PEDIATRICS Vol. 97 No. 5 May 1996, pp. 653-657
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Measles Antibody in Vaccinated Human Immunodeficiency Virus Type 1-infected Children

Stephen M. Arpadi MD, MS1, Lauri E. Markowitz MD2, Andrew L. Baughman MPH2, Kiran Shah MD3, Henry Adam MD4, Andrew Wiznia MD5, Genevieve Lambert MD5, Joanna Dobroszycki MD5, Janet L. Heath BS6, and William J. Bellini PhD6

1 Bronx-Lebanon Hospital Center, Bronx; St. Luke's-Roosevelt Hospital Center, New York, NY 10025
2 National Immunization Program, Centers for Disease Control and Prevention, Atlanta
3 Lincoln Hospital Center, New York Medical College, Bronx
4 Bronx Municipal Hospital Center, Albert Einstein College of Medicine, Bronx
5 Bronx-Lebanon Hospital Center, Bronx
6 Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta

Objectives. The goals of this study were to evaluate the proportion of previously vaccinated human immunodeficiency virus (HIV) type 1-infected children with detectable postvaccination measles antibody; to assess risk factors for vaccine failure; and to evaluate the response to reimmunization.

Methods. A total of 81 perinatally HIV-infected children receiving medical care in the Bronx, New York, who had previously received measles vaccine were enrolled. The Centers for Disease Control and Prevention (CDC) HIV class, lymphocyte subsets, and measles antibody were determined upon enrollment. Additional data abstracted from medical records included dates and number of prior measles vaccinations and CDC HIV class at the time of vaccination. Measles antibody was determined by microneutralization enzyme-linked immunosorbent assay (ELISA).

Results. The median age at time of study was 42 months (range, 9 to 168 months). Overall, 58 (72%) subjects had detectable measles antibody (microneutralization ELISA titer > 1:5). Children studied within 1 year of vaccination were more likely to have detectable measles antibody than children evaluated more than 1 year after vaccination (83% vs 52%, P < .01). The proportion of children with detectable measles antibody was higher among children with no or moderate immunosuppression compared to those with severe immunosuppression when immune status was based on CD4%. Children vaccinated at 6 to 11 months of age appeared to have a higher proportion of detectable measles antibody than those who received a first measles vaccination after age 1. Only 1 (14%) of 7 previously vaccinated children who were seronegative or had very low titers experienced a fourfold rise in measles antibody when reimmunized.

Conclusion. These results support current recommendations to vaccinate HIV-infected children against measles. The proportion of children with detectable measles antibody among vaccinated HIV-infected children is considerably lower than in vaccinated healthy children. HIV-infected children may respond better to measles vaccine when it is administered before the first birthday. From our limited data it appears that reimmunization of previously vaccinated HIV-infected children with moderate to severe immunosuppression does not result in an antibody recall response.

Submitted on March 20, 1995
Accepted on July 7, 1995




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