6 research outputs found
Eff ectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control study
Background The 13-valent pneumococcal conjugate vaccine (PCV13) was designed to include disease-causing
serotypes that are important in low-income and middle-income countries. Vaccine eff ectiveness estimates are scarce
in these settings. South Africa replaced PCV7 with PCV13 in 2011 using a 2 + 1 schedule. We aimed to assess the
eff ectiveness of two or more doses of PCV13 against invasive pneumococcal disease in children with HIV infection
and in those not infected with HIV.
Methods Cases of invasive pneumococcal disease in children aged 5 years or younger were identifi ed through national
laboratory-based surveillance. Isolates were serotyped with the Quellung reaction or PCR. We sought in-hospital
controls for every case, matched for age, HIV status, and study site. We aimed to enrol four controls for every case not
infected with HIV and six controls for every case with HIV infection (case-control sets). With conditional logistic
regression, we calculated vaccine eff ectiveness as a percentage, with the equation 1 – [adjusted odds ratio for
vaccination] × 100. We included data from an earlier investigation of PCV7 to assess vaccine eff ectiveness in children
exposed to but not infected with HIV and in malnourished children not infected with HIV.
Findings Between January, 2012, and December, 2014, we enrolled children aged 16 weeks or older to our study:
240 were cases not infected with HIV, 75 were cases with HIV infection, 1118 were controls not infected with HIV,
and 283 were controls with HIV infection. The eff ectiveness of two or more doses of PCV13 against PCV13-serotype
invasive pneumococcal disease was 85% (95% CI 37 to 96) among 11 case-control sets of children not infected with
HIV and 91% (–35 to 100) among three case-control sets of children with HIV infection. PCV13 eff ectiveness among
26 case-control sets of children not infected with HIV was 52% (95% CI –12 to 79) against all-serotype invasive
pneumococcal disease and 94% (44 to 100) for serotype 19A. Vaccine eff ectiveness against PCV7-serotype
invasive pneumococcal disease was 87% (95% CI 38 to 97) in children exposed to HIV but uninfected and 90%
(53 to 98) in malnourished children not infected with HIV.
Interpretation Our results indicate that PCV13 in a 2 + 1 schedule is eff ective for preventing vaccine-type
pneumococcal infections in young children not infected with HIV, including those who are malnourished or who
have been exposed to HIV. Although the point estimate for PCV13 vaccine eff ectiveness in children infected with
HIV was high, it did not reach signifi cance, possibly because of the small sample size. These fi ndings support
recommendations for widespread use of pneumococcal conjugate vaccine in low-income and middle-income
countries
Epidemiology of Serotype 1 Invasive Pneumococcal Disease, South Africa, 2003–2013
In South Africa, 7-valent pneumococcal conjugate vaccine (PCV) was introduced in April 2009 and replaced with 13-valent PCV in April 2011. We describe the epidemiology of serotype 1 Streptococcus pneumoniae disease during the pre- and post-PCV eras (2003–2013). Using laboratory-based invasive pneumococcal disease (IPD) surveillance, we calculated annual incidences, identified IPD clusters, and determined serotype 1–associated factors. Of 46,483 IPD cases, 4,544 (10%) were caused by serotype 1. Two clusters of serotype 1 infection were detected during 2003–2004 and 2008–2012, but incidence decreased after 2011. Among children <5 years of age, those who had non–serotype 1 IPD had shorter hospital stays, fewer cases of penicillin-nonsusceptible disease, and lower HIV prevalence and in-hospital death rates than did those with serotype 1 IPD; similar factors were noted for older patients. Serotype 1 IPD had distinctive clinical features in South Africa, and annual incidences fluctuated, with decreases noted after the introduction of PCV13
Increased risk for and mortality from invasive pneumococcal disease in HIV-exposed but uninfected infants aged < 1 year in South Africa, 2009-2013
