TY - JOUR
T1 - Safety and Immunogenicity of Measles Vaccination in HIV-Infected and HIV-Exposed Uninfected Children
T2 - A Systematic Review and Meta-Analysis
AU - Mutsaerts, Eleonora A.M.L.
AU - Nunes, Marta C.
AU - van Rijswijk, Martijn N.
AU - Klipstein-Grobusch, Kerstin
AU - Grobbee, Diederick E.
AU - Madhi, Shabir A.
N1 - Funding Information:
MCN reports personal fees from Pfizer and non-financial support from Sanofi outside the submitted work. SAM reports grants from Medical Research Council South Africa, grants from Department Science and Technology/National Research Foundation during the conduct of the study; grants and personal fees from the Bill and Melinda Gates Foundation, grants from GSK, grants and personal fees from Sanofi, grants from Pfizer outside the submitted work. All other authors declare no competing interests.
Funding Information:
This work was partially supported by the South African Research Chairs Initiative of the Department of Science and Technology , National Research Foundation in Vaccine Preventable Diseases ( MADH018 ), and the Medical Research Council . We would like to thank Dr. P Scott for providing additional data.
Publisher Copyright:
© 2018 The Author(s)
PY - 2018/7
Y1 - 2018/7
N2 - 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.
AB - 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.
KW - HIV-exposure
KW - HIV-infection
KW - Immunogenicity
KW - Measles vaccine
KW - Safety
UR - http://www.scopus.com/inward/record.url?scp=85064164185&partnerID=8YFLogxK
U2 - 10.1016/j.eclinm.2018.06.002
DO - 10.1016/j.eclinm.2018.06.002
M3 - Article
C2 - 31193646
SN - 2589-5370
VL - 1
SP - 28
EP - 42
JO - EClinicalMedicine
JF - EClinicalMedicine
ER -