MMR Vaccination May Not Be Reliable in HIV+ Children

George K Siberry, MD, MPH, Medical Officer Maternal and Pediatric Infectious Disease (MPID) Branch Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda, MDMedicalResearch.com Interview with:
George K Siberry, MD, MPH, Medical Officer
Maternal and Pediatric Infectious Disease (MPID) Branch
Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institutes of Health
Bethesda, MD

Medical Research: What is the background for this study?

Dr. Siberry:  Vaccines may not work as reliably in children with HIV infection, especially when their HIV is not under effective treatment. Today, most children in the United States who were born with HIV infection are receiving effective HIV treatment and have reached school age or even young adulthood. However, many received their childhood vaccines before they got started on their HIV treatment (because modern HIV treatments weren’t available when they were very young or their HIV infection was diagnosed late). So we wanted to see if these older children still had immunity from the vaccines they received when they were much younger.

Medical Research:  What are the main findings?

Dr. Siberry: We looked specifically at whether older children with HIV since birth were protected against measles, mumps, and rubella, the three viral infections covered by the measles-mumps-rubella (or MMR) vaccine. We found that 1/3 up to almost 1/2 of these children were not protected against these viruses, even though nearly all of the children had received at least 2 MMR doses, as recommended. And even if their HIV was currently under excellent control.  When we analyzed factors that were linked to being protected, we found that one of the most important factors was whether you got your MMR vaccine doses after you got on good treatment for your HIV infection.  For instance, over 85% of children who had gotten at least 2 MMR vaccine doses after being on effective HIV treatment were protected against measles compared to less than half of those who didn’t get both of their MMR vaccine doses while on effective HIV treatment.

Medical Research: What should clinicians and patients take away from your report?

Dr. Siberry: For clinicians caring for people (children and young adults) who were born with HIV infection, it is important to review each patient’s medical record to determine the dates the MMR vaccines were given and the date when effective HIV treatment was started.  If 2 MMR vaccines were given at least 3 months after effective HIV treatment was started, then that patient should be protected against measles, mumps and rubella. But MMR vaccine doses given prior to at least 3 months of effective HIV treatment should be repeated now (while the patient is on effective HIV treatment) to make sure the patient is protected against these viral infections. This practice is consistent with the current recommendations from the CDC for measles immunization in people born with HIV infection.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Siberry: We noted that the levels of protection were much higher (e.g., 85% for measles) in HIV-infected children who got their MMR doses while on effective HIV treatment but still not as high as the >95% of healthy children protected after 2 doses of MMR. We would like to find strategies that further improve MMR vaccine response in HIV-infected children.

We are also interested in determining if this approach for determining which HIV-infected children need additional MMR vaccine doses may also apply to other childhood vaccines.

Citation:

George K. Siberry, Kunjal Patel, William Bellini, Brad Karalius, Murli Purswani, Sandra K. Burchett, William A. Meyer III, Sun Bae Sowers, Angela Ellis,and Russell B. Van Dyke For the Pediatric HIV AIDS Cohort Study (PHACS)

Immunity to Measles, Mumps and Rubella in US Children with Perinatal HIV Infection or Perinatal HIV Exposure without Infection

Clin Infect Dis. 2015 Jun 9. pii: civ440. [Epub ahead of print]

 

 

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George K Siberry, MD, MPH (2015). MMR Vaccination May Not Be Reliable in HIV+ Children

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