Response to pneumococcal polysaccharide vaccine in children with asthma, and children with recurrent respiratory infections, and healthy children

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Martinez-Estevez, A.N. Alvarez-Guevara, C.E. Rodriguez-Martinez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "N.S." "apellidos" => "Martinez-Estevez" ] 1 => array:2 [ "nombre" => "A.N." "apellidos" => "Alvarez-Guevara" ] 2 => array:2 [ "nombre" => "C.E." "apellidos" => "Rodriguez-Martinez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054616300192?idApp=UINPBA00004N" "url" => "/03010546/0000004400000004/v1_201607130013/S0301054616300192/v1_201607130013/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Response to pneumococcal polysaccharide vaccine in children with asthma, and children with recurrent respiratory infections, and healthy children" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "376" "paginaFinal" => "381" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Quezada, L. Maggi, X. Norambuena, J. Inostroza, F. Quevedo" "autores" => array:5 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Quezada" "email" => array:1 [ 0 => "aquezada@med.uchile.cl" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Maggi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "X." "apellidos" => "Norambuena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Inostroza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "F." "apellidos" => "Quevedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Department of Pediatrics, School of Medicine, University of Chile, Santiago de Chile, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Children's Hospital, Dr. Exequiel Gonzalez Cortes, Santiago de Chile, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Clinical Laboratory, University of La Frontera, Temuco, Chile" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Public Health School University of Chile, Santiago de Chile, Chile" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 952 "Ancho" => 1537 "Tamanyo" => 106931 ] ] "descripcion" => array:1 [ "en" => "Percentage of postvaccination responses over 1.3μg/mL." ] ] ] "textoCompleto" => "IntroductionIn subjects with recurrent respiratory infections older than two years and with normal serum immunoglobulins, response to the pneumococcal polysaccharide vaccine (PPV) is used as diagnostic test for selective antibody deficiency (SAD).<a class="elsevierStyleCrossRef" href="#bib0150">1</a> In a prior study, we found a strong association between asthma and this primary immunodeficiency (PID).<a class="elsevierStyleCrossRef" href="#bib0155">2</a>Certain disorders involve elevated risk for invasive pneumococcal disease, due to deficient immunological response to encapsulated agents. Groups at greatest risk include children under the age of two years, sickle cell anaemia carriers, patients with functional or surgical asplenia, and patients with primary or secondary immunodeficiencies. Other high-risk groups are patients with diabetes, with nephropathy, with chronic heart disease, with chronic pulmonary damage, and others over the age of two years who are recommended to receive the 23-valent PPV.<a class="elsevierStyleCrossRef" href="#bib0160">3</a> Children with asthma are also at high risk for invasive pneumococcal infections.<a class="elsevierStyleCrossRef" href="#bib0165">4</a> Asthma is one of the most common chronic diseases in children, affecting from 1% to 25% of various populations studied, and its prevalence seems to be rising.<a class="elsevierStyleCrossRef" href="#bib0170">5</a> In Chile, studies have reported a prevalence of 7% in a population of children aged 6–7 years and 23% in children aged 13–14 years.<a class="elsevierStyleCrossRef" href="#bib0175">6</a>It has been found that patients with asthma have a 2.4-fold greater risk of developing an invasive pneumococcal infection than their healthy counterparts.<a class="elsevierStyleCrossRef" href="#bib0165">4</a> Even those with mild asthma have a risk 1.7 times higher than that of the general population, while those with severe asthma have a risk 2.6 times higher.<a class="elsevierStyleCrossRefs" href="#bib0165">4,7</a>Children with asthma are at particularly elevated risk for invasive pneumococcal infections when the clinical presentation of the asthma is severe or requires corticosteroid treatment.<a class="elsevierStyleCrossRef" href="#bib0165">4</a> Studies of patients with severe pneumococcal infections confirm that asthma patients are at higher risk for pneumonia and positive Streptococcus pneumoniae sputum culture.<a class="elsevierStyleCrossRef" href="#bib0185">8</a> Children with asthma develop pneumonia at a rate higher than that of the general population. According to a U.S. study of over 500 children under the age of 18 years, asthma patients acquire pneumonia more frequently than children without known risk factors.<a class="elsevierStyleCrossRef" href="#bib0190">9</a> Asthmatic children treated with inhaled corticosteroids also have higher rates of oropharyngeal colonisation with S. pneumoniae.<a class="elsevierStyleCrossRef" href="#bib0195">10</a>In many reports, approximately 50% of primary immunodeficiencies are antibody deficiencies,<a class="elsevierStyleCrossRef" href="#bib0200">11</a> and more than 10% of children with recurrent respiratory infections have selective antibody deficiency (SAD).<a class="elsevierStyleCrossRefs" href="#bib0205">12,13</a> The frequency of this condition in asthmatic children has not been established, but it is noteworthy that a large proportion of children with recurrent respiratory infections are asthma patients. Associations between asthma and allergic illnesses with other types of primary immunodeficiencies have been reported.<a class="elsevierStyleCrossRef" href="#bib0215">14</a>The objective of this study was to assess the specific immune response measured through pneumococcal antibody levels, to administration of 23-valent polysaccharide pneumococcal vaccine (PPV) in asthmatic children older than two years without recurrent respiratory infections and normal immunoglobulin concentrations, and to compare the response to PPV in children with respiratory recurrent infections without immunodeficiency, and in healthy children.Patients and methodsProspective, controlled clinical study of 60 children divided in three groups from an urban area (Santiago, Chile):<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">Group A: Twenty patients between 2 and 15 years old, random included, with a diagnosis of GINA-defined mild-to-moderate, well-controlled asthma, without history of recurrent respiratory infections, selected from a primary care office.</li><li class="elsevierStyleListItem" id="lsti0010">Group B: Twenty patients between 2 and 15 years old, with a history of recurrent respiratory infections, selected from the Immunology Unit of Dr. Exequiel Gonzalez Cortes Hospital (Santiago, Chile), according to at least one of the following criteria: six or more episodes per year of respiratory infection; one or more episodes per month of respiratory infection during the winter period; or three or more lower respiratory tract infections.<a class="elsevierStyleCrossRef" href="#bib0220">15</a> Children were excluded if there was another cause of recurrent respiratory infection, such as immunodeficiency, local anatomical damage resulting in localised pneumonia, or concomitant neutropenia.