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

Abstract

Background HIV-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. Methods Observational 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. Results Efficacy 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). Conclusion Unlike 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 registration The study protocol was registered at PROSPERO (registration ID: CRD42018108187). Electronic supplementary material The online version of this article (10.1186/s12879-019-4325-4) contains supplementary material, which is available to authorized users.

Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low- and middle-income countries (LMICs): An umbrella review

“…The vast majority of included reviews covered interventions aiming at preventing infectious diseases in children [ 49 , 50 , 54 – 59 , 62 , 64 , 65 , 68 , 69 , 71 – 82 , 84 – 99 , 101 , 102 , 104 , 106 , 108 – 110 ]. Over a quarter included health promoting interventions [ 48 , 49 , 60 – 64 , 66 , 67 , 70 , 72 , 78 , 83 , 92 , 103 , 107 ] and only two covered health protection interventions [ 100 , 105 ].…”

“…Looking at the number of included reviews per intervention level, two reviews included interventions at the structural level [ 49 , 85 ], twenty-five covered interventions at the public policy level [ 49 , 55 , 58 , 62 , 64 , 68 , 69 , 72 , 78 , 81 , 83 , 85 – 88 , 90 , 91 , 93 , 97 , 98 , 101 , 102 , 104 , 108 , 110 ], twenty-four at the community level [ 50 , 59 , 62 , 64 , 65 , 69 , 72 – 74 , 76 , 78 , 80 , 82 , 84 , 85 , 89 , 92 , 95 – 97 , 99 , 100 , 106 , 109 ] and twenty-five at the individual level [ 48 , 55 – 57 , 60 , 61 , 63 …”

“…Regarding approaches to health inequalities adopted by the interventions covered, the vast majority of reviews (forty-five in total) included interventions with a universal approach [ 48 , 50 , 55 , 58 – 63 , 66 – 68 , 71 – 74 , 77 – 81 , 85 – 88 , 90 – 102 , 104 – 108 , 110 ]. Twenty-six reviews included interventions adopting a targeted approach [ 48 , 49 , 54 , 56 , 57 , 62 – 65 , 67 , 68 , 70 , 72 , 75 , 76 , 78 , 82 – 85 , 89 , 92 , 97 , 99 , 103 , 109 ], and ten included a mix of both approaches [ 48 , 62 , 63 , 68 , 72 , 78 , 85 , 92 , 97 , 99 ].…”

“…Only twenty reviews reported intervention effects across different groups [ 48 , 50 , 58 , 63 , 68 , 69 , 72 , 77 , 80 , 81 , 83 , 88 , 93 , 94 , 97 , 99 , 102 , 104 , 109 , 110 ]. Another twenty one reviews reported the interventions’ effect on targeted disadvantaged groups as one population [ 49 , 54 , 56 , 57 , 61 – 64 , 67 , 75 , 76 , 82 – 85 , 88 , 89 , 92 , 97 , 99 , 103 ].…”

“…We found forty-eight reviews that looked at interventions aiming to prevent infectious diseases in children ( Table 5 ). Seventeen covered interventions at the structural and policy intervention levels [ 49 , 55 , 58 , 68 , 81 , 86 – 88 , 90 , 91 , 93 , 98 , 101 , 102 , 104 , 108 , 110 ], three included multilevel interventions [ 62 , 69 , 97 ] and thirty-one looked at interventions at the community, households and individual levels [ 50 , 54 – 57 , 59 , 64 , 65 , 69 , 71 – 77 , 79 , 80 , 82 , 84 , 85 , 89 , 90 , 92 , 94 – 97 , 99 , 106 , 109 ].…”