Immunity Against Measles in Urban Refugee Children, Adolescents, and Young Adults in Eastleigh, Kenya

  • Lilian Zighe Maseghe Jomo Kenyatta University of Agriculture and Technology
  • Daniel Kariuki, PhD Jomo Kenyatta University of Agriculture and Technology
  • Eddy Okoth Odari, PhD Jomo Kenyatta University of Agriculture and Technology
  • Daniel Ochiel, PhD International AIDS Vaccine Initiative
  • Calvin Mandela Achieng Kitui Referral Hospital
Keywords: Measles, Measles IgG, Refugees, Neutralisation Assay, Herd Immunity
Share Article:

Abstract

Background: Kenya has made progress towards the elimination of measles through routine and supplementary immunisation activities; however, sporadic outbreaks still occur. Studies on measles seroprevalence in Kenya are few and extensive analysis of refugee and migrant populations’ immunity against measles is lacking. This cross-sectional study aimed at assessing the presence of immunity against measles in children, adolescents and young adults living in the high urban refugee area of Eastleigh Nairobi, Kenya. Method: A total of 384 samples serum samples were collected from consenting respondents and tested for measles IgG antibodies. Syncytium Inhibition Assay, a neutralisation assay was used to determine functionality. The establishment of herd immunity was calculated using the Plans- Rubio formulae. Results: Seropositive rate for all respondents were 84.38%, while equivocal and negative were 4.95% and 10.68%, respectively. None of the factors analysed was a significant predictor of positive measles antibodies. 87.76% of the total sera were neutralising, while 12.23 % were negative. There was a significant correlation between the neutralisation titres and ELISA values. Conclusion:  This study highlights age-specific measles immunity gaps in an urban refugee population. Although measles antibodies are present in all age groups, none has established herd immunity. In order to avert outbreaks in the study population, it is necessary to direct immunisation interventions to increase the measles antibody prevalence to recommended levels.

Downloads

Download data is not yet available.

References

Barnett, E. D., Christiansen, D., & Figueira, M. (2002). Seroprevalence of measles, rubella, and varicella in refugees. Clinical infectious diseases, 35(4), 403-408.

Campbell, E. H. (2006). Urban refugees in Nairobi: Problems of protection, mechanisms of survival, and possibilities for integration. Journal of refugee studies, 19(3), 396-413.

Campbell, E., Crisp, J., & Kiragu, E. (2011). Navigating Nairobi: A review of the implementation of UNHCR’s urban refugee policy in Kenya’s capital city. Geneva: UNHCR. http://reliefweb.int/sites/reliefweb.int/files/resources/DD1F3B9EF6706831852578340073DA 98-Full_Report.pdf.

Carballo, M., & Nerukar, A. (2001). Migration, refugees, and health risks. Emerging infectious diseases, 7(3 Suppl), 556-60. doi: 10.3201/eid0707.017733.

Hickman, C. J., Hyde, T. B., Sowers, S. B., Mercader, S., McGrew, M., Williams, N. J., ... & Bellini, W. J. (2011). Laboratory characterisation of measles virus infection in previously vaccinated and unvaccinated individuals. The Journal of infectious diseases, 204(suppl_1), S549-S558. https://doi.org/10.1093/infdis/jir106

Cutts, F. T., Lessler, J., & Metcalf, C. J. (2013). Measles elimination: progress, challenges and implications for rubella control. Expert review of vaccines, 12(8), 917-932. DOI: 10.1586/14760584.2013.814847

Domínguez, A., Plans, P., Costa, J., Torner, N., Cardenosa, N., Batalla, J., ... & Salleras, L. (2006). Seroprevalence of measles, rubella, and mumps antibodies in Catalonia, Spain: results of a cross-sectional study. European Journal of Clinical Microbiology and Infectious Diseases, 25, 310-317. https://doi.org/10.1007/s10096-006-0133-z

Gastañaduy, P. A., Banerjee, E., DeBolt, C., Bravo-Alcántara, P., Samad, S. A., Pastor, D., Rota, P. A., Patel, M., Crowcroft, N. S., & Durrheim, D. N. (2018). Public health responses during measles outbreaks in elimination settings: Strategies and challenges. Human Vaccines & Immunotherapeutics, 14(9), 2222–2238. https://doi.org/10.1080/21645515.2018.1474310

