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Note:  There are studies that I am not sending you which purport to show that waning immunity is not a problem.  I am not trying to show both sides, just evidence that waning immunity is an issue.  Although I didn't keep track, it seems as if more often it was the earlier studies which found less evidence for waning immunity.  - SM

 

Measles eradication: is it in our future?
Orenstein-WA; Strebel-PM; Papania-M; Sutter-RW; Bellini-WJ; Cochi-SL
Am-J-Public-Health. 2000 Oct; 90(10): 1521-5
"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."

 

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
Epidemiol-Infect. 2000 Apr; 124(2): 263-71

"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."
In other words, we need measles to circulate to boost vaccine induced immunity and prevent it from waning! (It may also be true of natural immunity, if the study showing lack of transplacental maternal antibodies in naturally immune mothers not exposed to wild virus proves to be relevant to all naturally immune people as well.)

 

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
Am-J-Epidemiol. 1999 Dec 1; 150(11): 1238-49
"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."

 

The control of mumps in Israel.
Slater-PE; Anis-E; Leventhal-A
Eur-J-Epidemiol. 1999 Sep; 15(8): 765-7
"Although small outbreaks occur and may continue to occur in future years, because of under-vaccination of children, primary vaccine failure and waning immunity, it can tentatively be said that mumps is no longer a public health problem in Israel."

 

Immunization and vaccine-preventable illness, United States, 1992 to 1997.
Teitelbaum-MA; Edmunds-M
Stat-Bull-Metrop-Insur-Co. 1999 Apr-Jun; 80(2): 13-20
"Pertussis (whooping cough), however, continued its pattern of periodic increases and decreases. This lack of improvement is probably due to a combination of lower immunization levels for pertussis and waning immunity in previously immunized adolescents and young adults."

 

Resurgent diphtheria--are we safe?
Eskola-J; Lumio-J; Vuopio-Varkila-J
Br-Med-Bull. 1998; 54(3): 635-45

"Diphtheria, one of the major causes of morbidity and mortality in the past, seemed nearly eliminated from industrialized countries, thanks to improved hygienic conditions and large scale vaccinations. In 1990, a large epidemic started in Eastern Europe, mainly in Russia and Ukraine, with over 70,000 cases reported within a 5 year period. The main factors leading to the epidemic included low immunization coverage among infants and children, waning immunity to diphtheria among (previously vaccinated?) adults, and profound social changes in the former Soviet Union."

 

Analysis of mumps vaccine failure by means of avidity testing for mumps virus-specific immunoglobulin G.
Narita-M; Matsuzono-Y; Takekoshi-Y; Yamada-S; Itakura-O; Kubota-M; Kikuta-H; Togashi-T
Clin-Diagn-Lab-Immunol. 1998 Nov; 5(6): 799-803
"These results showed that secondary mumps vaccine failure occurs not infrequently, even among school age children under condition in which the vaccine coverage is low (i.e., 33% in our study population), and therefore, vaccinees are prone to be exposed to wild-type viruses."

I need to read the article itself, which I do not currently have, to understand their point. I know they are saying that low vaccine coverage leads to circulation of wild-type viruses, but the I don't understand the significance or meaning of the "even under" statement.  Sleep deprivation?

 

Estimated susceptibility to asymptomatic secondary immune response against measles in late convalescent and vaccinated persons.
Damien-B; Huiss-S; Schneider-F; Muller-CP
J-Med-Virol. 1998 Sep; 56(1): 85-90
"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.........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."

 

Pertussis infection in adults.
Wright-SW
South-Med-J. 1998 Aug; 91(8): 702-8; quiz 709
"Pertussis infection, because of waning immunity, is common in adults (previously vaccinated?). Routine booster immunization of adults with the newer acellular vaccine may lead to the elimination of the disease in both children and adults."

 

Five cases of measles secondary vaccine failure with confirmed seroconversion after live measles vaccination.
Hirose-M; Hidaka-Y; Miyazaki-C; Ueda-K; Yoshikawa-H
Scand-J-Infect-Dis. 1997; 29(2): 187-90
"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.......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."

Antibody persistence after primary measles-mumps-rubella vaccine and response to a second dose given at four to six vs. eleven to thirteen years.
Johnson-CE; Kumar-ML; Whitwell-JK; Staehle-BO; Rome-LP; Dinakar-C; Hurni-W; Nalin-DR
Pediatr-Infect-Dis-J. 1996 Aug; 15(8): 687-92
"Rubella ELISA seropositivity was 67% in 11- to 13-year-olds, compared with 90% in 4- to 6-year-olds (P < 0.01), suggestive of waning immunity. Rubella NT seropositivity was also lower in 11- to 13-year-olds than in 4- to 6-year-olds (63% vs. 100%, P < 0.01). "

 

Resurgence of diphtheria.
Galazka-AM; Robertson-SE; Oblapenko-GP
Eur-J-Epidemiol. 1995 Feb; 11(1): 95-105
"The main reasons for the return of diphtheria in these countries were: decreasing immunization coverage among infants and children waning immunity to diphtheria in adults, movements of the population during the last few years, and an irregular supply of vaccines."

