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 Most studies of Haemophilus influenzae type b ( Hib ) disease in Asia have found low rates , and few Asian countries use Hib vaccine in routine immunisation programmes . Whether Hib disease truly is rare or whether many cases remain undetected is unclear . METHODS To estimate incidences of vaccine-preventable Hib pneumonia and meningitis among children younger than 2 years in Lombok , Indonesia , during 1998 - 2002 , we undertook a hamlet-r and omised , controlled , double-blind vaccine-probe study ( 818 hamlets ) . Children were immunised ( WHO schedule ) with diphtheria , tetanus , pertussis ( DTP ) or DTP-PRP-T ( Hib conjugate ) vaccine . Vaccine-preventable disease incidences were calculated as the difference in rates of clinical outcomes between DTP and DTP-PRP-T groups . Analyses included all children who received at least one vaccine dose . FINDINGS We enrolled 55073 children : 28147 were assigned DTP-PRP-T and 26926 DTP . The proportion of pneumonia outcomes prevented by vaccine ranged from less than 0 to 4.8 % . Calculated incidences of vaccine-preventable Hib disease ( per 10(5 ) child-years of observation ) for outcome categories were : substantial alveolar consolidation or effusion , less than zero ( -43 [ 95 % CI -185 to 98 ] ) ; all severe pneumonia , 264 ( 95 % CI less than zero to 629 ) ; all clinical pneumonia , 1561 ( 270 to 2853 ) ; confirmed Hib meningitis , 16 ( 1.4 to 31 ) ; meningitis with cerebrospinal-fluid findings consistent with a bacterial aetiology , 67 ( 22 to 112 ) ; and admission for suspected meningitis or presenting to a clinic with convulsions , 158 ( 42 to 273 ) . INTERPRETATION Hib vaccine did not prevent the great majority of pneumonia cases , including those with alveolar consolidation . These results do not support a major role for Hib vaccine in overall pneumonia-prevention programmes . Nevertheless , the study identified high incidences of Hib meningitis and pneumonia ; inclusion of Hib vaccine in routine infant immunisation programmes in Asia deserves consideration OBJECTIVE To determine the two-year results of nationwide vaccination with Haemophilus influenzae type b ( Hib ) vaccine on the occurrence of Hib meningitis in the Netherl and s. DESIGN Retrospective controlled study . SETTING The Netherl and s. METHOD Children born since April 1 , 1993 are vaccinated at the age of 3 , 4 , 5 and 11 months to protect them from infections with Hib . The number of Hib meningitis patients in the period 1 April , 1993 to 1 April , 1995 , among infants born in this period who were offered the Hib vaccine  ( study group ) , was compared with the number of Hib meningitis patients in the period 1 April , 1991 to 1 April , 1993 among children born in last-mentioned period ( control group ) . RESULTS Twenty-one cases of meningitis by Hib were observed in the study group . Twelve children who , as a consequence of their age , had only been vaccinated once or not at all ; 7 children were not vaccinated for several reasons . In addition one patient was infected by H. influenzae type f strain and one by a non-typable strain . In the control group 185 cases of Hib meningitis occurred . CONCLUSION Hib meningitis was not observed among infants who had been vaccinated at least twice Haemophilus influenzae type b capsular polysaccharide-diphtheria toxoid conjugate vaccine has recently been shown to be capable of inducing antibodies to H. influenzae in infants . In an evaluation of its clinical efficacy , 60,000 children were enrolled in an open trial in Finl and . Children born on odd-numbered days between October 1 , 1985 , and September 30 , 1986 , received the vaccine at 3 , 4 , 6 , and 14 months ; those born on even-numbered days served as controls . The geometric mean antibody titer measured in a cohort of 99 children rose from a prevaccination level of 0.08 microgram per milliliter at three months of age to 0.42 microgram per milliliter at seven months . Only minor adverse reactions were reported . Up to February 1987 , two cases of invasive H. influenzae infection had occurred among the children who had received three doses of vaccine , whereas 12 cases had occurred among the controls ( P = 0.0005 by Poisson one-tailed test ) . The rate of short-term ( average follow-up time , five months ) protection provided by this conjugate vaccine in infancy was thus 83 percent BACKGROUND AND METHODS Several conjugate vaccines against Haemophilus influenzae type b have been developed in the search for one that induces protection even in young infants . We evaluated the safety and efficacy of a conjugate vaccine that links the H. influenzae type b capsular polysaccharide to the outer-membrane protein complex ( OMPC ) of Neisseria meningitidis serogroup B. We conducted a double-blind , placebo , controlled trial in Navajo infants , who are at high risk for systemic infections caused by H. influenzae type b. The infants were r and omly assigned to receive the first dose of vaccine or placebo at 42 to 90 days of age and the second at 70 to 146 days of age . RESULTS Of the infants in the trial , 2588 were assigned to receive the vaccine and 2602 to receive placebo .  