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Versteegen P, Berbers GA, Smits G, Sanders EA, van der Klis FR, de Melker HE, van der Maas NA. More than 10 years after introduction of an acellular pertussis vaccine in infancy: a cross-sectional serosurvey of pertussis in the Netherlands. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100196. [PMID: 34806066 PMCID: PMC8589709 DOI: 10.1016/j.lanepe.2021.100196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Pertussis is a respiratory disease and still endemic despite high vaccination coverage. In the Dutch national immunisation programme (NIP) whole cell pertussis (wP) priming vaccines for infants were replaced by acellular pertussis (aP) priming vaccines in 2005. Serosurveillance gives the opportunity to objectively monitor effects of changes in the NIP on infection prevalence and vaccine response in the population over time. Methods For this population-based cross-sectional serosurvey a representative sample of Dutch residents (0-89 years) was drawn in 2016/2017. Primary outcome was the percentage of participants with pertussis toxin specific antibody concentrations ≥ 100 IU/ml as an indicator of recent infection, and to identify groups possibly more vulnerable to pertussis infection. Percentages were compared with previous results from 2006/2007. Findings In total 7621 persons were included in the analysis. An increase in recent infections from 3•5% to 5•9% was found in the population from 7 years and older (n=6013) in 2016/2017 compared with 2006/2007. Most noteworthy increase was seen in 12-18-year-olds who were wP primed and aP boosted. Interpretation Infection prevalence is still increasing in the Netherlands inducing a risk of pertussis disease in vulnerable (age) groups. Delaying the preschool booster might prolong the period of protection during primary school and thereby possibly protect younger siblings. Extra boosters might be considered for risk populations like older adults and people with (pulmonary) co-morbidities, since they have higher chances of complications and hospitalisation. An unedited Dutch translation of the abstract is available in Supplementary text 1: Nederlandse samenvatting. Funding The Dutch Ministry of Health, Welfare, and Sport.
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Affiliation(s)
- Pauline Versteegen
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, 3720 BA, Netherlands
- Corresponding author: Pauline Versteegen, MD, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands, +31 6 23 76 44 11
| | - Guy A.M. Berbers
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, 3720 BA, Netherlands
| | - Gaby Smits
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, 3720 BA, Netherlands
| | - Elisabeth A.M. Sanders
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, 3720 BA, Netherlands
- Wilhelmina Children's Hospital, Department of Paediatric Immunology and Infectious Diseases, Lundlaan 6, 3584 EA Utrecht, Netherlands
| | - Fiona R.M. van der Klis
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, 3720 BA, Netherlands
| | - Hester E. de Melker
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, 3720 BA, Netherlands
| | - Nicoline A.T. van der Maas
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, 3720 BA, Netherlands
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2
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Doornekamp L, Comvalius AD, GeurtsvanKessel CH, Slobbe L, Scherbeijn SMJ, van Genderen PJJ, van Binnendijk RS, van Gorp ECM, de Swart RL, Goeijenbier M. Measles seroprevalence among Dutch travelling families. Travel Med Infect Dis 2021; 44:102194. [PMID: 34728385 DOI: 10.1016/j.tmaid.2021.102194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/05/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND While measles vaccination is widely implemented in national immunisation programmes, measles incidence rates are increasing worldwide. Dutch inhabitants who were born between 1965-1975 may have fallen between two stools, lacking protection from a natural infection, and having missed the introduction of the measles vaccination schedule. With this study we aim to find the measles seroprevalence in travellers born between 1965 and 1975, compared to those born before 1965 and after 1975. METHODS Families travelling to Eastern Europe or outside Europe during the preceding year were recruited via Dutch secondary schools between 2016 and 2018. Their vaccination status was assessed using questionnaires, vaccination records and measles serology in dried blood spot (DBS) eluates. Measles virus antibody concentrations were determined with an ELISA (EUROIMMUNE®) and a subset was retested with a focus reduction neutralization assay (FRNT). RESULTS In 188 (79%) of the 239 available DBS eluates, the ELISA could detect sufficient measles virus-specific IgG antibodies. Of the negative samples that were retested with FRNT, 85% remained negative, resulting in an overall seroprevalence of 82% [95% CI 76-86]. Children had a lower seroprevalence (72%) than adults (87%). Travellers born between 1965 and 1975 were protected in 89%. CONCLUSIONS In this study, we report a measles seroprevalence of 82% among Dutch travelling families. Remarkably, seroprevalence rates were lowest in children (12-18 years) instead of travellers born between 1965 and 1975. Although a fraction of people without detectable antibodies may be protected by other immune mechanisms, these data suggest that measles (re)vaccination should be considered for travellers to endemic regions.
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Affiliation(s)
- Laura Doornekamp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Travel Clinic, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anouskha D Comvalius
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Corine H GeurtsvanKessel
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lennert Slobbe
- Travel Clinic, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Tropical Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sandra M J Scherbeijn
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Perry J J van Genderen
- Travel Clinic, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Tropical Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rob S van Binnendijk
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Eric C M van Gorp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Travel Clinic, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rik L de Swart
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Friedrich N, Poethko-Müller C, Kuhnert R, Matysiak-Klose D, Koch J, Wichmann O, Santibanez S, Mankertz A. Seroprevalence of Measles-, Mumps-, and Rubella-specific antibodies in the German adult population - cross-sectional analysis of the German Health Interview and Examination Survey for Adults (DEGS1). THE LANCET REGIONAL HEALTH. EUROPE 2021; 7:100128. [PMID: 34557838 PMCID: PMC8454806 DOI: 10.1016/j.lanepe.2021.100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The WHO European Region targets the elimination of measles, rubella, and the congenital rubella syndrome and welcomes mumps elimination via the joint MMR vaccine. In a push towards this elimination goal, Germany introduced a recommendation on MMR vaccination for adults in 2010 to prevent increasing numbers of measles cases among adults and to strengthen herd immunity. METHODS The prevalence of anti-measles, -mumps, and -rubella IgG antibodies was analysed in 7,115 participants between the ages of 18 and 79 years in the German Health Interview and Examination Survey. Risk factors of seronegativity of adults born 1970 or later were determined. FINDINGS The seroprevalence of anti-measles IgG antibodies was more than 97% in adults born before 1965 and less than 90% in adults born afterwards. Prevalence and GMTs declined with later years of birth. Seronegativity was associated with two-sided migration background and region of residence in East Germany. For anti-mumps IgG antibodies, the seroprevalence was less than 90% in almost all age groups. Prevalence and GMTs declined with later years of birth. Seronegativity was not associated with any socio-demographic factor. Anti-rubella IgG seropositivity was found in more than 90% of adults born before 1985. GMTs declined in younger age groups. Seronegativity was associated with birth between 1980 and 1993 and male gender. High socio-economic status lowered the odds of being seronegative. INTERPRETATION These data reinforce the implementation of the vaccination recommendation for adults and provide the basis for further evaluation of this measure. FUNDING The Federal Ministry of Health, Germany.
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Affiliation(s)
- Nicole Friedrich
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
| | | | - Ronny Kuhnert
- Epidemiological Data Centre, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany
| | | | - Judith Koch
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
| | - Sabine Santibanez
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
| | - Annette Mankertz
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
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4
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Zheng H, Jia KM, Sun R, Hu P, Wang MH, Zee BCY, Liang W, Chong KC. Epidemiological changes in measles infections in southern China between 2009 and 2016: a retrospective database analysis. BMC Infect Dis 2020; 20:197. [PMID: 32138688 PMCID: PMC7059666 DOI: 10.1186/s12879-020-4919-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 02/26/2020] [Indexed: 11/15/2022] Open
Abstract
Background The incidence rate of measles in China reached a nadir in 2012 after 2 supplementary immunization activities (SIAs) were undertaken in 2009 and 2010. However, the disease began re-emerging in 2013, with a high prevalence rate observed in 2013–2014 in the southern province of Guangdong. In this study, we assessed the changes that occurred in measles epidemiology during 2009–2016, particularly between 2009 and 2011 (when the influence of the SIAs were in full effect) and between 2012 and 2016 (when this influence subsided). Methods Data from 22,362 patients with measles diagnosed between 2009 and 2016, and whose diagnoses were confirmed clinically and/or with laboratory testing, were extracted from the National Infectious Disease Monitoring Information System. Descriptive analyses were performed, and changes in epidemiological characteristics between 2009 and 2011 and 2012–2016 were compared. Results There was a substantial surge in 0–8-month-old patients after 2012; the incidence rate increased from 4.0 per 100,000 population in 2011 (10.3% of the total) to 280 per 100,000 population in 2013 (32.8% of the total). Patients aged 0–6 years represented 73.4% of the total increase between 2011 and 2013. Compared with 2009–2011, adults aged ≥25 years accounted for a higher proportion of patients in 2013 and after (p < 0.01), and were highest in 2016 (31% of the patient total). Conclusion Despite the remarkable results achieved by SIAs in terms of providing herd immunity, the 2013 resurgence of measles revealed insufficient immunization coverage among children. Therefore routine immunization programs should be strengthened, and supplementary vaccinations targeting adults should also be contemplated.
