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Moss WJ, Griffin DE. What's going on with measles? J Virol 2024; 98:e0075824. [PMID: 39041786 PMCID: PMC11334507 DOI: 10.1128/jvi.00758-24] [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] [Indexed: 07/24/2024] Open
Abstract
Measles is a highly transmissible systemic viral infection associated with substantial mortality primarily due to secondary infections. Measles induces lifelong immunity to reinfection but loss of immunity to other pathogens. An attenuated live virus vaccine is highly effective, but lapses in delivery have resulted in increasing cases worldwide. Although the primary cause of failure to control measles is failure to vaccinate, waning vaccine-induced immunity and the possible emergence of more virulent virus strains may also contribute.
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Affiliation(s)
- William J. Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diane E. Griffin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Castiñeiras ACP, Sales AC, Picone CDM, Diogo CL, Rossi ÁD, Galliez RM, Ferreira ODC, Castiñeiras TMPP, Lopes MH, Sartori AMC. The decline of measles antibody titers in previously vaccinated adults: a cross-sectional analysis. Rev Inst Med Trop Sao Paulo 2024; 66:e4. [PMID: 38198377 PMCID: PMC10768653 DOI: 10.1590/s1678-9946202466004] [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: 07/10/2023] [Accepted: 11/01/2023] [Indexed: 01/12/2024] Open
Abstract
The global reemergence of measles in 2018-2019 reinforces the relevance of high-coverage immunization to maintain the disease elimination. During an outbreak in the Sao Paulo State in 2019, several measles cases were reported in individuals who were adequately vaccinated according to the current immunization schedule recommends. This study aimed to assess measles IgG antibody seropositivity and titers in previously vaccinated adults. A cross-sectional study was conducted at CRIE-HC-FMUSP (Sao Paulo, Brazil) in 2019. It included healthy adults who had received two or more Measles-Mumps-Rubella vaccines (MMR) and excluded individuals with immunocompromising conditions. Measles IgG antibodies were measured and compared by ELISA (Euroimmun®) and chemiluminescence (LIASON®). The association of seropositivity and titers with variables of interest (age, sex, profession, previous measles, number of measles-containing vaccine doses, interval between MMR doses, and time elapsed since the last MMR dose) was analyzed. A total of 162 participants were evaluated, predominantly young (median age 30 years), women (69.8%) and healthcare professionals (61.7%). The median interval between MMR doses was 13.2 years, and the median time since the last dose was 10.4 years. The seropositivity rate was 32.7% by ELISA and 75.3% by CLIA, and a strong positive correlation was found between the tests. Multivariate analyses revealed that age and time since the last dose were independently associated with positivity. Despite being a single-center evaluation, our results suggest that measles seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose.
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Affiliation(s)
- Anna Carla Pinto Castiñeiras
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
- Universidade Federal do Rio de Janeiro, Núcleo de Enfrentamento e Estudos de Doenças Infecciosas e Emergentes e Reemergentes, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Amanda Caroline Sales
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
| | - Camila de Melo Picone
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
| | - Constância Lima Diogo
- Universidade Federal do Rio de Janeiro, Núcleo de Enfrentamento e Estudos de Doenças Infecciosas e Emergentes e Reemergentes, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Átila Duque Rossi
- Universidade Federal do Rio de Janeiro, Núcleo de Enfrentamento e Estudos de Doenças Infecciosas e Emergentes e Reemergentes, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Mello Galliez
- Universidade Federal do Rio de Janeiro, Núcleo de Enfrentamento e Estudos de Doenças Infecciosas e Emergentes e Reemergentes, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Orlando da Costa Ferreira
- Universidade Federal do Rio de Janeiro, Núcleo de Enfrentamento e Estudos de Doenças Infecciosas e Emergentes e Reemergentes, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Terezinha Marta Pereira Pinto Castiñeiras
- Universidade Federal do Rio de Janeiro, Núcleo de Enfrentamento e Estudos de Doenças Infecciosas e Emergentes e Reemergentes, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marta Heloísa Lopes
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica em Imunologia (LIM-48), São Paulo, São Paulo, Brazil
| | - Ana Marli Christovam Sartori
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica em Imunologia (LIM-48), São Paulo, São Paulo, Brazil
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3
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Alonge OD, Marin M, Hickman CJ, Sowers SB, Chen MH, Hao L, Mercader S, El-Badry E, McClure DL, Icenogle JP, Sugerman DE, Crooke SN, Nguyen HQ. Long-term Neutralizing Antibody Levels Against Measles and Rubella Viruses Among Adults With 3 Doses of Measles-Mumps-Rubella Vaccine. Open Forum Infect Dis 2024; 11:ofad700. [PMID: 38213634 PMCID: PMC10783245 DOI: 10.1093/ofid/ofad700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024] Open
Abstract
Background A third dose of measles-mumps-rubella vaccine (MMR) may be administered for various reasons, but data on long-term immunity are limited. We assessed neutralizing antibody levels against measles and rubella among adults up to 11 years after receipt of a third MMR dose. Methods In this longitudinal study, healthy adults who received a third MMR dose as young adults (ages 18-28 years) were recalled around 5 years and 9-11 years after the third dose. Measles and rubella antibody levels were assessed by plaque-reduction and immunocolorimetric neutralization assays, respectively. Antibody concentrations <120 mIU/mL and <10 U/mL were considered potentially susceptible to measles and rubella, respectively. Geometric mean concentrations (GMCs) and 95% confidence intervals (CIs) over time were estimated from generalized estimating equation models. Results Approximately 5 and 9-11 years after receipt of the third dose, 405 and 304 adults were assessed, respectively. Measles GMC was 428 mIU/mL (95% CI, 392-468 mIU/mL) 5 years postvaccination, declining to 381 mIU/mL (95% CI, 339-428 mIU/mL) 11 years postvaccination. At the last follow-up visit (9-11 years postvaccination), 10% of participants were potentially susceptible to measles infection. Rubella GMCs were stable throughout the follow-up period (63 U/mL to 65 U/mL); none of the participants was susceptible to rubella at the last follow-up visit. Conclusions Eleven years after receiving a third MMR dose, measles and rubella neutralizing antibody levels remained high in adults. However, on the basis of waning antibody levels, some adults may become susceptible to measles infection over time despite receipt of 3 vaccine doses.
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Affiliation(s)
- Oluwakemi D Alonge
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carole J Hickman
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sun B Sowers
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min-hsin Chen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lijuan Hao
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara Mercader
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elina El-Badry
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David L McClure
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Joseph P Icenogle
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David E Sugerman
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen N Crooke
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Huong Q Nguyen
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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Kim YC, Nam H, Choi JY, Shin EC, Choi YH. The third dose of measles-containing vaccine induces robust immune responses against measles in young seronegative healthcare workers who had previous two-dose measles vaccination. J Infect Public Health 2023; 16:1643-1649. [PMID: 37597451 DOI: 10.1016/j.jiph.2023.08.002] [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: 02/14/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Despite the low measles antibody positivity rate among young healthcare workers (HCWs) who have previously received two doses of a measles-containing vaccine (MCV), whether an additional dose of MCV acts as a booster remains unknown. Thus, we aimed to evaluate the immune responses to a third dose of MCV in young HCWs. METHODS Hospital-wide measles seroprevalence was assessed using enzyme-linked immunosorbent assay (ELISA). The immunogenicity of a third dose of MCV was determined in young seronegative HCWs (born between 1986 and 1997) who had previously received a two-dose measles vaccination. RESULTS A total of 3033 (92.6%) HCWs had anti-measles immunoglobulin G. The lowest seropositivity rate was observed in HCWs aged 20-24 years (87.7%). In this group, HCWs who received a third dose of MCV had higher seropositivity than those who received a second dose (89.5% vs. 75.4%). A third dose of MCV was administered to 18 HCWs who did not have anti-measles IgG despite two doses. Neutralizing antibody titers increased significantly 4 weeks after the third vaccination. Although neutralizing antibody titers decreased 1 year post vaccination, 17 (94.4%) HCWs had medium (121-900 mIU/mL) or high (>900 mIU/mL) levels. Furthermore, the third dose of MCV increased the measles virus-specific T-cell effector function. CONCLUSIONS The third dose of MCV induced a strong immune response against measles in young seronegative HCWs who had previously received a two-dose measles vaccination.
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Affiliation(s)
- Yong Chan Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heejin Nam
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Eui-Cheol Shin
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea; The Center for Viral Immunology, Korea Virus Research Institute, Institute for Basic Science (IBS), Daejeon, Republic of Korea.
