title: Safety and immunogenicity of early measles vaccination in children born to HIV-infected mothers in the United States: results of Pediatric AIDS Clinical Trials Group (PACTG) protocol 225.
abstract: BACKGROUND.: ACTG (Pediatric AIDS Clinical Trials Group) 225, a multicenter, randomized, open-label trial in the United States evaluated reactogenicity and immunogenicity of 2 vaccination regimens: monovalent measles vaccine (Attenuvax) at 6 months of age and measles, mumps, and rubella, live attenuated (MMRII) vaccine at 12 months of age (2D), or only MMRII at 12 months of age (1D) in human immunodeficiency virus-infected (HIV-infected) (POS) and uninfected (NEG) children in the pre-highly active antiretroviral therapy (pre-HAART) period.
  
  
  METHODS
  Plaque-reduction neutralization (PRN) of measles-neutralizing antibody titers were evaluated at study weeks 0, 6, 26, 32, 52, and 130 (∼3 years of age).
  
  
  RESULTS
  The 110 subjects included: 65 2DNEG; 30 1DNEG; 7 2DPOS and 8 1DPOS. Vaccinations (n=175) were associated with no adverse experiences >Grade 2 except for Grade 3 fever (n=2, 1 1DPOS and 1 1DNEG). Six weeks after Attenuvax, all 2DPOS subjects (7/7) seroresponded (PRN titers ≥120 mIU/mL) with median titers significantly exceeding 2DNEG titers (2115 vs 628 mIU/mL, respectively; P=.023). At ∼3 years of age, 67% 1DPOS (4/6) and 83% 2DPOS (4/5) subjects maintained titers ≥120 mIU/mL. Prevaccination titers ≥25 mIU/mL among 2DNEG subjects correlated inversely with the likelihood of achieving titers ≥120 mIU/mL (56% vs 90%; P=.004).
  
  
  CONCLUSIONS
  Among HIV-infected children pre-HAART, Attenuvax at 6 months was well tolerated and immunogenic. These data support the current World Health Organization (WHO) recommendation to administer a first dose of measles vaccine at 6 months of age to HIV-infected children.
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York City, NY 10016, USA. sulachni.chandwani@nyumc.org
authors.forename: Sulachni
authors.initials: S
authors.lastname: Chandwani
authors.forename: Judy
authors.initials: J
authors.lastname: Beeler
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.forename: Susette
authors.initials: S
authors.lastname: Audet
authors.forename: Betsy
authors.initials: B
authors.lastname: Smith
authors.forename: John
authors.initials: J
authors.lastname: Moye
authors.forename: David
authors.initials: D
authors.lastname: Nalin
authors.forename: Keith
authors.initials: K
authors.lastname: Krasinski
mesh_terms: D057134:Antibodies, Neutralizing / Q000097:blood*; D000914:Antibodies, Viral / Q000097:blood; D018791:CD4 Lymphocyte Count; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D007115:Immunization Schedule; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008457:Measles / Q000150:complications / Q000517:prevention & control*; D008458:Measles Vaccine / Q000009:adverse effects* / Q000276:immunology*; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage / Q000276:immunology; D011247:Pregnancy; D014481:United States / Q000453:epidemiology; D014613:Vaccines, Attenuated / Q000009:adverse effects / Q000276:immunology; D014763:Viral Matrix Proteins / Q000276:immunology
chemical_list: D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral; D008458:Measles Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D014613:Vaccines, Attenuated; D014763:Viral Matrix Proteins