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Pneumococcal vaccination in people living with HIV
G Model
ARTICLE IN PRESS
JVAC-15631; No. of Pages 2
Vaccine xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Letter to the Editor Pneumococcal vaccination in people living with HIV
a r t i c l e
i n f o
Keywords: HIV Invasive Pneumococcal Disease Pneumococcal vaccination
a b s t r a c t Streptococcus pneumoniae is the leading bacterial opportunistic infection (OI) in HIV positive individuals. Anti-retroviral treatment (ART) reduces their risk of Invasive Pneumococcal Disease (IPD), however, it remains 20- to 40-fold greater than that of the general population. In HIV-infected adults, pneumococcal vaccination (PCV) induces more durable and functional antibody responses in individuals on ART at the time of vaccination than in ART-naive adults, independently of the baseline CD4+ cell count. National guidelines in the UK recommend vaccination in HIV-infected adults with CD4 count >200 cells/mL and advise that it be considered for those with CD4 count <200 cells/mL3 . We report data on IPD from a London HIV cohort of 3500 north-east London patients from 2009 to 2012. IPD was defined as a positive pneumococcal culture from blood, CSF, joint aspirate or pericardial fluid. HIV positive cases were identified by cross-referencing hospital identifiers with a positive HIV Ab/Ag test result or HIV viral load test result on the virology database. There were a total 189 cases of Invasive Pneumococcal Disease identified over the three years. 4.8% (n = 9) were known to be HIV positive at the time of their Invasive Pneumococcal infection. The serotypes of S. pneumoniae in the HIV positive cases included 3, 7F, 10F, 19A (n = 2), 19F and 31. The estimated incidence of IPD in our HIV cohort was 85.7 per 100,000, (based on an overall HIV cohort size of 3500) which is significantly higher when compared to the general population in London (local epidemiological data reported the incidence rate for IPD at 7.5 per 100,000 in London). Given the higher burden of Invasive Pneumococcal Disease in this cohort, low levels of vaccination, and the predominance of vaccine sensitive strains in our cases, vaccination and strategies to improve vaccine uptake is a priority in this at risk group. © 2014 Elsevier Ltd. All rights reserved.
Dear Sir, We read with interest the article by Valour et al. (18th June 2014) on Vaccination coverage against hepatitis A and B viruses, Streptococcus pneumoniae, seasonal and pandemic influenza in HIVinfected patients, with particular interest in the S. pneumoniae data. We describe a large burden of Invasive Pneumococcal Disease (IPD) in a UK HIV positive cohort with poor vaccine uptake among S. pneumoniae cases. S. pneumoniae is the leading bacterial opportunistic infection (OI) in HIV positive individuals. Anti-retroviral treatment (ART) reduces their risk of IPD, however, it remains 20- to 40-fold greater than that of the general population [1]. In HIV-infected adults, pneumococcal vaccination (PCV) induces more durable and functional antibody responses in individuals on ART at the time of vaccination than in ART-naive adults, independently of the baseline CD4+ cell count [2]. National guidelines in the UK recommend vaccination in HIV-infected adults with CD4 count >200 cells/mL and advise that it be considered for those with CD4 count <200 cells/mL [3].
We report data on IPD from a London HIV cohort of 3500 north-east London patients from 2009 to 2012. IPD was defined as a positive pneumococcal culture from blood, CSF, joint aspirate or pericardial fluid. HIV positive cases were identified by crossreferencing hospital identifiers with a positive HIV Ab/Ag test result or HIV viral load test result on the virology database. There were a total 189 cases of Invasive Pneumococcal Disease identified over the three years. 4.8% (n = 9) were known to be HIV positive at the time of their Invasive Pneumococcal infection. The serotypes of S. pneumoniae in the HIV positive cases included 3, 7F, 10F, 19A (n = 2), 19F and 31. The serotype was unavailable for one case. Six of the serotypes were vaccine strains. Only one patient had a record of pneumococcal vaccination with her General Practitioner and subsequently developed IPD with serotype 3 (a vaccine strain). The estimated incidence of IPD in our HIV cohort was 85.7 per 100,000, (based on an overall HIV cohort size of 3500) which is significantly higher when compared to the general population in London (local epidemiological data reported the incidence rate for IPD at 7.5 per 100,000 in London).
