Alternative pneumococcal vaccination schedules for infants in Fiji and pneumococcal epidemiology
Year: 2010
Type: dissertation
Abstract: This thesis documents the pneumococcal disease burden and the results of a Phase II pneumococcal vaccine trial in the low middle income country, Fiji.The overall objective was to gather sufficient evidence for the Fiji Ministry of Health to decide whether to introduce the pneumococcal vaccination into its national schedule and define an appropriate and affordable vaccination strategy.The nasopharynx is the main reservoir for pneumococci and plays an important role in the spread of the organism.Studies of nasopharyngeal carriage offer insights into the pneumococcal disease burden in a community, particularly for potential serotypes which may cause pneumonia, and are a convenient way of determining the level of antibiotic resistance among pneumococcal isolates circulating in a population.The first study, a crosssectional pneumococcal nasopharyngeal carriage survey of healthy children aged 3-13 months, was undertaken to document the prevalence of pneumococcal nasopharyngeal carriage, risk factors for carriage, serotypes and antimicrobial susceptibility patterns of carried pneumococci in healthy young children in Fiji (Chapter 3).Pneumococcal nasopharyngeal carriage was common in Fijian children.Penicillin resistance was documented for the first time, and, as a result, first-line treatment for meningitis was altered.A low proportion of carriage serotypes were included in the 7-valent pneumococcal conjugate vaccine.Invasive pneumococcal disease is an important cause of morbidity and mortality, particularly in the very young and the elderly.The introduction of the 7-valent pneumococcal conjugate vaccine in the national immunisation schedule in the USA has resulted in an impressive reduction in infant invasive pneumococcal disease.In addition, the vaccine has had a more than expected herd immunity effect on invasive pneumococcal disease in the elderly and other age groups.Chapter 4 reports on a study that aimed to document age-specific burden of invasive pneumococcal disease including clinical syndromes, underlying conditions, serotype distribution, and the potential protection against invasive pneumococcal disease and chest X-ray confirmed pneumonia by 7-valent pneumococcal conjugate vaccine in Fiji.The annual invasive pneumococcal disease incidence was comparable to countries of similar socioeconomic status.Being indigenous Fijian was an independent risk factor for disease.Underlying conditions were common and the case fatality rate was high particularly in the elderly population.For every 1,930 and 128 infants vaccinated, one death and one case DECLARATION This is to certify that 1. the thesis comprises only my original work towards the PhD except where indicated in the Preface, 2. due acknowledgement has been made in the text to all other materials used, 3. the thesis is less than 100,000 words in length, exclusive of tables, maps, bibliographies, and appendices.
Author: Fiona M. Russell
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2213881532