Factors Determining Prevalence of Maternal Antibody to Measles Virus throughout Infancy: A Review

Abstract

The effectiveness of vaccination against measles, the leading cause of vaccine-preventable deaths in infants globally, is greatly impacted by the level of maternal antibody to measles virus (or "measles maternal antibody"; MMA) during infancy. Variation in the prevalence of maternal antibody to measles virus between infant populations across countries and sociodemographic strata is poorly understood. We reviewed the literature on the prevalence of MMA, focusing on 3 principal determinants: starting level of maternal antibody, placental transfer of maternal antibody, and rate of decay of maternal antibody after birth. Our review identified placental transfer as an important determinant, with greater efficiency found in studies performed in developed countries. Placental transfer was influenced by gestational age, human immunodeficiency virus infection, and malaria. Antibody levels in mothers varied widely between countries, although predictably according to vaccination status within populations. Rates of antibody decay across studies were similar. Future studies should evaluate the utility of the cord blood level of MMA as a predictor of vaccine efficacy in infancy; inclusion of World Health Organization international reference sera will facilitate comparisons. Greater understanding of the determinants of the prevalence of MMA will help national policy makers determine the appropriate age for measles vaccination.

Kinetics of Decline of Maternal Measles Virus-Neutralizing Antibodies in Sera of Infants in France in 2006

“…Placental transfer has also been found to be less efficient in infants in developing countries than in industrialized countries (22). Coexisting infections such as malaria and human immunodeficiency virus infections are also associated with decreased levels of maternal antibodies in infants (5,17). These factors should not have complicated the results of the present study, since premature infants and infants whose mothers were not living in metropolitan France at the time of pregnancy were excluded from the study.…”

“…Although the percentage of infants with detectable measles-neutralizing antibody levels remained around 40% for infants 7 to 8 months old, 90% of the infants included in the study had antibody concentrations under 120 mIU/ml after 6 months of age. Studies carried out in other countries have also shown that infants over 6 months of age in a well-immunized population may be poorly protected against measles (5,12,24,32,40,44).…”

“…Since antibody transfer occurs mainly during the third trimester of pregnancy, preterm infants have low levels of maternal antibodies (5,21,26,28,31,41,46). Placental transfer has also been found to be less efficient in infants in developing countries than in industrialized countries (22).…”

Clinical characteristics, complications and prognosis of seventy-nine measles cases Yetmişdokuz kızamık olgusunda klinik özellikler, komplikasyonlar ve prognoz

“…More than one-half of the patients had contact history with another measles patient. In developing countries high birth rates and high contact rates combined with early decrease of maternal antibodies result in high incidence of measles, during the first year of life (12,13,14). It was demonstrated that the ratio of children with detectable antibodies declined from 61.4 percent at 22-23 weeks of age to 20 percent at 26-27 weeks of age in Turkey (15).…”

Review of immunological and virological aspects as contributory factors in Sudden Unexpected Death in Infancy (SUDI)

“…Placental transfer of IgG provides specific immune protection in infants during the early weeks of life [43]. The benefits are short-lived and only limited protection is conferred [42].…”