Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Comment
Identifieur interne : 004B26 ( PascalFrancis/Corpus ); précédent : 004B25; suivant : 004B27Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Comment
Auteurs : Bradford D. Gessner ; Agustinus Sutanto ; Mary Linehan ; I. Gusti Gede Djelantik ; Tracy Fletcher ; I. Komang Gerudug ; INGERANI ; David Mercer ; Vanda Moniaga ; Lawrence H. Moulton ; Kim Mulholland ; Carib Nelson ; Soewignjo Soemohardjo ; Mark Steinhoff ; Anton Widjaya ; Philippe Stoeckel ; James Maynard ; Soemarjati Arjoso ; Ana Lucia S. Sgambatti De Andrade ; Celina M. Turchi MartelliSource :
- Lancet : (British edition) [ 0140-6736 ] ; 2005.
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Abstract
Background Most studies of Haemophilus influenzae type b (Hib) disease in Asia have found low rates, and few Asian countries use Hib vaccine in routine immunisation programmes. Whether Hib disease truly is rare or whether many cases remain undetected is unclear. Methods To estimate incidences of vaccine-preventable Hib pneumonia and meningitis among children younger than 2 years in Lombok, Indonesia, during 1998-2002, we undertook a hamlet-randomised, controlled, double-blind vaccine-probe study (818 hamlets). Children were immunised (WHO schedule) with diphtheria, tetanus, pertussis (DTP) or DTP-PRP-T (Hib conjugate) vaccine. Vaccine-preventable disease incidences were calculated as the difference in rates of clinical outcomes between DTP and DTP-PRP-T groups. Analyses included all children who received at least one vaccine dose. Findings We enrolled 55 073 children: 28 147 were assigned DTP-PRP-T and 26 926 DTP. The proportion of pneumonia outcomes prevented by vaccine ranged from less than 0 to 4.8%. Calculated incidences of vaccine-preventable Hib disease (per 105 child-years of observation) for outcome categories were: substantial alveolar consolidation or effusion, less than zero (-43 [95% CI -185 to 98]); all severe pneumonia, 264 (95% CI less than zero to 629); all clinical pneumonia, 1561 (270 to 2853); confirmed Hib meningitis, 16 (1.4 to 31); meningitis with cerebrospinal-fluid findings consistent with a bacterial aetiology, 67 (22 to 112); and admission for suspected meningitis or presenting to a clinic with convulsions, 158 (42 to 273). Interpretation Hib vaccine did not prevent the great majority of pneumonia cases, including those with alveolar consolidation. These results do not support a major role for Hib vaccine in overall pneumonia-prevention programmes. Nevertheless, the study identified high incidences of Hib meningitis and pneumonia; inclusion of Hib vaccine in routine infant immunisation programmes in Asia deserves consideration.
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NO : | PASCAL 05-0068634 INIST |
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ET : | Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Comment |
AU : | GESSNER (Bradford D.); SUTANTO (Agustinus); LINEHAN (Mary); GEDE DJELANTIK (I. Gusti); FLETCHER (Tracy); GERUDUG (I. Komang); INGERANI; MERCER (David); MONIAGA (Vanda); MOULTON (Lawrence H.); MULHOLLAND (Kim); NELSON (Carib); SOEMOHARDJO (Soewignjo); STEINHOFF (Mark); WIDJAYA (Anton); STOECKEL (Philippe); MAYNARD (James); ARJOSO (Soemarjati); SGAMBATTI DE ANDRADE (Ana Lucia S.); TURCHI MARTELLI (Celina M.) |