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea.
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Chung H, Cho SK, Joo J, Kim SK, Kim EO, Kim MJ, Chong YP, Choi SH, Lee SO, Kim YS, Jung J, Kim SH. Causes of a Low Measles Seroprevalence among Young Healthcare Workers in Korea. Infect Chemother 2023; 55:388-393. [PMID: 37674337 PMCID: PMC10551712 DOI: 10.3947/ic.2023.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/15/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Sporadic measles outbreaks have continued to occur in Korea, mainly in adults in their 20s and 30s, most notably in 2014 and 2019. We here evaluated the possible causes of a low seroprevalance of measles by testing young healthcare workers (HCWs). MATERIALS AND METHODS This study was conducted in a 2,743-bed tertiary-care hospital in Seoul between 2020 and 2021. We performed a measles antibody test (chemiluminescence immunoassay), measured the IgM/IgG index ratio, and conducted an avidity test at 1-month after Measles-Mumps-Rubella (MMR) vaccination in HCWs who had been seronegative for measles. Measles vaccination histories were obtained from the national vaccine registry. RESULTS Of the 3,173 HCWs newly employed in our hospital during the study period, 54 with a negative measles IgG at commencement were enrolled. Thirty six (67%) of these subjects were female, and the median age was 25 years (interquartile range [IQR]: 24 - 27). Fourty nine (91%) showed seroconversion at 1 month after the first vaccination. Of these individuals, 38 received both measles IgM and IgG test, and all had an IgM/IgG index <1. Of the 49 seroconverters, all HCWs showed a high avidity index. According to the national immunization registry, 45 (83%) received at least 2 doses of an MMR vaccination. CONCLUSION Secondary vaccine failure may underlie vaccine failure in young Korean adults. HCWs born after 1985 with a negative measles antibody may need only a single dose booster vaccination rather than a 2-dose vaccination regimen.
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Affiliation(s)
- Hyemin Chung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Sung-Kwan Cho
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiyeon Joo
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Sun-Kyung Kim
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Eun Ok Kim
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Office for Infection Control, Asan Medical Center, Seoul, Korea.
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Office for Infection Control, Asan Medical Center, Seoul, Korea
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6
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Chen CJ, Yang CH. Seroepidemiology of measles in immune generation in Taiwan: Prevalence of neutralizing antibody and immune response to reimmunization. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023:S1684-1182(23)00012-9. [PMID: 36707365 DOI: 10.1016/j.jmii.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Secondary vaccine failure was the principal mechanic of measles reemergence in countries with high measles vaccine coverage. The information on neutralizing antibody (nAb) prevalence, epidemiological factors of waned immunity and immune response after reimmunization was essential to measles control but largely lacking in Taiwan. METHODS The nAb and factors of wanned immunity to measles were evaluated in a cohort of 333 subjects aged 11-30 years in 2010. The longitudinal immune response to reimmunization (n = 30) and potential virus exposure (n = 24) were assessed in young healthcare workers (HCWs) during a hospital outbreak. The nAb titer was used to define susceptibility to measles disease (<120 mIU/mL) and infection (120-900 mIU/mL). RESULTS In the 2010 cohort, the susceptibility to measles diseases and infections was respectively identified in 35 (10.5%) and 226 (67.9%) subjects. A generalized linear model identified earlier ages of first immunization in childhood (P = 0.0214) and subjects aged ≥18 years (versus <18 years, P = 0.0425) as significant factors associated with lower nAb titers. Reimmunization of 30 seronegative HCWs resulted in seroconversion for all, with nAb titers significantly rising on day 5, peaking on day 15 and declining in month 4 post-immunization. Similar measles-specific IgG levels were observed in 24 seropositive HCWs before and 4 months after measles contact (P = 0.2352). CONCLUSION A lack of protective immunity to measles diseases might be identified in 10% of the Taiwanese population aged 11-30 years and associated with a trend toward earlier ages of the first measles vaccination. The wanned immunity can be boosted promptly by reimmunization but with uncertain durability.
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Affiliation(s)
- Chih-Jung Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan; Molecular Infectious Diseases Research Center, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan.
| | - Chin-Hui Yang
- Taiwan Centers for Disease Control, Ministry of Health and Welfare, 100 Taipei, Taiwan
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7
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Quach HQ, Chen J, Monroe JM, Ratishvili T, Warner ND, Grill DE, Haralambieva IH, Ovsyannikova IG, Poland GA, Kennedy RB. The Influence of Sex, Body Mass Index, and Age on Cellular and Humoral Immune Responses Against Measles After a Third Dose of Measles-Mumps-Rubella Vaccine. J Infect Dis 2022; 227:141-150. [PMID: 35994504 DOI: 10.1093/infdis/jiac351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A third dose of measles-mumps-rubella vaccine (MMR3) is recommended in mumps outbreak scenarios, but the immune response and the need for widespread use of MMR3 remain uncertain. Herein, we characterized measles-specific immune responses to MMR3 in a cohort of 232 healthy subjects. METHODS Serum and peripheral blood mononuclear cells (PBMCs) were sampled at day 0 and day 28 after MMR3. Measles-specific binding and neutralizing antibodies were quantified in sera by enzyme-linked immunosorbent assay and a microneutralization assay, respectively. PBMCs were stimulated with inactivated measles virus, and the release of cytokines/chemokines was assessed by a multiplex assay. Demographic variables of subjects were examined for potential correlations with immune outcomes. RESULTS Of the study participants, 95.69% and 100% were seropositive at day 0 and day 28, respectively. Antibody avidity significantly increased from 38.08% at day 0 to 42.8% at day 28 (P = .00026). Neutralizing antibodies were significantly enhanced, from 928.7 at day 0 to 1289.64 mIU/mL at day 28 (P = .0001). Meanwhile, cytokine/chemokine responses remained largely unchanged. Body mass index was significantly correlated with the levels of inflammatory cytokines/chemokines. CONCLUSIONS Measles-specific humoral immune responses, but not cellular responses, were enhanced after MMR3 receipt, extending current understanding of immune responses to MMR3 and supporting MMR3 administration to seronegative or high-risk individuals.
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Affiliation(s)
- Huy Quang Quach
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jun Chen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathon M Monroe
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tamar Ratishvili
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathaniel D Warner
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Diane E Grill
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Iana H Haralambieva
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Inna G Ovsyannikova
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory A Poland
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard B Kennedy
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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8
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Jang B, Kim HW, Kim HS, Park JY, Seo H, Kim YK. Measles Virus Neutralizing Antibody Response and Durability Two Years after One or Two Doses of Measles-Mumps-Rubella Vaccine among Young Seronegative Healthcare Workers. Vaccines (Basel) 2022; 10:vaccines10111812. [PMID: 36366321 PMCID: PMC9698570 DOI: 10.3390/vaccines10111812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/04/2022] Open
Abstract
Although there have been several studies regarding the immunogenicity of one or two booster doses of the measles−mumps−rubella (MMR) vaccine in measles-seronegative young adults, limited data are available about how long the immune response is sustained compared with natural infection. This study included seronegative healthcare workers (HCWs) (aged 21−38 years) who received one or two doses of the measles−mumps−rubella (MMR) vaccine and HCWs with laboratory-confirmed measles infection during an outbreak in 2019. We compared neutralizing antibody titers measured using the plaque reduction neutralization (PRN) test and measles-specific immunoglobulin G (IgG) using chemiluminescent immunoassays 2 years after vaccination or infection. Among 107 HCWs with seronegative measles IgGs, the overall seroconversion rate of measles IgGs remained 82.2% (88/107), and 45.8% (49/107) of the participants had a medium (121−900) or high (>900) PRN titer after 2 years from one or two booster doses. The measles-neutralizing antibody titers of both PRN titer (ND50) and geometric mean concentration 2 years after natural infection were significantly higher than those of one or two booster doses of the MMR vaccine (p < 0.001 and p < 0.001, respectively). Our results suggest that serologic screening followed by appropriate postexposure prophylaxis can be beneficial for young HCWs without a history of natural infection especially in a measles outbreak setting, because of possible susceptibility to measles despite booster MMR vaccination 2 years ago. Long-term data about sustainable humoral immunity after one or two booster vaccination are needed based on the exact vaccination history.
