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Clinical and Diagnostic Laboratory Immunology, January 2004, p. 119-122, Vol. 11, No. 1
1071-412X/04/$08.00+0     DOI: 10.1128/CDLI.11.1.119-122.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Identification of Primary and Secondary Measles Vaccine Failures by Measurement of Immunoglobulin G Avidity in Measles Cases during the 1997 São Paulo Epidemic

Instituto de Medicina Tropical de São Paulo—LIM-HC, Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina,¹ Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo,² Secretaria de Estado da Saúde de São Paulo, Centro de VigilÂncia Epidemiológica Professor Alexandre Vranjac ,³ Laboratório de Vírus Exantemáticos, Instituto Adolfo Lutz, São Paulo, Brazil⁴

Received 22 August 2003/ Returned for modification 15 October 2003/ Accepted 6 November 2003

Despite almost universal use of measles vaccines in recent decades, epidemics of the disease continue to occur. Understanding the role of primary vaccine failure (failure to seroconvert after vaccination) and secondary vaccine failures (waning immunity after seroconversion) in measles epidemics is important for the evaluation of measles control programs in developing countries. After a measles epidemic in São Paulo, Brazil, 159 cases previously confirmed by detection of specific immunoglobulin M (IgM) antibodies were tested for IgG avidity, and a secondary immune response, defined by an IgG avidity index of at least 30%, was established in 30 of 159 (18.9%) patients. Among the 159 patients, 107 (67.3%) had not been vaccinated and 52 (32.7%) had received one or more doses of measles vaccine. Of the 107 unvaccinated patients, 104 (97.2%) showed a primary immune response, defined as an IgG avidity index of less than 30%. Among the 52 patients with documented vaccination, 25 (48.1%) showed a primary immune response and 27 (51.9%) showed a secondary immune response, thereby constituting a secondary vaccine failure. Primary vaccine failure was observed in 13 of 13 patients vaccinated prior to 1 year of age and in 43.5 and 12.5%, respectively, of patients receiving one or two doses after their first birthdays. These results provide evidence that measurement of IgG avidity can be used to distinguish between primary and secondary vaccine failures in vaccinated patients with measles; the method can also be a useful tool for the evaluation of measles control programs.

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