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PubMed2005

Global Measles and Rubella Laboratory Network, January 2004-June 2005.

Measles continues to be a leading cause of childhood morbidity and mortality in developing countries and an outbreak threat in the majority of countries. In 2000, measles was considered the fifth leading cause of childhood mortality, and the World Health Organization (WHO) estimated that approximately 777,000 measles-associated deaths occurred worldwide. In 2001, WHO and the United Nations Children's Fund (UNICEF) developed a 5-year strategic plan, endorsed by the World Health Assembly in 2003, to reduce measles mortality by 50% by 2005 (relative to 1999 estimates) and to achieve and maintain interruption of indigenous measles transmission in large geographic areas with established measles elimination goals. This plan included strengthening routine vaccination coverage, providing a second opportunity for measles immunization to children, improving measles case management, and improving surveillance with laboratory confirmation of suspected measles cases. To date, four of six WHO regions have established measles elimination targets: the Americas Region (AMR) by 2000, the European Region (EUR) by 2010, the Eastern Mediterranean Region (EMR) by 2010, and the Western Pacific Region (WPR) by 2012. The remaining two WHO regions, the African (AFR) and South East Asian (SEAR) regions, are continuing work toward the measles mortality reduction goal. Likewise, to reduce the burden of disease from congenital rubella syndrome (CRS), currently estimated at 100,000 cases per year worldwide, several countries have developed or continue to develop rubella control programs, and AMR and EUR have established regional rubella elimination and CRS reduction goals, respectively. Because improved global surveillance is essential for monitoring progress toward mortality reduction and elimination of these diseases, WHO established the Measles and Rubella Laboratory Network (LabNet) in 2003 to promote case identification and confirmation. This report provides an update on the development of LabNet during January 2004-June 2005 and describes the geographic distribution of measles and rubella virus genotypes as of June 2005.

Clinical Laboratory Techniques↗

PubMed1996

[A non-specific, beneficial effect of measles vaccination. Analysis of mortality studies from developing countries].

The study examined whether the reduction in mortality after standard titre measles immunization in developing countries can be explained by the prevention of acute measles and its long-term consequences. All studies comparing mortality of unimmunised children and children immunised with standard titre measles vaccine in developing countries were included; ten cohort and two case-control studies from Bangladesh, Benin, Burundi, Guinea-Bissau, Haiti, Senegal, and Zaire. We examined the protective efficacy of standard titre measles immunization against all cause mortality. Furthermore, by restricting the analysis to children who had not developed measles, we examined how much of the difference in mortality between immunised and unimmunised children could be explained by prevention of measles disease. In the ten cohort studies, protective efficacy against death after measles immunization was found to be in the range of 30-86%. Efficacy was highest in the studies with short follow-up and where children were immunised in infancy (range: 44-100%). Vaccine efficacy against death was much greater than the proportion of deaths attributed to acute measles disease. In four studies from Guinea-Bissau, Senegal and Burundi, vaccine efficacy against death remained almost unchanged when measles cases were excluded from the analysis. Hence, the reduction in mortality among immunized children cannot be explained by the prevention of acute and long-term consequences of measles. In contrast to the effect of measles vaccine, studies from Guinea-Bissau, Senegal and Benin suggest that diphtheria-tetanus-pertussis and polio vaccinations are not associated with reduction in mortality. These observations suggest that standard titre measles vaccine may confer a beneficial effect which is unrelated to the specific protection against measles disease.

Cohort Studies↗

PubMed1991

Transmission of measles in medical settings--United States, 1985-1989.

Measles cases reported to the Centers for Disease Control from 1985 to 1989 were analyzed to determine the characteristics of measles cases transmitted in medical settings. A total of 1,209 medial setting cases were identified, which represented 3.5% of all reported cases. Of medical setting cases, 66% (795) were in known or presumed patients and 28% (341) were in health care workers. The largest groups of health care workers with measles were nurses (101, 29.6%) and physicians (65, 19.1%). Health care workers acquired measles from patients (90.6%) and other health care workers (9.4%), and transmitted measles to patients, other health care workers, and family members. Of 333 (97.7%) health care workers with known measles vaccination status, 232 (68.0%) were eligible for vaccine; only 46 (19.8%) had received a documented dose. Twenty-nine percent of health care workers with measles were born before 1957, older than the age for routine measles vaccination. The relative risk of measles for physicians and nurses was 8.4 (95% confidence interval [CI], 6.6, 10.8) and 2.1 (95% CI, 1.8, 2.7) respectively, compared with nonhealth care workers of the same ages. In 1989 the Immunization Practices Advisory Committee (ACIP) recommended that health care workers be required to document two doses of measles vaccine or other evidence of measles immunity at the time of employment. Implementation of ACIP recommendations for health care workers and appropriate isolation precautions for known and suspected patients with measles could reduce the transmission of measles in medical settings.

