Immunogenicity and Safety of an Early Measles Vaccination Schedule at 6 and 12 Months of Age in Human Immunodeficiency Virus (HIV)–Unexposed and HIV-Exposed, Uninfected South African Children

2019 ◽  
Vol 220 (9) ◽  
pp. 1529-1538 ◽  
Author(s):  
Eleonora A M L Mutsaerts ◽  
Marta C Nunes ◽  
Sutika Bhikha ◽  
Benit T Ikulinda ◽  
Welekazi Boyce ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Vaccine Dose ◽  
Vaccination Schedule ◽  
Enzyme Linked Immunosorbent Assay ◽  
Measles Vaccine ◽  
Immunodeficiency Virus ◽  
Measles Vaccination ◽  
Hiv Exposed ◽  
Vaccine Availability ◽  
Exposed Uninfected

Abstract Background Measles morbidity and mortality rates are greatest in children <12 months old, with increased susceptibility in human immunodeficiency virus (HIV)–exposed children. We evaluated the immunogenicity and safety of an early 2-dose measles vaccine regimen administered at 6 and 12 months of age in South Africa. Methods HIV-unexposed (HU) (n = 212) and HIV-exposed, uninfected (HEU) (n = 71) children received measles vaccination (CAM-70) at 6 and 12 months of age. Measles immunoglobulin G titers were measured by means of enzyme-linked immunosorbent assay before and 1 month after each vaccine dose. Results The majority of children (88.2% HU and 95.8% HEU; P = .04) were seronegative (<150 mIU/mL) to measles at 4.2 months of age. This was particularly evident among infants of mothers born from 1992 onwards (year of public nationwide measles vaccine availability). One month after the first measles vaccine, 42.3% of HU and 46.4% of HEU children were seropositive (≥330 mIU/mL). After the second dose, the proportion seropositive increased to 99.0% in HU and 95.3% in HEU children. Safety profiles were similar between HU and HEU children. Conclusions Early 2-dose measles vaccination at 6 and 12 months of age was safe and induced antibody responses in HU and HEU children, which could partly offset the early loss of maternally derived antibodies in infants born to predominantly measles-vaccinated mothers. Clinical Trials Registration NCT03330171

scholarly journals Measles Immunity at 4.5 Years of Age Following Vaccination at 9 and 15–18 Months of Age Among Human Immunodeficiency Virus (HIV)–infected, HIV-exposed–uninfected, and HIV-unexposed Children

2018 ◽  
Vol 69 (4) ◽  
pp. 687-696 ◽  
Author(s):  
Eleonora A M L Mutsaerts ◽  
Marta C Nunes ◽  
Martijn N van Rijswijk ◽  
Kerstin Klipstein-Grobusch ◽  
Kennedy Otwombe ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Geometric Mean ◽  
Treatment Interruption ◽  
Enzyme Linked Immunosorbent Assay ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Antibody Titers ◽  
Measles Vaccination ◽  
Hiv Exposed ◽  
Exposed Uninfected

AbstractBackgroundHuman immunodeficiency virus (HIV)–infected and HIV-exposed–uninfected (HEU) children may be at increased risk of measles infection due to waning of immunity following vaccination. We evaluated persistence of antibodies to measles vaccination at 4.5 years of age in HIV-unexposed, HEU, and HIV-infected children with CD4+ ≥25% previously randomized to immediate antiretroviral therapy (ART) interrupted at 12 months (HIV/Immed-ART-12), 24 months (HIV/Immed-ART-24), or when clinically/immunologically indicated (HIV/Def-ART). The HIV/Def-ART group initiated ART by median 5.8 (interquartile range, 4.4–10.3) months of age.MethodsIn this study, HIV-unexposed (n = 95), HEU (n = 84), HIV/Immed-ART-12 (n = 70), HIV/Immed-ART-24 (n = 70), and HIV/Def-ART (n = 62) children were scheduled to receive measles vaccination at age 9 and 15–18 months. Antimeasles serum immunoglobulin G titers were quantified using enzyme-linked immunosorbent assay at 4.5 years.ResultsCompared with HIV-unexposed children (2860 mIU/mL), measles antibody geometric mean titers (GMTs) were significantly lower in both HIV/Immed-ART-12 (571; P < .001) and HIV/Immed-ART-24 (1136; P < .001) but similar in the HIV/Def-ART (2777) and HEU (3242) groups. Furthermore, compared with HIV-unexposed, antibody titers ≥330 mIU/mL (ie, presumed serocorrelate for protection; 99%) were also significantly lower in HIV/Immed-ART-12 (70%; P < .001) and HIV/Immed-ART-24 (83%; P < .001) but similar in the HIV/Def-ART (90%) and HEU (98%) groups.ConclusionsHIV-infected children in whom ART was interrupted at either 12 or 24 months had lower GMTs and lower proportions with seroprotective titers than HIV-unexposed children, indicating a potential downside of ART treatment interruption.Clinical Trials RegistrationNCT00099658 and NCT00102960.

