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Waning measles vaccine immunity (evidence for and against)

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Vaccine 2002 Jan 15;20(7-8):1134-40 Related Articles, Help
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Immunogenicity of second dose measles-mumps-rubella (MMR) vaccine and implications for serosurveillance.

Pebody RG, Gay NJ, Hesketh LM, Vyse A, Morgan-Capner P, Brown DW, Litton P, Miller E.

Sero-Epidemiology Unit, Immunisation Division, PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London, UK.

Measles and mumps, but not rubella, outbreaks have been reported amongst populations highly vaccinated with a single dose of measles-mumps-rubella (MMR) vaccine. Repeated experience has shown that a two-dose regime of measles vaccine is required to eliminate measles. This paper reports the effect of the first and second MMR doses on specific antibody levels in a variety of populations.2-4 years after receiving a first dose of MMR vaccine at age 12-18 months, it was found that a large proportion of pre-school children had measles (19.5%) and mumps (23.4%) IgG antibody below the putative level of protection. Only a small proportion (4.6%) had rubella antibody below the putative protective level. A total of 41% had negative or equivocal levels to one or more antigens. The proportion measles antibody negative (but not rubella or mumps) was significantly higher in children vaccinated at 12 months of age than at 13-17 months. There was no evidence for correlation of seropositivity to each antigen, other than that produced by a small excess of children (1%) negative to all three antigens. After a second dose of MMR, the proportion negative to one or more antigens dropped to <4%. Examination of national serosurveillance data, found that following an MR vaccine campaign in cohorts that previously received MMR, both measles and rubella antibody levels were initially boosted but declined to pre-vaccination levels within 3 years. Our study supports the policy of administering a second dose of MMR vaccine to all children. However, continued monitoring of long-term population protection will be required and this study suggests that in highly vaccinated populations, total measles (and rubella) IgG antibody levels may not be an accurate reflection of protection. Further studies including qualitative measures, such as avidity, in different populations are merited and may contribute to the understanding of MMR population protection.

PMID: 11803074 [PubMed - indexed for MEDLINE]

This study does not give the reason for the vaccine failure, merely that it occurred; hence it is unknown how many of the 19.5% of pre-school children who had below protective levels of antibody were due to secondary vaccine failure. - SM

Viral Immunol 2001;14(4):297-309 Related Articles, Help
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Immune responses to measles and measles vaccine: challenges for measles control.

Moss WJ, Polack FP.

W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,USA.

Most strategies for reducing global measles morbidity and mortality and eliminating measles are based on the ability to enhance immune responses to measles virus. Challenges to measles elimination and eradication are based in part on the need to sustain high levels of population immunity to interrupt transmission of measles virus. We review aspects of the immunology of measles and measles vaccination with the aim of demonstrating how knowledge of the immune responses is essential to furthering the goals of reducing measles morbidity and mortality and the elimination of measles. Better understanding of the mechanisms of immune suppression after measles, the potential for alternative vaccination strategies to induce immunity in young infants, and the immunologic basis of atypical measles, increased mortality after high-titer measles vaccine, and waning immunity will lead to improved strategies for measles control and elimination.

Publication Types:
  • Review
  • Review, Tutorial

PMID: 11792060 [PubMed - indexed for MEDLINE]

AN: 21649557

J Virol Methods 2000 Feb;84(2):191-200 Related Articles, Help
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Evaluation of different measles IgG assays based on recombinant proteins using a panel of low-titre sera.

Hartter HK, de Swart RL, Hanses F, Vos HW, Bouche FB, Osterhaus AD, Schneider F, Muller CP.

Department of Immunology and WHO Collaborating Center for Measles, Laboratoire National de Sante, Luxembourg, Luxembourg.

During the WHO campaign to eradicate measles, accurate discrimination between immune and non-immune individuals will become increasingly important. Due to waning immunity in vaccinated populations, the performance of a measles IgG assay depends mainly on its ability to detect reliably seronegative individuals among many vaccinees with low antibody levels. New serological tests based on recombinant proteins detect only a fraction of the total measles virus (MV) specific antibodies. Therefore, several assays based on recombinant MV-haemagglutinin (ELISA and flow cytometry) or MV-fusion protein (flow cytometry) as well as neutralisatlon and haemagglutination test have been evaluated using a large panel of low-titre and negative sera. Since such an evaluation is highly dependent on threshold values for positivity, the receiver operating characteristic curve analysis was applied. The H-FACS and the H-ELISA showed the best performing characteristics (specificity: 97.4 and 96.1%, respectively; sensitivity: 88.1 and 89.6%, respectively) and may be an alternative to the neutralisation assay. The number of undefined/grey zone sera was significantly lower compared to a commercial whole virus-based ELISA and therefore fewer individuals would be vaccinated unnecessarily.

PMID: 10680969 [PubMed - indexed for MEDLINE]

AN: 20143204

: Epidemiol Infect 2000 Apr;124(2):263-71 Related Articles, Help

Secondary measles vaccine failures identified by measurement of IgG avidity: high occurrence among teenagers vaccinated at a young age.

Paunio M, Hedman K, Davidkin I, Valle M, Heinonen OP, Leinikki P, Salmi A, Peltola H.

Department of Public Health, University of Helsinki, Finland.

Failure to seroconvert (primary vaccine failure) is believed to be the principal reason (approx. > 95%) why some vaccinees remain susceptible to measles and is often attributed to the persistence of maternal antibodies in children vaccinated at a young age. Avidity testing is able to separate primary from secondary vaccine failures (waning and/or incomplete immunity), but has not been utilized in measles epidemiology. Low-avidity (LA) and high-avidity (HA) virus-specific IgG antibodies indicate primary and secondary failure, respectively. Measles vaccine failures (n = 142; mean age 10.1 years, range 2-22 years) from an outbreak in 1988-9 in Finland were tested for measles-virus IgG avidity using a protein denaturating EIA. Severity of measles was recorded in 89 failures and 169 non-vaccinees (mean age 16.2 years, range 2-22 years). The patients with HA antibodies (n = 28) tended to have clinically mild measles and rapid IgG response. Among failures vaccinated at < 12, 12-15 and > 15 months of age with single doses of Schwarz-strain vaccine in the 1970s, 50 (95% CI 1-99), 36 (CI 16-56) and 25% (CI 8-42) had HA antibodies, respectively. When a single measles, mumps and rubella (MMR) vaccine had been given after 1982 at 15 months of age, only 7% (CI 0-14) showed HA antibodies. Omitting re-vaccinees and those vaccinated at < 15 months, Schwarz-strain recipients had 3.6 (CI 1.1-11.5) higher occurrence of HA responses compared to MMR recipients. Apart from one municipality, where even re-vaccinees had high risk of primary infection, 89% (CI 69 to approximately 100) of the infected re-vaccinees had an HA response. Secondary measles-vaccine failures are more common than was more previously thought, particularly among individuals vaccinated in early life, long ago, and among re-vaccinees. Waning immunity even among individuals vaccinated after 15 months of age, without the boosting effect of natural infections should be considered a relevant possibility in future planning of vaccination against measles.