</li><li class="elsevierStyleListItem" id="lsti0015">Group C: Control group of 20 children between 2 and 15 years old, with no history of pathology, selected randomly from the same primary care office as Group A.</li></ul>Parents of all participating children provided written informed consent, and the study was approved by the Ethics Committee of the University of Chile.Patients were excluded for previously-diagnosed primary or secondary immunodeficiency; local anatomical defect (cause of recurrent localised pneumonia); concomitant neutropenia; pathology such as cystic fibrosis, nephropathy, cardiac disease, chronic respiratory disease, sickle-cell anaemia, functional or surgical asplenia, or diabetes; or inability to obtain the informed consent of parents.Baseline immunological studies were performed for serum IgG, IgM, and IgA, complement C3, and IgG subclasses, as well as haemogram with absolute lymphocyte and neutrophil count. All children included had normal immunoglobulin concentrations and normal immunological laboratory parameters in order to excluding hypogammaglobulinaemia and other primary and secondary immunodeficiencies.All children received the 23-valent PPV (Pneumo 23®, Sanofi Pasteur), containing 25μg of each of the 23 polysaccharides included in the formulation. The IgG-class anti-polysaccharide pneumococcal antibody levels for 10 serotypes (S1, S3, S4, S5, S6B, S9V, S14, S18C, S19F, and S23F) were measured using third-generation ELISA techniques as standardised by the Centers for Disease Control (CDC),<a class="elsevierStyleCrossRef" href="#bib0225">16</a> at study enrolment (T1) and 45–60 days post-vaccination (T2). Antibody concentration equal to or greater than 1.3μg/mL of specific IgG for each serotype was considered a normal protective response.For statistical analysis, serological response was measured as the concentration of specific IgG antibody against each of the 10 pneumococcal serotypes in the three groups (children with asthma, children with recurrent respiratory infections, and healthy children), using x2 for the geometric mean titres expressed in micrograms per ml of blood in each group, for each serotype, at two times: at study enrolment (T1) and at 45–60 days post-vaccination (T2).ResultsOf the 20 children with asthma (group A), 14 were male, and the age range was 2–14 years. One patient had an episode of pneumonia during the six months prior to vaccination (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In this group of children, 15/20 children responded with levels above 1.3μg/mL for the 10 serotypes tested, and the average values for four serotypes, S5, S6B, S14, and S19F, were greater than 1.3μg/mL before vaccination, with levels rising five- to seven-fold after vaccination (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). All serotypes reached geometric mean titres above 1.3μg/mL by day 45–60 post-vaccination, with levels ranging from 2.01 (S3) to 10.72μg/mL (S5); an adequate protective response was observed in 70% to 100% of subjects (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The lowest individual value observed pre-vaccination was 0.04μg/mL, for S4, and the highest was 10.59μg/mL, for S14. After vaccination, individual levels varied from 0.57μg/mL, for S4 and S23F, to 28.6μg/mL, for S14 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Of the 20 children with RRI (group B), 12 were male, and the age range was 3–13 years. Eight patients had episodes of pneumonia during the six months prior to vaccination, three of whom had two episodes (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). All of the children in this group showed a normal response at 45–60 days post-vaccination, and 14/20 children reached levels above 1.3μg/mL for the 10 serotypes measured. At 45–60 days, the geometric mean titres of the IgG antibodies against all 10 serotypes studied were above 1.3μg/mL, ranging from 2.12 (S1) to 8.54 (S5)μg/mL. An adequate protective response was observed for 70–100% of serotypes (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Of the 20 healthy children (group C), 13 were male, and the age range was 2–13 years. No child in this group had a pneumonia episode during the six months prior to vaccination (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Serotypes with pre-vaccine levels above 1.3μg/mL were S5, S6B, S9, S14, and S19F, with levels rising four-fold after vaccination. All children showed an adequate protective response to the vaccine, with 100% showing values above 1.3μg/mL for all 10 serotypes. Geometric mean titres ranged from 2.29 for S3 to 12.83μg/mL for S14 (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The geometric mean titres of IgG antibodies against serotypes S6B, S9, S14, S18C, S19F, and S23F were lower in children with RRI versus controls, but there were no statistically significant differences between groups in the percentage of children who reached protective levels above 1.3μg/mL.DiscussionResponse to the pneumococcal polysaccharide vaccine, expressed as the geometric mean titres of the IgG antibodies and the percentage of children who showed an adequate protective response, was similar across the three groups studied. Given the high percentages of children in all three groups with antibody levels over 1.3μg/mL after vaccination for the various serotypes analysed, with no significant differences between the groups of children with asthma and those with recurrent infections, it can be inferred that the immunological response is independent of the baseline pathologies studied in this series of patients.It is interesting that the pre-vaccine titres for serotypes 5 and 14 were above 1.3μg/mL and then showed the robust increases after vaccination. It is possible that the patients had been exposed to these serotypes, as carriers or during a prior infection. Epidemiological studies in developing South American countries have shown that the serotypes responsible for the most prevalent infections in children are S14, S5, S6A/B, and S1.<a class="elsevierStyleCrossRef" href="#bib0230">17</a>We recently published a report in which we found a relationship between asthma and selective antibody deficiency<a class="elsevierStyleCrossRef" href="#bib0155">2</a>; however, in the present study, we excluded children with primary or secondary abnormalities in immune antibody response using the available methodology. It would be interesting to perform a follow-up study with repeated measurements of antibody levels, to evaluate the duration of protection conferred by the vaccine.In terms of responses to the different serotypes contained in the pneumococcal vaccine, studies have reported variations in asthmatic children. For instance, after the pneumococcal 7-valent conjugate vaccine, protection (defined as a geometric mean titre of specific IgG antibodies above 1μg/mL) varied from 40.9%, for serotype 6B, to 90.9%, for serotype 19F. After the polysaccharide vaccine, protective responses ranged from 31.6%, for serotypes 6B and 23F, to 81.6%, for serotype 19F.<a class="elsevierStyleCrossRef" href="#bib0235">18</a>In children of asthmatic mothers, higher rates of nasopharyngeal colonisation with S. pneumoniae have been found beginning in the new-born period,<a class="elsevierStyleCrossRef" href="#bib0240">19</a> and children with other atopic conditions such as dermatitis show a deficient antibody response to S. pneumoniae after the PPV.