human
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The impact of pneumococcal conjugate vaccination on the prevalence of nasopharyngeal carriage with pneumococci and other bacteria in adults is unknown . The direct effects of the 13-valent pneumococcal conjugate vaccine ( PCV13 ) in community dwelling older adults was investigated as part of the r and omized controlled Community Acquired Pneumonia immunization Trial in Adults ( CAPiTA ) . Methods We determined the carriage of Streptococcus pneumoniae , Staphylococcus aureus , Haemophilus influenzae , and Moraxella catarrhalis before and 6 , 12 , and 24 months after vaccination using polymerase chain reaction (PCR)-based methods and conventional cultures of nasopharyngeal and oropharyngeal swab sample s in 1006 PCV13 recipients and 1005 controls . Serotyping of the 13 vaccine-type ( VT ) pneumococci was performed by PCR targeting capsular synthesis genes and Quellung reaction of isolates . Results Before r and omization and based on PCR , 339 of 1891 subjects had nasopharyngeal carriage with any pneumococci ( 17.9 % ) , and 114 of 1891 ( 6.0 % ) carried VT pneumococci . At 6 months after vaccination , VT pneumococcal carriage was significantly lower in PCV13 recipients than in the placebo group ( relative risk , 0.53 ; 95 % confidence interval , .35-.80 ; P = .04 ) . There was no difference between the groups at 12 and 24 months after vaccination . Carriage of non-VT pneumococci , S. aureus , H. influenzae , and M. catarrhalis did not change between groups . Conclusions In community-dwelling adults aged ≥65 years , a single dose of PCV13 seems to elicit a small and temporary reduction in VT carriage 6 months after vaccination . Neither replacement by non-VT serotypes nor impact on other nasopharyngeal bacteria was observed The Community-Acquired Pneumonia Immunization Trial in Adults ( CAPiTA ) demonstrated the efficacy of 13-valent pneumococcal conjugate vaccine ( PCV13 ) in preventing vaccine-type community-acquired pneumonia and vaccine-type invasive pneumococcal disease in elderly subjects . We examined the cost-effectiveness of PCV13 vaccination in the Netherl and s. Using a Markov-type model , incremental cost-effectiveness ratios ( ICER ) of PCV13 vaccination in different age- and risk-groups for pneumococcal disease were evaluated using a societal perspective . Estimates of quality -adjusted life-years ( QALYs ) , costs , vaccine efficacy and epidemiological data were based on the CAPiTA study and other prospect i ve studies . The base-case was PCV13 vaccination of adults aged 65–74 years compared to no vaccination , assuming no net indirect effects in base-case due to paediatric 10-valent pneumococcal conjugate vaccine use . Analyses for age- and risk-group specific vaccination strategies and for different levels of hypothetical herd effects from a paediatric PCV programme were also conducted . The ICER for base-case was € 8650 per QALY ( 95 % CI 5750–17 100 ) . Vaccination of high-risk individuals aged 65–74 years was cost-saving and extension to medium-risk individuals aged 65–74 years yielded an ICER of € 2900 . Further extension to include medium- and high-risk individuals aged ≥18 years yielded an ICER of € 3100 . PCV13 vaccination is highly cost-effective in the Netherl and s. The transferability of our results to other countries depends upon vaccination strategies already implemented in those countries . Vaccinating the elderly with 13-valent pneumococcal conjugate vaccine is highly cost-effective BACKGROUND The benefits of using the 23-valent pneumococcal polysaccharide vaccine ( PPV23 ) are controversial . This study assessed clinical effectiveness of PPV23 in preventing community-acquired pneumonia ( CAP ) among the general population aged ≥ 60 years . METHODS This was a population -based cohort study involving 27 204 individuals aged ≥ 60 years in Tarragona , Spain , who were prospect ively followed from 1 December 2008 until 30 November 2011 . Primary outcomes were hospitalization for pneumococcal CAP ( bacteremic and nonbacteremic cases ) and all-cause CAP . All CAP cases were radiographically confirmed and vali date d by checking clinical records . Cox regression was used to evaluate the association between pneumococcal vaccination and the risk of each outcome . RESULTS Cohort members were followed for a total of 76 033 person-years ( 29 065 person-years for vaccinated subjects ) . Incidence rates ( per 1000 person-years ) were 0.21 for bacteremic pneumococcal CAP ( 0.14 vs 0.26 among vaccinated and unvaccinated subjects , respectively ) , 1.45 for nonbacteremic