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Monitoring IPD • May indicate when replacement has neutralized effectiveness (eg. Alaska) • May miss this altogether – Pnc serotypes vary with respect to: • Disease patterns • Probability of disease given carriage • Probability of bacteraemia given disease – In US replacement was identified because 19A was dominant replacing serotype and quite likely to cause bacteraemia
IPD in high risk groups • Immunocompromised are more susceptible to disease due to replacement serotypes • Monitoring IPD in HIV+ may be a useful way of monitoring replacement in settings with many HIV+ cases (eg. S Africa)
Page 1 and 2: How to determine the effectiveness
Page 3 and 4: But difficult questions have arisen
Page 5 and 6: Bohol study of PCV‐11 • 12,194
Page 7 and 8: But difficult questions have arisen
Page 9 and 10: So the key questions are… • How
Page 11 and 12: Before and after… • Need consis
Page 13 and 14: ARI surveillance system Viet Nam Ta
Page 15 and 16: Seasonal Prevalence of Major Pediat
Page 17 and 18: Before and after ‐ conclusions
Page 19 and 20: Community controls • Usually matc
Page 21 and 22: Potential for bias • Community co
Page 23 and 24: Lau et al. Acta Paediatr 1995;84:17
Page 25 and 26: An Effectiveness Trial of Hib Vacci
Page 27 and 28: How to establish the effectiveness
Page 29 and 30: Lancet 2005;365:43‐52
Page 31 and 32: Pneumonia results Incidences per 10
Page 33 and 34: Consider country X • East Asia
Page 35 and 36: Phased introduction • Risks - May
Page 37: What of serotype replacement? • O

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