PMID: 10813152 [PubMed - indexed for MEDLINE]

AN: 20271260

Am J Public Health 2000 Oct;90(10):1521-5 Related Articles, Help
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Measles eradication: is it in our future?

Orenstein WA, Strebel PM, Papania M, Sutter RW, Bellini WJ, Cochi SL.

National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga. 30333, USA.

Measles eradication would avert the current annual 1 million deaths and save the $1.5 billion in treatment and prevention costs due to measles in perpetuity. The authors evaluate the biological feasibility of eradicating measles according to 4 criteria: (1) the role of humans in maintaining transmission, (2) the availability of accurate diagnostic tests, (3) the existence of effective vaccines, and (4) the need to demonstrate elimination of measles from a large geographic area. Recent successes in interrupting measles transmission in the United States, most other countries in the Western Hemisphere, and selected countries in other regions provide evidence for the feasibility of global eradication. Potential impediments to eradication include (1) lack of political will in some industrialized countries, (2) transmission among adults, (3) increasing urbanization and population density, (4) the HIV epidemic, (5) waning immunity and the possibility of transmission from subclinical cases, and (6) risk of unsafe injections. Despite these challenges, a compelling case can be made in favor of measles eradication, and the authors believe that it is in our future. The question is when.

PMID: 11029981 [PubMed - indexed for MEDLINE]

AN: 20484429

Am J Epidemiol 1999 Dec 1;150(11):1238-49 Related Articles, Help

Modeling the impact of subclinical measles transmission in vaccinated populations with waning immunity.

Mossong J, Nokes DJ, Edmunds WJ, Cox MJ, Ratnam S, Muller CP.

Department of Biological Sciences, University of Warwick, Conventry, England.

An increasing body of evidence suggests that a substantial proportion of individuals who respond to measles vaccine display an antibody boost accompanied by mild or no symptoms on exposure to wild virus. It is unknown whether this emerging class of individuals can support transmission. The epidemiologic consequences of vaccinated individuals able to transmit virus are investigated using a mathematical model. Parameters for this model are estimated using regression analysis on a Canadian serologic data set. The authors confirm that neutralizing antibodies are decaying significantly in absence of circulating virus. Based on a protective threshold plaque reduction neutralization (PRN) titer of 120, the authors estimate the mean duration of vaccine-induced protection in absence of reexposure to be 25 years (95% confidence interval (CI) 18, 48). After long-term absence of circulating virus, the mathematical model predicts that 80% (95% CI 65, 91) of all seroconverted vaccinees have titers below the protective threshold. In this case, elimination of measles virus cannot be achieved by a single-dose routine vaccination strategy if the basic reproduction number in vaccinated individuals exceeds 1.24 (95% CI 1.10, 1.53). For this reason, there is a need to establish the intensity and duration of infectiousness in vaccinated individuals.

PMID: 10588085 [PubMed - indexed for MEDLINE]

AN: 20053306

Ann Med 1998 Apr;30(2):131-3 Related Articles, Help

Total elimination of measles in Finland.

Heinonen OP, Paunio M, Peltola H.

On average, 15,000 cases of measles occurred annually in Finland before the initiation of a vaccination programme in 1975. Because of insufficient activity, the vaccination coverage failed to reach the required level of over 90%, and cases continued to occur. The policy was revolutionized in 1982 by launching a project in which the Schwarz strain was substituted by an attenuated Enders-Edmonston strain given as a component of a trivalent live-virus measles-mumps-rubella vaccine (MMRII). This vaccine is given twice, at the ages of 14-18 months and 6 years. The impact of the vaccinations has been monitored in several prospective studies. In addition to a very favourable safety profile, good immunogenicity and excellent clinical effectiveness have also been demonstrated. Since 1996 not a single case of measles has been found in Finland, although cases have been searched actively and serological confirmation has been required. Total interruption of virus circulation has brought a new problem: the possibility of vaccinees to acquire natural boosters is so rare that waning immunity has become a reality. As there is a continuous risk of measles originating from a foreign source, the only tool against an outbreak is to maintain a high vaccination coverage and to continue the two-dose schedule as a minimum policy.

Publication Types:
  • Editorial

PMID: 9667790 [PubMed - indexed for MEDLINE]

AN: 98330364

J Med Virol 1998 Sep;56(1):85-90 Related Articles, Help
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Estimated susceptibility to asymptomatic secondary immune response against measles in late convalescent and vaccinated persons.

Damien B, Huiss S, Schneider F, Muller CP.

Laboratoire National de Sante, Luxembourg, Germany.

Serological evidence indicates that measles virus (MV) could circulate in seropositive, fully protected populations. Among individuals fully protected against disease, those prone to asymptomatic secondary immune response are the most likely to support subclinical MV transmission. The serological characteristics of protected subjects who developed secondary immune response after reexposure to measles have been described recently [Huiss et al. (1997): Clinical and Experimental Immunology 109:416-420]. On the basis of these data, a threshold of susceptibility was defined to estimate frequencies of secondary immune response competence in different populations. Among measles, late convalescent adults (n = 277) and vaccinated high school children (n = 368), 3.2-3.9% and 22.2-33.2%, respectively, were considered susceptible to secondary immune response. A second vaccination did not seem to lower this incidence. Even when estimates of symptomatic secondary immune response (e.g., secondary vaccine failure) were taken into account, susceptibility to subclinical secondary immune response was still 5-8 times higher after vaccination than after natural infection. Although viral transmission between protected individuals has never been directly demonstrated, the data describe a population in which protected but infectious persons could potentially be of epidemiological importance.

PMID: 9700638 [PubMed - indexed for MEDLINE]

Scand J Infect Dis 1997;29(2):187-90 Related Articles, Help

Five cases of measles secondary vaccine failure with confirmed seroconversion after live measles vaccination.

Hirose M, Hidaka Y, Miyazaki C, Ueda K, Yoshikawa H.

Hirose Children's Clinic, Saga, Japan.

We report 5 patients with secondary vaccine failure (SVF) who were infected with natural measles 2, 5, 5, 7 and 12 years, respectively, after vaccination with further attenuated live measles vaccine during infancy. Their seroconversion had been confirmed after vaccination. Three of the 5 patients had mild (modified) measles, while the remaining 2 patients had typical measles. The hemagglutination inhibition antibody titers to measles virus in paired acute and convalescent sera showed a secondary response pattern in 4/5 patients, and a primary response pattern was present in the remaining patient. Measles IgM antibodies were present in all patients during the convalescent stage. The patient with the primary response pattern may have had a decrease in the B cell memory during the 5-year period between vaccination and infection. This may be the first SVF case report that confirms the existence of completely waning immunity in recipients of the further attenuated live measles vaccines.

PMID: 9181657 [PubMed - indexed for MEDLINE]

AN: 97325604

Clin Diagn Lab Immunol 1996 Mar;3(2):211-5 Related Articles, Help
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Immunoglobulin G avidity testing in serum and cerebrospinal fluid for analysis of measles virus infection.

