27 SEPTEMBER 2013, 88th YEAR / 27 SEPTEMBRE 2013, 88° ANNEE
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", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 0, - "coordinates": [ - { - "x0": 63.77, - "y0": 618.62, - "x1": 118.72, - "y1": 639.79 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f49587144a9bab52c9bc41bc868ca80f", - "text": "The position papers are designed to be used mainly by national public health officials and managers of immunization programmes. They may also be of interest to international funding agencies, vaccine manufacturers, the medical community, the scientific media, and the public.", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "4de44fedb2346fde6852aeeb01259bb5", - "text_as_html": "The position papers are designed to be used mainly by national public health officials and managers of immunization programmes. They may also be of interest to international funding agencies, vaccine manufacturers, the medical community, the scientific media, and the public.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 0, - "coordinates": [ - { - "x0": 169.74, - "y0": 504.66, - "x1": 342.89, - "y1": 569.08 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "526e0595c2e1bf520b89d89d1ab788cd", - "text": "This updated position paper on Haemophi- lus influenzae type b (Hib) vaccines replaces the previous 2006 WHO position paper, and summarizes recent develop- ments in the field. Recommendations on the use of Hib vaccines were last discussed", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "4de44fedb2346fde6852aeeb01259bb5", - "text_as_html": "This updated position paper on Haemophi- lus influenzae type b (Hib) vaccines replaces the previous 2006 WHO position paper, and summarizes recent develop- ments in the field. Recommendations on the use of Hib vaccines were last discussed
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 0, - "coordinates": [ - { - "x0": 169.17, - "y0": 585.53, - "x1": 341.49, - "y1": 640.68 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "122151f7213efe63710f91e93fef56a7", - "text": "Ces notes sont principalement destinées aux responsables nationaux de la santé publique et aux administrateurs des programmes de vaccination. Ils peuvent cependant aussi inté- resser les organismes internationaux de finan- cement, les fabricants de vaccins, la commu- nauté médicale, les médias scientifiques et le public.", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "4de44fedb2346fde6852aeeb01259bb5", - "text_as_html": "Ces notes sont principalement destinées aux responsables nationaux de la santé publique et aux administrateurs des programmes de vaccination. Ils peuvent cependant aussi inté- resser les organismes internationaux de finan- cement, les fabricants de vaccins, la commu- nauté médicale, les médias scientifiques et le public.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 0, - "coordinates": [ - { - "x0": 363.35, - "y0": 504.27, - "x1": 552.43, - "y1": 577.93 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "52552683bfe50c77061153a506b8a228", - "text": "Cette note de synthése actualisée relative a la position de OMS sur les vaccins conjugués anti-Haemophilus influenzae type b (Hib) remplace celle publiée en 2006 par POMS et résume les faits récents dans le domaine. Les recommandations concernant [utilisation", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "4de44fedb2346fde6852aeeb01259bb5", - "text_as_html": "Cette note de synthése actualisée relative a la position de OMS sur les vaccins conjugués anti-Haemophilus influenzae type b (Hib) remplace celle publiée en 2006 par POMS et résume les faits récents dans le domaine. Les recommandations concernant [utilisation
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 0, - "coordinates": [ - { - "x0": 363.16, - "y0": 584.84, - "x1": 551.89, - "y1": 640.82 - } - ] - } - }, - { - "type": "UncategorizedText", - "element_id": "6e71d640880c86be76899b51caa9e4b1", - "text": "413", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "4de44fedb2346fde6852aeeb01259bb5", - "text_as_html": "413
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 0, - "coordinates": [ - { - "x0": 538.78, - "y0": 645.88, - "x1": 549.57, - "y1": 650.06 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "92caa4b89f49908a0e21866a9f8cf3d2", - "text": "by SAGE at its meeting in April 2013. Evidence presented at this meeting can be accessed at: http://www.who.int/ immunization/sage/previous/en/index.html.", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "4de44fedb2346fde6852aeeb01259bb5", - "text_as_html": "by SAGE at its meeting in April 2013. Evidence presented at this meeting can be accessed at: http://www.who.int/ immunization/sage/previous/en/index.html.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 1, - "coordinates": [ - { - "x0": 43.81, - "y0": 55.63, - "x1": 274.08, - "y1": 88.62 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-6", - "text": "\n\n\nBackground", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "338d0ef56f86b48d4118c811f92b64c5", - "text": "Background", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "", - "text_as_html": "In the year 2000, before widespread introduction of Hib vaccine in resource-poor countries, Hib was responsible for at least 8.13 million cases of serious disease in chil- dren aged 1-59 months (uncertainty range 7.33-13.2 mil- lion) and 371000 deaths (uncertainty range 247000- 527000).' At that time, 62 Member States reported using Hib vaccine in their national immunization schedules. By 2008, 136 Member States had introduced the vaccine, and it was estimated that Hib caused 203 000 deaths in children aged <60 months (uncertainty range 136000- 281000).2
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 1, - "coordinates": [ - { - "x0": 45.31, - "y0": 144.85, - "x1": 273.99, - "y1": 268.53 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "e78ed76e57513888179332c679c6ae09", - "text": "Hib bacteria are carried in the moist mucosa of the human nasopharynx from where they can be transmit- ted to other humans via droplets from nasopharyngeal secretions. Only a very small proportion of those who harbour Hib will develop clinical disease, however those who carry Hib in the nasopharynx are important dis- seminators of the organism. The prevalence of nasopha- ryngeal carriage varies with age, geographic location, crowding, socioeconomic factors, and vaccine coverage. In the pre-vaccination era, 3%-5% of healthy pre-school children in developed countries were asymptomatic Hib carriers and the prevalence gradually declined with age. Studies performed in unvaccinated populations in Asian countries found that carriage rates in children <5 years varied considerably from very low, e.g. 0.6%-1.3% in Taiwan and Hong Kong, to 6%-8% in India and Thai- land?", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "633a8f7467df293894dad5847500097e", - "text_as_html": "Hib bacteria are carried in the moist mucosa of the human nasopharynx from where they can be transmit- ted to other humans via droplets from nasopharyngeal secretions. Only a very small proportion of those who harbour Hib will develop clinical disease, however those who carry Hib in the nasopharynx are important dis- seminators of the organism. The prevalence of nasopha- ryngeal carriage varies with age, geographic location, crowding, socioeconomic factors, and vaccine coverage. In the pre-vaccination era, 3%-5% of healthy pre-school children in developed countries were asymptomatic Hib carriers and the prevalence gradually declined with age. Studies performed in unvaccinated populations in Asian countries found that carriage rates in children <5 years varied considerably from very low, e.g. 0.6%-1.3% in Taiwan and Hong Kong, to 6%-8% in India and Thai- land?
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 1, - "coordinates": [ - { - "x0": 44.85, - "y0": 276.9, - "x1": 272.76, - "y1": 469.65 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "e7a7711ac427737a6c81864df5d3ac20", - "text": "Hib infection and disease start with colonization of the nasopharynx. Following colonization the organism can cause disease either (i) through invasion of the blood- stream with secondary spread to other sites leading to meningitis, pneumonia, and other serious diseases including septic arthritis, osteomyelitis, pericarditis, cellulitis and epiglottitis (referred to collectively as invasive Hib disease) or (ii) through contiguous spread to the paranasal sinuses or the middle ear leading to sinusitis and otitis media.", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "633a8f7467df293894dad5847500097e", - "text_as_html": "Hib infection and disease start with colonization of the nasopharynx. Following colonization the organism can cause disease either (i) through invasion of the blood- stream with secondary spread to other sites leading to meningitis, pneumonia, and other serious diseases including septic arthritis, osteomyelitis, pericarditis, cellulitis and epiglottitis (referred to collectively as invasive Hib disease) or (ii) through contiguous spread to the paranasal sinuses or the middle ear leading to sinusitis and otitis media.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 1, - "coordinates": [ - { - "x0": 45.19, - "y0": 490.39, - "x1": 272.55, - "y1": 603.25 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "48e69e1a84a76cbe372d188bace63a19", - "text": "In unvaccinated populations, Hib is the dominant cause of non-epidemic bacterial meningitis in children <12 months of age. Environmental factors, such as over- crowded housing, poor household ventilation, and environmental smoke exposure including indoor air", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "633a8f7467df293894dad5847500097e", - "text_as_html": "In unvaccinated populations, Hib is the dominant cause of non-epidemic bacterial meningitis in children <12 months of age. Environmental factors, such as over- crowded housing, poor household ventilation, and environmental smoke exposure including indoor air
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 1, - "coordinates": [ - { - "x0": 45.81, - "y0": 610.7, - "x1": 272.3, - "y1": 666.29 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "64c41cf8711bd12b1cd1675ca73c3126", - "text": "1 Watt JP et al. Burden of disease caused by Haemophilus influenzae type b in child- ren younger than 5 years: global estimates. The Lancet, 2009, 374:(9693) 903-911.", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "633a8f7467df293894dad5847500097e", - "text_as_html": "des vaccins anti-Hib ont été discutées pour la derniére fois par le SAGE lors de sa réunion d’avril 2013. Les éléments d’apprécia- tion présentés a cette réunion peuvent étre consultés a l’adresse: http://www.who.int/immunization/sage/previous/en/index.html.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 1, - "coordinates": [ - { - "x0": 293.99, - "y0": 55.59, - "x1": 551.72, - "y1": 100.12 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-9", - "text": "\n\n\nGénéralités", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "80cb356acd742fcf024b7f328151e7db", - "text": "Généralités", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "", - "text_as_html": "En 2000, avant lintroduction a grande échelle du vaccin anti- Hib dans les pays pauvres, Haemophilus influenzae type b (Hib) était responsable d’au moins 8,13 millions de cas de maladie grave chez les enfants de 1 a 59 mois (plage d’incertitude: 7,33- 13,2 millions) et de 371000 décés (plage d’incertitude: 247 000-527000).! A cette époque, 62 Etats Membres mention- naient utilisation du vaccin anti-Hib dans leur calendrier de vaccination national. En 2008, 136 Etats Membres de OMS avaient introduit ce vaccin et on estimait a 203000 le nombre de décés imputables au Hib chez les enfants de <60 mois (plage @incertitude: 136 000-281 000).?
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 1, - "coordinates": [ - { - "x0": 294.63, - "y0": 144.47, - "x1": 553.25, - "y1": 268.99 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "656f993ce78573065a7247abe9cbb6d0", - "text": "Les bactéries Hib colonisent la muqueuse humide du nasopha- rynx humain a partir de laquelle elles peuvent se transmettre a dautres individus par le biais de gouttelettes de sécrétions nasopharyngiennes. Seule une trés faible proportion des personnes porteuses de Hib présentera par la suite une maladie clinique, mais celles dont le nasopharynx est colonisé jouent un réle important dans la dissémination de cet organisme. La prévalence du portage nasopharyngé varie selon lage, le lieu géographique, la densité de population, des facteurs socio- économiques et la couverture vaccinale. Avant l’ére de la vacci- nation, 3 4 5% des enfants d’age préscolaire en bonne santé étaient porteurs asymptomatiques de Hib dans les pays déve- loppés et cette prévalence diminuait progressivement avec l’age. Des études réalisées parmi des populations non vaccinées de pays asiatiques ont mis en évidence des taux de portage chez les enfants de <5 ans extrémement variables, allant de valeurs trés basses, 0,6%-1,3% par exemple a Taiwan et Hong Kong, a des taux de 6%-8% en Inde et en Thailande.*", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "Les bactéries Hib colonisent la muqueuse humide du nasopha- rynx humain a partir de laquelle elles peuvent se transmettre a dautres individus par le biais de gouttelettes de sécrétions nasopharyngiennes. Seule une trés faible proportion des personnes porteuses de Hib présentera par la suite une maladie clinique, mais celles dont le nasopharynx est colonisé jouent un réle important dans la dissémination de cet organisme. La prévalence du portage nasopharyngé varie selon lage, le lieu géographique, la densité de population, des facteurs socio- économiques et la couverture vaccinale. Avant l’ére de la vacci- nation, 3 4 5% des enfants d’age préscolaire en bonne santé étaient porteurs asymptomatiques de Hib dans les pays déve- loppés et cette prévalence diminuait progressivement avec l’age. Des études réalisées parmi des populations non vaccinées de pays asiatiques ont mis en évidence des taux de portage chez les enfants de <5 ans extrémement variables, allant de valeurs trés basses, 0,6%-1,3% par exemple a Taiwan et Hong Kong, a des taux de 6%-8% en Inde et en Thailande.*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 1, - "coordinates": [ - { - "x0": 293.7, - "y0": 277.32, - "x1": 553.59, - "y1": 482.47 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "522cd967824ddb1b2f6b9ff1035cc37c", - "text": "Linfection et la maladie 4 Hib débutent avec la colonisation du nasopharynx. A la suite de cette colonisation, Hib peut provo- quer une maladie soit: 1) par invasion de la circulation sanguine avec propagation secondaire a d’autres sites débouchant sur une méningite, une pneumonie ou d’autres maladies graves comme l’arthrite septique, l’ostéomyélite, la péricardite, la cellu- lite et Pépiglottite (désignées collectivement comme des mala- dies 4 Hib invasives); ou 2) par propagation contigué aux sinus paranasaux ou a loreille moyenne, conduisant a une sinusite ou a une otite moyenne.", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "Linfection et la maladie 4 Hib débutent avec la colonisation du nasopharynx. A la suite de cette colonisation, Hib peut provo- quer une maladie soit: 1) par invasion de la circulation sanguine avec propagation secondaire a d’autres sites débouchant sur une méningite, une pneumonie ou d’autres maladies graves comme l’arthrite septique, l’ostéomyélite, la péricardite, la cellu- lite et Pépiglottite (désignées collectivement comme des mala- dies 4 Hib invasives); ou 2) par propagation contigué aux sinus paranasaux ou a loreille moyenne, conduisant a une sinusite ou a une otite moyenne.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 1, - "coordinates": [ - { - "x0": 293.3, - "y0": 489.59, - "x1": 553.23, - "y1": 603.22 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "286646473ca5309e9014a2b15dd16a9e", - "text": "Chez les populations non vaccinées, Hib est la cause prédomi- nante de méningites bactériennes non épidémiques chez les enfants de <12 mois. Des facteurs environnementaux comme le surpeuplement des logements, une ventilation insuffisante a Dintérieur des habitations et une exposition environnementale", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "Chez les populations non vaccinées, Hib est la cause prédomi- nante de méningites bactériennes non épidémiques chez les enfants de <12 mois. Des facteurs environnementaux comme le surpeuplement des logements, une ventilation insuffisante a Dintérieur des habitations et une exposition environnementale
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 1, - "coordinates": [ - { - "x0": 294.95, - "y0": 610.47, - "x1": 550.64, - "y1": 666.6 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "33c2b10af71c2526648063da92b705e3", - "text": "Watt JP et al. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. The Lancet, 2009, 374:(9693) 903-911.", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 39, 27 SEPTEMBER 2013
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 1, - "coordinates": [ - { - "x0": 378.35, - "y0": 778.38, - "x1": 549.62, - "y1": 786.51 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "fe9d84004daa478befedb23186d7ff31", - "text": "pollution, have been associated with an increased risk of Hib diseases.*°", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "pollution, have been associated with an increased risk of Hib diseases.*°
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 2, - "coordinates": [ - { - "x0": 43.57, - "y0": 55.96, - "x1": 271.73, - "y1": 75.81 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f5b42e15d21d07465c9cf359ac6ddbc8", - "text": "Although Hib diseases may occur in any age group, over 90% of cases of invasive Hib disease occur in children <5 years of age. For Hib meningitis, 59% of the cases in children aged <5 years (95% CI: 55%-62%) are in infants aged <12 months. However, this proportion var- ies between regions and mortality settings. In low mor- tality regions and Europe, the proportion of cases in infants aged <12 months is 37%-46%. However, in high mortality settings in Africa and Asia, the proportion is closer to 80%; elsewhere it ranges from 68% to 86%. While 20% (95% CI: 18%-23%) of reported Hib menin- gitis cases occur in infants aged <6 months, this also varies considerably. In low mortality regions and Europe, 9%-13% of cases occur in infants aged <6 months, whereas the proportion of cases in this age group ranges from 20% to 46% elsewhere.®’", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "Although Hib diseases may occur in any age group, over 90% of cases of invasive Hib disease occur in children <5 years of age. For Hib meningitis, 59% of the cases in children aged <5 years (95% CI: 55%-62%) are in infants aged <12 months. However, this proportion var- ies between regions and mortality settings. In low mor- tality regions and Europe, the proportion of cases in infants aged <12 months is 37%-46%. However, in high mortality settings in Africa and Asia, the proportion is closer to 80%; elsewhere it ranges from 68% to 86%. While 20% (95% CI: 18%-23%) of reported Hib menin- gitis cases occur in infants aged <6 months, this also varies considerably. In low mortality regions and Europe, 9%-13% of cases occur in infants aged <6 months, whereas the proportion of cases in this age group ranges from 20% to 46% elsewhere.®’
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 2, - "coordinates": [ - { - "x0": 45.11, - "y0": 84.91, - "x1": 272.57, - "y1": 266.36 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5fdda4f44bc88192cde759ee78aa6169", - "text": "The incidence of Hib diseases is relatively low in the first 2 months of life, probably due to the protection conferred by transplacentally-acquired maternal anti- bodies. Previously healthy children aged >24 months usually mount a robust immune response when infected with Hib. Thus, in most populations the greatest disease burden is seen in children aged 4-18 months. However, the age of peak burden varies considerably.* An excep- tion to the general pattern is seen in children infected with the human immunodeficiency virus (HIV) who may develop Hib disease at older ages.’ In a South African study, approximately 25% (5/19) of HIV-infected children with bacteraemic pneumonia were aged >2 years. Similar patterns were observed with Hib men- ingitis.'°", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "The incidence of Hib diseases is relatively low in the first 2 months of life, probably due to the protection conferred by transplacentally-acquired maternal anti- bodies. Previously healthy children aged >24 months usually mount a robust immune response when infected with Hib. Thus, in most populations the greatest disease burden is seen in children aged 4-18 months. However, the age of peak burden varies considerably.* An excep- tion to the general pattern is seen in children infected with the human immunodeficiency virus (HIV) who may develop Hib disease at older ages.’ In a South African study, approximately 25% (5/19) of HIV-infected children with bacteraemic pneumonia were aged >2 years. Similar patterns were observed with Hib men- ingitis.'°
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 2, - "coordinates": [ - { - "x0": 44.95, - "y0": 286.09, - "x1": 272.43, - "y1": 455.23 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "7e58992fac472d4e02c9da4c205fbbd9", - "text": "Overall, children infected with HIV have a 5.9 fold (95% CI: 2.7-12.6) increased risk of Hib invasive disease com- pared to children who have not been infected by HIV.\" HIV-infected children are more likely to present with bacteraemic Hib pneumonia than Hib meningitis. Com- pared to HIV-uninfected children, the risk of developing Hib meningitis is only slightly higher in HIV-infected children, however the severity is increased with severe", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "Overall, children infected with HIV have a 5.9 fold (95% CI: 2.7-12.6) increased risk of Hib invasive disease com- pared to children who have not been infected by HIV.\" HIV-infected children are more likely to present with bacteraemic Hib pneumonia than Hib meningitis. Com- pared to HIV-uninfected children, the risk of developing Hib meningitis is only slightly higher in HIV-infected children, however the severity is increased with severe
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 2, - "coordinates": [ - { - "x0": 45.14, - "y0": 475.3, - "x1": 272.45, - "y1": 565.58 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "05ede5e626baa198346387b20219395d", - "text": "Wenger J. Epidemiology of Haemophilus Influenzae type b disease and impact of Haemophilus influenzae type b vaccines in the United States and Canada. The Pediatric Infectious Disease Journal, 1998, 17: S132-S136.", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "a la fumée et notamment a la pollution de lair intérieur, ont été associés 4 un risque accru de maladie a Hib.**
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 2, - "coordinates": [ - { - "x0": 293.17, - "y0": 56.1, - "x1": 551.71, - "y1": 77.15 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4c58e3b87b35d412b455139325917f1e", - "text": "Si les maladies 4 Hib peuvent toucher toutes les tranches d’age, >90% des cas de forme invasive de la maladie apparaissent chez des enfants de <5 ans. En ce qui concerne la méningite a Hib, 59% des enfants atteints de <5 ans (IC a 95%: 55 62%) sont des nourrissons de <12 mois. Néanmoins, ce pourcentage varie une région a l’autre et avec le niveau de mortalité. Dans les régions présentant une faible mortalité et en Europe, le pour- centage de cas concernant des nourrissons de <12 mois est de 37 a 46%. En revanche, dans les zones d’Afrique et d’Asie ow la mortalité est forte, ce pourcentage plus proche de 80% et se situe ailleurs entre 68 et 86%. Bien que 20% (IC a 95%: 18-23%) des cas de méningite a Hib notifiés concernent des enfants de <6 mois, ce pourcentage peut aussi varier considérablement. Dans les régions ow la mortalité est faible et en Europe, 9 a 13% des cas apparaissent chez des nourrissons de <6 mois, tandis que le pourcentage de cas appartenant a cette tranche d’age va de 20% a 46% ailleurs.®’", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "Si les maladies 4 Hib peuvent toucher toutes les tranches d’age, >90% des cas de forme invasive de la maladie apparaissent chez des enfants de <5 ans. En ce qui concerne la méningite a Hib, 59% des enfants atteints de <5 ans (IC a 95%: 55 62%) sont des nourrissons de <12 mois. Néanmoins, ce pourcentage varie une région a l’autre et avec le niveau de mortalité. Dans les régions présentant une faible mortalité et en Europe, le pour- centage de cas concernant des nourrissons de <12 mois est de 37 a 46%. En revanche, dans les zones d’Afrique et d’Asie ow la mortalité est forte, ce pourcentage plus proche de 80% et se situe ailleurs entre 68 et 86%. Bien que 20% (IC a 95%: 18-23%) des cas de méningite a Hib notifiés concernent des enfants de <6 mois, ce pourcentage peut aussi varier considérablement. Dans les régions ow la mortalité est faible et en Europe, 9 a 13% des cas apparaissent chez des nourrissons de <6 mois, tandis que le pourcentage de cas appartenant a cette tranche d’age va de 20% a 46% ailleurs.®’
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 2, - "coordinates": [ - { - "x0": 293.33, - "y0": 84.95, - "x1": 554.12, - "y1": 277.28 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f7c7e367c53f00a84074cc584ae7be04", - "text": "Vincidence des maladies a Hib est relativement faible pendant les 2 premiers mois de vie, en raison probablement de la protec- tion conférée par les anticorps maternels passés a travers le placenta. Chez les enfants de >24 mois initialement en bonne santé, infection par Hib déclenche habituellement une réponse immunitaire robuste. Ainsi, dans la plupart des populations, ce sont les enfants de 4 4 18 mois qui supportent la plus forte charge de morbidité. Cependant, l’'4ge auquel se manifeste le pic de morbidité varie de maniére trés importante.’ On observe une exception a ce schéma général chez les enfants infectés par le virus de Pimmunodéficience humaine (VIH), qui peuvent contracter une maladie a Hib a un age plus avancé.’ En Afrique du Sud, une étude a constaté qu’approximativement 25% (5/19) des enfants infectés par ce virus et atteints d'une pneumonie bactériémique avaient >2 ans. On reléve des situations simi- laires avec la méningite a Hib.\"", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "Vincidence des maladies a Hib est relativement faible pendant les 2 premiers mois de vie, en raison probablement de la protec- tion conférée par les anticorps maternels passés a travers le placenta. Chez les enfants de >24 mois initialement en bonne santé, infection par Hib déclenche habituellement une réponse immunitaire robuste. Ainsi, dans la plupart des populations, ce sont les enfants de 4 4 18 mois qui supportent la plus forte charge de morbidité. Cependant, l’'4ge auquel se manifeste le pic de morbidité varie de maniére trés importante.’ On observe une exception a ce schéma général chez les enfants infectés par le virus de Pimmunodéficience humaine (VIH), qui peuvent contracter une maladie a Hib a un age plus avancé.’ En Afrique du Sud, une étude a constaté qu’approximativement 25% (5/19) des enfants infectés par ce virus et atteints d'une pneumonie bactériémique avaient >2 ans. On reléve des situations simi- laires avec la méningite a Hib.\"
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 2, - "coordinates": [ - { - "x0": 293.39, - "y0": 285.43, - "x1": 554.26, - "y1": 467.47 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "eac13566d5489b546c52621bdebfea70", - "text": "Globalement, les enfants infectés par le VIH ont un risque 5,9 fois supérieur (IC 4 95%: 2,7-12,6) de contracter une maladie a Hib invasive que les enfants non infectés par ce virus.’ Ils sont aussi plus susceptibles de présenter une pneumonie a Hib bactériémique qu'une méningite a Hib. Chez les enfants porteurs du VIH, le risque de contracter une méningite a Hib nest que faiblement augmenté, mais si cette maladie se déclare, elle sera plus grave, avec des séquelles neurologiques sévéres pour", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "Globalement, les enfants infectés par le VIH ont un risque 5,9 fois supérieur (IC 4 95%: 2,7-12,6) de contracter une maladie a Hib invasive que les enfants non infectés par ce virus.’ Ils sont aussi plus susceptibles de présenter une pneumonie a Hib bactériémique qu'une méningite a Hib. Chez les enfants porteurs du VIH, le risque de contracter une méningite a Hib nest que faiblement augmenté, mais si cette maladie se déclare, elle sera plus grave, avec des séquelles neurologiques sévéres pour
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 2, - "coordinates": [ - { - "x0": 293.58, - "y0": 474.97, - "x1": 551.58, - "y1": 565.42 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "ec765381e2e3f4335525cb359952a16a", - "text": "Wenger J. Epidemiology of Haemophilus influenzae type b disease and impact of Haemophilus influenzae type b vaccines in the United States and Canada. The Pediatric Infectious Disease Journal, 1998, 17: S132-S136.", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "415
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 2, - "coordinates": [ - { - "x0": 538.78, - "y0": 779.62, - "x1": 549.57, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f6459ccc3ecacc2dc74f1012a736f7b1", - "text": "neurological sequelae in survivors seen in 5/7 (71%) of HIV-infected children compared to 7/30 (33%) of HIV- uninfected children. HIV-infected children with Hib meningitis are also more likely to have concurrent pneumonia and local infections such as otitis media, mastoiditis or sinusitis.’", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "d3dc93b41b704b44a0ec5bf8afe65e54", - "text_as_html": "neurological sequelae in survivors seen in 5/7 (71%) of HIV-infected children compared to 7/30 (33%) of HIV- uninfected children. HIV-infected children with Hib meningitis are also more likely to have concurrent pneumonia and local infections such as otitis media, mastoiditis or sinusitis.’
