Reikie Brian A, Naidoo Shalena, Ruck Candice E, Slogrove Amy L, de Beer Corena, la Grange Heleen, Adams Rozanne C M, Ho Kevin, Smolen Kinga, Speert David P, Cotton Mark F, Preiser Wolfgang, Esser Monika, Kollmann Tobias R
Division of Infectious & Immunological Diseases and Centre for Understanding and Preventing Infections in Children, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Clin Vaccine Immunol. 2013 Jan;20(1):33-8. doi: 10.1128/CVI.00557-12. Epub 2012 Oct 31.
HIV-exposed but uninfected (HEU) infants born to HIV-infected mothers from areas in the world with a high burden of infectious disease suffer higher infectious morbidity and mortality than their HIV unexposed uninfected (HUU) peers. Vaccination provides protection from infection. The possibility exists that altered response to vaccination contributes to the higher rate of infection in HEU than in HUU infants. While short-term, cross-sectional studies support this notion, it is unclear whether or not HEU infants develop long-term protective immune responses following the WHO extended program on immunization (EPI). Vaccine-specific antibody responses were compared between HEU and HUU infants from 2 weeks until 2 years of age in a longitudinal South African cohort. Total IgG and antibodies specific for Bordetella pertussis, Haemophilus influenzae type b (Hib), tetanus toxoid, hepatitis B virus (HepB), and measles virus were measured at multiple time points throughout the first 2 years of life. Prevaccine antibodies (maternal antibodies passively acquired) specific for tetanus were lower in HEU than in HUU infants, while prevaccine antibodies to HepB were higher in HEU than in HUU infants. Both groups responded similarly to tetanus, Hib, and HepB vaccination. HEU demonstrated stronger pertussis vaccine responses, developing protective titers 1 year earlier than HUU patients, and maintained higher anti-tetanus titers at 24 months of age. Vaccine-induced antibodies to measles virus were similar in both groups at all time points. Our results suggest that the current EPI vaccination program as practiced in South Africa leads to the development of vaccine-specific antibody responses that are equivalent in HEU and HUU infants. However, our data also suggest that a large fraction of both HEU and HUU South African infants have antibody titers for several infectious threats that remain below the level of protection for much of their first 2 years of life.
在世界上传染病负担较重地区，感染艾滋病毒的母亲所生的暴露于艾滋病毒但未感染（HEU）的婴儿，比未暴露于艾滋病毒且未感染（HUU）的同龄人遭受更高的感染发病率和死亡率。疫苗接种可预防感染。HEU婴儿比HUU婴儿感染率更高，有可能是对疫苗接种的反应改变所致。虽然短期横断面研究支持这一观点，但尚不清楚HEU婴儿在接受世界卫生组织扩大免疫规划（EPI）后是否会产生长期保护性免疫反应。在南非一个纵向队列中，比较了HEU和HUU婴儿从2周龄至2岁的疫苗特异性抗体反应。在生命的头2年中的多个时间点测量了总IgG以及针对百日咳博德特氏菌、b型流感嗜血杆菌（Hib）、破伤风类毒素、乙型肝炎病毒（HepB）和麻疹病毒的特异性抗体。HEU婴儿中破伤风特异性的疫苗接种前抗体（被动获得的母体抗体）低于HUU婴儿，而HEU婴儿中HepB的疫苗接种前抗体高于HUU婴儿。两组对破伤风、Hib和HepB疫苗接种的反应相似。HEU对百日咳疫苗的反应更强，比HUU患者早1年产生保护性滴度，并在24月龄时维持较高的抗破伤风滴度。两组在所有时间点对麻疹病毒的疫苗诱导抗体相似。我们的结果表明，南非目前实施的EPI疫苗接种计划可使HEU和HUU婴儿产生等效的疫苗特异性抗体反应。然而，我们的数据还表明，很大一部分南非HEU和HUU婴儿针对多种感染威胁的抗体滴度在其生命的头2年大部分时间里都低于保护水平。
