Dose Of Mumps, And Rubella Vaccine Research Articles

Seroepidemiology of measles and rubella among Hong Kong young adults and the humoral responses of an MMR booster among participants with low antibody levels.

Some individuals may not retain adequate immunity against measles and rubella years after two doses of measles, mumps, and rubella (MMR) vaccination due to vaccine failure. This study aimed to investigate the rates of vaccine failure and seroconversion by administering an MMR booster to young adults. We first assessed measles and rubella antibody levels using the Luminex multiplex assay, VIDAS IgG assay, and plaque reduction neutralization test (PRNT) among individuals aged 18-30 years old who had received two doses of MMR vaccine. Participants with low measles and/or rubella antibody levels as confirmed by VIDAS received an MMR booster. Antibody levels were measured at 1-month post-booster. Among 791 participants, the measles and rubella seroprevalence rates were 94.7% (95% CI: 92.9%-96.0%) and 97.3% (95% CI: 96.0%-98.3%), respectively. Lower seroprevalence rates were observed among older participants. 113 participants who received an MMR booster acquired higher measles and rubella antibody levels at 1-month post-booster compared to baseline. Although measles and rubella vaccine failures were observed among 5.3% and 2.7% of young adults, respectively, an MMR booster triggered a significant antibody response.

A national registry-based study on uptake of the first dose of MMR vaccine in 380 administrative regions in Poland, 2013-2016-2020.

Regular monitoring of the measles, mumps, and rubella (MMR) vaccine uptake quickly exposes immunity gaps in the population. In Poland, the first dose of the MMR vaccine is mandatory for children between 13 and 15 months of life. This study aimed to assess the uptake of the first dose of MMR vaccine in 380 administrative counties in Poland in 2020, as well as to analyze the MMR vaccine uptake trends in 2013-2016-2020. This study is an epidemiological retrospective national registry-based analysis. Data on mandatory childhood vaccinations in all 380 counties in Poland were collected from the epidemiological reports of the State Sanitary Inspectorate territorial representatives. MMR vaccine uptake was calculated as the percentage of children who received the first dose of MRR vaccine to all children subject to mandatory vaccination in the county. The uptake of the first dose of MMR vaccine decreased from 99.4% in 2013, to 95.5% in 2016 and 91.9% in 2020. In 2013, 93.2% of countys MMR vaccine uptake level reached the herd immunity level, followed by 77.1% of counties in 2016 and only 38.3% of countys in 2020. In 2020, two counties reached complete (100%) MMR vaccine uptake, and the lowest MMR vaccine uptake was 63.88%. Of the 380 counties in Poland, in 226 (61.1%) the MMR vaccine uptake level was lower than the herd immunity level, and a downward trend was observed. MMR vaccine uptake decreased with an increased number of residents in a county (r= -0.35; p<0.001). This study revealed that in 61% of administrative regions in Poland, the MMR vaccine uptake was below the herd immunity level. Regional differences in the MMR vaccine uptake were observed. A significant decrease in MMR vaccine uptake between 2013 - 2020 poses a risk of measles outbreaks.

Quantification of waning immunity after measles vaccination - evidence from a seroprevalence study.

The aim of this study was to quantify waning rates from seroprevalence data collected in a study of population with a high vaccination coverage and fixed vaccination schedule. Data were collected during the national Immunologic Survey in the Slovak Republic in 2018. The average waning rate after the first dose (age 1.5 - 10 years) is 9.7% per year from the geometric mean titre (GMT) value 2634 mUI/ml. The average waning rate after the second dose (age 10 - 33 years) is significantly lower, 4.8% per year from the lower GMT value 1331 mUI/ml. This decline in antibody levels suggests that vaccine-induced protection may be compromised and results in the increase in the proportion of seronegative/borderline individuals. These outcomes may provide a valuable source for critical assessment of direct and indirect effects of vaccination.

Recommended Adult Immunization Schedule, United States, 2023.

Recommended Adult Immunization Schedule, United States, 2023.

