A measles outbreak from an index case with immunologically confirmed secondary vaccine failure

Kurata, Takako; Kanbayashi, Daiki; Egawa, Kohji; Kinoshita, Masaru; Yoshida, Hideki; Miyazono, Masaya; Motomura, Kazushi

doi:10.1016/j.vaccine.2019.11.075

Cited by 15 publications

(16 citation statements)

References 20 publications

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“…Recently, Kurata et al described a cluster of measles cases, seven of which (including the index case) involved fully vaccinated individuals. 36 The confirmation of our results may lead to a revision of the mathematical algorithms used in disease elimination strategies. Current mathematical models 37 applied to reach the elimination goal consider the vaccinated population to be 100% immunized, ignoring the possibility of vaccination failure or the waning of circulating antibodies in those previously vaccinated (20% in our sample) or with a history of measles (6%).…”

Section: Discussionsupporting

confidence: 60%

Long-term immunogenicity after measles vaccine vs. wild infection: an Italian retrospective cohort study

Bianchi

Mascipinto

Stefanizzi

et al. 2021

Human Vaccines & Immunotherapeutics

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The persistence of specific IgG after measles infection and after measles vaccination has not been sufficiently investigated. Current evidence suggests that immunity after the disease is lifelong , whereas the response after two doses of measles-containing vaccine declines within 10-15 years. This study evaluated the proportion of individuals with detectable anti-measles IgG in two groups, those vaccinated with two doses of anti-MMR vaccine and those with a self-reported history of measles infection. Among the 611 students and residents who were tested, 94 (15%) had no detectable protective anti-measles IgG. This proportion was higher among vaccinated individuals (20%; GMT = 92.2) than among those with a selfreported history of measles (6%; GMT = 213.3; p < .0001). After one or two MMR vaccine booster doses, the overall seroconversion rate was 92%. An important proportion of people immunized for measles did not have a protective IgG titer in the years after vaccination, but among those who had a natural infection the rate was threefold lower. This finding should be considered in the pre-elimination phase, given the resurgence of measles cases among individuals who after being vaccinated lost their circulating IgG after several years, especially if they failed to receive a natural booster.

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Section: Discussionsupporting

confidence: 60%

Long-term immunogenicity after measles vaccine vs. wild infection: an Italian retrospective cohort study

Bianchi

Mascipinto

Stefanizzi

et al. 2021

Human Vaccines & Immunotherapeutics

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“…The median viral loads in the blood, throat swab, and urine in the HA group were twofold lower than those in the LA group. Previous studies have found that viral loads in MeV reinfection cases were lower than those in primary infection cases 29,35,36 . Kurata et al 29 reported that the viral load in the blood, throat swab, and urine of patients with high and low avidities was approximately 10 2 and 10 5 –10 7 copies/mL, respectively, which is similar to the corresponding values obtained in the present study.…”

Section: Discussionsupporting

confidence: 91%

“…However, reports on the value of measuring the IgM antibody level in reinfection cases are variable. 6,[27][28][29] In addition, there is no unified knowledge on these antibody levels. In this study, we found that measuring the titers of IgM antibodies improved diagnostic performance when combined with the avidity of MeV-specific IgG antibodies.…”

Section: Discussionmentioning

confidence: 99%

“…MeV infection has also been reported from exposure to reinfection cases, 4,6,[28][29][30] suggesting that infectious viral particles are multiplied and released externally despite limited viral replication. Considering these findings, there may potentially be an increase in LDH levels in MeV reinfection cases as found in primary infections.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic significance of lactate dehydrogenase in measles virus reinfection cases

