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Early waning of maternal measles antibodies in era of measles elimination: longitudinal study

BMJ 2010; 340 doi: (Published 18 May 2010) Cite this as: BMJ 2010;340:c1626
  1. E Leuridan, pre-doctoral fellow1,
  2. N Hens, professor in biostatistics and evidence-based vaccinology2,
  3. V Hutse, pre-doctoral fellow3,
  4. M Ieven, professor in medicine4,
  5. M Aerts, professor in biostatistics5,
  6. P Van Damme, professor in medicine/vaccinology1
  1. 1Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, Faculty of Medicine, University of Antwerp, Universiteitsplein, 1, 2610 Wilrijk, Belgium
  2. 2Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Campus Diepenbeek, Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp
  3. 3National Laboratory for Measles and Rubella, Scientific Institute of Public Health, Programme of Virology, Brussels, Belgium
  4. 4Department of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine, University of Antwerp
  5. 5Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University
  1. Correspondence to: E Leuridan elke.leuridan{at}
  • Accepted 25 January 2010


Objective To investigate the duration of the presence of maternal antibodies to measles in infants.

Design Prospective study (May 2006 to November 2008).

Setting Five hospitals in the Province of Antwerp, Belgium.

Participants Of 221 pregnant women recruited, 207 healthy woman-infant pairs were included—divided into a vaccinated group (n=87) and naturally immune group (n=120), according to vaccination documents and history.

Main outcome measure Measles IgG antibodies measured by enzyme linked immunosorbent assay (ELISA) at seven time points (week 36 of pregnancy, birth (cord), and 1, 6, 9, and 12 months); decay of maternal antibody in infants modelled with linear mixed models.

Results Vaccinated women had significantly fewer IgG antibodies (geometric mean titre 779 (95% confidence interval 581 to 1045) mIU/ml) than did naturally immune women (2687 (2126 to 3373) mIU/ml) (P<0.001). Maternal values were highly correlated with neonatal values (r=0.93 at birth). Infants of vaccinated women had significantly lower antibody concentrations than did infants of naturally immune women (P<0.001 at all ages over the follow-up period). Presence of maternal antibodies endured for a median of 2.61 months—3.78 months for infants of naturally infected women and 0.97 months for infants of vaccinated women. At 6 months of age, more than 99% of infants of vaccinated women and 95% of infants of naturally immune women had lost maternal antibodies according to the model.

Conclusions This study describes a very early susceptibility to measles in infants of both vaccinated women and women with naturally acquired immunity. This finding is important in view of recent outbreaks and is an argument for timeliness of the first dose of a measles vaccine and vaccination of travelling or migrating children under the age of 1 year.


  • Contributors: EL and PVD were responsible for the conception and design of the study. VH, EL, and MI did the laboratory tests. EL, NH, and MA analysed and interpreted the data. EL, NH, and PVD drafted the manuscript and completed critical revisions. All authors approved the final manuscript. EL is the guarantor.

  • Funding: EL obtained a research grant from the Faculty of Medicine at the University of Antwerp. An unrestricted educational grant from GlaxoSmithKline Belgium, Genval, covered part of the nursing activities. The study sponsors had no role in the study design; the collection, analysis and interpretation of the data; the writing of the report; or the decision to submit the article for publication.

  • Competing interests: None declared.

  • Ethical approval: Study protocol and documents were reviewed and approved by the ethics committee at each participating institution; the leading ethics committee is based at the University Hospital in Antwerp.

  • We thank all the participating women and their children.

  • Data sharing: No additional data available.

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