The mean follow-up was 269 days in the vaccine group and 267 days in the placebo group . Before the age of 18 months , there was 1 systemic H. influenzae type b infection in the vaccine group , as compared with 22 in the placebo group ( P less than 0.001 ; point estimate of efficacy , 95 percent ; 95 percent confidence interval , 72 to 99 percent ) . Of the 22 H. influenzae type b infections in the placebo group , 13 were meningitis . Among the children who received both doses , there was 1 H. influenzae type b infection in the vaccine group ( n = 2056 ) and 14 in the placebo group ( n = 2105 ) ( P less than 0.001 ; point estimate of efficacy , 93 percent ; 95 percent confidence interval , 53 to 98 percent ) . The single infection in the vaccine group occurred at 15 1/2 months of age in an infant with osteomyelitis . Between the first and second doses there were no H. influenzae type b infections in the vaccine group and eight in the placebo group ( P less than 0.005 ; point estimate of efficacy , 100 percent ; 95 percent confidence interval , 41 to 100 percent ) . CONCLUSIONS The H. influenzae type b OMPC vaccine , administered at 2 and 4 months of age , is safe and induces a high rate of protection against invasive disease caused by H. influenzae type b in infants under the age of 18 months . Protection begins after the first dose The efficacy of the HbOC conjugate Haemophilus influenzae type b vaccine was evaluated in a study population of 61 080 infants in the Northern California Kaiser Permanente Medical Care Program . Between February , 1988 , and June , 1990 , the HbOC vaccine was given as part of a three-dose series at 2 , 4 and 6 months of age to 20 800 infants . The study population included children with a well-care visit at a study center during the first 6 months of life . There were 25 cases of Haemophilus influenzae type b disease in the study population : 22 in unvaccinated children and 3 in children who received only one dose of HbOC vaccine .  The efficacy of the full three-dose series was evaluated by several methods : a primary analysis comparing fully vaccinated children with unvaccinated children from 7 to 18 months of age ; a stratified exact analysis adjusted for age and seasonality ; and a case-control analysis which further adjusted for known risk factors . The efficacy of three doses of vaccine was 100 % with the lower bound of the 95 % confidence interval for the three analyses at 68 , 71 , and 64 % , respectively . There were no cases of disease result ing from two doses of HbOC vaccine yielding an estimate of 100 % efficacy ( 95 % confidence interval , 47 to 100 ) for two doses of HbOC vaccine . However , for children who had received only one dose of HbOC vaccine , vaccine efficacy was estimated to be 26 % and the possibility that one dose of HbOC vaccine had no efficacy could not be excluded . An intent-to-treat analysis and supplementary analyses of possible sources of bias supported the conclusion that immunization with HbOC vaccine was effective in preventing H. influenzae type b disease in infancy Efficacy of the Haemophilus influenzae type b ( Hib ) conjugate vaccine PRP-T ( Pasteur-Merieux ) was evaluated in a controlled community intervention study in the Oxford region , UK .  PRP-T was offered to infants from May 1 , 1991 in three of the region 's eight districts and from July 1 , 1991 , in a fourth district . It was given by separate injection in addition to the st and ard diphtheria , tetanus , and pertussis vaccine according to an accelerated 2 , 3 , and 4 month schedule without a booster dose in the second year of life . By October 1 , 1992 , more than 90 % of infants in vaccine districts had received at least one dose of PRP-T. None of the infants given three doses had developed Hib infection , whereas 11 infections occurred in the control population ( vaccine efficacy 100 % , 95 % CI 80 - 100 % ) . Intention-to-treat analysis also showed a high estimate of efficacy for the vaccine ( 90 % , 50 - 99 % ) . Follow-up of study children until November 1 , 1993 , has shown only 1 vaccine failure in an infant , and no invasive infections in those older than 1 year ( average age 22 months ) . PRP-T vaccine had high protective efficacy with an