Summary
The immunogenicity and clinical efficacy of high-titer measles vaccines were evaluated in a randomized controlled trial in Niakhar, a rural area of Senegal that is under demographic surveillance. Two high-titer vaccines were studied: a high-titer Edmonston-Zagreb vaccine (EZ-HT) and a high-titer Schwarz vaccine (SW-HT). Both HT vaccines were administered at five months of age, and they were compared to a Schwarz standard vaccine, administered at 10 months of age. At age five months, 56.9% of the children had medium or high levels of maternal antibodies (at least 250 milli-international units), whereas at 10 months of age only 25.5% of children had residual maternal antibodies.
Both high-titer vaccines were immunogenic when given to children with low levels of maternal antibodies; seroconversion rates were 98.6% (95% confidence interval, CI = 95.9 – 99.9) for the EZ-HT and 85.5% (CI = 78.5 – 93.2) for the SW-HT. There was no definitive evidence of seroconversion among children with high levels of maternal antibodies. However, levels of antibodies at age 10 months were significantly higher in the vaccinated groups than in the placebo group. The EZ-HT vaccine produced a higher response than the SW-HT vaccine (P<0.01). Both the titer at time of vaccination and the age at vaccination had a significant impact on the rate of seroconversion and the percentage of seropositive children at 10 months.
Clinical efficacy (EF) of HT vaccines was highest and significant among children with low levels of maternal antibodies [EF = 100.0%, CI = 50.0–100.0, P = 0.0001 for EZ-HT; and EF = 86.3%, CI = 43.9–96.7, P = 0.0060 for SW-HT], and lowest and not significant among children with high levels of maternal antibodies. Vaccine failures after the HT vaccines were 8.75 times more frequent than after the standard vaccine (CI = 1.02–75.1, P = 0.048]. These results indicate that vaccination of children with Schwarz measles vaccine at nine months of age remains the safest and most effective strategy for controlling measles.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Chen RT, Markowitz LA, Albrecht P, Stewart JA, Mofenson LM, Preblud SR, Orenstein WA (1990) Measles antibody: reevaluation of protective titers. J Infect Dis 162: 1036–1042
Garenne M, Cantrelle P (1986) Rougeole et mortalité au Sénégal. Etude de l’impact de la vaccination effectuée à Khombole 1965–1968 sur la survie des enfants. In: Estimation de la mortalité du jeune enfant (0–5 ans) pour guider les actions de santé dans les pays en dévelopement. Séminaire INSERM 145: 515–532
Garenne M, Leroy O, Beau JP, et al (1991) Efficacy, safety and immunogenicity of two high-titer measles vaccines: Final report. ORSTOM, Dakar, June 1991, 229 p
Garenne M, Leroy O, Beau JP, et al (1991) Child mortality after high-titer measles vac cination: a prospective study in Senegal. Lancet 338: 903–907
Hayden GF, Sato PA ,Wright PF ,et al (1989) Progress in worldwide control and elimination of disease through immunization. J Pediatr 114: 520–527
Henderson RH ,Keja J, Hayden G, et al (1988) Immunizing the children of the world: progress and prospects. Bull WHO 66: 535–543
Hersh BS, Markowitz LE, Hoffman RE, et al (1991) A measles outbreak at a college with a prematriculation immunization requirement. Am J Public Health 81(3): 360–364
Koenig MA, Khan MA, Wojtyniak B, et al (1990) The impact of measles vaccination on childhood mortality in Matlab, Bangladesh. Population Council, programs division, Working papers 3: 18
Markowitz LE, Sepulveda J, Diaz-Ortega JL, et al (1990) Immunization of six month-old infants with different doses of Edmonston-Zagreb and Schwarz measles vaccines. N Engl J Med 332: 580–587
Nirshansy H, Shasyi A, Bahrani S et al (1977) Comparative field trial of five measles vaccines produced in human diploid cells MRC-5. J Biolog Standard 5: 1–18
Orenstein WA, Bernier RH, Hinman AR (1988) Assessing vaccine efficacy in the field: further observations. Epidemiol Rev 10: 212–241
Preblud SR, Katz SL (1988) Measles vaccine. In: Plotkin SA, Mortimer EA (eds) Vaccines. WB Saunders, Philadelphia pp 182–222
Sabin AB, Arechiga FA, Fernandez de Castro J, et al (1983) Successful immunization of children with and without maternal antibody by aerosolized measles vaccine. I. Different results with undiluted human diploid cell and chick embryo fibroblast vaccines. JAMA 249: 2651–2662
Sabin AB, Arechiga FA, Fernandez de Castro J et al (1984) Successful immunization of children with and without maternal antibody by aerosolized measles vaccine. II. Vaccine comparisons and evidence for multiple antibody response. JAMA 251: 2363–2371
Tidjani O, Grunitsky B, Guérin N et al (1989) Serological effects of Edmonston-Zagreb, Schwarz and AIK-C measles vaccine strains given at ages 4–5 or 8–10 months. Lancet ii: 1357–1360
Van Ginneken JK, Muller AS (1984) Maternal and child health in rural Kenya, Croom Helm, London
Whittle HC, Rowland MGM, Mann GF, Lamb WH, Lewis RA (1984) Immunization of 4–6 month old Gambian infants with Edmonston-Zagreb measles vaccine. Lancet ii: 834–837
Whittle HC, Mann G, Eccles M, et al (1988) Effect of dose and strain of vaccine on success of measles vaccination of infants aged 4–5 months. Lancet i: 963–966
WHO/EPI (1990) Measles immunization before 9 months of age. Wkly Epidem Rec 2: 8–9
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1993 Springer-Verlag/Wien
About this chapter
Cite this chapter
Garenne, M., Leroy, O., Beau, J.P., Sene, I. (1993). High-titer measles virus vaccines: protection evaluation. In: Kurstak, E. (eds) Measles and Poliomyelitis. Springer, Vienna. https://doi.org/10.1007/978-3-7091-9278-8_10
Download citation
DOI: https://doi.org/10.1007/978-3-7091-9278-8_10
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-82436-8
Online ISBN: 978-3-7091-9278-8
eBook Packages: Springer Book Archive