title: Residual susceptibility to measles among young adults in Victoria, Australia following a national targeted measles-mumps-rubella vaccination campaign.
abstract: BACKGROUND
  Past measles immunisation policies in Australia have resulted in a cohort of young adults who have been inadequately vaccinated, but who also have low levels of naturally acquired immunity because immunisation programs have decreased the circulation of wild virus. A measles-mumps-rubella (MMR) immunisation campaign aimed at addressing this susceptibility to measles among young adults was conducted in Australia in 2001-2. By estimating age-specific immunity, we aimed to evaluate the success of this campaign in the state of Victoria.
  
  
  METHODS
  We conducted serosurveys after the young adult MMR program at state and national levels to estimate immunity among young adults born between 1968-82. We compared results of the Victorian (state) surveys with the Victorian component of the national surveys and compared both surveys with surveys conducted before the campaign. We also reviewed all laboratory confirmed measles cases in Victoria between 2000-4.
  
  
  RESULTS
  The Victorian state serosurveys indicated no significant change in immunity of the cohort following the young adult MMR campaign (83.9% immune pre and 85.5% immune post campaign) while the Victorian component of the national serosurvey indicated a significant decline in immunity (91.0% to 84.2%; p = 0.006). Both surveys indicated about 15% susceptibility to measles among young Victorian adults after the campaign. Measles outbreaks in Victoria between 2000-4 confirmed the susceptibility of young adults. Outbreaks involved a median of 2.5 cases with a median age of 24.5 years.
  
  
  CONCLUSIONS
  In Victoria, the young adult MMR program appears to have had no effect on residual susceptibility to measles among the 1968-82 birth cohort. Young adults in Victoria, as in other countries where past immunisation policies have left a residual susceptible cohort, represent a potential problem for the maintenance of measles elimination.
authors.affiliation: Epidemiology Unit, Victorian Infectious Diseases Reference Laboratory (VIDRL) and World Health Organization (WHO) Western Pacific Region Measles Reference Laboratory, Melbourne, Australia. heath.kelly@mh.org.au
authors.forename: Heath A
authors.initials: HA
authors.lastname: Kelly
authors.forename: Heather F
authors.initials: HF
authors.lastname: Gidding
authors.forename: Theo
authors.initials: T
authors.lastname: Karapanagiotidis
authors.forename: Jennie A
authors.initials: JA
authors.lastname: Leydon
authors.forename: Michaela A
authors.initials: MA
authors.lastname: Riddell
mesh_terms: D000328:Adult; D000367:Age Factors; D000914:Antibodies, Viral / Q000097:blood; D015331:Cohort Studies; D004198:Disease Susceptibility; D006291:Health Policy; D006801:Humans; D007110:Immunity, Active; D017589:Immunization Programs / Q000592:standards* / Q000706:statistics & numerical data; D007124:Immunoenzyme Techniques; D008457:Measles / Q000276:immunology* / Q000517:prevention & control*; D008459:Measles virus / Q000276:immunology / Q000472:pathogenicity*; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage* / Q000600:supply & distribution; D015397:Program Evaluation; D016036:Seroepidemiologic Studies; D014739:Victoria
chemical_list: D000914:Antibodies, Viral; D022542:Measles-Mumps-Rubella Vaccine