Adolescent↗

PubMedDate not supplied

Impact of measles in the United States.

Measles has had a severe impact on children in the United States since colonial times. In the early decades of the 20th century, thousands of fatal measles infections were reported each year. During the 1950s an annual average of greater than 500,000 cases of measles and nearly 500 deaths due to measles were reported in the United States. Surveys indicated that 95% of the population had been infected with measles by the age of 15 years. The introduction of measles vaccine and its widespread use, which began in 1963, has had a major impact on the occurrence of measles in the United States. Reported numbers of cases, deaths due to measles, and complications of measles (e.g., encephalitis) have declined dramatically. Accompanying the decline in reported incidence of measles and following it by approximately seven years, has been a decline in the reported incidence of subacute sclerosing panencephalitis (SSPE). In recent years, the incidence of measles has dropped to levels that are less than 1% of those seen in the prevaccine era. In 1981, provisional figures indicated that only 10% of counties in the United States reported any cases of measles. The reported incidence in 1981 was 1.3 cases per 100,000 population, compared with an average incidence of 336.3 cases per 100,000 population in the decade 1950-1959. Thus, the impact of measles in the United States has been markedly reduced, and it is anticipated that indigenous transmission will be eliminated entirely from the country within the year.

Adolescent↗

PubMed2002

Measles in suburban Khartoum: an epidemiological and clinical study.

Clinical and epidemiological data were collected from 187 clinically diagnosed measles patients in Haj Yousif area, suburban Khartoum. Laboratory tests confirmed the diagnosis in 141 (75%) of the cases, but demonstrated that in 46 (25%) patients the clinical symptoms were not caused by an acute measles virus (MV) infection. According to their vaccination card, 59% of the laboratory-confirmed measles cases had been vaccinated for measles. Compared with non-measles rash disease cases, confirmed measles cases more often had severe illness (P < 0.0001), were dehydrated (P=0.01) at presentation and less likely to recover without complications [OR 0.19 (95% CI 0.09, 0.39)]. There was no difference in death rate (P=0.20). Underweight [weight-for-age Z score (WAZ) <or= -2 SD] was an independent predictor of recovery with complications [OR 0.4 (95% CI 0.2, 0.99)]. Severe measles cases (those who developed diarrhoea, pneumonia, otitis media, encephalitis or haemorrhagic rash) had similar vaccination rates and time intervals since vaccination as uncomplicated measles cases. Although severe measles had lower WAZ-scores (P=0.004), none of the nutritional parameters studied were predictive of outcome. Mortality was higher in the severe measles group [OR 8.8 (95% CI 1.7, 85.2)]. In 11 of 141 confirmed measles cases serological evidence of a recent infection with another virus was found, most commonly varicella zoster virus and dengue virus; spotted fever and rubella were among the most frequent diagnoses in 17 of 47 cases of the non-measles cases.

Adolescent↗

PubMed2004

Measles in Mexico, 1941-2001: interruption of endemic transmission and lessons learned.

In Mexico, measles occurred in a cyclical endemic-epidemic pattern until the early 1970s. Beginning in 1973, routine vaccination augmented by mass vaccination campaigns led to a decrease in the incidence of measles until the 1989-1990 regional pandemic, when the measles attack rate rose to 80 cases per 100000, resulting in 5899 deaths. Since the pandemic, measles elimination efforts in Mexico have resulted in increasing coverage to >95% among children aged 1-6 years with 2 doses of either measles or measles-mumps-rubella vaccine since 1996 and in coverage of 97.6% among children aged 6-10 since 1999. Surveillance data suggest that the transmission of indigenous measles virus was interrupted in 1997. After almost 4 years without measles cases, in April 2000, measles virus was reintroduced into Mexico and 30 laboratory-confirmed cases were reported. Detection of relatively few cases in nonprogrammatic age groups affirms the high immunization coverage and the sensitivity of measles surveillance in Mexico. We conclude that the specific strategies adopted for measles elimination have enabled Mexico to eliminate the endemic transmission of measles.