Role of intralesional measles, mumps and rubella vaccine in treatment of warts

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Objective of the research was to study the efficacy and safety of measles, mumps and rubella (MMR) vaccine in the treatment of warts.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 53 patients with single or multiple warts in all age groups were included in the study. The patients received intralesional MMR vaccine 0.5ml into a single wart or the largest wart in case of multiple lesions at interval of 3 weeks for 3 treatments. All patients were followed up every 2 months up to 6 months regarding relapses. side effects and therapeutic outcomes were evaluated.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 53 patients, 50 completed the study. Complete response was seen in 36 (72%), partial response in 09 (18%) and no response in 05 (10%) patients. 3 out of 36 patients with complete response were having recurrence of warts. Pain at the site of injection and flu like symptoms were the main side effects observed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intralesional immunotherapy with MMR vaccine was found to be a simple, effective, and safe treatment for warts. This study proved to be cost effective as patients can be treated with just 03 doses of MMR vaccine given at the interval of three weeks.&lt;/p&gt;

Intralesional Injection of Measles, Mumps, and Rubella Vaccine in Molluscum Contagiosum Treatment: An Experimental Study

Molluscum contagiosum (MC) is a common viral infection that affects the skin and the mucous membranes. Several studies have shown that intralesional Measles, Mumps, and Rubella (MMR) immunotherapy is beneficial for treating warts. There is very little information about the effectiveness of this treatment method in patients with MC. The study's objective was to assess whether patients with MC benefit from intralesional MMR vaccination. This experimental study was carried out on 20 patients of MC (11 men and 9 women) who visited Sulaimani Dermatology Teaching Center, who received a maximum of six doses of intralesional MMR vaccine with an interval of two weeks between sessions. Three kinds of therapy responses were identified; complete, partial, and no response. A number of side effects were recorded. The mean ± SD of the age, duration of the disease, and the number of skin lesions were 17.9 ±17.1 years, 5.1 ±2.2 months, and 10.4 ±7.9 lesions, respectively. Sixty-five percent of patients had complete clearance, 25% with partial clearance and 10% experienced no clearance. According to the examined variables, no significant difference was present in the frequency of the various treatment responses (p&gt;0.05). The noticed side effects were temporary mild redness, edema, and pain at the site of injection. Recurrence was not seen in any of the patients who responded completely to the treatment. Although it seems that intralesional MMR immunotherapy was effective and safe in the treatment of the skin lesions due to MC. To further support the results of the current study, larger prospective studies that are placebo-controlled and have longer follow-ups are required.

Does Measles, Mumps, and Rubella (MMR) Vaccination Protect against COVID-19 Outcomes: A Nationwide Cohort Study

Cross-protection from previous live attenuated vaccines is proposed to explain the low impact of COVID-19 on children. This study aimed to evaluate the effect of live attenuated MMR vaccines on the risk of being hospitalized for COVID-19 in children. An exposed (MMR vaccine)-non-exposed cohort study was conducted using the nationwide French National Health Data System (SNDS). We included children born between 1 January 2009 and 31 December 2019. Exposure was defined as a claim of at least one dose of MMR vaccine since birth. Hospitalization for COVID-19 was defined using main diagnostic ICD10 codes. Non-conditional logistic regression was used to calculate the adjusted odds ratios (aORs) of the association between MMR exposure and hospitalization for COVID-19, controlling for socio-demographic and socio-economic factors, co-morbidities, and general health. In total, 6,800,542 (median age 6 IQR [3-8] years) children exposed to a MMR vaccine and 384,162 (6 [3-9] years) not exposed were followed up with for 18 months. Among them, 873 exposed to the MMR vaccine and 38 who were not exposed were hospitalized for COVID-19. In a multi-variate analysis, the exposure of children to MMR vaccination was not associated with a decreased risk of COVID-19 hospitalization versus non-exposure (aOR (95%CI) = 1.09 [0.81-1.48]). A stratified analysis by age showed an aOR = 1.03 [0.64-1.66] for children aged 1-4, an aOR = 1.38 [0.82-2.31] for those aged 5-9, and an aOR = 1.11 [0.54-2.29] for those aged 10-12. Our study suggests that the live attenuated MMR vaccine does not protect children against COVID-19 hospitalization.

