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Title: Effect of multivitamin supplementation on measles vaccine response among HIV-infected and HIV-exposed Tanzanian infants

Author
item Sudfeld, Christopher - Harvard University
item Duggan, Christopher - Harvard University
item Histed, Alex - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item Manji, Karim - Muhimbili University
item Meydani, Simin - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item Aboud, Said - Muhimbili University
item Wang, Molin - Harvard University
item Giovannucci, Edward - Harvard University
item Fawzi, Wafaie - Harvard University

Submitted to: Clinical and Vaccine Immunology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/21/2013
Publication Date: 8/1/2013
Citation: Sudfeld, C., Duggan, C., Histed, A., Manji, K., Meydani, S., Aboud, S., Wang, M., Giovannucci, E., Fawzi, W. 2013. Effect of multivitamin supplementation on measles vaccine response among HIV-infected and HIV-exposed Tanzanian infants. Clinical and Vaccine Immunology. 20(8):1123-1132.

Interpretive Summary: Vaccination and nutritional interventions are the basis for most child health programs worldwide but there is limited information on the interaction between vaccine response and nutrition. In this study, we focused on a measles vaccine. Our theory was that multivitamins given to HIV-exposed but not infected infants would improve their response to measles vaccine. We included HIV-infected infants in this trial since they are well-documented to have a reduced response to vaccination. Overall, we found no effect of supplementing infants with multi-vitamins (B-complex, C and E) on immune response to measles’ vaccine. However, we found that if the infants were vaccinated before the age of 10 months or if they were stunted (indication of malnutrition) or if their mother’s CD4 (a type of T cells) was below 200 cells per microliter of blood (indication of poor immune system and more advanced HIV), they then had a worse immune response to measles compared to those vaccinated later, or who were not stunted or if their mother had CD4 cell count of greater than 350 cells per microliter. Our findings suggest that vaccinations administered too early, nutritional status, and the mother’s immune status impact the ability of the infant to develop an immune response to measles vaccine.

Technical Abstract: Immunization and nutritional interventions are mainstays of child health programs in sub-Saharan Africa, yet few published data on their interaction exist. HIV-exposed infants (uninfected) enrolled in a randomized placebo-controlled trial of multivitamins (vitamin B-complex, C and E) conducted in Tanzania were sampled for assessment of measles IgG quantity and avidity at 15-18 months. Infants were vaccinated between 8.5-12 months and all mothers received high dose multivitamins as standard of care. Of 201 HIV-exposed infants enrolled, 138 (68.7%) were measles seropositive. There was no effect of infant multivitamin supplementation on measles seroconversion proportions, IgG concentrations, and IgG avidity (p>0.05). The measles seroconversion proportion was greater for HIV-exposed infants vaccinated at 10-11 as compared to 8.5-10 months (p=0.032), and for infants whose mothers had a CD4 T-cell count <200 cells/µL as compared to >350 cells/µL (p=0.039). Stunted infants had significantly decreased IgG quantity as compared to non-stunted infants (p=0.012). As for measles avidity, HIV-exposed infants vaccinated at 10-11 months had increased antibody avidity (p=0.031). Maternal CD4 T-cell counts <200 cells/µL were associated with decreased avidity as compared to >350 cells/µL (p=0.047), as were lower infant height-for-age z-scores (p=0.016). Supplementation with multivitamins containing B-complex, C, and E does not appear to improve measles vaccine response for HIV-exposed infants. Studies are needed to better characterize the impact of maternal HIV disease severity on immune system development of HIV-exposed infants and the effect of malnutrition interventions on vaccine responses.