***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: A new pneumococcal serotype 6C , earlier typed as 6A , was discovered in 2007 . We retyped all 6A isolates to evaluate vaccine efficacy against 6C acute otitis media ( AOM ) in the phase III r and omized , double-blind Finnish Otitis Media trial conducted in 1995–1999 . Efficacy against 6C AOM was −1 ( 95 % confidence interval : −248 to 71 ) during the per protocol follow-up period . The up date d vaccine efficacy estimate for serotype 6A AOM was 65 % ( 95 % confidence interval : 31–82 ) . Seven-valent pneumococcal conjugate vaccine offered excellent cross-protection against 6A AOM , but our data do not support cross-protection against 6C AOM Objective To evaluate the effects of influenza vaccination with or without heptavalent pneumococcal conjugate vaccination on  respiratory tract infections ( RTIs ) in children . Study design This was a r and omized , double-blind , placebo-controlled trial comprising 579 children age 18 to 72 months with a previous history of physician-diagnosed RTI , recruited between 2003 and 2005 . The children were assigned to 2 doses of parenteral inactivated trivalent subunit influenza plus heptavalent pneumococcal conjugate vaccination ( TIV+PCV7 ) , influenza plus placebo vaccination ( TIV+plac ) , or control hepatitis B virus vaccination plus placebo ( HBV+plac ) . Main outcome measures were febrile RTI and related polymerase chain reaction (PCR)-confirmed influenza , primary care visits , antibiotic prescriptions , and acute otitis media ( AOM ) episodes . Results During influenza seasons , febrile RTI were reduced by 24 % ( 95 % confidence interval [ CI ] = 1 % to 42 % ) in the TIV+PCV7 group and by 13 % ( 95 % CI = -12 % to 32 % ) in the TIV+plac group compared with the control group . The occurrence of PCR-confirmed influenza was reduced by 52 % ( 95 % CI = 7 % to 75 % ) in the TIV+PCV7 group and by 51 % ( 95 % CI = 3 % to 75 % ) in the TIV+plac group . Episodes of AOM were reduced by 57 % ( 95 % CI = 6 % to 80 % ) in the TIV+PCV7 group and by 71 % ( 95 % CI = 30 % to 88 % ) in the TIV+plac group . Outside of the influenza seasons , no significant effects of vaccinations were demonstrated on the studied outcomes . Conclusions During influenza seasons , influenza vaccination with or without pneumococcal conjugate vaccination substantially reduced cases of confirmed influenza and AOM episodes ABSTRACT We previously reported 10-valent pneumococcal non-typeable Haemophilus influenzae ( NTHi ) protein D conjugate vaccine ( PHiD-CV ) efficacy in a double-blind r and omized trial ( Clinical Trials.gov : NCT00466947 ) against various diseases , including acute otitis media ( AOM ) . Here , we provide further analyses . In the Panamanian subset , 7,359 children were r and omized ( 1:1 ) to receive PHiD-CV or control vaccine at age 2/4/6 and 15–18 months . Of these , 2,000 had nasopharyngeal swabs collected . AOM cases were captured when parents sought medical attention for children with AOM symptoms ; surveillance was enhanced approximately 2 y into the study through regular telephone calls or home visits by study personnel , who advised parents to visit the clinic if their child had AOM symptoms . Mean follow-up was 31.4 months . Clinical AOM ( C-AOM ) cases were assessed by physicians and confirmed by otorhinolaryngologists . Middle ear fluid sample s , taken from children with C-AOM after specific informed consent , and nasopharyngeal sample s were cultured for pathogen identification . For 7,359 children , 2,574 suspected AOM cases were assessed by a primary healthcare physician ; 649 cases were C-AOM cases as per protocol definition . From the 503 MEF sample s collected , 158 result ed in a positive culture . In the intent-to-treat cohort ( 7,214 children ) , PHiD-CV showed VE against first C-AOM ( 24.0 % [ 95 % CI : 8.7 , 36.7 ] ) and bacterial ( B-AOM ) episodes ( 48.0 % [ 20.3 , 66.1 ] ) in children < 24 months , which