title: Laboratory characterization of measles virus infection in previously vaccinated and unvaccinated individuals.
abstract: Waning immunity or secondary vaccine failure (SVF) has been anticipated by some as a challenge to global measles elimination efforts. Although such cases are infrequent, measles virus (MeV) infection can occur in vaccinated individuals following intense and/or prolonged exposure to an infected individual and may present as a modified illness that is unrecognizable as measles outside of the context of a measles outbreak. The immunoglobulin M response in previously vaccinated individuals may be nominal or fleeting, and viral replication may be limited. As global elimination proceeds, additional methods for confirming modified measles cases may be needed to understand whether SVF cases contribute to continued measles virus (MeV) transmission. In this report, we describe clinical symptoms and laboratory results for unvaccinated individuals with acute measles and individuals with SVF identified during MeV outbreaks. SVF cases were characterized by the serological parameters of high-avidity antibodies and distinctively high levels of neutralizing antibody. These parameters may represent useful biomarkers for classification of SVF cases that previously could not be confirmed as such using routine laboratory diagnostic techniques.
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. cjh3@cdc.gov
authors.forename: Carole J
authors.initials: CJ
authors.lastname: Hickman
authors.forename: Terri B
authors.initials: TB
authors.lastname: Hyde
authors.forename: Sun Bae
authors.initials: SB
authors.lastname: Sowers
authors.forename: Sara
authors.initials: S
authors.lastname: Mercader
authors.forename: Marcia
authors.initials: M
authors.lastname: McGrew
authors.forename: Nobia J
authors.initials: NJ
authors.lastname: Williams
authors.forename: Judy A
authors.initials: JA
authors.lastname: Beeler
authors.forename: Susette
authors.initials: S
authors.lastname: Audet
authors.forename: Bryan
authors.initials: B
authors.lastname: Kiehl
authors.forename: Robin
authors.initials: R
authors.lastname: Nandy
authors.forename: Azaibi
authors.initials: A
authors.lastname: Tamin
authors.forename: William J
authors.initials: WJ
authors.lastname: Bellini
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral / Q000097:blood; D000915:Antibody Affinity; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D047468:Immunoprecipitation; D007223:Infant; D008457:Measles / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control; D008458:Measles Vaccine / Q000008:administration & dosage* / Q000276:immunology*; D008459:Measles virus / Q000145:classification* / Q000276:immunology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral; D015415:Biomarkers; D007075:Immunoglobulin M; D008458:Measles Vaccine