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Vol. 56. Núm. 1.
Páginas 79-90 (Enero 2002)
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Vol. 56. Núm. 1.
Páginas 79-90 (Enero 2002)
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La enfermedad neumocócica y su prevención. Vacuna neumocócica conjugada heptavalente
Pneumococcal Disease And Its Prevention. The Heptavalent Pneumococcal Conjugate Vaccine
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F.A. Moraga Llop
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fmoraga@acmcb.es

Correspondencia: Dr. F.A. Moraga Llop. Doctor Roux, 103. 08017 Barcelona.
Comité Asesor de Vacunas de la Asociación Española de Pediatría.
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Las infecciones neumocócicas son una causa importante de morbilidad, hospitalización y mortalidad, con dos grupos de edad de mayor incidencia y gravedad, uno pediátrico, los niños menores de 5 años (sobre todo los dos primeros años de edad), y otro de adulto (personas mayores de 65 años). La vacuna neumocócica conjugada heptavalente, comercializada en España en junio de 2001, es eficaz en niños menores de 2 años de edad e induce memoria inmunitaria, a diferencia de la vacuna no conjugada 23-va-lente. La cobertura de los serotipos de la vacuna heptava-lente en España es el 80 % de los que causan enfermedad neumocócica invasora y otitis media aguda en los niños de 2 a 59 meses de edad. La vacuna heptavalente es inmunó-gena, eficaz y segura. Su eficacia está demostrada en la prevención de la enfermedad invasora causada por los siete serotipos vacunales; también produce una disminución significativa de neumonía y una reducción de otitis media aguda; la vacuna tiene una indicación preferente: los niños menores de 2 años; los niños entre 2 y 5 años también se pueden beneficiar de la vacuna, pero con prioridad para los pertenecientes a grupos de riesgo. Un mejor co-nocimiento en nuestro medio de la epidemiología de la infección neumocócica y de la eficiencia de esta inmuniza-ción permitirá determinar la necesidad o no de incluir esta vacuna en el calendario de inmunizaciones sistemáticas.

Palabras clave:
Neumococo Infección neumocócica
Enfermedad neumocócica
Enfermedad invasora
Vacunación
Vacunas antineumocócicas
Vacuna conjugada neumocócica heptavalente

Pneumococcal disease is a major cause of morbidity, hospitalization and mortality. Two age groups show a greater incidence and severity of the disease: children under the age of 5 years (mainly during the first 2 years of life) and adults aged more than 65 years. The heptavalent pneumococcal conjugate vaccine, which was commercialized in Spain in June 2001, is efficacious in children aged less than 2 years and, unlike the non-conjugate 23-valent vaccine, it induces immunological memory. In Spain the heptavalent vaccine covers 80 % of serotypes causing pneumococcal invasive disease and acute otitis media in children aged 2-59 months. The heptavalent vaccine has been shown to be immunogenic, efficacious and safe. It has proven efficacy in the prevention of invasive disease caused by the seven vaccine serotypes. In addition, it significantly decreases pneumonia and also prevent acute otitis media. The vaccine is preferably indicated in children aged less than 2 years; children aged 2-5 years may also benefit from the vaccine but those in risk groups should be prioritized. Greater knowledge of the epidemiology of pneumococcal disease and the efficiency of this vaccine in Spain will determine whether it should be included in the immunization schedule.

Key words:
Pneumococcus
Pneumococcal infection
Pneumococcal disease
Invasive disease
Vaccination Pneumococcal vaccines
Pneumococcal 7-valent conjugate vaccine
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Bibliografía
[1.]
W.P. Hausdorff, J. Bryant, P.R. Paradiso, G.R. Siber.
Which pneumococcal serogroups cause the most invasive disease: Implications for conjugate vaccine formulation and use, Part I. Clin..
Infect Dis, 30 (2000), pp. 100-121
[2.]
Pneumococcal vaccines. WHO position paper. Wkly Epidemiol..
Rec, 74 (1999), pp. 177-184
[3.]
J. Eskola, J.O. Klein, K.P. Klugman, P. McIntyre.
Strategies for controlling pneumococcal disease: Selected proceedings of the First International Pediatric Infectious Disease Conference..
Monterey, CA, September, 21 (1995), pp. 19-24
[4.]
A. Fenoll, I. Jado, D. Vicioso, S. Berrón, J.E. Yuste, J. Casal.
Streptococcus pneumoniae in children in Spain: 1990-1999..
