Asthma Status and Waning of Measles Antibody Concentrations after Measles Immunization

Abstract

Background Asthmatics have increased risks of common and serious microbial infections including vaccine preventable diseases. Little is known about whether asthma influences waning of humoral immunity. We assessed whether asthma status influences waning of anti-measles virus antibody concentrations over time. Methods The study utilized a cross-sectional study cohort of healthy children who had been immunized with one-dose of MMR-II at age approximately 15 months. Between 5 and 12 years of age, measles vaccine virus-specific antibody (IgG) values were measured by EIA and considered seropositive if the EIA index unit was ≥ 1. The medical records were reviewed to determine asthma status during the first 18 years of life by applying predetermined criteria for asthma. A least squares regression model was used to evaluate the effect of asthma status on the relationship between measles antibody titer and time elapsed between the initial measles vaccination and measurement of measles antibody concentrations. Results Of the 838 eligible children, 281 (34%) met criteria for asthma. Measles antibody waned over time (r=-0.19, p<0.001), specifically more rapidly in asthmatics (r=-0.30, p<0.001, a decrease of -0.114 unit per year) than non-asthmatics (r=-0.13, p=0.002, a decrease of -0.046 unit per year) (p-value for interaction=0.010). This differential waning rate resulted in a lower mean (SD) measles antibody concentration [1.42 (0.67) vs. 1.67 (0.69), p=0.008] and lower seropositivity rate (73% vs. 84%, p=0.038) in asthmatics than non-asthmatics starting around 9.3 years after the initial measles vaccination. Conclusion Asthma status is associated with waning kinetics of measles antibody among children.

Asthma and risk of breakthrough varicella infection in children

“…1 Recently, we reported that children with clinical asthma and those with an immunogenetic predisposition to asthma (develop asthma later) have a more rapid waning of measles vaccine virus-specific immunoglobulin G levels over time than those without asthma (a decrement of Ϫ0.114 unit per year in children with asthma versus Ϫ0.046 unit per year in children without asthma; p value for trend ϭ 0.01). 4 Because a history of asthma ever is associated with the risk of breakthrough varicella infection, our study results might be consistent with these study findings. We postulated that asthma may affect the kinetics of vaccine-induced memory B cells or long-lived plasma cells.…”

“…These results indicated that children with an immunogenetic predisposition to asthma may still have a potential risk for breakthrough varicella infection because they already have airway, clinical, and immunologic features of asthma before the development of clinical asthma. 4,18,19 There is evidence that the effect of atopic conditions on the risk of microbial infections or immune dysfunction might begin before the onset of clinical asthma. 19 -21 These findings may be consistent with the notion that some phenotypic features of asthma (e.g., poor lung function) begin before the development of clinical asthma in children (even during newborn period) (i.e., the "hypothesis of early programming of asthma").…”

“…We found that, compared with children without asthma, those with asthma who had received one dose of measles, mumps, rubella vaccine had a more rapid waning of measles vaccine virus-specific immunoglobulin G levels over time. 4 This differential waning resulted in a lower seropositive rate in children with asthma than in children without asthma (73 versus 84%; p ϭ 0.038). Importantly, children who developed asthma subsequently (i.e., no asthma at the time of antibody measurement) also had a more rapid waning of antimeasles antibody levels than children without asthma.…”

“…2 As discussed in the recent review, it has been postulated that T-helper 2 predominant immune milieu observed in individuals with asthma or other atopic conditions results in suboptimal innate and adaptive immunity and an increased propensity to microbial infections, including vaccine-preventable disease, e.g., pertussis. 1 On exploring the mechanisms that underlie the association between asthma and increased risk of vaccine-preventable infections, e.g., measles or pertussis, 3,4 we recently examined a possibility of waning of vaccine-induced humoral immunity over time in children with asthma (i.e., secondary vaccine failure). We found that, compared with children without asthma, those with asthma who had received one dose of measles, mumps, rubella vaccine had a more rapid waning of measles vaccine virus-specific immunoglobulin G levels over time.…”

Risk of herpes zoster in children with asthma

“…7 Both innate and adaptive immune dysfunctions associated with clinical asthma and immunogenic predisposition to asthma might play a role. One noteworthy study showed a more rapid waning of humoral immunity (antimeasles immunoglobulin G levels) over time in children with asthma than in children without asthma, 38 which potentially indicates that asthma might affect kinetics or functions of B cells over time in a way that makes the host susceptible to vaccineinduced microbial infections. 10 Given that cell-mediated immunity (CMI) is known to decline with age as part of immunosenescence and that decreased CMI is associated with reactivation of varicella zoster virus, our study results might indicate that asthma affects the waning of CMI in addition to the reported impaired innate immunity.…”