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

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.

Surprisingly Low Levels of Measles Immunity in Persons With HIV: A Seroprevalence Survey in a United States HIV Clinic

“…Although the WHO recommendations support the administration of an additional dose of measles-containing vaccines for children with HIV on ART following immune reconstitution, they do not recommend the routine administration of an additional dose of a measles-containing vaccine in adults with HIV. However, the data to support the WHO recommendation in adults with HIV are based on a limited number of studies in both adolescents and adults from varying time periods from around the world that show no difference in seroprevalence rates among adolescents and adults with and without HIV [ 19 ]. Measles serology is not routinely collected in PWH, so knowing which patients are at risk for seronegativity and thus stand to benefit from vaccination could help providers apply the guidelines to their practices.…”

“…Response to measles vaccination is not completely known in PWH, as outlined by Loevinsohn et al In 6 studies comprised of 109 measles-seronegative patients, measles immunogenicity postvaccination ranged from 0% to 56%. The studies were dated from 1993 to 2016, with a trend toward higher immunogenicity rates in studies conducted after the introduction of combination ART [ 19 ]. Additionally, Fieberkohn and colleagues found that a third dose of MMR vaccine did not result in a significant improvement in seroprevalence in an HIV-negative population.…”

“…Studies in the general population have demonstrated immunity rates around 92% [ 18 ]. A recent systematic review reported a measles seroprevalence of 92% among adolescents and adults with HIV, but the US-based studies included in the review were either very small, published before combination ART (CART), or retrospective in nature (and thus included serology data collected before CART), so little is known about current seroprevalence rates among PWH in the United States [ 19 ].…”

Identifying Missed Opportunities for Routine Vaccination among People Who Use Drugs

“…Across the three cities, however, we found no significant differences for MMR or Tdap vaccination. As these vaccines are typically associated with childhood receipt or for infant cocooning purposes, it is not surprising that the adults in our sample recalled having received MMR or did not identify with having any pertussis risk given their adult circumstances [48,[53][54][55].…”

Association of persistent wild-type measles virus RNA with long-term humoral immunity in rhesus macaques

“…Unlike infection with WT MeV, protective immunity induced by the live attenuated MeV vaccine may not be life-long and waning immunity with secondary vaccine failure can occur (25)(26)(27)(28). Understanding the mechanisms involved in the generation and maintenance of life-long protective immunity to measles is thus critical for assessing the challenges of achieving and sustaining measles elimination through vaccination (29). To that end, we have characterized the cell type-specific sites of viral RNA persistence and evolution of the MeV-specific antibody response in rhesus macaques over 6 months after WT MeV infection.…”