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 3, - "coordinates": [ - { - "x0": 45.37, - "y0": 55.93, - "x1": 274.1, - "y1": 122.52 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-11", - "text": "\n\n\nImpact of vaccination\nHib conjugate vaccines have been in use since the early 1990s and vaccination with these vaccines is considered a highly effective public health intervention. By March 2013, 184 countries (95% of WHO member states, ac- counting for 81% of the children born in 2012) had included conjugated Hib vaccines in their immunization programmes. Use of Hib conjugate vaccines has led to dramatic declines of >90% in invasive Hib disease in the countries which have included these vaccines in national immunization programmes.'»”\nNasopharyngeal colonization by Hib has also been reduced considerably in populations where Hib immu- nization has achieved high coverage, in part as a consequence of the herd protection conferred by the use of conjugate Hib vaccines.\"", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "dd00eeb374cff031576971e5310d2caf", - "text": "Impact of vaccination", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "", - "text_as_html": "Hib conjugate vaccines have been in use since the early 1990s and vaccination with these vaccines is considered a highly effective public health intervention. By March 2013, 184 countries (95% of WHO member states, ac- counting for 81% of the children born in 2012) had included conjugated Hib vaccines in their immunization programmes. Use of Hib conjugate vaccines has led to dramatic declines of >90% in invasive Hib disease in the countries which have included these vaccines in national immunization programmes.'»”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 3, - "coordinates": [ - { - "x0": 45.81, - "y0": 149.35, - "x1": 273.01, - "y1": 262.46 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "de766e4bbe355289436b47895fc9700f", - "text": "Nasopharyngeal colonization by Hib has also been reduced considerably in populations where Hib immu- nization has achieved high coverage, in part as a consequence of the herd protection conferred by the use of conjugate Hib vaccines.\"", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "dd00eeb374cff031576971e5310d2caf", - "text_as_html": "Nasopharyngeal colonization by Hib has also been reduced considerably in populations where Hib immu- nization has achieved high coverage, in part as a consequence of the herd protection conferred by the use of conjugate Hib vaccines.\"
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 3, - "coordinates": [ - { - "x0": 45.22, - "y0": 269.66, - "x1": 274.36, - "y1": 325.28 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-12", - "text": "\n\n\nPathogen\nHaemophilus influenzae is a gram-negative coccobacil- lus which exists in encapsulated and non-encapsulated strains, both of which can cause infection. Non-encap- sulated strains commonly cause diseases such as otitis media and sinusitis, through contiguous spread from the nasopharynx, while infections secondary to invasion of the bloodstream are usually caused by encapsulated strains.\nEncapsulated strains are classified according to the chemical composition of the polysaccharide capsule. Six serotypes, types a, b, c, d, e and f, have been identified. Of these, serotype b is responsible for approximately 95% of all invasive disease due to Haemophilus influen- zae. Other serotypes and non-encapsulated strains can cause otitis media in children and disease in the elderly and in immunocompromised populations.\"\nThe Hib capsule is composed of repeating polymers of ribosyl and ribitol-phosphate (PRP), and this is the pri- mary factor associated with virulence of the organism. The structure of the capsule enables the bacterium to evade phagocytosis and thereby facilitates spread via\nWatt JP, Chen S, Santosham M. Haemophilus influenzae type b conjugate vaccine: review of observational data on long term vaccine impact to inform recommenda- tions for vaccine schedules, Geneva, World Health Organization, 2012. Available from http://www.who.int/immunization/sage/meetings/2012/november/5_Re- view_observational_data_long_term_vaccine_impact_recommendations_vac- cine_schedules_Watt_J_et_al_2012.pdf; accessed September 2013.\nMorris SK, Moss WJ, Halsey N. Haemophilus influenzae type b conjugate vaccine use and effectiveness. The Lancet Infectious Diseases, 2010, 8: 435-443.\nJackson C et al. Effectiveness of Haemophilus influenzae Type b Vaccines Adminis- tered According to Various Schedules: Systematic Review and Meta-Analysis of Observational Data, Pediatric Infectious Disease Journal, post-acceptance, July 2013, online PDF version only: http://journals.lww.com/pidj/Abstract/publishahead/ Effectiveness_of_Haemophilus_influenzae_Type_b.98281.aspx\nImmunological basis for immunization series-module 9: Haemophilus influenzae type b. Geneva, World Health Organization, 2009. Available from http://whqlibdoc. who.int/publications/2009/9789241597869_eng.pdf; accessed September 2013.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "0652c2c2e62a6579d323f8695c1213ad", - "text": "Pathogen", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "", - "text_as_html": "Haemophilus influenzae is a gram-negative coccobacil- lus which exists in encapsulated and non-encapsulated strains, both of which can cause infection. Non-encap- sulated strains commonly cause diseases such as otitis media and sinusitis, through contiguous spread from the nasopharynx, while infections secondary to invasion of the bloodstream are usually caused by encapsulated strains.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 3, - "coordinates": [ - { - "x0": 45.08, - "y0": 351.25, - "x1": 273.26, - "y1": 441.77 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "6eea7ce7b59c3950f9e3360f6bbe2b3d", - "text": "Encapsulated strains are classified according to the chemical composition of the polysaccharide capsule. Six serotypes, types a, b, c, d, e and f, have been identified. Of these, serotype b is responsible for approximately 95% of all invasive disease due to Haemophilus influen- zae. Other serotypes and non-encapsulated strains can cause otitis media in children and disease in the elderly and in immunocompromised populations.\"", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "0652c2c2e62a6579d323f8695c1213ad", - "text_as_html": "Encapsulated strains are classified according to the chemical composition of the polysaccharide capsule. Six serotypes, types a, b, c, d, e and f, have been identified. Of these, serotype b is responsible for approximately 95% of all invasive disease due to Haemophilus influen- zae. Other serotypes and non-encapsulated strains can cause otitis media in children and disease in the elderly and in immunocompromised populations.\"
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 3, - "coordinates": [ - { - "x0": 45.7, - "y0": 460.09, - "x1": 273.0, - "y1": 550.62 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "851abd72f78d9fc7210a670ad3363a7e", - "text": "The Hib capsule is composed of repeating polymers of ribosyl and ribitol-phosphate (PRP), and this is the pri- mary factor associated with virulence of the organism. The structure of the capsule enables the bacterium to evade phagocytosis and thereby facilitates spread via", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "0652c2c2e62a6579d323f8695c1213ad", - "text_as_html": "The Hib capsule is composed of repeating polymers of ribosyl and ribitol-phosphate (PRP), and this is the pri- mary factor associated with virulence of the organism. The structure of the capsule enables the bacterium to evade phagocytosis and thereby facilitates spread via
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 3, - "coordinates": [ - { - "x0": 45.6, - "y0": 558.0, - "x1": 272.64, - "y1": 613.71 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "5f582c26857fcfc1069b719b2047be4b", - "text": "Watt JP, Chen S, Santosham M. Haemophilus influenzae type b conjugate vaccine: review of observational data on long term vaccine impact to inform recommenda- tions for vaccine schedules, Geneva, World Health Organization, 2012. Available from http://www.who.int/immunization/sage/meetings/2012/november/5_Re- view_observational_data_long_term_vaccine_impact_recommendations_vac- cine_schedules_Watt_J_et_al_2012.pdf; accessed September 2013.", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "0652c2c2e62a6579d323f8695c1213ad", - "text_as_html": "5/7 (71%) des survivants séropositifs, contre 7/30 (33%) pour les enfants non infectés par ce virus. Les enfants infectés par le VIH et atteints d'une méningite 4 Hib ont aussi une plus grande probabilité de souffrir en méme temps d’une pneumo- nie et dune infection locale telle qu'une otite moyenne, une mastoidite ou une sinusite.°
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 3, - "coordinates": [ - { - "x0": 294.68, - "y0": 55.93, - "x1": 552.12, - "y1": 122.79 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-14", - "text": "\n\n\nImpact de la vaccination\nLes vaccins anti-Hib conjugués sont utilisés depuis le début des années 1990 et la vaccination par ces vaccins est considé- rée comme une intervention sanitaire hautement efficace. En mars 2013, 184 pays (95% des Etats Membres de !’OMS, tota- lisant 81% des enfants nés en 2012) avaient inclus un vaccin anti-Hib conjugué dans leur programme de vaccination. Lem- ploi de ce type de vaccin a conduit a une baisse considérable, allant au-dela de 90%, des maladies 4 Hib invasives dans ces pays.!) 2\nLa colonisation nasopharyngée par la bactérie Hib a aussi gran- dement régressé dans les populations ou l’on atteint une forte couverture par la vaccination, comme conséquence de l’immu- nité collective conférée par Vutilisation des vaccins anti-Hib conjugués.\"*", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "2f8bdf443f8f438497c89e372f02bfa6", - "text": "Impact de la vaccination", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "", - "text_as_html": "Les vaccins anti-Hib conjugués sont utilisés depuis le début des années 1990 et la vaccination par ces vaccins est considé- rée comme une intervention sanitaire hautement efficace. En mars 2013, 184 pays (95% des Etats Membres de !’OMS, tota- lisant 81% des enfants nés en 2012) avaient inclus un vaccin anti-Hib conjugué dans leur programme de vaccination. Lem- ploi de ce type de vaccin a conduit a une baisse considérable, allant au-dela de 90%, des maladies 4 Hib invasives dans ces pays.!) 2
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 3, - "coordinates": [ - { - "x0": 294.5, - "y0": 148.36, - "x1": 552.38, - "y1": 250.06 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "28cf1d9877ad3ba565d85b5ab118233a", - "text": "La colonisation nasopharyngée par la bactérie Hib a aussi gran- dement régressé dans les populations ou l’on atteint une forte couverture par la vaccination, comme conséquence de l’immu- nité collective conférée par Vutilisation des vaccins anti-Hib conjugués.\"*", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "2f8bdf443f8f438497c89e372f02bfa6", - "text_as_html": "La colonisation nasopharyngée par la bactérie Hib a aussi gran- dement régressé dans les populations ou l’on atteint une forte couverture par la vaccination, comme conséquence de l’immu- nité collective conférée par Vutilisation des vaccins anti-Hib conjugués.\"*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 3, - "coordinates": [ - { - "x0": 294.81, - "y0": 269.11, - "x1": 551.0, - "y1": 324.91 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-15", - "text": "\n\n\nAgent pathogéne\nHaemophilus influenzae est un coccobacille Gram négatif susceptible d’exister sous forme encapsulée ou non encapsulée selon les souches, ces 2 formes pouvant lune et l’autre provo- quer une infection. Les souches non encapsulées sont fréquem- ment a lorigine de maladies telles que des otites moyennes et des sinusites, par propagation contigué a partir du nasopha- rynx, tandis que les infections secondaires 4 une invasion de la circulation sanguine sont habituellement dues a des souches encapsulées.\nLes souches encapsulées sont classées selon la composition chimique de la capsule polysaccharidique. Six sérotypes, a, b, c, d, e et f, ont été identifiés. Parmi ces sérotypes, le type b est responsable d’environ 95% des maladies invasives a Haemophi- lus influenzae. D’autres sérotypes et souches non encapsulées peuvent étre a l’origine d’otites moyennes et de maladies chez les personnes agées et les populations immunodéprimées.\"*\nLa capsule de Hib est composée d’unités polyméres répétitives de ribosyl et de ribitol-phosphate (PRP), et Cest le principal facteur conditionnant la virulence de cet organisme. Cette structure de la capsule permet a la bactérie d’échapper a la phagocytose et facilite ainsi sa propagation par le biais de\nWatt JP, Chen S, Santosham M. Haemophilus influenzae type b conjugate vaccine: review of obser- vational data on long term vaccine impact to inform recommendations for vaccine schedules, Geneva, World Health Organization, 2012. Available from http://www.who.intimmunization/ sage/meetings/2012/november/5_Review_observational_data_long_term_vaccine_impact_re- commendations_vaccine_schedules_Watt_J_et_al_2012.pdf; accessed September 2013.\nMorris SK, Moss W4, Halsey N. Haemophilus influenzae type b conjugate vaccine use and effec- tiveness. The Lancet Infectious Diseases, 2010, 8: 435-443.\nJackson C et al. Effectiveness of Haemophilus influenzae Type b Vaccines Administered Accor- ding to Various Schedules: Systematic Review and Meta-Analysis of Observational Data, Pedia- tric Infectious Disease Journal, post-acceptance, July 2013, online PDF version only: http:// journals.lww.com/pidj/Abstract/publishahead/Effectiveness_of_Haemophilus_influenzae_ Type_b.98281 aspx.\n4 Immunological basis for immunization series-module 9: Haemophilus influenzae type b. Genéve, Organisation mondiale de la Santé, 2009. Disponible sur http://whqlibdoc.who.int/ publications/2009/9789241597869_eng.pdf; consulté en septembre 2013.\nthe bloodstream; hence the PRP capsule is an important determinant of the pathogenesis of invasive disease. A specific antibody to the capsule is associated with protection from disease. Like other bacteria-derived polysaccharides, PRP induces a T-independent antibody response. Children are unable to mount robust responses to pure polysaccharide antigens before 18 months of age, thus making them highly susceptible to invasive Hib disease.'*", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "fc3142ee90a14bc36b7b19d2a5924bb2", - "text": "Agent pathogéne", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "", - "text_as_html": "Haemophilus influenzae est un coccobacille Gram négatif susceptible d’exister sous forme encapsulée ou non encapsulée selon les souches, ces 2 formes pouvant lune et l’autre provo- quer une infection. Les souches non encapsulées sont fréquem- ment a lorigine de maladies telles que des otites moyennes et des sinusites, par propagation contigué a partir du nasopha- rynx, tandis que les infections secondaires 4 une invasion de la circulation sanguine sont habituellement dues a des souches encapsulées.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 3, - "coordinates": [ - { - "x0": 294.21, - "y0": 351.6, - "x1": 553.22, - "y1": 453.04 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "47120b6bff89609e1de72435843c4765", - "text": "Les souches encapsulées sont classées selon la composition chimique de la capsule polysaccharidique. Six sérotypes, a, b, c, d, e et f, ont été identifiés. Parmi ces sérotypes, le type b est responsable d’environ 95% des maladies invasives a Haemophi- lus influenzae. D’autres sérotypes et souches non encapsulées peuvent étre a l’origine d’otites moyennes et de maladies chez les personnes agées et les populations immunodéprimées.\"*", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "fc3142ee90a14bc36b7b19d2a5924bb2", - "text_as_html": "Les souches encapsulées sont classées selon la composition chimique de la capsule polysaccharidique. Six sérotypes, a, b, c, d, e et f, ont été identifiés. Parmi ces sérotypes, le type b est responsable d’environ 95% des maladies invasives a Haemophi- lus influenzae. D’autres sérotypes et souches non encapsulées peuvent étre a l’origine d’otites moyennes et de maladies chez les personnes agées et les populations immunodéprimées.\"*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 3, - "coordinates": [ - { - "x0": 293.82, - "y0": 459.95, - "x1": 551.39, - "y1": 538.96 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "87146b404da36a2345505f6bec16534e", - "text": "La capsule de Hib est composée d’unités polyméres répétitives de ribosyl et de ribitol-phosphate (PRP), et Cest le principal facteur conditionnant la virulence de cet organisme. Cette structure de la capsule permet a la bactérie d’échapper a la phagocytose et facilite ainsi sa propagation par le biais de", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "fc3142ee90a14bc36b7b19d2a5924bb2", - "text_as_html": "La capsule de Hib est composée d’unités polyméres répétitives de ribosyl et de ribitol-phosphate (PRP), et Cest le principal facteur conditionnant la virulence de cet organisme. Cette structure de la capsule permet a la bactérie d’échapper a la phagocytose et facilite ainsi sa propagation par le biais de
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 3, - "coordinates": [ - { - "x0": 294.5, - "y0": 557.48, - "x1": 550.16, - "y1": 614.03 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "57932bb9cef649b01a7cb27331de905a", - "text": "Watt JP, Chen S, Santosham M. Haemophilus influenzae type b conjugate vaccine: review of obser- vational data on long term vaccine impact to inform recommendations for vaccine schedules, Geneva, World Health Organization, 2012. Available from http://www.who.intimmunization/ sage/meetings/2012/november/5_Review_observational_data_long_term_vaccine_impact_re- commendations_vaccine_schedules_Watt_J_et_al_2012.pdf; accessed September 2013.", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "fc3142ee90a14bc36b7b19d2a5924bb2", - "text_as_html": "the bloodstream; hence the PRP capsule is an important determinant of the pathogenesis of invasive disease. A specific antibody to the capsule is associated with protection from disease. Like other bacteria-derived polysaccharides, PRP induces a T-independent antibody response. Children are unable to mount robust responses to pure polysaccharide antigens before 18 months of age, thus making them highly susceptible to invasive Hib disease.'*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 45.5, - "y0": 56.16, - "x1": 272.49, - "y1": 157.04 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-16", - "text": "\n\n\nDisease\nInvasive Hib disease presents most frequently as men- ingitis (approximately 50%-65% of invasive Hib infec- tions), but may also present as bacteraemic pneumonia, bacteraemia, cellulitis, epiglottitis, septic arthritis, osteomyelitis and pericarditis.\nDiseases caused by direct spread from the nasopharynx are usually considered non-invasive and include non- bacteraemic pneumonia, otitis media, sinusitis and conjunctivitis. The time between infection with Hib and the appearance of symptoms is between 2 and 10 days.\nHib meningitis cannot be differentiated from meningi- tis caused by other bacterial pathogens on clinical examination alone; the clinical presentation of bacterial meningitis can vary considerably. The most common symptoms are acute onset of fever, headache, seizures and one or more of the following signs: neck stiffness, altered consciousness or other meningeal signs (e.g. photophobia). In infants <6 months of age, the signs and symptoms may be non-specific but often include a bulging fontanelle. Even with adequate medical treat- ment, 5% of children with Hib meningitis die and 20%- 40% of survivors suffer severe sequelae including blind- ness, deafness, and learning disabilities.'* Where resources are limited, the fatality rates are considerably higher, ranging from 20% to 60%.°'°\nHib pneumonia is clinically indistinguishable from pneumonia caused by other bacteria. Symptoms include cough, fever, rapid breathing (>40 breaths per minute) and lower chest wall in-drawing.”\nAcute epiglottitis is the swelling and inflammation of the epiglottis and surrounding tissues and may lead to acute respiratory obstruction. This form of Hib disease was common in older children in North America and Europe in the pre-vaccination era; it is rarely reported from developing countries where Hib disease occurs in younger children. Symptoms include high fever, sore throat, difficulty in swallowing and stridor.\n18 Edmond K et al. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infectious Diseases, 2010, 10(5):317-328.\n'© de Jonge RC et al. Predicting sequelae and death after bacterial meningitis in child- hood: a systematic review of prognostic studies. BMC Infectious Disease, 2010, 10:232. Available at http://www.biomedcentral.com/1471-2334/10/232; accessed September 2013.\n\" Pocket Book of Hospital Care for Children. Geneva, World Health Organization, 2013. Available at http://www.who.int/maternal_child_adolescent/documents/ child_hospital_care/en/; accessed September 2013.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 39, 27 SEPTEMBRE 2013\nla circulation sanguine; cest pourquoi cette capsule en PRP est un déterminant important de la pathogenése des maladies inva- sives. La présence d’un anticorps spécifique dirigé contre la capsule est associée a une protection contre la maladie. Comme les autres polysaccharides provenant de bactéries, le PRP induit une réponse en anticorps T-indépendante. Les enfants sont incapables de générer des réponses robustes a des antigénes polysaccharidiques purs avant l’age de 18 mois, ce que les rend hautement sensibles aux maladies 4 Hib invasives.'*", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "d2b3beb10e61bfc8c2ee7ed60be9349d", - "text": "Disease", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "", - "text_as_html": "Invasive Hib disease presents most frequently as men- ingitis (approximately 50%-65% of invasive Hib infec- tions), but may also present as bacteraemic pneumonia, bacteraemia, cellulitis, epiglottitis, septic arthritis, osteomyelitis and pericarditis.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 46.24, - "y0": 183.03, - "x1": 272.54, - "y1": 239.9 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "81a62efebf1566e1d26d7fa4d88bec43", - "text": "Diseases caused by direct spread from the nasopharynx are usually considered non-invasive and include non- bacteraemic pneumonia, otitis media, sinusitis and conjunctivitis. The time between infection with Hib and the appearance of symptoms is between 2 and 10 days.", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "d2b3beb10e61bfc8c2ee7ed60be9349d", - "text_as_html": "Diseases caused by direct spread from the nasopharynx are usually considered non-invasive and include non- bacteraemic pneumonia, otitis media, sinusitis and conjunctivitis. The time between infection with Hib and the appearance of symptoms is between 2 and 10 days.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 45.48, - "y0": 246.06, - "x1": 272.32, - "y1": 313.71 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "a5d888ef8e6245a0e6a19d7ad73becfb", - "text": "Hib meningitis cannot be differentiated from meningi- tis caused by other bacterial pathogens on clinical examination alone; the clinical presentation of bacterial meningitis can vary considerably. The most common symptoms are acute onset of fever, headache, seizures and one or more of the following signs: neck stiffness, altered consciousness or other meningeal signs (e.g. photophobia). In infants <6 months of age, the signs and symptoms may be non-specific but often include a bulging fontanelle. Even with adequate medical treat- ment, 5% of children with Hib meningitis die and 20%- 40% of survivors suffer severe sequelae including blind- ness, deafness, and learning disabilities.'* Where resources are limited, the fatality rates are considerably higher, ranging from 20% to 60%.°'°", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "d2b3beb10e61bfc8c2ee7ed60be9349d", - "text_as_html": "Hib meningitis cannot be differentiated from meningi- tis caused by other bacterial pathogens on clinical examination alone; the clinical presentation of bacterial meningitis can vary considerably. The most common symptoms are acute onset of fever, headache, seizures and one or more of the following signs: neck stiffness, altered consciousness or other meningeal signs (e.g. photophobia). In infants <6 months of age, the signs and symptoms may be non-specific but often include a bulging fontanelle. Even with adequate medical treat- ment, 5% of children with Hib meningitis die and 20%- 40% of survivors suffer severe sequelae including blind- ness, deafness, and learning disabilities.'* Where resources are limited, the fatality rates are considerably higher, ranging from 20% to 60%.°'°
