C-reactive protein and procalcitonin in the evaluation of the efficacy of a pneumococcal conjugate vaccine in Gambian children.


Cheung, YB; Zaman, SM; Ruopuro, ML; Enwere, G; Adegbola, RA; Greenwood, B; Cutts, FT; (2008) C-reactive protein and procalcitonin in the evaluation of the efficacy of a pneumococcal conjugate vaccine in Gambian children. Tropical medicine & international health , 13 (5). pp. 603-11. ISSN 1360-2276 DOI: 10.1111/j.1365-3156.2008.02050.x

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Abstract

OBJECTIVE: To determine the value of C-reactive protein (CRP) and procalcitonin in the evaluation of the efficacy of a pneumococcal conjugate vaccine in Gambian children. METHODS: The investigation was done as a substudy of a phase III pneumococcal conjugate vaccine trial. A pilot study (n = 120) to compare CRP and procalcitonin concentrations in children with pneumonia was undertaken, followed by a larger study of CRP concentrations (n = 1868) obtained from a subsample of children with clinical pneumonia seen during the trial. RESULTS: In the pilot study, CRP had a higher sensitivity and specificity for the detection of primary endpoint (radiographic) pneumonia than procalcitonin. In the subsequent study of 1868 episodes of clinical pneumonia, CRP showed moderate sensitivity but poor positive predictive value in identifying primary endpoint pneumonia or pneumococcal bacteraemia. Addition of CRP thresholds of 40, 60 or 120 mg/l to the diagnosis of clinical pneumonia did not give higher estimates of vaccine efficacy or vaccine attributable reduction in incidence than primary endpoint pneumonia. CONCLUSION: A combination of a raised CRP concentration with a clinical diagnosis of pneumonia is a more specific endpoint than clinical pneumonia alone but less appropriate than primary endpoint pneumonia as a measure of the impact of a pneumococcal vaccine in a Gambian setting.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Research Centre: Vaccine Centre
Centre for Maternal, Reproductive and Child Health (MARCH)
Tropical Epidemiology Group
PubMed ID: 18331385
Web of Science ID: 255062200002
URI: http://researchonline.lshtm.ac.uk/id/eprint/8118

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