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Meta-Analysis
. 2009 Oct 7;2009(4):CD004977.
doi: 10.1002/14651858.CD004977.pub2.

Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age

Marilla G Lucero  1 , Vernoni E Dulalia, Leilani T Nillos, Gail Williams, Rhea Angela N Parreño, Hanna Nohynek, Ian D Riley, Helena Makela
Affiliations
Meta-Analysis

Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age

Marilla G Lucero et al. Cochrane Database Syst Rev. .

Abstract

Background: Pneumonia, caused by Streptococcus pneumoniae, is a major cause of morbidity and mortality among children in low-income countries. The effectiveness of pneumococcal conjugate vaccines (PCVs) against invasive pneumococcal disease (IPD), pneumonia, and mortality needs to be evaluated.

Objectives: To update the 2004 review on the efficacy of PCVs in preventing vaccine-serotypes IPD (VT-IPD) , X-ray defined pneumonia among HIV-1 negative children, and other new outcomes.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 1), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1990 to Week 4 February 2009); and EMBASE (1974 to March 2009).

Selection criteria: Randomised controlled trials (RCTs) comparing PCV with placebo, or another vaccine, in children under two with IPD and clinical / radiographic pneumonia as outcomes.

Data collection and analysis: Two review authors independently identified studies, extracted data, and evaluated their corresponding risks of bias. Differences were resolved by discussion. Meta-analysis used the inverse variance method.

Main results: We identified 11 publications from six RCTs conducted in Africa, US, Philippines and Finland where 57,015 children received PCV; while 56,029 received placebo or another vaccine. Seven publications provided high quality evidence on PCV efficacy against IPD and four provided moderate quality evidence against pneumonia. None of the five trials with all-cause mortality data were powered to investigate this outcome. Only two trials have data on all-cause admissions.The main analysis for this review involved HIV-1 negative children and used the pooled results of random-effects model, intent-to-treat analysis (ITT).Pooled vaccine efficacy (VE) for VT-IPD was 80% (95% confidence interval (CI) 58% to 90%, P < 0.0001); all serotypes-IPD, 58% (95% CI 29% to 75%, P = 0.001); World Health Organization X-ray defined pneumonia was 27% (95% CI 15% to 36%, P < 0.0001); clinical pneumonia, 6% (95% CI 2% to 9%, P = 0.0006); and all-cause mortality, 11% (95% CI -1% to 21%, P = 0.08). Analysis involving HIV-1 positive children had similar findings.

Authors' conclusions: PCV is effective in preventing IPD, X-ray defined pneumonia, and clinical pneumonia among HIV-1 negative and HIV-1 positive children under two years. The impact was greater for VT-IPD than for all serotypes-IPD, and for X-ray defined pneumonia than for clinical pneumonia. An 11% reduction with a 95% CI of -1% to 21% and a P = 0.08 is compatible with reduction in all-cause mortality.

PubMed Disclaimer

Conflict of interest statement

The Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP) provided funding for the update of this review.

