Higher Risk of Measles When the First Dose of a 2-Dose Schedule of Measles Vaccine Is Given at 12-14 Months Versus 15 Months of Age
Institut national de santé publique du Québec, Quebec City, Canada. Clinical Infectious Diseases
(Impact Factor: 8.89).
04/2012; 55(3):394-402. DOI: 10.1093/cid/cis439
In 2011, >750 cases of measles were reported in Quebec, Canada, where a routine 2-dose measles immunization schedule, in which measles vaccine is given at 12 and 18 months of age, had been in effect since 1996. Effectiveness of this schedule was assessed during a high school outbreak.
Cases were identified by passive followed by active surveillance. Classical cases met the national surveillance definition; attenuated cases showed clinical signs and high measles-specific immunoglobulin G but did not fulfill all classical criteria. Immunization status was ascertained from written records, and vaccine effectiveness (VE) was calculated as 1 - [(risk of measles in vaccinated individuals)/(risk in unvaccinated individuals)] × 100%.
Among 1306 students, 110 measles cases were identified; 98 were classical cases, and 12 were attenuated cases. The attack rates among unvaccinated and fully vaccinated students were 82% and 4.8%, respectively. The VE among 2-dose recipients was 95.5% against classical and 94.2% against all (classical + attenuated) measles. Among 2-dose recipients, attack rates with first immunization at 12 and ≥15 months of age were 5.8% and 2.0%, respectively, with corresponding VE values of 93.0% and 97.5%. The risk of measles in 2-dose recipients was significantly (3-4-fold) higher when vaccine was first administered at 12 months of age, compared with ≥15 months of age (P = .04).
Despite compliance with the recommended 2-dose measles immunization schedule, 6% of high school students were susceptible during this outbreak. Residual susceptibility was 2-4-fold higher among 2-dose recipients who had received the first dose of vaccine prior to 15 months of age. If confirmed in other settings, these results suggest that administration of the first dose of measles vaccine before 15 months of age may not be optimal for measles elimination efforts.
Available from: Haitao Yang
- "Both GMTs and seroprevalence declined in adults from 15–29-year-olds who were born in the post-vaccine era. Gaston De Serres and others recently found indications that there may be a higher risk of measles among high school students when the first dose of measles vaccine is given before 15 months of age . "
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ABSTRACT: Changes in the epidemiological characteristics of measles since 2007 appeared in the Jiangsu province. Although the reported coverage with two doses of measles vaccine was greater than 95% in most regions of the province, measles incidence remained high across the whole province. Cross-sectional serological surveys of measles antibodies in the Jiangsu province of China were conducted from 2008 to 2010 to assess and track population immunity.
Measles-specific IgG levels were measured in serum samples using ELISA. GMTs and seroprevalence with 95% CIs were calculated by region, gender, and age. ANOVA and χ(2) tests were used to test for statistically significant differences between groups for GMT levels and seroprevalence, respectively.
Seroprevalence showed a significantly increasing trend annually (CMH χ(2) = 40.32, p<0.0001). Although the seroprevalence among children aged 2-15 years was consistently over 95%, vaccine-induced measles antibodies may wane over time. Measles seropositivity in the Jiangsu province was 91.7% (95% CI: 90.1-93.2%) in 2010. Among adults aged 15 to 29-year-olds, the seropositivity rate was 88.4% (95% CI: 82.7-92.8%).
Vaccination strategies may need to be adjusted depending on the individual age and regions, particularly individuals between the ages of 8 months-14 years old and 20-29 years old. Additional SIAs are likely required to eliminate measles in China.
Available from: cid.oxfordjournals.org
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