Epidemiology and Infection

Research Article

Measles immunity and response to revaccination among secondary school children in Cumbria

N. Calverta1, F. Cuttsa2, R. Irvinga1, D. Browna3, J. Marsha1 and E. Millera4 c1

a1 Department of Public Health Medicine, North Cumbria Health Authority, Lakeland Business Park, Cockermouth, Cumbria CA13 0QT

a2 Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT

a3 Enteric and Respiratory Virus Laboratory, Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5HT

a4 Immunisation Division, Public Health Laboratory Service Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ

Summary

The prevalence of antibody to measles virus in 759 children aged 11–18 years attending a secondary school in Cumbria was measured using a salivary IgG antibody capture assay. Serum IgG antibody levels were measured using a plaque reduction neutralization assay in subjects whose saliva was antibody negative. Vaccination histories were obtained from the child health computer and general practice records. A total of 662 pupils (87 % of those tested) had detectable measles-specific IgG in saliva. Of the remaining 97, 82 provided blood samples and 29 had serum neutralizing antibody levels above 200 mlU/ml. After adjusting for non-participation rates, the proportion considered non-immune (no IgG in saliva and ≤ 200 mlU/ml in serum) was 9 % overall, ranging from 6 % in vaccinated children to 20 % in unvaccinated children. Measles-mumps-rubella vaccine was given to 50 children of whom 38 provided post-vaccination serum and 32 saliva samples. Thirty (79 %) had a fourfold or greater rise in serum neutralizing antibody and 28 (88 %) developed IgG antibody in saliva. Half of the children considered non-immune by antibody testing would have been overlooked in a selective vaccination programme targeted at those without a history of prior vaccination. A programme targeted at all school children should substantially reduce the proportion non-immune since a primary or booster response was achieved in three quarters of previously vaccinated children with low antibody levels and in all unvaccinated children. While it is feasible to screen a school-sized population for immunity to measles relatively quickly using a salivary IgG assay, a simple inexpensive field assay would need to be developed before salivary screening and selective vaccination could substitute for universal vaccination of populations at risk of measles outbreaks. The salivary IgG assay provided a sensitive measure of a booster response to vaccination.

(Accepted September 22 1995)

Correspondence:

c1 Author for correspondence.

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