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Preoperative, intraoperative, and postoperative data of 390 children who underwent bilateral cataract surgery between 2007 and 2009 were analyzed. Forty-two (10.8%) children came from Nepal and 348 (89.2%) from India (mainly Bihar State). Intraocular lens (IOL) implantation with posterior capsule opening and anterior vitrectomy were achieved in 386 (99.0%) children. Median age at surgery was 7 years and 69.2% were male. At first presentation, 243 (62.3%) of the children were blind (<3/60 in the better eye). After more than 1 year, 53.5% had a normal visual status (range: 6/6 to 6/18), 5.6% of children were still blind, and mean refractive error spherical equivalent was +1.0 ± 2.4 diopters. Mean long-term astigmatic error was 1.0 ± 0.9 diopters after 1 year. Glaucoma was rare. Even in a setting with limited resources, successful, cost-effective, high-volume surgery for pediatric cataract is possible. Despite late presentation and limited follow-up, more than half achieved good outcomes after more than 1 year. Only 5.6% remained blind due to amblyopia or eye anomalies. Bilateral surgery during one hospital stay, IOL implantation with undercorrection according to age, aggressive surgery to prevent secondary cataract, intensive anti-inflammatory therapy, and provision of durable, high-quality spectacles to take home all proved beneficial because many children cannot attend regular follow-up.

This randomized double-blind trial compared the impact of PCV13 versus PCV7 on nasopharyngeal (NP) colonization and immunogenicity. Healthy infants were randomized (1:1) to receive PCV7 or PCV13 at age 2, 4, 6, and 12 months; NP swabs were collected at 2, 4, 6, 7, 12, 13, 18, and 24 months; blood was drawn at 7 and 13 months. Rates of NP-acquisition and prevalence, and serotype-specific immunoglobulin G concentrations were assessed. The per protocol analysis population included 881 PCV13 and 873 PCV7 recipients. PCV13 significantly reduced NP-acquisition of the additional PCV13-serotypes 1, 6A, 7F and 19A; the cross-reacting serotype 6C; and the common PCV7-serotype 19F. For serotype 3, and the other PCV7-serotypes, there were no significant differences between the vaccine groups. There were too few serotype 5 events to draw inference. The impact on prevalence at pre-defined time points was similar to that observed with NP-acquisition. PCV13 elicited significantly higher IgG responses for PCV13 additional serotypes and serotype 19F, and similar or lower responses for 6/7 PCV7-serotypes. The study clearly shows that in a clinical setting, PCV13 resulted in lower acquisition and prevalence of NP-colonization than PCV7 for 4 additional PCV13 serotypes, and serotypes 6C and 19F. It was comparable with PCV7 for all other common serotypes. These findings predict vaccine effectiveness through both direct and indirect protection.