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PubMed2005

Migration as a risk factor for measles after a mass vaccination campaign, Burkina Faso, 2002.

BACKGROUND: Shortly after a measles supplementary immunization activity (SIA) targeting children from 9 months to 14 years of age that achieved high coverage, Burkina Faso had a large, serologically confirmed measles outbreak. To investigate the causes of this first reported failure of a widely successful measles control strategy we conducted a case-control study. METHODS: Serologically confirmed measles cases aged > or =9 months at the time of the SIA in 6 heavily affected districts were frequency matched on age to 3 controls recruited from people frequenting health centres in the same districts. RESULTS: Between January and July 2002, 1287 measles cases were reported throughout Burkina Faso. Of the 707 cases that were serologically confirmed, 358 (51%) were from 9 months to 14 years of age and 265 (37%) were > or =15 years of age. Among cases and controls from 9 months to 14 years of age significant risk factors for measles were lack of measles vaccination and, in the unvaccinated, recent travel to Cote d'Ivoire. Of the recent measles cases in Cote d'Ivoire 54% were there when exposed to measles. Among adults, risk factors included non-vaccination and the lack of school attendance during childhood. Vaccine effectiveness was estimated to be 98%. CONCLUSIONS: Migration of children between Cote d'Ivoire and Burkina Faso played a major role in the failure of the SIA to interrupt measles transmission. Synchronization of measles control activities should be a high priority in countries with regions where much migration occurs.

Adolescent↗
PubMed1998

Explosive school-based measles outbreak: intense exposure may have resulted in high risk, even among revaccinees.

Even high levels of measles vaccination coverage have not always prevented outbreaks of measles spread by airborne transmission. It has been suggested that a large inoculum might increase vaccine failure risk. Airbome transmission might occasionally entail a large measles inoculum. The epidemiologic relevance of measles among properly vaccinated persons (i.e., those vaccinated after 15 months of age and with live attenuated virus) is increased when they become contagious. The authors studied inoculum intensities as measured by proxy variables and the contagiousness of properly vaccinated persons who contracted measles among 51 measles patients infected in one school, at home, or elsewhere, utilizing preexisting records of measles cases and 214 healthy controls from an explosive school outbreak that occurred in a rural Finnish municipality in 1989. One "super-spreader" infected 22 others in one day, including eight once-vaccinated students and one twice-vaccinated student, probably during an assembly of 144 students in a poorly ventilated hallway with no sunlight. Those infected later at home had high measles risk, even if they were revaccinees. When siblings shared a bedroom with a measles case, a 78 percent risk (seven out of nine children) was observed among vaccinees. Vaccinees had approximately 2 days' shorter incubation time than unvaccinated persons. Vaccinated and unvaccinated students were equally able to infect their siblings. Total protection against measles might not be achievable, even among revaccinees, when children are confronted with intense exposure to measles virus.

Adolescent↗
PubMed2002

Consequences of delayed measles vaccination in Germany.

BACKGROUND: In recent surveillance data there are still many cases of measles and even local epidemics in Germany. We studied whether delayed measles vaccination contributes to this situation. METHODS: Vaccine coverage data in children <3 years of age were assessed by a telephone survey. Three data sources for measles surveillance were analyzed: official measles notifications; sentinel data; and official hospital discharge diagnoses. RESULTS: After the time recommended for completion of measles vaccination at Month 15, only 22% of German children had received their first vaccine dose. This percentage increased to 77% at the age of 24 months and to 87% at 36 months of age. According to all three surveillance instruments, the number of measles cases was highest in children age 1 to 4 years with a peak in the second year of life. CONCLUSIONS: More than 50% of measles cases in 1-year-old children would be prevented if presently observed vaccine coverage rates in the third year of life could be achieved 12 months earlier. Delayed measles vaccination is responsible for a large number of measles cases still occurring in the German population, where measles has not yet been eliminated. If vaccination were delivered according to the recommended time schedule, the incidence of measles would be considerably reduced.

Age Factors↗
PubMed1998

The effect of live measles vaccines on serum vitamin A levels in healthy children.

