MMR Immunization Research Articles

Self-collected buccal swabs and rapid, real-time PCR during a large measles outbreak in Wales: Evidence for the protective effect of prior MMR immunisation

BackgroundWe describe the laboratory response to a large measles outbreak that occurred during 2012–2013 centred in mid and west Wales, UK. ObjectivesTo demonstrate the impact of rapid measles testing on the management of a large outbreak, to show the complex molecular epidemiology and determine the role of previous MMR immunisation on a large cohort of exposed people. Study DesignResults from oral fluid antibody testing and self-collected buccal swabs tested by real-time PCR were reconciled and analysed to determine level of agreement and to calculate MMR vaccine efficacy during the outbreak. ResultsDuring the outbreak 1435 notifications of measles were received from across Wales. Samples were received from 70% of notified cases with a positivity rate of 56% within the outbreak compared to 15% for the rest of Wales. Measles RNA was detected in 53 cases with previous history of MMR immunisation, but viral loads were lower than those detected in unimmunised cases. The molecular epidemiology showed at least two distinct D8 strains of measles virus were introduced into Wales along with a separate introduction of a B3 strain outside the outbreak area. ConclusionMolecular testing of all notified measles cases offers the most rapid way of confirming the introduction of measles into a population potentially before secondary transmission has already occurred. The outbreak data confirms the protective effect of the MMR vaccine with vaccine efficacy calculated at 96% for one dose and 99% for two doses supporting the WHO recommendations for a two dose MMR immunisation schedule.

Neurological Disorders Associated with Measles-Mumps-Rubella Vaccination- a Review

Background: The safety of the measles-mumps-rubella (MMR) vaccine has always been doubtful due to its side effects reported over time. Current criticism revolves around the fact that the trials were too small and did not follow up on children involved in the study for long enough periods to determine if there would be any potential hazards involved. Objective: To assess the risks of seizures and other neurological events following MMR immunization in children up to 16 years of age. Methodology: The data was collected from retrospective and prospective cohort studies carried out worldwide on around 8 million children who received MMR immunization up to their 16 years of life. About 110 published articles (from 1991 to 2014), satisfied the inclusion criteria and 38 of them were included in the review. Main Results: MMR immunization was associated with consistent increase in febrile seizures in the 7- through 14-day interval. Delaying MMR vaccine past 15 months of age resulted in a higher risk of seizures. The long-term rate of epilepsy was not increased in children who had febrile seizures following vaccination compared with children who had febrile seizures of a different etiology. The reports on other neurological disorders included the rare adverse events of aseptic meningitis associated with a form of the MMR vaccine containing the Urabe mumps strain, and very few cases of encephalitis, convulsions, Guillain-Barre syndrome and subacute sclerosing panencephalitis. The most commonly occurring adverse reaction was syncopal fit. Conclusion: Measles, mumps, and rubella are all very serious illnesses and can have complications leading to lifetime disability or even death. The long-term effects of the MMR vaccine are still in question, but on comparing its risks and benefits, the benefits far outweigh the incidence of serious adverse events associated with immunization. Changes in the vaccine formulation may help to reduce side-effects, and further advances may help make current vaccines even safer.

Immunization Against Influenza but Not MMR Modulates the Anti-Factor VIII Immune Response in Hemophilia Α Mice

