Measles outbreak between people with previous immunity tests, New York City, 2011
Clinical Infectious Diseases Oxford Academic - Oxford Journals
Rosen JB, Rota JS, Hickman CJ, Sowers SB, Mercader S, Rota PA, Bellini WJ, Huang AJ, Doll MK, Zucker JR, Zimmerman CM
A measles outbreak occurred in New York City. All cases had prior evidence of measles immunity. The symptoms were consistent with measles. Laboratory results indicated secondary immune responses. This report documents the transmission of measles from an individual with verified secondary vaccine failure.
background. Measles has been eliminated in the United States through high vaccination coverage and a public health system capable of responding quickly to measles. Measles can occur among vaccinated individuals, but secondary transmission from such individuals has not been documented.
Methods. Suspect patients and exposed contacts were investigated during a measles outbreak in New York City in 2011. Medical stories and vaccination records have been obtained. Cases were confirmed by the detection of measles specific M and / or RNA immunoglobulins. Measles for measles immunoglobulin G (IgG), avidity of IgG, measurement of antibody titers neutralizing measles and genotyping were performed to characterize the cases.
Results. The index patient had 2 doses of measles-containing vaccine; of 88 contacts, 4 secondary patients were confirmed to have either 2 doses of measles-containing vaccine or a past positive measles IgG antibody. All patients had laboratory confirmation of measles infection, clinical symptoms consistent with measles and characteristics of high avidity IgG antibodies of a secondary immune response. Neutralizing antibody titers of secondary patients reached> 80.000 mIU / mL 3-4 days after eruption onset and that of the index was <500 mIU / mL 9 days after eruption onset. No additional measles cases occurred among 231 contacts of secondary patients.
Conclusions. This is the first report on the transmission of measles by an individual vaccinated twice with documented secondary vaccine failure. The clinical presentation and laboratory data of the index patient were typical of measles in a naive individual. Secondary patients had robust anamnestic antibody responses. There have been no tertiary cases despite numerous contacts. This outbreak highlights the need for careful epidemiological and laboratory investigation of suspected measles cases regardless of vaccination status.