Incremental Effectiveness of 2 Doses of Measles-Containing Vaccine Compared with 1 Dose among High School Students during an Outbreak

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Abstract
A measles outbreak occurred among a highly vaccinated population in Alaska during 1998, providing an opportunity to determine the incremental efficacy of ⩾2 doses of measles-containing vaccine (MCV) compared with 1 dose. Of 33 confirmed case patients identified, 31 had been vaccinated with 1 dose of MCV, 1 had received 2 doses, and vaccination status was unknown in 1 case. Seventy percent of cases were school-associated; 58% of cases occurred in 2 high schools. Of 3679 students attending the 2 schools, 50.4% and 45.5% had received ⩾2 doses of MCV before measles introduction at the schools. The relative risk of developing measles among persons vaccinated with ⩾2 doses of MCV compared with 1 dose was 0.06 (95% confidence interval, 0.01–0.44; P<.001), yielding an estimated incremental vaccine efficacy of 94.1% (95% confidence interval, 55.9%–99.2%; P < .001). Rapid implementation of a mandatory second-dose MCV requirement probably limited the extent of this outbreak.