【柳叶刀2011】Effective management in clusters of pneumococcal disease:a SR

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题目：Effective management in clusters of pneumococcal disease:a systematic review

Marina Basarab, Chikwe Ihekweazu, Robert George, Richard Pebody
Outbreaks of serious pneumococcal disease can occur with high attack rates in certain settings. We systematically
reviewed studies of interventions implemented in pneumococcal clusters and those reporting the eff ect of
antibiotics on carriage reduction to assess the eff ectiveness of interventions. Evidence was graded according to the
Scottish Intercollegiate Guidelines Network system. Of 28 identifi ed cluster reports, one showed that administration
of antibiotics to close contacts reduced risk of pneumococcal disease. In three of four clusters where rifampicin
chemoprophylaxis was used and in four of fi ve clusters where penicillin was used no further cases were seen after
intervention. In clusters where pneumococcal polysaccharide vaccine was used, subsequent cases occurred, all
within around 2 weeks of vaccination, which suggests delayed benefi t with this approach (evidence grade D). Use
of infection control measures alone was reported in eight clusters, with no further cases being reported in seven
(grade D). From 21 selected carriage studies, large carriage reductions were observed consistently with use of
penicillin and azithromycin, with median values being 90% and 73%, respectively (grade C). The fi ndings were
presented to a working group for pneumococcal cluster guidelines and used to develop key recommendations on
the management of clusters that supported prompt use of amoxicillin or azithromycin chemoprophylaxis,
pneumococcal vaccination for close contacts, and implementation of infection control measures.

Lancet Infect Dis 2011;11: 119–30