declined thereafter with age . Pre-booster VE against C-AOM was 30.7 % [ 12.9 , 44.9 ] ; post-booster , −6.7 % [ −36.4 , 16.6 ] . PHiD-CV VE was 17.7 % [ −6.1 , 36.2 ] against moderate and 32.7 % [ −20.5 , 62.4 ] against severe C-AOM . VE against vaccine-serotype pneumococcal NPC was 31.2 % [ 5.3 , 50.3 ] 3 months post-booster , and 25.6 % [ 12.7 , 36.7 ] across all visits . NTHi colonization rates were low and no significant reduction was observed . PHiD-CV showed efficacy against C-AOM and B-AOM in children younger than 24 months , and reduced vaccine-serotype NPC Estimation of the full disease burden caused by Streptococcus pneumoniae is challenging due to the difficulties in assigning the aetiology especially in lower and upper respiratory infections . We estimated the pneumococcal disease burden by using the vaccine-preventable disease incidence ( VPDI ) of PHiD-CV10 vaccine ( GSK ) in our clinical trial setting . Finnish Invasive Pneumococcal disease ( FinIP ) trial was a cluster-r and omized , double-blind trial in children < 19 months who received PHiD-CV10 in 52 clusters or hepatitis B/A vaccine as control in 26 clusters according to 3 + 1 or 2 + 1 schedules ( infants < 7 months ) or catch-up schedules ( children 7 - 18 months ) . Outcome data were collected using Finnish routine health-care registers , consisting of THL National Infectious Diseases Register , THL Care register , and Benefits Register of Social Insurance Institution of Finl and . Blinded follow-up lasted from the date of first vaccination ( trial enrolment Feb-2009 through Aug-2010 ) to January 31 , 2012 for Invasive Pneumococcal Disease ( IPD ) and to end of December 2011 for four other outcomes : non-laboratory-confirmed IPD , hospital-diagnosed pneumonia , tympanostomy tube placements , and antimicrobial purchases . VPDI was estimated as difference in disease incidences between PHiD-CV10 clusters and control clusters . Altogether > 47,000 children were enrolled . In 30,527 vaccinated infants < 7 months at first dose , the VPDIs per 100,000 person-years were 75 for laboratory-confirmed IPD , 210 for non-laboratory-confirmed IPD , 271 for hospital-diagnosed pneumonia , 1143 for any tympanostomy tube placements and 11,381 for antimicrobial outpatient prescription , mainly due to otitis media . In a European developed-country setting , over 95 % of the disease episode reductions in vaccinated children were seen in mild upper respiratory infections . The VPDIs of severe diseases are underestimated , because the majority of invasive disease goes undetected with routine blood-culture-based definitions . Evaluation of the absolute reduction achievable with vaccinations using sensitive case detection is essential for underst and ing the full disease burden , for valid cost-effectiveness analyses and for appropriate vaccination policy decisions . Registration : Clinical Trials.gov , NCT00861380 and NCT00839254 After administering the 10-valent pneumococcal polysaccharide nontypeable Haemophilus influenzae protein D – conjugated vaccine ( PHiD-CV ) to children aged 2–18 months , we observed a reduction in vaccine-type nasopharyngeal carriage , result ing in a reduction of overall pneumococcal nasopharyngeal carriage , which may be important for indirect vaccine effects . We noted a trend toward reduction of acute otitis media . Background This trial ( Clinical Trials.gov identifier NCT00839254 ) , nested within a cluster-r and omized double-blind invasive pneumococcal disease effectiveness study in Finl and ( Clinical Trials.gov identifier NCT00861380 ) , assessed the effectiveness of the 10-valent pneumococcal polysaccharide nontypeable Haemophilus influenzae protein D – conjugated vaccine ( PHiD-CV or PCV10 ) against bacterial nasopharyngeal carriage and acute otitis media ( AOM ) . Methods Infants ( aged 6 weeks to 6 months ) received the PHiD-CV or a control vaccine ( hepatitis B ) ( schedule 3 + 1 or 2 + 1 ) . Nasopharyngeal swabs were