In addition to reducing Haemophilus influenzae type b (Hib) disease in vaccinated individuals, the Hib conjugate vaccine (HibCV) has indirect effects; it reduces Hib disease in unvaccinated individuals by decreasing carriage. Human immunodeficiency virus (HIV)-infected children are at increased risk for Hib disease and live in families where multiple members may have HIV. The aim of this study is to look at the impact of 2 doses of the HibCV on nasopharyngeal carriage of Hib in HIV-infected Indian children (2–15 years) and the indirect impact on carriage in their parents.
This prospective cohort study was conducted in HIV-infected and HIV-uninfected families. Nasopharyngeal swabs were collected from children and parents before and after vaccination. HIV-infected children 2–15 years of age got two doses of HibCV and were followed up for 20 months. Uninfected children 2–5 years of age got 1 dose of HibCV as catch-up.
123 HIV-infected and 44 HIV-uninfected children participated. Baseline colonization in HIV-infected children was 13.8% and dropped to 1.8% (P = 0.002) at 20 months. Baseline carriage in HIV-uninfected children was 4.5% and dropped to 2.3% after vaccination (P = 0.3). HIV-infected parents had 12.3 times increased risk of Hib carriage if their child was colonized (P = 0.04) and had 9.3 times increased risk if their child had persistent colonization postvaccine (P = 0.05). No parent of HIV-uninfected children had Hib colonization at any point. Pneumococcal colonization was associated with increased Hib colonization.
Making the HibCV available to HIV-infected children could interrupt Hib carriage in high-risk families.
From the *School of Medical Science and Technology, Indian Institute of Technology (IIT), Kharagpur, West Bengal, India; †International Vaccine Access Center (IVAC) and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ‡Division of Epidemiology, National Institute of Cholera and Enteric Diseases (NICED)/ Indian Council of Medical Research, Kolkata, West Bengal, India; §Department of Pediatrics, Midnapore Medical College, Midnapore, West Bengal, India; and ¶Department of Health and Family Welfare, Hijli Rural Hospital, Kharagpur, West Bengal, India.
Accepted for publication February 15, 2016.
Supported by Indian Council of Medical Research under Department of Health Research, Government of India as ad hoc project sanctioned (dated: 15-06-2011; letter number: 5/7/463/2010-RHN); and Fulbright Nehru Doctoral Research Award 2014 (Sponsored by United States Department of State’s Bureau of Educational and Cultural Affairs, and United States-India Educational Foundation-New Delhi). The authors have no conflicts of interest to disclose.
Address for correspondence: Sangeeta Das Bhattacharya MD, MPH, FAAP, PhD, School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, West Bengal, 721302, India. E-mail: email@example.com.