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Impact of the 23-valent pneumococcal polysaccharide vaccination in pregnancy against infant acute lower respiratory infections in the Northern Territory of Australia

Binks, Michael J.; Moberley, Sarah A.; Balloch, Anne; Leach, A. J.; Nelson, Sandra; Hare, Kim M.; Wilson, Cate; Nelson, Jane; Morris, Peter; Ware, Robert S.; Andrews, Ross

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BackgroundIndigenous children in Australia's Northern Territory are densely colonised with the pneumococcus within weeks of birth antecedent to a high prevalence of acute lower respiratory infection (ALRI). We assessed the impact of the 23-valent pneumococcal polysaccharide vaccine (23vPPV) in pregnancy against infant ALRI in this setting.MethodsIn an open label, allocation concealed, outcome-assessor blinded, randomised controlled trial conducted in the Northern Territory of Australia, healthy...[Show more]

dc.contributor.authorBinks, Michael J.
dc.contributor.authorMoberley, Sarah A.
dc.contributor.authorBalloch, Anne
dc.contributor.authorLeach, A. J.
dc.contributor.authorNelson, Sandra
dc.contributor.authorHare, Kim M.
dc.contributor.authorWilson, Cate
dc.contributor.authorNelson, Jane
dc.contributor.authorMorris, Peter
dc.contributor.authorWare, Robert S.
dc.contributor.authorAndrews, Ross
dc.date.accessioned2019-12-18T23:33:40Z
dc.date.available2019-12-18T23:33:40Z
dc.identifier.issn2200-6133
dc.identifier.urihttp://hdl.handle.net/1885/196228
dc.description.abstractBackgroundIndigenous children in Australia's Northern Territory are densely colonised with the pneumococcus within weeks of birth antecedent to a high prevalence of acute lower respiratory infection (ALRI). We assessed the impact of the 23-valent pneumococcal polysaccharide vaccine (23vPPV) in pregnancy against infant ALRI in this setting.MethodsIn an open label, allocation concealed, outcome-assessor blinded, randomised controlled trial conducted in the Northern Territory of Australia, healthy Indigenous women aged 17-39years were randomised to receive the 23vPPV during pregnancy (n=75; 30-36weeks gestation), at birth (n=75), or at 7months post-partum (n=77). Randomisation was stratified by community of residence. In a secondary analysis, we compared the incidence of ALRI hospitalisations and ALRI clinic presentations (ascertained from electronic medical records) among infants of pregnancy vaccinees versus infants of mothers not vaccinated in pregnancy (controls) in the first year of life.ResultsALRI hospitalisation incidence was 12.3 per 100 child-years among infants of pregnancy vaccinees compared with 15.8 per 100 child-years among controls (hazard ratio (HR) 0.77, 95%CI 0.29-2.03). ALRI hospitalisations were more common among remote compared to urban infants (27.7 versus 8.6 per 100 child-years). Stratification by dwelling highlighted a differential antenatal vaccine effect against ALRI hospitalisations (urban HR 2.45, 95%CI 0.60-9.99; remote HR 0.21, 95%CI 0.04-1.08). ALRI clinic presentation incidence was similar among infants of pregnancy vaccinees and controls.ConclusionsIn this small study, antenatal 23vPPV vaccination was not associated with a reduced incidence of infant ALRI hospitalisations or ALRI clinic presentations during the first year of life. A potential differential effect between urban and remote settings warrants further investigation.
dc.description.sponsorshipThis work was supported by the National Health and Medical Research Council of Australia (project grants 350499, 490320 and scholarship 1017225).
dc.format.mimetypeapplication/pdf
dc.language.isoen_AU
dc.publisherBioMed Central Ltd.
dc.rights© 2018 The Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourcePneumonia
dc.source.urihttps://pneumonia.biomedcentral.com
dc.subject23-valent pneumococcal polysaccharide vaccine
dc.subjectPregnancy
dc.subjectAcute lower respiratory infection
dc.subjectAustralia
dc.subjectIndigenous
dc.titleImpact of the 23-valent pneumococcal polysaccharide vaccination in pregnancy against infant acute lower respiratory infections in the Northern Territory of Australia
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume10
dcterms.dateAccepted2018-11-20
dc.date.issued2018-05-16
local.identifier.absfor110203 - Respiratory Diseases
local.identifier.ariespublicationu3102795xPUB2380
local.type.statusPublished Version
local.contributor.affiliationBinks, Michael J., Charles Darwin University
local.contributor.affiliationMoberley, Sarah A, Charles Darwin University
local.contributor.affiliationBalloch, Anne, University of Melbourne
local.contributor.affiliationLeach, A J, Charles Darwin University
local.contributor.affiliationNelson, Sandra, Department of Health and Families
local.contributor.affiliationHare, Kim M, Charles Darwin University
local.contributor.affiliationWilson, Cate, Charles Darwin University
local.contributor.affiliationNelson, Jane, Charles Darwin University
local.contributor.affiliationMorris, Peter, Menzies School of Health Research
local.contributor.affiliationWare, Robert S., Griffith University
local.contributor.affiliationAndrews, Ross, College of Health and Medicine, ANU
dc.relationhttp://purl.org/au-research/grants/nhmrc/350499
dc.relationhttp://purl.org/au-research/grants/nhmrc/490320
dc.relationhttp://purl.org/au-research/grants/nhmrc/1017225
local.bibliographicCitation.issue13
local.bibliographicCitation.startpage1
local.bibliographicCitation.lastpage9
local.identifier.doi10.1186/s41479-018-0057-2
local.identifier.absseo920204 - Evaluation of Health Outcomes
dc.date.updated2019-08-04T08:19:06Z
local.identifier.thomsonID4.54273E+11
dcterms.accessRightsOpen Access
dc.provenanceThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
dc.rights.licensereative Commons Attribution 4.0 International License
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