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Affiliation(s)
- Huizhen Zheng
- Center for Disease Control and Prevention of Guangdong Province, Guangzhou, China
| | - Katherine Min Jia
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Riyang Sun
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Pui Hu
- Center for Disease Control and Prevention of Guangdong Province, Guangzhou, China
| | - Maggie Haitian Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Benny Chung-Ying Zee
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Wenjia Liang
- Center for Disease Control and Prevention of Guangdong Province, Guangzhou, China.
| | - Ka Chun Chong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China. .,Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
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Sampaio BCF, Rodrigues JP, Meireles LR, Andrade Junior HFD. Measles, rubella, mumps and Toxoplasma gondii antibodies in saliva of vaccinated students of schools and universities in São Paulo City, Brazil. Braz J Infect Dis 2019; 24:51-57. [PMID: 31866191 PMCID: PMC9392031 DOI: 10.1016/j.bjid.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/08/2019] [Accepted: 11/10/2019] [Indexed: 02/08/2023] Open
Abstract
Introduction Vaccines are well-established public health interventions with major impact on the prevalence of infectious diseases, but outbreaks are occurring frequently due to primary and secondary failures, despite high coverage. Surveillance of efficacy and duration of induced immunity is a difficult task as it requires invasive blood sampling in children and teenagers. Saliva can be an acceptable alternative source of IgG to assess vaccine efficacy and toxoplasmosis incidence. We investigated IgG response for measles, mumps, rubella, and T. gondii in saliva samples of vaccinated young people. Methods Saliva was collected from 249 public schools students from São Paulo, Brazil, aged 7 to 13 years old, during an interactive exhibition on hygiene. We used S. aureus protein A solid phase capture assay for IgG reactive to biotinylated purified proteins. Paired saliva and serum (47) were tested from young adults with serum evidence of T. gondii infection and from negative children less than 12 month old for standardization. Reproducibility was greater than 98% and sensitivity and specificity of the saliva assays were greater than 95%, as well as the concordance of paired saliva and serum samples. Results Saliva from high school students showed a prevalence of 8.5% (95% CI: 5.0–11.9%) for anti T. gondii IgG; 96.8% (94.6–99%) of anti-measles IgG; 59.1% (53–65%) of anti-rubella IgG, and 57.5% (51.3–63.6%) of anti-mumps IgG. Discussion The prevalence of antibodies against mumps and rubella after 6–8 years of vaccination was lower than against measles among students. The findings of this study demonstrate the feasibility of saliva sampling for follow-up of vaccine immune status in teenagers. This useful approach allows for IgG detection for vaccine control or epidemiological studies.
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Affiliation(s)
- Barbara Carvalho Fialho Sampaio
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Protozoologia, São Paulo, SP, Brazil.
| | - Jaqueline Polizeli Rodrigues
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Protozoologia, São Paulo, SP, Brazil.
| | - Luciana Regina Meireles
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Protozoologia, São Paulo, SP, Brazil.
| | - Heitor Franco de Andrade Junior
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Protozoologia, São Paulo, SP, Brazil; Universidade de São Paulo, Escola de Medicina, Departamento de Patologia, São Paulo, SP, Brazil.
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6
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Woudenberg T, van Binnendijk R, Veldhuijzen I, Woonink F, Ruijs H, van der Klis F, Kerkhof J, de Melker H, de Swart R, Hahné S. Additional Evidence on Serological Correlates of Protection against Measles: An Observational Cohort Study among Once Vaccinated Children Exposed to Measles. Vaccines (Basel) 2019; 7:vaccines7040158. [PMID: 31652599 PMCID: PMC6963647 DOI: 10.3390/vaccines7040158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 12/11/2022] Open
Abstract
To assess correlates of protection against measles and against subclinical measles virus (MV) infection, we recruited once-vaccinated children from geographic regions associated with increased MV circulation and/or at schools with low vaccination coverage in the Netherlands. Paired blood samples were collected shortly after onset of the measles outbreak and after the outbreak. A questionnaire was used to document the likelihood of exposure to MV and occurrence of measles-like symptoms. All blood samples were tested for MV-specific antibodies with five different assays. Correlates of protection were assessed by considering the lowest neutralizing antibody levels in children without MV infection, and by ROC analyses. Among 91 participants, two seronegative children (2%) developed measles, and an additional 19 (23%) experienced subclinical MV infection. The correlate of protection against measles was lower than 0.345 IU/mL. We observed a decreasing attack rate of subclinical MV infection with increasing levels of specific antibodies until 2.1 IU/mL, above which no subclinical MV infections were detected. The ROC analyses found a correlate of protection of 1.71 IU/mL (95% CI 1.01–2.11) for subclinical MV infection. Our correlates of protection were consistent with previous estimates. This information supports the analyses of serosurveys to detect immunity gaps that require targeted intervention strategies.
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Affiliation(s)
- Tom Woudenberg
- Centre for Infectious Disease Control, Netherlands Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoek 9, 3720 MA Bilthoven, The Netherlands.
| | - Rob van Binnendijk
- Centre for Infectious Disease Control, Netherlands Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoek 9, 3720 MA Bilthoven, The Netherlands.
| | - Irene Veldhuijzen
- Centre for Infectious Disease Control, Netherlands Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoek 9, 3720 MA Bilthoven, The Netherlands.
| | - Frits Woonink
- Public Health Service, Region Utrecht, De Dreef 5, 3706 BR Zeist, The Netherlands.
| | - Helma Ruijs
- Centre for Infectious Disease Control, Netherlands Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoek 9, 3720 MA Bilthoven, The Netherlands.
| | - Fiona van der Klis
- Centre for Infectious Disease Control, Netherlands Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoek 9, 3720 MA Bilthoven, The Netherlands.
| | - Jeroen Kerkhof
- Centre for Infectious Disease Control, Netherlands Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoek 9, 3720 MA Bilthoven, The Netherlands.
| | - Hester de Melker
- Centre for Infectious Disease Control, Netherlands Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoek 9, 3720 MA Bilthoven, The Netherlands.
| | - Rik de Swart
- Department of Viroscience, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Susan Hahné
- Centre for Infectious Disease Control, Netherlands Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoek 9, 3720 MA Bilthoven, The Netherlands.
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7
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Hoes J, Boef AGC, Knol MJ, de Melker HE, Mollema L, van der Klis FRM, Rots NY, van Baarle D. Socioeconomic Status Is Associated With Antibody Levels Against Vaccine Preventable Diseases in the Netherlands. Front Public Health 2018; 6:209. [PMID: 30140666 PMCID: PMC6094970 DOI: 10.3389/fpubh.2018.00209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/05/2018] [Indexed: 12/04/2022] Open
Abstract
Background: We investigated whether low socioeconomic status (SES), which is associated with reduced health and life expectancy, might play a role in increased risk for infectious diseases. Therefore, we explored the association between SES and immunoglobulin G (IgG) levels against various pathogens. Methods: We analyzed the association between SES [educational level and net household income (NHI)] and serum IgG concentration against measles, mumps, rubella, varicella, Haemophilus influenzae type B (HiB), pneumococcus, meningococcus serogroup C (MenC), and cytomegalovirus (CMV) collected within a national cross-sectional serosurvey (2006/2007) using linear regression analyses among non-vaccinated individuals. Results: Higher educational level was associated with higher IgG concentrations against measles (GMC ratio 1.34, 95% CI 1.18–1.53) and rubella (1.13, 1.02–1.25) compared to low education level. In contrast, higher education level was associated with lower IgG concentrations against pneumococcus (0.78, 0.70–0.88), MenC (0.54, 0.44–0.68), and CMV (0.23, 0.18–0.31) compared to low education level. This pattern was also evident when NHI was used as SES indicator. Conclusion: Our study suggests that socioeconomic status is associated with antibody levels in a pathogen-dependent manner. The results suggest that differences in serological response upon infection or differences in exposure might be involved in the variation in IgG levels between SES groups.
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Affiliation(s)
- Joske Hoes
- Centre for Epidemiology and Surveillance of Infectious Diseases, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Anna G C Boef
- Centre for Epidemiology and Surveillance of Infectious Diseases, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Mirjam J Knol
- Centre for Epidemiology and Surveillance of Infectious Diseases, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Hester E de Melker
- Centre for Epidemiology and Surveillance of Infectious Diseases, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Liesbeth Mollema
- Centre for Epidemiology and Surveillance of Infectious Diseases, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Fiona R M van der Klis
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Nynke Y Rots
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Debbie van Baarle
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands.,Laboratory for Translational Immunology, Department Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
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8
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MacIntyre CR, Kpozehouen E, Kunasekaran M, Harriman K, Conaty S, Rosewell A, Druce J, Martin N, Heywood AE, Gidding HF, Wood J, Nicholl S. Measles control in Australia - threats, opportunities and future needs. Vaccine 2018; 36:4393-4398. [PMID: 29934234 DOI: 10.1016/j.vaccine.2018.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/18/2022]
Abstract
Control of measles was the focus of a national workshop held in 2015 in Sydney, Australia, bringing together stakeholders in disease control and immunisation to discuss maintaining Australia's measles elimination status in the context of regional and global measles control. The global epidemiology of measles was reviewed, including outbreaks in countries that have achieved elimination, such as the Disneyland outbreak in the United States and large outbreaks in Sydney, Australia. Transmission of measles between Australia and New Zealand occurs, but has not been a focus of control measures. Risk groups, the genetic and seroepidemiology of measles as well as surveillance, modelling and waning vaccine-induced immunity were reviewed. Gaps in policy, research and practice for maintaining measles elimination status in Australia were identified and recommendations were developed. Elimination of measles globally is challenging because of the infectiousness of measles and the need for 2-dose vaccine coverage rates in excess of 95% in all countries to achieve it. Until this occurs, international travel will continue to permit measles importation from endemic countries to countries that have achieved elimination. When measles cases are imported, failure to diagnose and isolate cases places the health system at risk of measles outbreaks. Vaccine funding models can result in gaps in vaccine coverage for adults and migrants. Australia introduced a whole-of-life immunisation register in 2016 and catch-up vaccination for at-risk communities, which will improve measles control. Research on diagnosis, immunology, case management and modelling of vaccination strategies are important to ensure continued control of measles.