accelerated immunisation schedule . Furthermore , the vaccine appears to remain protective through the second year of life without a booster dose . These findings provide encouragement for use of PRP-T in the Exp and ed Programme of Immunisation OBJECTIVE To compare two Haemophilus influenzae type B ( HiB ) conjugate vaccines , a polysaccharide-diphtheria toxoid conjugate ( PRP-D ) vaccine and an oligosaccharide-CRM197 protein conjugate ( HBOC [ PRP-CRM ] ) vaccine , in the same population . DESIGN One hundred twenty-five thous and infants were r and omized to receive the PRP-D or HBOC vaccine . Primary immunization consisted of two doses of either vaccine administered at 4 and 6 months and a booster dose was given at 14 to 18 months . Protection was assessed by recording episodes of invasive disease with HiB isolated from the blood or another normally sterile body site . SETTING One thous and thirty-six child health care centers in Finl and . PARTICIPANTS Infants born in Finl and during the 24-month period from 1987 to 1989 . INTERVENTION Each vaccine dose was injected intramuscularly in a volume of 0.5 mL. At the same time , a separate site was injected with the diphtheria and tetanus toxoids and pertussis vaccine at 4 months of age , with inactivated poliovirus vaccine at 6 months of age , and with measles-mumps-rubella vaccine at 14 to 18 months of age . MAIN RESULTS The mean anticapsular antibody concentration 1 month after the second dose was 0.63 micrograms/mL and 4.32 micrograms/mL in the PRP-D and HBOC vaccine recipients , respectively . The booster dose result ed in a high antibody concentration : 33.3 micrograms/mL and 58.3 micrograms/mL for PRP-D and HBOC vaccine recipients , respectively . At 36 months of age , the antibody concentration declined to 2.5 micrograms/mL and 5.6 micrograms/mL for PRP-D and HBOC vaccine recipients , respectively . After two doses of the vaccine , there were five episodes ( 39 were expected based on historical controls ) of invasive HiB disease in the PRP-D group and two episodes ( 35 were expected ) in the HBOC group . Hence , an 87 % ( 95 % confidence limit [ CL ] , 69 , 96 ) protection rate in the PRP-D group and a 95 % ( 95 % CL , 76 , 99 ) protection rate in the HBOC group were achieved . No episodes occurred after the booster dose in either group . CONCLUSIONS Both the PRP 
    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 Most studies of Haemophilus influenzae type b ( Hib ) disease in Asia have found low rates , and few Asian countries use Hib vaccine in routine immunisation programmes . Whether Hib disease truly is rare or whether many cases remain undetected is unclear . METHODS To estimate incidences of vaccine-preventable Hib pneumonia and meningitis among children younger than 2 years in Lombok , Indonesia , during 1998 - 2002 , we undertook a hamlet-r and omised , controlled , double-blind vaccine-probe study ( 818 hamlets ) . Children were immunised ( WHO schedule ) with diphtheria , tetanus , pertussis ( DTP ) or DTP-PRP-T ( Hib conjugate ) vaccine . Vaccine-preventable disease incidences were calculated as the difference in rates of clinical outcomes between DTP and DTP-PRP-T groups . Analyses included all children who received at least one vaccine dose . FINDINGS We enrolled 55073 children : 28147 were assigned DTP-PRP-T and 26926 DTP . The proportion of pneumonia outcomes prevented by vaccine ranged from less than 0 to 4.8 % . Calculated incidences of vaccine-preventable Hib disease ( per 10(5 ) child-years of observation ) for outcome categories were : substantial alveolar consolidation or effusion , less than zero ( -43 [ 95 % CI -185 to 98 ] ) ; all severe pneumonia , 264 ( 95 % CI less than zero to 629 ) ; all clinical pneumonia , 1561 ( 270 to 2853 ) ; confirmed Hib meningitis , 16 ( 1.4 to 31 ) ; meningitis with cerebrospinal-fluid findings consistent with a bacterial aetiology , 67 ( 22 to 112 ) ; and admission for suspected meningitis or presenting to a clinic with convulsions , 158 ( 42 to 273 ) . INTERPRETATION Hib vaccine did not prevent the great majority of pneumonia cases , including those with alveolar consolidation . These results do not support a major role for Hib vaccine in overall pneumonia-prevention programmes . Nevertheless , the study identified high incidences of Hib meningitis and pneumonia ; inclusion of Hib vaccine in routine infant immunisation programmes in Asia deserves consideration OBJECTIVE To determine the two-year results of nationwide vaccination with Haemophilus influenzae type b ( Hib ) vaccine on the occurrence of Hib meningitis in the Netherl and s. DESIGN Retrospective controlled study . SETTING The Netherl and s. METHOD Children born since April 