VoICE Immunization Evidence: Health inequity

Key Concept

Key Evidence: Among both HIV positive and HIV negative parents in a study in Kenya, 99% of pneumococcal strains found and tested were resistant to one or more antibiotics. HIV positive parents carried 16% more strains that were resistant to penicillin than those carried by HIV negative parents.

Conklin, L.M., Bigogo, G., Jagero, G., et al 2016. High Streptococcus pneumoniae colonization prevalence among HIV-infected Kenyan parents in the year before pneumococcal conjugate vaccine introduction. BMC Infectious Disease. 16:18.

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Key Evidence: In a study of national surveillance records in South Africa, HIV positive people over 5 years of age were found to have a 43-fold risk of invasive pneumococcal disease compared to HIV negative person. This risk was highest among children age 5-19 who were found have a more than 120-fold risk of invasive pneumococcal disease compared to HIV negative uninfected children of the same age. 90% of South Africa’s invasive pneumococcal disease cases during the 5 year period occurred in the 18% of the population who are HIV positive.

Meiring, S., Cohen, C., Quan, V., et al 2016. HIV infection and the epidemiology of invasive pneumococcal disease (IPD) in South African adults and older children prior to the introduction of pneumococcal conjugate vaccine (PCV). PLOS ONE. 11(2).

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Key Evidence: Human Papillomavirus (HPV) infections are more prevalent and persistent in HIV-infected individuals — HPV prevalence rates of 76% in HIV-infected women compared to the 46% prevalence rate in HIV-uninfected women. Cervical prevalence rates are also higher in HIV-infected women — between 48-73% in case compared to 28% in HIV-uninfected women. Additionally, HPV infections and HPV-associated diseases appear to exert a disproportionately higher burden of disease in HIV-infected women as opposed to HIV-uninfected women.

Kojic, E.M., Rana, A.I., and Cu-Uvin, A. 2016. Human Papillomavirus vaccination in HIV-infected women: need for increased coverage. Expert Review of Vaccines. 15(1):105-17.

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Key Evidence: Prior to the introduction of PCV, adults with HIV in a rural area of Kenya were nearly five times more likely to have pneumococcal pneumonia than non-infected adults, and the majority of cases with bacteremia (blood infection) occurred in HIV positive individuals.

Bigogo GM, Audi A, Auko J et al. 2019. Indirect effect of 10-valent pneumococcal conjugated vaccine against adult pneumococcal pneumonia in rural Western Kenya. Clinical Infectious Diseases.

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Key Evidence: A small hospital-based study in India found that 6 month old infants born to HIV-infected women were 11 times more likely to lack measles antibodies than 6 month olds not exposed to HIV whether or not the exposed infants were themselves infected with HIV. The lack of antibodies in most HIV-exposed infants — making them more vulnerable to measles — may be due to lower levels of measles antibodies in HIV-infected mothers or to poorer transfer of antibodies to the fetus across the placenta.

Jain S, Seth A, Khare S, Chandra J 2017. Seroprevalence of transplacentally acquired measles antibodies in HIV-exposed versus HIV-unexposed infants at six months of age. Indian Journal of Medical Research. 145.

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