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: OBJECTIVE : Observational studies suggest that serum levels of 25-hydroxyvitamin D ( 25[OH]D ) are inversely associated with acute respiratory infections ( ARIs ) . We hypothesized that vitamin D supplementation of children with vitamin D deficiency would lower the risk of ARIs . METHODS : By using cluster r and omization , classrooms of 744 Mongolian schoolchildren were r and omly assigned to different treatments in winter ( January – March ) . This analysis focused on a subset of 247 children who were assigned to daily ingestion of unfortified regular milk ( control ; n = 104 ) or milk fortified with 300 IU of vitamin D3 ( n = 143 ) . This comparison was double-blinded . The primary outcome was the number of parent-reported ARIs over the past 3 months . RESULTS : At baseline , the median serum 25(OH)D level was 7 ng/mL ( interquartile range : 5–10 ng/mL ) . At the end of the trial , follow-up was 99 % ( n = 244 ) , and the median 25(OH)D levels of children in the control versus vitamin D groups was significantly different ( 7 vs 19 ng/mL ; P < .001 ) . Compared with controls , children receiving vitamin D reported significantly fewer ARIs during the study period ( mean : 0.80 vs 0.45 ; P = .047 ) , with a rate ratio of 0.52 ( 95 % confidence interval : 0.31–0.89 ) . Adjusting for age , gender , and history of wheezing , vitamin D continued to halve the risk of ARI ( rate ratio : 0.50 [ 95 % confidence interval : 0.28–0.88 ] ) . Similar results were found among children either below or above the median 25(OH)D level at baseline ( rate ratio : 0.41 vs 0.57 ; Pinteraction = .27 ) . CONCLUSIONS : Vitamin D supplementation significantly reduced the risk of ARIs in winter among Mongolian children with vitamin D deficiency BACKGROUND We previously showed that mortality from infectious diseases among young adults in rural Gambia is strongly correlated with the season of their birth . This suggests that early life insults that involve fetal malnutrition , exposure to natural toxins , or highly seasonal infections affecting the infant or pregnant mother cause permanent damage to the immune system . Excess mortality begins after puberty and has a maximal odds ratio of > 10 for deaths between ages 25 and 50 y. OBJECTIVE We investigated the immune function of children according to birth weight , season of birth , and exposure to maternal dietary supplementation during pregnancy . DESIGN Immune function was measured in 472 prepubertal children aged 6.5 - 9.5 y from 28 villages in rural Gambia . The mothers of these children had been r and omly assigned to a high-energy prenatal supplementation program , which significantly increased birth weight . This permitted supplementation status , birth weight , and season of birth to be investigated as exposure variables . The outcome variables tested were naive responses to rabies and pneumococcus vaccines , delayed-type hypersensitivity skin reactions , and mucosal defense ( secretory immunoglobulin A and dual-sugar permeability ) . RESULTS Immune responses were strongly related to current age and sex , suggesting a high level of sensitivity , but were not consistently related to birth weight , season of birth , or maternal supplementation ( control compared with intervention ) . CONCLUSION Events in early life did not predict a measurable defect in immune response within this cohort of rural Gambian children . It is possible that the early programming of immune function may be mediated through a defect in immunologic memory or early senescence rather than through impairment of early responses BACKGROUND Previous analyses derived the relative risk ( RR ) of dying as a result of low weight-for-age and calculated the proportion of child deaths worldwide attributable to underweight . OBJECTIVES The objectives were to examine whether the risk of dying because of underweight varies by cause of death and to estimate the fraction of deaths by cause attributable to underweight . DESIGN Data were obtained from investigators of 10 cohort studies with both weight-for-age category ( < -3 SDs , -3 to < -2 SDs , -2 to < -1 SD , and > -1 SD ) and cause of death information . All 10 studies contributed information on weight-for-age and risk of diarrhea , pneumonia , and all-cause mortality ; however , only 6 studies contributed information on deaths because of measles , and only 3 studies contributed information on deaths because of malaria or fever . With use of weighted r and om effects models , we related the log mortality rate by cause and anthropometric status in each study to derive cause-specific RRs of dying because of undernutrition . Prevalences of each weight-for-age category were obtained from analyses of 310 national nutrition surveys . With use of the RR and prevalence information , we then calculated the fraction of deaths by cause attributable to undernutrition . RESULTS The RR of mortality because of low weight-for-age was elevated for each cause of death and for