An Evaluation of Measles Revaccination Among School-entry-aged Children

PEDIATRICS ◽  
1996 ◽  
Vol 97 (5) ◽  
pp. 613-618
Author(s):  
John C. Watson ◽  
John A. Pearson ◽  
Lauri E. Markowitz ◽  
Andrew L. Baughman ◽  
Dean D. Erdman ◽  
...  
Keyword(s):  
Dose Schedule ◽  
Vaccination Schedule ◽  
Immunoglobulin M ◽  
Primary Immune Response ◽  
Enzyme Linked Immunosorbent Assay ◽  
Measles Vaccine ◽  
Measles Vaccination ◽  
Measles Outbreaks ◽  
The Cost ◽  
Vaccination Time

Background. A two dose measles vaccination schedule is recommended routinely for all schoolentry-aged children. We evaluated this recommendation by determining both measles antibody seroprevalence and the response to revaccination in seronegative children in this age group. Methods. Children 4 to 6 years of age who had received a single dose of measles vaccine between the ages of 15 to 17 months were tested for measles antibody by using an enzyme-linked immunosorbent assay (ELISA) microneutralization technique. Seronegative children were revaccinated and again tested for measles antibody (immunoglobulin M [IgM] and neutralizing). Results. Of 679 children tested, 37 (5.4%) were seronegative. Seronegativity was not significantly associated with age, sex, race, age at initial vaccination, time since vaccinalion, or maternal year of birth. However, children of mothers with a college degree were 12 times more likely to be seronegative than children of mothers who never attended college (P&lt; .01). Of the 37 seronegative children, 36 seroconverted after revaccination—33 producing IgM measles antibody, suggestive of a primary immune response. The cost per seroconversion would have been an estimated $415 if all 679 children had been revaccinated. Conclusions. Revaccination reduces the pool of children who are susceptible to measles. Although the cost per seroconversion is high, a two-dose schedule should reduce the substantial costs of controlling measles outbreaks by reducing the number of outbreaks.

scholarly journals Rates of Hospitalization and Infection-Related Hospitalization Among Human Immunodeficiency Virus (HIV)–Exposed Uninfected Children Compared to HIV-Unexposed Uninfected Children in the United States, 2007–2016

2019 ◽  
Vol 71 (2) ◽  
pp. 332-339
Author(s):  
Sarah M Labuda ◽  
Yanling Huo ◽  
Deborah Kacanek ◽  
Kunjal Patel ◽  
Krista Huybrechts ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Poisson Regression ◽  
The United States ◽  
Hiv Disease ◽  
Significant Difference ◽  
Immunodeficiency Virus ◽  
Maternal Hiv ◽  
Hiv Exposed ◽  
Exposed Uninfected

Abstract Background Studies from multiple countries have suggested impaired immunity in perinatally human immunodeficiency virus (HIV)–exposed uninfected children (HEU), with elevated rates of all-cause hospitalization and infections. We estimated and compared the incidence of all-cause hospitalization and infection-related hospitalization in the first 2 years of life among HEU and HIV-unexposed uninfected children (HUU) in the United States. Among HEU, we evaluated associations of maternal HIV disease–related factors during pregnancy with risk of child hospitalization. Methods HEU data from subjects enrolled in the Surveillance Monitoring for Antiretroviral Therapy Toxicities Study (SMARTT) cohort who were born during 2006–2017 were analyzed. HUU comparison data were obtained from the Medicaid Analytic Extract database, restricted to states participating in SMARTT. We compared rates of first hospitalization, total hospitalizations, first infection-related hospitalization, total infection-related hospitalizations, and mortality between HEU and HUU using Poisson regression. Among HEU, multivariable Poisson regression models were fitted to evaluate associations of maternal HIV factors with risk of hospitalization. Results A total of 2404 HEU and 3 605 864 HUU were included in the analysis. HEU children had approximately 2 times greater rates of first hospitalization, total hospitalizations, first infection-related hospitalization, and total infection-related hospitalizations compared with HUUs. There was no significant difference in mortality. Maternal HIV disease factors were not associated with the risk of child infection or hospitalization. Conclusions Compared with HUU, HEU children in the United States have higher rates of hospitalization and infection-related hospitalization in the first 2 years of life, consistent with studies in other countries. Closer monitoring of HEU infants for infection and further elucidation of immune mechanisms is needed.

