Short communicationMeasles infection in persons with secondary vaccine failure, New York City, 2018–19
Section snippets
Background
Measles elimination has been sustained in the United States since 2000 through the effective implementation of a routine 2-dose measles vaccination policy [1]. However, measles is endemic in many parts of the world, and imported disease remains a threat to measles virus transmission even in settings with high vaccination coverage. Two doses of measles-containing vaccine is approximately 97% effective against measles, and vaccine-induced immunity is likely life-long in most vaccinees [2].
Methods
All cases of suspected measles that occur in NYC are immediately reportable by law to the NYC Department of Health and Mental Hygiene (DOHMH) [8]. To characterize the clinical course of illness and to identify potential settings of transmission of patients with measles, we interviewed patients or their families and reviewed medical, laboratory, and immunization records [7]. Further laboratory investigation was pursued for measles in persons who we would have expected to be immune based on
Results
Measles IgG antibody avidity was measured on samples from 62 patients with laboratory-confirmed measles infection: 53 (85.5%) patients had high-avidity measles IgG results, presumed to be a result of secondary vaccine failure, and avidity was low in 9 (14.5%) patients consistent with a primary immunological response either to recent infection or recent vaccination. Among the 53 patients with presumed secondary vaccine failure, 16 (30.2%) had documentation of one or more doses of
Discussion
Measles IgG avidity testing of serum samples from measles patients who we expected to be immune was used to identify 53 cases of secondary measles vaccine failure in NYC during 2018–19. Findings from this evaluation illustrates that secondary vaccine failure, although uncommon, was a cause of morbidity and transmission in a post-elimination setting. The clinical, immunological, and epidemiological responses to measles among persons with secondary vaccine failure differ from those associated
Disclaimer
The findings and conclusion in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgements
We gratefully acknowledge Mekete Asfaw, Antonine Jean, Vanessa Collado, Mohammed Mannan, Francis Megafu, Gamal Sihly, Denille Gerard, Beth Isaac, Allison Scaccia, and other staff members at the Department of Health and Mental Hygiene who responded to the measles outbreak in NYC.
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