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Measles outbreak in Africa--is there a link to the HIV-1 epidemic?

Nilsson A, Chiodi F - PLoS Pathog. (2011)

View Article: PubMed Central - PubMed

Affiliation: Department of Women and Child Health at Karolinska Institutet, Astrid Lindgrens Childrens Hospital, Stockholm, Sweden. Anna.Nilsson.1@ki.se

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Measles remains an important cause of child mortality, although the numbers of measles-related deaths has decreased during the last decade through childhood immunisation programmes and follow-up measles vaccine campaigns... Which, then, could be the mechanism accounting for the decreased amount of measles antibodies circulating in mothers with HIV-1 and poor response to measles vaccination in children with HIV-1? During HIV-1 infection, the structure of lymphoid tissue is altered, leading to follicular hyperplasia and likely to impairment of marginal zone responses... We suggest that the decline of resting memory B cells reported by us – and others that occurs during HIV-1 infection may be an important pathogenic mechanism linked to the low level of measles-specific antibodies found in mothers with HIV-1 and their children (Figure 1)... The decline in B cells carrying immunological memory correlated to loss of antibody titres to measles, tetanus, and pneumococcal antigens, ... Interestingly, in turn, the decline of serum measles antibodies correlated to a decreased number of measles-specific memory B cells in blood... The antibody levels to pneumococcal antigens were dramatically reduced already from primary HIV-1 infection... Our studies on the loss of memory B cells strongly suggest that this pathogenic mechanism may be causing a reduced level of protective anti-measles antibodies in mothers with HIV-1; it is also very likely that the levels of measles antibodies in breast milk of mothers with HIV-1 may be reduced in comparison to that of healthy women... When matched with the measles vaccination studies conducted in developing countries, our findings indicate that a low level of protective measles antibodies in children with HIV-1, resulting from the impaired incapacity to mount serological memory, may represent the cause of measles outbreaks in countries with high levels of HIV-1 infection... It is encouraging that measles catch-up vaccination programmes have been shown to reduce measles morbidity and mortality in southern Africa, although children born to mothers with HIV-1 remained highly susceptible to measles infection and its lethal consequences... In conclusion, the recommended vaccination schedule to eradicate measles may be inadequate in countries with a high proportion of adults and children with HIV-1.

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Maintenance and formation of measles-specific antibodies and memory B cells in mother and child.(A) In the non-infected mother, a normal number of memory B cells produce a protective level of measles specific antibodies, which are transmitted to the child via the placental barrier. In addition, the child will respond to measles vaccination by producing memory B cells and specific antibodies. (B) The HIV-1-infected mother loses a large number of memory B cells as a result of pathogenic mechanisms linked to HIV-1 infection; this phenomenon leads to a reduced amount of measles-specific antibodies in the mother and a low level of transmitted antibodies to the child. The HIV-1-exposed, non-infected child, is, however, competent to respond to measles vaccination by generating protective levels of measles antibodies and measles-specific memory B cells. (C) As a consequence of HIV-1 infection, both the HIV-1-infected mother and child lose measles-specific memory B cells formed upon measles natural infection or vaccination. This leads to a low, non-protective level of measles antibodies in the mother, a low level of antibodies transmitted through the placental barrier to the child, and a low, non-protective level of measles-specific antibodies produced from the infected child upon vaccination.
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ppat-1001241-g001: Maintenance and formation of measles-specific antibodies and memory B cells in mother and child.(A) In the non-infected mother, a normal number of memory B cells produce a protective level of measles specific antibodies, which are transmitted to the child via the placental barrier. In addition, the child will respond to measles vaccination by producing memory B cells and specific antibodies. (B) The HIV-1-infected mother loses a large number of memory B cells as a result of pathogenic mechanisms linked to HIV-1 infection; this phenomenon leads to a reduced amount of measles-specific antibodies in the mother and a low level of transmitted antibodies to the child. The HIV-1-exposed, non-infected child, is, however, competent to respond to measles vaccination by generating protective levels of measles antibodies and measles-specific memory B cells. (C) As a consequence of HIV-1 infection, both the HIV-1-infected mother and child lose measles-specific memory B cells formed upon measles natural infection or vaccination. This leads to a low, non-protective level of measles antibodies in the mother, a low level of antibodies transmitted through the placental barrier to the child, and a low, non-protective level of measles-specific antibodies produced from the infected child upon vaccination.

Mentions: We suggest that the decline of resting memory B cells reported by us [17]–[19] and others [20] that occurs during HIV-1 infection may be an important pathogenic mechanism linked to the low level of measles-specific antibodies found in mothers with HIV-1 and their children (Figure 1). Memory B cells are responsible for mounting and maintaining an adequate serological response to antigens previously encountered in life through natural infection or vaccination. The decline in B cells carrying immunological memory correlated to loss of antibody titres to measles, tetanus, and pneumococcal antigens [17], [18]. Interestingly, in turn, the decline of serum measles antibodies correlated to a decreased number of measles-specific memory B cells in blood. The antibody levels to pneumococcal antigens were dramatically reduced already from primary HIV-1 infection [17].