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Affiliation(s)
- C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Kirby Institute, Biosecurity Program, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Kpozehouen
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia.
| | - Mohana Kunasekaran
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | | | - Stephen Conaty
- Public Health Unit, South Western Sydney Local Health District, Australia
| | - Alexander Rosewell
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, Australia; VIDRL, Doherty Institute, Australia
| | - Nicolee Martin
- Victorian Infectious Diseases Reference Laboratory, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Heather F Gidding
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - James Wood
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
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Abstract
Vaccination programmes are considered a main contributor to the decline of infectious diseases over the 20th century. In recent years, the national vaccination coverage in the Netherlands has been declining, highlighting the need for continuous monitoring and evaluation of vaccination programmes. Our aim was to quantify the impact of long-standing vaccination programmes on notified cases in the Netherlands. We collected and digitised previously unavailable monthly case notifications of diphtheria, poliomyelitis, mumps and rubella in the Netherlands over the period 1919-2015. Poisson regression models accounting for seasonality, multi-year cycles, secular trends and auto-correlation were fit to pre-vaccination periods. Cases averted were calculated as the difference between observed and expected cases based on model projections. In the first 13 years of mass vaccinations, case notifications declined rapidly with 82.4% (95% credible interval (CI): 74.9-87.6) of notified cases of diphtheria averted, 92.9% (95% CI 85.0-97.2) cases of poliomyelitis, and 79.1% (95% CI 67.1-87.4) cases of mumps. Vaccination of 11-year-old girls against rubella averted 49.9% (95% CI 9.3-73.5) of cases, while universal vaccination averted 68.1% (95% CI 19.4-87.3) of cases. These findings show that vaccination programmes have contributed substantially to the reduction of infectious diseases in the Netherlands.
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10
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An increasing, potentially measles-susceptible population over time after vaccination in Korea. Vaccine 2017; 35:4126-4132. [PMID: 28669617 DOI: 10.1016/j.vaccine.2017.06.058] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/16/2017] [Accepted: 06/18/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND In Korea, measles occurs mainly in infants <12months of age, who are unvaccinated. In addition, vaccine populations, including adolescents and young adults, can become infected though importation. Thus, the question arises whether the current level of herd immunity in Korea is now insufficient for protecting against measles infection. METHODS Age-specific measles seroprevalence was evaluated by performing enzyme immunoassays and plaque reduction-neutralization tests on 3050 subjects aged 0-50years (birth cohort 1964-2014) and 480 subjects aged 2-30years (birth cohort 1984-2012). RESULTS The overall seropositivity and measles antibody concentrations were 71.5% and 1366mIU/mL, respectively. Progressive decline in antibody levels and seropositivity were observed over time after vaccination in infants, adolescents, and young adults. The accumulation of potentially susceptible individuals in the population was confirmed by comparing data from 2010 and 2014 seroprevalence surveys. The statistical correlation between measles incidence and measles seronegativity was determined. CONCLUSIONS Waning levels of measles antibodies with increasing time post-vaccination suggests that measles susceptibility is potentially increasing in Korea. This trend may be related to limitations of vaccine-induced immunity in the absence of natural boosting by the wild virus, compared to naturally acquired immunity triggered by measles infection. This study provides an important view into the current measles herd immunity in Korea.
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Smetana J, Chlibek R, Hanovcova I, Sosovickova R, Smetanova L, Gal P, Dite P. Decreasing Seroprevalence of Measles Antibodies after Vaccination - Possible Gap in Measles Protection in Adults in the Czech Republic. PLoS One 2017; 12:e0170257. [PMID: 28085960 PMCID: PMC5234812 DOI: 10.1371/journal.pone.0170257] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/30/2016] [Indexed: 11/19/2022] Open
Abstract
Aims In recent years, Europe has recorded an increase in the number of measles outbreaks despite the implementation of vaccination into the National Immunization Programs. The Czech Republic introduced vaccination against measles into National Immunization Program in 1969. The aim of this study was to determine seroprevalence of IgG antibodies against measles in adults. Methods Our study was designed as a prospective, multicenter cohort study. Samples of blood were taken from adults aged 18 years and over. Specific IgG antibodies were determined by ELISA method. Results A number of 1911 sera samples were obtained. The total seropositivity reached 83.3%, 14.3% of the results were negative and 2.4% were borderline. When comparing the individual age groups, the highest antibody seropositivity (> 96%) was detected in persons aged 50 years and over who were naturally infected in pre-vaccine era. The lowest seropositivity was recorded in the age groups 30–39 years (61.5%), 40–49 years (77.5%) and 18–29 years (81.1%). Conclusions A long term high rate of seropositivity persists after natural measles infection. By contrast, it decreases over time after vaccination. Similarly, the concentrations of antibodies in persons with measles history persist for a longer time at a higher level than in vaccinated persons. Our results indicate possible gap in measles protection in adults born after implementation of vaccination into the National Immunization Programs. There are two probable reasons, decrease of measles antibody seropositivity in time after vaccination in setting of limited natural booster and one-dose vaccination schedule used in the first years after implementation.
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Affiliation(s)
- Jan Smetana
- Department of Epidemiology, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
- * E-mail: (JS); (RC)
| | - Roman Chlibek
- Department of Epidemiology, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
- * E-mail: (JS); (RC)
| | - Irena Hanovcova
- Department of Epidemiology, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Renata Sosovickova
- Department of Epidemiology, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Libuse Smetanova
- Department of Rehabilitation, University Hospital, Hradec Kralove, Czech Republic
| | - Peter Gal
- Military Health Institute, Ceske Budejovice, Czech Republic
| | - Petr Dite
- Department of Epidemiology, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
- Military Health Institute, Brno, Czech Republic
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Thompson KM, Odahowski CL, Goodson JL, Reef SE, Perry RT. Synthesis of Evidence to Characterize National Measles and Rubella Exposure and Immunization Histories. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1427-1458. [PMID: 26249328 DOI: 10.1111/risa.12454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
Population immunity depends on the dynamic levels of immunization coverage that countries achieve over time and any transmission of viruses that occur within the population that induce immunity. In the context of developing a dynamic transmission model for measles and rubella to support analyses of future immunization policy options, we assessed the model inputs required to reproduce past behavior and to provide some confidence about model performance at the national level. We reviewed the data available from the World Health Organization (WHO) and existing measles and rubella literature for evidence of historical reported routine and supplemental immunization activities and reported cases and outbreaks. We constructed model input profiles for 180 WHO member states and three other areas to support disease transmission model development and calibration. The profiles demonstrate the significant variability in immunization strategies used historically by regions and member states and the epidemiological implications of these historical choices. The profiles provide a historical perspective on measles and rubella immunization globally at the national level, and they may help immunization program managers identify existing immunity and/or knowledge gaps.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | | | - James L Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan E Reef
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Thompson KM, Odahowski CL. Systematic Review of Measles and Rubella Serology Studies. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1459-1486. [PMID: 26077609 DOI: 10.1111/risa.12430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Serological tests provide information about individual immunity from historical infection or immunization. Cross-sectional serological studies provide data about the age- and sex-specific immunity levels for individuals in the studied population, and these data can provide a point of comparison for the results of transmission models. In the context of developing an integrated model for measles and rubella transmission, we reviewed the existing measles and rubella literature to identify the results of national serological studies that provided cross-sectional estimates of population immunity at the time of data collection. We systematically searched PubMed, the Science Citation Index, and references we identified from relevant articles published in English. We extracted serological data for comparison to transmission model outputs. For rubella, serological studies of women of child-bearing age provide information about the potential risks of infants born with congenital rubella syndrome. Serological studies also document the loss of maternal antibodies, which occurs at different rates for the different viruses and according to the nature of the induced immunity (i.e., infection or vaccine). The serological evidence remains limited for some areas, with studies from developed countries representing a disproportionate part of the evidence. The collection and review of serological evidence can help program managers identify immunity gaps in the population, which may help them better understand the characteristics of individuals within their populations who may participate in transmission and manage risks.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
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van der Maas NAT, Woudenberg T, Hahné SJM, de Melker HE. Tolerability of Early Measles-Mumps-Rubella Vaccination in Infants Aged 6-14 Months During a Measles Outbreak in The Netherlands in 2013-2014. J Infect Dis 2015; 213:1466-71. [PMID: 26690343 PMCID: PMC4813742 DOI: 10.1093/infdis/jiv756] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/14/2015] [Indexed: 12/12/2022] Open
Abstract
Background. In 2013–2014, a measles outbreak spread through the Netherlands. To protect young infants, measles-mumps-rubella (MMR) vaccination was offered to those aged 6–14 months in municipalities with routine first-dose MMR vaccine coverage of <90%. We assessed the tolerability of this early administration of MMR vaccine. Methods. After study entry (n = 1866), parents of eligible infants (n = 10 097) completed a questionnaire (n = 1304). For infants who received an early MMR vaccine dose (n = 962), we asked for information about adverse events (AEs) associated with the dose. AE frequencies were compared between infants aged 6–8, 9–11, and 12–14 months. Using multivariable logistic regression, we assessed the association between the risk of AEs and age at early MMR vaccination. Results. The response rate was 13%. Parents of 59 infants (6.1%) and 350 infants (36.4%) who received early MMR vaccination reported local and systemic AEs, respectively. Parents of infants vaccinated at 6–8 months of age reported systemic AEs less frequently (32%) than parents of children vaccinated at 9–11 months (45%) and 12–14 months (43%) of age (P = <.001). For local AEs, there were no differences (5%, 7%, and 10%, respectively; P = .08). Compared with vaccination at 6 months, all older infants except those aged 14 months showed an increased risk for any AE and for systemic AEs starting 5–12 days after vaccination. Conclusions. Early MMR vaccination is well tolerated, with the lowest AE frequencies found in infants aged 6–8 months. It is a safe intervention for protecting young infants against measles.