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 44.72, - "y0": 321.4, - "x1": 273.25, - "y1": 492.0 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5e358a81747b2a106f72aa233f223ee9", - "text": "Hib pneumonia is clinically indistinguishable from pneumonia caused by other bacteria. Symptoms include cough, fever, rapid breathing (>40 breaths per minute) and lower chest wall in-drawing.”", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "d2b3beb10e61bfc8c2ee7ed60be9349d", - "text_as_html": "Hib pneumonia is clinically indistinguishable from pneumonia caused by other bacteria. Symptoms include cough, fever, rapid breathing (>40 breaths per minute) and lower chest wall in-drawing.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 44.75, - "y0": 510.58, - "x1": 272.91, - "y1": 555.24 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "20f3d2b0704efe89499ccfaa609ba1a4", - "text": "Acute epiglottitis is the swelling and inflammation of the epiglottis and surrounding tissues and may lead to acute respiratory obstruction. This form of Hib disease was common in older children in North America and Europe in the pre-vaccination era; it is rarely reported from developing countries where Hib disease occurs in younger children. Symptoms include high fever, sore throat, difficulty in swallowing and stridor.", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "d2b3beb10e61bfc8c2ee7ed60be9349d", - "text_as_html": "Acute epiglottitis is the swelling and inflammation of the epiglottis and surrounding tissues and may lead to acute respiratory obstruction. This form of Hib disease was common in older children in North America and Europe in the pre-vaccination era; it is rarely reported from developing countries where Hib disease occurs in younger children. Symptoms include high fever, sore throat, difficulty in swallowing and stridor.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 45.84, - "y0": 562.05, - "x1": 272.51, - "y1": 653.21 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "a0077dfd6ec0eabb6300dd15b931f5a4", - "text": "18 Edmond K et al. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infectious Diseases, 2010, 10(5):317-328.", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "d2b3beb10e61bfc8c2ee7ed60be9349d", - "text_as_html": "la circulation sanguine; cest pourquoi cette capsule en PRP est un déterminant important de la pathogenése des maladies inva- sives. La présence d’un anticorps spécifique dirigé contre la capsule est associée a une protection contre la maladie. Comme les autres polysaccharides provenant de bactéries, le PRP induit une réponse en anticorps T-indépendante. Les enfants sont incapables de générer des réponses robustes a des antigénes polysaccharidiques purs avant l’age de 18 mois, ce que les rend hautement sensibles aux maladies 4 Hib invasives.'*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 293.65, - "y0": 55.99, - "x1": 552.0, - "y1": 157.73 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-17", - "text": "\n\n\nMaladie\nLes maladies 4 Hib invasives prennent le plus souvent la forme de méningites (environ 50% a 65% des infections a Hib inva- sives), mais aussi de pneumonies bactériémiques, de bactérié- mies, de cellulites, d’épiglottites, d’arthrites septiques, d’ostéo- myélites et de péricardites.\nLes maladies dues a une propagation directe 4 partir du naso- pharynx sont habituellement considérées comme non invasives et incluent des pneumonies non bactériémiques, des otites moyennes, des sinusites et des conjonctivites. Le temps qui s’écoule entre l’infection par Hib et apparition des symptémes est compris entre 2 et 10 jours.\nLes méningites 4 Hib ne peuvent étre différenciées des ménin- gites causées par d’autres agents pathogénes bactériens sur la base du seul examen clinique; la présentation clinique des méningites bactériennes peut varier considérablement. Les symptémes les plus courants sont une fiévre aigué, des cépha- lées, des convulsions et un ou plusieurs des signes suivants: raideur de la nuque, état de conscience altéré ou autres signes méningés (photophobie, par exemple). Chez les nourrissons de <6 mois, les signes et les symptémes peuvent étre non spéci- fiques, mais incluent souvent un bombement de la fontanelle. Méme avec un traitement médical approprié, 5% des enfants atteints dune méningite a Hib décédent, et 20% a 40% des survivants souffrent de séquelles sévéres telles que cécité, surdité ou difficultés d’apprentissage.'* Lorsque les ressources sont limitées, les taux de létalité sont considérablement plus élevés, allant de 20 a 60%.° *\nLes pneumonies a Hib sont impossibles a distinguer clinique- ment des pneumonies dues a d’autres bactéries. Parmi les symp- témes, on peut observer de la toux, de la fiévre, une respiration rapide (>40 respirations/minute) et un tirage sous-sternal.””\nLépiglottite aigué désigne un gonflement et une inflammation de Pépiglotte et des tissus environnants, qui peut conduire a une obstruction respiratoire aigué. Cette forme de maladie a Hib était courante chez les enfants plus a4gés en Amérique du Nord et en Europe avant lére de la vaccination. Elle est rare- ment signalée dans les pays en développement ou les maladies a Hib touchent des enfants plus jeunes. Les symptémes peuvent étre une forte fiévre, des douleurs a la gorge, des difficultés a avaler ou un stridor.\n‘8 Edmond K et al. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infectious Diseases, 2010, 10(5):317-328.\n\"© de Jonge RC et al. Predicting sequelae and death after bacterial meningitis in childhood: a systematic review of prognostic studies. BMC Infectious Disease, 2010, 10:232. Disponible sur http:/Awww.biomedcentral.com/1471-2334/10/232; consulté en septembre 2013.\n\" Pocket Book of Hospital Care for Children. Genéve, Organisation mondiale de la Santé, 2013. Disponible sur _http://www.who.int/maternal_child_adolescent/documents/child_hospital_ care/en/; consulté en septembre 2013.\n417", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "dd5157af2b1287b8496aaf5c388f0eca", - "text": "Maladie", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "", - "text_as_html": "Les maladies 4 Hib invasives prennent le plus souvent la forme de méningites (environ 50% a 65% des infections a Hib inva- sives), mais aussi de pneumonies bactériémiques, de bactérié- mies, de cellulites, d’épiglottites, d’arthrites septiques, d’ostéo- myélites et de péricardites.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 294.97, - "y0": 182.87, - "x1": 551.17, - "y1": 239.52 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4e619af42ac896a063e9245edc0fece8", - "text": "Les maladies dues a une propagation directe 4 partir du naso- pharynx sont habituellement considérées comme non invasives et incluent des pneumonies non bactériémiques, des otites moyennes, des sinusites et des conjonctivites. Le temps qui s’écoule entre l’infection par Hib et apparition des symptémes est compris entre 2 et 10 jours.", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "dd5157af2b1287b8496aaf5c388f0eca", - "text_as_html": "Les maladies dues a une propagation directe 4 partir du naso- pharynx sont habituellement considérées comme non invasives et incluent des pneumonies non bactériémiques, des otites moyennes, des sinusites et des conjonctivites. Le temps qui s’écoule entre l’infection par Hib et apparition des symptémes est compris entre 2 et 10 jours.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 293.16, - "y0": 246.16, - "x1": 552.04, - "y1": 314.14 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "75e6f9f0265eb773bd4eda6a64881f0a", - "text": "Les méningites 4 Hib ne peuvent étre différenciées des ménin- gites causées par d’autres agents pathogénes bactériens sur la base du seul examen clinique; la présentation clinique des méningites bactériennes peut varier considérablement. Les symptémes les plus courants sont une fiévre aigué, des cépha- lées, des convulsions et un ou plusieurs des signes suivants: raideur de la nuque, état de conscience altéré ou autres signes méningés (photophobie, par exemple). Chez les nourrissons de <6 mois, les signes et les symptémes peuvent étre non spéci- fiques, mais incluent souvent un bombement de la fontanelle. Méme avec un traitement médical approprié, 5% des enfants atteints dune méningite a Hib décédent, et 20% a 40% des survivants souffrent de séquelles sévéres telles que cécité, surdité ou difficultés d’apprentissage.'* Lorsque les ressources sont limitées, les taux de létalité sont considérablement plus élevés, allant de 20 a 60%.° *", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "dd5157af2b1287b8496aaf5c388f0eca", - "text_as_html": "Les méningites 4 Hib ne peuvent étre différenciées des ménin- gites causées par d’autres agents pathogénes bactériens sur la base du seul examen clinique; la présentation clinique des méningites bactériennes peut varier considérablement. Les symptémes les plus courants sont une fiévre aigué, des cépha- lées, des convulsions et un ou plusieurs des signes suivants: raideur de la nuque, état de conscience altéré ou autres signes méningés (photophobie, par exemple). Chez les nourrissons de <6 mois, les signes et les symptémes peuvent étre non spéci- fiques, mais incluent souvent un bombement de la fontanelle. Méme avec un traitement médical approprié, 5% des enfants atteints dune méningite a Hib décédent, et 20% a 40% des survivants souffrent de séquelles sévéres telles que cécité, surdité ou difficultés d’apprentissage.'* Lorsque les ressources sont limitées, les taux de létalité sont considérablement plus élevés, allant de 20 a 60%.° *
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 293.74, - "y0": 321.54, - "x1": 552.42, - "y1": 502.33 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "59fd4a2fc8f5257de7cfe321b3d86532", - "text": "Les pneumonies a Hib sont impossibles a distinguer clinique- ment des pneumonies dues a d’autres bactéries. Parmi les symp- témes, on peut observer de la toux, de la fiévre, une respiration rapide (>40 respirations/minute) et un tirage sous-sternal.””", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "dd5157af2b1287b8496aaf5c388f0eca", - "text_as_html": "Les pneumonies a Hib sont impossibles a distinguer clinique- ment des pneumonies dues a d’autres bactéries. Parmi les symp- témes, on peut observer de la toux, de la fiévre, une respiration rapide (>40 respirations/minute) et un tirage sous-sternal.””
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 293.41, - "y0": 510.12, - "x1": 551.74, - "y1": 555.06 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "89f78e0fd2661e6d54b69207efc83927", - "text": "Lépiglottite aigué désigne un gonflement et une inflammation de Pépiglotte et des tissus environnants, qui peut conduire a une obstruction respiratoire aigué. Cette forme de maladie a Hib était courante chez les enfants plus a4gés en Amérique du Nord et en Europe avant lére de la vaccination. Elle est rare- ment signalée dans les pays en développement ou les maladies a Hib touchent des enfants plus jeunes. Les symptémes peuvent étre une forte fiévre, des douleurs a la gorge, des difficultés a avaler ou un stridor.", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "dd5157af2b1287b8496aaf5c388f0eca", - "text_as_html": "Lépiglottite aigué désigne un gonflement et une inflammation de Pépiglotte et des tissus environnants, qui peut conduire a une obstruction respiratoire aigué. Cette forme de maladie a Hib était courante chez les enfants plus a4gés en Amérique du Nord et en Europe avant lére de la vaccination. Elle est rare- ment signalée dans les pays en développement ou les maladies a Hib touchent des enfants plus jeunes. Les symptémes peuvent étre une forte fiévre, des douleurs a la gorge, des difficultés a avaler ou un stridor.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 292.88, - "y0": 562.06, - "x1": 553.53, - "y1": 664.28 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "9de957b486a9724809bf49ddc2d45776", - "text": "‘8 Edmond K et al. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infectious Diseases, 2010, 10(5):317-328.", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "dd5157af2b1287b8496aaf5c388f0eca", - "text_as_html": "417
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 4, - "coordinates": [ - { - "x0": 538.78, - "y0": 779.62, - "x1": 549.57, - "y1": 784.66 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-18", - "text": "\n\n\nDiagnosis\nIn clinically suspected Hib meningitis the etiological diagnosis can be achieved by: isolating Hib from cere- brospinal fluid (CSF); a positive latex agglutination or polymerase chain reaction (PCR) test for Hib from CSF; finding purulent CSF with a gram stain showing gram negative coccobacilli; or by growth of Hib from blood cultures. Infection in other sites may be proven through demonstration of Hib or Hib-specific components in the affected body fluid or tissue. However, culturing Hib requires special transport and growth conditions; anti- biotic treatment given prior to bacteriological sampling may impair isolation of the organism.\"*\nIt is difficult to identify the bacterial etiology of pneu- monia. Blood cultures are an accurate way of identifying a bacterial agent as a cause of pneumonia, but for the reasons noted above blood cultures are positive in only a small proportion of cases of bacterial pneumonia, in- cluding those caused by Hib. Cultures of lung aspirates are also accurate but this procedure is rarely carried out due to its invasiveness. Consequently, it is likely that the burden of Hib pneumonia is underestimated.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "2a442445d1f7a78af701b863be8c9d66", - "text": "Diagnosis", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "", - "text_as_html": "In clinically suspected Hib meningitis the etiological diagnosis can be achieved by: isolating Hib from cere- brospinal fluid (CSF); a positive latex agglutination or polymerase chain reaction (PCR) test for Hib from CSF; finding purulent CSF with a gram stain showing gram negative coccobacilli; or by growth of Hib from blood cultures. Infection in other sites may be proven through demonstration of Hib or Hib-specific components in the affected body fluid or tissue. However, culturing Hib requires special transport and growth conditions; anti- biotic treatment given prior to bacteriological sampling may impair isolation of the organism.\"*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 5, - "coordinates": [ - { - "x0": 44.79, - "y0": 69.36, - "x1": 273.1, - "y1": 205.42 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "7a0ea2533442ebe6def6418cecc5edc1", - "text": "It is difficult to identify the bacterial etiology of pneu- monia. Blood cultures are an accurate way of identifying a bacterial agent as a cause of pneumonia, but for the reasons noted above blood cultures are positive in only a small proportion of cases of bacterial pneumonia, in- cluding those caused by Hib. Cultures of lung aspirates are also accurate but this procedure is rarely carried out due to its invasiveness. Consequently, it is likely that the burden of Hib pneumonia is underestimated.", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "2a442445d1f7a78af701b863be8c9d66", - "text_as_html": "It is difficult to identify the bacterial etiology of pneu- monia. Blood cultures are an accurate way of identifying a bacterial agent as a cause of pneumonia, but for the reasons noted above blood cultures are positive in only a small proportion of cases of bacterial pneumonia, in- cluding those caused by Hib. Cultures of lung aspirates are also accurate but this procedure is rarely carried out due to its invasiveness. Consequently, it is likely that the burden of Hib pneumonia is underestimated.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 5, - "coordinates": [ - { - "x0": 44.9, - "y0": 236.11, - "x1": 273.14, - "y1": 337.73 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-19", - "text": "\n\n\nTreatment\nHib disease is treated with appropriate antibiotics, symptomatic treatment, and supportive treatment of sequelae. The choice of therapy depends on the presen- tation of Hib disease and local patterns of antibiotic resistance. Antibiotic resistance is a growing challenge. Antibiotic resistant Hib isolates were first reported between 1972 and 1974 in Europe and the United States and currently 20%-30% of isolates are resistant to am- picillin. Resistant strains have now spread to all regions of the world.\nPneumonia is treated with different regimes depending on clinical severity. In most settings, non-immunocom- promised children aged 2-59 months with pneumonia may still be treated with oral amoxicillin. For those in this age group presenting with very severe pneumonia, parenteral ampicillin and gentamicin are recommended. Immunocompromised children (such as those with HIV) should also receive this latter regime, regardless of the assessed severity of pneumonia. Ceftriaxone can be used as a second-line treatment in children with se- vere pneumonia if the first-line treatment fails.”\nMeningitis must be treated parenterally. In most cases, use of ampicillin or 3rd generation cephalosporins (cef- triaxone, cefotaxime), is still appropriate.” If there are signs of hypoxaemia, oxygen should be given.”\nBacterial meningitis (including Haemophilus influenzae type b (Hib), Neisseria meningitidis and Streptococcus pneumoniae. Geneva, World Health Organization, 1999. Available from http://www.who.int/immunization_monitoring/diseases/ meningitis_surveillance/en/; accessed September 2013.\n18 Gentamicin is not useful for treatment of meningitis since it does not cross the blood-brain barrier.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "d6dc9513c7457cf38e74a3a5e64ee026", - "text": "Treatment", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "", - "text_as_html": "Hib disease is treated with appropriate antibiotics, symptomatic treatment, and supportive treatment of sequelae. The choice of therapy depends on the presen- tation of Hib disease and local patterns of antibiotic resistance. Antibiotic resistance is a growing challenge. Antibiotic resistant Hib isolates were first reported between 1972 and 1974 in Europe and the United States and currently 20%-30% of isolates are resistant to am- picillin. Resistant strains have now spread to all regions of the world.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 5, - "coordinates": [ - { - "x0": 44.45, - "y0": 375.14, - "x1": 273.83, - "y1": 487.76 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "82e846b252c154b07f8eae918d57a070", - "text": "Pneumonia is treated with different regimes depending on clinical severity. In most settings, non-immunocom- promised children aged 2-59 months with pneumonia may still be treated with oral amoxicillin. For those in this age group presenting with very severe pneumonia, parenteral ampicillin and gentamicin are recommended. Immunocompromised children (such as those with HIV) should also receive this latter regime, regardless of the assessed severity of pneumonia. Ceftriaxone can be used as a second-line treatment in children with se- vere pneumonia if the first-line treatment fails.”", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "d6dc9513c7457cf38e74a3a5e64ee026", - "text_as_html": "Pneumonia is treated with different regimes depending on clinical severity. In most settings, non-immunocom- promised children aged 2-59 months with pneumonia may still be treated with oral amoxicillin. For those in this age group presenting with very severe pneumonia, parenteral ampicillin and gentamicin are recommended. Immunocompromised children (such as those with HIV) should also receive this latter regime, regardless of the assessed severity of pneumonia. Ceftriaxone can be used as a second-line treatment in children with se- vere pneumonia if the first-line treatment fails.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 5, - "coordinates": [ - { - "x0": 45.73, - "y0": 507.28, - "x1": 273.1, - "y1": 631.97 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "8418fbd26c6831a9e9b18a46c24374d7", - "text": "Meningitis must be treated parenterally. In most cases, use of ampicillin or 3rd generation cephalosporins (cef- triaxone, cefotaxime), is still appropriate.” If there are signs of hypoxaemia, oxygen should be given.”", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "d6dc9513c7457cf38e74a3a5e64ee026", - "text_as_html": "Meningitis must be treated parenterally. In most cases, use of ampicillin or 3rd generation cephalosporins (cef- triaxone, cefotaxime), is still appropriate.” If there are signs of hypoxaemia, oxygen should be given.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 5, - "coordinates": [ - { - "x0": 45.47, - "y0": 651.4, - "x1": 272.82, - "y1": 694.59 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "a3859a687c3b68327739d6ff1692b2a6", - "text": "Bacterial meningitis (including Haemophilus influenzae type b (Hib), Neisseria meningitidis and Streptococcus pneumoniae. Geneva, World Health Organization, 1999. Available from http://www.who.int/immunization_monitoring/diseases/ meningitis_surveillance/en/; accessed September 2013.", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "d6dc9513c7457cf38e74a3a5e64ee026", - "text_as_html": "Lorsqu’on suspecte, d’aprés la présentation clinique, une ménin- gite a Hib, le diagnostic étiologique peut étre établi par: isole- ment de la bactérie Hib dans le liquide céphalorachidien (LCR); obtention d’un test d’agglutination au latex ou d’amplification génique (PCR) positif pour Hib dans le LCR; observation d’un LCR purulent avec mise en évidence de coccobacilles Gram négatifs par coloration de Gram; ou encore par croissance de Hib a partir d’hémocultures. La présence d’une infection en d’autres sites peut étre prouvée par mise en évidence de Hib ou de composants spécifiques de cette bactérie dans les fluides corporels ou les tissus touchés. Néanmoins, la culture de Hib requiert des conditions spéciales de transport et de croissance; Padministration d’un traitement antibiotique avant le préléve- ment biologique peut empécher l’isolement de cet organisme.'*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 5, - "coordinates": [ - { - "x0": 294.39, - "y0": 69.38, - "x1": 551.59, - "y1": 228.81 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4f6fc3cc2e70e131b6761346413bb6fa", - "text": "Il est difficile de déterminer l’étiologie bactérienne des pneu- monies. Les hémocultures sont un moyen précis @identifier un agent bactérien comme responsable d’une pneumonie, mais, pour les raisons indiquées plus haut, ces cultures ne sont posi- tives que pour une faible proportion des cas de pneumonie bactérienne, y compris ceux de pneumonie a Hib. La culture daspirats pulmonaires donne aussi des résultats précis, mais cette procédure est rarement appliquée, compte tenu de son invasivité. La charge de pneumonies a Hib est donc probable- ment sous-estimée.", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "11d4d30159024ee9121b085c04bb0555", - "text_as_html": "Il est difficile de déterminer l’étiologie bactérienne des pneu- monies. Les hémocultures sont un moyen précis @identifier un agent bactérien comme responsable d’une pneumonie, mais, pour les raisons indiquées plus haut, ces cultures ne sont posi- tives que pour une faible proportion des cas de pneumonie bactérienne, y compris ceux de pneumonie a Hib. La culture daspirats pulmonaires donne aussi des résultats précis, mais cette procédure est rarement appliquée, compte tenu de son invasivité. La charge de pneumonies a Hib est donc probable- ment sous-estimée.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 5, - "coordinates": [ - { - "x0": 294.68, - "y0": 235.87, - "x1": 552.23, - "y1": 348.7 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-22", - "text": "\n\n\nTraitement\nPour traiter les maladies 4 Hib, on utilise des antibiotiques appropriés, un traitement symptomatique et un traitement dappoint des séquelles. Le choix du traitement dépend de la présentation de la maladie et des profils locaux de résistance aux antibiotiques. La résistance aux antibiotiques est un défi qui prend des proportions grandissantes. Des isolements de Hib résistants aux antibiotiques ont été signalés pour la premiére fois entre 1972 et 1974 en Europe et aux Etats-Unis et actuelle- ment, 20 a 30% des isolements de ce type sont résistants a Pampicilline. Les souches résistantes se sont maintenant propa- gées a toutes les régions du monde.\nLa pneumonie est traitée par différents schémas thérapeutiques selon sa sévérité clinique. Dans la plupart des contextes, les enfants non immunodéprimés de 2 a 59 mois atteints de pneu- monie sont traités avec de l’amoxicilline par voie orale. Pour les enfants de cette tranche d’age souffrant d'une pneumonie trés sévére, ampicilline et la gentamicine par voie parentérale sont recommandées. Les enfants immunodéprimés (tels que ceux vivant avec le VIH) devront recevoir ce dernier schéma quelle que soit la gravité évaluée de leur pneumonie. Le ceftriaxone est utilisable comme traitement de deuxiéme inten- tion chez les enfants atteints d’une pneumonie sévére et dont le traitement de premiére intention a échoué.””\nLa méningite doit étre traitée par voie parentérale. Dans la plupart des cas, Putilisation d’ampicilline ou de céphalospo- rines de troisitme génération (ceftriaxone, cefotaxime) est encore appropriée.’” En présence de signes d’hypoxémie, on administrera de loxygéne.””\nBacterial meningitis (including Haemophilus influenzae type b (Hib), Neisseria meningitidis and Streptococcus pneumoniae. Geneve, Organisation mondiale de la Santé, 1999. Disponible sur http:/Awww.who.int/immunization_monitoring/diseases/meningitis_surveillance/en/; consulté en septembre 2013.\nIl est inutile de traiter la méningite avec de la gentamicine car elle ne traverse pas la barriére hémo-méningée.\nEpiglottitis is a medical emergency. A child presenting with symptoms of epiglottitis should be treated imme- diately with antibiotics and airway support.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "525f9ccf564c571d8c6f318d16817c72", - "text": "Traitement", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "", - "text_as_html": "Pour traiter les maladies 4 Hib, on utilise des antibiotiques appropriés, un traitement symptomatique et un traitement dappoint des séquelles. Le choix du traitement dépend de la présentation de la maladie et des profils locaux de résistance aux antibiotiques. La résistance aux antibiotiques est un défi qui prend des proportions grandissantes. Des isolements de Hib résistants aux antibiotiques ont été signalés pour la premiére fois entre 1972 et 1974 en Europe et aux Etats-Unis et actuelle- ment, 20 a 30% des isolements de ce type sont résistants a Pampicilline. Les souches résistantes se sont maintenant propa- gées a toutes les régions du monde.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 5, - "coordinates": [ - { - "x0": 294.07, - "y0": 375.05, - "x1": 552.41, - "y1": 499.18 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "84bb4ad10cb135f206106df3e758e490", - "text": "La pneumonie est traitée par différents schémas thérapeutiques selon sa sévérité clinique. Dans la plupart des contextes, les enfants non immunodéprimés de 2 a 59 mois atteints de pneu- monie sont traités avec de l’amoxicilline par voie orale. Pour les enfants de cette tranche d’age souffrant d'une pneumonie trés sévére, ampicilline et la gentamicine par voie parentérale sont recommandées. Les enfants immunodéprimés (tels que ceux vivant avec le VIH) devront recevoir ce dernier schéma quelle que soit la gravité évaluée de leur pneumonie. Le ceftriaxone est utilisable comme traitement de deuxiéme inten- tion chez les enfants atteints d’une pneumonie sévére et dont le traitement de premiére intention a échoué.””", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "525f9ccf564c571d8c6f318d16817c72", - "text_as_html": "La pneumonie est traitée par différents schémas thérapeutiques selon sa sévérité clinique. Dans la plupart des contextes, les enfants non immunodéprimés de 2 a 59 mois atteints de pneu- monie sont traités avec de l’amoxicilline par voie orale. Pour les enfants de cette tranche d’age souffrant d'une pneumonie trés sévére, ampicilline et la gentamicine par voie parentérale sont recommandées. Les enfants immunodéprimés (tels que ceux vivant avec le VIH) devront recevoir ce dernier schéma quelle que soit la gravité évaluée de leur pneumonie. Le ceftriaxone est utilisable comme traitement de deuxiéme inten- tion chez les enfants atteints d’une pneumonie sévére et dont le traitement de premiére intention a échoué.””
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 5, - "coordinates": [ - { - "x0": 293.79, - "y0": 507.47, - "x1": 553.72, - "y1": 642.97 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "bd8e9ce42a8c247a09312e139cc31eb0", - "text": "La méningite doit étre traitée par voie parentérale. Dans la plupart des cas, Putilisation d’ampicilline ou de céphalospo- rines de troisitme génération (ceftriaxone, cefotaxime) est encore appropriée.’” En présence de signes d’hypoxémie, on administrera de loxygéne.””", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "525f9ccf564c571d8c6f318d16817c72", - "text_as_html": "La méningite doit étre traitée par voie parentérale. Dans la plupart des cas, Putilisation d’ampicilline ou de céphalospo- rines de troisitme génération (ceftriaxone, cefotaxime) est encore appropriée.’” En présence de signes d’hypoxémie, on administrera de loxygéne.””