The authors collaborated with the ARIVAC consortium composed of scientists from the National Public Health Institute of Finland, the University of Queensland, University of Colorado, and sanofi‐pasteur, the pharmaceutical company which developed the 11‐valent PCV used in the phase three RCT in the Philippines. The primary author of this review was the principal investigator of the trial (Lucero 2009) included in this review.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each of the six included trials.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Forest plot of comparison: 1 HIV‐1 negative and <24 months children, outcome: 1.1 IPD, vaccine serotypes, ITT (Random‐effects model).
4
4
Forest plot of comparison: 1 HIV‐1 negative and <24 months children, outcome: 1.2 IPD, all serotypes, ITT (Random‐effects model).
5
5
Forest plot of comparison: 1 HIV‐1 negative and <24 months children, outcome: 1.3 IPD, non‐vaccine serotypes, ITT (Random‐effects model).
6
6
Forest plot of comparison: HIV‐1 negative and <24 months children, outcome: X‐ray defined pneumonia ITT (Random‐effects model) with five studies included in the model (includes the PCV X‐ray pneumonia effect among American Indian children as provided in O'Brien 2009c)
7
7
Forest plot of comparison: HIV‐1 negative and <24 months children, outcome: X‐ray defined pneumonia ITT (Random‐effects model); excludes the outlier result of the PCV effect against X‐ray defined pneumonia among American Indian children
8
8
Forest plot of comparison: 1 HIV‐1 negative and <24 months children, outcome: 1.6 Clinical pneumonia, ITT (Random‐effects model).
9
9
Forest plot of comparison: 1 HIV‐1 negative and <24 months children, outcome: 1.8 All‐cause mortality, ITT (Random‐effects model).
1.1
1.1. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 1 IPD, vaccine serotypes, ITT (Random).
1.2
1.2. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 2 IPD, all serotypes, ITT (Random).
1.3
1.3. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 3 IPD, non‐vaccine serotypes, ITT (Random).
1.4
1.4. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 4 IPD, vaccine‐related serotypes, ITT (Random).
1.5
1.5. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 5 X‐ray defined pneumonia, ITT (Random).
1.6
1.6. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 6 Clinical pneumonia, ITT (Random).
1.7
1.7. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 7 All‐cause admissions, ITT (Random).
1.8
1.8. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 8 All‐cause mortality, ITT (Random).
1.9
1.9. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 9 IPD, vaccine serotypes, ITT (Fixed).
1.10
1.10. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 10 IPD, all serotypes, ITT (Fixed).
1.11
1.11. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 11 IPD, non‐vaccine serotypes, ITT (Fixed).
1.12
1.12. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 12 IPD, vaccine‐related serotypes, ITT (Fixed).
1.13
1.13. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 13 X‐ray defined pneumonia, ITT (Fixed).
1.14
1.14. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 14 Clinical pneumonia, ITT (Fixed).
1.15
1.15. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 15 All‐cause admissions, ITT (Fixed).
1.16
1.16. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 16 All‐cause mortality, ITT (Fixed).
1.17
1.17. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 17 IPD, vaccine serotypes, PP (Random).
1.18
1.18. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 18 IPD, all serotypes, PP (Random).
1.19
1.19. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 19 IPD, non‐vaccine serotypes, PP (Random).
1.20
1.20. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 20 IPD, vaccine‐related serotypes, PP (Random).
1.21
1.21. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 21 X‐ray defined pneumonia, PP (Random).
1.22
1.22. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 22 Clinical pneumonia, PP (Random).
1.23
1.23. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 23 All‐cause admissions, PP (Random).
1.24
1.24. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 24 All‐cause mortality, PP (Random).
1.25
1.25. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 25 Invasive Disease, Vaccine Serotype PP (Fixed).
1.26
1.26. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 26 IPD, all serotypes, PP (Fixed).
1.27
1.27. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 27 IPD, non‐vaccine serotypes, PP (Fixed).
1.28
1.28. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 28 IPD, vaccine‐related serotypes, PP (Fixed).
1.29
1.29. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 29 X‐ray defined pneumonia, PP (Fixed).
1.30
1.30. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 30 Clinical pneumonia, PP (Fixed).
1.31
1.31. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 31 All‐cause admissions, PP (Fixed).
1.32
1.32. Analysis
Comparison 1 Children < 24 months and/or HIV‐1 negative children, Outcome 32 All‐cause mortality, PP (Fixed).