<a class="elsevierStyleCrossRef" href="#bib0245">20</a>Preschool-aged children with persistent wheezing in the absence of acute infectious symptoms show elevated bacterial counts in bronchoalveolar lavage fluid and high rates of positive culture for bacterial agents such as S. pneumoniae; after antibiotic treatment, obstructive symptoms improve, suggesting that chronic bacterial infection may underlie the persistent wheezing.<a class="elsevierStyleCrossRef" href="#bib0250">21</a>Patients with asthma are not presently included among the risk groups recommended to receive the pneumonia vaccine, unless they are immunosuppressed or their symptoms are severe enough to warrant chronic or frequent treatment with systemic corticosteroids.<a class="elsevierStyleCrossRef" href="#bib0255">22</a>A systematic Cochrane review evaluating use of the PPV in children with asthma updated in 2015 concluded that there was limited evidence supporting routine use of the vaccine, and that randomised trials were needed to confirm its efficacy in this group.<a class="elsevierStyleCrossRef" href="#bib0260">23</a>Asthma is not currently included on the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention list of indications for receiving the pneumococcal vaccine. A recent recommendation proposes that children over the age of six years who have not received the conjugate pneumococcal vaccine and who are at high risk for invasive pneumococcal infection should be given a dose of the 13-valent conjugate vaccine followed by the 23-valent polysaccharide vaccine after eight weeks, and then revaccinated with the PPV five years later.<a class="elsevierStyleCrossRef" href="#bib0265">24</a>Studies on response to the polysaccharide vaccine in children with recurrent infections have provided dissimilar results. In general, immunogenicity seems to improve with age.<a class="elsevierStyleCrossRef" href="#bib0225">16</a> It is has been impossible to establish definitive conclusions, due to the use of different vaccination schedules, for example, the combination of the PPV with the conjugate vaccine versus separate administration, and the use of heterogeneous patient groups, for example, the inclusion of individuals with and without immunosuppressive conditions.<a class="elsevierStyleCrossRef" href="#bib0270">25</a> In the present study, we excluded for immunodeficiencies in the group with recurrent infections, and the children studied had not previously received either the conjugate or the polysaccharide vaccine.Different parameters have been used as the cut-off for a protective response to the polysaccharide vaccine.<a class="elsevierStyleCrossRef" href="#bib0275">26</a> In this study, we used specific IgG serum concentration above 1.3μg/mL for each serotype in order to rule out children with recurrent infections and specific antibody deficiency.<a class="elsevierStyleCrossRef" href="#bib0225">16</a>Immune response to the PPV depends on various factors such as age, baseline disease, and immunogenicity of the various serotypes; however, the advantages of the vaccine are greater than the potential risks.<a class="elsevierStyleCrossRef" href="#bib0270">25</a> Various studies in healthy children on the immunogenicity of the PPV have noted more robust response in poorest low incomes areas and countries<a class="elsevierStyleCrossRef" href="#bib0280">27</a>; differences in response according to age for the various serotypes; and poor specific IgG antibody response for S14, S6B, and S19F before 24 months of age.<a class="elsevierStyleCrossRef" href="#bib0285">28</a> One study reported a significant, four-fold increase in specific IgG levels at two weeks post-vaccination for 18 of the 23 serotypes in children who received the vaccine at 12 months of age, with poorest response for S14, S19F, and S23F.<a class="elsevierStyleCrossRef" href="#bib0290">29</a>In conclusion, asthmatic children without RRI responded with pneumococcal antibodies and percentages of serotype-specific protection comparable to those of healthy children. The children with RRI without PID also responded normally to the PPV, and although they had lower titres, the differences were not statistically significant. Asthmatic children with recurrent infections and normal immunoglobulin levels should be evaluated for SAD. Because children with asthma are at high risk for invasive pneumococcal infection, it would be worthwhile to evaluate the systematic use of the PPV in children over the age of two years who have not received the conjugate vaccine, considering the positive response to this vaccine reported here.Conflicts of interestThe authors have no conflict of interest to declare.Ethical disclosuresConfidentiality of dataThe authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.Right to privacy and informed consentThe authors have obtained the informed consent of the patients and/or subjects mentioned in the article. The author for correspondence is in possession of this document.Protection of human and animal subjectsThe authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration." 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MethodsThe study included 60 children, divided into three groups: 20 with asthma, 20 with RRI, and 20 healthy controls. Post-vaccination specific IgG antibodies against 10 pneumococcal serotypes (S1, S3, S4, S5, S6B, S9V, S14, S18C, S19F, and S23F) contained in the 23-valent pneumococcal polysaccharide vaccine (PPV) were measured. A specific IgG concentration ≥1.3μg/mL was considered a protective response to the vaccine. For statistical analysis, levels of specific IgG antibodies against each of the 10 pneumococcal serotypes were compared across the three groups of children using the x2 test. ResultsAll of the children showed antipneumococcal antibody levels >1.3μg/mL for over 70% of the serotypes, considered within the normal range of response. Average IgG antibody levels and percentages of children protected were statistically comparable among the three groups studied. ConclusionThe asthmatic children without RRI had pneumococcal antibody levels and percentages of serotype-specific protection to PPV comparable to those of healthy children. Asthmatic children with recurrent infections should be evaluated for specific antibody deficiency (SAD). Because asthma patients are at high risk for invasive pneumococcal infections, it would be worthwhile to explore systematic administration of PPV in children over the age of two years who have not received a pneumococcal conjugate vaccine, considering the positive response to PPV reported here." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1099 "Ancho" => 1481 "Tamanyo" => 101749 ] ] "descripcion" => array:1 [ "en" => "Postvaccination geometric mean titre of serum IgG antibodies (μg/mL) for 10 pneumococcal serotypes. S – serotype; RRI – recurrent respiratory infection." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 952 "Ancho" => 1537 "Tamanyo" => 106931 ] ] "descripcion" => array:1 [ "en" => "Percentage of postvaccination responses over 1.3μg/mL." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "RRI – recurrent respiratory infections." