The prevalence of
Streptococcus pneumoniae (pneumococcus) carriage is higher in adults who are
infected with human immunodeficiency virus (HIV) than in adults who are not. We hypothesized that infants
exposed to HIV become
carriers of nasopharyngeal pneumococcus earlier and more frequently than
infants who are not exposed to HIV. We compared infant pneumococcal acquisition by maternal HIV status
and household exposure in Karonga District, Malawi, in 2009-2011, before the
introduction of pneumococcal conjugate vaccine. Nasopharyngeal swabs were
collected every 4-6 weeks in the first year of life from infants with known HIV-exposure status, their mothers, and other household members.
We studied infant pneumococcal acquisition by maternal HIV status, serotype-specific household exposure, and other risk factors, including seasonality. We recruited 54 infants who were exposed to HIV and 131 infants who were not. There was no significant difference in pneumococcal acquisition by maternal HIVstatus (adjusted rate ratio (aRR) = 1.00, 95% confidence interval (CI): 0.87, 1.15).
Carriage by the mother was associated with greater acquisition of the same serotype (aRR = 3.09, 95% CI: 1.47, 6.50), but the adjusted population attributable fraction was negligible (1.9%, 95% CI: 0.0, 4.3). Serotype-specific exposure to children under 5 years of age was associated with higher acquisition (aRR = 4.30, 95% CI: 2.80, 6.60; adjusted population attributable fraction = 8.8%, 95% CI: 4.0, 13.4).
We found no evidence to suggest that maternal HIV infection would affect the impact of pneumococcal vaccination on colonization in this population.
We studied infant pneumococcal acquisition by maternal HIV status, serotype-specific household exposure, and other risk factors, including seasonality. We recruited 54 infants who were exposed to HIV and 131 infants who were not. There was no significant difference in pneumococcal acquisition by maternal HIVstatus (adjusted rate ratio (aRR) = 1.00, 95% confidence interval (CI): 0.87, 1.15).
Carriage by the mother was associated with greater acquisition of the same serotype (aRR = 3.09, 95% CI: 1.47, 6.50), but the adjusted population attributable fraction was negligible (1.9%, 95% CI: 0.0, 4.3). Serotype-specific exposure to children under 5 years of age was associated with higher acquisition (aRR = 4.30, 95% CI: 2.80, 6.60; adjusted population attributable fraction = 8.8%, 95% CI: 4.0, 13.4).
We found no evidence to suggest that maternal HIV infection would affect the impact of pneumococcal vaccination on colonization in this population.
Below: Prevalence of pneumococcal carriage by age of the index infant (weeks), Karonga District, Malawi, 2009–2011. Bars, 95% confidence intervals.
Below: Fitted parametric seasonal trend in the incidence of pneumococcal carriage among infants in Karonga District, Malawi, 2009–2011. Gray areas, 95% confidence intervals.
Below: Nonparametric spline fitted to the secular trend in pneumococcal carriage incidence in infants, Karonga District, Malawi, 2009–2011. Gray areas, 95% confidence intervals.
Full article at: http://goo.gl/iStGNB
By:
Correspondence to Prof. Neil French, Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, United Kingdom (e-mail: ku.ca.looprevil@hcnerf).
More at: https://twitter.com/hiv
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