2.1
2.1. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 1 IPD, vaccine serotypes, ITT (Random).
2.2
2.2. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 2 IPD, all serotypes, ITT (Random).
2.3
2.3. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 3 IPD, non‐vaccine serotypes, ITT (Random).
2.4
2.4. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 4 IPD, vaccine‐related serotypes, ITT (Random).
2.5
2.5. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 5 X‐ray defined pneumonia, ITT (Random).
2.6
2.6. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 6 Clinical pneumonia, ITT (Random).
2.7
2.7. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 7 All‐cause admissions, ITT (Random).
2.8
2.8. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 8 All‐cause mortality, ITT (Random).
2.9
2.9. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 9 IPD, vaccine serotypes, ITT (Fixed).
2.10
2.10. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 10 IPD, all serotypes, ITT (Fixed).
2.11
2.11. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 11 IPD, non‐vaccine serotypes, ITT (Fixed).
2.12
2.12. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 12 IPD, vaccine‐related serotypes, ITT (Fixed).
2.13
2.13. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 13 X‐ray defined pneumonia, ITT (Fixed).
2.14
2.14. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 14 Clinical pneumonia, ITT (Fixed).
2.15
2.15. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 15 All‐cause admissions, ITT (Fixed).
2.16
2.16. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 16 All‐cause mortality, ITT (Fixed).
2.17
2.17. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 17 IPD, vaccine serotypes, PP (Random).
2.18
2.18. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 18 IPD, all serotypes, PP (Random).
2.19
2.19. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 19 IPD, non‐vaccine serotypes, PP (Random).
2.20
2.20. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 20 IPD, vaccine‐related serotypes, PP (Random).
2.21
2.21. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 21 X‐ray defined pneumonia, PP (Random).
2.22
2.22. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 22 Clinical pneumonia, PP (Random).
2.23
2.23. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 23 All‐cause admissions, PP (Random).
2.24
2.24. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 24 All‐cause mortality, PP (Random).
2.25
2.25. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 25 IPD, vaccine serotypes, PP (Fixed).
2.26
2.26. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 26 IPD, all serotypes, PP (Fixed).
2.27
2.27. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 27 IPD, non‐vaccine serotypes, PP (Fixed).
2.28
2.28. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 28 IPD, vaccine‐related serotypes, PP (Fixed).
2.29
2.29. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 29 X‐ray defined pneumonia, PP (Fixed).
2.30
2.30. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 30 Clinical pneumonia, PP (Fixed).
2.31
2.31. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 31 All‐cause admissions, PP (Fixed).
2.32
2.32. Analysis
Comparison 2 Children < 24 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 32 All‐cause mortality, PP (Fixed).
3.1
3.1. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 1 IPD, vaccine serotypes, ITT (Random).
3.2
3.2. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 2 IPD, all serotypes, ITT (Random).
3.3
3.3. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 3 IPD, non‐vaccine serotypes, ITT (Random).
3.4
3.4. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 4 IPD, vaccine‐related serotypes, ITT (Random).
3.5
3.5. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 5 X‐ray defined pneumonia, ITT (Random).
3.6
3.6. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 6 Clinical pneumonia, ITT (Random).
3.7
3.7. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 7 All‐cause admissions, ITT (Random).
3.8
3.8. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 8 All‐cause mortality, ITT (Random).
3.9
3.9. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 9 IPD, vaccine serotypes, ITT (Fixed).
3.10
3.10. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 10 IPD, all serotypes, ITT (Fixed).
3.11
3.11. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 11 IPD, non‐vaccine serotypes, ITT (Fixed).
3.12
3.12. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 12 IPD, vaccine‐related serotypes, ITT (Fixed).
3.13
3.13. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 13 X‐ray defined pneumonia, ITT (Fixed).
3.14
3.14. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 14 Clinical pneumonia, ITT (Fixed).
3.15
3.15. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 15 All‐cause admissions, ITT (Fixed).
3.16
3.16. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 16 All‐cause mortality, ITT (Fixed).
3.17
3.17. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 17 IPD, vaccine serotypes, PP (Random).
