BHIVA recommendations on measles in the UK

Measles is an air-borne and highly contagious infection that poses serious risks to adults, particularly pregnant women and people who are immunocompromised. [1]

Approximately 10% of adolescents and adults with HIV lack measles IgG and are therefore regarded as susceptible to measles. [2–6]

With measles resurging in the UK, it is critical to safeguard susceptible individuals. The MMR vaccine is deemed safe and effective in individuals with well-controlled HIV. [7–10]

However, available MMR vaccines contain live attenuated virus, and are therefore not recommended for women who are pregnant or people who are immunocompromised persons, including those with HIV iof they have a CD4 count below 200 cells/mm³. Post-exposure prophylaxis is paramount for protecting at-risk individuals following significant exposure. [1]

BHIVA recommendations

Screening for measles IgG in all people with HIV lacking documented seropositivity, regardless of prior vaccination or disease history

Administering the MMR vaccine to measles IgG seronegative individuals with a CD4 count ≥200 cells/mm³ who are clinically stable and not pregnant. Pregnancy should be avoided for one month post-vaccination

Providing one additional vaccine dose to measles IgG seronegative individuals with a reliable vaccination history; those without a reliable history should receive two doses at least one month apart

Although the MMR vaccine is generally well-tolerated, it can occasionally cause side effects like fever, rash, lymphadenopathy, parotid swelling, arthropathy and thrombocytopaenia. In individuals with a history of thrombocytopenia, the benefits of vaccination usually outweigh risks. If thrombocytopenia occurs post-first dose, measles IgG serological testing is advised to assess the need for a second dose

Offering post-exposure prophylaxis following significant exposure to measles. This may include the MMR vaccine within 3 days of exposure if not contraindicated. Those with HIV-related or other immunosuppression and pregnant women must be prioritised for post-exposure prophylaxis with intravenous immunoglobulin (IVIG) or intramuscular human normal immunoglobulin (HNIG) given within 6 days of exposure (or later in selected cases). Urgent measles IgG testing is recommended to determine prophylaxis need, but individuals at high risk should not delay prophylaxis waiting for test results.

References

UK Health Security Agency. Measles guidelines. January 2024.
https://www.gov.uk/government/publications/national-measles-guidelines (web page)
https://assets.publishing.service.gov.uk/media/65a7a806867cd800135ae9bb/national-measles-guidelines-january-2024.pdf )PDF)

Molton J et al. Seroprevalence of common vaccine-preventable viral infections in HIV-positive adults. J Infect 2010; 61: 73–80.

Loevinsohn G et al. Measles seroprevalence and vaccine responses in adolescents and adults who are living with HIV: a systematic review. Clin Infect Dis 2019; 69: 836–844.

Lefebvre M et al. Measles seroprevalence in human immunodeficiency virus-infected adults born in the era of measles vaccination. AIDS 2022; 36: 1273–1278.

Kerr C et al. Changing demographics and immunity to vaccine preventable diseases in people with HIV in Ireland. BMC Infect Dis 2022; 22: 582.

Kolakowska A, Brichler S, Delagrèverie H, Marin J, Alloui AC, Cailhol J. Cross sectional survey of varicella-zoster virus and measles seropositivity in people living with HIV in a Parisian suburb and a review of current immunization guidelines. Vaccine 2023; 41: 3266–3274.

UK Health Security Agency. Measles: the Green Book, chapter 21. 31 Dec 2019.

Geretti AM et al. British HIV Association Guidelines on the Use of Vaccines in HIV-Positive Adults 2015. HIV Med 2016; 17 Suppl 3: s2–s81.

Mehtani NJ et al. Immunogenicity and safety of the measles vaccine in HIV-infected children: an updated systematic review. Am J Epidemiol 2019; 188: 2240–2251.

Simakawa RM et al. Measles seroprevalence in adolescents and young adults living with HIV and response to MMR booster in seronegative ones. AIDS 2024; 38: 123–125.