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Subclinical rubella disease among the vaccinated

Subclinical rubella disease among the vaccinated

Epidemiol Infect 1998 Dec;121(3):653-71 Related Articles, Books, LinkOut

A model-based evaluation of the national immunization programme against rubella infection and congenital rubella syndrome in The Netherlands.

van der Heijden OG, Conyn-van Spaendonck MA, Plantinga AD, Kretzschmar ME.

National Institute of Public Health and the Environment, Department of Infectious Diseases Epidemiology, Bilthoven, The Netherlands.

In order to improve the prevention of cases of congenital rubella syndrome in The Netherlands, in 1987 the selective vaccination strategy against rubella infection in girls was replaced by mass vaccination. This decision was supported by mathematical model analyses carried out by Van Druten and De Boo. In order to compare the predicted impact of the rubella vaccination programme with the current available data in more detail, a similar model was built. Although the model predicts elimination of the rubella virus, data show that virus circulation is still present at a higher level than expected by the model. Simulation studies indicate that import of infection and a lower vaccine effectiveness, related to possible asymptomatic reinfection of vaccinated people, could be sources contributing to the present virus circulation. Even though the number of infections is much higher than the number of reported cases of disease, limited serosurveillance data and case notification data show that females of childbearing age are well protected by immunization.

PMID: 10030716 [PubMed - indexed for MEDLINE]

Soz Praventivmed 1995;40(2):110-5 Related Articles, Books, LinkOut

[Mumps vaccines: vaccination failures from an immunological viewpoint]

[Article in German]

Hess U.

Bundesamt fur Gesundheitswesen, Bern.

The significance of mucosal and systemic immunity is illustrated with the example of the different immune response of Poliovaccine live oral (Sabin) and Poliovaccine inactivated parenteral (Salk). On the occasion of rubella- and measles-outbreaks it will be demonstrated that in vaccinated people subclinical reinfections may much more frequently occur than clinically manifest diseases. On the basis of these findings one may consider the large number of parotitis cases without complications in mumps vaccinated Swiss pupils as secondary mucosal vaccine failures at a time, when systemic immunity still was protective. Significance for vaccination policy and consequences for handling of vaccines shall be briefly discussed.

PMID: 7747520 [PubMed - indexed for MEDLINE]

Ugeskr Laeger 1992 Jul 13;154(29):2008-13 Related Articles, Books, LinkOut

[Duration of immunity and occurrence of secondary vaccine failure following vaccination against measles, mumps and rubella]

[Article in Danish]

Trier H, Ronne T.

Epidemiologisk afdeling, Statens Seruminstitut, Kobenhavn.

The present article illustrates the extent of secondary vaccine failure after vaccination for measles, mumps and rubella (MMR). Secondary vaccine failure means loss of the immunity induced by vaccination to such an extent that infection becomes possible. Serological investigations carried out with follow-up periods of up to 16 years after vaccination for measles, 21 years after vaccination for rubella and 12 years after vaccination for mumps reveal that loss of antibodies occurs with the elapse of time but that the clinical significance of this is probably very limited. Where all three types of vaccination are concerned, secondary vaccine failure has hitherto been very seldom. Infection with measles after secondary vaccine failure is generally described as running a milder course. In rare cases, rubella re-infection has resulted in infection in utero, so that a slight risk of congenital rubella cannot be entirely excluded after successful vaccination. No extensive systematic investigations of the effect of revaccination have been carried out and, similarly, the optimal interval between two or more vaccinations has not been illustrated in more detail in the literature. Subclinical infection is not uncommon after all three vaccines. Where measles is concerned, immunity may possibly be regarded as a continuum which, depending upon the antibody level, protects the individual from various degrees of clinical disease. If wild virus can be spread via individuals with subclinical infections, it is doubtful whether population immunity (herd immunity), which is necessary to eliminate the three diseases, can be attained in large populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Publication Types:
  • Review
  • Review, Tutorial

PMID: 1509566 [PubMed - indexed for MEDLINE]

Int J Epidemiol 1992 Dec;21(6):1165-74 Related Articles, Books, LinkOut

Seroepidemiology and evaluation of passive surveillance during 1988-1989 measles outbreak in Taiwan.

Lee MS, King CC, Jean JY, Kao CL, Wang CC, Ho MS, Chen CJ, Lee GC.