Introduction: The etiology of inhibitory factor VIII (FVIII) antibodies in 25-30% of hemophilia A (HA) patients remains poorly understood. It is possible that concurrent exposure to inflammatory stimuli, or 'danger signals’, with FVIII increases the risk of inhibitor formation. HA patients generally begin FVIII replacement therapy around 12 months of age, and the median age of inhibitors onset is between 15-21 months. During this time frame, patients may be exposed to vaccines, such as the mumps-measles-rubella (MMR) and seasonal influenza vaccines. Our investigation is the first to address the concern that these vaccines may serve as danger signals that augment FVIII immunogenicity.Methods: Our studies used 8-12 week-old FVIII E17KO C57Bl6/S129 HA mice, which carry a complete knockout of all murine MHC class II molecules, and instead express a chimeric human-mouse HLA-DRB1*1501 allele associated with increased inhibitor risk. Our preliminary studies show that 40-80% of these animals develop FVIII inhibitors following treatment.HA mice were immunized with 10x the standard human dose of live-attenuated MMR vaccine (Priorix) subcutaneously or intravenously 24 hrs prior to 4 weekly intravenous infusions of 2 IU recombinant human FVIII (rhFVIII, Advate). Mice were subsequently re-challenged with MMR 24 hrs prior to 4 biweekly infusions of 6 IU rhFVIII. Blood samples were collected retro-orbitally or via cardiac puncture. Plasma from weeks 5 and 9 was assessed for anti-FVIII IgG by ELISA; inhibitor concentrations were assessed by a Bethesda assay on week 9.The inactivated influenza vaccine (Agriflu) was administered at standard human doses either intramuscularly or intravenously 24 hrs before, after, or concurrently with the first of 7 biweekly infusions of 6 IU rhFVIII. Week 5 plasma samples were subjected to anti-FVIII and anti-influenza IgG ELISA and Bethesda assays. Statistical comparisons were made using the Fisher’s exact Mann-Whitney U tests, as appropriate.Results: Subcutaneous MMR vaccination exhibited no significant differences in the incidence or titres of anti-FVIII IgG compared to HBSS-injected controls at weeks 5 and 9 (n=13). Similarly, no differences in the incidence or concentration of inhibitors were detected at week 9. We next evaluated the effects of intravenous MMR immunization on FVIII immunogenicity. Surprisingly, we again observed no differences in the incidence or magnitude of the anti-FVIII immune response at weeks 5 and 9 (n=28-30).Importantly, we found a significant decrease in the incidence of FVIII-specific IgG in mice that were immunized intramuscularly with the influenza vaccine 24 hrs after and at the same time as the first infusion of rhFVIII (t=-24 hrs: 30%, t=0 hrs: 20%, t=+24 hrs: 26% vs control: 67%; p=0.11, 0.06, 0.04; n=10-15). Similarly, there was a significant decrease in the incidence of inhibitors at all immunization time points (t=-24 hrs: 30%, t=0 hrs: 43%, t=+24 hrs: 11% vs control: 80%; p=0.03, 0.02, 0.0022). No differences in IgG titres or inhibitor concentrations were detected. When immunized intravenously with the influenza vaccine, we observed an increase in the presence of FVIII-specific IgG, but no differences in titres. However, these differences were not statistically significant and need confirmation (t=-24 hrs: 80%, t=0 hrs: 90%, t=+24 hrs 40% vs control: 50%; p=0.58, 0.14, 1.00; n=5-10).Conclusion: These are the first experimental studies to address vaccination as a potential danger signal in the development of an anti-FVIII immune response. Our results suggest that both subcutaneous and intravenous immunization of HA mice with the MMR vaccine do not influence the incidence or magnitude of the anti-FVIII immune response. In contrast, our data suggest that intramuscular immunization with the inactivated influenza vaccine modulates the anti-FVIII immune response and may enhance tolerance induction to FVIII, possibly through antigen competition. However, this proposal awaits further confirmation. Finally, a trend in increased antibody and inhibitor incidence in intravenously immunized mice suggests that the influenza vaccine can serve as a danger signal, but is dependent on the route of administration. Our findings contradict current vaccination concerns in the treatment of young HA patients, and instead suggest an inhibitor-protective effect from influenza immunization. DisclosuresMoorehead:Baxter: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Bayer: Membership on an entity’s Board of Directors or advisory committees; Pfizer: Honoraria. Steinitz:Baxter: Employment. Reipert:Baxter: Employment. Hough:Bayer: Research Funding. Lillicrap:Baxter: Research Funding; Bayer: Research Funding; CSL Behring: Research Funding; Biogen Idec: Research Funding.

