What Is the Evidence to Support a Correlate of Protection for Measles? A Systematic Review

Author:

Bolotin Shelly123,Hughes Stephanie L1,Gul Nazish1,Khan Sumaiya1,Rota Paul A4,Severini Alberto56,Hahné Susan7,Tricco Andrea28,Moss William J9,Orenstein Walter10,Turner Nikki11,Durrheim David12,Heffernan Jane M13,Crowcroft Natasha12314

Affiliation:

1. Public Health Ontario, Toronto, Ontario, Canada

2. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

3. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada

4. Centers for Disease Control and Prevention, Atlanta, Georgia, USA

5. National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada

6. Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada

7. National Institute for Public Health and the Environment, Bilthoven, The Netherlands

8. Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada

9. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

10. Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA

11. Department of General Practice and Primary Health Care, Faculty of Medicine and Health Science, University of Auckland, Tamaki Campus, Auckland, New Zealand

12. University of Newcastle, New South Wales, Australia

13. Centre for Disease Modelling, Mathematics and Statistics, York University,, Toronto, Ontario, Canada

14. ICES, Toronto, Ontario, Canada

Abstract

Abstract Background Many studies assume that the serologic correlate of protection from measles disease is 120 mIU/mL. We systematically reviewed the literature to examine the evidence supporting this correlate of protection. Methods We searched peer-reviewed and gray literature for articles reporting a measles correlate of protection. We excluded studies focusing on special populations, infants aged <9 months, and those using animal models or nonstandard vaccines or administration routes. We extracted and synthesized data from full-text articles that met inclusion criteria. Results We screened 14 778 articles and included 5 studies in our review. The studies reported either preexposure antibody concentrations of individuals along with a description of symptoms postexposure, or the proportion of measles cases that had preexposure antibody concentrations above a threshold of immunity specified by the authors. Some studies also described secondary antibody responses upon exposure. The variation in laboratory methods between studies made comparisons difficult. Some of the studies that assumed 120 mIU/mL as a correlate of protection identified symptomatic individuals with preexposure titers exceeding this threshold. Conclusions Our findings underscore the scant data upon which the commonly used 120 mIU/mL measles threshold of protection is based, suggesting that further work is required to characterize the measles immunity threshold.

Funder

WHO

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Immunology and Allergy

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