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Temporal changes in pneumococcal colonization in a rural African community with high HIV prevalence following routine

Susan A Nzenze1, Tinevimbo Shiri, Marta C Nunes

  • 1From the *Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases; †Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; ‡Department of Global Health, Rollins School of Public Health; and §Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia; ¶MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‖Centre for Global Health Research, Umeå University, Umeå, Sweden; **INDEPTH Network, Accra, Ghana; and ††National Institute for Communicable Diseases, National Health Laboratory Service, Sandringham, South Africa.

The Pediatric Infectious Disease Journal
|September 25, 2013
PubMed

Insights

Routine infant pneumococcal conjugate vaccine (PCV) immunization significantly reduced vaccine-type nasopharyngeal colonization in a South African community. This indirect effect was observed within two years, even in a high HIV prevalence setting.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Vaccinology

Background:

  • Pneumococcal conjugate vaccine (PCV) immunization in children reduces nasopharyngeal carriage of vaccine-type *Streptococcus pneumoniae*.
  • The study investigated the impact of routine infant PCV immunization on pneumococcal colonization in a rural African community with a high prevalence of HIV.

Purpose of the Study:

  • To assess the effect of routine infant PCV immunization on the epidemiology of nasopharyngeal pneumococcal colonization.
  • To evaluate the indirect impact of PCV on different age groups and the prevalence of non-vaccine serotypes in a high HIV setting.

Main Methods:

  • Two cross-sectional surveys were conducted in a rural South African community before and after the introduction of 7-valent PCV (PCV7) in April 2009.
  • Nasopharyngeal swabs were collected from household members of randomly selected households with at least one child under two years old.
  • Swabs were cultured for *Streptococcus pneumoniae* and serotyped using the Quellung method.

Main Results:

  • Overall prevalence of vaccine serotype colonization decreased from 18.3% to 11.4% (P<0.0001) within two years of PCV7 introduction.
  • Significant reductions in vaccine serotype colonization were observed across all age groups, including children under 2 years (50% reduction), 6-12 year olds (34% reduction), and adults (64% reduction).
  • Prevalence of non-vaccine serotype colonization increased in young children (<2 years) but decreased significantly in adolescents and adults.

Conclusions:

  • Routine infant PCV7 immunization demonstrated an indirect protective effect against vaccine serotype colonization within two years in a high HIV prevalence setting.
  • The observed decline in non-vaccine serotype colonization among adolescents and adults suggests a potential lag in replacement colonization in these groups.
Abstract

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