Skip to main content
NCBI home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1999 Mar;53(3):173–178. doi: 10.1136/jech.53.3.173

Twice vaccinated recipients are better protected against epidemic measles than are single dose recipients of measles containing vaccine

M Paunio, H Peltola, M Valle, I Davidkin, M Virtanen, O P Heinonen
PMCID: PMC1756841  PMID: 10396495

Abstract

OBJECTIVE: To study measles risk after revaccination. DESIGN: A population-based case-control study during an epidemic season. MAIN OUTCOME MEASURE: Relative serologically confirmed measles risk. PARTICIPANTS AND METHODS: 153 vaccinated cases, mostly from rural areas, were serologically confirmed as measles at the central laboratory in 1988-89. A randomly selected group of 453 controls from either municipalities of vaccinated cases or from areas where measles attack rate was > 600/10(5), was identified via the population registry. Vaccination and measles histories of cases and controls were determined from official vaccination cards. RESULTS: Once and twice vaccinated had crude relative risk 15.6 and 2.3 compared with thrice vaccinated. When cases who had received their first vaccination at less than 14 months of age were omitted from analysis, once vaccinated had 4.0 (95% CI 1.2, 16.6) times higher age adjusted measles risk compared with twice vaccinated. When, omission was extended to cases from one particular municipality where even revaccinees had high measles risk during an explosive outbreak the corresponding risk ratio was 17.8 (2.8, 67.8). CONCLUSIONS: Twice vaccinated have better protection against epidemic measles compared with single dose recipients.

 

Full Text

The Full Text of this article is available as a PDF (104.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aaby P., Bukh J., Leerhøy J., Lisse I. M., Mordhorst C. H., Pedersen I. R. Vaccinated children get milder measles infection: a community study from Guinea-Bissau. J Infect Dis. 1986 Nov;154(5):858–863. doi: 10.1093/infdis/154.5.858. [DOI] [PubMed] [Google Scholar]
  2. Agócs M. M., Markowitz L. E., Straub I., Dömök I. The 1988-1989 measles epidemic in Hungary: assessment of vaccine failure. Int J Epidemiol. 1992 Oct;21(5):1007–1013. doi: 10.1093/ije/21.5.1007. [DOI] [PubMed] [Google Scholar]
  3. Anderson R. M., May R. M. Directly transmitted infections diseases: control by vaccination. Science. 1982 Feb 26;215(4536):1053–1060. doi: 10.1126/science.7063839. [DOI] [PubMed] [Google Scholar]
  4. Boulianne N., De Serres G., Ratnam S., Ward B. J., Joly J. R., Duval B. Measles, mumps, and rubella antibodies in children 5-6 years after immunization: effect of vaccine type and age at vaccination. Vaccine. 1995 Nov;13(16):1611–1616. doi: 10.1016/0264-410x(95)00098-l. [DOI] [PubMed] [Google Scholar]
  5. Brown P., Gajdusek D. C., Tsai T. Persistence of measles antibody in the absence of circulating natural virus five years after immunization of an isolated virgin population with Edmonston B vaccine. Am J Epidemiol. 1969 Dec;90(6):514–518. doi: 10.1093/oxfordjournals.aje.a121097. [DOI] [PubMed] [Google Scholar]
  6. Brunell P. A., Weigle K., Murphy M. D., Shehab Z., Cobb E. Antibody response following measles-mumps-rubella vaccine under conditions of customary use. JAMA. 1983 Sep 16;250(11):1409–1412. [PubMed] [Google Scholar]
