Introduction: Invasive pneumococcal disease (IPD) causes significant disease burden, especially in developing countries, even in the era of pneumococcal conjugate vaccine (PCV) and maternal-to-child HIV transmission prevention programs. We evaluated factors that might increase IPD risk in young children in a high HIV prevalence setting.
Methods: We conducted a case-control study using IPD cases identified at 24 Group for Enteric, Respiratory and Meningeal disease Surveillance - South Africa (GERMS-SA) program sites (2010-2012). At least four controls were matched by age, HIV status and hospital to each case. Potential risk factors were evaluated using multivariable conditional logistic regression.
Results: In total 486 age-eligible cases were enrolled. Factors associated with IPD in HIV-uninfected children (237 cases, 928 controls) included: siblings <5 years (adjusted odds ratio [aOR]=1.68, 95% confidence interval [CI] 1.16-2.46), underlying medical conditions (aOR=1.99, CI 1.22-3.22), preceding upper respiratory tract infection (URTI) (aOR=1.79, CI 1.19-2.69), daycare attendance (aOR=1.58, CI 1.01-2.47), perinatal HIV exposure (aOR=1.62, CI 1.10-2.37), household car ownership (aOR=0.45, CI 0.25-0.83) and >=2 PCV-7 doses (aOR=0.67, CI 0.46-0.99). Amongst HIV-infected children (124 cases, 394 controls), IPD-associated factors included malnutrition (aOR=2.68, CI 1.40-5.14), URTI (aOR=3.49, CI 1.73-7.03), tuberculosis in last 3 months (aOR=5.12, CI 1.69-15.50), and current antiretroviral treatment (ART) (aOR=0.13, CI 0.05-0.38).
Conclusion: Previously-identified factors related to poverty, poor health, and intense exposure continue to be risk factors for IPD in children. Ensuring delivery of PCV and ART are important for improving disease prevention.
(C) 2014 by Lippincott Williams & Wilkins, Inc.