A systematic review and modelling insights of factors impacting measles vaccine effectiveness, efficacy and immunogenicity.

Introduction: Outbreaks of measles have been frequently reported despite the availability of an effective vaccine. In this systematic review we examine the potential factors that could impact the effectiveness, efficacy and immunogenicity of the measles vaccine (MV) in children.

Methods: We conducted a literature search using PubMed and Google Scholar for primary articles published between January 2010 and April 2025. Articles reporting the effectiveness, efficacy or immunogenicity of MV in children aged 0-15 years were included. Additionally, we use regression analysis on data available from few cohort studies in India and epidemiological modelling simulations to assess the effect of factors on vaccine effectiveness (VE), efficacy and immunogenicity.

Results: Overall, 48 primary articles involving 172,464 children who had received the MV were included in the analysis. Key factors that may affect VE, efficacy and immunogenicity were malnutrition, genetic variants, chemotherapy and gender. Through statistical modelling we identified an inverse relationship between malnutrition and measles VE and estimated the possible percentage decrease in VE due to malnutrition across different states of India. Additionally, simulations from a Susceptible-Infected type model showed the effect of varying VE on the modelling outcomes and measles elimination targets.

Conclusions: We identified a few key factors including malnutrition, genetic variants, chemotherapy and gender that impact measles VE, efficacy and immunogenicity. Therefore, in addition to maintaining WHO recommended vaccine coverages, addressing the problems related to vaccine performance, evaluated in terms of VE, efficacy and immunogenicity, is crucial for achieving measles elimination targets.

Supplementary Information: The online version contains supplementary material available at 10.1007/s44370-025-00027-8.