Incremental effectiveness of 2 doses of measles-containing vaccine compared with 1 dose among high school students during an outbreak

Abstract

A measles outbreak occurred among a highly vaccinated population in Alaska during 1998, providing an opportunity to determine the incremental efficacy of ≥2 doses of measles-containing vaccine (MCV) compared with 1 dose. Of 33 confirmed case patients identified, 31 had been vaccinated with 1 dose of MCV, 1 had received 2 doses, and vaccination status was unknown in 1 case. Seventy percent of cases were school-associated; 58% of cases occurred in 2 high schools. Of 3679 students attending the 2 schools, 50.4% and 45.5% had received ≥2 doses of MCV before measles introduction at the schools. The relative risk of developing measles among persons vaccinated with ≥2 doses of MCV compared with 1 dose was 0.06 (95% confidence interval, 0.01-0.44; P < .001), yielding an estimated incremental vaccine efficacy of 94.1% (95% confidence interval, 55.9%-99.2%; P < .001). Rapid implementation of a mandatory second-dose MCV requirement probably limited the extent of this outbreak.