Immunity and Vaccination Against Measles, Mumps, and Rubella in Adult Allogeneic Hematopoietic Stem Cell Transplant Recipients

Large outbreaks of measles or rubella occasionally occur around the world, and measles infection can be severe and even fatal in transplant patients. However, limited data are available on immunity to measles, mumps, and rubella (MMR) in adult patients after allogeneic stem cell transplantation (allo-HCT). The aim of this study was to evaluate the immune status against MMR and the effects of vaccination against MMR in adult patients after allo-HCT. A total of 135 adult patients who were alive without relapse and new malignancy at 2 years after allo-HCT were included in this study. We measured IgG antibody to MMR before allo-HCT and annually thereafter. The probabilities of being seropositive to measles, mumps or rubella after allo-HCT were estimated according to the Kaplan-Meier method and compared among groups with the log-rank test. The probability of being seropositive at 2 years after allo-HCT in patients who were seropositive before allo-HCT was 60.6% for measles, 39.7% for mumps, and 52.2% for rubella. History of chronic graft-versus-host disease tended to be a risk factor for the loss of immunity against measles (hazard ratio [HR] 1.69, P = .064) and rubella (HR 1.75, P = .056). To predict the loss of immunity against MMR at 2 years after allo-HCT, we defined the following cutoff values for the IgG index before HCT: 18.2 for measles, 5.3 for mumps, and 21.4 for rubella using a receiver-operating characteristics curve. The lower-IgG groups experienced a significant loss of seropositivity at 2 years (39% versus 82% for measles, P < .001; 13% versus 59% for mumps, P < .001; and 33% versus 90% for rubella, P < .001). After this loss of immunity, 25 patients received a single vaccination against MMR. The seroconversion rates were 64%, 36%, and 72% for measles, mumps, and rubella, respectively. Loss of immunity to MMR commonly occurs in the first several years after transplantation. In the patients who lose the immunity, the seroconversion rate after 1 dose of MMR vaccine given at ≥2 years after transplantation is suboptimal.

Determination of ELISA reactive mumps IgG antibodies in MMR vaccine recipients in comparison with MMR vaccine naive children: A cross sectional study

Background/Aim: Mumps is by vaccine preventable infectious disease characterised by parotitis. In India mumps vaccines are not currently used under National Immunisation Programme (NIP). Waning of vaccine-induced immunity is considered to play a central role in the re-emergence of mumps. The comprehensive data on the seroepidemiology of measles, mumps, and rubella (MMR) as well as studies which compare the antibody titre among mumps vaccine naiveand mumps vaccinated children are lacking. The aim of this study was to estimate and compare mumps specific antibody titre in children with and without MMR vaccine. Methods: In 2019/2020, blood samples were collected from 100 healthy children attending immunisation clinic in Government Medical College Kota and associated J K Lon Maternal and Child care hospital Kota. The samples were investigated for MMR IgG antibodies using ELISA. Results: Out of total 100 children included in the study, 32.27 % vaccinated and 4.83 % non-vaccinated children were positive for mumps IgG antibody in the age group of 6 months to 6 years of age. Children aged 6 to 12 years, vaccinated and non-vaccinated, had 31.57 % and 26.57 % positivity, respectively. The seroprevalence of measles, mumps and rubella antibodies among 50 MMR vaccinated children were 94 %, 64 %, and 96 %, respectively. A high measles and rubella seroprevalences were observed among all children age groups, suggesting an effective control program, while the mumps seroprevalence decreased significantly with age. Conclusion: The maximum vaccine effectiveness against mumps for 2 doses of MMR vaccine is ≈ 96 %. The herd immunity threshold to block mumps virus transmission is ≥ 86 %. In this study only 64 % of the vaccinated children were found to have IgG mumps antibodies. In view of morbidity following mumps infection there is a need to incorporate mumps vaccine along with measles and rubella vaccine in the NIP instead of Mr.

