In Elimination Settings, Measles Antibodies Wane After Vaccination but Not After Infection: A Systematic Review and Meta-Analysis
Shelly Bolotin, Selma Osman, Stephanie L. Hughes, Archchun Ariyarajah, Andrea C. Tricco, Sumaiya Khan, Lennon Li, Caitlin Johnson, Lindsay Friedman, Nazish Gul, Rachel Jardine, Mary-Rose Faulkner, Susan Hahné, Jane M. Heffernan, Alya Dabbagh, Paul A. Rota, Alberto Severini, Mark Jit, David N Dürrheim, Walter A. Orenstein, William J. Moss, Sebastian Funk, Nikki Turner, W. William Schluter, Jaleela S. Jawad, Natasha S. Crowcroft
Abstract
BACKGROUND: We conducted a systematic review to assess whether measles humoral immunity wanes in previously infected or vaccinated populations in measles elimination settings. METHODS: After screening 16 822 citations, we identified 9 articles from populations exposed to wild-type measles and 16 articles from vaccinated populations that met our inclusion criteria. RESULTS: Using linear regression, we found that geometric mean titers (GMTs) decreased significantly in individuals who received 2 doses of measles-containing vaccine (MCV) by 121.8 mIU/mL (95% confidence interval [CI], -212.4 to -31.1) per year since vaccination over 1 to 5 years, 53.7 mIU/mL (95% CI, -95.3 to -12.2) 5 to 10 years, 33.2 mIU/mL (95% CI, -62.6 to -3.9), 10 to 15 years, and 24.1 mIU/mL (95% CI, -51.5 to 3.3) 15 to 20 years since vaccination. Decreases in GMT over time were not significant after 1 dose of MCV or after infection. Decreases in the proportion of seropositive individuals over time were not significant after 1 or 2 doses of MCV or after infection. CONCLUSIONS: Measles antibody waning in vaccinated populations should be considered in planning for measles elimination.