Invasive pneumococcal disease among human immunodeficiency virus-infected children, 1989-2006.
OBJECTIVE
The heptavalent pneumococcal conjugate vaccine (PCV7) has decreased the incidence of pediatric invasive pneumococcal disease (IPD) in the United States. Few data exist on the changing IPD incidence in HIV-infected children.


METHODS
Diagnostic codes and clinical microbiology laboratory records identified cases of IPD from 1989 to 2006 in perinatally-infected children <18 years of age followed at an urban HIV clinic. IPD incidence was calculated and serotype distribution and antibiotic resistance were recorded.


RESULTS
Two-hundred fifty-six patients were followed for 1756 person-years (PY). The sample was 59% female, 76% black, 14% white, and 8% Hispanic. Of 21 episodes of IPD (1200/100,000 PY), 17 (81%) were female. IPD cases had a median age of 6.3 years (interquartile range [IQR]: 2.3-9.9 years), median CD4% of 17% (IQR: 11-28%), and median CD4 count of 415 cells/mm (range, 2-1699 cells/mm). Bacteremia was the commonest form of IPD (19 episodes; 1080/100,000 PY). After HAART introduction in 1996, the incidence of IPD decreased 84% from 1862/100,000 PY in 1989-1995 to 292/100,000 PY in 1997-1999 (incidence rate ratio [IRR]: 0.16, P = 0.03). After PCV7 introduction in 2000, IPD incidence showed a nonsignificant increase from 292 of 100,000 PY in 1997-1999 to 860 of 100,000 PY in 2001-2006 (IRR: 2.94; P = 0.16). The percentages of IPD isolates nonsusceptible to penicillin and trimethoprim-sulfamethoxazole were 19% and 33%, respectively. Vaccine serotypes accounted for 38% of isolates, vaccine-related 14%, nonvaccine 33%, and the serotype was unknown in 14%.


CONCLUSIONS
The incidence of IPD among perinatally HIV-infected children decreased after the introduction of HAART. Ongoing monitoring is required to determine the effect of PCV7 on IPD in this vulnerable population.
Steenhoff
Andrew P
AP
Division of Special Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. steenhoff@email.chop.edu
Wood
Sarah M
SM
Rutstein
Richard M
RM
Wahl
Allison
A
McGowan
Karin L
KL
Shah
Samir S
SS
D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D022401:Meningococcal Vaccines / Q000008:administration & dosage*; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D012189:Retrospective Studies; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification
D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines