A measles outbreak at a college with a prematriculation immunization requirement.

Abstract

BACKGROUND. In early 1988 an outbreak of 84 measles cases occurred at a college in Colorado in which over 98 percent of students had documentation of adequate measles immunity (physician diagnosed measles, receipt of live measles vaccine on or after the first birthday, or serologic evidence of immunity) due to an immunization requirement in effect since 1986. METHODS. To examine potential risk factors for measles vaccine failure, we conducted a retrospective cohort study among students living in campus dormitories using student health service vaccination records. RESULTS. Overall, 70 (83 percent) cases had been vaccinated at greater than or equal to 12 months of age. Students living in campus dormitories were at increased risk for measles compared to students living off-campus (RR = 3.0, 95% CI = 2.0, 4.7). Students vaccinated at 12-14 months of age were at increased risk compared to those vaccinated at greater than or equal to 15 months (RR = 3.1, 95% CI = 1.7, 5.7). Time since vaccination was not a risk factor for vaccine failure. Measles vaccine effectiveness was calculated to be 94% (95% CI = 86, 98) for vaccination at greater than or equal to 15 months. CONCLUSIONS. As in secondary schools, measles outbreaks can occur among highly vaccinated college populations. Implementation of recent recommendations to require two doses of measles vaccine for college entrants should help reduce measles outbreaks in college populations.

Influence of Vaccination Dose and Clinico-Demographical Factors on Antibody Titers against Measles, Rubella, Mumps, and Varicella-Zoster Viruses among University Students in Japan

“…Of note, 2-dose vaccination substantially enhanced immunity to measles and rubella. WHO recommends a 2-dose strategy in MMR vaccinations since occasional individuals, who had received only 1-dose vaccination, continued to develop infections that resulted in a number of outbreaks in colleges and schools in the 1980s (15)(16)(17)(18). Results of the current analysis support this recommendation for at least measles and rubella.…”

Twice vaccinated recipients are better protected against epidemic measles than are single dose recipients of measles containing vaccine

“…[60][61][62][63] Many studies have found that time since vaccination increases the risk of measles vaccine failure, 21-23 25-27 29-32 35 36 41 but this may have been because of the introduction of the new heat stabiliser in measles vaccines after 1979 9 17-20 36 or to previous low vaccination age. 24 27 41 Many studies 28 33 38 39 58 have not found that time since vaccination predicts vaccine failure. So far some circumstantial 9 15 56 57 65 and even some direct 7 8 60 evidence implies that waning vaccine induced immunity might become a true problem in conditions without natural boosters.…”

Reasons for non-uptake of measles, mumps, and rubella catch up immunisation in a measles epidemic and side effects of the vaccine

“…Key messages * Parents frequently object to immunisations for their children on various grounds, including previous immunity and concern about adverse effects * Previous immunisation or clinical measles was found to be a frequent reason for nonimmunisation in a mass campaign * Advice to parents should emphasise that primary immunisation against measles, mumps, and rubella may fail to confer immunity and that a clinical diagnosis ofmeasles is unreliable * The incidence of adverse effects of measles, mumps, and rubella vaccine in the [11][12][13][14][15] year age group in the United Kingdom is low objections raised by parents could be overcome by providing clear and consistent professional advice and by emphasising that primary immunisation with measles vaccine or measles, mumps, and rubella vaccine does not confer immunity on all recipients. Diagnosis of measles is unreliable, and doctors have a responsibility for improving diagnostic accuracy.…”