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A measles outbreak from an index case with immunologically confirmed secondary vaccine failure
Takako Kurata1, Daiki Kanbayashi1, Kazutaka Egawa2
1Osaka Institute of Public Health, Morinomiya Center, 1-3-69, Nakamichi, Higashinari-ku, Osaka 537-0025, Japan.
Abstract:
During the elimination stage of measles, the development of such disease in individuals who received measles-containing vaccine (MCV) is a concern from an epidemiological standpoint. A few cases in which measles was transmitted from a patient who received two doses of MCV have been reported. However, whether such transmissions were caused by primary vaccine failure (PVF) or secondary vaccine failure (SVF) remains unclear. All patients suspected of measles in Osaka Prefecture between November and December 2018 were enrolled. Data about age, gender, immunization record, and clinical signs were obtained. Laboratory examinations were performed, which included virus isolation in tissue culture, a nucleic acid test based on virus-specific real-time polymerase chain reaction and humoral responses to the measles virus measuring immunoglobulin (Ig) M, IgG, avidity of IgG, and neutralizing antibody concentration. The measles outbreak comprised 10 laboratory confirmed cases, including three secondary and six tertiary patients. Among them, three secondary patients were unvaccinated. The index case had received two MCV doses, and the six tertiary patients were vaccinated. Both the index and tertiary patients had high specific IgG concentration with high avidity. In particular, the index patient had a markedly high neutralization antibody concentration of 425,590 mIU/mL, which indicated immunological SVF. This study first reported about measles transmission from an individual with SVF who received two vaccination doses. To prevent measles transmission and outbreak particularly in countries where measles was almost eliminated, patients with SVF for measles should be cautiously monitored.
Insights
Measles can spread even after two vaccine doses due to secondary vaccine failure (SVF). This study identified measles transmission from an individual with SVF, highlighting the need for monitoring vaccinated individuals.
Area of Science:
- Immunology
- Epidemiology
- Virology
Background:
- Measles transmission in vaccinated individuals is a concern during elimination phases.
- Distinguishing between primary vaccine failure (PVF) and secondary vaccine failure (SVF) is crucial for understanding measles spread.
- Previous reports lacked clarity on the cause of measles transmission from doubly vaccinated individuals.
Purpose of the Study:
- To investigate measles transmission dynamics in a 2018 outbreak in Osaka.
- To determine if measles transmission originated from individuals with primary vaccine failure (PVF) or secondary vaccine failure (SVF).
- To characterize the immunological status of measles cases, particularly the index case.
Main Methods:
- Case enrollment and data collection for suspected measles patients (November-December 2018).
- Laboratory analysis including virus isolation, real-time PCR, and serological tests (IgM, IgG, IgG avidity, neutralizing antibodies).
- Epidemiological investigation of transmission chains and vaccination status.
Main Results:
- Ten laboratory-confirmed measles cases were identified, with three secondary and six tertiary transmissions.
- The index case, responsible for tertiary transmissions, had received two measles-containing vaccine (MCV) doses.
- Immunological analysis of the index case revealed high IgG and neutralizing antibody levels, indicative of secondary vaccine failure (SVF).
Conclusions:
- This study reports the first documented instance of measles transmission from an individual with secondary vaccine failure (SVF) after two vaccine doses.
- Individuals with SVF for measles require careful monitoring to prevent further transmission, especially in regions nearing measles elimination.
- Understanding SVF is critical for effective measles control strategies and outbreak prevention.
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