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ACIP recommends changes to MMR vaccine for children with HIV
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The Advisory Committee on Immunization Practices voted unanimously to recommend changes to the measles-mumps-rubella vaccine that ensure children with HIV are adequately protected against the diseases.
“The majority of HIV-infected individuals in this country are adolescents or young adults who received MMR vaccines before effective antiretroviral therapy,” Huong McLean, PhD, MPH, an epidemiologist at the CDC, said. “The concern at this point is that they lack protection from measles due to a combination of primary vaccine failure or waning response over time. Even if they respond well to ART, they are unlikely to have high levels of immunity if they are not revaccinated. There is increasing evidence to support revaccination with MMR vaccine once stable effective ART has been placed.”
According to McLean, studies of children receiving measles vaccines as infants before ART show that after 6 months or more, the percentage of children with detectable antibody levels varied from 6% to 83%. In two studies that looked at antibody levels, 42% and 52% of children had levels considered protective. Another study showed that MMR protection was significantly lower in HIV-infected individuals compared with HIV-exposed, but uninfected, individuals.
The new recommendations include revaccinating children with the MMR vaccine who received their initial vaccination before receiving ART. For children with perinatal HIV infection, the recommended timing of their doses is at age 12 to 15 months and at age 4 to 6 years.
“Infants born with HIV are routinely started on ART right away,” McLean said. “We expect that these infants will have an immune response to MMR vaccine similar to those of uninfected children. For the same reason, these children are also recommended to have a second dose of MMR vaccine at age 4 to 6 years.”