pneumococcal CAP ( 1.46 vs 1.44 ) , and 7.51 for all-cause CAP ( 7.19 vs 7.71 ) . In primary analyses including all cohort members , PPV23 did not appear to be effective against any analyzed outcome . However , a beneficial effect emerged in sensitive and stratified analyses . After multivariable adjustments , as compared with those never vaccinated , recent vaccination with PPV23 ( < 5 years ago ) was associated with reduced risks of bacteremic pneumococcal CAP ( hazard ratio [ HR ] , 0.38 ; 95 % confidence interval [ CI ] , .09 - 1.68 ) , nonbacteremic pneumococcal CAP ( HR , 0.52 ; 95 % CI , .29-.92 ) , overall pneumococcal CAP ( HR , 0.49 ; 95 % CI , .29-.84 ) , and all-cause CAP ( HR , 0.75 ; 95 % CI , .58-.98 ) . CONCLUSIONS Our data support a protective effect of recent PPV23 vaccination ( within previous 5 years ) against both pneumococcal and all-cause CAP Objective To evaluate the cost-effectiveness of introducing universal vaccination of adults aged 60 years with the 23-valent pneumococcal polysaccharide vaccine ( PPV23 ) into the National Immunization Program ( NIP ) in Brazil . Methods Economic evaluation using a Markov model to compare two strategies : ( 1 ) universal vaccination of adults aged 60 years  with one dose of PPV23 and 2 ) current practice ( vaccination of institutionalized elderly and elderly with underlying diseases ) . The perspective was from the health system and society . Temporal horizon was 10 years . Discount rate of 5 % was applied to costs and benefits . Clinical syndromes of interest were invasive pneumococcal disease ( IPD ) including meningitis , sepsis and others and pneumonia . Vaccine efficacy against IPD was obtained from a meta- analysis of r and omized control trials and r and omized studies , whereas vaccine effectiveness against pneumonia was obtained from cohort studies . Re source utilization and costs were obtained from the Brazilian Health Information Systems . The primary outcome was cost per life year saved ( LYS ) . Univariate and multivariate sensitivity analysis were performed . Results The universal vaccination strategy avoided 7,810 hospitalizations and 514 deaths , saving 3,787 years of life and costing a total of USD$31,507,012 and USD$44,548,180 , respectively , from the health system and societal perspective . The universal immunization would result in ICERs of USD$1,297 per LYS , from the perspective of the health system , and USD$904 per LYS , from the societal perspective . Conclusion The results suggest that universal vaccination of adults aged 60 years with the 23-valent pneumococcal polysaccharide vaccine ( PPV23 ) is a very cost-effective intervention for preventing hospitalization and deaths for IPD and pneumonia is this age group in Brazil BACKGROUND The 23-valent polysaccharide pneumococcal vaccine ( PPV ) is currently recommended for elderly persons and persons who are at high risk of infection . However , the effectiveness of the 23-valent PPV remains controversial . We assessed the effectiveness of this vaccine in older adults . METHODS A prospect i ve cohort study was conducted from January 2002 through April 2005 ; it included all community-dwelling individuals aged > or=65 years who were assigned to 1 of 8 primary health care centers in Tarragona , Spain ( 11,241 subjects ) . The primary outcomes were invasive pneumococcal disease , pneumococcal pneumonia , overall pneumonia rate , and death due to pneumonia . All cases were vali date d by a check of the clinical records . The association between pneumococcal vaccination and the risk of each outcome was evaluated by means of multivariate Cox proportional hazard models , adjusted for age , sex , comorbidity , immunocompetence , and influenza vaccine status . RESULTS Pneumococcal vaccination was associated with significant reductions in the risk of hospitalization for pneumonia ( hazard ratio [ HR ] , 0.74 ; 95 % confidence interval [ CI ] , 0.59 - 0.92 ) and in the overall pneumonia rate ( HR , 0.79 ; 95 % CI , 0.64 - 0.98 ) . The incidence of invasive pneumococcal disease was low ( 64 cases per 100,000 person-years ) , and a considerable protective effect against invasive pneumococcal disease did not attain statistical significance ( HR , 0.60 ; 95 % CI , 0.22 - 1.65 ) . However , the vaccine showed a significant effectiveness of 45 % to prevent pneumococcal pneumonia ( HR , 0.55 ; 95 % CI , 0.34 - 0.88 ) . Finally , vaccination was associated with a significant 59 % reduction in the risk of death due to pneumonia among vaccinated subjects ( HR , 0.41 ; 95 % CI , 0.23 - 0.72 ) . CONCLUSIONS These results