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Mild Measles and Secondary Vaccine Failure During a Sustained Outbreak in a Highly Vaccinated Population
M. Bruce Edmonson, MD;
David G. Addiss, MD, MPH;
J. Todd McPherson, MS;
Jeffrey L. Berg;
S. Richard Circo, MS;
Jeffrey P. Davis, MD
JAMA. 1990;263(18):2467-2471.
Abstract
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A prolonged school-based outbreak of measles provided an opportunity to study "vaccine-modified" mild measles and secondary vaccine failure. Thirty-six (97%) of 37 unvaccinated patients had rash illnesses that met the Centers for Disease Control clinical case definition of measles, but 29 (15%) of 198 vaccinated patients did not, primarily because of low-grade or absent fever. Of 122 patients with seroconfirmed measles, 10 patients (all previously vaccinated) had no detectable measles-specific IgM and significantly milder illness than either vaccinated or unvaccinated patients with IgM-positive serum. Of 108 vaccinated patients with seroconfirmed measles, 17 patients (16%) had IgM-negative serology or rash illnesses that failed to meet the clinical case definition; their mean age (13 years), age at the time of vaccination, and time since vaccination did not differ from those of other vaccinated patients. The occurrence of secondary vaccine failure and vaccine-modified measles does not appear to be a major impediment to measles control in the United States but may lead to underreporting of measles cases and result in overestimation of vaccine efficacy in highly vaccinated populations.
(JAMA. 1990;263:2467-2471)
Author Affiliations
From the Departments of Pediatrics (Drs Edmonson and Davis) and Preventative Medicine (Dr Davis) and the State Laboratory of Hygiene (Messrs McPherson and Circo), Center for Health Sciences, University of Wisconsin, Madison; the Section of Acute and Communicable Disease Epidemiology, Wisconsin Division of Health, Madison (Drs Addiss and Davis and Mr Berg); and the Division of Field Services, Epidemiology Program Office, Centers for Disease Control, Atlanta, Ga (Dr Addiss).
Footnotes
Presented, in part, at the annual meeting of the Society for Pediatric Research, Washington, DC, May 3, 1989.
Reprint requests to Department of Pediatrics, H6/4 Clinical Science Center, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (Dr Edmonson).
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