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PubMed2006

[A study on measles epidemic in Sukagawa area, Fukushima Prefecture from 2002 to 2003].

Measles epidemic occurred in southern part of Fukushima Prefecture from April 2002 to July 2003. Public Iwase hospital in Sukagawa City was the central hospital in the measles epidemic area and 382 patients with measles were admitted to the hospital during the epidemic. Based on clinical records, age distribution, vaccination history, familiar infection and complications were retrospectively investigated. Moreover, the vaccination rates and their calculating methods in the area were compared and the problems on immunization against measles were discussed. As the result, we found that 1) measles epidemic centered on unvaccinated infants, 2) measles was still serious disease with many complications and sometimes fatal, 3) measles was highly infectious and there was no way for prevention except vaccination, 4) the actual condition of measles vaccination was not reflected exactly by the current calculating methods used for the local health reports by the Ministry of Health Labour and Welfare. For the prevention of measles epidemic, it is necessary to know the exact numbers of patients infected with measles and patients deceased due to measles, to calculate precise vaccination rate, and to form the consensus among parents, physicians and administrators to control measles epidemic by the vaccination.

Child↗
PubMed2002

Measles in bone marrow transplant recipients during an outbreak in São Paulo, Brazil.

In 1997, a measles outbreak was identified in São Paulo. Between February and December, 20 185 cases were confirmed. From April to July 1997, a seroepidemiologic survey was conducted to identify the recipients of bone marrow (BM) transplants who were susceptible to measles and the occurrence of measles in this population. A total of 156 patients were screened by enzyme immunoassay (EIA). Patients with IgG titers more than 100 mIU/mL were considered immune. Measles reimmunization records were also reviewed. Thirty-two vaccinated patients underwent serologic evaluation. Six of 22 patients (27.3%) within 3 years after vaccination lost measles immunity, in contrast to 7 of 10 patients (70%) vaccinated longer than 3 years previously (P =.049). Among the 122 nonvaccinated patients, 41 (33.6%) were susceptible to measles: 4 of 47 patients (8.5%) within the first year after BM transplantation (BMT), and 37 of the 75 patients (49.3%) after the first year after BMT (P <.001). Eight recipients acquired measles, confirmed by serology (EIA). High-avidity IgG antibodies were observed in the acute phase of measles, suggesting a secondary immune response. Measles interstitial pneumonia was observed in one patient. Seven patients had mild symptoms. Exanthema was present in all patients. All but one patient had fever and nonproductive cough. Koplik spots could be observed in 5 patients. Measles can be mild in BM transplant recipients. Exanthema is frequently present but not often typical. Immunity to measles decreases after day +365 after BMT. Additional studies are needed to evaluate the safety of measles vaccine after the first year of BMT, mostly during outbreaks.

Adolescent↗
PubMed2003

Measles trends and vaccine effectiveness in Nairobi, Kenya.

OBJECTIVES: To determine morbidity and mortality from measles and to estimate measles vaccine effectiveness among children hospitalised with measles in two hospitals in Nairobi. DESIGN: A review of hospital records (index cards). SETTING: Kenyatta National Hospital and Mbagathi District Hospitals covering the years 1996-2000. METHOD: A review of index cards for measles morbility and mortality was undertaken in the two hospitals. Measles data at the Kenya Expanded Programme on Immunisation covering both hospitals was analysed for vaccine effectiveness. RESULTS: The incidence of measles was unusually high in 1998 between July and November (monthly range 130-305), reflecting on the occurrence of an outbreak at that time. There was no definite monthly incidence trend of measles in 1996,1997, 1999 and 2000. The median age of cases was 13 months (range 0-420 months) for Kenyatta hospital and 18 months (range 1-336 months) for Mbagathi Hospital. Significantly, 29.8% of all cases were aged below nine months when routine immunisation for measles had not begun. The median number of days spent in hospital were five days (range 0-87 days) for Kenyatta and four days (range 1-13 days) for Mbagathi. The overall case fatality rate was 5.6% and was similar for both males and females. The overall measles vaccine effectiveness among measles cases admitted to Kenyatta and Mbagathi Hospitals was 84.1%. CONCLUSION: The case admissions in Kenyatta and Mbagathi Hospitals suggest measles was prevalent in Nairobi over the latter half decade of the 1990's. Apart from 1998 when there was an outbreak, the seasonality of measles was dampened. The 1998 outbreak suggests a build up of susceptible children the majority of whom were born in the last quarter of 1996. The high mortality may have had to do with the majority of cases presenting late when symptoms were already complicated and severe.