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 5, - "coordinates": [ - { - "x0": 294.04, - "y0": 650.65, - "x1": 550.78, - "y1": 705.57 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "77d48ceaf744e5d166e018b191bd0662", - "text": "Bacterial meningitis (including Haemophilus influenzae type b (Hib), Neisseria meningitidis and Streptococcus pneumoniae. Geneve, Organisation mondiale de la Santé, 1999. Disponible sur http:/Awww.who.int/immunization_monitoring/diseases/meningitis_surveillance/en/; consulté en septembre 2013.", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "525f9ccf564c571d8c6f318d16817c72", - "text_as_html": "Epiglottitis is a medical emergency. A child presenting with symptoms of epiglottitis should be treated imme- diately with antibiotics and airway support.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 6, - "coordinates": [ - { - "x0": 44.15, - "y0": 55.66, - "x1": 273.22, - "y1": 88.71 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-23", - "text": "\n\n\nVaccines\nThe observation that the low incidence of Hib disease in older children and adults correlated with the pres- ence in their serum of bactericidal antibodies directed against the Hib capsular polysaccharide, PRP, led to de- velopment of a vaccine based on the type b capsular polysaccharide alone. In 1977, this Hib PRP vaccine was shown to be protective in older children in Finland. However, the vaccine was found to be ineffective in chil- dren aged <18 months.” Two immunological properties limit its use in infants and young children - the poor immunogenicity of polysaccharide antigens in young children and its failure to induce immunological memory. Efforts to overcome the limitations of PRP using covalent linkage (conjugation) of the PRP with T-cell dependent protein antigens led to more effective vaccines. When conjugated with a carrier protein, a T-cell dependent B-cell immune response to the PRP that produces longer lasting immunity and immuno- logical memory is induced.”!", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "3baf9167ccb1836de851b01fa35f5a52", - "text": "Vaccines", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "", - "text_as_html": "The observation that the low incidence of Hib disease in older children and adults correlated with the pres- ence in their serum of bactericidal antibodies directed against the Hib capsular polysaccharide, PRP, led to de- velopment of a vaccine based on the type b capsular polysaccharide alone. In 1977, this Hib PRP vaccine was shown to be protective in older children in Finland. However, the vaccine was found to be ineffective in chil- dren aged <18 months.” Two immunological properties limit its use in infants and young children - the poor immunogenicity of polysaccharide antigens in young children and its failure to induce immunological memory. Efforts to overcome the limitations of PRP using covalent linkage (conjugation) of the PRP with T-cell dependent protein antigens led to more effective vaccines. When conjugated with a carrier protein, a T-cell dependent B-cell immune response to the PRP that produces longer lasting immunity and immuno- logical memory is induced.”!
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 6, - "coordinates": [ - { - "x0": 44.89, - "y0": 115.64, - "x1": 272.76, - "y1": 331.97 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-24", - "text": "\n\n\nCurrent formulations\nAll vaccines currently licensed for use against Hib dis- ease are conjugated, but they differ in their carrier pro- tein, method of chemical conjugation, polysaccharide size, and their adjuvant, giving them somewhat different immunological properties.‘ Four carrier types have been used in licensed Hib vaccines: diphtheria toxoid (PRP-D); tetanus toxoid (PRP-T); a non-toxic variant of diphtheria toxin CRM 197 (PRP-CRM197); and Neisseria meningitidis type B outer membrane protein complex (PRP-OMP). PRP-D was found to be less immunogenic in children <18 months of age than the other conju- gates, and has been withdrawn from the market.\nHib vaccine is available in a variety of formulations: liquid Hib conjugate vaccine (monovalent), liquid Hib conjugate combined with diphtheria-tetanus-pertussis (DTP) and/ or hepatitis B; Hib conjugate in combination with meningococcal antigens; lyophilized Hib-conjugate with saline diluent (monovalent) and lyophilized Hib- conjugate for use with liquid DTP, or DTP in combina- tion with other antigens - such as inactivated polio vaccine or hepatitis B vaccine.\nAll Hib-containing vaccines should be stored between +2 and +8 °C. Liquid Hib vaccine should never be fro- zen. Lyophilized vaccine may be frozen until reconsti- tuted. However, since the liquid most commonly used for reconstituting is the liquid containing DTP, which cannot be frozen, it is recommended that lyophilized\n20 Peltola H. Haemophilus influenzae type b disease and vaccination in Europe: lessons learned. Pediatric Infectious Diseases Journal, 1998, 17:5126-S132.\n21 WHO Expert Committee on biological standardization (Annex 1). Geneva, World Health Organization, 2000, WHO Technical report series 897. Available from http:// whqlibdoc.who.int/trs\\WHO_TRS_897.pdf; accessed September 2013.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 39, 27 SEPTEMBRE 2013\nLépiglottite est une urgence médicale. Un enfant présentant des symptémes d’épiglottite devra recevoir immédiatement un trai- tement antibiotique et une assistance respiratoire.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "54754fe8fcf164568addcc2a5c4bafd4", - "text": "Current formulations", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "", - "text_as_html": "All vaccines currently licensed for use against Hib dis- ease are conjugated, but they differ in their carrier pro- tein, method of chemical conjugation, polysaccharide size, and their adjuvant, giving them somewhat different immunological properties.‘ Four carrier types have been used in licensed Hib vaccines: diphtheria toxoid (PRP-D); tetanus toxoid (PRP-T); a non-toxic variant of diphtheria toxin CRM 197 (PRP-CRM197); and Neisseria meningitidis type B outer membrane protein complex (PRP-OMP). PRP-D was found to be less immunogenic in children <18 months of age than the other conju- gates, and has been withdrawn from the market.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 6, - "coordinates": [ - { - "x0": 45.32, - "y0": 369.58, - "x1": 272.68, - "y1": 505.51 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "8ff5c4e6bdf8d6a00aeb64ec0b7ba384", - "text": "Hib vaccine is available in a variety of formulations: liquid Hib conjugate vaccine (monovalent), liquid Hib conjugate combined with diphtheria-tetanus-pertussis (DTP) and/ or hepatitis B; Hib conjugate in combination with meningococcal antigens; lyophilized Hib-conjugate with saline diluent (monovalent) and lyophilized Hib- conjugate for use with liquid DTP, or DTP in combina- tion with other antigens - such as inactivated polio vaccine or hepatitis B vaccine.", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "54754fe8fcf164568addcc2a5c4bafd4", - "text_as_html": "Hib vaccine is available in a variety of formulations: liquid Hib conjugate vaccine (monovalent), liquid Hib conjugate combined with diphtheria-tetanus-pertussis (DTP) and/ or hepatitis B; Hib conjugate in combination with meningococcal antigens; lyophilized Hib-conjugate with saline diluent (monovalent) and lyophilized Hib- conjugate for use with liquid DTP, or DTP in combina- tion with other antigens - such as inactivated polio vaccine or hepatitis B vaccine.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 6, - "coordinates": [ - { - "x0": 44.89, - "y0": 524.83, - "x1": 272.19, - "y1": 626.22 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "eb9822fb8a3b299e66266bdda1e8d8c2", - "text": "All Hib-containing vaccines should be stored between +2 and +8 °C. Liquid Hib vaccine should never be fro- zen. Lyophilized vaccine may be frozen until reconsti- tuted. However, since the liquid most commonly used for reconstituting is the liquid containing DTP, which cannot be frozen, it is recommended that lyophilized", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "54754fe8fcf164568addcc2a5c4bafd4", - "text_as_html": "All Hib-containing vaccines should be stored between +2 and +8 °C. Liquid Hib vaccine should never be fro- zen. Lyophilized vaccine may be frozen until reconsti- tuted. However, since the liquid most commonly used for reconstituting is the liquid containing DTP, which cannot be frozen, it is recommended that lyophilized
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 6, - "coordinates": [ - { - "x0": 45.87, - "y0": 644.94, - "x1": 272.53, - "y1": 712.87 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "65f43bc25bdec4111dece75a65c643fe", - "text": "20 Peltola H. Haemophilus influenzae type b disease and vaccination in Europe: lessons learned. Pediatric Infectious Diseases Journal, 1998, 17:5126-S132.", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "54754fe8fcf164568addcc2a5c4bafd4", - "text_as_html": "Lépiglottite est une urgence médicale. Un enfant présentant des symptémes d’épiglottite devra recevoir immédiatement un trai- tement antibiotique et une assistance respiratoire.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 6, - "coordinates": [ - { - "x0": 294.23, - "y0": 55.56, - "x1": 551.94, - "y1": 88.61 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-25", - "text": "\n\n\nVaccins\nLobservation d’une faible incidence des maladies a Hib chez les enfants plus agés et les adultes, corrélée a la présence dans leur sérum d’anticorps bactéricides dirigés contre le polysac- charide capsulaire de Hib, le PRP, a amené a mettre au point un vaccin reposant uniquement sur le polysaccharide capsulaire du type b. En 1977, il a été montré que ce vaccin anti-Hib PRP apportait une protection aux enfants plus agés en Finlande. Cependant, on a constaté qu'il était inefficace chez les enfants de <18 mois.” Deux des propriétés immunologiques de ce vaccin limitent son utilisation chez les nourrissons et les jeunes enfants: la faible immunogénicité des antigénes polysacchari- diques chez les jeunes enfants et leur incapacité a induire une mémoire immunologique. Les efforts pour surmonter ces limi- tations du PRP en faisant intervenir une liaison covalente (conjugaison) de ce polysaccharide avec des antigénes protéiques T-dépendants ont conduit a l’élaboration de vaccins plus effi- caces. Lorsque le PRP est conjugué a une protéine porteuse, le vaccin induit une réponse immunitaire en lymphocytes B T-dépendante, qui génére une immunité de longue durée et une mémoire immunologique.”'", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "4458684234c69003425bb0f4768b55d2", - "text": "Vaccins", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "", - "text_as_html": "Lobservation d’une faible incidence des maladies a Hib chez les enfants plus agés et les adultes, corrélée a la présence dans leur sérum d’anticorps bactéricides dirigés contre le polysac- charide capsulaire de Hib, le PRP, a amené a mettre au point un vaccin reposant uniquement sur le polysaccharide capsulaire du type b. En 1977, il a été montré que ce vaccin anti-Hib PRP apportait une protection aux enfants plus agés en Finlande. Cependant, on a constaté qu'il était inefficace chez les enfants de <18 mois.” Deux des propriétés immunologiques de ce vaccin limitent son utilisation chez les nourrissons et les jeunes enfants: la faible immunogénicité des antigénes polysacchari- diques chez les jeunes enfants et leur incapacité a induire une mémoire immunologique. Les efforts pour surmonter ces limi- tations du PRP en faisant intervenir une liaison covalente (conjugaison) de ce polysaccharide avec des antigénes protéiques T-dépendants ont conduit a l’élaboration de vaccins plus effi- caces. Lorsque le PRP est conjugué a une protéine porteuse, le vaccin induit une réponse immunitaire en lymphocytes B T-dépendante, qui génére une immunité de longue durée et une mémoire immunologique.”'
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 6, - "coordinates": [ - { - "x0": 293.37, - "y0": 115.55, - "x1": 553.81, - "y1": 342.72 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-26", - "text": "\n\n\nFormulations actuelles\nTous les vaccins actuellement autorisés contre les maladies a Hib sont des vaccins conjugués, mais different par leur protéine porteuse, la méthode de conjugaison chimique, la taille du poly- saccharide ou l’adjuvant utilisé, ce qui leur confére des proprié- tés immunologiques quelque peu différentes.\" Quatre types de porteuses sont employés dans les vaccins anti-Hib autorisés: Panatoxine diphtérique (PRP-D); ’anatoxine tétanique (PRP-T); une toxine diphtérique mutante non toxique CRM 197 (PRP- CRM197); et un complexe protéique de la membrane externe de Neisseria meningiditis type B (PRP-OMP). On a trouvé le vaccin PRP-D moins immunogéne chez les enfants de <18 mois que les autres vaccins conjugués et il a donc été retiré du marché.\nLes vaccins anti-Hib sont disponibles sous diverses formula- tions: vaccin anti-Hib conjugué liquide (monovalent), vaccin anti-Hib conjugué liquide combiné au vaccin antidiphtérique- antitétanique-anticoquelucheux (DTC) et/ou au vaccin anti- hépatite B; vaccin anti-Hib conjugué combiné a des antigénes méningococciques; vaccin anti-Hib conjugué lyophilisé avec un diluant salin (monovalent) et vaccin anti-Hib conjugué lyophi- lisé utilisable avec un vaccin DTC liquide ou avec un DTC combiné a d’autres antigénes - tels que le vaccin antipoliomyé- litique inactivé ou anti-hépatite B.\nTous les vaccins contenant une valence Hib devront étre conser- vés entre +2°C et +8°C. Le vaccin anti-Hib liquide ne doit jamais étre congelé. Les vaccins lyophilisés peuvent étre congelés jusqu’a leur reconstitution. Néanmoins, comme le diluant le plus couramment utilisé pour reconstituer le vaccin est le liquide contenant le DTC, qui ne peut étre congelé, il est recommandé\n20 Peltola H. Haemophilus influenzae type b disease and vaccination in Europe: lessons learned. Pediatric Infectious Diseases Journal, 1998, 17:5126-S132.\n21 WHO Expert Committee on biological standardization (Annex 1). Genéve, Organisation mondiale de la Santé, 2000, série de rapports techniques de I'OMS No 897. Disponible uniquement en langue anglaise sur http://whqlibdoc.who.int/trs/)WHO_TRS_897.pdf; consulté en septembre 2013.\n419\nHib vaccine should also be stored at temperatures between +2 and +8 °C. Manufacturers’ recommenda- tions vary between formulations; product information inserts should be consulted for specific details.\nManufacturers’ recommended administration and scheduling\nHib conjugate vaccine is administered as an intramus- cular injection into the anterolateral thigh or, in older children, into the deltoid muscle on the outer aspect of the upper arm. The standard dose is 0.5 ml.\nAccording to manufacturers’ specifications, Hib vaccine is given as a primary series of either 2 or 3 doses with the first dose administered as early as possible after the age of 6 weeks. The interval between doses should be at least 4 weeks. The primary series should be com- pleted by the age of 6 months.\nSchedules currently in use include: 3 primary doses without a booster dose (3p+0); 2 primary doses at an 8 week interval followed by a booster dose (2p+1); and 3 primary doses plus a booster dose (3p +1).\nAccording to most manufacturers’ specifications the booster dose may be administered between 12 and 18 months, with variations between formulations. Some manufacturers recommend a booster dose at the age of 5 years.\nManufacturers indicate that Hib vaccine can be given safely and effectively at the same time as routine vac- cines included in national immunization programmes. If Hib vaccine is given as a separate injection at the same time as other vaccines, it should be administered at a different site. It should not be mixed in the vial or syringe with any other vaccine unless it has been spe- cifically manufactured and licensed for use in this way.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "772be47b898a1d79ccd0b41876b4a75e", - "text": "Formulations actuelles", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "", - "text_as_html": "Tous les vaccins actuellement autorisés contre les maladies a Hib sont des vaccins conjugués, mais different par leur protéine porteuse, la méthode de conjugaison chimique, la taille du poly- saccharide ou l’adjuvant utilisé, ce qui leur confére des proprié- tés immunologiques quelque peu différentes.\" Quatre types de porteuses sont employés dans les vaccins anti-Hib autorisés: Panatoxine diphtérique (PRP-D); ’anatoxine tétanique (PRP-T); une toxine diphtérique mutante non toxique CRM 197 (PRP- CRM197); et un complexe protéique de la membrane externe de Neisseria meningiditis type B (PRP-OMP). On a trouvé le vaccin PRP-D moins immunogéne chez les enfants de <18 mois que les autres vaccins conjugués et il a donc été retiré du marché.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 6, - "coordinates": [ - { - "x0": 293.81, - "y0": 369.52, - "x1": 553.08, - "y1": 516.49 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "84c9587c156cf7d147fb151f42bf5637", - "text": "Les vaccins anti-Hib sont disponibles sous diverses formula- tions: vaccin anti-Hib conjugué liquide (monovalent), vaccin anti-Hib conjugué liquide combiné au vaccin antidiphtérique- antitétanique-anticoquelucheux (DTC) et/ou au vaccin anti- hépatite B; vaccin anti-Hib conjugué combiné a des antigénes méningococciques; vaccin anti-Hib conjugué lyophilisé avec un diluant salin (monovalent) et vaccin anti-Hib conjugué lyophi- lisé utilisable avec un vaccin DTC liquide ou avec un DTC combiné a d’autres antigénes - tels que le vaccin antipoliomyé- litique inactivé ou anti-h��patite B.", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "772be47b898a1d79ccd0b41876b4a75e", - "text_as_html": "Les vaccins anti-Hib sont disponibles sous diverses formula- tions: vaccin anti-Hib conjugué liquide (monovalent), vaccin anti-Hib conjugué liquide combiné au vaccin antidiphtérique- antitétanique-anticoquelucheux (DTC) et/ou au vaccin anti- hépatite B; vaccin anti-Hib conjugué combiné a des antigénes méningococciques; vaccin anti-Hib conjugué lyophilisé avec un diluant salin (monovalent) et vaccin anti-Hib conjugué lyophi- lisé utilisable avec un vaccin DTC liquide ou avec un DTC combiné a d’autres antigénes - tels que le vaccin antipoliomyé- litique inactivé ou anti-hépatite B.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 6, - "coordinates": [ - { - "x0": 293.47, - "y0": 524.44, - "x1": 553.79, - "y1": 637.37 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "c5eef3f3484bfc8e53990894ae290fba", - "text": "Tous les vaccins contenant une valence Hib devront étre conser- vés entre +2°C et +8°C. Le vaccin anti-Hib liquide ne doit jamais étre congelé. Les vaccins lyophilisés peuvent étre congelés jusqu’a leur reconstitution. Néanmoins, comme le diluant le plus couramment utilisé pour reconstituer le vaccin est le liquide contenant le DTC, qui ne peut étre congelé, il est recommandé", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "772be47b898a1d79ccd0b41876b4a75e", - "text_as_html": "Tous les vaccins contenant une valence Hib devront étre conser- vés entre +2°C et +8°C. Le vaccin anti-Hib liquide ne doit jamais étre congelé. Les vaccins lyophilisés peuvent étre congelés jusqu’a leur reconstitution. Néanmoins, comme le diluant le plus couramment utilisé pour reconstituer le vaccin est le liquide contenant le DTC, qui ne peut étre congelé, il est recommandé
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 6, - "coordinates": [ - { - "x0": 292.54, - "y0": 644.85, - "x1": 553.2, - "y1": 712.85 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "243d9cc82739a83c19efc0c0b72acf52", - "text": "20 Peltola H. Haemophilus influenzae type b disease and vaccination in Europe: lessons learned. Pediatric Infectious Diseases Journal, 1998, 17:5126-S132.", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "772be47b898a1d79ccd0b41876b4a75e", - "text_as_html": "419
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 6, - "coordinates": [ - { - "x0": 538.78, - "y0": 779.62, - "x1": 549.57, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "04db30ca6be633b4eb0db1d0c6638535", - "text": "Hib vaccine should also be stored at temperatures between +2 and +8 °C. Manufacturers’ recommenda- tions vary between formulations; product information inserts should be consulted for specific details.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "772be47b898a1d79ccd0b41876b4a75e", - "text_as_html": "Hib vaccine should also be stored at temperatures between +2 and +8 °C. Manufacturers’ recommenda- tions vary between formulations; product information inserts should be consulted for specific details.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 43.75, - "y0": 55.95, - "x1": 273.89, - "y1": 100.02 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "b3bd77b4cec212d47e9b83a3ea49ce96", - "text": "Manufacturers’ recommended administration and scheduling", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "772be47b898a1d79ccd0b41876b4a75e", - "text_as_html": "Manufacturers’ recommended administration and scheduling
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 44.48, - "y0": 124.36, - "x1": 241.9, - "y1": 146.47 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "6cf00a681b100e61cb39de944543696a", - "text": "Hib conjugate vaccine is administered as an intramus- cular injection into the anterolateral thigh or, in older children, into the deltoid muscle on the outer aspect of the upper arm. The standard dose is 0.5 ml.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "772be47b898a1d79ccd0b41876b4a75e", - "text_as_html": "Hib conjugate vaccine is administered as an intramus- cular injection into the anterolateral thigh or, in older children, into the deltoid muscle on the outer aspect of the upper arm. The standard dose is 0.5 ml.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 44.04, - "y0": 148.71, - "x1": 273.49, - "y1": 193.21 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "6e8d6a3e8239261e0de7a8cb6269a09e", - "text": "According to manufacturers’ specifications, Hib vaccine is given as a primary series of either 2 or 3 doses with the first dose administered as early as possible after the age of 6 weeks. The interval between doses should be at least 4 weeks. The primary series should be com- pleted by the age of 6 months.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "772be47b898a1d79ccd0b41876b4a75e", - "text_as_html": "According to manufacturers’ specifications, Hib vaccine is given as a primary series of either 2 or 3 doses with the first dose administered as early as possible after the age of 6 weeks. The interval between doses should be at least 4 weeks. The primary series should be com- pleted by the age of 6 months.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 47.13, - "y0": 200.04, - "x1": 273.45, - "y1": 267.73 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "064ce81e5cef87ddb8a711a751f7b37a", - "text": "Schedules currently in use include: 3 primary doses without a booster dose (3p+0); 2 primary doses at an 8 week interval followed by a booster dose (2p+1); and 3 primary doses plus a booster dose (3p +1).", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "772be47b898a1d79ccd0b41876b4a75e", - "text_as_html": "Schedules currently in use include: 3 primary doses without a booster dose (3p+0); 2 primary doses at an 8 week interval followed by a booster dose (2p+1); and 3 primary doses plus a booster dose (3p +1).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 43.52, - "y0": 275.32, - "x1": 274.57, - "y1": 319.51 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "7b6a107485152813c5c8be27ee24caea", - "text": "According to most manufacturers’ specifications the booster dose may be administered between 12 and 18 months, with variations between formulations. Some manufacturers recommend a booster dose at the age of 5 years.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "772be47b898a1d79ccd0b41876b4a75e", - "text_as_html": "According to most manufacturers’ specifications the booster dose may be administered between 12 and 18 months, with variations between formulations. Some manufacturers recommend a booster dose at the age of 5 years.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 44.26, - "y0": 338.43, - "x1": 274.33, - "y1": 393.84 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f73ee8407390a6b93a2488161f1edb71", - "text": "Manufacturers indicate that Hib vaccine can be given safely and effectively at the same time as routine vac- cines included in national immunization programmes. If Hib vaccine is given as a separate injection at the same time as other vaccines, it should be administered at a different site. It should not be mixed in the vial or syringe with any other vaccine unless it has been spe- cifically manufactured and licensed for use in this way.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "772be47b898a1d79ccd0b41876b4a75e", - "text_as_html": "Manufacturers indicate that Hib vaccine can be given safely and effectively at the same time as routine vac- cines included in national immunization programmes. If Hib vaccine is given as a separate injection at the same time as other vaccines, it should be administered at a different site. It should not be mixed in the vial or syringe with any other vaccine unless it has been spe- cifically manufactured and licensed for use in this way.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 45.33, - "y0": 401.2, - "x1": 273.42, - "y1": 492.23 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-27", - "text": "\n\n\nImmunogenicity, efficacy and effectiveness\nAnimal and human studies of anti-PRP IgG established 0.15ug/ml as the level needed to give short-term protec- tion from invasive Hib disease. Field studies set a threshold of 1ug/ml, one month after completion of the primary vaccination series, as the level required to con- fer long-term protection from invasive Hib disease.’ Although subsequent observations have suggested that the induction of immune memory may be a more rele- vant marker of long-term protection,” these thresholds continue to be used by regulatory agencies for clinical evaluation of the vaccine, together with additional data on isotype and subclass composition, antibody avidity and functional activity including serum bactericidal ac- tivity.”\nThe currently available Hib conjugate vaccines have dif- ferent immunologic profiles, depending on the carrier\n» Eskola J et al. Combined vaccination of Haemophilus influenzae type b conjugate and diphtheria-tetanus-pertussis containing acellular pertussis. The Lancet, 1999, 354 (9195): 2063-2068.\nde conserver également le vaccin anti-Hib lyophilisé a une température comprise entre +2°C et + 8°C. Les recommanda- tions du fabricant varient d’une formulation a l’autre; les notices d’information des produits devront étre consultées pour plus de précisions.\nAdministration et calendrier de vaccination recommandés par les fabricants\nLe vaccin anti-Hib conjugué est administré par injection intra- musculaire dans la face antérolatérale de la cuisse ou, chez les enfants plus agés, dans le deltoide sur la partie externe de lavant-bras. La dose standard est de 0,5 ml.\nD’aprés les spécifications des fabricants, le vaccin anti-Hib doit étre administré sous forme de série primaire de 2 ou 3 doses, dont la premiére est injectée dés que possible aprés lage de 6 semaines. L’intervalle entre les doses devra étre de 4 semaines au moins. La série primaire doit étre achevée a l’age de 6 mois.\nParmi les calendriers de vaccination actuellement appliqués figurent: administration de 3 doses primaires sans dose de rappel (3p + 0); Padministration de 2 doses primaires a 8 semaines d’intervalle suivies d’une dose de rappel (2p + 1); et celle de 3 doses primaires plus une dose de rappel (3p + 1).\nD’aprés les instructions de la plupart des fabricants, la dose de rappel peut étre injectée entre 12 et 18 mois, selon les formu- lations. Certains fabricants recommandent une dose de rappel a Page de 5 ans.\nLes fabricants indiquent que le vaccin anti-Hib peut étre admi- nistré de maniére stire et efficace en méme temps que d’autres vaccinations systématiques faisant partie des programmes nationaux de vaccination. Si le vaccin anti-Hib fait objet d’une injection séparée en méme temps que l’administration d’autres vaccins, le site dinjection devra étre différent. Il ne devra pas étre mélangé dans un flacon ou dans une seringue avec un quelconque autre vaccin, 4 moins quil rait été spécifiquement fabriqué et autorisé pour un tel usage.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "979ceaf740e4cb56d92c3f24d1abdda6", - "text": "Immunogenicity, efficacy and effectiveness", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "", - "text_as_html": "Animal and human studies of anti-PRP IgG established 0.15ug/ml as the level needed to give short-term protec- tion from invasive Hib disease. Field studies set a threshold of 1ug/ml, one month after completion of the primary vaccination series, as the level required to con- fer long-term protection from invasive Hib disease.’ Although subsequent observations have suggested that the induction of immune memory may be a more rele- vant marker of long-term protection,” these thresholds continue to be used by regulatory agencies for clinical evaluation of the vaccine, together with additional data on isotype and subclass composition, antibody avidity and functional activity including serum bactericidal ac- tivity.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 44.75, - "y0": 530.19, - "x1": 273.24, - "y1": 687.7 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "e905dfb8363e5faeaec0f930feecc181", - "text": "The currently available Hib conjugate vaccines have dif- ferent immunologic profiles, depending on the carrier", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "979ceaf740e4cb56d92c3f24d1abdda6", - "text_as_html": "The currently available Hib conjugate vaccines have dif- ferent immunologic profiles, depending on the carrier
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 43.37, - "y0": 708.26, - "x1": 272.05, - "y1": 728.84 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "eed7ef336b0279d6ff4f62f3a6dc87b7", - "text": "» Eskola J et al. Combined vaccination of Haemophilus influenzae type b conjugate and diphtheria-tetanus-pertussis containing acellular pertussis. The Lancet, 1999, 354 (9195): 2063-2068.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "979ceaf740e4cb56d92c3f24d1abdda6", - "text_as_html": "de conserver également le vaccin anti-Hib lyophilisé a une température comprise entre +2°C et + 8°C. Les recommanda- tions du fabricant varient d’une formulation a l’autre; les notices d’information des produits devront étre consultées pour plus de précisions.
