Published online October 15, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. e1190-e1202 (doi:10.1542/peds.2007-0729)
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ARTICLE

Pertussis Booster Vaccination in HIV-Infected Children Receiving Highly Active Antiretroviral Therapy

Mark J. Abzug, MDa, Lin-Ye Song, PhDb, Terence Fenton, EdDb, Sharon A. Nachman, MDc, Myron J. Levin, MDa, Howard M. Rosenblatt, MDd, Stephen I. Pelton, MDe, William Borkowsky, MDf, Kathryn M. Edwards, MDg, Jody Peters, MSg for the International Maternal Pediatric Adolescent AIDS Clinical Trials Group P1024 Protocol Team

a School of Medicine, University of Colorado and Children's Hospital, Denver, Colorado
b Statistical and Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts
c School of Medicine, State University of New York, Stony Brook, New York
d School of Medicine, Baylor College of Medicine, and Texas Children's Hospital, Houston, Texas
e School of Medicine, Boston University, and Boston Medical Center, Boston, Massachusetts
f School of Medicine, New York University Medical Center, and Bellevue Hospital, New York, New York
g School of Medicine, Vanderbilt University, Nashville, Tennessee

OBJECTIVE. Our goal was to evaluate the immunogenicity and safety of pertussis booster vaccination in children infected with HIV on highly active antiretroviral therapy (HAART).

PATIENTS AND METHODS. HIV-infected children on stable HAART for ≥3 months with plasma HIV-RNA concentrations of <30000 to 60000 copies per mL who previously received ≥4 doses of diphtheria-tetanus-pertussis (DTP)–containing vaccine were eligible. Diphtheria-tetanus-acellular pertussis (DTaP) vaccine was administered to subjects 2 to <7 years old who had 4 previous DTP-containing vaccines, subjects 2 to <7 years old who had ≥5 previous DTP-containing vaccines and negative tetanus antibody, and subjects ≥7 to ≤13 years old who had negative tetanus antibody. Pertussis toxin and filamentous hemagglutinin antibodies were measured before and 8, 24, and 72 weeks after DTaP vaccine.

RESULTS. Ninety-two subjects received DTaP vaccine and met criteria for analysis. Antibody concentrations were low at entry: pertussis toxin geometric mean concentration at 4.8 enzyme-linked immunosorbent assay units (EU) per mL and filamentous hemagglutinin geometric mean concentration at 4.1 EU/mL. Pertussis toxin and filamentous hemagglutinin geometric mean concentrations rose to 22.3 and 77.0 EU/mL, respectively, 8 weeks after the study DTaP vaccine. Antibody concentrations fell by 24 weeks after vaccination but remained higher than before vaccination. Predictors of response 8 weeks after DTaP vaccine included the concentration of homologous antibody, lower HIV-RNA level, and higher CD4 percentage at entry. One vaccinated subject experienced erythema and induration of ≥25 mm.

CONCLUSIONS. A DTaP vaccine booster was well tolerated by children on HAART and induced increases in antibodies. Antibody concentrations after vaccination were lower than those reported in populations uninfected by HIV. Although comparison among studies must be made with caution, these data suggest that children infected with HIV may be deficient in immunologic memory from previous DTP-containing vaccination and/or that immune reconstitution with HAART may be incomplete for pertussis antigens.

Key Words: pertussis • pertussis vaccine • Bordetella pertussis • HIV • highly active antiretroviral therapy

Abbreviations: HAART—highly active antiretroviral therapy, DTP—diphtheria-tetanus-pertussis • DTaP—diphtheria-tetanus-acellular pertussis • PT—pertussis toxin • FHA—filamentous hemagglutinin • ELISA—enzyme-linked immunosorbent assay • EU—enzyme-linked immunosorbent assay unit • GMC—geometric mean concentration • CI—confidence interval

Accepted May 3, 2007.