Hidaka Y, Aoki T, Akeda H, Miyazaki C, Ueda K
Section of Pediatric Infectious Diseases, Fukuoka Children's Hospital, Japan.
Scand J Infect Dis. 1994;26(6):725-30. doi: 10.3109/00365549409008642.
In 1991, in Fukuoka, Japan, a measles outbreak occurred in which we observed 15 cases of measles vaccine failure (MVF). We examined these patients both clinically and serologically. Seven of them, with a response pattern of an early rise in and attainment of a high hemagglutination inhibition (HI) antibody titre, were considered to be secondary vaccine failures (EH group). Eight others showed a normal (relatively late rise and low titre) HI antibody response pattern and were considered to be primary vaccine failures (LL group). In both MVF groups, measles-specific IgM antibody was detected by enzyme immunoassay. The EH group had a milder rash than did the LL group and unvaccinated controls. We believe they had an immunological memory that modified the clinical manifestations of measles. Two cases of encephalitis were observed in the EH group; both patients recovered without sequelae. These data suggest that the mere presence or absence of IgM antibody is not sufficient to differentiate primary from secondary MVFs. A two-dose measles vaccination scheme should be recommended to secure a booster effect, because immunity is waning in the population in which the measles vaccination rate is not high enough and in which natural measles still exists.
1991年，在日本福冈发生了一次麻疹疫情，我们观察到15例麻疹疫苗失效（MVF）病例。我们对这些患者进行了临床和血清学检查。其中7例患者的血凝抑制（HI）抗体滴度早期升高并达到高水平，被认为是继发性疫苗失效（EH组）。另外8例患者的HI抗体反应模式正常（升高相对较晚且滴度较低），被认为是原发性疫苗失效（LL组）。在两个MVF组中，均通过酶免疫测定法检测到麻疹特异性IgM抗体。EH组的皮疹比LL组和未接种疫苗的对照组要轻。我们认为他们具有免疫记忆，从而改变了麻疹的临床表现。在EH组中观察到2例脑炎病例；两名患者均康复且无后遗症。这些数据表明，仅根据是否存在IgM抗体不足以区分原发性和继发性MVF。应推荐采用两剂麻疹疫苗接种方案以确保产生加强免疫效果，因为在麻疹疫苗接种率不够高且仍存在自然麻疹的人群中，免疫力正在下降。