Measles Seroprevalence and Vaccine Responses in Human Immunodeficiency Virus–infected Adolescents and Adults: A Systematic Review

2018 ◽  
Vol 69 (5) ◽  
pp. 836-844 ◽  
Author(s):  
Gideon Loevinsohn ◽  
Lori Rosman ◽  
William J Moss
Keyword(s):  
Systematic Review ◽  
Human Immunodeficiency Virus ◽  
Highly Active Antiretroviral Therapy ◽  
World Health ◽  
Additional Dose ◽  
Measles Vaccine ◽  
Significant Difference ◽  
Immunodeficiency Virus ◽  
Adolescents And Adults ◽  
Measles Vaccination

Abstract Background The World Health Organization (WHO) recommends an additional dose of measles-containing vaccine (MCV) for human immunodeficiency virus (HIV)–infected children receiving highly active antiretroviral therapy following immune reconstitution. We conducted a systematic review to synthesize available evidence regarding measles seroprevalence and measles vaccine immunogenicity, efficacy, and safety in HIV-infected adolescents and adults to provide the evidence base for recommendations on the need for measles vaccination. Methods We conducted searches of 8 databases through 26 September 2017. Identified studies were screened independently by 2 reviewers. Results The search identified 30 studies meeting inclusion criteria. Across studies, measles seroprevalence among HIV-infected adolescents and adults was high (median, 92%; 27 studies), with no significant difference compared to HIV-uninfected participants (10 studies). In 6 studies that evaluated the immunogenicity of MCVs among seronegative HIV-infected adults, measles seropositivity at end of follow-up ranged from 0% to 56% (median, 39%). No severe adverse events were reported following measles vaccination in HIV-infected patients. Conclusions Based on similar measles seroprevalence between HIV-infected and HIV-uninfected adolescents and adults, and the low response to vaccination, these studies do not support the need for an additional dose of MCV in HIV-infected adolescents and adults. These findings support WHO guidelines that measles vaccine be administered to potentially susceptible, asymptomatic HIV-infected adults, and may be considered for those with symptomatic HIV infection if not severely immunosuppressed. Measles-susceptible adolescents and adults, regardless of HIV status, may require targeted vaccination efforts to reach critical vaccination thresholds and achieve regional elimination goals.

scholarly journals Gamma Interferon Production in Response to Mycobacterium bovis BCG and Mycobacterium tuberculosis Antigens in Infants Born to Human Immunodeficiency Virus-Infected Mothers

2006 ◽  
Vol 13 (2) ◽  
pp. 246-252 ◽  
Author(s):  
Annelies Van Rie ◽  
Shabir A. Madhi ◽  
Jayvant R. Heera ◽  
Stephen Meddows-Taylor ◽  
Aaron M. Wendelboe ◽  
...  
Keyword(s):  
Immune Response ◽  
Human Immunodeficiency Virus ◽  
Mycobacterium Bovis ◽  
Immune Activation ◽  
Immunodeficiency Virus ◽  
Ifn Γ ◽  
Hiv Exposed ◽  
Cellular Immune ◽  
Mycobacterial Antigens ◽  
Exposed Uninfected

ABSTRACT In utero sensitization to infectious pathogens can establish immunological memory and may influence the immune response to unrelated antigens. Little is known about the influence of intrauterine human immunodeficiency virus (HIV) exposure on the cellular immune response to mycobacterial antigens. Whole-blood culture gamma interferon (IFN-γ) production in response to mycobacterial antigens was measured at birth and 6 weeks of age to determine the characteristics of the IFN-γ response in HIV-exposed infants to Mycobacterium bovis BCG and mycobacterial antigens. At birth, we observed an increased immune activation in response to phytohemagglutinin among HIV-exposed, uninfected infants. In a proportion of these infants, we also observed an increased immune activation in response to purified protein derivative, BCG, and early secreted antigen target 6. Increases in the IFN-γ response to the four antigens between birth and 6 weeks of age, observed in all HIV-unexposed infants, was absent in a substantial proportion of HIV-exposed, uninfected infants. The immunological differences persisted at 6 weeks of age, suggesting a sustained impact of in utero immune priming by HIV. Intrauterine exposure to HIV affects the infants' cellular immune response to mycobacterial antigens, either specifically or as a consequence of nonspecific, broadly reactive immune activation. Further studies will be important to help determine optimal vaccination and disease prevention strategies for this vulnerable population group.

scholarly journals A Randomized Controlled Trial of Isoniazid to Prevent Mycobacterium tuberculosis Infection in Kenyan Human Immunodeficiency Virus–Exposed Uninfected Infants

