Impact of 13-Valent Pneumococcal Conjugate Vaccine on Invasive Pneumococcal Disease Among Adults With HIV—United States, 2008–2018

Supplemental Digital Content is Available in the Text. 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.

[1]  R. Lynfield,et al.  Invasive pneumococcal strain distributions and isolate clusters associated with persons experiencing homelessness during 2018. , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  L. McGee,et al.  Upsurge of conjugate vaccine serotype 4 invasive pneumococcal disease clusters among adults experiencing homelessness in California, Colorado, and New Mexico. , 2020, The Journal of infectious diseases.

[3]  W. Schaffner,et al.  Early Impact of 13-valent Pneumococcal Conjugate Vaccine Use on Invasive Pneumococcal Disease among Adults with and without Underlying Medical Conditions-United States. , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  Miwako Kobayashi,et al.  Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices , 2019, MMWR. Morbidity and mortality weekly report.

[5]  D. Swerdlow,et al.  Pneumococcal conjugate vaccine against serotype 3 pneumococcal pneumonia in adults: A systematic review and pooled analysis. , 2019, Vaccine.

[6]  N. Andrews,et al.  Effectiveness of the seven-valent and thirteen-valent pneumococcal conjugate vaccines in England: The indirect cohort design, 2006-2018. , 2019, Vaccine.

[7]  Kenneth J. Smith,et al.  Racial Disparities in Adult Pneumococcal Vaccination Indications and Pneumococcal Hospitalizations in the U.S. , 2019, Journal of the National Medical Association.

[8]  N. Andrews,et al.  Rapid increase in non-vaccine serotypes causing invasive pneumococcal disease in England and Wales, 2000-17: a prospective national observational cohort study. , 2018, The Lancet. Infectious diseases.

[9]  N. Crepaz,et al.  Racial and Ethnic Disparities in Sustained Viral Suppression and Transmission Risk Potential Among Persons Receiving HIV Care — United States, 2014 , 2018, MMWR. Morbidity and mortality weekly report.

[10]  Ronald Anderson,et al.  HIV-related pneumococcal disease prevention in adults , 2017, Expert review of respiratory medicine.

[11]  H. Bradley,et al.  Increased antiretroviral therapy prescription and HIV viral suppression among persons receiving clinical care for HIV infection , 2016, AIDS.

[12]  Laila N. Abudulai,et al.  Chronic HIV-1 Infection Induces B-Cell Dysfunction That Is Incompletely Resolved by Long-Term Antiretroviral Therapy , 2016, Journal of acquired immune deficiency syndromes.

[13]  W. Schaffner,et al.  Twenty Years of Active Bacterial Core Surveillance , 2015, Emerging infectious diseases.

[14]  W. Schaffner,et al.  Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance. , 2015, The Lancet. Infectious diseases.

[15]  I. Ssinabulya,et al.  Low antigen-specific CD4 T-cell immune responses despite normal absolute CD4 counts after long-term antiretroviral therapy an African cohort. , 2014, Immunology letters.

[16]  C. Whitney,et al.  Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP) , 2014, MMWR. Morbidity and mortality weekly report.

[17]  W. Schaffner,et al.  Racial disparities in invasive Streptococcus pneumoniae infections, 1998-2009. , 2014, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  M. Farley,et al.  Socioeconomic and Racial Disparities of Pediatric Invasive Pneumococcal Disease After the Introduction of the 7-valent Pneumococcal Conjugate Vaccine , 2014, The Pediatric infectious disease journal.

[19]  Jeffrey N. Martin,et al.  Composition and Function of T Cell Subpopulations Are Slow to Change Despite Effective Antiretroviral Treatment of HIV Disease , 2014, PloS one.

[20]  D. Cooper,et al.  The 13-valent pneumococcal conjugate vaccine (PCV13) elicits cross-functional opsonophagocytic killing responses in humans to Streptococcus pneumoniae serotypes 6C and 7A. , 2011, Vaccine.

[21]  Irene Hall,et al.  HIV surveillance--United States, 1981-2008. , 2011, MMWR. Morbidity and mortality weekly report.

[22]  C. Whitney,et al.  Prevention of pneumococcal disease among infants and children - use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine - recommendations of the Advisory Committee on Immunization Practices (ACIP). , 2010, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[23]  W. Schaffner,et al.  Prevention of invasive pneumococcal disease among HIV-infected adults in the era of childhood pneumococcal immunization , 2010, AIDS.

[24]  C. Whitney,et al.  Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). , 2010, MMWR. Morbidity and mortality weekly report.

[25]  Licensure of a 13-valent pneumococcal conjugate vaccine (PCV13) and recommendations for use among children - Advisory Committee on Immunization Practices (ACIP), 2010. , 2010, MMWR. Morbidity and mortality weekly report.

[26]  W. Schaffner,et al.  Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. , 2010, The Journal of infectious diseases.

[27]  Richard D Moore,et al.  Invasive pneumococcal disease in a cohort of HIV-infected adults: incidence and risk factors, 1990–2003 , 2006, AIDS.

[28]  W. Schaffner,et al.  Changes in Invasive Pneumococcal Disease among HIV-Infected Adults Living in the Era of Childhood Pneumococcal Immunization , 2006, Annals of Internal Medicine.

[29]  Tamara Pilishvili,et al.  Changing epidemiology of invasive pneumococcal disease among older adults in the era of pediatric pneumococcal conjugate vaccine. , 2005, JAMA.

[30]  A. Schuchat,et al.  Declining incidence of invasive Streptococcus pneumoniae infections among persons with AIDS in an era of highly active antiretroviral therapy, 1995-2000. , 2005, The Journal of infectious diseases.

[31]  Steven Black,et al.  Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. , 2003, The Journal of pediatrics.

[32]  J. Ward,et al.  Pneumococcal disease among human immunodeficiency virus-infected persons: incidence, risk factors, and impact of vaccination. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[33]  K. Jenpanich,et al.  [Drug administration]. , 1976, Thai journal of nursing.