OBJECTIVE: Serum retinol levels have been shown to be depressed during measles infection. This study aims to demonstrate whether there is any decrease in serum vitamin A level following immunization with live viral vaccine and its relation with vaccine seroconversion in children with measles. Since many children receive measles vaccine alone or in combination with measles-mumps-rubella vaccine, we studied serum vitamin A levels and antibody levels in healthy, well-nourished children before and after immunization with monovalent and combined live attenuated measles vaccine. METHODS: The first group included 21 healthy children between the ages of 9-11 months who received live measles (Schwarz) vaccine. There were also 21 healthy children (range 14-20 months of age) who received measles-mumps-rubella Trimovax (Pasteur Merieux) vaccine. All children were tested for serum vitamin A levels before vaccination, on days 9-14 and 30-42 following both vaccinations. Measles specific antibody levels were also measured on admission and 30-42 days following vaccinations. RESULTS: In both vaccination groups, mean serum vitamin A levels reduced significantly on days 9-14, but increased slightly on days 30-42 in the measles-mumps-rubella vaccinated group (P < 0.05). The baseline and follow-up levels of mean serum vitamin A did not differ between seroconverted and nonseroconverted cases within the measles vaccinated group. CONCLUSION: Serum vitamin A levels are reduced following vaccination with monovalent and combined live attenuated measles vaccines.

Antibodies, Viral↗
PubMed2006

Promoting measles vaccination in attendees not yet immunized at day-care centers in Kyoto City.

BACKGROUND: Due to the low measles vaccination rate, localized measles epidemics occasionally occur in Japan with the majority of sufferers being children under 2 years of age. Despite an increased risk of infection at day-care centers, the measles vaccination coverage for day-care attendees is lower than children who are reared-at-home or attend kindergartens. This study aims to describe the current state of measles prevention policy at day-care centers and to examine factors associated with vaccine promotion. METHODS: A cross-sectional study using anonymous self-administered questionnaires were distributed to the director or person-in-charge at 250 all licensed day-care centers in Kyoto City, Japan, in 2004. The preventive measures against measles at day-care centers and factors related to carrying out the promotion of measles vaccination were examined. Descriptive statistics and odds ratios (OR) using a logistical model were presented. RESULTS: Out of 250 day-care centers, 187 questionnaires were returned (response rate, 74.8%). Measles vaccination history was taken at 161 day-care centers (86.1%) at the time of enrollment; only 61 day-care centers (32.6%) took a history during the school year. A total of 101 day-care centers (54.0%) promoted measles vaccination in day-care attendees who had not yet been immunized. Day-care centers which promoted it were more likely to be 'public facility' (OR, 3.09) and 'having opportunities to learn about vaccination' (OR, 5.55). After adjustment, 'having opportunities to learn about vaccination' and 'having knowledge that measles vaccination is best under the age of 15 months' were significantly related to carrying out the promotion of measles vaccination (OR, 6.47; 95% confidence interval, 2.52-18.61; OR, 3.12; 95% confidence interval, 1.45-6.95, respectively). CONCLUSION: Preventive measures for measles at day-care centers are currently insufficient. Increasing opportunities to learn about vaccination may encourage promotional behavior.

Adult↗
PubMed2004

A new complication of stem cell transplantation: measles inclusion body encephalitis.

Measles inclusion body encephalitis (MIBE) is a disease of the immunocompromised host and typically occurs within 1 year of acute measles infection or vaccination. We report a 13-year-old boy who had chronic granulomatous disease and presented 38 days after stem cell transplantation with afebrile focal seizures that progressed despite multiple anticonvulsants. After an extensive diagnostic evaluation, brain biopsy was performed, revealing numerous intranuclear inclusion bodies consistent with paramyxovirus nucleocapsids. Measles studies including reverse transcriptase-polymerase chain reaction and viral growth confirmed measles virus, genotype D3. Immunohistochemistry was positive for measles nucleoprotein. Despite intravenous ribavirin therapy, the patient died. MIBE has not been described in stem cell recipients but is a disease of immunocompromised hosts and typically occurs within 1 year of measles infection, exposure, or vaccination. Our case is unusual as neither the patient nor the stem cell donor had apparent recent measles exposure or vaccination, and neither had recent travel to measles-endemic regions. The patient had an erythematous rash several weeks before the neurologic symptoms; however, skin biopsy was consistent with graft-versus-host disease, and immunohistochemistry studies for measles nucleoprotein were negative. As measles genotype D3 has not been seen in areas where the child lived since his early childhood, the possibility of an unusually long latency period between initial measles infection and MIBE is raised. In addition, this case demonstrates the utility of brain biopsy in the diagnosis of encephalitis of unknown cause in the immunocompromised host.