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Affiliation(s)
- Byungki Jang
- Ilsong Institute of Life Science, Hallym University, Seoul 01000, Korea
| | - Han Wool Kim
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14100, Korea
| | - Han-Sung Kim
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14100, Korea
| | - Ji Young Park
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14100, Korea
| | - Hyeonji Seo
- Department of Internal Medicine, Division of Infectious Diseases, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14100, Korea
| | - Yong Kyun Kim
- Department of Internal Medicine, Division of Infectious Diseases, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14100, Korea
- Correspondence: ; Tel.: +82-31-380-3724
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9
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Puthanakit T, Anugulruengkitt S, Angsuwatcharakon P, Bunjoungmanee P, Kowitdamrong E, Primsirikunawut A, Intarakhao S, Chetsonwisorn P, Sophonphan J, Tangsathapornpong A. Low Measles Seropositivity Rate among Thai Adolescents in the Thai National Immunization Program. Vaccines (Basel) 2022; 10:vaccines10081269. [PMID: 36016157 PMCID: PMC9412740 DOI: 10.3390/vaccines10081269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
To achieve the goal of measles elimination, herd immunity with 95% seroprotection in the community is required. This study aimed to describe the measles seropositivity rate among Thai children and adolescents. A cross-sectional study was conducted among children aged 3−18 years in Bangkok and its suburbs. Measles IgG antibodies were measured using a EUROIMMUN enzyme-linked immunosorbent assay kit. Seropositivity is defined as a measles IgG titer of ≥200 IU/L, due to a correlation with a >85% positive rate with a plaque reduction neutralizing titer of >120. Factors associated with seropositivity were analyzed using logistic regression analysis. From May to July 2020, 570 children with a median (IQR) age of 11.7 (9.4−14.8) years were enrolled. The geometric mean titer (GMT) of anti-measles IgG was 281 IU/L (95% CI; 257−306). The proportion of children with seropositivity was inversely correlated with age; 3−5 years 85.3%, 6−9 years 72.5%, 10−14 years 50.7%, and 15−18 years 56.3%. Adolescents aged 10−18 years had a lower measles seropositivity rate compared with young children; aOR 0.29 (95% CI 0.17−0.48). Only half of the adolescents who received two doses of measles-containing vaccine maintained measles IgG above the seropositive level. A measles booster dose for young adults may be needed to achieve the measles elimination goal.
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Affiliation(s)
- Thanyawee Puthanakit
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok 10330, Thailand
- Correspondence: ; Tel.: +66-22-564-930
| | - Suvaporn Anugulruengkitt
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok 10330, Thailand
| | | | - Pornumpa Bunjoungmanee
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand
| | - Ekasit Kowitdamrong
- Division of Virology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Athiwat Primsirikunawut
- National Institute of Thailand, Department of Medical Sciences, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Sukkrawan Intarakhao
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand
| | - Panadda Chetsonwisorn
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok 10330, Thailand
| | - Jiratchaya Sophonphan
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok 10330, Thailand
| | - Auchara Tangsathapornpong
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand
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10
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Immunogenicity after outbreak response immunization activities among young healthcare workers with secondary vaccine failure during the measles epidemic in Korea, 2019. BMC Infect Dis 2022; 22:530. [PMID: 35676650 PMCID: PMC9175155 DOI: 10.1186/s12879-022-07511-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite high vaccination coverage, measles outbreaks have been reported in measles elimination countries, especially among healthcare workers in their 20 and 30 s. This study was designed to identify measles-susceptible individuals and to evaluate whether primary or secondary vaccine failure occurred during measles outbreak response immunization (ORI) activities. METHODS The study population was divided into three groups as follows: natural immunity group (Group 1), vaccine-induced immunity group (Group 2), and vaccine failure group (Group 3). We evaluated the immunogenicity of measles among healthcare workers using three methods-enzyme-linked immunoassays, plaque reduction neutralization tests, and avidity assays. The results were assessed at baseline, 4 weeks after, and 6 months after the completion of measles-mumps-rubella (MMR) vaccination. RESULTS In total, 120 subjects were enrolled, with 40 subjects in each group. The median age of Group 3 was 29 years, which was significantly lower than that of the other groups. The baseline negative measles virus (MeV) IgG in Group 3 increased to a median value of 165 AU/mL at 4 weeks after ORI and was lower than that in Groups 1 and 2. The median neutralizing antibody titer was highest in Group 1, and this was significantly different from that in Group 2 or Group 3 at 4 weeks (944 vs. 405 vs. 482 mIU/mL, P = 0.001) and 6 months (826 vs. 401 vs. 470, P = 0.011) after ORI. The rates of high MeV avidity IgG were highest in Group 2, and these were significantly different from those in Groups 1 or 3 at 4 weeks (77.5 vs. 90% vs. 88.6%, P = 0.03) and 6 months (81 vs. 94.8 vs. 82.1%, P = 0.01) after ORI. CONCLUSIONS Considering the MeV-neutralizing antibodies and IgG avidity after MMR vaccination in measles-susceptible group, vaccine failure is inferred as secondary vaccine failure, and further data regarding the maintenance of immunogenicity are needed based on long-term data. The MeV-neutralizing antibody levels were highest in the natural immunity group, and the primary vaccine-induced immunity group showed the highest rates of high MeV IgG avidity.
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11
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Population immunity to measles in Canada using Canadian Health Measures survey data - A Canadian Immunization Research Network (CIRN) study. Vaccine 2022; 40:3228-3235. [PMID: 35491342 PMCID: PMC9246716 DOI: 10.1016/j.vaccine.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 01/13/2023]
Abstract
We aimed to determine population immunity to measles in Canada, and to assess the risk of future outbreaks. We tested 11,176 sera from Cycles 2 (2009-2011) and 3 (2011-2013) cohorts from the biobank of Statistics Canada's Canadian Health Measures Survey (CHMS) using the BioPlex 2220 MMRV IgG assay. We then tested all BioPlex negative and equivocal samples using a more sensitive Plaque Reduction Neutralization Test (PRNT). We determined the weighted proportion of positive, equivocal, and negative samples by age, sex, region and whether individuals were born in Canada. We found that 90.0% (95% confidence interval (CI): 88.2, 91.9) of samples were positive, 4.5% (95% CI: 3.4, 5.5) were equivocal and 5.5% (95% CI: 4.3, 6.7) were negative. Individuals in the 12-19 year age band had the lowest proportion positive at 78.7% (95% CI: 74.2, 83.2) and the highest proportion of positive samples was found in those 60-79 years (99.6%, 95% CI: 99.3, 99.9). Seropositivity was consistently <90% across a broad range of pediatric and adult age bands (6-39 years). We found that a slightly higher proportion of females were positive (91.9%, 95% CI: 90.1, 93.6) compared to males (88.3%, 95% CI: 85.8, 90.7). When taking into account interaction between age and born in Canada status, we found individuals born in Canada aged 19 and under were less susceptible (OR = 0.6 (95% CI: 0.4, 0.95)) compared to those born outside Canada whereas, those aged 20 and over were more susceptible (OR = 1.7 (95% CI: 1.1, 2.8)). Our findings indicate that measles immunity in Canada is below the 95% immunity threshold required to sustain measles elimination, underscoring the importance of maintaining high vaccine coverage to prevent future measles outbreaks and sustain Canada's elimination status.
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12
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Krupka M, Matusu T, Sutova H, Wezdenkova K, Vecerova R, Smesna Y, Kolar M, Frankova HB, Krivankova J, Jorenek M, Novak Z, Raska M, Holy O. Seroprevalence of Measles Antibodies in the Population of the Olomouc Region, Czech Republic—Comparison of the Results of Four Laboratories. Vaccines (Basel) 2022; 10:vaccines10020185. [PMID: 35214643 PMCID: PMC8880731 DOI: 10.3390/vaccines10020185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 01/06/2023] Open
Abstract
Objectives: Although the incidence of measles has decreased globally since the introduction of regular vaccination, its frequency has increased again in recent years. The study is focused on data from the Olomouc Region in the Czech Republic analyzed in four laboratories. The obtained results were compared with already published data. Methods: The data were provided by individual laboratories in an anonymized form—age at the time of the examination, sex, and result of test. Samples were collected between June 2018 and September 2019 and evaluated on the scale positive–borderline–negative. Results: A total of 7962 sera samples were evaluated using three different methods—two types of ELISA tests and CLIA. Positive result was issued in a total of 62.6 percent of samples, but the results of individual laboratories varied widely from 55.5 to 70.8 percent. However, the same trend with the highest levels of antibodies in people born before beginning of vaccination was observed. Conclusions: Data show significantly different results depending on the individual laboratories and the detection kits used. The underestimation of the proportion of positive results can cause problems in selecting individuals for revaccination with a live vaccine, which may fail in weakly positive individuals.
