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Additional dose of measles vaccine unnecessary in patients with HIV

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December 5, 2018

Findings from a systematic review of published studies showed there is no need for an additional dose of measles vaccine in HIV-infected adolescents and adults.

According to Gideon Loevinsohn, PhD, and fellow researchers from Johns Hopkins University, the review found no difference in measles seroprevalence between HIV-infected and -uninfected patients — “no evidence of a population-specific immunity gap among adolescents and adults infected with HIV,” they wrote — and showed that patients had a low immune response to vaccination.

The findings were used as the basis of a decision last year by WHO’s vaccine advisory committee not to recommend measles revaccination in these populations. The Strategic Advisory Group of Experts (SAGE) had recommended in 2015 the administration of an additional dose of measles-containing vaccine (MCV) to HIV-infected children receiving highly active antiretroviral therapy following immune reconstitution, Loevinsohn and colleagues noted.

Cases of measles surged 31% worldwide in 2017, driven by gaps in vaccination coverage and large outbreaks in Europe and South America, according to a recent report. But the report also noted substantial gains made since 2000, including large decreases in annual incidence and deaths and an increase in global coverage of one dose of measles-containing vaccine from 72% to 85%.

“Yet significant challenges remain in reaching regional and global elimination goals,” Loevinsohn and colleagues wrote. “Given the high contagiousness of measles virus, population immunity as high as 95% is estimated to be necessary to achieve and sustain measles elimination. Achieving these levels requires identification of immunity gaps among specific age groups, geographical areas and special populations for targeted vaccination strategies.”

One potential target is HIV-infected children and adults, who may be at an increased risk for measles and measles-related complications because of immune dysfunction, Loevinsohn and colleagues said.

To examine the SAGE recommendation, Loevinsohn and colleagues searched for relevant studies in Medline, Embase, Cohrane Library, PubMed, LILACS, INDMED, AIM, and the WHO Global Index Medicus databases.

The search identified 30 studies published between 1991 and 2017, most of which (92%) showed that measles seroprevalence was high. Ten studies demonstrated that there was no significant difference in seroprevalence between HIV-infected and -uninfected participants. Loevinsohn and colleagues identified six studies that evaluated immunogenicity of MCV among seronegative HIV-infected adults; measles seropositivity at the end of follow-up ranged from 0% to 56%, they reported.

“Based on similar measles seroprevalence between HIV-infected and HIV-uninfected adolescents and adults, these studies do not support the need for an additional dose of MCV in all HIV-infected adolescents and adults,” the authors concluded. “These recommendations are in contrast to those adopted by the WHO [in 2015] for HIV-infected children, reflecting differences in the relative timing of exposure to measles vaccine and HIV infection. 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.”– by Caitlyn Stulpin

Reference:

WHO. Weekly epidemiological record. http://apps.who.int/iris/bitstream/handle/10665/259533/WER9248.pdf;jsessionid=5638F60CCE372BDE92F3DC56C33F9948?sequence=1. Accessed December 5, 2018.

Disclosures: Loevinsohn reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.