3.18
3.18. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 18 IPD, all serotypes, PP (Random).
3.19
3.19. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 19 IPD, non‐vaccine serotypes, PP (Random).
3.20
3.20. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 20 IPD, vaccine‐related serotypes, PP (Random).
3.21
3.21. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 21 X‐ray defined pneumonia, PP (Random).
3.22
3.22. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 22 Clinical pneumonia, PP (Random).
3.23
3.23. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 23 All‐cause admissions, PP (Random).
3.24
3.24. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 24 All‐cause mortality, PP (Random).
3.25
3.25. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 25 IPD, vaccine serotypes, PP (Fixed).
3.26
3.26. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 26 IPD, all serotypes, PP (Fixed).
3.27
3.27. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 27 IPD, non‐vaccine serotypes, PP (Fixed).
3.28
3.28. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 28 IPD, vaccine‐related serotypes, PP (Fixed).
3.29
3.29. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 29 X‐ray defined pneumonia, PP (Fixed).
3.30
3.30. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 30 Clinical pneumonia, PP (Fixed).
3.31
3.31. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 31 All‐cause admissions, PP (Fixed).
3.32
3.32. Analysis
Comparison 3 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative children, Outcome 32 All‐cause mortality, PP (Fixed).
4.1
4.1. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 1 IPD, vaccine serotypes, ITT (Random).
4.2
4.2. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 2 IPD, all serotypes, ITT (Random).
4.3
4.3. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 3 IPD, non‐vaccine serotypes, ITT (Random).
4.4
4.4. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 4 IPD, vaccine‐related serotypes, ITT (Random).
4.5
4.5. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 5 X‐ray defined pneumonia, ITT (Random).
4.6
4.6. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 6 Clinical pneumonia, ITT (Random).
4.7
4.7. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 7 All‐cause admissions, ITT (Random).
4.8
4.8. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 8 All‐cause mortality, ITT (Random).
4.9
4.9. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 9 IPD, vaccine serotypes, ITT (Fixed).
4.10
4.10. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 10 IPD, all serotypes, ITT (Fixed).
4.11
4.11. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 11 IPD, non‐vaccine serotypes, ITT (Fixed).
4.12
4.12. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 12 IPD, vaccine‐related serotypes, ITT (Fixed).
4.13
4.13. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 13 X‐ray defined pneumonia, ITT (Fixed).
4.14
4.14. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 14 Clinical pneumonia, ITT (Fixed).
4.15
4.15. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 15 All‐cause admissions, ITT (Fixed).
4.16
4.16. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 16 All‐cause mortality, ITT (Fixed).
4.17
4.17. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 17 IPD, vaccine serotypes, PP (Random).
4.18
4.18. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 18 IPD, all serotypes, PP (Random).
4.19
4.19. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 19 IPD, non‐vaccine serotypes, PP (Random).
4.20
4.20. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 20 IPD, vaccine‐related serotypes, PP (Random).
4.21
4.21. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 21 X‐ray defined pneumonia, PP (Random).
4.22
4.22. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 22 Clinical pneumonia, PP (Random).
4.23
4.23. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 23 All‐cause admissions, PP (Random).
4.24
4.24. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 24 All‐cause mortality, PP (Random).
4.25
4.25. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 25 IPD, vaccine serotypes, PP (Fixed).
4.26
4.26. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 26 IPD, all serotypes, PP (Fixed).
4.27
4.27. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 27 IPD, non‐vaccine serotypes, PP (Fixed).
4.28
4.28. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 28 IPD, vaccine‐related serotypes, PP (Fixed).
4.29
4.29. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 29 X‐ray defined pneumonia, PP (Fixed).
4.30
4.30. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 30 Clinical pneumonia, PP (Fixed).
4.31
4.31. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 31 All‐cause admissions, PP (Fixed).
4.32
4.32. Analysis
Comparison 4 Pooled with Cutts 2005 children < 29 months and/or HIV‐1 negative and HIV‐1 positive children, Outcome 32 All‐cause mortality, PP (Fixed).
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References

