Estimating age-specific vaccine effectiveness using data from a large measles outbreak in Berlin, Germany, 2014/15: evidence for waning immunity

BackgroundMeasles elimination is based on 95% coverage with two doses of a measles-containing vaccine (MCV2), high vaccine effectiveness (VE) and life-long vaccine-induced immunity. Longitudinal analysis of antibody titres suggests existence of waning immunity, but the relevance at the population-le...

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Veröffentlicht in:Euro surveillance : bulletin européen sur les maladies transmissibles 2019-04, Vol.24 (17)
Hauptverfasser: Bitzegeio, Julia, Majowicz, Shannon, Matysiak-Klose, Dorothea, Sagebiel, Daniel, Werber, Dirk
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container_issue 17
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container_title Euro surveillance : bulletin européen sur les maladies transmissibles
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creator Bitzegeio, Julia
Majowicz, Shannon
Matysiak-Klose, Dorothea
Sagebiel, Daniel
Werber, Dirk
description BackgroundMeasles elimination is based on 95% coverage with two doses of a measles-containing vaccine (MCV2), high vaccine effectiveness (VE) and life-long vaccine-induced immunity. Longitudinal analysis of antibody titres suggests existence of waning immunity, but the relevance at the population-level is unknown.AimWe sought to assess presence of waning immunity by estimating MCV2 VE in different age groups (2-5, 6-15, 16-23, 24-30 and 31-42 years) in Berlin.MethodsWe conducted a systematic literature review on vaccination coverage and applied the screening-method using data from a large measles outbreak (2014/15) in Berlin. Uncertainty in input variables was incorporated by Monte Carlo simulation. In a scenario analysis, we estimated the proportion vaccinated with MCV2 in those 31-42 years using VE of the youngest age group, where natural immunity was deemed negligible.ResultsOf 773 measles cases (median age: 20 years), 40 had received MCV2. Average vaccine coverage per age group varied (32%-88%). Estimated median VE was  > 99% (95% credible interval (CrI): 98.6-100) in the three youngest age groups, but lower (90.9%, 95% CrI: 74.1-97.6) in the oldest age group. In the scenario analysis, the estimated proportion vaccinated was 98.8% (95% CrI: 96.5-99.8).ConclusionVE for MCV2 was generally high, but lower in those aged 31-42 years old. The estimated proportion with MCV2 should have led to sufficient herd immunity in those aged 31-42 years old. Thus, lower VE cannot be fully explained by natural immunity, suggesting presence of waning immunity.
doi_str_mv 10.2807/1560-7917.ES.2019.24.17.1800529
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Longitudinal analysis of antibody titres suggests existence of waning immunity, but the relevance at the population-level is unknown.AimWe sought to assess presence of waning immunity by estimating MCV2 VE in different age groups (2-5, 6-15, 16-23, 24-30 and 31-42 years) in Berlin.MethodsWe conducted a systematic literature review on vaccination coverage and applied the screening-method using data from a large measles outbreak (2014/15) in Berlin. Uncertainty in input variables was incorporated by Monte Carlo simulation. In a scenario analysis, we estimated the proportion vaccinated with MCV2 in those 31-42 years using VE of the youngest age group, where natural immunity was deemed negligible.ResultsOf 773 measles cases (median age: 20 years), 40 had received MCV2. Average vaccine coverage per age group varied (32%-88%). Estimated median VE was  &gt; 99% (95% credible interval (CrI): 98.6-100) in the three youngest age groups, but lower (90.9%, 95% CrI: 74.1-97.6) in the oldest age group. In the scenario analysis, the estimated proportion vaccinated was 98.8% (95% CrI: 96.5-99.8).ConclusionVE for MCV2 was generally high, but lower in those aged 31-42 years old. The estimated proportion with MCV2 should have led to sufficient herd immunity in those aged 31-42 years old. Thus, lower VE cannot be fully explained by natural immunity, suggesting presence of waning immunity.