  7. Chen R. T., Goldbaum G. M., Wassilak S. G., Markowitz L. E., Orenstein W. A. An explosive point-source measles outbreak in a highly vaccinated population. Modes of transmission and risk factors for disease. Am J Epidemiol. 1989 Jan;129(1):173–182. doi: 10.1093/oxfordjournals.aje.a115106. [DOI] [PubMed] [Google Scholar]
  8. Chen R. T., Markowitz L. E., Albrecht P., Stewart J. A., Mofenson L. M., Preblud S. R., Orenstein W. A. Measles antibody: reevaluation of protective titers. J Infect Dis. 1990 Nov;162(5):1036–1042. doi: 10.1093/infdis/162.5.1036. [DOI] [PubMed] [Google Scholar]
  9. Coté T. R., Sivertson D., Horan J. M., Lindegren M. L., Dwyer D. M. Evaluation of a two-dose measles, mumps, and rubella vaccination schedule in a cohort of college athletes. Public Health Rep. 1993 Jul-Aug;108(4):431–435. [PMC free article] [PubMed] [Google Scholar]
  10. Crawford G. E., Gremillion D. H. Epidemic measles and rubella in air force recruits: impact of immunization. J Infect Dis. 1981 Nov;144(5):403–410. doi: 10.1093/infdis/144.5.403. [DOI] [PubMed] [Google Scholar]
  11. Dai B., Chen Z. H., Liu Q. C., Wu T., Guo C. Y., Wang X. Z., Fang H. H., Xiang Y. Z. Duration of immunity following immunization with live measles vaccine: 15 years of observation in Zhejiang Province, China. Bull World Health Organ. 1991;69(4):415–423. [PMC free article] [PubMed] [Google Scholar]
  12. Davis R. M., Whitman E. D., Orenstein W. A., Preblud S. R., Markowitz L. E., Hinman A. R. A persistent outbreak of measles despite appropriate prevention and control measures. Am J Epidemiol. 1987 Sep;126(3):438–449. doi: 10.1093/oxfordjournals.aje.a114675. [DOI] [PubMed] [Google Scholar]
  13. Edmonson M. B., Addiss D. G., McPherson J. T., Berg J. L., Circo S. R., Davis J. P. Mild measles and secondary vaccine failure during a sustained outbreak in a highly vaccinated population. JAMA. 1990 May 9;263(18):2467–2471. [PubMed] [Google Scholar]
  14. Erdman D. D., Heath J. L., Watson J. C., Markowitz L. E., Bellini W. J. Immunoglobulin M antibody response to measles virus following primary and secondary vaccination and natural virus infection. J Med Virol. 1993 Sep;41(1):44–48. doi: 10.1002/jmv.1890410110. [DOI] [PubMed] [Google Scholar]
  15. Erdman D. D., Heath J. L., Watson J. C., Markowitz L. E., Bellini W. J. Immunoglobulin M antibody response to measles virus following primary and secondary vaccination and natural virus infection. J Med Virol. 1993 Sep;41(1):44–48. doi: 10.1002/jmv.1890410110. [DOI] [PubMed] [Google Scholar]
  16. Fescharek R., Quast U., Maass G., Merkle W., Schwarz S. Measles-mumps vaccination in the FRG: an empirical analysis after 14 years of use. I. Efficacy and analysis of vaccine failures. Vaccine. 1990 Aug;8(4):333–336. doi: 10.1016/0264-410x(90)90090-9. [DOI] [PubMed] [Google Scholar]
  17. Fox J. P., Elveback L., Scott W., Gatewood L., Ackerman E. Herd immunity: basic concept and relevance to public health immunization practices. Am J Epidemiol. 1971 Sep;94(3):179–189. doi: 10.1093/oxfordjournals.aje.a121310. [DOI] [PubMed] [Google Scholar]
  18. Gray D., Skarvall H. B-cell memory is short-lived in the absence of antigen. Nature. 1988 Nov 3;336(6194):70–73. doi: 10.1038/336070a0. [DOI] [PubMed] [Google Scholar]
