 |
|
Evaluation of Effectiveness of the 23-Valent Pneumococcal Capsular Polysaccharide Vaccine for HIV-Infected Patients
Robert F. Breiman, MD;
David W. Keller, MD;
Maureen A. Phelan, MS;
David H. Sniadack, MD;
David S. Stephens, MD;
David Rimland, MD;
Monica M. Farley, MD;
Anne Schuchat, MD;
Arthur L. Reingold, MD
Arch Intern Med. 2000;160:2633-2638.
Background We conducted a retrospective case-control study to evaluate effectiveness of pneumococcal vaccine against invasive disease among adults with human immunodeficiency virus (HIV) infection in San Francisco, Calif, and Atlanta, Ga.
Methods Case patients were 18- to 55-year-old subjects with HIV infection who were admitted to selected hospitals in Atlanta or San Francisco from February 1992 to April 1995 from whom Streptococcus pneumoniae was isolated from a normally sterile site. Controls were HIV-infected patients of similar age matched to cases by hospital of admission and CD4 lymphocyte count (<0.20, 0.20-0.499,  0.50 x 109/L [<200, 200-499, 500 cells/mm3]) or clinical stage of acquired immunodeficiency syndrome. Case and control subjects were restricted to persons known to have HIV infection before hospital admission. Analysis used matched univariate and conditional logistic regression.
Results One hundred seventy-six case patients and 327 controls were enrolled. By univariate analysis, persons with pneumococcal disease were more likely to be black, be current smokers, and have close contact with children. Adjusted for these factors and CD4 cell count, pneumococcal vaccine effectiveness was 49% (95% confidence interval [CI], 12%-70%). Adjusting for all variables and key interaction terms, vaccine effectiveness among whites was 76% (95% CI, 35%-91%), whereas effectiveness among blacks was 24% (95% CI, -50% to 61%). Among controls, vaccination was significantly less common among blacks (29% vs 45%; P<.005).
Conclusions Pneumococcal vaccine demonstrated protection against invasive pneumococcal infections among white but not black HIV-infected adults. Failure to demonstrate effectiveness among blacks may be due to limited power because of low use of the vaccine in this population, immunization at more advanced stages of immunosuppression, or unmeasured factors. These data support current recommendations for use of pneumococcal vaccine in HIV-infected persons and highlight a clear need for strategies to improve vaccine-induced protection.
From the National Center for Infectious Diseases, Centers for Disease Control and Prevention (Drs Breiman, Keller, Phelan, Sniadack, and Schuchat), and Emory University School of Medicine and Veterans Administration Medical Center (Drs Stephens, Rimland, and Farley), Atlanta, Ga; and School of Public Health, University of California, Berkeley (Dr Reingold).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2000;160(17):2688-2689.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Pneumonia in HIV-infected Persons: Increased Risk with Cigarette Smoking and Treatment Interruption
Gordin et al.
Am. J. Respir. Crit. Care Med. 2008;178:630-636.
ABSTRACT
| FULL TEXT
Risk Factors for Invasive Pneumococcal Disease among Navajo Adults
Watt et al.
Am J Epidemiol 2007;166:1080-1087.
ABSTRACT
| FULL TEXT
Changes in Invasive Pneumococcal Disease among HIV-Infected Adults Living in the Era of Childhood Pneumococcal Immunization
Flannery et al.
ANN INTERN MED 2006;144:1-9.
ABSTRACT
| FULL TEXT
Epidemiologic Changes in Bacteremic Pneumococcal Disease in Patients With Human Immunodeficiency Virus in the Era of Highly Active Antiretroviral Therapy
Grau et al.
Arch Intern Med 2005;165:1533-1540.
ABSTRACT
| FULL TEXT
Screening for HIV: A Review of the Evidence for the U.S. Preventive Services Task Force
Chou et al.
ANN INTERN MED 2005;143:55-73.
ABSTRACT
| FULL TEXT
Multiplex PCR for Identification of Seven Streptococcus pneumoniae Serotypes Targeted by a 7-Valent Conjugate Vaccine
O'Halloran and Cafferkey
J. Clin. Microbiol. 2005;43:3487-3490.
ABSTRACT
| FULL TEXT
Specificity of the Antibody Response to the Pneumococcal Polysaccharide and Conjugate Vaccines in Human Immunodeficiency Virus-Infected Adults
Feikin et al.
CVI 2004;11:137-141.
ABSTRACT
| FULL TEXT
Cost-Effectiveness of Vaccination against Invasive Pneumococcal Disease among People 50 through 64 Years of Age: Role of Comorbid Conditions and Race
Sisk et al.
ANN INTERN MED 2003;138:960-968.
ABSTRACT
| FULL TEXT
Decline in Invasive Pneumococcal Disease after the Introduction of Protein-Polysaccharide Conjugate Vaccine
Whitney et al.
NEJM 2003;348:1737-1746.
ABSTRACT
| FULL TEXT
Effectiveness of Pneumococcal Polysaccharide Vaccine in Older Adults
Jackson et al.
NEJM 2003;348:1747-1755.
ABSTRACT
| FULL TEXT
Guidelines for Preventing Opportunistic Infections among HIV-Infected Persons--2002: Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America
Masur et al.
ANN INTERN MED 2002;137:435-478.
ABSTRACT
| FULL TEXT
Use of Logistic Regression Analysis in the Diagnosis of Shoulder Impingement Syndrome
Stieler
Journal of Diagnostic Medical Sonography 2002;18:279-286.
ABSTRACT
Pyogenic bacterial lower respiratory tract infection in human immunodeficiency virus-infected patients
Mayaud et al.
Eur Respir J 2002;20:28S-39s.
ABSTRACT
| FULL TEXT
Pneumococcal vaccination: current and future issues
Ortqvist
Eur Respir J 2001;18:184-195.
ABSTRACT
| FULL TEXT
AIDS and the lung in a changing world
MAYAUD and CADRANEL
Thorax 2001;56:423-426.
FULL TEXT
Multidrug-Resistant Streptococcus pneumoniae
Foster et al.
NEJM 2001;344:1329-1331.
FULL TEXT
More on Pneumococcal Vaccine
AIDS Clin Care 2001;2001:5-5.
FULL TEXT
|
