High Streptococcus pneumoniae colonization prevalence among HIV-infected Kenyan parents in the year before pneumococcal conjugate vaccine introduction
Tóm tắt
Streptococcus pneumoniae is a leading cause of pneumonia, meningitis and sepsis in developing countries, particularly among children and HIV-infected persons. Pneumococcal oropharyngeal (OP) or nasopharyngeal (NP) colonization is a precursor to development of invasive disease. New conjugate vaccines hold promise for reducing colonization and disease. Prior to introduction of 10-valent pneumococcal conjugate vaccine (PCV10), we conducted a cross-sectional survey among HIV-infected parents of children <5 years old in rural Kenya. Other parents living with an HIV-infected adult were also enrolled. After broth enrichment, NP and OP swabs were cultured for pneumococcus. Serotypes were identified by Quellung. Antimicrobial susceptibility was performed using broth microdilution. We enrolled 973 parents; 549 (56.4 %) were HIV-infected, 153 (15.7 %) were HIV-uninfected and 271 (27.9 %) had unknown HIV status. Among HIV-infected parents, the median age was 32 years (range 15-74) and 374/549 (68 %) were mothers. Pneumococci were isolated from 237/549 (43.2 %) HIV-infected parents and 41/153 (26.8 %) HIV-non-infected parents (p = 0.0003). Colonization with PCV10 serotypes was not significantly more frequent in HIV-infected (12.9 %) than HIV-uninfected parents (11.8 %; p = 0.70). Among HIV-infected parents, cooking site separate from sleeping area and CD4 count >250 were protective (OR = 0.6; 95 % CI 0.4, 0.9 and OR = 0.5; 95 % CI 0.2, 0.9, respectively); other associations were not identified. Among 309 isolates tested from all parents, 255 (80.4 %) were penicillin non-susceptible (MIC ≥0.12 μg/ml). Prevalence of pneumococcal colonization is high among HIV-infected parents in rural Kenya. If young children are the pneumococcal reservoir for this population, PCV10 introduction may reduce vaccine-type colonization and disease among HIV-infected parents through indirect protection.
Tài liệu tham khảo
Scott JA. The preventable burden of pneumococcal disease in the developing world. Vaccine. 2007;25(13):2398–405.
Greenwood B. The epidemiology of pneumococcal infection in children in the developing world. Philos Trans R Soc Lond B Biol Sci. 1999;354(1384):777–85.
Samore MH, Magill MK, Alder SC, Severina E, Morrison-de Boer L, Lyon JL, et al. High rates of multiple antibiotic resistance in Streptococcus pneumoniae from healthy children living in isolated rural communities: association with cephalosporin use and intrafamilial transmission. Pediatrics. 2001;108(4):856–65.
Rivera-Olivero IA, Bogaert D, Bello T, del Nogal B, Sluijter M, Hermans PW, et al. Pneumococcal carriage among indigenous Warao children in Venezuela: serotypes, susceptibility patterns, and molecular epidemiology. Clin Infect Dis. 2007;45(11):1427–34.
Darboe MK, Fulford AJC, Secka O, Prentice AM. The dynamics of nasopharyngeal streptococcus pneumoniae carriage among rural Gambian mother-infant pairs. BMC Infect Dis. 2010;10(1):195.
Feikin DR, Feldman C, Schuchat A, Janoff EN. Global strategies to prevent bacterial pneumonia in adults with HIV disease. Lancet Infect Dis. 2004;4(7):445–55.
Cohen AL, Harrison LH, Farley MM, Reingold AL, Hadler J, Schaffner W, et al. Prevention of invasive pneumococcal disease among HIV-infected adults in the era of childhood pneumococcal immunization. AIDS. 2010;24(14):2253–62.
Klugman KP, Madhi SA, Feldman C. HIV and pneumococcal disease. Curr Opin Infect Dis. 2007;20(1):11–5.
Whitney C, Farley M, Hadler J, Harrison L, Bennett N, Lynfield R, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med. 2003;348:1737–46.
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. 2006;144(1):1–9.
Nuorti JP, Butler JC, Gelling L, Kool JL, Reingold AL, Vugia DJ. Epidemiologic relation between HIV and invasive pneumococcal disease in San Francisco County, California. Ann Intern Med. 2000;132(3):182–90.
Crewe-Brown HH, Karstaedt AS, Saunders GL, Khoosal M, Jones N, Wasas A, et al. Streptococcus pneumoniae blood culture isolates from patients with and without human immunodeficiency virus infection: alterations in penicillin susceptibilities and in serogroups or serotypes. Clin Infect Dis. 1997;25(5):1165–72.
Buie KA, Klugman KP, von Gottberg A, Perovic O, Karstaedt A, Crewe-Brown HH, et al. Gender as a risk factor for both antibiotic resistance and infection with pediatric serogroups/serotypes, in HIV-infected and -uninfected adults with pneumococcal bacteremia. J Infect Dis. 2004;189(11):1996–2000.
