Risk of Invasive Meningococcal Disease in Children & Adults with HIV in England

Background

Recent studies have identified HIV infection as a potential risk factor for invasive meningococcal disease (IMD), suggesting that HIV-infected individuals could benefit from meningococcal vaccination to reduce their risk of this rare, but severe and potentially fatal infection. In the United Kingdom, as in most industrialised countries, HIV is not considered a risk factor for IMD.

Methods

IMD incidence and relative risk by age group and meningococcal capsular group in HIV-positive compared with HIV-uninfected individuals was estimated through data linkage of national datasets in England between 2011 and 2013.

Results

IMD incidence among persons diagnosed with HIV was 6.6 per 100,000 compared to 1.5 per 100,000 among HIV-negative individuals, with a relative risk of 4.5 (95 % CI, 2.7–7.5). All but one case occurred in adults aged 16–64 years, who had a 22.7-fold (95 % CI, 12.4–41.6; P <0.001) increased risk compared with the HIV-negative adults. IMD risk by capsular group varied with age. HIV-positive children and adolescents had a higher risk of meningococcal group B disease, while adults were at increased risk of groups C, W and Y disease. Most HIV-positive individuals had been born in Africa, had acquired HIV through heterosexual contact, and were known to be HIV-positive and receiving antiretroviral treatment at IMD diagnosis. The most common clinical presentation was septicemia and, although intensive care admission was common, none died of IMD.

Conclusions

HIV-positive children and adults are at significantly increased risk of IMD, providing an evidence base for policy makers to consider HIV as a risk factor for meningococcal vaccination.

Full article at:  http://goo.gl/uGXzsr

By:  Ruth D. Simmons^1*, Peter Kirwan², Kazim Beebeejaun¹, Andrew Riordan³, Ray Borrow⁴,Mary E. Ramsay¹, Valerie Delpech², Samuel Lattimore¹ and Shamez Ladhani¹

¹Immunisation Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK

²HIV and STI Department, Public Health England, London, UK

³Royal Liverpool Children’s Hospital, Liverpool, UK

⁴Vaccine Evaluation Unit, Public Health England, Manchester, UK

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Evaluation of Immune Response to Measles Component of MMR Vaccine in Children with HIV Infection Receiving Antiretroviral Therapy

Children with HIV (CLHIV), respond poorly to primary immunization with measles vaccine and those responding tend to lose protective titre of antibodies by 2-3 years of age. Revaccinating CLHIV after immune reconstitution with anti-retroviral therapy (ART) may result in good sero-conversion,thereby confering them protection from measles.

To study prevalence of -measles antibodies in CLHIV receiving ART before and after inmunization with MMR vaccine.

CLHIV in the age 5-18 years,receiving ART for >6 months and with CD 4 count >15% were included in this prospective study. Their serum was assayed for IgG measles antibodies by qualitative immune-enzymatic determination using ELISA. The subjects were then immunized with a single dose of MMR vaccine. A repeat venous sample was assayed for measles antibiodies 8-12 weeks after immunization.

Sixty six subjects (46 males,20 females, mean age 10.4±2.8 years )were enrolled. The mean duration of ART was 3.4±1.5 years and median CD4 count 716.5µ/L. At enrollment, 16 (24.2%) subjects tested positive, 8 (12.1%)equivocal and 42 (63.6%) negative for -measles antibodies. After 8-12 weeks of immunization, 62 (93.3%)tested positive, 1(1.5%) equivocal and 3 (4.5%) negative. There was no difference among the sero-positive and sero-negative subjects post immunization with respect to age, sex, duration of ART, nutritional status, CD4 count or WHO clinical stage. No serious adverse reaction was observed to vaccination.

MMR vaccine leads to an excellent seroconversion to measles component of vaccine in immune- reconstituted CLHIV.

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By: Seth A1, Deepa S, Dutta R, Chandra J.

• 11Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India 2Department of Microbiology, Lady Hardinge Medical College, New Delhi, India. 

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