Measles seroprevalence in human immunodeficiency virus-infected adults born in the era of measles vaccination

Abstract

Objective: Widespread use of the measles vaccine should lead to the elimination of this disease. Here, we study the seroprevalence of measles in a cohort of adults living with HIV born after the introduction of measles vaccine in France and attempt to identify risk factors for the absence of serum measles antibody. Design: In this multi-centre cross-sectional study, adult outpatients born after 1980 were screened for the presence of measles IgG antibody. Demographic and clinical data were obtained from the standardized electronic medical record system. Univariate and multivariate logistic regressions were performed to identify factors associated with the absence of measles antibodies. Results: Between April 2019 and April 2020, 648 participants were enrolled. The median age was 33 years, 53.6% were born outside of France, and 74% were considered as socially deprived. Plasma HIV RNA was undetectable in 86% of patients. Among 603 evaluable patients, measles serology was positive in 87.2%. Only 81.8% of the patients with documented vaccination tested positive for measles IgG. Younger age was significantly associated with the absence of measles serum antibodies (P = 0.004 for each 10-year lower), as was birth in France (P < 0.001) and absence of social vulnerability (P = 0.04). Conclusion: The current study revealed a low seroprevalence of measles compared with that previously reported in France 6 years earlier and to the expected rate to achieve herd immunity. Checking vaccination record should be systematically carried out in patients living with HIV to fill the immunity gaps.

Immunity against measles in people with HIV: the need for more research and surveillance

“…In the general population, two vaccine doses provide protective immunity against measles in nearly 97% of recipients. Nonetheless, documented vaccination does not always ensure protective antibody levels, especially among immunosuppressed hosts as seen in the current study and prior studies [3,6]. It is quite possible that some PWH are unable to mount and/sustain antibody responses due to defective TFH.…”

“…Their results are supported by a recent US-based study [5] showing only 70% seropositivity rate in PWH. Both of these recent studies found that younger age was associated with seronegativity [3,5]. Like the prior literature [5,6], antiretroviral therapy (ART) and virologic suppression were not associated with seropositivity.…”

“…This study provides timely and important data on seroprotection rates for measles among a contemporary cohort of PWH [3]. It highlights three important points: we should not just be concerned about seroprotection among immigrant populations, but even more so among native-born persons, young PWH should not necessarily be considered immune, and the seropositivity rate in adult PWH is too low for population immunity.…”

“…How does the data by Lefebvre et al [3] compare with previous published literature? Historical data from the 1990 s showed that PWH had high measles seropositivity rates of 95% [4].…”

“…In this context, the data by Lefebvre et al . [3] have demonstrated alarmingly lower seropositivity rates. Their results are supported by a recent US-based study [5] showing only 70% seropositivity rate in PWH.…”