High Rates of Colonization with Drug Resistant Hemophilus Influenzae Type B and Streptococccus Pneumoniae in Unvaccinated HIV Infected Children from West Bengal
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To determine nasopharyngeal colonization rates of two vaccine preventable bacterial pathogens Hemophilus influenzae type b (Hib), and Streptococcus pneumoniae (Pneumococcus), antibiotic susceptibility of isolates, factors associated with their colonization, and immunization history in a cohort of HIV infected children.
The authors conducted a cross-sectional nasopharyngeal swab survey of 151 children affected with HIV presenting for routine outpatient care in West Bengal, India.
151 HIV affected children were enrolled. The median age was 6, 148/151 children were HIV positive, 65% had moderate to severe malnutrition, 53% were moderately to severely immunosuppressed, 17% were on antiretroviral therapy (ART), 90% were on cotrimoxazole prophylaxis (TMP/SMX). None had received the pneumococcal or Hib conjugate vaccines. Hib prevalence was 13% and pneumococcal prevalence was 28%. Children with normal or moderate immune suppression had high rates of colonization compared to those with severe immunosuppression (71% Hib, 61% pneumococcus). Hib and pneumococcal isolates had high rates of resistance to tested antibiotics including TMP/SMX and third generation cephalosporins. Neither ART nor TMP/SMX prevented colonization. Children colonized with multidrug resistant isolates had high rates of exposure to TMP/SMX.
HIV infection, late access to ART, high rates of colonization to resistant organisms and lack of access to vaccines makes this population vulnerable to invasive disease from Hib and pneumococcus.
KeywordsHemophilus influenzae type b Streptococcus pneumonia Pediatric HIV Hib Conjugate vaccines Hib conjugate vaccine Pneumococcal conjugate vaccine
- 4.Madhi SA, Petersen K, Madhi A, Khoosal M, Klugman KP. Increased disease burden and antibiotic resistance of bacteria causing severe community-acquired lower respiratory tract infections in human immunodeficiency virus type 1-infected children. Clin Infect Dis. 2000;31:170–6.PubMedCrossRefGoogle Scholar
- 9.National AIDS Control Orgnaization, Ministry of Women and Child Health, Government of India, UNICEF. Policy Framework for Children and AIDS: India. 2007. Available from: http://www.unicef.org/india/hiv_aids_156.htm.
- 13.Department of Nutrition for Health and Development. WHO global database on child growth and malnutrition. 2006.Google Scholar
- 14.Caldwell M, Oxtoby M, Simonde R, Lindgren M, Rogers M. 1994 Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. Morbidity and Mortality Weekly Report. [serial online] 1994;43:1–10.Google Scholar
- 26.International Institute for Population Sciences. National Family Health Survey 3 Fact Sheets for Key Indicators--West Bengal. 2007. Available from: http://www.nfhsindia.org/pdf/West%20Bengal.pdf.
- 27.UNICEF. Product Menu for Vaccine Supplied by UNICEF for GAVI Alliance. February 1, 2010.Google Scholar
- 28.Millar EV, O’Brien KL, Bronsdon MA, Madore D, Reid R, Santosham M. Anticapsular serum antibody concentration and protection against pneumococcal colonization among children vaccinated with 7-valent pneumococcal conjugate vaccine. Clin Infect Dis. 2007;44:1173–9. Epub 2007 Mar 23.PubMedCrossRefGoogle Scholar
- 30.Indian Academy of Pediatrics Committee on Immunization 2005–2006. IAP Guide Book on Immunization. 2006.Google Scholar