Adolescent↗

PubMed1993

Secondary measles vaccine failure in healthcare workers exposed to infected patients.

OBJECTIVE: To describe 4 healthcare workers who developed measles despite pre-existing antimeasles antibody levels. DESIGN: Hospital employees working in patient care areas from July through November 1990 were screened for measles antibody levels using a commercially available enzyme immunoassay (EIA). The clinical course and laboratory evaluation of the 4 healthcare workers who developed measles were reviewed. SETTING: An academic tertiary care children's hospital. PARTICIPANTS: A convenience sample of resident physicians, nurses, ward clerks, Child Life workers, physical and occupational therapists, radiology technicians, and housekeeping staff were screened regardless of age, immunization status, or history of measles infection. RESULTS: Of 1,311 employees working in patient care areas, 900 (68.6%) had sera tested for measles antibody. Fourteen (1.5%) were negative, 338 (37.6%) had low positive antibody levels, 372 (41.3%) were mid-positive, and 171 (19%) were high-positive; 5 (0.6%) showed equivocal results. Four healthcare workers vaccinated in the past developed measles. All had positive pre-illness measles antibody levels and all had a significant rise in measles-specific IgG following infection. Three of the them had received at least 2 live measles vaccinations prior to caring for patients with measles. CONCLUSIONS: These cases raise concerns regarding detection of adequate protective measles immunity. We recommend that all healthcare workers observe respiratory precautions in caring for patients with measles.

Antibodies, Viral↗

PubMed1990

Optimal age for measles and mumps vaccination in Australia.

Trivalent measles-mumps-rubella vaccine has recently replaced measles-mumps vaccine in Australia and is recommended as a single dose at the age of 12 to 15 months, with the exception of Aboriginal children in central Australia who are vaccinated at 9 months. The timing of measles vaccination has been controversial not only in Australia but also in the United States, where measles outbreaks continue to occur. This study aimed to determine seroconversion rates for measles-mumps vaccine in children aged 12 to 18 months and to make a recommendation for the timing of vaccination based on seroconversion rates and attack rates. The parents of 425 children aged 12 to 18 months gave consent for their children to have serum collected at the time of measles-mumps vaccination and three months later. The mean age at vaccination of the children who had two serum samples for measles and mumps antibody estimations was 13.9 months (mode, 13.1). The seroconversion rate for measles was 95% (314/329) (95% confidence interval (CI), 92.5% to 97.3%) and for mumps 97% (309/320) (95% CI, 93.8% to 98.1%). There were no statistically significant differences in the rates of seroconversion for measles or mumps related to age in months at the time of vaccination or in post-vaccination measles antibody titres related to age at vaccination. Post-vaccination mumps antibody titres tended to be lower in older vaccinees. None of the children who presented for vaccination had serological evidence of prior measles infection but five had evidence suggestive of prior mumps. As the seroconversion rates for measles and mumps vaccines were very high in these children it was concluded that no advantage resulted from delaying vaccination until 15 months and that the current National Health and Medical Research Council recommendations for vaccination at age 12 to 15 months should remain.

Age Factors↗

PubMed2001

National serologic survey of measles immunity among persons 6 years of age or older, 1988-1994.

CONTEXT: Measles incidence in the United States is at a record low, and indigenous transmission has been interrupted in each year since 1996, suggesting that measles is no longer endemic. A national estimate of measles immunity and an understanding of predictors of measles susceptibility are essential for assuring sustained elimination of endemic disease. OBJECTIVE: To assess patterns of immunity and to determine predictors of susceptibility to measles. DESIGN/SETTING: Sera and data on participants from the third National Health and Nutrition Examination Survey (1988-1994) (NHANES III) were examined. NHANES III was a cross-sectional survey of a representative sample of the civilian, noninstitutionalized population of the United States. POPULATION: 20,100 persons 6 years of age or older were tested for measles-specific immunoglobulin G (IgG) antibody by an enzyme immunoassay. MAIN OUTCOME MEASURE: Participants with serum positive for measles antibody were considered protected or immune to measles disease. RESULTS: Prevalence of measles immunity was 93%. Nearly all persons (99%) born in the prevaccine era (before 1957) were immune. Immunity declined among persons born in the vaccine era (after 1956) to 81% among those born in 1967-1976, and increased again to 89% among those born in 1977-1988. Among persons born in the vaccine era, independent predictors of measles susceptibility varied by birth cohort and included birth in the United States, residence in a noncrowded household, residence in a nonmetropolitan area, and, among males, non-Hispanic white and Mexican American race/ethnicity. Among adults 17 years of age or older, additional predictors of susceptibility included living at or above the poverty line and not currently being married. CONCLUSIONS: Population immunity among persons 6 years of age or older is very high; however, as many as 15 million persons across the United States may lack humoral immunity. While it is unclear that the susceptible population can support continuous, indigenous transmission of measles, providers should follow current recommendations to evaluate the measles susceptibility of patients born in the vaccine era and vaccinate eligible patients.

