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Population-based study of measles and measles immunization in human immunodeficiency virus-infected children
1Department of Pediatrics, UMD-New Jersey Medical School, Newark 07103.
Insights
Measles is dangerous for children with human immunodeficiency virus (HIV). Many HIV-infected children lack immunity, and the measles-mumps-rubella (MMR) vaccine is less effective in them, highlighting critical prevention gaps.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Measles poses a severe threat to human immunodeficiency virus (HIV)-infected children, with high rates of complications and mortality.
- Limited data exist on measles immunization effectiveness in this vulnerable population.
Purpose of the Study:
- To evaluate measles incidence and the efficacy of measles-mumps-rubella (MMR) immunization in a cohort of HIV-infected children.
- To identify factors influencing vaccine response and seroprotection.
Main Methods:
- Retrospective analysis of measles cases and immunization records in HIV-infected children.
- Serologic screening for measles antibodies before and after MMR vaccination.
- Comparison of CD4 lymphocyte counts between MMR responders and nonresponders.
Main Results:
- Six measles cases were identified, with severe manifestations including pneumonia (5/6) and death (3/6).
- Only 35% of children had documented prior MMR immunization; 56% were measles antibody-negative pre-intervention.
- Post-intervention, 36% remained antibody-negative, and 6 children lost immunity over time. MMR nonresponders had significantly lower CD4 counts (P=0.0058).
Conclusions:
- Measles is a potentially fatal illness in HIV-infected children, underscoring the need for effective prevention.
- Low MMR immunization rates, poor serologic response, and seroreversion limit current prevention strategies in this population.
- Further research is needed to optimize measles prevention and control in HIV-infected children.
Abstract:
This study reports the course of measles and results of measles immunization in a cohort of human immunodeficiency virus-infected children. Six cases of measles were identified. All had typical clinical manifestations, 5 of 6 developed pneumonia and 3 of 6 died. A measles intervention program consisting of serologic screening and active immunization (measles-mumps-rubella (MMR)) was instituted in 1990. Among 127 children with data available for analysis (mean age, 6.7 years), only 35% had documentation of prior immunization with MMR. Among 80 children who had preimmunization measles serology reported, 56% were measles antibody-negative and 40% were antibody-positive; following intervention 36% remained measles antibody-negative. Six children lost measles antibody over time. MMR nonresponders had lower CD4 lymphocyte counts (303 +/- 394) compared with responders (865 +/- 677; P = 0.0058). Measles is a potentially fatal illness in human immunodeficiency virus-infected children. Prevention strategies are limited by low rates of age-appropriate MMR immunization, poor antibody responses to MMR in older human immunodeficiency virus-infected children and seroreversion.