Response to influenza virus vaccination in vertical HIV infection
a Imperial College School of Medicine at St Mary's,
London: Department of Paediatric Infectious Diseases, b Department of Virology, c Central Public
Health Laboratory, 61 Colindale Avenue, Colindale, London:
PHLS Statistics Unit, Communicable Diseases Service Centre, d Enteric and Respiratory Virus
Laboratory
Correspondence to: Dr EGH Lyall, Department of Paediatric Infectious Diseases, 7th Floor QEQM Building, St Mary's Hospital, South Wharf Rd, London W2 1NY.
Accepted 4 November 1996
OBJECTIVE
To assess the antibody response to
influenza vaccine of children vertically infected with HIV.
DESIGNProspective study in HIV infected children
vaccinated during the winter of 1994-5.
SETTINGFamily HIV clinic at St Mary's Hospital, Paddington.
SUBJECTS25 children, aged 1-11 years, vertically
infected with HIV.
MAIN OUTCOME MEASURESResponses to influenza
antigens (H1N1-A /Taiwan /1/86, H3N2-A /Shandong /9/93, B /Panama
/45/90) were tested by haemagglutination inhibition. Antibody responses
were assessed according to clinical symptoms and immune function,
stratified according to the 1994 revised classification for HIV
infection in children.
RESULTS23 children (92%) had either very low or
no detectable antibody before vaccination. New protective antibody
responses were made by 10 children (40%): in seven to a single
antigen, in two to two antigens, and in one to all three antigens. For
each antigen there was an overall small increase in the mean geometric
titre of antibody produced, but this only reached a protective level for antigen H1N1 and for children with minimal symptoms. Less symptomatic children were significantly more likely to produce a
protective antibody response to influenza vaccination. No association was found between immune function, as measured by CD4 count, and vaccine response.
CONCLUSIONSOnly vaccination of the least
symptomatic HIV infected children against influenza is likely to be
effective. This will not only protect them against influenza, but will
also protect other more immunosuppressed and vulnerable members of
their families.
© 1997 by Archives of Disease in Childhood
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