G142(P) MMR Vaccine: No jab, no school or your child, your choice

IntroductionIn March 2012 there was Measles outbreak in Gwynedd because of poor MMR vaccination uptake rates.AimsTo review MMR vaccine uptake in primary and secondary schools in Caerphilly Borough and to...

Juvenile Idiopathic Arthritis and Live Virus Vaccines

Juvenile Idiopathic Arthritis and Live Virus Vaccines

Validation of the French national health insurance information system as a tool in vaccine safety assessment: Application to febrile convulsions after pediatric measles/mumps/rubella immunization

In the French national health insurance information system (SNIIR-AM), routine records of health claimed reimbursements are linked to hospital admissions for the whole French population. The main focus of this work is the usability of this system for vaccine safety assessment programme. Self-controlled case series analyses were performed using an exhaustive SNIIR-AM extraction of French children aged less than 3 years, to investigate the relationship between MMR immunization and children hospitalizations for febrile convulsions, a well-documented rare adverse event, over 2009–2010. The results suggest a significant increase of febrile convulsions during the 6–11 days period following any MMR immunization (IRR=1.49, 95% CI=1.22, 1.83; p=0.0001) and no increase 15–35 days post any MMR immunization (IRR=1.03, 95% CI=0.89, 1.18; p=0.72). These results are in accordance with other results obtained from large epidemiologic studies, which suggest the usability of the SNIIR-AM as a relevant database to study the occurrence of adverse events associated with immunization. For future use, results associated with risk of convulsion during the day of vaccination should nevertheless be considered with particular caution.

Serologic Protection to Routine Vaccinations in Children with Inflammatory Bowel Disease

Background: Treatment for inflammatory bowel disease [IBD] frequently involves the aggressive use of immunosuppressants that increases susceptibility to and severity of other infections. Consequently, many individuals postpone or refuse immunizations due to unstable disease activity and of fear of disease exacerbation. The aim was to evaluate serologic protection to and completeness of routine vaccinations in children with IBD. Methods: In this single-center cross-sectional study, children with IBD followed at the Alberta Children's Hospital were recruited from September 15, 2011 to August 15, 2012. Demographic data, IBD medication use, infection risk factors, and vaccination records were collected. Serum was also collected for rubella, hepatitis A virus [HAV], and hepatitis B virus [HBV] serology and analyzed by the Provincial Laboratory of Public Health. From review of vaccination records, the proportion with complete series for each vaccine according to the Alberta schedule (at age of vaccination) was evaluated. Results: 155 children with IBD (93 Crohn’s disease, 46 ulcerative colitis, 16 IBD-unclassified) underwent serum collection; complete vaccine records were available for 152 of these children. At enrolment, 93 subjects (60%) were currently using immunosuppressive medications (systemic corticosteroids n=20; immunomodulators n=70; and biologic n=48); an additional 30 subjects had a past history of immunosuppressive medication use. Of 155 participants, 69.7% had up to date MMR, DTap-IPV-Hib, and HBV immunizations. Of 152 participants, 81.9% mounted serologic protection to rubella; 20.6% to hepatitis A, and 65.8% to hepatitis B. Of those who had completed the specific vaccinations, serologic immunity was mounted by 113 of the 142 participants (79.6%) to rubella, 79 of the 114 participants (69.3%) to HBV, and 100% of the participants to HAV. Conclusions: Children with IBD are at risk for vaccine-preventable illnesses due to lack of receiving complete vaccine series and mounting an inadequate serologic response to vaccinations. Therefore, clinicians caring for patients with IBD should be conscientious about adherence to recommended vaccination schedules, measurement of immune response to vaccines, and administering booster vaccinations where appropriate.

