Field Effectiveness of Live Attenuated Measles-Containing Vaccines: A Review of Published Literature

Background. Information on measles vaccine effectiveness (VE) is critical to help inform policies for future global measles control goals. Methods. We reviewed results of VE studies published during 1960-2010. Results. Seventy papers with 135 VE point estimates were identified. For a single dose of vaccine administered at 9-11 months of age and >= 12 months, the median VE was 77.0% (interquartile range [IQR], 62%-91%) and 92.0% (IQR, 86%-96%), respectively. When analysis was restricted to include only point estimates for which vaccination history was verified and cases were laboratory confirmed, the median VE was 84.0% (IQR, 72.0%-95.0%) and 92.5% (IQR, 84.8%-97.0%) when vaccine was received at 9-11 and >= 12 months, respectively. Published VE vary by World Health Organization region, with generally lower estimates in countries belonging to the African and South East Asian Regions. For 2 doses of measles-containing vaccine, compared with no vaccination, the median VE was 94.1% (IQR, 88.3%-98.3%). Conclusions. The VE of the first dose of measles-containing vaccine administered at 9-11 months was lower than what would be expected from serologic evaluations but was higher than expected when administered at >= 12 months. The median VE increased in a subset of articles in which classification bias was reduced through verified vaccination history and laboratory confirmation. In general, 2 doses of measles-containing vaccine provided excellent protection against measles.