Maternal HIV infection associated with reduced transplacental transfer of measles antibodies and increased susceptibility to disease

Jallow, Sabelle; Cutland, Clare; Masbou, A.K.; Adrian, Peter V.; Madhi, Shabir А.

doi:10.1016/j.jcv.2017.07.009

Cited by 19 publications

(18 citation statements)

References 36 publications

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“…HIV-exposed children showed a non-significant trend towards improved serological response when vaccinated at 6-months of age compared with HIV-unexposed children. This could be explained by reduced transplacental transfer of antibodies from HIV-infected women, resulting in lower levels of maternal antibodies in the infant and less interference with the B-cell response to vaccination [21]. Maternal PMTCT regimens and breastfeeding recommendations for HIV-infected mothers varied substantially between 1987 and 2018, and may have contributed to differences between HEU and other groups.…”

Section: Discussionmentioning

confidence: 99%

“…HIV-infected children have an increased risk of severe measles disease and complications compared with HIV-unexposed children [18], [19], [20]. The increased susceptibility to developing measles during early infancy in HIV-exposed infants may be explained by lower levels of maternally acquired measles antibody than HIV-unexposed [21]. Furthermore, HIV-infected, antiretroviral-naïve children have a reduced serological response to primary measles vaccination and increased waning of immunity compared with HIV-uninfected and HEU children [22], [23], [24], [25].…”

Section: Introductionmentioning

confidence: 99%

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Safety and Immunogenicity of Measles Vaccination in HIV-Infected and HIV-Exposed Uninfected Children: A Systematic Review and Meta-Analysis

et al. 2018

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Background HIV-infected and HIV-exposed uninfected (HEU) children have an increased risk of measles that may be due to altered immune responses or suboptimal timing of measles vaccination. We aimed to evaluate the safety and immunogenicity of measles vaccination in HIV-infected and HEU children. Methods For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Library, CINAHL, Global Health Library and IndMED on May 9, 2018. Studies were included if they reported on safety or seroresponse (either seroprotection/seropositivity/seroconversion) after measles vaccination in HIV-infected or HEU children. We calculated pooled estimates to compare immunogenicity outcomes between HIV-infected, HEU and HIV-unexposed children, using risk ratios [RRs] (with 95%CIs). PROSPERO registration number: CRD42017057411. Findings Seventy-one studies met the inclusion criteria (15,363 children). Twenty-eight studies reported on safety; vaccine-associated adverse events and deaths were uncommon. Sixty-two studies reported on immunogenicity, 27 were included in the meta-analysis. HIV-infected children had lower seroresponse rates after primary vaccination compared with HIV-unexposed (RR 0.74; 95%CI: 0.61–0.90, I 2 = 85.9%) and HEU children (0.78; 0.69–0.88, I 2 = 77.1%), which was mitigated by antiretroviral therapy and time interval between vaccination and serology. HEU and HIV-unexposed children had similar seroresponses. Vaccination at 6-months resulted in similar proportions of HIV-infected children having seroresponse compared with HIV-unexposed (0.96; 0.77–1.19) and HEU children (1.00; 0.73–1.37, I 2 = 63.7%). Interpretation Primary measles vaccination at 6-months of age may provide protection against measles during early infancy in settings with high prevalence of maternal HIV-infection, however, further studies are needed to evaluate this strategy in HEU children and HIV-infected children receiving antiretroviral therapy. Funding South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation in Vaccine Preventable Diseases; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety and Immunogenicity of Measles Vaccination in HIV-Infected and HIV-Exposed Uninfected Children: A Systematic Review and Meta-Analysis

et al. 2018

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“…We deduce that the increase in morbidity is related to the development of abnormal microbiota among infants that exposes them to ailments. Simultaneously, maternal HIV infection has been linked to the negligible provision of resistant immunity against ordinary germs among infants (21). Since any strategy aimed at tackling diseases focuses more on risk factors, it is essential to understand any risk factors associated with BV.…”

Section: Introductionmentioning

confidence: 99%

Morbidities and mortality among infants of HIV-1-infected mothers with bacterial vaginosis in Kenya

