21272792
not annotated - annotated - LINNAEUS only
Effective management in clusters of pneumococcal disease: a systematic review.
Outbreaks of serious pneumococcal disease can occur with high attack rates in certain settings. We systematically reviewed studies of interventions implemented in pneumococcal clusters and those reporting the effect of antibiotics on carriage reduction to assess the effectiveness of interventions. Evidence was graded according to the Scottish Intercollegiate Guidelines Network system. Of 28 identified cluster reports, one showed that administration of antibiotics to close contacts reduced risk of pneumococcal disease. In three of four clusters where rifampicin chemoprophylaxis was used and in four of five clusters where penicillin was used no further cases were seen after intervention. In clusters where pneumococcal polysaccharide vaccine was used, subsequent cases occurred, all within around 2 weeks of vaccination, which suggests delayed benefit with this approach (evidence grade D). Use of infection control measures alone was reported in eight clusters, with no further cases being reported in seven (grade D). From 21 selected carriage studies, large carriage reductions were observed consistently with use of penicillin and azithromycin, with median values being 90% and 73%, respectively (grade C). The findings were presented to a working group for pneumococcal cluster guidelines and used to develop key recommendations on the management of clusters that supported prompt use of amoxicillin or azithromycin chemoprophylaxis, pneumococcal vaccination for close contacts, and implementation of infection control measures.
Ann file
T1 Species 36 48 pneumococcal
N1 Reference T1 Taxonomy:1313
T2 Species 101 113 pneumococcal
N2 Reference T2 Taxonomy:1313
T3 Species 243 255 pneumococcal
N3 Reference T3 Taxonomy:1313
T4 Species 582 594 pneumococcal
N4 Reference T4 Taxonomy:1313
T5 Species 793 805 pneumococcal
N5 Reference T5 Taxonomy:1313
T6 Species 1349 1361 pneumococcal
N6 Reference T6 Taxonomy:1313
T7 Species 1526 1538 pneumococcal
N7 Reference T7 Taxonomy:1313