Setse Rosanna W, Siberry George K, Moss William J, Wheeling John, Bohannon Beverly A, Dominguez Kenneth L
From the *Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; †Pediatric Adolescent Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; ‡Northrop Grumman Inc., Atlanta, GA; and §Epidemiology Branch, Division of HIV/AIDS Prevention, Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Pediatr Infect Dis J. 2016 May;35(5):e152-7. doi: 10.1097/INF.0000000000001078.
The meningococcal conjugate vaccine (MCV4) and the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) were first recommended for adolescents in the US in 2005. The goal of our study was to determine MCV4 and Tdap vaccines coverage among perinatally and behaviorally HIV-infected adolescents in 2006 and to compare coverage estimates in our study population to similarly aged healthy youth in 2006.
Longitudinal Epidemiologic Study to Gain Insight into HIV/AIDS in Children and Youth (LEGACY) is a retrospective cohort study of HIV-infected youth in 22 HIV specialty clinics across the US. Among LEGACY participants ≥11 years of age in 2006, we conducted a cross-sectional analysis to determine MCV4, Tdap and MCV4/Tdap vaccine coverage. We compared vaccine coverage among our study population to coverage among similarly aged youth in the 2006 National Immunization Survey for Teens (NIS-Teen Survey). Multivariable mixed effects logistic regression modeling was used to examine associations between MCV4/Tdap vaccination and mode of HIV transmission.
MCV4 and Tdap coverage rates among 326 eligible participants were 31.6% and 28.8%, respectively. Among adolescents 13-17 years of age, MCV4 and Tdap coverage was significantly higher among HIV-infected youth than among youth in the 2006 NIS-Teen Survey (P <0.01). In multivariable analysis, perinatally HIV-infected youth were significantly more likely to have received MCV4/Tdap vaccination compared with their behaviorally infected counterparts (adjusted odds ratio: 5.1; 95% confidence interval: 2.0, 12.7). HIV-infected youth with CD4 cell counts of 200-499 cells/μL were more likely to have had MCV4/Tdap vaccination compared with those with CD4 counts ≥500 cells/μL (adjusted odds ratio: 2.2; 95% confidence interval: 1.2, 4.3). Participants with plasma HIV RNA viral loads of >400 copies/mL were significantly less likely to have received MCV4/Tdap vaccination (P < 0.05).
MCV4 and Tdap coverage among HIV-infected youth was suboptimal but higher than for healthy adolescents in the 2006 NIS-Teen Survey. Perinatal HIV infection was associated with increased likelihood of vaccination. Specific measures are needed to improve vaccine coverage among adolescents in the US.
脑膜炎球菌结合疫苗（MCV4）以及破伤风类毒素、低剂量白喉类毒素和无细胞百日咳疫苗（Tdap）于2005年首次被推荐用于美国青少年。我们研究的目的是确定2006年围产期感染HIV和行为感染HIV的青少年中MCV4和Tdap疫苗的接种率，并将我们研究人群的接种率估计值与2006年年龄相仿的健康青少年进行比较。
儿童和青少年HIV/AIDS深入了解纵向流行病学研究（LEGACY）是一项对美国22家HIV专科诊所中感染HIV的青少年进行的回顾性队列研究。在2006年年龄≥11岁的LEGACY参与者中，我们进行了一项横断面分析以确定MCV4、Tdap和MCV4/Tdap疫苗的接种率。我们将研究人群的疫苗接种率与2006年青少年国家免疫调查（NIS - Teen Survey）中年龄相仿的青少年的接种率进行了比较。使用多变量混合效应逻辑回归模型来检验MCV4/Tdap疫苗接种与HIV传播方式之间的关联。
326名符合条件的参与者中，MCV4和Tdap的接种率分别为31.6%和28.8%。在13 - 17岁的青少年中，感染HIV的青少年的MCV4和Tdap接种率显著高于2006年NIS - Teen Survey中的青少年（P <0.01）。在多变量分析中，与行为感染HIV的青少年相比，围产期感染HIV的青少年接受MCV4/Tdap疫苗接种的可能性显著更高（调整后的优势比：5.1；95%置信区间：2.0，12.7）。CD4细胞计数为200 - 499个/μL的感染HIV的青少年比CD4细胞计数≥500个/μL的青少年更有可能接受MCV4/Tdap疫苗接种（调整后的优势比：2.2；95%置信区间：1.2，4.3）。血浆HIV RNA病毒载量>400拷贝/mL的参与者接受MCV4/Tdap疫苗接种的可能性显著更低（P <0.05）。
感染HIV的青少年中MCV4和Tdap的接种率未达最佳水平，但高于2006年NIS - Teen Survey中的健康青少年。围产期HIV感染与疫苗接种可能性增加相关。需要采取具体措施来提高美国青少年的疫苗接种率。