AF : | Association Pour l'Aide à la Médecine Préventive/Paris/France (1 aut., 16 aut.); West Nusa Tenggara Provincial Government/Lombok/Indonésie (2 aut., 4 aut., 6 aut., 13 aut.); Program for Appropriate Technology in Health/Seattle, WA/Etats-Unis (3 aut., 5 aut., 8 aut., 9 aut., 12 aut., 15 aut., 17 aut.); Indonesian Ministry of Health/Jakarta/Indonésie (7 aut., 18 aut.); Department of International Health, Bloomberg School of Public Health, Johns Hopkins University/Baltimore, MD/Etats-Unis (10 aut., 14 aut.); University of Melbourne/Melbourne/Australie (11 aut.); Departamento de Saúde Coletiva, Universidade Federal de Goiás. S Universitário/Goiânia, 74605-050/France (19 aut., 20 aut.) |
DT : | Publication en série; Article; Commentaire; Niveau analytique |
SO : | Lancet : (British edition); ISSN 0140-6736; Coden LANCAO; Royaume-Uni; Da. 2005; Vol. 365; No. 9453; 5-7,43-52 [13 p.]; Bibl. 43 ref. |
LA : | Anglais |
EA : | Background Most studies of Haemophilus influenzae type b (Hib) disease in Asia have found low rates, and few Asian countries use Hib vaccine in routine immunisation programmes. Whether Hib disease truly is rare or whether many cases remain undetected is unclear. Methods To estimate incidences of vaccine-preventable Hib pneumonia and meningitis among children younger than 2 years in Lombok, Indonesia, during 1998-2002, we undertook a hamlet-randomised, controlled, double-blind vaccine-probe study (818 hamlets). Children were immunised (WHO schedule) with diphtheria, tetanus, pertussis (DTP) or DTP-PRP-T (Hib conjugate) vaccine. Vaccine-preventable disease incidences were calculated as the difference in rates of clinical outcomes between DTP and DTP-PRP-T groups. Analyses included all children who received at least one vaccine dose. Findings We enrolled 55 073 children: 28 147 were assigned DTP-PRP-T and 26 926 DTP. The proportion of pneumonia outcomes prevented by vaccine ranged from less than 0 to 4.8%. Calculated incidences of vaccine-preventable Hib disease (per 105 child-years of observation) for outcome categories were: substantial alveolar consolidation or effusion, less than zero (-43 [95% CI -185 to 98]); all severe pneumonia, 264 (95% CI less than zero to 629); all clinical pneumonia, 1561 (270 to 2853); confirmed Hib meningitis, 16 (1.4 to 31); meningitis with cerebrospinal-fluid findings consistent with a bacterial aetiology, 67 (22 to 112); and admission for suspected meningitis or presenting to a clinic with convulsions, 158 (42 to 273). Interpretation Hib vaccine did not prevent the great majority of pneumonia cases, including those with alveolar consolidation. These results do not support a major role for Hib vaccine in overall pneumonia-prevention programmes. Nevertheless, the study identified high incidences of Hib meningitis and pneumonia; inclusion of Hib vaccine in routine infant immunisation programmes in Asia deserves consideration. |
CC : | 002B01 |
FD : | Immunoprophylaxie; Incidence; Epidémiologie; Pneumonie; Prévention; Vaccin; Méningite; Haemophilus influenzae; Indonésie; Enfant; Essai clinique; Sonde; Médecine |
FG : | Pasteurellaceae; Bactérie; Asie; Homme; Appareil respiratoire pathologie; Poumon pathologie; Système nerveux central pathologie; Système nerveux pathologie |
ED : | Immunoprophylaxis; Incidence; Epidemiology; Pneumonia; Prevention; Vaccine; Meningitis; Haemophilus influenzae; Indonesia; Child; Clinical trial; Probe; Medicine |
EG : | Pasteurellaceae; Bacteria; Asia; Human; Respiratory disease; Lung disease; Central nervous system disease; Nervous system diseases |
SD : | Inmunoprofilaxia; Incidencia; Epidemiología; Neumonía; Prevención; Vacuna; Meningitis; Haemophilus influenzae; Indonesia; Niño; Ensayo clínico; Sonda; Medicina |
