Pediatrics
November 2013, VOLUME 132 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml

Article
Measles in Children Vaccinated With 2 Doses of MMR
Fannie Defay, MSca, Gaston De Serres, MD, PhDa,b,c, Danuta M. Skowronski, MD, FRCPCd, Nicole Boulianne, RN, MSca,b, Manale Ouakki, MScb, Monique Landry, MDe, Nicholas Brousseau, MD, FRCPCf, and Brian J. Ward, MD, FRCPCg
http://pediatrics.aappublications.org/content/132/5/e1126.abstract

Abstract
OBJECTIVE: A previous measles outbreak investigation in a high school in Quebec, Canada identified 2-dose vaccine effectiveness of 94%. The risk of measles in 2-dose recipients was significantly higher (2–4 times) when measles vaccine was first administered at 12 versus ≥15 months of age, with no significant effect of the age at second dose. Generalizability of this association was also assessed in the expanded provincial data set of notified cases.

METHODS: This matched case–control study included only 2-dose recipients. All confirmed (laboratory or epidemiologically linked) cases in patients aged 5 to 17 years were included. Each case was matched to 5 controls.

RESULTS: A total of 102 cases and 510 controls were included; 89% of cases were in patients 13 to 17 years old. When the first dose was administered at 12 to 13 months compared with ≥15 months of age, the risk of measles in participants outside the outbreak school was 6 times higher (95% confidence interval, 1.33–29.3) and was 5.2 times higher (95% confidence interval, 1.91–14.3) in the pooled estimate (participants from the outbreak school + outside that school).

CONCLUSIONS: A significantly greater risk of measles among 2-dose recipients whose first dose was given at 12 to 13 months rather than ≥15 months of age is confirmed in the larger Quebec data set. The mechanism remains unknown, but vaccine failures in 2-dose recipients could have substantial implications for measles elimination efforts through 2-dose vaccination. The optimal age at first dose may warrant additional evaluation.