Child Mortality↗
PubMed2000

Enhanced measles surveillance during an interepidemic period in Victoria.

OBJECTIVE: To describe results of the first two years of enhanced measles surveillance in Victoria. DESIGN: Case series identified through enhanced measles surveillance. PARTICIPANTS AND SETTING: All measles cases notified to the Disease Control Section, Department of Human Services, Victoria, in 1997 and 1998. MAIN OUTCOME MEASURES: Proportion of notified cases laboratory confirmed as measles, rubella, or human parvovirus infection; identification of clusters (two or more linked cases of measles); and utility of the National Health and Medical Research Council clinical case definition for suspected measles. RESULTS: Rates of laboratory testing of notified cases improved after introduction of a paediatric phlebotomy service in July 1997, from 21 of 90 notified patients (23%) in the preceding six months, to 258 of 317 notified patients (81%) between July 1997 and December 1998. Of the 317, only 19 (6%) were laboratory confirmed with measles, while a further 26 (8%) were laboratory confirmed with human parvovirus infection (18) or rubella (8). Three clusters of measles, involving 11 cases, were identified during 1998. Use of the NHMRC case definition did not greatly improve the positive predictive value for diagnosis of measles above that of notification alone (14% versus 8%). CONCLUSIONS: Circulation of measles virus in Victoria in 1997 and 1998 appeared minimal. In this interepidemic period most notified cases of measles were not measles; to identify true cases, surveillance during an interepidemic period must include laboratory testing of notified cases.

Adolescent↗
PubMed2003

Update: global measles control and mortality reduction--worldwide, 1991-2001.

Despite international recognition of the high burden of disease associated with measles and the existence for 40 years of a safe, effective, and inexpensive vaccine, measles remains the leading cause of vaccine-preventable childhood mortality. In 1990, the World Summit for Children adopted a goal of vaccinating 90% of the world's children against measles by 2000 (1). In 2001, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) developed the Global Measles Strategic Plan for 2001-2005. The plan's objectives are 1) to decrease the annual number of measles deaths by 50% by 2005 compared with 1999 levels (875,000 deaths), 2) to achieve and maintain interruption of indigenous measles transmission in large geographic areas with elimination goals, and 3) to convene a global consultation in 2005 to review progress and assess the feasibility of global measles eradication. In May 2002, the United Nations General Assembly Special Session on Children also resolved to reduce measles deaths by 50% by 2005 compared with 1999 levels. This report describes progress toward eliminating measles worldwide. Data from WHO's Global Burden of Disease (GBD) project indicate that approximately 1.7 million vaccine-preventable childhood deaths occurred in 2000, of which 777,000 (46%) were attributed to measles. The measles deaths occurred overwhelmingly among children living in poor countries with inadequate vaccination services. To prevent these deaths, stronger political commitment is needed to provide all children worldwide with two opportunities for measles immunization.

Global Health↗
PubMed1977

Is multiple sclerosis an age-dependent host response to measles?

A hypothesis is presented that multiple sclerosis (MS) may represent an unusual host response to measles virus, dependent upon when the measles virus is acquired. If acquired late in childhood or near adolescence, the risk of MS is increased. Evidence to support this hypothesis is still meager, but there is ample support from many types of infection for the idea that a host's response may vary with age at the time of infection. As measles virus titers are somewhat increased in MS, evidence for age-dependent alteration in host responsiveness to measles may be taken as further support for the hypothesis. In addition, epidemiologic and clinical data linking MS frequency and average age at the time of measles infection exist. In those areas where MS is rare, measles tends to occur early in life; where MS is common, measles tends to occur later. In case-control studies, measles occurred later in MS patients than in the control groups. Finally mechanisms which might explain an age-dependent alteration in host responsiveness were considered, including maturation of an immune system or maturation of a CNS target cell, e.g. the oligocyte. Additional studies are needed to establish a firmer basis for the concept that risk of MS might be determined, in part, by the age at which a certain infection (e.g. measles) is acquired. If the hypothesis is correct, the mass measles vaccination programs should start to produce a decline in MS frequency. Because the event causing MS is believed to occur before age 15 and MS begins on the average by age 30, a 15-year lag in the effect of measles vaccine on MS frequency is to be expected. Mass measles vaccination was began in 1965, thus by 1980, a decline in MS frequency might be looked for as a test of the hypothesis. Perhaps by the V Pan-American Congress of Neurology, we shall be able to report that MS is disappearing.

