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Measles-specific Neutralizing Antibodies in Rural Mozambique: Seroprevalence and Presence in Breast Milk

In Mozambique, as in many sub-Saharan countries, measles remains a public health problem. We conducted cross-sectional surveys in which we assessed measles-specific antibodies in serum and breast milk by plaque reduction neutralization (PRN) assay and measles secretory IgA in breast milk by enzyme-linked immunosorbent assay. A total of 151 persons < 1 month to 23 years of age were surveyed; 81 (53.6%) of 151 had PRN titers equal to or above the protective level ( 200 mIU/mL). We found many serosusceptible persons, including 20.5% in whom no PRN antibody was detected. Almost all (96%) infants 6–8 months of age had non-protective PRN titers. Overall, 20.7% (6 of 29) of persons known to have received measles vaccine had non-protective titers. The geometric mean titer (GMT) of breast milk PRN antibodies was 41.6 mIU/mL (95% confidence interval [CI] = 34.0–51.0 mIU/mL) and the secretory IgA GMT was 227.6 (EU/mL) (95% CI = 179.1–289.1 EU/mL). The PRN titers of breast milk tended to increase with age. A notable proportion of the population in Manhiça, Mozambique apparently remains susceptible to clinical measles despite recent mass vaccination campaigns.

Received March 5, 2008. Accepted for publication July 6, 2008.

Acknowledgments: We thank the parents and guardians of study participants for cooperation, the Manhiça Health District Authorities for assistance, Samira Sirage (Centro de Investigação em Saúde da Manhiça) for sample collection, and Mardi Reymann and Yu Lim (Applied Immunology Section, Center for Vaccine Development, University of Maryland School of Medicine) for excellent technical support and shipment of samples.

Financial support: This study was supported by grants from the Bill & Melinda Gates Foundation.

^* Address correspondence to Inácio M. Mandomando, Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique. E-mail: inacio.mandomando{at}manhica.net

Authors’ addesses: Inácio M. Mandomando, Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique; Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique; Barcelona Centre for International Health Research, Hospital Clinic/Institut d’Investigação Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Spain. Denise Naniche, Barcelona Centre for International Health Research, Hospital Clinic/Institut d’Investigação Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Spain. Marcela F. Pasetti, Lilian Cuberos, Karen L. Kotloff, and Myron M. Levine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD. Xavier Vallès and Ariel Nhacolo, Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique. Helder Martins, Ministério da Saúde, Maputo, Mozambique. Pedro Alonso, Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique; Barcelona Centre for International Health Research, Hospital Clinic/Institut d’Investigação Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Spain.