Streptococcus pneumoniae Acquisition and Carriage in Vaccine Naïve Indian Children with HIV and their Parents: A Longitudinal Household Study
- 92 Downloads
To investigate the difference in pneumococcal carriage, acquisition, antibiotic resistance profiles and serotype distribution, in human immunodeficiency virus (HIV) affected and unaffected families.
A prospective cohort study was conducted in children with and without HIV in West Bengal from March 2012 through August 2014, prior to 13-valent pneumococcal conjugate vaccine (PCV-13) immunization. One thousand four hundred forty one nasopharyngeal swabs were collected and cultured at five-time points from children and their parents for pneumococcal culture, and serotyping by Quellung method.
One hundred twenty five HIV infected children and their parents, and 47 HIV uninfected children and their parents participated. Two hundred forty pneumococcal isolates were found. In children under 6 y, the point prevalence of colonization was 31% in children living with HIV (CLH) and 32% in HIV uninfected children (HUC), p = 0.6. The most common vaccine type (VT) serotypes were 6A, 6B and 19A. All isolates from parents and 71% from children in the HIV uninfected cohort were PCV-13 representative, compared to 33% of isolates from CLH and their parents. Acquisition rate in children was 1.77 times that of parents (OR = 1.77, 95%CI: 1.18–2.65). The HIV status of child or parent did not affect acquisition. Isolates from CLH were more frequently resistant to multiple antibiotics (p = 0.02).
While the rate of pneumococcal carriage and acquisition did not differ between CLH and HUC, HIV affected families had exposure to a wider range of serotypes including non-vaccine type serotypes and antibiotic resistant serotypes, than HIV unaffected families.
KeywordsStreptococcus pneumoniae HIV Risk factors Pneumococcal conjugate vaccine Serotype Antibiotic resistance
This study was funded by Indian Council of Medical Research (funded by MoHFW, Government of India) (dated: 15-06-2011; letter number: 5/7/463/2010-RHN). The first author acknowledges Fulbright-Nehru Doctoral Research Award 2014 while analysis of the study results. The authors recognize the contribution of Lt. Col. Dr. Ashok Kumar, Lt. Col. Dr. SatyajitGorain, Dr. Mausami Nandi Ghosh, Dr. Sunil Hemram, Dr. Pampa Ray, their support staff and participating families at various stages of the study.
SDB and BKA conceived and designed the study; BKA, SDB, GH, RSD, SKN, SB, SP, SM, BA were involved in nasopharyngeal swab collection, swab processing by culture, antimicrobial resistance and data acquisition; FG, KLR, AM contributed to pneumococcal serotyping; GH, BKA, RSD, SDB performed data and statistical analysis; SDB, BKA, TK, GH were involved in manuscript preparation, editing and review. All authors have read and approved the manuscript. SDB is the guarantor for this article.
Compliance with Ethical Standards
All procedures performed in this study were in accordance with the ethical standards of the institutional research committees. The ethics committees of the Indian Institute of Technology-Kharagpur (IIT-KGP), Midnapore Medical College Hospital (MMCH) and, NICED approved this study. Additional approvals were obtained from the district and state health authorities and the Drugs Controller General of India (DCGI). All parents and guardians included in the study provided written informed consent for themselves and their children.
Conflict of Interest
Source of Funding
Primary: Indian Council of Medical Research (funded by MoHFW, Government of India) (Reference number: 5/7/463/2010-RHN). Others: Fulbright-Nehru Doctoral Research Award 2014-15 (Sponsored by United States Department of State’s Bureau of Educational and Cultural Affairs, and USIEF, New Delhi.
- 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.Google Scholar