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Affiliation(s)
- Nicoline A T van der Maas
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - T Woudenberg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - S J M Hahné
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - H E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Seroprevalence of measles and rubella virus antibodies in the population of the Community of Madrid, 2008-2009. J Infect Public Health 2015; 8:432-40. [PMID: 25957894 DOI: 10.1016/j.jiph.2015.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/23/2015] [Indexed: 11/20/2022] Open
Abstract
The seroprevalence (SP) of measles and rubella virus antibodies is presented by age groups obtained in the IV Serosurvey of the Region of Madrid (2008-2009). The target population is composed of residents with ages ranging between 2 and 60 years in the Region of Madrid. A two-stage cluster sample is used. The SP of measles virus antibodies is 97.8% (CI 95%: 97.3-98.2). The highest SP is observed in the 2-5 year and 41-60 year age groups. The point estimate does not reach 95% in the 16-20 and 21-30 year age groups. The SP of rubella virus antibodies is 97.2% (CI 95%: 96.5-97.7). The SP is over 95% in all of the age groups. In immigrant women between the ages of 16 and 49, the SP is 95.9% (CI 95%: 93.7-97.4). The identification of groups susceptible to the measles virus in young adults could lead to outbreaks as a result of importing the virus. The circulation of the rubella virus is possible among immigrant women aged between 16 and 49 years, which could lead to the appearance of SRC cases. Epidemiological surveillance will allow the impact on the measles and rubella elimination plan to be determined in the future.
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Measles vaccine coverage estimates in an outbreak three years after the nation-wide campaign in China: implications for measles elimination, 2013. BMC Infect Dis 2015; 15:23. [PMID: 25608672 PMCID: PMC4307911 DOI: 10.1186/s12879-015-0752-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/12/2015] [Indexed: 12/04/2022] Open
Abstract
Background China is approaching measles elimination, but indigenous measles still circulates. County L in China has reported measles-containing vaccine (MCV) coverage rates >95% since 2000. Despite high reported coverage, a large measles outbreak occurred among young children in L County. We measured MCV coverage using 5 different methods during an investigation on this outbreak and compared our estimates with reported rates. Methods Reported coverage rates are determined by aggregating clinic-based data across the county: doses administered in each clinic divided by the number of children registered in each clinic. Our methods estimated coverage for the 2010–2012 birth cohort, and were (1) administrative method: doses administered in clinics divided by the birth cohort recorded in the Statistical Year Book, (2) house-to-house convenience-sample survey of children living near cases, (3) vaccination clinic records review, (4) determination of a convenience sample of measles outbreak cases’ vaccination statuses and using the field vaccine efficacy outbreak equation to estimate population coverage, and (5) a seroprevalence survey using a convenience sample of residual blood samples from hospitals. Results The measles outbreak totaled 215 cases, representing an incidence of 195.8 per million population. Our estimated MCV coverage rates were: (1) administrative method: 84.1%-87.0% for MCV1 and 80.3%-90.0% for MCV2, (2) in-house survey: 83.3% of 9–17 month children received MCV1, and 74.5% of 24–47 month children received MCV2, (3) clinic record review: 85.5% of 9–17 month children received MCV1, and 73.2% of 24–59 month children received MCV2, (4) field VE method: 83.6% of 9–47 month children received one or more MCV doses, and (5) serology: seropositive rates were <80% in the 12–17 and 18–23 month age cohorts. Conclusions Compared with reported coverage >95%, our 5 coverage assessments all showed substantially lower coverage. China should evaluate guidelines for reporting vaccination coverage and identify feasible improvements to the assessment methods.
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van den Berg JP, Westerbeek EAM, Smits GP, van der Klis FRM, Berbers GAM, van Elburg RM. Lower transplacental antibody transport for measles, mumps, rubella and varicella zoster in very preterm infants. PLoS One 2014; 9:e94714. [PMID: 24728480 PMCID: PMC3984210 DOI: 10.1371/journal.pone.0094714] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/19/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Maternal antibodies, transported over the placenta during pregnancy, contribute to the protection of infants from infectious diseases during the first months of life. In term infants, this protection does not last until the first recommended measles-mumps-rubella vaccination at 14 months in the Netherlands, while these viruses still circulate. The aim of the study was to investigate the antibody concentration against measles, mumps, rubella and varicella (MMRV) in mothers and preterm infants or healthy term infants at birth. METHODS Antibody concentrations specific for MMRV were measured in cord blood samples from preterm (gestational age <32 weeks and/or birth weight <1500 g) and term infants, and matched maternal serum samples, using a fluorescent bead-based multiplex immune-assay. RESULTS Due to lower placental transfer ratios of antibodies against MMRV in 96 preterm infants (range 0.75-0.87) compared to 42 term infants (range 1.39-1.65), the preterm infants showed 1.7-2.5 times lower geometric mean concentrations at birth compared to term infants. Maternal antibody concentration is the most important determinant of infant antibody concentration against MMRV. CONCLUSIONS Preterm infants benefit to a lesser extent from maternal antibodies against measles, mumps, rubella and varicella than term infants, posing them even earlier at risk for infectious diseases caused by these still circulating viruses.
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Affiliation(s)
- Jolice P. van den Berg
- Department of Paediatrics, Division of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Elisabeth A. M. Westerbeek
- Department of Paediatrics, Division of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Gaby P. Smits
- Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Fiona R. M. van der Klis
- Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Guy A. M. Berbers
- Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Ruurd M. van Elburg
- Department of Paediatrics, Division of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
- Centre for Specialised Nutrition, Nutricia Research, Utrecht, The Netherlands
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Rosen JB, Rota JS, Hickman CJ, Sowers SB, Mercader S, Rota PA, Bellini WJ, Huang AJ, Doll MK, Zucker JR, Zimmerman CM. Outbreak of measles among persons with prior evidence of immunity, New York City, 2011. Clin Infect Dis 2014; 58:1205-10. [PMID: 24585562 DOI: 10.1093/cid/ciu105] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Measles was eliminated in the United States through high vaccination coverage and a public health system able to rapidly respond to measles. Measles may occur among vaccinated individuals, but secondary transmission from such individuals has not been documented. METHODS Suspected patients and contacts exposed during a measles outbreak in New York City in 2011 were investigated. Medical histories and immunization records were obtained. Cases were confirmed by detection of measles-specific immunoglobulin M and/or RNA. Tests for measles immunoglobulin G (IgG), IgG avidity, measurement of measles neutralizing antibody titers, and genotyping were performed to characterize the cases. RESULTS The index patient had 2 doses of measles-containing vaccine; of 88 contacts, 4 secondary patients were confirmed who had either 2 doses of measles-containing vaccine or a past positive measles IgG antibody. All patients had laboratory confirmation of measles infection, clinical symptoms consistent with measles, and high-avidity IgG antibody characteristic of a secondary immune response. Neutralizing antibody titers of secondary patients reached >80 000 mIU/mL 3-4 days after rash onset and that of the index was <500 mIU/mL 9 days after rash onset. No additional cases of measles occurred among 231 contacts of secondary patients. CONCLUSIONS This is the first report of measles transmission from a twice-vaccinated individual with documented secondary vaccine failure. The clinical presentation and laboratory data of the index patient were typical of measles in a naive individual. Secondary patients had robust anamnestic antibody responses. No tertiary cases occurred despite numerous contacts. This outbreak underscores the need for thorough epidemiologic and laboratory investigation of suspected cases of measles regardless of vaccination status.
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Affiliation(s)
- Jennifer B Rosen
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York
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Knol M, Urbanus A, Swart E, Mollema L, Ruijs W, van Binnendijk R, Te Wierik M, de Melker H, Timen A, Hahne S. Large ongoing measles outbreak in a religious community in the Netherlands since May 2013. ACTA ACUST UNITED AC 2013; 18:pii=20580. [PMID: 24079377 DOI: 10.2807/1560-7917.es2013.18.36.20580] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite vaccination coverage over 95%, a measles outbreak started in May 2013 in the Netherlands. As of 28 August, there were 1,226 reported cases, including 82 hospitalisations. It is anticipated that the outbreak will continue. Most cases were orthodox Protestants (n=1,087/1,186; 91.7%) and unvaccinated (n=1,174/1,217; 96.5%). A unique outbreak control intervention was implemented: a personal invitation for measles-mumps-rubella (MMR) vaccination was sent for all children aged 6–14 months living in municipalities with MMR vaccination coverage below 90%.