Acta Paediatrica, 435 (2000), pp. 44-50
[5.]
S. Black, H. Shinefield, B. Fireman, E. Lewis, P. Ray, J.R. Hansen.
The Northern California Kaiser Permanente Vaccine Study Center Group. Efficacy, safety and immunogenicity of a Heptavalent Pneumococcal Conjugate Vaccine in Children..
Pediatr Infect Dis J, 19 (2000), pp. 187-195
[6.]
Black S, Shinefield H, Ray P, Lewis EM, Fireman B, the Kaiser Permanente Vaccine Study Efficacy Trial et al. Efficacy of Heptavalent Conjugate Pneumococcal Vaccine (Wyeth Lederle) in 37,000 Infants and Children: Impact on Pneumonia, Otitis Media, and an Update on Invasive Disease-Results of The Northern California Kaiser Permanente Efficacy Trial. Abstracts. 39th Annual ICAAC. San Francisco, California, Paper 1398, 1999.
[7.]
Eskola J, Kilpi T, Palmu A, Jokinen J, Haapakoski J, Herva E et al, for The Finnish Otitis Media Study Group. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001; 344: 403-409.
[8.]
Kilpi T, Palmu A, Leinonen M, Eskola J, Finom SG. Efficacy of a seven-valent pneumococcal conjugate vaccine (PncOMPC) against serotype-specific acute otitis media (AOM) caused by Streptococcus pneumoniae (Pnc). 40th Interscience Conference on antimicrobial Agents and Chemotherapy. Abst. 689. Sept. 17-20, 2000, Toronto, Canada.
[9.]
T.A. Lieu, G.T. Ray, S.B. Black, J.C. Butler, J.O. Klein, R.F. Breiman.
Projected cost-effectiveness of pneumococcal conjugate vaccination of healthy infants and young children..
Jama, 283 (2000), pp. 1460-1468
[10.]
Centers for Disease Control and Prevention. Preventing pneumococcal disease among infants and young children: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000; 49 (No. RR-9): 1-35.
[11.]
American Academy of Pediatrics. Policy statement: Recommendations for the prevention of pneumococcal infections,including the use of pneumococcal conjugate vaccine (Prevnar),pneumococcal polisaccharide vaccine, and antibiotic prophylaxis..
Pediatrics, 106 (2000), pp. 362-366
[12.]
Centers for Disease Control and Prevention. Prevention of pneumococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997; 46 (No. RR-8): 1-24.
[13.]
Baraibar Castelló R. Estado de portador nasofaríngeo de Streptococcus pneumoniae. En: Moraga Llop FA, ed. La enfermedad neumocócica en el niño. Barcelona: Prous Science, 2001; 31-53.
[14.]
Dagan R, Melamed R, Muallem M, Piglansky L, Yagupsky P. Nasopharyngeal Colonization in Southern Israel With antibiotic- resistant pneumococci during the first 2 years of life: Relation to serotypes likely to be included in pneumococcal conjugated vaccines. J Infect Dis 1996; 174: 1352-1355.
[15.]
Boersma WG, Löwenberg A, Holloway Y, Kuttschrütter H, Snijder JAM, Koëter GH. The role of antigen detection on pneumococcal carriers: A comparison between cultures and capsular antigen detection in upper respiratory tract secretions. Scand J Infect Dis 1993; 25: 51-56.
[16.]
D.M. Barnes, S. Whittier, P.H. Gilligan, S. Soares, A. Tomasz, F.W. Henderson.
Transmission of multidrug-resistant serotype 23 F Streptococcus pneumoniae in group day care: Evidence suggestingcapsular transformation of the resistant strain in vivo..
J Infect Dis, 97 (1995), pp. 1-11
[17.]
E.A. Kabat.
The nature of an antigenic determinant..
J Immunol, 97 (1966), pp. 1-11
[18.]
K.E. Stein.
Thymus-independent and thymus-dependent responses to polysaccharide antigens..
J Infect Dis, 165 (1992), pp. 49-52
[19.]
P.J. Delves, I.M. Roitt.
The immune system..
N Engl J Med, 343 (2000), pp. 108-117
[20.]
Sniadack DH, Schwartz B, Lipman H, Bogaerts J, Butler JC, Dagan R et al. Potential interventions for the prevention of childhood pneumonia: Geographic and temporal differences in serotype and serogroup distribution of sterile site pneumococcal isolates from children implications for vaccine strategies. Pediatr Infect Dis J 1995; 14: 503-510.
