Measles Acquisition and Transmission, Despite Evidence of Immunity

Summary and Comment |
April 14, 2014

Measles Acquisition and Transmission, Despite Evidence of Immunity

  1. Neil M. Ampel, MD

An immunized patient who developed measles transmitted it to four others who were either vaccinated or had evidence of measles immunity.

  1. Neil M. Ampel, MD

Although endemic measles was eradicated in 2000 in the U.S., international travelers with measles can still transmit the virus while visiting this country. The Advisory Committee on Immunization Practices presumes immunity to the illness in individuals who have received two doses of live measles virus–containing vaccine, such as combined measles/mumps/rubella (MMR), or have laboratory evidence of immunity. Although cases of measles have occurred among people who meet these criteria, until now, those who develop measles despite vaccination have not been shown to transmit it to others.

Investigators recently reported secondary measles transmission by a 22-year-old woman who had received two doses of MMR early in life. Her measles exposure likely occurred at her place of employment — a theater frequented by tourists. Four other people developed measles after exposure to her. Three were healthcare workers who saw her on the day she developed a rash. Two of the secondary patients had received two doses of MMR, and two had prior positive measles IgG antibody results. No tertiary cases of measles were identified among 231 contacts determined to be exposed. The index patient and one secondary patient had IgG avidity measuring in the intermediate range on presentation, and all five patients had high-avidity IgG in follow-up serum samples.


This report is timely, given several very recent outbreaks of measles in the U.S. originating from unvaccinated foreign visitors. Given that we can no longer count on immunity, we must be vigilant in recognizing cases and cognizant of secondary transmission.

Editor Disclosures at Time of Publication

  • Disclosures for Neil M. Ampel, MD at time of publication Editorial boards Medical Mycology Leadership positions in professional societies Coccidiodomycosis Study Group (President-Elect)


Reader Comments (1)

Hayati Demiraslan, Assistan prof Physician, Infectious Disease, Erciyes University, Kayseri, Turkey

We saw some cases of measles in our department like your cases. One of them was 20 year-old, 5th month of hematologic stem cell transplant receiver, and had GVHD. He admitted at 15th day of fever, and had anti-measles IgG 339, IgM negative. Then, he had IgM positive. Prevention of transmission to immünsupressed patients is especially important.

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