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group A (asthma) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group B (RRI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group C (control) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M–F (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14–6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12–8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13–7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age×(years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age range (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2–14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3–13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2–13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pneumonia in past 6 months (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1120678.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographics." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "T1 – prevaccination; T2 – postvaccination." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Serotype \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Geometric mean titre (range)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Values >1.3μg/mL</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">% Values >1.3μg/mL</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.30 (0.11–0.71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.18 (0.75–4.83) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.53 (0.10–2.89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.01 (0.73–4.68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.33 (0.04–1.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.06 (0.57–4.86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.11 (0.38–5.51) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.72 (3.97–20.46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S6B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.40 (0.15–9.06) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.94 (1.34–27.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.22 (0.24–8.60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.30 (1.47–15.80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.66 (0.74–10.59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.19 (0.92–28.60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S18C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.74 (0.21–3.16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.28 (1.47–16.81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S19F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.84 (0.67–6.71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.62 (2.04–28.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S23F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.95 (0.10–3.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.02 (0.57–19.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1120681.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Specific IgG antibody response against 10 pneumococcal serotypes in children with asthma." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "T1 – prevaccination; T2 – postvaccination." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Serotype \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Geometric mean titre (range)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Values >1.3μg/mL</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">% Values >1.3μg/mL</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.58 (0.30–1.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.12 (0.73–29.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.08 (0.32–3.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.57 (0.57–16.40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.65 (0.23–3.16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.59 (0.69–31.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.59 (0.43–6.49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.54 (2.17–70.06) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S6B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.88 (0.24–2.94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.90 (1.31–24.34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.62 (0.07–2.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.88 (1.07–13.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.29 (0.25–8.35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.48 (0.54–38.70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S18C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.69 (0.13–2.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.07 (1.04–20.37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S19F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.41 (0.47–6.87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.97 (0.96–44.33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S23F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.91 (0.10–13.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.94 (0.29–35.26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1120680.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Specific IgG antibody response against 10 pneumococcal serotypes in children with recurrent respiratory infections." ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "T1 – prevaccination; T2 – postvaccination." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Serotype \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Geometric mean titre (range)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Values >1.3μg/mL</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">% Values >1.3μg/mL</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.22 (0.15–0.32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.18 (1.69–8.32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.97 (0.49–1.66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.29 (1.59–3.56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27 (0.14–0.64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.39 (1.43–4.36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.41 (0.99–4.57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.43 (5.28–32.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S6B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.81 (0.70–4.44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.04 (3.92–27.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.41 (0.29–3.68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.61 (2.93–10.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.83 (1.98–4.97) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.83 (2.53–27.40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S18C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.88 (0.28–3.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.34 (1.41–17.40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S19F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.78 (0.96–3.77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.41 (2.51–18.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S23F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.03 (0.44–3.35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.51 (2.08–23.80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1120679.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Specific IgG antibody response against 10 pneumococcal serotypes in healthy children." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0150" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of age on the response to Streptococcus pneumoniae vaccine in patients with recurrent infections and normal immunoglobulin concentrations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.U. 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A. Quezadaa,

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aquezada@med.uchile.cl

Corresponding author.

