HIV Infection and the Epidemiology of Invasive Pneumococcal Disease IPD in South African Adults and Older Children Prior to the Introduction of a Pneumococcal Conjugate Vaccine PCVReportar como inadecuado




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Journal Title:

PLoS ONE

Volume:

Volume 11, Number 2

Publisher:

Public Library of Science | 2016-02-10, Pages e0149104-e0149104

Type of Work:

Article | Final Publisher PDF

Abstract: IntroductionStreptococcus pneumoniae is the commonest cause of bacteremic pneumonia among HIVinfected persons. As more countries with high HIV prevalence are implementing infant pneumococcal conjugate vaccine PCV programs, we aimed to describe the baseline clinical characteristics of adult invasive pneumococcal disease IPD in the pre-PCV era in South Africa in order to interpret potential indirect effects following vaccine use. MethodsNational, active, laboratory-based surveillance for IPD was conducted in South Africa from 1 January 2003 through 31 December 2008. At 25 enhanced surveillance ES hospital sites, clinical data, including HIV serostatus, were collected from IPD patients ≥ 5 years of age. We compared the clinical characteristics of individuals with IPD in those HIV-infected and -uninfected using multivariable analysis. PCV was introduced into the routine South African Expanded Program on Immunization EPI in 2009. ResultsIn South Africa, from 2003-2008, 17 604 cases of IPD occurred amongst persons ≥ 5 years of age, with an average incidence of 7 cases per 100 000 person-years. Against a national HIV-prevalence of 18%, 89% 4190-4734 of IPD patients from ES sites were HIV-infected. IPD incidence in HIV-infected individuals is 43 times higher than in HIV-uninfected persons 52 per 100 000 vs. 1.2 per 100 000, with a peak in the HIV-infected elderly population of 237 per 100 000 persons. Most HIV-infected individuals presented with bacteremia 74%, 3 091-4 190. HIV-uninfected individuals were older; and had more chronic conditions excluding HIV than HIV-infected persons 39% 210-544 vs. 19% 790-4190, p<0.001. During the pre-PCV immunization era in South Africa, 71% of serotypes amongst HIVinfected persons were covered by PCV13 vs. 73% amongst HIV-uninfected persons, p = 0.4, OR 0.9 CI 0.7-1.1. ConclusionSeventy to eighty-five percent of adult IPD in the pre-PCV era were vaccine serotypes and 93% of cases had recognized risk factors including HIV-infection for pneumococcal vaccination. These data describe the epidemiology of IPD amongst HIV-infected and -uninfected adults during the pre-PCV era and provide a robust baseline to calculate the indirect effect of PCV in future studies.

Keywords: Science and Technology - Multidisciplinary Sciences - Science and Technology - Other Topics - IMMUNODEFICIENCY-VIRUS-INFECTION - ACTIVE ANTIRETROVIRAL THERAPY - ANTIBIOTIC-RESISTANCE - BACTEREMIA - IMPACT - ERA - PREVALENCE - COHORT - INDIVIDUALS - MORTALITY -



Autor: Susan Meiring, Cheryl Cohen, Vanessa Quan, Linda de Gouveia, Charles Feldman, Alan Karstaedt, Keith Klugman, Shabir A. Madhi, Hel

Fuente: https://open.library.emory.edu/



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