CDC Guidance for Use of a Third Dose of MMR Vaccine During Mumps Outbreaks.

In response to numerous mumps outbreaks reported throughout the United States in 2016 and 2017, the Advisory Committee on Immunization Practices (ACIP) recommended a third dose of measles, mumps, and rubella (MMR) vaccine for groups of persons determined by public health authorities to be at increased risk for acquiring mumps because of an outbreak. To provide guidance for health departments when implementing the ACIP recommendation. Draft guidance was developed by Centers for Disease Control and Prevention subject matter experts based on technical consultations with health departments and review of published and unpublished data regarding mumps outbreaks. The guidance was finalized based on input from experts from the ACIP Mumps Work Group and local and state epidemiologists through the Council of State and Territorial Epidemiologists and the National Association of County and City Health Officials. We developed guidance to assist public health authorities when determining which groups are at increased risk for acquiring mumps and should receive a third dose of MMR vaccine. During outbreaks, public health authorities identify groups of persons with known or likely close contact exposure to a mumps patient. Then, evidence of transmission and likelihood of transmission in a group's setting can be used to determine whether these groups are at increased risk. Additional epidemiologic and implementation factors may also be considered. All persons in the group at increased risk for acquiring mumps should receive a dose of MMR vaccine, including those with unknown vaccination status or those who have evidence of presumptive immunity other than documented 2 doses of MMR vaccine; no additional dose is recommended for persons who had received 3 or more doses before the outbreak. This guidance provides a framework for public health authorities to use when considering a third dose of MMR in response to mumps outbreaks while maintaining flexibility to incorporate local factors related to individual outbreaks.

Health Departments' Experience With Mumps Outbreak Response and Use of a Third Dose of Measles, Mumps, and Rubella Vaccine.

During January 2016 to June 2017, US health departments (HDs) reported 150 mumps outbreaks. Most occurred among populations with high 2-dose measles, mumps, and rubella (MMR) vaccine coverage, prompting the Advisory Committee on Immunization Practices to examine the evidence for use of a third dose of MMR vaccine. To evaluate HD experiences with mumps outbreak control and use of a third MMR dose during outbreaks. An online survey assessing mumps outbreak characteristics, outbreak response measures, challenges, and lessons learned from previous outbreaks was distributed to all 81 Council of State and Territorial Epidemiologists member HDs in August 2017. Sixty-one (75%) HDs responded; 46 (75%) had experience with ≥1 mumps outbreak(s) during January 2016 to August 2017. Twenty (43%) HDs recommended a third or outbreak MMR dose during mumps outbreaks; of these, 19 completed the section on use of a third dose and 8 (40%) rated the intervention "somewhat effective" or better. Health departments that used a third/outbreak dose suggested implementing the recommendation early and to a targeted group. Forty-three (73%) HDs reported having a policy for excluding persons without presumptive immunity from outbreak settings; of these, 37 (86%) had some degree of legal authority to implement this policy. Exclusion compliance improved with the use of personalized notification letters, focus groups of excluded persons and the community, and standardized messaging. Other outbreak control measures included cohorting of exposed or susceptible persons, mobile vaccination clinics and home visits, contact monitoring via text messaging, and facilitating student isolation with meal delivery and excused class absences. Our study revealed heterogeneity across HDs' mumps outbreak responses but also identified common challenges that will inform future Centers for Disease Control and Prevention guidance. These results were considered in the October 2017 Advisory Committee on Immunization Practices recommendation for use of a third dose of MMR vaccine for persons at increased risk for mumps during an outbreak and in the development of Centers for Disease Control and Prevention guidance for HDs when applying the Advisory Committee on Immunization Practices recommendation.

