A Research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in Paediatrics
Johannesburg 2015 / Children hospitalized with culture-confirmed pulmonary tuberculosis (PTB) frequently present with acute symptoms, possibly because underlying PTB may predispose to superimposed bacterial pneumonia. Immunization of children with pneumococcal conjugate vaccine (PCV) could protect against such superimposed bacterial pneumonia and reduce the incidence of PTB hospitalization.
OBJECTIVE
We studied the temporal association of childhood immunization with pneumococcal conjugate vaccine on the incidence of hospitalization for culture-confirmed PTB in children.
METHODS
A retrospective study on the incidence of hospitalization for culture-confirmed childhood PTB at Chris Hani Baragwanath Academic Hospital was undertaken from 2005 to 2012. This included a pre-PCV era (2005-2008) and a PCV era (2011-2012).
RESULTS
Overall, there was a 69.2% (95% CI: 62.8-74.6%) decline in the incidence of hospitalization for culture-confirmed PTB when comparing the PCV and pre-PCV-eras, with the decline in HIV-uninfected children only significant in the 3-11 month age category and the decline in HIV-infected significant across all age categories. There was
a trend for reduced pneumococcal bacteraemia in the PCV era compared to the pre-PCV era, with the odds of having a blood culture positive for pneumococcus being 1.91-fold (95% CI, 0.26-84.56) greater in the Pre-PCV era.
CONCLUSION
There has been a significant decline in culture-confirmed PTB hospitalization in children comparing the pre-PCV to the PCV-era. However, the incidence of culture-confirmed PTB prior to the introduction of PCV had been reduced to low levels due to antiretroviral therapy. This confounder together with the retrospective ecological study design and other several possible confounders limited any robust estimate as to whether there was a temporal association between PCV immunization and incidence of culture-confirmed PTB hospitalization in our study setting.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/18470 |
| Date | 04 September 2015 |
| Creators | Mammen, Vijay |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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