References to studies included in this review

Black 2000 {published data only}
    1. Black S, Shinefield H, Fireman B, Lewis E, Ray P, Hansen J, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Pediatric Infectious Disease Journal 2000;19(3):187‐95. - PubMed
Black 2002a {published data only}
    1. Black S, Shinefield H, Ling S, Hansen J, Fireman B, Spring D, et al. Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia. Pediatric Infectious Disease Journal 2002;21(9):810‐5. - PubMed
Cutts 2005 {published data only}
    1. Cutts FT, Zaman SMA, Enwere G, Jaffar S, Levine OS, Okoko JB, et al. Efficacy of nine‐valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double‐blind, placebo‐controlled trial. Lancet 2005;365(9465):1139–46. - PubMed
Eskola 2001 {published data only}
    1. Eskola J, Kilpi T, Palmu A, Jokinen J, Haapakoski J, Herva E, et al. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. New England Journal of Medicine 2001;344(6):403‐9. - PubMed
Hansen 2006 {published data only}
    1. Hansen J, Black S, Shinefield H, Cherian T, Benson J, Fireman B, et al. Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than 5 years of age for prevention of pneumonia: updated analysis using World Health Organization standardized interpretation of chest radiographs. Pediatric Infectious Disease Journal 2006;25(9):779‐81. - PubMed
Kilpi 2003 {published data only}
    1. Kilpi T, Ahman H, Jokinen J, Lankinen KS, Palmu A, Savolainen H, et al. Protective efficacy of a second pneumococcal conjugate vaccine against pneumococcal acute otitis media in infants and children: randomized, controlled trial of a 7‐valent pneumococcal polysaccharide‐meningococcal outer membrane protein complex conjugate vaccine in 1666 children. Clinical Infectious Diseases 2003;37(9):1155‐64. - PubMed
Klugman 2003 {published data only}
    1. Klugman K, Madhi S, Huebner R, Kohberger R, Mbelle N, Pierce N for the Vaccine Trialists Group. A trial of a 9‐valent pneumococcal conjugate vaccine in children with and those without HIV infection. New England Journal of Medicine 2003;349(14):1341‐8. - PubMed
Lucero 2009 {published data only}
    1. Lucero M, Nohynek H, Williams G, Tallo V, Simoes E, Lupisan S, et al. Efficacy of an 11‐valent pneumococcal conjugate vaccine against radiologically confirmed pneumonia among children less than two years of age in the Philippines: a randomized, double‐blind, placebo‐controlled trial. Pediatric Infectious Disease Journal June 2009;28(6):455‐62. - PubMed
Madhi 2005a {published data only}
    1. Madhi SA, Kuwanda L, Cutland C, Klugman KP. The impact of a 9‐valent pneumococcal conjugate vaccine on the public health burden of pneumonia in HIV‐infected and ‐uninfected children. Clinical Infectious Diseases 2005;40(10):1511‐8. - PubMed
O'Brien 2002 {published data only}
    1. OBrien KL, David A, Benson J, Moenne K, Reid R, Moulton L, et al. The effect of conjugate pneumococcal vaccine on pneumonia and otitis media among Navajo and White Mountain Apache children. 3rd International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD) Book of Abstracts. Anchorage Alaska, USA, 2002:110‐11.
O'Brien 2003 {published data only}
    1. O'Brien K, Moulton L, Reid R, Weatherholtz R, Oski J, Brown L, et al. Efficacy and safety of seven‐valent conjugate pneumococcal vaccine in American Indian children: group randomised trial. Lancet 2003;362(9381):355‐61. [MEDLINE: ] - PubMed