LO : | INIST-5004.354000126042790080 |
ID : | 05-0068634 |
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Pascal:05-0068634Le document en format XML
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Comment</title>
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<author><name sortKey="Nelson, Carib" sort="Nelson, Carib" uniqKey="Nelson C" first="Carib" last="Nelson">Carib Nelson</name>
<affiliation><inist:fA14 i1="03"><s1>Program for Appropriate Technology in Health</s1>
<s2>Seattle, WA</s2>
<s3>USA</s3>
<sZ>3 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
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<sZ>15 aut.</sZ>
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<author><name sortKey="Soemohardjo, Soewignjo" sort="Soemohardjo, Soewignjo" uniqKey="Soemohardjo S" first="Soewignjo" last="Soemohardjo">Soewignjo Soemohardjo</name>
<affiliation><inist:fA14 i1="02"><s1>West Nusa Tenggara Provincial Government</s1>
<s2>Lombok</s2>
<s3>IDN</s3>
<sZ>2 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>13 aut.</sZ>
</inist:fA14>
</affiliation>
</author>
<author><name sortKey="Steinhoff, Mark" sort="Steinhoff, Mark" uniqKey="Steinhoff M" first="Mark" last="Steinhoff">Mark Steinhoff</name>
<affiliation><inist:fA14 i1="05"><s1>Department of International Health, Bloomberg School of Public Health, Johns Hopkins University</s1>
<s2>Baltimore, MD</s2>
<s3>USA</s3>
<sZ>10 aut.</sZ>
<sZ>14 aut.</sZ>
</inist:fA14>
</affiliation>
</author>
<author><name sortKey="Widjaya, Anton" sort="Widjaya, Anton" uniqKey="Widjaya A" first="Anton" last="Widjaya">Anton Widjaya</name>
<affiliation><inist:fA14 i1="03"><s1>Program for Appropriate Technology in Health</s1>
<s2>Seattle, WA</s2>
<s3>USA</s3>
<sZ>3 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>12 aut.</sZ>
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<author><name sortKey="Stoeckel, Philippe" sort="Stoeckel, Philippe" uniqKey="Stoeckel P" first="Philippe" last="Stoeckel">Philippe Stoeckel</name>
<affiliation><inist:fA14 i1="01"><s1>Association Pour l'Aide à la Médecine Préventive</s1>
<s2>Paris</s2>
<s3>FRA</s3>
<sZ>1 aut.</sZ>
<sZ>16 aut.</sZ>
</inist:fA14>
</affiliation>
</author>
<author><name sortKey="Maynard, James" sort="Maynard, James" uniqKey="Maynard J" first="James" last="Maynard">James Maynard</name>
<affiliation><inist:fA14 i1="03"><s1>Program for Appropriate Technology in Health</s1>
<s2>Seattle, WA</s2>
<s3>USA</s3>
<sZ>3 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>17 aut.</sZ>
</inist:fA14>
</affiliation>
</author>
<author><name sortKey="Arjoso, Soemarjati" sort="Arjoso, Soemarjati" uniqKey="Arjoso S" first="Soemarjati" last="Arjoso">Soemarjati Arjoso</name>
<affiliation><inist:fA14 i1="04"><s1>Indonesian Ministry of Health</s1>
<s2>Jakarta</s2>
<s3>IDN</s3>
<sZ>7 aut.</sZ>
<sZ>18 aut.</sZ>
</inist:fA14>
</affiliation>
</author>
<author><name sortKey="Sgambatti De Andrade, Ana Lucia S" sort="Sgambatti De Andrade, Ana Lucia S" uniqKey="Sgambatti De Andrade A" first="Ana Lucia S." last="Sgambatti De Andrade">Ana Lucia S. Sgambatti De Andrade</name>
<affiliation><inist:fA14 i1="07"><s1>Departamento de Saúde Coletiva, Universidade Federal de Goiás. S Universitário</s1>
<s2>Goiânia, 74605-050</s2>
<s3>FRA</s3>
<sZ>19 aut.</sZ>
<sZ>20 aut.</sZ>
</inist:fA14>
</affiliation>
</author>
<author><name sortKey="Turchi Martelli, Celina M" sort="Turchi Martelli, Celina M" uniqKey="Turchi Martelli C" first="Celina M." last="Turchi Martelli">Celina M. Turchi Martelli</name>