Narita M, Yamada S, Matsuzono Y, Itakura O, Togashi T, Kikuta H.

Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Japan.

We studied a variety of patients with measles virus infection by using avidity testing for measles virus-specific immunoglobulin G (IgG) in serum and cerebrospinal fluid samples. For the avidity testing, an Enzygnost measles IgG enzyme-linked immunosorbent assay kit was used with an 8 M urea denaturing method. With this method, low-avidity IgG (acute primary infection, avidity of < 30% within 15 days of the onset of rash) and high-avidity IgG (subacute sclerosing panencephalitis, avidity of > 75%) could be clearly distinguished by using serum samples. One patient, who developed a typical course of measles despite a previous vaccination, showed a positive IgM response with an initial low titer of measles virus-specific IgG of low avidity, but a later sample revealed a high titer of IgG of intermediate (40%) avidity, suggesting previous immunological priming. Two patients with breakthrough infection (secondary vaccine failure), both having central nervous system involvement, showed a positive IgM response with initial high titers of serum IgG of high avidity. In addition, one of the patients had a detectable level of measles-specific IgG in cerebrospinal fluid. In this patient, the avidity of both serum and cerebrospinal fluid IgG decreased during the short follow-up period. This phenomenon has never before been reported. In subacute sclerosing panencephalitis patients, the avidity of cerebrospinal fluid IgG was consistently lower than that of serum IgG. The difference in avidity between cerebrospinal fluid and serum IgG may be used as a direct indicator of intrathecal production of IgG. In conclusion, the avidity testing is simple to perform, reliable, and highly informative in the analysis of measles virus infection.

PMID: 8991638 [PubMed - indexed for MEDLINE]

AN: 96265446

Acta Paediatr Jpn 1995 Jun;37(3):374-6 Related Articles, Help

Measles encephalomyelitis in a patient with a history of vaccination.

Matsuzono Y, Narita M, Satake A, Togashi T, Itakura O, Ozutsumi K, Iguchi M.

Department of Pediatrics, Hokkaido University, School of Medicine, Sapporo, Japan.

Secondary vaccine failure (SVF) of measles is generally believed to run a milder course of illness than an ordinary course of infection. Severe complications such as central nervous system involvement have rarely been reported. A 12 year old girl, who had received a live attenuated measles vaccine 10 years earlier, developed an encephalomyelitis in the absence of symptoms indicative of ordinary measles such as Koplik spots. Anti-measles hemagglutination inhibition (HI) titer and measles IgM and IgG antibody titers were measured in a commercial laboratory. Measles virus genomic sequence was detected by polymerase chain reaction. Both serum and cerebrospinal fluid (CSF) samples obtained at acute phase already showed extremely high titers of HI (x8192 in serum and x1024 in CSF, respectively) and IgG antibody along with the presence of IgM antibody. Polymerase chain reaction detected the measles virus genomic sequence in the acute phase CSF. The patient's definite history of measles vaccination, high titers of HI and IgG antibodies observed at the very early stage of illness and the clinical course indicated that this patient has an encephalomyelitis due to SVF of measles. It is suggested that measles virus can be a pathogen of encephalitis without symptoms indicative of ordinary measles in individuals who received live attenuated measles vaccines.

PMID: 7645392 [PubMed - indexed for MEDLINE]

: J Infect Dis 1995 Dec;172(6):1591-5 Related Articles, Help

Cellular immunity in measles vaccine failure: demonstration of measles antigen-specific lymphoproliferative responses despite limited serum antibody production after revaccination.

Ward BJ, Boulianne N, Ratnam S, Guiot MC, Couillard M, De Serres G.

McGill Centre for the Study of Host Resistance, Montreal General Hospital, Quebec, Canada.

Measles antigen-specific immune responses were evaluated 1 and 6 months after revaccination in 60 previously vaccinated subjects (9.4 +/- 3.4 years of age) who had either undetectable or low plaque reduction neutralization (PRN) titers (< 200). PRN titers were increased in all subjects at 1 month (590 +/- 61; range, 129-2513) but fell again in 66% of subjects by 6 months (214 +/- 29; range, 30-794). At 6 months, 23 (38%) had subprotective (< 120) or borderline (< 200) PRN titers. Lymphoproliferative responses to measles virus antigens were low overall before revaccination (mean stimulation index [SI], 2.6 +/- 0.4; range, 0.5-13.5) but were readily detectable at 1 (SI, 145.8 +/- 2.6; range, 1.4-80) and 6 months after revaccination (SI, 9.4 +/- 1.8; range, 1.1-87). Before revaccination, 10 of the subjects (50%) with low positive PRN titers had SIs > or = 3. At 6 months after revaccination, 18 subjects (78%) with PRN titers < or = 200 had SIs > or = 3. These data suggest that cellular responses to measles virus may be better sustained than antibody titers after vaccination and revaccination in some subjects.

PMID: 7594723 [PubMed - indexed for MEDLINE]

Math Biosci 1994 Nov;124(1):59-82 Related Articles, Help

Waning immunity and its effects on vaccination schedules.

Rouderfer V, Becker NG, Hethcote HW.

School of Statistics, La Trobe University, Bundoora, Vic, Australia.

A relatively comprehensive age-specific transmission model is used to determine the effect of various factors on the optimal vaccination ages in one-dose and two-dose vaccination schedules. Motivated by the situation for measles, the model allows the duration of immunity of newborns to depend on the level of immunity of the mother at the time of the birth and allows for waning immunity as well as boosting of immunity by exposure to the disease. It is found that a significant amount of waning of disease-acquired immunity is plausible when boosting occurs but this is not an important factor in determining optimal vaccination schedules. On the other hand, plausible rates of loss of vaccine-induced immunity can have a substantial effect on the optimal vaccination schedule, particularly when there is no boosting of immunity. For two-dose schedules the optimal vaccination ages depend significantly on the level of vaccination coverage achieved. In the presence of plausible rates of loss of vaccine-induced immunity for measles, it is found that the vaccination coverage required to eradicate the disease is substantially higher than previously suggested.

PMID: 7827424 [PubMed - indexed for MEDLINE]

S Afr Med J 1994 Mar;84(3):145-9 Related Articles, Help

The 1992 measles epidemic in Cape Town--a changing epidemiological pattern.

Coetzee N, Hussey GD, Visser G, Barron P, Keen A.

Department of Community Health, University of Cape Town.

