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Measles and measles immunity in children infected with human immunodeficiency virus

K Krasinski1, W Borkowsky

  • 1Deparment of Pediatrics, New York University Medical Center, NY 10016.

JAMA
|May 5, 1989
PubMed

Insights

Measles vaccination in children with human immunodeficiency virus (HIV) showed low effectiveness but was safe. Post-exposure immunoglobulin is recommended due to vaccine failure risks.

Area of Science:

  • Pediatrics
  • Immunology
  • Infectious Diseases

Background:

  • Measles poses a severe risk to immunodeficient children, including those with human immunodeficiency virus (HIV).
  • Previous measles immunization does not guarantee protection in HIV-infected children, as evidenced by severe cases and fatalities despite prior vaccination.

Purpose of the Study:

  • To assess the risks and benefits of measles vaccination in children with HIV.
  • To evaluate the immunogenicity and safety of measles vaccine in this vulnerable population.

Main Methods:

  • Retrospective and prospective study of measles vaccination in HIV-infected children.
  • Antibody levels measured by enzyme-linked immunosorbent assay (ELISA) and hemagglutination inhibition (HAI).

Main Results:

  • Measles infection in 4 HIV-infected children led to severe pneumonia in 3 and 1 death, even with prior immunization.
  • Low measles antibody levels were detected post-vaccination (25% in prospective group) and pre-vaccination (12.5% retrospectively).
  • Vaccine failure occurred in children with negative ELISA but positive HAI results, indicating unreliable immunity.

Conclusions:

  • Measles vaccination in HIV-infected children demonstrates low immunogenicity and vaccine failure.
  • Despite low efficacy, the vaccine appears safe, supporting its use in the context of potentially fatal measles disease.
  • Due to unreliable immunity from vaccination alone, passive post-exposure immunoglobulin prophylaxis is recommended for all HIV-infected children.

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