<affiliation><inist:fA14 i1="07"><s1>Departamento de Saúde Coletiva, Universidade Federal de Goiás. S Universitário</s1>
<s2>Goiânia, 74605-050</s2>
<s3>FRA</s3>
<sZ>19 aut.</sZ>
<sZ>20 aut.</sZ>
</inist:fA14>
</affiliation>
</author>
</analytic>
<series><title level="j" type="main">Lancet : (British edition)</title>
<title level="j" type="abbreviated">Lancet : (Br. ed.)</title>
<idno type="ISSN">0140-6736</idno>
<imprint><date when="2005">2005</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">Lancet : (British edition)</title>
<title level="j" type="abbreviated">Lancet : (Br. ed.)</title>
<idno type="ISSN">0140-6736</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Child</term>
<term>Clinical trial</term>
<term>Epidemiology</term>
<term>Haemophilus influenzae</term>
<term>Immunoprophylaxis</term>
<term>Incidence</term>
<term>Indonesia</term>
<term>Medicine</term>
<term>Meningitis</term>
<term>Pneumonia</term>
<term>Prevention</term>
<term>Probe</term>
<term>Vaccine</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Immunoprophylaxie</term>
<term>Incidence</term>
<term>Epidémiologie</term>
<term>Pneumonie</term>
<term>Prévention</term>
<term>Vaccin</term>
<term>Méningite</term>
<term>Haemophilus influenzae</term>
<term>Indonésie</term>
<term>Enfant</term>
<term>Essai clinique</term>
<term>Sonde</term>
<term>Médecine</term>
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<front><div type="abstract" xml:lang="en">Background Most studies of Haemophilus influenzae type b (Hib) disease in Asia have found low rates, and few Asian countries use Hib vaccine in routine immunisation programmes. Whether Hib disease truly is rare or whether many cases remain undetected is unclear. Methods To estimate incidences of vaccine-preventable Hib pneumonia and meningitis among children younger than 2 years in Lombok, Indonesia, during 1998-2002, we undertook a hamlet-randomised, controlled, double-blind vaccine-probe study (818 hamlets). Children were immunised (WHO schedule) with diphtheria, tetanus, pertussis (DTP) or DTP-PRP-T (Hib conjugate) vaccine. Vaccine-preventable disease incidences were calculated as the difference in rates of clinical outcomes between DTP and DTP-PRP-T groups. Analyses included all children who received at least one vaccine dose. Findings We enrolled 55 073 children: 28 147 were assigned DTP-PRP-T and 26 926 DTP. The proportion of pneumonia outcomes prevented by vaccine ranged from less than 0 to 4.8%. Calculated incidences of vaccine-preventable Hib disease (per 10<sup>5</sup>
child-years of observation) for outcome categories were: substantial alveolar consolidation or effusion, less than zero (-43 [95% CI -185 to 98]); all severe pneumonia, 264 (95% CI less than zero to 629); all clinical pneumonia, 1561 (270 to 2853); confirmed Hib meningitis, 16 (1.4 to 31); meningitis with cerebrospinal-fluid findings consistent with a bacterial aetiology, 67 (22 to 112); and admission for suspected meningitis or presenting to a clinic with convulsions, 158 (42 to 273). Interpretation Hib vaccine did not prevent the great majority of pneumonia cases, including those with alveolar consolidation. These results do not support a major role for Hib vaccine in overall pneumonia-prevention programmes. Nevertheless, the study identified high incidences of Hib meningitis and pneumonia; inclusion of Hib vaccine in routine infant immunisation programmes in Asia deserves consideration.</div>
