Pneumococcal immunization in HIV-infected adults
- Patricia L Hibberd, MD, PhD
Patricia L Hibberd, MD, PhD
- Chair, Department of Global Health
- Boston University School of Public Health
Pneumococcal infections, including pneumonia and invasive disease such as bacteremia and meningitis, have been a major source of morbidity and mortality since the beginning of the HIV epidemic, leading many experts to endorse use of pneumococcal vaccine for primary prevention in HIV-infected patients . However, the efficacy of pneumococcal vaccine in this patient population has been debated for many years . In addition, pneumococcal vaccines are serotype-specific, so efficacy will also vary depending on the prevalent serotypes within the community.
This topic addresses data on the use of polysaccharide and conjugate pneumococcal vaccines in HIV-infected patients and suggestions for primary prevention. Data on the use of pneumococcal vaccines in the immunocompetent host are found elsewhere. Advice on the use of other vaccines in HIV-infected patients is discussed in detail elsewhere. (See "Immunizations in HIV-infected patients" and "Prevention of hepatitis B virus infection in the HIV-infected adult".)
EPIDEMIOLOGY OF PNEUMOCOCCAL DISEASE
Pneumococcal pneumonia and meningitis are leading causes of morbidity and mortality among HIV-infected patients worldwide and treatment is complicated by the increasing incidence of drug-resistant pneumococcal strains [3,4]. The overall incidence of invasive pneumococcal disease was 677 cases per 100,000 person-years in HIV-infected patients . The case fatality rate of invasive disease ranges from 8 percent with pneumococcal bacteremia to 50 percent with meningitis [5,6].
A retrospective study performed in San Francisco, prior to the era of potent antiretroviral therapy (ART), found that the rates of pneumococcal bacteremia were approximately 100-fold greater in HIV-infected patients compared with those who were not infected with HIV . In addition, recurrent invasive pneumococcal disease is common, occurring in up to 25 percent of patients within a year after the initial episode .
Risk factors — The most important risk factor for developing pneumococcal infections is the level of immunosuppression [7-10]. In one trial of pneumococcal vaccine efficacy, the vast majority of HIV-infected patients who developed invasive pneumococcal disease had a CD4 count <200 cells/mm3 .
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- EPIDEMIOLOGY OF PNEUMOCOCCAL DISEASE
- Risk factors
- AVAILABLE VACCINE FORMULATIONS
- EFFICACY AND IMMUNOGENICITY OF PNEUMOCOCCAL VACCINATION
- Polysaccharide vaccine
- Conjugate vaccine
- VACCINE RECOMMENDATIONS
- Vaccine administration
- When to immunize
- ROLE OF PROPHYLAXIS AGAINST PNEUMOCYSTIS AND PNEUMOCOCCAL DISEASE
- ADVERSE EVENTS
- SUMMARY AND RECOMMENDATIONS