Vaccinated mothers pass on less measles immunity to their infants
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Vaccine 2001 Mar 21;19(17-19):2258-61 |
Measles elimination: old and new challenges?
Muller CP.
Department of Immunology, WHO Collaborative Center for Measles, Laboratoire
National de Sante, P.O. Box 1102, L-1011, Luxembourg. claude.muller@santel.lu
Life attenuated measles vaccines have dramatically reduced measles morbidity
and mortality world-wide. Despite high vaccination coverage, measles outbreaks
continue to occur both in developed and developing countries. While secondary
vaccine failure may be responsible for disease in some seroconverted
individuals, evidence suggests that many more vaccinees who are protected
against disease may not be fully protected against virus infection. In low-income developing
countries protection by maternal antibodies seems to erode faster than
previously estimated especially in infants who were born to vaccinated mothers.
Problems of infectivity and susceptibility of vaccinees will be compounded in
case wild-type viruses become less sensitive to vaccine induced immunity. These
observations suggest that elimination may be more easily achieved as long as
large proportions of populations are protected by wild-type virus-induced
immunity.
PMID: 11257344 [PubMed - indexed for MEDLINE]
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Schweiz Med Wochenschr 2000 Oct 14;130(41):1479-86 |
[Seroprevalence of IgG antibodies against
measles, mumps and rubella in Swiss children during the first 16 months of
life]
[Article in German]
Desgrandchamps D, Schaad UB, Glaus J, Tusch G, Heininger U.
Abteilung fur Infektiologie und Vakzinologie, Universitats-Kinderspital beider
Basel.
OBJECTIVE: To study the question of how long maternal IgG antibodies against
measles, mumps and rubella persist in infants. METHODS: Sera of children aged
0-16 months who had been hospitalised in our institution between 1994 and 1999
were identified from our routine serum collection. Exclusion criteria were:
preterm delivery; suspected measles, mumps or rubella illness or exanthema of
unknown aetiology; transfusion of blood products in the 6 months preceding
serum collection; foreign-born mother; previous MMR immunisation. IgG
antibodies were measured by use of commercially available ELISA kits. RESULTS:
254 serum specimens were analysed. Age distribution of patients was as follows:
0-3 months n = 58; > 3-6 months n = 48; > 6-9 months n = 52; > 9-12
months n = 42; > 12-16 months n = 54. The following seroprevalence rates for
IgG antibodies were found (measles/mumps/rubella): 0-3 months 97%/62%/91%; >
3-6 months 40%/2%/42%; > 6-9 months 4%/2%/10%; > 9-12 months 2%/0%/12%;
> 12-16 months 0%/7%/7%. CONCLUSIONS: Our results demonstrate high levels of passive immunity
against measles and rubella in Swiss infants during the first months of
life, whereas immunity against mumps appears to be considerably less reliable.
Beyond the first 3 months of life, IgG antibodies against all 3 illnesses are
lacking in the majority of patients; beyond 12 months of age they are only rarely
detectable. These results raise the question whether the first MMR
immunisation, currently recommended at the age of 15 months in Switzerland,
should be brought forward.
PMID: 11075412 [PubMed - indexed for MEDLINE]
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Pediatr Int 2000 Jun;42(3):233-5 |
Recent increase in the frequency of infant
measles in Japan.
Ohsaki M, Tsutsumi H, Takeuchi R, Seki K, Chiba S.
Department of Pediatrics, Sapporo Medical University School of Medicine, Japan.
BACKGROUND: Because there has been no major outbreak of measles in Japan during
the last decade, subclinical boosting of pre-existing immunity by exposure to
epidemic measles is unlikely to have occurred. Consequently, the measles immunity of mothers of this
generation is less well developed and they provide less effective passive
immunity to their infants. An increase in the frequency of infant
measles is therefore probable. METHOD AND RESULTS: A retrospective review was
undertaken of the clinical records of all measles cases that occurred in the
last 3 years in eight hospitals and two out-patient clinics in Hokkaido. Of 541
recorded cases, 96 (17.7%) were infants and of these, 66 patients (68.8%) were
over 9 months of age. Only 20 children had received measles vaccination.