</description><identifier>ISSN: 1560-7917</identifier><identifier>ISSN: 1025-496X</identifier><identifier>EISSN: 1560-7917</identifier><identifier>DOI: 10.2807/1560-7917.ES.2019.24.17.1800529</identifier><identifier>PMID: 31039834</identifier><language>eng</language><publisher>Sweden: Centre Europeen pour la Surveillance Epidemiologique du SIDA (European Centre for the Epidemiological Monitoring of AIDS)</publisher><subject>Effectiveness studies ; Immunization ; Measles ; Preventive medicine ; Vaccines</subject><ispartof>Euro surveillance : bulletin européen sur les maladies transmissibles, 2019-04, Vol.24 (17)</ispartof><rights>Copyright Centre Europeen pour la Surveillance Epidemiologique du SIDA (European Centre for the Epidemiological Monitoring of AIDS) Apr 25, 2019</rights><rights>This article is copyright of the authors or their affiliated institutions, 2019. 2019 The authors or their affiliated institutions</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c531t-78979445ef2be7874e6657209ee552a9cf9ebbbf84bb6d02baa627d2ab8d66ca3</citedby><cites>FETCH-LOGICAL-c531t-78979445ef2be7874e6657209ee552a9cf9ebbbf84bb6d02baa627d2ab8d66ca3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628761/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628761/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31039834$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bitzegeio, Julia</creatorcontrib><creatorcontrib>Majowicz, Shannon</creatorcontrib><creatorcontrib>Matysiak-Klose, Dorothea</creatorcontrib><creatorcontrib>Sagebiel, Daniel</creatorcontrib><creatorcontrib>Werber, Dirk</creatorcontrib><title>Estimating age-specific vaccine effectiveness using data from a large measles outbreak in Berlin, Germany, 2014/15: evidence for waning immunity</title><title>Euro surveillance : bulletin européen sur les maladies transmissibles</title><addtitle>Euro Surveill</addtitle><description>BackgroundMeasles elimination is based on 95% coverage with two doses of a measles-containing vaccine (MCV2), high vaccine effectiveness (VE) and life-long vaccine-induced immunity. Longitudinal analysis of antibody titres suggests existence of waning immunity, but the relevance at the population-level is unknown.AimWe sought to assess presence of waning immunity by estimating MCV2 VE in different age groups (2-5, 6-15, 16-23, 24-30 and 31-42 years) in Berlin.MethodsWe conducted a systematic literature review on vaccination coverage and applied the screening-method using data from a large measles outbreak (2014/15) in Berlin. Uncertainty in input variables was incorporated by Monte Carlo simulation. In a scenario analysis, we estimated the proportion vaccinated with MCV2 in those 31-42 years using VE of the youngest age group, where natural immunity was deemed negligible.ResultsOf 773 measles cases (median age: 20 years), 40 had received MCV2. Average vaccine coverage per age group varied (32%-88%). Estimated median VE was  &gt; 99% (95% credible interval (CrI): 98.6-100) in the three youngest age groups, but lower (90.9%, 95% CrI: 74.1-97.6) in the oldest age group. In the scenario analysis, the estimated proportion vaccinated was 98.8% (95% CrI: 96.5-99.8).ConclusionVE for MCV2 was generally high, but lower in those aged 31-42 years old. The estimated proportion with MCV2 should have led to sufficient herd immunity in those aged 31-42 years old. Thus, lower VE cannot be fully explained by natural immunity, suggesting presence of waning immunity.</description><subject>Effectiveness studies</subject><subject>Immunization</subject><subject>Measles</subject><subject>Preventive medicine</subject><subject>Vaccines</subject><issn>1560-7917</issn><issn>1025-496X</issn><issn>1560-7917</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNpdkctu1DAUhiMEohd4BWSJBSyawXbiGwsQrYaCVIlFYW3ZzvHgkjiDnQyat-CRcdRhVFjZR-fzr3P8VdUrgldUYvGGMI5roYhYrW9XFBO1ou2qVERizKh6VJ0eiccP7ifVWc53GLcNVvRpddIQ3CjZtKfV73WewmCmEDfIbKDOW3DBB4d2xrkQAYH34Kawgwg5ozkvYGcmg3waB2RQb9IG0AAm95DROE82gfmBQkSXkPoQL9A1pMHE_QUq87Zlg7cIdqGD6AD5MaFfJi6ZYRjmGKb9s-qJN32G54fzvPr2cf316lN98-X689WHm9qxhky1kEqotmXgqQUhRQucM0GxAmCMGuW8Amutl621vMPUGsOp6KixsuPcmea8enefu53tAJ2DOCXT620qv5H2ejRB_9uJ4bvejDvNOZWCkxLw-hCQxp8z5EkPITvoexNhnLOmlMgGUyybgr78D70b5xTLeoWiWDAhGSvU-3vKpTHnBP44DMF6sa8Xn3rxqde3erGvaatLdbBfEl483On4_q_u5g_O9a4y</recordid><startdate>20190425</startdate><enddate>20190425</enddate><creator>Bitzegeio, Julia</creator><creator>Majowicz, Shannon</creator><creator>Matysiak-Klose, Dorothea</creator><creator>Sagebiel, Daniel</creator><creator>Werber, Dirk</creator><general>Centre