Digestive Diseases and Sciences

, Volume 64, Issue 1, pp 189–195 | Cite as

Immunosuppression Does Not Affect Antibody Concentrations to Measles, Mumps, and Rubella in Patients with Inflammatory Bowel Disease

  • Freddy CalderaEmail author
  • Elizabeth Ann Misch
  • Sumona Saha
  • Arnold Wald
  • Youqi Zhang
  • Jeffrey Hubers
  • Bryant Megna
  • Dana Ley
  • Mark Reichelderfer
  • Mary S. Hayney
Original Article



The Advisory Committee on Immunization Practices (ACIP) recommends using the immunization record and not serologic testing to determine immunity against measles and rubella in the general population, due to potential false negatives. However, it is unknown whether the immune response is less durable among patients who are immunosuppressed.


The primary aim of this study was to evaluate sustained vaccine-induced measles, mumps, and rubella (MMR) antibody concentrations in immunosuppressed patients with inflammatory bowel disease (IBD).


We performed a cross-sectional study to compare antibody concentrations following the two-dose (MMR) vaccine among 46 patients with IBD and 20 healthy controls (HC). Three IBD groups stratified by the immunosuppressive regimen that preceded study entry for at least 3 months: (1) thiopurine monotherapy, (2) anti-TNF monotherapy, or (3) combination therapy (anti-TNF agent combined with an immunomodulator) were enrolled.


All subjects had measurable antibody concentrations to the three vaccine viruses. Age and time since receipt of MMR series were similar in both groups. There were no difference in the antibody concentration of measles (IBD 667 mIU/ml vs HC 744 mIU/ml; p = 0.45), mumps (IBD 339 EU/ml vs HC 402 EU/ml; p = 0.62), or rubella (IBD 25 mIU/ml vs HC 62 mIU/ml; p = 0.11) among the groups. No differences in antibody concentrations were found among the IBD treatment groups.


Immunosuppressed patients with IBD have sustained antibody concentrations comparable to healthy controls. Thus, gastroenterologist should follow the ACIP recommendations and use the immunization record when available to determine immunity to measles and rubella in patients with IBD.

Clinical Trials Registry # NCT02434133.


Immunization Measles Mumps Rubella Inflammatory bowel disease Immunity 



This work was supported by Judy L. and Sal A. Troia, University of Wisconsin Division of Gastroenterology and Hepatology and the University of Wisconsin School of Pharmacy.

Compliance with ethical standards

Conflict of interest

Drs. Caldera, Misch, Wald, and Reichelderfer and Ms. McCrone, Ms. Garmoe, Mr. Megna, and Miss Ley declare that they have no competing interests/financial disclosures. Dr. Hayney served on the speakers’ bureau for Sanofi Pasteur Vaccines and an advisory board for GlaxoSmithKline Vaccines. Dr. Saha is a consultant with UCB Biosciences.


