23-valent pneumococcal polysaccharide vaccine in HIV-1-infected Ugandan adults: double-blind, randomised and placebo controlled trial.
Lancet
; 355(9221): 2106-11, 2000 Jun 17.
Article
en En
| MEDLINE
| ID: mdl-10902624
ABSTRACT
BACKGROUND:
Infection with Streptococcus pneumoniae is a frequent and serious problem for HIV-immunosuppressed adults. Vaccination is recommended in the USA and Europe, but there are no prospective data that show vaccine efficacy.METHODS:
1392 (937 female) HIV-1-infected adults in Entebbe, Uganda, were enrolled. 697 received 23-valent pneumococcal polysaccharide vaccine and 695 received placebo. The primary endpoint was first event invasive pneumococcal disease. Secondary endpoints included vaccine serogroup-specific invasive disease, all (probable and definite) pneumococcal events, all-cause pneumonia, and death.FINDINGS:
First invasive events occurred in 25 individuals (24 bacteraemias, one pyomyositis), 15 in the vaccine arm and ten in the placebo arm (hazard ratio [HR] 1.47; 95% CI 0.7-3.3). 22 isolates (88%) were of vaccine-specific serogroups with 15 events in the vaccine arm compared with seven in the placebo arm (HR 2.10; 0.9-5.2). All pneumococcal events had a similar distribution (20 vs 14; HR 1.41; 0.7-2.8) though all-cause pneumonia was significantly more frequent in the vaccine arm (40 vs 21; HR 1.89; 1.1-3.2). Mortality was unaffected by vaccination.INTERPRETATION:
23-valent pneumococcal polysaccharide vaccination is ineffective in HIV-1-infected Ugandan adults and probably has little, or no, public health value elsewhere in sub-Saharan Africa. Increased rates of pneumococcal disease in vaccine recipients may necessitate a reappraisal of this intervention in other settings.Palabras clave
Africa; Africa South Of The Sahara; Bacterial And Fungal Diseases--prevention and control; Case Control Studies; Clinical Research; Delivery Of Health Care; Developing Countries; Diseases; Eastern Africa; English Speaking Africa; Health; Health Services; Hiv Infections--prevention and control; Immunization; Infections; Primary Health Care; Public Health; Research Methodology; Research Report; Studies; Uganda; Vaccination; Vaccines; Viral Diseases
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Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
10_ODS3_salud_sexual_reprodutiva
/
2_ODS3
/
4_TD
/
6_ODS3_enfermedades_notrasmisibles
Problema de salud:
10_sexually_transmitted_infections
/
2_enfermedades_transmissibles
/
4_aids
/
4_pneumonia
/
6_sense_organ_diseases
Asunto principal:
Infecciones Neumocócicas
/
Vacunas Bacterianas
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Infecciones por VIH
/
VIH-1
/
Infecciones Oportunistas Relacionadas con el SIDA
Tipo de estudio:
Clinical_trials
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Male
País/Región como asunto:
Africa
Idioma:
En
Revista:
Lancet
Año:
2000
Tipo del documento:
Article
País de afiliación:
Reino Unido