Vaccination Failure
SYNOPSIS
Persistent exposure to faecal pathogens due to open defecation may cause environmental enteropathy that, in turn, may lead to undernutrition and vaccine failure in under 5-year-old (u5) children.
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Association between vaccine preventable diseases in children and improved sanitation following a nationwide sanitation campaign in India: an ecological analysis
P. Singh, D. N. Forthal, M. Shah, T.A. Bruckner
Persistent exposure to faecal pathogens due to open defecation may cause environmental enteropathy that, in turn, may lead to undernutrition and vaccine failure in under 5-year-old (u5) children. The Swachh Bharat Mission (SBM) programme in India, launched in 2014, aimed to construct toilets for every household nationwide and reduce open defecation. This programme, if successful, had the potential to reduce the burden of four vaccine preventable diseases (VPDs): diphtheria, pertussis, tetanus and measles. We examine whether increased household toilet availability in Indian districts following SBM corresponds with a reduction in diphtheria, pertussis, tetanus and measles in u5 children.
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Waning levels of measles antibodies with increasing time post-vaccination suggests that measles susceptibility is potentially increasing in Korea.
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An increasing, potentially measles-susceptible population over time after vaccination in Korea
CITATION
Kang, H. J., et al. Vaccine, 35 (2017) 4126–4132.
SUMMARY
In Korea, measles occurs mainly in infants <12 months of age, who are unvaccinated. In
addition, vaccine populations, including adolescents and young adults, can become infected through importation. Thus, the question arises whether the current level of herd immunity in Korea is now insufficient for protecting against measles infection.
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About 2%–10% of healthy individuals fail to mount antibody levels to routine vaccines.
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Primary vaccine failure to routine vaccines: Why and what to do?
CITATION
Wiedermann U, Garner-Spitzer E, Wagner A. Human Vaccines & Immunotherapeutics. 2016;12(1):239–243.
SUMMARY
Two sets of factors are responsible for vaccine failure: vaccine-related factors (e.g., failures in vaccine attenuation, vaccination regimes or administration) and host-related factors (e.g., genetics, immune status, age, health or nutritional status). Primary vaccine failure describes the inability to respond to primary vaccination, and secondary vaccine failure is characterized by a loss of protection after initial effectiveness. Studies indicate that about 2%–10% of healthy individuals fail to mount antibody levels to routine vaccines. T-regulatory as well as B-regulatory cells and the production of IL-10 are involved in non/hypo-responsiveness to vaccination. Non-responsiveness increases with age, indicating that vaccine schedules and doses (at least for primary vaccination) should be adapted according to age. Studies also suggest that different vaccination approaches may be needed for allergic or obese individuals. The significant paradigm shift taking place in many fields of medical research and care should extend the concept of personalized medicine into the field of vaccinology.
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Outbreaks of measles can occur in secondary schools, even when more than 99 percent of the students have been vaccinated and more than 95 percent are immune.
TITLE
Measles outbreak in a fully immunized secondary-school population.
CITATION
Gustafson TL, Lievens AW, Brunell PA, Moellenberg RG, Buttery CM, Sehulster LM. New England Journal of Medicine, 1987 Mar 26;316(13):771-4.
SUMMARY
An outbreak of measles occurred among adolescents in Corpus Christi, Texas, in the spring of 1985, even though vaccination requirements for school attendance had been thoroughly enforced. Serum samples from 1806 students at two secondary schools were obtained eight days after the onset of the first case. Only 4.1 percent of these students (74 of 1806) lacked detectable antibody to measles according to enzyme-linked immunosorbent assay, and more than 99 percent had records of vaccination with live measles vaccine. Stratified analysis showed that the number of doses of vaccine received was the most important predictor of antibody response. Ninety-five percent confidence intervals of seronegative rates were 0 to 3.3 percent for students who had received two prior doses of vaccine, as compared with 3.6 to 6.8 percent for students who had received only a single dose. After the survey, none of the 1732 seropositive students contracted measles. Fourteen of 74 seronegative students, all of whom had been vaccinated, contracted measles. In addition, three seronegative students seroconverted without experiencing any symptoms. We conclude that outbreaks of measles can occur in secondary schools, even when more than 99 percent of the students have been vaccinated and more than 95 percent are immune.
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In Israel in 2017, nine measles cases were identified in a population with high measles vaccination coverage.
TITLE
Measles Outbreak in a Highly Vaccinated Population – Israel, July-August 2017
Citation
Avramovich E, Indenbaum V, Haber M, Amitai Z, Tsifanski E, Farjun S, Sarig A, Bracha A, Castillo K, Markovich MP, Galor I. MMWR Morbidity and Mortality Weekly Report. 2018 Oct 26;67(42):1186-1188.
Summary
On August 6, 2017, the Israeli Defense Force Public Heath Branch (IDFPHB) was notified of two suspected measles cases. IDFPHB conducted an epidemiologic investigation, which identified nine measles cases in a population with high measles vaccination coverage. All measles patients had signs and symptoms consistent with modified measles (i.e., less severe disease with milder rash, fever, or both, with or without other mild typical measles symptoms). A total of 1,392 contacts were identified, and 162 received postexposure prophylaxis (PEP) with measles-mumps-rubella (MMR) vaccine; the remaining contacts were followed for 21 days (one incubation period). No tertiary cases were identified.
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These data provide a plausible explanation for pertussis resurgence and suggest that attaining herd immunity will require the development of improved vaccination strategies that prevent B. pertussis colonization and transmission.