Over the last 6 years there has been a decline in the incidence of measles in Cape Town. However, during August 1992 an outbreak occurred, with cases reported at many schools in children presumably immunised. The objectives of this study were to characterise the epidemic in Cape Town and to determine possible reasons for the outbreak. The investigation consisted of two components--a description of the epidemic and an investigation of an outbreak at one primary school. Results indicate that during the last 4 months of the year, 757 cases were notified in Cape Town, compared with 144 in the first 8 months. The epidemic affected mainly white and coloured children over 5 years of age (P < 0.001). In contrast, during the period before the epidemic most cases occurred in black children and in those aged less than 1 year (P < 0.001). There was no significant increase in hospitalised cases. Investigation of the outbreak at one school revealed that the attack rate was 7.6% (25/329 children). Immunisation coverage (at least one dose of any measles vaccine) was 91% and vaccine efficacy was estimated to be 79% (95% CI 55-90); it was highest for monovalent measles (100%) and lowest for measles-mumps-rubella (74%). The epidemiology of measles in Cape Town has thus changed as evinced in this epidemic, with an increase in the number of cases occurring in older, previously vaccinated children. The possible reasons for this include both primary and secondary vaccine failure.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 7740350 [PubMed - indexed for MEDLINE]

AN: 95258851

Scand J Infect Dis 1994;26(6):725-30 Related Articles, Help

Serological and clinical characteristics of measles vaccine failure in Japan.

Hidaka Y, Aoki T, Akeda H, Miyazaki C, Ueda K.

Section of Pediatric Infectious Diseases, Fukuoka Children's Hospital, Japan.

In 1991, in Fukuoka, Japan, a measles outbreak occurred in which we observed 15 cases of measles vaccine failure (MVF). We examined these patients both clinically and serologically. Seven of them, with a response pattern of an early rise in and attainment of a high hemagglutination inhibition (HI) antibody titre, were considered to be secondary vaccine failures (EH group). Eight others showed a normal (relatively late rise and low titre) HI antibody response pattern and were considered to be primary vaccine failures (LL group). In both MVF groups, measles-specific IgM antibody was detected by enzyme immunoassay. The EH group had a milder rash than did the LL group and unvaccinated controls. We believe they had an immunological memory that modified the clinical manifestations of measles. Two cases of encephalitis were observed in the EH group; both patients recovered without sequelae. These data suggest that the mere presence or absence of IgM antibody is not sufficient to differentiate primary from secondary MVFs. A two-dose measles vaccination scheme should be recommended to secure a booster effect, because immunity is waning in the population in which the measles vaccination rate is not high enough and in which natural measles still exists.

PMID: 7747097 [PubMed - indexed for MEDLINE]

Proc Natl Acad Sci U S A 1993 Dec 15;90(24):11698-702 Related Articles, Help
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Pulse mass measles vaccination across age cohorts.

Agur Z, Cojocaru L, Mazor G, Anderson RM, Danon YL.

Department of Applied Mathematics and Computer Science, Weizmann Institute of Science, Rehovot, Israel.

Although vaccines against measles have been routinely applied over a quarter of a century, measles is still persistent in Israel, with major epidemics roughly every 5 years. Recent serological analyses have shown that only 85% of Israelis aged 18 years have anti-measles IgG antibodies. Considering the high transmissibility of the virus and the high level of herd immunity required for disease eradication, the Israeli vaccination policy against measles is now being reevaluated. Motivated by theoretical studies of populations in perturbed environments, we examined the possibility of replacing the conventional cohort vaccination strategy by a pulse strategy--i.e., periodic vaccination of several age cohorts at the same time. Numerical studies of a deterministic age-structured model suggest that vaccination, which renders immunity to no more than 85% of the susceptible children aged 1-7 years, once every 5 years will suffice to prevent epidemics in Israel, where infection rate is highest amongst schoolchildren. The model suggests that by using such a strategy the density of susceptible individuals is always kept below the threshold above which recurrent epidemics will be maintained. Analysis of simpler, non-age-structured, models serves to clarify the basic properties of the proposed strategy. Our theoretical results indicate that the advantages and disadvantages of a pulse strategy should be seriously examined in Israel and in countries with similar patterns of measles virus transmission.

PMID: 8265611 [PubMed - indexed for MEDLINE]

Although it is note stipulated here that any of these are due to waning immunity, since there are no estimates of primary vaccine failure being as high as 15% one can assume that a portion of the 15% are secondary vaccine failures. - AM

Infect Control Hosp Epidemiol 1993 Feb;14(2):81-6 Related Articles, Help

Secondary measles vaccine failure in healthcare workers exposed to infected patients.

Ammari LK, Bell LM, Hodinka RL.

Department of Pediatrics, Children's Hospital of Philadelphia, PA 19104.

OBJECTIVE: To describe 4 healthcare workers who developed measles despite pre-existing antimeasles antibody levels. DESIGN: Hospital employees working in patient care areas from July through November 1990 were screened for measles antibody levels using a commercially available enzyme immunoassay (EIA). The clinical course and laboratory evaluation of the 4 healthcare workers who developed measles were reviewed. SETTING: An academic tertiary care children's hospital. PARTICIPANTS: A convenience sample of resident physicians, nurses, ward clerks, Child Life workers, physical and occupational therapists, radiology technicians, and housekeeping staff were screened regardless of age, immunization status, or history of measles infection. RESULTS: Of 1,311 employees working in patient care areas, 900 (68.6%) had sera tested for measles antibody. Fourteen (1.5%) were negative, 338 (37.6%) had low positive antibody levels, 372 (41.3%) were mid-positive, and 171 (19%) were high-positive; 5 (0.6%) showed equivocal results. Four healthcare workers vaccinated in the past developed measles. All had positive pre-illness measles antibody levels and all had a significant rise in measles-specific IgG following infection. Three of the them had received at least 2 live measles vaccinations prior to caring for patients with measles. CONCLUSIONS: These cases raise concerns regarding detection of adequate protective measles immunity. We recommend that all healthcare workers observe respiratory precautions in caring for patients with measles.

PMID: 8440884 [PubMed - indexed for MEDLINE]

AN: 93179722

J Clin Microbiol 1992 Jul;30(7):1778-82 Related Articles, Help

Secondary immune response in a vaccinated population during a large measles epidemic.

Ozanne G, d'Halewyn MA.

Laboratoire de sante publique du Quebec, Immunodiagnostic, Ste-Anne-de-Bellevue, Canada.

The rates of secondary immune response (SIR) and secondary vaccine failure (SVF) during a measles epidemic (10,184 notifications) were evaluated. A patient with SIR was defined as a subject for whom all sera were immunoglobulin G (IgG) positive and IgM negative with a significant increase in complement fixation titer. A patient with SVF was defined as a vaccinated symptomatic subject showing a SIR. Sequential sera from 898 subjects were tested for measles antibody by enzyme-linked immunosorbent assay (IgG and IgM) and by complement fixation. Evidence of recent anti-measles virus specific immune response was found in 496 subjects (55.5%). The vaccination rate was estimated at 74.6% (99% confidence interval [CI], 67.9 to 80.7%). The number of exposed vaccinated subjects was estimated at 370 (74.6% of 496). The SIR rate was 4.03% (20 of 496) (99% CI, 2.1 to 6.9%) among subjects with immune response. These 20 subjects were 2 with measles (Centers for Disease Control's definition), 6 with measles with rash of unknown duration, 8 with presumed measles with either rash or fever, 3 asymptomatic subjects (2 with recent contact with a measles case), and 1 undocumented subject. Since 3 patients with SIR were asymptomatic and 2 others were documented as not vaccinated, there was a maximum of 15 probable occurrences of SVF among the 20 patients with SIR. The SVF rate among exposed vaccinated subjects was estimated at 4.05% (15 of 370) (99% CI, 1.9 to 7.5%). In conclusion, neither prior vaccination nor detectable SIR ensures protective immunity. Measles virus may induce asymptomatic SIR in IgG-seropositive subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 1629334 [PubMed - indexed for MEDLINE]

AN: 92332717

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

[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]

AN: 92376936

Pediatrie 1992;47(9):597-601 Related Articles, Help

[Reappearance of post-vaccination infection of measles, rubella and mumps. Should adolescents be revaccinated?]