[21.]
Butler JC, Breiman RF, Lipman HB, Hofmann J, Facklam RR. Serotype distribution of Streptococcus pneumoniae infections among preschool children in the United States, 1978-1994: implications for development of a conjugate vaccine. J Infect Dis 1995; 171: 885-889.
[22.]
Dagan R, Yagupsky P, Goldbart A, Wasas A, Klugman K. Increasing prevalence of penicillin-resistant pneumococcal infections in children in southern Israel: implications for future immunization policies. Pediatr Infect Dis J 1994; 13: 782-786.
[23.]
Nava JM, Bella F, Garau J, Lite J, Morera MA, Marti C et al. Predictive factors for invasive disease due to penicillin-resistantStreptococcus pneumoniae: A population-based study. Clin Infect Dis 1994; 19: 884-890.
[24.]
Fenoll A, Martin-Bourgon C, Muñoz R, Vicioso D, Casal J. Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolates causing systemic infections in Spain, 1979-1989. Rev Infect Dis 1991; 13: 56-60.
[25.]
Fenoll A, Jado I, Vicioso D, Pérez A, Casal J. Evolution of Streptococcus pneumoniae serotypes and antibiotic resistance in Spain: Update (1990 to 1996). J Clin Microbiol 1998; 36: 3447-3454.
[26.]
Jacobs NM, Lerdachornsuk S, Metzger WI. Pneumococcal bacteremia in infants and children: A ten-year experience at the Cook County Hospital with special reference to the pneumococcal serotypes isolated. Pediatrics 1979; 64: 296-300.
[27.]
Teele DW, Klein JO, Rosner B, and the Greater Boston Otitis Media Group. Epidemiology of otitis media during the first seven years of life in children in greater Boston: A prospective cohort study. J Infect Dis 1989; 160: 83-94.
[28.]
Ahman H, Kayhty H, Tamminen P, Vuorela A, Malinoski F, Eskola J. Pentavalent pneumococcal oligosaccharide conjugate vaccine PncCRM is well tolerated and able to induce an antibody response in infants. Pediatr Infect Dis J 1996; 15: 134-139.
[29.]
Bisno AL, Freeman JC. The syndrome of asplenia, pneumococcal sepsis, and disseminated intravascular coagulation. Ann Intern Med 1970; 72: 389-393.
[30.]
Takala AK, Jero J, Kela E, Rönnenberg P-R, Koskenniemi E,Eskola J. Risk factors for primary invasive pneumococcal diseaseamong children in Finland. JAMA 1995; 273: 859-864.
[31.]
Centers for Disease Control and Prevention. Pneumococcal polysaccharide vaccine usage. United States..
Mmwr, 33 (1984), pp. 273-281
[32.]
D. Fedson, D. Musher, J. Eskola.
Pneumococcal vaccine.
Vaccines, pp. 553-607
[33.]
L.J. Baraff, J.W. Bass, G.R. Fleisher, J.O. Klein, G.H. McCracken, K.R. Powell.
Practice guideline for the management of infants and children 0 to 36 months of age with fever without source..
Pediatrics, pp. 1-12
[34.]
Hausdorff WP, Siber GR, Bryant J, Paradiso P. Geographic differences in reported invasive pneumococcal disease rates and serotype prevalence for young children: Less than meets the eye? Lancet 2001 (aceptado para publicación).
[35.]
Diez Domingo J, Morant A, Pereiro I, Gimeno C, Brines J, Gonzalez A. Childhood invasive pneumococcal disease in Valencia, Spain. Population-based surveillance system. Abstract book of the 17th annual meeting of the European Society for Paediatric Infectious Diseases, 1999; 92.
[36.]
Dominguez A, Ciruela P, Martinez A, Carmona G, Torner N, Cardeñosa N et al. Epidemiology of invasive pneumococcal disease in infants in Catalonia (Spain). Abstract book of 19th annual meeting of the European Society for Paediatric Infectious Diseases, 2001; 109.
[37.]
Iglesias L, García-Arenzana JM, Valiente A, Gomariz M, Pérez Trallero E. Meningitis neumocócica en la población pediátrica de Gipuzkoa. Enferm Infecc Microbiol Clin 2001; 19 (Supl 1): 11.
[38.]
L. Bratton, D.W. Teele, J.O. Klein.
Outcome of unsuspected pneumococcemia in children not initially admitted to the hospital..
