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Abstract

Background

Measles elimination is based on 95% coverage with two doses of a measles-containing vaccine (MCV2), high vaccine effectiveness (VE) and life-long vaccine-induced immunity. Longitudinal analysis of antibody titres suggests existence of waning immunity, but the relevance at the population-level is unknown.

Aim

We sought to assess presence of waning immunity by estimating MCV2 VE in different age groups (2–5, 6–15, 16–23, 24–30 and 31–42 years) in Berlin.

Methods

We conducted a systematic literature review on vaccination coverage and applied the screening-method using data from a large measles outbreak (2014/15) in Berlin. Uncertainty in input variables was incorporated by Monte Carlo simulation. In a scenario analysis, we estimated the proportion vaccinated with MCV2 in those 31-42 years using VE of the youngest age group, where natural immunity was deemed negligible.

Results

Of 773 measles cases (median age: 20 years), 40 had received MCV2. Average vaccine coverage per age group varied (32%–88%). Estimated median VE was  > 99% (95% credible interval (CrI): 98.6–100) in the three youngest age groups, but lower (90.9%, 95% CrI: 74.1–97.6) in the oldest age group. In the scenario analysis, the estimated proportion vaccinated was 98.8% (95% CrI: 96.5–99.8).

Conclusion

VE for MCV2 was generally high, but lower in those aged 31-42 years old. The estimated proportion with MCV2 should have led to sufficient herd immunity in those aged 31-42 years old. Thus, lower VE cannot be fully explained by natural immunity, suggesting presence of waning immunity.

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/content/10.2807/1560-7917.ES.2019.24.17.1800529
2019-04-25
2024-12-22
/content/10.2807/1560-7917.ES.2019.24.17.1800529
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References