Mwenda

Nduati

Kosgey

et al. 2020

Preprint

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Background: This study aimed to assess the effects of maternal bacterial vaginosis (BV) on the morbidity and mortality of HIV-exposed infants of women enrolled in a randomized controlled trial (pre-dating antiretroviral therapy) at birth, 6 months, and 12 months. Methods: Four hundred and twenty-five HIV-positive pregnant women were enrolled in this trial and were categorized as exposed if they had a laboratory-based diagnosis of BV (Nugent method). We compared the morbidity and mortality of infants of the mothers at birth, 6 months, and 12 months. We assessed morbidities from the mother’s history and clinical examination during scheduled and non-scheduled visits. The data that were collected longitudinally were then analyzed via multiple logistic regression with the generalized estimating equation. An independent correlation structure was assumed to evaluate the specific morbidity risks to infants associated with exposure to BV. We used the Kaplan–Meier method to generate the cumulative hazard curve, to determine mortalities at different stages between the two groups. Overall, only data for 328 infants were complete and used in the analysis.Results: Data were available for 159 and 171 BV exposed and non-exposed mothers, respectively. Exposure to BV was not associated with any neonatal morbidity at birth, but was associated with adverse maternal condition (unadjusted odds ratio [OR], 2.93; 95% confidence interval [CI], 1.19–7.20, P=0.02) and maternal hospital admissions (unadjusted OR, 1.95; 95% CI, 1.08–3.51, P=0.02). At 6 months, infants of BV exposed mothers had higher odds of bloody stool (adjusted OR, 3.08; 95% CI, 1.11–10.00, P=0.04), dehydration (adjusted OR, 2.94; 95% CI, 1.44–6.37, P=0.01), vomiting (adjusted OR, 1.64; 95% CI, 1.06–2.56, P=0.03), and mouth ulcers (adjusted OR, 12.8; 95% CI, 2.27–241.21, P=0.02). At 12 months, exposure to BV was associated with dehydration (adjusted OR, 1.81; 95% CI, 1.05–3.19, P=0.03) and vomiting (adjusted OR, 1.39; 95% CI, 1.01–1.92, P=0.04). Kaplan–Meier survival analysis showed no association of BV with infant mortality (P=0.65); however, the cumulative hazard curve showed a higher trend toward deaths among BV exposed infants.Conclusion: Our findings demonstrate that BV is a good predictor of maternal and infant morbidities. Infants of both HIV and BV exposed mothers can manifest these symptoms at any stage within a year of growth. Adverse maternal condition and hospitalization of mothers after birth could indicate exposure to BV. Bloody stool, dehydration, vomiting, and mouth ulcers could indicate exposure to BV among infants.

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“…[219] This is due to lower antibody concentrations in pregnant women who have acquired immunity through vaccination, rather than through wild-type virus exposure, as well as possible waning of immunity in women living with HIV. [220,221] The WHO recommends that children receive 2 doses of the measles vaccine, the first at 9 months of age and a booster dose at 15 -18 months of age. [222] However, for infants born to women living with HIV, and in settings with a high risk of measles in young infants, an additional dose is recommended at 6 months of age.…”

Section: Specific Preventive Strategies Immunisationmentioning

confidence: 99%

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

Zar

Moore

Andronikou

et al. 2020

Afr J Thorac Crit Care Med

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Background. Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. Objective. To produce revised guidelines for pneumonia in South African children under 5 years of age. Methods. The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. Recommendations. Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. Validation. The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.

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Maternal HIV infection associated with reduced transplacental transfer of measles antibodies and increased susceptibility to disease

Cited by 19 publications

References 36 publications

Safety and Immunogenicity of Measles Vaccination in HIV-Infected and HIV-Exposed Uninfected Children: A Systematic Review and Meta-Analysis

Safety and Immunogenicity of Measles Vaccination in HIV-Infected and HIV-Exposed Uninfected Children: A Systematic Review and Meta-Analysis

Morbidities and mortality among infants of HIV-1-infected mothers with bacterial vaginosis in Kenya

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

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