Adolescent↗
PubMed1995

Early loss of passive measles antibody in infants of mothers with vaccine-induced immunity.

BACKGROUND: Maternally derived passive measles antibody may interfere with vaccine-induced immunity in infants less than 12 months of age. However, early loss of passive measles antibody may occur in infants of women who received measles vaccine because measles vaccine induces lower antibody titers than does natural infection. METHODS: Persistence of passive neutralizing measles antibody was studied longitudinally in a group of normal infants as a function of maternal measles titer at birth and maternal date of birth. Maternal serum and cord blood specimens were tested from 162 women and their newborns, from 51 of these infants at 9 months of age and from 63 at 12 months of age. RESULTS: Seventy-one percent of sera from 9-month-old infants (36 of 51, 95% confidence interval 68% to 84%) and 95% of samples from 12-month-old infants (60 of 63, 95% confidence interval 89% to 101%) had no detectable neutralizing measles antibody. Measles geometric mean titers were significantly higher at delivery in mothers whose infants were seropositive at 9 and 12 months compared with mothers whose infants were seronegative at 9 and 12 months. All infants with detectable measles antibody at 9 or 12 months had mothers born before 1963, before the vaccine era, and both material and cord blood measles geometric mean titers decreased significantly with decreasing maternal age. CONCLUSIONS: Persistence of passive measles antibody is uncommon by 12 months of age; earlier antibody loss is related to lower maternal age and maternal measles titer.

Antibodies, Viral↗
PubMed1994

The impact of college prematriculation immunization requirements on risk for measles outbreaks.

OBJECTIVE: To assess whether prematriculation immunization requirements (PIRs) affect the number of measles cases on college campuses. DESIGN: We surveyed a stratified random sample of 880 colleges and universities to determine their immunization policies and practices and occurrence of measles outbreaks from 1988 through 1991. We merged national measles surveillance data with survey data by county to determine the risk for measles introduction on college campuses. We used logistic regression methods to estimate the effect of PIRs and assess risk factors for college measles outbreaks. SETTING: A total of 3205 US colleges and universities listed in standard guides. RESULTS: Of selected schools, 91 (11%) of the 796 responding schools reported one or more measles cases occurring from 1988 through 1991. Schools with a state-mandated PIR were significantly less likely to report measles outbreaks of two or more cases than other institutions (adjusted relative risk [RR] = 0.30; 95% confidence interval [Cl], 0.11 to 0.84). None of the 14 schools that reported outbreaks of 10 or more cases was subject to state regulation or had a PIR specifying two doses of measles vaccine in place. Of schools with introduction of measles, residential colleges were more likely to report extensive spread of measles (five or more cases) than nonresidential colleges (RR = 35.8; 95% Cl, 2.08 to 617.0). Of public schools, 4-year programs had a higher risk of a large outbreak (five or more cases) than 2-year programs. CONCLUSIONS: These results strongly support current recommendations for requiring proof of vaccination of college students to decrease the risk for measles outbreaks on college campuses. State regulations mandating PIRs ensure the best protection against widespread measles transmission.

Adolescent↗
PubMedDate not supplied

Worldwide measles prevention.