  1. Rota PA, Moss WJ, Takeda M, de Swart RL, Thompson KM, Goodson JL. Measles. Nat Rev Dis Primers. 2016;2:16049.  https://doi.org/10.1038/nrdp.2016.49  PMID: 27411684 
  2. World Health Organization (WHO). Global eradication of measles: 63rd World Health Assembly. Geneva: WHO; 2010. Available from: http://apps.who.int/gb/ebwha/pdf_files/wha63/a63_18-en.pdf
  3. World Health Organization, Regional Office for Europe. (WHO/Euro). Eliminating measles and rubella - Framework for the verification process in the WHO European Region. Copenhagen: WHO/Euro; 2014. Available from: http://www.euro.who.int/__data/assets/pdf_file/0009/247356/Eliminating-measles-and-rubella-Framework-for-the-verification-process-in-the-WHO-European-Region.pdf?ua=1
  4. German Ministry of Health. Nationaler Aktionsplan 2015-2020 zur Elimination der Masern und Röteln in Deutschland [National Action Plan 2015-2020 on elimination of measles and rubella in Germany]. Berlin: Ministry of Health; 2015. German. Available from: https://www.gmkonline.de/documents/Aktionsplan_Masern_Roeteln_2.pdf.
  5. World Health Organization (WHO). WHO measles vaccines: WHO position paper – April 2017 Geneva: WHO; 2017. Available from: https://apps.who.int/iris/bitstream/handle/10665/255149/WER9217.pdf?sequence=1
  6. Gay NJ. The theory of measles elimination: implications for the design of elimination strategies. J Infect Dis. 2004;189(s1) Suppl 1;S27-35. PMID: 15106086 
  7. Takla A, Wichmann O, Rieck T, Matysiak-Klose D. Measles incidence and reporting trends in Germany, 2007-2011. Bull World Health Organ. 2014;92(10):742-9.  https://doi.org/10.2471/BLT.13.135145  PMID: 25378728 
  8. Werber D, Hoffmann A, Santibanez S, Mankertz A, Sagebiel D. Large measles outbreak introduced by asylum seekers and spread among the insufficiently vaccinated resident population, Berlin, October 2014 to August 2015. Euro Surveill. 2017;22(34):30599.  https://doi.org/10.2807/1560-7917.ES.2017.22.34.30599  PMID: 28857043 
  9. Hellenbrand W, Siedler A, Tischer A, Meyer C, Reiter S, Rasch G, et al. Progress toward measles elimination in Germany. J Infect Dis. 2003;187(s1) Suppl 1;S208-16.  https://doi.org/10.1086/368046  PMID: 12721915 
  10. Robert Koch Institut (RKI). Epidemiologisches Bulletin 32/2010. Mitteilung der Ständigen Impfkommission (STIKO) am Robert Koch-Institut (RKI) [Communication from the Standing Vaccination Commission (STIKO) at the Robert Koch Institute (RKI)]. Berlin: RKI; 2010. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2010/Ausgaben/32_10.pdf?__blob=publicationFile
  11. Siedler A, Rieck T, Reuss A, Walter D, Poggensee G, Poethko-Muller C, et al. Estimating vaccination coverage in the absence of immunisation registers--the German experience. Euro Surveill. 2012;17(17):20152.  https://doi.org/10.2807/ese.17.17.20152-en  PMID: 22551497 
  12. Davidkin I, Jokinen S, Broman M, Leinikki P, Peltola H. Persistence of measles, mumps, and rubella antibodies in an MMR-vaccinated cohort: a 20-year follow-up. J Infect Dis. 2008;197(7):950-6.  https://doi.org/10.1086/528993  PMID: 18419470 
  13. LeBaron CW, Beeler J, Sullivan BJ, Forghani B, Bi D, Beck C, et al. Persistence of measles antibodies after 2 doses of measles vaccine in a postelimination environment. Arch Pediatr Adolesc Med. 2007;161(3):294-301.  https://doi.org/10.1001/archpedi.161.3.294  PMID: 17339511 
  14. Mossong J, O’Callaghan CJ, Ratnam S. Modelling antibody response to measles vaccine and subsequent waning of immunity in a low exposure population. Vaccine. 2000;19(4-5):523-9.  https://doi.org/10.1016/S0264-410X(00)00175-4  PMID: 11027817 
  15. Farrington CP. Estimation of vaccine effectiveness using the screening method. Int J Epidemiol. 1993;22(4):742-6.  https://doi.org/10.1093/ije/22.4.742  PMID: 8225751 
  16. Robert Koch-Institut (RKI). VacMap - Masern-Impfquoten in Deutschland. [VacMap – Measles vaccination coverage in Germany]. Berlin: RKI; [Accessed Sep 2018]. German. Available from: http://www.vacmap.de/
  17. Robert Koch-Insitut (RKI). Epidemiologisches Bulletin. [Epidemiological Bulletin]. Berlin: RKI; [Accessed Sep 2018]. German. Available from: https://www.rki.de/SiteGlobals/Forms/Suche/EpidBull/epidbullsuche_formular.html
  18. Deeks SL, Lim GH, Simpson MA, Gagné L, Gubbay J, Kristjanson E, et al. An assessment of mumps vaccine effectiveness by dose during an outbreak in Canada. CMAJ. 2011;183(9):1014-20.  https://doi.org/10.1503/cmaj.101371  PMID: 21576295 
  19. Das statistische Informationssystem Berlin Brandenburg. AfS StatIS-BBB - Tabellenansicht. [Statistical Information System Berlin Brandenburg]. Berlin; [Accessed Sep 2018]. German. Available from: https://www.statistik-berlin-brandenburg.de/webapi/jsf/tableView/tableView.xhtml.
