Measles Virus Neutralizing Antibody Response Cell-Mediated Immunity and Immunoglobulin G Antibody Avidity Before and After Receipt of a Third Dose of Measles Mumps and Rubella Vaccine in Young Adults

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Measles Virus Neutralizing Antibody Response Cell-Mediated Immunity and Immunoglobulin G Antibody Avidity Before and After Receipt of a Third Dose of Measles Mumps and Rubella Vaccine in Young Adults

  1. 1.        Amy Parker Fiebelkorn1 
  2. 2.        Laura A. Coleman2a 
  3. 3.        Edward A. Belongia2 
  4. 4.        Sandra K. Freeman2
  5. 5.        Daphne York2 
  6. 6.        Daoling Bi1 
  7. 7.        Ashwin Kulkarni3 
  8. 8.        Susette Audet3 
  9. 9.        Sara Mercader1
  10. 10.     Marcia McGrew1 
  11. 11.     Carole J. Hickman1 
  12. 12.     William J. Bellini1 
  13. 13.     Rupak Shivakoti4a
  14. 14.     Diane E. Griffin4 and 
  15. 15.     Judith Beeler3

+Author Affiliations

  1. 1National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Atlanta Georgia
  2. 2Marshfield Clinic Research Foundation Wisconsin
  3. 3Center for Biologics Evaluation and Research Food and Drug Administration Silver Spring
  4. 4W. Harry Feinstone Department of Molecular Microbiology and Immunology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland
  5. Correspondence: A. P. Fiebelkorn CDC/NCIRD 1600 Clifton Rd MS A-34 Atlanta GA 30333 (afiebelkorn@cdc.gov).
  6. Presented in part: IDWeek 2014 Philadelphia Pennsylvania 8–12 October 2014.
  7. ↵a Present affiliations: Abbott Nutrition Columbus Ohio (L. A. C.); Department of Medicine Johns Hopkins School of Medicine Baltimore Maryland (R. S.).

Abstract

Background. Two doses of measles mumps and rubella (MMR) vaccine are 97% effective against measles but waning antibody immunity to measles and failure of the 2-dose vaccine occur. We administered a third MMR dose (MMR3) to young adults and assessed immunogenicity over 1 year.

Methods. Measles virus (MeV) neutralizing antibody concentrations cell-mediated immunity (CMI) and immunoglobulin G (IgG) antibody avidity were assessed at baseline and 1 month and 1 year after MMR3 receipt.

Results. Of 662 subjects at baseline 1 (0.2%) was seronegative for MeV-neutralizing antibodies (level <8 mIU/mL) and 23 (3.5%) had low antibody levels (8–120 mIU/mL). One month after MMR3 receipt 1 subject (0.2%) was seronegative and 6 (0.9%) had low neutralizing antibodies with only 21 of 662 (3.2%) showing a ≥4-fold rise in neutralizing antibodies. One year after MMR3 receipt no subject was seronegative and 10 of 617 (1.6%) had low neutralizing antibody levels. CMI analyses showed low levels of spot-forming cells after stimulation suggesting the presence of T-cell memory but the response was minimal after MMR3 receipt. MeV IgG avidity did not correlate with findings of neutralization analyses.

Conclusions. Most subjects were seropositive before MMR3 receipt and very few had a secondary immune response after MMR3 receipt. Similarly CMI and avidity analyses showed minimal qualitative improvements in immune response after MMR3 receipt. We did not find compelling data to support a routine third dose of MMR vaccine.