Long-term immunogenicity of measles, mumps and rubella-containing vaccines in healthy young children: A 10-year follow-up

Measles and mumps outbreaks still occur in countries that have successfully implemented universal routine immunization programs. Measles outbreaks are mostly associated to absent or incomplete vaccination, whereas for mumps outbreaks the combined effects of waning of immunity and circulating new strains are incriminated. It is therefore increasingly useful to characterize the long-lasting immunity induced by measles-, mumps, and rubella (MMR)-containing vaccines.In this 10-year study, 1887 healthy children aged 12–22 months, randomized to receive 1 or 2 doses of MMR-containing vaccines (Priorix or Priorix-Tetra; GSK), were included in an antibody persistence analysis. A total of 364 children in the 1-dose group received a second dose out of study according to their local vaccination schedule between Years 4 and 10 post-dose 1, and were included in a separate post-hoc analysis to evaluate the effect of the second dose when given later. Anti-measles, -mumps and -rubella antibody titers were measured by commercial ELISA kits (Enzygnost, Siemens) after each vaccine dose and at Years 1, 2, 4, 6, 8 and 10 post-vaccination.Antibodies against measles and rubella declined moderately after vaccination but remained well above the seropositivity threshold after 10 years. The anti-measles antibody titers elicited by Priorix-Tetra remained about 2-fold higher throughout the study as compared with Priorix. A second dose of MMR vaccine later in life had a minor and transient effect on anti-measles and anti-rubella waning titers. In contrast, anti-mumps antibody levels remained relatively stable over the 10-year follow-up and a second dose of MMR vaccine, given anytime over the 10-year period, had a boosting effect on anti-mumps antibody titers and seropositivity rates.In conclusion, 1 or 2 doses of MMR-containing vaccines given to children in their second year of life induced antibody responses against measles, mumps and rubella viruses that persisted at least up to 10 years post-vaccination.Clinical trial registration number: NCT00226499.

Seroprevalence of measles, mumps & rubella antibodies among 5-10 years old children in north India.

Background & objectives:Globally, there is an effort to eliminate the measles and control rubella as these diseases lead to considerable morbidity and mortality especially among under-five children and are important public health problems. This study was aimed to estimate the seroprevalence of measles, mumps and rubella (MMR) antibodies among children of age 5-10 yr in Chandigarh, north India, to provide evidence on prevalent immunity levels.Methods:This cross-sectional study was conducted in Chandigarh, among 196 randomly selected healthy children (5-10 yr), who received either one or two doses of measles or MMR combination vaccine. Socio-economic background and immunization history were recorded. Blood sample (2 ml) was collected to estimate the MMR IgG antibody titres by using ELISA kits.Results:Protective seroprevalence of MMR antibodies was 40.8, 75.5 and 86.2 per cent, respectively. The geometric mean titres of MMR IgG antibodies in the study children were 11.3, 50.6 and 54.3 international units (IU)/ ml, respectively. The proportion of seroprotected children for measles was significantly higher among those who had received two or more doses (46.4%) of measles vaccine compared to those who had received single dose (35.6%) (P<0.001). About 16 per cent of children had received single dose of MMR vaccine. Among these, 71.4 and 100 per cent were seroprotected against mumps and rubella, respectively.Interpretation & conclusions:A large proportion of children aged 5-10 yr lacked protective immunity against measles (60%); about one-fourth (15-25%) were susceptible to infection with mumps and rubella virus. Mumps vaccination may be considered to be included in National Immunization Schedule for children with periodic serosurveillance.

Immunogenicity and safety of a second dose of a measles-mumps-rubella vaccine administered to healthy participants 7 years of age or older: A phase III, randomized study