Gastañaduy, P. A., Goodson, J. L., Panagiotakopoulos, L., Rota, P. A., Orenstein, W. A., & Patel, M. (2021). Measles in the 21st Century: Progress Toward Achieving and Sustaining Elimination. The Journal of Infectious Diseases, 224(12 Suppl 2), S420–S428. https://doi.org/10.1093/infdis/jiaa793

Hazlina, Y., Marlindawati, M. A., & Shamsuddin, K. (2016). Serological assessment of the establishment of herd immunity against measles in a health district in Malaysia. BMC infectious diseases, 16, 1-9. https://doi.org/10.1186/s12879-016-2069-y

Holzmann, H., Hengel, H., Tenbusch, M., & Doerr, H. W. (2016). Eradication of measles: remaining challenges. Medical microbiology and immunology, 205, 201-208. https://doi.org/10.1007/s00430-016-0451-4

Hong, J., Kim, D., Won, Y., Yoon, J., Park, K. J., Oh, J., & Kim, C. W. (2019). Correlation between the results of two analytical methods for measuring measles virus neutralising antibodies in source plasma and therapeutic immunoglobulin products. Biologicals: Journal of the International Association of Biological Standardization, 59, 20–28. https://doi.org/10.1016/j.biologicals.2019.03.009

Hyde, T. B., Dayan, G. H., Langidrik, J. R., Nandy, R., Edwards, R., Briand, K., Konelios, M., Marin, M., Nguyen, H. Q., Khalifah, A. P., O’Leary, M. J., Williams, N. J., Bellini, W. J., Bi, D., Brown, C. J., Seward, J. F., & Papania, M. J. (2006). Measles outbreak in the Republic of the Marshall Islands, 2003. International Journal of Epidemiology, 35(2), 299–306. https://doi.org/10.1093/ije/dyi222

International Organisation of Migration (IOM). (2015). Migration in Kenya: A Country Profile. https://publications.iom.int/books/migration-kenya-country-profile-2015

International Organisation of Migration (IOM). (2011). Access to Maternal and Early Childhood Heath Care for Urban Migrants in Eastleigh, Nairobi, Kenya: A Pilot Study. http://nairobi.iom.int/resources/publications/item/download/9_463b2cac841ee4451a08386f4

Kanga, A. J., Kaggia, S., Ongus, J. R., & Lwembe, R. M. (2017). Seroprevalence and Risk Factors Associated with Measles outbreaks among Children in Kwale, Lamu and Narok Counties in Kenya, 2014. J Hum Virol Retrovirol, 5(5), 00172. DOI: 10.15406/jhvrv.2017.05.00172

Kisangau, N., Sergon, K., Ibrahim, Y., Yonga, F., Langat, D., Nzunza, R., ... & Lowther, S. A. (2018). Progress towards elimination of measles in Kenya, 2003-2016. Pan African Medical Journal, 31(1). https://doi.org/10.11604/pamj.2018.31.65.16309

Kostinov, P. M., Zhuravlev, I. P., Filatov, N. N., Kostinova, M. А., Polishchuk, B. V., Shmitko, D. A., Mashilov, V. C., Vlasenko, E. A., Ryzhov, A. A., & Kostinov, M. А. (2021). Gender Differences in the Level of Antibodies to Measles Virus in Adults. Vaccines, 9(5), 494. https://doi.org/10.3390/vaccines9050494

LeBaron, C.W., Beeler, J., Sullivan, B.J., Forghani, B., Bi, D., Beck, C., Audet, S. & Gargiullo, P. (2007). Persistence of Measles Antibodies after 2 doses of Measles Vaccine in a Post- elimination Environment. Archives of Pediatrics & Adolescent Medicine 161(3) pp 294–301

Levine, H., Zarka, S., Ankol, O. E., Rozhavski, V., Davidovitch, N., Aboudy, Y., & Balicer, R. D. (2015). Seroprevalence of measles, mumps, and rubella among young adults, after 20 years of universal 2-dose MMR vaccination in Israel. Human vaccines & immunotherapeutics, 11(6), 1400–1405. https://doi.org/10.1080/21645515.2015.1032489

