Meningococcal and pneumococcal carriage in children with HIV.

BACKGROUND

Children with HIV (CWH) remain at increased risk for colonization and invasive disease by Neisseria meningitidis and Streptococcus pneumoniae despite antiretroviral therapy (ART) and vaccination. Data on nasopharyngeal carriage in this group are limited in Türkiye.

METHODS

In this multicenter prospective study, nasopharyngeal swabs were obtained from 80 CWH and 180 age-matched healthy controls between July and December 2024 in İstanbul and İzmir. Samples were analyzed by real-time PCR for N. meningitidis and S. pneumoniae , and meningococcal serogroups and pneumococcal serotypes were determined by molecular methods including capsular sequence typing. Demographic, clinical, and vaccination data were collected. Univariate and multivariate analyses assessed factors associated with carriage.

RESULTS

Meningococcal carriage was detected in 3 of 80 (3.8%) CWH and 16 of 180 (8.9%) controls ( P  = 0.15). All meningococcal isolates from CWH were nongroupable and were unvaccinated. Pneumococcal carriage occurred in 23 of 80 (28.7%) CWH and 43 of 180 (23.9%) controls ( P  = 0.40). Among CWH isolates, 65.2% were PCV13 serotypes, 26.1% were non-PCV13 serotypes, and 8.7% were nontypeable. Time since the last PCV13 dose was weakly but independently associated with lower pneumococcal carriage [adjusted odds ratio (OR) per month 0.98, 95% confidence interval (CI) 0.97-0.99; P  = 0.011], while having vaccinated siblings showed a borderline protective effect.

CONCLUSION

In this contemporary cohort from Türkiye, CWH exhibited low meningococcal carriage dominated by nongroupable strains and pneumococcal carriage comparable to healthy children, with a serotype distribution shaped by vaccination and host immunity. These findings support sustained risk-group vaccination, reinforcement of household-level immunization, and continued molecular surveillance to optimize prevention strategies for CWH.