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Khalil A, Samara A, Campbell C, Ladhani SN. Pregnant women and measles: we need to be vigilant during outbreaks. EClinicalMedicine 2024; 72:102594. [PMID: 38666235 PMCID: PMC11043813 DOI: 10.1016/j.eclinm.2024.102594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
A number of countries including the UK are currently experiencing large outbreaks of measles affecting mainly young children but also adolescents and young adults. Women of childbearing age are a particular group of concern because the 1988 Wakefield Lancet paper, which falsely asserted a connection between the MMR vaccine and autism, was associated with a large and sharp decline in childhood MMR uptake over several years. This has left large cohorts of non-immune adolescents and young adults (born between 1998 and 2004), including young women who are now of childbearing age and remain susceptible to measles as well as rubella. Pregnant mothers are at higher risk of serious complications, such as pneumonia, with adverse pregnancy complications including fetal loss, premature birth, and neonatal death. Measles infection may also result in subacute sclerosing panencephalitis (SSPE), a very rare but very severe and invariably fatal neurodegenerative complication that typically manifests many years after acute measles infection but can have a short-onset latency with a fulminant course in pregnant women. Here, we summarise the epidemiology of measles infection, factors associated with the current measles outbreaks, as well as the risks and outcomes of measles, including SSPE, in pregnancy. We propose an algorithm for clinical management of measles infection in pregnancy. We also highlight the importance of early liaison with local health protection teams for risk assessment, diagnosis and management of suspected measles in pregnancy and close contacts as well as susceptible pregnant women exposed to a person with measles in the community.
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Affiliation(s)
- Asma Khalil
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, UK
- The Royal College of Obstetricians and Gynaecologists, London, UK
| | - Athina Samara
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
- FUTURE, Center for Functional Tissue Reconstruction, University of Oslo, Oslo, Norway
| | - Colin Campbell
- Immunisation and Countermeasures Division, UK Health Security Agency, UK
| | - Shamez N. Ladhani
- Immunisation and Countermeasures Division, UK Health Security Agency, UK
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George’s University of London, London, UK
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Santacruz-Sanmartin E, Hincapié-Palacio D, Ochoa-Acosta JE, Buitrago-Giraldo S, Ospina MC. Measles Serostatus in Mothers and Their Newborns in Antioquia, Colombia: Implications for Measles Elimination. Am J Trop Med Hyg 2023; 108:93-100. [PMID: 36509051 PMCID: PMC9833067 DOI: 10.4269/ajtmh.22-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 10/01/2022] [Indexed: 12/15/2022] Open
Abstract
To describe the serostatus of measles IgG antibodies in pregnant women and newborns, placental transfer, and factors that determine being below the threshold of 150 mIU/mL, a cross-sectional study was conducted. Blood samples of 790 pregnant women at the time of delivery and 734 umbilical cord samples were analyzed from eight hospitals in the Aburrá Valley of Antioquia, Colombia. Measles IgG antibody measurement was performed with ELISA. The proportion of individuals with antibodies < 150 mIU/mL was 13.9% (95% CI: 12.2-15.8) in pregnant women and 11.1% (95% CI: 9.2-13.4) in newborns. The geometric mean of the antibody level of the pregnant women was 552 mIU/mL (95% CI: 504-605) and in the umbilical cord 662 mIU/mL (95% CI: 604-727). A positive correlation between pregnant woman and umbilical cord antibodies was found. The median ratio of measles IgG antibodies in umbilical cord/pregnant woman was 1.22 for all participants. A seroprevalence below the threshold of 150 mIU/mL was found in newborns whose mothers were born between 1983 and 1994, compared with those born before that period, when exposure to the wildtype virus was common (adjusted prevalence ratio: 3.6, 95% CI: 1.3-9.6). These findings suggest that there are gaps in measles immunity among women of childbearing age, before pregnancy. To close this immune gap and support efforts to maintain measles control, serological screening for measles antibodies should be routinely included in reproductive health and antenatal care programs to identify women without immunity who should be vaccinated before pregnancy or after delivery.
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Affiliation(s)
| | | | - Jesús E. Ochoa-Acosta
- “Héctor Abad Gómez” National Faculty of Public Health, Universidad of Antioquia, Medellin, Colombia
| | - Seti Buitrago-Giraldo
- Departmental Laboratory of Public Health, The Sectional Secretariat of Health and Social Protection of Antioquia, Medellin, Colombia
| | - Marta C. Ospina
- Departmental Laboratory of Public Health, The Sectional Secretariat of Health and Social Protection of Antioquia, Medellin, Colombia
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Malama K, Tichacek A, Kelly H, Parker R, Inambao M, Sharkey T, Wall KM, Kilembe W, Price MA, Fast P, Priddy F, Allen S. Measles immunity gap among reproductive-age women participating in a simulated HIV vaccine efficacy trial in Zambia. Hum Vaccin Immunother 2022; 18:2066426. [PMID: 35446726 PMCID: PMC9302517 DOI: 10.1080/21645515.2022.2066426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Measles is a vaccine-preventable viral disease whose vaccination coverage remains low in Zambia, where the target group for vaccination is children aged 9 to 18 months. In addition to inadequate measles vaccination coverage among children, few studies address potential resultant immunity gaps among adults. We analyzed data from a simulated HIV vaccine efficacy trial (SiVET) conducted from 2015–2017 among adult Zambian women of childbearing age to determine measles antibody seroprevalence before and after vaccination with the measles, mumps and rubella (MMR) vaccine. We used MMR vaccine as a substitute for an experimental HIV vaccine as part of a simulation exercise to prepare for an HIV vaccine efficacy trial. We found that 75% of women had measles antibodies prior to receiving MMR, which increased to 98% after vaccination. In contrast, mumps and rubella antibody prevalence was high before (93% and 97%, respectively) and after (99% and 100%, respectively) vaccination. The low baseline measles seropositivity suggests an immunity gap among women of childbearing age. We recommend that measles vaccination programs target women of childbearing age, who can pass antibodies on to neonates. Moreover, administering the MMR vaccine to clinical trial candidates could prevent measles, mumps or rubella-related adverse events during actual trials.
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Affiliation(s)
- Kalonde Malama
- Center for Family Health Research in Zambia, Rwanda Zambia HIV Research Group, Lusaka, Zambia
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Emory University, School of Medicine, Atlanta, GA, USA
| | - Hilary Kelly
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Emory University, School of Medicine, Atlanta, GA, USA
| | - Mubiana Inambao
- Center for Family Health Research in Zambia, Rwanda Zambia HIV Research Group, Ndola, Zambia
| | - Tyronza Sharkey
- Center for Family Health Research in Zambia, Rwanda Zambia HIV Research Group, Lusaka, Zambia
| | - Kristin M Wall
- Rwanda Zambia HIV Research Group, Emory University, School of Medicine, Atlanta, GA, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - William Kilembe
- Center for Family Health Research in Zambia, Rwanda Zambia HIV Research Group, Lusaka, Zambia
| | - Matt A Price
- IAVI, New York, NY, USA.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | | | | | - Susan Allen
- Rwanda Zambia HIV Research Group, Emory University, School of Medicine, Atlanta, GA, USA
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Papailiou S, Soldatou A, Marmarinos A, Avgeris M, Papathoma E, Sindos M, Georgantzi S, Rodolakis Α, Iacovidou N, Gourgiotis D, Tsolia M. Inadequate protection against measles and rubella among pregnant women in Greece during the last measles outbreak. J Infect 2022; 84:e95-e97. [DOI: 10.1016/j.jinf.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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