all-cause mortality . Overall , 52.5 % of all deaths in young children were attributable to undernutrition , varying from 44.8 % for deaths because of measles to 60.7 % for deaths because of diarrhea . CONCLUSION A significant proportion of deaths in young children worldwide is attributable to low weight-for-age , and efforts to reduce malnutrition should be a policy priority The immunogenicity of three currently used hepatitis B vaccines was compared in an unselected study population in an every day travel clinical setting . Five hundred and eighteen vaccinees received Engerix-B ( EB ) , 990 received Twinrix ( TWX ) , and  366 were immunised with Gen-HB-Vax ( GHB ) . Overall , 88.6 % of the vaccinees , tested within the first 6 months after completion of the vaccination series , developed protective levels of anti-HBs ( > or = 10 mIU/ml ) . However , GHB recipients showed significantly lower seroprotection rates ( SPR ) than EB and TWX recipients ( 79.3 % vs. 87.7 % vs. 92.3 % , P < 0.000001 ) . GMTs for anti-HBs , tested within 6 months after the third vaccination , showed the lowest results in the GHB group , followed by EB and TWX ( 142 vs. 523 vs. 1008 mIU/ml , P < 0.000001 ) . TWX vaccinees , however , showing a higher antibody decline rate than EB recipients within the first years after completion of the full immunisation course ( 30 % vs. 25 % ; P = 0.0538 ) . This study confirms an overall good immune response to the 20 microg-dose vaccine , in the course of a regular clinical setting . The significant difference in SPRs and GMTs to the 10 microg-dose vaccine , however , may influence future immunisation practice s for the elderly BACKGROUND We assessed the association between the duration of diarrhoea and the risk ofpneumonia incidence  among children < 5 years of age . METHODS We analysed data from a cluster r and omized controlled trial in Karachi , Pakistan , which assessed the effect of promoting h and washing with soap ( antibacterial and plain ) on child health . Field workers visited households with children < 5 years of age weekly and asked primary caregivers if their child had diarrhoea , cough or difficulty breathing in the preceding week . We used the WHO clinical case definitions for diarrhoea and pneumonia . We used adjusted time-to-event analyses with cumulative diarrhoea prevalence over the previous 2 and 4 weeks as exposure and pneumonia as outcome . We calculated the attributable risk of pneumonia due to recent diarrhoea across the intervention groups . RESULTS 873 households with children < 5 years were visited . Children had an increased risk of pneumonia for every additional day of diarrhoea in the 2 weeks ( 1.06 , 95 % CI : 1.03 - 1.09 ) and 4 weeks ( 1.04 , 95 % CI : 1.03 - 1.06 ) prior to the week of pneumonia onset . The attributable risk of pneumonia cases due to recent exposure to diarrhoea was 6 % . A lower associated pneumonia risk following diarrhoea was found in the control group : ( 3 % ) compared with soap groups ( 6 % in antibacterial soap , 9 % in plain soap ) . CONCLUSION Children < 5 years of age are at an increased risk of pneumonia following recent diarrhoeal illness . Public health programmes that prevent diarrhoea may also reduce the burden of respiratory illnesses In a 3-year prospect i ve study of 9584 consecutive paediatric admissions to the Royal Victoria Hospital in Banjul , The Gambia , we examined the impact of seasonal variations in childhood diseases . The four principal diseases ( falciparum malaria , pneumonia , gastro-enteritis and malnutrition ) all peaked in September to October following the rainy season . The mortality rate was also higher in the rainy season than in the dry season . Of the 1525 children with cerebral malaria , 83 % were admitted during the extended rainy season from July to December . With the emergence of chloroquine-resistant malaria over the 3 years , there was a 27 % annual increase in severe anaemia owing to malaria . The median age of malarial anaemia ( 23 months ) was significantly younger than that of cerebral malaria ( 42 months ) . Malnutrition peaked immediately following the annual rainy season epidemics of bacterial gastro-enteritis but was not associated with the cool dry season rotavirus outbreaks . Rainy season diarrhoea was also associated with more persistent diarrhoea , an older mean age and a higher mortality . Meningitis was caused by either pneumococcus or Haemophilus influenzae in 64 % of cases , of whom 19 % were 0 - 2 months of age . Causes of death in hospital showed good agreement with Gambian community studies . We conclude that analysis of hospital data in a developing country can give accurate information on childhood morbidity and mortality patterns which can be used to set priorities for health care interventions . Seasonal variation is a cardinal feature of paediatric diseases in this part of Africa , and accentuates the vulnerability of children in poor families BACKGROUND The antibody response to pneumococcal conjugate vaccines ( PCVs ) in infants is variable . Factors responsible for this variability have not been fully eluci date d. The objective of this study was to investigate whether pneumococcal carriage around the time of the first dose of 7-valent PCV ( PCV7 ) affects serotype-specific immunologic response . METHODS Healthy 2-month old infants were r and omized to receive 2 ( at the ages of 4 and 6 months ) or 3 ( at the ages of 2 , 4 , and 6 months ) PCV7 doses and a booster dose ( at the age of 12 months ) . Nasopharyngeal or oropharyngeal specimens were obtained for culture shortly before the first PCV7 dose . Serotype-specific immunoglobulin ( Ig ) G levels were measured at ages 2 , 7 , and 13 months . RESULTS Of 545 children studied , 332 received a booster dose . The most common serotypes carried around the time of the first PCV7 dose were 6B ( n = 37 ) , 19F ( n = 22 ) , and 23F ( n = 14 ) . In carriers before the first dose , the IgG response to the carried serotype after 2 or 3 doses was significantly lower than in noncarriers . In contrast , response to the noncarried serotypes was not affected . Although all children responded to the booster dose , the response to the originally carried serotype was generally lower . CONCLUSIONS Serotype-specific hyporesponsiveness to PCV7 after pneumococcal carriage in infants is demonstrated for the first time . This phenomenon was common , lasted for at least several months , and was only partially overcome by the 12-month booster . TRIAL REGISTRATION is rct n.org identifier : IS RCT N28445844 To assess factors that may influence the immunogenicity of oral poliovirus vaccine ( OPV ) , neutralizing antibody responses were measured in 1409 infants in Brazil and the Gambia who were r and omized to receive one of four different formulations of OPV at approximately birth and at 6 , 10 , and 14 weeks .  Overall seroconversion rates at the end of the trial were 85 % for poliovirus type 1 ( P1 ) , 94 % for type 2 ( P2 ) , and 68 % for type 3 ( P3 ) . Factors associated with vaccine failure included high levels of maternal antibody ( P1 , P2 , and P3 ) , vaccination during the rainy season ( P1 , P2 , and P3 ) , diarrhea at the time of vaccination ( P2 and P3 ) , household exposure to other OPV recipients ( P1 ) , and breast-feeding ( P3 ) ( P < .05 for each factor , logistic regression analysis ) . OPV containing twice the st and ard potency of Sabin type 1 virus increased seroconversion rates to P1 by 8 % in Brazil ( P < .05 ) and 15 % in the Gambia 
    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: OBJECTIVE : Observational studies suggest that serum levels of 25-hydroxyvitamin D ( 25[OH]D ) are inversely associated with acute respiratory infections ( ARIs ) . We hypothesized that vitamin D supplementation of children with vitamin D deficiency would lower the risk of ARIs . METHODS : By using cluster r and omization , classrooms of 744 Mongolian schoolchildren were r and omly assigned to different treatments in winter ( January – March ) . This analysis focused on a subset of 247 children who were assigned to daily ingestion of unfortified regular milk ( control ; n = 104 ) or milk fortified with 300 IU of vitamin D3 ( n = 143 ) . This comparison was double-blinded . The primary outcome was the number of parent-reported ARIs over the past 3 months . RESULTS : At baseline , the median serum 25(OH)D level was 7 ng/mL ( interquartile range : 5–10 ng/mL ) . At the end of the trial , follow-up was 99 % ( n = 244 ) , and the median 25(OH)D levels of children in the control versus vitamin D groups was significantly different ( 7 vs 19 ng/mL ; P < .001 ) . Compared with controls , children receiving vitamin D reported significantly fewer ARIs during the study period ( mean : 0.80 vs 0.45 ; P = .047 ) , with a rate ratio of 0.52 ( 95 % confidence interval : 0.31–0.89 ) . Adjusting for age , gender , and history of wheezing , vitamin D continued to halve the risk of ARI ( rate ratio : 0.50 [ 95 % confidence interval : 0.28–0.88 ] ) . Similar results were found among children either below or above the median 25(OH)D level at baseline ( rate ratio : 0.41 vs 0.57 ; Pinteraction = .27 ) . CONCLUSIONS : Vitamin D supplementation significantly reduced the risk of ARIs in winter among Mongolian children with vitamin D deficiency BACKGROUND We previously showed that mortality from infectious diseases among young adults in rural Gambia is strongly correlated with the season of their birth . This suggests that early life insults that involve fetal malnutrition , exposure to natural toxins , or highly seasonal infections affecting the infant or pregnant mother cause permanent damage to the immune system . Excess mortality begins after puberty and has a maximal odds ratio of > 10 for deaths between ages 25 and 50 y. OBJECTIVE We investigated the immune function of children according to birth weight , season of birth , and exposure to maternal dietary supplementation during pregnancy . DESIGN Immune function was measured in 472 prepubertal children