Measles Vaccination: New Strategies and Formulations

Rory D de Vries; Koert J Stittelaar; Albert DME Osterhaus; Rik L de Swart

Disclosures

Expert Rev Vaccines. 2008;7(8):1215-1223. 

In This Article

Expert Commentary

Over the past decade, the number of measles cases and fatalities has been significantly reduced. However, the number of fatal cases is still unacceptably high for a vaccine-preventable disease. A good LAV with an excellent safety record is available and in use, but has some major limitations. Under optimal conditions, LAV leads to seroconversion in 95% of cases,[22] but in several instances seroconversion levels may be lower. Since immunity in a population has to be over 95% to prevent endemic measles transmission, this may pose serious problems.[98] Furthermore, vaccination of infants below 9 months of age with LAV is not very effective due to maternal antibody interference and immaturity of the immune system.

Further reduction of measles mortality is probably possible by continued implementation of the current strategy in Africa and Asia, based on increasing vaccination coverage at 9 months and providing a second dose at a later age. At the same time there seems to be a trend towards increasing numbers of measles cases in industrialized countries, in many cases associated with communities or individuals refusing vaccination on religious or philosophical grounds.

If new-generation measles vaccines were to be implemented, a priming vaccine that protects in the presence of maternal antibodies (e.g., vectored or DNA vaccines) would be most attractive, followed by a booster vaccination with LAV. Aerosol administration of LAV could be a highly effective route for the booster vaccination.

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