collected at 4 time points post-vaccination from all of the infants and at pre-vaccination from a subset . Parent-reported physician-diagnosed AOM was assessed from first vaccination until last contact ( mean follow-up , 18 months ) . Vaccine effectiveness ( VE ) was derived as ( 1 – relative risk)*100 , accounting for cluster design in AOM analysis . Significant VE was assessed descriptively ( positive lower limit of the non-adjusted 95 % confidence interval [ CI ] ) . Results The vaccinated cohort included 5093 infants for carriage assessment and 4117 infants for AOM assessment . Both schedules decreased vaccine-serotype carriage , with a trend toward a lesser effect from the 2 + 1 schedule ( VE across timpoints 19%–56 % [ 3 + 1 ] and 1%–38 % [ 2 + 1 ] ) . Trends toward reduced pneumococcal carriage ( predominantly vaccine serotypes 6B , 14 , 19F , and 23F ) , decreased carriage of vaccine-related serotype 19A , and small increases at later time points ( ages 14–15 months ) in non – vaccine-serotype carriage were observed . No effects on nontypeable Haemophilus influenzae , Staphylococcus aureus , or Moraxella catarrhalis carriage were observed . There were non-significant trends toward a reduction in the number of infants reporting AOM episodes ( VE 3 + 1 : 6.1 % [ 95 % CI , −2.7 % to 14.1 % ] and 2 + 1 : 7.4 % [ −2.8 % to 16.6 % ] ) and all AOM episodes ( VE 3 + 1 : 2.8 % [ −9.5 % to 13.9 % ] and 2 + 1 : 10.2 % [ −4.1 % to 22.9 % ] ) . PHiD-CV was immunogenic and had an acceptable safety profile . Conclusions We observed reduced vaccine-type pneumococcal carriage , a limited increase in non – vaccine-type carriage , and a trend toward AOM reduction In a double-blind r and omized controlled trial , Xavier Saez-Llorens and colleagues examine the vaccine efficacy of PHiD-CV  against community-acquired pneumonia in young children in Panama , Argentina , and Columbia . Please see later in the article for the Editors ' BACKGROUND Pneumococcal conjugate vaccine prevents recurrent acute otitis media ( AOM ) in infants immunised at 2 , 4 , 6 , and 12 - 15 months of age . We aim ed to find out whether this vaccine also prevents AOM in older children who have had previous episodes of AOM . METHODS In this double-blind , r and omised study , we enrolled 383 patients aged 1 - 7 years who had had two or more episodes of AOM in the year before entry . R and omisation was stratified in four groups according to age ( 12 - 24 months vs 25 - 84 months ) and the number of previous AOM episodes ( two or three episodes vs four or more episodes ) . Children received either 7-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine , or hepatitis A or B vaccines . They were followed up for 18 months for recurrence of AOM . We also cultured sample s of middle-ear fluid and nasopharyngeal swabs to assess association of pneumococcal serotypes with AOM after vaccination . FINDINGS We noted no reduction of AOM episodes in the pneumococcal vaccine group compared with controls ( intention-to-treat analysis : rate ratio 1.25 , 95 % CI 0.99 - 1.57 ) . Although nasopharyngeal carriage of pneumococci of serotypes included in the conjugate-v 
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Administration of the licenced CRM197-PCV7 and PHiD-CV10 during early infancy is associated with large relative risk reductions in pneumococcal AOM .
However , the effects of these vaccines on all-cause AOM is far more uncertain .
We found no evidence of a beneficial effect on all-cause AOM of administering PCVs in high-risk infants , after early infancy ( i.e. in children one year and above ) , and in older children with a history of respiratory illness .
Compared to control vaccines , PCVs were associated with an increase in mild local reactions ( redness , swelling ) , fever , and pain and /or tenderness .
We found no evidence of a difference in more severe local reactions , fever , or serious adverse events judged causally related to vaccination