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 KlugmanCynthia G. Whitney, Anne Von Gottberg

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)808-818
Number of pages11
JournalClinical Infectious Diseases
Volume59
Issue number6
DOIs
StatePublished - Sep 15 2014

Keywords

  • Children
  • HIV
  • Pneumococcal conjugate vaccine
  • Pneumococcus
  • South Africa

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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