title: Effectiveness of 7-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in HIV-infected and -uninfected children in south africa: a matched case-control study.
abstract: BACKGROUND
  South Africa introduced 7-valent pneumococcal conjugate vaccine (PCV7) in April 2009 using a 2 + 1 schedule (6 and 14 weeks and 9 months). We estimated the effectiveness of ≥2 PCV7 doses against invasive pneumococcal disease (IPD) in human immunodeficiency virus (HIV)-infected and -uninfected children.
  
  
  METHODS
  IPD (pneumococcus identified from a normally sterile site) cases were identified through national laboratory-based surveillance. Specimens were serotyped by Quellung or polymerase chain reaction. Four controls, matched for age, HIV status, and hospital were sought for each case. Using conditional logistic regression, we calculated vaccine effectiveness (VE) as 1 minus the adjusted odds ratio for vaccination.
  
  
  RESULTS
  From March 2010 through November 2012, we enrolled 187 HIV-uninfected (48 [26%] vaccine serotype) and 109 HIV-infected (43 [39%] vaccine serotype) cases and 752 HIV-uninfected and 347 HIV-infected controls aged ≥16 weeks. Effectiveness of ≥2 PCV7 doses against vaccine-serotype IPD was 74% (95% confidence interval [CI], 25%-91%) among HIV-uninfected and -12% (95% CI, -449% to 77%) among HIV-infected children. Effectiveness of ≥3 doses against vaccine-serotype IPD was 90% (95% CI, 14%-99%) among HIV-uninfected and 57% (95% CI, -371% to 96%) among HIV-infected children. Among HIV-exposed but -uninfected children, effectiveness of ≥2 doses was 92% (95% CI, 47%-99%) against vaccine-serotype IPD. Effectiveness of ≥2 doses against all-serotype multidrug-resistant IPD was 96% (95% CI, 62%-100%) among HIV-uninfected children.
  
  
  CONCLUSIONS
  A 2 + 1 PCV7 schedule was effective in preventing vaccine-serotype IPD in HIV-uninfected and HIV-exposed, uninfected children. This finding supports the World Health Organization recommendation for this schedule as an alternative to a 3-dose primary series among HIV-uninfected individuals.
authors.affiliation: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cohen
authors.affiliation: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
authors.forename: Claire
authors.initials: C
authors.lastname: von Mollendorf
authors.affiliation: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service.
authors.forename: Linda
authors.initials: L
authors.lastname: de Gouveia
authors.affiliation: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
authors.forename: Nireshni
authors.initials: N
authors.lastname: Naidoo
authors.affiliation: Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service.
authors.forename: Susan
authors.initials: S
authors.lastname: Meiring
authors.affiliation: Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Quan
authors.affiliation: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service.
authors.forename: Vusi
authors.initials: V
authors.lastname: Nokeri
authors.affiliation: Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service.
authors.forename: Melony
authors.initials: M
authors.lastname: Fortuin-de Smit
authors.affiliation: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service.
authors.forename: Babatyi
authors.initials: B
authors.lastname: Malope-Kgokong
authors.affiliation: Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases.
authors.forename: David
authors.initials: D
authors.lastname: Moore
authors.affiliation: Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand.
authors.forename: Gary
authors.initials: G
authors.lastname: Reubenson
authors.affiliation: Dr George Mukhari Hospital, Paediatrics Department, Medunsa University, Gauteng Province.
authors.forename: Mamokgethi
authors.initials: M
authors.lastname: Moshe
authors.affiliation: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases School of Pathology Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.affiliation: Red Cross War Memorial Children's Hospital, and the Department of Paediatrics and Child Health, University of Cape Town.
authors.forename: Brian
authors.initials: B
authors.lastname: Eley
authors.affiliation: Department of Paediatrics and Child Health, Universitas and Pelonomi Hospitals, University of the Free State, Bloemfontein.
authors.forename: Ute
authors.initials: U
authors.lastname: Hallbauer
authors.affiliation: Rahima Moosa Mother and Child Hospital, Department of Clinical Microbiology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Ranmini
authors.initials: R
authors.lastname: Kularatne
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Laura
authors.initials: L
authors.lastname: Conklin
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: O'Brien
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Zell
authors.affiliation: School of Pathology Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg Hubert Department of Global Health, Rollins School of Public Health, and Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Keith
authors.initials: K
authors.lastname: Klugman
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Whitney
authors.affiliation: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service School of Pathology Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg.
authors.forename: Anne
authors.initials: A
authors.lastname: von Gottberg
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D012307:Risk Factors; D065288:Serogroup; D013019:South Africa / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000145:classification / Q000235:genetics
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines
keywords: HIV; South Africa; children; pneumococcal conjugate vaccine; pneumococcus