J Pediatr, 90 (1977), pp. 703-706
[39.]
M.A. Mufson.
Streptococcus pneumoniae..
pp. 1539-1550
[40.]
Asensi F, Otero MC, Pérez-Tamarit D, Ridaura S, San Miguel MJ, Torres D et al. Pneumococcal meningitis. Experience of theChildren's Hospital La Fe of Valencia, Spain, 1992-2000. Abstract book of 18th annual meeting of the European Society for Paediatric Infectious Diseases, 2000; 57.
[41.]
S. Mencia Bartolomé, J. Casado Flores, C. Martín Barba, M. González-Vicente, M.J. Ruiz López.
Meningitis neumocócica en la infancia. Revisión de 28 casos..
An Esp Pediatr, 53 (2000), pp. 94-99
[42.]
A. Morant, J. Diez, C. Gimeno, N. De la Muela, I. Pereiro, J. Brines.
Epidemiology of Haemophilus influenzae type b, Neisseria meningitidis, and Streptococcus pneumoniae in children in the..
Valencia community, Spain. Acute diseases study group [in Spanish]. Rev Neurol, 26 (1998), pp. 34-37
[43.]
J. Casado Flores, M.A. García Teresa, J. Pilar Orive, J.L. Teja, R. Rodríguez Núñez, E. Quiroga.
Estudio prospectivo multicéntrico de la meningitis bacteriana grave pediátrica..
An Esp Pediatr, 47 (1997), pp. 466-472
[44.]
L. Wubbel, I. Muniz, A. Ahmed, M. Trujillo, C. Carubelli, C. Mc Coig.
Etiology and treatment of community-acquired pneumonia in ambulatory children..
Pediatr Infect Dis J, 18 (1999), pp. 98-104
[45.]
T. Heiskanen-Kosma, M. Korppi, C. Jokinen, S. Kurki, L. Heiskanen, H. Juvonen.
Etiology of childhood pneumonia: Serologic results of a prospective, population-based study..
Pediatr Infect Dis J, 17 (1998), pp. 865-871
[46.]
J.A. Harris, A. Kolokathis, M. Campbell, G.H. Cassell, H.R. Hammerschlag.
Safety and efficacy of azithromicin in the treatment of community-acquired pneumonia in children. Pediatr Infect..
Dis J, 17 (1998), pp. 865-871
[47.]
G. Pérez, M. Navarro.
Manejo de las neumonías de la comunidad..
An Esp Pediatr, 123 (1999), pp. 17-24
[48.]
T. Juven, J. Mertsola, M. Waris, M. Leinonen, O. Meurman, M. Roivainen.
Etiology of community-acquired pneumonia in 254 hospitalized children..
Pediatr Infect Dis J, 19 (2000), pp. 293-298
[49.]
D.W. Teele, J.O. Teele, B. Rosner.
Epidemiology of otitis media in children..
Ann Oto Rhinol Laryngol, 89 (1980), pp. 5-6
[50.]
F.M. Del Castillo, B.L. Baselga, F.A. Baquero, M.J. García Miguel.
Estudio prospectivo de 122 aislamientos de otitis media aguda en niños..
Acta Pediatr Esp, 57 (1999), pp. 465-469
[51.]
M.P. Riquelme, C.I.A. Gásquez, E.M. Mena, D.H. Mugurza.
Otitis media aguda en una consulta pediátrica..
An Esp Pediatr, 44 (1996), pp. 433-436
[52.]
K.P. Klugman.
Pneumococcal resistance to antibiotics. Clin..
Microbiol Rev, 3 (1990), pp. 171-196
[53.]
J.C. Butler, J. Hofmann, M.S. Cetron, J.A. Elliott, R.R. Facklam, R.F. Breiman.
and the Pneumococcal Sentinel Surveillance Working Group. The continued emergence of drug-resistantStreptococcus pneumoniae in the United States: An update from the Centers for Disease Control and Prevention's Pneumococcal Sentinel Surveillance System..
J Infect Dis, 174 (1996), pp. 986-993
[54.]
C.G. Whitney, M.M. Farley, J. Hadler, L.H. Harrison, C. Lexau, A. Reingold.
Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States..
N Engl J Med, 343 (2000), pp. 1917-1924
[55.]
S.F. Dowell, J.C. Butler, G.S. Giebink, M.R. Jacobs, D. Jernigan, D.M. Musher.