, L. Maggia, X. Norambuenab, J. Inostrozac, F. Quevedod

a Department of Pediatrics, School of Medicine, University of Chile, Santiago de Chile, Chile

b Children's Hospital, Dr. Exequiel Gonzalez Cortes, Santiago de Chile, Chile

c Clinical Laboratory, University of La Frontera, Temuco, Chile

d Public Health School University of Chile, Santiago de Chile, Chile

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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Percentage of postvaccination responses over 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In subjects with recurrent respiratory infections older than two years and with normal serum immunoglobulins&#44; response to the pneumococcal polysaccharide vaccine &#40;PPV&#41; is used as diagnostic test for selective antibody deficiency &#40;SAD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> In a prior study&#44; we found a strong association between asthma and this primary immunodeficiency &#40;PID&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Certain disorders involve elevated risk for invasive pneumococcal disease&#44; due to deficient immunological response to encapsulated agents&#46; Groups at greatest risk include children under the age of two years&#44; sickle cell anaemia carriers&#44; patients with functional or surgical asplenia&#44; and patients with primary or secondary immunodeficiencies&#46; Other high-risk groups are patients with diabetes&#44; with nephropathy&#44; with chronic heart disease&#44; with chronic pulmonary damage&#44; and others over the age of two years who are recommended to receive the 23-valent PPV&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> Children with asthma are also at high risk for invasive pneumococcal infections&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> Asthma is one of the most common chronic diseases in children&#44; affecting from 1&#37; to 25&#37; of various populations studied&#44; and its prevalence seems to be rising&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> In Chile&#44; studies have reported a prevalence of 7&#37; in a population of children aged 6&#8211;7 years and 23&#37; in children aged 13&#8211;14 years&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It has been found that patients with asthma have a 2&#46;4-fold greater risk of developing an invasive pneumococcal infection than their healthy counterparts&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> Even those with mild asthma have a risk 1&#46;7 times higher than that of the general population&#44; while those with severe asthma have a risk 2&#46;6 times higher&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Children with asthma are at particularly elevated risk for invasive pneumococcal infections when the clinical presentation of the asthma is severe or requires corticosteroid treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> Studies of patients with severe pneumococcal infections confirm that asthma patients are at higher risk for pneumonia and positive <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> sputum culture&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> Children with asthma develop pneumonia at a rate higher than that of the general population&#46; According to a U&#46;S&#46; study of over 500 children under the age of 18 years&#44; asthma patients acquire pneumonia more frequently than children without known risk factors&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> Asthmatic children treated with inhaled corticosteroids also have higher rates of oropharyngeal colonisation with <span class="elsevierStyleItalic">S&#46; pneumoniae</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In many reports&#44; approximately 50&#37; of primary immunodeficiencies are antibody deficiencies&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> and more than 10&#37; of children with recurrent respiratory infections have selective antibody deficiency &#40;SAD&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">12&#44;13</span></a> The frequency of this condition in asthmatic children has not been established&#44; but it is noteworthy that a large proportion of children with recurrent respiratory infections are asthma patients&#46; Associations between asthma and allergic illnesses with other types of primary immunodeficiencies have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The objective of this study was to assess the specific immune response measured through pneumococcal antibody levels&#44; to administration of 23-valent polysaccharide pneumococcal vaccine &#40;PPV&#41; in asthmatic children older than two years without recurrent respiratory infections and normal immunoglobulin concentrations&#44; and to compare the response to PPV in children with respiratory recurrent infections without immunodeficiency&#44; and in healthy children&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">Prospective&#44; controlled clinical study of 60 children divided in three groups from an urban area &#40;Santiago&#44; Chile&#41;&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Group A</span>&#58; Twenty patients between 2 and 15 years old&#44; random included&#44; with a diagnosis of GINA-defined mild-to-moderate&#44; well-controlled asthma&#44; without history of recurrent respiratory infections&#44; selected from a primary care office&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Group B</span>&#58; Twenty patients between 2 and 15 years old&#44; with a history of recurrent respiratory infections&#44; selected from the Immunology Unit of Dr&#46; Exequiel Gonzalez Cortes Hospital &#40;Santiago&#44; Chile&#41;&#44; according to at least one of the following criteria&#58; six or more episodes per year of respiratory infection&#59; one or more episodes per month of respiratory infection during the winter period&#59; or three or more lower respiratory tract infections&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> Children were excluded if there was another cause of recurrent respiratory infection&#44; such as immunodeficiency&#44; local anatomical damage resulting in localised pneumonia&#44; or concomitant neutropenia&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Group C</span>&#58; Control group of 20 children between 2 and 15 years old&#44; with no history of pathology&#44; selected randomly from the same primary care office as Group A&#46;</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">Parents of all participating children provided written informed consent&#44; and the study was approved by the Ethics Committee of the University of Chile&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Patients were excluded for previously-diagnosed primary or secondary immunodeficiency&#59; local anatomical defect &#40;cause of recurrent localised pneumonia&#41;&#59; concomitant neutropenia&#59; pathology such as cystic fibrosis&#44; nephropathy&#44; cardiac disease&#44; chronic respiratory disease&#44; sickle-cell anaemia&#44; functional or surgical asplenia&#44; or diabetes&#59; or inability to obtain the informed consent of parents&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Baseline immunological studies were performed for serum IgG&#44; IgM&#44; and IgA&#44; complement C3&#44; and IgG subclasses&#44; as well as haemogram with absolute lymphocyte and neutrophil count&#46; All children included had normal immunoglobulin concentrations and normal immunological laboratory parameters in order to excluding hypogammaglobulinaemia and other primary and secondary immunodeficiencies&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">All children received the 23-valent PPV &#40;Pneumo 23<span class="elsevierStyleSup">&#174;</span>&#44; Sanofi Pasteur&#41;&#44; containing 25<span class="elsevierStyleHsp" style=""></span>&#956;g of each of the 23 polysaccharides included in the formulation&#46; The IgG-class anti-polysaccharide pneumococcal antibody levels for 10 serotypes &#40;S1&#44; S3&#44; S4&#44; S5&#44; S6B&#44; S9V&#44; S14&#44; S18C&#44; S19F&#44; and