  19. Gustafson T. L., Lievens A. W., Brunell P. A., Moellenberg R. G., Buttery C. M., Sehulster L. M. Measles outbreak in a fully immunized secondary-school population. N Engl J Med. 1987 Mar 26;316(13):771–774. doi: 10.1056/NEJM198703263161303. [DOI] [PubMed] [Google Scholar]
  20. Güriş D., McCready J., Watson J. C., Atkinson W. L., Heath J. L., Bellini W. J., Polloi A. Measles vaccine effectiveness and duration of vaccine-induced immunity in the absence of boosting from exposure to measles virus. Pediatr Infect Dis J. 1996 Dec;15(12):1082–1086. doi: 10.1097/00006454-199612000-00005. [DOI] [PubMed] [Google Scholar]
  21. Hersh B. S., Markowitz L. E., Hoffman R. E., Hoff D. R., Doran M. J., Fleishman J. C., Preblud S. R., Orenstein W. A. A measles outbreak at a college with a prematriculation immunization requirement. Am J Public Health. 1991 Mar;81(3):360–364. doi: 10.2105/ajph.81.3.360. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hethcote H. W. Measles and rubella in the United States. Am J Epidemiol. 1983 Jan;117(1):2–13. doi: 10.1093/oxfordjournals.aje.a113511. [DOI] [PubMed] [Google Scholar]
  23. Hidaka Y., Aoki T., Akeda H., Miyazaki C., Ueda K. Serological and clinical characteristics of measles vaccine failure in Japan. Scand J Infect Dis. 1994;26(6):725–730. doi: 10.3109/00365549409008642. [DOI] [PubMed] [Google Scholar]
  24. Hull H. F., Montes J. M., Hays P. C., Lucero R. L. Risk factors for measles vaccine failure among immunized students. Pediatrics. 1985 Oct;76(4):518–523. [PubMed] [Google Scholar]
  25. Hutchins S. S., Markowitz L. E., Mead P., Mixon D., Sheline J., Greenberg N., Preblud S. R., Orenstein W. A., Hull H. F. A school-based measles outbreak: the effect of a selective revaccination policy and risk factors for vaccine failure. Am J Epidemiol. 1990 Jul;132(1):157–168. doi: 10.1093/oxfordjournals.aje.a115627. [DOI] [PubMed] [Google Scholar]
  26. KRUGMAN S., GILES J. P., FRIEDMAN H., STONE S. STUDIES ON IMMUNITY TO MEASLES. J Pediatr. 1965 Mar;66:471–488. doi: 10.1016/s0022-3476(65)80112-3. [DOI] [PubMed] [Google Scholar]
  27. Klamm H., Pollex G., Henning U. Thermal inactivation of different measles virus strains. Acta Virol. 1991 Apr;35(2):200–202. [PubMed] [Google Scholar]
  28. Krugman S. Further-attenuated measles vaccine: characteristics and use. Rev Infect Dis. 1983 May-Jun;5(3):477–481. doi: 10.1093/clinids/5.3.477. [DOI] [PubMed] [Google Scholar]
  29. Lerman S. J., Gold E. Measles in children previously vaccinated against measles. JAMA. 1971 May 24;216(8):1311–1314. [PubMed] [Google Scholar]
  30. MARTIN C. M., MANFREDONIA S. J., WEBB N. C., Jr, MARKHAM F. S., RUEGSEGGER J. M. CONTROLLED TRIAL OF LIVE MEASLES VACCINE. EFFECTS OF AGE, HISTORY OF MEASLES IN SIBLINGS, PREVACCINE ANTIBODY, AND HUMAN GAMMA-GLOBULIN ON SYMPTOMATIC AND IMMUNE RESPONSES. Am J Dis Child. 1963 Sep;106:267–279. [PubMed] [Google Scholar]
  31. Markowitz L. E., Preblud S. R., Fine P. E., Orenstein W. A. Duration of live measles vaccine-induced immunity. Pediatr Infect Dis J. 1990 Feb;9(2):101–110. doi: 10.1097/00006454-199002000-00008. [DOI] [PubMed] [Google Scholar]