[Article in French]

Malengreau M.

Measles-mumps-rubella immunization has had a dramatic impact on the incidence of these diseases and their complications. However, a partial coverage, as seen in Belgium and France, only slows the spread of the wild virus, thus increasing the age at infection and the risk of complications. This is to be added to the fact that there are 5% primary vaccine failure (no antibody production) and 5% secondary vaccine failure (loss of antibodies over time). When introducing first immunization at 15 months of age it is thus very important to increase quickly the immunization coverage by immunization of all non-immune children entering school and by re-immunization of all teenagers.

Publication Types:
  • Editorial
  • Review
  • Review, Tutorial

PMID: 1336841 [PubMed - indexed for MEDLINE]

AN: 93141337

J Infect Dis 1992 Jul;166(1):205-8 Related Articles, Help

Persistence of measles antibody after revaccination.

Markowitz LE, Albrecht P, Orenstein WA, Lett SM, Pugliese TJ, Farrell D.

Division of Immunization, Disease Control, Atlanta, Georgia 30333.

To evaluate persistence of measles antibody after revaccination, antibody levels were measured 6 years after revaccination of 40 hemagglutination-inhibition (HAI) antibody-negative students who had participated in a serosurvey in Massachusetts. Twelve subjects who had been HAI antibody-positive and were not revaccinated were included as a comparison group. Before revaccination, 7 revaccinees had no detectable plaque reduction neutralization (PRN) antibody (group 1) and 33 had low levels of PRN antibody (group 2). Three weeks after revaccination, all in group 1 and 30 (90%) of 33 in group 2 had developed a fourfold or greater rise in PRN antibody. Six years after revaccination, all subjects had PRN-detectable antibody. However, 12 in group 2 (36%) had antibody titers less than or equal to 1:120 compared with none in group 1 (P less than .01). Persons without PRN antibody will respond to revaccination and maintain protective antibody titers. In contrast, persons with low levels of PRN antibody may respond initially to revaccination, but their antibody titers may fall again to low levels.

PMID: 1607699 [PubMed - indexed for MEDLINE]

: J Adolesc Health 1991 May;12(3):273-8 Related Articles, Help

Serological response to measles revaccination in a highly immunized military dependent adolescent population.

Veit BC, Schydlower M, McIntyre S, Simmons D, Lampe RM, Fearnow RG, Stewart J.

Department of Clinical Investigation, William Beaumont Army Medical Center, El Paso, Texas 79920-5001.

In the spring of 1986, there was a measles outbreak in the city of El Paso, Texas, with 92 cases reported to the City-County Health Department. Of those 92 cases, 31 (32%) occurred within a public high school's student population of 2524. A mass measles vaccination program was undertaken at that high school in order to limit the outbreak. The student enrollment included a military dependent population of 368 students. Despite documented histories of prior measles immunizations in this military dependent subgroup, three individuals contracted the disease. Since this subgroup of students represented a highly immunized adolescent population, it was of interest to serologically determine their immune status prior to and following reimmunization with the expectation that such a study would provide information relating to the level of "protective" immunity. Prevaccination and postvaccination sera were obtained from 95 students. Results of measuring anti-measles antibody activity by ELISA indicate that 13 (14%) students responded to revaccination and experienced a fourfold or greater rise in IgG antibody levels. There were no detectable IgM responses. All of the students who responded to revaccination produced an anamnestic response (IgG boost only). Since most of these individuals had received first immunizations at 15 months of age or older, these findings suggest that secondary vaccine failure (waning immunity) was responsible for the putative "lowered" immunity in these individuals, instead of primary vaccine failure (maternal antibody suppression). These findings support current recommendations for measles booster revaccination of school-age children and adolescents.

PMID: 2054370 [PubMed - indexed for MEDLINE]

AN: 91274326

Pediatr Infect Dis J 1990 Feb;9(2):101-10 Related Articles, Help

Duration of live measles vaccine-induced immunity.

Markowitz LE, Preblud SR, Fine PE, Orenstein WA.

Division of Immunization, Centers for Disease Control, Atlanta, GA 30333.

Publication Types:
  • Review
  • Review, Tutorial

From the article Similar to immunity after natural measles infection, live measles vaccine-induced immunity has been thought to be lifelong.  Vaccinees who subsequently develop measles have been considered primary vaccine failures, defined as the failure of the initial vaccination to elicit an appropriate immune response.  Primary vaccine failures are believed to be caused by (1) interference by maternal antibody when vaccination occurs at a young age, (2) technical problems, such as improper vaccine storage or administration, or (2) other unknown reasons.  Transmission of measles among older children in the United States, most of whom have been appropriately vaccinated, has raised the question of whether waning vaccine-induced immunity may also be responsible for some vaccine failures.  Current vaccination policy as well as mathematical models assume that vaccine-induced immunity is life-long.  If waning vaccine-induced immunity does occur, changes in measles vaccination strategies might be necessary.  The purpose of this paper is to review information concerning the duration and quality of measles vaccine-induced immunity.

Discussion: Several types of studies have been applied to evaluate the duration and quality of measles vaccine-induced immunity.  The few reports of measles disease in persons who had seroconverted after vaccination document that secondary vaccine failure can occur.  In addition two studies provide data on the potential magnitude of the risk of secondary vaccine failure.  However, most data suggest that waning immunity is uncommon.

Many questions concerning the duration of vaccine-induced immunity remain to be answered, including what percentage of cases reported in previously vaccinated persons in the United States is caused by primary or secondary vaccine failure, whether different measles vaccine strains produce immunity which is more or less "durable", whether reexposure to wild measles virus is important for maintenance of vaccine-induced immunity and whether it is possible to identify individuals at risk for waning immunity.

The consequences of waning measles vaccine-induced immunity may be minor for individuals if secondary vaccine failure is associated with mild disease.  However, waning vaccine-induced immunity could be of greater consequence to a population.  Although persons with subclinical reinfection have not been shown to transmit virus, it is not known whether this is true for persons with secondary vaccine failure.  If these individuals are able to transmit disease to other susceptibles, waning immunity, even in a small percentage of persons, may impede realization of the goal of measles elimination.  Revaccination may be successful in decreasing the number of persons who become susceptible due to waning immunity.  However, it is not known whether revaccination of such persons will result in sustained immunity. 