  20. Schuster M, Stelzer T, Burckhardt F. Why are young adults affected? Estimating measles vaccination coverage in 20-34 year old germans in order to verify progress towards measles elimination. PLoS Curr. 2015;7:ecurrents.outbreaks.0a2d3e9465f067a0b2933d598d504d2e.  PMID: 25789202 
  21. Poethko-Müller C, Kuhnert R, Schlaud M. Durchimpfung und Determinanten des Impfstatus in Deutschland. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007;50(5-6):851-62.  https://doi.org/10.1007/s00103-007-0248-0  PMID: 17514471 
  22. Robert Koch Institut (RKI). Epidemiologoshces Bulletin. Impfschutz bei Erwachsenen in Schleswig-Holstein 2011 - ein Update nach acht Jahren: Ergebnisse einer Erhebung verbunden mit den Maßnahmen zur Verbesserung des Impfschutzes durch die Arbeitsmedizinischen Dienste [Vaccination coverage in adults in Schleswig-Holstein 2011 – an update 8 years later: Results of a survey in connection with measurements for improvement in vaccination coverage through occupational health services]. Berlin: RKI; 2013. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2013/Ausgaben/22_13.pdf?__blob=publicationFile
  23. Uzicanin A, Zimmerman L. Field effectiveness of live attenuated measles-containing vaccines: a review of published literature. J Infect Dis. 2011;204(Suppl 1):S133-48.  https://doi.org/10.1093/infdis/jir102  PMID: 21666154 
  24. Wichmann O, Hellenbrand W, Sagebiel D, Santibanez S, Ahlemeyer G, Vogt G, et al. Large measles outbreak at a German public school, 2006. Pediatr Infect Dis J. 2007;26(9):782-6.  https://doi.org/10.1097/INF.0b013e318060aca1  PMID: 17721371 
  25. Mossong J, Nokes DJ, Edmunds WJ, Cox MJ, Ratnam S, Muller CP. Modeling the impact of subclinical measles transmission in vaccinated populations with waning immunity. Am J Epidemiol. 1999;150(11):1238-49.  https://doi.org/10.1093/oxfordjournals.aje.a009951  PMID: 10588085 
  26. Farrington CP. The measurement and interpretation of age-specific vaccine efficacy. Int J Epidemiol. 1992;21(5):1014-20.  https://doi.org/10.1093/ije/21.5.1014  PMID: 1468838 
  27. Crowcroft NS, Levy-Bruhl D. Registries: An essential tool for maximising the health benefits of immunisation in the 21st century. Euro Surveill. 2017;22(17):30523.  https://doi.org/10.2807/1560-7917.ES.2017.22.17.30523  PMID: 28488997 
  28. European Centre for Disease Prevention and Control (ECDC). Measles and Rubella Surveillance 2017. Stockholm: ECDC; 2017. Available from: https://ecdc.europa.eu/sites/portal/files/documents/Measles-and-Rubella-Surveillance-2017.pdf
  29. Rosen JB, Rota JS, Hickman CJ, Sowers SB, Mercader S, Rota PA, et al. Outbreak of measles among persons with prior evidence of immunity, New York City, 2011. Clin Infect Dis. 2014;58(9):1205-10.  https://doi.org/10.1093/cid/ciu105  PMID: 24585562 
  30. Rota JS, Hickman CJ, Sowers SB, Rota PA, Mercader S, Bellini WJ. Two case studies of modified measles in vaccinated physicians exposed to primary measles cases: high risk of infection but low risk of transmission. J Infect Dis. 2011;204(Suppl 1):S559-63.  https://doi.org/10.1093/infdis/jir098  PMID: 21666213 
  31. Chen CJ, Lin TY, Huang YC. Letter to the editor: Occurrence of modified measles during outbreak in Taiwan in 2018. Euro Surveill. 2018;23(37):1800485.
Estimating age-specific vaccine effectiveness using data from a large measles outbreak in Berlin, Germany, 2014/15: evidence for waning immunity
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Julia+Bitzegeio&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bitzegeio Julia</a>, <a href="/search?value1=Shannon+Majowicz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Majowicz Shannon</a>, <a href="/search?value1=Dorothea+Matysiak-Klose&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Matysiak-Klose Dorothea</a>, <a href="/search?value1=Daniel+Sagebiel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sagebiel Daniel</a>, <a href="/search?value1=Dirk+Werber&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Werber Dirk</a></span>. Estimating age-specific vaccine effectiveness using data from a large measles outbreak in Berlin, Germany, 2014/15: evidence for waning immunity. <a href="/content/ecdc">Euro Surveill.</a> 2019;24(17):pii=1800529. <a href="https://doi.org/10.2807/1560-7917.ES.2019.24.17.1800529" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2019.24.17.1800529</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 27 Sept 2018;&nbsp;&nbsp; <span class="generated">Accepted</span>: 23 Jan 2019 </span> </p>
/content/10.2807/1560-7917.ES.2019.24.17.1800529
/content/10.2807/1560-7917.ES.2019.24.17.1800529
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