Acute otitis media: Management and surveillance Acute otitis media: Management and surveillance in an era of pneumococcal resistance: A report from theDrug-resistant Streptococcus pneumoniae Therapeutic Working Group..
Pediatr Infect Dis J, 18 (1999), pp. 1-9
[56.]
R. Dagan, K.P. Klugman, W.A. Craig, F. Baquero.
Evidence to support the rationale that bacterial eradication in respiratory tractinfection is an important aim of antimicrobial therapy. J Antimicrob..
Chemother, 47 (2001), pp. 129-140
[57.]
R. Dagan, O. Abramson, R. Leibovitz, Lang, S. Goshen, D. Greenberg.
Impaired bacteriologic response to oral cephalosporins in acute otitis media caused by pneumococci with intermediate resistance to penicillin..
Pediatr Infect Dis J, 15 (1996), pp. 980-985
[58.]
M.J. Catalan, J.M. Fernández, A. Vázquez, E. Varela de Seijas, A. Suárez.
Failure of cefotaxime in the treatment of meningitis due to relatively resistant Streptococcus pneumoniae..
Clin Infect Dis, 18 (1994), pp. 766-769
[59.]
L.F. McCaig, J.M. Hughes.
Trends in antimicrobial drug prescribing among office-based physicians in the United States..
Jama, 273 (1995), pp. 214-219
[60.]
R.F. Breiman, J.C. Butler, F.C. Tenover, J.A. Elliott, R.R. Facklam.
Emergence of drug-resistant pneumococcal infections in the United States..
Jama, 271 (1994), pp. 1831-1835
[61.]
Marco F, Bouza E, García-de-Lomas J, Aguilar L, and the Spanish Surveillance Group for Respiratory Pathogens. Streptococcus pneumoniae in community-acquired respiratory tract infections in Spain: The impact of serotype and geographical, seasonal and clinical factors on its susceptibility to the most commonly prescribed antibiotics. J Antimicrobial Chemother 2000; 46: 557-564.
[62.]
B. Lopez, M.D. Cima, E. Vázquez, A. Fenoll, J. Gutierrez, C. Fidalgo.
Epidemiological study of Streptococcus pneumoniae carriers in healthy primary-school children. Eur J Microbiol Infect..
Dis, 18 (1999), pp. 771-776
[63.]
E.R. Wald, E.O. Mason, J.S. Bradley, W.J. Barson, S.L. Kaplan.
The us pediatric multicenter penumococcal surveillance group. Acute otitis media caused by Streptococcus pneumoniae in children's hospitals between 1994 and 1997. Pediatr Infect..
Dis J, 20 (2001), pp. 34-39
[64.]
J.O. Klein.
Otitis media..
Clin Infect Dis, 19 (1994), pp. 823-833
[66.]
J.O. Klein.
Management of otitis media: 2000 and beyond. Pediatr..
Infect Dis J, 19 (2000), pp. 383-387
[67.]
American Academy of Pediatrics. Therapy for children with invasive pneumococcal infections..
Pediatrics, 99 (1997), pp. 289-299
[68.]
R.W. Steele.
Drug-resistant pneumococci: What to expect, what to do..
J Respir Dis, 16 (1995), pp. 624-633
[69.]
M.D. Poole.
Otitis media complications and treatment failures: Implications of pneumococcal resistance..
Pediatr Infect Dis J, 14 (1995), pp. 23-26
[70.]
S.L. Kaplan, E.O. Mason Jr, E.R. Wald, K.S. Kim, L.B. Givner, J.S. Bradley.
Pneumococcal mastoiditis in children..
Pediatrics, 106 (2000), pp. 695-699
[71.]
F.M. Del Castillo, F. Baquero-, A. Garcia-Perea.
Influence of recent antibiotic therapy on antimicrobial resistance of Streptococcus of recent antibiotic therapy on antimicrobial resistance of Streptococcus..
Pediatr Infect Dis J, 17 (1998), pp. 94-97
[72.]
G.R. Siber.
Pneumococcal disease: Prospects for a new generation of vaccines..
Science, 265 (1994), pp. 1385-1387
[73.]
R.M. Douglas, D. Hansman, H.B. Miles, J.C. Paton.
Pneumococcal carriage and type-specific antibody..
Am J Dis Child, 140 (1986), pp. 1183-1185
[74.]
F.A. Moraga Llop, M. Campins Martí, F. De Juan Martín.
