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

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 O'Brien; Elizabeth R Zell; Keith Klugman; Cynthia G Whitney; Anne von Gottberg; South African Invasive Pneumococcal Disease Case-Control Study Group

doi:10.1093/cid/ciu431

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

Clin Infect Dis. 2014 Sep 15;59(6):808-18. doi: 10.1093/cid/ciu431. Epub 2014 Jun 9.

Authors

Cheryl Cohen¹, Claire von Mollendorf¹, Linda de Gouveia², Nireshni Naidoo¹, Susan Meiring³, Vanessa Quan³, Vusi Nokeri², Melony Fortuin-de Smit³, Babatyi Malope-Kgokong², David Moore⁴, Gary Reubenson⁵, Mamokgethi Moshe⁶, Shabir A Madhi⁷, Brian Eley⁸, Ute Hallbauer⁹, Ranmini Kularatne¹⁰, Laura Conklin¹¹, Katherine L O'Brien¹², Elizabeth R Zell¹¹, Keith Klugman¹³, Cynthia G Whitney¹¹, Anne von Gottberg¹⁴; South African Invasive Pneumococcal Disease Case-Control Study Group

Affiliations

¹ Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
² Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service.
³ Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service.
⁴ Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases.
⁵ Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand.
⁶ Dr George Mukhari Hospital, Paediatrics Department, Medunsa University, Gauteng Province.
⁷ Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases School of Pathology Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg.
⁸ Red Cross War Memorial Children's Hospital, and the Department of Paediatrics and Child Health, University of Cape Town.
⁹ Department of Paediatrics and Child Health, Universitas and Pelonomi Hospitals, University of the Free State, Bloemfontein.
¹⁰ Rahima Moosa Mother and Child Hospital, Department of Clinical Microbiology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa.
¹¹ National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
¹² Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
¹³ School of Pathology Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg Hubert Department of Global Health, Rollins School of Public Health, and Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia.
¹⁴ Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service School of Pathology Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg.

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.

Keywords: HIV; South Africa; children; pneumococcal conjugate vaccine; pneumococcus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Case-Control Studies
Child, Preschool
Coinfection*
Female
HIV Infections / drug therapy
HIV Infections / immunology*
Humans
Infant
Male
Pneumococcal Infections / epidemiology
Pneumococcal Infections / immunology
Pneumococcal Infections / prevention & control*
Pneumococcal Vaccines / administration & dosage
Pneumococcal Vaccines / immunology*
Risk Factors
Serogroup
South Africa / epidemiology
Streptococcus pneumoniae / classification
Streptococcus pneumoniae / genetics

Substances

13-valent pneumococcal vaccine
Pneumococcal Vaccines