aged 6.5 - 9.5 y from 28 villages in rural Gambia . The mothers of these children had been r and omly assigned to a high-energy prenatal supplementation program , which significantly increased birth weight . This permitted supplementation status , birth weight , and season of birth to be investigated as exposure variables . The outcome variables tested were naive responses to rabies and pneumococcus vaccines , delayed-type hypersensitivity skin reactions , and mucosal defense ( secretory immunoglobulin A and dual-sugar permeability ) . RESULTS Immune responses were strongly related to current age and sex , suggesting a high level of sensitivity , but were not consistently related to birth weight , season of birth , or maternal supplementation ( control compared with intervention ) . CONCLUSION Events in early life did not predict a measurable defect in immune response within this cohort of rural Gambian children . It is possible that the early programming of immune function may be mediated through a defect in immunologic memory or early senescence rather than through impairment of early responses BACKGROUND Previous analyses derived the relative risk ( RR ) of dying as a result of low weight-for-age and calculated the proportion of child deaths worldwide attributable to underweight . OBJECTIVES The objectives were to examine whether the risk of dying because of underweight varies by cause of death and to estimate the fraction of deaths by cause attributable to underweight . DESIGN Data were obtained from investigators of 10 cohort studies with both weight-for-age category ( < -3 SDs , -3 to < -2 SDs , -2 to < -1 SD , and > -1 SD ) and cause of death information . All 10 studies contributed information on weight-for-age and risk of diarrhea , pneumonia , and all-cause mortality ; however , only 6 studies contributed information on deaths because of measles , and only 3 studies contributed information on deaths because of malaria or fever . With use of weighted r and om effects models , we related the log mortality rate by cause and anthropometric status in each study to derive cause-specific RRs of dying because of undernutrition . Prevalences of each weight-for-age category were obtained from analyses of 310 national nutrition surveys . With use of the RR and prevalence information , we then calculated the fraction of deaths by cause attributable to undernutrition . RESULTS The RR of mortality because of low weight-for-age was elevated for each cause of death and for all-cause mortality . Overall , 52.5 % of all deaths in young children were attributable to undernutrition , varying from 44.8 % for deaths because of measles to 60.7 % for deaths because of diarrhea . CONCLUSION A significant proportion of deaths in young children worldwide is attributable to low weight-for-age , and efforts to reduce malnutrition should be a policy priority The immunogenicity of three currently used hepatitis B vaccines was compared in an unselected study population in an every day travel clinical setting . Five hundred and eighteen vaccinees received Engerix-B ( EB ) , 990 received Twinrix ( TWX ) , and  366 were immunised with Gen-HB-Vax ( GHB ) . Overall , 88.6 % of the vaccinees , tested within the first 6 months after completion of the vaccination series , developed protective levels of anti-HBs ( > or = 10 mIU/ml ) . However , GHB recipients showed significantly lower seroprotection rates ( SPR ) than EB and TWX recipients ( 79.3 % vs. 87.7 % vs. 92.3 % , P < 0.000001 ) . GMTs for anti-HBs , tested within 6 months after the third vaccination , showed the lowest results in the GHB group , followed by EB and TWX ( 142 vs. 523 vs. 1008 mIU/ml , P < 0.000001 ) . TWX vaccinees , however , showing a higher antibody decline rate than EB recipients within the first years after completion of the full immunisation course ( 30 % vs. 25 % ; P = 0.0538 ) . This study confirms an overall good immune response to the 20 microg-dose vaccine , in the course of a regular clinical setting . The significant difference in SPRs and GMTs to the 10 microg-dose vaccine , however , may influence future immunisation practice s for the elderly BACKGROUND We assessed the association between the duration of diarrhoea and the risk ofpneumonia incidence  among children < 5 years of age . METHODS We analysed data from a cluster r and omized controlled trial in Karachi , Pakistan , which assessed the effect of promoting h and washing with soap ( antibacterial and plain ) on child health . Field workers visited households with children < 5 years of age weekly and asked primary caregivers if their child had diarrhoea , cough or difficulty breathing in the preceding week . We used the WHO clinical case definitions for diarrhoea and pneumonia . We used adjusted time-to-event analyses with cumulative diarrhoea prevalence over the previous 2 and 4 weeks as exposure and pneumonia as outcome . We calculated the attributable risk of pneumonia due to recent diarrhoea across the intervention groups . RESULTS 