Evaluation of the immune response to a 2-dose measles vaccination schedule administered at 6 and 9 months of age to HIV-infected and HIV-uninfected children in Malawi.
BACKGROUND
The World Health Organization recommends that infants at high risk for developing measles before 9 months of age, including human immunodeficiency virus (HIV)-infected infants, receive measles vaccination (MV) at 6 and 9 months of age.


METHODS
Children born to HIV-infected mothers received MV at 6 and 9 months, and children of HIV-uninfected mothers were randomized to receive MV at 6 and 9 months, MV at 9 months, or routine MV without follow-up. Blood samples were obtained before and 3 months after each MV. Data were collected on adverse events for 21 days after each MV, at all clinic visits, on any hospitalization, and for subjects who died. HIV-infection status was determined by antibody assays and polymerase chain reaction; the presence of measles IgG was determined by EIA.


RESULTS
Twenty-two hundred mother-infant pairs were enrolled. After the first and second doses of measles vaccine, respectively, the percentages of children who were measles seropositive were 59% (36 of 61) and 64% (29 of 45) among HIV-infected children, 68% (152 of 223) and 94% (189 of 202) among HIV-exposed but uninfected children, and 62% (288 of 467) and 92% (385 of 417) among HIV-unexposed children. Of 521 HIV-unexposed children vaccinated only at 9 months, 398 (76%) were measles seropositive at 12 months. No serious vaccine-related adverse events were identified.


CONCLUSIONS
An early, 2-dose MV schedule was immunogenic, but a higher proportion of HIV-infected children remained susceptible to measles, compared with HIV-uninfected children (whether HIV exposed or HIV unexposed).
Helfand
Rita F
RF
Centers for Disease Control and Prevention, Altanta, GA 30333, USA. rzh7@cdc.gov
Witte
Desiree
D
Fowlkes
Ashley
A
Garcia
Philip
P
Yang
Chunfu
C
Fudzulani
Richard
R
Walls
Laura
L
Bae
Sun
S
Strebel
Peter
P
Broadhead
Robin
R
Bellini
William J
WJ
Cutts
Felicity
F
D000914:Antibodies, Viral / Q000097:blood; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology; D007223:Infant; D053208:Kaplan-Meier Estimate; D008295:Malawi; D008297:Male; D008457:Measles / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage* / Q000276:immunology*; D008459:Measles virus / Q000276:immunology*; D014611:Vaccination
D000914:Antibodies, Viral; D008458:Measles Vaccine