Questions concerning duration of vaccine-induced immunity and secondary vaccine failure were raised at the time of vaccine licensure and discussed 10 to 15 years later when outbreaks occurred in vaccinated children.  Now, 26 years after licensure, many of the same issues remain unresolved.  Although waning immunity has been documented to occur in a small proportion of vaccinees, the epidemiologic significance of this is still unclear.


PMID: 2179836 [PubMed - indexed for MEDLINE]

Zh Mikrobiol Epidemiol Immunobiol 1990 Aug;(8):66-70 Related Articles, Help

[The results of multiyear observations on the duration of the maintenance of immunity in those vaccinated and revaccinated against and recovered from measles]

[Article in Russian]

Sliusar' LI, Sokhin AA, Radomskaia FS, Degtiareva GV, Panasenko LI, Litvinova TP, Komarevskaia RV, Bol'shinskaia ZhI.

The results of 5-year observations on the duration of immunity to measles virus in persons vaccinated and revaccinated against measles, as well as in persons having had this infection, are presented. The intensity of immunity was determined in the same persons with the use of the passive hemagglutination test. The study revealed differences in the formation, intensity and duration of postvaccinal immunity. A significant decrease in the concentration of antibodies over the period of 5 years was established in 50.0-52.3% of vaccines. Revaccination with live measles vaccine is an effective measure for enhancing immunity to measles virus in persons with initial antibody titers less than 1:10-1:20, but revaccination made in a single injection is not sufficient for the stable maintenance of measles morbidity at the sporadic level. Postinfectious immunity is characterized by stability and has no tendency towards decrease. Persons having had measles have no need in additional measures irrespective of the time elapsed after the disease.

PMID: 2239007 [PubMed - indexed for MEDLINE]

JAMA 1990 May 9;263(18):2467-71 Related Articles, Help

Comment in:

Mild measles and secondary vaccine failure during a sustained outbreak in a highly vaccinated population.

Edmonson MB, Addiss DG, McPherson JT, Berg JL, Circo SR, Davis JP.

Department of Pediatrics, University of Wisconsin, Madison 53792.

A prolonged school-based outbreak of measles provided an opportunity to study "vaccine-modified" mild measles and secondary vaccine failure. Thirty-six (97%) of 37 unvaccinated patients had rash illnesses that met the Centers for Disease Control clinical case definition of measles, but 29 (15%) of 198 vaccinated patients did not, primarily because of low-grade or absent fever. Of 122 patients with seroconfirmed measles, 10 patients (all previously vaccinated) had no detectable measles-specific IgM and significantly milder illness than either vaccinated or unvaccinated patients with IgM-positive serum. Of 108 vaccinated patients with seroconfirmed measles, 17 patients (16%) had IgM-negative serology or rash illnesses that failed to meet the clinical case definition; their mean age (13 years), age at the time of vaccination, and time since vaccination did not differ from those of other vaccinated patients. The occurrence of secondary vaccine failure and vaccine-modified measles does not appear to be a major impediment to measles control in the United States but may lead to underreporting of measles cases and result in overestimation of vaccine efficacy in highly vaccinated populations.

PMID: 2278542 [PubMed - indexed for MEDLINE]

AN: 90230400

Am J Public Health 1989 Apr;79(4):475-8 Related Articles, Help

The role of secondary vaccine failures in measles outbreaks.

Mathias RG, Meekison WG, Arcand TA, Schechter MT.

Department of Health Care and Epidemiology, University of British Columbia, Vancouver.

An outbreak of measles in 1985-86 in a community where measles vaccine trials had been carried out from 1974-76 allowed the assessment of the role of secondary vaccine failures in previously immunized children. A total of 188 children from the vaccine trial were followed. Of these, 175 seroconverted initially while 13 (6 per cent) required re-immunization (primary failure). A total of 13 cases of measles, eight of which were laboratory and/or physician-confirmed, were reported in this cohort. Of these, nine cases occurred in the 175 subjects who had hemagglutination inhibition test (HI) and neutralizing antibody responses following the initial immunization. These nine cases represent secondary vaccine failures. An additional four cases occurred in the 13 subjects with primary vaccine failure. We conclude that secondary vaccine failures occur and that while primary failures account for most cases, secondary vaccine failures contribute to the occurrence of measles cases in an epidemic. A booster dose of measles vaccine may be necessary to reduce susceptibility to a sufficiently low level to allow the goal of measles elimination to be achieved.

PMID: 2929807 [PubMed - indexed for MEDLINE]

: J Med Virol 1984;13(1):93-103 Related Articles, Help

The use of IgM tests for analysis of the causes of measles vaccine failures: experience gained in an epidemic in Hungary in 1980 and 1981.

Nagy G, Kosa S, Takatsy S, Koller M.

Following a period of 6 years of low measles incidence, an epidemic occurred in Hungary with more than 11,000 reported cases between September 1980 and August 1981. About 60% of the cases had a documented history of previous measles vaccination. Serum samples obtained from 7815 patients were examined for measles antibody by haemagglutination inhibition (HI). In addition to conventional antibody titration, most of the sera or their IgM fraction obtained by a simple ion exchange chromatography were tested for the presence of measles-specific IgM antibodies by 2-mercaptoethanol (2-ME) treatment, and in 300 patients also by the fluorescent antibody (FA) technique. Laboratory results confirmed the diagnosis of measles in 5356 patients and supported it in 685 cases. Primary antibody response was found in 96.1% of unvaccinated and in 77.4% of previously vaccinated patients. The percentage of secondary antibody responses increased with increasing time from vaccination only in patients vaccinated before their first birthday, whereas in those who were immunized when over 12 months old, the distribution of primary and secondary antibody responses was independent from the time that had elapsed since vaccination. Therefore, secondary vaccine failure due to waning immunity account for only 6.2% of previously vaccinated patients, whereas in 93.8% of patients, including the majority of those with secondary antibody response, a primary failure of vaccination due to unsuccessful immunization was incriminated.

PMID: 6693863 [PubMed - indexed for MEDLINE]

AN: 84113582

This abstract was put here because although most vaccine failures were considered to be "primary", secondary vaccine failures did occur. - SM

: Can J Public Health 1978 Jul-Aug;69(4):325-33 Related Articles, Help

The measles epidemic in Calgary, 1974-1975: the duration of protection conferred by vaccine.

O'Neil AE.
From the article: Individual immunity to measles, derived from live vaccine, wanes with time.

PMID: 688165 [PubMed - indexed for MEDLINE]

: J Pediatr 1977 Jan;90(1):17-20 Related Articles, Help

A measles outbreak among adolescents.

Weiner LB, Corwin RM, Nieburg PI, Feldman HA.

