Infant Immunization to Reduce Pneumonia in HIV +ve women

婴儿免疫接种可减少艾滋病毒 ve 妇女的肺炎

• 批准号: 6778684
• 负责人: JAMES W. CURRAN
• 金额: $ 30.7万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6778684
• 关键词: Infant; Immunization; Reduce; Pneumonia; HIV

DESCRIPTION (provided by applicant): Pneumonia is the leading cause of hospitalization of HIV-positive adults in Soweto, South Africa, where 30% of the population is HIV-positive. Streptococcus pneumoniae is implicated in the etiology of up to 46% of pneumonia episodes in HIV-positive adults in Africa, and the 23-valent pneumococcal vaccine appears ineffective and possibly deleterious to the health of African HIV-positive adults not receiving antiretroviral therapy. Data from a recently completed prospective randomized trial of a conjugate pneumococcal vaccine among 39,836 children in Soweto has demonstrated a 72% efficacy of this vaccine in preventing vaccine type invasive pneumococcal disease (IPD) and a 17% reduction in all pneumonia in these children. A similar vaccine, given to children in the United States, has recently been demonstrated to reduce IPD in adults by means of a herd immunity effect. The vaccine is thought to interrupt transmission of vaccine serotypes (pediatric serotypes) from children to adults. The effectiveness of this approach to prevent IPD (and possibly non-bacteremic pneumococcal pneumonia) depends on the fraction of pediatric serotypes causing invasive disease in adults. The research team has demonstrated that conjugate pneumococcal vaccines interrupt transmission of pediatric serotypes in children in Soweto. It has also shown there to be a significantly increased risk of pediatric serotypes causing IPD in HIV-positive adults (and particularly in women) in Soweto. This proposal's objective is to determine whether pneumococcal conjugate vaccination of infants will reduce the burden of pneumococcal disease in HIV-positive women. This objective will be met by first (Specific Aim 1) investigating retrospectively whether IPD and pneumonia were reduced in the mothers of 19,922 children vaccinated compared to 19,914 controls enrolled in the previous pediatric vaccine trial. The extent of herd immunity induced by that trial may, however, be expected to be limited. A prospective study (Specific Aim 2) will ascertain the vaccine preventable burden of IPD and pneumonia in 2,000 adults in the community prior to the routine introduction of pneumococcal conjugate vaccination in infants in order to assess the impact of that intervention on IPD and pneumonia in HIV-positive women.

描述（由申请人提供）：肺炎是南非索韦托 HIV 阳性成年人住院的主要原因，该国 30% 的人口 HIV 阳性。非洲 HIV 阳性成人中高达 46% 的肺炎发作与肺炎链球菌有关，23 价肺炎球菌疫苗似乎无效，并且可能对未接受抗逆转录病毒治疗的非洲 HIV 阳性成人的健康有害。最近完成的一项针对索韦托 39,836 名儿童的肺炎球菌结合疫苗前瞻性随机试验的数据表明，该疫苗在预防疫苗型侵袭性肺炎球菌疾病 (IPD) 方面的功效为 72%，并使这些儿童的所有肺炎减少了 17%。最近，在美国给儿童注射的一种类似疫苗已被证明可以通过群体免疫效应减少成人的 IPD。该疫苗被认为可以阻断疫苗血清型（儿童血清型）从儿童向成人的传播。这种方法预防 IPD（以及可能的非菌血症性肺炎球菌肺炎）的有效性取决于引起成人侵袭性疾病的儿科血清型的比例。 研究小组已经证明，肺炎球菌结合疫苗可以阻断索韦托儿童中儿科血清型的传播。研究还表明，索韦托的艾滋病毒阳性成人（特别是女性）中，引起 IPD 的儿科血清型风险显着增加。该提案的目的是确定婴儿肺炎球菌结合疫苗接种是否会减轻艾滋病毒阳性女性的肺炎球菌疾病负担。为了实现这一目标，首先（具体目标 1）对 19,922 名接种疫苗的儿童的母亲进行回顾性调查，与参加先前儿科疫苗试验的 19,914 名对照儿童相比，IPD 和肺炎是否有所减少。然而，该试验引发的群体免疫的程度预计将是有限的。一项前瞻性研究（具体目标 2）将在婴儿中常规引入肺炎球菌结合疫苗接种之前，确定社区 2,000 名成年人中 IPD 和肺炎的疫苗可预防负担，以评估该干预措施对 HIV 感染中的 IPD 和肺炎的影响- 积极向上的女性。