Changes in Invasive Pneumococcal Disease for Patients Living with HIV Following 13-Valent Pneumococcal Conjugate Vaccine
Presenter: Miwako Kobayashi, MD, MPH, Medical Epidemiologist, Centers for Disease Control and Prevention, Atlanta, Georgia
A summary of Changes in Invasive Pneumococcal Disease among Adults Living with HIV Following Introduction of 13-Valent Pneumococcal Conjugate Vaccine, 2008-2018, September 30, 2021
According to medical epidemiologist, Miwako Kobayashi, MD, MPH, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, people living with HIV (PLWH) have a 10 to 324 times increased risk of invasive pneumococcal disease, even after widespread use of antiretroviral therapy.
Further, Kobayashi stated that the 13-valent pneumococcal conjugate vaccine (PCV13) was recommended for all children in 2010 and for immunocompromised adults, including PLWH, in a series with 23-valent pneumococcal polysaccharide vaccine (PPV23) in 2012 to reduce disease burden.
Researchers at the CDC evaluated changes in invasive pneumococcal disease incidence in adults 19 years of age or older according to HIV status after PCV13 introduction and the proportion of remaining invasive pneumococcal disease due to serotypes included in the 15-valent (PCV15) and 20-valent (PCV20) conjugate vaccines expected to be licensed in 2021.
Invasive pneumococcal disease cases were identified through the Active Bacterial Core surveillance (ABCs) of the CDC, and HIV status was obtained from medical records. Isolates were serotyped by Quellung reaction or whole-genome sequencing and grouped into PCV13-types, PPV11-types (unique to PPV23), or non-vaccine types.
Researchers estimated invasive pneumococcal disease incidence per 100,000 people using national projections of ABCs’ cases as numerators and national case-based HIV surveillance (PLWH) or US census data (non-PLWH) as denominators. Kobayashi stated that they “compared invasive pneumococcal disease incidence in 2011–2012 and 2017–2018 to pre-PCV13 baseline (2008–2009) by serotype groups and assessed the proportion of invasive pneumococcal disease due to serotypes included in PCV15 and PCV20.”
Researchers identified 29,668 invasive pneumococcal disease cases reported in 9 ABCs sites, including 8.2% (2,440/29,668) with known HIV infection. Patients with HIV tended to be younger, male and Black non-Hispanic.
Overall, the incidence rate of invasive pneumococcal disease for PLWH changed from 306.7 in 2008–2009 to 183 in 2017–2018 per 100,000, a decline of 40%. The invasive pneumococcal disease incidence also declined in non-PLWH over the same time periods from 15.2 to 10.9, a 28% decline.
“The largest reductions were in PCV13-type invasive pneumococcal disease during both periods, compared to baseline,” said Kobayashi. Those changes were –44.2% for PLWH and –42.2% for non-PLWH in 2011–2012, and –72.5% for PLWH and –62.2% for non-PLWH in 2017–2018.
Kobayashi continued, “In 2017–2018, overall invasive pneumococcal disease and PCV13-type rates were 16.8 (95% confidence interval: 15.1, 18.5) and 12.6 (95% confidence interval: 9.9, 15.3) times as high in PLWH vs non-PLWH, respectively; PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes comprised 21.5%, 11.2%, and 16.5% of invasive pneumococcal disease in PLWH.”
Kobayashi concluded, “Significant reductions in overall and PCV13 serotype invasive pneumococcal disease rates were observed in both PLWH and non-PLWH during 2008–2018. PLWH continue to be at increased risk of invasive pneumococcal disease, including PCV13-type invasive pneumococcal disease. Newly licensed, higher-valent PCVs may help further reduce the disease burden in PLWH. Ensuring improved vaccine coverage is needed to maximize vaccine benefits.”
Disclosures
Miwako Kobayashi, MD, MPH: Nothing to disclose.
References
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