Manakongtreecheep, K., & Davis, R. (2017). A review of measles control in Kenya, with focus on recent innovations. The Pan African medical journal, 27(Suppl 3), 15. https://doi.org/10.11604/pamj.supp.2017.27.3.12118

Mathew, J. L., Riopelle, D., Ratho, R. K., Bharti, B., Singh, M. P., Suri, V., Carlson, B. F., Wagner, A. L., & Boulton, M. L. (2022). Measles seroprevalence in persons over one year of age in Chandigarh, India. Human vaccines & immunotherapeutics, 18(6), 36453. https://doi.org/10.1080/21645515.2022.2136453

McQuillan, G. M., Kruszon-Moran, D., Hyde, T. B., Forghani, B., Bellini, W., & Dayan, G. H. (2007). Seroprevalence of measles antibody in the US population, 1999–2004. The Journal of infectious diseases, 196(10), 1459-1464.

Mina, M. J. (2017). Measles, immune suppression and vaccination: direct and indirect nonspecific vaccine benefits. Journal of Infection, 74, S10-S17. https://doi.org/10.1016/S0163-4453(17)30185-8

Plans, P., Torner, N., Godoy, P., & Jané, M. (2014). Lack of herd immunity against measles in individuals aged <35 years could explain re-emergence of measles in Catalonia (Spain). International Journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases, 18, 81–83. https://doi.org/10.1016/j.ijid.2013.09.015s, 17(7), e552–e555.

Plans-Rubió, P. (2021). Vaccination coverage for routine vaccines and herd immunity levels against measles and pertussis in the world in 2019. Vaccines, 9(3), 256. https://doi.org/10.3390/vaccines9030256

Poethko-Müller, C., & Mankertz, A. (2012). Seroprevalence of measles-, mumps- and rubella-specific IgG antibodies in German children and adolescents and predictors for seronegativity. PloS one, 7(8), e42867. https://doi.org/10.1371/journal.pone.0042867

Rabenau, H. F., Marianov, B., Wicker, S., & Allwinn, R. (2007). Comparison of the neutralising and ELISA antibody titres to measles virus in human sera and in gamma globulin preparations. Medical microbiology and immunology, 196(3), 151–155. https://doi.org/10.1007/s00430-007-0037-2

Rabenau, H. F., Marianov, B., Wicker, S., & Allwinn, R. (2007). Comparison of the neutralising and ELISA antibody titres to measles virus in human sera and in gamma globulin preparations. Medical microbiology and immunology, 196(3), 151–155. https://doi.org/10.1007/s00430-007-0037-2

Ratnam, S., Gadag, V., West, R., Burris, J., Oates, E., Stead, F., & Bouilianne, N. (1995). Comparison of commercial enzyme immunoassay kits with plaque reduction neutralisation test for detection of measles virus antibody. Journal of clinical microbiology, 33(4), 811–815. https://doi.org/10.1128/jcm.33.4.811-815.1995

Strebel, P., Cochi, S., Grabowsky, M., Bilous, J., Hersh, B. S., Okwo‐Bele, J. M., ... & Katz, S. (2003). The unfinished measles immunisation agenda. Journal of Infectious Diseases, 187(Supplement_1), S1-S7. Doi: 10.1086/368226.

van den Hof, S., van Gageldonk-Lafeber, A. B., van Binnendijk, R. S., van Gageldonk, P. G., & Berbers, G. A. (2003). Comparison of measles virus-specific antibody titres as measured by enzyme-linked immunosorbent assay and virus neutralisation assay. Vaccine, 21(27-30), 4210–4214. https://doi.org/10.1016/s0264-410x(03)00490-0

World Health Organization Africa. (2022). Health-topics. Measles. World Health Organization Africa.

World Health Organization. (2012). Surveillance Guidelines for Measles, Rubella and Congenital Rubella Syndrome in the WHO European Region. Annex 3, collection, storage and shipment of specimens for laboratory diagnosis and interpretation of results.

Published
23 February, 2023
How to Cite
Maseghe, L., Kariuki, D., Odari, E., Ochiel, D., & Achieng, C. (2023). Immunity Against Measles in Urban Refugee Children, Adolescents, and Young Adults in Eastleigh, Kenya. East African Journal of Health and Science, 6(1), 20-32. https://doi.org/10.37284/eajhs.6.1.1103