References to studies excluded from this review

Adam 2001 {published data only}
    1. Adam D, Scholz H. Value of pneumococcal vaccination in infants and young children. Klinische Padiatrie 2001;213(3):109‐13. - PubMed
Black 2004a {published data only}
    1. Black S, Shinefield H, Baxter R, Austrian R, Bracken L, Hansen J, et al. Postlicensure surveillance for pneumococcal invasive disease after use of heptavalent pneumococcal conjugate vaccine in Northern California Kaiser Permanente. Pediatric Infectious Disease Journal 2004;23(6):485‐9. - PubMed
Black 2004b {published data only}
    1. Black S, Shinefield H, Cohen R, Floret D, Gaudelus J, Olivier C, et al. Clinical effectiveness of seven‐valent pneumococcal conjugate vaccine (Prevenar) against invasive pneumococcal diseases: prospects for children in France. Archives de Pediatrie 2004;11(7):843‐53. - PubMed
Blum 2000 {published data only}
    1. Blum MD, Dagan R, Mendelman PM, Pinsk V, Giordani M, Li S, et al. A comparison of multiple regimens of pneumococcal polysaccharide‐meningococcal outer membrane protein complex conjugate vaccine and pneumococcal polysaccharide vaccine in toddlers. Vaccine 2000;18(22):2359‐67. - PubMed
Bogaert 2005 {published data only}
    1. Bogaert D, Veenhoven RH, Ramdin R, Luijendijk IH, Rijkers GT, Sanders EA, et al. Pneumococcal conjugate vaccination does not induce a persisting mucosal IgA response in children with recurrent acute otitis media. Vaccine 2005;23(20):2607‐13. - PubMed
Brouwer 2005 {published data only}
    1. Brouwer CN, Maille AR, Rovers MM, Veenhoven RH, Grobbee DE, Sanders EA, et al. Effect of pneumococcal vaccination on quality of life in children with recurrent acute otitis media: a randomized, controlled trial. Pediatrics 2005;115(2):273‐9. - PubMed
Choo 2000 {published data only}
    1. Choo S, Seymour L, Morris R, Quataert S, Lockhart S, Cartwright K, et al. Immunogenicity and reactogenicity of a pneumococcal conjugate vaccine administered combined with a hemophilus influenzae type b conjugate vaccine in United Kingdom infants. Pediatric Infectious Disease Journal 2000;19(9):854‐62. - PubMed
Dagan 2001 {published data only}
    1. Dagan R, Sikuler‐Cohen M, Zamir O, Janco J, Givon‐Lavi N, Fraser D. Effect of a conjugate pneumococcal vaccine on the occurrence of respiratory infections and antibiotic use in day‐care center attendees. Pediatric Infectious Disease Journal 2001;20(10):951‐8. - PubMed
Dagan 2002 {published data only}
    1. Dagan R, Givon‐Lavi N, Zamir O, Sikuler‐Cohen M, Guy L, Janco J, et al. Reduction of nasopharyngeal carriage of Streptococcus pneumoniae after administration of a 9‐valent pneumococcal conjugate vaccine to toddlers attending day care centers. Journal of Infectious Diseases 2002;185(7):927‐36. - PubMed
Dagan 2003 {published data only}
    1. Dagan R, Givon‐Lavi N, Zamir O, Fraser D. Effect of a nonavalent conjugate vaccine on carriage of antibiotic‐resistant Streptococcus pneumoniae in day‐care centers. Pediatric Infectious Disease Journal 2003;22(6):532‐40. [MEDLINE: ] - PubMed
Dagan 2005 {published data only}
    1. Dagan R, Givon‐Lavi N, Fraser D, Lipsitch M, Sibe GR, Kohberger R. Serum serotype‐specific pneumococcal anticapsular immunoglobulin G concentrations after immunization with a 9‐valent conjugate pneumococcal vaccine correlate with nasopharyngeal acquisition of pneumococcus. Journal of Infectious Diseases 2005;192(3):367‐76. - PubMed
De Aristegui Fernan 2005 {published data only}
    1. Aristegui Fernandez J, Cos Arregui B, Zurimendi Carril A, Alday Esteban MV, Alzua Ruiz J, Fuente Jausoro E, et al. Evaluation of the safety and immunogenicity of pneumococcal seven‐valent conjugate vaccine (Prevenar) administered in previously unvaccinated Spanish children aged 24 to 36 months. Vaccine 2005;23(16):1917‐22. - PubMed
Einarsdottir 2005 {published data only}
    1. Einarsdottir HM, Erlendsdottir H, Kristinsson KG, Gottfredsson M. Nationwide study of recurrent invasive pneumococcal infections in a population with a low prevalence of human immunodeficiency virus infection. Clinical Microbiology and Infection 2005;11(9):744‐9. - PubMed
Ekstrom 2005 {published data only}
    1. Ekstrom N, Ahman H, Verho J, Jokinen J, Vakevainen M, Kilpi T, et al. Kinetics and avidity of antibodies evoked by heptavalent pneumococcal conjugate vaccines PncCRM and PncOMPC in the Finnish Otitis Media Vaccine Trial. Infection and Immunity 2005;73(1):369‐77. - PMC - PubMed
Esposito 2005 {published data only}
    1. Esposito S, Pugni L, Bosis S, Proto A, Cesati L, Bianchi C, et al. Immunogenicity, safety and tolerability of heptavalent pneumococcal conjugate vaccine administered at 3, 5 and 11 months post‐natally to pre‐ and full‐term infants. Vaccine 2005;23(14):1703‐8. - PubMed
