Correlation of Herd Immunity to Measles Vaccination Rate and Disease Incidence

Edita Goranci Haxhiu, Isme Humolli, Donjeta Pllana

International Journal of Biomedicine. 2023;13(1):151-155.
DOI: 10.21103/Article13(1)_OA22
Originally published March 3, 2023


Background: Measles is one of the most contagious diseases faced by humans. Despite considerable progress, measles remains one of the leading global causes of death among children.
Methods and Results: The seroprevalence of antibodies against measles in Kosovo was determined with a serological survey of measles. In total, 768 participants aged between 3 days and 45 years of both sexes were included. Enzyme-linked immunosorbent assay results revealed total seropositivity of 74.5% (95% CI: 0.70–0.88) among participants. Those in the unvaccinated 0–1.9-year age group had the lowest seropositivity (33.2%). The 2–6-year age group, which received one dose of the vaccine, had higher seropositivity (78.6%) than the youngest group. The 8–17-year age group, which received two doses of the measles vaccine, had significantly higher seropositivity (91.3%) than the 2–6-year age group. The highest level of seropositivity (93.4%) was observed in the 18–45-year age group. An analysis of sex-specific IgG antigen levels indicated that female participants had significantly higher seropositivity than male participants (P<0.01).
Conclusion: The seroprevalence of measles antibodies in Kosovo has not yet reached the required 95% threshold, and the threat of a possible measles epidemic exists. An immunization strategy that targets vulnerable groups and the entire population is required.