Adolescent↗

PubMed1997

Measles reimmunization in children seronegative after initial immunization.

OBJECTIVE: To evaluate the success of measles reimmunization in children without measles antibody after the initial dose of measles vaccine. DESIGN AND SETTING: A prospective clinical trial in Olmsted County, Minnesota, and Northern Newfoundland and Labrador in Canada. SUBJECTS: A total of 130 healthy white, Innu, and Inuit schoolchildren. All subjects had received the post-1980 Moraten measles vaccine 4 to 11 years earlier. METHODS: Children previously identified as measles antibody seronegative or equivocal after 1 dose of measles vaccine were entered into the trial and reimmunized. Measles antibody was measured a minimum of 6 weeks later using a whole-virus IgG measles-specific enzyme-linked immunoassay (EIA). RESULTS: Of the 130 children reimmunized, 106 (81.5%) became measles antibody seropositive, but 24 children (18.5%) remained seronegative. Younger age at initial immunization (<13 months vs > or = 13 months) was significantly associated with lack of seropositive antibody levels following reimmunization (odds ratio, 3.9; 95% confidence interval, 1.5-9.7). In addition, antibody levels after reimmunization were significantly reduced with increasing time since initial immunization (P=.001). CONCLUSIONS: After 2 doses of measles vaccine, 98.2% of all subjects in this study were seropositive for measles antibody, despite the fact that almost 20% of children did not have measurable antibodies 4 to 11 years following a first dose. These findings suggest that the current public health policy recommending a 2-dose measles immunization strategy, with the second dose given at school entry, will provide high levels of immunity in the community.

Antibodies, Viral↗

PubMed2005

Evaluating the impact of the HIV pandemic on measles control and elimination.

OBJECTIVE: To estimate the impact of the HIV pandemic on vaccine-acquired population immunity to measles virus because high levels of population immunity are required to eliminate transmission of measles virus in large geographical areas, and HIV infection can reduce the efficacy of measles vaccination. METHODS: A literature review was conducted to estimate key parameters relating to the potential impact of HIV infection on the epidemiology of measles in sub-Saharan Africa; parameters included the prevalence of HIV, child mortality, perinatal HIV transmission rates and protective immune responses to measles vaccination. These parameter estimates were incorporated into a simple model, applicable to regions that have a high prevalence of HIV, to estimate the potential impact of HIV infection on population immunity against measles. FINDINGS: The model suggests that the HIV pandemic should not introduce an insurmountable barrier to measles control and elimination, in part because higher rates of primary and secondary vaccine failure among HIV-infected children are counteracted by their high mortality rate. The HIV pandemic could result in a 2-3% increase in the proportion of the birth cohort susceptible to measles, and more frequent supplemental immunization activities (SIAs) may be necessary to control or eliminate measles. In the model the optimal interval between SIAs was most influenced by the coverage rate for routine measles vaccination. The absence of a second opportunity for vaccination resulted in the greatest increase in the number of susceptible children. CONCLUSION: These results help explain the initial success of measles elimination efforts in southern Africa, where measles control has been achieved in a setting of high HIV prevalence.

Adolescent↗

PubMed2006

Is global measles eradication feasible?

Measles is one of most infectious diseases. Before the introduction of the measles vaccine, practically all children in the long run contracted measles. By the end of the 1980s most countries of the world had incorporated measles vaccine into their routine vaccination programs. Globally, some 800,000 deaths due to measles still occur every year, half of them in Africa. Eradication of measles would play an important role in improving child survival. The goal to eradicate measles from the Americas was set by the Pan American Sanitary Conference in 1994. Progress to date has been remarkable. Measles is no longer an endemic disease in the Americas and interruption of transmission has been documented in most countries. As of August 2005, 3 years have elapsed since the detection of the last indigenous case in Venezuela in September 2002. This experience shows that interruption of measles transmission can be achieved and sustained over a long period of time and that global eradication is feasible if appropriate strategy is implemented. Even in a new paradigm in which eradication is not followed by the discontinuation of vaccination, eradication of measles will be a good investment to avoid expensive epidemics and save the almost one million children that die every year to infection with the measles virus. It is not a dream to think that we will se a world free of measles by the year 2015.