  1. 1.
    Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG Clinical Guideline: management of Crohn’s disease in adults. Am J Gastroenterol. 2018;113:481–517.CrossRefGoogle Scholar
  2. 2.
    Melmed GY, Ippoliti AF, Papadakis KA, et al. Patients with inflammatory bowel disease are at risk for vaccine-preventable illnesses. Am J Gastroenterol. 2006;101:1834–1840.CrossRefGoogle Scholar
  3. 3.
    McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). Morb Mortal Wkly Rep. 2013;62:1–33.Google Scholar
  4. 4.
    Roush SW, Murphy TV, Vaccine-Preventable Disease Table Working Group a. Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the united states. JAMA. 2007;298:2155–2163.CrossRefGoogle Scholar
  5. 5.
    Fiebelkorn AP, Redd SB, Gastañaduy PA, et al. A comparison of post-elimination measles epidemiology in the United States, 2009–2014 versus 2001–2008. J Pediatr Infect Dis Soc. 2017;6:40–48.Google Scholar
  6. 6.
    Davidkin I, Jokinen S, Broman M, Leinikki P, Peltola H. Persistence of measles, mumps, and rubella antibodies in an MMR-vaccinated cohort: a 20-year follow-up. J Infect Dis. 2008;197:950–956.CrossRefGoogle Scholar
  7. 7.
    Seagle EE, Bednarczyk RA, Hill T, et al. Measles, mumps, and rubella antibody patterns of persistence and rate of decline following the second dose of the MMR vaccine. Vaccine. 2018;36:818–826.CrossRefGoogle Scholar
  8. 8.
    Gidding HF, Quinn HE, Hueston L, Dwyer DE, McIntyre PB. Declining measles antibodies in the era of elimination: Australia’s experience. Vaccine. 2018;36:507–513.CrossRefGoogle Scholar
  9. 9.
    Farraye FA, Melmed GY, Lichtenstein GR, Kane SV. ACG Clinical Guideline: preventive care in inflammatory bowel disease. Am J Gastroenterol. 2017;112:241–258.CrossRefGoogle Scholar
  10. 10.
    Naganuma M, Nagahori M, Fujii T, Morio J, Saito E, Watanabe M. Poor recall of prior exposure to varicella zoster, rubella, measles, or mumps in patients with IBD. Inflamm Bowel Dis. 2013;19:418–422.CrossRefGoogle Scholar
  11. 11.
    Cleveland NK, Rodriquez D, Wichman A, Pan I, Melmed GY, Rubin DT. Many inflammatory bowel disease patients are not immune to measles or pertussis. Dig Dis Sci. 2016;61:2972–2976. Scholar
  12. 12.
    Caldera F, Saha S, Wald A, et al. Lower sustained diphtheria and pertussis antibody concentrations in inflammatory bowel disease patients. Dig Dis Sci. 2018;63:1532–1540. Scholar
  13. 13.
    Wisconsin Department of Health Services. Wisconsin Immunization Registry (WIR). Accessed May 1, 2018.
  14. 14.
    Ratnam S, Gadag V, West R, et al. Comparison of commercial enzyme immunoassay kits with plaque reduction neutralization test for detection of measles virus antibody. J Clin Microbiol. 1995;33:811–815.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Tharmaphornpilas P, Yoocharean P, Rasdjarmrearnsook A-O, Theamboonlers A, Poovorawan Y. Seroprevalence of antibodies to measles, mumps, and rubella among Thai population: evaluation of measles/MMR immunization programme. J Health, Popul Nutr. 2009;27:80–86.CrossRefGoogle Scholar
  16. 16.
    Chen RT, Markowitz LE, Albrecht P, et al. Measles antibody: reevaluation of protective titers. J Infect Dis. 1990;162:1036–1042.CrossRefGoogle Scholar
  17. 17.
    Plotkin SA. Correlates of protection induced by vaccination. Clin Vaccine Immunol CVI. 2010;17:1055–1065.CrossRefGoogle Scholar
  18. 18.
    Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices, 2010. MMWR Morb Mortal Wkly Rep. 2011;60:13–50.Google Scholar
  19. 19.
    Schwartz KL, Kwong JC, Deeks SL, et al. Effectiveness of pertussis vaccination and duration of immunity. CMAJ Can Med Assoc J. 2016;188:E399–E406.CrossRefGoogle Scholar
  20. 20.
    Hinman AR, Lynn TV, Beller M, et al. Incremental effectiveness of 2 doses of measles-containing vaccine compared with 1 Dose among high school students during an outbreak. J Infect Dis. 2004;189:S86–S90.CrossRefGoogle Scholar
  21. 21.
    Papania MJ, Wallace GS, Rota PA, et al. Elimination of endemic measles, rubella, and congenital rubella syndrome from the Western Hemisphere: the US experience. JAMA Pediatrics. 2014;168:148–155.CrossRefGoogle Scholar
  22. 22.
    Marin M, Marlow M, Moore K, Patel M. Recommendation of the advisory committee on immunization practices for use of a third dose of mumps virus-containing vaccine in persons at increased risk for mumps during an outbreak. MMWR Morb Mortal Wkly Rep. 2018;67:33–38.CrossRefGoogle Scholar
  23. 23.
    Erdman DD, Heath JL, Watson JC, Markowitz LE, Bellini WJ. Immunoglobulin M antibody response to measles virus following primary and secondary vaccination and natural virus infection. J Med Virol. 1993;41:44–48.CrossRefGoogle Scholar
  24. 24.
    de Silva PSA, Fishman LN. Transition of the patient with IBD from pediatric to adult care—an assessment of current evidence. Inflamm Bowel Dis. 2014;20:1458–1464.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine and Public HealthUniversity of Wisconsin—MadisonMadisonUSA
  2. 2.Department of Medicine, Division of Infectious Disease, School of Medicine and Public HealthUniversity of Wisconsin—MadisonMadisonUSA
  3. 3.School of Medicine and Public HealthUniversity of Wisconsin—MadisonMadisonUSA
  4. 4.School of Pharmacy, School of Medicine and Public HealthUniversity of Wisconsin—MadisonMadisonUSA

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