Vaccines, US Health Outcomes, GSK, Philadelphia, Pennsylvania.
now with Health Economics and Outcomes Research, Moderna Inc, Cambridge, Massachusetts.
JAMA Netw Open. 2022 Apr 1;5(4):e228573. doi: 10.1001/jamanetworkopen.2022.8573.
In the United States, individuals with HIV infection have been recommended to receive a 2-dose series of the meningococcal A, C, W, Y (MenACWY) vaccine since 2016 owing to their increased risk of meningococcal disease.
To examine uptake and time to receipt of the MenACWY vaccine among people with a new diagnosis of HIV.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used health insurance data from the US Optum Research Database from January 1, 2016, through March 31, 2018, to retrospectively identify 1208 individuals aged 2 years or older with 1 or more inpatient claim or 2 or more outpatient claims evidencing a new diagnosis of HIV infection and with continuous insurance enrollment for 12 or more months before and 6 or more months after diagnosis. Follow-up was 6 to 33 months. Statistical analysis was conducted from March 7, 2019, to January 5, 2022.
Receipt of the MenACWY vaccine.
The coprimary outcomes were uptake and time to receipt of 1 or more doses of the MenACWY vaccine after a new HIV diagnosis. Secondary outcomes included uptake and time to receipt of 2 or more doses of the MenACWY vaccine. Vaccination uptake and receipt were estimated by Kaplan-Meier analysis; factors associated with receipt of 1 or more doses of the MenACWY vaccine were identified with multivariable Cox proportional hazards regression analysis.
Of 1208 individuals eligible for vaccination (1024 male patients [84.8%]; mean [SD] age, 38.8 [12.5] years; 35 [2.9%] Asian; 273 [22.6%] Black; 204 [16.9%] Hispanic; 442 [36.6%] White), 16.3% were estimated to have received a first dose of the MenACWY vaccine in the 2 years after a new HIV diagnosis. Among individuals who received a first dose, at 1 year or more of enrollment after the first dose, 66.2% were estimated to have received a second dose within 1 year of the first dose. Factors statistically significantly associated with uptake of the MenACWY vaccine included receipt of a pneumococcal vaccine (hazard ratio [HR], 23.03; 95% CI, 13.93-38.09), attendance at a well-care visit (HR, 3.67; 95% CI, 1.11-12.12), West or Midwest geographic region (West: HR, 2.24; 95% CI, 1.44-3.47; Midwest: HR, 1.78; 95% CI, 1.16-2.71), and male sex (HR, 2.72; 95% CI, 1.18-6.26), whereas age of 56 years or older was significantly associated with reduced uptake of the MenACWY vaccine (HR, 0.42; 95% CI, 0.18-0.97).
This cohort study suggests that MenACWY vaccine uptake among people with a new diagnosis of HIV was low, highlighting the need to educate patients and clinicians about the recommendations for conditions such as HIV infection that increase the risk of meningococcal disease among high-risk populations.
在美国，由于感染 HIV 的个体患脑膜炎球菌病的风险增加，自 2016 年以来，建议他们接种 2 剂脑膜炎球菌 A、C、W、Y（MenACWY）疫苗。
检查新诊断为 HIV 的人群中 MenACWY 疫苗的接种情况和接种时间。
设计、地点和参与者：这项队列研究使用了来自美国 Optum Research Database 的健康保险数据，时间为 2016 年 1 月 1 日至 2018 年 3 月 31 日，回顾性地确定了 1208 名年龄在 2 岁或以上的个体，这些个体有 1 次或多次住院或 2 次或多次门诊就诊的证据，表明有新诊断的 HIV 感染，并在诊断前 12 个月或更长时间和诊断后 6 个月或更长时间内持续有保险覆盖。随访时间为 6 至 33 个月。统计分析于 2019 年 3 月 7 日至 2022 年 1 月 5 日进行。
接种 MenACWY 疫苗。
主要结果是新诊断 HIV 后接种 1 剂或多剂 MenACWY 疫苗的接种率和时间。次要结果包括接种 2 剂或多剂 MenACWY 疫苗的接种率和时间。通过 Kaplan-Meier 分析估计疫苗接种率和接种时间；使用多变量 Cox 比例风险回归分析确定与接种 1 剂或多剂 MenACWY 疫苗相关的因素。
在 1208 名符合接种条件的个体中（1024 名男性患者[84.8%]；平均[SD]年龄，38.8[12.5]岁；35 名[2.9%]亚洲人；273 名[22.6%]黑人；204 名[16.9%]西班牙裔；442 名[36.6%]白人），估计有 16.3%的人在新诊断 HIV 后 2 年内接种了第一剂 MenACWY 疫苗。在接种第一剂疫苗的个体中，在接种第一剂疫苗后 1 年或更长时间内，估计有 66.2%的人在第一剂疫苗接种后 1 年内接种了第二剂疫苗。与 MenACWY 疫苗接种率呈统计学显著相关的因素包括接种肺炎球菌疫苗（风险比[HR]，23.03；95%CI，13.93-38.09）、参加常规保健就诊（HR，3.67；95%CI，1.11-12.12）、西部或中西部地理位置（西部：HR，2.24；95%CI，1.44-3.47；中西部：HR，1.78；95%CI，1.16-2.71）和男性（HR，2.72；95%CI，1.18-6.26），而年龄为 56 岁或以上与 MenACWY 疫苗接种率降低显著相关（HR，0.42；95%CI，0.18-0.97）。
这项队列研究表明，新诊断为 HIV 的人群中 MenACWY 疫苗的接种率较低，这突出表明需要向患者和临床医生宣传有关 HIV 感染等疾病的建议，这些疾病会增加高危人群患脑膜炎球菌病的风险。