http://dx.doi.org/10.1016/j.vaccine.2014.07.086 0264-410X/© 2014 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Thornhill J, et al. Pneumococcal vaccination in people living with HIV. Vaccine (2014), http://dx.doi.org/10.1016/j.vaccine.2014.07.086
G Model JVAC-15631; No. of Pages 2
ARTICLE IN PRESS Letter to the Editor / Vaccine xxx (2014) xxx–xxx
2
Given the higher burden of Invasive Pneumococcal Disease in this cohort, low levels of vaccination, and the predominance of vaccine sensitive strains in our cases, vaccination and strategies to improve vaccine uptake is a priority in this at risk group. References [1] Heffernan RT, Barrett NL, Gallagher KM, Hadler JL, Harrison LH, Reingold AL, et al. Declining incidence of invasive Streptococcus pneumoniae infections among persons with AIDS in an era of highly active antiretroviral therapy, 1995–2000. J Infect Dis 2005;191:2038–45, http://dx.doi.org/10.1086/430356. PMID: 15897989. [2] Nunes M, Madh S. Safety immunogenicity and efficacy of pneumococcal conjugate vaccine in HIV-infected individuals. Hum Vaccine Immunother 2012;8(2):161–73.
[3] Geretti AM, on behalf of the BHIVA Immunization Writing Committee. British HIV Association guidelines for immunization of HIV-infected adults 2008. HIV Med 2008;9(10):795–848.
John Thornhill ∗ Anand Sivaramakrishnan Chloe Orkin Barts Health NHS Trust, London E1 1BB, United Kingdom ∗ Corresponding
author. E-mail address: [email protected] (J. Thornhill) 14 July 2014 Available online xxx
Please cite this article in press as: Thornhill J, et al. Pneumococcal vaccination in people living with HIV. Vaccine (2014), http://dx.doi.org/10.1016/j.vaccine.2014.07.086
ARTICLE IN PRESS
JVAC-15631; No. of Pages 2
Vaccine xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Letter to the Editor Pneumococcal vaccination in people living with HIV
a r t i c l e
i n f o
Keywords: HIV Invasive Pneumococcal Disease Pneumococcal vaccination
a b s t r a c t Streptococcus pneumoniae is the leading bacterial opportunistic infection (OI) in HIV positive individuals. Anti-retroviral treatment (ART) reduces their risk of Invasive Pneumococcal Disease (IPD), however, it remains 20- to 40-fold greater than that of the general population. In HIV-infected adults, pneumococcal vaccination (PCV) induces more durable and functional antibody responses in individuals on ART at the time of vaccination than in ART-naive adults, independently of the baseline CD4+ cell count. National guidelines in the UK recommend vaccination in HIV-infected adults with CD4 count >200 cells/mL and advise that it be considered for those with CD4 count <200 cells/mL3 . We report data on IPD from a London HIV cohort of 3500 north-east London patients from 2009 to 2012. IPD was defined as a positive pneumococcal culture from blood, CSF, joint aspirate or pericardial fluid. HIV positive cases were identified by cross-referencing hospital identifiers with a positive HIV Ab/Ag test result or HIV viral load test result on the virology database. There were a total 189 cases of Invasive Pneumococcal Disease identified over the three years. 4.8% (n = 9) were known to be HIV positive at the time of their Invasive Pneumococcal infection. The serotypes of S. pneumoniae in the HIV positive cases included 3, 7F, 10F, 19A (n = 2), 19F and 31. The estimated incidence of IPD in our HIV cohort was 85.7 per 100,000, (based on an overall HIV cohort size of 3500) which is significantly higher when compared to the general population in London (local epidemiological data reported the incidence rate for IPD at 7.5 per 100,000 in London). Given the higher burden of Invasive Pneumococcal Disease in this cohort, low levels of vaccination, and the predominance of vaccine sensitive strains in our cases, vaccination and strategies to improve vaccine uptake is a priority in this at risk group. © 2014 Elsevier Ltd. All rights reserved.