Finn 2002 {published data only}
    1. Finn A, Arnaoutakis K, Race G, Burkinshaw R, Shaw L, Zhang Q. Mucosal anticapsular polysaccharide responses at 3 years of age after pneumococcal immunization in infancy and their relation to pneumococcal carriage. 3rd International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD) (May 5‐8). Anchorage Alaska, USA, 2002.
Fireman 2003 {published data only}
    1. Fireman B, Black SB, Shinefield HR, Lee J, Lewis E, Ray P. Impact of the pneumococcal conjugate vaccine on otitis media. Erratum appears in Pediatric Infectious Disease Journal 2003;22(2):163. Pediatric Infectious Disease Journal 2003;22(1):10‐6. - PubMed
Frazao 2005 {published data only}
    1. Frazao N, Brito‐Avo A, Simas C, Saldanha J, Mato R, Nunes S, et al. Effect of the seven‐valent conjugate pneumococcal vaccine on carriage and drug resistance of Streptococcus pneumoniae in healthy children attending day‐care centers in Lisbon. Pediatric Infectious Disease Journal 2005;24(3):243‐52. - PubMed
Ghaffar 2005 {published data only}
    1. Ghaffar F. The safety of 7‐valent pneumococcal conjugate vaccine. Expert Opinion on Drug Safety 2005;4(4):631‐6. - PubMed
Givon‐Lavi 2003 {published data only}
    1. Givon‐Lavi N, Fraser D, Dagan R. Vaccination of day‐care center attendees reduces carriage of Streptococcus pneumoniae among their younger siblings. Pediatric Infectious Disease Journal 2003;22(6):524‐32. - PubMed
Goldblatt 2006 {published data only}
    1. Goldblatt D, Southern J, Ashton L, Richmond P, Burbidge P, Tasevska J, et al. Immunogenicity and boosting after a reduced number of doses of a pneumococcal conjugate vaccine in infants and toddlers. Pediatric Infectious Disease Journal 2006;25(4):312‐9. - PubMed
Hanna 2006 {published data only}
    1. Hanna JN, Humphreys JL, Murphy DM. Invasive pneumococcal disease in Indigenous people in north Queensland, 1999‐2004. Medical Journal of Australia 2006;184(1):118‐21. - PubMed
Jokinen 2004 {published data only}
    1. Jokinen JT, Ahman H, Kilpi TM, Makela PH, Kayhty MH. Concentration of anti‐pneumococcal antibodies as a serological correlate of protection: an application to acute otitis media. Journal of Infectious Diseases 2004;190(3):545‐50. - PubMed
Kayhty 2005 {published data only}
    1. Kayhty H, Ahman H, Eriksson K, Sorberg M, Nilsson L. Immunogenicity and tolerability of a heptavalent pneumococcal conjugate vaccine administered at 3, 5 and 12 months of age. Pediatric Infectious Disease Journal 2005;24(2):108‐14. - PubMed
Madhi 2004 {published data only}
    1. Madhi SA, Klugman KP, Group VT. A role for Streptococcus pneumoniae in virus‐associated pneumonia. Nature‐Medicine 2004;10(8):811‐3. - PMC - PubMed
Madhi 2005b {published data only}
    1. Madhi SA, Heera JR, Kuwanda L, Klugman KP. Use of procalcitonin and C‐reactive protein to evaluate vaccine efficacy against pneumonia. PLoS Medicine 2005;2(2):e38. - PMC - PubMed
Moulton 2006 {published data only}
    1. Moulton LH, O'Brien KL, Reid R, Weatherholtz R, Santosham M, Siber GR. Evaluation of the indirect effects of a pneumococcal vaccine in a community‐randomized study. Journal of Biopharmaceutical Statistics 2006;16(4):453‐62. - PubMed
Palmu 2002 {published data only}
    1. Palmu A, Verho J, Makela PH, Kilpi TM. Long‐term efficacy of the seven‐valent PncCRM vaccine on otitis media. 3rd International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD) (May 5‐8). Anchorage Alaska, USA, 2002.
Palmu 2004 {published data only}
    1. Palmu AA, Verho J, Jokinen J, Karma P, Kilpi TM. The seven‐valent pneumococcal conjugate vaccine reduces tympanostomy tube placement in children. Pediatric Infectious Disease Journal 2004;23(8):732‐8. - PubMed
Plotkin 2000 {published data only}
    1. Plotkin SA. Development of a nonavalent pneumococcal conjugate vaccine. Medecine Therapeutique Pediatrie 2000;3(Spec. Iss. 2):17‐8.
Prymula 2006 {published data only}
    1. Prymula R, Peeters P, Chrobok V, Kriz P, Novakova E, Kaliskova E, et al. Pneumococcal capsular polysaccharides conjugated to protein D for prevention of acute otitis media caused by both Streptococcus pneumoniae and non‐typable Haemophilus influenzae: a randomised double‐blind efficacy study. Lancet 2006;367(9512):740‐8. - PubMed
Reinert 2003 {published data only}
    1. Reinert P, Guy M, Girier B, Szelechowski B, Baudoin B, Deberdt P, et al. The safety and immunogenicity of an heptavalent pneumococcal polysaccharide conjugate vaccine (Prevenar) administered in association with a whole‐cell pertussis‐based pediatric combination vaccine (DTP‐IPV/PRP‐T) to French infants with a two‐, three‐, and four‐month schedule. Archives de Pediatrie 2003;10(12):1048‐55. - PubMed