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Affiliation(s)
- Mj Knol
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Scalia Tomba G, Manfredi P. Quantifying the re-exposure process to an infectious agent. Measles and Varicella as examples. Math Biosci 2013; 245:31-9. [DOI: 10.1016/j.mbs.2013.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 06/20/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
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Hu Y, Li Q, Luo S, Lou L, Qi X, Xie S. Timeliness vaccination of measles containing vaccine and barriers to vaccination among migrant children in East China. PLoS One 2013; 8:e73264. [PMID: 24013709 PMCID: PMC3755000 DOI: 10.1371/journal.pone.0073264] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 07/19/2013] [Indexed: 11/26/2022] Open
Abstract
Background The reported coverage rates of first and second doses of measles containing vaccine (MCV) are almost 95% in China, while measles cases are constantly being reported. This study evaluated the vaccine coverage, timeliness, and barriers to immunization of MCV1 and MCV2 in children aged from 8–48 months. Methods We assessed 718 children aged 8–48 months, of which 499 children aged 18–48 months in September 2011. Face to face interviews were administered with children’s mothers to estimate MCV1 and MCV2 coverage rate, its timeliness and barriers to vaccine uptake. Results The coverage rates were 76.9% for MCV1 and 44.7% for MCV2 in average. Only 47.5% of surveyed children received the MCV1 timely, which postpone vaccination by up to one month beyond the stipulated age of 8 months. Even if coverage thus improves with time, postponed vaccination adds to the pool of unprotected children in the population. Being unaware of the necessity for vaccination and its schedule, misunderstanding of side-effect of vaccine, and child being sick during the recommended vaccination period were significant preventive factors for both MCV1 and MCV2 vaccination. Having multiple children, mother’s education level, household income and children with working mothers were significantly associated with delayed or missing MCV1 immunization. Conclusions To avoid future outbreaks, it is crucial to attain high coverage levels by timely vaccination, thus, accurate information should be delivered and a systematic approach should be targeted to high-risk groups.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, P. R. China
- * E-mail:
| | - Qian Li
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, P. R. China
| | - Shuying Luo
- Institute of Immunization and Prevention, Yiwu Center for Disease Control and Prevention, Yiwu, P. R. China
| | - Linqiao Lou
- Institute of Immunization and Prevention, Yiwu Center for Disease Control and Prevention, Yiwu, P. R. China
| | - Xiaohua Qi
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, P. R. China
| | - Shuyun Xie
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, P. R. China
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High risk of a large measles outbreak despite 30 years of measles vaccination in The Netherlands. Epidemiol Infect 2013; 142:1100-8. [PMID: 23915981 DOI: 10.1017/s0950268813001532] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Our aim was to assess progress towards measles elimination from The Netherlands by studying humoral measles immunity in the Dutch population. A population-based seroepidemiological study was conducted in 2006-2007 (N = 7900). Serum samples were analysed by a bead-based multiplex immunoassay. IgG levels ⩾0·2 IU/ml were considered protective. The overall seroprevalence in the Dutch population was 96%. However, 51% of socio-geographically clustered orthodox Protestant individuals aged <10 years were susceptible. Infants might be susceptible to measles between ages 4 months and 14 months, the age at which maternal antibodies have disappeared and the first measles, mumps, rubella (MMR) vaccination is administered, respectively. Waning of antibody concentrations was slower after the second MMR vaccination than after the first. The Netherlands is at an imminent risk of a measles outbreak in the orthodox Protestant minority. To prevent subsequent transmission to the general population, efforts to protect susceptible age groups are needed.
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Waaijenborg S, Hahné SJM, Mollema L, Smits GP, Berbers GAM, van der Klis FRM, de Melker HE, Wallinga J. Waning of maternal antibodies against measles, mumps, rubella, and varicella in communities with contrasting vaccination coverage. J Infect Dis 2013; 208:10-6. [PMID: 23661802 DOI: 10.1093/infdis/jit143] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The combined measles, mumps, and rubella (MMR) vaccine has been successfully administered for >20 years. Because of this, protection by maternal antibodies in infants born to vaccinated mothers might be negatively affected. METHODS A large cross-sectional serologic survey was conducted in the Netherlands during 2006-2007. We compared the kinetics of antibody concentrations in children and women of childbearing age in the highly vaccinated general population with those in orthodox Protestant communities that were exposed to outbreaks. RESULTS The estimated duration of protection by maternal antibodies among infants in the general population, most of whom were born to vaccinated mothers, was short: 3.3 months for measles, 2.7 months for mumps, 3.9 months for rubella, and 3.4 months for varicella. The duration of protection against measles was 2 months longer for infants born in the orthodox communities, most of whom had unvaccinated mothers. For rubella, mothers in the orthodox communities had higher concentrations of antibodies as compared to the general population. CONCLUSION Children of mothers vaccinated against measles and, possibly, rubella have lower concentrations of maternal antibodies and lose protection by maternal antibodies at an earlier age than children of mothers in communities that oppose vaccination. This increases the risk of disease transmission in highly vaccinated populations.
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Affiliation(s)
- Sandra Waaijenborg
- Department of Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
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Smits G, Mollema L, Hahné S, de Melker H, Tcherniaeva I, Waaijenborg S, van Binnendijk R, van der Klis F, Berbers G. Seroprevalence of mumps in The Netherlands: dynamics over a decade with high vaccination coverage and recent outbreaks. PLoS One 2013; 8:e58234. [PMID: 23520497 PMCID: PMC3592917 DOI: 10.1371/journal.pone.0058234] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 02/05/2013] [Indexed: 11/24/2022] Open
Abstract
Here we present mumps virus specific antibody levels in a large cross-sectional population-based serosurveillance study performed in the Netherlands in 2006/2007 (n = 7900). Results were compared with a similar study (1995/1996) and discussed in the light of recent outbreaks. Mumps antibodies were tested using a fluorescent bead-based multiplex immunoassay. Overall seroprevalence was 90.9% with higher levels in the naturally infected cohorts compared with vaccinated cohorts. Mumps virus vaccinations at 14 months and 9 years resulted in an increased seroprevalence and antibody concentration. The second vaccination seemed to be important in acquiring stable mumps antibody levels in the long term. In conclusion, the Dutch population is well protected against mumps virus infection. However, we identified specific age- and population groups at increased risk of mumps infection. Indeed, in 2007/2008 an outbreak has occurred in the low vaccination coverage groups emphasizing the predictive value of serosurveillance studies.
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Affiliation(s)
- Gaby Smits
- Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
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Development of a bead-based multiplex immunoassay for simultaneous quantitative detection of IgG serum antibodies against measles, mumps, rubella, and varicella-zoster virus. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:396-400. [PMID: 22237896 DOI: 10.1128/cvi.05537-11] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Enzyme-linked immunosorbent assay (ELISA) is normally used to quantify the amount of serum IgG antibodies against measles, mumps, rubella, and varicella-zoster virus (MMRV). However, this method is time- and material-consuming. Therefore, a multiplex immunoassay for the simultaneous quantitative detection of antibodies against MMRV was developed. In-house as well as commercially available antigens can be used, making the assay available for all laboratories. The multiplex assay is much more sensitive than the separate ELISAs and has a high specificity, and only 5 μl of serum is needed. Heterologous inhibition did not exceed 11.5%, while homologous inhibition varied between 91.3 and 97.9%. Good correlations with the in-house ELISAs for measles (R(2) = 0.98), mumps (R(2) = 0.97), and rubella (R(2) = 0.97) virus as well as with the ELISA kit for varicella-zoster virus (R(2) = 0.95) were obtained. In conclusion, the MMRV multiplex assay is a good alternative to the conventional ELISAs and suitable for use in serosurveillance and vaccine studies.
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26
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Measles antibodies and response to vaccination in children aged less than 14 months: implications for age of vaccination. Epidemiol Infect 2011; 140:1599-606. [PMID: 22074684 DOI: 10.1017/s0950268811002184] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Passive immunity against measles decreases during the first months of life. The objective of this study was to determine titres of measles antibodies in children aged 9-14 months and their mothers before vaccination, and the children's response to vaccination. Blood samples were collected by capillary puncture before and 28 days after vaccination. Samples were obtained between February and June 2007 during an ongoing measles outbreak. Titres of specific measles IgG antibodies were determined by enzyme-linked immunosorbent assay. Seroconversion was defined as the presence of antibodies after vaccination in subjects without antibodies before vaccination. Maternal antibodies were present in 37·7% of all 69 children included and in 45·1% of children aged 9 months. Of the 51 children in whom a second sample was obtained, 31 (60·8%) were seronegative before vaccination and 61·3% seroconverted. Interference of maternal antibodies was 30%. Advancing the first dose of measles vaccination from 15 to 12 months is a correct strategy, given the increase in the time of susceptibility of infants to measles.