S23F&#41; were measured using third-generation ELISA techniques as standardised by the Centers for Disease Control &#40;CDC&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a> at study enrolment &#40;T1&#41; and 45&#8211;60 days post-vaccination &#40;T2&#41;&#46; Antibody concentration equal to or greater than 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL of specific IgG for each serotype was considered a normal protective response&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">For statistical analysis&#44; serological response was measured as the concentration of specific IgG antibody against each of the 10 pneumococcal serotypes in the three groups &#40;children with asthma&#44; children with recurrent respiratory infections&#44; and healthy children&#41;&#44; using <span class="elsevierStyleItalic">x</span><span class="elsevierStyleSup">2</span> for the geometric mean titres expressed in micrograms per ml of blood in each group&#44; for each serotype&#44; at two times&#58; at study enrolment &#40;T1&#41; and at 45&#8211;60 days post-vaccination &#40;T2&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">Of the 20 children with asthma &#40;group A&#41;&#44; 14 were male&#44; and the age range was 2&#8211;14 years&#46; One patient had an episode of pneumonia during the six months prior to vaccination &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In this group of children&#44; 15&#47;20 children responded with levels above 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL for the 10 serotypes tested&#44; and the average values for four serotypes&#44; S5&#44; S6B&#44; S14&#44; and S19F&#44; were greater than 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL before vaccination&#44; with levels rising five- to seven-fold after vaccination &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; All serotypes reached geometric mean titres above 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL by day 45&#8211;60 post-vaccination&#44; with levels ranging from 2&#46;01 &#40;S3&#41; to 10&#46;72<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL &#40;S5&#41;&#59; an adequate protective response was observed in 70&#37; to 100&#37; of subjects &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; The lowest individual value observed pre-vaccination was 0&#46;04<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#44; for S4&#44; and the highest was 10&#46;59<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#44; for S14&#46; After vaccination&#44; individual levels varied from 0&#46;57<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#44; for S4 and S23F&#44; to 28&#46;6<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#44; for S14 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Of the 20 children with RRI &#40;group B&#41;&#44; 12 were male&#44; and the age range was 3&#8211;13 years&#46; Eight patients had episodes of pneumonia during the six months prior to vaccination&#44; three of whom had two episodes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; All of the children in this group showed a normal response at 45&#8211;60 days post-vaccination&#44; and 14&#47;20 children reached levels above 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL for the 10 serotypes measured&#46; At 45&#8211;60 days&#44; the geometric mean titres of the IgG antibodies against all 10 serotypes studied were above 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#44; ranging from 2&#46;12 &#40;S1&#41; to 8&#46;54 &#40;S5&#41;<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#46; An adequate protective response was observed for 70&#8211;100&#37; of serotypes &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Of the 20 healthy children &#40;group C&#41;&#44; 13 were male&#44; and the age range was 2&#8211;13 years&#46; No child in this group had a pneumonia episode during the six months prior to vaccination &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Serotypes with pre-vaccine levels above 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL were S5&#44; S6B&#44; S9&#44; S14&#44; and S19F&#44; with levels rising four-fold after vaccination&#46; All children showed an adequate protective response to the vaccine&#44; with 100&#37; showing values above 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL for all 10 serotypes&#46; Geometric mean titres ranged from 2&#46;29 for S3 to 12&#46;83<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL for S14 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The geometric mean titres of IgG antibodies against serotypes S6B&#44; S9&#44; S14&#44; S18C&#44; S19F&#44; and S23F were lower in children with RRI versus controls&#44; but there were no statistically significant differences between groups in the percentage of children who reached protective levels above 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Response to the pneumococcal polysaccharide vaccine&#44; expressed as the geometric mean titres of the IgG antibodies and the percentage of children who showed an adequate protective response&#44; was similar across the three groups studied&#46; Given the high percentages of children in all three groups with antibody levels over 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL after vaccination for the various serotypes analysed&#44; with no significant differences between the groups of children with asthma and those with recurrent infections&#44; it can be inferred that the immunological response is independent of the baseline pathologies studied in this series of patients&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">It is interesting that the pre-vaccine titres for serotypes 5 and 14 were above 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL and then showed the robust increases after vaccination&#46; It is possible that the patients had been exposed to these serotypes&#44; as carriers or during a prior infection&#46; Epidemiological studies in developing South American countries have shown that the serotypes responsible for the most prevalent infections in children are S14&#44; S5&#44; S6A&#47;B&#44; and S1&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">We recently published a report in which we found a relationship between asthma and selective antibody deficiency<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a>&#59; however&#44; in the present study&#44; we excluded children with primary or secondary abnormalities in immune antibody response using the available methodology&#46; It would be interesting to perform a follow-up study with repeated measurements of antibody levels&#44; to evaluate the duration of protection conferred by the vaccine&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In terms of responses to the different serotypes contained in the pneumococcal vaccine&#44; studies have reported variations in asthmatic children&#46; For instance&#44; after the pneumococcal 7-valent conjugate vaccine&#44; protection &#40;defined as a geometric mean titre of specific IgG antibodies above 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#41; varied from 40&#46;9&#37;&#44; for serotype 6B&#44; to 90&#46;9&#37;&#44; for serotype 19F&#46; After the polysaccharide vaccine&#44; protective responses ranged from 31&#46;6&#37;&#44; for serotypes 6B and 23F&#44; to 81&#46;6&#37;&#44; for serotype 19F&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In children of asthmatic mothers&#44; higher rates of nasopharyngeal colonisation with <span class="elsevierStyleItalic">S&#46; pneumoniae</span> have been found beginning in the new-born period&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> and children with other atopic conditions such as dermatitis show a deficient antibody response to <span class="elsevierStyleItalic">S&#46; pneumoniae</span> after the PPV&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Preschool-aged children with persistent wheezing in the absence of acute infectious symptoms show elevated bacterial counts in bronchoalveolar lavage fluid and high rates