Changes in invasive Pneumococcal disease among HIV-infected adults living in the era of childhood pneumococcal immunization

Ann Intern Med. 2006 Jan 3;144(1):1-9. doi: 10.7326/0003-4819-144-1-200601030-00004.


Background: Adults infected with HIV have high rates of invasive pneumococcal disease. Introduction of pneumococcal conjugate vaccine for children could affect disease among HIV-infected adults.

Objective: To compare invasive pneumococcal disease among HIV-infected adults before and after the introduction of a pediatric conjugate vaccine.

Design: Active laboratory-based surveillance in an adult population of 10.8 million, including 38,314 living with AIDS.

Setting: 7 Active Bacterial Core surveillance areas in the United States.

Patients: All surveillance-area residents 18 to 64 years of age with Streptococcus pneumoniae isolated from a sterile site between 1998 and 2003.

Measurements: Ratio of the number of cases of invasive pneumococcal disease among HIV-infected adults to the estimated number of adults 18 to 64 years of age living with AIDS; serotype-specific subset analyses; and comparison of periods before and after introduction of conjugate vaccine by using exact tests.

Results: Of 8582 cases of invasive pneumococcal disease in adults, 2013 (24%) occurred among persons infected with HIV. Between baseline (1998 to 1999) and 2003, the ratio of invasive pneumococcal disease in HIV-infected adults to the number of adults living with AIDS in the surveillance areas decreased from 1127 to 919 cases per 100 000 AIDS population, a reduction of 19% (P = 0.002). Among HIV-infected adults, the ratio for disease caused by pneumococcal serotypes included in the conjugate vaccine decreased 62% (P < 0.001), although the ratio for disease caused by nonvaccine serotypes increased 44% (P < 0.001).

Limitations: Ratios are proxy measures of incidence rates. The denominator of surveillance-area residents living with HIV infection was not available.

Conclusions: Introduction of the pediatric conjugate vaccine was associated with an overall decrease in invasive pneumococcal disease among HIV-infected adults, despite increased disease caused by nonvaccine serotypes.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology*
  • AIDS-Related Opportunistic Infections / ethnology
  • Adolescent
  • Adult
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pneumococcal Infections / epidemiology*
  • Pneumococcal Infections / ethnology
  • Pneumococcal Vaccines*
  • Population Surveillance*
  • Serotyping
  • United States / epidemiology
  • Vaccines, Conjugate


  • Pneumococcal Vaccines
  • Vaccines, Conjugate