{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T11:51:42Z","timestamp":1778327502150,"version":"3.51.4"},"reference-count":53,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibodies"],"abstract":"<jats:p>Background\/Objectives: Romania remains endemic for measles due to suboptimal vaccine coverage rates. During the last three epidemics, the highest incidence of measles was recorded in children younger than 1 year, who should have been partially protected by maternal antibodies. A nationwide cross-sectional seroprevalence study was conducted on persons of fertile age, to evaluate potential immunity gaps in the population. Methods: Between June and October 2020, 959 serum samples were collected from individuals aged 25\u201344 years (46.5% females) from all the geographic regions in Romania. Measles IgG antibodies were assessed using an enzyme-linked immune assay (DIA.PRO-Diagnostic Bioprobes Srl, Italy). Statistical analysis was performed in IBM SPSS Statistics 27.0, using Fisher\u2019s exact and chi-squared tests to test for associations between seropositivity and demographic factors, with p &lt; 0.05 considered statistically significant. Results: The overall measles seroprevalence was 77%, without gender- or geographic region-related differences. Both the seropositivity rate and the measles antibodies titers increased with age, with the highest difference between the oldest and the youngest age group (p = 0.057), suggesting persistent immunity after natural infection in older individuals or anamnestic responses in vaccinated persons, caused by repeated exposures to the circulating virus. An additional confirmatory pilot study on 444 pregnant women confirmed the low level of measles seroprevalence (68.4%), with a significant upward trend in older ages (75% in those aged &gt;40 years old vs. 65% in those aged 25\u201329 years, p = 0.018 and mean reactivity of measles antibodies 3.05 \u00b1 1.75 in those aged &gt;40 years vs. 2.28 \u00b1 1.39 in those aged 25\u201329 years, p = 0.037). Conclusions: This study signals critical immunity gaps in the population that contribute to the accumulation of susceptible individuals and recurrent measles outbreaks. The absence of measles antibodies in women of childbearing age increases the newborn\u2019s susceptibility to infection, with potentially severe complications.<\/jats:p>","DOI":"10.3390\/antib14020032","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T04:06:05Z","timestamp":1743566765000},"page":"32","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Nationwide Seroprevalence Study for Measles in Individuals of Fertile Age in Romania"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4127-481X","authenticated-orcid":false,"given":"Aurora","family":"Stanescu","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"National Institute of Public Health, National Centre for Communicable Diseases Surveillance and Control, 050463 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2492-6073","authenticated-orcid":false,"given":"Simona Maria","family":"Ruta","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Emerging Viral Diseases, Stefan. S. Nicolau Institute of Virology, 030304 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihaela","family":"Leustean","sequence":"additional","affiliation":[{"name":"National Institute of Public Health, National Centre for Communicable Diseases Surveillance and Control, 050463 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ionel","family":"Iosif","sequence":"additional","affiliation":[{"name":"National Institute of Public Health, National Centre for Communicable Diseases Surveillance and Control, 050463 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5954-3312","authenticated-orcid":false,"given":"Camelia","family":"Sultana","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Emerging Viral Diseases, Stefan. S. Nicolau Institute of Virology, 030304 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9213-6735","authenticated-orcid":false,"given":"Anca Maria","family":"Panaitescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Filantropia Hospital, 011171 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4441-1325","authenticated-orcid":false,"given":"Florentina Ligia","family":"Furtunescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"National Institute of Public Health, National Centre for Communicable Diseases Surveillance and Control, 050463 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Costin","family":"Cernescu","sequence":"additional","affiliation":[{"name":"Medical Sciences Section, Romanian Academy, 010071 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana","family":"Pistol","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"National Institute of Public Health, National Centre for Communicable Diseases Surveillance and Control, 050463 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e420","DOI":"10.1016\/S1473-3099(17)30307-9","article-title":"The basic reproduction number (R0) of measles: A systematic review","volume":"17","author":"Guerra","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Plans-Rubi\u00f3, P. (2020). Are the Objectives Proposed by the WHO for Routine Measles Vaccination Coverage and Population Measles Immunity Sufficient to Achieve Measles Elimination from Europe?. Vaccines, 8.","DOI":"10.3390\/vaccines8020218"},{"key":"ref_3","unstructured":"(2024, July 05). Immunization Agenda 2030: A Global Strategy to Leave No One Behind. Available online: https:\/\/www.who.int\/teams\/immunization-vaccines-and-biologicals\/strategies\/ia2030."