Fry AM, Facklam RR, Whitney CG, Plikaytis BD, Schuchat A. Multistate evaluation of invasive pneumococcal diseases in adults with human immunodeficiency virus infection: serotype and antimicrobial resistance patterns in the United States. J Infect Dis. 2003;188(5):643–52.
Pilishvili T, Lexau C, Farley MM, Hadler J, Harrison LH, Bennett NM, et al. Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis. 2010;201(1):32–41.
Hammitt LL, Bruden DL, Butler JC, Baggett HC, Hurlburt DA, Reasonover A, et al. Indirect effect of conjugate vaccine on adult carriage of Streptococcus pneumoniae : An explanation of trends in invasive pneumococcal disease. J Infect Dis. 2006;193(11):1487–94.
Scott JR, Millar EV, Lipsitch M, Moulton LH, Weatherholtz R, Perilla MJ, et al. Impact of more than a decade of pneumococcal conjugate vaccine use on carriage and invasive potential in Native American communities. J Infect Dis. 2012;205(2):280–8.
Feikin DR, Olack B, Bigogo GM, Audi A, Cosmas L, Aura B, et al. The burden of common infectious disease syndromes at the clinic and household level from population-based surveillance in rural and urban Kenya. PLoS One. 2011;6(1):e16085.
Adazu K, Lindblade KA, Rosen DH, Odhiambo F, Ofware P, Kwach J, et al. Health and demographic surveillance in rural western Kenya: a platform for evaluating interventions to reduce morbidity and mortality from infectious diseases. Am J Trop Med Hyg. 2005;73(6):1151–8.
Dalal W, Feikin DR, Amolloh M, Ransom R, Burke H, Lugalia F, et al. Home-based HIV testing and counseling in rural and urban Kenyan communities. J Acquir Immune Defic Syndr. 2013;62(2):e47–54.
Feikin DR, Njenga MK, Bigogo G, Aura B, Aol G, Audi A, et al. Etiology and Incidence of viral and bacterial acute respiratory illness among older children and adults in rural western Kenya, 2007-2010. PLoS One. 2012;7(8):e43656.
O'Brien KL, Nohynek H, World Health Organization Pneumococcal Vaccine Trials Carraige Working G. Report from a WHO working group: standard method for detecting upper respiratory carriage of Streptococcus pneumoniae. Pediatr Infect Dis J. 2003;22(2):133–40.
da Gloria Carvalho M, Pimenta FC, Jackson D, Roundtree A, Ahmad Y, Millar EV, et al. Revisiting pneumococcal carriage by use of broth enrichment and PCR techniques for enhanced detection of carriage and serotypes. Journal of clinical microbiology. 2010;48(5):1611–8.
Arbique JC, Poyart C, Trieu-Cuot P, Quesne G, Carvalho Mda G, Steigerwalt AG, et al. Accuracy of phenotypic and genotypic testing for identification of Streptococcus pneumoniae and description of Streptococcus pseudopneumoniae sp. nov. J Clin Microbiol. 2004;42(10):4686–96.
Hamel MJ, Greene C, Chiller T, Ouma P, Polyak C, Otieno K, et al. Does cotrimoxazole prophylaxis for the prevention of HIV-associated opportunistic infections select for resistant pathogens in Kenyan adults? Am J Trop Med Hyg. 2008;79(3):320–30.
Blossom DB, Namayanja-Kaye G, Nankya-Mutyoba J, Mukasa JB, Bakka H, Rwambuya S, et al. Oropharyngeal colonization by Streptococcus pneumoniae among HIV-infected adults in Uganda: assessing prevalence and antimicrobial susceptibility. Int J Infect Dis. 2006;10(6):458–64.
Gill CJ, Mwanakasale V, Fox MP, Chilengi R, Tembo M, Nsofwa M, et al. Impact of human immunodeficiency virus infection on Streptococcus pneumoniae colonization and seroepidemiology among Zambian women. J Infect Dis. 2008;197(7):1000–5.
Nunes MC, Shiri T, van Niekerk N, Cutland CL, Groome MJ, Koen A, et al. Acquisition of Streptococcus pneumoniae in Pneumococcal Conjugate Vaccine-Naive South African Children and Their Mothers. Pediatr Infect Dis J. 2013.
Pemba L, Charalambous S, von Gottberg A, Magadla B, Moloi V, Seabi O, et al. Impact of cotrimoxazole on non-susceptibility to antibiotics in Streptococcus pneumoniae carriage isolates among HIV-infected mineworkers in South Africa. J Infect. 2008;56(3):171–8.
Adetifa IM, Antonio M, Okoromah CA, Ebruke C, Inem V, Nsekpong D, et al. Pre-vaccination nasopharyngeal pneumococcal carriage in a Nigerian population: epidemiology and population biology. PLoS One. 2012;7(1):e30548.
