1811. Changes in invasive pneumococcal disease among adults living with HIV following introduction of 13-valent pneumococcal conjugate vaccine, 2008–2014
Session: Oral Abstract Session: HIV: Co-morbidities and Co-infections
Saturday, October 7, 2017: 10:30 AM
Room: 08

Background:
People living with HIV (PLHIV) are at increased risk of invasive pneumococcal disease (IPD). Introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in children in 2010 reduced adult IPD burden (indirect effects). In 2012, PCV13 was recommended in series with 23-valent polysaccharide vaccine (PPSV23) for adults with immunocompromising conditions, including PLHIV. We evaluated changes in IPD incidence in adults ≥19 years old with and without HIV after PCV13 introduction for children in 2010 and for immunocompromised adults in 2012. PCV13 coverage for adults 19-64 years old with indications was 6% in 2014.

Methods:
IPD cases, defined as pneumococcal isolation from sterile sites, were identified through CDC’s Active Bacterial Core surveillance, with counts projected nationally. HIV status was obtained from medical records. Isolates were serotyped by Quellung reaction or PCR and grouped into PCV13-types, PPV11-types (unique to PPSV23), or non-vaccine types. We estimated IPD incidence (cases per 100,000 people) using national case-based HIV surveillance (for PLHIV) or US Census data (for non-PLHIV) as denominators. We compared IPD incidence in 2011–12 and 2013–14 to the pre-PCV13 baseline (2008–09) by serotype groups.

Results:
Overall IPD incidence at baseline was 354.0 for PLHIV and 15.5 for non-PLHIV. From baseline to 2013–14, IPD rates declined in both PLHIV (-36.3%; 95% CI: -38.8, -33.7%) and non-PLHIV (-27.3%; 95% CI: -28.2, -26.5%). The largest reductions were noted in PCV13-type IPD in both PLHIV (Figure 1) and non-PLHIV (Figure 2) for both periods (-46.8% for PLHIV and -45.9% for non-PLHIV in 2011–12; -60.3% for PLHIV and -65.8% for non-PLHIV in 2013–14). Overall IPD rates were 22.8 (95% CI: 22.2, 23.4) times as high in PLHIV compared to non-PLHIV at baseline, and 19.4 (95% CI: 18.8, 20.0) times as high in 2013–2014.

Conclusion:

IPD rates declined significantly in both PLHIV and non-PLHIV during the study period due to reductions in PCV13-type IPD; however, IPD rates remained 20-fold in PLHIV compared to non-PLHIV. Similar magnitude reductions in PCV13-type IPD in both groups and low PCV13 coverage in immunocompromised adults suggest that most of the observed decline is due to PCV13 indirect effects from childhood immunization.


Miwako Kobayashi, MD, MPH1, William Adih, DrPH, MPH, MD1, Jianmin Li, DPE1, Ryan Gierke, MPH2, Olivia M. Almendares, MSPH1, James Watt, MD, MPH3, Nisha Alden, MPH4, Susan Petit, MPH5, Monica Farley, MD, FIDSA6, Lee Harrison, MD7, Ruth Lynfield, MD, FIDSA8, Joan Baumbach, MD, MPH, MS9, Ann Thomas, MD, MPH10, William Schaffner, MD, FIDSA, FSHEA11 and Tamara Pilishvili, MPH, PhD2, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (3)Center for Infectious Diseases, California Department of Public Health, Sacramento, CA, (4)Colorado Department of Public Health and Environment, Denver, CO, (5)Connecticut Department of Public Health, New Haven, CT, (6)Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, GA, (7)University of Pittsburgh, Pittsburgh, PA, (8)State Epidemiologist and Medical Director for Infectious Diseases, Epidemiology & Community Health, Minnesota Department of Health, St. Paul, MN, (9)New Mexico Department of Health, Santa Fe, NM, (10)Oregon Public Health Division, Portland, OR, (11)Vanderbilt University School of Medicine, Nashville, TN

Disclosures:

M. Kobayashi, None

W. Adih, None

J. Li, None

R. Gierke, None

O. M. Almendares, None

J. Watt, None

N. Alden, None

S. Petit, None

M. Farley, None

L. Harrison, GSK: Scientific Advisor , Consulting fee

R. Lynfield, None

J. Baumbach, None

A. Thomas, None

W. Schaffner, Pfizer: Scientific Advisor , Consulting fee
Merck: Scientific Advisor , Consulting fee
Novavax: Consultant , Consulting fee
Dynavax: Consultant , Consulting fee
Sanofi-pasteur: Consultant , Consulting fee
GSK: Consultant , Consulting fee
Seqirus: Consultant , Consulting fee

T. Pilishvili, None

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