The Interplay of Public Intervention and Private Choices in Determining the Outcome of Vaccination Programmes

After a long period of stagnation, traditionally explained by the voluntary nature of the programme, a considerable increase in routine measles vaccine uptake has been recently observed in Italy after a set of public interventions aiming to promote MMR immunization, whilst retaining its voluntary aspect. To account for this take-off in coverage we propose a simple SIR transmission model with vaccination choice, where, unlike similar works, vaccinating behaviour spreads not only through the diffusion of “private” information spontaneously circulating among parents of children to be vaccinated, which we call imitation, but also through public information communicated by the public health authorities. We show that public intervention has a stabilising role which is able to reduce the strength of imitation-induced oscillations, to allow disease elimination, and to even make the disease-free equilibrium where everyone is vaccinated globally attractive. The available Italian data are used to evaluate the main behavioural parameters, showing that the proposed model seems to provide a much more plausible behavioural explanation of the observed take-off of uptake of vaccine against measles than models based on pure imitation alone.

Caracterización de pacientes con convulsión febril simple en urgencias del Hospital San José

BackgroundFebrile seizures are a common pediatric problem, which occurs in children between 3 months and 5 years of age; generally they have a benign prognosis. However, there are few studies in Colombia about their behavior and there is unawareness of the characteristics in our population. ObjectivesTo describe patients aged 3 months to 5 years who were seen at the Pediatric Emergency Department of Hospital San José for simple febrile seizures. MethodsWe describe a case series of children fulfilling simple febrile seizure criteria. Variables studies include socio-demographic, prenatal and perinatal history, family history of febrile seizure, vaccination, clinical data on seizure-associated infections and drugs used. ResultsThe median of age was 24 months (IQR 18-37), with no difference between genders. No prenatal or neonatal risk factors for febrile seizures were found; 87.5% of the children were born at term, with birth weight (median) of 3,080g (IQR 2720-33 3 0). There were no patients with recent (last 15 days) MMR immunization. The most common associated infection was upper respiratory (71.9%) followed by gastrointestinal (21%). Febrile seizure type was tonic-clonic seizures in all age groups (56.1%). ConclusionsThe findings in this study agree with those reported worldwide; however, the median age of onset of febrile seizures was later (24 months). There was also a low prevalence of perinatal risk factors and no association between the febrile seizures and the use of antihistamines or prior vaccination. This study reveals the clinical characteristics and risk factors associated with febrile seizures, which can guide future studies and the development of clinical practice guidelines.

Measles, Mumps, and Rubella

Measles, mumps, and rubella are viral diseases that may adversely affect nonimmune pregnant women and their fetuses/neonates. Prevention of these diseases and their complications can be achieved through measles-mumps-rubella (MMR) vaccination before pregnancy. The vaccine is contraindicated during pregnancy, because it contains live, attenuated viruses that pose a theoretical risk to the fetus. However, accidental receipt of MMR vaccination is not known to cause maternal/fetal complications. MMR immunization is recommended to nonimmune obstetric patients upon completion or termination of pregnancy.

Factors Influencing Childhood Immunization Defaulters in Sabah, Malaysia

Introduction: The purpose of this study was to determine the prevalence of defaulters of immunization, and their associated risk factors among children age 12 to 24 months. Materials and Methods: A cross-sectional study was conducted in all government's maternal child health clinics in District of Kota Kinabalu, Sabah. Data was collected using a standardised questionnaire from July to November 2006. Results: The prevalence rate for defaulting immunization was 16.8% from the 315 respondents. Bivariable analysis showed various significant factors associated with defaulters such as mother’s employment status, family mobility, transportation and cost. Nonetheless, multivariable analysis showed only mother’s age, mother employment status and family size were the significant predictors for defaulting immunization. Immunization that had the highest rate of defaulters was DPT–OPV booster dose (56.6%), followed by MMR immunization (43.4 %) and DPT-Hib/OPV and Hep B third dose (37.7%).Conclusion: Employed mothers with bigger family size should be more closely monitored and advised to reduce the chance of defaulting on the immunization. Health promotion activities also should focus to these groups of mothers.