 

Measles encephalomyelitis in a patient with a history of vaccination.
Matsuzono-Y; Narita-M; Satake-A; Togashi-T; Itakura-O; Ozutsumi-K; Iguchi-M
Acta-Paediatr-Jpn. 1995 Jun; 37(3): 374-6
"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........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."

 

TI:  Present and future challenges of immunizations on the health of our patients.
AU:  Gershon-AA
SO:  Pediatr-Infect-Dis-J. 1995 May; 14(5): 445-9
JN:  The-Pediatric-infectious-disease-journal
ISSN:  0891-3668
LA:  ENGLISH
"Diseases that now pose special problems include pertussis, hepatitis A and B and varicella. The incidence of pertussis surged in 1994, possibly in part because of waning immunity in the immunized population. Acellular pertussis vaccines are available for booster doses in children but are not now recommended for adults. Licensure of acellular pertussis vaccines for primary immunization of infants is eagerly awaited. Recombinant hepatitis B vaccine has been licensed for more than 10 years but there has been little change in disease incidence in the United States. Routine immunization of infants is now recommended but concerns exist about cost and persistence of immunity into adolescence."

 

Pertussis in the young infant.
Hampl-SD; Olson-LC
Semin-Respir-Infect. 1995 Mar; 10(1): 58-62
"(Previously vaccinated?) Adults with waning immunity, who have subclinical pertussis, frequently infect nonimmunized or underimmunized children within the same household. High levels of pertussis activity persist, even in highly immunized populations."

 

Pertussis in adolescents and adults: time to reimmunize?
Keitel-WA; Edwards-KM
Semin-Respir-Infect. 1995 Mar; 10(1): 51-7
"The role of adults as reservoirs of pertussis infections and as victims of symptomatic disease has recently been recognized. Waning immunity after routine pertussis immunization in childhood appears to contribute to this problem." Record 33 of 61 in

 

The 1992 measles epidemic in Cape Town--a changing epidemiological pattern.
Coetzee-N; Hussey-GD; Visser-G; Barron-P; Keen-A
S-Afr-Med-J. 1994 Mar; 84(3): 145-9
"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."

 

Secondary measles vaccine failure in healthcare workers exposed to infected patients.
Ammari-LK; Bell-LM; Hodinka-RL
Infect-Control-Hosp-Epidemiol. 1993 Feb; 14(2): 81-6
"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."

 

Reappearance of post-vaccination infection of measles, rubella and mumps. Should adolescents be revaccinated? (editorial)]
Malengreau-M
Pediatrie-Bucur. 1992; 47(9): 597-601
"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)." 

 

[Duration of immunity and occurrence of secondary vaccine failure following vaccination against measles, mumps and rubella]
Trier-H; Ronne-T
Ugeskr-Laeger. 1992 Jul 13; 154(29): 2008-13
"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."

These authors conclude that waning immunity, although it exists, is not a problem.  Without reading the article I cannot determine the strength of their argument.  However, they make a very important observation which I have boldly highlighted in blue.

 

TI:  Secondary immune response in a vaccinated population during a large measles epidemic.
AU:  Ozanne-G; d'Halewyn-MA
SO:  J-Clin-Microbiol. 1992 Jul; 30(7): 1778-82
JN:  Journal-of-clinical-microbiology
ISSN:  0095-1137
LA:  ENGLISH
"In conclusion, neither prior vaccination nor detectable SIR ensures protective immunity."

 

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
J-Adolesc-Health. 1991 May; 12(3): 273-8
"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)."

 

Mild measles and secondary vaccine failure during a sustained outbreak in a highly vaccinated population [see comments]
Edmonson-MB; Addiss-DG; McPherson-JT; Berg-JL; Circo-SR; Davis-JP
JAMA. 1990 May 9; 263(18): 2467-71
"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."

 

The changing epidemiology of pertussis in young infants. The role of adults as reservoirs of infection.
Nelson-JD
Am-J-Dis-Child. 1978 Apr; 132(4): 371-3
"We reviewed 400 bacteriologically confirmed cases of pertussis in infants and children during the past 18 years. Several changes in the epidemiology have occurred in the most recent six-year period. The incidence of whooping cough in children has decreased by at least 50%, but the proportion of cases occurring in infants younger than 12 weeks of age has doubled to 30% of all cases. Formerly most young infants acquired their illness from siblings or other children, but in the recent period adults in the household were the most common source of infection to neonates and young infants. This observation plus the increasingly high level of immunization in preschool and school-aged children suggest that young adults with waning immunity and mild illness are a major reservoir for transmission of pertussis to infants too young to be immunized."

 

Breaking News Archives - each day's breaking news from December 1, 2003 (check here for breaking news you might have missed and breaking news that didn't ever hit the "front page")

More News - all the news most recently posted on this website

All the News - a running tab of everything posted on this website since October 29, 2003

Top Stories Archives - daily breaking and other important news stories

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Hot Topics - selected stories, by category

Return to Vaccination News Home Page (for best results, right click to "open in new window")

DISCLAIMER:    All information, data, and material contained, presented, or provided here is for general information purposes only and is not to be construed as reflecting the knowledge or opinions 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.