Katherine E. Gallagher, United Kingdom
London School of Hygiene and Tropical Medicine Epidemiology and Population HealthAuthor Of 2 Presentations
PNEUMOCOCCAL CONJUGATE VACCINE DOSE-RANGING STUDIES IN HUMANS: A SYSTEMATIC REVIEW (ID 268)
Abstract
Background
Reduced dose vaccination with pneumococcal conjugate vaccines may protect against infection. We sought to examine the relationship between the dose of polysaccharide in conjugate vaccines (PCVs) and immunogenicity.
Methods
A systematic review of English publications that evaluated variable dose immunogenicity of PCVs in humans was performed in Medline and Embase databases (Ovid SP) in August 2019. Results were synthesised descriptively due to the heterogeneity of product valency, content and vaccine schedule.
Results
We identified 1691 articles after de-duplication; 9 studies met our inclusion criteria; 2 in adults, 6 in children and 1 in both. Doses of polysaccharide evaluated ranged from 0.44 mcg to 17.6 mcg. Thirty days after vaccination following a single dose or 2p+1 schedule, all doses tested in infants achieved mean IgG concentrations (GMCs) above the acceptable correlate of protection (COP; 0.35 mcg) and only three GMCs' 95% confidence intervals crossed the COP. All doses tested in adults achieved GMCs that were comparable to those considered protective in children who have received 3 standard vaccine doses.
Conclusions
For some products, the mean antibody concentrations induced for some pneumococcal serotypes increased with increasing doses of the polysaccharide but the functional significance of these is uncertain.
CHILDREN ADMITTED TO HOSPITAL WITH LOWER-CHEST-WALL INDRAWING PNEUMONIA IN SEVEN LOW AND MIDDLE-INCOME COUNTRIES: WHO DIED AND WHO SURVIVED? (ID 758)
- Katherine E. Gallagher, United Kingdom
- Juliet O. Awori, Kenya
- Maria D. Knoll, United States of America
- Chrissy Prosperi, United States of America
- Henry C. Baggett, United States of America
- W. A. Brooks, United States of America
- Daniel R. Feiken, United States of America
- Laura L. Hammitt, United States of America
- Stephen Howie, Gambia
- Karen L. Kotloff, United States of America
- Orin S. Levine, United States of America
- Shabir A. Madhi, South Africa
- David Murdoch, New Zealand
- Katherine L. O'Brien, United States of America
- Donald M. Thea, United States of America
- Vicky L. Baillie, South Africa
- Bernard E. Ebruke, Gambia
- Doli Goswami, Bangladesh
- Alice Kamau, Kenya
- David P. Moore, South Africa
- Lawrence Mwananyanda, United States of America
- Emmanuel O. Olutunde, Gambia
- Phil Seidenberg, United States of America
- Seydou Sissoko, Mali
- Mamadou Sylla, Mali
- Somsak Thamthitiwat, Thailand
- Khalequ Zaman, Bangladesh
- J.A.G Scott, Kenya
Abstract
Background
In 2013, to increase effective distribution of antibiotics, WHO revised treatment guidelines for childhood pneumonia with lower chest wall indrawing (LCWI) to recommend home-based-treatment with oral antibiotics rather than hospital-based management. We analysed the implications of this policy in the PERCH study, where all children were hospitalised.
Methods
In PERCH, 2113 children aged 2-59 months were admitted with LCWI pneumonia between 2011-2014 in Kenya, Zambia, South Africa, Mali, The Gambia, Bangladesh and Thailand. We analysed their mortality risk, and risk factors for mortality using logistic regression.
Results
Among cases with LCWI pneumonia, 76 (3.6%) died in hospital or within 7 days of discharge. Factors associated with fatal outcome included age (aOR 2.03 (95%CI 1.05-3.93) for infants vs older children), absence of cough, oxygen saturation (80-91% oxygen aOR 2.04 (1.07-3.90), <80% aOR 6.51 (2.82-15.0)), low anthropometric scores and HIV exposure.
Conclusions
Despite hospital admission, 3.6% of children with LCWI pneumonia died; mortality may be higher among similar children if treated in the community. Among children with LCWI pneumonia presenting to hospital, selective admission for those who also have hypoxia, features of malnutrition and young age may ensure that those with the greatest risk of death receive optimal supportive therapy.
Presenter of 1 Presentation
CHILDREN ADMITTED TO HOSPITAL WITH LOWER-CHEST-WALL INDRAWING PNEUMONIA IN SEVEN LOW AND MIDDLE-INCOME COUNTRIES: WHO DIED AND WHO SURVIVED? (ID 758)
- Katherine E. Gallagher, United Kingdom
- Juliet O. Awori, Kenya
- Maria D. Knoll, United States of America
- Chrissy Prosperi, United States of America
- Henry C. Baggett, United States of America
- W. A. Brooks, United States of America
- Daniel R. Feiken, United States of America
- Laura L. Hammitt, United States of America
- Stephen Howie, Gambia
- Karen L. Kotloff, United States of America
- Orin S. Levine, United States of America
- Shabir A. Madhi, South Africa
- David Murdoch, New Zealand
- Katherine L. O'Brien, United States of America
- Donald M. Thea, United States of America
- Vicky L. Baillie, South Africa
- Bernard E. Ebruke, Gambia
- Doli Goswami, Bangladesh
- Alice Kamau, Kenya
- David P. Moore, South Africa
- Lawrence Mwananyanda, United States of America
- Emmanuel O. Olutunde, Gambia
- Phil Seidenberg, United States of America
- Seydou Sissoko, Mali
- Mamadou Sylla, Mali
- Somsak Thamthitiwat, Thailand
- Khalequ Zaman, Bangladesh
- J.A.G Scott, Kenya
Abstract
Background
In 2013, to increase effective distribution of antibiotics, WHO revised treatment guidelines for childhood pneumonia with lower chest wall indrawing (LCWI) to recommend home-based-treatment with oral antibiotics rather than hospital-based management. We analysed the implications of this policy in the PERCH study, where all children were hospitalised.
Methods
In PERCH, 2113 children aged 2-59 months were admitted with LCWI pneumonia between 2011-2014 in Kenya, Zambia, South Africa, Mali, The Gambia, Bangladesh and Thailand. We analysed their mortality risk, and risk factors for mortality using logistic regression.
Results
Among cases with LCWI pneumonia, 76 (3.6%) died in hospital or within 7 days of discharge. Factors associated with fatal outcome included age (aOR 2.03 (95%CI 1.05-3.93) for infants vs older children), absence of cough, oxygen saturation (80-91% oxygen aOR 2.04 (1.07-3.90), <80% aOR 6.51 (2.82-15.0)), low anthropometric scores and HIV exposure.
Conclusions
Despite hospital admission, 3.6% of children with LCWI pneumonia died; mortality may be higher among similar children if treated in the community. Among children with LCWI pneumonia presenting to hospital, selective admission for those who also have hypoxia, features of malnutrition and young age may ensure that those with the greatest risk of death receive optimal supportive therapy.