The 1988–1989 Measles Epidemic in Hungary: Assessment of Vaccine Failure

Abstract

Hungary has had a successful measles vaccination programme, achieving over 93% coverage in targeted groups. However, from September 1988 until December 1989, 17,938 measles cases were reported among the civilian population (attack rate [AR] = 169 per 100,000 population) with the majority of cases occurring in vaccinated people. National surveillance data were analysed to determine reasons for the outbreak and risk factors for vaccine failure. People born during 1971 and 1972 had been targeted for vaccination during campaigns in April and September of 1973 and had the highest AR (1332 and 1632 per 100,000, respectively). Epidemiological studies of vaccine efficacy conducted among secondary school students corroborated these findings. Among 754 secondary school students, those vaccinated during the April 1973 campaign were at highest risk compared with those vaccinated at routine health care after 1974 (relative risk = 10.9, 95% confidence interval [Cl]: 2.5-47.9). Among 341 primary school students, one-dose recipients were at higher risk compared with two-dose recipients controlling for age at and time elapsed since vaccination (P = 0.04).

Application of a fast and cost-effective ‘three-in-one’ MMR ELISA as a tool for surveying anti-MMR humoral immunity: the Hungarian experience

“…The 1988-1989 epidemics affected individuals (16-22 years old) who were vaccinated in the early era with a singular measles vaccine. Following the 1988-1989 epidemics, persons born between 1973 and 1977 were revaccinated [33]. Even though a significant portion of the age groups indicated with ** in Figure 9 later were our test expressed in percentages.…”

“…A recent publication by Hungarian colleagues has reported 86.2% seropositivity for the 41-45 years old individuals [32], a cluster partially overlapping with the two abovementioned age groups of our classification. The potential gap detected in herd immunity is also supported by the already known insufficiencies during the initial vaccination era [33]. These individuals were vaccinated during the early 1970s, when the optimal age of vaccination was not well defined, and the thermolability of the reconstituted vaccine was not fully characterised [5].…”

The Challenge of Achieving Measles Elimination in the Eastern Mediterranean Region by 2010

“…Maintaining high population immunity can interrupt endemic transmission of measles virus [12] but accumulation of susceptible populations represents the greatest risk to measles elimination [13][14][15]. Countries that conducted high quality catch-up campaigns have had a marked decrease in cases.…”

Epidemiology of measles in Taiwan: dynamics of transmission and timeliness of reporting during an epidemic in 1988–9

“…The recent global resurgence of measles epidemics in several developed countries in 1988-91 reinforces the importance of timely measles surveillance and the need to investigate the dynamics of measles transmission after mass immunization [11][12][13][14][15]. This study illustrates a longer duration of epidemics in Taiwan compared to the pre-vaccination era.…”

“…In addition, the school holidays certainly facilitated transmission to wider areas. These findings demonstrate the urgent need to establish a schoolbased surveillance system, to implement school immunization requirements [25] and to investigate the possible role of declining immunity in the effective control of vaccine-preventable diseases in Taiwan. A long duration and widespread infection were common characteristics of the 1988-9 measles epidemic in Taiwan as well as several other countries during 1988-91 [11][12][13][14][15]. The epidemic diffused from the northern suburban area, where 14 % of population were migratory in 1989 [26], to a metropolitan city and then out to other regional cities and rural areas.…”