Vaccine-Associated Measles Pneumonitis in an Adult with AIDS

The United States last encountered a measles epidemic in the late 1980s, a time when HIV infection was rapidly penetrating urban centers. The coincidence of these epidemics prompted reappraisal of the long-standing proscription against the use of live-virus vaccine in immunocompromised patients. Recognizing the severity of measles infection, particularly in patients with cell-mediated immune dysfunction [1-5], the Advisory Committee on Immunization Practices (ACIP) revised its measles vaccination guidelines in 1988. They began to recommend that 12- to 15-month-old children with asymptomatic HIV infection be vaccinated and that vaccination be considered for symptomatic HIV-infected children [1]. Many HIV-infected children have since been safely immunized with live, attenuated measles vaccine [5-7], causing the ACIP to expand the measles immunization indication to include all persons infected with HIV, including adults, when immunization is medically warranted [1].

We describe the first recognized serious complication of a measles vaccine virus (fatal giant-cell pneumonitis) in a young male vaccine recipient with AIDS.