Prior to measles vaccine use, measles accounted for over 2.5 million deaths annually. Measles epidemiology in the developed countries is different from that in less developed countries. Whereas in the developing world, measles is a disease primarily of young children, particularly infants in urban areas, in the developed world, school-age children > 5 years old play a greater role. Prevention of measles in developing countries has relied principally on a single dose of Schwarz strain vaccine at age 9 months (> 85% efficacy); 80% coverage has prevented > 1.6 million deaths. However, problems have been encountered because of the narrow window to deliver vaccines between the time an infant becomes susceptible and exposure to disease. Recent studies suggest that some strains of measles vaccines given at potencies 10-100 times higher than standard vaccines may achieve good efficacy in infants aged 4-6 months, but safety of these vaccines has been questioned. Widespread use of standard vaccines in the West has resulted in dramatic reductions in measles incidence but has not prevented outbreaks among the 2-5% of persons not protected by a single dose. Such outbreaks often appear after extended periods either without measles or with low measles incidence. A single dose appears adequate to control measles well but inadequate to eliminate the disease. Many developed countries have adopted two-dose schedules. Measles immunization has dramatically reduced measles occurrence, but improved control is necessary to prevent the estimated 1 million deaths still occurring each year.

Child↗
PubMed1996

Outbreak of measles in a highly vaccinated secondary school population.

OBJECTIVE: To examine the factors associated with measles vaccine effectiveness and the effect of two doses of vaccine on measles susceptibility during an outbreak. DESIGN: Retrospective cohort study. SETTING: A secondary school in the City of Toronto. SUBJECTS: The entire school population (1135 students 14 to 21 years of age). MAIN OUTCOME MEASURES: Risk of measles during an outbreak associated with age at first measles vaccination, length of time since vaccination, vaccination before 1980 and whether date of vaccination was estimated; vaccine efficacy of one dose versus two doses. RESULTS: Eighty-seven laboratory-confirmed or clinically confirmed cases of measles were identified (for an attack rate of 7.7%). The measles vaccination rate was 94.2%, and 10% of the students had received two doses of measles vaccine before the outbreak. Among those who had received only one dose of vaccine, vaccination at less than 15 months of age was associated with vaccine failure (relative risk 3.62, 95% confidence interval 2.32 to 5.66). There was no increased risk of vaccine failure associated with length of time since vaccination once the relative risk was adjusted for age at vaccination in a stratified analysis. Vaccination before 1980 and an estimated date of vaccination were not associated with increased risk of vaccine failure. Administration of a second dose of vaccine during the outbreak was not protective. Two doses of vaccine given before the outbreak conferred significant protection, and the relative risk of failure after one dose versus two doses was 5.0 (95% confidence interval 1.25 to 20.15). Of the 87 cases, 76 (87%) could have been prevented had all the students received two doses of measles vaccine before the outbreak, with the first at 12 months of age or later. CONCLUSIONS: Delayed primary measles vaccination (at 15 months of age or later) significantly reduced measles risk at later ages. However, revising the timing of the current 12-month dose would leave children vulnerable during a period in which there is increased risk of complications. The findings support a population-based two-dose measles vaccination strategy for optimal measles control and eventual disease elimination.

Adolescent↗
PubMed1998

[Measles outbreaks in the Bern canton].

Currently, overall vaccination coverage against measles among infants ranges between 77% and 89% in Switzerland. Experience in other countries has shown that this level of vaccination is not sufficient to prevent measles outbreaks, especially among schoolchildren. During 1992 surveillance for measles outbreaks in closed populations was conducted in the Canton of Berne. Outbreaks were investigated for vaccine efficacy. Two measles outbreaks in schoolchildren were observed during the study period. In 2 Bernese suburban schools 6 measles cases in children (median age 12.5 years) occurred over a period of 37 days. One of the cases had been vaccinated. Vaccination rate in the healthy control children was 89.7%. Estimated vaccine efficacy was 97.7% (95% confidence interval [CI]: 68%, 99%). The second outbreak occurred in a rural region and comprised 21 measles cases (median age 7.5 years) within 43 days. 10 (47.6%) of the cases attended the same school. None of the cases had been vaccinated. Of the healthy control children 82.6% had received measles vaccine. Estimated vaccine efficacy was 100% (CI: 87%, 100%). These two measles outbreaks were due to failure to vaccinate rather than low vaccine efficacy. Surveillance for measles cases is currently not sufficient for the detection of measles outbreaks in our population. Laboratory confirmation of measles, especially in vaccinated persons, has become more important in a time of relatively low measles incidence.

Adolescent↗
PubMed2004

Humoral and cell-mediated immune responses to an early 2-dose measles vaccination regimen in the United States.