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27
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Poethko-Müller C, Mankertz A. Sero-epidemiology of measles-specific IgG antibodies and predictive factors for low or missing titres in a German population-based cross-sectional study in children and adolescents (KiGGS). Vaccine 2011; 29:7949-59. [DOI: 10.1016/j.vaccine.2011.08.081] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 08/03/2011] [Accepted: 08/15/2011] [Indexed: 10/17/2022]
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28
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Hickman CJ, Hyde TB, Sowers SB, Mercader S, McGrew M, Williams NJ, Beeler JA, Audet S, Kiehl B, Nandy R, Tamin A, Bellini WJ. Laboratory characterization of measles virus infection in previously vaccinated and unvaccinated individuals. J Infect Dis 2011; 204 Suppl 1:S549-58. [PMID: 21666212 DOI: 10.1093/infdis/jir106] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Waning immunity or secondary vaccine failure (SVF) has been anticipated by some as a challenge to global measles elimination efforts. Although such cases are infrequent, measles virus (MeV) infection can occur in vaccinated individuals following intense and/or prolonged exposure to an infected individual and may present as a modified illness that is unrecognizable as measles outside of the context of a measles outbreak. The immunoglobulin M response in previously vaccinated individuals may be nominal or fleeting, and viral replication may be limited. As global elimination proceeds, additional methods for confirming modified measles cases may be needed to understand whether SVF cases contribute to continued measles virus (MeV) transmission. In this report, we describe clinical symptoms and laboratory results for unvaccinated individuals with acute measles and individuals with SVF identified during MeV outbreaks. SVF cases were characterized by the serological parameters of high-avidity antibodies and distinctively high levels of neutralizing antibody. These parameters may represent useful biomarkers for classification of SVF cases that previously could not be confirmed as such using routine laboratory diagnostic techniques.
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Affiliation(s)
- Carole J Hickman
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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29
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Liu Y, Tao H, Ma F, Lu P, Hu Y, Ding X, Liu P, Min J, Li J, Sun J, Xiao S. Sero-epidemiology of measles in general population in Jiangsu province of China: application of mixture models to interpret the results from a cross-sectional study. Vaccine 2010; 29:1000-4. [PMID: 21163248 DOI: 10.1016/j.vaccine.2010.11.081] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 11/06/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022]
Abstract
A cross-sectional survey of measles seroprevalence in general population was conducted in Jiangsu province of China. Data were analyzed by employing commercial ELISA cut-offs and mixture models. The results suggest that the overall measles seroprevalence rate in Jiangsu province (88.7%, 95% confidence interval 87.7-89.6%) was lower than the level believed to be necessary for the elimination of measles. Mixture model could provide a more comprehensive understanding of these results by investigating the different levels of antibody response to vaccination or natural infection in the population, and suggest that the vaccine-induced antibody levels may wane with time. Additional actions should be conducted in the young adult cohorts aged 15-19 years in center region. SIAs for susceptible birth cohorts over the whole province are urgent.
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Affiliation(s)
- Yuanbao Liu
- Department of Expanded Programme on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province 210009, China.
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30
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Buisman AM, de Rond CGH, Oztürk K, Ten Hulscher HI, van Binnendijk RS. Long-term presence of memory B-cells specific for different vaccine components. Vaccine 2009; 28:179-86. [PMID: 19799844 DOI: 10.1016/j.vaccine.2009.09.102] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Revised: 09/04/2009] [Accepted: 09/22/2009] [Indexed: 11/28/2022]
Abstract
Vaccination against infectious diseases ideally should provide lifelong immunity, but in many cases waning of antibody titers has been observed over time. In this study we describe the identification of antigen-specific memory B-cells in peripheral blood of persons born between 1940 and 2004 in The Netherlands. Polyclonal stimulation of either PBMCs or purified B-cells induced proliferation and differentiation of B-cells of the memory phenotype (CD19(+)/CD27(+)) into antibody secreting cells (ASC). Memory B-cells against components of bacterial vaccines (Bordetella pertussis and tetanus) as well as viral vaccines (measles and influenza) were thus identified, even in persons with low serum antibody titers. Enrichment of B-cells increased the sensitivity of memory B-cell detection when compared to PBMCs. Low, but significant correlations between numbers of antigen-specific memory B-cells and the corresponding circulating antibody titers were found for the pertussis proteins and measles virus, but not for tetanus. The identification of the numbers and specificities of peripheral memory B-cells and their relationship with circulating antibodies may be very useful to determine the long-term efficacy of vaccination.
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Affiliation(s)
- A M Buisman
- Laboratory for Infectious Diseases and Screening, Centre for Infectious Diseases and Control, National Institute for Public Health and Environment, Antonie van Leeuwenhoeklaan 9, 3720 BA Bilthoven, The Netherlands.
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31
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de Swart RL, Yüksel S, Langerijs CN, Muller CP, Osterhaus ADME. Depletion of measles virus glycoprotein-specific antibodies from human sera reveals genotype-specific neutralizing antibodies. J Gen Virol 2009; 90:2982-2989. [PMID: 19710253 DOI: 10.1099/vir.0.014944-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Measles virus (MV)-neutralizing antibodies in sera from vaccinated subjects are mainly directed against the haemagglutinin (H) protein. It has been shown previously that depletion of vaccination-induced H-specific antibodies by co-culture of sera with cells expressing the MV Edmonston strain H glycoprotein resulted in almost complete elimination of neutralizing activity. In the present study, MV H and/or fusion (F) protein-specific antibodies were depleted from sera of naturally immune subjects. Early convalescent samples were collected 1.5 years after a well-characterized measles outbreak in Luxembourg caused by a genotype C2 virus, whilst late convalescent samples were collected from healthy Dutch subjects born between 1960 and 1970. Depletion of both H- and F-specific antibodies completely eliminated virus-neutralizing (VN) activity against MV Edmonston. However, in the early convalescent samples, residual VN antibody against wild-type MV genotype C2 was detected. This demonstrated that, although the majority of MV-specific VN antibodies recognized epitopes conserved between different genotypes, genotype-specific VN epitopes were also induced. In sera depleted of H-specific antibodies only, VN activity against MV Edmonston was not completely eliminated, demonstrating the presence of F-specific VN antibodies. In conclusion, this study demonstrated that a fraction of VN antibodies induced by wild-type MV genotype C2 does not neutralize MV strain Edmonston. In addition, it was shown that, in sera from naturally immune donors, the majority of VN antibodies are specific for MV H protein, but up to 10 % of neutralizing antibodies are specific for MV F protein.
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Affiliation(s)
- Rik L de Swart
- Department of Virology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Selma Yüksel
- Department of Virology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Carianne N Langerijs
- Department of Virology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Claude P Muller
- Laboratoire National de Santé/CRP-Santé, WHO Regional Reference Centre for Measles and Rubella, PO Box 1102, L-1011 Luxembourg, Luxembourg
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32
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Poethko-Müller C, Ellert U, Kuhnert R, Neuhauser H, Schlaud M, Schenk L. Vaccination coverage against measles in German-born and foreign-born children and identification of unvaccinated subgroups in Germany. Vaccine 2009; 27:2563-9. [PMID: 19428862 DOI: 10.1016/j.vaccine.2009.02.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 01/19/2009] [Accepted: 02/02/2009] [Indexed: 10/21/2022]
Abstract
Data from the representative German Health Interview and Examination Survey for Children and Adolescents were used to identify unvaccinated subgroups that should be targeted by vaccination programmes in order to interrupt measles transmission. Measles vaccination coverage was low among children below the age of 3, having > or =3 siblings and in foreign-born migrants. Multivariate analyses show that vaccination coverage was strongly related to the place of birth in migrants: foreign-born children have a three-fold odds of being unvaccinated. Odds were also higher in children living in former West Germany, having > or =3 siblings, and it was especially high in children with parents reporting reservations against vaccinations.
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33
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van Binnendijk RS, Hahné S, Timen A, van Kempen G, Kohl RH, Boot HJ, Wolthers KC, Wetsteijn JC, de Vries A, Westert K, Brown KE, de Swart RL. Air travel as a risk factor for introduction of measles in a highly vaccinated population. Vaccine 2008; 26:5775-7. [DOI: 10.1016/j.vaccine.2008.08.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 07/23/2008] [Accepted: 08/31/2008] [Indexed: 11/26/2022]
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Bernsen RMD, van der Wouden JC. Measles, mumps and rubella infections and atopic disorders in MMR-unvaccinated and MMR-vaccinated children. Pediatr Allergy Immunol 2008; 19:544-51. [PMID: 18266826 DOI: 10.1111/j.1399-3038.2007.00684.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vaccinations have been incriminated in the increase of atopic disorders. Especially the measles-mumps-rubella (MMR) vaccination is often refused by people having a notion that these infectious diseases are beneficial for a healthy development of a child's immune system. This practice endangers herd immunity and is the cause of repeated outbreaks. As the clinical course of infections and also its possible impact on the development of atopy may be different in vaccinated and unvaccinated individuals, we explored in vaccinated and unvaccinated children associations of MMR infection with atopic disorders. Using data from a previously conducted study on the relationship between the diphtheria-tetanus-pertussis-(inactivated) poliomyelitis vaccination in the first year of life and atopic disorders, the study population of 1872 8-12-yr-old was divided as children MMR-unvaccinated and children MMR-vaccinated in the first year of life. Within each group the association between MMR infections and atopic disorders (both as reported by the parents) was assessed. We found a statistically significant positive association between measles infection and 'any atopic disorder' [adjusted odds ratio, OR (95% confidence interval, CI): 1.77 (1.20-2.61)] in the MMR-vaccinated group, mainly because of the relationship with eczema. For rubella there was a negative association with eczema and food allergy in the unvaccinated group: adjusted OR (95% CI): 0.57 (0.38-0.85) and 0.23 (0.07-0.76), respectively. All other associations were not statistically significant. We found a positive relationship between measles infection and any atopy in a group of MMR-vaccinated children and a negative association between rubella infection and eczema and food allergy in unvaccinated children. However, we cannot conclude that these relationships are causal. The negative association with rubella may be an artefact. This study shows no evidence for any protective effects from MMR diseases for the development of atopy and therefore supports conclusions found elsewhere that childhood vaccinations do not cause atopy.
