Increased risk for and mortality from invasive pneumococcal disease in HIV-exposed but uninfected infants aged <1 year in South Africa, 2009-2013

Claire von Mollendorf; Anne von Gottberg; Stefano Tempia; Susan Meiring; Linda de Gouveia; Vanessa Quan; Sarona Lengana; Theunis Avenant; Nicolette du Plessis; Brian Eley; Heather Finlayson; Gary Reubenson; Mamokgethi Moshe; Katherine L O'Brien; Keith P Klugman; Cynthia G Whitney; Cheryl Cohen; Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa

doi:10.1093/cid/civ059

Increased risk for and mortality from invasive pneumococcal disease in HIV-exposed but uninfected infants aged <1 year in South Africa, 2009-2013

Clin Infect Dis. 2015 May 1;60(9):1346-56. doi: 10.1093/cid/civ059. Epub 2015 Feb 2.

Authors

Claire von Mollendorf¹, Anne von Gottberg², Stefano Tempia³, Susan Meiring⁴, Linda de Gouveia⁵, Vanessa Quan⁴, Sarona Lengana⁵, Theunis Avenant⁶, Nicolette du Plessis⁶, Brian Eley⁷, Heather Finlayson⁸, Gary Reubenson⁹, Mamokgethi Moshe¹⁰, Katherine L O'Brien¹¹, Keith P Klugman¹², Cynthia G Whitney¹³, Cheryl Cohen¹; Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa

Collaborators

Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa:
Sandeep Vasaikar, Dania Perez, Eugene Elliot, Ute Hallbauer, Alan Karstaedt, Jeannette Wadula, Charl Verwey, Kathy Lindeque, Charlotte Sriruttan, Sharona Seetharam, Charles Feldman, Trusha Nana, Norma Bosman, Sheeba Varughese, Adrian Duse, Warren Lowman, David Moore, Charl Verwey, Mamokgethi Moshe, Kamaldeen Baba, Theunis Avenant, Nicolette du Plessis, Gary Reubenson, Ranmini Kularatne, Maphoshane Nchabeleng, Anwar Hoosen, Bonnie Maloba, Ruth Lekalakala, Yacoob Coovadia, Koleka Mlisana, Moherndran Archary, Ramola Naidoo, Khatija Dawood, Fathima Naby, Khine Sweswe, Prathna Bhola, Prasha Mahabeer, Lisha Sookan, Praksha Ramjathan, Halima Dawood, Sumayya Haffejee, Ken Hamese, Phasweni Maredi, Takalani Muditambi, Greta Hoyland, Jacob Lebudi, Barry Spies, Stan Harvey, Pieter Jooste, Dhamiran Naidoo, Eunice Weenink, Andrew Rampe, Lino Sono, Elizabeth Wasserman, Preneshni Naicker, Andrew Whitelaw, Brian Eley, James Nuttal, Louise Cooke, Heather Finalyson, Helena Rabie, Collleen Bamford, Heidi Orth, Mark Nicol, Rena Hoffmann, Steve Oliver, Keshree Pillay, Chetna Govind, Adrian Brink, Maria Botha, Inge Zietsman, Inge Zietsman, Suzy Budavari, Xoliswa Poswa, Mark Cruz da Silva, Jennifer Coetzee, Marthinus Senekal, Chris van Beneden, Stephanie Schrag, Elizabeth Zell, Anne Schuchat, Tom Chiller, Angela Ahlquist, Fred Angulo, Keith Klugman, Katherine O'Brien, Anne von Gottberg, Linda de Gouveia, Mignon du Plessis, Karen Keddy, Arvinda Sooka, Nelesh Govender, Jaymati Patel, Vanessa Quan, Susan Meiring, Melony Fortuin-de Smidt, Mohlamme John Mathabathe, Claire von Mollendorf, John Frean, Desiree du Plessis, Bhavani Poonsamy, Olga Perovic, Marshagne Smith, Cheryl Cohen, Penny Crowther, Jabulani Ncayiyana, Languta Sibiya, Sonwabo Lindani, Nevashan Govender, Nireshni Naidoo, Babatyi Kgokong, Vusi Nokeri, Sarona Lengana, Ntombenhle Ngcobo, Johann van den Heever, Shabir Madhi, Laura Conklin, Jennifer Verani, Cynthia Whitney, Elizabeth Zell, Jennifer Loo, George Nelson

