Letters to the Editor
Measles Reimmunization May Not Be Effective in Protecting HIV-Infected Children To the Editors:
W
e were interested to read the paper by Newman et al.1 They conclude that most HIV-infected children were not immune to measles and “might benefit from revaccination.” We agree that many HIVinfected children are not immune to measles, but revaccination may only benefit a proportion of these children. We have audited immunity to measles in HIV-infected children seen in our 3 centers in England. All children were reported to have been given measles vaccine as part of their routine childhood immunizations. Measles immunoglobulin G (IgG) was measured by enzyme-linked immunoassay. If measles IgG was not detected, children were given up to 2 doses of measles, mumps and rubella vaccine, if their CD4 count was >15%.2 Measles IgG was measured 6–12 weeks after vaccination to assess response.
RESULTS Only 83 of 224 (37%) HIV-infected children in our clinics had detectable measles IgG, suggesting immunity to measles (Table 1). Twenty-four of the 141 nonimmune children were not subsequently immunized for a variety of reasons (CD4% 15%. Response is much more likely if they are receiving cART and have an undetectable viral load.
However, despite these measures, a substantial proportion of HIV-infected children will remain nonimmune to measles.
Katie Rowson, RN Anton Tan, FRCPCH North Manchester General Hospital Manchester, United Kingdom
Sheila Donaghy, RN Katja Doerholt, MD Paul Heath, MD St. George’s Healthcare NHS Trust London, United Kingdom
Andrew Riordan, MD Alder Hey Children’s NHS Trust Liverpool, United Kingdom REFERENCES 1. Newman LP, Njoroge A, Ben-Youssef L, et al. Measles seropositivity in HIV-infected Kenyan children on antiretroviral therapy. Pediatr Infect Dis J. 2014;33:843–845. 2. Menson EN, Mellado MJ, Bamford A, et al.; Paediatric European Network for Treatment of AIDS (PENTA) Vaccines Group; PENTA Steering Committee; Children’s HIV Association (CHIVA). Guidance on vaccination of HIV-infected children in Europe. HIV Med. 2012;13:333–6; e1. 3. Arpadi SM, Markowitz LE, Baughman AL, et al. Measles antibody in vaccinated human immunodeficiency virus type 1-infected children. Pediatrics. 1996;97:653–657. 4. Berkelhamer S, Borock E, Elsen C, et al. Effect of highly active antiretroviral therapy on the serological response to additional measles vaccinations in human immunodeficiency virus-infected children. Clin Infect Dis. 2001;32:1090–1094. 5. Aurpibul L, Puthanakit T, Sirisanthana T, et al. Response to measles, mumps, and rubella revaccination in HIV-infected children with immune recovery after highly active antiretroviral therapy. Clin Infect Dis. 2007;45:637–642.
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
Measles Reimmunization May Not Be Effective in Protecting HIV-Infected Children To the Editors:
W
e were interested to read the paper by Newman et al.1 They conclude that most HIV-infected children were not immune to measles and “might benefit from revaccination.” We agree that many HIVinfected children are not immune to measles, but revaccination may only benefit a proportion of these children. We have audited immunity to measles in HIV-infected children seen in our 3 centers in England. All children were reported to have been given measles vaccine as part of their routine childhood immunizations. Measles immunoglobulin G (IgG) was measured by enzyme-linked immunoassay. If measles IgG was not detected, children were given up to 2 doses of measles, mumps and rubella vaccine, if their CD4 count was >15%.2 Measles IgG was measured 6–12 weeks after vaccination to assess response.
RESULTS Only 83 of 224 (37%) HIV-infected children in our clinics had detectable measles IgG, suggesting immunity to measles (Table 1). Twenty-four of the 141 nonimmune children were not subsequently immunized for a variety of reasons (CD4% 15%. Response is much more likely if they are receiving cART and have an undetectable viral load.
However, despite these measures, a substantial proportion of HIV-infected children will remain nonimmune to measles.
Katie Rowson, RN Anton Tan, FRCPCH North Manchester General Hospital Manchester, United Kingdom
Sheila Donaghy, RN Katja Doerholt, MD Paul Heath, MD St. George’s Healthcare NHS Trust London, United Kingdom
Andrew Riordan, MD Alder Hey Children’s NHS Trust Liverpool, United Kingdom REFERENCES 1. Newman LP, Njoroge A, Ben-Youssef L, et al. Measles seropositivity in HIV-infected Kenyan children on antiretroviral therapy. Pediatr Infect Dis J. 2014;33:843–845. 2. Menson EN, Mellado MJ, Bamford A, et al.; Paediatric European Network for Treatment of AIDS (PENTA) Vaccines Group; PENTA Steering Committee; Children’s HIV Association (CHIVA). Guidance on vaccination of HIV-infected children in Europe. HIV Med. 2012;13:333–6; e1. 3. Arpadi SM, Markowitz LE, Baughman AL, et al. Measles antibody in vaccinated human immunodeficiency virus type 1-infected children. Pediatrics. 1996;97:653–657. 4. Berkelhamer S, Borock E, Elsen C, et al. Effect of highly active antiretroviral therapy on the serological response to additional measles vaccinations in human immunodeficiency virus-infected children. Clin Infect Dis. 2001;32:1090–1094. 5. Aurpibul L, Puthanakit T, Sirisanthana T, et al. Response to measles, mumps, and rubella revaccination in HIV-infected children with immune recovery after highly active antiretroviral therapy. Clin Infect Dis. 2007;45:637–642.
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