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Affiliation(s)
- Roos M D Bernsen
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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35
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Rota MC, Massari M, Gabutti G, Guido M, De Donno A, Ciofi degli Atti ML. Measles serological survey in the Italian population: interpretation of results using mixture model. Vaccine 2008; 26:4403-9. [PMID: 18585420 DOI: 10.1016/j.vaccine.2008.05.094] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 05/23/2008] [Accepted: 05/26/2008] [Indexed: 10/21/2022]
Abstract
In 2003-2004, a national measles seroprevalence study was conducted in Italy and data were analysed by using both commercial ELISA cut-off, and by applying a mixture model. Results of the two methods were compared and interpreted in the light of measles incidence, vaccination coverage and previous seroprevalence data. Seroprevalence rates observed in 2004 were similar to those observed in a previous study conducted in 1996 for children up to 9 years of age, while they were significantly lower in individuals aged 10-19 years. Mixture model approach allowed to better understand these results, suggesting that in these latter age groups there was a waning of vaccine-induced immunity mainly in Northern-Central regions which historically had the highest vaccination coverage.
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Affiliation(s)
- Maria Cristina Rota
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy.
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36
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Vandermeulen C, Mathieu R, Geert LR, Pierre VD, Karel H. Long-term persistence of antibodies after one or two doses of MMR-vaccine. Vaccine 2007; 25:6672-6. [PMID: 17692439 DOI: 10.1016/j.vaccine.2007.07.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 07/09/2007] [Accepted: 07/10/2007] [Indexed: 11/23/2022]
Abstract
Outbreaks of measles, mumps and rubella have occurred recently despite long-standing mass immunization with MMR. Antibody titres for measles, mumps and rubella of 160 students (17-23 years) with proof of at least one MMR-vaccine were studied according to the number of MMR-vaccines received. The proportion of subjects with positive antibody titres was significantly higher in those who received two vaccines against measles (77.1% versus 58.7%, p=0.05), mumps (67.5% versus 55.6%, p=0.009) and rubella (99.2% versus 71.4%, p=0.008). Comparable significant trends were seen for GMTs for measles and mumps. A similar non-significant trend was noted for rubella.
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Affiliation(s)
- Corinne Vandermeulen
- Department of Youth Health Care, K.U. Leuven, Kapucijnenvoer 35, Block D, Box 7001, 3000 Leuven, Belgium.
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37
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Vainio K, Samdal HH, Anestad G, Skutlaberg DH, Bransdal KT, Mundal R, Aaberge I. Seroprevalence of measles among Norwegian military conscripts in 2004. Eur J Clin Microbiol Infect Dis 2007; 26:217-20. [PMID: 17273828 DOI: 10.1007/s10096-007-0258-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The study presented here was conducted in order to evaluate the impact of Norway's childhood immunization program against measles, which was implemented in 1969. In the study, the level of measles immunity was measured among 1,405 military conscripts belonging to the first childhood immunization cohorts that were offered two doses of the measles, mumps and rubella vaccine. The overall seroprevalence of measles antibodies in this cohort was 89.3%. Two commercially available antibody assays were used, and the discordance between the two assays was 10.5%. Similar levels of immunity to measles were detected in earlier studies of Norwegian conscripts belonging to different childhood immunization cohorts.
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Affiliation(s)
- K Vainio
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Geitmyrsveien 75, 0403 Oslo, Norway.
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38
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Wallinga J, Heijne JCM, Kretzschmar M. A measles epidemic threshold in a highly vaccinated population. PLoS Med 2005; 2:e316. [PMID: 16218769 PMCID: PMC1255760 DOI: 10.1371/journal.pmed.0020316] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 08/02/2005] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mass vaccination against measles has successfully lowered the incidence of the disease and has changed the epidemic pattern from a roughly biennial cycle to an irregular sequence of outbreaks. A possible explanation for this sequence of outbreaks is that the vaccinated population is protected by solid herd immunity. If so, we would expect to see the fraction of susceptible individuals remaining below an epidemic threshold. An alternative explanation is the occurrence of occasional localised lapses in herd immunity that allow for major outbreaks in areas with a low vaccine coverage. In that case, we would expect the fraction of susceptible individuals to exceed an epidemic threshold before outbreaks occur. These two explanations for the irregular sequence of measles outbreaks can be tested against observations of both the fraction of susceptible individuals and infection attack rates. METHODS AND FINDINGS We have estimated both the fraction of susceptible individuals at the start of each epidemic year and the infection attack rates for each epidemic year in the Netherlands over a 28-y period. During this period the vaccine coverage averaged 93%, and there was no sustained measles transmission. Several measles outbreaks occurred in communities with low vaccine coverage, and these ended without intervention. We show that there is a clear threshold value for the fraction of susceptible individuals, below which only minor outbreaks occurred, and above which both minor and major outbreaks occurred. A precise, quantitative relationship exists between the fraction of susceptible individuals in excess of this threshold and the infection attack rate during the major outbreaks. CONCLUSION In populations with a high but heterogeneous vaccine coverage, measles transmission can be interrupted without establishing solid herd immunity. When infection is reintroduced, a major outbreak can occur in the communities with low vaccine coverage. During such a major outbreak, each additional susceptible individual in excess of the threshold is associated with almost two additional infections. This quantitative relationship offers potential for anticipating both the likelihood and size of future major outbreaks when measles transmission has been interrupted.
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Affiliation(s)
- Jacco Wallinga
- Centre for Infectious Disease Epidemiology, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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39
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Huertas Zarco I, González Morán F, Pérez Pérez E, Castellanos Martínez T, Martín Sierra M, Vanaclocha Luna H. [Elimination of measles plan in the Valencia community: epidemiological surveillance in 2003]. Aten Primaria 2005; 36:306-11. [PMID: 16238940 PMCID: PMC7681828 DOI: 10.1157/13079864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS Describing the clinical and epidemiological characteristics of the suspicions of measles notified in the CV during the year 2003 and evaluating the system of surveillance. DESIGN Cross-sectional, descriptive study. SETTING Community of Valencia (CV), Spain. PARTICIPANTS Cases of suspected measles notified in 2003. MAIN MEASUREMENTS Description of the data collected in the questionnaires (including names) of the Plan to Eliminate Measles of the CV, and obtaining of quality indicators for this plan and those proposed in the national action plan. RESULTS From 43 notified suspicions, 11 (25.6%) were confirmed, 29 (67.4%) discarded, and 3 (7%) compatible. The rate of effect was 0.33 of 105. From 11 confirmed cases, 10 belonged to two outbreaks (one familiar and an other one communitary) and one was an isolated and imported case. 80% of areas of health were declared. The majority of the suspicions and all the cases were given in the first half of the year. Five cases were given in cohorts of age not submitted to the program of vaccination (minors of 15 months and major of 20 years), and 2 cases might have been avoidable in agreement with the program (6 and 12-year-old children not vaccinated). 40 samples of whey and 33 of urine were collect within the recommended periods. The majority of quality indicators were over the recommended ones (80%). CONCLUSIONS In year 2003 no case of measles has taken place from autochthonous virus in the CV.
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Affiliation(s)
- I Huertas Zarco
- Vigilancia y Control Epidemiológicos, Dirección General de Salud Pública, Valencia, Spain.
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40
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de Swart RL, Yüksel S, Osterhaus ADME. Relative contributions of measles virus hemagglutinin- and fusion protein-specific serum antibodies to virus neutralization. J Virol 2005; 79:11547-51. [PMID: 16103210 PMCID: PMC1193617 DOI: 10.1128/jvi.79.17.11547-11551.2005] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The relative contribution of measles virus hemagglutinin (H)- or fusion protein (F)-specific antibodies to virus neutralization (VN) has not been demonstrated. We have depleted these specific antibodies from sera collected from young adults, who had been vaccinated during childhood, by prolonged incubation with viable transfected human melanoma cells expressing H or F. Simultaneous depletion of antibodies of both specificities completely abrogated VN activity. Depletion of F-specific antibodies only had a minimal effect, whereas removal of H-specific antibodies resulted in almost complete reduction of VN activity. These results demonstrate that measles virus neutralizing antibodies are mainly directed to the H protein.
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Affiliation(s)
- Rik L de Swart
- Department of Virology, Erasmus MC, Rotterdam, The Netherlands.
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41
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Wiertsema SP, Sanders EAM, Veenhoven RH, Van Heerbeek N, van den Hof S, Berbers GAM, Rijkers GT. Antibody levels after regular childhood vaccinations in the immunological screening of children with recurrent otitis media. J Clin Immunol 2005; 24:354-60. [PMID: 15163891 DOI: 10.1023/b:joci.0000029114.84417.45] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Recurrent otitis media may be related to defects in specific antibody production, as suggested previously. This might be reflected in lower antibody responses to vaccinations administered in the context of the national childhood vaccination program in children suffering from recurrent otitis media. In a cross-sectional study we determined the levels of antidiphtheria, antitetanus, anti- Haemophilus influenzae type b (anti-Hib) and antimeasles antibodies in sera of 163 children with two or more episodes of acute otitis media per year and in 143 children with repeated periods of persistent otitis media with effusion each lasting at least 3 months. The control group consisted of 521 age-matched healthy children, who were free of recurrent respiratory tract infections. Children with recurrent acute otitis media, including highly otitis-prone children, showed higher antidiphtheria and antitetanus antibody titers compared to controls. No differences were observed in anti-Hib and antimeasles antibody levels between children with recurrent acute otitis media and controls, nor did any of the antibody levels in children with persistent otitis media with effusion differ from those in controls. Therefore, the results of our study do not point toward a generalized immunological hyporesponsiveness in children with recurrent acute otitis media and persistent otitis media with effusion. Determination of antibody responses to regular vaccines is not indicative for otitis-proneness.
