Decreased diarrheal and respiratory disease in HIV exposed uninfected children following vaccination with rotavirus and pneumococcal conjugate vaccines

• Main Authors: Ajibola, G. (Author), Batlang, O. (Author), Bennett, K. (Author), Hughes, M.D (Author), Kgole, S. (Author), Leidner, J. (Author), Lockman, S. (Author), Makhema, J. (Author), Mmalane, M. (Author), Powis, K.M (Author), Shapiro, R. (Author)
• Format: Article
• Language: English
• Published: Public Library of Science 2021
• Subjects: Article; Botswana; child; Child; Child, Preschool; childhood mortality; city; clinical trial; confidence interval; controlled study; cotrimoxazole; diarrhea; Diarrhea; double blind procedure; female; Female; geographic distribution; hazard ratio; HIV Infections; hospitalization; Hospitalization; human; Human immunodeficiency virus infection; Humans; infant; Infant; infant mortality; infection prevention; Kaplan Meier method; major clinical study; placebo; Pneumococcal Vaccines; Pneumococcus vaccine; Pneumonia, Pneumococcal; Pneumonia, Viral; preschool child; randomized controlled trial; risk factor; risk reduction; Rotavirus infection; Rotavirus vaccine; Rotavirus Vaccines; rural area; secondary analysis; Streptococcus pneumonia; vaccination; vaccine; Vaccines, Conjugate; viral gastroenteritis; virus pneumonia
• Online Access: View Fulltext in Publisher

 Background Rotavirus vaccine (RV) and pneumococcal vaccine (PCV) decrease diarrheal and respiratory disease incidence and severity, but there are few data about the effects of these vaccines among HIV-exposed uninfected (HEU) children. Methods We recorded RV and PCV vaccination history in a placebo-controlled trial that studied the need for cotrimoxazole among HEU infants in Botswana (the Mpepu Study). We categorized infants by enrollment before or after the simultaneous April 2012 introduction of RV and PCV, and compared diagnoses of diarrhea and pneumonia (grade 3/4), hospitalizations, and deaths from both disease conditions through the 12-month study visit by vaccine era/status across two sites (a city and a village) by Kaplan-Meier estimates. Results Two thousand six hundred and thirty-five HEU infants were included in this secondary analysis, of these 1689 (64%) were enrolled in Gaborone (344 pre-vaccine, 1345 vaccine) and 946 (36%) in Molepolole (209 pre-vaccine, 737 vaccine). We observed substantial reduction in hazard of hospitalization or death for reason of diarrhea and pneumonia in the vaccine era versus the pre-vaccine era in Molepolole (hazard ratio, HR = 0.44, 95% confidence interval, CI = 0.28, 0.71) with smaller reduction in Gaborone (HR = 0.91, 95% CI = 0.57, 1.45). Similar downward trends were observed for diagnoses of diarrhea and pneumonia separately during the vaccine versus pre-vaccine era. Conclusions Although temporal confounding cannot be excluded, significant declines in the burden of diarrheal and respiratory illness were observed among HEU children in Botswana following the introduction of RV and PCV. RV and PCV may maximally benefit HEU children in rural areas with higher disease burden. © 2020 Ajibola et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.