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Public Health Agency of Canada (PHAC)
Canada Communicable Disease Report

Volume 22-14
15 July 1996

[Table of Contents]

 

National Advisory Committee On Immunization (NACI)

INTERIM ADVISORY ON MEASLES REVACCINATION OF PERSONS WITH ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

In a recent Supplementary Statement on Measles Elimination in Canada (CCDR 1996;22:9-15), NACI supported routine measles vaccination for infants infected with human immunodeficiency virus (HIV) if their immune function at 12 to 15 months of age is compatible with measles-mumps-rubella (MMR) vaccination. The committee decided that second doses of measles vaccine should also be safe later in the second year of life if immune function remains stable. The committee noted, however, that safety of doses at later ages is uncertain because immune function can be expected to decline with age. The committee has recently been advised of a case that emphasizes this point.

A progressive pneumonia occurred in a 21-year-old American male with AIDS who had received a second dose of live attenuated measles vaccine about 1 year earlier when his immune function was severely impaired. Measles virus was repeatedly isolated from lung biopsy and bronchial-alveolar lavage specimens and was most closely related to the vaccine strain in genetic tests. The case is alleged to be the first instance of disease due to vaccine-strain measles virus in a patient with advanced HIV disease. Details will be reported in the coming months.

This isolated case reinforces concerns over the safety of routine re-immunization with a second dose of measles vaccine of persons with advanced HIV infection. In light of the decreasing risk of wild-strain measles virus infection in Canada associated with current, aggressive control measures, the risk-benefit ratio of measles vaccination and re-vaccination in HIV-infected persons with advanced disease may need to be reassessed. Until this reassessment is complete, NACI recommends:

  1. HIV-infected persons who have not demonstrated evidence of advanced immunodeficiency should be immunized with a first dose of MMR vaccine (1994 Pediatric HIV Classification categories, E, N1, A1) (1) . This should be undertaken at 12 months of age or as soon as possible thereafter. This recom-mendation is unchanged from the recent supplementary statement.

  2. A second dose of measles-containing vaccine should be deferred for HIV-infected persons with moderate or advanced immunodeficiency (1) . Consultation with an expert in the care of HIV-infected persons may be required to determine the presence or absence of significant immunodeficiency in individual cases. At present, significant immunodeficiency can be assumed to exist in children receiving long-term anti-retroviral therapy, prophylaxis against Pneumocystis pneumonitis or intravenous immunoglobulin infusions.

Measles re-vaccination may still be appropriate for HIV-infected persons with moderate immunodeficiency (1) if there is a high risk of wild-strain measles in the local community or travel to an area where measles is endemic. Consultation with local public health authorities will assist in determining the local level of wild-strain measles activity and risks to travellers abroad.

Passive immunoprophylaxis with immune globulin (IG) (2) is an option for HIV-infected persons with moderate or advanced immunodeficiency and short-term risk of exposure to wild measles, e.g., during community outbreaks or travel abroad. IG is also warranted after exposure to measles because prior vaccination does not reliably protect HIV-infected persons.

  1. rotracted measles virus infection should be considered in HIV-infected persons who present with chronic pneumonitis within a year after receiving vaccine. An attempt should be made to isolate the virus from appropriate specimens. Isolates should be sent to LCDC for further characterization.

References

  1. National Working Group on Comprehensive Care for Persons with HIV Disease. A comprehensive guide for the care of persons with HIV disease, Module 2: infants, children and youth. Mississauga, Ont: The College of Family Physicians of Canada, 1995:77.

  2. National Advisory Committee on Immunization. Canadian immunization guide. 4th ed. Ottawa, Ont: Health Canada, 1993:131. (Supply and Services Canada, Cat. no. H49-8/1993E.)

 

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