  32. Markowitz L. E., Preblud S. R., Orenstein W. A., Rovira E. Z., Adams N. C., Hawkins C. E., Hinman A. R. Patterns of transmission in measles outbreaks in the United States, 1985-1986. N Engl J Med. 1989 Jan 12;320(2):75–81. doi: 10.1056/NEJM198901123200202. [DOI] [PubMed] [Google Scholar]
  33. Marks J. S., Halpin T. J., Orenstein W. A. Measles vaccine efficacy in children previously vaccinated at 12 months of age. Pediatrics. 1978 Dec;62(6):955–960. [PubMed] [Google Scholar]
  34. Mast E. E., Berg J. L., Hanrahan L. P., Wassell J. T., Davis J. P. Risk factors for measles in a previously vaccinated population and cost-effectiveness of revaccination strategies. JAMA. 1990 Nov 21;264(19):2529–2533. [PubMed] [Google Scholar]
  35. Mathias R. G., Meekison W. G., Arcand T. A., Schechter M. T. The role of secondary vaccine failures in measles outbreaks. Am J Public Health. 1989 Apr;79(4):475–478. doi: 10.2105/ajph.79.4.475. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. McIntyre R. C., Preblud S. R., Polloi A., Korean M. Measles and measles vaccine efficacy in a remote island population. Bull World Health Organ. 1982;60(5):767–775. [PMC free article] [PubMed] [Google Scholar]
  37. Melnick J. L. Virus vaccines: principles and prospects. Bull World Health Organ. 1989;67(2):105–112. [PMC free article] [PubMed] [Google Scholar]
  38. Miller C. Live measles vaccine: a 21 year follow up. Br Med J (Clin Res Ed) 1987 Jul 4;295(6589):22–24. doi: 10.1136/bmj.295.6589.22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Nkowane B. M., Bart S. W., Orenstein W. A., Baltier M. Measles outbreak in a vaccinated school population: epidemiology, chains of transmission and the role of vaccine failures. Am J Public Health. 1987 Apr;77(4):434–438. doi: 10.2105/ajph.77.4.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Osterman J. W., Melnychuk D. Revaccination of children during school-based measles outbreaks: potential impact of a new policy recommendation. CMAJ. 1992 Mar 15;146(6):929–936. [PMC free article] [PubMed] [Google Scholar]
  41. Ozanne G., d'Halewyn M. A. Secondary immune response in a vaccinated population during a large measles epidemic. J Clin Microbiol. 1992 Jul;30(7):1778–1782. doi: 10.1128/jcm.30.7.1778-1782.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Paunio M., Virtanen M., Peltola H., Cantell K., Paunio P., Valle M., Karanko V., Heinonen O. P. Increase of vaccination coverage by mass media and individual approach: intensified measles, mumps, and rubella prevention program in Finland. Am J Epidemiol. 1991 Jun 1;133(11):1152–1160. doi: 10.1093/oxfordjournals.aje.a115827. [DOI] [PubMed] [Google Scholar]
  43. Pedersen I. R., Mordhorst C. H., Glikmann G., von Magnus H. Subclinical measles infection in vaccinated seropositive individuals in arctic Greenland. Vaccine. 1989 Aug;7(4):345–348. doi: 10.1016/0264-410x(89)90199-0. [DOI] [PubMed] [Google Scholar]
  44. Peltola H., Davidkin I., Valle M., Paunio M., Hovi T., Heinonen O. P., Leinikki P. No measles in Finland. Lancet. 1997 Nov 8;350(9088):1364–1365. doi: 10.1016/S0140-6736(05)65134-3. [DOI] [PubMed] [Google Scholar]
  45. Peltola H., Heinonen O. P., Valle M., Paunio M., Virtanen M., Karanko V., Cantell K. The elimination of indigenous measles, mumps, and rubella from Finland by a 12-year, two-dose vaccination program. N Engl J Med. 1994 Nov 24;331(21):1397–1402. doi: 10.1056/NEJM199411243312101. [DOI] [PubMed] [Google Scholar]