indicate that the 23-valent PPV effectively prevented pneumococcal pneumonia ( with or without bacteremia ) and decreased the rates of overall pneumonia and of mortality due to pneumonia in older adults , providing new arguments for systematic vaccination in the elderly population Background The 13-valent pneumococcal conjugate vaccine ( PCV13 ) was licensed based on the results of immunogenicity studies and correlates of protection derived from r and omized clinical trials of the 7-valent conjugate pneumococcal vaccine . We assessed the vaccination effectiveness ( VE ) of the PCV13 in preventing invasive pneumococcal disease ( IPD ) in children aged 7–59 months in a population with suboptimal vaccination coverage of 55 % . Methods The study was carried out in children with IPD admitted to three hospitals in Barcelona ( Spain ) and controls matched by hospital , age , sex , date of hospitalization and underlying disease . Information on the vaccination status was obtained from written medical records . Conditional logistic regression was made to estimate the adjusted VE and 95 % confidence intervals ( CI ) . Results 169 cases and 645 controls were included .  The overall VE of ≥1 doses  of PCV13 in preventing IPD due to vaccine serotypes was 75.8 % ( 95 % CI , 54.1–87.2 ) and 90 % ( 95 % CI , 63.9–97.2 ) when ≥2 doses before 12 months , two doses on or after 12 months or one dose on or after 24 months , were administered . The VE of ≥1 doses was 89 % ( 95 % CI , 42.7–97.9 ) against serotype 1 and 86.0 % ( 95 % CI , 51.2–99.7 ) against serotype 19A . Serotype 3 showed a non-statistically significant effectiveness ( 25.9 % ; 95 % CI , -65.3 to 66.8 ) . Conclusions The effectiveness of ≥1 doses of PCV13 in preventing IPD caused by all PCV13 serotypes in children aged 7–59 months was good and , except for serotype 3 , the effectiveness of ≥1 doses against the most frequent PCV13 serotypes causing IPD was high when considered individually BACKGROUND Infection with Streptococcus pneumoniae is a frequent and serious problem for HIV-immunosuppressed adults .  Vaccination is recommended in the USA and Europe , but there are no prospect i ve data that show vaccine efficacy . METHODS 1392 ( 937 female ) HIV-1-infected adults in Entebbe , Ug and a , were enrolled . 697 
    Output:
    
agent
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The impact of pneumococcal conjugate vaccination on the prevalence of nasopharyngeal carriage with pneumococci and other bacteria in adults is unknown . The direct effects of the 13-valent pneumococcal conjugate vaccine ( PCV13 ) in community dwelling older adults was investigated as part of the r and omized controlled Community Acquired Pneumonia immunization Trial in Adults ( CAPiTA ) . Methods We determined the carriage of Streptococcus pneumoniae , Staphylococcus aureus , Haemophilus influenzae , and Moraxella catarrhalis before and 6 , 12 , and 24 months after vaccination using polymerase chain reaction (PCR)-based methods and conventional cultures of nasopharyngeal and oropharyngeal swab sample s in 1006 PCV13 recipients and 1005 controls . Serotyping of the 13 vaccine-type ( VT ) pneumococci was performed by PCR targeting capsular synthesis genes and Quellung reaction of isolates . Results Before r and omization and based on PCR , 339 of 1891 subjects had nasopharyngeal carriage with any pneumococci ( 17.9 % ) , and 114 of 1891 ( 6.0 % ) carried VT pneumococci . At 6 months after vaccination , VT pneumococcal carriage was significantly lower in PCV13 recipients than in the placebo group ( relative risk , 0.53 ; 95 % confidence interval , .35-.80 ; P = .04 ) . There was no difference between the groups at 12 and 24 months after vaccination . Carriage of non-VT pneumococci , S. aureus , H. influenzae , and M. catarrhalis did not change between groups . Conclusions In community-dwelling adults aged ≥65 years , a single dose of PCV13 seems to elicit a small and temporary reduction in VT carriage 6 months after vaccination . Neither replacement by non-VT serotypes nor impact on other nasopharyngeal bacteria was observed The Community-Acquired Pneumonia Immunization Trial in Adults ( CAPiTA ) demonstrated the efficacy of 13-valent pneumococcal conjugate vaccine ( PCV13 ) in preventing vaccine-type community-acquired pneumonia and vaccine-type invasive pneumococcal disease in elderly subjects . We examined the cost-effectiveness of PCV13 vaccination in the Netherl and s. Using a Markov-type model , incremental cost-effectiveness ratios ( ICER ) of PCV13 vaccination in different age- and risk-groups for pneumococcal