ABSTRACTThe introduction of vaccination programs against measles, mumps, and rubella (MMR) led to significant global reduction in morbidity and mortality from these diseases. The currently recommended MMR vaccination schedule in the United States of America comprises 2 vaccine doses typically administered at 12–15 months and 4–6 years, respectively. Considering recent outbreaks in the USA, catch-up vaccination with an additional dose of MMR vaccine could contribute to outbreak control and community protection. This phase III, observer-blind, randomized controlled trial (NCT02058563) assessed the immunogenicity and safety of a dose of the MMR-RIT vaccine (Priorix, GSK) compared to MMR II vaccine (control; M-M-R II, Merck&Co Inc.) in ≥7-year-olds who had received ≥1 previous dose of MMR vaccine. We assessed anti-measles, anti-mumps, and anti-rubella antibody geometric mean concentrations (GMCs; primary endpoint) and seroresponse rates (SRRs) at day 42 post-vaccination. Solicited, unsolicited, and serious adverse events (AEs) were recorded. The according-to-protocol cohort for immunogenicity included 869 participants (MMR-RIT: N = 433; MMR II: N = 436). We observed anti-measles, anti-mumps, and anti-rubella antibody GMCs of 1790.2 mIU/mL, 113.5 EU/mL, and 76.1 IU/mL, respectively, and SRRs of 98.8%, 98.4%, and 99.5%, respectively, after a dose of MMR-RIT; non-inferiority compared to MMR II was demonstrated. Both vaccines showed comparable reactogenicity profiles; the most common solicited AEs were injection site redness and pain, and fever (MMR-RIT: 12.2%, 11.8%, and 3.0%; MMR II: 11.7%, 11.5%, and 5.2%, respectively). The dose of MMR-RIT induced robust immune responses that were not inferior to those of MMR II, and was well tolerated.

Sustained Immune Response to Measles, Mumps and Rubella in Immunosuppressed Inflammatory Bowel Disease Patients

Introduction: Patients with inflammatory bowel disease (IBD) are routinely immunosuppressed, and those on anti-TNF therapy can have a lower sustained antibody response to vaccines. Recent measles and mumps outbreaks have occurred in those not receiving measles, mumps and rubella (MMR) vaccine. There is a paucity of data regarding response to the MMR vaccine in IBD patients. Methods: We performed a cross sectional study measuring antibody concentrations to MMR vaccine among IBD patients compared to healthy controls. Our study consisted of three IBD groups: adults with IBD stratified based on maintenance medication regimen for at least three months 1) azathioprine/6-mercaptopurine (AZA/6MP); 2) biologic (TNF alpha inhibitor); and 3) combination therapy (biologic and immunomodulator (AZA/6MP or methotrexate). The healthy control group consisted of patient without chronic health conditions. All subjects received the two doses of MMR vaccine. Measles,mumps, and rubella antibody concentrations were measured using ELISA methods (Alpha Diagnostic International; San Antonio, TX) and the results adjusted to WHO standards. The primary objective of this study is to compare MMR antibody concentrations in three IBD treatment groups: azathioprine/6-mercaptopurine, anti-TNF agents, and combination therapy. Results: Sixty-six individuals with documented MMR immunization (n=46 IBD patients; n=20 healthy) were used. The patients with IBD and the healthy controls were comparable in age, sex distribution, and time since MMR administration. (Table 1). The antibody concentrations in subjects with IBD were not significantly different from that of the healthy subjects (Table 2). Among the three treatment groups, statistically significant difference was found in the mumps antibody concentration between the azathioprine and the combination treatment groups. MMR antibody concentrations were not significantly different among all other comparison groups.Table. DemographicsTable: Table. Measels, Mumps and Rubella Antibody ConcentrationsConclusion: This is the first study evaluating sustained antibody concentrations in immunosuppressed IBD patients with confirmed history of MMR vaccine series. No significant difference in MMR antibody concentrations were found between IBD and healthy patients, as well as among three common IBD treatment groups. IBD patients immunized with the MMR series have sustained protection comparable to healthy controls regardless of immunosuppressive regimen. Immunization history is a reliable surrogate for determining seroprotection to measles and rubella.