of positive culture for bacterial agents such as <span class="elsevierStyleItalic">S&#46; pneumoniae</span>&#59; after antibiotic treatment&#44; obstructive symptoms improve&#44; suggesting that chronic bacterial infection may underlie the persistent wheezing&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Patients with asthma are not presently included among the risk groups recommended to receive the pneumonia vaccine&#44; unless they are immunosuppressed or their symptoms are severe enough to warrant chronic or frequent treatment with systemic corticosteroids&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">A systematic Cochrane review evaluating use of the PPV in children with asthma updated in 2015 concluded that there was limited evidence supporting routine use of the vaccine&#44; and that randomised trials were needed to confirm its efficacy in this group&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Asthma is not currently included on the Advisory Committee on Immunization Practices &#40;ACIP&#41; of the Centers for Disease Control and Prevention list of indications for receiving the pneumococcal vaccine&#46; A recent recommendation proposes that children over the age of six years who have not received the conjugate pneumococcal vaccine and who are at high risk for invasive pneumococcal infection should be given a dose of the 13-valent conjugate vaccine followed by the 23-valent polysaccharide vaccine after eight weeks&#44; and then revaccinated with the PPV five years later&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Studies on response to the polysaccharide vaccine in children with recurrent infections have provided dissimilar results&#46; In general&#44; immunogenicity seems to improve with age&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a> It is has been impossible to establish definitive conclusions&#44; due to the use of different vaccination schedules&#44; for example&#44; the combination of the PPV with the conjugate vaccine versus separate administration&#44; and the use of heterogeneous patient groups&#44; for example&#44; the inclusion of individuals with and without immunosuppressive conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> In the present study&#44; we excluded for immunodeficiencies in the group with recurrent infections&#44; and the children studied had not previously received either the conjugate or the polysaccharide vaccine&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Different parameters have been used as the cut-off for a protective response to the polysaccharide vaccine&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> In this study&#44; we used specific IgG serum concentration above 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL for each serotype in order to rule out children with recurrent infections and specific antibody deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Immune response to the PPV depends on various factors such as age&#44; baseline disease&#44; and immunogenicity of the various serotypes&#59; however&#44; the advantages of the vaccine are greater than the potential risks&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> Various studies in healthy children on the immunogenicity of the PPV have noted more robust response in poorest low incomes areas and countries<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a>&#59; differences in response according to age for the various serotypes&#59; and poor specific IgG antibody response for S14&#44; S6B&#44; and S19F before 24 months of age&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> One study reported a significant&#44; four-fold increase in specific IgG levels at two weeks post-vaccination for 18 of the 23 serotypes in children who received the vaccine at 12 months of age&#44; with poorest response for S14&#44; S19F&#44; and S23F&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In conclusion&#44; asthmatic children without RRI responded with pneumococcal antibodies and percentages of serotype-specific protection comparable to those of healthy children&#46; The children with RRI without PID also responded normally to the PPV&#44; and although they had lower titres&#44; the differences were not statistically significant&#46; Asthmatic children with recurrent infections and normal immunoglobulin levels should be evaluated for SAD&#46; Because children with asthma are at high risk for invasive pneumococcal infection&#44; it would be worthwhile to evaluate the systematic use of the PPV in children over the age of two years who have not received the conjugate vaccine&#44; considering the positive response to this vaccine reported here&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Ethical disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Confidentiality of data</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Right to privacy and informed consent</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors have obtained the informed consent of the patients and&#47;or subjects mentioned in the article&#46; The author for correspondence is in possession of this document&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Protection of human and animal subjects</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration&#46;</p></span></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyse specific immune response to the 23-valent pneumococcal polysaccharide vaccine by measuring pneumococcal antibodies in children with asthma and with respiratory recurrent infection &#40;RRI&#41; as compared to healthy children&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study included 60 children&#44; divided into three groups&#58; 20 with asthma&#44; 20 with RRI&#44; and 20 healthy controls&#46; Post-vaccination specific IgG antibodies against 10 pneumococcal serotypes &#40;S1&#44; S3&#44; S4&#44; S5&#44; S6B&#44; S9V&#44; S14&#44; S18C&#44; S19F&#44; and S23F&#41; contained in the 23-valent pneumococcal polysaccharide vaccine &#40;PPV&#41; were measured&#46; A specific IgG concentration &#8805;1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL was considered a protective response to the vaccine&#46; For statistical analysis&#44; levels of specific IgG antibodies against each of the 10 pneumococcal serotypes were compared across the three groups of children using the <span class="elsevierStyleItalic">x</span><span class="elsevierStyleSup">2</span> test&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All of the children showed antipneumococcal antibody levels &#62;1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL for over 70&#37; of the serotypes&#44; considered within the normal range of response&#46; Average IgG antibody levels and percentages of children protected were statistically comparable among the three groups studied&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The asthmatic children without RRI had pneumococcal antibody levels and percentages of serotype-specific protection to PPV comparable to those of healthy children&#46; Asthmatic children with recurrent infections should be evaluated for specific antibody deficiency &#40;SAD&#41;&#46; Because asthma patients are at high risk for invasive pneumococcal infections&#44; it would be worthwhile to explore systematic administration of PPV in children over the age of two years who have not received a pneumococcal conjugate vaccine&#44; considering the positive response to PPV reported here&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Postvaccination geometric mean titre of serum IgG antibodies &#40;&#956;g&#47;mL&#41; for 10 pneumococcal serotypes&#46; S &#8211; serotype&#59; RRI &#8211; recurrent respiratory infection&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Percentage of postvaccination responses over 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">RRI &#8211; recurrent respiratory infections&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group A &#40;asthma&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group B &#40;RRI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group C &#40;control&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#8211;F &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#8211;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#8211;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#8211;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age range &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#8211;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#8211;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#8211;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pneumonia in past 6 months &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1120678.