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Affiliation(s)
- Michal Krupka
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, 775 15 Olomouc, Czech Republic; (M.K.); (M.R.)
| | - Tereza Matusu
- Mikrochem Laboratories a.s., 779 00 Olomouc, Czech Republic; (T.M.); (H.S.); (K.W.)
| | - Helena Sutova
- Mikrochem Laboratories a.s., 779 00 Olomouc, Czech Republic; (T.M.); (H.S.); (K.W.)
| | - Katerina Wezdenkova
- Mikrochem Laboratories a.s., 779 00 Olomouc, Czech Republic; (T.M.); (H.S.); (K.W.)
| | - Renata Vecerova
- Department of Microbiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 775 15 Olomouc, Czech Republic; (R.V.); (Y.S.); (M.K.)
| | - Yvona Smesna
- Department of Microbiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 775 15 Olomouc, Czech Republic; (R.V.); (Y.S.); (M.K.)
| | - Milan Kolar
- Department of Microbiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 775 15 Olomouc, Czech Republic; (R.V.); (Y.S.); (M.K.)
| | | | - Jana Krivankova
- Šumperk Hospital, 787 01 Šumperk, Czech Republic; (J.K.); (M.J.)
| | - Miroslav Jorenek
- Šumperk Hospital, 787 01 Šumperk, Czech Republic; (J.K.); (M.J.)
| | - Zdenek Novak
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Milan Raska
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, 775 15 Olomouc, Czech Republic; (M.K.); (M.R.)
| | - Ondrej Holy
- Science and Research Centre, Faculty of Health Sciences, Palacky University Olomouc, Hněvotínská 3, 775 15 Olomouc, Czech Republic
- Correspondence: ; Tel.: +420-585-632-818
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13
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OUP accepted manuscript. J Infect Dis 2022; 226:1127-1139. [DOI: 10.1093/infdis/jiac039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 03/16/2022] [Indexed: 11/15/2022] Open
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14
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Haralambieva IH, Eberhard KG, Ovsyannikova IG, Grill DE, Schaid DJ, Kennedy RB, Poland GA. Transcriptional signatures associated with rubella virus-specific humoral immunity after a third dose of MMR vaccine in women of childbearing age. Eur J Immunol 2021; 51:1824-1838. [PMID: 33818775 PMCID: PMC9841595 DOI: 10.1002/eji.202049054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/03/2021] [Accepted: 12/17/2020] [Indexed: 01/19/2023]
Abstract
Multiple factors linked to host genetics/inherent biology play a role in interindividual variability in immune response outcomes after rubella vaccination. In order to identify these factors, we conducted a study of rubella-specific humoral immunity before (Baseline) and after (Day 28) a third dose of MMR-II vaccine in a cohort of 109 women of childbearing age. We performed mRNA-Seq profiling of PBMCs after rubella virus in vitro stimulation to delineate genes associated with post-vaccination rubella humoral immunity and to define genes mediating the association between prior immune response status (high or low antibody) and subsequent immune response outcome. Our study identified novel genes that mediated the association between prior immune response and neutralizing antibody titer after a third MMR vaccine dose. These genes included the following: CDC34; CSNK1D; APOBEC3F; RAD18; AAAS; SLC37A1; FAS; and JAK2. The encoded proteins are involved in innate antiviral response, IFN/cytokine signaling, B cell repertoire generation, the clonal selection of B lymphocytes in germinal centers, and somatic hypermutation/antibody affinity maturation to promote optimal antigen-specific B cell immune function. These data advance our understanding of how subjects' prior immune status and/or genetic propensity to respond to rubella/MMR vaccination ultimately affects innate immunity and humoral immune outcomes after vaccination.
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Affiliation(s)
| | | | | | - Diane E. Grill
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel J. Schaid
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Richard B. Kennedy
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA
| | - Gregory A. Poland
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA
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15
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Coughlin MM, Matson Z, Sowers SB, Priest JW, Smits GP, van der Klis FRM, Mitchell A, Hickman CJ, Scobie HM, Goodson JL, Alexander JP, Rota PA, Bankamp B. Development of a Measles and Rubella Multiplex Bead Serological Assay for Assessing Population Immunity. J Clin Microbiol 2021; 59:e02716-20. [PMID: 33731416 PMCID: PMC8316076 DOI: 10.1128/jcm.02716-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/11/2021] [Indexed: 02/01/2023] Open
Abstract
Serosurveys are important tools for estimating population immunity and providing immunization activity guidance. The measles and rubella multiplex bead assay (MBA) offers multiple advantages over standard serological assays and was validated by comparison with the enzyme-linked immunosorbent assay (ELISA) and the measles plaque reduction neutralization (PRN) assay. Results from a laboratory-produced purified measles virus whole-virus antigen MBA (MeV WVAL) correlated better with ELISA and PRN than results from the baculovirus-expressed measles nucleoprotein (N) MBA. Therefore, a commercially produced whole-virus antigen (MeV WVAC) was evaluated. Serum IgG antibody concentrations correlated significantly with a strong linear relationship between the MeV WVAC and MeV WVAL MBAs (R = 0.962 and R2 = 0.926). IgG concentrations from the MeV WVAC MBA showed strong correlation with PRN titers (R = 0.846), with a linear relationship comparable to values obtained with the MeV WVAL MBA and PRN assay (R2 = 0.716 and R2 = 0.768, respectively). Receiver operating characteristic (ROC) curve analysis of the MeV WVAC using PRN titer as the comparator resulted in a seroprotection cutoff of 153 mIU/ml, similar to the established correlate of protection of 120 mIU/ml, with a sensitivity of 98% and a specificity of 83%. IgG concentrations correlated strongly between the rubella WVA MBA and ELISA (R = 0.959 and R2 = 0.919). ROC analysis of the rubella MBA using ELISA as the comparator yielded a cutoff of 9.36 IU/ml, similar to the accepted cutoff of 10 IU/ml for seroprotection, with a sensitivity of 99% and a specificity of 100%. These results support use of the MBA for multiantigen serosurveys assessing measles and rubella population immunity.
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Affiliation(s)
- Melissa M Coughlin
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Viral Vaccine Preventable Diseases Branch, Atlanta, Georgia, USA
| | - Zachary Matson
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Viral Vaccine Preventable Diseases Branch, Atlanta, Georgia, USA
| | - Sun B Sowers
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Viral Vaccine Preventable Diseases Branch, Atlanta, Georgia, USA
| | - Jeffrey W Priest
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Food, Waterborne, and Environmental Diseases, Waterborne Disease Prevention Branch, Atlanta, Georgia, USA
| | - Gaby P Smits
- Laboratory for Infectious Diseases and Screening, National Institute for Public Health and Environment, Bilthoven, The Netherlands
| | - Fiona R M van der Klis
- Laboratory for Infectious Diseases and Screening, National Institute for Public Health and Environment, Bilthoven, The Netherlands
| | - Alexandria Mitchell
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Viral Vaccine Preventable Diseases Branch, Atlanta, Georgia, USA
| | - Carole J Hickman
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Viral Vaccine Preventable Diseases Branch, Atlanta, Georgia, USA
| | - Heather M Scobie
- Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Strategic Information and Work Development Branch, Atlanta, Georgia, USA
| | - James L Goodson
- Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Accelerated Disease Control and Vaccine Preventable Disease (VPD) Surveillance Branch, Atlanta, Georgia, USA
| | - James P Alexander
- Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Accelerated Disease Control and Vaccine Preventable Disease (VPD) Surveillance Branch, Atlanta, Georgia, USA
| | - Paul A Rota
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Viral Vaccine Preventable Diseases Branch, Atlanta, Georgia, USA
| | - Bettina Bankamp
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Viral Vaccine Preventable Diseases Branch, Atlanta, Georgia, USA
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16
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Kim CJ, Bae JY, Jun KI, Chung HS, Kim A, Kim J, Son HJ, Lee M, Choi HJ. Risk of Absence of Measles Antibody in Healthcare Personnel and Efficacy of Booster Vaccination. Vaccines (Basel) 2021; 9:vaccines9050501. [PMID: 34066145 PMCID: PMC8151488 DOI: 10.3390/vaccines9050501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 11/18/2022] Open
Abstract
We aimed to identify the presence of the measles IgG antibody (mIgG-Ab) in healthcare personnel and finding out who needs the measles vaccination. The history of measles vaccination was obtained from the national vaccine registry. A baseline mIgG-Ab test was performed, and the measles vaccine was administered to participants who tested negative or equivocal for mIgG-Abs. During the study, 2885 (87.3%) of the 3303 employees were tested for measles serostatus. The baseline seropositivity rate for mIgG-Abs was 91.9%. Among the 234 seronegative cases, 82.9% were born after 1985. The seroprevalence rate was lower in those who received the measles–mumps–rubella (MMR) vaccine >10 years before the testing time, especially if they were born after 1985 and if there was only one previous record of vaccination. Among the 234 seronegative cases, MMR vaccination was administered in 174 cases, of which serostatus was evaluated in 146 cases. After the first dose, positive seroconversion was achieved in 126 participants (86.3%). After a second dose, 15 achieved (75.0%) positive seroconversion. In healthcare personnel born after the period when measles incidence significantly decreased, it may be necessary to reassess their immune status for measles if more than 10 years have elapsed since the last vaccination.