  46. Peltola H., Karanko V., Kurki T., Hukkanen V., Virtanen M., Penttinen K., Nissinen M., Heinonen O. P. Rapid effect on endemic measles, mumps, and rubella of nationwide vaccination programme in Finland. Lancet. 1986 Jan 18;1(8473):137–139. doi: 10.1016/s0140-6736(86)92270-1. [DOI] [PubMed] [Google Scholar]
  47. Poland G. A., Jacobson R. M., Thampy A. M., Colbourne S. A., Wollan P. C., Lipsky J. J., Jacobsen S. J. Measles reimmunization in children seronegative after initial immunization. JAMA. 1997 Apr 9;277(14):1156–1158. [PubMed] [Google Scholar]
  48. Ramsay M. E., Moffatt D., O'Connor M. Measles vaccine: a 27-year follow-up. Epidemiol Infect. 1994 Apr;112(2):409–412. doi: 10.1017/s0950268800057824. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Rawls W. E., Rawls M. L., Chernesky M. A. Analysis of a measles epidemic; possible role of vaccine failures. Can Med Assoc J. 1975 Nov 22;113(10):941–944. [PMC free article] [PubMed] [Google Scholar]
  50. Reyes M. A., de Borrero M. F., Roa J., Bergonzoli G., Saravia N. G. Measles vaccine failure after documented seroconversion. Pediatr Infect Dis J. 1987 Sep;6(9):848–851. doi: 10.1097/00006454-198709000-00012. [DOI] [PubMed] [Google Scholar]
  51. Riley E. C., Murphy G., Riley R. L. Airborne spread of measles in a suburban elementary school. Am J Epidemiol. 1978 May;107(5):421–432. doi: 10.1093/oxfordjournals.aje.a112560. [DOI] [PubMed] [Google Scholar]
  52. Robertson S. E., Markowitz L. E., Berry D. A., Dini E. F., Orenstein W. A. A million dollar measles outbreak: epidemiology, risk factors, and a selective revaccination strategy. Public Health Rep. 1992 Jan-Feb;107(1):24–31. [PMC free article] [PubMed] [Google Scholar]
  53. Rosenthal S. R., Clements C. J. Two-dose measles vaccination schedules. Bull World Health Organ. 1993;71(3-4):421–428. [PMC free article] [PubMed] [Google Scholar]
  54. Shasby D. M., Shope T. C., Downs H., Herrmann K. L., Polkowski J. Epidemic measles in a highly vaccinated population. N Engl J Med. 1977 Mar 17;296(11):585–589. doi: 10.1056/NEJM197703172961102. [DOI] [PubMed] [Google Scholar]
  55. Shelton J. D., Jacobson J. E., Orenstein W. A., Schulz K. F., Donnell H. D., Jr Measles vaccine efficacy: influence of age at vaccination vs. duration of time since vaccination. Pediatrics. 1978 Dec;62(6):961–964. [PubMed] [Google Scholar]
  56. Tulchinsky T. H., Ginsberg G. M., Abed Y., Angeles M. T., Akukwe C., Bonn J. Measles control in developing and developed countries: the case for a two-dose policy. Bull World Health Organ. 1993;71(1):93–103. [PMC free article] [PubMed] [Google Scholar]
  57. Wassilak S. G., Orenstein W. A., Strickland P. L., Butler C. A., Bart K. J. Continuing measles transmission in students despite school-based outbreak control program. Am J Epidemiol. 1985 Aug;122(2):208–217. doi: 10.1093/oxfordjournals.aje.a114091. [DOI] [PubMed] [Google Scholar]
  58. Yuan L. Measles outbreak in 31 schools: risk factors for vaccine failure and evaluation of a selective revaccination strategy. CMAJ. 1994 Apr 1;150(7):1093–1098. [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES