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How Effective is Measles Vaccine?


How effective is the measles vaccine

The CDC estimates that measles antibodies develop in approximately 95 percent of children vaccinated at 12 months and 98 percent of children vaccinated at 15 months or older. It is estimated that about 2-5 percent of children, who receive the vaccine at 12 months of age or younger or who only get one dose of MMR, fail to be protected. A second dose or MMR is thought to stimulate a protective immune response in about 99 percent of vaccine recipients.1

Following the introduction of the measles vaccine in 1963, until December of 1989, public health officials recommended only one dose of measles vaccine for all children. However, by 1989, following multiple outbreaks, including several occurring in fully vaccinated populations,2 3  the CDC’s Advisory Committee on Immunization Practices (ACIP) updated its measles vaccination recommendation, and recommended that a second dose of a measles vaccine, preferably the MMR vaccine, be administered to all children prior to school entry.4

Currently the CDC states that vaccine-induced immunity “appears to be long-term and probably lifelong in most persons”5 however, studies have shown that vaccine failure due to waning immunity can occur.6 7 8 In 2015, infectious disease experts  reported that approximately 1 in 10 measles vaccinated individuals may be at risk of measles due to vaccine waning.9 In 2011, news reports from India publicly stated that only 1 child in 5 vaccinated for measles was actually protected from getting the disease, even after being fully vaccinated.10 Measles vaccine acquired immunity is reported to wane in at least 5 percent of cases, within 10 to 15 years after vaccination.11 12  13  Outbreaks of measles can still occur in highly vaccinated populations. In 2017, an outbreak of measles occurred among young soldiers in Israel. The primary patient involved in the outbreak had documentation of having received three doses of measles vaccine and the additional eight cases of measles were found to have occurred in persons who reported having, or provided documentation of having, at least 2 doses of a measles containing vaccine.14

The use of a third MMR vaccine dose to boost low measles vaccine induced antibodies also does not appear to be effective. A recent study found that administering an additional dose of MMR vaccine in an attempt to boost antibodies in persons in persons found to have low vaccine induced measles antibodies was ineffective, leaving this particular population at risk for developing measles infection.15

According to the Merck product information insert, there is some evidence that if infants born to mothers, who have experienced natural measles infection, are vaccinated at less than one year of age, they may not develop long lasting vaccine acquired antibodies because natural maternal antibodies interfere with vaccine induced antibodies.16 Research on maternal antibodies has also found that infants born to mothers who were vaccinated against measles had lower levels of maternal antibodies and lost them sooner in comparison to infants born to mothers who had developed natural immunity from prior infection. As a result, babies born to vaccinated mothers may be at a greater risk of developing measles due to the poor quality and short duration of maternal antibodies.17  18 

The number of vaccinated people infected with measles and who show few or no symptoms but transmit measles to others is also unknown as vaccinated individuals are not routinely surveyed to determine whether they are experiencing asymptomatic or atypical measles and transmitting it to other. 19  20 As well, researchers have found that exposure to natural measles to be necessary for the maintenance of protective antibodies in vaccinated persons.21

IMPORTANT NOTE: NVIC encourages you to become fully informed about Measles and the Measles vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

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References

1 CDC Measles – Measles Vaccine Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

2 Gustabson TL, Lievens AW, Brunell PA, et al. Measles Outbreak in a Fully Immunized Secondary-School Population. N Engl J Med. 1987 Mar 26;316(13):771-4.

3 CDC Measles Outbreak among Vaccinated High School Students - Illinois. MMWR  Jun. 22, 1984; 33(24);349-51.

4 CDC Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP) MMWR Dec 29, 1989; 38(S-9);1-18

5 Ibid

6 Kang HJ, Han YW, Kim SJ et al. An increasing, potentially measles-susceptible population over time after vaccination in Korea. Vaccine. 2017 Jul 24; 35(33):4126-4132.

7 Hahné SJ, Nic Lochlainn LM, van Burgel ND et al. Measles Outbreak Among Previously Immunized Healthcare Workers, the Netherlands, 2014. J Infect Dis. 2016 Dec 15; 214(12):1980-1986.

8 Rosen JB, Rota JS, Hickman CJ et al. Outbreak of measles among persons with prior evidence of immunity, New York City, 2011. Clin Infect Dis. 2014 May; 58(9):1205-10

9 Briggs B. Have You Had Your Measles Shot? Maybe You Need AnotherNBC News Jan. 21, 2015.

10 Chatterjee P. Measles Vaccine Protects Only 1 Out of 5 Children in Delhi: Study. The Indian Express. Oct. 1, 2011.

11 Sabella C. Measles: Not just a childhood rash Cleve Clin J Med 2010 Mar. 77(3):207-213

12 Markowitz LE, Preblud SR, Fine PE, Orenstein WA. Duration of Live Measles Vaccine-Induced Immunity. Pediatr Infect Dis J. 1990; 9:101-110.

13 Anders JF, Jacobsen RM, Poland GA, et al. Secondary Failure Rates of Measles Vaccines: a Meta-analysis of Published Studies. Pediatr Infect Dis J. 1996 Jan;15(1):62-6.

14 CDC Measles Outbreak in a Highly Vaccinated Population — Israel, July–August 2017. MMWR. Oct. 26, 2018; 67(42);1186–1188

15 Fiebelkorn AP, Coleman LA, Belongia EA et al. Measles Virus Neutralizing Antibody Response, Cell-Mediated Immunity, and Immunoglobulin G Antibody Avidity Before and After Receipt of a Third Dose of Measles, Mumps, and Rubella Vaccine in Young Adults. J Infect Dis. 2016 Apr 1;213(7):1115-23

16 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

17 Waaijenborg S, Hahné SJ, Mollema L et al. Waning of maternal antibodies against measles, mumps, rubella, and varicella in communities with contrasting vaccination coverage. J Infect Dis. 2013 Jul;208(1):10-6

18 Zhao H, Lu P-S, Hu Yali, et al. Low Titers of Measles Antibody in Mothers Whose Infants Suffered from Measles before Eligible Age for Measles Vaccination. Virology 2010, 7:87.

19 Whittle HC, Aaby P, Samb B et al. Effect of subclinical infection on maintaining immunity against measles in vaccinated children in West Africa. Lancet. 1999 Jan 9; 353(9147):98-102.

20 Mossong J, Muller CP. Modelling Measles Re-Emergence as a Result of Waning of Immunity in Vaccinated Populations. Vaccine. Nov. 7, 2003.  21 (31); 4597-4603.

21 Aaby P, Cisse B, Simondon F, et al.  Waning of Vaccine-Induced Immunity: Is It a Problem in Africa? Am J Epidemiol 1999 Feb. 15;149(4); 304-305


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