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But difficult questions have arisen… • Uncertain disease burden – Few data on pneumococcal disease burden in Asia – Philippines 11‐v PCV trial • No impact on clinical pneumonia • Serotype replacement – Wherever PCV’s introduced, carriage and disease due to non‐<strong>vaccine</strong> types (NVT) ↑
Bohol study of PCV‐11 • 12,194 infants randomized (individually) to receive PCV‐11 (Sanofi Pasteur, never licensed) or placebo at 6, 10 and 14 weeks • Radiological pneumonia – PCV‐11 – 93 – Placebo – 120 • Clinical pneumonia – PCV‐11 – 934 – Placebo ‐ 930 Vaccine efficacy 23%, N/S Vaccine efficacy 0 PIDJ 2009;28:456-62
Page 1 and 2: How to determine the effectiveness
Page 3: But difficult questions have arisen
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 and 38: What of serotype replacement? • O
Page 39 and 40: IPD in high risk groups • Immunoc

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