title: Mutual interference on the immune response to yellow fever vaccine and a combined vaccine against measles, mumps and rubella.
abstract: A randomized trial was conducted to assess the immunogenicity and reactogenicity of yellow fever vaccines (YFV) given either simultaneously in separate injections, or 30 days or more after a combined measles-mumps-rubella (MMR) vaccine. Volunteers were also randomized to YFV produced from 17DD and WHO-17D-213 substrains. The study group comprised 1769 healthy 12-month-old children brought to health care centers in Brasilia for routine vaccination. The reactogenicity was of the type and frequency expected for the vaccines and no severe adverse event was associated to either vaccine. Seroconversion and seropositivity 30 days or more after vaccination against yellow fever was similar across groups defined by YFV substrain. Subjects injected YFV and MMR simultaneously had lower seroconversion rates--90% for rubella, 70% for yellow fever and 61% for mumps--compared with those vaccinated 30 days apart--97% for rubella, 87% for yellow fever and 71% for mumps. Seroconversion rates for measles were higher than 98% in both comparison groups. Geometric mean titers for rubella and for yellow fever were approximately three times higher among those who got the vaccines 30 days apart. For measles and mumps antibodies GMTs were similar across groups. MMR's interference in immune response of YFV and YFV's interference in immune response of rubella and mumps components of MMR had never been reported before but are consistent with previous observations from other live vaccines. These results may affect the recommendations regarding primary vaccination with yellow fever vaccine and MMR.
authors.affiliation: Departamento de Epidemiologia, Escola Nacional de Saúde Pública, FIOCRUZ, Rua Leopoldo Bulhões, 1480, sala 820, Manguinhos, Rio de Janeiro 21041-210, RJ, Brazil. julianarns@gmail.com
authors.forename: Juliana Romualdo
authors.initials: JR
authors.lastname: Nascimento Silva
authors.forename: Luiz Antonio B
authors.initials: LA
authors.lastname: Camacho
authors.forename: Marilda M
authors.initials: MM
authors.lastname: Siqueira
authors.forename: Marcos de Silva
authors.initials: Mde S
authors.lastname: Freire
authors.forename: Yvone P
authors.initials: YP
authors.lastname: Castro
authors.forename: Maria de Lourdes S
authors.initials: Mde L
authors.lastname: Maia
authors.forename: Anna Maya Y
authors.initials: AM
authors.lastname: Yamamura
authors.forename: Reinaldo M
authors.initials: RM
authors.lastname: Martins
authors.forename: Maria de Luz F
authors.initials: Mde L
authors.lastname: Leal
mesh_terms: D000914:Antibodies, Viral; D003625:Data Collection; D004336:Drug Antagonism; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008457:Measles / Q000276:immunology / Q000517:prevention & control; D008459:Measles virus / Q000276:immunology; D022542:Measles-Mumps-Rubella Vaccine / Q000009:adverse effects / Q000037:antagonists & inhibitors* / Q000276:immunology*; D009107:Mumps / Q000276:immunology / Q000517:prevention & control; D009109:Mumps virus / Q000276:immunology; D012409:Rubella / Q000276:immunology / Q000517:prevention & control; D012412:Rubella virus / Q000276:immunology; D011795:Surveys and Questionnaires; D017778:Vaccines, Combined / Q000009:adverse effects / Q000276:immunology; D015004:Yellow Fever / Q000276:immunology / Q000517:prevention & control; D022341:Yellow Fever Vaccine / Q000009:adverse effects / Q000037:antagonists & inhibitors* / Q000276:immunology*; D015005:Yellow fever virus / Q000276:immunology
chemical_list: D000914:Antibodies, Viral; D022542:Measles-Mumps-Rubella Vaccine; D017778:Vaccines, Combined; D022341:Yellow Fever Vaccine