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Ann Intern Med. 2006 Jan 3;144(1):1-9.

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

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  • 1National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. bflannery@cdc.gov

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.

PMID:
16389249
[PubMed - indexed for MEDLINE]
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