Immune responses to measles and smallpox vaccinations in malnourished children

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Abstract
Children with different levels of nutritional status were studied to determine their immune response to, and complications from, immunization with live measles vaccine and lyophilized smallpox vaccine. Two hundred forty-one children between the ages of 5 months and 9 years were examined to assess their nutritional status at the time of immunization. Sero-con version was defined as a hemagglutination-inhibition titer to measles virus, of ≥1:20 6 to 8 weeks after vaccination in initially sero-negative children. Of 111 initially sero-negative children 94% had an adequate immune response, shown by sero-con version. Of 193 children without a smallpox vaccination scar 97% were successfully immunized against smallpox. These rates of immune response were independent of age, sex, and nutritional status of the children. The geometric mean titer rise to measles immunization of groups, whose nutritional status was normal (>90% of median weight for age), mildly (75 to 90%), moderately (60 to 75%), or severely (<60%) malnourished were 7.5, 8.8, 7.9, and 7.9, respectively. Malnutrition did not affect the children's ability to develop adequate immune response to measles or smallpox vaccine, and there were no major complications during the 8-week period of follow-up. Since measles is a very severe disease, which in malnourished children can carry a case fatality rate as high as 50%, malnutrition should be a prime indication for measles immunization, and certainly not a contraindication.