title: Changes in invasive Pneumococcal disease among HIV-infected adults living in the era of childhood pneumococcal immunization.
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.
  
  
  METHODS
  Active laboratory-based surveillance in an adult population of 10.8 million, including 38,314 living with AIDS.
  
  
  METHODS
  7 Active Bacterial Core surveillance areas in the United States.
  
  
  METHODS
  All surveillance-area residents 18 to 64 years of age with Streptococcus pneumoniae isolated from a sterile site between 1998 and 2003.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. bflannery@cdc.gov
authors.forename: Brendan
authors.initials: B
authors.lastname: Flannery
authors.forename: Richard T
authors.initials: RT
authors.lastname: Heffernan
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ray
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Reingold
authors.forename: James
authors.initials: J
authors.lastname: Hadler
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.forename: Ann R
authors.initials: AR
authors.lastname: Thomas
authors.forename: Jianmin
authors.initials: J
authors.lastname: Li
authors.forename: Michael
authors.initials: M
authors.lastname: Campsmith
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Whitney
authors.forename: Anne
authors.initials: A
authors.lastname: Schuchat
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000208:ethnology; D000293:Adolescent; D000328:Adult; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000208:ethnology; D022242:Pneumococcal Vaccines; D011159:Population Surveillance; D012703:Serotyping; D014481:United States / Q000453:epidemiology; D018074:Vaccines, Conjugate
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate