title: Risk factors for invasive pneumococcal disease among children less than 5 years of age in a high HIV prevalence setting, South Africa, 2010 to 2012.
abstract: BACKGROUND
  Invasive pneumococcal disease (IPD) causes significant disease burden, especially in developing countries, even in the era of pneumococcal conjugate vaccine and maternal-to-child HIV transmission prevention programs. We evaluated factors that might increase IPD risk in young children in a high HIV prevalence setting.
  
  
  METHODS
  We conducted a case-control study using IPD cases identified at 24 Group for Enteric, Respiratory and Meningeal disease Surveillance-South Africa program sites (2010-2012). At least 4 controls were matched by age, HIV status and hospital to each case. Potential risk factors were evaluated using multivariable conditional logistic regression.
  
  
  RESULTS
  In total, 486 age-eligible cases were enrolled. Factors associated with IPD in HIV-uninfected children (237 cases, 928 controls) included siblings <5 years [adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI): 1.16-2.46], underlying medical conditions (aOR = 1.99, CI 1.22-3.22), preceding upper respiratory tract infection (aOR = 1.79, CI 1.19-2.69), day-care attendance (aOR = 1.58, CI 1.01-2.47), perinatal HIV exposure (aOR = 1.62, CI 1.10-2.37), household car ownership (aOR = 0.45, CI 0.25-0.83) and ≥2 7-valent pneumococcal conjugate vaccine doses (aOR = 0.67, CI 0.46-0.99). Among HIV-infected children (124 cases, 394 controls), IPD-associated factors included malnutrition (aOR = 2.68, CI 1.40-5.14), upper respiratory tract infection (aOR = 3.49, CI 1.73-7.03), tuberculosis in the last 3 months (aOR = 5.12, CI 1.69-15.50) and current antiretroviral treatment (aOR = 0.13, CI 0.05-0.38).
  
  
  CONCLUSIONS
  Previously identified factors related to poverty, poor health and intense exposure continue to be risk factors for IPD in children. Ensuring delivery of pneumococcal conjugate vaccine and antiretroviral treatment are important for improving disease prevention.
authors.affiliation: From the *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; ‡Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; §Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Gauteng, South Africa; ¶Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand; ‖Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; **Dr George Mukhari Hospital, Paediatrics Department, Medunsa University, Gauteng, South Africa; ††Red Cross War Memorial Children's Hospital, and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, Western Cape; ‡‡Universitas and Pelonomi Hospitals, Department of Paediatrics and Child Health, University of the Free State, Bloemfontein, Free State, South Africa; §§Tygerberg Hospital and Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, Western Cape, South Africa; ¶¶ National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention; and ‖‖Hubert Department of Global Health, Emory University, Atlanta, GA.
authors.forename: Claire
authors.initials: C
authors.lastname: von Mollendorf
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cohen
authors.forename: Linda
authors.initials: L
authors.lastname: de Gouveia
authors.forename: Nireshni
authors.initials: N
authors.lastname: Naidoo
authors.forename: Susan
authors.initials: S
authors.lastname: Meiring
authors.forename: Vanessa
authors.initials: V
authors.lastname: Quan
authors.forename: Sonwabo
authors.initials: S
authors.lastname: Lindani
authors.forename: David P
authors.initials: DP
authors.lastname: Moore
authors.forename: Gary
authors.initials: G
authors.lastname: Reubenson
authors.forename: Mamokgethi
authors.initials: M
authors.lastname: Moshe
authors.forename: Brian
authors.initials: B
authors.lastname: Eley
authors.forename: Ute M
authors.initials: UM
authors.lastname: Hallbauer
authors.forename: Heather
authors.initials: H
authors.lastname: Finlayson
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.forename: Laura
authors.initials: L
authors.lastname: Conklin
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Zell
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Whitney
authors.forename: Anne
authors.initials: A
authors.lastname: von Gottberg
mesh_terms: D016470:Bacteremia / Q000453:epidemiology*; D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology*; D011008:Pneumococcal Infections / Q000453:epidemiology*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D022242:Pneumococcal Vaccines