Vaccination of HIV-Infected Pregnant Women with Trivalent Influenza Vaccine in the Prevention of Streptococcus pneumoniae and Staphylococcus aureus Colonization during Early Infancy in South Africa Open Access

Abstract

Background: Synergistic lethality of influenza and bacterial pathogens such as S. pneumoniae is greatly attributable to influenza virus associated morbidity and mortality. Data on the efficacy of maternal vaccination of trivalent, inactivated influenza vaccine (TIV) to protect children from influenza and pneumococcal pneumonia, particularly in Africa, is limited. This study evaluated the efficacy of TIV in reducing the risk of S. pneumoniae and S. aureus acquisition among HIV seropositive children at early infancy.

Method: Nasopharyngeal (NP) specimens were collected and DNA was extracted utilizing the easyMAG 2.0.1 system. Real-time PCR was performed to detect and quantify Streptococcus pneumoniae and Staphylococcus aureus in the specimens. Association between treatment group and early bacteria acquisition was assessed by cross-tabulation; Kaplan-Meir curves and Cox-proportional model were employed to compare hazards in two groups and a mixed model was used to evaluate the change of colonization density over the three schedule visits.

Results: Laboratory immunogenicity test revealed that the flu vaccination failed to yield immunogenicity against S. pneumoniae. The odds ratio between TIV group and placebo group in early S. pneumoniae acquisition is 1.01 (95% CI: 0.50-2.04) and is 1.03 (95% CI: 0.51-2.10) in early S. aureus acquisition. Taking the placebo group as the reference group, the hazard ratio in S. pneumoniae acquisition is 1.2 (95% CI: 0.72-1.87) and the hazard ratio in S. aureus acquisition is 1.62 (95% CI: 0.89-2.94). There was therefore no significant percent change in density of S. pneumoniae and S. aureus in either TIV group or placebo group over the three schedule visits.

Conclusion: Maternal TIV immunization is not efficacious in either delaying incidence of first S. pneumoniae or S. aureus colonization, or decreasing the density of colonization from both bacteria in HIV seropositive infant younger than 6 months of age. Further evaluation of effectiveness of maternal TIV immunization should be implemented among HIV uninfected infants.

Table of Contents

Table of Contents

BACKGROUND ..........................................................................................................................1
METHODS ................................................................................................................................5
STUDY DESIGN ..........................................................................................................................5
SAMPLE SIZE ............................................................................................................................5
LABORATORY TEST .....................................................................................................................6
STATISTICAL ANALYSIS ..............................................................................................................9
RESULTS ................................................................................................................................10
EFFICACY OF THE VACCINATION AMONG MOTHERS: ........................................................................10
ASSOCIATION BETWEEN MATERNAL VACCINATION STATUS AND EARLY BACTERIA ACQUISITION ...............11
DIFFERENCE IN TIME TO FIRST ACQUISITION .................................................................................11
CHANGE OF BACTERIA DENSITY OVER 6 MONTHS SINCE BIRTH ..........................................................12
DISCUSSION ...........................................................................................................................13
FUTURE DIRECTIONS ................................................................................................................16
REFERENCES ...........................................................................................................................17
TABLES ...................................................................................................................................21
FIGURES .................................................................................................................................24
APPENDIX ...............................................................................................................................28

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Biology, Microbiology
Keyword	HIV Streptococcus pneumoniae Trivalent Influenza Vaccine Staphylococcus aureus Maternal immunization
Committee Chair / Thesis Advisor	Klugman, Keith P, Emory University
Committee Members	Vidal Graniel, Jorge Eugenio, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti)

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