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What Is the Prevalence of Measles Immunity among Pregnant Women?
Objective This study aimed to estimate the prevalence of measles immunity in a cohort of pregnant women in New York City and determine if there is a positive correlation of measles immunity with patient demographics, rubella immunity, number of measles, mumps, and rubella vaccine (MMR) doses received, and age at last vaccination.
Study Design This is a cross-sectional study of pregnant patients seen at a single institution from January 2019 to May 2019. Patients were classified as measles and rubella immune or nonimmune using commercial immunoglobulin G (IgG) tests. Patient characteristics were compared using t-tests, Chi-square tests, or Fisher's exact tests as appropriate. The association of age at last vaccination with immunity status was assessed using multivariable logistic regression adjusted for age at presentation. The utility of rubella IgG for distinguishing measles immunity was assessed using receiver operating characteristic curve analysis.
Results Serologic immunity for measles and rubella was obtained for 1,366 patients. Of these, 1,047 (77%) were measles immune and 1,291 (95%) were rubella immune. Patients born after 1989 were less likely to be immune to measles, while multiparity and private insurance were associated with increased measles immunity. Documentation of MMR vaccination was available for 140 (10%) patients. Of these, 44 (31%) were serologically nonimmune to measles and 9 (6.4%) were nonimmune to rubella. In patients known to have received one dose of MMR, 62% (24/39) were immune to measles with an improvement to 72% (69/96) among those who received two or more doses. Age at last vaccination was not associated with measles immunity. Rubella IgG level was a poor predictor of positive measles titer (area under the curve = 0.59).
Conclusion Approximately one of every four pregnant patients is serologically measles nonimmune, even among women with documented MMR vaccination or documented rubella immunity. These findings raise concerns that relying on vaccination history or rubella immune status may not be sufficient to assure protection from infection with measles. If further suggests that measles serology should be added to routine prenatal laboratory testing to identify nonimmune patients that may benefit from postpartum vaccination.
Approximately one of every four pregnant patients were serologically measles nonimmune.
Rubella immunoglobulin G was a poor predictor of measles immunity status.
Measles serology should be added to routine prenatal laboratory testing.
Received: 07 January 2020
Accepted: 26 May 2020
09 July 2020 (online)
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- 1 Hamborsky J, Kroger A, Wolfe S. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases 13th Edition. Washington D.C.: Public Health Foundation; 2015
- 2 Howard Z, Ruppert P, Blog D. Measles Review for Providers: Responding to New York State's largest outbreak since measles elimination. Accessed November 28, 2018 at: https://www.health.ny.gov/publications/2170/docs/2018-11_presentation_for_providers.pdf
- 3 WHO, Measles surveillance data. Accessed May 7, 2020 at: https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/2019
- 4 Manikkavasagan G, Ramsay M. The rationale for the use of measles post-exposure prophylaxis in pregnant women: a review. J Obstet Gynaecol 2009; 29 (07) 572-575
- 5 McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention. Accessed June 14, 2013 at: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm
- 6 Markowitz LE, Preblud SR, Fine PE, Orenstein WA. Duration of live measles vaccine-induced immunity. Pediatr Infect Dis J 1990; 9 (02) 101-110
- 7 NYC Department of Health & Mental Hygiene. Citywide Immunization Registry. Accessed May 2007 at: http://www.chcanys.org/clientuploads/downloads/ep_callarchives/051107/NYCDOHMH_CIR_slides_051107.pdf
- 8 Kelley PW, Petruccelli BP, Stehr-Green P, Erickson RL, Mason CJ. The susceptibility of young adult Americans to vaccine-preventable infections. A national serosurvey of US Army recruits. JAMA 1991; 266 (19) 2724-2729
- 9 Kennedy CM, Burns BA, Ault KA. Does rubella immunity predict measles immunity? A serosurvey of pregnant women. Infect Dis Obstet Gynecol 2006; 2006: 13890
- 10 Haas DM, Flowers CA, Congdon CL. Rubella, rubeola, and mumps in pregnant women: susceptibilities and strategies for testing and vaccinating. Obstet Gynecol 2005; 106 (02) 295-300
- 11 Libman MD, Behr MA, Martel N, Ward BJ. Rubella susceptibility predicts measles susceptibility: implications for postpartum immunization. Clin Infect Dis 2000; 31 (06) 1501-1503
- 12 Haralambieva IH, Ovsyannikova IG, Vierkant RA, Poland GA. Development of a novel efficient fluorescence-based plaque reduction microneutralization assay for measles virus immunity. Clin Vaccine Immunol 2008; 15 (07) 1054-1059
- 13 Gonçalves G, Cutts F, Forsey T, Andrade HR. Comparison of a commercial enzyme immunoassay with plaque reduction neutralization for maternal and infant measles antibody measurement. Rev Inst Med Trop São Paulo 1999; 41 (01) 21-26
- 14 de Ory F, Minguito T, Balfagón P, Sanz JC. Comparison of chemiluminescent immunoassay and ELISA for measles IgG and IgM. APMIS 2015; 123 (08) 648-651
- 15 Krugman S, Giles JP, Friedman H, Stone S. Studies on Immunity to Measles. J Pediatr 1965; 66: 471-488
- 16 University of Washington, Department of Obstetrics and Gynecology. Measles & the MMR Vaccine: recommendations around pregnancy, including the periconception and peripartum periods, M.E.O. Alisa Kachikis, MD; Raj Swati Shree, MD; Kristina Adams Waldorf, MD; Jane Hitti, MD, MPH; Linda Eckert, MD, Editor. Accessed April 2019 at: https://www.uwmedicine.org/sites/stevie/files/2019-04/UW_Measles-in-pregnancy-consensus_2.pdf
- 17 Terada K, Itoh Y, Wakabayashi T. et al. Rubella specific cell-mediated and humoral immunity following vaccination in college students with low antibody titers. Vaccine 2015; 33 (45) 6093-6098
- 18 Krugman S. Further-attenuated measles vaccine: characteristics and use. Rev Infect Dis 1983; 5 (03) 477-481
- 19 DiaSorin, Product update-liason measles IgG (PN 318810) lot number 159026. Accessed 2019 at: https://www.diasorin.com/sites/default/files/allegati_prodotti/scheda_measles_igg.pdf
- 20 Muzzio D, Zenclussen AC, Jensen F. The role of B cells in pregnancy: the good and the bad. Am J Reprod Immunol 2013; 69 (04) 408-412
- 21 Fettke F, Schumacher A, Canellada A. et al. Maternal and fetal mechanisms of B cell regulation during pregnancy: human chorionic gonadotropin stimulates B cells to produce IL-10 while alpha-fetoprotein drives them into apoptosis. Front Immunol 2016; 7: 495