},{"key":"ref_4","unstructured":"WHO Regional Office for Europe (2021). European Immunization Agenda 2030."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"127","DOI":"10.22207\/JPAM.13.1.13","article-title":"The Influence of Antivaccination Movements on the Re-emergence of Measles","volume":"13","author":"Patricia","year":"2019","journal-title":"J. Pure Appl. Microbiol."},{"key":"ref_6","unstructured":"(2024, June 27). European Centre for Diseases Control, Measles on the Rise in the EU\/EEA: Considerations for Public Health Response, 16 February 2024. Available online: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/measles-eu-threat-assessment-brief-february-2024.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Muscat, M., Ben Mamou, M., Reynen-de Kat, C., Jankovic, D., Hagan, J., Singh, S., and Datta, S.S. (2024). Progress and Challenges in Measles and Rubella Elimination in the WHO European Region. Vaccines, 12.","DOI":"10.3390\/vaccines12060696"},{"key":"ref_8","unstructured":"European Centre for Diseases Control (2024, October 15). Weekly Communicable Disease Threats Report, Week 41, 5\u201311 October 2024. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/communicable-disease-threats-report-5-11-october-2024-week-41."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1080\/21645515.2018.1517074","article-title":"Measles vaccination in an increasingly immunized and developed world","volume":"15","author":"Hayman","year":"2019","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_10","unstructured":"Manual for the Laboratory-Based Surveillance of Measles, Rubella, and Congenital Rubella Syndrome (2024, December 20). Laboratory Testing for Determination of Population Immune Status. Available online: https:\/\/www.who.int\/publications\/m\/item\/chapter-9-manual-for-the-laboratory-based-surveillance-of-measles-rubella-and-congenital-rubella-syndrome."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sbarra, A.N., Cutts, F.T., Fu, H., Poudyal, I., Rhoda, D.A., Mosser, J.F., and Jit, M. (2024). Evaluating Scope and Bias of Population-Level Measles Serosurveys: A Systematized Review and Bias Assessment. Vaccines, 12.","DOI":"10.3390\/vaccines12060585"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e319","DOI":"10.1017\/S0950268819002048","article-title":"Measles and rubella seroprevalence among adults in Georgia in 2015: Helping guide the elimination efforts","volume":"147","author":"Khetsuriani","year":"2019","journal-title":"Epidemiol. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1093\/infdis\/jiy137","article-title":"Benefits and Challenges in Using Seroprevalence Data to Inform Models for Measles and Rubella Elimination","volume":"218","author":"Winter","year":"2018","journal-title":"J. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1017\/S095026881400301X","article-title":"Estimating seroprevalence of vaccine-preventable infections: Is it worth standardizing the serological outcomes to adjust for different assays and laboratories?","volume":"143","author":"Kafatos","year":"2015","journal-title":"Epidemiol. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"197","DOI":"10.2471\/BLT.07.041129","article-title":"Towards elimination: Measles susceptibility in Australia and 17 European countries","volume":"86","author":"Andrews","year":"2008","journal-title":"Bull. World Health Organ."},{"key":"ref_16","unstructured":"National Center for Disease Control (2024, November 12). Evolution Analysis of Communicable Diseases Under Surveillance, Annual Reports, Available online: https:\/\/vajiramandravi.com\/upsc-daily-current-affairs\/prelims-pointers\/national-centre-for-disease-control-ncdc\/."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Donadel, M., Stanescu, A., Pistol, A., Stewart, B., Butu, C., Jankovic, D., Paunescu, B., and Zimmerman, L. (2021). Risk factors for measles deaths among children during a Nationwide measles outbreak\u2014Romania, 2016\u20132018. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-05966-3"},{"key":"ref_18","unstructured":"National Institute of Public Health (2024, November 12). National Centre for Communicable Diseases Surveillance and Control, Monthly Reports. Romanian, Available online: https:\/\/insp.gov.ro\/informari-lunare\/."