Adolescent↗
PubMed2001

Measles epidemiology and outbreak investigation using IgM test in Laos.

Following the Pan American Health Organization (PAHO) recommendation on measles elimination, the Western Pacific Region of WHO (WPR) is emphasizing accelerated measles control programme especially since the achievement of polio eradication in WPR in 2000. This includes upgraded surveillance and mass measles vaccination campaign for children aged 9 months to 4 years. However, there are limited scientific evidences supporting the feasibility of this programme in Laos. To examine measles elimination feasibility in the country, we conducted measles outbreak investigation using immunoglobulin M (IgM). From March 1999 to March 2000, we conducted 7 outbreak investigations. At the outbreak sites, we examined clinical manifestations of cases and collected individual data. About five blood samples were drawn from each outbreak, and IgM antibodies to measles were tested. Of 7 investigated outbreaks, 5 were confirmed as measles, one was chickenpox, and one occurred in the inaccessible area due to flooding. In a village of high land Lao, blood drawn was refused. Of 185 cases, 64 (34.6%) cases were immunized, and 110 (59.5%) were unimunized. The estimated vaccine efficacy is 67.9%. The number of measles cases among school-aged children was 74 (40.0%), which represented 2.5% of the total population in investigated villages. Our findings showed various difficulties of the surveillance and the limited outcomes of mass measles vaccination campaign under the accelerated measles control programme by WPR. Efforts to improve cold chain as well as increasing routine immunization coverage must be the priority of measles control.

Antibodies, Viral↗
PubMed1999

[Progress of speeding up measles control strategies in Anhui].

OBJECTIVE: To speed up measles control program. METHODS: Catching-up immunization campaigns on measles have been conducted among the children aged 1-6 years in three prefectures of Anhui by the end of 1997 and the measles surveillance system was established at the beginning of 1998. IgM antibody of measles and rubella was tested with ELISA and IgG antibody was examined with HI test. RESULTS: The positive rate of measles antibody among children was 100%, GMT increased from 1:18.97 to 1:43.45 after the campaigns. Measles cases in the three districts from January to June 1998 had a 87.71% decrease, comparing with the same period of 1997 with measles outbreak avoided. There were 105(58.01%) cases of measles with positive IgM and 32(17.68%) cases of rubella with positive IgM out of 181 testees having fever and rash illnesses. CONCLUSION: Results indicated the programs as catching-up immunization campaigns on measles and keeping high level of MV immunization, establishing measles surveillance system with improvement of its sensibility together with rubella control program all seemed to be important strategies in speeding up the positive outcome of measles control.

Child↗
PubMed2001

Immune response to measles vaccine in Peruvian children.

OBJECTIVE: To evaluate the immune response in Peruvian children following measles vaccination. METHODS: Fifty-five Peruvian children received Schwarz measles vaccine (about 10(3) plaque forming units) at about 9 months of age. Blood samples were taken before vaccination, then twice after vaccination: one sample at between 1 and 4 weeks after vaccination and the final sample 3 months post vaccination for evaluation of immune cell phenotype and lymphoproliferative responses to measles and non-measles antigens. Measles-specific antibodies were measured by plaque reduction neutralization. FINDINGS: The humoral response developed rapidly after vaccination; only 4 of the 55 children (7%) had plaque reduction neutralization titres <200 mlU/ml 3 months after vaccination. However, only 8 out of 35 children tested (23%) had lymphoproliferative responses to measles antigens 3-4 weeks after vaccination. Children with poor lymphoproliferative responses to measles antigens had readily detectable lymphoproliferative responses to other antigens. Flow cytometric analysis of peripheral blood mononuclear cells revealed diffuse immune system activation at the time of vaccination in most children. The capacity to mount a lymphoproliferative response to measles antigens was associated with expression of CD45RO on CD4+ T-cells. CONCLUSION: The 55 Peruvian children had excellent antibody responses after measles vaccination, but only 23% (8 out of 35) generated detectable lymphoproliferative responses to measles antigens (compared with 55-67% in children in the industrialized world). This difference may contribute to the less than uniform success of measles vaccination programmes in the developing world.

