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. 2021 Jul 1;4(7):e2118508.
doi: 10.1001/jamanetworkopen.2021.18508.

Seroprevalence of Measles and Mumps Antibodies Among Individuals With Cancer

Sara R Marquis  1 , Jennifer K Logue  2 , Helen Y Chu  2 , Tillie Loeffelholz  1 , Z Z Quinn  1 , Catherine Liu  1   2   3   4 , F Marc Stewart  5 , Paul A Carpenter  4   6   7 , Steven A Pergam  1   2   4   8 , Elizabeth M Krantz  1
Affiliations

Seroprevalence of Measles and Mumps Antibodies Among Individuals With Cancer

Sara R Marquis et al. JAMA Netw Open. .

Abstract

Importance: Although patients with cancer are at an increased risk of infection-related complications, few studies have characterized their vulnerability to measles and mumps. Given the recent outbreaks and increased community vaccine hesitancy, understanding measles and mumps immunity within this population is vital.

Objectives: To identify a point prevalence estimate of protective measles and mumps antibodies among ambulatory patients with cancer.

Design, setting, and participants: In this cross-sectional study, residual clinical plasma samples were obtained from consecutive patients with cancer at Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center in Seattle, Washington, in August 2019. These samples were tested for measles and mumps IgG using a commercial enzyme-linked immunosorbent assay. Patients without cancer were excluded from the analysis.

Exposures: Patient age, sex, self-reported race and ethnicity, primary disease, receipt of chemotherapy in the past 30 days before sample collection, hematopoietic cell transplant (HCT) history, and date of most recent intravenous immunoglobulin treatment were abstracted from electronic medical records.

Main outcomes and measures: Measles and mumps IgG seroprevalence, defined as the proportion of patients with positive antibody test results, was measured overall and among the subgroups.

Results: Of the 959 patients included in the analysis, 510 (53%) were male individuals and the mean (SD) age at sample collection was 60 (15) years. Most patients (576 [60%]) had a malignant solid tumor, and 383 patients (40%) had a hematologic malignant neoplasm; 146 patients (15%) had an HCT history. Overall, the seroprevalence of measles antibodies was 0.75 (95% CI, 0.72-0.78), and the seroprevalence of mumps antibodies was 0.62 (95% CI, 0.59-0.65). The lowest seroprevalences were among patients with a hematologic malignant neoplasm (0.63 for measles and 0.48 for mumps), those with a history of HCT (0.46 for measles and 0.29 for mumps), and those aged 30 to 59 years (0.49-0.63 for measles and 0.41-0.58 for mumps).

Conclusions and relevance: In this study, 25% of ambulatory patients with cancer lacked protective antibodies for measles and 38% lacked protective antibodies for mumps. Deficits in protective antibodies underscore patients' increased risk during outbreaks and emphasize the need for community-based efforts to increase herd immunity to protect this population.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Chu reported receiving personal fees from Ellume, Merck, Pfizer, Bill and Melinda Gates Foundation, and GlaxoSmithKline; grants from Gates Ventures and Sanofi Pasteur; and nonfinancial support (testing supplies) from Cepheid and Ellume outside the submitted work. Dr Liu reported receiving personal fees from Duke University Antibacterial Resistance Leadership Group outside the submitted work. Dr Pergam reported receiving grants from Global Life Technologies and other (vaccines for National Institutes of Health–supported clinical trials) from Chimerix, Merck, and Sanofi Aventis outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Measles Seroprevalence and Adjusted Prevalence Ratio (PR) Estimates by Subgroup
Squares represent measles seroprevalence estimates, and the error bars show the 95% CIs for these estimates. The vertical dashed line shows the middle value (0.94) for the recommended range required for herd immunity (0.93-0.95). The PR estimates from a multivariable model were adjusted for age group, sex, primary disease, hematopoietic cell transplant (HCT) history before sample collection, chemotherapy in the 30 days before sample collection, and intravenous immunoglobulin (IVIG) treatment before sample collection. aThe P values correspond to the adjusted PR estimates.
Figure 2.
Figure 2.. Distribution of Age at Sample Collection and Measles and Mumps IgG Antibody Test Results
Total height of filled bars indicates the frequency of patient age in the study cohort, with the height of the blue, orange, and gray bars representing the number of patients with negative, equivocal, or positive test results. The vertical arrowhead points to those born in 1957 (age 62 years at sample collection). Those older than 62 years (under right arrow) were older than 5 years at the introduction of the measles-mumps-rubella vaccine and alive when measles and mumps were common and were therefore presumed to have naturally acquired immunity. Those younger than 62 years (under left arrow) were presumed to have vaccine-acquired immunity.,
Figure 3.
Figure 3.. Mumps Seroprevalence and Adjusted Prevalence Ratio (PR) Estimates by Subgroup
Squares represent mumps seroprevalence estimates, and error bars show the 95% CIs for these estimates. The vertical dashed line shows the middle value (0.90) for the recommended range required for herd immunity (0.88-0.92). The PR estimates from a multivariable model were adjusted for age group, sex, primary disease, hematopoietic cell transplant (HCT) history before sample collection, chemotherapy in the 30 days before sample collection, and intravenous immunoglobulin (IVIG) treatment before sample collection. aThe P values correspond to the adjusted PR estimates.
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