Effectiveness of pneumococcal conjugate vaccination against invasive pneumococcal disease among children with and those without HIV infection: a systematic review and meta-analysis

Hossein Molavi Vardanjani,Ali Ahmadi,Hodjat Borna

doi:10.1186/s12879-019-4325-4

Hossein Molavi Vardanjani, Ali Ahmadi + Show 1 more

Open Access

https://doi.org/10.1186/s12879-019-4325-4

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Abstract

BackgroundHIV-infected children are at a higher risk of Invasive Pneumococcal Disease (IPD) and its mortality, even in the era of antiretroviral therapy. Therefore, an effective vaccination strategy would be beneficial. To investigate the effectiveness of Pneumococcal Conjugate Vaccination (PCV) against IPD among HIV-Infected and HIV-Uninfected Children through a systematic review and meta-analysis.MethodsObservational studies and randomized trials on 7 years old or older children were searched in the Cochrane Library, Web of Science core collection, Embase, Medline/PubMed, and Google Scholar. Critical appraisal was done using the Cochrane risk of bias tool and the Newcastle-Ottawa quality assessment form. Effectiveness and efficacy of at least one dose of PCV was investigated among children with and without HIV considering subgroups of pneumococcal serotypes. We meta-analyzed the effect sizes using random-effects modeling.ResultsEfficacy of PCV was estimated as 45.0% (31.2, 56.1) and 52.6% (25.7, 69.8) among HIV-infected and HIV-uninfected children, respectively. Effectiveness of PCV among HIV-infected children as − 6.2% (− 67.6, 32.7) was significantly lower than HIV-uninfected children 65.1% (47.3, 76.9). Effectiveness of PCV among HIV-infected children for IPDs caused by vaccine serotypes was estimated as 7.7(− 66.7, 48.9), and for IPDs caused by non-vaccine serotypes was estimated as − 402.8(− 1856, − 29.2).ConclusionUnlike the evidence on the efficacy of PCV against IPD among both of HIV-infected and HIV-uninfected children, its effectiveness against IPD among HIV-infected children is much less limited.Review registrationThe study protocol was registered at PROSPERO (registration ID: CRD42018108187).

Highlights

HIV-infected children are at a higher risk of Invasive Pneumococcal Disease (IPD) and its mortality, even in the era of antiretroviral therapy
Based on case-control studies, the overall effectiveness of Pneumococcal Conjugate Vaccination (PCV) against any IPD was estimated as − 6.2% and 65.1% among HI and Children Without HIV Infection (HUI) children, respectively
The results showed that the overall effectiveness of PCVs in preventing IPD among HI children was significantly lower than HUI children (− 6.2% vs. 65.1%)

Summary

Introduction

HIV-infected children are at a higher risk of Invasive Pneumococcal Disease (IPD) and its mortality, even in the era of antiretroviral therapy. Children with HIV-infection (HI) are prone to invasive pneumococcal disease (IPD) roughly 40 times more than those without HIV-infection (HUI) [1, 2]. The risk of IPD-related mortality among them is higher than children without HIV-infection (HUI) [3, 4]. Of the most appropriate preventive strategies, for the time being, may be boosting the immune system function through antiretroviral therapy (ART) and/or vaccination against pneumococcal diseases [2]. Effective vaccination can prove to be an important strategy for prevention of IPD and IPD-related mortality in HI [8, 9].

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