BACKGROUND : High antenatal HIV seroprevalence rates (∽30%) with low perinatal HIV transmission rates (2.5%) due to HIV prevention of mother-to-child transmission program improvements in South Africa, has resulted in increasing numbers of HIV-exposed-uninfected (HEU) children. We aimed to describe the epidemiology of invasive pneumococcal disease (IPD) in HEU infants. METHODS : We conducted a cross-sectional study of infants aged <1 year with IPD enrolled in a national, laboratory-based surveillance program for incidence estimations. Incidence was reported for two time points, 2009 and 2013. At enhanced sites we collected additional data including HIV status and in-hospital outcome. RESULTS : We identified 2099 IPD cases in infants from 2009-2013 from all sites. In infants from enhanced sites (n=1015), 92% had known HIV exposure status and 86% had known outcomes. IPD incidence was highest in HIV-infected infants, ranging from 272-654/100,000 population between time points (2013 and 2009), followed by HEU (33-88/100,000) and HIV-unexposed-uninfected (HUU) infants (18-28/100,000). Case fatality rate in HEU (29%, 74/253) was intermediate between HUU (25%, 94/377) and HIV-infected infants (34%, 81/242). When restricted to cases <6 months of age, HEU infants (37%, 59/175) were at significantly higher risk of dying than HUU infants (32%, 51/228; Adjusted relative risk ratio = 1.76 [95% confidence interval 1.09-2.85]). DISCUSSION : HEU infants are at increased risk of IPD and mortality from IPD compared with HUU children, especially as young infants. HEU infants, whose numbers will likely continue to increase, should be prioritized for interventions such as pneumococcal vaccination along with HIV-infected infants and children.http://cid.oxfordjournals.org2016-05-31hb201
Effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control study
Summary: Background: The 13-valent pneumococcal conjugate vaccine (PCV13) was designed to include disease-causing serotypes that are important in low-income and middle-income countries. Vaccine effectiveness estimates are scarce in these settings. South Africa replaced PCV7 with PCV13 in 2011 using a 2 + 1 schedule. We aimed to assess the effectiveness of two or more doses of PCV13 against invasive pneumococcal disease in children with HIV infection and in those not infected with HIV. Methods: Cases of invasive pneumococcal disease in children aged 5 years or younger were identified through national laboratory-based surveillance. Isolates were serotyped with the Quellung reaction or PCR. We sought in-hospital controls for every case, matched for age, HIV status, and study site. We aimed to enrol four controls for every case not infected with HIV and six controls for every case with HIV infection (case-control sets). With conditional logistic regression, we calculated vaccine effectiveness as a percentage, with the equation 1 – [adjusted odds ratio for vaccination] × 100. We included data from an earlier investigation of PCV7 to assess vaccine effectiveness in children exposed to but not infected with HIV and in malnourished children not infected with HIV. Findings: Between January, 2012, and December, 2014, we enrolled children aged 16 weeks or older to our study: 240 were cases not infected with HIV, 75 were cases with HIV infection, 1118 were controls not infected with HIV, and 283 were controls with HIV infection. The effectiveness of two or more doses of PCV13 against PCV13-serotype invasive pneumococcal disease was 85% (95% CI 37 to 96) among 11 case-control sets of children not infected with HIV and 91% (−35 to 100) among three case-control sets of children with HIV infection. PCV13 effectiveness among 26 case-control sets of children not infected with HIV was 52% (95% CI −12 to 79) against all-serotype invasive pneumococcal disease and 94% (44 to 100) for serotype 19A. Vaccine effectiveness against PCV7-serotype invasive pneumococcal disease was 87% (95% CI 38 to 97) in children exposed to HIV but uninfected and 90% (53 to 98) in malnourished children not infected with HIV. Interpretation: Our results indicate that PCV13 in a 2 + 1 schedule is effective for preventing vaccine-type pneumococcal infections in young children not infected with HIV, including those who are malnourished or who have been exposed to HIV. Although the point estimate for PCV13 vaccine effectiveness in children infected with HIV was high, it did not reach significance, possibly because of the small sample size. These findings support recommendations for widespread use of pneumococcal conjugate vaccine in low-income and middle-income countries. Funding: Gavi, The Vaccine Alliance