Elsevier

Vaccine

Volume 25, Issues 37–38, 17 September 2007, Pages 6672-6676
Vaccine

Long-term persistence of antibodies after one or two doses of MMR-vaccine

https://doi.org/10.1016/j.vaccine.2007.07.008Get rights and content

Abstract

Outbreaks of measles, mumps and rubella have occurred recently despite long-standing mass immunization with MMR. Antibody titres for measles, mumps and rubella of 160 students (17–23 years) with proof of at least one MMR-vaccine were studied according to the number of MMR-vaccines received. The proportion of subjects with positive antibody titres was significantly higher in those who received two vaccines against measles (77.1% versus 58.7%, p = 0.05), mumps (67.5% versus 55.6%, p = 0.009) and rubella (99.2% versus 71.4%, p = 0.008). Comparable significant trends were seen for GMTs for measles and mumps. A similar non-significant trend was noted for rubella.

Introduction

In countries with a long-standing national MMR vaccination program the incidence of measles, mumps and rubella and their rate of complications has been significantly reduced. In spite of this, the target set by the WHO regional office, namely the elimination of these infections in the European region, is far from being achieved [1]. After more than 20 years of universal vaccination, measles and mumps still remain endemic in countries with suboptimal or unequally distributed MMR-vaccination coverage (Germany, Greece, Italy, UK) [2], [3], [4], [5], [6]. Even in countries with high vaccination coverage (>90%) (Denmark, Sweden, Spain, The Netherlands, USA) small outbreaks of measles, mumps and rubella have occurred [7], [8], [9], [10], [11]. Apart from high vaccination coverage rates the degree of long-lasting immunity and effectiveness of the vaccine are also of crucial importance for the success of MMR vaccination programs. In pre-licensure studies the three components of the MMR combination vaccine induced positive antibody titres in ±95% of the vaccine recipients in the months following immunization [12]. However, follow-up studies consistently reported a decline of circulating antibody levels over time after one dose of mumps and measles containing vaccines [13], [14], [15], [16]. In general, studies performed after outbreaks of mumps showed a lower effectiveness of the mumps vaccine than expected on the basis of pre-licensure data, and antibody levels for mumps appeared to be low in different populations several years after vaccination [17].

Mass vaccination with MMR-vaccine remarkably reduced circulation of measles and mumps viruses. In the absence of repeated natural boosting both vaccine-induced and naturally acquired antibodies may wane over time [13], [15], [16]. As a consequence, the number of susceptible subjects in those populations increases progressively. Accumulation may lead to outbreaks, most likely in young adults, if the virus is re-introduced. Long-term immunity after MMR-vaccination is therefore a prerequisite for sustained protection against measles, mumps and rubella. In order to prevent the occurrence of further outbreaks of measles and mumps in the last decade of the 20th century, the administration of a second dose of MMR vaccine was implemented in most countries of the European and Northern American region. This second dose is basically seen as a catch-up to fill the gaps in the blanket of protection [12].

In Belgium children are offered two MMR doses, of which the first is recommended to be given at 12 months of age (since 1985) and the second at 10–12 years of age (since 1995). The incidence of measles, mumps and rubella has markedly decreased since the use of two doses [18]. However, during the years 2003–2005 small clusters of measles and mumps have been identified by a laboratory and paediatric surveillance system. These clusters were usually confined to one school or family [19]. Through the laboratory surveillance system a limited number of rubella cases has been identified without giving rise to an epidemic level [20].

To examine the potential booster effect of the second MMR-dose, we compared the persistence of circulating antibodies induced by one or two doses of MMR vaccine in Belgian students who had received the first vaccine dose at least 17 years before the blood sample was taken.

Section snippets

Population

During a routine hepatitis A and B vaccination program, university students were asked to participate in a study on humoral and cellular immunity against measles, mumps and rubella. After written informed consent, a venipuncture of 50 mL was carried out immediately before administration of the first dose of a combined hepatitis A and B vaccine. Blood was kept at room temperature for 30–60 min and at 4–8 °C thereafter. Serum was harvested by centrifugation within 8 h after sampling. Measles IgG and

Population

The study population consisted of 160 university students (25 men and 135 women (84.4%); mean age of 19.78 ± 1.13 years; range 17.8–23.8 years). The difference in gender was mainly due to the fact that subjects were recruited in training programmes in which the majorities of students are female (e.g. medicine, dentistry, physiotherapy, biomedical sciences and psychology). The criteria for analysis of long-term immunity according to one or two doses of MMR vaccination were met by 129 students for

Discussion

In a cohort of students in the age range of 17–23 years we examined the persistence of the humoral immunity induced by one or two doses of measles, mumps and rubella containing vaccines. We found that two doses of vaccine provided a significantly better humoral protection against measles and mumps in terms of seropositive rates and GMT. The difference in GMT for rubella did not reach statistical significance (p > 0.05). However, the statistical power was very low, since only seven subjects were

Acknowledgement

Conflict of interest: KH, GLR and PVD have been principal investigator of vaccine trials for several vaccine manufacturers for which the respective universities obtained research grants. CV and MR have no conflict of interest. Funding: The analyses on rubella were funded by the Research Foundation-Flanders grant nr G.0603.07. The author's work was independent of the funders.

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