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Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination

Noemí López-Perea1,2, Aurora Fernández-García2,3, Juan Emilio Echevarría2,3

  • 1Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain.

Viruses
|October 26, 2021
PubMed

Insights

Spain achieved measles elimination in 2014, but challenges remain. Breakthrough measles cases in vaccinated individuals, particularly healthcare workers, require updated surveillance and control strategies for global measles eradication.

Area of Science:

  • Epidemiology
  • Public Health
  • Infectious Diseases

Background:

  • Spain introduced the measles, mumps, and rubella (MMR) vaccination program in 1981.
  • High vaccination coverage led to Spain being declared free of endemic measles transmission in 2014.
  • Post-elimination (2014-2020) saw low incidence, primarily imported/related cases, with 70% in adults.

Purpose of the Study:

  • To analyze measles epidemiology in Spain during the post-elimination phase.
  • To identify challenges in surveillance and laboratory diagnosis of measles.
  • To inform strategies for measles eradication, especially concerning vaccinated individuals.

Main Methods:

  • Retrospective analysis of measles cases reported in Spain from 2014 to 2020.
  • Evaluation of vaccination status, clinical presentation, and transmission settings.
  • Assessment of diagnostic challenges, including immune response and viral detection.

Main Results:

  • An increasing proportion of measles cases (up to 14%) occurred in fully vaccinated individuals.
  • Vaccinated individuals experienced milder disease and varied IgM responses, complicating detection.
  • Healthcare settings were a significant source of infection for vaccinated individuals (one-third of cases).

Conclusions:

  • Advanced elimination settings require adapted surveillance and laboratory protocols.
  • Reinforcing immunity in high-exposure environments (e.g., healthcare) is crucial.
  • Enhanced infection control measures are vital for global measles eradication efforts.
Keywords:
eliminationhealthcare workersmeaslesnosocomial transmissionsurveillancevaccinationvaccine failurewaning immunity

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