</front>
</TEI>
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<fA06><s2>9453</s2>
</fA06>
<fA08 i1="01" i2="1" l="ENG"><s1>Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Comment</s1>
</fA08>
<fA11 i1="01" i2="1"><s1>GESSNER (Bradford D.)</s1>
</fA11>
<fA11 i1="02" i2="1"><s1>SUTANTO (Agustinus)</s1>
</fA11>
<fA11 i1="03" i2="1"><s1>LINEHAN (Mary)</s1>
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<fA11 i1="04" i2="1"><s1>GEDE DJELANTIK (I. Gusti)</s1>
</fA11>
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</fA11>
<fA11 i1="06" i2="1"><s1>GERUDUG (I. Komang)</s1>
</fA11>
<fA11 i1="07" i2="1"><s1>INGERANI</s1>
</fA11>
<fA11 i1="08" i2="1"><s1>MERCER (David)</s1>
</fA11>
<fA11 i1="09" i2="1"><s1>MONIAGA (Vanda)</s1>
</fA11>
<fA11 i1="10" i2="1"><s1>MOULTON (Lawrence H.)</s1>
</fA11>
<fA11 i1="11" i2="1"><s1>MULHOLLAND (Kim)</s1>
</fA11>
<fA11 i1="12" i2="1"><s1>NELSON (Carib)</s1>
</fA11>
<fA11 i1="13" i2="1"><s1>SOEMOHARDJO (Soewignjo)</s1>
</fA11>
<fA11 i1="14" i2="1"><s1>STEINHOFF (Mark)</s1>
</fA11>
<fA11 i1="15" i2="1"><s1>WIDJAYA (Anton)</s1>
</fA11>
<fA11 i1="16" i2="1"><s1>STOECKEL (Philippe)</s1>
</fA11>
<fA11 i1="17" i2="1"><s1>MAYNARD (James)</s1>
</fA11>
<fA11 i1="18" i2="1"><s1>ARJOSO (Soemarjati)</s1>
</fA11>
<fA11 i1="19" i2="1"><s1>SGAMBATTI DE ANDRADE (Ana Lucia S.)</s1>
<s9>comment.</s9>
</fA11>
<fA11 i1="20" i2="1"><s1>TURCHI MARTELLI (Celina M.)</s1>
<s9>comment.</s9>
</fA11>
<fA14 i1="01"><s1>Association Pour l'Aide à la Médecine Préventive</s1>
<s2>Paris</s2>
<s3>FRA</s3>
<sZ>1 aut.</sZ>
<sZ>16 aut.</sZ>
</fA14>
<fA14 i1="02"><s1>West Nusa Tenggara Provincial Government</s1>
<s2>Lombok</s2>
<s3>IDN</s3>
<sZ>2 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>13 aut.</sZ>
</fA14>
<fA14 i1="03"><s1>Program for Appropriate Technology in Health</s1>
<s2>Seattle, WA</s2>
<s3>USA</s3>
<sZ>3 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>17 aut.</sZ>
</fA14>
<fA14 i1="04"><s1>Indonesian Ministry of Health</s1>
<s2>Jakarta</s2>
<s3>IDN</s3>
<sZ>7 aut.</sZ>
<sZ>18 aut.</sZ>
</fA14>
<fA14 i1="05"><s1>Department of International Health, Bloomberg School of Public Health, Johns Hopkins University</s1>
<s2>Baltimore, MD</s2>
<s3>USA</s3>
<sZ>10 aut.</sZ>
<sZ>14 aut.</sZ>
</fA14>
<fA14 i1="06"><s1>University of Melbourne</s1>
<s2>Melbourne</s2>
<s3>AUS</s3>
<sZ>11 aut.</sZ>
</fA14>
<fA14 i1="07"><s1>Departamento de Saúde Coletiva, Universidade Federal de Goiás. S Universitário</s1>
<s2>Goiânia, 74605-050</s2>
<s3>FRA</s3>
<sZ>19 aut.</sZ>
<sZ>20 aut.</sZ>
</fA14>
<fA20><s2>5-7,43-52 [13 p.]</s2>
</fA20>
<fA21><s1>2005</s1>
</fA21>
<fA23 i1="01"><s0>ENG</s0>
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<s2>5004</s2>
<s5>354000126042790080</s5>
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<fA44><s0>0000</s0>
<s1>© 2005 INIST-CNRS. All rights reserved.</s1>
</fA44>
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<fA47 i1="01" i2="1"><s0>05-0068634</s0>
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<fA60><s1>P</s1>
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<fA64 i1="01" i2="1"><s0>Lancet : (British edition)</s0>
