TY - JOUR
T1 - Increased risk for and mortality from invasive pneumococcal disease in HIV-exposed but uninfected infants aged <1 year in South Africa, 2009-2013
AU - Von Mollendorf, Claire
AU - Von Gottberg, Anne
AU - Tempia, Stefano
AU - Meiring, Susan
AU - De Gouveia, Linda
AU - Quan, Vanessa
AU - Lengana, Sarona
AU - Avenant, Theunis
AU - Du Plessis, Nicolette
AU - Eley, Brian
AU - Finlayson, Heather
AU - Reubenson, Gary
AU - Moshe, Mamokgethi
AU - O'Brien, Katherine L.
AU - Klugman, Keith P.
AU - Whitney, Cynthia G.
AU - Cohen, Cheryl
N1 - Funding Information:
Potential conflicts of interest. C. v. M. has received honoraria from Pfizer. A. v. G. has received research funding from Pfizer. T. A. has received honoraria and conference support from Pfizer. G. R. has received honoraria and conference support from Pfizer and Sanofi. K. L. O. and K. P. K. have received research funding and honoraria from Pfizer and GlaxoSmithKline. All other authors report no potential conflicts.
Funding Information:
Financial support. This work was supported by NICD/NHLS; the President’s Emergency Plan for AIDS Relief through the CDC (grant number 5U2GPS001328); and the GAVI Accelerated Vaccine Initiative–Special Studies Team.
Publisher Copyright:
© 2015 The Author. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Background. High antenatal human immunodeficiency virus (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 but 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 2 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 to 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 to 654 per 100 000 population between time points (2013 and 2009), followed by HEU (33-88 per 100 000) and HIV-unexposed and uninfected (HUU) infants (18-28 per 100 000). The case-fatality rate in HEU infants (29% [74/253]) was intermediate between HUU (25% [94/377]) and HIV-infected infants (34% [81/242]). When restricted to infants <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.
AB - Background. High antenatal human immunodeficiency virus (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 but 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 2 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 to 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 to 654 per 100 000 population between time points (2013 and 2009), followed by HEU (33-88 per 100 000) and HIV-unexposed and uninfected (HUU) infants (18-28 per 100 000). The case-fatality rate in HEU infants (29% [74/253]) was intermediate between HUU (25% [94/377]) and HIV-infected infants (34% [81/242]). When restricted to infants <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.
KW - Children
KW - HIV exposure
KW - Pneumococcal conjugate vaccine
KW - South Africa
KW - Streptococcus pneumoniae
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U2 - 10.1093/cid/civ059
DO - 10.1093/cid/civ059
M3 - Article
C2 - 25645212
AN - SCOPUS:84928902809
SN - 1058-4838
VL - 60
SP - 1346
EP - 1356
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 9
ER -