CONCLUSION: There has been a recent increase in the frequency of infant
measles, suggesting an increased population of infants susceptible to measles
before the age of 1. Of the older patients, 95% had not been vaccinated against
measles. Increasing the rate of measles vaccination may help suppress future
measles outbreaks and assist in protecting infants until they pass their first
birthday.
PMID: 10881577 [PubMed - indexed for MEDLINE]
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Vaccine 2000 May 8;18(22):2411-5 |
Measles vaccine immunogenicity and antibody
persistence in 12 vs 15-month old infants.
Johnson CE, Darbari A, Darbari DS, Nalin D, Whitwell J, Chui LW, Cleves MA,
Kumar ML.
Department of Pediatrics, University of Colorado, Denver, USA.
johnson.candice@TCHDEN.ORG
HYPOTHESIS: Maternal
measles immunity in the United States today is primarily vaccine induced, with
corresponding lower antibody titers in infants, as compared to infants born in
an earlier era to mothers with naturally acquired measles immunity. We
hypothesized that, due to lower titer of passively transferred maternal measles
antibody, administration of measles vaccine at 12 months of age would result in
seroconversion and antibody persistence comparable to vaccination at 15 months
of age. POPULATION: Children at both an urban hospital and a suburban clinic.
METHODS: Informed consent was obtained from mothers for the infants to receive
M-M-R(R)II vaccine at either 12 or 15 months and to have serum samples obtained
before vaccination and 4 weeks post-vaccination (PV). Between 9 and 39 months
PV, a third serum sample was obtained from 28% of seroconverters. A diary of
adverse experiences was kept for 3 weeks PV. Sera were assayed by a
microneutralization assay (NT) and an enzyme immunoassay (EIA) for measles
antibody. RESULTS: Both age groups tolerated vaccination well with minor and
transient side effects. Forty-four of 47 (94%) 12-month-old infants
seroconverted by NT, compared to 45 of 46 (98%) 15-month-olds (p=NS). There was
no statistically significant decline in median NT titers or EIA titers in
nineteen 12-month-olds and thirteen 15-month olds followed for 9-39 months PV.
CONCLUSION: This study showed comparable serologic responses in 12- vs
15-month-old infants born to measles vaccine-immune mothers; however, the
sample size was too small to have adequate power and further study is
indicated. Titers of antibody were constant in both the 12-month-old and the
15-month-old infants, over a 9-39 month period, suggesting that waning immunity
over this period of time is not a problem in either age group.
PMID: 10738098 [PubMed - indexed for MEDLINE]
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Vaccine 1999 Jan;17(2):182-92 |
A comparison of alternate immunization
regimes for measles in vaccinated populations.
Pabst HF, Boothe PM, Carson MM.
Department of Pediatrics, University of Alberta, Edmonton, Canada.
Infants today lose
maternal measles antibody sooner than in the past. This is related to
demographic changes in maternal immunization. Data for rates of decay of
maternal antibody and seroconversion after measles vaccination for infants born
to naturally immune (Group 1) or vaccinated (Group 2) mothers have been used to
evaluate two vaccination schedules: Regime 1, measles-mumps-rubella (MMR) at 1
year of age and Regime 2, monovalent measles at 6 months followed by MMR at 15
months of age. Regime 2 costs less because MMR can be administered at 15 months
with the last pentavalent booster. Months of protection/1000 children aged 0-15
months (child-months of protection) were estimated for infant populations
ranging from 0 to 100% Group 1 for Regimes 1 and 2. Regime 1 provides more
child-months of protection only for 100% Group 1 populations. For the study
population Regime 2 provided at least 17% more child-months of protection than
Regime 1. Regime 2 provides increased medical and financial benefits in
proportion to the number of Group 2 infants in the population and thus is ever
more advantageous for today's increasingly vaccinated populations.
