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Meningococcal Conjugate and Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccination Among HIV-infected Youth

Setse, Rosanna W. MD, MPH, PhD; Siberry, George K. MD, MPH; Moss, William J. MD, MPH; Wheeling, John MS; Bohannon, Beverly A. MS, RN; Dominguez, Kenneth L. MD, MPHfor the LEGACY Consortium

The Pediatric Infectious Disease Journal: May 2016 - Volume 35 - Issue 5 - p e152–e157
doi: 10.1097/INF.0000000000001078
HIV Reports

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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.

Accepted for publication November 5, 2015.

R.W. Setse is currently at U.S. Food and Drug Agency (FDA), Silver Spring, MD.

The LEGACY project was funded by the Centers for Disease Control and Prevention, Atlanta, GA, contract number 200-2004-09976. This study was approved by the Institutional Review Board (IRB) of the Johns Hopkins School of Medicine, IRB No. NA_00011187.

The opinions expressed by authors contributing to this article do not necessarily reflect the opinions of the Centers for Disease Control and Prevention or the institutions with which the authors are affiliated. The authors have no conflicts of interest to disclose.

Address for correspondence: Rosanna W. Setse, MD, PHD. E-mail:

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