Antibodies, Viral↗
PubMed2000

[Analysis of clinical epidemiology for 208 patients of measles and some lessons learned].

OBJECTIVE: To survey the epidemic patterns and clinical characteristics of a relatively large scale measles epidemic in Shenzhen, 1998. METHODS: Morbidity among permanent and temporary residents in 4 different age groups, related to their history of measles vaccination among the infant cases of 8 month olds among the two types of residents. Using data originated from the hospital documents of 208 measles cases in 1998. RESULTS: Among the total 208 cases: (1) Of 107 cases of temporary residents in age > 8 mon., 79.4% were unvaccinated while 41.7% were unvaccinated among 72 cases of permanent inhabitants in age > 8 mon.; (2) The two peaks fell on 9 month to 5 year olds (32.7%), in which predominant cases were permanent inhabitant, while among the 14 - 36 year group (33.7%) temporary resident accounted for 71.4%; (3) Among 208 cases, there were 29 in 3 - 7 mon. olds, taking up 14.0% of the whole, who all did not receive the vaccinations. Seventeen of the 29 cases (58.6%) of the said children had mothers with positive histories of measles while the infants manifested atypical mild measles. The rest 12 of the 29 cases (41.4%) whose mothers had an negative histories of contracting measles, 4 infants manifested typical measles and 8 atypical mild measles. CONCLUSIONS: (1) One of the main causes of this epidemic was the unsound history of vaccination in the population; (2) In Shenzhen, preventive measures should focus on infants and young children among permanent inhabitants while focusing on adolescents and youths on temporary residents; (3) It was suggested that in Shenzhen, infants born to mothers without measles history or infants at the age borderline for measles immunization but without vaccination should receive it; Women in reproductive ages without measles history or vaccination should be considered as vaccination receivers.

Adolescent↗
PubMed2004

Outbreak of measles amongst vaccinated children in a slum of Chandigarh.

BACKGROUND: An outbreak of measles was reported from a slum, UT, Chandigarh in April 2003. Similar outbreak was also reported in less than three years from the same and adjoining areas. The present study was conducted to investigate and assess various epidemiological features associated with measles outbreak. MATERIAL AND METHODS: Three cases of measles were admitted in Dept. of Paediatrics, Govt. Medical College & Hospital, Chandigarh and were reported to the Dept. of Community Medicine for an outbreak investigation. A trained team investigated the slum having a population of 25,000 and studied various features associated with epidemic between the period of April 22 to May 10, 2003. RESULTS: The study covered 484 houses having 1130 children. Among the children who developed measles 32.76% were vaccinated ones. In them attack rate was 3%. Attack rate in vaccinated children went on increasing as age increased. An overall attack rate of 5.13% (Peak incidence 6% in 1-4 years age group) was recorded. Among measles cases, one-fifth had post measles complications. As much as 32.76% children with measles had received measles vaccination in the past. Therefore something more than immunization by single dose of vaccine is required. Measles was reported to be higher amongst the children without Vitamin A supplementation (P < 0.001). CONCLUSION: There is need to store vaccine properly and to strengthen routine immunization coverage, Vitamin A supplementation and health infrastructure in underprivileged population. Serological studies among vaccinated children against measles should be undertaken to explore the possibility of second dose of measles in older children.

Adolescent↗
PubMed2005

Progress in measles control--Zambia, 1999-2004.

Zambia, a southern African country with estimated population of 11.6 million in 2005, reported 1,698-23,518 measles cases annually during 1991-1999. During that period, measles was considered one of the five major causes of morbidity and mortality among children aged <5 years. During 1999-2004, the challenge of controlling measles led Zambia to try several strategies in succession. In addition to a single dose of measles vaccine offered at age 9 months through routine services, in 1999, measles supplemental immunization activities (SIAs) targeting children aged 9 months-4 years were held in four urban centers. Those activities were followed in 2000 by a subnational measles SIA targeting children aged 9 months-4 years in approximately half of the country's 72 districts. In 2003, Zambia adopted a strategy of accelerated measles control that included strengthening routine vaccination, providing a second opportunity for measles immunization for all children, and conducting case-based surveillance. As part of this strategy, a nationwide measles SIA targeting all children aged 6 months-14 years was conducted in 2003. This report summarizes progress in measles control in Zambia during 1999--2004, as measured through surveillance data, which demonstrates a marked reduction in measles transmission after the 2003 SIA.