873 households with children < 5 years were visited . Children had an increased risk of pneumonia for every additional day of diarrhoea in the 2 weeks ( 1.06 , 95 % CI : 1.03 - 1.09 ) and 4 weeks ( 1.04 , 95 % CI : 1.03 - 1.06 ) prior to the week of pneumonia onset . The attributable risk of pneumonia cases due to recent exposure to diarrhoea was 6 % . A lower associated pneumonia risk following diarrhoea was found in the control group : ( 3 % ) compared with soap groups ( 6 % in antibacterial soap , 9 % in plain soap ) . CONCLUSION Children < 5 years of age are at an increased risk of pneumonia following recent diarrhoeal illness . Public health programmes that prevent diarrhoea may also reduce the burden of respiratory illnesses In a 3-year prospect i ve study of 9584 consecutive paediatric admissions to the Royal Victoria Hospital in Banjul , The Gambia , we examined the impact of seasonal variations in childhood diseases . The four principal diseases ( falciparum malaria , pneumonia , gastro-enteritis and malnutrition ) all peaked in September to October following the rainy season . The mortality rate was also higher in the rainy season than in the dry season . Of the 1525 children with cerebral malaria , 83 % were admitted during the extended rainy season from July to December . With the emergence of chloroquine-resistant malaria over the 3 years , there was a 27 % annual increase in severe anaemia owing to malaria . The median age of malarial anaemia ( 23 months ) was significantly younger than that of cerebral malaria ( 42 months ) . Malnutrition peaked immediately following the annual rainy season epidemics of bacterial gastro-enteritis but was not associated with the cool dry season rotavirus outbreaks . Rainy season diarrhoea was also associated with more persistent diarrhoea , an older mean age and a higher mortality . Meningitis was caused by either pneumococcus or Haemophilus influenzae in 64 % of cases , of whom 19 % were 0 - 2 months of age . Causes of death in hospital showed good agreement with Gambian community studies . We conclude that analysis of hospital data in a developing country can give accurate information on childhood morbidity and mortality patterns which can be used to set priorities for health care interventions . Seasonal variation is a cardinal feature of paediatric diseases in this part of Africa , and accentuates the vulnerability of children in poor families BACKGROUND The antibody response to pneumococcal conjugate vaccines ( PCVs ) in infants is variable . Factors responsible for this variability have not been fully eluci date d. The objective of this study was to investigate whether pneumococcal carriage around the time of the first dose of 7-valent PCV ( PCV7 ) affects serotype-specific immunologic response . METHODS Healthy 2-month old infants were r and omized to receive 2 ( at the ages of 4 and 6 months ) or 3 ( at the ages of 2 , 4 , and 6 months ) PCV7 doses and a booster dose ( at the age of 12 months ) . Nasopharyngeal or oropharyngeal specimens were obtained for culture shortly before the first PCV7 dose . Serotype-specific immunoglobulin ( Ig ) G levels were measured at ages 2 , 7 , and 13 months . RESULTS Of 545 children studied , 332 received a booster dose . The most common serotypes carried around the time of the first PCV7 dose were 6B ( n = 37 ) , 19F ( n = 22 ) , and 23F ( n = 14 ) . In carriers before the first dose , the IgG response to the carried serotype after 2 or 3 doses was significantly lower than in noncarriers . In contrast , response to the noncarried serotypes was not affected . Although all children responded to the booster dose , the response to the originally carried serotype was generally lower . CONCLUSIONS Serotype-specific hyporesponsiveness to PCV7 after pneumococcal carriage in infants is demonstrated for the first time . This phenomenon was common , lasted for at least several months , and was only partially overcome by the 12-month booster . TRIAL REGISTRATION is rct n.org identifier : IS RCT N28445844 To assess factors that may influence the immunogenicity of oral poliovirus vaccine ( OPV ) , neutralizing antibody responses were measured in 1409 infants in Brazil and the Gambia who were r and omized to receive one of four different formulations of OPV at approximately birth and at 6 , 10 , and 14 weeks .  Overall seroconversion rates at the end of the trial were 85 % for poliovirus type 1 ( P1 ) , 94 % for type 2 ( P2 ) , and 68 % for type 3 ( P3 ) . Factors associated with vaccine failure included high levels of maternal antibody ( P1 , P2 , and P3 ) , vaccination during the rainy season ( P1 , P2 , and P3 ) , diarrhea at the time of vaccination ( P2 and P3 ) , household exposure to other OPV recipients ( P1 ) , and breast-feeding ( P3 ) ( P < .05 for each factor , logistic regression analysis ) . OPV containing twice the st and ard potency of Sabin type 1 virus increased seroconversion rates to P1 by 8 % in Brazil ( P < .05 ) and 15 % in the Gambia 
    Output:
    