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)

Susan Meiring; Cheryl Cohen; Vanessa Quan; Linda de Gouveia; Charles Feldman; Alan Karstaedt; Keith P Klugman; Shabir A Madhi; Helene Rabie; Charlotte Sriruttan; Anne von Gottberg; GERMS-SA

doi:10.1371/journal.pone.0149104

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. 2016 Feb 10;11(2):e0149104. doi: 10.1371/journal.pone.0149104. eCollection 2016.

Authors

Susan Meiring¹, Cheryl Cohen^{2

3}, Vanessa Quan¹, Linda de Gouveia¹, Charles Feldman⁴, Alan Karstaedt⁵, Keith P Klugman^{2

6}, Shabir A Madhi^{2

7

8}, Helene Rabie⁹, Charlotte Sriruttan¹⁰, Anne von Gottberg^{2

8}; GERMS-SA

Affiliations

¹ Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
² Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa.
³ School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴ Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁵ Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
⁶ Department of Global Health, Hubert School of Public Health, Emory University, Atlanta, GA, United States of America.
⁷ Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
⁸ Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
⁹ Department of Pediatric Medicine, Tygerberg Hospital, Cape Town, South Africa.
¹⁰ Centre for Opportunistic, Tropical and Hospital-associated Infections, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa.

Abstract

Introduction: 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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Child
Child, Preschool
Female
HIV Infections / complications*
HIV Infections / epidemiology*
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Multivariate Analysis
Pneumococcal Infections / complications*
Pneumococcal Infections / epidemiology*
Pneumococcal Vaccines / immunology
Pneumococcal Vaccines / therapeutic use*
Prevalence
Risk Factors
Serogroup
South Africa / epidemiology
Streptococcus pneumoniae
Vaccination
Vaccines, Conjugate / immunology
Vaccines, Conjugate / therapeutic use
Young Adult

Substances

Pneumococcal Vaccines
Vaccines, Conjugate

Grants and funding

Development of this publication was partially funded by the National Health Laboratory Service/National Institute for Communicable Disease and by the HHS Centers for Disease Control and Prevention (CDC), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Global AIDS Program (GAP) Cooperative Agreement U62/PSO022901. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.