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Affiliation(s)
- Chung-Jong Kim
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul 07804, Korea;
- Ewha Education and Research Center for Infection, Seoul 07985, Korea; (J.-Y.B.); (H.-S.C.); (M.L.); (H.-J.C.)
- Correspondence: ; Tel.: +82-2-6986-1643
| | - Ji-Yun Bae
- Ewha Education and Research Center for Infection, Seoul 07985, Korea; (J.-Y.B.); (H.-S.C.); (M.L.); (H.-J.C.)
- Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, Korea
| | - Kang-Il Jun
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul 07804, Korea;
- Ewha Education and Research Center for Infection, Seoul 07985, Korea; (J.-Y.B.); (H.-S.C.); (M.L.); (H.-J.C.)
| | - Hae-Sun Chung
- Ewha Education and Research Center for Infection, Seoul 07985, Korea; (J.-Y.B.); (H.-S.C.); (M.L.); (H.-J.C.)
- Department of Laboratory Medicine, Ewha Womans University Seoul Hospital, Seoul 07804, Korea
| | - Aeyeon Kim
- Office of Infection Control, Ewha Womans University Seoul Hospital, Seoul 07804, Korea; (A.K.); (J.K.)
| | - Jihee Kim
- Office of Infection Control, Ewha Womans University Seoul Hospital, Seoul 07804, Korea; (A.K.); (J.K.)
| | - Hee-Jung Son
- Office of Infection Control, Ewha Womans University Mokdong Hospital, Seoul 07985, Korea;
| | - Miae Lee
- Ewha Education and Research Center for Infection, Seoul 07985, Korea; (J.-Y.B.); (H.-S.C.); (M.L.); (H.-J.C.)
- Department of Laboratory Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, Korea
| | - Hee-Jung Choi
- Ewha Education and Research Center for Infection, Seoul 07985, Korea; (J.-Y.B.); (H.-S.C.); (M.L.); (H.-J.C.)
- Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, Korea
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17
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Han SB, Park SH, Yi Y, Ji SK, Jang SH, Park MH, Lee JE, Jeong HS, Shin S. Measles seroprevalence among healthcare workers in South Korea during the post-elimination period. Hum Vaccin Immunother 2021; 17:2517-2521. [PMID: 33689571 DOI: 10.1080/21645515.2021.1888623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
During the measles epidemic in 2019, in-hospital transmission of measles contributed to more than two-thirds of measles cases in South Korea, where measles is declared eliminated. This study aimed to examine measles seropositivity among healthcare workers (HCWs) in South Korea to help develop an effective measles prevention strategy for hospital settings. Measles IgG titer was tested in 1,579 HCWs working in a university-affiliated hospital and the measles-containing vaccine (MCV) immunization records of 870 HCWs were identified. The overall seropositivity was 92.0%, but the seropositivity and antibody titers were significantly low among HCWs aged 20-25 years (78.6%) and among one-dose vaccine recipients (86.7%). Among two-dose recipients, seropositivity was lower among young HCWs who received two doses during their childhood than among those who received the catch-up vaccination as part of job requirements (70.3% vs. 98.0%). Among 87 seronegative HCWs who received two-dose MMR vaccination, the seroconversion rate was 98.9%. A considerable proportion of young HCWs were potentially susceptible to measles despite receiving the two-dose vaccination during childhood because of the waning immunity against measles in a country with measles-eliminated status. Serological screening for measles of newly employed HCWs and MCV immunization of seronegative HCWs appears to be an effective prevention strategy.
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Affiliation(s)
- Seung Beom Han
- Infection Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.,The Catholic University of Korea, Daejeon, Republic of Korea
| | - Sun Hee Park
- Infection Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.,Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yunmi Yi
- Infection Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.,Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seul Ki Ji
- Infection Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - So Hee Jang
- Infection Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Min Hee Park
- Infection Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Ji Eun Lee
- Infection Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Hye Sook Jeong
- Infection Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Soyoung Shin
- Infection Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.,Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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18
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Lucca A, Bayoumi N, Ramanathan LV, Sepkowitz K, Kamboj M. Lower Rate of Seropositivity to Measles Among Young Healthcare Personnel in New York City. Clin Infect Dis 2020; 71:3241-3243. [PMID: 32478832 DOI: 10.1093/cid/ciaa660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/26/2020] [Indexed: 11/12/2022] Open
Abstract
We examined the prevalence of measles antibody among 12 349 newly hired HCP between 2009 and 2019. Younger HCP were significantly more likely to have no immunity. Compared with a 92.2% seropositive rate among 1057 persons hired at age >50 years, only 84.4% of approximately 10 000 HCP aged <40 years had protective antibody.
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Affiliation(s)
- Anabella Lucca
- Employee Health and Wellness Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nagla Bayoumi
- Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lakshmi V Ramanathan
- Clinical Chemistry Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kent Sepkowitz
- Division of Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mini Kamboj
- Infection Control and Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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19
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Marin M, Fiebelkorn AP, Bi D, Coleman LA, Routh J, Curns AT, McLean HQ. Adverse Events Among Young Adults Following a Third Dose of Measles-Mumps-Rubella Vaccine. Clin Infect Dis 2020; 73:e1546-e1553. [PMID: 32766827 DOI: 10.1093/cid/ciaa1090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A third measles-mumps-rubella vaccine (MMR) dose (MMR3) is recommended in the United States for persons at increased risk for mumps during outbreaks. MMR3 is also likely given to persons who might have received 2 doses of MMR but lack documentation. Since MMR3 safety data are limited, we describe adverse events in persons receiving MMR3 in a nonoutbreak setting. METHODS Young adults with 2 documented MMR doses were administered MMR3. From 2 weeks before until 4 weeks after MMR3 receipt, participants reported daily on 11 solicited, common symptoms potentially associated with MMR. Weekly rate differences in post- vs prevaccination (baseline) were evaluated by Poisson regression. Baseline rates were subtracted from postvaccination rates of significantly different symptoms to estimate the number and percentage of participants with excess risk for symptoms post-MMR3. Descriptive analyses were performed for 3 postvaccination injection-site symptoms. RESULTS The 662 participants were aged 18-28 years (median = 20 years); 56% were women. Headache, joint problems, diarrhea, and lymphadenopathy rates were significantly higher postvaccination vs baseline. We estimate that 119 participants (18%) reported more symptoms after MMR3 than prevaccination. By symptom, 13%, 10%, 8%, and 6% experienced increased symptoms of headache, joint problems, diarrhea, and lymphadenopathy, respectively, after MMR3. The median onset was Days 3-6 postvaccination; the median duration was 1-2 days. One healthcare visit for a potential vaccination-related symptom (urticaria) was reported. Injection-site symptoms were reported by 163 participants (25%); the median duration was 1-2 days. CONCLUSIONS Reported systemic and local events were mild and transient. MMR3 is safe and tolerable among young adults.
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Affiliation(s)
- Mona Marin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy Parker Fiebelkorn
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daoling Bi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura A Coleman
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Janell Routh
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron T Curns
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Huong Q McLean
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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Kennedy RB, Ovsyannikova IG, Palese P, Poland GA. Current Challenges in Vaccinology. Front Immunol 2020; 11:1181. [PMID: 32670279 PMCID: PMC7329983 DOI: 10.3389/fimmu.2020.01181] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
The development of vaccines, which prime the immune system to respond to future infections, has led to global declines in morbidity and mortality from dreadful infectious communicable diseases. However, many pathogens of public health importance are highly complex and/or rapidly evolving, posing unique challenges to vaccine development. Several of these challenges include an incomplete understanding of how immunity develops, host and pathogen genetic variability, and an increased societal skepticism regarding vaccine safety. In particular, new high-dimensional omics technologies, aided by bioinformatics, are driving new vaccine development (vaccinomics). Informed by recent insights into pathogen biology, host genetic diversity, and immunology, the increasing use of genomic approaches is leading to new models and understanding of host immune system responses that may provide solutions in the rapid development of novel vaccine candidates.
