Prevention of invasive pneumococcal disease among HIV-infected adults in the era of childhood pneumococcal immunization.
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.
Cohen
Adam L
AL
Respiratory Diseases Branch, Division of Bacterial Diseases, USA. dvj1@cdc.gov
Harrison
Lee H
LH
Farley
Monica M
MM
Reingold
Arthur L
AL
Hadler
James
J
Schaffner
William
W
Lynfield
Ruth
R
Thomas
Ann R
AR
Campsmith
Michael
M
Li
Jianmin
J
Schuchat
Anne
A
Moore
Matthew R
MR
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
D022242:Pneumococcal Vaccines