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", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 293.63, - "y0": 122.94, - "x1": 541.93, - "y1": 146.07 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "68c2d89292b0b8171de7a3383f3ade65", - "text": "Le vaccin anti-Hib conjugué est administré par injection intra- musculaire dans la face antérolatérale de la cuisse ou, chez les enfants plus agés, dans le deltoide sur la partie externe de lavant-bras. La dose standard est de 0,5 ml.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "", - "text_as_html": "Le vaccin anti-Hib conjugué est administré par injection intra- musculaire dans la face antérolatérale de la cuisse ou, chez les enfants plus agés, dans le deltoide sur la partie externe de lavant-bras. La dose standard est de 0,5 ml.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 292.23, - "y0": 149.27, - "x1": 551.3, - "y1": 193.31 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "aedc17e9734fd212ca58483b31166b7c", - "text": "D’aprés les spécifications des fabricants, le vaccin anti-Hib doit étre administré sous forme de série primaire de 2 ou 3 doses, dont la premiére est injectée dés que possible aprés lage de 6 semaines. L’intervalle entre les doses devra étre de 4 semaines au moins. La série primaire doit étre achevée a l’age de 6 mois.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "", - "text_as_html": "D’aprés les spécifications des fabricants, le vaccin anti-Hib doit étre administré sous forme de série primaire de 2 ou 3 doses, dont la premiére est injectée dés que possible aprés lage de 6 semaines. L’intervalle entre les doses devra étre de 4 semaines au moins. La série primaire doit étre achevée a l’age de 6 mois.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 294.43, - "y0": 200.06, - "x1": 551.8, - "y1": 256.41 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "359da87ec636e0f85cab3c3c36cdcd6e", - "text": "Parmi les calendriers de vaccination actuellement appliqués figurent: administration de 3 doses primaires sans dose de rappel (3p + 0); Padministration de 2 doses primaires a 8 semaines d’intervalle suivies d’une dose de rappel (2p + 1); et celle de 3 doses primaires plus une dose de rappel (3p + 1).", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "", - "text_as_html": "Parmi les calendriers de vaccination actuellement appliqués figurent: administration de 3 doses primaires sans dose de rappel (3p + 0); Padministration de 2 doses primaires a 8 semaines d’intervalle suivies d’une dose de rappel (2p + 1); et celle de 3 doses primaires plus une dose de rappel (3p + 1).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 293.73, - "y0": 275.09, - "x1": 551.97, - "y1": 331.5 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "c4440458d90af3c5d764d1337b5fa50b", - "text": "D’aprés les instructions de la plupart des fabricants, la dose de rappel peut étre injectée entre 12 et 18 mois, selon les formu- lations. Certains fabricants recommandent une dose de rappel a Page de 5 ans.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "", - "text_as_html": "D’aprés les instructions de la plupart des fabricants, la dose de rappel peut étre injectée entre 12 et 18 mois, selon les formu- lations. Certains fabricants recommandent une dose de rappel a Page de 5 ans.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 293.69, - "y0": 338.47, - "x1": 550.1, - "y1": 382.7 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "26c64f9a8615149a3a2d06de7d1b3e12", - "text": "Les fabricants indiquent que le vaccin anti-Hib peut étre admi- nistré de maniére stire et efficace en méme temps que d’autres vaccinations systématiques faisant partie des programmes nationaux de vaccination. Si le vaccin anti-Hib fait objet d’une injection séparée en méme temps que l’administration d’autres vaccins, le site dinjection devra étre différent. Il ne devra pas étre mélangé dans un flacon ou dans une seringue avec un quelconque autre vaccin, 4 moins quil rait été spécifiquement fabriqué et autorisé pour un tel usage.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "", - "text_as_html": "Les fabricants indiquent que le vaccin anti-Hib peut étre admi- nistré de maniére stire et efficace en méme temps que d’autres vaccinations systématiques faisant partie des programmes nationaux de vaccination. Si le vaccin anti-Hib fait objet d’une injection séparée en méme temps que l’administration d’autres vaccins, le site dinjection devra étre différent. Il ne devra pas étre mélangé dans un flacon ou dans une seringue avec un quelconque autre vaccin, 4 moins quil rait été spécifiquement fabriqué et autorisé pour un tel usage.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 294.08, - "y0": 401.28, - "x1": 551.82, - "y1": 503.38 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-28", - "text": "\n\n\nImmunogénicité, efficience et efficacité\nDes études chez homme et chez l’animal sur les IgG anti-PRP ont établi quun titre de 0,15 g/ml était nécessaire pour confé- rer une protection 4 court terme contre les maladies a Hib invasives. Des études sur le terrain ont fixé un titre de 1 ug/ml, mesuré un mois aprés l’achévement de la série de primovacci- nation, comme le seuil requis pour conférer une protection a long terme contre les maladies 4 Hib invasives.'* Méme si des observations ultérieures laissent 4 penser que l’induction d’une mémoire immunologique peut étre un marqueur plus pertinent dune protection de longue durée,” ces seuils continuent d’étre utilisés par les organismes de réglementation pour l’évaluation clinique des vaccins, en association avec des données supplé- mentaires sur l’isotype et la composition en sous-classes, et sur Pavidité et Pactivité fonctionnelle des anticorps, y compris leur activité sérique bactéricide.”!\nLes vaccins anti-Hib conjugués actuellement disponibles présentent différents profils immunologiques, qui dépendent de\n» Eskola J et al. Combined vaccination of Haemophilus influenzae type b conjugate and diphtheria- tetanus-pertussis containing acellular pertussis. The Lancet, 1999, 354 (9195): 2063-2068.\nprotein. PRP-OMP has been shown to induce levels of anti-PRP antibodies above the set thresholds of 0.15yg/ ml or lpg/ml in a greater proportion of children after one dose than the other conjugate Hib vaccines.” For this reason, PRP-OMP has been used in populations with a high incidence of early onset disease. However, PRP-T and PRP-CRM197 elicit high levels of anti-PRP antibody after a 3-dose primary series.” All the Hib conjugate vaccines induce a strong response when given as a booster dose in the second year of life, though the booster response following PRP-OMP appears attenua- ted compared to those seen with PRP-T and PRP- CRM197.\"*\nThere is no conclusive evidence of differences in the immune response to monovalent or combined Hib con- jugate vaccines.” However, there is some evidence that Hib conjugate vaccine in combination with acellular pertussis (DTaP-Hib) induces a lower antibody response than Hib conjugate in combination with whole cell per- tussis (DTwP-Hib) or separately administered DTaP and Hib conjugate vaccines.\nThe introduction of Hib vaccine has dramatically reduced reported Hib diseases in the countries using it, regardless of their levels of development and economic status.\"\nRandomized controlled trials (RCTs) and observational studies of the clinical effectiveness of Hib vaccines against meningitis, pneumonia and other forms of in- vasive Hib disease have demonstrated that Hib vaccine effectively protects against these diseases.’ >”\nMajor declines in levels of nasopharyngeal Hib coloni- zation have also been observed following introduction of Hib conjugate vaccines. This has led to substantially greater reduction in disease incidence than can be directly attributed to the effects of the vaccine, suggest- ing that widespread use of the vaccine has resulted in the induction of herd protection.”", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "1bf1abd2515919ecd2a799cafee84fcc", - "text": "Immunogénicité, efficience et efficacité", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "", - "text_as_html": "Des études chez homme et chez l’animal sur les IgG anti-PRP ont établi quun titre de 0,15 g/ml était nécessaire pour confé- rer une protection 4 court terme contre les maladies a Hib invasives. Des études sur le terrain ont fixé un titre de 1 ug/ml, mesuré un mois aprés l’achévement de la série de primovacci- nation, comme le seuil requis pour conférer une protection a long terme contre les maladies 4 Hib invasives.'* Méme si des observations ultérieures laissent 4 penser que l’induction d’une mémoire immunologique peut étre un marqueur plus pertinent dune protection de longue durée,” ces seuils continuent d’étre utilisés par les organismes de réglementation pour l’évaluation clinique des vaccins, en association avec des données supplé- mentaires sur l’isotype et la composition en sous-classes, et sur Pavidité et Pactivité fonctionnelle des anticorps, y compris leur activité sérique bactéricide.”!
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 293.55, - "y0": 530.0, - "x1": 553.3, - "y1": 700.21 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "b536a249bf12cc192370b518e6e46af5", - "text": "Les vaccins anti-Hib conjugués actuellement disponibles présentent différents profils immunologiques, qui dépendent de", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "1bf1abd2515919ecd2a799cafee84fcc", - "text_as_html": "Les vaccins anti-Hib conjugués actuellement disponibles présentent différents profils immunologiques, qui dépendent de
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 7, - "coordinates": [ - { - "x0": 294.49, - "y0": 707.4, - "x1": 549.61, - "y1": 728.81 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "522af051568b5d1c27b77006bc7e7913", - "text": "» Eskola J et al. Combined vaccination of Haemophilus influenzae type b conjugate and diphtheria- tetanus-pertussis containing acellular pertussis. The Lancet, 1999, 354 (9195): 2063-2068.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "1bf1abd2515919ecd2a799cafee84fcc", - "text_as_html": "protein. PRP-OMP has been shown to induce levels of anti-PRP antibodies above the set thresholds of 0.15yg/ ml or lpg/ml in a greater proportion of children after one dose than the other conjugate Hib vaccines.” For this reason, PRP-OMP has been used in populations with a high incidence of early onset disease. However, PRP-T and PRP-CRM197 elicit high levels of anti-PRP antibody after a 3-dose primary series.” All the Hib conjugate vaccines induce a strong response when given as a booster dose in the second year of life, though the booster response following PRP-OMP appears attenua- ted compared to those seen with PRP-T and PRP- CRM197.\"*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 44.7, - "y0": 57.28, - "x1": 272.19, - "y1": 202.76 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "8fc4d4b63f10995901dfaed14bf862a5", - "text": "There is no conclusive evidence of differences in the immune response to monovalent or combined Hib con- jugate vaccines.” However, there is some evidence that Hib conjugate vaccine in combination with acellular pertussis (DTaP-Hib) induces a lower antibody response than Hib conjugate in combination with whole cell per- tussis (DTwP-Hib) or separately administered DTaP and Hib conjugate vaccines.", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "", - "text_as_html": "There is no conclusive evidence of differences in the immune response to monovalent or combined Hib con- jugate vaccines.” However, there is some evidence that Hib conjugate vaccine in combination with acellular pertussis (DTaP-Hib) induces a lower antibody response than Hib conjugate in combination with whole cell per- tussis (DTwP-Hib) or separately administered DTaP and Hib conjugate vaccines.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 44.68, - "y0": 234.45, - "x1": 272.71, - "y1": 324.58 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "9054bcf2d2b43c2690cccb137b1fc20a", - "text": "The introduction of Hib vaccine has dramatically reduced reported Hib diseases in the countries using it, regardless of their levels of development and economic status.\"", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "", - "text_as_html": "The introduction of Hib vaccine has dramatically reduced reported Hib diseases in the countries using it, regardless of their levels of development and economic status.\"
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 44.09, - "y0": 342.53, - "x1": 273.6, - "y1": 386.74 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5e033ba363ea4149df117584855af97c", - "text": "Randomized controlled trials (RCTs) and observational studies of the clinical effectiveness of Hib vaccines against meningitis, pneumonia and other forms of in- vasive Hib disease have demonstrated that Hib vaccine effectively protects against these diseases.’ >”", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "", - "text_as_html": "Randomized controlled trials (RCTs) and observational studies of the clinical effectiveness of Hib vaccines against meningitis, pneumonia and other forms of in- vasive Hib disease have demonstrated that Hib vaccine effectively protects against these diseases.’ >”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 45.86, - "y0": 393.81, - "x1": 272.45, - "y1": 450.6 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "d729e37104923d867b32fca85748351b", - "text": "Major declines in levels of nasopharyngeal Hib coloni- zation have also been observed following introduction of Hib conjugate vaccines. This has led to substantially greater reduction in disease incidence than can be directly attributed to the effects of the vaccine, suggest- ing that widespread use of the vaccine has resulted in the induction of herd protection.”", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "", - "text_as_html": "Major declines in levels of nasopharyngeal Hib coloni- zation have also been observed following introduction of Hib conjugate vaccines. This has led to substantially greater reduction in disease incidence than can be directly attributed to the effects of the vaccine, suggest- ing that widespread use of the vaccine has resulted in the induction of herd protection.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 45.31, - "y0": 457.08, - "x1": 273.37, - "y1": 536.62 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-29", - "text": "\n\n\nVaccination schedules\nAvailable evidence suggests that at least 3 doses are needed to achieve high vaccine efficacy and effective- ness. These can be administered as 3 primary doses without a booster (3p+0) or with a booster (3p+1), or 2 primary doses with a booster (2p+1).\n2 Watt J, Levine O, Santosham M. Global reduction of Hib disease: what are the next steps? Proceedings of the meeting, Scotsdale, Arizona, September 22-25, 2002. The Journal of Pediatrics, 203,143: $163-S187.\n* Bar-On ES et al. Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae b (Hib) (Review). Cochrane Database sys- tematic reviews, 2012.\n5 Grading of scientific evidence —Table 1: Clinical effectiveness of Hib vaccine against Hib invasive disease. Available at http://www.who.int/immunization/position_pa- pers/Hib_effectiveness.pdf\n6 Low et al. Comparing Haemophilus influenzae type b Conjugate Vaccine Schedules: A Systematic Review and Meta-Analysis of Vaccine Trials, Pediatric Infectious Disease Journat post-acceptance, June 2013, online PDF version only: http://jour- nals.lww.com/pidj/Abstract/publishahead/Comparing_Haemophilus_influenzae_ type_b_Conjugate.98295.aspx\nla protéine porteuse. Il a été montré que le vaccin PRP OMP induisait la production de titres d’anticorps anti-PRP supé- rieurs aux valeurs seuil fixées de 0,15ug/ml ou de 1 pg/ml chez une plus forte proportion d’enfants aprés |’administration une dose que d’autres vaccins anti-Hib conjugués.\" Pour cette raison, le PRP OMP est utilisé dans des populations présentant une forte incidence de l’apparition précoce de la maladie. Néan- moins, les vaccins PRP-T et PRP-CRM197 induisent la produc- tion de titres élevés d’anticorps anti-PRP aprés une série primaire de 3 doses. Tous les vaccins anti-Hib conjugués induisent une réponse forte lorsqu’on administre une dose de rappel au cours de la deuxiéme année de vie, méme si la réponse provoquée par la dose de rappel aprés administration du vaccin PRP-OMP semble atténuée par rapport a celle observée avec le PRP-T et le PRP-CRM197.\"*\nIl n’y a pas de preuve concluante de l’existence de différences dans la réponse immunitaire aux divers vaccins anti-Hib conju- gués monovalents ou combinés.”* Cependant, certains éléments indiquent quwun vaccin anti-Hib associé a un vaccin anticoque- lucheux acellulaire (DTaP-Hib) provoquerait une réponse en anticorps plus faible quune association vaccin anti Hib conju- gué-vaccin anticoquelucheux a cellules entiéres (DTwP-Hib) ou que l’administration séparée des vaccins DTaP et anti-Hib conjugué.\nLintroduction du vaccin anti-Hib a fait régresser considérable- ment le nombre de maladies 4 Hib notifiées dans les pays concernés, indépendamment de leur niveau de développement et de leur situation économique.\"\nDes essais contrélés randomisés (ECR) et des études d’obser- vation de l’efficacité clinique des vaccins anti-Hib contre la méningite, les pneumonies et d’autres formes de maladie a Hib invasives ont démontré que ces vaccins protégeaient efficace- ment contre ces maladies,’**>*°\nIl a également été observé des baisses de grande ampleur de la colonisation nasopharyngée par Hib suite a introduction des vaccins anti-Hib conjugués. Il en a résulté une diminution de Vincidence des maladies a Hib substantiellement plus impor- tante que celle imputable directement au vaccin, ce qui améne a penser que utilisation 4 grande échelle de celui-ci a induit une immunité collective.”", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "b6f3dc98e944f5f92e8ede27bd0afa75", - "text": "Vaccination schedules", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "", - "text_as_html": "Available evidence suggests that at least 3 doses are needed to achieve high vaccine efficacy and effective- ness. These can be administered as 3 primary doses without a booster (3p+0) or with a booster (3p+1), or 2 primary doses with a booster (2p+1).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 44.82, - "y0": 562.45, - "x1": 272.89, - "y1": 618.06 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "35574630582989185524c6558a7b879e", - "text": "2 Watt J, Levine O, Santosham M. Global reduction of Hib disease: what are the next steps? Proceedings of the meeting, Scotsdale, Arizona, September 22-25, 2002. The Journal of Pediatrics, 203,143: $163-S187.", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "b6f3dc98e944f5f92e8ede27bd0afa75", - "text_as_html": "la protéine porteuse. Il a été montré que le vaccin PRP OMP induisait la production de titres d’anticorps anti-PRP supé- rieurs aux valeurs seuil fixées de 0,15ug/ml ou de 1 pg/ml chez une plus forte proportion d’enfants aprés |’administration une dose que d’autres vaccins anti-Hib conjugués.\" Pour cette raison, le PRP OMP est utilisé dans des populations présentant une forte incidence de l’apparition précoce de la maladie. Néan- moins, les vaccins PRP-T et PRP-CRM197 induisent la produc- tion de titres élevés d’anticorps anti-PRP aprés une série primaire de 3 doses. Tous les vaccins anti-Hib conjugués induisent une réponse forte lorsqu’on administre une dose de rappel au cours de la deuxiéme année de vie, méme si la réponse provoquée par la dose de rappel aprés administration du vaccin PRP-OMP semble atténuée par rapport a celle observée avec le PRP-T et le PRP-CRM197.\"*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 293.75, - "y0": 57.0, - "x1": 552.06, - "y1": 226.75 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "70745f94faeb43c8190442d4bfb6754e", - "text": "Il n’y a pas de preuve concluante de l’existence de différences dans la réponse immunitaire aux divers vaccins anti-Hib conju- gués monovalents ou combinés.”* Cependant, certains éléments indiquent quwun vaccin anti-Hib associé a un vaccin anticoque- lucheux acellulaire (DTaP-Hib) provoquerait une réponse en anticorps plus faible quune association vaccin anti Hib conju- gué-vaccin anticoquelucheux a cellules entiéres (DTwP-Hib) ou que l’administration séparée des vaccins DTaP et anti-Hib conjugué.", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "b6f3dc98e944f5f92e8ede27bd0afa75", - "text_as_html": "Il n’y a pas de preuve concluante de l’existence de différences dans la réponse immunitaire aux divers vaccins anti-Hib conju- gués monovalents ou combinés.”* Cependant, certains éléments indiquent quwun vaccin anti-Hib associé a un vaccin anticoque- lucheux acellulaire (DTaP-Hib) provoquerait une réponse en anticorps plus faible quune association vaccin anti Hib conju- gué-vaccin anticoquelucheux a cellules entiéres (DTwP-Hib) ou que l’administration séparée des vaccins DTaP et anti-Hib conjugué.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 293.17, - "y0": 233.9, - "x1": 552.96, - "y1": 335.41 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "e522005ca7bc2268f1cc40ef61f811a4", - "text": "Lintroduction du vaccin anti-Hib a fait régresser considérable- ment le nombre de maladies 4 Hib notifiées dans les pays concernés, indépendamment de leur niveau de développement et de leur situation économique.\"", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "b6f3dc98e944f5f92e8ede27bd0afa75", - "text_as_html": "Lintroduction du vaccin anti-Hib a fait régresser considérable- ment le nombre de maladies 4 Hib notifiées dans les pays concernés, indépendamment de leur niveau de développement et de leur situation économique.\"
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 293.78, - "y0": 342.3, - "x1": 551.49, - "y1": 387.13 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "fca816ef1666a802122284a938524547", - "text": "Des essais contrélés randomisés (ECR) et des études d’obser- vation de l’efficacité clinique des vaccins anti-Hib contre la méningite, les pneumonies et d’autres formes de maladie a Hib invasives ont démontré que ces vaccins protégeaient efficace- ment contre ces maladies,’**>*°", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "b6f3dc98e944f5f92e8ede27bd0afa75", - "text_as_html": "Des essais contrélés randomisés (ECR) et des études d’obser- vation de l’efficacité clinique des vaccins anti-Hib contre la méningite, les pneumonies et d’autres formes de maladie a Hib invasives ont démontré que ces vaccins protégeaient efficace- ment contre ces maladies,’**>*°
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 293.14, - "y0": 395.24, - "x1": 551.92, - "y1": 449.36 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "511e734d5af545bd6e7384d95d6333c9", - "text": "Il a également été observé des baisses de grande ampleur de la colonisation nasopharyngée par Hib suite a introduction des vaccins anti-Hib conjugués. Il en a résulté une diminution de Vincidence des maladies a Hib substantiellement plus impor- tante que celle imputable directement au vaccin, ce qui améne a penser que utilisation 4 grande échelle de celui-ci a induit une immunité collective.”", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "b6f3dc98e944f5f92e8ede27bd0afa75", - "text_as_html": "Il a également été observé des baisses de grande ampleur de la colonisation nasopharyngée par Hib suite a introduction des vaccins anti-Hib conjugués. Il en a résulté une diminution de Vincidence des maladies a Hib substantiellement plus impor- tante que celle imputable directement au vaccin, ce qui améne a penser que utilisation 4 grande échelle de celui-ci a induit une immunité collective.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 292.95, - "y0": 457.07, - "x1": 552.58, - "y1": 536.17 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-30", - "text": "\n\n\nCalendriers de vaccination\nD’aprés les éléments disponibles, 3 doses au moins sont néces- saires pour obtenir une efficience et une efficacité vaccinales élevées. Ces doses peuvent étre administrées sous la forme de 3 doses primaires non suivies d'une dose de rappel (3p + 0) ou suivies d’une dose de rappel (3p + 1), ou encore sous la forme de 2 doses primaires plus une dose de rappel (2p + 1).\n23 Watt J, Levine O, Santosham M. Global reduction of Hib disease: what are the next steps? Pro- ceedings of the meeting, Scotsdale, Arizona, September 22-25, 2002. The Journal of Pediatrics, 2003,143: $163-S187.\nBar-On ES et al. Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophi- lus influenzae b (Hib) (Review). Cochrane Database systematic reviews, 2012.\nCotation des preuves scientifiques — Tableau 1: Clinical effectiveness of Hib vaccine against Hib invasive disease. Disponible uniquement en langue anglaise sur http://www.who.int/immuniza- tion/position_papers/Hib_effectiveness.pdf\nLow et al. Comparing Haemophilus influenzae type b Conjugate Vaccine Schedules: A Systematic Review and Meta-Analysis of Vaccine Trials, Pediatric Infectious Disease Journal post-accep- tance, June 2013, online PDF version only: http://journals.lww.com/pidj/Abstract/publishahead/ Comparing_Haemophilus_influenzae_type_b_Conjugate.98295.aspx.\n421\nSystematic reviews of both observational data and RCTs have found that the 2-dose and 3-dose primary schedules currently in use confer similar short-term levels of protection. However, one RCT has found that using 2 primary doses plus a booster dose induces anti-PRP antibodies above lyg/ml in a higher propor- tion of recipients than using a 3 primary dose sched- ule.!) 13, 26, 27\nTwo RCTs comparing 3 primary doses plus a booster (3p+1) with 2 primary doses plus a booster (2p+1) found that both schedules induced similar immuno- logical responses.”*\nComparison of a 3 primary doses plus a booster (3p+1) schedule with a 3 primary dose without booster (3p+0) schedule in 2 RCTs, found that the 3p+1 schedule in- duced greater responses above a set threshold than did the 3p+0 schedule.' !26 29\nAvailable data suggest that after 5 years of use of Hib conjugate vaccines, using a 3p+0 schedule, a sustained reduction in meningitis in young children has occurred in a number of developing countries. A recent evalua- tion from 4 South American countries reported that Hib meningitis rates were similar 6-10 years after introduc- tion of the vaccine in countries where booster doses were used and in those where boosters were not used.\"", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "e5037599256910574d4d09e9d6f3768c", - "text": "Calendriers de vaccination", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "", - "text_as_html": "D’aprés les éléments disponibles, 3 doses au moins sont néces- saires pour obtenir une efficience et une efficacité vaccinales élevées. Ces doses peuvent étre administrées sous la forme de 3 doses primaires non suivies d'une dose de rappel (3p + 0) ou suivies d’une dose de rappel (3p + 1), ou encore sous la forme de 2 doses primaires plus une dose de rappel (2p + 1).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 293.92, - "y0": 561.92, - "x1": 551.56, - "y1": 629.95 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "87875c70a9443f596ae3b95a0d96aa14", - "text": "23 Watt J, Levine O, Santosham M. Global reduction of Hib disease: what are the next steps? Pro- ceedings of the meeting, Scotsdale, Arizona, September 22-25, 2002. The Journal of Pediatrics, 2003,143: $163-S187.", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "e5037599256910574d4d09e9d6f3768c", - "text_as_html": "421
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 8, - "coordinates": [ - { - "x0": 538.78, - "y0": 779.62, - "x1": 548.85, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "581839b0d30981e6138bfa4b9af36894", - "text": "Systematic reviews of both observational data and RCTs have found that the 2-dose and 3-dose primary schedules currently in use confer similar short-term levels of protection. However, one RCT has found that using 2 primary doses plus a booster dose induces anti-PRP antibodies above lyg/ml in a higher propor- tion of recipients than using a 3 primary dose sched- ule.!) 13, 26, 27", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "e5037599256910574d4d09e9d6f3768c", - "text_as_html": "Systematic reviews of both observational data and RCTs have found that the 2-dose and 3-dose primary schedules currently in use confer similar short-term levels of protection. However, one RCT has found that using 2 primary doses plus a booster dose induces anti-PRP antibodies above lyg/ml in a higher propor- tion of recipients than using a 3 primary dose sched- ule.!) 13, 26, 27
