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Poverty, poor health, exposure are risk factors for IPD among South African children
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Recent data shows previously identified risk factors related to poverty, poor health, and intense exposure continue to be risk factors for invasive pneumococcal disease among children in settings with a high prevalence of HIV.
Claire von Mollendorf, MBBCh, MSc, of the Centre for Respiratory Diseases and Meningitis in Johannesburg, South Africa, and colleagues used multivariable conditional logistic regression to determine risk factors for invasive pneumococcal diseases (IPD) among South African children. Children included in the study ranged in age from 8 weeks to 5 years and were admitted to 24 hospitals between March 2010 and November 2012. The study cohort consisted of 361 children with IPD, of which 124 were HIV positive. Researchers age-matched study participants with 1,322 children, 394 with HIV, to serve as the control group.
Among children who did not have HIV, 64 had vaccine-type IPD and 128 had non-vaccine-type IPD. HIV exposure and not having a flushable toilet were associated with increased risk for vaccine-type IPD, according to the study data. Male sex and receipt of two or more doses of seven-valent pneumococcal conjugate vaccine (PCV7; Prevnar, Pfizer) were associated with decreased risk for vaccine-type IPD.
When stratified by vaccination status, vaccinated children with vaccine-type IPD were more likely to be malnourished, have a wood fire in their home, and have been previously admitted to the hospital compared with the control group. Exposure to HIV was associated with vaccine-type IPD among vaccinated children. HIV-exposure and underlying conditions were associated with vaccine-type IPD.
Having siblings aged younger than 5 years, preceding upper respiratory tract infection, and exposure to HIV were two times more common among children with non-vaccine-type IPD compared with controls. Additionally, having a wood fire in the home was also associated with non-vaccine-type IPD.
Among children with HIV and IPD, a preceding upper respiratory tract infection and receipt of PCV7 or antibiotics was associated with penicillin-resistant IPD. Black race, hospital admission within the past year, HIV-exposure, and daycare attendance were associated with all-serotype IPD that was not susceptible to penicillin among children who did not have HIV.
Tuberculosis diagnosis within the past 3 months, preceding upper respiratory tract infection, and malnutrition were associated with increased odds of all-serotype disease among children with IPD. Children who received antiretroviral treatment (ART) had decreased odd of all-serotype IPD.
Certain risk factors for vaccine-type IPD among children with HIV were similar to those for all-serotype IPD, including malnutrition, tuberculosis diagnosis in the past 3 months, and receipt of ART.
Preceding upper respiratory tract infection and receipt of ART were associated with vaccinated children with vaccine-type IPD and HIV.
ART was associated with lower odds of IPD that had a penicillin non-susceptible isolate, according to the study findings.
“This study demonstrated that in the era of programs to prevent HIV transmission to newborns and antiretroviral treatment, HIV still plays an important role in the risk of pneumococcal disease…We conclude that health care workers should promote pneumococcal vaccination in high risk groups like [HIV-exposed but uninfected] children at routine health visits and, if doses are missed, provide catch-up vaccination at outpatient visits or when hospitalized,” the researchers concluded.
Disclosure: Some of the researchers have financial ties with Pfizer, GlaxoSmithKline and Sanofi Pasteur.
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