Adolescent↗
PubMed2006

Effects of measles-control activities--African region, 1999-2005.

In 1999, of approximately 871,000 deaths from measles worldwide, 61% occurred in sub-Saharan Africa. In 2001, countries in the World Health Organization (WHO) African Region began an accelerated measles-control program to reduce by half by 2005 the number of deaths that were caused by measles in 1999. The African Region accelerated measles-control program was based on four strategies: improving routine vaccinations; providing a second opportunity for measles vaccination through a routine, 2-dose vaccination schedule or through supplementary immunization activities (SIAs); improving measles case management; and establishing case-based surveillance with laboratory confirmation for all suspected measles cases. Seven countries in the region had already completed catch-up SIAs by 2000, before the regional program began; in 2001, additional countries in the region began implementing catch-up, and later, follow-up SIAs, and steps were taken to improve routine vaccination coverage with measles vaccine and other vaccines in the Expanded Programme on Immunization schedule. This report summarizes the nationwide SIAs and other measles-control activities conducted in the WHO African Region during 1999-2004, analyzes the trends in reported measles cases since 1990, and compares the annual number of measles cases reported in 2005 with those reported in 1999.

Africa↗
PubMed1994

Measles associated diarrhea and pneumonia in south India.

A prospective study was undertaken from April 1988 to April 1989, to assess the diarrheal and respiratory complications of measles. Standard definitions were used for the cases, Measles Associated Diarrhea (MAD) and Measles Related Pneumonia (MRP). Children with diarrhea not related to measles were recruited for comparison for MAD. There was a total of 454 cases, measles 53 (11.7%), measles associated diarrhea (MAD) 113 (24.9%), measles related pneumonia (MRP) 186 (41.0%) and MAD with MRP 102 (22.5%). Children under 10 months and 24 months were 11% and 51.5%, respectively. Altogether 215/401 (53.6%) and 288/401 (71.8%) had diarrhea and pneumonia. Children who had been measles vaccinated were 8.4%. The overall case fatality was 4.2%. Case fatality in pneumonia was 1.1%. There was no statistically significant difference between the MAD and diarrhea in relation to religion, water supply, the method of excreta disposal, nutritional status and immunization status other than measles vaccination. There was significant difference in the nature of stools between the two groups, the stools of MAD were more of dysenteric in nature (p < 0.005). Vitamin A deficiency as evidenced by eye signs, was significantly more in MAD than in diarrhea (p < 0.001). It is recommended that Vitamin-A be given to all children with measles, complication due to diarrhea be promptly and adequately treated and to consider measles vaccination earlier than 9 months.

Cause of Death↗
PubMed1977

Immunologic injury in measles virus infection. III. Presence and characterization of human cytotoxic lymphocytes.

Human peripheral blood leukocytes (PBL) from patients with chronic measles virus infection (SSPE) or from immune, adult humans (convalescent from acute childhood measles virus infection) are cytotoxic for target cells infected with measles virus as measured by a 51Cr assay. Specific release of 51Cr by immune PBL occurred both with and without human antibodies added to measles virus-infected cultures. Maximal killing in the absence of added antibodies to measles virus was usually detected only after 15 to 18 hr of incubation and with a high PBL to target ratio (100:1). When antibody to measles virus was added, PBL-mediated killing of virus-infected cells was not blocked. Instead, killing was enhanced and maximal lysis occurred with fewer PBL and a shorter incubation time. This cytotoxic reaction was inhibited in a dose-response manner upon the addition of Fab fragments of IgG containing antibodies to measles virus. On the average 4 to 5 x 105 antibody molecules bound per infected target cell before initiation of antibody-enhanced PBL killing. Depletion of either glass-adhering or E-rosette-forming cells did not reduce PBL killing of measles virus-infected target cells in either system. In contrast, removal of non-E rosette or of EAC rosette-forming population of PBL almost completely abrogated cytotoxicity. When Fc-bearing cells were removed, killing of virus-infected target cells was concomitantly reduced. Lysis of measles virus-infected target cells did not require histocompatibility between the PBL and the target cell. Further, immunospecific lymphocyte killing was not enhanced by such a histocompatibility fit. These experiments indicate first, that the effector PBL involved in lysis of measles virus-infected targets are not T cells but are probably K cells and, second, that PBL obtained from patients with SSPE are competent in killing measles virus-infected targets. Moreover, sera from SSPE patients did not contain a factor(s) that blocked PBL-mediated cytotoxicity.

