Immunogenicity of High-Titer Edmonston-Zagreb Measles Vaccine in Human Immunodeficiency Virus-Infected Children in Kinshasa, Zaire

Abstract

The response to Edmonston-Zagreb vaccine (titer, 5.4 log10 pfu) was evaluated among children in a study of perinatal transmission of human immunodeficiency virus (HIV) in Kinshasa. Acute postvaccination adverse events were monitored for 49 HIV-infected and 376 non-HIV-infected infants, and measles antibody responses were assessed by ELISA for 34 HIV-infected and 255 non-HIV-infected infants. There was no increase in the incidence of common symptoms 7-10 days after vaccination. HIV-infected infants were more likely to have detectable prevaccination measles antibody, and seroconversion after vaccination was somewhat lower in HIV-infected (76.5%) than non-HIV-infected infants (85.5%). Seroconversion rates did not differ among children with or without rhinitis or fever at vaccination. High-titer Edmonston-Zagreb vaccine given at 6 months of age has the potential to provide earlier protection against measles; however, this vaccine is no longer recommended for routine use, and two doses of standard-titer vaccines remains the preferred option for measles vaccination of HIV-infected infants.

Seroprevalence of transplacentally acquired measles antibodies in HIV-exposed versus HIV-unexposed infants at six months of age

“…Our study also demonstrated a higher seroprevalence of measles antibodies in HIV infected as compared to HIV-uninfected exposed infants. This observation was in concordance with reports by Cutts et al 24 (11.8% of HIV-infected and 6.5% of HIV-exposed uninfected infants), Rudy et al 25 (16.7% of HIV-infected and 0% of HIV-exposed uninfected infants) and Lepage et al 22 (15% of HIV-infected and 10% of HIV-exposed uninfected infants). The possible explanation for apparent longer persistence of maternally acquired measles antibodies among HIV-infected infants may be the presence of polyclonal B-cell activation and hypergammaglobulinemia in these infants giving rise to false positive test results 26 .…”

“…Despite measles being a live-attenuated vaccine, none of our infants had any serious adverse effects associated with vaccination. Some other studies 22 24 where a high titre measles vaccine was used also reported similar low incidence of adverse effects with no serious or life-threatening adverse effect to be associated with measles vaccine. In a systematic review and meta-analysis on safety and immunogenicity of measles vaccination in HIV-infected children, among 39 studies involving >1200 HIV-infected children, none of the study reported death in relation to measles vaccine in HIV-infected children 29 .…”

Implications of the Human Immunodeficiency Virus Epidemic for Control and Eradication of Measles

“…However, the geometric mean titer was not statistically different between the three groups. No significant difference in the presence of measles antibody measured by EIA at 6 months of age in children born to HIV-infected and -uninfected mothers was demonstrated in former Zaire [46]. In the United States, only 1 of 23 HIV-infected infants Ͻ6 months of age had maternally acquired measles antibody [13].…”

“…In prospective studies in Rwanda [45] and the former Zaire [46], high-titer EdmonstonZagreb vaccine was administered to HIV-infected children, HIV-uninfected children born to seropositive mothers, and children born to HIV-seronegative mothers. The antibody responses to measles virus at 9 months of age were similar in the three groups, with 76%-94% of children responding to the vaccine.…”

Pesquisa de anticorpos contra o sarampo em crianças infectadas pelo HIV, após a imunização básica

“…Até 1996, os estudos disponíveis na literatura não relatavam aumento de efeitos colaterais da vacina contra o sarampo em pacientes infectados pelo HIV [3][4][5][6][7][8] . A ocorrên-cia de um caso fatal de pneumonite atípica, causada pela cepa vacinal do vírus do sarampo, fez ressurgir a discussão sobre os riscos dessa vacina em soropositivos para o HIV 9 .…”