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Affiliation(s)
- Richard B Kennedy
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, United States
| | - Inna G Ovsyannikova
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, United States
| | - Peter Palese
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gregory A Poland
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, United States
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21
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Comparison of Captia TM Measles IgG Assay with Vidas® Measles IgG Assay for determination of immune protection status against measles virus. J Clin Virol 2020; 127:104342. [PMID: 32283504 DOI: 10.1016/j.jcv.2020.104342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/20/2020] [Accepted: 03/28/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Correlation of the assay cut-off values for CaptiaTM Measles IgG and the Vidas® Measles IgG assays with the World Health Organization recommended immunoprotective level of ≥120 mIU/mL is not stated by the manufacturers. Lack of such information may affect interpretation of immune protection (IP) for measles. OBJECTIVE The aim of this study was to compare the relative performance of the CaptiaTM Measles IgG assay and the Vidas® Measles IgG assay for determination of IP against measles virus. STUDY DESIGN Correlation of the cut-off value of both assays with the immunoprotective level was determined with the 3rd WHO Measles IgG International Standard. One hundred clinical samples including frozen and fresh were tested with both assays. The positive percentage agreement (PPA) based on the manufacturers' interpretation and the WHO recommended immunoprotective level was compared. RESULTS Samples tested positive by the CaptiaTM assay were at or above the immunoprotective level while those tested equivocal and positive by the Vidas® assay were immune protective. The overall PPA between both assays was 78.31 % (95 % CI = 67.91-86.61%). When Vidas® equivocal results were regarded as immunoprotective, the overall IP agreement was 96.39 % (95 % CI = 89.80-99.25 %). CONCLUSIONS CaptiaTM assay was more sensitive than the Vidas® assay in determination of IP against measles virus. Testing of measles immunity with the Vidas® Measles IgG assay might underestimate the IP unless equivocal results were regarded as immunoprotective.
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Anichini G, Gandolfo C, Fabrizi S, Miceli GB, Terrosi C, Gori Savellini G, Prathyumnan S, Orsi D, Battista G, Cusi MG. Seroprevalence to Measles Virus after Vaccination or Natural Infection in an Adult Population, in Italy. Vaccines (Basel) 2020; 8:vaccines8010066. [PMID: 32028593 PMCID: PMC7158681 DOI: 10.3390/vaccines8010066] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 11/16/2022] Open
Abstract
An increase in measles cases worldwide, with outbreaks, has been registered in the last few years, despite the availability of a safe and highly efficacious vaccine. In addition to an inadequate vaccination coverage, even in high-income European countries studies proved that some vaccinated people were also found seronegative years after vaccination, thus increasing the number of people susceptible to measles infection. In this study, we evaluated the immunization status and the seroprevalence of measles antibodies among 1092 healthy adults, either vaccinated or naturally infected, in order to investigate the persistence of anti-measles IgG. Among subjects who received two doses of measles vaccine, the neutralizing antibody titer tended to decline over time. In addition, data collected from a neutralization assay performed on 110 healthy vaccinated subjects suggested an inverse correlation between neutralizing antibody titers and the time elapsed between the two vaccinations, with a significant decline in the neutralizing titer when the interval between the two doses was ≥11 years. On the basis of these results, monitoring the serological status of the population 10-12 years after vaccination could be important both to limit the number of people who are potentially susceptible to measles, despite the high efficacy of MMR vaccine, and to recommend a booster vaccine for the seronegatives.
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Affiliation(s)
- Gabriele Anichini
- Department of Medical Biotechnologies, University of Siena, Santa Maria delle Scotte Hospital, V.le Bracci, 1 53100 Siena, Italy; (G.A.); (C.G.); (C.T.); (G.G.S.); (S.P.)
| | - Claudia Gandolfo
- Department of Medical Biotechnologies, University of Siena, Santa Maria delle Scotte Hospital, V.le Bracci, 1 53100 Siena, Italy; (G.A.); (C.G.); (C.T.); (G.G.S.); (S.P.)
| | - Simonetta Fabrizi
- Preventive Medicine and Health Surveillance Unit, Santa Maria delle Scotte Hospital, V.le Bracci, 1 53100 Siena, Italy; (S.F.); (G.B.M.); (D.O.); (G.B.)
| | - Giovan Battista Miceli
- Preventive Medicine and Health Surveillance Unit, Santa Maria delle Scotte Hospital, V.le Bracci, 1 53100 Siena, Italy; (S.F.); (G.B.M.); (D.O.); (G.B.)
| | - Chiara Terrosi
- Department of Medical Biotechnologies, University of Siena, Santa Maria delle Scotte Hospital, V.le Bracci, 1 53100 Siena, Italy; (G.A.); (C.G.); (C.T.); (G.G.S.); (S.P.)
| | - Gianni Gori Savellini
- Department of Medical Biotechnologies, University of Siena, Santa Maria delle Scotte Hospital, V.le Bracci, 1 53100 Siena, Italy; (G.A.); (C.G.); (C.T.); (G.G.S.); (S.P.)
| | - Shibily Prathyumnan
- Department of Medical Biotechnologies, University of Siena, Santa Maria delle Scotte Hospital, V.le Bracci, 1 53100 Siena, Italy; (G.A.); (C.G.); (C.T.); (G.G.S.); (S.P.)
| | - Daniela Orsi
- Preventive Medicine and Health Surveillance Unit, Santa Maria delle Scotte Hospital, V.le Bracci, 1 53100 Siena, Italy; (S.F.); (G.B.M.); (D.O.); (G.B.)
| | - Giuseppe Battista
- Preventive Medicine and Health Surveillance Unit, Santa Maria delle Scotte Hospital, V.le Bracci, 1 53100 Siena, Italy; (S.F.); (G.B.M.); (D.O.); (G.B.)
| | - Maria Grazia Cusi
- Preventive Medicine and Health Surveillance Unit, Santa Maria delle Scotte Hospital, V.le Bracci, 1 53100 Siena, Italy; (S.F.); (G.B.M.); (D.O.); (G.B.)
- Correspondence: ; Tel.: +39-0577-233871
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Haralambieva IH, Ovsyannikova IG, Kennedy RB, Goergen KM, Grill DE, Chen MH, Hao L, Icenogle J, Poland GA. Rubella virus-specific humoral immune responses and their interrelationships before and after a third dose of measles-mumps-rubella vaccine in women of childbearing age. Vaccine 2019; 38:1249-1257. [PMID: 31732325 DOI: 10.1016/j.vaccine.2019.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 01/06/2023]
Abstract
In the U.S., measles, mumps, and rubella vaccination is recommended as two vaccine doses. A third dose of measles-mumps-rubella (MMR) vaccine is being administered in certain situations (e.g., identified seronegativity and during outbreaks). We studied rubella-specific humoral immunity (neutralizing antibody, enzyme-linked immunosorbent assay/ELISA IgG titer and antibody avidity) and the frequencies of antigen-specific memory B cells before and after a third dose of MMR-II in 109 female participants of childbearing age (median age, 34.5 years old) from Olmsted County, MN, with two documented prior MMR vaccine doses. The participants were selected from a cohort of 1117 individuals if they represented the high and the low ends of the rubella-specific antibody response spectrum. Of the 109 participants, we identified four individuals (3.67% of all study participants; 7.14% of the low-responder group) that were seronegative at Baseline (rubella-specific ELISA IgG titers <10 IU/mL), suggesting a lack of protection against rubella before receipt of a third MMR vaccine dose. The peak geometric mean neutralizing antibody titer one month following the third dose of MMR vaccine for the cohort was 243 NT50 (CI; 241, 245), which is expected for a cohort with two doses of MMR, and the peak geometric mean IgG titer was 150 IU/mL (CI; 148, 152) with no seronegative individuals at Day 28. One-third of all subjects (31.8% for the neutralizing antibody; 30.8% for the IgG titer) experienced a significant boost (≥4-fold) of antibody titers one month following vaccination. Antibody titers and other tested immune-response variables were significantly higher in the high-responder group compared to the low-responder group. The frequencies of rubella-specific memory B cells were modestly associated with the antibody titers. Our study suggests the importance of yet unknown inherent biologic and immune factors for the generation and maintenance of rubella-vaccine-induced humoral immune responses.