Institute of Public Health, National Taiwan University (NTU), Taipei, Republic of China ROC.

A seroepidemiological study was carried out to explore the risk factors of a measles outbreak that occurred among school children at a rural village (Li-Tse) in Taiwan. Among the 1166 participants, the percentage susceptible before the outbreak was 10.5% (122/1158) which was estimated as the sum of measles IgG-negative (29/1158) and IgM-positive (93/1166) individuals. Among 340 vaccinated children, 16 (4.7%) were measles IgM-positive and 10 (2.9%) were measles IgG-negative; therefore the vaccine failure rate was estimated to be 7.6% (26/340) and vaccine efficacy was 79.7% (95% confidence interval [CI] : 65.0-88.5). The most important risk factors for acquiring measles infection were the presence of other measles cases in the family (Odds Ratio [OR] = 32.5, P = 0.002) and the presence of more than two cases in a class (OR = 29.1, P = 0.003). The physician reporting rate was 6.1% (4/66), and the sensitivity of passive measles surveillance was only 4.3% (4/93) by active serosurvey. A concomitant rubella epidemic also amplified the inaccuracy of a passive reporting system based only on clinical diagnosis. Five children developed measles IgM but did not experience any symptoms, indicating that asymptomatic measles infection can occur. Our experience has highlighted three important areas for future measles elimination: (1) the need for serological evaluation of vaccinees, particularly those who were born during the introduction of mass immunization; (2) improvement in measles vaccine efficacy; and (3) further investigations on the role of asymptomatic transmission and susceptibles who remain after mass immunization.

PMID: 1483823 [PubMed - indexed for MEDLINE]

Rev Infect Dis 1985 Mar-Apr;7 Suppl 1:S157-63 Related Articles, Books, LinkOut

Challenge with rubella virus after loss of detectable vaccine-induced antibody.

Schiff GM, Young BC, Stefanovic' GM, Stamler EF, Knowlton DR, Grundy BJ, Dorsett PH.

Studies were conducted of experimental challenge with rubella virus in vaccinees whose possession of vaccine-induced antibody after vaccination had been documented and whose antibody level had become undetectable or very low over time. The challenge virus was the Howell strain, which had been shown to produce typical clinical and laboratory features of rubella in susceptible persons. The challenge of the vaccinees resulted in local viral replication in all but one; in viremia, a primary immunologic response, and a secondary antibody response in some; and usually in illness without a rash or in subclinical infection. The results emphasize the importance of continuing careful clinical and laboratory surveillance of vaccinees for determining the persistence of vaccine-induced immunity and of considering methods for identifying and revaccinating the minority of vaccinees who lose such immunity.

PMID: 4001723 [PubMed - indexed for MEDLINE]

: Rev Infect Dis 1985 Mar-Apr;7 Suppl 1:S91-4 Related Articles, Books, LinkOut

Duration of immunity after rubella vaccination: a long-term study in Switzerland.

Just M, Just V, Berger R, Burkhardt F, Schilt U.

In Switzerland 319 of 594 young women seronegative for rubella antibody vaccinated at 15-25 years of age against rubella with the Cendehill vaccine strain were retested 15 years later with three tests (hemagglutination inhibition, enzyme-linked immunosorbent assay, and a neutralization technique) for the presence of rubella antibodies. For 307 women rubella antibodies were still detectable by all three techniques. For nine women rubella antibodies were demonstrable by only one or two tests. Only three vaccinees were seronegative by all three tests. These three women also showed no booster response after challenge with the vaccine strain. The high percentage of women with persistent rubella antibodies 15 years after vaccination might be explained in part by the presence of subclinical reinfections due to a wild rubella virus. NOTE: In Europe at this time, "a significant decrease in the number of childhood rubella cases has not occurred" because children are not routinely vaccinated against the disease.
From the article: "For nine of these women, a significant increase in antibody levels was observed, a finding which suggests that for at least 10% of the vaccinees a subclinical reinfection must have occurred."

PMID: 4001742 [PubMed - indexed for MEDLINE]

AN:  85218138

Biken J 1978 Mar;21(1):25-31 Related Articles, Books, LinkOut

Rubella epidemic in an institution: protective value of live rubella vaccine and serological behavior of vaccinated, revaccinated and naturally immune groups.

Baba K, Yabuuchi H, Okuni H, Harima R, Minekawa Y, Taniuchi M, Otsuka T, Takahashi M, Okuno Y.