1 , 1993 are vaccinated at the age of 3 , 4 , 5 and 11 months to protect them from infections with Hib . The number of Hib meningitis patients in the period 1 April , 1993 to 1 April , 1995 , among infants born in this period who were offered the Hib vaccine  ( study group ) , was compared with the number of Hib meningitis patients in the period 1 April , 1991 to 1 April , 1993 among children born in last-mentioned period ( control group ) . RESULTS Twenty-one cases of meningitis by Hib were observed in the study group . Twelve children who , as a consequence of their age , had only been vaccinated once or not at all ; 7 children were not vaccinated for several reasons . In addition one patient was infected by H. influenzae type f strain and one by a non-typable strain . In the control group 185 cases of Hib meningitis occurred . CONCLUSION Hib meningitis was not observed among infants who had been vaccinated at least twice Haemophilus influenzae type b capsular polysaccharide-diphtheria toxoid conjugate vaccine has recently been shown to be capable of inducing antibodies to H. influenzae in infants . In an evaluation of its clinical efficacy , 60,000 children were enrolled in an open trial in Finl and . Children born on odd-numbered days between October 1 , 1985 , and September 30 , 1986 , received the vaccine at 3 , 4 , 6 , and 14 months ; those born on even-numbered days served as controls . The geometric mean antibody titer measured in a cohort of 99 children rose from a prevaccination level of 0.08 microgram per milliliter at three months of age to 0.42 microgram per milliliter at seven months . Only minor adverse reactions were reported . Up to February 1987 , two cases of invasive H. influenzae infection had occurred among the children who had received three doses of vaccine , whereas 12 cases had occurred among the controls ( P = 0.0005 by Poisson one-tailed test ) . The rate of short-term ( average follow-up time , five months ) protection provided by this conjugate vaccine in infancy was thus 83 percent BACKGROUND AND METHODS Several conjugate vaccines against Haemophilus influenzae type b have been developed in the search for one that induces protection even in young infants . We evaluated the safety and efficacy of a conjugate vaccine that links the H. influenzae type b capsular polysaccharide to the outer-membrane protein complex ( OMPC ) of Neisseria meningitidis serogroup B. We conducted a double-blind , placebo , controlled trial in Navajo infants , who are at high risk for systemic infections caused by H. influenzae type b. The infants were r and omly assigned to receive the first dose of vaccine or placebo at 42 to 90 days of age and the second at 70 to 146 days of age . RESULTS Of the infants in the trial , 2588 were assigned to receive the vaccine and 2602 to receive placebo .  The mean follow-up was 269 days in the vaccine group and 267 days in the placebo group . Before the age of 18 months , there was 1 systemic H. influenzae type b infection in the vaccine group , as compared with 22 in the placebo group ( P less than 0.001 ; point estimate of efficacy , 95 percent ; 95 percent confidence interval , 72 to 99 percent ) . Of the 22 H. influenzae type b infections in the placebo group , 13 were meningitis . Among the children who received both doses , there was 1 H. influenzae type b infection in the vaccine group ( n = 2056 ) and 14 in the placebo group ( n = 2105 ) ( P less than 0.001 ; point estimate of efficacy , 93 percent ; 95 percent confidence interval , 53 to 98 percent ) . The single infection in the vaccine group occurred at 15 1/2 months of age in an infant with osteomyelitis . Between the first and second doses there were no H. influenzae type b infections in the vaccine group and eight in the placebo group ( P less than 0.005 ; point estimate of efficacy , 100 percent ; 95 percent confidence interval , 41 to 100 percent ) . CONCLUSIONS The H. influenzae type b OMPC vaccine , administered at 2 and 4 months of age , is safe and induces a high rate of protection against invasive disease caused by H. influenzae type b in infants under the age of 18 months . Protection begins after the first dose The efficacy of the HbOC conjugate Haemophilus influenzae type b vaccine was evaluated in a study population of 61 080 infants in the Northern California Kaiser Permanente Medical Care Program . Between February , 1988 , and June , 1990 , the HbOC vaccine was given as part of a three-dose series at 2 , 4 and 6 months of age to 20 800 infants . The study population included children with a well-care visit at a study center during the first 6 months of life . There were 25 cases of Haemophilus influenzae type b disease in the study population : 22 in unvaccinated children and 3 in children who received only one dose of HbOC vaccine .  