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Affiliation(s)
| | | | - Richard B Kennedy
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA
| | - Krista M Goergen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Diane E Grill
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Min-Hsin Chen
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta 30333, Georgia
| | - Lijuan Hao
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta 30333, Georgia
| | - Joseph Icenogle
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta 30333, Georgia
| | - Gregory A Poland
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA.
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24
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Javelle E, Colson P, Parola P, Raoult D. Measles, the need for a paradigm shift. Eur J Epidemiol 2019; 34:897-915. [DOI: 10.1007/s10654-019-00569-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/03/2019] [Indexed: 01/24/2023]
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Measles outbreak from Hong Kong International Airport to the hospital due to secondary vaccine failure in healthcare workers. Infect Control Hosp Epidemiol 2019; 40:1407-1415. [PMID: 31587686 DOI: 10.1017/ice.2019.278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To report an outbreak of measles with epidemiological link between Hong Kong International Airport (HKIA) and a hospital. METHODS Epidemiological investigations, patients' measles serology, and phylogenetic analysis of the hemagglutinin (H) and nucleoprotein (N) genes of measles virus isolates were conducted. RESULTS In total, 29 HKIA staff of diverse ranks and working locations were infected with measles within 1 month. Significantly fewer affected staff had history of travel than non-HKIA-related measles patients [10 of 29 (34.5%) vs 28 of 35 (80%); P < .01]. Of 9 airport staff who could recall detailed exposure history, 6 (66.7%) had visited self-service food premises at HKIA during the incubation period, where food trays, as observed during the epidemiological field investigation, were not washed after use. Furthermore, 1 airport baggage handler who was admitted to hospital A before rash onset infected 2 healthcare workers (HCWs) known to have 2 doses of MMR vaccination with positive measles IgG and lower viral loads in respiratory specimens. Infections in these 2 HCWs warranted contact tracing of another 168 persons (97 patients and 71 HCWs). Phylogenetic comparison of H and N gene sequences confirmed the clonality of outbreak strains. CONCLUSION Despite good herd immunity with overall seroprevalence of >95% against measles, major outbreaks of measles occurred among HKIA staff having daily contact with many international pssengers. Lessons from severe acute respiratory syndrome (SARS) and measles outbreaks suggested that an airport can be a strategic epidemic center. Pre-exanthem transmission of measles from airport staff to HCWs with secondary vaccine failure poses a grave challenge to hospital infection control.
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26
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Plotkin SA. Measles: Breakouts and Breakthroughs. J Pediatric Infect Dis Soc 2019; 8:289-290. [PMID: 31282536 DOI: 10.1093/jpids/piz043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/26/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Stanley A Plotkin
- Emeritus Professor of Pediatrics, University of Pennsylvania, Vaxconsult, Doylestown, Pennsylvania
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27
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Berry L, Palmer T, Wells F, Williams E, Sibal B, Timms J. Nosocomial outbreak of measles amongst a highly vaccinated population in an English hospital setting. Infect Prev Pract 2019; 1:100018. [PMID: 34368679 PMCID: PMC8336304 DOI: 10.1016/j.infpip.2019.100018] [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: 07/02/2019] [Accepted: 08/06/2019] [Indexed: 12/04/2022] Open
Abstract
In May 2017 a patient attended the emergency department at a hospital in England, with a presumed allergic reaction. He was subsequently diagnosed with measles. There were seven further confirmed cases, five of whom had received two doses of MMR vaccine. This outbreak highlights the importance of not relying on vaccination status to rule out the diagnosis of measles. Epidemiological investigations of this outbreak were particularly challenging due to the highly infectious nature of the measles virus, and prevented full elucidation of either the source of this outbreak or the transmission pathways.
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Affiliation(s)
- L Berry
- University Hospital Coventry and Warwickshire NHS Trust Coventry, United Kingdom
| | - T Palmer
- Communicable Disease Control, West Midlands Health Protection Team, Public Health England, Birmingham, United Kingdom
| | - F Wells
- Infection prevention and control, University Hospital Coventry and Warwickshire NHS Trust, United Kingdom
| | - E Williams
- Coventry & Warwickshire Occupational Health Shared Service, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
| | - B Sibal
- Communicable Disease Control, West Midlands Health Protection Team, Public Health England, Birmingham, United Kingdom
| | - J Timms
- Department of Virology and Molecular Pathology, Coventry and Warwickshire Pathology Services, University Hospital Coventry and Warwickshire NHS Trust, United Kingdom
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28
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Pergam SA, Englund JA, Kamboj M, Gans HA, Young JAH, Hill JA, Savani B, Chemaly RF, Dadwal SS, Storek J, Duchin J, Carpenter PA. Preventing Measles in Immunosuppressed Cancer and Hematopoietic Cell Transplantation Patients: A Position Statement by the American Society for Transplantation and Cellular Therapy. Biol Blood Marrow Transplant 2019; 25:e321-e330. [PMID: 31394271 DOI: 10.1016/j.bbmt.2019.07.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/29/2022]
Abstract
Until recently, measles exposures were relatively rare and so, consequently, were an afterthought for cancer patients and/or blood and marrow transplant recipients and their providers. Declines in measles herd immunity have reached critical levels in many communities throughout the United States due to increasing vaccine hesitancy, so that community-based outbreaks have occurred. The reemergence of measles as a clinical disease has raised serious concerns among immunocompromised patients and those who work within the cancer and hematopoietic cell transplantation (HCT) community. Since live attenuated vaccines, such as measles, mumps, and rubella (MMR), are contraindicated in immunocompromised patients, and with no approved antiviral therapies for measles, community exposures in these patients can lead to life-threatening infection. The lack of data regarding measles prevention in this population poses a number of clinical dilemmas. Herein specialists in Infectious Diseases and HCT/cellular therapy endorsed by the American Society of Transplant and Cellular Therapy address frequently asked questions about measles in these high-risk cancer patients and HCT recipients and provide expert opinions based on the limited available data.
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Affiliation(s)
- Steven A Pergam
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Mini Kamboj
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hayley A Gans
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jo-Anne H Young
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Bipin Savani
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California
| | - Jan Storek
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada
| | - Jeffery Duchin
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Public Health, Seattle & King County, Seattle, Washington
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington.
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Loeb M, Russell ML, Neupane B, Thanabalan V, Singh P, Newton J, Pullenayegum E. A randomized, blinded, placebo-controlled trial comparing antibody responses to homeopathic and conventional vaccines in university students. Vaccine 2018; 36:7423-7429. [PMID: 30352746 DOI: 10.1016/j.vaccine.2018.08.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Homeopathic vaccines are licensed in many countries but scientific data to support their use are sparse. The goal of this study was to compare the antibody response of homeopathic and conventional vaccines and placebo in young adults. We hypothesized that there would be no significant difference between homeopathic vaccines and placebo, while there would be a significant increase in antibodies in those received conventional vaccines. METHODS A randomized blinded placebo-controlled trial was conducted where 150 university students who had received childhood vaccinations were assigned to diphtheria, pertussis, tetanus, mumps, measles homeopathic vaccine, placebo, or conventional diphtheria, pertussis, tetanus (Tdap) and mumps, measles, rubella (MMR) vaccines. The primary outcome was a ≥ two-fold increase in antibodies from baseline following vaccination as measured by ELISA. Participants, investigators, study coordinator, data blood drawers, laboratory technician, and data analyst were blinded. RESULTS None of the participants in either the homeopathic vaccine or the placebo group showed a ≥ two-fold response to any of the antigens. In contrast, of those vaccinated with Tdap, 68% (33/48) had a ≥ two-fold response to diphtheria, 83% (40/48) to pertussis toxoid, 88% (42/48) to tetanus, and 35% (17/48) of those vaccinated with MMR had a response to measles or mumps antigens (p < 0.001 for each comparison of conventional vaccine to homeopathic vaccine or to placebo). There was a significant increase in geometric mean titres of antibody from baseline for conventional vaccine antigens (p < 0.001 for each), but none for the response to homeopathic antigens or placebo. CONCLUSIONS Homeopathic vaccines do not evoke antibody responses and produce a response that is similar to placebo. In contrast, conventional vaccines provide a robust antibody response in the majority of those vaccinated. TRIAL REGISTRY NCT 02825368.
