Integrating pneumonia prevention and treatment interventions with immunization services in resource-poor countries

Cohen, Adam L.; Hyde, Terri B.; Verani, Jennifer R.; Watkins, Margaret

doi:10.2471/blt.11.094029

Cited by 14 publications

(8 citation statements)

References 26 publications

(13 reference statements)

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“…As a means of preventing CAP, the WHO recommends that immunization programs include vaccines against measles, pertussis and influenza as well as Haemophilus influenzae type b and pneumococcal conjugate vaccines [ 31 , 32 ]. The majority of case-control studies published in the literature were conducted prior to the introduction of the pneumococcal conjugate vaccine or were carried out in countries in which the vaccine was not routinely used [ 9 , 10 , 19 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for community-acquired pneumonia in children under five years of age in the post-pneumococcal conjugate vaccine era in Brazil: a case control study

et al. 2016

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BackgroundPneumonia plays an important role in children’s morbidity and mortality. In Brazil, epidemiological and social changes occurred concomitantly with the universal introduction of the 10-valent pneumococcal conjugate vaccine. This study identified risk factors for pneumonia following the implementation of a pneumococcal vaccination program.MethodsA hospital-based, case-control study involving incident cases of pneumonia in children aged 1–59 months was conducted between October 2010 and September 2013 at a tertiary hospital in northeastern Brazil. The diagnosis of pneumonia was based on the World Health Organization (WHO) criteria. The control group consisted of children admitted to the day-hospital ward for elective surgery. Children with comorbidities were excluded. The risk factors for pneumonia that were investigated were among those classified by the WHO as definite, likely and possible. A multivariate analysis was performed including variables that were significant at p ≤ 0.25 in the bivariate analysis.ResultsThe study evaluated 407 children in the case group and 407 children in the control group. Household crowding (OR = 2.15; 95 % CI, 1,46–3,18) and not having been vaccinated against the influenza virus (OR = 3.59; 95 % CI, 2,62–4.91) were the only factors found to increase the likelihood of pneumonia. Male gender constituted a protective factor (OR = 0.53; 95 % CI, 0,39–0,72).ConclusionChanges on risk factors for pneumonia were most likely associated with the expansion of the vaccination program and social improvements; however, these improvements were insufficient to overcome inequalities, given that household crowding remained a significant risk factor. The protection provided by the influenza vaccine must be evaluated new etiological studies. Furthermore, additional risk factors should be investigated.

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Section: Discussionmentioning

confidence: 99%

Risk factors for community-acquired pneumonia in children under five years of age in the post-pneumococcal conjugate vaccine era in Brazil: a case control study

et al. 2016

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“…To establish how social behaviour shapes individual-level infection, we explored whether the frequency and duration of different types of social encounters were associated with an individual’s risk of respiratory infection, using nasopharyngeal (NP) carriage of Streptococcus pneumoniae (the pneumococcus) and self-reported acute respiratory symptoms (ARS) as endpoints. S.pneumoniae is one of the main causes of pneumonia and sepsis globally [19], disproportionally so in low-income settings [19-21]. Colonization of the nasopharynx is a precondition to disease, and the main source of human-to-human transmission.…”

Section: Introductionmentioning

confidence: 99%

Identifying Human Encounters that Shape the Transmission ofStreptococcus Pneumoniaeand Other Respiratory Infections

