Sex: F
Vaccine: MMR
Symptoms: Rash maculo-papular, Skin exfoliation, Viral infection
Clinical narrative: The patient was diagnosed with measles; Secondary measles due to vaccine failure.; This literature marketed report has been received from the authors of a published literature article, referring to a 59-year-old female patient. The patient's medical history, concurrent conditions, concomitant medications, and historical drugs were not reported.  On an unknown date, the patient was vaccinated with one dose of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live(manufacturer unknown)(strength, route, dose, frequency, anatomical location, lot # and expiration date were unknown) for prophylaxis.    On an unknown date, the patient experienced cough, fever, weakness from diarrhea, diffuse maculopapular rash, and facial skin peeling. The initial diagnosis for this case was reported as Influenza-likebillness and viral syndrome. There was no clear history of a measles exposure for this patient. Additionally, it was reported that on day11 of symptoms and day 6 of the rash some samples were collected for testing.   On an unspecified dates, reported as day 11 of symptoms and day 6 of the rash the samples were collected for the following tests: a measles IgG (chemiluminescent immunoassay [CLIA], LIAISON XL) was performed to the patient and showed a result of high positive at >10 X the cutoff, a measles IgM (laboratory-developed immunofluorescenceassay [IFA]) testing that was negative, a measles real-time reverse transcriptase PCR (RT-PCR) that returned positive (cycle threshold 27), an additional measles IgM testing that resulted Positive (5 X cutoff), and finally a IgG avidity test that was high. At the time of the report, the outcome of the events was not reported.   The authors considered that while the majority of measles cases are primary infections in persons who had not been vaccinated, measles can also occur in previously vaccinated individuals. In 2019, a record number of measles cases were reported as a result of suboptimal vaccination rates and a loss of herd immunity. Moreover, measles cases due to secondary vaccine failures are more common than previously thought, comprising approximately 11% of cases reported in 2019. Attenuated or modified presentations, lack of overt epidemiologic risk factors, and false-negative IgM and strong-positive measles IgG results may mislead clinicians to favor alternate diagnoses, creating delays in identification and increasing the risk of transmission. Due to this, clinical laboratorians and clinicians should be aware of the pitfalls in diagnosing measles in previously vaccinated persons by serology alone and be proactive in obtaining nasopharyngeal (NP) or throat swabs for measles real-time reverse transcriptase PCR (RT-PCR) in addition to serum samples.  In conclusion, testing by both RT-PCR and serology is especially important for the diagnosis of index cases, which may occur in the absence of clear epidemiologic risk factors.  Upon internal review, measles was considered to be medically significant.   Literature Report. Sender's Comments:  US-009507513-2011USA011191:Original Case : 2011USA011191