2020 ◽  
Author(s):  
Sylvia M LaCourse ◽  
Barbra A Richardson ◽  
John Kinuthia ◽  
A J Warr ◽  
Elizabeth Maleche-Obimbo ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Mycobacterium Tuberculosis ◽  
High Risk ◽  
Adverse Events ◽  
Controlled Trial ◽  
Preventive Therapy ◽  
Infection Prevalence ◽  
Mycobacterium Tuberculosis Infection ◽  
Immunodeficiency Virus ◽  
Exposed Uninfected

Abstract Background Human immunodeficiency virus (HIV)–exposed uninfected (HEU) infants in endemic settings are at high risk of tuberculosis (TB). For infants, progression from primary Mycobacterium tuberculosis (Mtb) infection to TB disease can be rapid. We assessed whether isoniazid (INH) prevents primary Mtb infection. Methods We conducted a randomized nonblinded controlled trial enrolling HEU infants 6 weeks of age without known TB exposure in Kenya. Participants were randomized (1:1) to 12 months of daily INH (10 mg/kg) vs no INH. Primary endpoint was Mtb infection at end of 12 months, assessed by interferon-γ release assay (QuantiFERON-TB Gold Plus) and/or tuberculin skin test (TST, added 6 months after first participant exit). Results Between 15 August 2016 and 6 June 2018, 416 infants were screened, with 300 (72%) randomized to INH or no INH (150 per arm); 2 were excluded due to HIV infection. Among 298 randomized HEU infants, 12-month retention was 96.3% (287/298), and 88.9% (265/298) had primary outcome data. Mtb infection prevalence at 12-month follow-up was 10.6% (28/265); 7.6% (10/132) in the INH arm and 13.5% (18/133) in the no INH arm (7.0 vs 13.4 per 100 person-years; hazard ratio, 0.53 [95% confidence interval {CI}, .24–1.14]; P = .11]), and driven primarily by TST positivity (8.6% [8/93] in INH and 18.1% [17/94] in no INH; relative risk, 0.48 [95% CI, .22–1.05]; P = .07). Frequency of severe adverse events was similar between arms (INH, 14.0% [21/150] vs no INH, 10.7% [16/150]; P = .38), with no INH-related adverse events. Conclusions Further studies evaluating TB preventive therapy to prevent or delay primary Mtb infection in HEU and other high-risk infants are warranted. Clinical Trials Registration NCT02613169.

scholarly journals Prevalence of Sexually Transmitted Diseases and Transmission of HIV in Dhaka, Bangladesh

2009 ◽  
Vol 3 (1) ◽  
pp. 27-33
Author(s):  
Tahmina Shirin ◽  
Saidur Rahman ◽  
Fareha Jesmin Rabbi ◽  
Md Humayun Kabir ◽  
KZ Mamun
Keyword(s):  
Human Immunodeficiency Virus ◽  
Herpes Simplex ◽  
Chlamydia Trachomatis ◽  
Sexually Transmitted Diseases ◽  
Treponema Pallidum ◽  
Enzyme Linked Immunosorbent Assay ◽  
Sexually Transmitted ◽  
Immunodeficiency Virus ◽  
Simplex Virus

The prevalence of sexually transmitted diseases (STDs) among patients attending out patients department of Skin and Venereal diseases of Dhaka Medical College Hospital, Dhaka and Shahid Sohrawardy Hospital, Dhaka was studied. A total of 230 patients were enrolled in the study during the period of July, 2006 to May, 2007. Urethral and endocervical swabs were collected from the participants for detection of Neisseria gonorrheae (by culture), Chlamydia trachomatis (by immunochromatoghraphy) and blood samples for the detection of Treponema pallidum antibody (by rapid plasma regain and Treponema pallidum haemagglutination assay), Herpes simplex virus type 2 antibody (both IgM and IgG by enzyme linked immunosorbent assay) and Human Immunodeficiency virus antibody (by enzyme linked immunosorbent assay). Socio-demographic data and data regarding high-risk sexual behavior were also collected. Out of 230 participants, 199 (86.5%) were positive for STDs pathogens studied, among them, 98 (42.6%) were infected with single pathogen and 101 (43.9%) were suffering from multiple infections. The prevalences of N. gonorrheae, C. trachomatis, T. pallidum, and HSV type 2 were 90 (39.1%), 110 (47.8%), 28 (12.2%) and 88 (38.2%) respectively. However, none of them were positive for HIV infection. Use of condom was significantly associated with protection of the participants against STDs. Keywords: Sexually Transmitted Diseases, Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, Herpes simplex virus type-2, Human Immunodeficiency virus   doi: 10.3329/bjmm.v3i1.2968 Bangladesh J Med Microbiol 2009; 03 (01): 27-33

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