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<fC01 i1="01" l="ENG"><s0>Background Most studies of Haemophilus influenzae type b (Hib) disease in Asia have found low rates, and few Asian countries use Hib vaccine in routine immunisation programmes. Whether Hib disease truly is rare or whether many cases remain undetected is unclear. Methods To estimate incidences of vaccine-preventable Hib pneumonia and meningitis among children younger than 2 years in Lombok, Indonesia, during 1998-2002, we undertook a hamlet-randomised, controlled, double-blind vaccine-probe study (818 hamlets). Children were immunised (WHO schedule) with diphtheria, tetanus, pertussis (DTP) or DTP-PRP-T (Hib conjugate) vaccine. Vaccine-preventable disease incidences were calculated as the difference in rates of clinical outcomes between DTP and DTP-PRP-T groups. Analyses included all children who received at least one vaccine dose. Findings We enrolled 55 073 children: 28 147 were assigned DTP-PRP-T and 26 926 DTP. The proportion of pneumonia outcomes prevented by vaccine ranged from less than 0 to 4.8%. Calculated incidences of vaccine-preventable Hib disease (per 10<sup>5</sup>
child-years of observation) for outcome categories were: substantial alveolar consolidation or effusion, less than zero (-43 [95% CI -185 to 98]); all severe pneumonia, 264 (95% CI less than zero to 629); all clinical pneumonia, 1561 (270 to 2853); confirmed Hib meningitis, 16 (1.4 to 31); meningitis with cerebrospinal-fluid findings consistent with a bacterial aetiology, 67 (22 to 112); and admission for suspected meningitis or presenting to a clinic with convulsions, 158 (42 to 273). Interpretation Hib vaccine did not prevent the great majority of pneumonia cases, including those with alveolar consolidation. These results do not support a major role for Hib vaccine in overall pneumonia-prevention programmes. Nevertheless, the study identified high incidences of Hib meningitis and pneumonia; inclusion of Hib vaccine in routine infant immunisation programmes in Asia deserves consideration.</s0>
</fC01>
<fC02 i1="01" i2="X"><s0>002B01</s0>
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<s5>01</s5>
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<s5>01</s5>
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<fC03 i1="02" i2="X" l="FRE"><s0>Incidence</s0>
<s5>02</s5>
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<fC03 i1="02" i2="X" l="ENG"><s0>Incidence</s0>
<s5>02</s5>
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<fC03 i1="02" i2="X" l="SPA"><s0>Incidencia</s0>
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<s5>03</s5>
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</fC03>
<fC03 i1="10" i2="X" l="FRE"><s0>Enfant</s0>
<s5>11</s5>
</fC03>
<fC03 i1="10" i2="X" l="ENG"><s0>Child</s0>
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<s5>37</s5>
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<s5>37</s5>
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<server><NO>PASCAL 05-0068634 INIST</NO>
<ET>Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Comment</ET>
<AU>GESSNER (Bradford D.); SUTANTO (Agustinus); LINEHAN (Mary); GEDE DJELANTIK (I. Gusti); FLETCHER (Tracy); GERUDUG (I. Komang); INGERANI; MERCER (David); MONIAGA (Vanda); MOULTON (Lawrence H.); MULHOLLAND (Kim); NELSON (Carib); SOEMOHARDJO (Soewignjo); STEINHOFF (Mark); WIDJAYA (Anton); STOECKEL (Philippe); MAYNARD (James); ARJOSO (Soemarjati); SGAMBATTI DE ANDRADE (Ana Lucia S.); TURCHI MARTELLI (Celina M.)</AU>
<AF>Association Pour l'Aide à la Médecine Préventive/Paris/France (1 aut., 16 aut.); West Nusa Tenggara Provincial Government/Lombok/Indonésie (2 aut., 4 aut., 6 aut., 13 aut.); Program for Appropriate Technology in Health/Seattle, WA/Etats-Unis (3 aut., 5 aut., 8 aut., 9 aut., 12 aut., 15 aut., 17 aut.); Indonesian Ministry of Health/Jakarta/Indonésie (7 aut., 18 aut.); Department of International Health, Bloomberg School of Public Health, Johns Hopkins University/Baltimore, MD/Etats-Unis (10 aut., 14 aut.); University of Melbourne/Melbourne/Australie (11 aut.); Departamento de Saúde Coletiva, Universidade Federal de Goiás. S Universitário/Goiânia, 74605-050/France (19 aut., 20 aut.)</AF>