PMID: 9987153 [PubMed - indexed for MEDLINE]
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: Acta Med Port 1998 Oct;11(10):847-53 |
[Anti-measles igg concentration in maternal
blood and in umbilical cord blood: according to the mother's vaccination
status]
[Article in Portuguese]
Goncalves G, De Andrade HR, Cutts F.
Instituto Nacional de Saude Dr. Ricardo Jorge (INSA), Delegacao no Porto.
A study on passive immunity against measles was conducted in four hospitals of
Oporto, Portugal. The objectives were to assess whether maternal measles
vaccination status was associated to the levels of measles IgG in maternal and
cord sera, and with the transplacental transport efficiency. Cord and venous
maternal blood samples were collected from 1539 mother-child pairs enrolled. An
enzyme immunoassay was used to measure measles IgG levels in the study sera.
Results were expressed in mIU/ml. Vaccination records were consulted. Geometric
mean concentration of measles IgG among vaccinated mothers (730 mIU/ml; 95% CI
602 to 884 mIU/ml; n = 79) was significantly (P < 0.0001) lower than among
their unvaccinated counterparts (1535 mIU/ml; 95% CI 1460 to 1613 mIU/ml; n =
1317). The same was observed in the corresponding cord sera: those born to
vaccinated mothers had significantly (P < 0.0001) lower levels of measles
IgG (1083 mIU/ml; 95% CI 908 to 1291) than the newborns of unvaccinated mothers
(2230 mIU/ml; 95% CI 2119 to 2347). Transplacental transport efficiency was not
related with maternal vaccination status (P = 0.67). Measles IgG levels observed
in this Portuguese study were similar to those observed in a study conducted in
South Africa, but higher than those reported in a British study. The
differences in measles IgG levels between vaccinated and unvaccinated mothers
(and corresponding newborns) are consistent with similar findings already
published in different countries. The lower levels of measles IgG among children born to vaccinated
mothers may lead to the anticipation of the recommended age to vaccinate
against measles in Portugal.
PMID: 10021779 [PubMed - indexed for MEDLINE]
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Vaccine 1997 Apr-May;15(6-7):620-3 |
Passive immunity against measles during the
first 8 months of life of infants born to vaccinated mothers or to mothers who
sustained measles.
De Serres G, Joly JR, Fauvel M, Meyer F, Masse B, Boulianne N.
Centre de Sante Publique de Quebec, Beauport, Canada.
Neutralizing antibody titers of 47 infants whose mothers sustained measles
(measles group) and 70 whose mothers were vaccinated (vaccine group) were
compared at birth, 4 and 8 months of age. All children had antibodies at birth
and 88% at 4 months. At 8
months, 49% had antibodies in the measles group and 15% in the vaccine group (P
< 0.001). The geometric mean titers were significantly lower in the
vaccine group than in the measles group and the difference corresponded to the
antibody loss occurring in only 1.5 months of life. This small difference may
reflect past exposure to wild virus of many vaccinated mothers.
PMID: 9178461 [PubMed - indexed for MEDLINE]
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Epidemiol Infect 1996 Dec;117(3):519-24 |
A study of maternally derived measles
antibody in infants born to naturally infected and vaccinated women.
Brugha R, Ramsay M, Forsey T, Brown D.
Immunisation Division, Public Health Laboratory Service (PHLS) Communicable
Disease Surveillance Centre, London.
Maternal, cord and infant measles antibody levels were measured and compared in
a group of 411 vaccinated mothers and 240 unvaccinated mothers, and their
babies, between 1983 and 1991. Maternal and cord sera were tested by
haemagglutination inhibition and/or enzyme-linked immunosorbent assay, and
plaque reduction neutralization tests were also used to test infant sera.
