Brendan Flannery, PhD; Richard T. Heffernan, MPH; Lee H. Harrison, MD; Susan M. Ray, MD; Arthur L. Reingold, MD; James Hadler, MD, MPH; William Schaffner, MD; Ruth Lynfield, MD; Ann R. Thomas, MD, MPH; Jianmin Li, DPE; Michael Campsmith, DDS, MPH; Cynthia G. Whitney, MD, MPH; Anne Schuchat, MD
Note: This paper was presented in part at the 4th International Symposium on Pneumococci and Pneumococcal Diseases, Helsinki, Finland, 9 to 13 May 2004 (abstract EPI-05), and at the 42nd Annual Meeting of the Infectious Diseases Society of America, Boston, Massachusetts, 30 September to 3 October 2004 (abstract 746).
Acknowledgments: The authors thank the study personnel from the following institutions: Centers for Disease Control and Prevention; the Active Bacterial Core surveillance sites; Minnesota Department of Health; and the University of Texas Health Science Center. They also thank the AIDS surveillance officers.
Grant Support: By the Emerging Infections Program of the Centers for Disease Control and Prevention.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Brendan Flannery, PhD, Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C-23, Atlanta, GA 30333; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Flannery, Campsmith, Li, Whitney, and Schuchat: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333.
Mr. Heffernan: Connecticut Emerging Infections Program, 410 Capital Avenue, Hartford, CT 06134.
Dr. Harrison: Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205.
Dr. Ray: Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303.
Dr. Reingold: University of California, Berkeley, 140 Warren, Berkeley, CA 94720-7360.
Dr. Hadler: Connecticut Department of Public Health, 410 Capital Avenue, MS 11 FDS, Hartford, CT 06134-0308.
Dr. Schaffner: Vanderbilt University Medical School, A-1124 MCN, Nashville, TN 37232.
Dr. Lynfield: Minnesota Department of Health, 717 Delaware Street SE, Minneapolis, MN 55414.
Dr. Thomas: Oregon Department of Human Services, 800 NE Oregon Street, Portland, OR 97212.
Author Contributions: Conception and design: B. Flannery, L.H. Harrison, A.L. Reingold, J. Hadler, A.R. Thomas, A. Schuchat.
Analysis and interpretation of the data: B. Flannery, R.T. Heffernan, A.L. Reingold, A.R. Thomas, J. Li, C.G. Whitney, A. Schuchat.
Drafting of the article: B. Flannery, A.L. Reingold, M. Campsmith.
Critical revision of the article for important intellectual content: L.H. Harrison, S.M. Ray, A.L. Reingold, J. Hadler, W. Schaffner, R. Lynfield, A.R. Thomas, J. Li, M. Campsmith, C.G. Whitney, A. Schuchat.
Final approval of the article: B. Flannery, L.H. Harrison, S.M. Ray, A.L. Reingold, J. Hadler, W. Schaffner, R. Lynfield, A.R. Thomas, J. Li, M. Campsmith, C.G. Whitney, A. Schuchat.
Provision of study materials or patients: J. Hadler, W. Schaffner, R. Lynfield.
Statistical expertise: J. Li.
Obtaining of funding: C.G. Whitney, A. Schuchat.
Administrative, technical, or logistic support: A.L. Reingold, W. Schaffner, R. Lynfield, C.G. Whitney.
Collection and assembly of data: R.T. Heffernan, S.M. Ray, J. Hadler, W. Schaffner, A.R. Thomas.
Adults infected with HIV have high rates of invasive pneumococcal disease. Introduction of pneumococcal conjugate vaccine for children could affect disease among HIV-infected adults.
To compare invasive pneumococcal disease among HIV-infected adults before and after the introduction of a pediatric conjugate vaccine.
Active laboratory-based surveillance in an adult population of 10.8 million, including 38 314 living with AIDS.
7 Active Bacterial Core surveillance areas in the United States.
All surveillance-area residents 18 to 64 years of age with Streptococcus pneumoniae isolated from a sterile site between 1998 and 2003.
Ratio of the number of cases of invasive pneumococcal disease among HIV-infected adults to the estimated number of adults 18 to 64 years of age living with AIDS; serotype-specific subset analyses; and comparison of periods before and after introduction of conjugate vaccine by using exact tests.
Of 8582 cases of invasive pneumococcal disease in adults, 2013 (24%) occurred among persons infected with HIV. Between baseline (1998 to 1999) and 2003, the ratio of invasive pneumococcal disease in HIV-infected adults to the number of adults living with AIDS in the surveillance areas decreased from 1127 to 919 cases per 100 000 AIDS population, a reduction of 19% (P = 0.002). Among HIV-infected adults, the ratio for disease caused by pneumococcal serotypes included in the conjugate vaccine decreased 62% (P < 0.001), although the ratio for disease caused by nonvaccine serotypes increased 44% (P < 0.001).
Ratios are proxy measures of incidence rates. The denominator of surveillance-area residents living with HIV infection was not available.
Introduction of the pediatric conjugate vaccine was associated with an overall decrease in invasive pneumococcal disease among HIV-infected adults, despite increased disease caused by nonvaccine serotypes.
Flannery B, Heffernan RT, Harrison LH, Ray SM, Reingold AL, Hadler J, et al. Changes in Invasive Pneumococcal Disease among HIV-Infected Adults Living in the Era of Childhood Pneumococcal Immunization. Ann Intern Med. ;144:1–9. doi: 10.7326/0003-4819-144-1-200601030-00004
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Published: Ann Intern Med. 2006;144(1):1-9.
HIV, Infectious Disease, Prevention/Screening, Streptococcal Infections, Vaccines/Immunization.
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