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Stanescu, A., Ruta, S.M., Cernescu, C., and Pistol, A. (2024). Suboptimal MMR Vaccination Coverages\u2014A Constant Challenge for Measles Elimination in Romania. Vaccines, 12.","DOI":"10.3390\/vaccines12010107"},{"key":"ref_20","unstructured":"Eurostat (2024, June 10). The Statistical Office of the European Union, Reference Metadata, Fertility. Available online: https:\/\/ec.europa.eu\/eurostat\/cache\/metadata\/en\/demo_fer_esms.htm."},{"key":"ref_21","unstructured":"Steven, K., and Thompson, S. (2012). Wiley Series in Probability and Statistics, John Wiley & Sons. [3rd ed.]."},{"key":"ref_22","unstructured":"National Institute of Statistics (2024, June 10). Romanian. Available online: http:\/\/statistici.insse.ro\/tempoins\/."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1080\/21645515.2015.1093263","article-title":"Primary vaccine failure to routine vaccines: Why and what to do?","volume":"12","author":"Wiedermann","year":"2016","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/j.egyr.2021.12.039","article-title":"Vaccine cold chain management and cold storage technology to address the challenges of vaccination programs","volume":"8","author":"Pambudi","year":"2022","journal-title":"Energy Rep."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Griffin, D.E. (2016). The Immune Response in Measles: Virus Control, Clearance and Protective Immunity. Viruses, 8.","DOI":"10.3390\/v8100282"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1016\/S1473-3099(19)30395-0","article-title":"Immunogenicity, effectiveness, and safety of measles vaccination in infants younger than 9 months: A systematic review and meta-analysis","volume":"19","author":"Strebel","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"5057","DOI":"10.1016\/j.vaccine.2015.08.057","article-title":"Persistence of measles antibodies, following changes in the recommended age for the second dose of MMR-vaccine in Portugal","volume":"33","author":"Frade","year":"2015","journal-title":"Vaccine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"4126","DOI":"10.1016\/j.vaccine.2017.06.058","article-title":"An increasing, potentially measles-susceptible population over time after vaccination in Korea","volume":"35","author":"Kang","year":"2017","journal-title":"Vaccine"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ghafoori, F., Mokhtari-Azad, T., Foroushani, A.R., Farahmand, M., Shadab, A., and Salimi, V. (2024). Assessing seropositivity of MMR antibodies in individuals aged 2\u201322: Evaluating routine vaccination effectiveness after the 2003 mass campaign-a study from Iran\u2019s National Measles Laboratory. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-09593-6"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Williamson, K.M., Faddy, H., Nicholson, S., Stambos, V., Hoad, V., Butler, M., Housen, T., Merritt, T., and Durrheim, D.N. (2024). A Cross-Sectional Study of Measles-Specific Antibody Levels in Australian Blood Donors\u2014Implications for Measles Post-Elimination Countries. Vaccines, 12.","DOI":"10.3390\/vaccines12070818"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Quach, H.Q., Ovsyannikova, I.G., Grill, D.E., Warner, N.D., Poland, G.A., and Kennedy, R.B. (2022). Seroprevalence of Measles Antibodies in a Highly MMR-Vaccinated Population. Vaccines, 10.","DOI":"10.3390\/vaccines10111859"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Sarawanangkoor, N., Wanlapakorn, N., Srimuan, D., Thatsanathorn, T., Thongmee, T., and Poovorawan, Y. (2024). Persistence of Antibodies against Measles, Mumps, and Rubella after the Two-Dose MMR Vaccination: A 7-Year Follow-Up Study. Vaccines, 12.","DOI":"10.3390\/vaccines12070744"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"5797","DOI":"10.1016\/j.vaccine.2023.08.018","article-title":"Two-dose measles vaccine effectiveness remains high over time: A French observational study, 2017\u20132019","volume":"41","author":"Franconeri","year":"2023","journal-title":"Vaccine"},{"key":"ref_34","unstructured":"Plotkin, S.A., Orenstein, W.A., Offit, P., and Edwards, K.M. (2018). Plotkin\u2019s Vaccines, Elsevier. [7th ed.]."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e109","DOI":"10.1017\/S0950268819000050","article-title":"Measles and rubella seroprevalence in a population of young adult blood donors, France 2013","volume":"147","author":"Antona","year":"2019","journal-title":"Epidemiol. Infect."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e766","DOI":"10.1016\/S2468-2667(24)00181-6","article-title":"Long-term waning of vaccine-induced immunity to measles in England: A mathematical modelling study","volume":"9","author":"Robert","year":"2024","journal-title":"Lancet Public Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1800529","DOI":"10.2807\/1560-7917.ES.2019.24.17.1800529","article-title":"Estimating age-specific vaccine effectiveness using data from a large measles outbreak in Berlin, Germany, 2014\/15: Evidence for waning immunity","volume":"24","author":"Bitzegeio","year":"2019","journal-title":"Eurosurveillance"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1017\/S0950268805004437","article-title":"Rubella and measles seroprevalence among women of childbearing age, Argentina, 2002","volume":"133","author":"Dayan","year":"2005","journal-title":"Epidemiol. Infect."