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Affiliation(s)
- Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada; Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada; Institute for Infectious Diseases Research, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada.
| | - Margaret L Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive W Calgary, Alberta T2N4Z6, Canada
| | - Binod Neupane
- Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada
| | - Vitheya Thanabalan
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada
| | - Pardeep Singh
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada
| | - Jennifer Newton
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada
| | - Eleanor Pullenayegum
- Hospital for Sick Childrene, 555 University Avenue Toronto, Ontario M5G 1X8, Canada
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30
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McLean HQ, Fiebelkorn AP, Ogee-Nwankwo A, Hao L, Coleman LA, Adebayo A, Icenogle JP. Rubella virus neutralizing antibody response after a third dose of measles-mumps-rubella vaccine in young adults. Vaccine 2018; 36:5732-5737. [DOI: 10.1016/j.vaccine.2018.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/21/2018] [Accepted: 08/03/2018] [Indexed: 11/25/2022]
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Ramanathan R, Voigt EA, Kennedy RB, Poland GA. Knowledge gaps persist and hinder progress in eliminating mumps. Vaccine 2018; 36:3721-3726. [PMID: 29784466 PMCID: PMC6031229 DOI: 10.1016/j.vaccine.2018.05.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 01/27/2023]
Abstract
Mumps, a common childhood disease in the pre-vaccine era that causes swelling of the parotid salivary glands, can lead to orchitis, viral meningitis, and sensorineural deafness. While the incidence of disease decreased dramatically after the vaccine was added to standard vaccination schedules, the disease has made a substantial resurgence in recent years. As a result, it becomes critical to examine the factors involved in recurring outbreaks. Although low and incomplete vaccination coverage may be a key reason, it does not fully explain the issue due to the high rate of occurrence in populations with high vaccination coverage rates. Multiple studies suggest that waning immunity and secondary vaccine failure play a large role, the effects of which were previously masked by subclinical boosting. Significant knowledge gaps persist around the exact role and mechanism of waning immunity and demonstrate the need for more research in this area, as well as a reevaluation of mumps vaccine policy.
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Affiliation(s)
- R Ramanathan
- Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA
| | - E A Voigt
- Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA
| | - R B Kennedy
- Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA
| | - G A Poland
- Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA.
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32
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Abstract
Measles remains an important cause of child morbidity and mortality worldwide despite the availability of a safe and efficacious vaccine. The current measles virus (MeV) vaccine was developed empirically by attenuation of wild-type (WT) MeV by in vitro passage in human and chicken cells and licensed in 1963. Additional passages led to further attenuation and the successful vaccine strains in widespread use today. Attenuation is associated with decreased replication in lymphoid tissue, but the molecular basis for this restriction has not been identified. The immune response is age dependent, inhibited by maternal antibody (Ab) and involves induction of both Ab and T cell responses that resemble the responses to WT MeV infection, but are lower in magnitude. Protective immunity is correlated with levels of neutralizing Ab, but the actual immunologic determinants of protection are not known. Because measles is highly transmissible, control requires high levels of population immunity. Delivery of the two doses of vaccine needed to achieve >90% immunity is accomplished by routine immunization of infants at 9-15 months of age followed by a second dose delivered before school entry or by periodic mass vaccination campaigns. Because delivery by injection creates hurdles to sustained high coverage, there are efforts to deliver MeV vaccine by inhalation. In addition, the safety record for the vaccine combined with advances in reverse genetics for negative strand viruses has expanded proposed uses for recombinant versions of measles vaccine as vectors for immunization against other infections and as oncolytic agents for a variety of tumors.
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Affiliation(s)
- Diane E Griffin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
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33
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Latner DR, Parker Fiebelkorn A, McGrew M, Williams NJ, Coleman LA, McLean HQ, Rubin S, Hickman CJ. Mumps Virus Nucleoprotein and Hemagglutinin-Specific Antibody Response Following a Third Dose of Measles Mumps Rubella Vaccine. Open Forum Infect Dis 2017; 4:ofx263. [PMID: 29308410 DOI: 10.1093/ofid/ofx263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/07/2017] [Indexed: 11/12/2022] Open
Abstract
Background Recent mumps outbreaks among 2-dose measles mumps rubella (MMR) vaccine recipients have raised questions regarding the potential benefits of a third dose of vaccine (MMR3). If MMR3 provides a sustained elevation in mumps antibody, it may be beneficial for certain at-risk groups or as an outbreak control measure. Methods Sera were collected immediately prior to MMR3 and at 1 month and 1 year post-MMR3 from 656 healthy adults aged 18-28 years in a nonoutbreak setting. Immunoglobulin G (IgG) was measured by enzyme-linked immunosorbent assay (ELISA) using whole mumps virus (commercial ELISA), hemagglutinin (HN; major neutralizing target), and nucleoprotein (NP; immunodominant) antigens. ELISA measurements were compared with in vitro plaque reduction neutralization (PRN) titers, and baseline antibody was compared with post-MMR3 levels. Results There were modest but statistically significant (P < .05) increases in mumps antibody at 1 month post-MMR3 by all 3 ELISA methods and by PRN titer. At 1 year post-MMR3, mumps antibody declined toward baseline but remained elevated (P < .05). The correlation between PRN titers and ELISA measurements was poor (r2 = .49), although sera with the highest amount of HN IgG also had the highest PRN titers. Conclusions Individuals with the lowest baseline PRN titers had the largest increase in frequency of samples that became positive for HN and NP by ELISA. A third dose of MMR may benefit certain individuals with a low level of mumps virus-neutralizing antibody, especially in the context of an outbreak or other high-risk setting. Additionally, poor correlation among serologic tests does not allow effective prediction of PRN titer by ELISA.
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Affiliation(s)
- Donald R Latner
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Parker Fiebelkorn
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marcia McGrew
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nobia J Williams
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura A Coleman
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, Wisconsin.,Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Huong Q McLean
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Steven Rubin
- Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Maryland
| | - Carole J Hickman
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Modrof J, Tille B, Farcet MR, McVey J, Schreiner JA, Borders CM, Gudino M, Fitzgerald P, Simon TL, Kreil TR. Measles Virus Neutralizing Antibodies in Intravenous Immunoglobulins: Is an Increase by Revaccination of Plasma Donors Possible? J Infect Dis 2017; 216:977-980. [DOI: 10.1093/infdis/jix428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/16/2017] [Indexed: 11/13/2022] Open
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Hahné SJM, Nic Lochlainn LM, van Burgel ND, Kerkhof J, Sane J, Yap KB, van Binnendijk RS. Measles Outbreak Among Previously Immunized Healthcare Workers, the Netherlands, 2014. J Infect Dis 2016; 214:1980-1986. [PMID: 27923955 DOI: 10.1093/infdis/jiw480] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/30/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We investigated a measles outbreak among healthcare workers (HCWs) by assessing laboratory characteristics, measles vaccine effectiveness, and serological correlates for protection. METHODS Cases were laboratory-confirmed measles in HCWs from hospital X during weeks 12-20 of 2014. We assessed cases' severity and infectiousness by using a questionnaire. We tested cases' sera for measles immunoglobulin M, immunoglobulin G, avidity, and plaque reduction neutralization (PRN). Throat swabs and oral fluid samples were tested by quantitative polymerase chain reaction. We calculated attack rates (ARs) by vaccination status and estimated measles vaccine effectiveness as 1 - [ARvaccinated/ARunvaccinated]. RESULTS Eight HCWs were notified as measles cases; 6 were vaccinated with measles vaccine twice, 1 was vaccinated once, and 1 was unvaccinated. All 6 twice-vaccinated cases had high avidity and PRN titers. None reported severe measles or onward transmission. Two of 4 investigated twice-vaccinated cases had pre-illness PRN titers of >120 mIU/mL. Among 106 potentially exposed HCWs, the estimated effectiveness of 2 doses of measles vaccine was 52% (95% confidence interval [CI], -207%-93%). CONCLUSIONS Measles occurred in 6 twice-vaccinated HCWs, despite 2 having adequate pre-exposure neutralizing antibodies. None of the twice-vaccinated cases had severe measles, and none had onward transmission, consistent with laboratory findings suggesting a secondary immune response. Improving 2-dose MMR coverage among HCWs would have likely reduced the size of this outbreak.
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Affiliation(s)
- Susan J M Hahné
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | - Laura M Nic Lochlainn
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven.,European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Jeroen Kerkhof
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | - Jussi Sane
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven.,European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Kioe Bing Yap
- Municipal Health Service Haaglanden, the Hague, The Netherlands
| | - Rob S van Binnendijk
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
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