Rosenfeld 2005 {published data only}
    1. Rosenfeld RM, Lous J, Bluestone CD, Marchisio P, Casselbrant ML, Paradise JL, et al. Recent advances in otitis media. Annals of Otology, Rhinology, & Laryngology 2005;194:114‐39. - PubMed
Scheifele 2006 {published data only}
    1. Scheifele DW, Halperin SA, Smith B, Ochnio J, Meloff K, Duarte‐Monteiro D. Assessment of the compatibility of co‐administered 7‐valent pneumococcal conjugate, DTaP.IPV/PRP‐T Hib and hepatitis B vaccines in infants 2‐7 months of age. Vaccine 2006;24(12):2057‐64. - PubMed
Schmitt 2003 {published data only}
    1. Schmitt HJ, Faber J, Lorenz I, Schmole‐Thoma B, Ahlers N. The safety, reactogenicity and immunogenicity of a 7‐valent pneumococcal conjugate vaccine (7VPnC) concurrently administered with a combination DTaP‐IPV‐Hib vaccine. Vaccine 2003;21(25‐6):3653‐62. - PubMed
Shinefield 1999 {published data only}
    1. Shinefield HR, Black S, Ray P, Chang I, Lewis N, Fireman B, et al. Safety and immunogenicity of heptavalent pneumococcal CRM197 conjugate vaccine in infants and toddlers. Pediatric Infectious Disease Journal 1999;18(9):757‐63. - PubMed
Shinefield 2002a {published data only}
    1. Shinefield H, Black S, Ray P, Fireman B, Schwalbe J, Lewis E. Efficacy, immunogenicity and safety of heptavalent pneumococcal conjugate vaccine in low birth weight and preterm infants. Pediatric Infectious Disease Journal 2002;21(3):182‐6. - PubMed
Straetemans 2003 {published data only}
    1. Straetemans M, Palmu A, Auranen K, Zielhuis GA, Kilpi T. The effect of a pneumococcal conjugate vaccine on the risk of otitis media with effusion at 7 and 24 months of age. International Journal of Pediatric Otorhinolaryngology 2003;67(11):1235‐42. - PubMed
Tichmann‐Schumann 2005 {published data only}
    1. Tichmann‐Schumann I, Soemantri P, Behre U, Disselhoff J, Mahler H, Maechler G, et al. Immunogenicity and reactogenicity of four doses of diphtheria‐tetanus‐three‐component acellular pertussis‐hepatitis B‐inactivated polio virus‐Haemophilus influenzae type b vaccine coadministered with 7‐valent pneumococcal conjugate vaccine. Pediatric Infectious Disease Journal 2005;24(1):70‐7. - PubMed
Van Kempen 2006 {published data only}
    1. Kempen MJ, Vermeiren JS, Vaneechoutte M, Claeys G, Veenhoven RH, Rijkers GT, et al. Pneumococcal conjugate vaccination in children with recurrent acute otitis media: a therapeutic alternative?. International Journal of Pediatric Otorhinolaryngology 2006;70(2):275‐85. - PubMed
Veenhoven 2002a {published data only}
    1. Veenhoven RH, Schilder AGM, Bogaert D, Brouwer CNM, Kiezebrink HH, Uiterwaal CSPM, et al. Prevention of acute otitis media by pneumococcal conjugate vaccine combined with 23‐valent polysaccharide vaccine in children with recurrent acute otitis media (Dutch OMAVAX‐ study). 3rd International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD) (May 5‐8). Anchorage Alaska, USA, 2002.
Veenhoven 2003a {published data only}
    1. Veenhoven R, Bogaert D, Uiterwaal C, Brouwer C, Kiezebrink H, Bruin J, et al. Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomised study. Lancet 2003;361(9376):2189‐95. [MEDLINE: ] - PubMed
Veenhoven 2003b {published data only}
    1. Veenhoven RH, Bogaert D, Schilder AGM, Uiterwaal CSPM, Rijkers GT, Hermans PWM, et al. Clinical ineffectiveness of combined vaccination with 7‐valent pneumococcal conjugate vaccine and 23‐valent pneumococcal polysaccharide vaccine in children with recurrent acute otitis media: a randomised double‐blind study. Nederlands Tijdschrift voor Geneeskunde 2003;147(45):2220‐6.
Veenhoven 2004 {published data only}
    1. Veenhoven RH, Bogaert D, Schilder AG, Rijkers GT, Uiterwaal CS, Kiezebrink HH, et al. Nasopharyngeal pneumococcal carriage after combined pneumococcal conjugate and polysaccharide vaccination in children with a history of recurrent acute otitis media. Clinical Infectious Diseases 2004;39(7):911‐9. - PubMed
Yeh 2003 {published data only}
    1. Yeh SH, Zangwill KM, Lee H, Chang SJ, Wong VI, Greenberg DP, et al. Heptavalent pneumococcal vaccine conjugated to outer membrane protein of Neisseria meningitidis serogroup b and nasopharyngeal carriage of Streptococcus pneumoniae in infants. Vaccine 2003;21(19‐20):2627‐31. - PubMed
Zangwill 2003 {published data only}
    1. Zangwill KM, Greenberg DP, Chiu CY, Mendelman P, Wong VK, Chang SJ, et al. Safety and immunogenicity of a heptavalent pneumococcal conjugate vaccine in infants. Vaccine 2003;21(17‐18):1894‐900. [MEDLINE: ] - PubMed

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References to other published versions of this review

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MeSH terms