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1.
Vaccine ; 28(30): 4851-7, 2010 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-20392430

RESUMO

Polysaccharide-protein conjugate vaccines against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae have proven efficacy against radiologically confirmed pneumonia. Measurement of pneumonia incidence provides a platform to estimate of the vaccine-preventable burden. Over 24 months, we conducted surveillance for radiologically confirmed severe pneumonia episodes among children <2 years of age admitted to a rural hospital in Manhiça, southern Mozambique. Study children were tested for HIV during the second year of surveillance. Severe pneumonia accounted for 15% of 5132 hospital admissions and 32% of in-hospital mortality among children <2 years of age. Also, 43% of chest radiographs were interpreted as radiologically confirmed pneumonia. HIV-infection was associated with 81% of fatal pneumonia episodes among children tested for HIV. The minimum incidence rate of radiologically confirmed pneumonia requiring hospitalization was 19 episodes/1000 child-years. Incidence rates among HIV-infected children were 9.3-19.0-fold higher than HIV-uninfected. Introduction of Hib and pneumococcal conjugate vaccines would have a substantial impact on pneumonia hospitalizations among African children if vaccine effects are similar to those observed in clinical trials.


Assuntos
Vacinas Anti-Haemophilus/uso terapêutico , Vacinas Pneumocócicas/uso terapêutico , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/prevenção & controle , Efeitos Psicossociais da Doença , Interpretação Estatística de Dados , Determinação de Ponto Final , Infecções por HIV/epidemiologia , Haemophilus influenzae tipo b/imunologia , Hospitalização , Humanos , Lactente , Recém-Nascido , Moçambique/epidemiologia , Pneumonia Bacteriana/diagnóstico por imagem , Vigilância da População , Radiografia , Terminologia como Assunto , Vacinas Conjugadas
2.
HIV Med ; 9(9): 757-64, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18651857

RESUMO

OBJECTIVES: Malaria infection may impact on mother-to-child transmission (MTCT) of HIV-1. Prevention of malaria in pregnancy could thus potentially affect MTCT of HIV. We studied the impact of intermittent preventive treatment during pregnancy (IPTp) on HIV-1 MTCT in southern Mozambique. METHODS: A total of 207 HIV-positive Mozambican pregnant women were enrolled in the study as part of a randomized placebo-controlled trial of two-dose sulfadoxine-pyrimethamine (SP) IPTp in women receiving single-dose nevirapine to prevent MTCT of HIV. HIV RNA viral load, maternal anaemia and peripheral and placental malaria were assessed at delivery. Infant HIV status was determined by DNA polymerase chain reaction (PCR) at 1 month of age. RESULTS: There were 19 transmissions of HIV in 153 mother-infant pairs. IPTp with SP did not have a significant impact on MTCT (11.8% in the SP group vs. 13.2% in the placebo group; P=0.784) or on maternal HIV RNA viral load [16 312 (interquartile range {IQR} 4076-69 296) HIV-1 RNA copies/mL in the SP group vs. 18 274 (IQR 5471-74 104) copies/mL in the placebo group; P=0.715]. In multivariate analysis, maternal HIV RNA viral load [adjusted odds ratio (AOR) 19.9; 95% confidence interval (CI) 2.3-172; P=0.006] and anaemia (haematocrit <33%; AOR 7.5; 95% CI 1.7-32.4; P=0.007) were independent risk factors for MTCT. Placental malaria was associated with a decrease in MTCT (AOR 0.23; 95% CI 0.06-0.89; P=0.034). CONCLUSIONS: IPTp with SP was not associated with a significant impact on MTCT of HIV. Maternal anaemia was an independent risk factor for MTCT.


Assuntos
Antimaláricos/uso terapêutico , Infecções por HIV/transmissão , HIV-1 , Malária Falciparum/tratamento farmacológico , Complicações Infecciosas na Gravidez/prevenção & controle , Pirimetamina/uso terapêutico , Sulfadoxina/uso terapêutico , Adulto , Anemia/parasitologia , Anemia/virologia , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Combinação de Medicamentos , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Recém-Nascido , Malária Falciparum/transmissão , Malária Falciparum/virologia , Moçambique , Nevirapina/uso terapêutico , Doenças Placentárias/parasitologia , Doenças Placentárias/virologia , Reação em Cadeia da Polimerase , Gravidez , Complicações Hematológicas na Gravidez/etiologia , RNA Viral , Carga Viral
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