title: Prevention of invasive pneumococcal disease among HIV-infected adults in the era of childhood pneumococcal immunization.
abstract: OBJECTIVE
  Human immunodeficiency virus (HIV) infection and AIDS increase the risk of invasive pneumococcal disease (IPD). We evaluated IPD among HIV-infected adults over a 10-year period in the US to identify opportunities for prevention of IPD among HIV-infected adults.
  
  
  METHODS
  IPD and HIV surveillance in seven population-based and laboratory-based Active Bacterial Core surveillance areas.
  
  
  METHODS
  IPD cases were adults 18-64 years old with pneumococcus isolated from a normally sterile site during 1998-2007. Isolates were serotyped using the Quellung reaction. HIV/AIDS status was determined by medical record review. We calculated incidence of IPD among adults with AIDS using national case-based surveillance data.
  
  
  RESULTS
  Of 13 812 IPD cases among 18-64-year-olds, 3236 (23%) occurred among HIV-infected adults (with or without AIDS) and 1313 (10%) occurred among the subset of HIV-infected adults with AIDS. Compared with the period (1998-1999) before childhood 7-valent pneumococcal conjugate vaccine (PCV7) introduction in the US, the overall incidence of IPD among adults with AIDS decreased 25% from 399 to 298 cases per 100 000 by 2007 (P = 0.008). In 2006-2007, 8, 39 and 55% of IPD cases among adults with AIDS were caused by serotypes included in the 7-valent PCV, 13-valent PCV and 23-valent pneumococcal polysaccharide vaccines, respectively.
  
  
  CONCLUSIONS
  Sustained declines in IPD have occurred among adults with AIDS in the US, but incidence remained high 7 years after PCV7 introduction. More aggressive efforts, including HIV-prevention measures and the use of new PCVs in children and possibly HIV-infected adults, are necessary to further reduce IPD among HIV-infected adults.
authors.affiliation: Respiratory Diseases Branch, Division of Bacterial Diseases, USA. dvj1@cdc.gov
authors.forename: Adam L
authors.initials: AL
authors.lastname: Cohen
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.forename: Monica M
authors.initials: MM
authors.lastname: Farley
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: Michael
authors.initials: M
authors.lastname: Campsmith
authors.forename: Jianmin
authors.initials: J
authors.lastname: Li
authors.forename: Anne
authors.initials: A
authors.lastname: Schuchat
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Moore
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D000293:Adolescent; D000328:Adult; D024881:Drug Resistance, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000276:immunology; D018571:Sentinel Surveillance; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D022242:Pneumococcal Vaccines