b型流感嗜血杆菌英文课件

Haemophilus influenzae type b Using vaccines to measure disease burden:A Tale of Two StudiesPresentation to PABIO 550Diseases of Public Health Importance and Their Control David Mercer,Ph.D.Haemophilus influenzae type b Hib-characteristicsGram negative coccobacillicarried by 3%to 15%of young children in the worldcauses disease in young childrenmeningitispneumoniaepiglottitisseptic arthritisHib characteristicsGram negaHib diseaseIndustrialized countriesmedian age 12 yearsmost meningitis then epiglottitis?meningitis mortality under 5%affects 12/1000 childrenDeveloping countries(Africa)median age 69 monthsmost pneumonia,then meningitismeningitis mortality 2050%affects 10/1000 children?Hib diseaseIndustrialized counb型流感嗜血杆菌英文课件Gambian PRP-T trial42,000 infants randomized to receive PRPT or placebo at 2,3 and 4 months of agepopulation studied for:Hib meningitisHib pneumoniaall pneumoniaHib carriageGambia slides courtesy of Kim Mulholland,MD University of MelbourneGambian PRPT trial42,000 infaStudy designindividually randomized,double blind studymajor effort to detect Hib pneumoniarandomization in 10 groups numbered 0 through 9:DTP+PRP-TDTP+placeboat 2,3 and 4 months of age5 numbers5 numbersStudy designindividually randoFinal results,March 199642,848 infants enrolledPRPT group21,490 infants1272 possible Hib disease616 chest radiographs173 lumbar punctures71 lung aspiratesControl group21,358 infants1342 possible Hib disease653 chest radiographs192 lumbar punctures75 lung aspiratesFinal results,March 199642,8Did the vaccine actually prevent pneumonia?*cough+fast breathing or lower chest wall indrawingDid the vaccine actually preveWhat did the Gambia trial tell us about the epidemiology of Hib pneumonia in West Africa?Hib is responsible for about 20%of radiological pneumonia in Gambian infantsPrevious studies had suggested 510%of pneumonia due to HibVery little“WHO pneumonia”which is not radiologically obvious is due to HibWhat did the Gambia trial tellConclusionsPRPT effectively prevented meningitis and pneumonia due to Hib in The GambiaHib vaccines have been proven in Finland,USA,UK,Chile and other countries Why arent Hib vaccines used everywhere?ConclusionsPRPT effectively pb型流感嗜血杆菌英文课件Why are Hib vaccines not used all over the world?costvaries,currently$2 per doseaffordable for most Asian countriesunderstanding of burden of disease is the major problem in AsiaWhy are Hib vaccines not used AsiaMany Asian countries can afford Hib vaccineHib was known to be an important cause of bacterial meningitis in AsiaBut:Microbiologically confirmed Hib incidence lower than elsewhere(one color vaccineAverage age at enrollment(i.e.,first vaccine plus 2 week delay):13 weeksVaccination of childrenVaccinaAll incidences are per 100,000 childyearsPneumonia OutcomesAll incidences are per 100,000All incidences are per 100,000 childyearsPneumonia OutcomesAll incidences are per 100,000All incidences are per 100,000 childyearsMeningitis OutcomesAll incidences are per 100,000All incidences are per 100,000 childyearsMeningitis OutcomesAll incidences are per 100,000Published rates of Hib meningitis(Children under 5 years per 100K person-years)Published rates of Hib meningib型流感嗜血杆菌英文课件Mortality rates are per 100,000 childyearsMortality after at least 1 doseMortality rates are per 100,00Mortality rates are per 100,000 childyearsMortality after 3 dosesMortality rates are per 100,00ConclusionsHib vaccine not an effective intervention against ALRI(pneumonia)in LombokHib meningitis burden underestimated by microbiology true burden 10X greaterHib vaccine may significantly reduce meningitis mortality1 in 33 unvaccinated children on Lombok develop invasive Hib disease before age 2.ConclusionsHib vaccine not an 写在最后写在最后成功的基成功的基础在于好的学在于好的学习习惯The foundation of success lies in good habits30写在最后成功的基础在于好的学习习惯30谢谢大家荣幸这一路，与你同行ItS An Honor To Walk With You All The Way讲师：XXXXXX XX年XX月XX日 31谢谢大家讲师：XXXXXX 31