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Demographics&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">T1 &#8211; prevaccination&#59; T2 &#8211; postvaccination&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Serotype&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Geometric mean titre &#40;range&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Values &#62;1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#37; Values &#62;1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;30 &#40;0&#46;11&#8211;0&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;18 &#40;0&#46;75&#8211;4&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;53 &#40;0&#46;10&#8211;2&#46;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;01 &#40;0&#46;73&#8211;4&#46;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;33 &#40;0&#46;04&#8211;1&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;06 &#40;0&#46;57&#8211;4&#46;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;11 &#40;0&#46;38&#8211;5&#46;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;72 &#40;3&#46;97&#8211;20&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S6B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;40 &#40;0&#46;15&#8211;9&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;94 &#40;1&#46;34&#8211;27&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;22 &#40;0&#46;24&#8211;8&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;30 &#40;1&#46;47&#8211;15&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;66 &#40;0&#46;74&#8211;10&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;19 &#40;0&#46;92&#8211;28&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S18C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;74 &#40;0&#46;21&#8211;3&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;28 &#40;1&#46;47&#8211;16&#46;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S19F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;84 &#40;0&#46;67&#8211;6&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;62 &#40;2&#46;04&#8211;28&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S23F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;95 &#40;0&#46;10&#8211;3&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;02 &#40;0&#46;57&#8211;19&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Specific IgG antibody response against 10 pneumococcal serotypes in children with asthma&#46;</p>"
        ]
      ]
      4 => array:8 [
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">T1 &#8211; prevaccination&#59; T2 &#8211; postvaccination&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Serotype&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Geometric mean titre &#40;range&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Values &#62;1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#37; Values &#62;1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;58 &#40;0&#46;30&#8211;1&#46;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;12 &#40;0&#46;73&#8211;29&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;08 &#40;0&#46;32&#8211;3&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;57 &#40;0&#46;57&#8211;16&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;65 &#40;0&#46;23&#8211;3&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;59 &#40;0&#46;69&#8211;31&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;59 &#40;0&#46;43&#8211;6&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;54 &#40;2&#46;17&#8211;70&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S6B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;88 &#40;0&#46;24&#8211;2&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;90 &#40;1&#46;31&#8211;24&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;62 &#40;0&#46;07&#8211;2&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;88 &#40;1&#46;07&#8211;13&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;29 &#40;0&#46;25&#8211;8&#46;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;48 &#40;0&#46;54&#8211;38&#46;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S18C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;69 &#40;0&#46;13&#8211;2&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;07 &#40;1&#46;04&#8211;20&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S19F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;41 &#40;0&#46;47&#8211;6&#46;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;97 &#40;0&#46;96&#8211;44&#46;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S23F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;91 &#40;0&#46;10&#8211;13&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;94 &#40;0&#46;29&#8211;35&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Specific IgG antibody response against 10 pneumococcal serotypes in children with recurrent respiratory infections&#46;</p>"
        ]
      ]
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">T1 &#8211; prevaccination&#59; T2 &#8211; postvaccination&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Serotype&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Geometric mean titre &#40;range&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Values &#62;1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#37; Values &#62;1&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;22 &#40;0&#46;15&#8211;0&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;18 &#40;1&#46;69&#8211;8&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;97 &#40;0&#46;49&#8211;1&#46;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;29 &#40;1&#46;59&#8211;3&#46;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;41 &#40;0&#46;99&#8211;4&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Specific IgG antibody response against 10 pneumococcal serotypes in healthy children&#46;</p>"
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Article information

ISSN: 03010546
Original language: English

DOI:10.1016/j.aller.2016.01.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	7	0	7
2024 October	37	4	41
2024 September	44	9	53
2024 August	46	11	57
2024 July	43	3	46
2024 June	62	1	63
2024 May	72	8	80
2024 April	58	5	63
2024 March	57	2	59
2024 February	58	10	68
2024 January	40	9	49
2023 December	56	9	65
2023 November	75	19	94
2023 October	64	13	77
2023 September	39	4	43
2023 August	63	5	68
2023 July	66	7	73
2023 June	56	7	63
2023 May	62	8	70
2023 April	38	2	40
2023 March	37	4	41
2023 February	34	4	38
2023 January	12	6	18
2022 December	28	9	37
2022 November	27	6	33
2022 October	9	8	17
2022 September	16	12	28
2022 August	12	10	22
2022 July	8	8	16
2022 June	33	7	40
2022 May	36	11	47
2022 April	20	10	30
2022 March	14	8	22
2022 February	9	6	15
2022 January	22	8	30
2021 December	16	8	24
2021 November	9	12	21
2021 October	24	8	32
2021 September	27	9	36
2021 August	22	9	31
2021 July	27	10	37
2021 June	23	10	33
2021 May	18	13	31
2021 April	26	20	46
2021 March	37	8	45
2021 February	26	11	37
2021 January	9	13	22
2020 December	2	1	3
2020 October	1	0	1
2020 July	0	1	1
2018 February	7	8	15
2018 January	5	1	6
2017 December	0	4	4
2017 November	6	10	16
2017 October	3	3	6
2017 September	7	8	15
2017 August	4	5	9
2017 July	4	0	4
2017 June	8	6	14
2017 May	9	6	15
2017 April	4	0	4
2016 September	1	1	2
2016 August	1	0	1
2016 July	2	1	3

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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