Abstract
BackgroundPneumonia remains the leading cause of death in young children. The poor specificity of chest radiographs (CXRs) to diagnose pneumococcal pneumonia may underestimate the efficacy of pneumococcal conjugate vaccine in preventing pneumococcal pneumonia.Methods and FindingsThe efficacy of nine-valent pneumococcal conjugate vaccine among children not infected with HIV (21%; 95% confidence interval, 1%–37%) increased when CXR-confirmed pneumonia was associated with serum C-reactive protein of 120 mg/l (12mg/dl) or more and procalcitonin of 5.0 ng/ml or more (64%; 95% confidence interval, 23%–83%). Similar results were observed in children infected with HIV.ConclusionC-reactive protein and procalcitonin improve the specificity of CXR to diagnose pneumococcal pneumonia and may be useful for the future evaluation of the effectiveness of pneumococcal conjugate vaccine in preventing pneumococcal pneumonia.
Highlights
While pneumonia remains the leading cause of death in children, the absence of sensitive and specific tools to make an etiological diagnosis is a major limitation to our understanding of the efficacy of vaccines against pneumonia
C-reactive protein and procalcitonin improve the specificity of chest radiograph (CXR) to diagnose pneumococcal pneumonia and may be useful for the future evaluation of the effectiveness of pneumococcal conjugate vaccine in preventing pneumococcal pneumonia
Based on the postulate that the most likely chest radiograph (CXR) manifestation of pneumococcal pneumonia is alveolar consolidation, we reported the efficacy of a nine-valent pneumococcal conjugate vaccine (PnCV) in reducing CXRconfirmed pneumonia based on definitions recommended by a World Health Organization working group [9]
Summary
While pneumonia remains the leading cause of death in children, the absence of sensitive and specific tools to make an etiological diagnosis is a major limitation to our understanding of the efficacy of vaccines against pneumonia. Our recent observation that many children with viral-associated pneumonia have a bacterial super-infection [7], suggests that a high level of CRP and procalcitonin may be associated with unrecognised bacterial co-infection in a child with an established viral aetiology for pneumonia. The researchers involved in this study have evaluated vaccines against a particular bacterium (called Pneumococcus) that is the leading cause of pneumonia in children. They have begun to test these vaccines in children, but were looking for more specific ways to distinguish cases of pneumonia caused by this particular bacterium from those caused by other bacteria or viruses. They checked those blood samples for two markers that indicate a bacterial infection and reanalyzed the study
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