R. Dagan et al., Effect of a conjugate pneumococcal vaccine on the occurrence of respiratory infections and antibiotic use in day-care center attendees, PEDIAT INF, 20(10), 2001, pp. 951-958
Background. Incidence and severity of respiratory infections are increased
in day-care center attendees. Streptococcus pneumoniae is an important cont
ributor to these infections.
Objective. To examine whether the use of a pneumococcal conjugate vaccine c
ould reduce the occurrence of respiratory infections and the ensuing antibi
otic drug use in the day care.
Method. In this double blind, randomized, controlled study performed in 8 d
ay-care centers located in Beer-Sheva, Israel, 264 toddlers ages 12 to 35 m
onths at enrollment were randomized to receive either a 9-valent conjugate
pneumococcal vaccine (conjugated to CRM197) or a control vaccine [conjugate
meningococcus C vaccine (conjugated to CRM197)] and were followed for an a
verage of 22 months. The main outcome measures were respiratory morbidity a
nd antibiotic use.
Results. An overall reduction of 7% in child months with greater than or eq
ual to1 reported illness episodes was observed among vaccinees (P = 0.008),
and 85% of all episodes were related to the respiratory tract. Reductions
of 15, 16 and 17% were observed in upper respiratory infections, lower resp
iratory problems and otitis media, respectively. An overall reduction of 17
% in antibiotic days was observed [10% for upper respiratory infections, 20
% for otitis and 47% for lower respiratory problems (P less than or equal t
o 0.005 for each entity)]. The reduction in episodes and antibiotic use was
greater for those < 36 months of age than for the older children.
Conclusion. The reduction of respiratory problems, including those not trad
itionally considered of pneumococcal origin and the ensuing lowered antibio
tic use in day-care center attendees by pneumococcal conjugate vaccination
suggest a broader benefit from the vaccine than preventing invasive disease
only.