measles • seroprevalence • vaccination
  1. WHO. History of the Measles Vaccine. Available from:
  2. World Health Organization (WHO). Measles fact sheet N286. Geneva: WHO; November 2015 [updated 2016 Mar].
  3. Dixon MG, Ferrari M, Antoni S, Li X, Portnoy A, Lambert B, Hauryski S, Hatcher C, Nedelec Y, Patel M, Alexander JP Jr, Steulet C, Gacic-Dobo M, Rota PA, Mulders MN, Bose AS, Rosewell A, Kretsinger K, Crowcroft NS. Progress Toward Regional Measles Elimination - Worldwide, 2000-2020. MMWR Morb Mortal Wkly Rep. 2021 Nov 12;70(45):1563-1569. doi: 10.15585/mmwr.mm7045a1.
  4. Schenk J, Abrams S, Theeten H, Van Damme P, Beutels P, Hens N. Immunogenicity and persistence of trivalent measles, mumps, and rubella vaccines: a systematic review and meta-analysis. Lancet Infect Dis. 2021 Feb;21(2):286-295. doi: 10.1016/S1473-3099(20)30442-4. 
  5. Nelson R. COVID-19 disrupts vaccine delivery. Lancet Infect Dis. 2020 May;20(5):546. doi: 10.1016/S1473-3099(20)30304-2. 
  6. Durrheim DN, Andrus JK, Tabassum S, Bashour H, Githanga D, Pfaff G. A dangerous measles future looms beyond the COVID-19 pandemic. Nat Med. 2021 Mar;27(3):360-361. doi: 10.1038/s41591-021-01237-5. 
  7. Orenstein WA, Hinman A, Nkowane B, Olive JM, Reingold A. Measles and Rubella Global Strategic Plan 2012-2020 midterm review. Vaccine. 2018 Jan 11;36 Suppl 1:A1-A34. doi: 10.1016/j.vaccine.2017.09.026. 
  8. World Health Organization Regional Office for Europe (2014) Eliminating measles and rubella. Framework for the verification process in the WHO European Region. Copenhagen, WHO Regional Office for Europe; 2014. Available from:
  9. Gidding HF, Quinn HE, Hueston L, Dwyer DE, McIntyre PB. Declining measles antibodies in the era of elimination: Australia's experience. Vaccine. 2018 Jan 25;36(4):507-513. doi: 10.1016/j.vaccine.2017.12.002.
  10. National Institute of Public Health of Kosovo. [Communicable diseases in Kosovo, 2017. Annual report].
  11. Kmietowicz Z. Measles: Europe sees record number of cases and 37 deaths so far this year. BMJ. 2018 Aug 20;362:k3596. doi: 10.1136/bmj.k3596. 
  12. Ligjet - Ministria e Shendetesise. Available from:
  13. Kish L. A procedure for objective respondent selection within the household. Journal of the American Statistical Association. 1949;44:92-115.
  14. Poethko-Müller C, Mankertz A. Sero-epidemiology of measles-specific IgG antibodies and predictive factors for low or missing titres in a German population-based cross-sectional study in children and adolescents (KiGGS). Vaccine. 2011 Oct 19;29(45):7949-59. doi: 10.1016/j.vaccine.2011.08.081.
  15. Gallone MS, Germinario C, Larocca A, Tafuri S. Long time immunogenicity of measles vaccine in the vaccination era: An open question. Hum Vaccin Immunother. 2017 Jan 2;13(1):117-119. doi: 10.1080/21645515.2016.1227519.
  16. Holka J, Pawlak K, Ciepiela O. Seroprevalence of IgG antibodies against measles in a selected Polish population - do we need to be re-vaccinated? Cent Eur J Immunol. 2019;44(4):380-383. doi: 10.5114/ceji.2019.92789. 
  17. Klein SL, Flanagan KL. Sex differences in immune responses. Nat Rev Immunol. 2016 Oct;16(10):626-38. doi: 10.1038/nri.2016.90.
  18. Quach HQ, Ovsyannikova IG, Grill DE, Warner ND, Poland GA, Kennedy RB. Seroprevalence of Measles Antibodies in a Highly MMR-Vaccinated Population. Vaccines (Basel). 2022 Nov 3;10(11):1859. doi: 10.3390/vaccines10111859. 
  19. Kontio M, Jokinen S, Paunio M, Peltola H, Davidkin I. Waning antibody levels and avidity: implications for MMR vaccine-induced protection. J Infect Dis. 2012 Nov 15;206(10):1542-8. doi: 10.1093/infdis/jis568.
  20. Shoho Y, Kimura T, Yanagawa Y, Saito A, Inoue T, Suto C, Tsunekawa K, Araki O, Nara M, Tokue Y, Murakami M. Vaccination Status and Antibody Titers against Rubella and Measles among Japanese Female College Students Majoring in Childcare between 2015 and 2018. Tohoku J Exp Med. 2018 Oct;246(2):73-79. doi: 10.1620/tjem.246.73. 
  21. Bolotin S, Severini A, Hatchette T, McLachlan E, Savage R, Hughes SL, Wang J, Deeks SL, Wilson S, Brisson M, Halperin SA, Gubbay J, Mazzulli T, Serhir B, Ward BJ, Crowcroft N. Assessment of population immunity to measles in Ontario, Canada: a Canadian Immunization Research Network (CIRN) study. Hum Vaccin Immunother. 2019;15(12):2856-2864. doi: 10.1080/21645515.2019.1619402.
  22. Anichini G, Gandolfo C, Fabrizi S, Miceli GB, Terrosi C, Gori Savellini G, Prathyumnan S, Orsi D, Battista G, Cusi MG. Seroprevalence to Measles Virus after Vaccination or Natural Infection in an Adult Population, in Italy. Vaccines. 2020; 8(1):66. doi: 10.3390/vaccines8010066
  23. Tomášková H, Zelená H, Kloudová A, Tomášek I. Serological survey of measles immunity in the Czech Republic, 2013. Cent Eur J Public Health. 2018 Mar;26(1):22-27. doi: 10.21101/cejph.a5251. 
  24. Hayman DTS. Measles vaccination in an increasingly immunized and developed world. Hum Vaccin Immunother. 2019;15(1):28-33. doi: 10.1080/21645515.2018.1517074.
  25. Funk S. Critical immunity thresholds for measles elimination. Cmmid. 2019. Available from:
  26. Zhang Z, Chen M, Wang Y, Li J, Li X, Lu L. Seroepidemiology of measles in Beijing, China: a cross-sectional study. Hum Vaccin Immunother. 2019;15(9):2112-2116. doi: 10.1080/21645515.2019.1581527. 

Download Article
Received January 19, 2023.
Accepted February 23, 2023.
©2023 International Medical Research and Development Corporation.