Health of children born to older mothers in the UK

Aims There is a strong trend towards later childbearing.1 Older maternity is associated with increased risks of preterm labour, fetal malformations and fetal death, but there has been little research into the longer term welfare of offspring. We studied the effects of maternal age on the health and well-being of children age 9 months to 5 years. Methods The sample consisted of children in the Millennium Cohort Study2 and the National Evaluation of Sure Start Impact Study.3 Outcomes were: child has had an accident in the last year, child has had a hospital admission in the last year, child has had all recommended immunisations, child9s BMI and child9s BAS Naming Vocabulary Score. Outcomes were modelled using logistic and linear regression models, polynomial in maternal age. Models controlled for sex, age, parity, birth weight, breast feeding, ethnicity, lone parenting, paternal age, worklessness, income, mother9s education and social class. Models of child9s BMI controlled for maternal BMI. The sample size at 9 months was 31,257 (table 1). Results Older motherhood was associated with more favourable outcomes for accidents, hospital admissions, and naming vocabulary. Immunisation rates were better for older mothers at 9 months, and unrelated to maternal age at 3 years once the controversial MMR immunisation was discounted. Child9s BMI was unrelated to maternal age. Conclusions Offspring of older mothers have more favourable outcomes for some measures of health and well-being, once socio-economic factors associated with increased maternal age are controlled.

Who are the children at risk? Lessons learned from measles outbreaks

We investigated a measles outbreak in the Jerusalem district in 2007-2008 (992 cases). Most cases (72·6%) were aged <15 years, 42·9% aged <5 years, and 12·8% were infants aged <1 year. The peak incidence rate was in infants aged 6-12 months (916·2/100 000). This represents a significant shift from former outbreaks in 2003-2004, where the peak incidence was in the 1-4 years age group. Of children aged <5 years the proportion aged 6-12 months tripled (7·7% vs. 25·6%). In a case-control study (74 cases, 148 controls) children who developed measles were less likely to be registered in a well-baby clinic and had lower overall immunization coverage. The differences in proportions for registration, DTaP3 and MMR1 coverage were 35·1%, 48·6% and 80·8%, respectively (all P<0·001). Rising birth order of cases and their siblings was associated with non-registration and non-compliance with MMR immunization. The vulnerability of young infants and the risk markers noted above should be taken into account in planning intervention programmes.

Safe Measles, Mumps and Rubella Vaccine Administration in Atopic Children with High Levels of Egg White-Specific IgE Antibody

Aim: To present our clinical experience vaccinating egg allergic patients with a regular triple viral vaccine. Material and Methods: Twenty seven children with atopic dermatitis and high levels of egg whitespecific IgE antibody were recruited. The patients were selected in two groups: group without history of allergic reaction to egg consumption and group with convincing history of egg allergic reaction. In children aged less than 13 months open food challenge test was performed. Results: Thirteen children without history of allergic reaction to egg received ambulatory MMR immunization with no reaction. Fourteen children with convincing history of egg allergy, aged under 13 months had not been vaccinated, and they underwent open food challenge test in the hospital. They had increased IgE specific antibodies to egg white allergen and six of them had increased specific IgE to yolk. Nine children had history of mild to moderate allergic reaction while five had severe allergic reaction. Open food challenge test was performed. Eleven children with negative food challenge test were immunized in hospital; none had an adverse reaction. Three of them had positive food challenge test and due to anxiety of the parents the immunization was dallied at age of 2 years. One of them had worsening of the eczema; the two other had no adverse reaction. Conlusion: The measles, mumps and rubella vaccine can be safely administered ambulatory to children with atopic dermatitis allergic to eggs.