In a May, 1975, outbreak, 147 adolescents, ages 12 to 19 years, were identified as having measles by a physician or school nurse. One junior high school, with an enrollment of 1,122, contributed 131 of the cases. Of the 147 students, 54 were seen by physicians who also supplied their immunization records; 19 of 54 (35%) had received live measles virus vaccine without measles immune globulin, after age one year. The remaining 35 received: killed virus vaccine only (1), K + L (4), L + MIG (4), L at less than 1 year of age (4), L + ? MIG (4), immune serum globulin only, for exposure (6), no vaccine but history of measles previously (9); history uncertain (3). Hemagglutination-inhibition antibody titers were consistent with the diagnosis of acute measles in 11 children. No index case was identified and no secondary cases occured within the families of the 54 cases. This measles outbreak among seemingly immunized adolescents raises a serious question as to the duration of such protection.

PMID: 830888 [PubMed - indexed for MEDLINE]

: Am J Epidemiol 1969 Dec;90(6):514-8 Related Articles, Help

Persistence of measles antibody in the absence of circulating natural virus five years after immunization of an isolated virgin population with Edmonston B vaccine.

Brown P, Gajdusek DC, Tsai T.
From the abstract:  In the absence of circulating natural measles virus in an isolated Pacific atoll community after immunization of 136 immunologically virgin individuals from 1 to 24 years of age with Edmonston B strain live attenuated measles vaccine, serum levels of HI antibody remained stable between 1 and 2 1/2 years after immunization, but decline 2 to 3-fold by 5 years after immunization.  Sera having the highest antibody titers at 1 year showed the greatest decline, with a resultant narrowing of the titer range at 5 years.  Individuals with even undetectable HI antibody levels at 5 years, nevertheless showed neutralizing antibody at a serum dilution of at least 1:2, and thus presumably remain immune from infection.

PMID: 5362859 [PubMed - indexed for MEDLINE]


Contrary Views

Pediatr Infect Dis J 1996 Dec;15(12):1082-6 Related Articles, Help
Click here to read 
Measles vaccine effectiveness and duration of vaccine-induced immunity in the absence of boosting from exposure to measles virus.

Guris D, McCready J, Watson JC, Atkinson WL, Heath JL, Bellini WJ, Polloi A.

Center for Disease Control and Prevention, Atlanta, GA, USA.

BACKGROUND: It is unknown whether vaccine-induced immunity is lifelong in the absence of periodic exposure to measles virus. After 27 years of no known exposure to measles, an outbreak in Palau in 1993 offered the opportunity to study this issue and the measles vaccine effectiveness. METHODS: Household contacts of a sample of confirmed cases were interviewed for exposure, symptoms and vaccination status verified by records. Serum from symptomatic contacts was tested for measles antibodies. RESULTS: Among 78 contacts 4 of 5 (80%) unvaccinated, 4 of 35 (11%) 1-dose vaccine recipients and none of 38 (0%) > 1-dose recipients developed measles. Effectiveness of 1-dose vaccine was 86% (95% confidence interval, 60 to 95%). An additional dose significantly reduced the risk of measles (P = 0.048). Time since vaccination was not a significant risk factor for developing measles (relative risk, 1.6; 95% confidence interval, 0.3 to 9.4; persons vaccinated > 15 years ago vs. < 5 years ago). CONCLUSIONS: Similar to the estimates previously obtained in the area, measles vaccine effectiveness in Palau was lower than the estimates obtained in the US. A second dose of vaccine further reduced the risk for developing measles. We found no evidence that waning immunity was an important problem in this limited population with no known previous exposure to measles virus. The small number of vaccinated contacts precludes a definitive assessment.

PMID: 8970216 [PubMed - indexed for MEDLINE]

AN: 97125112

Am J Epidemiol 1999 Dec 1;150(11):1250-7 Related Articles, Help

Measles epidemic in Romania, 1996-1998: assessment of vaccine effectiveness by case-control and cohort studies.

Hennessey KA, Ion-Nedelcu N, Craciun MD, Toma F, Wattigney W, Strebel PM.

Vaccine-Preventable Disease Eradication Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, CA 30333, USA.

A measles epidemic occurred in Romania with 32,915 cases and 21 deaths reported between November 1996 and June 1998, despite high vaccination coverage since the early 1980s. Most cases were unvaccinated children aged <2 years and vaccinated school-aged children. A case-control study among preschool children and a cohort study among primary-school children were conducted to estimate effectiveness of Romanian-produced measles vaccine, and to evaluate age at vaccination and waning immunity as risk factors for vaccine failure. Both studies indicated that measles vaccine was highly effective. One dose reduced the risk for measles by 89% (95% confidence interval (CI) 85, 91); two doses reduced the risk by 96% (95% CI 92, 98). Children vaccinated at <1 year of age were not at increased risk for measles compared with children vaccinated at > or =1 year. Waning immunity was not identified as a risk factor since vaccine effectiveness was similar for children vaccinated 6-8, 9-11, and 12-14 years in the past. Because specific groups were not at risk for vaccine failure, an immunization campaign that targets all school-aged children who lack two doses may be an effective strategy for preventing outbreaks. A mass campaign followed by increased first-dose coverage should provide the population immunity required to interrupt indigenous measles virus transmission in Romania.

PMID: 10588086 [PubMed - indexed for MEDLINE]

Epidemiol Infect 1994 Apr;112(2):409-12 Related Articles, Help

Measles vaccine: a 27-year follow-up.

Ramsay ME, Moffatt D, O'Connor M.

Immunisation Division, PHLS Communicable Disease Surveillance Centre, London.

In 1964, the Medical Research Council undertook a trial of measles vaccine in over 36,000 United Kingdom children; 9577 of whom received live vaccine, 10,625 received inactivated followed by live vaccines, and 16,328 acted as unvaccinated controls. Participants in this study have been followed to determine the long term protection from measles vaccine and follow-up data were available on 4194, 4638 and 274 respectively. During the 5-year period 1986-90, the protective efficacy of live measles vaccine has remained high at 87%, but the 95% confidence interval was wide (-43 to 99%) due to the small numbers of cases. Between 1976 and 1990, however, the overall efficacy of the live vaccine was 92% (95% confidence interval 86 to 95%) and there was no evidence of a decline in efficacy (P = 0.13) over the 15-year period. This study suggests that the protection from live measles vaccine persists for up to 27 years after vaccination, and that no change in the current United Kingdom measles immunization policy should be made on the grounds of waning immunity.

PMID: 8150015 [PubMed - indexed for MEDLINE]

: Clin Pediatr (Phila) 1992 Apr;31(4):194-9 Related Articles, Help

Comment in:

Should all children receive two measles vaccinations? A study of measles susceptibility in a suburban New Jersey private practice.

Tesoro LJ, Levin MB, Atkin MD, Katz NS, Cotton JM, Patrick-Miller T, Langer MS.

Pediatric Group, Princeton, New Jersey.