Affiliations

¹ Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service School of Public Health, Faculty of Health Sciences.
² Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
³ Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia Influenza Division, Centers for Disease Control and Prevention, Pretoria.
⁴ Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg.
⁵ Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service.
⁶ Pediatric Infectious Diseases Unit, Steve Biko (Pretoria Academic Hospital) and Kalafong Hospital, University of Pretoria, Gauteng.
⁷ Red Cross War Memorial Children's Hospital, Department of Paediatrics and Child Health, University of Cape Town.
⁸ Tygerberg Hospital and Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, Western Cape.
⁹ Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg.
¹⁰ Department of Paediatrics and Child Health, Dr George Mukhari Hospital, Medunsa University, Tshwane, Gauteng Province, South Africa.
¹¹ International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
¹² Hubert Department of Global Health, Rollins School of Public Health Division of Infectious Diseases, School of Medicine, Emory University.
¹³ National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

PMID: 25645212
DOI: 10.1093/cid/civ059

Abstract

Background: High antenatal human immunodeficiency virus (HIV) seroprevalence rates (∼ 30%) with low perinatal HIV transmission rates (2.5%), due to HIV prevention of mother-to-child transmission program improvements in South Africa, has resulted in increasing numbers of HIV-exposed but uninfected (HEU) children. We aimed to describe the epidemiology of invasive pneumococcal disease (IPD) in HEU infants.

Methods: We conducted a cross-sectional study of infants aged <1 year with IPD enrolled in a national, laboratory-based surveillance program for incidence estimations. Incidence was reported for 2 time points, 2009 and 2013. At enhanced sites we collected additional data including HIV status and in-hospital outcome.

Results: We identified 2099 IPD cases in infants from 2009 to 2013 from all sites. In infants from enhanced sites (n = 1015), 92% had known HIV exposure status and 86% had known outcomes. IPD incidence was highest in HIV-infected infants, ranging from 272 to 654 per 100,000 population between time points (2013 and 2009), followed by HEU (33-88 per 100,000) and HIV-unexposed and uninfected (HUU) infants (18-28 per 100,000). The case-fatality rate in HEU infants (29% [74/253]) was intermediate between HUU (25% [94/377]) and HIV-infected infants (34% [81/242]). When restricted to infants <6 months of age, HEU infants (37% [59/175]) were at significantly higher risk of dying than HUU infants (32% [51/228]; adjusted relative risk ratio, 1.76 [95% confidence interval, 1.09-2.85]).

Discussion: HEU infants are at increased risk of IPD and mortality from IPD compared with HUU children, especially as young infants. HEU infants, whose numbers will likely continue to increase, should be prioritized for interventions such as pneumococcal vaccination along with HIV-infected infants and children.

Keywords: HIV exposure; South Africa; Streptococcus pneumoniae; children; pneumococcal conjugate vaccine.

Publication types

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

MeSH terms

Cross-Sectional Studies
Female
HIV Infections / diagnosis
HIV Infections / microbiology*
Humans
Incidence
Infant
Infant, Newborn
Male
Pneumococcal Infections / complications
Pneumococcal Infections / epidemiology*
Pneumococcal Infections / mortality*
Pneumococcal Infections / virology
Pneumococcal Vaccines / administration & dosage
Regression Analysis
Risk Factors
Seroepidemiologic Studies
South Africa / epidemiology
Time Factors

Substances

Pneumococcal Vaccines

Abstract

Publication types

MeSH terms

Substances

Grants and funding