Sutcliffe Catherine G, Searle Kelly, Matakala Hellen K, Greenman Michelle P, Rainwater-Lovett Kaitlin, Thuma Philip E, Moss William J
From the *Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; †Macha Research Trust, Macha Hospital, Choma, Zambia; and ‡Department of Pediatrics-Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Pediatr Infect Dis J. 2017 Mar;36(3):301-306. doi: 10.1097/INF.0000000000001422.
Measles and congenital rubella syndrome remain significant causes of morbidity and mortality despite available vaccines. HIV-infected youth may be at increased risk of measles because of greater waning immunity after vaccination. At a population level, they constitute a potentially large pool of susceptibles to measles and rubella. More data among HIV-infected youth in sub-Saharan Africa are needed to guide vaccination policy and control strategies.
This cross-sectional study was nested within 2 ongoing studies of malaria and HIV in Zambia. Dried blood spot cards from youth (5-15 years) in these studies from 2009 to 2013 were tested for IgG antibodies to measles and rubella viruses. HIV-uninfected youth, HIV-infected treatment-naive youth and HIV-infected youth receiving antiretroviral therapy (ART) were compared.
A total of 617 HIV-uninfected, 144 HIV-infected treatment-naive and 128 HIV-infected youth receiving ART were included in this study. The proportion seropositive for measles virus was significantly higher among HIV-uninfected youth (92.5%) compared with HIV-infected treatment-naive youth (74.1%) and HIV-infected youth receiving ART (71.9%). No differences by age were observed. The proportion seropositive for rubella virus was significantly higher among HIV-uninfected youth (54.7%) compared with HIV-infected treatment-naive youth (41.7%) and HIV-infected youth receiving ART (49.6%), with increases observed by age for all groups.
Measles seroprevalence was lower among HIV-infected than uninfected youth, consistent with waning immunity after measles vaccination. HIV-infected youth would benefit from revaccination. Half of all youth in rural Zambia were susceptible to rubella and may need targeting for catch-up rubella campaigns when measles-rubella vaccine is introduced.
尽管有可用疫苗，但麻疹和先天性风疹综合征仍是发病和死亡的重要原因。感染艾滋病毒的青少年可能因接种疫苗后免疫力下降幅度更大而面临更高的麻疹风险。在人群层面，他们构成了麻疹和风疹潜在的大量易感人群。撒哈拉以南非洲地区感染艾滋病毒的青少年需要更多数据来指导疫苗接种政策和控制策略。
这项横断面研究嵌套在赞比亚正在进行的两项疟疾和艾滋病毒研究中。对2009年至2013年这些研究中青少年（5 - 15岁）的干血斑卡片进行麻疹和风疹病毒IgG抗体检测。比较了未感染艾滋病毒的青少年、未接受过治疗的感染艾滋病毒的青少年以及接受抗逆转录病毒疗法（ART）的感染艾滋病毒的青少年。
本研究共纳入617名未感染艾滋病毒的青少年、144名未接受过治疗的感染艾滋病毒的青少年和128名接受ART的感染艾滋病毒的青少年。未感染艾滋病毒的青少年中麻疹病毒血清阳性比例（92.5%）显著高于未接受过治疗的感染艾滋病毒的青少年（74.1%）和接受ART的感染艾滋病毒的青少年（71.9%）。未观察到年龄差异。未感染艾滋病毒的青少年中风疹病毒血清阳性比例（54.7%）显著高于未接受过治疗的感染艾滋病毒的青少年（41.7%）和接受ART的感染艾滋病毒的青少年（49.6%），所有组的血清阳性比例均随年龄增加。
感染艾滋病毒的青少年中麻疹血清流行率低于未感染的青少年，这与麻疹疫苗接种后免疫力下降一致。感染艾滋病毒的青少年将从再次接种疫苗中受益。赞比亚农村地区一半的青少年对风疹易感，在引入麻疹 - 风疹疫苗时可能需要针对他们开展风疹补种活动。
