Undervaccination of Perinatally HIV-infected and HIV-exposed Uninfected Children in Latin America and the Caribbean

Abstract

Background Perinatally HIV-infected children (PHIV) may be at risk of undervaccination. Vaccination coverage rates among PHIV and HIV-exposed uninfected children (HEU) in Latin America and the Caribbean were compared. Methods All PHIV and HEU children born from 2002–2007 that were enrolled in a multi-site observational study conducted in Latin America and the Caribbean were included in this analysis. Children were classified as up to date (UTD) if they had received the recommended number of doses of each vaccine at the appropriate intervals by 12 and 24 months of age. Fisher’s exact test was used to analyze the data. Covariates potentially associated with a child’s HIV status were considered in multivariable logistic regression modeling. Results Of 1156 eligible children, 768 (66.4%) were HEU and 388 (33.6%) were PHIV. HEU children were significantly (p<0.01) more likely to be UTD by 12 and 24 months of age for all vaccines examined. Statistically significant differences persisted when the analyses were limited to children enrolled prior to 12 months of age. Controlling for birth weight, sex, primary caregiver education and any use of tobacco, alcohol or illegal drugs during pregnancy did not contribute significantly to the logistic regression models. Conclusions PHIV children were significantly less likely than HEU children to be UTD for their childhood vaccinations at 12 and 24 months of age, even when limited to children enrolled before 12 months of age. Strategies to increase vaccination rates in PHIV are needed.

Low vaccine coverage among children born to HIV infected women in Niamey, Niger

“…Other studies carried out in Africa found that children born to HIV-infected mothers had lower immunization coverage than those born to HIV-negative mothers, 14,18 and even that HIV seropositive children were more likely to be incompletely vaccinated than their seronegative pairs. 12,19 To this regard, HIV seropositive children may be more likely to be hospitalized than other children and miss appointments at times when their immune system is suppressed. It is also possible that doctors and parents may tend not to immunize HIV positive children to avoid complications from vaccination.…”

Immunity After Childhood Vaccinations in Perinatally HIV-exposed Children With and Without HIV Infection in Latin America

“…This risk may be compounded by missed opportunities for recommended immunizations in PHIV, despite specific immunization guidelines for HIV-infected children (1, 2, 3), perhaps because healthcare providers may be unaware of the recommendations or concerned that vaccination poses greater risks in this population. In a previous study of Latin American and Caribbean PHIV and HEU children enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) International Site Development Initiative (NISDI), the rates of complete vaccination of children at age 24 months varied from 43.5% to 74.5% in the PHIV group and 74.2% to 94.2% in the HEU group with PHIV children being significantly less likely to be vaccinated for all vaccines examined (4).…”

Temporal Trends in Mortality and Loss to Follow-up Among Children Enrolled in Côte d’Ivoire’s National Antiretroviral Therapy Program

“…31 Clinician hesitancy to provide live attenuated vaccines (measles and yellow fever vaccines) to symptomatic children might explain low rates of these 2 vaccines, however, all children should have received the DTPPH series in the first 8-12 months of life. Suboptimal vaccination completion among HIV-infected children has been reported in other countries.…”