International Journal of Epidemiology, Vol 28, 341-346, Copyright © 1999 by International Epidemiological Association
P Waibale, SJ Bowlin, EA Mortimer Jr and C Whalen
BACKGROUND: Measles is an important public health problem in developing
nations and there is concern that immune response to measles vaccination
may be compromised by paediatric human immunodeficiency virus (HIV)
infection. Therefore, this study investigated the relationship of
immunoglobulin-G (Ig-G) antibody levels in children vaccinated against
measles and HIV-1 infection. Further analysis was done to assess the
influence of nutritional status on this relationship. METHODS: The authors
measured HIV and measles antibodies in 243 vaccinated children aged 17-41
months from Kampala, Uganda. Children were from paediatric and HIV clinics.
Potential confounders of this relationship included nutritional
anthropometric measures, age at and time since vaccination, measles
exposure, family crowding, vaccination clinic and gender. Univariable and
multivariable analyses were used to study these associations. RESULTS:
Fifty children (21%) were HIV infected. In univariable analysis, low
measles antibody (<15 ELISA units/ml) was associated with HIV (P = 0.05;
odds ratio (OR) = 1.86) and stunting (P = 0.06; OR = 1.68). Stunting,
measured as height- for-age and defined as <-2 standard deviations of
the reference population median, was a surrogate for chronic malnutrition.
HIV was strongly associated with stunting (P = 0.0001; OR = 6.62). In
multiple logistic regression, HIV was not associated with low measles
antibodies; however, stunting (P = 0.04; OR = 1.81), and <3 children in
the home (P = 0.01; OR = 1.96) were. Conversely, being male (P = 0.05; OR =
0.58), and measles in the home in the previous month (P = 0.04; OR = 0.33)
were associated with high antibody levels. CONCLUSIONS: These findings
suggest that HIV in Ugandan children immunized for measles may indirectly
interfere with measles antibody levels by causing malnutrition, the latter
being the direct cause. Programmes to improve childhood nutrition,
especially for HIV-infected children, should accompany measles control
programmes in developing nations for maximum benefit from measles
vaccination. HIV infection per se should not change measles vaccination
programmes.
ARTICLES
The effect of human immunodeficiency virus-1 infection and stunting on measles immunoglobulin-G levels in children vaccinated against measles in Uganda
AIDS Control Program, Ministry of Health, Entebbe, Uganda.
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