Evaluation of measles-rubella vaccination for mothers in early puerperal phase.

Monday, 25th of January 2016

Vaccine. 2016 Jan 19. pii: S0264-410X(16)00041-4. doi: 10.1016/j.vaccine.2016.01.015. [Epub ahead of print]

Evaluation of measles-rubella vaccination for mothers in early puerperal phase.

Hisano M¹ Kato T² Inoue E³ Sago H⁴ Yamaguchi K⁴.

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Abstract

BACKGROUND:

The postpartum period is an ideal opportunity to vaccinate mothers with inadequate immunity to vaccine-preventable diseases including measles and rubella.

METHODS:

A prospective study of measles-rubella (MR) vaccination in the early puerperal phase was conducted in 171 mothers who had insufficient antibody titers when screened for immunity to measles (≤1:4 on the neutralization test [NT]) or rubella (≤1:16 on the hemagglutination inhibition [HI] test) during pregnancy. To evaluate the efficacy of MR vaccination in the postpartum period we determined their post-vaccination antibody titers and immune responses to vaccination and investigated the association between these and their prolactin (PRL) levels and Th1/Th2 ratios at the time of vaccination. We also examined the passage of viral RNA and antigen into breast milk.

RESULTS:

Of the 169 participants who completed the study schedule 117 and 101 had low antibody titers against measles and rubella respectively. In the measles-seronegative group the antibody-positive rate was 87% on the NT assay and the NT geometric mean antibody titer was 11.4 (95% confidence interval [CI] 10.0-13.0). In the rubella-seronegative group the antibody-positive rate was 88% on the HI test assay and the HI geometric mean antibody titer was 64.0 (95% CI 53.9-76.0). There was no association between the post-vaccination antibody titers and the PRL levels or Th1/Th2 ratios at the time of vaccination. In the rubella-seronegative group subjects with higher Th1/Th2 ratios showed higher rates of responsiveness than those with lower ratios (P=0.045). Although measles virus RNA was isolated from the breast milk of two vaccinated mothers breastfeeding was not associated with clinical disease in any infants.

CONCLUSION:

MR vaccination in the early puerperal phase is considered an effective way to prevent the diseases regardless of the mothers immunological status and hormonal milieu.