PEDIATRICS Vol. 93 No. 6 June 1994, pp. 939-943
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Measles Vaccine Immunogenicity in 6- Versus 15-Month-Old Infants Born to Mothers in the Measles Vaccine Era

Candice E. Johnson MD, PhD1, Judy Whitwell RN, CPNP1, Mary L. Kumar MD1, David R. Nalin MD2, Linda W. Chui MSc, CCM3, and Raymond G. Marusyk PhD3

1 Department of Pediatrics, Case Western Reserve School of Medicine and MetroHealth Medical Center, West Point, PA
2 Merck Research Laboratories, West Point, PA
3 Department of Medical Microbiology and Infectious Disease, University of Alberta, Edmonton, Alberta, Canada

Hypothesis. The low titer of measles antibody in infants of mothers with vaccine-induced immunity may allow immunization against measles before 15 months of age.

Methods. Six- and 15-month-old infants born to mothers le 30 years of age with no history of measles were recruited. Infants enrolled at 6 months of age were immunized with monovalent measles vaccine (Attenuvax), and maternal serum and infant pre- and postvaccination sera were obtained. Those enrolled for primary vaccination at 15 months of age received either Attenuvax (N = 12) or M-M-RII (N = 3). Six-month-old infants were revaccinated with M-M-RII at 15 months of age; pre- and postrevaccination sera were again obtained. Three antibody assays were used: a measles neutralizing assay (NT) and two enzyme immunoassays (EIA) for measles IgG and measles IgM.

Results. Among primary vaccinees, 14 of 19 infants aged 6 months (74%) developed NT antibody, as did 15 of 15 infants aged 15 months (100%). The reciprocal geometric mean titer of 6-month-old seroresponders was 23.3, significantly lower than that of the 15-month-old primary vaccinees (87.7, P < .001). Primary seroconversion rates by EIA were 53% for 6-month-old infants and 100% for those aged 15 months. Revaccination of infants who had received Attenuvax at 6 months of age resulted in 100% NT positivity; the geometric mean titer rose to equal that of the group given primary immunization at 15 months of age. Measles IgM antibody was detected in 10 of 14 infants tested 1 month after primary vaccination at 15 months, but was not detected in any of the revaccinated infants after the second dose at 15 months of age (P < .001).

Conclusions. 1) Immunization with measles vaccine in infants born to vaccine-immune mothers at 6 months of age induced NT antibody in 74% of infants. 2) Revaccination of prior 6-month-old vaccinees at 15 months resulted in antibody titers equivalent to 15-month-old vaccinees. 3) Lack of an IgM response following revaccination suggests that even seronegative infants may be primed to respond on re-exposure to measles.

Submitted on July 14, 1993
Accepted on November 12, 1993




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