A rubella epidemic occurred in an institutional population composed of 189 susceptible, 37 naturally immune, 35 previously vaccinated and 38 serologically uncharacterized children and nursing staff. The epidemic lasted 3.5 months and showed more than 5 waves. Detailed clinical and serological examinations of these subjects were made. A rash appeared in 156 (52%) of 299 persons, including 145 (87%) of 166 unvaccinated and serologically uncharacterized subjects, but not in the 72 immune persons. In the middle of the 3rd wave urgent vaccination of 61 children aged 0 to 2 years of the susceptible group reduced the rate of appearance of a rash to 11 of the children (18%), as compared with 126 (98%) of 128 subjects in the unvaccinated non-immune group. The epidemic only reached a 4th wave in the vaccinated group, but it extended to a 5th wave or more in unvaccinated subjects. None of the 35 subjects in a previously vaccinated group developed rubella, although the rate of subclinical reinfection in this previously vaccinated group was higher (35%) than that in the naturally immune group (17%). Three cases of subclinical reinfection were detected even among 6 previously revaccinated subjects.

PMID: 666723 [PubMed - indexed for MEDLINE]

JAMA 1978 Dec 8;240(24):2635-7 Related Articles, Books, LinkOut

Rubella-vaccinated students. Follow-up in a public school system.

Schiff GM, Rauh JL, Young B, Trimble S, Rotte T, Schiff BE.

In a 7 1/2-year follow-up evaluation of the duration of rubella-vaccine-induced immunity of students who received either HPV-77 DK-12 or Cendehill vaccine, both groups showed a continous decline in hemagglutination-inhibition antibody from seven weeks after vaccination but a lower decline between 4 1/2 and 7 1/2 years after vaccination. However, at 7 1/2 years only 16 students (8%) receiving the Cendehill vaccine and one student (0.5%) receiving the HPV-77 DK-12 vaccine lacked detectable antibody. Despite the persistence of antibody titers, there was evidence of subclinical rubella among both groups of vaccinated students. These results emphasize the importance of continued evaluation of the conditions of persons receiving rubella vaccine.

PMID: 712979 [PubMed - indexed for MEDLINE]

Pediatrics 1978 Jan;61(1):5-11 Related Articles, Books, LinkOut

Persistence of antibody after administration of monovalent and combined live attenuated measles, mumps, and rubella virus vaccines.

Weibel RE, Buynak EB, McLean AA, Hilleman MR.

Hemagglutination-inhibiting antibodies were retained in comparable levels eight years after vaccination with Enders' original Edmonston and more attenuated Moraten (Attenuvax) and Schwarz line measles vaccines. Neutralizing antibody persisted without substantial decline in titer for at least 9.5 years after administration of Jeryl Lynn mumps virus vaccine (Mumpsvax). Antibodies were retained without important decline in children and adults for at least 7.5 and 7 years, respectively, after administration of HPV-77 duck-modified rubella vaccine (Meruvax). The patterns of antibody persistence 7.5 years after administration of combined measles-mumps-rubella (M-M-R) and mumps-rubella (Biavax) vaccines, 6 years after administration of measles-rubella vaccine (M-R-VAX), and 4 years after administration of measles-mumps vaccine (M-M-VAX) were the same as for the monovalent vaccines, indicating no alteration in the retention of immunity. Subclinical reinfection evidenced by increase in homologous antibody titer was observed to follow vaccination the same as occurs after natural infection.

PMID: 263873 [PubMed - indexed for MEDLINE]

Bull Pan Am Health Organ 1976;10(3):198-201 Related Articles, Books, LinkOut

Rubella vaccination.

Kono R.

Various attenuated live rubella vaccines now in use are considered generally safe and immunogenic, but to date the longest that vaccinal immunity has been shown to endure is seven years. Subclinical reinfection is not uncommon among vaccines, but its effect on pregnancy and fetal development is not yet fully known. At present two mass immunization strategies are used: vaccination of all children under 12 years of age or protection only of females 10-14 years of age. In either case susceptible women of childbearing age who have no detectable rubella HI antibody are immunized as well. Such women may receive the vaccine during the postpartum period or at any other time when they are not pregnant, but strict precautions must always be taken to make sure they do not conceive for at least two months thereafter.

PMID: 1000096 [PubMed - indexed for MEDLINE]

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