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Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model
CITATION
Jason M. Warfel, Lindsey I. Zimmerman, and Tod J. Merkel; Proceedings of the National Academy of Sciences; January 14, 2014, 111 (2), 787-792; https://doi.org/10.1073/pnas.1314688110.
SUMMARY
In this study, researchers found that current acellular pertussis (aP) vaccines fail to prevent colonization and transmission. Nonhuman primates vaccinated with current acellular Pertussis (aP) were protected from severe symptoms but not infection and readily transmitted Bordetella pertussis to contacts.
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Acellular Pertussis vaccination interferes with the optimal clearance of B. parapertussis and enhances the performance of this pathogen. Our data raise the possibility that widespread acellular Pertussis vaccination can create hosts more susceptible to B. parapertussis infection.
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Acellular pertussis vaccination facilitates Bordetella parapertussis infection in a rodent model of bordetellosis
CITATION
Gráinne H. Long, Alexia T. Karanikas, Eric T. Harvill, Andrew F. Read and Peter J. Hudson, Proceedings of the Royal Society B, Biological Sciences; 03 March, 2010; Volume 277; https://doi.org/10.1098/rspb.2010.0010
SUMMARY
Despite over 50 years of population-wide vaccination, whooping cough incidence is on the rise. Although Bordetella pertussis is considered the main causative agent of whooping cough in humans, Bordetella parapertussis infections are not uncommon. The widely used acellular whooping cough vaccines (aP) are comprised solely of B. pertussis antigens that hold little or no efficacy against B. parapertussis. Here, we ask how aP vaccination affects competitive interactions between Bordetella species within co-infected rodent hosts and thus the aP-driven strength and direction of in-host selection. We show that aP vaccination helped clear B. pertussis but resulted in an approximately 40-fold increase in B. parapertussis lung colony-forming units (CFUs). Such vaccine-mediated facilitation of B. parapertussis did not arise as a result of competitive release; B. parapertussis CFUs were higher in aP-relative to sham-vaccinated hosts regardless of whether infections were single or mixed. Further, we show that aP vaccination impedes host immunity against B. parapertussis—measured as reduced lung inflammatory and neutrophil responses. Thus, we conclude that aP vaccination interferes with the optimal clearance of B. parapertussis and enhances the performance of this pathogen. Our data raise the possibility that widespread aP vaccination can create hosts more susceptible to B. parapertussis infection.
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Repeated influenza vaccination at a young age substantially increases the risk of influenza at older ages.
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Repeated influenza vaccination of healthy children and adults: borrow now, pay later?
CITATION
Carrat F, Lavenu A, Cauchemez S, Deleger S. Repeated influenza vaccination of healthy children and adults: borrow now, pay later? Epidemiology & Infection 2006;134(1):63-70.
SUMMARY
This study shows that repeated influenza vaccination at younger ages may double the risk of influenza in the elderly. The study suggests that the “possible benefits of vaccinating children after 5 years of age, and otherwise healthy adults—particularly over a long period and mainly for economic reasons—could be outweighed by severe clinical consequences and increased costs in the elderly.” Moreover, the findings are “solely due to differences between vaccine-induced immunity and naturally acquired immunity.” Unlike vaccination, naturally acquired immunity can provide long-lasting protection against subsequent infection by the same viral subtype.
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A computer model was created to study the effect of the measles elimination program in the United States on the number of susceptibles in the population. The simulation reveals that in the prevaccine era, approximately 10.6% of the population was susceptible to measles, most of whom were children less than 10 years of age.
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The future of measles in highly immunized populations. A modeling approach.
CITATION
Levy DL. American Journal of Epidemiology. 1984 Jul;120(1):39-48.
SUMMARY
Little is known about how an intensive measles elimination program changes the overall immune status of the population. A computer model was created to study the effect of the measles elimination program in the United States on the number of susceptibles in the population. The simulation reveals that in the prevaccine era, approximately 10.6% of the population was susceptible to measles, most of whom were children less than 10 years of age. With the institution of the measles immunization program, the proportion of susceptibles in the population fell to 3.1% from 1978 through 1981, but then began to rise by approximately 0.1% per year to reach about 10.9% in the year 2050. The susceptibles at this time were distributed evenly throughout all age groups. The model did not consider the potential effect of waning immunity. The results of this study suggest that measles elimination in the United States has been achieved by an effective immunization program aimed at young susceptibles combined with a highly, naturally immunized adult population. However, despite short-term success in eliminating the disease, long-range projections demonstrate that the proportion of susceptibles in the year 2050 may be greater than in the prevaccine era. Present vaccine technology and public health policy must be altered to deal with this eventuality.
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The 1989 measles outbreak in the province of Quebec has been largely attributed to an incomplete vaccination coverage, despite a 99% vaccination rate.
TITLE
Major measles epidemic in the region of Quebec despite a 99% vaccine coverage
Citation
Boulianne N, De Serres G, Duval B, Joly JR, Meyer F, Déry P, Alary M, Le Hénaff D, Thériault N. Canadian Journal of Public Health. 1991 May-Jun;82(3):189-90.
Summary
The 1989 measles outbreak in the province of Quebec has been largely attributed to an incomplete vaccination coverage. In the Quebec City area (pop. 600,000) 1,363 confirmed cases of measles did occur. A case-control study conducted to evaluate risk factors for measles allowed us to estimate vaccination coverage. The vaccination coverage among cases was at least 84.5%. Vaccination coverage for the total population was 99.0%. Incomplete vaccination coverage is not a valid explanation for the Quebec City measles outbreak.