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

• Published in: Annals of internal medicine Vol. 144; no. 1; pp. 1 - 9
• Main Authors: FLANNERY, Brendan, HEFFERNAN, Richard T, CAMPSMITH, Michael, WHITNEY, Cynthia G, SCHUCHAT, Anne, HARRISON, Lee H, RAY, Susan M, REINGOLD, Arthur L, HADLER, James, SCHAFFNER, William, LYNFIELD, Ruth, THOMAS, Ann R, JIANMIN LI
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American College of Physicians 03.01.2006
• Subjects: Adolescent; Adult; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - ethnology; Bacteria; Biological and medical sciences; Children & youth; Disease control; Drug Resistance, Bacterial; Female; General aspects; HIV; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Incidence; Infections; Infectious diseases; Male; Medical records; Medical sciences; Middle Aged; Pneumococcal Infections - epidemiology; Pneumococcal Infections - ethnology; Pneumococcal Vaccines; Pneumonia; Population Surveillance; Respiratory diseases; Serotyping; United States - epidemiology; Vaccines, Conjugate; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; United States; Human; Immunopathology; Vaccination; Trend; AIDS; Change; Immune deficiency; Streptococcus pneumoniae; Infection; Medicine; Streptococcaceae; Vaccination coverage; Streptococcal infection; Viral disease; Bacteriosis; Bacteria; Micrococcales; Adult; Invasive form; Child; Pneumococcal infection; Public health
• ISSN: 0003-4819; 1539-3704
• DOI: 10.7326/0003-4819-144-1-200601030-00004

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. To compare invasive pneumococcal disease among HIV-infected adults before and after the introduction of a pediatric conjugate vaccine. Active laboratory-based surveillance in an adult population of 10.8 million, including 38,314 living with AIDS. 7 Active Bacterial Core surveillance areas in the United States. All surveillance-area residents 18 to 64 years of age with Streptococcus pneumoniae isolated from a sterile site between 1998 and 2003. 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. 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). Ratios are proxy measures of incidence rates. The denominator of surveillance-area residents living with HIV infection was not available. 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.