Antibodies, Viral↗
PubMed1997

Progress toward global measles control and elimination, 1990-1996.

In 1989, the World Health Assembly resolved to reduce measles morbidity by 90% and measles mortality by 95% by 1995, compared with disease burden during the prevaccine era. By 1996, the estimated incidence and death rates for measles worldwide were reduced by 78% and 88%, respectively. In 1990, the World Summit for Children adopted a goal of vaccinating 90% of children against measles by 2000. However, routine measles vaccination coverage has remained relatively stable since 1990, and an estimated 1 million children continue to die from this preventable disease each year. During the 1990s, the widespread use of innovative measles-control strategies in the Region of the Americas and countries such as Mongolia, South Africa, and the United Kingdom demonstrated that high-level measles control and even interruption of transmission is feasible over large geographic areas. This report updates the status of measles control and elimination worldwide and includes disease surveillance and vaccination coverage data received by the World Health Organization (WHO) headquarters in Geneva, Switzerland, as of August 29, 1997. These findings indicate that, in some regions, substantial progress has been made to control and interrupt measles transmission; in others, measles continues to cause high morbidity and mortality because of failure to implement measles-control strategies.

Child↗
PubMedDate not supplied

Evaluation of a two-dose measles, mumps, and rubella vaccination schedule in a cohort of college athletes.

Despite high vaccination levels, measles outbreaks continue to occur among vaccinated adults. In response, new guidelines call for two doses of measles vaccine. To determine seroprevalence and response to vaccination in seronegative persons, we tested serums from 256 college athletes at a Maryland State college by enzyme-linked immunosorbent assay, vaccinated seronegatives, then re-tested vaccinees. High school records were obtained for persons seronegative to measles. Of 256 students, 53 (21 percent) were seronegative to measles alone, 13 (5 percent) were seronegative to rubella alone, and 5 (2 percent) were seronegative to both. Among those seronegative to measles, 86 percent had previously received a dose of measles vaccine. After vaccination, 37 persons initially seronegative to measles and 9 seronegative to rubella were 97 percent and 100 percent seropositive, respectively. The high measles seroconversion rate suggests that the two-dose vaccine schedule should effectively control campus measles outbreaks and, if given as measles-mumps-rubella vaccine, will also improve immunity to rubella and mumps.

Adolescent↗
PubMed1981

Induction of subacute murine measles encephalitis by monoclonal antibody to virus haemagglutinin.

Although the events which predispose a host to measles virus persistence remain largely unknown, measles antibody has been shown to contribute to the production of a persistent infection by this virus both in vivo and in vitro. Thus, the addition of measles antibody to cells infected with measles virus promotes virus persistence. Latent measles infection occurs in newborn hamsters with maternally acquired antibody after inoculation with measles virus in the immediate neonatal period. A subacute encephalitis with measles virus persistence has been induced in weanling BALB/c mice that received antibody after virus inoculation and in measles-immune primates infected with a virus derived from a patient with subacute sclerosing panencephalitis. Measles virus consists of six polypeptides, and treatment of measles-infected cells with antibody has been shown to alter the pattern of their synthesis. As the antigenic specificity of the antibody responsible for these observations is not known, we decided to investigate the effects of monoclonal antibodies directed against the individual measles polypeptides. We report here that a monoclonal antibody directed against the virus haemagglutinin, unlike an antibody to the virus nucleocapsid protein, is able to induce a subacute encephalitis in vivo.

Animals↗