Immunizations and risk of multiple sclerosis: systematic review and meta-analysis

The role of vaccinations in risk of developing multiple sclerosis (MS) or in risk of relapse has not been well established. The aim of this study was to estimate the effect of immunizations on risk of developing MS in adults as well as in subsequent risk of relapse. Systematic search for publications in MEDLINE (1966-January 2011), EMBASE (1977-January 2011) and the Cochrane Central Register of Controlled Trials (CENTRAL) (1961-January 2011). Both randomized clinical trials and non-randomized studies addressing the effect of any Center for Diseases Control (CDC) recommended vaccine for children, adults or travelers and BCG on risk of MS or disease relapse were included. Two reviewers independently extracted information from articles selected using a predefined datasheet. No significant change in the risk of developing MS after vaccination was found for BCG (OR 0.96, 95% CI 0.69-1.34), Hepatitis B (OR 1.00, 95% CI 0.74-1.37), Influenza (OR 0.97, 95% CI 0.77-1.23), Measles-Mumps-Rubella (MMR) (OR 1.02, 95% CI 0.64-1.61), Polio (OR 0.87, 95% CI 0.61-1.25) and Typhoid fever (OR 1.05, 95% CI 0.72-1.53). We found decreased risk of developing MS for Diphtheria (OR 0.60, 95% CI 0.40-0.90) and Tetanus (OR 0.68, 95% CI 0.54-0.84). Influenza immunization was also associated with no change in risk of MS relapse (RR 1.24, 95% CI 0.89-1.72). Risk of developing multiple sclerosis remained unchanged after BCG, Hepatitis B, Influenza, MMR, Polio and Typhoid fever immunization, whereas diphtheria and tetanus vaccination may be associated with a decreased risk of MS. Further research is needed for the remaining vaccines.

Antibody persistence in young adults 1 year after MMR immunization by aerosol or by subcutaneous route

Information on antibody persistence after aerosol revaccination with MMR components is limited. Thus, antibody titers were determined in 283 adult participants in a MMR vaccine trial 12 months after revaccination. One group had received aerosolized Triviraten vaccine while two other groups received either injected Triviraten or MMR II vaccine. Both MMR vaccines contained the same rubella strain, but different measles and mumps strains. Seropositivity to measles persisted in 98% of aerosolized vaccine recipients, 92% of injected Triviraten, and 95% of injected MMR II. All participants in the three groups retained seropositivity to rubella, while less than 50% remained seropositive to mumps.

Immunisations among school leavers: is there a place for measles-mumps-rubella vaccine?

To ascertain measles-mumps-rubella (MMR) immunisation coverage among school leavers in an inner city London borough following a local MMR catch-up initiative, a questionnaire was sent to parents and guardians of adolescents who attended the 12 secondary schools in Haringey and were due for the school leavers' vaccination. The questionnaire enquired about previous history of MMR vaccination and a history of adverse events or contraindications to the vaccine. The electronic immunisation records of 400 children (30-35 students from each school) included in the catch up initiative were randomly selected. The childrens' school health records were manually compared with the electronic records. The mean age of the children was 14.7 years, and 224 (56%) were male. Of the 373 records examined prior to the local MMR catch-up initiative, 98 children (26%) had never received MMR, 173 (46.5%) had only had one dose, 100 (27%) had two doses, and two children had three doses of the vaccine. During the school leavers' MMR immunisation, 171 (43%) received a dose of MMR and the number of children immunised with two doses increased to 206 (55.3% versus 27% P<0.001), doubling the coverage. Offering MMR vaccination as part of the school leavers immunisation is logistically convenient and it may limit the extent of outbreaks.

Thrombocytopenic Purpura after Measles-Mumps-Rubella Vaccination: A Systematic Review of the Literature and Guidance for Management

To determine the incidence of immune thrombocytopenic purpura (ITP) after measles-mumps-rubella (MMR) immunization compared with natural measles and rubella, its clinical course and outcome, and the risk of recurrence after repeat MMR vaccination. We performed a systematic review of the Ovid MEDLINE (1950 to present) bibliographic database. We selected studies that reported cases of thrombocytopenia in a known number of children who were immunized with MMR vaccine before development of ITP. We also extracted data from the same and other studies regarding bleeding manifestations and the resolution of MMR-associated thrombocytopenia or thrombocytopenic purpura within 6 months. Finally, we studied the risk of ITP recurrence after MMR immunization or reimmunization. On the basis of 12 studies, the incidence of MMR-associated ITP ranged from 0.087 to 4 (median 2.6) cases per 100,000 vaccine doses. Severe bleeding manifestations were rare, and MMR-associated thrombocytopenia resolved within 6 months from diagnosis in 93% of the children. MMR vaccination of unimmunized patients with ITP and revaccination of patients with prior ITP did not lead to recurrence of thrombocytopenia. MMR-associated ITP is rare, self-limited, and non-life threatening, and susceptible children with ITP should be immunized with MMR at the recommended ages.

