Brother-to-sister transmission of measles after MMR immunisation

A systematic review of human-to-human transmission of measles vaccine virus

Measles is one of the most contagious human diseases. Administration of the live attenuated measles vaccine has substantially reduced childhood mortality and morbidity since its licensure in 1963. The live but attenuated form of the vaccine describes a virus poorly adapted to replicating in human tissue, but with a replication yield sufficient to elicit an immune response for long-term protection. Given the high transmissibility of the wild-type virus and that transmission of other live vaccine viruses has been documented, we conducted a systematic review to establish if there is any evidence of human-to-human transmission of the live attenuated measles vaccine virus. We reviewed 773 articles for genotypic confirmation of a vaccine virus transmitted from a recently vaccinated individual to a susceptible close contact. No evidence of human-to-human transmission of the measles vaccine virus has been reported amongst the thousands of clinical samples genotyped during outbreaks or endemic transmission and individual case studies worldwide.

Differentiating the wild from the attenuated during a measles outbreak

In the midst of a local measles outbreak, a recently immunized child was investigated for a new-onset measles-type rash. Nucleic acid testing identified that a vaccine-type measles virus was being shed in the urine. Clinically differentiating measles from a nonmeasles rash is challenging, but can be supported by a thorough medical history evaluation. Rashes are expected to occur after immunization; nucleic acid testing can be used when it is difficult to differentiate between wild and attenuated strains.