HIV infection and the epidemiology of Invasive Pneumococcal Disease (IPD) in South African adults and older children prior to the introduction of a Pneumococcal Conjugate Vaccine (PCV)

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dc.contributor.authorMeiring, Susanen_ZA
dc.contributor.authorCohen, Cherylen_ZA
dc.contributor.authorQuan, Vanessaen_ZA
dc.contributor.authorDe Gouveia, Lindaen_ZA
dc.contributor.authorFeldman, Charlesen_ZA
dc.contributor.authorKarstaedt, Alanen_ZA
dc.contributor.authorKlugman, Keith P.en_ZA
dc.contributor.authorMadhi, Shabir A.en_ZA
dc.contributor.authorRabie, Heleneen_ZA
dc.contributor.authorSriruttan, Charlotteen_ZA
dc.contributor.authorVon Gottberg, Anneen_ZA
dc.contributor.authorGERMS-SAen_ZA
dc.date.accessioned2017-10-02T14:06:52Z
dc.date.available2017-10-02T14:06:52Z
dc.date.issued2016
dc.descriptionCITATION: Meiring, S., et al. 2016. HIV infection and the epidemiology of Invasive Pneumococcal Disease (IPD) in South African adults and older children prior to the introduction of a Pneumococcal Conjugate Vaccine (PCV). PLoS ONE 11(2):e0149104, doi:10.1371/journal.pone.0149104.en_ZA
dc.descriptionThe original publication is available at http://journals.plos.org/plosoneen_ZA
dc.description.abstractIntroduction: Streptococcus pneumoniae is the commonest cause of bacteremic pneumonia among HIV-infected persons. As more countries with high HIV prevalence are implementing infant pneumococcal conjugate vaccine (PCV) programs, we aimed to describe the baseline clinical characteristics of adult invasive pneumococcal disease (IPD) in the pre-PCV era in South Africa in order to interpret potential indirect effects following vaccine use. Methods: National, active, laboratory-based surveillance for IPD was conducted in South Africa from 1 January 2003 through 31 December 2008. At 25 enhanced surveillance (ES) hospital sites, clinical data, including HIV serostatus, were collected from IPD patients ≥ 5 years of age. We compared the clinical characteristics of individuals with IPD in those HIV-infected and -uninfected using multivariable analysis. PCV was introduced into the routine South African Expanded Program on Immunization (EPI) in 2009. Results: In South Africa, from 2003–2008, 17 604 cases of IPD occurred amongst persons ≥ 5 years of age, with an average incidence of 7 cases per 100 000 person-years. Against a national HIV-prevalence of 18%, 89% (4190/4734) of IPD patients from ES sites were HIV-infected. IPD incidence in HIV-infected individuals is 43 times higher than in HIV-uninfected persons (52 per 100 000 vs. 1.2 per 100 000), with a peak in the HIV-infected elderly population of 237 per 100 000 persons. Most HIV-infected individuals presented with bacteremia (74%, 3 091/4 190). HIV-uninfected individuals were older; and had more chronic conditions (excluding HIV) than HIV-infected persons (39% (210/544) vs. 19% (790/4190), p<0.001). During the pre-PCV immunization era in South Africa, 71% of serotypes amongst HIV-infected persons were covered by PCV13 vs. 73% amongst HIV-uninfected persons, p = 0.4, OR 0.9 (CI 0.7–1.1). Conclusion: Seventy to eighty-five percent of adult IPD in the pre-PCV era were vaccine serotypes and 93% of cases had recognized risk factors (including HIV-infection) for pneumococcal vaccination. These data describe the epidemiology of IPD amongst HIV-infected and -uninfected adults during the pre-PCV era and provide a robust baseline to calculate the indirect effect of PCV in future studies.en_ZA
dc.description.urihttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0149104en_ZA
dc.description.versionPublisher's versionen_ZA
dc.format.extent17 pages : illustrations (chiefly colour)en_ZA
dc.identifier.citationMeiring, S., et al. 2016. HIV infection and the epidemiology of Invasive Pneumococcal Disease (IPD) in South African adults and older children prior to the introduction of a Pneumococcal Conjugate Vaccine (PCV). PLoS ONE 11(2):e0149104, doi:10.1371/journal.pone.0149104en_ZA
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0149104
dc.identifier.urihttp://hdl.handle.net/10019.1/102293
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectHIV infections -- South Africaen_ZA
dc.subjectInvasive Pneumococcal Diseaseen_ZA
dc.subjectPneumococcal vaccineen_ZA
dc.subjectHIV-positive persons -- South Africaen_ZA
dc.subjectEpidemiology -- Researchen_ZA
dc.titleHIV infection and the epidemiology of Invasive Pneumococcal Disease (IPD) in South African adults and older children prior to the introduction of a Pneumococcal Conjugate Vaccine (PCV)en_ZA
dc.typeArticleen_ZA
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