Neonatal Measles Immunity in Rural Kenya: The Influence of HIV and Placental Malaria Infections on Placental Transfer of Antibodies and Levels of Antibody in Maternal and Cord Serum Samples
1Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, 2Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, 3Enteric, Respiratory and Neurological Virus Laboratory, Specialist and Reference Microbiology Division, Health Protection Agency, Colindale, 4Homerton University Hospital NHS Foundation Trust, London, and 5School of Clinical and Laboratory Sciences (Pathology), University of Newcastle, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; 6Kenyan Medical Research Institute, Centre for Geographical Medicine Research Coast, Kilifi, Kenya; 7Medical Research Council Laboratories, Banjul, The Gambia
Introduction.
Young infants are protected from measles infection by maternal measles antibodies. The level of these antibodies at birth depends on the level of antibodies in the mother and the extent of placental transfer. We investigated predictors of levels of measles antibodies in newborns in rural Kenya.
Methods.A total of 747 paired maternal‐cord serum samples (91 from human immunodeficiency virus [HIV]–infected and 656 from HIV‐uninfected mothers) were tested for measles immunoglobulin G antibodies. Placental malaria infection was determined by biopsy. Data on pregnancy history, gestational age, and anthropometric and socioeconomic status were collected.
Results.Infants born to HIV‐infected mothers were more likely (odds ratio, 4.6 [95% confidence interval {CI}, 2.2–9.7]) to be seronegative and had 35.1% (95% CI, 9.8%–53.2%) lower levels of measles antibodies than did those born to HIV‐uninfected mothers. Preterm delivery, early maternal age, and ethnic group were also associated with reduced levels of measles antibodies. There was little evidence that placental malaria infection was associated with levels of measles antibodies in newborns.
Conclusion.Our results suggest that maternal HIV infection may reduce levels of measles antibodies in newborns. Low levels of measles antibodies at birth render children susceptible to measles infection at an early age. This is of concern in sub‐Saharan African countries, where not only is the prevalence of HIV high, but measles is the cause of much morbidity and mortality.
Received 25 October 2004; accepted 28 December 2004; electronically published 20 April 2005.
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Financial support: UK Department of International Development; Kenyan Medical Research Institute; Wellcome Trust. K.M. is a Wellcome Trust Senior Research Fellow (631342).
This study is published with the permission of the director of Kenyan Medical Research Institute.