Hib vaccine in India: A case for universal immunization

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Anthropometric measures during infancy and childhood and the risk of developing cardiovascular disease or diabetes mellitus type 2 in later life: A systematic review

Background: Concurrently, obesity and other related chronic diseases, in particular cardiovascular diseases (CVD) and diabetes mellitus (type-2: noninsulin-dependent), are increasing in most of the developing countries and in countries undergoing economic transition. The prevalence of these diseases has increased in the last two decades and researchers are involved in identifying the risk factors. Various birth cohorts have been established to identify the relevant risk factors of these diseases. This systematic review is one of the steps in achieving the conclusion of identifying risk factors for developing cardiovascular disease or diabetes mellitus type 2 in later life. Objectives: The objective of this series of systematic reviews was to assess the associations between anthropometric measurements during infancy and childhood, and the risk of developing cardiovascular disease or diabetes mellitus type II in later life. Search strategy: Two independent literature searches with predetermined search strategy were conducted at ICMR Advanced Centre for Evidence based child health, PGIMER, Chandigarh, India; comprising PubMed, Embase, Ovid Sp and manual searching of references from the relevant articles thus obtained. Selection Criteria: We selected published cohort or longitudinal studies evaluating the associations between infancy & childhood anthropometric measures and the risk of developing cardiovascular disease or diabetes mellitus type II in later life. The studies where the outcomes were restricted to associations between anthropometric measurements at birth and adulthood were not included in the systematic review. Data extraction and analysis: Five reviewers extracted the data independently and the discrepancies were resolved by consensus rating. Two reviewers independently evaluated the study quality using Newcastle-Ottawa scale and disagreements were resolved by discussion with the arbiter. Meta-analysis where-ever possible was done using Random effects inverse variance model using Stata MP 12 developed by Stata Corp Ltd. The data which were not meta-analyzed were described as narrative synthesis

Characteristics of included studies.

<p>Characteristics of included studies.</p

Burden of Invasive Pneumococcal Disease in Children Aged 1 Month to 12 Years Living in South Asia: A Systematic Review

<div><p>Objective</p><p>The primary objective was to estimate the burden of invasive pneumococcal disease (IPD) in children aged 1 month to 12 years in South Asian countries.</p><p>Methods</p><p>We searched three electronic databases (PubMed, Embase and the Cochrane Library) using a comprehensive search strategy, we manually searched published databases (Index Medicus and Current Contents) and we also searched the bibliographies of the included studies and retrieved reviews. The searches were current through June 2013. Eligible studies (community-based and hospital-based) were pooled and a separate analysis for India was also completed. A meta-regression analysis and heterogeneity analysis were performed. The protocol was registered with PROSPERO registration number CRD42013004483.</p><p>Results</p><p>A total of 22 studies surveying 36,714 children were included in the systematic review. Hospital-based prospective studies from South Asia showed that 3.57% of children had IPD, and 15% of all bacterial pneumonia cases were due to <i>Streptococcus pneumoniae</i>. Indian studies showed that the incidence of IPD was 10.58% in children admitted to hospitals with suspected invasive bacterial diseases, and 24% of all bacterial pneumonia cases were due to <i>S. pneumonia</i>. Population-based studies from South Asian countries showed that 12.8% of confirmed invasive bacterial diseases were caused by <i>S. pneumonia</i> whereas retrospective hospital-based studies showed that 28% of invasive bacterial diseases were due to <i>S. pneumoniae</i>. Meta-regression showed that there was a significant influence of the antigen testing method for diagnosing IPD on IPD prevalence.</p><p>Conclusion</p><p><i>S. pneumoniae</i> is responsible for a substantial bacterial disease burden in children of South Asian countries including India despite the presence of high heterogeneity in this meta-analysis. Treatment guidelines must be formulated, and preventive measures like vaccines must also be considered.</p></div

Forest plot showing the proportion of IPD from hospital-based prospective studies in South Asian children under the age of 5 with suspected invasive bacterial disease.

<p>The plot also shows a subgroup analysis for the pneumococcal pneumonia cases among all of the pneumonia patients and for the pneumococcal meningitis cases among all of the meningitis patients.</p

Corrected funnel plot using the trim and fill method.

<p>Corrected funnel plot using the trim and fill method.</p

Distribution of Serotypes, Vaccine Coverage, and Antimicrobial Susceptibility Pattern of Streptococcus Pneumoniae in Children Living in SAARC Countries: A Systematic Review

<div><p>Introduction</p><p>Each SAARC nation falls in the zone of high incidence of pneumococcal disease but there is a paucity of literature estimating the burden of pneumococcal disease in this region.</p><p>Objective</p><p>To identify the prevalent serotypes causing invasive pneumococcal disease in children of SAARC countries, to determine the coverage of these serotypes by the available vaccines, and to determine the antibiotic resistance pattern of <i>Streptococcus pneumoniae</i>.</p><p>Methods</p><p>We searched major electronic databases using a comprehensive search strategy, and additionally searched the bibliography of the included studies and retrieved articles till July 2014. Both community and hospital based observational studies which included children aged ≤12 years as/or part of the studied population in SAARC countries were included.</p><p>Results</p><p>A total of 17 studies were included in the final analysis. The period of surveillance varied from 12–96 months (median, 24 months). The most common serotypes country-wise were as follows: serotype 1 in Nepal; serotype 14 in Bangladesh and India; serotype 19F in Sri Lanka and Pakistan. PCV-10 was found to be suitable for countries like India, Nepal, Bangladesh, and Sri Lanka, whereas PCV-13 may be more suitable for Pakistan. An increasing trend of non-susceptibility to antibiotics was noted for co-trimoxazole, erythromycin and chloramphenicol, whereas an increasing trend of susceptibility was noted for penicillin.</p><p>Conclusion</p><p>Due to paucity of recent data in majority of the SAARC countries, urgent large size prospective studies are needed to formulate recommendations for specific pneumococcal vaccine introduction and usage of antimicrobial agents in these regions.</p></div

Characteristics of excluded studies.

<p>Characteristics of excluded studies.</p

Forest plot showing the proportion of IPD from hospital-based prospective studies in Indian children aged 1 month to 12 years with confirmed invasive bacterial disease.

<p>The plot also shows a subgroup analysis for the pneumococcal pneumonia cases among all of the bacterial pneumonia patients and for the pneumococcal meningitis cases among all of the pyogenic meningitis patients</p

Flow diagram of search results.

<p>Flow diagram of search results.</p