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Nasopharyngeal Pneumococcal Colonization and Impact of a Single Dose of 13-Valent Pneumococcal Conjugate Vaccine in Indian Children With HIV and Their Unvaccinated Parents

Arya, Bikas, K., MBBS, PhD*; Bhattacharya, Sangeeta, Das, MD, MPH, PhD*; Sutcliffe, Catherine, G., ScM, PhD; Ganaie, Feroze, MSc; Bhaskar, Arun, MBBS, MMST*; Bhattacharyya, Subhasish, MD, DNB§; Niyogi, Swapan, Kumar, MD; Moss, William, J., MD, MPH; Panda, Samiran, DTMH, MD; Ravikumar, Kadahalli, Lingegowda, MD; Das, Ranjan, Saurav, MSW*; Mandal, Sutapa, BSc

The Pediatric Infectious Disease Journal: May 2018 - Volume 37 - Issue 5 - p 451–458
doi: 10.1097/INF.0000000000001800
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Background: Human immunodeficiency virus (HIV) infection increases risk of invasive disease from Streptococcus pneumoniae. Pneumococcal conjugate vaccines (PCV) prevent invasive disease and acquisition of vaccine type (VT) pneumococcus in the nasopharynx.

Objective: To look at the safety and impact of one dose of PCV13 on acquisition of VT pneumococcal carriage in Indian children with HIV.

Method: We conducted a cohort study in families of HIV-infected children (CLH) and families of HIV-uninfected children (HUC) in West Bengal. All children received one dose of PCV13. Nasopharyngeal swabs were collected from children and parents at baseline and 2 months after vaccination.

Result: One hundred and fifteen CLH and 47 HUC received one dose of PCV13. Fifty-eight percent of CLH were on antiretroviral therapy (ART), and the median nadir CD4 count was 287. There were no significant adverse events in either group. HUC had more VT colonization than CLH—55% versus 23% of all pneumococcal isolates. HIV infection doubled the risk of nonvaccine serotype colonization (P = 0.03). There was no difference in acquisition of VT isolates in CLH (4.4%) and HUC (4.5%) post-PCV13; however, older CLH (>5 years) had decreased clearance of VT strains. ART made no difference in pneumococcal colonization at baseline or after PCV13; however, CLH with higher nadir CD4 counts before starting ART were less likely to have VT colonization post-PCV13 (prevalence ratio, 0.2; 95% confidence interval: 0.1–0.5).

Conclusion: While there was no difference in acquisition of VT nasopharyngeal carriage of pneumococcus in CLH and HUC after one dose of PCV13, earlier access to ART may impact response to PCV13 in CLH.

From the *School of Medical Science and Technology, Indian Institute of Technology (IIT), Kharagpur, India

International Vaccine Access Center and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Division of Bacteriology

Division of Epidemiology, National Institute of Cholera and Enteric Diseases (NICED)/Indian Council of Medical Research (ICMR), Kolkata, India

§Department of Pediatrics, Midnapore Medical College and Hospital, Midnapore, India

Department of Microbiology, Kempegowda Institute of Medical Sciences, Bangalore, India.

Accepted for publication March 16, 2017.

This study was registered with the Clinical Trial Registry-India hosted at National Institute of Medical Statistics, New Delhi (CTRI/2012/03/002515 and CTRI/2013/04/003535).

This study was conducted at no cost extension of a research project funded by Indian Council of Medical Research (MoHFW, Government of India; Reference no.: 5/7/463/2010-RHN). The primary sources of support were: (1) Robert Austrian Research Award for pneumococcal Vaccinology 2014; (2) Study vaccines were donated by Pfizer under Investigator-Initiated Research (IIR Reference no. WS2277799). The first author acknowledges Fulbright Nehru Doctoral Research Award 2014–15 (sponsored by United States Department of State’s Bureau of Educational and Cultural Affairs, and USIEF, New Delhi) while analysis of the study results.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Sangeeta Das Bhattacharya, MD, MPH, PhD, FAAP, FACP, School of Medical Science and Technology, Indian Institute of Technology (IIT), Kharagpur, India. E-mail: sangeeta@smst.iitkgp.ernet.in.

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