Dear Sir, We read with interest the article by Valour et al. (18th June 2014) on Vaccination coverage against hepatitis A and B viruses, Streptococcus pneumoniae, seasonal and pandemic influenza in HIVinfected patients, with particular interest in the S. pneumoniae data. We describe a large burden of Invasive Pneumococcal Disease (IPD) in a UK HIV positive cohort with poor vaccine uptake among S. pneumoniae cases. S. pneumoniae is the leading bacterial opportunistic infection (OI) in HIV positive individuals. Anti-retroviral treatment (ART) reduces their risk of IPD, however, it remains 20- to 40-fold greater than that of the general population [1]. In HIV-infected adults, pneumococcal vaccination (PCV) induces more durable and functional antibody responses in individuals on ART at the time of vaccination than in ART-naive adults, independently of the baseline CD4+ cell count [2]. National guidelines in the UK recommend vaccination in HIV-infected adults with CD4 count >200 cells/mL and advise that it be considered for those with CD4 count <200 cells/mL [3].
We report data on IPD from a London HIV cohort of 3500 north-east London patients from 2009 to 2012. IPD was defined as a positive pneumococcal culture from blood, CSF, joint aspirate or pericardial fluid. HIV positive cases were identified by crossreferencing hospital identifiers with a positive HIV Ab/Ag test result or HIV viral load test result on the virology database. There were a total 189 cases of Invasive Pneumococcal Disease identified over the three years. 4.8% (n = 9) were known to be HIV positive at the time of their Invasive Pneumococcal infection. The serotypes of S. pneumoniae in the HIV positive cases included 3, 7F, 10F, 19A (n = 2), 19F and 31. The serotype was unavailable for one case. Six of the serotypes were vaccine strains. Only one patient had a record of pneumococcal vaccination with her General Practitioner and subsequently developed IPD with serotype 3 (a vaccine strain). The estimated incidence of IPD in our HIV cohort was 85.7 per 100,000, (based on an overall HIV cohort size of 3500) which is significantly higher when compared to the general population in London (local epidemiological data reported the incidence rate for IPD at 7.5 per 100,000 in London).
http://dx.doi.org/10.1016/j.vaccine.2014.07.086 0264-410X/© 2014 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Thornhill J, et al. Pneumococcal vaccination in people living with HIV. Vaccine (2014), http://dx.doi.org/10.1016/j.vaccine.2014.07.086
G Model JVAC-15631; No. of Pages 2
ARTICLE IN PRESS Letter to the Editor / Vaccine xxx (2014) xxx–xxx
2
Given the higher burden of Invasive Pneumococcal Disease in this cohort, low levels of vaccination, and the predominance of vaccine sensitive strains in our cases, vaccination and strategies to improve vaccine uptake is a priority in this at risk group. References [1] Heffernan RT, Barrett NL, Gallagher KM, Hadler JL, Harrison LH, Reingold AL, et al. Declining incidence of invasive Streptococcus pneumoniae infections among persons with AIDS in an era of highly active antiretroviral therapy, 1995–2000. J Infect Dis 2005;191:2038–45, http://dx.doi.org/10.1086/430356. PMID: 15897989. [2] Nunes M, Madh S. Safety immunogenicity and efficacy of pneumococcal conjugate vaccine in HIV-infected individuals. Hum Vaccine Immunother 2012;8(2):161–73.
[3] Geretti AM, on behalf of the BHIVA Immunization Writing Committee. British HIV Association guidelines for immunization of HIV-infected adults 2008. HIV Med 2008;9(10):795–848.
John Thornhill ∗ Anand Sivaramakrishnan Chloe Orkin Barts Health NHS Trust, London E1 1BB, United Kingdom ∗ Corresponding
author. E-mail address: [email protected] (J. Thornhill) 14 July 2014 Available online xxx
Please cite this article in press as: Thornhill J, et al. Pneumococcal vaccination in people living with HIV. Vaccine (2014), http://dx.doi.org/10.1016/j.vaccine.2014.07.086