Risk of invasive meningococcal disease in children and adults with HIV in England: a population-based cohort study

BMC Medicine

Research Article

Peter Kirwan¹  Valerie Delpech¹  Mary E. Ramsay²  Samuel Lattimore²  Kazim Beebeejaun²  Ruth D. Simmons²  Shamez Ladhani²  Andrew Riordan³  Ray Borrow⁴ 

[1] HIV and STI Department, Public Health England, London, UK;Immunisation Department, Public Health England, 61 Colindale Avenue, NW9 5EQ, London, UK;Royal Liverpool Children’s Hospital, Liverpool, UK;Vaccine Evaluation Unit, Public Health England, Manchester, UK;

关键词: HIV;    Invasive meningococcal disease;    Serogroup;    Vaccination;    Relative risk;   

DOI  :  10.1186/s12916-015-0538-6

 received in 2015-09-08, accepted in 2015-11-26,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundRecent studies have identified HIV infection as a potential risk factor for invasive meningococcal disease (IMD), suggesting that HIV-infected individuals could benefit from meningococcal vaccination to reduce their risk of this rare, but severe and potentially fatal infection. In the United Kingdom, as in most industrialised countries, HIV is not considered a risk factor for IMD.MethodsIMD incidence and relative risk by age group and meningococcal capsular group in HIV-positive compared with HIV-uninfected individuals was estimated through data linkage of national datasets in England between 2011 and 2013.ResultsIMD incidence among persons diagnosed with HIV was 6.6 per 100,000 compared to 1.5 per 100,000 among HIV-negative individuals, with a relative risk of 4.5 (95 % CI, 2.7–7.5). All but one case occurred in adults aged 16–64 years, who had a 22.7-fold (95 % CI, 12.4–41.6; P <0.001) increased risk compared with the HIV-negative adults. IMD risk by capsular group varied with age. HIV-positive children and adolescents had a higher risk of meningococcal group B disease, while adults were at increased risk of groups C, W and Y disease. Most HIV-positive individuals had been born in Africa, had acquired HIV through heterosexual contact, and were known to be HIV-positive and receiving antiretroviral treatment at IMD diagnosis. The most common clinical presentation was septicemia and, although intensive care admission was common, none died of IMD.ConclusionsHIV-positive children and adults are at significantly increased risk of IMD, providing an evidence base for policy makers to consider HIV as a risk factor for meningococcal vaccination.

【 授权许可】

CC BY   
© Simmons et al. 2015