Europeen pour la Surveillance Epidemiologique du SIDA (European Centre for the Epidemiological Monitoring of AIDS)</general><general>European Centre for Disease Prevention and Control (ECDC)</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190425</creationdate><title>Estimating age-specific vaccine effectiveness using data from a large measles outbreak in Berlin, Germany, 2014/15: evidence for waning immunity</title><author>Bitzegeio, Julia ; Majowicz, Shannon ; Matysiak-Klose, Dorothea ; Sagebiel, Daniel ; Werber, Dirk</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c531t-78979445ef2be7874e6657209ee552a9cf9ebbbf84bb6d02baa627d2ab8d66ca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Effectiveness studies</topic><topic>Immunization</topic><topic>Measles</topic><topic>Preventive medicine</topic><topic>Vaccines</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bitzegeio, Julia</creatorcontrib><creatorcontrib>Majowicz, Shannon</creatorcontrib><creatorcontrib>Matysiak-Klose, Dorothea</creatorcontrib><creatorcontrib>Sagebiel, Daniel</creatorcontrib><creatorcontrib>Werber, Dirk</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Euro surveillance : bulletin européen sur les maladies transmissibles</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bitzegeio, Julia</au><au>Majowicz, Shannon</au><au>Matysiak-Klose, Dorothea</au><au>Sagebiel, Daniel</au><au>Werber, Dirk</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Estimating age-specific vaccine effectiveness using data from a large measles outbreak in Berlin, Germany, 2014/15: evidence for waning immunity</atitle><jtitle>Euro surveillance : bulletin européen sur les maladies transmissibles</jtitle><addtitle>Euro Surveill</addtitle><date>2019-04-25</date><risdate>2019</risdate><volume>24</volume><issue>17</issue><issn>1560-7917</issn><issn>1025-496X</issn><eissn>1560-7917</eissn><abstract>BackgroundMeasles elimination is based on 95% coverage with two doses of a measles-containing vaccine (MCV2), high vaccine effectiveness (VE) and life-long vaccine-induced immunity. Longitudinal analysis of antibody titres suggests existence of waning immunity, but the relevance at the population-level is unknown.AimWe sought to assess presence of waning immunity by estimating MCV2 VE in different age groups (2-5, 6-15, 16-23, 24-30 and 31-42 years) in Berlin.MethodsWe conducted a systematic literature review on vaccination coverage and applied the screening-method using data from a large measles outbreak (2014/15) in Berlin. Uncertainty in input variables was incorporated by Monte Carlo simulation. In a scenario analysis, we estimated the proportion vaccinated with MCV2 in those 31-42 years using VE of the youngest age group, where natural immunity was deemed negligible.ResultsOf 773 measles cases (median age: 20 years), 40 had received MCV2. Average vaccine coverage per age group varied (32%-88%). Estimated median VE was  &gt; 99% (95% credible interval (CrI): 98.6-100) in the three youngest age groups, but lower (90.9%, 95% CrI: 74.1-97.6) in the oldest age group. In the scenario analysis, the estimated proportion vaccinated was 98.8% (95% CrI: 96.5-99.8).ConclusionVE for MCV2 was generally high, but lower in those aged 31-42 years old. The estimated proportion with MCV2 should have led to sufficient herd immunity in those aged 31-42 years old. Thus, lower VE cannot be fully explained by natural immunity, suggesting presence of waning immunity.</abstract><cop>Sweden</cop><pub>Centre Europeen pour la Surveillance Epidemiologique du SIDA (European Centre for the Epidemiological Monitoring of AIDS)</pub><pmid>31039834</pmid><doi>10.2807/1560-7917.ES.2019.24.17.1800529</doi><oa>free_for_read</oa></addata></record>
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subjects Effectiveness studies
Immunization
Measles
Preventive medicine
Vaccines
title Estimating age-specific vaccine effectiveness using data from a large measles outbreak in Berlin, Germany, 2014/15: evidence for waning immunity
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