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 9, - "coordinates": [ - { - "x0": 45.07, - "y0": 55.82, - "x1": 273.24, - "y1": 145.28 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "2fe548cc26a01d236a2937a9e957fa97", - "text": "Two RCTs comparing 3 primary doses plus a booster (3p+1) with 2 primary doses plus a booster (2p+1) found that both schedules induced similar immuno- logical responses.”*", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "e5037599256910574d4d09e9d6f3768c", - "text_as_html": "Two RCTs comparing 3 primary doses plus a booster (3p+1) with 2 primary doses plus a booster (2p+1) found that both schedules induced similar immuno- logical responses.”*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 9, - "coordinates": [ - { - "x0": 44.34, - "y0": 164.41, - "x1": 273.69, - "y1": 208.2 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "26ceb5d8d67cf691407cbee78ea07e87", - "text": "Comparison of a 3 primary doses plus a booster (3p+1) schedule with a 3 primary dose without booster (3p+0) schedule in 2 RCTs, found that the 3p+1 schedule in- duced greater responses above a set threshold than did the 3p+0 schedule.' !26 29", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "e5037599256910574d4d09e9d6f3768c", - "text_as_html": "Comparison of a 3 primary doses plus a booster (3p+1) schedule with a 3 primary dose without booster (3p+0) schedule in 2 RCTs, found that the 3p+1 schedule in- duced greater responses above a set threshold than did the 3p+0 schedule.' !26 29
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 9, - "coordinates": [ - { - "x0": 46.07, - "y0": 228.14, - "x1": 273.3, - "y1": 282.47 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "173cee4cad5df78252a0bf91ecc82d53", - "text": "Available data suggest that after 5 years of use of Hib conjugate vaccines, using a 3p+0 schedule, a sustained reduction in meningitis in young children has occurred in a number of developing countries. A recent evalua- tion from 4 South American countries reported that Hib meningitis rates were similar 6-10 years after introduc- tion of the vaccine in countries where booster doses were used and in those where boosters were not used.\"", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "e5037599256910574d4d09e9d6f3768c", - "text_as_html": "Available data suggest that after 5 years of use of Hib conjugate vaccines, using a 3p+0 schedule, a sustained reduction in meningitis in young children has occurred in a number of developing countries. A recent evalua- tion from 4 South American countries reported that Hib meningitis rates were similar 6-10 years after introduc- tion of the vaccine in countries where booster doses were used and in those where boosters were not used.\"
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 9, - "coordinates": [ - { - "x0": 44.49, - "y0": 302.46, - "x1": 273.14, - "y1": 393.11 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-31", - "text": "\n\n\nAge at vaccination\nThe age at vaccination may be important for immuno- genicity and vaccine effectiveness. A study in British children found that the immune response to a PRP-T booster dose increased with increasing age.*° Data from 6 cohort studies suggests that starting vaccination at an older age may lead to higher vaccine effectiveness against invasive Hib disease,” but this needs to be balanced against the age of onset and peak incidence of disease which may vary between populations. Specific country evidence suggests a need for early primary vac- cination in settings with epidemiological characteristics favouring high Hib transmission at a younger age.”\n27 Grading of scientific evidence —Table 2: Hib vaccination schedules: 3 primary doses versus 2 primary doses plus one booster dose. Available at http://www.who.int/ immunization/position_papers/Hib_schedule_3p0_vs_2p1.pdf\nGrading of scientific evidence —Table 3: Hib vaccination schedules: 3 primary doses plus one booster dose versus 2 primary doses plus one booster dose. Avai- lable at http://www.who.int/immunization/position_papers/Hib_schedule_3p1 vs_2p1.pdf\nGrading of scientific evidence —Table 4: Hib vaccination schedules: 3 primary doses plus one booster versus 3 primary doses only. Available at http:/www.who.int/im- munization/position_papers/Hib_schedule_3p1_vs_3p0.pdf\nSouthern J et al. Immunogenicity of a fourth dose of Haemophilus influenzae type b Hib conjugate vaccine and antibody persistence in young children from the United Kingdom who were primed with acellular or whole cell pertussis component-contai- ning Hib combinations. Clinical Vaccine Immunology, 2007, 14 (10): 1328-1333.\nGalil K SR. Reemergence of invasive Haemophilus influenzae type b disease in a well-vaccinated population in remote Alaska. Journal of infectious Disease, 1999, 179:101-106.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "859e5b397696ecefe2b7283dd75be194", - "text": "Age at vaccination", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "", - "text_as_html": "The age at vaccination may be important for immuno- genicity and vaccine effectiveness. A study in British children found that the immune response to a PRP-T booster dose increased with increasing age.*° Data from 6 cohort studies suggests that starting vaccination at an older age may lead to higher vaccine effectiveness against invasive Hib disease,” but this needs to be balanced against the age of onset and peak incidence of disease which may vary between populations. Specific country evidence suggests a need for early primary vac- cination in settings with epidemiological characteristics favouring high Hib transmission at a younger age.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 9, - "coordinates": [ - { - "x0": 44.93, - "y0": 430.6, - "x1": 273.26, - "y1": 566.97 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "7c80026200025e35034708b44c053905", - "text": "27 Grading of scientific evidence —Table 2: Hib vaccination schedules: 3 primary doses versus 2 primary doses plus one booster dose. Available at http://www.who.int/ immunization/position_papers/Hib_schedule_3p0_vs_2p1.pdf", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "859e5b397696ecefe2b7283dd75be194", - "text_as_html": "Des revues systématiques d’études observationnelles et de ECR ont mis en évidence que les calendriers comprenant 2 doses et 3 doses primaires actuellement en usage conféraient de maniére similaire une protection de courte durée. Cependant, un des essais a constaté que l’utilisation de 2 doses primaires plus une dose de rappel induisait un titre d’anticorps anti-PRP supérieur a 1 pg/ml chez une plus forte proportion des individus vaccinés que ladministration d’un calendrier constitué de 3 doses primaires,!» ' 27
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 9, - "coordinates": [ - { - "x0": 293.59, - "y0": 56.1, - "x1": 552.68, - "y1": 156.28 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "76ab17e40a840973eb8021ed05d82473", - "text": "Deux ECR comparant un calendrier de vaccination composé de 3 doses primaires plus une dose de rappel (3p + 1) et un autre calendrier comprenant 2 doses primaires plus une dose de rappel (2p + 1) ont constaté que les deux généraient des réponses immunitaires similaires.*", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "18a31422d9b35c2ffd76014bd78c50f0", - "text_as_html": "Deux ECR comparant un calendrier de vaccination composé de 3 doses primaires plus une dose de rappel (3p + 1) et un autre calendrier comprenant 2 doses primaires plus une dose de rappel (2p + 1) ont constaté que les deux généraient des réponses immunitaires similaires.*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 9, - "coordinates": [ - { - "x0": 295.56, - "y0": 164.52, - "x1": 551.56, - "y1": 220.58 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "6b3db135a2e699e71be00daf9e84e075", - "text": "La comparaison, dans le cadre de 2 ECR, entre un calendrier prévoyant 3 doses primaires plus une dose de rappel (3p + 1) et un autre calendrier comprenant 3 doses primaires sans dose de rappel (3p + 0), a relevé pour le calendrier 3p + 1 des réponses immunitaires supérieures 4 un seuil défini de plus grande ampleur que pour le calendrier 3p + 0.121262", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "18a31422d9b35c2ffd76014bd78c50f0", - "text_as_html": "La comparaison, dans le cadre de 2 ECR, entre un calendrier prévoyant 3 doses primaires plus une dose de rappel (3p + 1) et un autre calendrier comprenant 3 doses primaires sans dose de rappel (3p + 0), a relevé pour le calendrier 3p + 1 des réponses immunitaires supérieures 4 un seuil défini de plus grande ampleur que pour le calendrier 3p + 0.121262
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 9, - "coordinates": [ - { - "x0": 294.01, - "y0": 227.9, - "x1": 552.43, - "y1": 294.84 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4939a00528041af65e5b4e9260e15e20", - "text": "D’aprés les données disponibles, il apparaitrait quaprés 5 ans utilisation des vaccins anti Hib conjugués avec un calendrier de type 3p + 0, une régression durable de la méningite chez les jeunes enfants soit intervenue dans un certain nombre de pays en développement. Une évaluation récente, réalisée dans 4 pays d’Amérique du Sud, a signalé que les taux de méningite étaient similaires 6 a 10 ans aprés l’introduction du vaccin dans les pays pratiquant une dose de rappel et dans ceux ot lon nen administrait pas.’", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "18a31422d9b35c2ffd76014bd78c50f0", - "text_as_html": "D’aprés les données disponibles, il apparaitrait quaprés 5 ans utilisation des vaccins anti Hib conjugués avec un calendrier de type 3p + 0, une régression durable de la méningite chez les jeunes enfants soit intervenue dans un certain nombre de pays en développement. Une évaluation récente, réalisée dans 4 pays d’Amérique du Sud, a signalé que les taux de méningite étaient similaires 6 a 10 ans aprés l’introduction du vaccin dans les pays pratiquant une dose de rappel et dans ceux ot lon nen administrait pas.’
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 9, - "coordinates": [ - { - "x0": 295.28, - "y0": 302.19, - "x1": 552.07, - "y1": 404.15 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-33", - "text": "\n\n\nAge lors de la vaccination\nLage au moment de la vaccination peut étre important pour Pimmunogénicité et Pefficacité du vaccin. Une étude menée sur des enfants britanniques a constaté que la réponse immunitaire a une dose de rappel de PRP-T augmentait avec lage.” Les données tirées de 6 études de cohorte laissent 4 penser que débuter la vaccination a un age plus avancé pourrait conduire a une plus grande efficacité vaccinale contre les maladies a Hib invasives,'”” mais cette observation doit étre mise en balance avec l’age d’apparition et le pic d’incidence de ces maladies qui peuvent varier d’une population a l’autre. D’aprés l’examen des données par pays, une primovaccination plus précoce serait nécessaire dans les contextes ou les caractéristiques épidémio- logiques favorisent une forte transmission de Hib chez les trés jeunes enfants.”\n7 Cotation des preuves scientifiques — Tableau 2: Hib vaccination schedules: 3 primary doses versus 2 primary doses plus one booster dose. Disponible uniquement en langue anglaise sur http:/www.who.int/immunization/position_papers/Hib_schedule_3p0_vs_2p1.pdf\nCotation des preuves scientifiques — Tableau 3: Hib vaccination schedules: 3 primary doses plus one booster dose versus 2 primary doses plus one booster dose. Disponible uniquement en langue anglaise sur http:/wvww.who.int/immunization/position_papers/Hib_schedule_3p1_ vs_2p1.pdf\nCotation des preuves scientifiques — Tableau 4: Hib vaccination schedules: 3 primary doses plus one booster versus 3 primary doses only. Disponible uniquement en langue anglaise sur http:// www.who.int/immunization/position_papers/Hib_schedule_3p1_vs_3p0.pdf\nSouthern J et al. Immunogenicity of a fourth dose of Haemophilus influenzae type b Hib conju- gate vaccine and antibody persistence in young children from the United Kingdom who were primed with acellular or whole cell pertussis component-containing Hib combinations. Clinical Vaccine Immunology, 2007, 14 (10): 1328-1333.\nGalil K SR. Reemergence of invasive Haemophilus influenzae type b disease in a well-vaccinated population in remote Alaska. Journal of infectious disease, 1999, 179:101-106.\nWEEKLY EPIDEMIOLOGICAL RECORD, NO. 39, 27 SEPTEMBER 2013", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "b18b01a5af45b73a705b8f3e4c5a612e", - "text": "Age lors de la vaccination", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "", - "text_as_html": "Lage au moment de la vaccination peut étre important pour Pimmunogénicité et Pefficacité du vaccin. Une étude menée sur des enfants britanniques a constaté que la réponse immunitaire a une dose de rappel de PRP-T augmentait avec lage.” Les données tirées de 6 études de cohorte laissent 4 penser que débuter la vaccination a un age plus avancé pourrait conduire a une plus grande efficacité vaccinale contre les maladies a Hib invasives,'”” mais cette observation doit étre mise en balance avec l’age d’apparition et le pic d’incidence de ces maladies qui peuvent varier d’une population a l’autre. D’aprés l’examen des données par pays, une primovaccination plus précoce serait nécessaire dans les contextes ou les caractéristiques épidémio- logiques favorisent une forte transmission de Hib chez les trés jeunes enfants.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 9, - "coordinates": [ - { - "x0": 294.78, - "y0": 430.37, - "x1": 552.47, - "y1": 588.96 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "e4b53d6df705d8d0dea33612dcd2029a", - "text": "7 Cotation des preuves scientifiques — Tableau 2: Hib vaccination schedules: 3 primary doses versus 2 primary doses plus one booster dose. Disponible uniquement en langue anglaise sur http:/www.who.int/immunization/position_papers/Hib_schedule_3p0_vs_2p1.pdf", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "b18b01a5af45b73a705b8f3e4c5a612e", - "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 39, 27 SEPTEMBER 2013
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 9, - "coordinates": [ - { - "x0": 377.42, - "y0": 778.91, - "x1": 550.51, - "y1": 786.25 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-34", - "text": "\n\n\nDuration of protection\nAlthough there is some evidence of a decrease over time in the proportion of Hib vaccine recipients with anti- body levels higher than the set thresholds, there is only limited evidence to suggest that this decline is associ- ated with an increase in clinical disease. After success- fully controlling Hib disease with a 3-dose primary schedule, a few countries have reported small increases in incidence, but these are much lower than levels seen in the pre-vaccine era.'’ * However, such resurgences may not occur until many years after vaccine introduc- tion, as was observed in the United Kingdom where resurgence in invasive Hib disease was reported after a decade of successful Hib control, requiring the intro- duction of a booster dose.*\nThere is currently insufficient information to determine whether or not there is a need for a booster dose, which may be influenced by local epidemiology, co-adminis- tered vaccines, and the potential for natural boosting as well as other factors. This uncertainty underscores the need for continuing high quality surveillance for Hib diseases.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "c7b058e26cdb2e5d3d128cc2971edb1a", - "text": "Duration of protection", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "", - "text_as_html": "Although there is some evidence of a decrease over time in the proportion of Hib vaccine recipients with anti- body levels higher than the set thresholds, there is only limited evidence to suggest that this decline is associ- ated with an increase in clinical disease. After success- fully controlling Hib disease with a 3-dose primary schedule, a few countries have reported small increases in incidence, but these are much lower than levels seen in the pre-vaccine era.'’ * However, such resurgences may not occur until many years after vaccine introduc- tion, as was observed in the United Kingdom where resurgence in invasive Hib disease was reported after a decade of successful Hib control, requiring the intro- duction of a booster dose.*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 10, - "coordinates": [ - { - "x0": 44.78, - "y0": 69.81, - "x1": 272.52, - "y1": 228.59 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4288cdf21acd266572e5ca14db3a6f87", - "text": "There is currently insufficient information to determine whether or not there is a need for a booster dose, which may be influenced by local epidemiology, co-adminis- tered vaccines, and the potential for natural boosting as well as other factors. This uncertainty underscores the need for continuing high quality surveillance for Hib diseases.", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "c7b058e26cdb2e5d3d128cc2971edb1a", - "text_as_html": "There is currently insufficient information to determine whether or not there is a need for a booster dose, which may be influenced by local epidemiology, co-adminis- tered vaccines, and the potential for natural boosting as well as other factors. This uncertainty underscores the need for continuing high quality surveillance for Hib diseases.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 10, - "coordinates": [ - { - "x0": 44.64, - "y0": 258.13, - "x1": 272.07, - "y1": 337.53 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-35", - "text": "\n\n\nInterval between doses\nSystematic reviews found no consistent or clinically rel- evant differences in terms of immunogenicity or disease outcomes between the use of shorter (e.g. 4 weeks) and longer (e.g. 8 weeks) intervals between the 3 doses of 3-dose primary schedules. However, it is important to note that an interval of at least 8 weeks was the only interval used for the primary doses in the studies assessing the 2+1 schedule.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "ffc4ca9e00fbffbf09c72d2a5e435f80", - "text": "Interval between doses", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "", - "text_as_html": "Systematic reviews found no consistent or clinically rel- evant differences in terms of immunogenicity or disease outcomes between the use of shorter (e.g. 4 weeks) and longer (e.g. 8 weeks) intervals between the 3 doses of 3-dose primary schedules. However, it is important to note that an interval of at least 8 weeks was the only interval used for the primary doses in the studies assessing the 2+1 schedule.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 10, - "coordinates": [ - { - "x0": 45.49, - "y0": 363.22, - "x1": 273.29, - "y1": 453.47 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-36", - "text": "\n\n\nSpecial risk groups\nLimited evidence (mainly from South Africa) suggests that HIV-infected children would benefit from receiving a booster dose regardless of the number of primary doses received and regardless of anti-retroviral therapy.’\nRecent evidence suggests that individuals with immuno- suppression caused by etiologies other than HIV are at greater risk of infection with non-typeable Haemophi- lus influenzae. There is insufficient evidence to indicate a significant risk of developing Hib diseases and, there- fore, there is no reason to promote a booster dose in such populations.** *\n2 Von Gottberg A. Invasive disease due to Haemophilus influenzae serotype b ten years after routine, South Africa, 2003-2009. Vaccine, 2012, 30(3): 565-571.\n® Ladhani S et al. Long-Term Immunological Follow-Up of Children with Haemophilus influenzae serotype b vaccine failure in the United Kingdom. Clinical Infectious Diseases, 2009, 49:372-380.\n* Hawdon et al. Antibody against Haemophilus influenzae protein D in patients with chronic conditions causing secondary immunodeficiency. Vaccine, 2012, 30(7):1235-1238,\n5 Samuelson et al. Characterization of Haemophilus influenzae isolates from the res- piratory tract of patients with primary antibody deficiencies: evidence for persistent colonizations. Scandinavian Journal of Infectious Disease, 1995,27(4):303-313.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 39, 27 SEPTEMBRE 2013", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "81c67746afcf3cb61fc8370ccae07864", - "text": "Special risk groups", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "", - "text_as_html": "Limited evidence (mainly from South Africa) suggests that HIV-infected children would benefit from receiving a booster dose regardless of the number of primary doses received and regardless of anti-retroviral therapy.’
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 10, - "coordinates": [ - { - "x0": 45.2, - "y0": 479.13, - "x1": 272.71, - "y1": 534.95 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "69373f3a7a30e581063729bacb2bc045", - "text": "Recent evidence suggests that individuals with immuno- suppression caused by etiologies other than HIV are at greater risk of infection with non-typeable Haemophi- lus influenzae. There is insufficient evidence to indicate a significant risk of developing Hib diseases and, there- fore, there is no reason to promote a booster dose in such populations.** *", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "81c67746afcf3cb61fc8370ccae07864", - "text_as_html": "Recent evidence suggests that individuals with immuno- suppression caused by etiologies other than HIV are at greater risk of infection with non-typeable Haemophi- lus influenzae. There is insufficient evidence to indicate a significant risk of developing Hib diseases and, there- fore, there is no reason to promote a booster dose in such populations.** *
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 10, - "coordinates": [ - { - "x0": 46.08, - "y0": 542.5, - "x1": 272.9, - "y1": 619.9 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "3c3047d7cfcff4023cabe3e3f2f8c5a4", - "text": "2 Von Gottberg A. Invasive disease due to Haemophilus influenzae serotype b ten years after routine, South Africa, 2003-2009. Vaccine, 2012, 30(3): 565-571.", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "81c67746afcf3cb61fc8370ccae07864", - "text_as_html": "Méme s'il existe certaines preuves d’une diminution avec le temps du pourcentage d’individus ayant recu le vaccin anti-Hib qui présentent des titres d’anticorps supérieurs aux seuils défi- nis, les éléments suggérant que cette baisse soit associée 4 une progression de la maladie clinique sont limités. Aprés avoir endigué avec succés les maladies 4 Hib avec un calendrier comprenant 3 doses primaires, quelques pays ont signalé de faibles augmentations de l’incidence de ces maladies, mais ces augmentations aboutissent a une incidence bien plus basse que les niveaux observés avant l’ére de la vaccination.’ Toutefois, si elles surviennent, de telles recrudescences ne peuvent se produire que de nombreuses années aprés l’introduction du vaccin, comme cela a été observé au Royaume-Uni oti une résur- gence des maladies a Hib invasives a été rapportée aprés une décennie de succés dans la maitrise de ce germe, ce qui a imposé lintroduction d’une dose de rappel.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 10, - "coordinates": [ - { - "x0": 294.14, - "y0": 69.53, - "x1": 554.03, - "y1": 250.43 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4d3c9614e98cc43d056e5b80c0e8eebd", - "text": "Les informations disponibles sont actuellement insuffisantes pour déterminer si une dose de rappel est nécessaire ou non, nécessité qui peut déprendre de l’épidémiologie locale, des vaccins coadministrés, des possibilités de renforcement naturel et d’autres facteurs. Cette incertitude souligne importance de poursuivre une surveillance de haute qualité des maladies a Hib.", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "f019e96fb4856592ecc9ee2a3fe07b73", - "text_as_html": "Les informations disponibles sont actuellement insuffisantes pour déterminer si une dose de rappel est nécessaire ou non, nécessité qui peut déprendre de l’épidémiologie locale, des vaccins coadministrés, des possibilités de renforcement naturel et d’autres facteurs. Cette incertitude souligne importance de poursuivre une surveillance de haute qualité des maladies a Hib.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 10, - "coordinates": [ - { - "x0": 294.08, - "y0": 258.21, - "x1": 552.29, - "y1": 337.22 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-38", - "text": "\n\n\nIntervalle entre les doses\nLes revues systématiques n’ont relevé aucune différence régu- ligre ou cliniquement pertinente dans l’immunogénicité ou les issues de la maladie entre l’administration des 3 doses primaires avec un intervalle court (4 semaines, par exemple) et leur injec- tion avec un intervalle plus long (8 semaines, par exemple). Cependant, il est important de noter que le seul intervalle utilisé entre les doses primaires dans les études évaluant le calendrier 2+ 1 était Pintervalle d’au moins 8 semaines.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "046fc012459e287d265c0a4525fc12d5", - "text": "Intervalle entre les doses", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "", - "text_as_html": "Les revues systématiques n’ont relevé aucune différence régu- ligre ou cliniquement pertinente dans l’immunogénicité ou les issues de la maladie entre l’administration des 3 doses primaires avec un intervalle court (4 semaines, par exemple) et leur injec- tion avec un intervalle plus long (8 semaines, par exemple). Cependant, il est important de noter que le seul intervalle utilisé entre les doses primaires dans les études évaluant le calendrier 2+ 1 était Pintervalle d’au moins 8 semaines.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 10, - "coordinates": [ - { - "x0": 293.76, - "y0": 363.2, - "x1": 551.74, - "y1": 453.44 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-39", - "text": "\n\n\nGroupes a risque spéciaux\nDes éléments limités (provenant principalement d’Afrique du Sud) laissent 4 penser que les enfants infectés par le VIH devraient tirer bénéfice d’une dose de rappel, indépendamment du nombre de doses primaires recues et de la prise d’un trai- tement antirétroviral.’\nD’aprés des données récentes, les individus dont ’immunodé- pression a d’autres causes que le VIH seraient exposés a un plus grand risque d’infection par Haemophilus influenzae non typable. Les données sont insuffisantes pour indiquer un risque significatif de développer une maladie a Hib et il n’y a donc pas de raison de promouvoir l’administration d’une dose de rappel a ces populations. *\n2 Von Gottberg A. Invasive disease due to Haemophilus influenzae serotype b ten years after routine, South Africa, 2003-2009. Vaccine, 2012, 30(3): 565-571.\n33 Ladhani S et al. Long-Term Immunological Follow-Up of Children with Haemophilus influenzae serotype b vaccine failure in the United Kingdom. Clinical Infectious Diseases, 2009, 49:372- 380.\n3 Hawdon et al. Antibody against Haemophilus influenzae protein D in patients with chronic conditions causing secondary immunodeficiency. Vaccine, 2012, 30(7):1235-1238.\n35 Samuelson et al. Characterization of Haemophilus influenzae isolates from the respiratory tract of patients with primary antibody deficiencies: evidence for persistent colonizations. Scandina- vian Journal of Infectious Disease, 1995,27(4):303-313.\n423", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "894296511d76d60a3485951b5fcd4cb1", - "text": "Groupes a risque spéciaux", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "", - "text_as_html": "Des éléments limités (provenant principalement d’Afrique du Sud) laissent 4 penser que les enfants infectés par le VIH devraient tirer bénéfice d’une dose de rappel, indépendamment du nombre de doses primaires recues et de la prise d’un trai- tement antirétroviral.’