Nishihara

Ogawa

Shirasawa

2022

Microbiology and Immunology

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Lactate dehydrogenase (LDH) levels in measles virus (MeV) reinfection cases for the diagnosis of measles have not been extensively studied. Thus, we evaluated the significance of serum LDH in the immune response of patients with MeV reinfection in comparison with those of patients with primary infection. Among 70 patients who tested positive for MeV‐RNA, 42 with high MeV–specific IgG avidity (HA) were suspected as cases of reinfection and 28 with low MeV–specific IgG (LA) were suspected as cases of primary infection. The viral loads in the HA group were also lower than those in the LA group (P < 0.001). The titers of MeV‐specific IgM and IgG in the HA group were significantly lower and higher, respectively, than those in the LA group (P < 0.001). The total LDH and LDH isozyme levels were elevated in the LA group compared with those in the HA group (P < 0.001). Through receiver operating characteristic curve analyses, we determined that the area under the curve of total LDH level was 0.87 (95% CI 0.74–1.00) and that the discriminatory accuracy was high for total LDH and all isozymes. By stepwise binary logistic regression analysis considering MeV‐specific IgG avidity, we developed a model using IgG, IgM, and total LDH as explanatory variables, which was optimal for distinguishing the LA and HA groups (adjusted R2 = 0.773, P < 0.001). Thus, the serum LDH level in addition to IgM and IgG may be useful parameters for differentiating MeV reinfection from primary infection.

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“…Given that the virus isolation rate in these samples was low (4.5%), the high copy number did not necessarily reflect high infectivity. A similar phenomenon has been observed in our previous study, 20,21 and the result of real-time PCR in both blood and throat swabs should be considered to estimate the number of patients with SVF and naive patients in outbreaks.…”

Section: Discussionsupporting

confidence: 85%

Relationship between biochemical markers and measles viral load in patients with immunologically naive cases and secondary vaccine failure: LDH is one of the potential auxiliary indicators for secondary vaccine failure

Kurata

Kanbayashi

Komano

et al. 2021

Microbiology and Immunology

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This study investigated the correlation between biochemical markers and viral load among 38 measles cases, including 15 immunologically naive patients and 23 patients with secondary vaccine failure (SVF). We examined four biochemical markers, namely, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, and lactate dehydrogenase (LDH) and their relationship between virus genome copy numbers in peripheral blood mononuclear cells (PBMCs) and throat swabs as well as the concentration of measles-specific IgG. Although viral genome copies in both clinical specimens showed a significant correlation with specific IgG concentration, they had a higher correlation in PBMCs (Pearson's product-moment correlation coefficient, −0.662; p < .0001) than in throat swabs (Spearman's rank correlation coefficient, −0.443; p = .0078). The viral load in PBMCs also significantly correlated with LDH values (correlation coefficient, 0.360; p = .036). Thus, the serum LDH level might be a potential auxiliary indicator to distinguish immunologically naive patients with measles from those with SVF.Measles is a highly contagious viral disease characterized by a generalized rash and severe fever. Since 1968, when an effective live attenuated measles-containing vaccine (MCV) was developed, the incidence and mortality rate of measles has decreased globally. 1 After introducing routine two-dose schedules with the measles-rubella vaccine in 2006, 2 the number of reported measles cases was drastically reduced in Japan, 3 and in 2015, measles elimination in Japan was verified by the World Health Organization Western Pacific Regional Office. 4 After the elimination of measles, outbreaks related with patients who had previously received an MCV have become an issue. According to the National Institute of Infectious Diseases (NIID), approximately 35% of patients with measles reported in 2019 had been vaccinated. 3 These measles infections were induced by primary vaccine failure (PVF) or secondary vaccine failure (SVF). PVF is a failed response to vaccination and is observed in approximately 2%-5% of children who receive a single MCV dose. 1 Patients with PVF are more likely to present severe clinical signs similar to unvaccinated patients and an immunological reaction (i.e., low

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A measles outbreak from an index case with immunologically confirmed secondary vaccine failure

Cited by 15 publications

References 20 publications

Long-term immunogenicity after measles vaccine vs. wild infection: an Italian retrospective cohort study

Long-term immunogenicity after measles vaccine vs. wild infection: an Italian retrospective cohort study

Diagnostic significance of lactate dehydrogenase in measles virus reinfection cases

Relationship between biochemical markers and measles viral load in patients with immunologically naive cases and secondary vaccine failure: LDH is one of the potential auxiliary indicators for secondary vaccine failure

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