Measles Vaccination: Weighing the Benefits and Risks of a Live Viral Vaccine for HIV-Infected Children

Children who are immunocompromised are at a higher risk of severe disease from measles but also have a lower response rate to immunization and a higher risk of serious adverse events from the vaccine. The medical literature describes cases of measles in human immunodeficiency virus (HIV)-infected children (1), small series reporting the serological responses to measles vaccination (2-8) and case reports of serious adverse events after measles immunization in immunecompromised hosts (9-14). Clearly, a description of both the possible outcomes and the likelihood of their occurrence are necessary when deciding on the benefits and risks of measles vaccination in HIV-infected children. As of 1992, 117 cases of measles in immunocompromised hosts have been reported; 2 7 were HIV-infected, 16 from Africa and 11 from the United States ( 1). Because there may be many factors contributing to the mortality rate from measles in African children this information cannot be generalized to Canadian children. Among the American cases nine (82%) developed pneumonia and three (27%) died. It might be expected that children with HIV infection would have a lower seroresponse rate to measles immunization than healthy children. Retrospective studies show that prevalence rates of measles antibody ranged from 25% to 79% in children infected with HIV at various intervals after immunization (2-5). In a cohort of HIV-infected children in New York, antibody to measles, measured by ELISA, developed in two of eight (25%) children (mean age 23 months) immunized and followed