AIDS PATIENT CARE and STDs Volume 29, Number 9, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/apc.2015.0050
LETTER TO THE EDITOR
Measles, Mumps, and Rubella Serostatus and Response to MMR Vaccination Among HIV-Infected Adults Harjot Kaur Singh, MD, ScM,1 Ya-Lin Chiu, MS,2 and Timothy Wilkin, MD, MPH 3
Dear Editor:
S
uccessful immunization against preventable illness is a cornerstone of HIV management. Despite the widespread availability of vaccines and literature supporting its safety and immunogenicity,1 vaccine-preventable illness such as measles, mumps, and rubella outbreaks continue to occur, often from importation or local unvaccinated cases.2,3 These illnesses tend to be more severe among HIV-infected persons, resulting in pneumonia or death.4,5 In June 2013, the Advisory Committee on Immunization Practices (ACIP) updated its recommendations for measles, mumps, and rubella (MMR) vaccination for HIV-infected adults, with CD4 cell counts >200 cells/mm3 without laboratory evidence of immunity or past disease,6 but provided little guidance on which patients should have MMR serostatus assessed. In this retrospective study, we assessed the frequency and risk factors of MMR seronegativity, as well as MMR vaccination seroconversion at the Center for Special Studies, an HIV primary care clinic for adults affiliated with New York Presbyterian Hospital/Weill Cornell Medical College. Inclusion criterion included any HIV-infected adults with MMR serostatus assessment who received sustained care at the clinic evidenced by at least two CD4 cell counts 6 months apart. MMR seroassessment was ordered at the discretion of the provider for the duration of the study period; in April 2009, measles serology was added to the new patient laboratory order set. We abstracted MMR serostatus, CD4 cell counts, and plasma HIV-1 RNA levels (within 2 months of MMR seroassessment), MMR vaccination dates, demographics, and date of HIV diagnosis. For the MMR seroconversion frequencies, we used the MMR pre and post vaccination serostatus results closest to the vaccination date. MMR components were reported as immune, non-immune, or equivocal, as defined by the IgG antibody levels. For analysis purposes, the non-immune and equivocal categories were combined into a category of seronegative and immune was reported as seropositive. We used chi-square or Fisher’s exact test to evaluate the association between two categorical variables and Wilcoxon Rank Sum test to evaluate the median differences for continuous variables between two groups. Multivariate logistic regressions were used to eval-
uate demographic characteristics associated with each component of MMR serostatus. We included all factors in the multivariate analysis that had a p value < 0.2 in the univariate analysis. The study was approved by the WCMC IRB. There were 1491 HIV-infected adults who had MMR serostatus assessed over the 13 years. Table 1 provides the baseline characteristics. Measles was the most frequently ordered serology, followed by rubella and mumps (n = 1311, 1142, and 958, respectively). Among the 1491 patients, 31.8%, 7.7%, and 60.6% of patients had one, two, and three MMR components assessed. Measles, mumps, and rubella seronegativity was 14.7%, 14.4%, and 12.8%, respectively. Table 2 provides the univariate characteristics associated with MMR seronegativity. Persons born after 1957 were
Table 1. Baseline Characteristics of 1491 HIV-Infected Patients at the Center for Special Studies in NYC Who Had MMR Serostatus Assessment Between 1998–2011 Patient characteristics Age at first serostatus, years, median (IQR) Born before 1957, n (%) Male gender, n (%) Duration of HIV infection, years, median (IQR) Race/ethnicity, n (%)a White African American Hispanic Asian Other/multiple HIV parametersb CD4 cell count, cells/mm3, (median, IQR) CD4% (median, IQR) Plasma RNA
LETTER TO THE EDITOR
Measles, Mumps, and Rubella Serostatus and Response to MMR Vaccination Among HIV-Infected Adults Harjot Kaur Singh, MD, ScM,1 Ya-Lin Chiu, MS,2 and Timothy Wilkin, MD, MPH 3
Dear Editor:
S
uccessful immunization against preventable illness is a cornerstone of HIV management. Despite the widespread availability of vaccines and literature supporting its safety and immunogenicity,1 vaccine-preventable illness such as measles, mumps, and rubella outbreaks continue to occur, often from importation or local unvaccinated cases.2,3 These illnesses tend to be more severe among HIV-infected persons, resulting in pneumonia or death.4,5 In June 2013, the Advisory Committee on Immunization Practices (ACIP) updated its recommendations for measles, mumps, and rubella (MMR) vaccination for HIV-infected adults, with CD4 cell counts >200 cells/mm3 without laboratory evidence of immunity or past disease,6 but provided little guidance on which patients should have MMR serostatus assessed. In this retrospective study, we assessed the frequency and risk factors of MMR seronegativity, as well as MMR vaccination seroconversion at the Center for Special Studies, an HIV primary care clinic for adults affiliated with New York Presbyterian Hospital/Weill Cornell Medical College. Inclusion criterion included any HIV-infected adults with MMR serostatus assessment who received sustained care at the clinic evidenced by at least two CD4 cell counts 6 months apart. MMR seroassessment was ordered at the discretion of the provider for the duration of the study period; in April 2009, measles serology was added to the new patient laboratory order set. We abstracted MMR serostatus, CD4 cell counts, and plasma HIV-1 RNA levels (within 2 months of MMR seroassessment), MMR vaccination dates, demographics, and date of HIV diagnosis. For the MMR seroconversion frequencies, we used the MMR pre and post vaccination serostatus results closest to the vaccination date. MMR components were reported as immune, non-immune, or equivocal, as defined by the IgG antibody levels. For analysis purposes, the non-immune and equivocal categories were combined into a category of seronegative and immune was reported as seropositive. We used chi-square or Fisher’s exact test to evaluate the association between two categorical variables and Wilcoxon Rank Sum test to evaluate the median differences for continuous variables between two groups. Multivariate logistic regressions were used to eval-
uate demographic characteristics associated with each component of MMR serostatus. We included all factors in the multivariate analysis that had a p value < 0.2 in the univariate analysis. The study was approved by the WCMC IRB. There were 1491 HIV-infected adults who had MMR serostatus assessed over the 13 years. Table 1 provides the baseline characteristics. Measles was the most frequently ordered serology, followed by rubella and mumps (n = 1311, 1142, and 958, respectively). Among the 1491 patients, 31.8%, 7.7%, and 60.6% of patients had one, two, and three MMR components assessed. Measles, mumps, and rubella seronegativity was 14.7%, 14.4%, and 12.8%, respectively. Table 2 provides the univariate characteristics associated with MMR seronegativity. Persons born after 1957 were
Table 1. Baseline Characteristics of 1491 HIV-Infected Patients at the Center for Special Studies in NYC Who Had MMR Serostatus Assessment Between 1998–2011 Patient characteristics Age at first serostatus, years, median (IQR) Born before 1957, n (%) Male gender, n (%) Duration of HIV infection, years, median (IQR) Race/ethnicity, n (%)a White African American Hispanic Asian Other/multiple HIV parametersb CD4 cell count, cells/mm3, (median, IQR) CD4% (median, IQR) Plasma RNA