Geometric mean titres were significantly higher in the unvaccinated than in the
vaccinated mothers (P < 0.001). Infants born to mothers with a history of measles had higher antibody
levels at birth than infants of vaccinated mothers and, although the difference
narrowed over time, continued to have higher levels up to 30 weeks of age.
Between 5 and 7 months of age significantly more of the children of vaccinated
mothers had plaque reduction neutralization antibody levels below that which
would interfere with vaccination. As the boosting effect of circulating natural
measles disappears, earlier measles vaccination may need to be considered,
perhaps as part of a two-dose policy.
PMID: 8972678 [PubMed - indexed for MEDLINE]
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Pediatrics 1996 Jan;97(1):53-8 |
Changing levels of measles antibody titers in
women and children in the United States: impact on response to vaccination.
Kaiser Permanente Measles Vaccine Trial Team.
Markowitz LE, Albrecht P, Rhodes P, Demonteverde R, Swint E, Maes EF, Powell
C, Patriarca PA.
National Immunization Program, Centers for Disease Control and Prevention,
Atlanta, Georgia 30333, USA.
OBJECTIVES. In the United States, younger women are more likely to have
immunity to measles from vaccination and are less likely to have been exposed
to the wild virus than are older women. To evaluate changes in measles antibody
titers in women in the United States and children's responses to measles
vaccination, we analyzed data from a measles vaccine trial. METHODS. Sera
collected from children before vaccination at 6, 9, or 12 months of age and
from their mothers were assayed for measles antibodies by plaque reduction
neutralization. Responses to vaccination with Merck Sharp & Dohme live
measles virus vaccines at 9 months (Attenuvax) and 12 months (M-M-R II) were
also analyzed. RESULTS. Among women born in the United States (n = 614),
geometric mean titers (GMTs) of measles antibodies decreased with increasing
birth year. For those born before 1957, 1957 through 1963, and after 1963, GMTs
were 4798, 2665, and 989, respectively. Among women born outside of the United
States (n = 394), there were no differences in GMTs by year of birth. Children
of younger women born in the United States were less likely than those of older
women to be seropositive at 6, 9, or 12 months. The response to the vaccines
varied by maternal birth year for children of women born in the United States.
Among 9-month-old children, 93% of those whose mothers were born after 1963
responded, compared with 77% and 60% of those whose mothers were born in 1957
through 1963 and before 1957, respectively. Among 12-month-old children, 98% of
those born to the youngest mothers responded, compared with 90% and 83% of
those whose mothers were born in 1957 through 1963 and before 1957. The
responses of children of women born outside of the United States were not
associated with maternal year of birth. CONCLUSIONS. An increasing proportion of children in the United
States will respond to the measles vaccine at younger ages because of lower
levels of passively acquired maternal measles antibodies.
PMID: 8545224 [PubMed - indexed for MEDLINE]
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Pediatrics 1995 Sep;96(3 Pt 1):447-50 |
Early loss of passive measles antibody in
infants of mothers with vaccine-induced immunity.
Maldonado YA, Lawrence EC, DeHovitz R, Hartzell H, Albrecht P.
Department of Pediatrics, Stanford University School of Medicine, California
94305, USA.
BACKGROUND. Maternally derived passive measles antibody may interfere with
vaccine-induced immunity in infants less than 12 months of age. However, early
loss of passive measles antibody may occur in infants of women who received
measles vaccine because measles vaccine induces lower antibody titers than does
natural infection. METHODS. Persistence of passive neutralizing measles
antibody was studied longitudinally in a group of normal infants as a function
of maternal measles titer at birth and maternal date of birth. Maternal serum
and cord blood specimens were tested from 162 women and their newborns, from 51
of these infants at 9 months of age and from 63 at 12 months of age. RESULTS.
