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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, MMST1; Bhattacharya, Sangeeta Das MD, MPH1; Sutcliffe, Catherine G PhD2; Ganaie, Feroze MSc6; Bhaskar, Arun MBBS, MMST1; Bhattacharyya, Subhasish MD, DNB5; Niyogi, Swapan Kumar MD3; Moss, William J MD, MPH2; Panda, Samiran DTMH, MD4; Ravikumar, K L MD6; Das, Ranjan Saurav MSW1; Mandal, Sutapa BSc3

The Pediatric Infectious Disease Journal: September 27, 2017 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/INF.0000000000001800
HIV Reports: PDF Only

Background: 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 two months after vaccination.

Result: 115 CLH and 47 HUC received one dose of PCV13. 58% of CLH were on antiretroviral therapy (ART), the median nadir CD4 count was 287. There were no significant adverse events in either group. HUC had more VT colonization than CLH-- 55% vs. 23% of all isolates. HIV infection doubled the risk of non-vaccine serotype colonization (NVT) (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 (PR 0.2; 95%CI 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.

Clinical Trial Registry: 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).

(1) School of Medical Science and Technology, Indian Institute of Technology (IIT) –Kharagpur (India)

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

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

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

(5) Department of Pediatrics, Midnapore Medical College and Hospital-Midnapore (India)

(6) Department of Microbiology, Kempegowda Institute of Medical Sciences, Bangalore (India)


Name and address for correspondence: Sangeeta Das Bhattacharya MD, MPH, FAAP, PhD, Associate Professor, School of Medical Science and Technology, Indian Institute of Technology (IIT) –Kharagpur,, Phone: +91 - 3222 – 283576; Fax: +91 - 3222 – 282221

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