of different schedules. The optimal schedule to maximize protection of vaccinated children against vaccine-type invasive pneumococcal disease (VT-IPD) is not known. To assess the relative benefit of various PCV dosing schedules, we conducted a systematic review of studies published in English from 1994 to 2010 (supplemented post hoc with studies from 2011) on PCV effectiveness against VT-IPD among children targeted to receive vaccine. Data on 2-dose and 3-dose primary series, both with and without a booster ("2+0," "2+1," "3+0" and "3+1"), were included. For observational studies using surveillance data or case counts, we calculated percentage reduction in VT-IPD before and after PCV introduction. Of 4 randomized controlled trials and 31 observational studies reporting VT-IPD among young children, none evaluated a 2+0 complete series, 7 (19%) evaluated 2+1, 4 (11%) 3+0 and 27 (75%) 3+1. Most (86%) studies were from North America or Europe. Only 1 study (observational) directly compared 2 schedules (3+0 vs. 3+1); results supported the use of a booster dose. In clinical trials, vaccine efficacy ranged from 65% to 71% with 3+0 and 83% to 94% with 3+1. Surveillance data and case counts demonstrate reductions in VT-IPD of up to 100% with 2+1 (6 studies) or 3+1 (17 studies) schedules and up to 90% with 3+0 (2 studies). Reductions were observed as early as 1 year after PCV introduction. These data support the use of 2+1, 3+0 and 3+1 schedules, although most data of PCV impact on VT-IPD among young children are from high-income countries using 3+1. Differences between schedules for impact on VT-IPD are difficult to discern based on available data.The Pediatric Infectious Disease Journal 01/2014; 33 Suppl 2:S109-18. · 3.14 Impact Factor