Safety and immunogenicity of high-dose Edmonston-Zagreb measles vaccine in children with HIV-1 infection. A cohort study in Kigali, Rwanda
P. Lepage, F. Dabis, P. Msellati, D. G. Hitimana, A. M. Stevens, B. Mukamabano, C. Van Goethem and P. Van de Perre
Department of Pediatrics, Centre Hospitalier de Kigali, Rwanda.
OBJECTIVE--To compare the reactogenicity and immunogenicity of high-dose
Edmonston-Zagreb (EZ) measles vaccine in children with and without human
immunodeficiency virus, type 1 (HIV-1), infection. DESIGN--Prospective
cohort study. SETTING--General pediatric clinic and home visits in Kigali,
the capital of Rwanda. PARTICIPANTS--Infants born to HIV-1-seropositive and
-seronegative mothers were vaccinated with a 10(5.0) 50% tissue culture
infective dose of EZ measles vaccine at 6 months of age. Control visits
were made 10 and 14 days later to monitor local and general reactions.
Measles serum antibodies were measured by an enzyme-linked immunosorbent
assay technique at birth and at 6 and 9 months of age. Three groups were
compared: infected children (n = 43), uninfected children born to
seropositive mothers (n = 135), and uninfected children born to
seronegative mothers (n = 194). RESULTS--Three hundred twenty-three
children (86.8%) were available for the reactogenicity study. No
statistically significant difference between the three groups was found in
the occurrence of minor adverse reactions. No severe adverse reaction was
observed. One hundred ninety children (51.1%) were available for the
immunogenicity study. The percentage of infants negative for measles
antibody at 6 months was significantly higher (P = .021) in HIV-infected
children (85%) and in uninfected children born to seropositive mothers
(90%) than in uninfected children born to seronegative mothers (75%). The
overall seroconversion rate at 9 months was 90% (95% confidence interval,
85.7% to 94.3%), without any statistically significant difference between
the three groups. CONCLUSION--High-dose EZ vaccine administered at 6 months
of age is safe and highly immunogenic in both HIV-infected and uninfected
children.