BACKGROUND: Shifts in peak measles incidence to children <12 months old and the associated high mortality support the study of an early 2-dose measles vaccine regimen. METHODS: Fifty-five infants were vaccinated with measles vaccine at age 6 (n=32) or 9 (n=23) months, followed by measles-mumps-rubella (MMR)-II vaccine at age 12 months. A control group received MMR-II only at age 12 months. Measles-specific humoral and cell-mediated immunity were evaluated before, 12 weeks after measles immunization, and 24 weeks after MMR-II. RESULTS: Measles-specific T cell proliferation after both doses of vaccine was equivalent, regardless of age or the presence of passive antibodies. Seroconversion rates, geometric mean titers, and the percentage of infants with antibody titers >120 mIU after the first measles vaccine were lower in infants vaccinated at age 6 months, regardless of the presence of passive antibodies, but measles humoral responses increased after the administration of MMR-II vaccine in children initially vaccinated at age 6 or 9 months. CONCLUSION: Measles vaccination elicits T cell responses in infants as young as 6 months old, which may prime the humoral response to the second dose. Initiating measles vaccination as an early 2-dose regimen results in an immunologic response that is likely to have clinical benefits in developed and developing countries.

Antibodies, Viral↗
PubMed1989

Impaired human leukocyte antigen-restricted measles virus-specific cytotoxic T-cell response in subacute sclerosing panencephalitis.

The capacity of peripheral blood lymphocytes to proliferate in response to measles virus and to generate measles virus-specific cytotoxic T lymphocytes (CTL) was examined in 4 patients with subacute sclerosing panencephalitis (SSPE). The lymphoproliferative response to measles virus was obtainable in the 4 SSPE patients. In contrast, the CTL response to measles virus was reduced in 3 of the 4 SSPE patients. This defect appeared to be in the generation of the measles virus-specific CTLs, since measles virus-infected target cells from the patients could be lysed by human leukocyte antigen-matched peripheral blood lymphocytes from healthy individuals. The SSPE patients with reduced measles virus CTL response had a normal ability to generate mumps virus, influenza virus, or alloantigen-specific CTLs. The lysis of measles virus-infected targets that was observed with these SSPE patients could be reduced by depleting the effectors of natural killer cells or by performing cold target blocking with K562 cells, indicating that the lysis of the measles virus-infected targets was probably mediated by natural killer cells. These results demonstrate a reduction in the cell-mediated immune response to measles virus as measured by the generation of measles virus-specific CTLs in 3 of the 4 SSPE patients studied. This defect could relate to the persistence of measles virus in these patients.

Adolescent↗
PubMed2004

Epidemiological study of measles in slum areas of Kolkata.

OBJECTIVE: An epidemiological study on measles was conducted among the under five children in slum areas of Kolkata to assess the incidence of measles. METHODS: 20 cluster sampling technique was followed and in each cluster 250 under five children were covered. Paramedical workers identified children of the target of age group who had history of measles in past one year and the medical officer confirmed the diagnosis following standard case definition. RESULTS: Incidence of measles was found as 5.76%. Incidence was equal in both the sex groups, but found more among infants. The incidence of measles gradually declined with the increase of age strengthening the view in favor of early immunization. Amongst the measles cases only 19.7% were immunized with measles vaccine. 100% of measles cases gave history of rash, 98.9% had history of fever, 82.8% reported that the rash started from face and progressed downwards to abdomen and leg. Cough, redness of eye and discoloration of skin were reported by 97.5%, 83.8% and 65.2% measles cases respectively. Only 16.9% and 8.6% children received Vitamin A oil before and after the illness respectively. 49% gave history of exposure to measles cases and 46.6% cases had measles within 2 weeks incubation period. CONCLUSION: The study highlighted the necessity of timely measles vaccine coverage, additional dose at a higher age and Vitamin A supplementation through IEC activities.

Age Distribution↗
PubMed2000

SLAM (CDw150) is a cellular receptor for measles virus.

