Journal of Tropical Pediatrics Advance Access published online on January 9, 2006
Journal of Tropical Pediatrics, doi:10.1093/tropej/fmk002
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1 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
* To whom correspondence should be addressed. 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.
Original Papers
HIV-1 Infection as a Risk Factor for Incomplete Childhood Immunization in Zambia
Rosanna W. Setse 1,
Felicity Cutts* 2,
Mwaka Monze 3,
Judith J. Ryon 4,
Thomas C. Quinn 5,
Diane E. Griffin 4,
and
William J. Moss 6 *
2 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
3 Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
4 W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, Maryland, USA
5 Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
6 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, Maryland, USA
William J. Moss, E-mail: wmoss{at}jhsph.edu
Abstract
*Current address: Initiative for Vaccine Research, World Health Organization, CH 1211 Geneva-27, Switzerland
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