An outbreak of rubella in a hilly district of Kangra-Chamba, Himachal Pradesh, India, 2006

Rubella is a minor disease that often goes unnoticed and seldom results in significant morbidity and mortality. However, the infection among pregnant women is associated with serious consequences for the fetus. On 5th November, 2006, a local community leader reported cases of fever with rash in three villages of Chamba district to Shahpur hospital. No death was reported. We investigated the outbreak as a suspected outbreak of measles with the objectives of confirming diagnosis, estimating the magnitude of outbreak and formulating recommendations for control and prevention. We defined a case of the rubella as occurrence of fever with rash in any resident of these three villages between 20th October to 9th December, 2006. We line listed the cases and collected information on age, sex, residence, date of onset, symptoms, signs, treatment history, traveling history, vaccination status and pregnancy status. We described the outbreak by time, place and person characteristics. Sera of a sample of case patients were tested for IgM antibodies to measles and later rubella viruses. We identified 61 cases in three villages - 39 cases in Hattli, 17 in Thulel and 5 in Dramman. The overall attack rate (AR) was 8.7%. Sex specific AR for males was 10% and females 7.4%. All case patients were less than 20 years of age and the attack rate was highest in the age group 11-20 years (median age 12 years). The index case was traced in Hattli Bengali slum and occurred on 20th October 2006 where majorities (41%) of the cases were reported. No pregnant woman was found to be affected. The number of cases peaked on 19th November and the last case was reported on 9th December 2006. Of 61 case-patients, 50 (82%) were immunized against measles while proportions of children vaccinated for measles were 96% (672/700) and none of them were immunized against rubella (including two (3%) who had MMR immunization privately). Out of six blood samples tested, all tested negative for measles IgM antibodies but four were positive for IgM antibodies to rubella. Only 36% (22/61) of the cases took the treatment from modern system of medicine. An outbreak of rubella was confirmed and was possibly due to the frequent traveling of Bengali colony patients to other areas for selling the food items. We advised the local health authorities to provide MMR vaccination to the unexposed and energetic IEC in three affected and neighboring villages.

The impact of maternal measles–rubella immunization on the 12-month-old infant’s immune response to measles–mumps–rubella vaccine immunogenicity

This study was conducted to assess the roles of maternal measles-rubella (MR) vaccination before pregnancy on the persistence of passive immunity against MR in their infant before measles-mumps-rubella (MMR) immunization and the effects on the immunogenicity of MMR vaccine. Before and 4-8 weeks after MMR immunization of all healthy 12-month-old infants, sera samples were prepared. According to their mother's history of MR vaccination, infants were divided into two groups. Anti-MR antibodies were measured by the quantitative enzyme-linked immunosorbent assay (ELISA) method. The difference in seroconversion rates and the mean concentration of antibodies (MCA) between the two groups of infants were analyzed by descriptive statistical methods. In total, 7 and 12 sera, all from infants born from MR-vaccinated mothers, were positive against measles and rubella, respectively. The seroconversion rates were 90.5 and 53% in seronegative infants against measles and rubella, respectively, without statistically significant differences between the two groups of infants. However, the MCA differences were significant; measles P = 0.000, rubella P = 0.019. The MR vaccination of mothers may cause the prolongation of passive immunity in their infants, and may influence the immunogenicity of MMR vaccination. This finding should be considered for the optimal scheduling of the first dose of MMR vaccine. Also, the results showed that the immunogenicity of the rubella component of the MMR vaccine was lower than that reported.