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Investigating the measles susceptibility gap in Ontario infants
Shelly Bolotin1, James Wright2, Elizabeth McLachlan3
1Public Health Ontario, Toronto, Ontario M5G 1M1, Canada; Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto M5T 3M7, Canada.
Insights
Infants lose maternal measles protection early, increasing susceptibility. High measles vaccination rates are crucial to protect vulnerable infants before they can be vaccinated.
Area of Science:
- Pediatrics
- Immunology
- Public Health
Background:
- Infants may be protected from measles by maternal antibodies or herd immunity before vaccination.
- Maternal antibody protection can decrease significantly before the infant's first measles vaccination.
- Waning maternal immunity leaves infants vulnerable to measles infection.
Purpose of the Study:
- To assess measles susceptibility in infants under 12 months.
- To determine the duration of passive antibody protection against measles.
- To evaluate the impact of age on infant measles immunity.
Main Methods:
- Cross-sectional study of infants (<12 months) and mothers at The Hospital for Sick Children.
- Calculation of measles susceptibility probability in infants.
- Prediction of mean antibody titers by infant age.
Main Results:
- Measles seroprevalence declined from 70.4% at 1 month to 0% by 4 months.
- Infant measles susceptibility increased significantly with age.
- Odds of susceptibility tripled with each additional month of age.
Conclusions:
- Infants are susceptible to measles for most of their first year.
- All infants exposed to measles should be considered susceptible.
- High population-level measles vaccination is vital to protect infants.
Background:
Prior to receiving their first dose of measles-containing vaccine, infants may be protected against infection either via antibodies obtained transplacentally from their mothers or by herd immunity. However, there is evidence that transplacental protection may wane well-before the age of first measles vaccination.
Methods:
We conducted a cross-sectional study of infants <12 months of age at The Hospital for Sick Children (SickKids) in Toronto, Ontario, and their mothers. We calculated the probability of measles susceptibility in infants and predicted the mean antibody titre by age.
Results:
Measles seroprevalence decreased with age, starting at 70.4 % (38/54) in the first month of life and declining to 0.0 % (0/18) by four months of age. Regression models adjusted for maternal place of birth and measles immunity status indicated that the odds of susceptibility approximately tripled with every increasing month of age.
Interpretation:
Infants in our study are likely susceptible to measles for the majority of their first year of life. All measles-exposed infants should be presumed susceptible, regardless of age. High population-level measles vaccine coverage is essential to protect this susceptible population.
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