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Post-exposure prophylaxis for the prevention of measles: A systematic review
Joshua Montroy1, Cathy Yan1, Faizan Khan1
1Centre for Immunization Surveillance and Programs, Infectious Disease and Vaccine Program Branch, Public Health Agency of Canada, 130 Colonnade Rd S, Nepean, ON K1A0K9, Canada.
Background:
In susceptible individuals, post-exposure prophylaxis (PEP) is often recommended following exposure to measles, however the data that these recommendations are based on are limited. The objective of this systematic review was to evaluate the efficacy/effectiveness and safety of immunoglobulins (Ig) or measles-containing vaccine (MCV) for the prevention of measles.
Methods:
Prospective studies evaluating the use of Ig or MCV as PEP in susceptible individuals exposed to measles were eligible for inclusion. For studies evaluating Ig, only studies published since 1970 were eligible. Critical outcomes included confirmed cases of measles infection, and death due to measles. The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and CINAHL were searched (until May 23, 2024). Risk of bias was assessed using the Cochrane ROBINS-I tool.
Results:
Nine studies were included, totalling 660 patients receiving PEP (434 Ig and 226 MCV). Three studies were in children, one in adults, and five included both children and adults. Data were limited in immunocompromised or pregnant individuals. Details regarding intensity of exposure, time from exposure to treatment, and dose of Ig were poorly reported, and all studies presented moderate/serious concerns regarding the risk of bias. Measles infection rates in those who received Ig PEP ranged from 0 to 30 % and from 0 to 15 % in those receiving MCV PEP. Estimates of effectiveness ranged from 76 % (95 % CI 0-94) to 100 % (95 % CI 56.2-99.8 %) for Ig PEP, and from 83.4 % (95 % CI 34.4-95.8) to 100 % (95 % CI not estimable) for MCV PEP.
Discussion:
Our systematic review provides a contemporary estimate of measles PEP effectiveness in the context of decreased measles antibody titres in donor-derived blood products over time, and highlights the key limitations to available evidence. Future research should seek to estimate effectiveness of measles PEP in populations of special interest, including immunocompromised and/or pregnant populations.
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