Elsevier

Vaccine

Volume 39, Issue 38, 7 September 2021, Pages 5346-5350
Vaccine

Short communication
Measles infection in persons with secondary vaccine failure, New York City, 2018–19

https://doi.org/10.1016/j.vaccine.2021.07.078Get rights and content

Highlights

  • During a large measles outbreak, cases occurred among vaccinated persons and adults presumed to be immune.

  • Avidity testing of measles IgG is useful to distinguish a primary immune response verus a secondary vaccine failure.

  • Secondary measles vaccine failure, although uncommon, was a cause of morbidity and transmission in a post-elimination setting.

  • It is important to maintain a high index of suspicion for measles despite vaccination history.

Abstract

A large measles outbreak in New York City, which included cases among vaccinated persons and adults presumed to be immune, provided the opportunity to better understand vaccine failure and the potential impact on measles transmission. Immunoglobulin G (IgG) avidity can distinguish primary (low avidity IgG, indicating no evidence of prior immunity) versus secondary vaccine failure (high avidity IgG, indicating prior immune response and waning antibody). Measles IgG avidity was measured on samples from 62 persons: avidity was high in 53 (16 vaccinated and 37 with unknown vaccination history) and low in 9 (1 recently vaccinated and 8 with unknown vaccination history). Secondary transmission from 2 persons with high-avidity IgG results occurred. These findings illustrate that in settings of sustained measles elimination, measles infection and transmission can occur in persons with secondary vaccine failure, underscoring the need to maintain a high index of suspicion for measles during an outbreak despite prior or presumed prior vaccination.

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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