Vaccines Must Be Given in Order to Protect

(See the articles by Gallagher et al. and Moss et al., on pages 339–46 and 347–55, respectively.) Potential conflicts of interest: none reported. The findings and conclusions in this article are those of the individual authors and do not necessarily reflect the views of the Centers for Disease Control and Prevention. Two articles in this issue of the Journal [1, 2] highlight the importance and challenges of protecting HIV-infected individuals from 2 vaccine-preventable diseases, measles and influenza. Great strides have been made recently in reducing deaths from measles. Between 1999 and 2005, mortality from measles dropped by 60%, from 873,000 to 345,000 deaths per year [3]. Seventy-five percent of this reduction occurred in Africa [4, 5]. This success is a result of substantial increases in measles vaccination coverage both through routine health services and mass vaccination campaigns. These accelerated control activities have been implemented by local Ministries of Health with the technical and financial support of the Measles Initiative, a partnership of multilateral , bilateral, and nongovernmental organizations spearheaded by 5 core members (the American Red Cross, the US Centers for Disease Control and Prevention , the United Nations Foundation, UNI-CEF, and the World Health Organization [WHO]) [5]. The strategy for achieving rapid reduction in measles mortality has 4 components: (1) improving routine immunization coverage to 190% in every district, (2) providing a second opportunity for measles immunization, (3) implementing effective measles surveillance, and (4) improving case management (e.g., with vitamin A and antibiotics). That said, globally, measles remains one of the leading causes of deaths from a vaccine preventable disease. In sub-Saharan Africa in 2005, there were still an estimated 126,000 measles-related deaths [3]. Often cited as a potential obstacle to achieving sustainable measles control is the HIV pandemic [6, 7]. In 2006, an estimated 2.1 million deaths from HIV occurred in this region [8]. Measles in children with HIV infection is more severe, resulting in a higher mortality. Infants born to HIV-infected mothers are at higher risk of measles at !9 months of age. Response to measles vaccination by HIV-infected children has been variable. In particular, limited data suggest that they have a lower response when vaccinated older than 12 months of age, presumably from increasing immune suppression [9–11]. Both the US Advisory Committee on Immunization Practices and the WHO recommend measles vaccination of HIV-infected children who are asymptomatic or have mild immunosup-pression, regardless of antiretroviral therapy , …