HIV-infected children living in Central Africa have low persistence of antibodies to vaccines used in the Expanded Program on Immunization.
BACKGROUND
The Expanded Program on Immunization (EPI) is the most cost-effective measures to control vaccine-preventable diseases. Currently, the EPI schedule is similar for HIV-infected children; the introduction of antiretroviral therapy (ART) should considerably prolong their life expectancy.


RESULTS
To evaluate the persistence of antibodies to the EPI vaccines in HIV-infected and HIV-exposed uninfected children who previously received these vaccines in routine clinical practice, we conducted a cross-sectional study of children, aged 18 to 36 months, born to HIV-infected mothers and living in Central Africa. We tested blood samples for antibodies to the combined diphtheria, tetanus, and whole-cell pertussis (DTwP), the measles and the oral polio (OPV) vaccines. We enrolled 51 HIV-infected children of whom 33 were receiving ART, and 78 HIV-uninfected children born to HIV-infected women. A lower proportion of HIV-infected children than uninfected children had antibodies to the tested antigens with the exception of the OPV types 1 and 2. This difference was substantial for the measles vaccine (20% of the HIV-infected children and 56% of the HIV-exposed uninfected children, p<0.0001). We observed a high risk of low antibody levels for all EPI vaccines, except OPV types 1 and 2, in HIV-infected children with severe immunodeficiency (CD4(+) T cells <25%).


CONCLUSIONS
Children were examined at a time when their antibody concentrations to EPI vaccines would have still not undergone significant decay. However, we showed that the antibody concentrations were lowered in HIV-infected children. Moreover, antibody concentration after a single dose of the measles vaccine was substantially lower than expected, particularly low in HIV-infected children with low CD4(+) T cell counts. This study supports the need for a second dose of the measles vaccine and for a booster dose of the DTwP and OPV vaccines to maintain the antibody concentrations in HIV-infected and HIV-exposed uninfected children.
Centre Pasteur du Cameroun, Laboratoire d'Epidémiologie et de Santé Publique, Yaoundé, Cameroun.
Mathurin C
MC
Tejiokem
Ionela
I
Gouandjika
Lydie
L
Béniguel
Marie-Claire Endegue
MC
Zanga
Gilbert
G
Tene
Jean C
JC
Gody
Elisabeth
E
Njamkepo
Anfumbom
A
Kfutwah
Ida
I
Penda
Catherine
C
Bilong
Dominique
D
Rousset
Régis
R
Pouillot
Frédéric
F
Tangy
Laurence
L
Baril
D000350:Africa, Central / Q000453:epidemiology; D000907:Antibodies, Bacterial / Q000097:blood*; D000914:Antibodies, Viral / Q000097:blood*; D001428:Bacterial Vaccines / Q000008:administration & dosage / Q000276:immunology* / Q000600:supply & distribution; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D007223:Infant; D014765:Viral Vaccines / Q000008:administration & dosage / Q000276:immunology* / Q000600:supply & distribution
D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D001428:Bacterial Vaccines; D014765:Viral Vaccines