This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Apparent Paradox of Measles Infections in Immunized Persons

Gregory A. Poland, MD; Robert M. Jacobson, MD

Arch Intern Med. 1994;154(16):1815-1820.

Abstract
Background
Measles is the most transmissible disease known to man. During the 1980s, the number of measles cases in the United States rose dramatically. Surprisingly, 20% to 40% of these cases occurred in persons who had been appropriately immunized against measles. In response, the United States adopted a two--dose universal measles immunization program. We critically examine the effect of vaccine failure in measles occurring in immunized persons.

Methods
We performed a computerized bibliographic literature search (National Library of Medicine) for all English-language articles dealing with measles outbreaks. We limited our search to reports of US and Canadian school-based outbreaks of measles, and we spoke with experts to get estimates of vaccine failure rates. In addition, we devised a hypothetical model of a school where measles immunization rates could be varied, vaccine failure rates could be calculated, and the percentage of measles cases occurring in immunized students could be determined.

Results
We found 18 reports of measles outbreaks in very highly immunized school populations where 71% to 99.8% of students were immunized against measles. Despite these high rates of immunization, 30% to 100% (mean, 77%) of all measles cases in these outbreaks occurred in previously immunized students. In our hypothetical school model, after more than 95% of schoolchildren are immunized against measles, the majority of measles cases occur in appropriately immunized children.

Conclusions
The apparent paradox is that as measles immunization rates rise to high levels in a population, measles becomes a disease of immunized persons. Because of the failure rate of the vaccine and the unique transmissibility of the measles virus, the currently available measles vaccine, used in a single-dose strategy, is unlikely to completely eliminate measles. The longterm success of a two-dose strategy to eliminate measles remains to be determined.

(Arch Intern Med. 1994;154:1815-1820)

Author Affiliations
From the Departments of Internal Medicine (Dr Poland) and Pediatrics and Adolescent Medicine (Dr Jacobson), Mayo Vaccine Research Group, Mayo Clinic and Foundation, Rochester, Minn.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Development of a Novel Efficient Fluorescence-Based Plaque Reduction Microneutralization Assay for Measles Virus Immunity
Haralambieva et al.
CVI 2008;15:1054-1059.
ABSTRACT | FULL TEXT  

Identification and Characterization of Novel, Naturally Processed Measles Virus Class II HLA-DRB1 Peptides
Ovsyannikova et al.
J. Virol. 2004;78:42-51.
ABSTRACT | FULL TEXT  

Frequency of Measles Virus-Specific CD4+ and CD8+ T Cells in Subjects Seronegative or Highly Seropositive for Measles Vaccine
Ovsyannikova et al.
CVI 2003;10:411-416.
ABSTRACT | FULL TEXT  

Effect of Differing Immunization Policies on Circulating Measles Antibody Levels in US and Canadian Children
Poland et al.
Mayo Clin Proc. 2002;77:446-452.
ABSTRACT