The efficacy of the full three-dose series was evaluated by several methods : a primary analysis comparing fully vaccinated children with unvaccinated children from 7 to 18 months of age ; a stratified exact analysis adjusted for age and seasonality ; and a case-control analysis which further adjusted for known risk factors . The efficacy of three doses of vaccine was 100 % with the lower bound of the 95 % confidence interval for the three analyses at 68 , 71 , and 64 % , respectively . There were no cases of disease result ing from two doses of HbOC vaccine yielding an estimate of 100 % efficacy ( 95 % confidence interval , 47 to 100 ) for two doses of HbOC vaccine . However , for children who had received only one dose of HbOC vaccine , vaccine efficacy was estimated to be 26 % and the possibility that one dose of HbOC vaccine had no efficacy could not be excluded . An intent-to-treat analysis and supplementary analyses of possible sources of bias supported the conclusion that immunization with HbOC vaccine was effective in preventing H. influenzae type b disease in infancy Efficacy of the Haemophilus influenzae type b ( Hib ) conjugate vaccine PRP-T ( Pasteur-Merieux ) was evaluated in a controlled community intervention study in the Oxford region , UK .  PRP-T was offered to infants from May 1 , 1991 in three of the region 's eight districts and from July 1 , 1991 , in a fourth district . It was given by separate injection in addition to the st and ard diphtheria , tetanus , and pertussis vaccine according to an accelerated 2 , 3 , and 4 month schedule without a booster dose in the second year of life . By October 1 , 1992 , more than 90 % of infants in vaccine districts had received at least one dose of PRP-T. None of the infants given three doses had developed Hib infection , whereas 11 infections occurred in the control population ( vaccine efficacy 100 % , 95 % CI 80 - 100 % ) . Intention-to-treat analysis also showed a high estimate of efficacy for the vaccine ( 90 % , 50 - 99 % ) . Follow-up of study children until November 1 , 1993 , has shown only 1 vaccine failure in an infant , and no invasive infections in those older than 1 year ( average age 22 months ) . PRP-T vaccine had high protective efficacy with an accelerated immunisation schedule . Furthermore , the vaccine appears to remain protective through the second year of life without a booster dose . These findings provide encouragement for use of PRP-T in the Exp and ed Programme of Immunisation OBJECTIVE To compare two Haemophilus influenzae type B ( HiB ) conjugate vaccines , a polysaccharide-diphtheria toxoid conjugate ( PRP-D ) vaccine and an oligosaccharide-CRM197 protein conjugate ( HBOC [ PRP-CRM ] ) vaccine , in the same population . DESIGN One hundred twenty-five thous and infants were r and omized to receive the PRP-D or HBOC vaccine . Primary immunization consisted of two doses of either vaccine administered at 4 and 6 months and a booster dose was given at 14 to 18 months . Protection was assessed by recording episodes of invasive disease with HiB isolated from the blood or another normally sterile body site . SETTING One thous and thirty-six child health care centers in Finl and . PARTICIPANTS Infants born in Finl and during the 24-month period from 1987 to 1989 . INTERVENTION Each vaccine dose was injected intramuscularly in a volume of 0.5 mL. At the same time , a separate site was injected with the diphtheria and tetanus toxoids and pertussis vaccine at 4 months of age , with inactivated poliovirus vaccine at 6 months of age , and with measles-mumps-rubella vaccine at 14 to 18 months of age . MAIN RESULTS The mean anticapsular antibody concentration 1 month after the second dose was 0.63 micrograms/mL and 4.32 micrograms/mL in the PRP-D and HBOC vaccine recipients , respectively . The booster dose result ed in a high antibody concentration : 33.3 micrograms/mL and 58.3 micrograms/mL for PRP-D and HBOC vaccine recipients , respectively . At 36 months of age , the antibody concentration declined to 2.5 micrograms/mL and 5.6 micrograms/mL for PRP-D and HBOC vaccine recipients , respectively . After two doses of the vaccine , there were five episodes ( 39 were expected based on historical controls ) of invasive HiB disease in the PRP-D group and two episodes ( 35 were expected ) in the HBOC group . Hence , an 87 % ( 95 % confidence limit [ CL ] , 69 , 96 ) protection rate in the PRP-D group and a 95 % ( 95 % CL , 76 , 99 ) protection rate in the HBOC group were achieved . No episodes occurred after the booster dose in either group . CONCLUSIONS Both the PRP 
    Output:
    