Pneumococcal acquisition among infants exposed to HIV in rural Malawi : a longitudinal household study

Heinsbroek, Ellen and Tafatatha, Terence and Chisambo, Christina and Phiri, Amos and Mwiba, Oddie and Ngwira, Bagrey and Crampin, Amelia C. and Read, Jonathan M. and French, Neil (2016) Pneumococcal acquisition among infants exposed to HIV in rural Malawi : a longitudinal household study. American Journal of Epidemiology, 183 (1). pp. 70-78. ISSN 0002-9262

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The prevalence of Streptococcus pneumoniae (pneumococcus) carriage is higher in adults who are infected with human immunodeficiency virus (HIV) than in adults who are not. We hypothesized that infants exposed to HIV become carriers of nasopharyngeal pneumococcus earlier and more frequently than infants who are not exposed to HIV. We compared infant pneumococcal acquisition by maternal HIV status and household exposure in Karonga District, Malawi, in 2009-2011, before the introduction of pneumococcal conjugate vaccine. Nasopharyngeal swabs were collected every 4-6 weeks in the first year of life from infants with known HIV-exposure status, their mothers, and other household members. We studied infant pneumococcal acquisition by maternal HIV status, serotype-specific household exposure, and other risk factors, including seasonality. We recruited 54 infants who were exposed to HIV and 131 infants who were not. There was no significant difference in pneumococcal acquisition by maternal HIV status (adjusted rate ratio (aRR) = 1.00, 95% confidence interval (CI): 0.87, 1.15). Carriage by the mother was associated with greater acquisition of the same serotype (aRR = 3.09, 95% CI: 1.47, 6.50), but the adjusted population attributable fraction was negligible (1.9%, 95% CI: 0.0, 4.3). Serotype-specific exposure to children under 5 years of age was associated with higher acquisition (aRR = 4.30, 95% CI: 2.80, 6.60; adjusted population attributable fraction = 8.8%, 95% CI: 4.0, 13.4). We found no evidence to suggest that maternal HIV infection would affect the impact of pneumococcal vaccination on colonization in this population.

Item Type:
Journal Article
Journal or Publication Title:
American Journal of Epidemiology
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© The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Uncontrolled Keywords:
?? africacarriagecohort studieshivinfantstreptococcus pneumoniaetransmissionepidemiology ??
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11 Mar 2016 08:58
Last Modified:
15 Jul 2024 15:53