The role of human herpesvirus 6 (HHV-6) infection in 227 children born to human immunodeficiency virus (HIV)-seropositive mothers was investigated. Of 41 HIV-uninfected infants, 3 (7%) were positive for HHV-6 DNA in the first month of life, suggesting possible intrauterine infection. The cumulative infection rates of HHV-6 at 6 and 12 months of age were significantly lower in HIV-infected children (11% and 33%, respectively) than in uninfected children (28% and 78%, respectively; P<.001). There was an association between high CD4+ cell numbers (>15%) before HHV-6 infection and high HHV-6 infection rate. Twenty-two infants with HIV classed as Centers for Disease Control and Prevention stages N1 or N2 were studied for an association of HHV-6 infection with progression of HIV disease. Ten of the infants had HHV-6, and 12 did not. In 5 of the infants without HHV-6 (42%), HIV disease had not progressed by 1 year of age; however, HIV disease had progressed in all 10 children with HHV-6 infection. These results suggest an association of HHV-6 infection and progression of HIV disease in the study children with vertical HIV-1 infection (P<.05).
As fewer children in Thailand are exposed to hepatitis A virus (HAV) and so do not have seroprotective anti-HAV antibodies, they are becoming an important source of HAV transmission. A flexible HAV vaccination schedule would facilitate incorporation of the vaccine into existing immunization programmes, and we compared the immunogenicity and safety of three HAV immunization schedules. An open, randomized, clinical trial was carried out in which healthy children were given a primary dose of the inactivated hepatitis A vaccine, Avaxim 80 paediatric, with a booster dose 6, 12 or 18 months later. Anti-HAV geometric mean concentrations (GMC), seroconversion rates, and GMC ratios (GMCR) of the three schedules were compared and reactogenicity was evaluated. Seroconversion rates were above 98 per cent (per group) up to the booster. The three schedules were equivalent in terms of GMCRs, each eliciting a large booster effect. Local reactions were reported for fewer than 9 per cent of each group after dose one and less frequently after the booster dose. Injection site pain, gastrointestinal tract disorders and fever were the most commonly reported adverse events. No vaccine-related serious adverse events were reported. It was concluded that the hepatitis A vaccine, Avaxim 80 paediatric, is safe and immunogenic when given as a two-dose schedule to healthy seronegative children aged 5-10 years, with the second dose given at either 6, 12 or 18 months after the first.
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