Measles virus continues to be a major killer of children, claiming roughly one million lives a year. Measles virus infection causes profound immunosuppression, which makes measles patients susceptible to secondary infections accounting for high morbidity and mortality. The Edmonston strain of measles virus, and vaccine strains derived from it, use as a cellular receptor human CD46 (refs 3, 4), which is expressed on all nucleated cells; however, most clinical isolates of measles virus cannot use CD46 as a receptor. Here we show that human SLAM (signalling lymphocyte-activation molecule; also known as CDw150), a recently discovered membrane glycoprotein expressed on some T and B cells, is a cellular receptor for measles virus, including the Edmonston strain. Transfection with a human SLAM complementary DNA enables non-susceptible cell lines to bind measles virus, support measles virus replication and develop cytopathic effects. The distribution of SLAM on various cell lines is consistent with their susceptibility to clinical isolates of measles virus. The identification of SLAM as a receptor for measles virus opens the way to a better understanding of the pathogenesis of measles virus infection, especially the immunosuppression induced by measles virus.

Animals↗
PubMed2004

Measles hospitalizations, United States, 1985-2002.

Cases of measles that require hospitalization are a good marker of the burden of clinically severe measles in the United States. Measles hospitalizations routinely are monitored by the National Notifiable Disease Surveillance System (NNDSS). Our objectives were to describe measles hospitalizations reported to the NNDSS in 1985-2002, to use hospital discharge data from independent data sets (the National Hospital Discharge Survey [NHDS] [data available for 1985-1999] and the Health Care Investment Analysts [HCIA] hospital discharge database [data available for 1985-1996]) to provide additional estimates of total measles hospitalizations, and to compare trends in measles-associated hospitalizations. In 1985-2002, a total of 13621 patients with measles reported to the NNDSS were hospitalized (annual average, 757; range, 19-5856 patients). In 1985-1996, a total of 13472 measles hospitalizations were reported from NNDSS, compared with 28047 estimated from the NHDS and 19352 extrapolated from HCIA data. In the NNDSS, the annual total number declined after 1992 to <or=45 measles hospitalizations per year; this trend was closely paralleled by both the NHDS and the HCIA data. We demonstrate a decline in reported measles hospitalizations since the 1989-1991 measles resurgence, with the lowest numbers ever reported in the NNDSS. These numbers are corroborated by the very low numbers of measles hospitalizations in the NHDS and HCIA data.

Disease Notification↗
PubMed1998

The interruption of transmission of indigenous measles in the United States during 1993.

BACKGROUND: The United States has a goal to eliminate all indigenous cases of measles by the year 2000. Initial interruption of indigenous measles transmission would be expected during a period of very low measles incidence as occurred during late 1993. METHODS: Indigenous measles cases (i.e. cases acquired in the United States and not traceable to any imported case) from 1993 were investigated to determine their source of infection. The probability of sustained undetected measles transmission between isolated indigenous cases was estimated. RESULTS: Of the 312 measles cases reported for 1993, only 25 (8%) occurred after September 19. Of these only 4 cases (16%) could be classified as indigenous. The estimated probability that any of these 4 cases resulted from indigenous measles transmission in theirs or any adjoining counties was 0.05 or less. CONCLUSIONS: Interruption of indigenous measles transmission appears to have occurred for the first time throughout the United States in 1993. This event provides strong support for the current national strategy for measles elimination. However, complete elimination of indigenous measles will require maintaining high population immunity to prevent spread from imported cases and attaining global measles control to prevent the importation of measles.

Adolescent↗
PubMed2001

Measles: how many hospitalised cases are we missing?

We aimed to determine whether the Victorian measles surveillance system had missed hospitalised cases of measles during an inter-epidemic period. We searched the Victorian Inpatient Minimum Dataset (VIMD) for the period 1 January 1997 to 30 June 1998 to identify patients with ICD-9 discharge codes for measles (055). The data were compared with that held in the Victorian measles surveillance dataset. The hospital case notes of patients identified in the VIMD but not in the measles surveillance dataset were reviewed systematically to determine whether the patients met case definitions for laboratory-confirmed or clinically compatible measles. Sixteen admissions (15 patients) were identified with a measles ICD-9 code. Eight patients were not identified in the measles surveillance dataset. Of these, one was a laboratory confirmed case of measles and two met a clinical case definition but all should have been notified to the Department of Human Services as suspected cases. While the small number of missed notifications is encouraging in terms of overall measles surveillance, it highlights important deficiencies in the awareness of hospital staff of their role in the control of measles, particularly as Australia moves towards the elimination of measles.

Adult↗