title: Two case studies of modified measles in vaccinated physicians exposed to primary measles cases: high risk of infection but low risk of transmission.
abstract: In 2009, measles outbreaks in Pennsylvania and Virginia resulted in the exposure and apparent infection of 2 physicians, both of whom had a documented history of vaccination with >2 doses of measles-mumps-rubella vaccine. These physicians were suspected of having been infected with measles after treating patients who subsequently received a diagnosis of measles. The clinical presentation was nonclassical in regard to progression, duration, and severity. It is hypothesized that the 2 physicians mounted vigorous secondary immune responses typified by high avidity measles immunoglobulin G antibody and remarkably high neutralizing titers in response to intense and prolonged exposure to a primary measles case patient. Both of the physicians continued to see patients, because neither considered that they could have measles. Despite surveillance for cases among contacts, including unvaccinated persons, no additional cases were identified.
authors.affiliation: Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jjs4@cdc.gov
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Rota
authors.forename: Carole J
authors.initials: CJ
authors.lastname: Hickman
authors.forename: Sun Bae
authors.initials: SB
authors.lastname: Sowers
authors.forename: Paul A
authors.initials: PA
authors.lastname: Rota
authors.forename: Sara
authors.initials: S
authors.lastname: Mercader
authors.forename: William J
authors.initials: WJ
authors.lastname: Bellini
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D000915:Antibody Affinity; D002648:Child; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007075:Immunoglobulin M / Q000097:blood / Q000276:immunology; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D008297:Male; D008457:Measles / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage* / Q000276:immunology*; D010414:Pennsylvania / Q000453:epidemiology; D012307:Risk Factors; D014768:Virginia / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D022542:Measles-Mumps-Rubella Vaccine