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 10, - "coordinates": [ - { - "x0": 295.56, - "y0": 479.55, - "x1": 551.37, - "y1": 534.64 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "642e1d6339309b9c0e983b43bd97d4ee", - "text": "D’aprés des données récentes, les individus dont ’immunodé- pression a d’autres causes que le VIH seraient exposés a un plus grand risque d’infection par Haemophilus influenzae non typable. Les données sont insuffisantes pour indiquer un risque significatif de développer une maladie a Hib et il n’y a donc pas de raison de promouvoir l’administration d’une dose de rappel a ces populations. *", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "894296511d76d60a3485951b5fcd4cb1", - "text_as_html": "D’aprés des données récentes, les individus dont ’immunodé- pression a d’autres causes que le VIH seraient exposés a un plus grand risque d’infection par Haemophilus influenzae non typable. Les données sont insuffisantes pour indiquer un risque significatif de développer une maladie a Hib et il n’y a donc pas de raison de promouvoir l’administration d’une dose de rappel a ces populations. *
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 10, - "coordinates": [ - { - "x0": 293.11, - "y0": 542.3, - "x1": 552.96, - "y1": 620.85 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "23a063142cd32bc54ed70c38d17505ee", - "text": "2 Von Gottberg A. Invasive disease due to Haemophilus influenzae serotype b ten years after routine, South Africa, 2003-2009. Vaccine, 2012, 30(3): 565-571.", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "894296511d76d60a3485951b5fcd4cb1", - "text_as_html": "423
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 10, - "coordinates": [ - { - "x0": 538.78, - "y0": 779.62, - "x1": 549.57, - "y1": 784.66 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-40", - "text": "\n\n\nAdverse events\nInjection site reactions are common following the administration of Hib vaccines, with 20%-25% of vaccinees experiencing pain and tenderness at the injection site within 24 hours. The rates did not differ according to the injection site. These reactions are usually mild and transient, resolving spontaneously within 3 days.** Fever occurs in 2% of vaccinees.””\nSerious adverse events after administration of Hib vac- cine, whether given as a monovalent vaccine or in com- bination with other antigens, are uncommon, making it one of the safest vaccines currently available.In a study of >4000 infants, there were no differences in the type and frequency of severe adverse events occurring among those receiving Hib conjugate vaccine and those receiving a placebo.*\nAnaphylaxis was not reported during pre-licensing clin- ical trials. Post-marketing surveillance has identified very few possible cases; from available data, no firm conclusions can be drawn about a causal relationship between Hib vaccine and anaphylaxis.”", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "6f98e82fb3065e7275da78f4b9663f44", - "text": "Adverse events", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "", - "text_as_html": "Injection site reactions are common following the administration of Hib vaccines, with 20%-25% of vaccinees experiencing pain and tenderness at the injection site within 24 hours. The rates did not differ according to the injection site. These reactions are usually mild and transient, resolving spontaneously within 3 days.** Fever occurs in 2% of vaccinees.””
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 11, - "coordinates": [ - { - "x0": 45.05, - "y0": 69.39, - "x1": 273.69, - "y1": 147.79 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "db0e55d1224c2f3f31eda04335358899", - "text": "Serious adverse events after administration of Hib vac- cine, whether given as a monovalent vaccine or in com- bination with other antigens, are uncommon, making it one of the safest vaccines currently available.In a study of >4000 infants, there were no differences in the type and frequency of severe adverse events occurring among those receiving Hib conjugate vaccine and those receiving a placebo.*", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "6f98e82fb3065e7275da78f4b9663f44", - "text_as_html": "Serious adverse events after administration of Hib vac- cine, whether given as a monovalent vaccine or in com- bination with other antigens, are uncommon, making it one of the safest vaccines currently available.In a study of >4000 infants, there were no differences in the type and frequency of severe adverse events occurring among those receiving Hib conjugate vaccine and those receiving a placebo.*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 11, - "coordinates": [ - { - "x0": 44.8, - "y0": 167.15, - "x1": 272.72, - "y1": 256.68 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "7bbf6e2a3a3a906062ada3622cbf3693", - "text": "Anaphylaxis was not reported during pre-licensing clin- ical trials. Post-marketing surveillance has identified very few possible cases; from available data, no firm conclusions can be drawn about a causal relationship between Hib vaccine and anaphylaxis.”", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "6f98e82fb3065e7275da78f4b9663f44", - "text_as_html": "Anaphylaxis was not reported during pre-licensing clin- ical trials. Post-marketing surveillance has identified very few possible cases; from available data, no firm conclusions can be drawn about a causal relationship between Hib vaccine and anaphylaxis.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 11, - "coordinates": [ - { - "x0": 45.5, - "y0": 275.24, - "x1": 273.27, - "y1": 331.89 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-41", - "text": "\n\n\nCost-effectiveness\nA review of cost-effectiveness studies identified 17 pa- pers examining the cost-effectiveness of Hib vaccine use in 14 countries.” Different methods were used to evalu- ate benefits, such as comparing the annual cost of Hib vaccination with gains achieved by reduction in disease, or costs per QALY gained, making inter-country com- parisons impossible. However, most studies concluded that Hib vaccination represented good value for money. Only 2 reports - one from Moscow which estimated much higher costs per DALY averted (due to high cost of the vaccine and low incidence of Hib disease) and one from South Korea - found Hib vaccine not to be cost-effective.\nSince publication of these papers, Hib vaccine prices have decreased substantially as additional manufactur- ers have entered the market. A regional cost-effective- ness analysis of Hib vaccine based on these lower vaccine prices, in addition to new evidence on substan- tial productivity loss due to meningitis sequelae in a\n36 Fritzell BPS. Efficacy and safety of a Haemophilus type b capsular polysaccharide- tetanus protein conjugate. Journal of Pediatrics, 1992,121:355-362.\nValdheim CM et al. Safety evaluation of PRP-D Haemophilus influenzae type b conjugate in children immunized at 18 months of age and older: Follow-up study of 30 000 children. Pediatric Infectious Disease Journal, 1990, 9:555-561.\nUS Centers for Disease Control and Prevention. Haemophilus b conjugate vaccines for prevention of Haemophilus influenzae type b disease among infants and child- ren. Recommendations of the advisory committee on immunization practices (ACIP).combined diptheria, tetanus. Morbidity and Mortality Weekly report, 40 (RR1): 1-7.\nInformation sheet on observed rate of vaccine ractions. Geneva, World Health Orga- nization (Department of Global Vaccine Safety, Immunization, Vaccines and Biolo- gicals), 2012. Available at http:/www.who.int/entity/vaccine_safety/initiative/ tools/HiB_Vaccine_rates_information_sheet.pdf; accessed September 2013.\nGriffiths UK. Economic evaluations of Haemophilus influenzae type b vaccine: sys- tematic review of the literature. Expert Reviews Pharmacoeconomic Outcomes Research, 2009, 9(4):333-346.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "0d97b9f51d10ec7045b4b3fea03bb949", - "text": "Cost-effectiveness", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "", - "text_as_html": "A review of cost-effectiveness studies identified 17 pa- pers examining the cost-effectiveness of Hib vaccine use in 14 countries.” Different methods were used to evalu- ate benefits, such as comparing the annual cost of Hib vaccination with gains achieved by reduction in disease, or costs per QALY gained, making inter-country com- parisons impossible. However, most studies concluded that Hib vaccination represented good value for money. Only 2 reports - one from Moscow which estimated much higher costs per DALY averted (due to high cost of the vaccine and low incidence of Hib disease) and one from South Korea - found Hib vaccine not to be cost-effective.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 11, - "coordinates": [ - { - "x0": 44.95, - "y0": 369.61, - "x1": 273.95, - "y1": 516.64 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4cd40540abbd085fcffc864e8ba233c7", - "text": "Since publication of these papers, Hib vaccine prices have decreased substantially as additional manufactur- ers have entered the market. A regional cost-effective- ness analysis of Hib vaccine based on these lower vaccine prices, in addition to new evidence on substan- tial productivity loss due to meningitis sequelae in a", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "0d97b9f51d10ec7045b4b3fea03bb949", - "text_as_html": "Since publication of these papers, Hib vaccine prices have decreased substantially as additional manufactur- ers have entered the market. A regional cost-effective- ness analysis of Hib vaccine based on these lower vaccine prices, in addition to new evidence on substan- tial productivity loss due to meningitis sequelae in a
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 11, - "coordinates": [ - { - "x0": 45.73, - "y0": 535.29, - "x1": 272.53, - "y1": 602.97 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "cef91c6ec015fc74d6aa00be0695b765", - "text": "36 Fritzell BPS. Efficacy and safety of a Haemophilus type b capsular polysaccharide- tetanus protein conjugate. Journal of Pediatrics, 1992,121:355-362.", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "0d97b9f51d10ec7045b4b3fea03bb949", - "text_as_html": "Les réactions au site d’injection sont courantes aprés l’admi- nistration d’un vaccin anti-Hib, 20 a 25% des personnes vacci- nées éprouvant de la douleur ou une sensibilité au niveau du point d’injection dans les 24 heures qui suivent. Les taux de réaction ne varient pas en fonction du site d’injection. Ces réac- tions sont habituellement bénignes, transitoires et spontané- ment résolutives dans les 3 jours. De la fiévre apparait chez 2% des personnes vaccinées.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 11, - "coordinates": [ - { - "x0": 294.57, - "y0": 68.94, - "x1": 552.5, - "y1": 158.23 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "e6c3a6abfd6c56fd4761cbd35c0e10ce", - "text": "Les manifestations indésirables graves sont rares aprés linjec- tion du vaccin anti-Hib lorsque celui-ci est administré sous forme de vaccin monovalent ou en association avec d’autres antigénes, ce qui en fait l'un des vaccins les plus stirs actuelle- ment disponibles. Dans le cadre d’une étude portant sur >4000 nourrissons, on n’a relevé aucune différence concernant le type et la fréquence des manifestations indésirables graves entre les enfants ayant recu le vaccin anti-Hib conjugué et ceux ayant recu un placebo.**", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "02a632a9fa445f53575e74eaf8ac66c1", - "text_as_html": "Les manifestations indésirables graves sont rares aprés linjec- tion du vaccin anti-Hib lorsque celui-ci est administré sous forme de vaccin monovalent ou en association avec d’autres antigénes, ce qui en fait l'un des vaccins les plus stirs actuelle- ment disponibles. Dans le cadre d’une étude portant sur >4000 nourrissons, on n’a relevé aucune différence concernant le type et la fréquence des manifestations indésirables graves entre les enfants ayant recu le vaccin anti-Hib conjugué et ceux ayant recu un placebo.**
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 11, - "coordinates": [ - { - "x0": 293.66, - "y0": 166.71, - "x1": 553.62, - "y1": 267.38 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5b7a5c5bef6c56d09798c3deb25eb9d5", - "text": "Il ra pas été rapporté de réaction anaphylactique pendant les essais cliniques préautorisation. La surveillance postcommer- cialisation a identifié trés peu de cas possibles d’une telle réac- tion; les données disponibles ne permettent de tirer aucune conclusion ferme sur une éventuelle relation de causalité entre le vaccin anti-Hib et des réactions anaphylactiques.”", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "02a632a9fa445f53575e74eaf8ac66c1", - "text_as_html": "Il ra pas été rapporté de réaction anaphylactique pendant les essais cliniques préautorisation. La surveillance postcommer- cialisation a identifié trés peu de cas possibles d’une telle réac- tion; les données disponibles ne permettent de tirer aucune conclusion ferme sur une éventuelle relation de causalité entre le vaccin anti-Hib et des réactions anaphylactiques.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 11, - "coordinates": [ - { - "x0": 294.08, - "y0": 275.12, - "x1": 552.06, - "y1": 343.37 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-44", - "text": "\n\n\nRapport coit/efficacité\nUne revue des études examinant le rapport cott/efficacité du vaccin anti-Hib a retenu 17 articles concernant 14 pays.” Diverses méthodes ont été appliquées pour évaluer les bénéfices tels que la comparaison des cotits annuels de la vaccination anti-Hib avec les gains obtenus en faisant régresser la maladie, ou les cots par QALY gagnée, ce qui rend les comparaisons entre les pays impossibles. Néanmoins, la plupart des études sont parvenues 4 la conclusion que le vaccin anti-Hib représen- tait une intervention rentable. Seuls 2 rapports, dont l'un émanait de Moscou et estimait le cout par DALY évitée 4 un niveau beaucoup plus élevé (en raison du coat élevé du vaccin et de la faible incidence des maladies 4 Hib) et l’autre de Corée du Sud, ont trouvé que ce vaccin roffrait pas un bon rapport cott/ efficacité.\nDepuis la publication de ces articles, les prix des vaccins anti- Hib ont diminué substantiellement avec l’arrivée d’autres fabri- cants sur le marché. Une analyse coiit/efficacité régionale de ce vaccin, se basant sur ces prix plus bas, en plus de mettre en évidence de nouvelles preuves des pertes conséquentes de productivité dues aux séquelles de la méningite dans les pays\n36 Fritzell BPS. Efficacy and safety of a Haemophilus type b capsular polysaccharide-tetanus protein conjugate. Journal of Pediatrics, 1992,121:355-362.\n37 Valdheim CM et al. Safety evaluation of PRP-D Haemophilus influenzae type b conjugate in children immunized at 18 months of age and older: Follow-up study of 30 000 children. Pediatric Infectious Disease Journal, 1990, 9:555-561.\n38 US Centers for Disease Control and Prevention. Haemophilus b conjugate vaccines for preven- tion of Haemophilus influenzae type b disease among infants and children. Recommendations of the advisory committee on immunization practices (ACIP).combined diptheria, tetanus. Mor- bidity and Mortality Weekly report, 40 (RR1): 1-7.\n33 Information sheet on observed rate of vaccine ractions. Genéve, Organisation mondiale de la Santé (Département Sécurité vaccinale mondiale, vaccination, vaccins et produits biologiques), 2012. Disponible sur: http://www.who.int/entity/vaccine_safety/initiative/tools/HiB_Vaccine_ rates_information_sheet.pdf; consulté en septembre 2013.\n“0 Griffiths UK. Economic evaluations of Haemophilus influenzae type b vaccine: systematic review of the literature. Expert Reviews Pharmacoeconomic Outcomes Research, 2009, 9(4):333-346.\nlow-income setting,“ concluded that Hib vaccine is ei- ther cost-saving or highly cost-effective in all low- and middle-income countries.”", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "9dadd7780d860a110351ab367956dd19", - "text": "Rapport coit/efficacité", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "", - "text_as_html": "Une revue des études examinant le rapport cott/efficacité du vaccin anti-Hib a retenu 17 articles concernant 14 pays.” Diverses méthodes ont été appliquées pour évaluer les bénéfices tels que la comparaison des cotits annuels de la vaccination anti-Hib avec les gains obtenus en faisant régresser la maladie, ou les cots par QALY gagnée, ce qui rend les comparaisons entre les pays impossibles. Néanmoins, la plupart des études sont parvenues 4 la conclusion que le vaccin anti-Hib représen- tait une intervention rentable. Seuls 2 rapports, dont l'un émanait de Moscou et estimait le cout par DALY évitée 4 un niveau beaucoup plus élevé (en raison du coat élevé du vaccin et de la faible incidence des maladies 4 Hib) et l’autre de Corée du Sud, ont trouvé que ce vaccin roffrait pas un bon rapport cott/ efficacité.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 11, - "coordinates": [ - { - "x0": 294.17, - "y0": 369.34, - "x1": 554.35, - "y1": 527.61 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "806feaae09e9fad1f32c4531867ac1d7", - "text": "Depuis la publication de ces articles, les prix des vaccins anti- Hib ont diminué substantiellement avec l’arrivée d’autres fabri- cants sur le marché. Une analyse coiit/efficacité régionale de ce vaccin, se basant sur ces prix plus bas, en plus de mettre en évidence de nouvelles preuves des pertes conséquentes de productivité dues aux séquelles de la méningite dans les pays", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "9dadd7780d860a110351ab367956dd19", - "text_as_html": "Depuis la publication de ces articles, les prix des vaccins anti- Hib ont diminué substantiellement avec l’arrivée d’autres fabri- cants sur le marché. Une analyse coiit/efficacité régionale de ce vaccin, se basant sur ces prix plus bas, en plus de mettre en évidence de nouvelles preuves des pertes conséquentes de productivité dues aux séquelles de la méningite dans les pays
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 11, - "coordinates": [ - { - "x0": 294.82, - "y0": 534.83, - "x1": 551.16, - "y1": 603.07 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "8a4e6a029aa9cb4f4fa3a50c1c055480", - "text": "36 Fritzell BPS. Efficacy and safety of a Haemophilus type b capsular polysaccharide-tetanus protein conjugate. Journal of Pediatrics, 1992,121:355-362.", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "9dadd7780d860a110351ab367956dd19", - "text_as_html": "low-income setting,“ concluded that Hib vaccine is ei- ther cost-saving or highly cost-effective in all low- and middle-income countries.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 43.88, - "y0": 55.76, - "x1": 273.67, - "y1": 88.37 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-45", - "text": "\n\n\nWHO position\nIn view of their demonstrated safety and efficacy, WHO recommends the inclusion of conjugate Hib vaccines in all infant immunization programmes.Vaccination remains the only effective means of preventing Hib dis- ease and is becoming increasingly important as Hib antibiotic resistance grows.\nThe use of Hib vaccines should be part of a compre- hensive strategy to control pneumonia including exclu- sive breastfeeding for 6 months, hand washing with soap, improved water supply and sanitation, reduction of household air pollution, and improved case manage- ment at community and health facility levels.”\nWHO recommends that any one of the following Hib immunization schedules may be followed: 3 primary doses without a booster (3p+0); 2 primary doses plus a booster (2p+1); and 3 primary doses with a booster (3p+1).\nIn countries where the peak burden of severe Hib disease occurs in young infants, providing 3 doses of vaccine early in life may confer a greater benefit.\nIn some settings (e.g. where the greatest disease morbidity and mortality occur later, or where rate reductions of disease are not fully sustained after the routine use of Hib vaccine), it may be advantageous to give a booster dose by following either a 2p+1 or 3p+1 schedule.\nThe age at first dose and the number of primary doses should be set after consideration of the local epide- mio-logy, vaccine presentation (Hib conjugate mono- valent vaccine or Hib conjugate vaccine in combina- tion with other antigens) and how this fits into the overall routine immunization schedule. Because seri- ous Hib disease occurs most commonly in children aged between 4 and 18 months, immunization should start from 6 weeks of age, or as early as possible there- after.\nThe interval between doses should be at least 4 weeks if 3 primary doses are given, and at least 8 weeks if 2 primary doses are given. When given, the booster dose\n4\" Griffiths UK et al. Costs of meningitis sequelae in children in Dakar, Senegal. Pedia- tric Infectious Disease Journal, 2012, 31(11):e189-195.\n2 Griffiths UK, (2013). Cost-Effectiveness of Haemophilus influenzae Type b Conju- gate Vaccine in Low- and Middle-Income Countries: Regional Analysis and Assess- ment of Major Determinants. Journal of Pediatrics, 2013, 163(1 Suppl):S50-S59.e9.\n*- Ending Preventable Child Deaths From Pneumonia and Diarrhoea by 2025: The inte- grated Global Action Plan for Pneumonia and Diarrhoea. Geneva, World Health Organization/The United Nations Children’s Fund (UNICEF), 2013. Available at http:/Awww.who.int/maternal_child_adolescent/news_events/news/2013/gappd_ launch/en/; accessed September 2013.\na faible revenu,\"' a conclu que le vaccin anti-Hib permet de réaliser des économies de coit ou présente un trés bon rapport cotit/efficacité dans ensemble des pays a revenu faible ou inter- meédiaire.”", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "2c94c4dad707e1e354d6917f4b4c9cc9", - "text": "WHO position", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "", - "text_as_html": "In view of their demonstrated safety and efficacy, WHO recommends the inclusion of conjugate Hib vaccines in all infant immunization programmes.Vaccination remains the only effective means of preventing Hib dis- ease and is becoming increasingly important as Hib antibiotic resistance grows.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 45.2, - "y0": 126.09, - "x1": 273.32, - "y1": 194.04 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5a0b2114492f2dbcd192039d5c3bc231", - "text": "The use of Hib vaccines should be part of a compre- hensive strategy to control pneumonia including exclu- sive breastfeeding for 6 months, hand washing with soap, improved water supply and sanitation, reduction of household air pollution, and improved case manage- ment at community and health facility levels.”", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "2c94c4dad707e1e354d6917f4b4c9cc9", - "text_as_html": "The use of Hib vaccines should be part of a compre- hensive strategy to control pneumonia including exclu- sive breastfeeding for 6 months, hand washing with soap, improved water supply and sanitation, reduction of household air pollution, and improved case manage- ment at community and health facility levels.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 44.98, - "y0": 200.95, - "x1": 273.4, - "y1": 268.45 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "566d1bc1e14c85801c4544330ee27600", - "text": "WHO recommends that any one of the following Hib immunization schedules may be followed: 3 primary doses without a booster (3p+0); 2 primary doses plus a booster (2p+1); and 3 primary doses with a booster (3p+1).", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "2c94c4dad707e1e354d6917f4b4c9cc9", - "text_as_html": "WHO recommends that any one of the following Hib immunization schedules may be followed: 3 primary doses without a booster (3p+0); 2 primary doses plus a booster (2p+1); and 3 primary doses with a booster (3p+1).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 44.53, - "y0": 287.22, - "x1": 272.74, - "y1": 342.34 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "8ef53f9adf4aa68e51fa5729d7862ebe", - "text": "In countries where the peak burden of severe Hib disease occurs in young infants, providing 3 doses of vaccine early in life may confer a greater benefit.", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "2c94c4dad707e1e354d6917f4b4c9cc9", - "text_as_html": "In countries where the peak burden of severe Hib disease occurs in young infants, providing 3 doses of vaccine early in life may confer a greater benefit.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 43.75, - "y0": 349.89, - "x1": 272.72, - "y1": 383.01 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "76597157a36f44c65b5497ef17f94b57", - "text": "In some settings (e.g. where the greatest disease morbidity and mortality occur later, or where rate reductions of disease are not fully sustained after the routine use of Hib vaccine), it may be advantageous to give a booster dose by following either a 2p+1 or 3p+1 schedule.", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "2c94c4dad707e1e354d6917f4b4c9cc9", - "text_as_html": "In some settings (e.g. where the greatest disease morbidity and mortality occur later, or where rate reductions of disease are not fully sustained after the routine use of Hib vaccine), it may be advantageous to give a booster dose by following either a 2p+1 or 3p+1 schedule.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 45.44, - "y0": 401.91, - "x1": 272.36, - "y1": 469.45 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4e1391e3ec45a4330d6f44830170bc84", - "text": "The age at first dose and the number of primary doses should be set after consideration of the local epide- mio-logy, vaccine presentation (Hib conjugate mono- valent vaccine or Hib conjugate vaccine in combina- tion with other antigens) and how this fits into the overall routine immunization schedule. Because seri- ous Hib disease occurs most commonly in children aged between 4 and 18 months, immunization should start from 6 weeks of age, or as early as possible there- after.", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "2c94c4dad707e1e354d6917f4b4c9cc9", - "text_as_html": "The age at first dose and the number of primary doses should be set after consideration of the local epide- mio-logy, vaccine presentation (Hib conjugate mono- valent vaccine or Hib conjugate vaccine in combina- tion with other antigens) and how this fits into the overall routine immunization schedule. Because seri- ous Hib disease occurs most commonly in children aged between 4 and 18 months, immunization should start from 6 weeks of age, or as early as possible there- after.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 44.89, - "y0": 488.11, - "x1": 272.75, - "y1": 601.41 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "c3dadf7a94d074ed6ea2121e0b024f52", - "text": "The interval between doses should be at least 4 weeks if 3 primary doses are given, and at least 8 weeks if 2 primary doses are given. When given, the booster dose", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "2c94c4dad707e1e354d6917f4b4c9cc9", - "text_as_html": "The interval between doses should be at least 4 weeks if 3 primary doses are given, and at least 8 weeks if 2 primary doses are given. When given, the booster dose
