Maternal HIV infection associated with reduced transplacental transfer of measles antibodies and increased susceptibility to disease

Background: Transplacental transfer of measles antibodies from mother to fetus is important in protecting against measles during early infancy. Changes in population immunity against measles in adults, including waning of immunity among HIV-infected pregnant women, could affect passive immunity acquired in utero by newborns. Objectives: To evaluate the effect of maternal HIV infection on transplacental transfer of measles antibody in mother-newborn dyads in a setting of high maternal HIV prevalence. Study design: Serum at birth was obtained from 303 mother-newborn dyads, including 196 HIV-infected and 107 HIV-uninfected women, and tested for measles IgG antibodies by ELISA. Seronegativity was defined as antibody levels < 150 mIU/ml and seroprotective titers as >= 330 mIU/ml. Results: HIV-infected and - uninfected women had similar measles antibody titers, however, cord-blood titers were lower among HIV-exposed (788.06 mIU/ml) compared to HIV-unexposed newborns (1306.6 mIU/ml; p <= 0.001), due to lower transplacental antibody transfer ratio in HIV-exposed (0.63) than in HIV-unexposed newborns (0.97; p <= 0.001). Maternal age < 25 years of age was associated with lower antibody titers and lower percentage with seroprotective titer, as well as less likelihood of their newborns having seroprotective titers (70.2% vs. 86.5%; p = 0.001). Conclusions: Lower levels of measles antibody in HIV-exposed newborns and in younger women < 25 years old, increases the susceptibility of their newborns to developing measles. This suggest a need to re-evaluate measles immunization of women of child bearing age and the timing of measles vaccination among infants in settings with a high prevalence of maternal HIV-infection.