Americas↗

PubMed2002

First 5 years of measles elimination in southern Africa: 1996-2000.

BACKGROUND: Measles is the leading cause of vaccine-preventable death in Africa. Regional measles elimination is considered feasible using current vaccines and a series of WHO-recommended strategies. We aimed to interrupt transmission of measles, and to use case-based surveillance to show the effect of such interruption. METHODS: In southern Africa from 1996, seven countries with a total population of approximately 70 million and with relatively high routine vaccination coverage implemented measles elimination strategies. In addition to routine measles immunisation at 9 months of age, these included nationwide catch-up campaigns among children aged 9 months to 14 years, then follow-up campaigns every 3-4 years among children aged 9-59 months, and the establishment of case-based measles surveillance with serological diagnostic confirmation. RESULTS: Nearly 24 million children aged 9 months to 14 years were vaccinated, with overall vaccination coverage of 91%. Reported clinical measles cases declined from 60000 in 1996 to 117 laboratory-confirmed measles cases in 2000. Reported measles deaths declined from 166 in 1996 to zero in 2000. No increase in adverse events was noted after the measles vaccination campaign. CONCLUSION: A reduction in measles mortality and morbidity can be achieved in very low-income countries, in countries that split their vaccination campaigns by geographical area or by age-group of the target population, and where initial routine measles vaccination coverage among infants was <90%, even when prevalence of HIV/AIDS was extremely high. Continued high-level national commitment will be crucial to implementation and maintenance of proven strategies in southern Africa.

Adolescent↗

PubMed2003

Measles: not just another viral exanthem.

Measles is the most frequent cause of vaccine-preventable childhood deaths. Infants younger than the recommended age for vaccination are susceptible to the disease, and in developing countries they have a high risk of complications and mortality. Vaccine coverage in excess of 95% interrupts endemic transmission of measles in many countries, but achievement of such coverage almost always requires coordinated supplementary mass vaccination campaigns. There are substantial health gains if countries improve measles vaccine coverage, irrespective of whether or not high coverage is achieved; these gains include much lower measles complication and case fatality rates, long-term interepidemic duration, and possibly non-specific improvements in survival of children. Investigation into the cost-effectiveness of different strategies for measles control, including mass campaigns, two-dose schedules, and young-infant doses, would help countries to formulate control policies appropriate to their setting. Pneumonia is the most common fatal complication associated with measles, and at least 50% of measles-related pneumonias are due to bacterial superinfection. WHO has developed standard case management programmes for measles, but there are several unresolved clinical issues, including optimum indications for antibiotic treatment, the importance of intravenous immunoglobulin, the role of viral coinfection, and the risk of tuberculosis after measles. The priority in worldwide efforts to control measles is to lend support to poor countries, helping them to increase vaccine coverage and sustain improvements to vaccination infrastructure, and to address technical issues with respect to optimum vaccination schedules. Measles represents a specific challenge, whereby partnerships between high-income and developing nations would reduce child mortality in developing countries; such partnerships are not without incentive for high-income countries, since without them imported measles cannot be prevented.

Adolescent↗

PubMed1999

Measles elimination: progress and challenges.

The accelerating progress in reducing measles incidence and mortality in many parts of the world has led to calls for its global eradication during the next 10-15 years. Three regions have established goals of elimination of indigenous transmission of measles. The strategy used in the Americas of a mass 'catchup' campaign of children 9 months to 15 years of age, high coverage through routine vaccination of infants, intensive surveillance and follow-up campaigns to prevent excessive build-up of susceptibles has had great success in reducing measles transmission close to zero. However, while these developments are impressive, much remains to be done to reduce measles-associated mortality in western and central Africa, where less than half of children are currently receiving measles vaccine and half a million children die from measles each year. The obstacles to global measles eradication are perceived to be predominantly political and financial. There are also technical questions, however. These include the refinement of measles elimination strategies in the light of recent outbreaks in the Americas; the implications of the HIV epidemic for measles elimination, issues around injection safety, and concerns about the possibility that secondary vaccine failures will contribute in sustaining transmission in highly vaccinated populations. The global priorities are to improve measles control in low income countries, increase awareness among industrialized countries of the importance of measles, and conduct studies to answer the technical questions about measles elimination strategies.

