The burden of vaccine-preventable diseases among HIV-infected and HIV-exposed children in sub-Saharan Africa: a systematic review and meta-analysis

Hum Vaccin Immunother. 2019;15(11):2590-2605. doi: 10.1080/21645515.2019.1599676. Epub 2019 May 22.

Abstract

There are knowledge gaps regarding evidence-based research on the burden of vaccine-preventable diseases among human immunodeficiency virus (HIV)-infected and HIV-exposed children aged <18 years in sub-Saharan Africa. It is therefore essential to determine the trend and burden of vaccine-preventable diseases. We completed a systematic review and meta-analysis to identify the incidence, prevalence and case-fatality rates (CFR) attributed to various vaccine-preventable diseases among HIV-infected and HIV-exposed children in sub-Saharan Africa. The trends in the prevalence of vaccine-preventable diseases among HIV-infected and HIV-exposed children were also determined. Nine studies on tuberculosis (TB) were pooled to give an overall incidence rate estimate of 60 (95% confidence interval [CI] 30-70) per 1,000 child-years. The incidence of pneumococcal infections varied between 109-1509 per 100,000 while pertussis was between 2.9 and 3.7 per 1000 child-year. Twenty-two TB prevalence studies reported an estimated prevalence of 16%. Fifteen prevalence studies on hepatitis B infection were pooled together with an estimated prevalence of 5%. The pooled prevalence for pneumococcal infections was 2% while rotavirus diarrhoea reported a prevalence of 13%. Twenty-nine studies on TB were pooled to give an overall CFR estimate of 17% while pneumococcal infections in HIV-infected and exposed children were pooled together with a resultant rate of 15%. Some of the vaccine-preventable diseases still have high incidences, prevalence and CFR among HIV-infected and HIV-exposed children. There is also a dearth of research data on the burden of several vaccine-preventable diseases among HIV-infected and exposed children and a need for more studies in this area.

Keywords: HIV; burden; sub-Saharan Africa; vaccine-preventable diseases.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Adolescent
  • Africa South of the Sahara / epidemiology
  • Child
  • Child, Preschool
  • Cost of Illness*
  • HIV Infections / epidemiology*
  • HIV Infections / immunology
  • Humans
  • Incidence
  • Infant
  • Pneumococcal Infections / epidemiology
  • Pneumococcal Infections / prevention & control
  • Prevalence
  • Tuberculosis / epidemiology
  • Tuberculosis / prevention & control
  • Vaccine-Preventable Diseases / epidemiology*
  • Whooping Cough / epidemiology
  • Whooping Cough / prevention & control

Grant support

National Research Foundation of South Africa. 106035; South African Medical Research Council. 10.13039/501100001322.