Seventy-one percent of sera from 9-month-old infants (36 of 51, 95% confidence
interval 68% to 84%) and 95% of samples from 12-month-old infants (60 of 63,
95% confidence interval 89% to 101%) had no detectable neutralizing measles
antibody. Measles geometric mean titers were significantly higher at delivery
in mothers whose infants were seropositive at 9 and 12 months compared with
mothers whose infants were seronegative at 9 and 12 months. All infants with detectable
measles antibody at 9 or 12 months had mothers born before 1963, before the
vaccine era, and both material and cord blood measles geometric mean
titers decreased significantly with decreasing maternal age. CONCLUSIONS. Persistence
of passive measles antibody is uncommon by 12 months of age; earlier antibody
loss is related to lower maternal age and maternal measles titer.
PMID: 7651776 [PubMed - indexed for MEDLINE]
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J Med Virol 1995 Feb;45(2):227-9 |
Measles antibodies in women and infants in
the vaccine era.
Kacica MA, Venezia RA, Miller J, Hughes PA, Lepow ML.
Department of Pediatrics, Albany Medical College, NY 12208, USA.
The present investigation was done to determine whether measles enzyme immune
assay (EIA) absorbency values were lower in women born in the vaccine era after
1963 and their infants in an upstate New York metropolitan area, an area of low
measles incidence during the past 10 years compared with women born before the
measles vaccine era who had natural measles. Aliquots of 202 sera from
mother-infant pairs collected for other purposes from November 1990 to June
1991 at Albany Medical Center Hospital were tested by EIA. The demographic data
available for analysis were maternal age and infant gestational age. Measles
mean absorbency values were analyzed according to maternal age. Of 202 mother-infant
pairs, 30% of mothers and 17% of their infants were seronegative (EIA <
0.16). Mothers born before 1963 and their infants had significantly higher mean
EIA absorbency values than mothers born after 1963 and their infants (P <
0.002). The percent seropositive for measles antibodies by EIA for mothers born
before 1963 and their infants, 87% and 94%, respectively, was significantly
higher than the percent seropositive for mothers born after 1963 and their
infants, 61% and 69%, respectively (P = 0.0001). Since the mean measles antibodies as measured by EIA
absorbency were significantly lower in the mothers born after 1963 and their
infants compared with women born before the vaccine era, the strategy for
measles control in the future may have to include lowering the age of infant
immunization.
PMID: 7775944 [PubMed - indexed for MEDLINE]
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Pediatr Infect Dis J 1995 Jan;14(1):17-22 |
Measles vaccination of infants in a
well-vaccinated population.
Carson MM, Spady DW, Albrecht P, Beeler JA, Thipphawong J, Barreto L,
Grimsrud KM, Pabst HF.
Department of Pediatrics, University of Alberta, Edmonton, Canada.
During outbreaks of measles, measles vaccine is recommended for infants
considered to be at risk who are 6 months of age and older. In a prospective
trial the serologic response to early measles immunization has been evaluated
in 125 infants given monovalent measles vaccine at 6 to 8.5 months of age and
measles-mumps-rubella at 15 months. The response to vaccination was measured by
plaque reduction neutralization (PRN) assay and enzyme immunoassay. Infants
were grouped by the mother's immunization history: natural immunity (n = 60,
Group 1); killed followed by live, further attenuated vaccine (n = 22, Group
2); and live, further attenuated vaccine only (n = 43, Group 3). The
prevaccination geometric mean titer (GMT) by PRN for Group 1 (GMT = 69) was
significantly higher than that of Group 2 (GMT = 18) or 3 (GMT = 13).
Seroconversion (4-fold increase in PRN titer) rates after monovalent vaccine
were 31, 71 and 76% for Groups 1, 2 and 3, respectively. Seroconversion
percentages were higher when measured 6 to 8 weeks after vaccination compared
with 4 to 5 weeks. After measles-mumps-rubella > or = 97% of all infants had
PRN titers > 120 and were measles IgG-positive by enzyme immunoassay. These data show that as
demographics shift to a well-vaccinated maternal population and susceptibility
in younger infants, measles vaccination before the currently recommended age
will be effective.
PMID: 7715983 [PubMed - indexed for MEDLINE]
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OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.