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Grand Rounds

Do Infants Have Measles Immunity Until the Time of Their First Vaccination?

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BACKGROUND AND PURPOSE:

  • Science et al. (Pediatrics, 2019) examined humoral immunity to measles in infants <12 months of age in Ontario, Canada

METHODS:

  • Time course study
  • Data collection
    • Sera were collected at a tertiary pediatric hospital from infants <12 months who were born at ≥37 weeks’ gestational age
    • Exclusion: Infants with conditions that could affect antibody levels
  • Study design
    • Sera selected from 8 predetermined age bands and tested for measles-neutralizing antibody using the plaque-reduction neutralization test (gold standard)
    • Proportion of sera immune at each age band was calculated
    • Predictors of infant susceptibility were assessed using regression analyses

RESULTS:

  • 196 infants were included
  • Percent of infants with titers below the protective threshold
    • First month: 20% of infants
    • Three months: 92% of infants
    • Six months: 100% of infants
  • Infant age was the strongest predictor of susceptibility
    • Odds ratio 2.13 for each additional month increase (95% CI, 1.52 to 2.97)
  • Breast feeding
    • Susceptibility was lower in those who had received any breast milk (58%) vs those who had not (76%) but was not statistically significant (P = .11)
  • No difference between boys and girls or week gestation at birth (37 to 41 weeks)

CONCLUSION:

  • Most infants were susceptible to measles by 3 months of age
  • Best strategy remains community vaccination
  • The authors suggest that these findings have implications for age at first vaccination and policies to limit infant exposure and in addition

Further research is needed prospectively to validate these findings and explore the impact of maternal age and breastfeeding on infant immunity in elimination settings

Learn More – Primary Sources:

Measles Antibody Levels in Young Infants

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