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1038\/nri.2016.90","article-title":"Sex differences in immune responses","volume":"16","author":"Klein","year":"2016","journal-title":"Nat. Rev. Immunol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Coppeta, L., Ferrari, C., Somma, G., Giovinazzo, V., Buonomo, E., Aurilio, M.T., Treglia, M., and Magrini, A. (2023). Serological Evaluation for Measles among Italian and Foreign Medical Students in a University Hospital in Rome. Vaccines, 11.","DOI":"10.3390\/vaccines11071256"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Nasika, A., Bogogiannidou, Z., Mouchtouri, V.A., Dadouli, K., Kyritsi, M.A., Vontas, A., Voulgaridi, I., Tsinaris, Z., Kola, K., and Matziri, A. (2023). Measles Immunity Status of Greek Population after the Outbreak in 2017\u20132018: Results from a Seroprevalence National Survey. Vaccines, 11.","DOI":"10.20944\/preprints202306.1156.v1"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"5928","DOI":"10.1016\/j.vaccine.2021.08.001","article-title":"Measles immunity over two decades in two large Italian Regions: How far is the elimination goal?","volume":"39","author":"Marchi","year":"2021","journal-title":"Vaccine"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"126012","DOI":"10.1016\/j.vaccine.2024.05.060","article-title":"Seroprevalence of measles antibodies in the Italian general population in 2019\u20132020","volume":"42","author":"Grassi","year":"2024","journal-title":"Vaccine"},{"key":"ref_44","first-page":"593","article-title":"Measles Seroprevalence and Related Factors in Women Aged 15\u201349 Years Old, in Mersin, Turkey","volume":"52","author":"Sasmaz","year":"2023","journal-title":"Iran. J. Public Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"4110","DOI":"10.1016\/j.vaccine.2016.06.002","article-title":"A 16-year review of seroprevalence studies on measles and rubella","volume":"34","author":"Dimech","year":"2016","journal-title":"Vaccine"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"102594","DOI":"10.1016\/j.eclinm.2024.102594","article-title":"Pregnant women and measles: We need to be vigilant during outbreaks","volume":"72","author":"Khalil","year":"2024","journal-title":"eClinicalMedicine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e265","DOI":"10.1128\/JCM.00265-20","article-title":"Qualitative Variation among Commercial Immunoassays for Detection of Measles-Specific IgG","volume":"58","author":"Latner","year":"2020","journal-title":"J. Clin. Microbiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"515.e1","DOI":"10.1016\/j.cmi.2019.11.006","article-title":"Measles seroprevalence in pregnant women in Soweto, South Africa: A nested cohort study","volume":"26","author":"Gieles","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2948","DOI":"10.1016\/S0264-410X(03)00113-0","article-title":"Immunity against measles in populations of women and infants in Poland","volume":"21","author":"Janaszek","year":"2003","journal-title":"Vaccine"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.cmi.2019.08.022","article-title":"Measles-related hospitalizations and associated complications in Jerusalem, 2018\u20132019","volume":"26","author":"Oster","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1016\/S1473-3099(19)30520-1","article-title":"Early vaccination: A provisional measure to prevent measles in infants","volume":"19","author":"Principi","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Mathew, J.L., Wagner, A.L., Ratho, R.K., Patel, P.N., Suri, V., Bharti, B., Carlson, B.F., Dutta, S., Singh, M.P., and Boulton, M.L. (2023). Maternally transmitted anti-measles antibodies, and susceptibility to disease among infants in Chandigarh, India: A prospective birth cohort study. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0287110"},{"key":"ref_53","first-page":"5","article-title":"Waning herd immunity: A challenge for eradication of measles","volume":"38","author":"Moghadas","year":"2008","journal-title":"J. Math."}],"container-title":["Antibodies"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-4468\/14\/2\/32\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:08:25Z","timestamp":1760029705000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-4468\/14\/2\/32"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,2]]},"references-count":53,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["antib14020032"],"URL":"https:\/\/doi.org\/10.3390\/antib14020032","relation":{},"ISSN":["2073-4468"],"issn-type":[{"value":"2073-4468","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,2]]}}}