Effect of a conjugate pneumococcal vaccine on the occurrence of respiratory infections and antibiotic use in day-care center attendees

Pediatr Infect Dis J. 2001 Oct;20(10):951-8. doi: 10.1097/00006454-200110000-00008.


Background: Incidence and severity of respiratory infections are increased in day-care center attendees. Streptococcus pneumoniae is an important contributor to these infections.

Objective: To examine whether the use of a pneumococcal conjugate vaccine could reduce the occurrence of respiratory infections and the ensuing antibiotic drug use in the day care.

Method: In this double blind, randomized, controlled study performed in 8 day-care centers located in Beer-Sheva, Israel, 264 toddlers ages 12 to 35 months at enrollment were randomized to receive either a 9-valent conjugate pneumococcal vaccine (conjugated to CRM197) or a control vaccine [conjugate meningococcus C vaccine (conjugated to CRM197)] and were followed for an average of 22 months. The main outcome measures were respiratory morbidity and antibiotic use.

Results: An overall reduction of 7% in child months with > or = 1 reported illness episodes was observed among vaccinees (P = 0.008), and 85% of all episodes were related to the respiratory tract. Reductions of 15, 16 and 17% were observed in upper respiratory infections, lower respiratory problems and otitis media, respectively. An overall reduction of 17% in antibiotic days was observed [10% for upper respiratory infections, 20% for otitis and 47% for lower respiratory problems (P < or = 0.005 for each entity)]. The reduction in episodes and antibiotic use was greater for those <36 months of age than for the older children.

Conclusion: The reduction of respiratory problems, including those not traditionally considered of pneumococcal origin and the ensuing lowered antibiotic use in day-care center attendees by pneumococcal conjugate vaccination suggest a broader benefit from the vaccine than preventing invasive disease only.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acidosis, Respiratory / microbiology
  • Anti-Bacterial Agents / administration & dosage*
  • Child Day Care Centers
  • Child, Preschool
  • Double-Blind Method
  • Drug Utilization / statistics & numerical data
  • Female
  • Humans
  • Infant
  • Israel / epidemiology
  • Male
  • Pneumococcal Infections / epidemiology
  • Pneumococcal Infections / prevention & control*
  • Pneumococcal Vaccines / therapeutic use*
  • Respiratory Tract Infections / drug therapy*
  • Respiratory Tract Infections / epidemiology
  • Respiratory Tract Infections / prevention & control*
  • Treatment Outcome
  • Vaccines, Conjugate / therapeutic use


  • Anti-Bacterial Agents
  • Pneumococcal Vaccines
  • Vaccines, Conjugate