Importation of Measles into America: How a Travel Clinic Can Help Prevent the Next Outbreak

There were an increased number of cases of measles in the United States (US) in the year 2014 including a major outbreak of measles originating at an amusement park in California. A visitor to the park, who probably was infected with measles during travel abroad, was suspected to be the source patient in the outbreak. This placed vaccination of children with the measles, mumps and rubella (MMR) vaccine at the center of medical, social and even political debate. Our travel clinic is accessed by a large number of persons prior to their travel abroad. Those who are not immune to measles have an opportunity to receive the MMR vaccine at their pre-travel visit. 912 persons were evaluated for in-person travel consultation at our travel clinic in the period January to December 2013 and 963 persons were evaluated during the same period in 2014. In addition to the traditional travel vaccines, 70 doses of the MMR vaccine were administered in 2013. 92 doses of MMR vaccine were administered in 2014. 315 tests for measles serology were performed in 2013, and 350 was the corresponding number for 2014. As seen in our data, among the large number of travelers seen at our clinic, a considerable number was not immune to measles and they were provided the MMR vaccine. The travel clinic thus represents a unique opportunity to increase the uptake of the MMR vaccine in healthy individuals. When these individuals are tested and vaccinated, it helps protect them from infection when they travel abroad and also increases herd immunity against measles in their communities when they return home.

Measles Virus Neutralizing Antibody Response, Cell-Mediated Immunity, and Immunoglobulin G Antibody Avidity Before and After Receipt of a Third Dose of Measles, Mumps, and Rubella Vaccine in Young Adults.

Two doses of measles, mumps, and rubella (MMR) vaccine are 97% effective against measles, but waning antibody immunity to measles and failure of the 2-dose vaccine occur. We administered a third MMR dose (MMR3) to young adults and assessed immunogenicity over 1 year. Measles virus (MeV) neutralizing antibody concentrations, cell-mediated immunity (CMI), and immunoglobulin G (IgG) antibody avidity were assessed at baseline and 1 month and 1 year after MMR3 receipt. Of 662 subjects at baseline, 1 (0.2%) was seronegative for MeV-neutralizing antibodies (level, <8 mIU/mL), and 23 (3.5%) had low antibody levels (8-120 mIU/mL). One month after MMR3 receipt, 1 subject (0.2%) was seronegative, and 6 (0.9%) had low neutralizing antibodies, with only 21 of 662 (3.2%) showing a ≥ 4-fold rise in neutralizing antibodies. One year after MMR3 receipt, no subject was seronegative, and 10 of 617 (1.6%) had low neutralizing antibody levels. CMI analyses showed low levels of spot-forming cells after stimulation, suggesting the presence of T-cell memory, but the response was minimal after MMR3 receipt. MeV IgG avidity did not correlate with findings of neutralization analyses. Most subjects were seropositive before MMR3 receipt, and very few had a secondary immune response after MMR3 receipt. Similarly, CMI and avidity analyses showed minimal qualitative improvements in immune response after MMR3 receipt. We did not find compelling data to support a routine third dose of MMR vaccine.

Rubella susceptibility in pregnant women and results of a postpartum immunization strategy in Catalonia, Spain

BackgroundElimination of congenital rubella syndrome depends not only on effective childhood immunization but also on the identification and immunization of rubella susceptible women. We assessed rubella susceptibility among pregnant women and evaluated the adherence and response to postpartum immunization with measles, mumps and rubella (MMR) vaccine. MethodsCross-sectional study of women who gave birth at the Hospital Clinic de Barcelona (Spain) between January 2008 and December 2013. Antenatal serological screening for rubella was performed in all women during pregnancy. In rubella-susceptible women, two doses of MMR vaccine were recommended following birth. We evaluated rubella serological response to MMR vaccination in mothers who complied with the recommendations. ResultsA total of 22,681 pregnant women were included in the study. The mean age was 32.3 years (SD 5.6), and 73.6% were primipara. The proportion of immigrants ranged from 43.4% in 2010 to 38.5% in 2012. The proportion of women susceptible to rubella was 5.9% (1328). Susceptibility to rubella declined with increasing maternal age. Immigrant pregnant women were more susceptible to rubella (7.6%) than women born in Spain (4.6%). Multivariate analyses showed that younger age (≤19 years) aOR 1.7 (95% CI 1.1–2.5), primiparas aOR 1.3 (95% CI 1.1–1.5) and immigrant women aOR 1.6 (95% CI 1.4–1.8) were more likely to be susceptible. The second dose of MMR vaccine was received by 57.2% (718/1256) of rubella-susceptible women, with the highest proportion being immigrant women compared with women born in Spain. After vaccination, all women showed rubella immunity. ConclusionsThe higher rubella susceptibility found in the three youngest age groups and in immigrant women highlights the relevance of antenatal screening, in order to ensure identification and postpartum immunization. The postpartum immunization strategy is an opportunity to protect women of childbearing age and consequently prevent occurrence of CRS, and to increase vaccination coverage against rubella and other vaccine-preventable diseases.

