Measles Virus Neutralizing Antibody Response, Cell-Mediated Immunity, and Immunoglobulin G Antibody Avidity Before and After Receipt of a Third Dose of Measles, Mumps, and Rubella Vaccine in Young Adults

Abstract

Background Two doses of measles-mumps-rubella (MMR) vaccine are 97% effective against measles, but waning antibody immunity and two-dose vaccine failures occur. We administered a third MMR dose (MMR3) to young adults and assessed immunogenicity over 1 year. Methods Measles virus (MeV) neutralizing antibody concentrations, cell-mediated immunity (CMI), and IgG antibody avidity were assessed at baseline, 1-month, and 1-year after MMR3. Results Of 662 subjects at baseline, 1 (0.2%) was seronegative (<8 mIU/mL) and 23 (3.5%) had low (8-120 mIU/mL) MeV neutralizing antibodies. At 1-month post-MMR3, 1 (0.2%) subject was seronegative and 6 (0.9%) had low neutralizing antibodies with only 21/662 (3.2%) showing a ≥4-fold rise in neutralizing antibodies. At 1-year post-MMR3, none were negative and 10 (1.6%) of 617 subjects had low neutralizing antibodies. CMI results showed low-levels of spot-forming cells after stimulation, suggesting T-cell memory, but the response was minimal post-MMR3. MeV IgG avidity results did not correlate with neutralization results. Conclusions Most subjects were seropositive pre-MMR3 and very few had a secondary immune response post-MMR3. Similarly, CMI and avidity results showed minimal qualitative improvements in immune response post-MMR3. We did not find compelling data to support a routine third dose of MMR vaccine.

Seroprevalence to Measles Virus after Vaccination or Natural Infection in an Adult Population, in Italy

“…Although MMR vaccine is very efficacious to induce a protective response against measles, considering that a physiological decline of the humoral response has been revealed in some studies [35], it could be important to monitor the population 10-15 years after vaccination, in order to revaccinate the seronegatives. However, since booster revaccination might not induce a sustainable increase of MV antibodies [40], it could be advisable to implement the prophylaxis with alternative vaccines that could obviate this possibility.…”

Mumps Virus Nucleoprotein and Hemagglutinin-Specific Antibody Response Following a Third Dose of Measles Mumps Rubella Vaccine

“…The study population and exclusion criteria have been previously described in detail [17, 22]. Briefly, the study population included healthy young adults aged 18–28 years who received care from the Marshfield Clinic (Marshfield, WI) or who participated in a longitudinal study examining immune response to a second dose of MMR vaccine at Marshfield Clinic.…”

Measles, the need for a paradigm shift

“…In addition, Paunio et al [86] reported during the 1988-89 measles outbreak in Finland that once and twice-vaccinated individuals had a crude relative risk of infection of 15.6 and 2.3, respectively, compared with thrice vaccinated individuals. Recently, minimal qualitative improvements in measles immune response magnitude and duration after a third MMR dose were reported in healthy young adults in the United Sates [140]. However, plaque reduction neutralization testing was performed using Edmonston measles virus, so it was not assessed if a third dose could re-boost the polyclonal immune response and clinical efficacy against the circulating genotypes.…”