Vacuna conjugada antineumocócica heptavalente. En: Moraga Llop FA,ed. La enfermedad neumocócica en el niño. Barcelona: Prous..
Science, 105 (2001), pp. 135
[75.]
M. Campins, M.J. Rodrigo, L. Callís, N. Pinart, M.J. Cruz.
Inmunogenicidad de la vacuna antineumocócica de 23 polisacáridos en niños con enfermedad renal crónica..
An Esp Pediatr, 52 (2000), pp. 220-224
[76.]
Comité Asesor de Vacunas de la Asociación Española de Pediatría. Manual de vacunas en Pediatría. Madrid: Litofinter, 2001; 289-316.
[77.]
Santosham M, Wolff M, Reid R, Hohenboken M, Bateman M, Goepp J et al. The efficacy in Navajo infants of a conjugate vaccine consisting of Haemophilus influenzae type b polysaccharide and Neisseria meningitidis outer-membrane protein complex. N Engl J Med 1991; 324: 1767-1772.
[78.]
Rennels MB, Edwards KM, Keyserling HL, Reisinger KS, Hogerman DA, Madore DV et al. Safety and immunogenicity of heptavalent pneumococcal vaccine conjugated to CRM197 in United States infants. Pediatrics 1998; 101: 604-611.
[79.]
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 Haemophilus influenzae type b conjugate vaccine in United Kingdom infants. Pediatr Infect Dis J 2000; 19: 854-862.
[80.]
Immunogenicity and safety of a pneumococcal conjugate vaccine administered concurrently with DTP-IPV/PRP-T at two different sites in healthy infants at 2, 3 and 4 months of age. Abstract book of II World Congress on Vaccines and Immunization, 2000; S4-2.
[81.]
K.L. O'Brien, A.J. Swift, J.A. Winkelstein, M. Santosham, B. Stover, R. Luddy.
Safety and immunogenicity of heptavalent pneumococcal Safety and immunogenicity of heptavalent pneumococcal..
Pediatrics, 16 (2000), pp. 965-972
[82.]
D. Feikin, C. Elie, M. Goetz, J. Lennox, G. Carlone, W. Obrien.
Immunologic and virologic response to a 7-valent pneumococcal among HIV-infected adults. Abstract book of 40th Interscience Conference on Antimicrobial..
Agents and Chemotherapy, 48 (2000),
[83]
R. Dagan, R. Melamed, M. Muallem, L. Piglansky, D. Greenberg, D. Abramson.
Reduction of nasopharyngeal carriage of pneumococci during the second year of life by a heptavalent conjugate pneumococcal vaccine..
J Infect Dis, 174 (1996), pp. 1271-1278
[84.]
R. Dagan, M. Muallem, R. Melamed, O. Leroy, P. Yagupsky.
Reduction of nasopharyngeal carriage in early infancy after immunization of nasopharyngeal carriage in early infancy after immunization tetanus toxoid or diphteria toxoid..
Pediatr Infect Dis J, 16 (1997), pp. 1060-1064
[85.]
R. Dagan, D. Fraser, M. Sikuler-Cohen, L. Guy, N. Givon-Lavi, J. Janco.
Reduction of nasopharyngeal (NP) carriage in day care center (DCC) attendees after vaccination with a 9-valent CRM197 conjugate pneumococcal vaccine (PncCRM9)-protectionagainst individual serotypes. Abstract book of 40th Interscience..
Conference on Antimicrobial Agents and Chemotherapy, 686 (2000),
[86.]
Dagan R, Givon-Lavi N, Porat N, Sikuler-Cohen M, Fraser D. Immunization of toddlers attending day care centers (DCCs) reduce transmission of Streptococcus pneumoniae (Pnc) and antibiotic resistant Streptococcus pneumoniae (R-Pnc) to theiryoung siblings. Abstract book of 40th Interscience Conference on Antimicrobial Agents and Chemotherapy, 2000; 687.
[87.]
Murphy TV, Pastor P, Medley F, Osterholm MT, Granoff DM. Decreased Haemophilus influenzae colonization in children vaccinated with Haemophilus influenzae type b conjugate vaccine. J Pediatr 1993; 122: 517-523.
[88.]
H.R. Shinefield, S. Black, P. Ray, L.H. Chang, B. Fireman.
Safety and immunogenicity of heptavalent pneumococcal CRM197 conjugate vaccine in infants and toddlers..
Pediatr Infect Dis J, 18 (1999), pp. 757-763
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