Measles vaccination in the presence or absence of maternal measles antibody: impact on child survival

Peter Aaby, Cesário L Martins, May-Lill Garly, Andreas Andersen, Ane B Fisker, Mogens H Claesson, Henrik Ravn, Amabelia Rodrigues, Hilton C Whittle, Christine S Benn, Peter Aaby, Cesário L Martins, May-Lill Garly, Andreas Andersen, Ane B Fisker, Mogens H Claesson, Henrik Ravn, Amabelia Rodrigues, Hilton C Whittle, Christine S Benn

Abstract

Background: Measles vaccine (MV) has a greater effect on child survival when administered in early infancy, when maternal antibody may still be present.

Methods: To test whether MV has a greater effect on overall survival if given in the presence of maternal measles antibody, we reanalyzed data from 2 previously published randomized trials of a 2-dose schedule with MV given at 4-6 months and at 9 months of age. In both trials antibody levels had been measured before early measles vaccination.

Results: In trial I (1993-1995), the mortality rate was 0.0 per 1000 person-years among children vaccinated with MV in the presence of maternal antibody and 32.3 per 1000 person-years without maternal antibody (mortality rate ratio [MRR], 0.0; 95% confidence interval [CI], 0-.52). In trial II (2003-2007), the mortality rate was 4.2 per 1000 person-years among children vaccinated in presence of maternal measles antibody and 14.5 per 1000 person-years without measles antibody (MRR, 0.29; 95% CI, .09-.91). Possible confounding factors did not explain the difference. In a combined analysis, children who had measles antibody detected when they received their first dose of MV at 4-6 months of age had lower mortality than children with no maternal antibody, the MRR being 0.22 (95% CI, .07-.64) between 4-6 months and 5 years.

Conclusions: Child mortality in low-income countries may be reduced by vaccinating against measles in the presence of maternal antibody, using a 2-dose schedule with the first dose at 4-6 months (earlier than currently recommended) and a booster dose at 9-12 months of age.

Clinical trials registration: NCT00168558.

Keywords: 2-dose measles vaccination; age of measles vaccination; maternal measles antibodies; nonspecific beneficial effects of measles vaccine.

© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

Figures

Figure 1.
Figure 1.
Cumulative mortality between 4.5 months and 5 years of age in relation to age of measles vaccination (MV) and presence of maternal antibody (trial II [5]). Children randomized to MV at 4.5 months received also MV at 9 months of age. Controls received only MV at 9 months of age. Abbreviations: Ab, antibody; MV, measles vaccination.

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Source: PubMed

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