disease were evaluated using a societal perspective . Estimates of quality -adjusted life-years ( QALYs ) , costs , vaccine efficacy and epidemiological data were based on the CAPiTA study and other prospect i ve studies . The base-case was PCV13 vaccination of adults aged 65–74 years compared to no vaccination , assuming no net indirect effects in base-case due to paediatric 10-valent pneumococcal conjugate vaccine use . Analyses for age- and risk-group specific vaccination strategies and for different levels of hypothetical herd effects from a paediatric PCV programme were also conducted . The ICER for base-case was € 8650 per QALY ( 95 % CI 5750–17 100 ) . Vaccination of high-risk individuals aged 65–74 years was cost-saving and extension to medium-risk individuals aged 65–74 years yielded an ICER of € 2900 . Further extension to include medium- and high-risk individuals aged ≥18 years yielded an ICER of € 3100 . PCV13 vaccination is highly cost-effective in the Netherl and s. The transferability of our results to other countries depends upon vaccination strategies already implemented in those countries . Vaccinating the elderly with 13-valent pneumococcal conjugate vaccine is highly cost-effective BACKGROUND The benefits of using the 23-valent pneumococcal polysaccharide vaccine ( PPV23 ) are controversial . This study assessed clinical effectiveness of PPV23 in preventing community-acquired pneumonia ( CAP ) among the general population aged ≥ 60 years . METHODS This was a population -based cohort study involving 27 204 individuals aged ≥ 60 years in Tarragona , Spain , who were prospect ively followed from 1 December 2008 until 30 November 2011 . Primary outcomes were hospitalization for pneumococcal CAP ( bacteremic and nonbacteremic cases ) and all-cause CAP . All CAP cases were radiographically confirmed and vali date d by checking clinical records . Cox regression was used to evaluate the association between pneumococcal vaccination and the risk of each outcome . RESULTS Cohort members were followed for a total of 76 033 person-years ( 29 065 person-years for vaccinated subjects ) . Incidence rates ( per 1000 person-years ) were 0.21 for bacteremic pneumococcal CAP ( 0.14 vs 0.26 among vaccinated and unvaccinated subjects , respectively ) , 1.45 for nonbacteremic pneumococcal CAP ( 1.46 vs 1.44 ) , and 7.51 for all-cause CAP ( 7.19 vs 7.71 ) . In primary analyses including all cohort members , PPV23 did not appear to be effective against any analyzed outcome . However , a beneficial effect emerged in sensitive and stratified analyses . After multivariable adjustments , as compared with those never vaccinated , recent vaccination with PPV23 ( < 5 years ago ) was associated with reduced risks of bacteremic pneumococcal CAP ( hazard ratio [ HR ] , 0.38 ; 95 % confidence interval [ CI ] , .09 - 1.68 ) , nonbacteremic pneumococcal CAP ( HR , 0.52 ; 95 % CI , .29-.92 ) , overall pneumococcal CAP ( HR , 0.49 ; 95 % CI , .29-.84 ) , and all-cause CAP ( HR , 0.75 ; 95 % CI , .58-.98 ) . CONCLUSIONS Our data support a protective effect of recent PPV23 vaccination ( within previous 5 years ) against both pneumococcal and all-cause CAP Objective To evaluate the cost-effectiveness of introducing universal vaccination of adults aged 60 years with the 23-valent pneumococcal polysaccharide vaccine ( PPV23 ) into the National Immunization Program ( NIP ) in Brazil . Methods Economic evaluation using a Markov model to compare two strategies : ( 1 ) universal vaccination of adults aged 60 years  with one dose of PPV23 and 2 ) current practice ( vaccination of institutionalized elderly and elderly with underlying diseases ) . The perspective was from the health system and society . Temporal horizon was 10 years . Discount rate of 5 % was applied to costs and benefits . Clinical syndromes of interest were invasive pneumococcal disease ( IPD ) including meningitis , sepsis and others and pneumonia . Vaccine efficacy against IPD was obtained from a meta- analysis of r and omized control trials and r and omized studies , whereas vaccine effectiveness against pneumonia was obtained from cohort studies . Re source utilization and costs were obtained from the Brazilian Health Information Systems . The primary outcome was cost per life year saved ( LYS ) . Univariate and multivariate sensitivity analysis were performed . Results The universal vaccination strategy avoided 7,810 hospitalizations and 514 deaths , saving 3,787 years of life and costing a total of USD$31,507,012 and USD$44,548,180 , respectively , from the health system and societal perspective . The universal immunization would result in ICERs of USD$1,297 per LYS , from the perspective of the health system , and USD$904 per LYS , from the societal perspective . Conclusion The results suggest that universal vaccination of adults aged 60 years with the 23-valent pneumococcal polysaccharide vaccine ( PPV23 ) is a very cost-effective intervention for preventing hospitalization and deaths for IPD and pneumonia is this age group in Brazil BACKGROUND The 23-valent polysaccharide pneumococcal vaccine ( PPV ) is currently recommended for elderly persons and persons who are at high risk of infection . However , the effectiveness of the 23-valent PPV remains controversial . We assessed the effectiveness of this vaccine in older adults . METHODS A prospect i ve cohort study was conducted from January 2002 through April 2005 ; it included all community-dwelling individuals aged > or=65 years who were assigned to 1 of 8 primary health care centers in Tarragona , Spain ( 11,241 subjects ) . The primary outcomes were invasive pneumococcal disease , pneumococcal pneumonia , overall pneumonia rate , and death due to pneumonia . All cases were vali date d by a check of the clinical records . The association between pneumococcal vaccination and the risk of each outcome was evaluated by means of multivariate Cox proportional hazard models , adjusted for age , sex , comorbidity , immunocompetence , and influenza vaccine status . RESULTS Pneumococcal vaccination was associated with significant reductions in the risk of hospitalization for pneumonia ( hazard ratio [ HR ] , 0.74 ; 95 % confidence interval [ CI ] , 0.59 - 0.92 ) and in the overall pneumonia rate ( HR , 0.79 ; 95 % CI , 0.64 - 0.98 ) . The incidence of invasive pneumococcal disease was low ( 64 cases per 100,000 person-years ) , and a considerable protective effect against invasive pneumococcal disease did not attain statistical significance ( HR , 0.60 ; 95 % CI , 0.22 - 1.65 ) . However , the vaccine showed a significant effectiveness of 45 % to prevent pneumococcal pneumonia ( HR , 0.55 ; 95 % CI , 0.34 - 0.88 ) . Finally , vaccination was associated with a significant 59 % reduction in the risk of death due to pneumonia among vaccinated subjects ( HR , 0.41 ; 95 % CI , 0.23 - 0.72 ) . CONCLUSIONS These results indicate that the 23-valent PPV effectively prevented pneumococcal pneumonia ( with or without bacteremia ) and decreased the rates of overall pneumonia and of mortality due to pneumonia in older adults , providing new arguments for systematic vaccination in the elderly population Background The 13-valent pneumococcal conjugate vaccine ( PCV13 ) was licensed based on the results of immunogenicity studies and correlates of protection derived from r and omized clinical trials of the 7-valent conjugate pneumococcal vaccine . We assessed the vaccination effectiveness ( VE ) of the PCV13 in preventing invasive pneumococcal disease ( IPD ) in children aged 7–59 months in a population with suboptimal vaccination coverage of 55 % . Methods The study was carried out in children with IPD admitted to three hospitals in Barcelona ( Spain ) and controls matched by hospital , age , sex , date of hospitalization and underlying disease . Information on the vaccination status was obtained from written medical records . Conditional logistic regression was made to estimate the adjusted VE and 95 % confidence intervals ( CI ) . Results 169 cases and 645 controls were included .  The overall VE of ≥1 doses  of PCV13 in preventing IPD due to vaccine serotypes was 75.8 % ( 95 % CI , 54.1–87.2 ) and 90 % ( 95 % CI , 63.9–97.2 ) when ≥2 doses before 12 months , two doses on or after 12 months or one dose on or after 24 months , were administered . The VE of ≥1 doses was 89 % ( 95 % CI , 42.7–97.9 ) against serotype 1 and 86.0 % ( 95 % CI , 51.2–99.7 ) against serotype 19A . Serotype 3 showed a non-statistically significant effectiveness ( 25.9 % ; 95 % CI , -65.3 to 66.8 ) . Conclusions The effectiveness of ≥1 doses of PCV13 in preventing IPD caused by all PCV13 serotypes in children aged 7–59 months was good and , except for serotype 3 , the effectiveness of ≥1 doses against the most frequent PCV13 serotypes causing IPD was high when considered individually BACKGROUND Infection with Streptococcus pneumoniae is a frequent and serious problem for HIV-immunosuppressed adults .  Vaccination is recommended in the USA and Europe , but there are no prospect i ve data that show vaccine efficacy . METHODS 1392 ( 937 female ) HIV-1-infected adults in Entebbe , Ug and a , were enrolled . 697 
    Output:
    