Waroux

Kucharski

Langendorf

et al. 2017

Preprint

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Although patterns of social contacts are believed to be an important determinant of infectious disease transmission, there is little empirical evidence to back this up. Indeed, no previous study has linked individuals’ risk of respiratory infection with their current pattern of social contacts. We explored whether the frequency of different types of social encounters were associated with current pneumococcal carriage and self-reported acute respiratory symptoms (ARS), though a survey in Uganda in 2014. In total 566 participants were asked about their daily social encounters and about symptoms of ARS in the last two weeks. A nasopharyngeal specimen was also taken from each participant. We found that the frequency of physical (i.e. skin-to-skin), long (≥1h) and household contacts – which capture some measure of close (i.e. relatively intimate) contact –, was higher among pneumococcal carriers than non-carriers, and among people with ARS compared to those without, irrespective of their age. With each additional physical encounter the age-adjusted risk of carriage and ARS increased by 6% (95%CI 2-9%) and 9% (1-18%) respectively. In contrast, the number of casual contacts (<5 minutes long) was not associated with either pneumococcal carriage or ARS. A detailed analysis by age of contacts showed that the number of close contacts with young children (<5 years) was particularly higher among older children and adult carriers than non-carriers, while the higher number of contacts among people with ARS was more homogeneous across contacts of all ages. Our findings provide key evidence that the frequency of close interpersonal contact is important for transmission of respiratory infections, but not that of casual contacts. Such results strengthen the evidence for public health measures based upon assumptions of what contacts are important for transmission, and are important to improve disease prevention and control efforts, as well as inform research on infectious disease dynamics.Author summaryAlthough social contacts are an important determinant for the transmission of many infectious diseases it is not clear how the nature and frequency of contacts shape individual infection risk. We explored whether frequency, duration and type of social encounters were associated with someone’s risk of respiratory infection, using nasopharyngeal carriage (NP) of Streptococcus pneumoniae and acute respiratory symptoms as endpoints. To do so, we conducted a survey in South-West Uganda collecting information on people’s social encounters, respiratory symptoms, and pneumococcal carriage status. Our results show that both pneumococcal carriage and respiratory symptoms are independently associated with a higher number of social encounters, irrespective of a person’s age. More specifically, our findings strongly suggest that the frequency of close contacts is important for transmission of respiratory infections, particularly pneumococcal carriage. In contrast, our study showed no association with the frequency of short casual contacts. Those results are essential for both improving disease prevention and control efforts as well as informing research on infectious disease dynamics and transmission models.

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“…Disease due to Streptococcus pneumoniae (the pneumococcus) is a leading cause of morbidity and mortality worldwide, disproportionally so in resource-poor settings [1-3].…”

Section: Introductionmentioning

confidence: 99%

Predicting the impact of pneumococcal conjugate vaccine programme options in Vietnam: a dynamic transmission model

Edmunds

Takahashi

et al. 2017

Preprint

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BackgroundCatch-up campaigns (CCs) at the introduction of the pneumococcal conjugate vaccines (PCVs) may accelerate the impact of PCVs. However, limited vaccine supplies may delay vaccine introduction if additional doses are needed for such campaigns. We studied the relative impact of introducing PCV13 with and without catch-up campaign, and the implications of potential introduction delays.MethodsWe used a dynamic transmission model applied to the population of Nha Trang in Sout central Vietnam. Four strategies were considered: routine vaccination (RV) only, and RV alongside catch-up campaigns among <1y olds (CC1), <2y olds (CC2) and <5y olds (CC5). The model was parameterised with local data on human social contact rates, and was fitted to local carriage data. Post-PCV predictions were based on best estimates of parameters governing post-PCV dynamics, including serotype competition, vaccine efficacy and duration of protection.ResultsOur model predicts elimination of vaccine-type (VT) carriage across all age groups within 10 years of introduction in all scenarios with near-complete replacement by non-VT. Most of the benefit of CCs is predicted to occur within the first 3 years after introduction, with the highest impact in the first year, when IPD incidence is predicted to be 11% (95%CrI 9 – 14%) lower than RV with CC1, 25% (21 – 30 %) lower with CC2 and 38% (32 – 46%) lower with CC5.However, CCs would only prevent more cases of IPD insofar such campaigns do not delay introduction by more than 31 (95%CrI 30 – 32) weeks with CC1, 58 (53 – 63) weeks with CC2 and 89 (78 – 101) weeks for CC5.ConclusionCCs are predicted to offer a substantial additional reduction in pneumococcal disease burden over RV alone, if their implementation does not result in much introduction delay. Those findings are important to help guide vaccine introduction in countries that have not yet introduced PCV, particularly in Asia.

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Integrating pneumonia prevention and treatment interventions with immunization services in resource-poor countries

Cited by 14 publications

References 26 publications

Risk factors for community-acquired pneumonia in children under five years of age in the post-pneumococcal conjugate vaccine era in Brazil: a case control study

Risk factors for community-acquired pneumonia in children under five years of age in the post-pneumococcal conjugate vaccine era in Brazil: a case control study

Identifying Human Encounters that Shape the Transmission ofStreptococcus Pneumoniaeand Other Respiratory Infections

Predicting the impact of pneumococcal conjugate vaccine programme options in Vietnam: a dynamic transmission model

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