Measles outbreak in Africa--is there a link to the HIV-1 epidemic?

Nilsson A, Chiodi F - PLoS Pathog. (2011)

Maintenance and formation of measles-specific antibodies and memory B cells in mother and child.(A) In the non-infected mother, a normal number of memory B cells produce a protective level of measles specific antibodies, which are transmitted to the child via the placental barrier. In addition, the child will respond to measles vaccination by producing memory B cells and specific antibodies. (B) The HIV-1-infected mother loses a large number of memory B cells as a result of pathogenic mechanisms linked to HIV-1 infection; this phenomenon leads to a reduced amount of measles-specific antibodies in the mother and a low level of transmitted antibodies to the child. The HIV-1-exposed, non-infected child, is, however, competent to respond to measles vaccination by generating protective levels of measles antibodies and measles-specific memory B cells. (C) As a consequence of HIV-1 infection, both the HIV-1-infected mother and child lose measles-specific memory B cells formed upon measles natural infection or vaccination. This leads to a low, non-protective level of measles antibodies in the mother, a low level of antibodies transmitted through the placental barrier to the child, and a low, non-protective level of measles-specific antibodies produced from the infected child upon vaccination.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3037349&req=5

ppat-1001241-g001: Maintenance and formation of measles-specific antibodies and memory B cells in mother and child.(A) In the non-infected mother, a normal number of memory B cells produce a protective level of measles specific antibodies, which are transmitted to the child via the placental barrier. In addition, the child will respond to measles vaccination by producing memory B cells and specific antibodies. (B) The HIV-1-infected mother loses a large number of memory B cells as a result of pathogenic mechanisms linked to HIV-1 infection; this phenomenon leads to a reduced amount of measles-specific antibodies in the mother and a low level of transmitted antibodies to the child. The HIV-1-exposed, non-infected child, is, however, competent to respond to measles vaccination by generating protective levels of measles antibodies and measles-specific memory B cells. (C) As a consequence of HIV-1 infection, both the HIV-1-infected mother and child lose measles-specific memory B cells formed upon measles natural infection or vaccination. This leads to a low, non-protective level of measles antibodies in the mother, a low level of antibodies transmitted through the placental barrier to the child, and a low, non-protective level of measles-specific antibodies produced from the infected child upon vaccination.
Mentions: We suggest that the decline of resting memory B cells reported by us [17]–[19] and others [20] that occurs during HIV-1 infection may be an important pathogenic mechanism linked to the low level of measles-specific antibodies found in mothers with HIV-1 and their children (Figure 1). Memory B cells are responsible for mounting and maintaining an adequate serological response to antigens previously encountered in life through natural infection or vaccination. The decline in B cells carrying immunological memory correlated to loss of antibody titres to measles, tetanus, and pneumococcal antigens [17], [18]. Interestingly, in turn, the decline of serum measles antibodies correlated to a decreased number of measles-specific memory B cells in blood. The antibody levels to pneumococcal antigens were dramatically reduced already from primary HIV-1 infection [17].

View Article: PubMed Central - PubMed

Affiliation: Department of Women and Child Health at Karolinska Institutet, Astrid Lindgrens Childrens Hospital, Stockholm, Sweden. Anna.Nilsson.1@ki.se

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Measles remains an important cause of child mortality, although the numbers of measles-related deaths has decreased during the last decade through childhood immunisation programmes and follow-up measles vaccine campaigns... Which, then, could be the mechanism accounting for the decreased amount of measles antibodies circulating in mothers with HIV-1 and poor response to measles vaccination in children with HIV-1? During HIV-1 infection, the structure of lymphoid tissue is altered, leading to follicular hyperplasia and likely to impairment of marginal zone responses... We suggest that the decline of resting memory B cells reported by us – and others that occurs during HIV-1 infection may be an important pathogenic mechanism linked to the low level of measles-specific antibodies found in mothers with HIV-1 and their children (Figure 1)... The decline in B cells carrying immunological memory correlated to loss of antibody titres to measles, tetanus, and pneumococcal antigens, ... Interestingly, in turn, the decline of serum measles antibodies correlated to a decreased number of measles-specific memory B cells in blood... The antibody levels to pneumococcal antigens were dramatically reduced already from primary HIV-1 infection... Our studies on the loss of memory B cells strongly suggest that this pathogenic mechanism may be causing a reduced level of protective anti-measles antibodies in mothers with HIV-1; it is also very likely that the levels of measles antibodies in breast milk of mothers with HIV-1 may be reduced in comparison to that of healthy women... When matched with the measles vaccination studies conducted in developing countries, our findings indicate that a low level of protective measles antibodies in children with HIV-1, resulting from the impaired incapacity to mount serological memory, may represent the cause of measles outbreaks in countries with high levels of HIV-1 infection... It is encouraging that measles catch-up vaccination programmes have been shown to reduce measles morbidity and mortality in southern Africa, although children born to mothers with HIV-1 remained highly susceptible to measles infection and its lethal consequences... In conclusion, the recommended vaccination schedule to eradicate measles may be inadequate in countries with a high proportion of adults and children with HIV-1.

Show MeSH
Related in: MedlinePlus