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Measles vaccine efficacy during an outbreak in a highly vaccinated population: Incremental increase in protection with age at vaccination up to 18 months

Published online by Cambridge University Press:  15 May 2009

G. De Serres
Centre de santé publique de Québec, 2400 D'estimauville, Beauport, Québec, Canada, G1E 7G9
N. Boulianne
Centre de santé publique de Québec, 2400 D'estimauville, Beauport, Québec, Canada, G1E 7G9
F. Meyer
Groupe de recherche en épidémiologie de l'Université Laval and Département de médecine sociale et préventive, Université Laval. Hôpital du St-Sacrement, 1050 chemin Ste-Foy, Québec, CanadaG1S 4L8
B. J. Ward
Center for the study of host resistance. McGill University, Montreal General Hospital, 1650 Cedar Avenue, room B.7118, Montréal. Québec, CanadaH3G 1A4
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During a large measles outbreak in Quebec City in 1989, two investigations conducted in parallel evaluated the relative risk of measles and measles vaccine effectiveness with respect to age at vaccination. The study was a school-based case-control study including 563 cases and 1126 classmate controls. The second was a cohort study of the siblings of school cases including 493 siblings aged between 1 and 19 years. The relative risks (RR) of measles were similar in both settings and the trend towards increased vaccine efficacy with increasing age at vaccination was highly significant (P < 0·001). Vaccine efficacy rose from 85% in children vaccinated at 12 months of age to ≥ 94% in those vaccinated at 15 months and older. Even for children vaccinated at or after 18 months of age. the RR of measles was reduced when compared with children vaccinated between 15 and 17 months of age (RR 0·61. CI 95% 0·33–1·15). Small changes in the timing of initial measles vaccination can have a major impact on vaccine efficacy.

Research Article
Copyright © Cambridge University Press 1995


1.Orenstein, WA, Markowitz, L.Preblud, SR, Hinman, AR, Tomasi, A, Bart, KJ. Appropriate age for measles vaccination in the United States. Dev Biol Stand 1986; 65: 1321.Google ScholarPubMed
2.Wilkins, J, Wehrle, PF. Evidence for reinstatement of infant 12 to 14 months of age into routine measles immunization programs. Am J Dis Child 1978; 132: 164–6.Google ScholarPubMed
3.Yuan, L. Measles outbreak in 31 schools: risk factors for vaccine failure and evaluation of a selective revaccination strategy. Can Med Assoc J 1994; 150: 1093–8.Google ScholarPubMed
4.Christenson, B, Bottiger, M.Heller, L. Mass vaccination programme aimed at eradicating measles, mumps and rubella in Sweden: first experience. BMJ 1983; 287: 389–91.CrossRefGoogle ScholarPubMed
5.Department of Health. Immunisation against infectious disease. London: HMSO, 1992.Google Scholar
6.Recommended childhood immunization schedule: United States, January 1995. MMWR 1995; 43: 959–60.Google Scholar
7.National Advisory Committee on Immunization. Canadian immunization guide. 4th ed.Ottawa: Dept of National Health and Welfare, 1994.Google Scholar
8.Albrecht, P.Ennis, FA.Saltzman, EJ.Krugman, S. Persistence of maternal antibody in infants beyond 12 months: mechanism of measles vaccine failure. J Pediatr 1977; 91: 715–18.CrossRefGoogle ScholarPubMed
9.Black, FL. Measles active and passive immunity in a worldwide perspective. Prog Med Virol 1989; 36: 133.Google Scholar
10.Boulianne, N, De Serres, G, Duval, B et al. , Major measles outbreak in the Quebec City area in spite of a 99% vaccine coverage. Can J Pub Hlth 1991; 82: 189–90.Google Scholar
11.National Advisory Committee on Immunization. Guidelines for measles control in Canada. Can Dis Weekly Rep 1991; 17: 3540.Google Scholar
12.Miettinen, O. Estimation and estimability in case-referent studies. Am J Epidemiol 1976; 103: 226–35.CrossRefGoogle ScholarPubMed
13.Orenstein, WA.Bernier, RH.Hinman, AR. Assessing vaccine efficacy in the field. Epidemiol Rev 1988; 10: 212–41.CrossRefGoogle ScholarPubMed
14.Halloran, ME.Haber, M.Longini, LM Jr. Interpretation and estimation of vaccine efficacy under heterogeneity. Am J Epidemiol 1992; 136: 328–43.CrossRefGoogle ScholarPubMed
15.Marks, JS.Hayden, GF.Orenstein, WA. Methodologic issues in the evaluation of vaccine effectiveness: measles vaccine at 12 vs 15 months. Am J Epidemiol 1982; 116: 510–23.CrossRefGoogle ScholarPubMed
16.Mast, EE.Berg, JL.Hanrahan, LP.Wassell, JT.Davis, JP. Risk factors for measles in a previously vaccinated population and cost-effectiveness of revaccination strategies. JAMA 1990. 264: 2529–33.CrossRefGoogle Scholar
17.King, GE.Markowitz, LE.Patriarca, PA.Dales, LG. Clinical effieacy of measles vaccine during the 1990 measles epidemic. Pediatr Infect Dis J 1991; 10: 883–8.Google ScholarPubMed
18.Chen, RT.Markowitz, LE.Albrecht, P et al. Measles antibody: reevaluation of protective titers. J Infect Dis 1990; 162: 1036–42.CrossRefGoogle ScholarPubMed
19.Bin, D.Zhihui, C.Qichang, L et al. Duration of immunity following immunization with live measles vaccine: 15 years of observation in Zhejiang province, China Bull WHO 1991; 69: 415–23.Google Scholar
20.McLean, ME.Walsh, PJ.Carter, AO.Lavigne, PM. Measles in Canada – 1989. Can Dis Weekly Rep 1990; 16: 213–18.Google ScholarPubMed
21.Wong, T.Lee-Han, H.Bell, B.Daley, J.Bailey, N.Vanderpol, M. Measles epidemic in Waterloo region. Ontario. 1990 1991. Can Dis Weekly Rep 1991; 17: 219–24.Google ScholarPubMed
22.Gustafson, TL.Lievens, AW.Brunell, PA.Moellenberg, RG.Buttery, CMG.Sehulster, LM. Measles outbreak in a fully immunized secondary school population. N Engl J Med 1987; 316: 771–4.CrossRefGoogle Scholar
23.Rosenthal, SR.Clements, CJ. Two-dose measles vaccination schedules. Bull WHO 1993; 71: 421–8.Google ScholarPubMed
24.Markowitz, LE.Preblud, SR.Fine, PEM.Orenstein, WA. Duration of live measles vaccine-induced immunity. Pediatr Infect Dis J 1990; 9: 101–10.CrossRefGoogle ScholarPubMed
25.Colin, ML.Robinson, ED.Faerber, M et al. Measles vaccine failures: lack of sustained measles-specific immunoglobulin G responses in revaccinated adolescents and young adults. Pediatr Infect Dis J 1994; 13: 34–8.Google Scholar