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 44.29, - "y0": 609.67, - "x1": 272.12, - "y1": 641.98 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "90b31d92119447ae2ae8f6cb5c249546", - "text": "4\" Griffiths UK et al. Costs of meningitis sequelae in children in Dakar, Senegal. Pedia- tric Infectious Disease Journal, 2012, 31(11):e189-195.", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "2c94c4dad707e1e354d6917f4b4c9cc9", - "text_as_html": "a faible revenu,\"' a conclu que le vaccin anti-Hib permet de réaliser des économies de coit ou présente un trés bon rapport cotit/efficacité dans ensemble des pays a revenu faible ou inter- meédiaire.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 293.86, - "y0": 55.8, - "x1": 551.1, - "y1": 99.29 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-46", - "text": "\n\n\nPosition de I'OMS\nAu vu de linnocuité et de Pefficacité démontrées des vaccins anti-Hib, 1OMS recommande leur introduction dans tous les programmes de vaccination infantile. La vaccination reste le seul moyen efficace pour prévenir les maladies a Hib et prend une importance croissante avec le développement de la résis- tance de cette bactérie aux antibiotiques.\nLutilisation des vaccins anti-Hib devra s’intégrer dans une stra- tégie compléte pour lutter contre les pneumonies incluant l’al- laitement au sein exclusif jusqu’a 6 mois, le lavage des mains au savon, l’amélioration de lapprovisionnement en eau et de Passainissement, la réduction de la pollution de lair dans les foyers et une meilleure prise en charge des cas au niveau des collectivités et des établissements de soins.”\nLOMS recommande d’appliquer l’un des calendriers de vacci- nation anti-Hib suivants: 3 doses primaires sans dose de rappel (3p + 0); 2 doses primaires plus une dose de rappel (2p + 1); et 3 doses primaires plus une dose de rappel (3p + 1).\nDans les pays ot le pic de maladies a Hib sévéres se produit chez les jeunes nourrissons, l’administration de 3 doses de vaccin 4 un stade précoce de la vie peut apporter un grand bénéfice.\nDans certains contextes (par exemple lorsque le maximum de la charge de morbidité et de mortalité se présente plus tardi- vement ou lorsque les taux de réduction de la maladie ne se maintiennent pas complétement une fois le vaccin anti-Hib utilisé de maniére systématique), il peut étre avantageux d’ad- joindre une dose de rappel selon un calendrier de type 2p + 1 ou 3p + 1.\nLage de la premiére dose et le nombre de doses primaires devront étre fixés aprés prise en compte de l’épidémiologie locale, de la présentation du vaccin (anti-Hib conjugué mono- valent ou combiné a d’autres antigénes) et des possibilités @intégration dans le calendrier de vaccination systématique global. Les maladies a Hib graves étant plus fréquentes chez les enfants de 4 4 18 mois, la vaccination devra débuter a 6 semaines ou dés que possible aprés cet age.\nVintervalle entre les doses devra étre de 4 semaines au moins si Pon administre 3 doses primaires, et de 8 semaines au moins si le nombre de doses primaires est de 2. Lorsqu’elle est admi-\n4 Griffiths UK et al. Costs of meningitis sequelae in children in Dakar, Senegal. Pediatric Infectious Disease Journal, 2012, 31(11):e189-195.\n® Griffiths UK, (2013). Cost-Effectiveness of Haemophilus influenzae Type b Conjugate Vaccine in Low- and Middle-Income Countries: Regional Analysis and Assessment of Major Determinants. Journal of Pediatrics, 2013, 163(1 Suppl):S50-S59.e9.\n* Mettre fin aux décés évitables d‘enfants par pneumonie et diarrhée d'ici 2025. Le Plan d'action mondial intégré pour prévenir et combattre la pneumonie et la diarrhée. Genéve, Organisation mondiale de la Santé / Fonds des Nations Unies pour l’enfance (UNICEF), 2013. Disponible uniquement en langue anglaise sur http://www.who.int/maternal_child_adolescent/news_ events/news/2013/gappd_launch/en mais résumé disponible en langue francaise sur http:// apps.who.int/iris/bitstream/10665/79213/1/WHO_FWC_MCA_13_01_fre.pdf; consulté en sep- tembre 2013.\n425\nshould be administered at least 6 months after comple- tion of the primary series.\nIf the vaccination course has been interrupted, the schedule should be resumed without repeating the pre- vious dose. Children who start vaccination late, but are aged <12 months, should complete the vaccination schedule (e.g. have 3 primary doses or 2 primary doses plus a booster). When a first dose is given to a child >12 months of age, only one dose is recommended. Hib vaccine is not required for healthy children after 5 years of age.\nThe Hib conjugate vaccine is contraindicated in people with known allergies to any component of the vaccine. There are no other known contraindications or precau- tions.\nIt is important to establish and maintain high quality surveillance for Hib disease, in order to monitor the impact and changes in disease epidemiology over time. Surveillance should cover not only the age group tar- geted for immunization but also older age groups in order to document the impact of vaccination on age patterns of disease and identify the need for, and timing of, booster dose.\nSome countries have observed increases in disease incidence several years after vaccine introduction, but these increases have been very small relative to the overall Hib disease reductions following vaccine intro- duction. Increases in the incidence of Hib cases should be investigated promptly and include documentation of the age, Hib vaccination status, time since last Hib vac- cine dose, and HIV status of the affected individuals.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text": "Position de I'OMS", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "", - "text_as_html": "Au vu de linnocuité et de Pefficacité démontrées des vaccins anti-Hib, 1OMS recommande leur introduction dans tous les programmes de vaccination infantile. La vaccination reste le seul moyen efficace pour prévenir les maladies a Hib et prend une importance croissante avec le développement de la résis- tance de cette bactérie aux antibiotiques.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 295.1, - "y0": 125.77, - "x1": 553.07, - "y1": 193.7 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "a09c360c24726cf6d456779cca4fcd80", - "text": "Lutilisation des vaccins anti-Hib devra s’intégrer dans une stra- tégie compléte pour lutter contre les pneumonies incluant l’al- laitement au sein exclusif jusqu’a 6 mois, le lavage des mains au savon, l’amélioration de lapprovisionnement en eau et de Passainissement, la réduction de la pollution de lair dans les foyers et une meilleure prise en charge des cas au niveau des collectivités et des établissements de soins.”", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text_as_html": "Lutilisation des vaccins anti-Hib devra s’intégrer dans une stra- tégie compléte pour lutter contre les pneumonies incluant l’al- laitement au sein exclusif jusqu’a 6 mois, le lavage des mains au savon, l’amélioration de lapprovisionnement en eau et de Passainissement, la réduction de la pollution de lair dans les foyers et une meilleure prise en charge des cas au niveau des collectivités et des établissements de soins.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 293.83, - "y0": 200.46, - "x1": 552.63, - "y1": 280.04 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "6d7356dd068de085165e30bd7788577e", - "text": "LOMS recommande d’appliquer l’un des calendriers de vacci- nation anti-Hib suivants: 3 doses primaires sans dose de rappel (3p + 0); 2 doses primaires plus une dose de rappel (2p + 1); et 3 doses primaires plus une dose de rappel (3p + 1).", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text_as_html": "LOMS recommande d’appliquer l’un des calendriers de vacci- nation anti-Hib suivants: 3 doses primaires sans dose de rappel (3p + 0); 2 doses primaires plus une dose de rappel (2p + 1); et 3 doses primaires plus une dose de rappel (3p + 1).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 294.91, - "y0": 286.85, - "x1": 551.89, - "y1": 331.92 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "ceee89241a9a06bb63afb0165b40860f", - "text": "Dans les pays ot le pic de maladies a Hib sévéres se produit chez les jeunes nourrissons, l’administration de 3 doses de vaccin 4 un stade précoce de la vie peut apporter un grand bénéfice.", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text_as_html": "Dans les pays ot le pic de maladies a Hib sévéres se produit chez les jeunes nourrissons, l’administration de 3 doses de vaccin 4 un stade précoce de la vie peut apporter un grand bénéfice.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 293.65, - "y0": 350.04, - "x1": 551.21, - "y1": 393.8 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "377150e2342fb4e15bc972b3a0f33cf7", - "text": "Dans certains contextes (par exemple lorsque le maximum de la charge de morbidité et de mortalité se présente plus tardi- vement ou lorsque les taux de réduction de la maladie ne se maintiennent pas complétement une fois le vaccin anti-Hib utilisé de maniére systématique), il peut étre avantageux d’ad- joindre une dose de rappel selon un calendrier de type 2p + 1 ou 3p + 1.", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text_as_html": "Dans certains contextes (par exemple lorsque le maximum de la charge de morbidité et de mortalité se présente plus tardi- vement ou lorsque les taux de réduction de la maladie ne se maintiennent pas complétement une fois le vaccin anti-Hib utilisé de maniére systématique), il peut étre avantageux d’ad- joindre une dose de rappel selon un calendrier de type 2p + 1 ou 3p + 1.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 293.15, - "y0": 401.63, - "x1": 552.18, - "y1": 480.51 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "d575bc117947c6faa727d817ec32d34f", - "text": "Lage de la premiére dose et le nombre de doses primaires devront étre fixés aprés prise en compte de l’épidémiologie locale, de la présentation du vaccin (anti-Hib conjugué mono- valent ou combiné a d’autres antigénes) et des possibilités @intégration dans le calendrier de vaccination systématique global. Les maladies a Hib graves étant plus fréquentes chez les enfants de 4 4 18 mois, la vaccination devra débuter a 6 semaines ou dés que possible aprés cet age.", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text_as_html": "Lage de la premiére dose et le nombre de doses primaires devront étre fixés aprés prise en compte de l’épidémiologie locale, de la présentation du vaccin (anti-Hib conjugué mono- valent ou combiné a d’autres antigénes) et des possibilités @intégration dans le calendrier de vaccination systématique global. Les maladies a Hib graves étant plus fréquentes chez les enfants de 4 4 18 mois, la vaccination devra débuter a 6 semaines ou dés que possible aprés cet age.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 293.62, - "y0": 487.83, - "x1": 551.42, - "y1": 578.51 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "997b698d4fb74514ff22b0674783195b", - "text": "Vintervalle entre les doses devra étre de 4 semaines au moins si Pon administre 3 doses primaires, et de 8 semaines au moins si le nombre de doses primaires est de 2. Lorsqu’elle est admi-", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text_as_html": "Vintervalle entre les doses devra étre de 4 semaines au moins si Pon administre 3 doses primaires, et de 8 semaines au moins si le nombre de doses primaires est de 2. Lorsqu’elle est admi-
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 293.3, - "y0": 609.31, - "x1": 550.01, - "y1": 641.78 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "3117c52bbe3a42c0ad4b2b73c86e1595", - "text": "4 Griffiths UK et al. Costs of meningitis sequelae in children in Dakar, Senegal. Pediatric Infectious Disease Journal, 2012, 31(11):e189-195.", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text_as_html": "425
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 12, - "coordinates": [ - { - "x0": 538.78, - "y0": 779.62, - "x1": 549.57, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4fde0711718ce59613aa3b673b830974", - "text": "should be administered at least 6 months after comple- tion of the primary series.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text_as_html": "should be administered at least 6 months after comple- tion of the primary series.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 43.5, - "y0": 55.89, - "x1": 272.49, - "y1": 77.0 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "6f36740fc0075e24d50293cac05b3e6e", - "text": "If the vaccination course has been interrupted, the schedule should be resumed without repeating the pre- vious dose. Children who start vaccination late, but are aged <12 months, should complete the vaccination schedule (e.g. have 3 primary doses or 2 primary doses plus a booster). When a first dose is given to a child >12 months of age, only one dose is recommended. Hib vaccine is not required for healthy children after 5 years of age.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text_as_html": "If the vaccination course has been interrupted, the schedule should be resumed without repeating the pre- vious dose. Children who start vaccination late, but are aged <12 months, should complete the vaccination schedule (e.g. have 3 primary doses or 2 primary doses plus a booster). When a first dose is given to a child >12 months of age, only one dose is recommended. Hib vaccine is not required for healthy children after 5 years of age.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 45.43, - "y0": 84.52, - "x1": 273.17, - "y1": 185.88 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4a3d8114cb6b7eeeb0229604e9992abe", - "text": "The Hib conjugate vaccine is contraindicated in people with known allergies to any component of the vaccine. There are no other known contraindications or precau- tions.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text_as_html": "The Hib conjugate vaccine is contraindicated in people with known allergies to any component of the vaccine. There are no other known contraindications or precau- tions.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 44.21, - "y0": 193.47, - "x1": 273.1, - "y1": 237.62 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "79fb3d66d9c3c5d3aa7b8cb441f659cf", - "text": "It is important to establish and maintain high quality surveillance for Hib disease, in order to monitor the impact and changes in disease epidemiology over time. Surveillance should cover not only the age group tar- geted for immunization but also older age groups in order to document the impact of vaccination on age patterns of disease and identify the need for, and timing of, booster dose.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text_as_html": "It is important to establish and maintain high quality surveillance for Hib disease, in order to monitor the impact and changes in disease epidemiology over time. Surveillance should cover not only the age group tar- geted for immunization but also older age groups in order to document the impact of vaccination on age patterns of disease and identify the need for, and timing of, booster dose.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 44.52, - "y0": 244.69, - "x1": 273.23, - "y1": 335.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "cd7fe6cd5ee4e7152b2c58b3908ad23e", - "text": "Some countries have observed increases in disease incidence several years after vaccine introduction, but these increases have been very small relative to the overall Hib disease reductions following vaccine intro- duction. Increases in the incidence of Hib cases should be investigated promptly and include documentation of the age, Hib vaccination status, time since last Hib vac- cine dose, and HIV status of the affected individuals.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "669f3e8505d8cc7cea8e1dacf84ab6c8", - "text_as_html": "Some countries have observed increases in disease incidence several years after vaccine introduction, but these increases have been very small relative to the overall Hib disease reductions following vaccine intro- duction. Increases in the incidence of Hib cases should be investigated promptly and include documentation of the age, Hib vaccination status, time since last Hib vac- cine dose, and HIV status of the affected individuals.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 44.82, - "y0": 354.44, - "x1": 273.43, - "y1": 444.42 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-47", - "text": "\n\n\nHow to obtain the WER through the Internet\n(1) WHO WWW server: Use WWW navigation software to connect to the WER pages at the following address: http://www.who.int/wer/\n(2) An e-mail subscription service exists, which provides by electronic mail the table of contents of the WER, together with other short epidemiological bulletins. To subscribe, send a message to listserv@who.int. The subject field should be left blank and the body of the message should contain only the line subscribe wer-reh. A request for confirmation will be sent in reply.\nWWW access © http:/)www.who.int/wer E-mail ¢ send message subscribe wer-reh to listserv@who.int Fax: (+4122) 791 48 21/791 42 85 Contact: wantzc@who.int or wer@who.int\n426\nnistrée, la dose devra étre injectée 6 mois au moins aprés l’aché- vement de la série primaire.\nSi le déroulement de la vaccination a été interrompu, le calen- drier peut étre repris sans renouveler la premiére injection. Pour les enfants dont la vaccination débute tardivement, mais dont Page ne dépasse pas 12 mois, il faudra achever le calen- drier de vaccination (par exemple administrer 3 ou 2 doses primaires plus une dose de rappel). Lorsque la premiére dose de vaccin est injectée 4 un enfant de >12 mois, il est recommandé de n’administrer quune seule dose. Le vaccin anti-Hib rest pas nécessaire chez les enfants de >5 ans en bonne santé.\nLe vaccin anti-Hib conjugué est contre-indiqué pour les personnes que l’on sait allergiques 4 l'un des composants de ce vaccin. Il n’y a pas d’autre contre-indication ou précaution a prendre connue.\nIl est important de mettre en place et de poursuivre une surveillance de haute qualité des maladies a Hib pour suivre Pimpact de la vaccination et les évolutions de l’épidémiologie de la maladie au cours du temps. Cette surveillance devra couvrir non seulement la tranche d’age visée par la vaccination, mais également certaines tranches d’age suivantes pour docu- menter l’impact de la vaccination sur la répartition selon age de la maladie et identifier la nécessité éventuelle d’une dose de rappel et le moment propice pour l’administrer.\nCertains pays ont observé des augmentations de l’incidence des maladies a Hib plusieurs années aprés l’introduction du vaccin, mais ces augmentations étaient trés faibles par comparaison avec les réductions globales des maladies a Hib obtenues suite a cette introduction. Les éventuels accroissements du nombre de cas de Hib doivent étre rapidement investigués, avec enre- gistrement de lage, du statut pour la vaccination anti-Hib, du temps écoulé depuis la derniére dose de vaccin et du statut VIH des individus touchés.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "44257843c713e2c899d976014275db0a", - "text": "How to obtain the WER through the Internet", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "", - "text_as_html": "WWW access © http:/)www.who.int/wer E-mail ¢ send message subscribe wer-reh to listserv@who.int Fax: (+4122) 791 48 21/791 42 85 Contact: wantzc@who.int or wer@who.int
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 45.56, - "y0": 735.27, - "x1": 218.33, - "y1": 771.53 - } - ] - } - }, - { - "type": "UncategorizedText", - "element_id": "195e14ff094d6a3563bdacc7c6a0e85b", - "text": "426", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "44257843c713e2c899d976014275db0a", - "text_as_html": "426
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 44.99, - "y0": 779.62, - "x1": 55.79, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "c17c3663478e1890a83d9413a34b4e83", - "text": "nistrée, la dose devra étre injectée 6 mois au moins aprés l’aché- vement de la série primaire.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "44257843c713e2c899d976014275db0a", - "text_as_html": "nistrée, la dose devra étre injectée 6 mois au moins aprés l’aché- vement de la série primaire.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 294.3, - "y0": 55.64, - "x1": 549.92, - "y1": 77.0 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "9f18d818a812c9191367e6e1e9d3519f", - "text": "Si le déroulement de la vaccination a été interrompu, le calen- drier peut étre repris sans renouveler la premiére injection. Pour les enfants dont la vaccination débute tardivement, mais dont Page ne dépasse pas 12 mois, il faudra achever le calen- drier de vaccination (par exemple administrer 3 ou 2 doses primaires plus une dose de rappel). Lorsque la premiére dose de vaccin est injectée 4 un enfant de >12 mois, il est recommandé de n’administrer quune seule dose. Le vaccin anti-Hib rest pas nécessaire chez les enfants de >5 ans en bonne santé.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "44257843c713e2c899d976014275db0a", - "text_as_html": "Si le déroulement de la vaccination a été interrompu, le calen- drier peut étre repris sans renouveler la premiére injection. Pour les enfants dont la vaccination débute tardivement, mais dont Page ne dépasse pas 12 mois, il faudra achever le calen- drier de vaccination (par exemple administrer 3 ou 2 doses primaires plus une dose de rappel). Lorsque la premiére dose de vaccin est injectée 4 un enfant de >12 mois, il est recommandé de n’administrer quune seule dose. Le vaccin anti-Hib rest pas nécessaire chez les enfants de >5 ans en bonne sant��.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 294.09, - "y0": 84.64, - "x1": 553.23, - "y1": 186.3 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "37370675da9358cdab723c795b223a27", - "text": "Le vaccin anti-Hib conjugué est contre-indiqué pour les personnes que l’on sait allergiques 4 l'un des composants de ce vaccin. Il n’y a pas d’autre contre-indication ou précaution a prendre connue.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "44257843c713e2c899d976014275db0a", - "text_as_html": "Le vaccin anti-Hib conjugué est contre-indiqué pour les personnes que l’on sait allergiques 4 l'un des composants de ce vaccin. Il n’y a pas d’autre contre-indication ou précaution a prendre connue.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 295.3, - "y0": 193.4, - "x1": 553.37, - "y1": 237.65 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "9edeaf534f9c97cca6ed2989ff20ae4d", - "text": "Il est important de mettre en place et de poursuivre une surveillance de haute qualité des maladies a Hib pour suivre Pimpact de la vaccination et les évolutions de l’épidémiologie de la maladie au cours du temps. Cette surveillance devra couvrir non seulement la tranche d’age visée par la vaccination, mais également certaines tranches d’age suivantes pour docu- menter l’impact de la vaccination sur la répartition selon age de la maladie et identifier la nécessité éventuelle d’une dose de rappel et le moment propice pour l’administrer.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "44257843c713e2c899d976014275db0a", - "text_as_html": "Il est important de mettre en place et de poursuivre une surveillance de haute qualité des maladies a Hib pour suivre Pimpact de la vaccination et les évolutions de l’épidémiologie de la maladie au cours du temps. Cette surveillance devra couvrir non seulement la tranche d’age visée par la vaccination, mais également certaines tranches d’age suivantes pour docu- menter l’impact de la vaccination sur la répartition selon age de la maladie et identifier la nécessité éventuelle d’une dose de rappel et le moment propice pour l’administrer.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 293.46, - "y0": 244.86, - "x1": 553.23, - "y1": 347.15 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "d6942c0ac5a725fde5804e75f6263063", - "text": "Certains pays ont observé des augmentations de l’incidence des maladies a Hib plusieurs années aprés l’introduction du vaccin, mais ces augmentations étaient trés faibles par comparaison avec les réductions globales des maladies a Hib obtenues suite a cette introduction. Les éventuels accroissements du nombre de cas de Hib doivent étre rapidement investigués, avec enre- gistrement de lage, du statut pour la vaccination anti-Hib, du temps écoulé depuis la derniére dose de vaccin et du statut VIH des individus touchés.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "44257843c713e2c899d976014275db0a", - "text_as_html": "Certains pays ont observé des augmentations de l’incidence des maladies a Hib plusieurs années aprés l’introduction du vaccin, mais ces augmentations étaient trés faibles par comparaison avec les réductions globales des maladies a Hib obtenues suite a cette introduction. Les éventuels accroissements du nombre de cas de Hib doivent étre rapidement investigués, avec enre- gistrement de lage, du statut pour la vaccination anti-Hib, du temps écoulé depuis la derniére dose de vaccin et du statut VIH des individus touchés.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 294.88, - "y0": 354.09, - "x1": 552.14, - "y1": 455.97 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-48", - "text": "\n\n\nComment accéder au REH sur Internet?\n1) Par le serveur Web de |'OMS: A l'aide de votre logiciel de navigation WWW, connectez-vous a la page diaccueil du REH al’adresse suivante: http://www.who.int/wer/\n2) Il existe également un service d'abonnement permettant de rece- voir chaque semaine par courrier électronique la table des matiéres du REH ainsi que d'autres bulletins épidémiologiques. Pour vous abonner, merci d’envoyer un message a listserv@who.int en lais- sant vide le champ du sujet. Le texte lui méme ne devra contenir que la phrase suivante: subscribe wer-reh.", - "filename": "WER8839_413-426.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "50d41ea3990b0a52b6a3d6c270d5c53c", - "text": "Comment accéder au REH sur Internet?", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "", - "text_as_html": "Courrier électronique * envoyer message subscribe wer-reh a listserv@who.int Fax: +41-(0)22 791 48 21/791 42 85 Contact: wantzc@who.int ou wer@who.int
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8839_413-426.PDF", - "page": 13, - "coordinates": [ - { - "x0": 297.26, - "y0": 742.63, - "x1": 507.28, - "y1": 772.23 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "dfaef31f6d0bcd01b9937367938fabc9", - "text": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 39, 27 SEPTEMBER 2013", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "3b0c65adde648099203600614642dd71", - "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 39, 27 SEPTEMBER 2013
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