Progress towards measles elimination in Singapore

ObjectiveWe describe the epidemiological trends of measles in Singapore in relation to its progress towards measles elimination and identify gaps in fulfilling the World Health Organization Western Pacific Regional Office regional measles elimination criteria. MethodsEpidemiological data on measles maintained by the Communicable Diseases Division, Ministry of Health from 1981 to 2012 were collated and analysed. Data on measles vaccination coverage were obtained from the National Immunization Registry and School Health Services, Health Promotion Board. To assess the seroprevalence of the population, the findings of periodic seroepidemiological surveys on measles were traced and reviewed. FindingsWith the successful implementation of the National Childhood Immunization Programme using the monovalent measles vaccine, measles incidence declined from 88.5 cases per 100,000 in 1984 to 6.9 per 100,000 in 1991. Resurgences were observed in 1992, 1993 and 1997. A ‘catch-up’ vaccination programme using the trivalent measles, mumps and rubella (MMR) vaccine was conducted in 1997, followed by introduction of the two-dose vaccination schedule in January 1998. Measles incidence subsequently declined sharply to 2.9 per 100,000 in 1998. Vaccination coverage was maintained at 95% for the first dose and 92–94% for the second dose. Seroprevalence surveys showed seropositivity for measles IgG antibodies in over 95% of adults in 2004, and in 83.1% of children aged 1–17 years in 2008–2010. Sporadic cases with occasional clusters of two or more cases continued to occur among the unvaccinated population, especially children aged below 4 years. The predominant measles virus genotype has shifted from D9 to the B3 and G3 genotypes, which are endemic in neighbouring countries. ConclusionSingapore has made good progress towards the elimination of endemic measles. To further eliminate sporadic cases of measles, the national immunisation schedule has recently been amended to vaccinate children with 2 doses of MMR vaccine before 2 years of age.

Seroprevalence of Antibodies to Measles, Mumps and Rubella (MMR) Vaccines in Previously Vaccinated Human Immunodeficiency Virus-Infected Children and their Control Counterparts

Background: Concerns remain regarding immunity to measles, mumps and rubella in HIV-infected children and need for booster doses during later adolescent-hood or young adulthood. Methods: We evaluated measles, mumps and rubella antibodies in 13 HIV- infected and 13 age-matched control children. All children had received 2 doses of the measles, mumps and rubella (MMR) vaccine. Anti-measles, mumps, and rubella antibody levels were assessed by ELISA at a mean of 30 months in the HIV-infected group and 27 months in the control children, following a second dose of the MMR vaccine. MMR antibodies considered to be protective levels were >1.1 ODR (Optical Density Ratio) for measles and mumps and >9.9 IU/ml for rubella. Results and Conclusions: Of the thirteen HIV-infected children, only four (31%) (p=0.01) had protective level (>1.11 ODR) of antibodies to measles and five (38%) (p=0.04) had protective level of antibodies to mumps compared to eleven (85%) of the thirteen controls. Although the prevalence of protective immunity (>9.9 IU/ml) for rubella was comparable in HIV-infected and control children, antibody levels were significantly lower (p=0.01) in HIVinfected children compared to their control counterparts. Our study results show that approximately seventy percent of HIV-infected children and adolescents compared to their control counterparts, remain susceptible to measles and mumps, despite two doses of the MMR vaccine. We therefore, recommend that booster doses of MMR vaccine be considered in HIV- infected children and adolescents when exposed to outbreaks of these infectious diseases in the US. Further prospective and larger studies may need to be conducted in HIV-infected children to determine if lower immunities in this group are due to primary vaccine failure or waning immunity.