Résumé :
|
[BDSP. Notice produite par INIST kfR0xOq7. Diffusion soumise à autorisation]. Background Infection with Streptococcus pneumoniae is a frequent and serious problem for HIV-immunosuppressed adults. Vaccination is recommended in the USA and Europe, but there are no prospective data that show vaccine efficacy. Methods 1392 (937 female) HIV-1-infected adults in Entebbe, Uganda, were enrolled. 697 received 23-valent pneumococcal polysaccharide vaccine and 695 received placebo. The primary endpoint was first event invasive pneumococcal disease. Secondary endpoints included vaccine serogroup-specific invasive disease, all (probable and definite) pneumococcal events, all-cause pneumonia, and death. Findings First invasive events occurred in 25 individuals (24 bacteraemias, one pyomyositis), 15 in the vaccine arm and ten in the placebo arm (hazard ratio [HR] 1.47 ; 95% CI 0.7-3.3). 22 isolates (88%) were of vaccine-specific serogroups with 15 events in the vaccine arm compared with seven in the placebo arm (HR 2.10 ; 0.9-5.2). All pneumococcal events had a similar distribution (20 vs 14 ; HR 1.41 ; 0.7-2.8) though all-cause pneumonia was significantly more frequent in the vaccine arm (40 vs 21 ; HR 1.89 ; 1.1-3.2). Mortality was unaffected by vaccination. Interpretation 23-valent pneumococcal polysaccharide vaccination is ineffective in HIV-1-infected Ugandan adults and probably has little, or no, public health value elsewhere in sub-Saharan Africa. (...)
|