Safety and Immunogenicity of Measles Vaccination in HIV-Infected and HIV-Exposed Uninfected Children: A Systematic Review and Meta-Analysis

Abstract

Background HIV-infected and HIV-exposed uninfected (HEU) children have an increased risk of measles that may be due to altered immune responses or suboptimal timing of measles vaccination. We aimed to evaluate the safety and immunogenicity of measles vaccination in HIV-infected and HEU children. Methods For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Library, CINAHL, Global Health Library and IndMED on May 9, 2018. Studies were included if they reported on safety or seroresponse (either seroprotection/seropositivity/seroconversion) after measles vaccination in HIV-infected or HEU children. We calculated pooled estimates to compare immunogenicity outcomes between HIV-infected, HEU and HIV-unexposed children, using risk ratios [RRs] (with 95%CIs). PROSPERO registration number: CRD42017057411. Findings Seventy-one studies met the inclusion criteria (15,363 children). Twenty-eight studies reported on safety; vaccine-associated adverse events and deaths were uncommon. Sixty-two studies reported on immunogenicity, 27 were included in the meta-analysis. HIV-infected children had lower seroresponse rates after primary vaccination compared with HIV-unexposed (RR 0.74; 95%CI: 0.61–0.90, I 2 = 85.9%) and HEU children (0.78; 0.69–0.88, I 2 = 77.1%), which was mitigated by antiretroviral therapy and time interval between vaccination and serology. HEU and HIV-unexposed children had similar seroresponses. Vaccination at 6-months resulted in similar proportions of HIV-infected children having seroresponse compared with HIV-unexposed (0.96; 0.77–1.19) and HEU children (1.00; 0.73–1.37, I 2 = 63.7%). Interpretation Primary measles vaccination at 6-months of age may provide protection against measles during early infancy in settings with high prevalence of maternal HIV-infection, however, further studies are needed to evaluate this strategy in HEU children and HIV-infected children receiving antiretroviral therapy. Funding South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation in Vaccine Preventable Diseases; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit.

Beyond the Disease: Contextualized Implications of the COVID-19 Pandemic for Children and Young People Living in Eastern and Southern Africa

“…These conditions raise the risk of sudden outbreaks of vaccine-preventable diseases occurring when social distancing restrictions are eased. For children who already have a compromised immune system (e.g., those living with HIV), likelihood of mortality from vaccinepreventable conditions (e.g., measles) is higher if immunizations are not received (10).…”

<b> Quimioprofilaxia, acompanhamento clínico e imunizações de crianças expostas ao HIV: avaliação da capacidade familiar / Chemopophilaxia, clinical follow-up and immunizations of children exposed to HIV: assessment of family capacity

“…As imunizações devem seguir o calendário vacinal de crianças vivendo com HIV, até definição da sua condição sorológica (3,(4)(5) . O acompanhamento recomendado em Serviço de Assistência Especializada (SAE) deve contemplar as especificidades da exposição ao HIV, e ser realizado mensalmente, no primeiro semestre e, no mínimo, bimensal até confirmação sorológica.…”

The burden of vaccine-preventable diseases among HIV-infected and HIV-exposed children in sub-Saharan Africa: a systematic review and meta-analysis

“…101,102 Vaccination is therefore essential in HIV-infected patients because of the increased risk of developing various infectious diseases. 103,104 This review revealed research inequalities across the African region regarding studies on the burden of vaccine-preventable diseases among HIV-infected and HIV-exposed children. South However, the same vaccine is contraindicated in immunocompromised children who ironically are susceptible to the disease.…”

“…Studies have also shown that there are poor immune responses to primary vaccination among HIV-infected children in comparison to HIV-unexposed and HIV-exposed children. The poor immune response among HIVinfected children may require booster doses for optimal immunity against vaccine-preventable diseases 103,104. This review revealed research inequalities across the African region regarding studies on the burden of vaccine-preventable diseases among HIV-infected and HIV-exposed children.South Africa contributed about half of the included articles with Nigeria and Kenya following with fewer studies.…”