MEASLES VACCINATION IN HIV-INFECTED CHILDREN: SYSTEMATIC REVIEW AND META-ANALYSIS OF SAFETY AND IMMUNOGENICITY

Tuesday, 28th of January 2014

[source]Journal of Infectious Diseases[|source]

The World Health Organization (WHO) recommended in 2004 that, unless severely immunocompromised, HIV-infected infants should receive measles vaccine at 6 months of age, followed by another dose at 9 months. However, putting this recommendation into practice is difficult because the child s HIV infection status is usually unknown during early infancy.

In this report, you will read the published report of the WHO Global Advisory Committee on Vaccine Safety (GACVS) subgroup on immune deficiencies. GACS commissioned this systematic review and contributed to formulating research questions to reassess current recommendations. The report examines the safety and immunogenicity of measles vaccine in HIV-1–infected children in order to assess the balance of benefits and risks. More details are available at:  http://jid.oxfordjournals.org/content/204/suppl_1/S164.long

 

Abstract

Background: Measles control may be more challenging in regions with a high prevalence of HIV infection. HIV-infected children are likely to derive particular benefit from measles vaccines because of an increased risk of severe illness. However, HIV infection can impair vaccine effectiveness and may increase the risk of serious adverse events after receipt of live vaccines. We conducted a systematic review to assess the safety and immunogenicity of measles vaccine in HIV-infected children.

Methods: The authors searched 8 databases through 12 February 2009 and reference lists. Study selection and data extraction were conducted in duplicate. Meta-analysis was conducted when appropriate.

Results: Thirty-nine studies published from 1987 through 2008 were included. In 19 studies with information about measles vaccine safety, more than half reported no serious adverse events. Among HIV-infected children, 59% (95% confidence intervals [CI], 46–71%) were seropositive after receiving standard-titer measles vaccine at 6 months (1 study), comparable to the proportion of seropositive HIV-infected children vaccinated at 9 (8 studies) and 12 months (10 studies). Among HIV-exposed but uninfected and HIV-unexposed children, the proportion of seropositive children increased with increasing age at vaccination. Fewer HIV-infected children were protected after vaccination at 12 months than HIV-exposed but uninfected children (relative risk, 0.61; 95% CI, .50–.73).

Conclusions: Measles vaccines appear to be safe in HIV-infected children, but the evidence is limited. When the burden of measles is high, measles vaccination at 6 months of age is likely to benefit children of HIV-infected women, regardless of the child s HIV infection status.