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Affiliation(s)
- Selma P Wiertsema
- Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
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42
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Dannetun E, Tegnell A, Hermansson G, Törner A, Giesecke J. Timeliness of MMR vaccination—influence on vaccination coverage. Vaccine 2004; 22:4228-32. [PMID: 15474712 DOI: 10.1016/j.vaccine.2004.04.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2003] [Revised: 04/26/2004] [Accepted: 04/28/2004] [Indexed: 11/26/2022]
Abstract
Over the last seven years, and especially in 2001, a declining coverage for MMR vaccination in 2-year-olds has been noted in Sweden. By recording actual date of vaccination in a cohort of almost 4,000 children in a county in central Sweden, we found that parents' decision to postpone vaccination by up to 1.5 years beyond the stipulated age of 18 months accounted for about half the reported drop in 2001. Even if coverage thus improves with time, postponed vaccination adds to the pool of unprotected children in the population. The design of the current national surveillance system overestimates coverage at 2 years and fails to record delayed vaccination. To avoid future outbreaks that can appear around imported cases of measles it is crucial to attain high coverage levels by timely vaccination.
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Affiliation(s)
- Eva Dannetun
- Department of Communicable Disease Control, Landstinget i Ostergötland, Sandbacksgatan 5, SE- 581 91 Linköping, Sweden
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43
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Mossong J, Muller CP. Modelling measles re-emergence as a result of waning of immunity in vaccinated populations. Vaccine 2004; 21:4597-603. [PMID: 14575773 DOI: 10.1016/s0264-410x(03)00449-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An age-structured mathematical model of measles transmission in a vaccinated population is used to simulate the shift from a population whose immunity is derived from natural infection to a population whose immunity is vaccine-induced. The model incorporates waning of immunity in a population of vaccinees that eventually will become susceptible to a milder form of vaccine-modified measles with a lower transmission potential than unvaccinated classical measles. Using current estimates of duration of vaccine-derived protection, measles would not be expected to re-emerge quickly in countries with sustained high routine vaccine coverage. However, re-emergence is possible to occur several decades after introduction of high levels of vaccination. Time until re-emergence depends primarily on the contagiousness of vaccine-modified measles cases in comparison to classical measles. Interestingly, in a population with a high proportion of vaccinees, vaccine-modified measles and classical measles would occur essentially in the same age groups. Although waning of humoral immunity in vaccinees is widely observed, re-emergence of measles in highly vaccinated populations depends on parameters for which better estimates are needed.
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Affiliation(s)
- Joël Mossong
- Laboratoire National de Santé, P.O. Box 1102, L-1011 Luxembourg, Luxembourg.
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44
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Abstract
During the 1997-1998 measles epidemic in Poland a high attack rate occurred in infants up to 1 year of age (24.6/100,000 in comparison with 5.5/100,000 in total population). Routine vaccination against measles for infants aged 13-15 months was introduced in Poland in 1975, and a second dose added in 1991. The recommended age for measles vaccination was based on information gathered in years when most mothers had a natural measles. Nowadays, many mothers have received measles vaccine. Early loss of passively acquired measles antibody may occur in infants of women who received measles vaccine, because measles vaccine induces lower antibody titres than does natural infection. Therefore, measles-specific antibody titres were determined among vaccinated and unvaccinated women as well as among infants, whose mothers were born after 1976 and likely were vaccinated (Group 1), and those, whose mothers were born before 1969 and likely have had a natural measles (Group 2). All women that were born in prevaccination era had significantly higher geometric mean titre (GMT) of measles antibody than those who were vaccinated (P<0.001). Also infants from Group 2 at every age had higher GMT of measles antibody than those of Group 1. The antibody decay was significantly faster among infants whose mothers acquired immunity by measles vaccination. Because nowadays the majority of women in childbearing age are vaccinated against measles, earlier vaccination in the infants should be considered.
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Affiliation(s)
- Wieslawa Janaszek
- Department of Sera and Vaccine Evaluation, National Institute of Hygiene, Chocimska 24, Warsaw, Poland.
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45
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Abstract
The evaluation of measles vaccination programmes has been problematic because the change in actual numbers of infections and susceptibles over time cannot be directly observed. In this paper, we present a method for estimating the time series of number of susceptibles and infections, as well as the critical vaccination coverage in a vaccinated population. The proposed method is applied to data on measles outbreaks in The Netherlands. We show that the results are self-consistent and in line with available independent estimates. A potential application of the proposed method lies in detecting the loss of herd immunity and assessing the risk of major outbreaks in vaccinated populations.
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Affiliation(s)
- J Wallinga
- National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands.
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46
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Pütz MM, Bouche FB, de Swart RL, Muller CP. Experimental vaccines against measles in a world of changing epidemiology. Int J Parasitol 2003; 33:525-45. [PMID: 12782053 DOI: 10.1016/s0020-7519(03)00062-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Vaccination with the current live attenuated measles vaccine is one of the most successful and cost-effective medical interventions. However, as a result of persisting maternal antibodies and immaturity of the infant immune system, this vaccine is poorly immunogenic in children <9 months old. Immunity against the live vaccine is less robust than natural immunity and protection less durable. There may also be some concern about (vaccine) virus spread during the final stage of an eventual measles eradication program. Opinions may differ with respect to the potential threat that some of these concerns may be to the World Health Organisation goal of measles elimination, but there is a consensus that the development of new measles vaccines cannot wait. Candidate vaccines are based on viral or bacterial vectors expressing recombinant viral proteins, naked DNA, immune stimulating complexes or synthetic peptides mimicking neutralising epitopes. While some of these candidate vaccines have proven their efficacy in monkey studies, aerosol formulated live attenuated measles vaccine are evaluated in clinical trials.
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Affiliation(s)
- Mike M Pütz
- Department of Immunology, Laboratoire National de Santé, 20A Rue Auguste Lumière, 1950 Luxembourg, Luxembourg
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47
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Glass K, Grenfell BT. Antibody dynamics in childhood diseases: waning and boosting of immunity and the impact of vaccination. J Theor Biol 2003; 221:121-31. [PMID: 12634049 DOI: 10.1006/jtbi.2003.3181] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The introduction of vaccination against acute diseases such as measles induced a dramatic decline in the prevalence of the disease, and a more gradual rise in the proportion of the population whose immunity is derived solely from vaccination. These two factors combine to constitute an important shift in the dynamics of immunity, especially in highly vaccinated populations. We develop a general model to describe both loss of immunity in the absence of disease, and boosting of immunity corresponding to subclinical infection in individuals whose immunity has waned. We consider the interaction between infection and immunity and identify the key parameters that determine the eradication threshold. We explore the dynamics in the years following the introduction of vaccination using a stochastic version of the model, and consider the effect of different assumptions concerning the nature of immunity. A comparison of the model results with recently published data suggests that heterogeneity in host immune response is an important feature of the antibody dynamics.
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Affiliation(s)
- K Glass
- University of Cambridge, Department of Zoology, Downing Street, Cambridge CB2 3EJ, UK.
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48
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Metintaş S, Akgün Y, Arslantaş D, Kalyoncu C, Uçar B. Decay of maternally derived measles antibody in central Turkey. Public Health 2002. [DOI: 10.1038/sj.ph.1900818] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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49
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van den Hof S, Meffre CM, Conyn-van Spaendonck MA, Woonink F, de Melker HE, van Binnendijk RS. Measles Outbreak in a Community with Very Low Vaccine Coverage, the Netherlands. Emerg Infect Dis 2001. [DOI: 10.3201/eid0707.017743] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Susan van den Hof
- National Institute of Public Health and the Environment, Bilthoven, the Netherlands
| | | | | | - Frits Woonink
- Public Health Service Southeast Utrecht, Zeist, the Netherlands
| | - Hester E. de Melker
- National Institute of Public Health and the Environment, Bilthoven, the Netherlands
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50
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van den Hof S, Meffre CM, Conyn-van Spaendonck MA, Woonink F, de Melker HE, van Binnendijk RS. Measles outbreak in a community with very low vaccine coverage, the Netherlands. Emerg Infect Dis 2001; 7:593-7. [PMID: 11485681 PMCID: PMC2631830 DOI: 10.3201/eid0707.010743] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 1999-2000 measles epidemic in the Netherlands started with an outbreak in an orthodox reformed elementary school with 7% vaccine coverage. The overall attack rate was 37%: 213 clinical cases among the 255 participating pupils (response 62%) and 327 household members. The attack rate ranged from 0% for the oldest groups of pupils to 88% for the youngest, who had not been exposed in previous measles epidemics. None of 25 vaccinated pupils had clinical symptoms. Among pupils with clinical symptoms, the self-reported complication rate was 25%. These data confirm that measles infection causes severe disease and that vaccination is the most effective means of preventing the disease and its complications. The data also show that clusters of persons refraining from vaccination interfere with measles elimination even in populations with very high overall vaccine coverage (96%).
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Affiliation(s)
- S van den Hof
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
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