Because of the rising incidence of rubeola, we tested all our patients who were vaccinated prior to 15 months of age and those vaccinated after 15 months, if requested, for susceptibility to measles (IgG, ELISA). Those found to be susceptible were revaccinated. Of 1,228 tested, 264 (21.5%) were susceptible. In the group vaccinated before 1980, 237 of 901 (26.3%) were susceptible, whereas only 27 of 327 (8.3%) vaccinated after 1980 were not immune. Susceptibility was sharply divided by month of age at vaccination at the 14-month mark. Less than 5% of those vaccinated after age 15 months in the 1980s (one of 22, or 4.5%) were susceptible. Waning immunity (secondary vaccine failure) was not found to be a factor in our patients. Despite outbreaks of measles in surrounding communities and in our area, none of our patients developed measles. Identification of high-risk groups and selective measles revaccination should be considered as an alternative to universal revaccination in populations such as ours, since it is more cost-effective and may prove equally successful.

PMID: 1563191 [PubMed - indexed for MEDLINE]

AN: 92224532

Zh Mikrobiol Epidemiol Immunobiol 1990 May;(5):32-7 Related Articles, Help

[The duration and strength of postvaccinal measles immunity]

[Article in Russian]

Bolotovskii VM, Gelikman BG, Auzinia AV, Glinskaia EV.

A prolonged immunoepidemiological follow-up of a large group of children immunized against measles revealed a high epidemiological efficacy of a single vaccination. Cases of measles were registered only among those vaccinees in whose blood sera no specific hemagglutinins were detectable by titration with 4 hemagglutinating units of measles antigen prior to the disease. The study showed that groups of children seronegative with respect to measles appeared, as a rule, after unsatisfactory immunization and not due to loss of postvaccinal immunity with time. Properly immunized children in whom the formation of antimeasles antibodies had occurred in response to the injection of live measles vaccine retained postvaccinal immunity for more that 15 years (the term of observation).

PMID: 2386001 [PubMed - indexed for MEDLINE]

Am J Public Health 1987 Apr;77(4):434-8 Related Articles, Help

Measles outbreak in a vaccinated school population: epidemiology, chains of transmission and the role of vaccine failures.

Nkowane BM, Bart SW, Orenstein WA, Baltier M.

An outbreak of measles occurred in a high school with a documented vaccination level of 98 per cent. Nineteen (70 per cent) of the cases were students who had histories of measles vaccination at 12 months of age or older and are therefore considered vaccine failures. Persons who were unimmunized or immunized at less than 12 months of age had substantially higher attack rates compared to those immunized on or after 12 months of age. Vaccine failures among apparently adequately vaccinated individuals were sources of infection for at least 48 per cent of the cases in the outbreak. There was no evidence to suggest that waning immunity was a contributing factor among the vaccine failures. Close contact with cases of measles in the high school, source or provider of vaccine, sharing common activities or classes with cases, and verification of the vaccination history were not significant risk factors in the outbreak. The outbreak subsided spontaneously after four generations of illness in the school and demonstrates that when measles is introduced in a highly vaccinated population, vaccine failures may play some role in transmission but that such transmission is not usually sustained.

PMID: 3826461 [PubMed - indexed for MEDLINE]

Pediatrics 1985 Oct;76(4):518-23 Related Articles, Help

Risk factors for measles vaccine failure among immunized students.

Hull HF, Montes JM, Hays PC, Lucero RL.

An outbreak of measles occurred in a municipal school system which had reported 98% of students immunized against measles. A case-control study was conducted to determine reasons for vaccine failure. Vaccine failure was associated with immunizations that could not be documented in the provider's records. Among children with provider-documented immunization, vaccine failure was associated with vaccination at 12 to 14 months of age with an odds ratio of 4.73. Among children vaccinated at 15 months or older, vaccine failure was not associated with time elapsed since vaccination. Studies should be conducted to determine whether unreliable immunization records are a more widespread problem. Further consideration should be given to routine revaccination of children previously vaccinated at 12 to 14 months of age.

PMID: 4047794 [PubMed - indexed for MEDLINE]

Med J Aust 1983 Nov 12;2(10):488-91 Related Articles, Help

Measles in the 1980s.

Christopher PJ, MacDonald PA, Murphy AM, Buckley PR.

We detail aspects of measles immunization programmes in several countries. Live measles vaccine has been available in Australia for 16 years, yet, in 1981, there were outbreaks of measles in the State of New South Wales (population 5 200 000) which led to 2200 admissions to hospital and five deaths. In response to complaints of "vaccine failure", a survey determined that 22.5% of children with measles seen by general practitioners and 10.3% of those admitted to hospitals had been previously immunized. There was no evidence of waning immunity, and noparticular batch of vaccine was implicated. The vaccine failures are attributed in part to failure of seroconversion in some recipients when immunized at 12 months of age as a result of interference by transplacentally acquired antibodies. As more of the susceptible population is vaccinated, there will be fewer cases of measles, but among these cases will be an increasing proportion of cases occurring in previously vaccinated individuals. The equation to calculate this expected proportion of "vaccine failures" is given. We support the measures to increase immunization compliance.

PMID: 6633361 [PubMed - indexed for MEDLINE]

AN: 84039106

Am J Dis Child 1978 Mar;132(3):287-90 Related Articles, Help

Measles revaccination. Persistence and degree of antibody titer by type of immune response.

Deseda-Tous J, Cherry JD, Spencer MJ, Welliver RC, Boyer KM, Dudley JP, Zahradnik JM, Krause PJ, Walbergh EW.

During a measles immunization campaign 203 children were enrolled in an antibody response study. Of this group, follow-up clinical data and sera samples were available from 125 children three weeks after immunization and from 90 children ten months later. Seventy-six of the children had been previously vaccinated, ten had a history of measles and 39 denied vaccination or illness. Twenty-six of the children had prevaccination hemagglutination inhibiting antibody titers of less than 5. Of this group 12 had a primary immune response (IgM measles antibody) with geometric mean titers (GMT) of 90 and 40 three weeks and ten months respectively after vaccination. In contrast, the other 14 children with initial titers of less than 5 had secondary immune responses (only IgG measles antibody) with GMTs of 28 and 9 three weeks and ten months after vaccination. Since the antibody responses in these children who had previously been stimulated by measles antigen were modest and transient, it is suggested that booster immunization may not be effective in preventing future secondary vaccine failures. Also noted in this study was a poor correlation between historical data and actual measles antibody.

PMID: 629246 [PubMed - indexed for MEDLINE]

Pediatrics 1978 Dec;62(6):961-4 Related Articles, Help

Measles vaccine efficacy: influence of age at vaccination vs. duration of time since vaccination.

Shelton JD, Jacobson JE, Orenstein WA, Schulz KF, Donnell HD Jr.

To evaluate the recent decision of the Advisory Committee on Immunization Practice to increase the recommended age for initial measles vaccination from 12 to 15 months, we carried out a case control study of vaccine failure in a recent measles epidemic. Compared to children vaccinated at ages 15 months or older, we found an increased risk of vaccine failure among those vaccinated at 12 to 14 months (relative risk = 19.2, 95% confidence interval = 4.6 to 80.1). In order to sort out the influence of age at vaccination from elapsed time since vaccination, we subjected the data to discriminant analysis. Age at vaccination subsumed all of the effect of duration of time since vaccination. Thus, we find no evidence of waning immunity over time.

PMID: 733424 [PubMed - indexed for MEDLINE]