The Indian Journal of Pediatrics

, Volume 78, Issue 4, pp 423–429 | Cite as

High Rates of Colonization with Drug Resistant Hemophilus Influenzae Type B and Streptococccus Pneumoniae in Unvaccinated HIV Infected Children from West Bengal

  • Sangeeta Das Bhattacharya
  • Swapan Kumar Niyogi
  • Subhasish Bhattacharyya
  • Sean Fitzwater
  • Nageshwar Chauhan
  • A. Sudar
  • Sutapa Mandal
Original Article

Abstract

Objective

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.

Methods

The authors conducted a cross-sectional nasopharyngeal swab survey of 151 children affected with HIV presenting for routine outpatient care in West Bengal, India.

Results

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.

Conclusions

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.

Keywords

Hemophilus influenzae type b Streptococcus pneumonia Pediatric HIV Hib Conjugate vaccines Hib conjugate vaccine Pneumococcal conjugate vaccine 

References

  1. 1.
    Bernstein LJ, Ochs HD, Wedgwood RJ, Rubinstein A. Defective humoral immunity in pediatric acquired immune deficiency syndrome. J Pediatr. 1985;107:352–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Bliss SJ, O’Brien KL, Janoff EN, et al. The evidence for using conjugate vaccines to protect HIV-infected children against pneumococcal disease. Lancet Infect Dis. 2008;8:67–80.PubMedCrossRefGoogle Scholar
  3. 3.
    Mangtani P, Mulholland K, Madhi SA, Edmond K, O’Loughlin R, Hajjeh R. Haemophilus influenzae type b disease in HIV-infected children: a review of the disease epidemiology and effectiveness of Hib conjugate vaccines. Vaccine. 2010;28:1677–83.PubMedCrossRefGoogle Scholar
  4. 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
  5. 5.
    Watt JP, Wolfson LJ, O’Brien KL, et al. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. Lancet. 2009;374:903–11.PubMedCrossRefGoogle Scholar
  6. 6.
    O’Brien KL, Wolfson LJ, Watt JP, et al. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet. 2009;374:893–902.PubMedCrossRefGoogle Scholar
  7. 7.
    Klugman KP, Madhi SA, Huebner RE, et al. A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection. N Engl J Med. 2003;349:1341–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Madhi SA, Kuwanda L, Saarinen L, et al. Immunogenicity and effectiveness of Haemophilus influenzae type b conjugate vaccine in HIV infected and uninfected African children. Vaccine. 2005;23:5517–25.PubMedCrossRefGoogle Scholar
  9. 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.
  10. 10.
    Singh HK, Gupta A, Siberry GK, et al. The Indian pediatric HIV epidemic: a systematic review. Curr HIV Res. 2008;6:419–32.PubMedCrossRefGoogle Scholar
  11. 11.
    Meehan A, Mackenzie G, Shingadia D, Booy R. Protecting children with HIV against pneumococcal disease. Lancet Infect Dis. 2009;9:394–5.PubMedCrossRefGoogle Scholar
  12. 12.
    O’Brien KL, Nohynek H, World Health Organization Pneumococcal Vaccine Trials Carriage Working Group. Report from a WHO Working Group: standard method for detecting upper respiratory carriage of Streptococcus pneumoniae. Pediatr Infect Dis J. 2003;22:e1–11.PubMedGoogle Scholar
  13. 13.
    Department of Nutrition for Health and Development. WHO global database on child growth and malnutrition. 2006.Google Scholar
  14. 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
  15. 15.
    Jain A, Kumar P, Awasthi S. High nasopharyngeal carriage of drug resistant streptococcus pneumoniae and haemophilus influenzae in North Indian school children. Trop Med Int Health. 2005;10:234–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Das BK, Arora NK, Mathur P, et al. Nasopharyngeal carriage of Haemophilus influenzae. Indian J Pediatr. 2002;69:775–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Gupta M, Kumar R, Deb AK, et al. Hib study working group. Multi-center surveillance for pneumonia & meningitis among children (<2 yr) for Hib vaccine probe trial preparation in India. Indian J Med Res. 2010;131:649–58.PubMedGoogle Scholar
  18. 18.
    Leibovitz E, Dragomir C, Sfartz S, et al. Nasopharyngeal carriage of multidrug-resistant Streptococcus pneumoniae in institutionalized HIV-infected and HIV-negative children in northeastern Romania. Int J Infect Dis. 1999;3:211–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Cardoso VC, Cervi MC, Cintra OA, Salathiel AS, Gomes AC. Nasopharyngeal Colonization with Streptococcus pneumoniae in children infected with human immunodeficiency virus. J Pediatr Rio J. 2006;82:51–7.PubMedGoogle Scholar
  20. 20.
    Gessner BD. Haemophilus influenzae type b vaccine impact in resource-poor settings in Asia and Africa. Expert Rev Vaccines. 2009;8:91–102.PubMedCrossRefGoogle Scholar
  21. 21.
    Gill CJ, Mwanakasale V, Fox MP, et al. Effect of presumptive co-trimoxazole prophylaxis on pneumococcal colonization rates, seroepidemiology and antibiotic resistance in Zambian infants: a longitudinal cohort study. Bull World Health Organ. 2008;86:929–38.PubMedCrossRefGoogle Scholar
  22. 22.
    Polack FP, Flayhart DC, Zahurak ML, Dick JD, Willoughby RE. Colonization by Streptococcus penumoniae in human immunodeficiency virus-infected children. Pediatr Infect Dis J. 2000;19:608–12.PubMedCrossRefGoogle Scholar
  23. 23.
    Janoff EN, O’Brien J, Thompson P, et al. Streptococcus pneumoniae colonization, bacteremia, and immune response among persons with human immunodeficiency virus infection. J Infect Dis. 1993;167:49–56.PubMedCrossRefGoogle Scholar
  24. 24.
    Coles CL, Rahmathullah L, Kanungo R, et al. Nasopharyngeal carriage of resistant pneumococci in young South Indian infants. Epidemiol Infect. 2002;129:491–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Saha SK, Baqui AH, Darmstadt GL, et al. Comparison of antibiotic resistance and serotype composition of carriage and invasive pneumococci among Bangladeshi children: implications for treatment policy and vaccine formulation. J Clin Microbiol. 2003;41:5582–7.PubMedCrossRefGoogle Scholar
  26. 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. 27.
    UNICEF. Product Menu for Vaccine Supplied by UNICEF for GAVI Alliance. February 1, 2010.Google Scholar
  28. 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
  29. 29.
    Moss WJ, Clements CJ, Halsey NA. Immunization of children at risk of infection with human immunodeficiency virus. Bull World Health Organ. 2003;81:61–70.PubMedGoogle Scholar
  30. 30.
    Indian Academy of Pediatrics Committee on Immunization 2005–2006. IAP Guide Book on Immunization. 2006.Google Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2010

Authors and Affiliations

  • Sangeeta Das Bhattacharya
    • 1
  • Swapan Kumar Niyogi
    • 2
  • Subhasish Bhattacharyya
    • 3
  • Sean Fitzwater
    • 4
  • Nageshwar Chauhan
    • 1
  • A. Sudar
    • 1
  • Sutapa Mandal
    • 2
  1. 1.School of Medical Science and TechnologyIndian Institute of Technology KharagpurKharagpurWest BengalIndia
  2. 2.Division of BacteriologyNational Institute of Cholera and Enteric DiseasesKolkataIndia
  3. 3.Department of PediatricsMedical College KolkataKolkataIndia
  4. 4.Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimore MDUSA

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