Changes in invasive Pneumococcal disease among HIV-infected adults living in the era of childhood pneumococcal immunization.

Abstract

BACKGROUND:

Adults infected with HIV have high rates of invasive pneumococcal disease. Introduction of pneumococcal conjugate vaccine for children could affect disease among HIV-infected adults.

OBJECTIVE:

To compare invasive pneumococcal disease among HIV-infected adults before and after the introduction of a pediatric conjugate vaccine.

DESIGN:

Active laboratory-based surveillance in an adult population of 10.8 million, including 38,314 living with AIDS.

SETTING:

7 Active Bacterial Core surveillance areas in the United States.

PATIENTS:

All surveillance-area residents 18 to 64 years of age with Streptococcus pneumoniae isolated from a sterile site between 1998 and 2003.

MEASUREMENTS:

Ratio of the number of cases of invasive pneumococcal disease among HIV-infected adults to the estimated number of adults 18 to 64 years of age living with AIDS; serotype-specific subset analyses; and comparison of periods before and after introduction of conjugate vaccine by using exact tests.

RESULTS:

Of 8582 cases of invasive pneumococcal disease in adults, 2013 (24%) occurred among persons infected with HIV. Between baseline (1998 to 1999) and 2003, the ratio of invasive pneumococcal disease in HIV-infected adults to the number of adults living with AIDS in the surveillance areas decreased from 1127 to 919 cases per 100 000 AIDS population, a reduction of 19% (P = 0.002). Among HIV-infected adults, the ratio for disease caused by pneumococcal serotypes included in the conjugate vaccine decreased 62% (P < 0.001), although the ratio for disease caused by nonvaccine serotypes increased 44% (P < 0.001).

LIMITATIONS:

Ratios are proxy measures of incidence rates. The denominator of surveillance-area residents living with HIV infection was not available.

CONCLUSIONS:

Introduction of the pediatric conjugate vaccine was associated with an overall decrease in invasive pneumococcal disease among HIV-infected adults, despite increased disease caused by nonvaccine serotypes.

• Authors: Brendan Flannery, Richard T Heffernan, Lee H Harrison, Susan M Ray, Arthur L Reingold, James Hadler, William Schaffner, Ruth Lynfield, Ann R Thomas, Jianmin Li, Michael Campsmith, Cynthia G Whitney, Anne Schuchat
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 144 Issue 1 Pg. 1-9 (Jan 03 2006) ISSN: 1539-3704 [Electronic] United States
• PMID: 16389249 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Pneumococcal Vaccines
• Vaccines, Conjugate

Topics

• AIDS-Related Opportunistic Infections (epidemiology, ethnology)
• Adolescent
• Adult
• Drug Resistance, Bacterial
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Pneumococcal Infections (epidemiology, ethnology)
• Pneumococcal Vaccines
• Population Surveillance
• Serotyping
• United States (epidemiology)
• Vaccines, Conjugate