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

• Authors: Cheryl Cohen, National Institute for Communicable Diseases; Claire von Mollendorf, National Institute for Communicable Diseases; Linda de Gouveia, National Institute for Communicable Diseases; Nireshni Naidoo, National Institute for Communicable Diseases; Susan Meiring, National Institute for Communicable Diseases; Vanessa Quan, National Institute for Communicable Diseases; Vusi Nokeri, National Institute for Communicable Diseases; Melony Fortuin-de Smit, National Institute for Communicable Diseases; Babatyi Malope-Kgokong, National Institute for Communicable Diseases; David Moore, National Research Foundation: Vaccine Preventable Diseases; Gary Reubenson, University of Witwatersrand; Mamokgethi Moshe, Medunsa Univ; Shabir A. Madhi, National Institute for Communicable Diseases; Brian Eley, University of Cape Town; Ute Hallbauer, University of the Free State; Ranmini Kularatne, University of Witwatersrand; Laura Conklin, Centers for Disease Control and Prevention; Katherine O'Brien, Johns Hopkins University; Elizabeth R. Zell, Centers for Disease Control and Prevention; Keith Klugman, Emory University; Cynthia G. Whitney, Centers for Disease Control and Prevention; Anne von Gottberg, National Institute for Communicable Diseases
• Journal Title: Clinical Infectious Diseases
• Volume: Volume 59, Number 6
• Publisher: Oxford University Press | 2014-09-15, Pages 808-818
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/cid/ciu431
• Subjects: Health Sciences, Public Health; Health Sciences, Immunology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Microbiology; children; HIV; pneumococcus; pneumococcal conjugate vaccine; South Africa; IMMUNIZATION PROGRAM; INFANTS; IMMUNOGENICITY; TRIAL; 1ST; METAANALYSIS; SCHEDULES; EFFICACY; IMPACT

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.