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1 September 2007

Volume 45, Number 5
Clinical Infectious Diseases 2007;45:637–642
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4505-0018$15.00
DOI: 10.1086/520651
HIV/AIDS MAJOR ARTICLE

Response to Measles, Mumps, and Rubella Revaccination in HIV‐Infected Children with Immune Recovery after Highly Active Antiretroviral Therapy

Linda Aurpibul,1

Thanyawee Puthanakit,1

Thira Sirisanthana,1 and

Virat Sirisanthana2

1Research Institute for Health Sciences and 2Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

Background.The low prevalence of measles antibody in human immunodeficiency virus (HIV)–infected children after immune recovery as a result of highly active antiretroviral therapy increases the risk of morbidity and mortality from disease. The objective of our study was to evaluate the efficacy and safety of revaccination with measles, mumps, and rubella (MMR) vaccine in HIV‐infected children with immune recovery.

Methods.Inclusion criteria were (1) HIV‐infected children aged >5 years, (2) a nadir CD4 lymphocyte percentage 15%, (3) immune recovery (defined as a CD4 lymphocyte percentage >15% for 3 months after highly active antiretroviral therapy), and (4) no protective antibody against measles. Each child received 1 dose of MMR vaccine, and antibodies were measured at 4 and 24 weeks after vaccination. Protective antibodies were defined as an antimeasles immunoglobulin G (IgG) level 320 mIU/mL, an antimumps IgG titer >1:500, and an antirubella IgG level >10 IU/mL.

Results.There were 51 participants. The mean age (± standard deviation) was 10.2 ± 2.5 years. Prior to revaccination, 28 participants (55%) had baseline protective antibody to mumps, and 11 (20%) had baseline protective antibody to rubella. The prevalence of protective antibody at 4 weeks was 90%, 100%, and 78% for measles, rubella, and mumps, respectively, and then slightly decreased to 80%, 94%, and 61%, respectively, at 24 weeks after revaccination. No serious adverse reactions were attributed to revaccination.

Conclusions.The majority of HIV‐infected children with immune recovery can develop protective antibodies after MMR revaccination. Revaccination with MMR vaccine in HIV‐infected children with immune recovery should be considered to ensure individual immunity and limit the spread of disease.

Received 3 January 2007; accepted 2 May 2007; electronically published 13 July 2007.

Reprints or correspondence: Dr. Thanyawee Puthanakit, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand 50200 ().

Cited by

Heidi M. Crane, Shireesha Dhanireddy, H. Nina Kim, Christian Ramers, Timothy H. Dellit, Mari M. Kitahata, Robert D. Harrington. (2009) Optimal timing of routine vaccination in HIV-infected persons. Current HIV/AIDS Reports 6:2, 93-99
Online publication date: 1-Jun-2009.
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Carey Farquhar, Dalton Wamalwa, Sara Selig, Grace John-Stewart, Jennifer Mabuka, Maxwel Majiwa, William Sutton, Nancy Haigwood, Grace Wariua, Barbara Lohman-Payne. (2009) Immune Responses to Measles and Tetanus Vaccines Among Kenyan Human Immunodeficiency Virus Type 1 (HIV-1)-Infected Children Pre- and Post-Highly Active Antiretroviral Therapy and Revaccination. The Pediatric Infectious Disease Journal 28:4, 295-299
Online publication date: 1-May-2009.
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Brian Eley. (2008) Immunization in Patients with HIV Infection. Drugs 68:11, 1473-1481
Online publication date: 1-Feb-2008.
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