Floyd S, Molesworth A, Dube A, Crampin AC, Houben R, Chihana M, et al. Underestimation of HIV prevalence in surveys when some people already know their status, and ways to reduce the bias. AIDS. 2013;27(2):233–42. 210.1097/QAD.1090b1013e32835848ab.
Onwubiko C, Swiatlo E, McDaniel LS. Cross-sectional study of nasopharyngeal carriage of Streptococcus pneumoniae in human immunodeficiency virus-infected adults in the conjugate vaccine era. J Clin Microbiol. 2008;46(11):3621–5.
Nicoletti C, Brandileone MC, Guerra ML, Levin AS. Prevalence, serotypes, and risk factors for pneumococcal carriage among HIV-infected adults. Diagn Microbiol Infect Dis. 2007;57(3):259–65.
Smith KR, McCracken JP, Weber MW, Hubbard A, Jenny A, Thompson LM, et al. Effect of reduction in household air pollution on childhood pneumonia in Guatemala (RESPIRE): a randomised controlled trial. Lancet. 2011;378(9804):1717–26.
Abdullahi O, Karani A, Tigoi CC, Mugo D, Kungu S, Wanjiru E, et al. The prevalence and risk factors for pneumococcal colonization of the nasopharynx among children in Kilifi District, Kenya. PLoS One. 2012;7(2):e30787.
Anthony L, Meehan A, Amos B, Mtove G, Mjema J, Malahiyo R, et al. Nasopharyngeal carriage of Streptococcus pneumoniae: prevalence and risk factors in HIV-positive children in Tanzania. Int J Infect Dis. 2012;16(10):e753–757.
Mackenzie G, Leach A, Carapetis J, Fisher J, Morris P. Epidemiology of nasopharyngeal carriage of respiratory bacterial pathogens in children and adults: cross-sectional surveys in a population with high rates of pneumococcal disease. BMC Infect Dis. 2010;10(1):304.
Lee C-C, Middaugh NA, Howie SRC, Ezzati M. Association of secondhand smoke exposure with pediatric invasive bacterial disease and bacterial carriage: a systematic review and meta-analysis. PLoS Med. 2010;7(12):e1000374.
Hanage WP, Finkelstein JA, Huang SS, Pelton SI, Stevenson AE, Kleinman K, et al. Evidence that pneumococcal serotype replacement in Massachusetts following conjugate vaccination is now complete. Epidemics. 2010;2(2):80–4.
Liesenborghs L, Verhaegen J, Peetermans WE, Vandeven J, Flamaing J. Trends in serotype prevalence in invasive pneumococcal disease before and after infant pneumococcal vaccination in Belgium, 2002–2010. Vaccine. 2013;31(11):1529–34.
Pai R, Moore MR, Pilishvili T, Gertz RE, Whitney CG, Beall B. Active Bacterial Core Surveillance T: Postvaccine genetic structure of Streptococcus pneumoniae serotype 19A from children in the United States. J Infect Dis. 2005;192(11):1988–95.
Moore MR, Gertz Jr RE, Woodbury RL, Barkocy-Gallagher GA, Schaffner W, Lexau C, et al. Population snapshot of emergent Streptococcus pneumoniae serotype 19A in the United States, 2005. J Infect Dis. 2008;197(7):1016–27.
Beall BW, Gertz RE, Hulkower RL, Whitney CG, Moore MR, Brueggemann AB. Shifting genetic structure of invasive serotype 19A pneumococci in the United States. J Infect Dis. 2011;203(10):1360–8.
Scott, JA. The Pneumococcal Conjugate Vaccine Impact Study (PCVIS). kemri-wellcome.org. Retrieved September 30, 2013, from http://www.kemri-wellcome.org/index.php/en/studies_inner/75
Hill PC, Townend J, Antonio M, Akisanya B, Ebruke C, Lahai G, et al. Transmission of Streptococcus pneumoniae in rural Gambian villages: a longitudinal study. Clin Infect Dis. 2010;50(11):1468–76.
Feikin DR, Jagero G, Aura B, Bigogo GM, Oundo J, Beall BW, et al. High rate of pneumococcal bacteremia in a prospective cohort of older children and adults in an area of high HIV prevalence in rural western Kenya. BMC Infect Dis. 2010;10(1):186.
Feikin DR, Elie CM, Goetz MB, Lennox JL, Carlone GM, Romero-Steiner S, et al. Specificity of the antibody response to the pneumococcal polysaccharide and conjugate vaccines in human immunodeficiency virus-infected adults. Clin Diagn Lab Immunol. 2004;11(1):137–41.
Miiro G, Kayhty H, Watera C, Tolmie H, Whitworth JA, Gilks CF, et al. Conjugate pneumococcal vaccine in HIV-infected Ugandans and the effect of past receipt of polysaccharide vaccine. J Infect Dis. 2005;192(10):1801–5.
Albrich WC, Madhi SA, Lafond KE, Klugman KP. Herd immunity after pneumococcal conjugate vaccination. Lancet. 2007;370(9583):218–9. author reply 219-220.