HIV Infections↗

PubMedDate not supplied

Post mass-immunization measles outbreak in Taoyuan County, Taiwan: dynamics of transmission, vaccine effectiveness, and herd immunity.

OBJECTIVES: Analysis of national surveillance data and a seroepidemiologic investigation were conducted to elucidate the causes and epidemiologic characteristics of a measles outbreak in Taoyuan, Taiwan, 1994. METHODS: Measles cases were identified through a national surveillance system. Reported cases and their physician or school nurses were interviewed to trace additional suspect cases and were sampled for serologic diagnosis. Measles-specific IgG and IgM were assayed. A confirmed case was defined as being positive for measles IgM test but not having received measles vaccination within the previous 3 months. RESULTS: The outbreak began in Taoyuan City in December 1993 and continued to spread in primary schools and kindergartens, but caused only sporadic cases in neighboring towns. Among 42 confirmed cases, 15 (38%) were primary school children and 16 (38%) were kindergarten children. Among 24 confirmed cases with a vaccination record, 7 had one dose of vaccination, 4 had two doses of vaccination, and 13 (54%) were unvaccinated. The overall measles susceptible proportion at a kindergarten before the outbreak was 8.1% (17/209) and the overall measles cumulative incidence among susceptibles was 0.65 (11/17). CONCLUSIONS: A measles vaccination coverage of 82% with the first dose at 9 months of age and 63% with the second dose (measles, mumps, and rubella) at 15 months was inadequate to block measles virus circulation in Taoyuan City in 1994. The city center, with a growing population, represents a high risk as an epicenter for measles outbreaks. Measles outbreaks may occur in a school population with 92% herd immunity.

Antibodies, Viral↗

PubMed1995

Measles encephalomyelitis in a patient with a history of vaccination.

Secondary vaccine failure (SVF) of measles is generally believed to run a milder course of illness than an ordinary course of infection. Severe complications such as central nervous system involvement have rarely been reported. A 12 year old girl, who had received a live attenuated measles vaccine 10 years earlier, developed an encephalomyelitis in the absence of symptoms indicative of ordinary measles such as Koplik spots. Anti-measles hemagglutination inhibition (HI) titer and measles IgM and IgG antibody titers were measured in a commercial laboratory. Measles virus genomic sequence was detected by polymerase chain reaction. Both serum and cerebrospinal fluid (CSF) samples obtained at acute phase already showed extremely high titers of HI (x8192 in serum and x1024 in CSF, respectively) and IgG antibody along with the presence of IgM antibody. Polymerase chain reaction detected the measles virus genomic sequence in the acute phase CSF. The patient's definite history of measles vaccination, high titers of HI and IgG antibodies observed at the very early stage of illness and the clinical course indicated that this patient has an encephalomyelitis due to SVF of measles. It is suggested that measles virus can be a pathogen of encephalitis without symptoms indicative of ordinary measles in individuals who received live attenuated measles vaccines.

Child↗

PubMed1994

An outbreak of measles in a highly immunised population: immunisation status and vaccine efficacy.

An outbreak of 18 cases of measles in a primary school in the Australian Capital Territory in August and September 1993 provided the opportunity to study measles immunisation status and measles vaccine efficacy. Parents of 384 (78 per cent) of 491 children answered a questionnaire on recent illness consistent with measles and measles immunisation. Parents transcribed details of measles immunisation from the personal health record of the child to the questionnaire. Thirty-three per cent of cases and 3.4 per cent of the other children had not been immunised. Overall, 95 per cent of children had been immunised. The efficacy for all measles vaccines was estimated to be 90 per cent (95 per cent confidence interval (CI) 75 to 96) and for measles-mumps vaccine 87 per cent (CI 70 to 95). All of the immunised cases had received measles-mumps vaccine. There was no increased risk of measles infection in those who had been immunised at under 15 months of age compared with those immunised at 15 months or older, or in those who could not provide a date of immunisation compared with those who could. None of the children who had received two doses of vaccine caught measles. The date of immunisation was provided by 65 per cent of the respondents who said their children had been immunised. Asking parents to provide this date instead of viewing the health record is a less expensive way of assessing immunisation status but this method needs to be evaluated. Measles outbreaks still occur in highly immunised populations when vaccine efficacy appears to be acceptable.

Australia↗