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vaccination / EDUCATION
Pneumococcal vaccination critical in HIV HIV positive or immune-compromised patients are at a high risk of contracting a potentially fatal pneumococcal disease
P
neumococcal disease (or pneumonia), is
Guidelines vary, but most
an infection caused by the Streptococcus
recommend conjugate vaccine to be
pneumoniae (pneumococcus) bacteria.
used in those who are HIV-infected. You could
In 2009, SA became the first African
follow with the polysaccharide vaccine about
country – and the first nation in the world with a high
8 weeks later. This would protect against a
HIV prevalence – to introduce the pneumococcal
broader range of serotypes.
vaccine into its routine immunisation programme.
The issue with vaccines for adults is that it isn’t covered by the state, as is the case in infants.
HOW DOES IT AFFECT HIV?
“In an ideal world, we would advocate the
According to Prof Sipho Dlamini, Associate Professor,
conjugate vaccine first followed by the polysaccharide
Division of Infectious Diseases & HIV Medicine –
vaccine. This is the approach that the US has taken.”
Groote Schuur Hospital, UCT, “In patients with HIV,
He emphasised that if we use the polysaccharide
the risk of pneumococcal disease is almost 100 times
vaccine only, most guidelines say this should only
greater compared to those who do not have HIV. Even
be used in HIV patients with a CD4 count of greater
on antiretroviral therapy (ART), that risk goes down to
than 200. The conjugate vaccine can be used
about 35-40-fold greater than in those without HIV.
irrespective of CD4 count.
ART doesn’t necessarily reduce the risk,” he said.
“It is important that HIV-positive patients have a discussion about getting vaccinated. Which one to use will be determined by local guidelines and
This is where vaccination comes in. The risk of
affordability,” he concluded.
pneumococcal disease in HIV is not only greater – the mortality and morbidity is high in this group of people. Globally, 1.6m people die of pneumococcal disease annually. This is a huge burden. In those not HIV infected, the greatest risk is in people younger than 2 and over 55. HIV mostly affects young adults. This population group (young adults with HIV) is now greatly at risk and vaccination is important for them. “People who are HIV infected should be vaccinated for pneumococcal disease to be protected from The vaccines available are PCV 13, a conjugate vaccine and the polysaccharide vaccine and
In patients with HIV, the risk of pneumococcal disease is almost 100 times greater compared to those who do not have HIV
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suffering consequences of a severe disease.”
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WHAT CAN BE DONE?
PPV-23 the polysaccharide vaccine. The difference between the two is the serotypes covered. However, the conjugate vaccine is more immunogenic, and works better for weaker immune systems.
Pharmacy Magazine APRIL 2020 |
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