Journal of Tropical Pediatrics Advance Access originally published online on January 9, 2006
Journal of Tropical Pediatrics 2006 52(5):324-328; doi:10.1093/tropej/fmk002
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HIV-1 Infection as a Risk Factor for Incomplete Childhood Immunization in Zambia
aDepartment of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
bDepartment of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
cVirology Laboratory, University Teaching Hospital, Lusaka, Zambia
dW. Harry Feinstone Department of Molecular Microbiology and Immunology, eDivision of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA, fNational Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
Correspondence: Dr William Moss, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. E-mail < wmoss{at}jhsph.edu>.
Immunizations are of particular importance for human immunodeficiency virus type 1(HIV-1)-infected children as they are at increased risk of severe disease and death from several vaccine-preventable diseases. Outside the United States, however, research on the impact of the HIV-1 epidemic on childhood immunization coverage is sparse. We conducted a nested case-control study in hospitalized children with measles to assess whether HIV-1 infection was a risk factor for incomplete immunization with diphtheria–tetanus–pertussis vaccine (DTP) and oral polio vaccine (OPV). Of 473 children, whose immunization status was determined from the immunization record or maternal recall, 23% were incompletely immunized and 19% were HIV-1 infected. After adjusting for age, sex, and measles vaccination status, HIV-1 infection was significantly associated with incomplete immunization with DTP and OPV (adjusted OR 1.9; 95% CI 1.1, 3.3). In a subset of children for whom information on maternal education was available, less than 7 years of school education was a risk factor for incomplete immunization (adjusted OR 3.7; 95% CI 1.8. 7.5). Children from homes with more than three children were twice as likely to be incompletely immunized as those from homes with one to three children. Our findings suggest that HIV-1-infected children are at increased risk of vaccine-preventable diseases not only because of impaired immune responses but because of lower rates of vaccine coverage.
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