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Vaccine, Vol. 19 (31) (2001) pp. 4473 - 4478
© 2001 Published by Elsevier Science Ltd. All rights reserved.
PII: S0264-410X(01)00207-9
a Division
of Pediatric Infectious Diseases, Hacettepe University School of Medicine,
Ankara, 06100 Turkey
b Department of Pediatrics, Kapiolani Medical Center for Women and
Children, University of Hawaii John A. Burns School of Medicine, Honolulu, HI,
USA
c Division of Pediatric Infectious Diseases, Hacettepe University
School of Medicine, Ankara, Turkey
Received 11 September 2000; received
in revised form 14 May 2001; accepted 21 May 2001
Background and methods: measles is a common cause of morbidity and
mortality in developing countries. Although the measles-mumps-rubella vaccine
(MMR) is currently in use in developed countries, monovalent measles vaccine
(MV) is routinely recommended by World Health Organization (WHO) at 9 months of
age in Turkey, as in many other developing countries. In this study, 442
Turkish children received MV at 9 months of age and were revaccinated with MMR
vaccine at 15 months of age. In the second group 495 children received MMR at
12 months of age with no earlier measles vaccination. Antibodies were measured
before the first vaccination and 6 weeks after the MMR. All children had been
followed for occurrence of measles infection for 60 months. Two vaccination
schedules were compared for immunogenicity and protection rates. Conclusions:
seroconversion and clinical protection rates were significantly higher in
children who received only MMR at 12 months of age than in children
revaccinated at 15 months of age. Seroconversion rate for measles was 69.9% in
children who received MMR at 12 months of age and 90.3% in children
revaccinated at 15 months of age (P=0.0003). While there was no measles
case in children who were revaccinated, 12 (2.7%) children in the first group
acquired measles during the follow-up period. Vaccination at 12 months of age
appeared to be better than the current national standard. The late elimination
of maternal antibodies and the inhibitory effect of a weak antibody response
after the first dose of vaccine at 9 months may explain the better
immunogenicity and efficacy of the MMR vaccine given at 12 months of age.
Keywords: Monovalent measles vaccine; MMR vaccine;
Developing countries
*Corresponding author. Tel.: +90-312-311-4963; fax:
+90-312-324-3284
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