<DT>Publication en série; Article; Commentaire; Niveau analytique</DT>
<SO>Lancet : (British edition); ISSN 0140-6736; Coden LANCAO; Royaume-Uni; Da. 2005; Vol. 365; No. 9453; 5-7,43-52 [13 p.]; Bibl. 43 ref.</SO>
<LA>Anglais</LA>
<EA>Background Most studies of Haemophilus influenzae type b (Hib) disease in Asia have found low rates, and few Asian countries use Hib vaccine in routine immunisation programmes. Whether Hib disease truly is rare or whether many cases remain undetected is unclear. Methods To estimate incidences of vaccine-preventable Hib pneumonia and meningitis among children younger than 2 years in Lombok, Indonesia, during 1998-2002, we undertook a hamlet-randomised, controlled, double-blind vaccine-probe study (818 hamlets). Children were immunised (WHO schedule) with diphtheria, tetanus, pertussis (DTP) or DTP-PRP-T (Hib conjugate) vaccine. Vaccine-preventable disease incidences were calculated as the difference in rates of clinical outcomes between DTP and DTP-PRP-T groups. Analyses included all children who received at least one vaccine dose. Findings We enrolled 55 073 children: 28 147 were assigned DTP-PRP-T and 26 926 DTP. The proportion of pneumonia outcomes prevented by vaccine ranged from less than 0 to 4.8%. Calculated incidences of vaccine-preventable Hib disease (per 10<sup>5</sup>
child-years of observation) for outcome categories were: substantial alveolar consolidation or effusion, less than zero (-43 [95% CI -185 to 98]); all severe pneumonia, 264 (95% CI less than zero to 629); all clinical pneumonia, 1561 (270 to 2853); confirmed Hib meningitis, 16 (1.4 to 31); meningitis with cerebrospinal-fluid findings consistent with a bacterial aetiology, 67 (22 to 112); and admission for suspected meningitis or presenting to a clinic with convulsions, 158 (42 to 273). Interpretation Hib vaccine did not prevent the great majority of pneumonia cases, including those with alveolar consolidation. These results do not support a major role for Hib vaccine in overall pneumonia-prevention programmes. Nevertheless, the study identified high incidences of Hib meningitis and pneumonia; inclusion of Hib vaccine in routine infant immunisation programmes in Asia deserves consideration.</EA>
<CC>002B01</CC>
<FD>Immunoprophylaxie; Incidence; Epidémiologie; Pneumonie; Prévention; Vaccin; Méningite; Haemophilus influenzae; Indonésie; Enfant; Essai clinique; Sonde; Médecine</FD>
<FG>Pasteurellaceae; Bactérie; Asie; Homme; Appareil respiratoire pathologie; Poumon pathologie; Système nerveux central pathologie; Système nerveux pathologie</FG>
<ED>Immunoprophylaxis; Incidence; Epidemiology; Pneumonia; Prevention; Vaccine; Meningitis; Haemophilus influenzae; Indonesia; Child; Clinical trial; Probe; Medicine</ED>
<EG>Pasteurellaceae; Bacteria; Asia; Human; Respiratory disease; Lung disease; Central nervous system disease; Nervous system diseases</EG>
<SD>Inmunoprofilaxia; Incidencia; Epidemiología; Neumonía; Prevención; Vacuna; Meningitis; Haemophilus influenzae; Indonesia; Niño; Ensayo clínico; Sonda; Medicina</SD>
<LO>INIST-5004.354000126042790080</LO>
<ID>05-0068634</ID>
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