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Serological and clinical characteristics of measles vaccine failure in Japan
1Section of Pediatric Infectious Diseases, Fukuoka Children's Hospital, Japan.
Abstract:
In 1991, in Fukuoka, Japan, a measles outbreak occurred in which we observed 15 cases of measles vaccine failure (MVF). We examined these patients both clinically and serologically. Seven of them, with a response pattern of an early rise in and attainment of a high hemagglutination inhibition (HI) antibody titre, were considered to be secondary vaccine failures (EH group). Eight others showed a normal (relatively late rise and low titre) HI antibody response pattern and were considered to be primary vaccine failures (LL group). In both MVF groups, measles-specific IgM antibody was detected by enzyme immunoassay. The EH group had a milder rash than did the LL group and unvaccinated controls. We believe they had an immunological memory that modified the clinical manifestations of measles. Two cases of encephalitis were observed in the EH group; both patients recovered without sequelae. These data suggest that the mere presence or absence of IgM antibody is not sufficient to differentiate primary from secondary MVFs. A two-dose measles vaccination scheme should be recommended to secure a booster effect, because immunity is waning in the population in which the measles vaccination rate is not high enough and in which natural measles still exists.
Insights
Measles vaccine failure (MVF) can be primary or secondary, distinguished by antibody response. A two-dose measles vaccination is recommended due to waning immunity and ongoing measles circulation.
Area of Science:
- Immunology
- Vaccinology
- Epidemiology
Background:
- Measles outbreaks can occur despite high vaccination rates.
- Measles vaccine failure (MVF) presents challenges in achieving herd immunity.
- Understanding the immunological differences between primary and secondary MVF is crucial.
Purpose of the Study:
- To clinically and serologically examine 15 cases of measles vaccine failure during a 1991 outbreak in Fukuoka, Japan.
- To differentiate between primary and secondary measles vaccine failures based on antibody response patterns.
- To evaluate the clinical manifestations and outcomes of different types of MVF.
Main Methods:
- Clinical examination of 15 measles vaccine failure patients.
- Serological analysis including hemagglutination inhibition (HI) antibody titres and measles-specific IgM detection by enzyme immunoassay.
- Categorization of patients into secondary vaccine failures (EH group) and primary vaccine failures (LL group) based on antibody response.
Main Results:
- Seven patients were classified as secondary vaccine failures (EH group) with early, high HI antibody titres; eight as primary vaccine failures (LL group) with normal HI antibody response.
- Measles-specific IgM antibody was detected in both MVF groups.
- The EH group exhibited milder rashes, suggesting immunological memory, and experienced two cases of encephalitis with full recovery.
Conclusions:
- IgM antibody presence alone is insufficient to distinguish primary from secondary MVF.
- Waning immunity in the population necessitates a two-dose measles vaccination strategy.
- A booster effect from a two-dose scheme is recommended to enhance population immunity against measles, especially where vaccination rates are suboptimal and natural measles persists.