Effectiveness of 7-valent Pneumococcal Conjugate Vaccine Against Invasive Pneumococcal Disease in HIV-infected and -uninfected Children in South Africa: a Matched Case-control Study

Overview

Journal Clin Infect Dis

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2014 Jun 12

PMID 24917657

Citations 25

Authors

Cheryl Cohen

Claire von Mollendorf

Linda de Gouveia

Nireshni Naidoo

Susan Meiring

Vanessa Quan

Vusi Nokeri

Melony Fortuin-de Smit

Babatyi Malope-Kgokong

David Moore

Gary Reubenson

Mamokgethi Moshe

Shabir A Madhi

Brian Eley

Ute Hallbauer

Ranmini Kularatne

Laura Conklin

Katherine L OBrien

Elizabeth R Zell

Keith Klugman

Cynthia G Whitney

Anne von Gottberg

Affiliations

Soon will be listed here.

Abstract

Background: South Africa introduced 7-valent pneumococcal conjugate vaccine (PCV7) in April 2009 using a 2 + 1 schedule (6 and 14 weeks and 9 months). We estimated the effectiveness of ≥2 PCV7 doses against invasive pneumococcal disease (IPD) in human immunodeficiency virus (HIV)-infected and -uninfected children.

Methods: IPD (pneumococcus identified from a normally sterile site) cases were identified through national laboratory-based surveillance. Specimens were serotyped by Quellung or polymerase chain reaction. Four controls, matched for age, HIV status, and hospital were sought for each case. Using conditional logistic regression, we calculated vaccine effectiveness (VE) as 1 minus the adjusted odds ratio for vaccination.

Results: From March 2010 through November 2012, we enrolled 187 HIV-uninfected (48 [26%] vaccine serotype) and 109 HIV-infected (43 [39%] vaccine serotype) cases and 752 HIV-uninfected and 347 HIV-infected controls aged ≥16 weeks. Effectiveness of ≥2 PCV7 doses against vaccine-serotype IPD was 74% (95% confidence interval [CI], 25%-91%) among HIV-uninfected and -12% (95% CI, -449% to 77%) among HIV-infected children. Effectiveness of ≥3 doses against vaccine-serotype IPD was 90% (95% CI, 14%-99%) among HIV-uninfected and 57% (95% CI, -371% to 96%) among HIV-infected children. Among HIV-exposed but -uninfected children, effectiveness of ≥2 doses was 92% (95% CI, 47%-99%) against vaccine-serotype IPD. Effectiveness of ≥2 doses against all-serotype multidrug-resistant IPD was 96% (95% CI, 62%-100%) among HIV-uninfected children.

Conclusions: A 2 + 1 PCV7 schedule was effective in preventing vaccine-serotype IPD in HIV-uninfected and HIV-exposed, uninfected children. This finding supports the World Health Organization recommendation for this schedule as an alternative to a 3-dose primary series among HIV-uninfected individuals.

Citing Articles

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