Riley I D, Lehmann D, Alpers M P
Tropical Health Program, University of Queensland, Brisbane, Australia.
Rev Infect Dis. 1991 May-Jun;13 Suppl 6:S535-41. doi: 10.1093/clinids/13.supplement_6.s535.
Field trials in Papua New Guinea have shown that pneumococcal capsular polysaccharide vaccine protects children less than 2 years of age from death due to acute lower respiratory infections (ALRI). The vaccine appears to reduce mortality by preventing bacteremia. Evidence suggests that highly invasive "adult" pneumococcal serotypes are comparatively more important as a cause of ALRI in developing countries where ALRI-related mortality is higher than in North America. Capsular polysaccharide vaccines are more likely to be immunogenic for these serotypes than for the "pediatric" serotypes. The evaluation of pneumococcal vaccines in areas where mortality is high should have the highest priority. For such trials investigators should, at minimum, define epidemiologic circumstances in terms of (1) the invasive serotypes of pneumococci, (2) the protective levels of antibody, (3) the antibody response to vaccination, and (4) the general immune status of the population.
在巴布亚新几内亚进行的现场试验表明，肺炎球菌荚膜多糖疫苗可保护2岁以下儿童免受急性下呼吸道感染（ALRI）导致的死亡。该疫苗似乎通过预防菌血症来降低死亡率。有证据表明，在与ALRI相关的死亡率高于北美的发展中国家，具有高度侵袭性的“成人”肺炎球菌血清型作为ALRI的病因相对更为重要。荚膜多糖疫苗对这些血清型的免疫原性比对“儿科”血清型的免疫原性更强。在死亡率高的地区对肺炎球菌疫苗进行评估应列为最优先事项。对于此类试验，研究人员至少应根据以下方面确定流行病学情况：（1）肺炎球菌的侵袭性血清型，（2）抗体的保护水平，（3）接种疫苗后的抗体反应，以及（4）人群的一般免疫状况。
