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Impact of 13-Valent Pneumococcal Conjugate Vaccine on Invasive Pneumococcal Disease Among Adults With HIV-United
Miwako Kobayashi1, Almea Matanock1, Wei Xing2
1Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
Insights
People with HIV (PWH) remain at higher risk for invasive pneumococcal disease (IPD) despite PCV13 vaccine introduction. Higher-valent pneumococcal vaccines (PCVs) offer potential to further reduce IPD burden in this population.
Area of Science:
- Epidemiology
- Vaccinology
- Public Health
Background:
- People with HIV (PWH) face elevated risk for invasive pneumococcal disease (IPD).
- The 13-valent pneumococcal conjugate vaccine (PCV13) was recommended for children in 2010 and for PWH aged 19+ in 2012.
- This study assesses the population-level impact of PCV13 on IPD in adults with and without HIV.
Purpose of the Study:
- To evaluate the impact of PCV13 on invasive pneumococcal disease (IPD) incidence among people with HIV (PWH) and without HIV.
- To analyze IPD trends by HIV status, age, and serotype coverage of PCV13, PCV15, and PCV20.
Main Methods:
- Utilized the Active Bacterial Core surveillance platform to identify IPD cases from 2008-2018.
- Estimated IPD incidence using HIV Surveillance System and US Census Bureau data.
- Calculated percent changes in IPD incidence pre- and post-PCV13 introduction, stratified by HIV status and age.
Main Results:
- In 2017-2018, PWH accounted for 8.0% of adult IPD cases, with a higher proportion in younger adults (19-64 years) and non-Hispanic Black individuals.
- Overall and PCV13-type IPD incidence in PWH decreased by 40.3% and 72.5%, respectively, post-PCV13 introduction.
- In 2017-2018, IPD incidence remained 16.8 times higher in PWH than non-PWH, with PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes causing 21.5%, 11.2%, and 16.5% of IPD in PWH.
Conclusions:
- Despite PCV13's impact, invasive pneumococcal disease (IPD) incidence remains significantly higher in people with HIV (PWH).
- Higher-valent pneumococcal vaccines (PCV15, PCV20) present an opportunity to further decrease the IPD burden in PWH.
- Continued surveillance and vaccination strategies are crucial for reducing IPD among PWH.
Background:
People with HIV (PWH) are at increased risk for invasive pneumococcal disease (IPD). Thirteen-valent pneumococcal conjugate vaccine (PCV13) was recommended for use in US children in 2010 and for PWH aged 19 years or older in 2012. We evaluated the population-level impact of PCV13 on IPD among PWH and non-PWH aged 19 years or older.
Methods:
We identified IPD cases from 2008 to 2018 through the Active Bacterial Core surveillance platform. We estimated IPD incidence using the National HIV Surveillance System and US Census Bureau data. We measured percent changes in IPD incidence from 2008 to 2009 to 2017-2018 by HIV status, age group, and vaccine serotype group, including serotypes in recently licensed 15-valent (PCV15) and 20-valent (PCV20) PCVs.
Results:
In 2008-2009 and 2017-2018, 8.4% (552/6548) and 8.0% (416/5169) of adult IPD cases were among PWH, respectively. Compared with non-PWH, a larger proportion of IPD cases among PWH were in adults aged 19-64 years (94.7%-97.4% vs. 56.0%-60.1%) and non-Hispanic Black people (62.5%-73.0% vs. 16.7%-19.2%). Overall and PCV13-type IPD incidence in PWH declined by 40.3% (95% confidence interval: -47.7 to -32.3) and 72.5% (95% confidence interval: -78.8 to -65.6), respectively. In 2017-2018, IPD incidence was 16.8 (overall) and 12.6 (PCV13 type) times higher in PWH compared with non-PWH; PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes comprised 21.5%, 11.2%, and 16.5% of IPD in PWH, respectively.
Conclusions:
Despite reductions post-PCV13 introduction, IPD incidence among PWH remained substantially higher than among non-PWH. Higher-valent PCVs provide opportunities to reduce remaining IPD burden in PWH.
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