14th ICID - Poster Abstracts - International Society for Infectious ...

When citing these abstracts please use the following reference:
Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.
Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1
is available electronically on http://www.sciencedirect.com
Final Abstract Number: 27.009
Session: HIV: Epidemiology and Prevention
Date: Wednesday, March 10, 2010
Time: 12:30-13:30
Room: Poster & Exhibition Area/Ground Level
Type: Poster Presentation
Safety and immunogenicity of measles vaccine in HIV-infected children: Systematic review and
meta-analysis
P. Scott 1 , W. J. Moss 2 , Z. Gilani 2 , N. Low 1
1 Institute of Social and Preventive Medicine, University of Bern, Berne, Switzerland, 2 Bloomberg
School of Public Health, Johns Hopkins University, Baltimore, MD, USA
Background: Measles vaccines could be less immunogenic in immunosuppressed people. We
conducted a systematic review to identify and synthesize evidence about the immunogenicity and
safety of measles vaccination in HIV-infected children.
Methods: We searched eight electronic databases for studies published through February 12th
2009. Identified studies were independently screened by two reviewers for eligibility based on
predefined criteria. Information was extracted independently by two reviewers. Meta-analysis was
conducted where appropriate, and heterogeneity in results between studies was investigated
through stratification of results.
Results: Seven-hundred and twenty-three articles were identified. Twenty-five studies with
comparison groups were included. Thirteen studies without comparison groups and one case
report were also examined for adverse event data.
After vaccination at 6 months, measles antibody levels were similar in HIV-infected and HIVunexposed
(combined relative risk (RR) 1.05, 95% confidence interval (CI) 0.83-1.34) or HIVexposed
but uninfected children (RR 0.91, 95%CI 0.80-1.04). Among HIV-uninfected children,
slightly more HIV-exposed but uninfected children responded when vaccinated at 6 months than
HIV-unexposed children (RR 1.11, 95%CI 0.99-1.25).
By nine months of age, fewer HIV-infected children responded to measles vaccine than HIVunexposed
(RR 0.79, 95% CI 0.61-1.02,) or HIV-exposed but uninfected children (RR 0.70, 95%
CI 0.56-0.88). HIV-uninfected children had similar levels of response after vaccination at nine
months regardless their mother’s HIV-infection status (RR 1.01, 95%CI 0.98-1.04).
Vaccination at twelve months of age resulted in poorer responses in HIV-infected children relative
to HIV-unexposed children (RR 0.52, 95% CI 0.21-1.33) and HIV-exposed but uninfected children
(RR 0.61, 95% CI 0.50-0.73).
No reference was made to adverse events in half the studies. In studies describing adverse
events, most reported no serious adverse events. There were limited data comparing vaccinated
to unvaccinated HIV-infected children.
Conclusion: Our findings suggest that children of HIV-infected women, regardless of the child’s
HIV infection status, might benefit from initial vaccination at 6 months of age in regions where
children are at risk for measles. Confirmation of the child’s HIV-infection status prior to
vaccination would not be needed. Measles vaccines appear to be safe in HIV-infected children
but there is an absence of studies reporting adverse events.