Monto A S, Lehmann D
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor 48109, USA.
Vaccine. 1998 Oct;16(16):1582-8. doi: 10.1016/s0264-410x(98)00049-8.
Acute respiratory infections (ARI) are a major cause of morbidity in children worldwide, and are estimated to cause four million deaths per year, mainly in the developing world. In those countries, bacterial infection with high case fatality is common, apparently following a primary viral infection. The case management strategy has had success in controlling severe outcomes. However, its dependence on the use of antibiotics and the advantage of primary prevention support the need for vaccines. Vaccines against viruses such as respiratory syncytial and parainfluenza would prevent what is often the initial infection and vaccines against Haemophilus influenzae and S. pneumoniae the major bacterial causes of mortality. Maternal immunization may have special relevance in developing countries where protection early in life is required. The development of combination vaccines would also be especially useful, since contacts with the medical system are often difficult. The introduction and use of new vaccines in those regions will require demonstration of cost effectiveness and acceptance by policy makers.
急性呼吸道感染（ARI）是全球儿童发病的主要原因，据估计每年导致400万人死亡，主要发生在发展中世界。在这些国家，高病死率的细菌感染很常见，显然是继发于原发性病毒感染之后。病例管理策略在控制严重后果方面取得了成功。然而，其对抗生素使用的依赖以及一级预防的优势支持了疫苗的需求。针对呼吸道合胞病毒和副流感病毒等病毒的疫苗可以预防通常的初始感染，而针对流感嗜血杆菌和肺炎链球菌这两种主要致死性细菌的疫苗也很有必要。在需要生命早期保护的发展中国家，母体免疫可能具有特殊意义。联合疫苗的研发也将特别有用，因为在这些地区就医往往困难。在这些地区引入和使用新疫苗需要证明其成本效益并得到政策制定者的认可。
