From the School of Medical Science and Technology, Indian Institute of Technology (IIT), Kharagpur, India.
International Vaccine Access Center and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Pediatr Infect Dis J. 2018 May;37(5):451-458. doi: 10.1097/INF.0000000000001800.
Human immunodeficiency virus (HIV) infection increases risk of invasive disease from Streptococcus pneumoniae. Pneumococcal conjugate vaccines (PCV) prevent invasive disease and acquisition of vaccine type (VT) pneumococcus in the nasopharynx.
To look at the safety and impact of one dose of PCV13 on acquisition of VT pneumococcal carriage in Indian children with HIV.
We conducted a cohort study in families of HIV-infected children (CLH) and families of HIV-uninfected children (HUC) in West Bengal. All children received one dose of PCV13. Nasopharyngeal swabs were collected from children and parents at baseline and 2 months after vaccination.
One hundred and fifteen CLH and 47 HUC received one dose of PCV13. Fifty-eight percent of CLH were on antiretroviral therapy (ART), and the median nadir CD4 count was 287. There were no significant adverse events in either group. HUC had more VT colonization than CLH-55% versus 23% of all pneumococcal isolates. HIV infection doubled the risk of nonvaccine serotype colonization (P = 0.03). There was no difference in acquisition of VT isolates in CLH (4.4%) and HUC (4.5%) post-PCV13; however, older CLH (>5 years) had decreased clearance of VT strains. ART made no difference in pneumococcal colonization at baseline or after PCV13; however, CLH with higher nadir CD4 counts before starting ART were less likely to have VT colonization post-PCV13 (prevalence ratio, 0.2; 95% confidence interval: 0.1-0.5).
While there was no difference in acquisition of VT nasopharyngeal carriage of pneumococcus in CLH and HUC after one dose of PCV13, earlier access to ART may impact response to PCV13 in CLH.
人类免疫缺陷病毒（HIV）感染会增加侵袭性肺炎链球菌疾病的风险。肺炎球菌结合疫苗（PCV）可预防侵袭性疾病，并可预防鼻咽部疫苗型（VT）肺炎球菌的感染。
观察 1 剂 PCV13 对印度 HIV 感染儿童携带 VT 肺炎球菌的安全性和影响。
我们在西孟加拉邦的 HIV 感染儿童（CLH）家庭和 HIV 未感染儿童（HUC）家庭中开展了一项队列研究。所有儿童均接受了 1 剂 PCV13 接种。在基线和接种疫苗后 2 个月，从儿童和父母中采集鼻咽拭子。
共有 115 名 CLH 和 47 名 HUC 接受了 1 剂 PCV13 接种。58%的 CLH 正在接受抗逆转录病毒治疗（ART），中位 CD4 细胞计数最低值为 287。两组均无明显不良事件。HUC 的 VT 定植率高于 CLH-55%比所有肺炎链球菌分离株的 23%。HIV 感染使非疫苗血清型定植的风险增加了一倍（P=0.03）。CLH（4.4%）和 HUC（4.5%）在接种 PCV13 后均未获得 VT 分离株；然而，年龄较大的 CLH（>5 岁）VT 株清除率降低。ART 对基线或接种 PCV13 后的肺炎球菌定植均无影响；然而，在开始 ART 之前 CD4 计数最低值较高的 CLH，接种 PCV13 后发生 VT 定植的可能性较低（患病率比，0.2；95%置信区间：0.1-0.5）。
尽管在 CLH 和 HUC 中，1 剂 PCV13 接种后，VT 鼻咽部携带肺炎球菌的获得率无差异，但早期获得 ART 可能会影响 CLH 对 PCV13 的反应。
