Impact of prior pneumococcal vaccination on clinical outcomes in HIV-infected adult patients hospitalized with invasive pneumococcal disease.
BACKGROUND
Recent studies in hospitalized patients with community-acquired pneumonia have found a lower risk of bacteraemia and better clinical outcomes in patients who had previously received the 23-valent pneumococcal polysaccharide vaccine (PPV) in comparison with unvaccinated individuals. The aim of this study was to assess the influence of prior PPV on clinical outcomes in HIV-infected adult patients hospitalized with invasive pneumococcal disease (IPD).


METHODS
This was an observational study of all consecutive HIV-infected adults hospitalized with IPD from January 1996 to October 2007 in three hospitals in Spain. Baseline characteristics and clinical outcome-related variables were compared according to prior PPV vaccination status.


RESULTS
A total of 162 episodes of IPD were studied. In 23 of these (14.2%), patients had previously received PPV. In both vaccinated and unvaccinated patients, most of the causal serotypes were included in the 23-valent PPV (76.9% and 84.1%, respectively). Overall, 25 patients (15.4%) died during hospitalization, 21 patients (13%) required admission to an intensive care unit (ICU) and 34 patients (21%) reached the composite outcome of death and/or admission to the ICU. None of the 23 patients who had previously received PPV died or required ICU admission, in comparison with 25 (18%; P=0.026) and 21 (15.1%; P=0.046), respectively, of the unvaccinated patients. The length of hospital stay for vaccinated patients was significantly shorter (8.48 vs. 13.27 days; P=0.011).


CONCLUSIONS
Although 23-valent PPV failed to prevent IPD in some HIV-infected patients, vaccination produced beneficial effects on clinical outcomes by decreasing illness severity and mortality related to IPD.
Imaz
A
A
Infectious Disease Department, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, P Vall d'Hebron 119-129, Barcelona 08035, Spain. aimaz@vhebron.net
Falcó
V
V
Peñaranda
M
M
Jordano
Q
Q
Martínez
X
X
Nadal
C
C
Curran
A
A
Planes
A M
AM
Dalmau
D
D
Ribera
E
E
Riera
M
M
Ruiz de Gopegui
E
E
Pahissa
A
A
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000517:prevention & control*; D000328:Adult; D017714:Community-Acquired Infections / Q000276:immunology / Q000517:prevention & control; D005260:Female; D015497:HIV-1; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D011014:Pneumonia / Q000276:immunology / Q000517:prevention & control*; D013030:Spain / Q000453:epidemiology
D022242:Pneumococcal Vaccines