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Invasive pneumococcal disease in Alaskan natives – under 2 years 450 400 350 300 250 200 150 all disease vaccine type non-vaccine type 100 50 0 1995-2000 2001-2003 2004-2006 JAMA 2007;297:1784‐92
So the key questions are… • How to establish the effectiveness of Pnc vaccines in settings where the contribution of Pnc to pneumonia burden is in doubt? • How to detect declining effectiveness that may be due to serotype replacement?
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: But difficult questions have arisen
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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