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PubMed2000

Recent increase in the frequency of infant measles in Japan.

BACKGROUND: Because there has been no major outbreak of measles in Japan during the last decade, subclinical boosting of pre-existing immunity by exposure to epidemic measles is unlikely to have occurred. Consequently, the measles immunity of mothers of this generation is less well developed and they provide less effective passive immunity to their infants. An increase in the frequency of infant measles is therefore probable. METHOD AND RESULTS: A retrospective review was undertaken of the clinical records of all measles cases that occurred in the last 3 years in eight hospitals and two out-patient clinics in Hokkaido. Of 541 recorded cases, 96 (17.7%) were infants and of these, 66 patients (68.8%) were over 9 months of age. Only 20 children had received measles vaccination. CONCLUSION: There has been a recent increase in the frequency of infant measles, suggesting an increased population of infants susceptible to measles before the age of 1. Of the older patients, 95% had not been vaccinated against measles. Increasing the rate of measles vaccination may help suppress future measles outbreaks and assist in protecting infants until they pass their first birthday.

Adolescent↗
PubMed2005

Neonatal measles immunity in rural Kenya: the influence of HIV and placental malaria infections on placental transfer of antibodies and levels of antibody in maternal and cord serum samples.

INTRODUCTION: Young infants are protected from measles infection by maternal measles antibodies. The level of these antibodies at birth depends on the level of antibodies in the mother and the extent of placental transfer. We investigated predictors of levels of measles antibodies in newborns in rural Kenya. METHODS: A total of 747 paired maternal-cord serum samples (91 from human immunodeficiency virus [HIV]-infected and 656 from HIV-uninfected mothers) were tested for measles immunoglobulin G antibodies. Placental malaria infection was determined by biopsy. Data on pregnancy history, gestational age, and anthropometric and socioeconomic status were collected. RESULTS: Infants born to HIV-infected mothers were more likely (odds ratio, 4.6 [95% confidence interval {CI}, 2.2-9.7]) to be seronegative and had 35.1% (95% CI, 9.8%-53.2%) lower levels of measles antibodies than did those born to HIV-uninfected mothers. Preterm delivery, early maternal age, and ethnic group were also associated with reduced levels of measles antibodies. There was little evidence that placental malaria infection was associated with levels of measles antibodies in newborns. CONCLUSION: Our results suggest that maternal HIV infection may reduce levels of measles antibodies in newborns. Low levels of measles antibodies at birth render children susceptible to measles infection at an early age. This is of concern in sub-Saharan African countries, where not only is the prevalence of HIV high, but measles is the cause of much morbidity and mortality.

Adolescent↗
PubMed1999

Transmission of measles virus in healthcare settings during a communitywide outbreak.

OBJECTIVE: To describe the epidemiology of measles in medical settings and to evaluate the implementation and effectiveness of the 1989 Advisory Committee on Immunization Practices (ACIP) guidelines for measles immunization in healthcare workers (HCWs). DESIGN: Confirmed cases of measles reported in Clark County, Washington, from March 14 to June 2, 1996, were analyzed for characteristics of cases occurring in medical settings. A questionnaire was used to assess employee immunization (95% response rate). SETTING AND PARTICIPANTS: Reported measles cases and HCWs at community hospitals, primary-care medical facilities, a health-maintenance organization, and a multispecialty group practice. RESULTS: Of 31 cases of measles, 8 (26%) occurred in HCWs, and 5 (16%) occurred in patients or visitors to medical facilities. Cases of measles occurred in HCWs who were not required to have proof of measles immunity as defined by the 1989 ACIP guidelines. The relative risk of measles in HCWs compared to Clark County adults was 18.6 (95% confidence interval, 7.4-45.8; P<.001). A survey of medical facilities revealed that 47% had an employee measles immunization policy; only 21% met ACIP recommendations and enforced their policies. CONCLUSIONS: HCWs were at higher risk of measles than the adult population. Transmission of measles in medical settings was related to both deficiencies in, and lack of implementation of, the ACIP guidelines.

Adolescent↗
PubMedDate not supplied

Malnutrition and overcrowding/intensive exposure in severe measles infection: review of community studies.

Most hospital studies of measles mortality suggest that high case fatality ratios are associated with malnutrition. However, no community study has documented this association. On the contrary, several community studies from Africa and Asia have found no relation between nutritional status and risk of severe or fatal measles. Instead, overcrowding and intensive exposure may be more important determinants of measles mortality. Clustering of several cases in the family and/or intensive exposure were associated with high measles mortality in community studies in West Africa, Bangladesh, and England. Thus sociocultural factors that concentrate many susceptible children in the home may increase the case-fatality ratio in measles. Conversely, this ratio will be lower when measles cases are dispersed. Siblings in rural areas, where long intervals separate epidemics, run a higher risk of contracting measles simultaneously than do their urban counterparts. Measles vaccination increases herd immunity and diminishes the clustering of several cases in a family. Vaccination may therefore reduce mortality even among unvaccinated children who contract measles. Crowding and intensive exposure may partly explain regional and historical variations in measles mortality; community studies suggest that mortality is high when a high proportion of measles patients have secondary cases (acquired through exposure at home).

Crowding↗
PubMed2000

Measles infection in HIV-infected African infants.

Measles infection remains a serious threat to child survival in the developing world despite vaccination and treatment with vitamin A. This report reviews the epidemiology of measles in HIV-infected children in Africa. In hospitalized infants, the rate of malnutrition before measles and the rate of death after measles are both higher in HIV-positive than in HIV-negative infants. However, the rates of pneumonia and diarrhea in infants hospitalized with measles are the same in HIV-positive as in HIV-negative infants. In an autopsy study, measles was associated with death in HIV-positive children, only for those over 15 months of age. A cohort study found that infants of HIV-positive women were more likely than infants of HIV-negative women to have measles before 9 months of age, although the rates of complications did not differ between the two groups. The HIV status of the infants and the measles serology were too incomplete to draw firm conclusions, though only 1 of 54 infants tested was seropositive for measles at 6 months of age. In the context of the HIV epidemic, further work is needed to determine the risk of measles and its complications in HIV-positive infants and the optimal age of measles immunization.

Africa↗
PubMed2005

Impact of emergency mass immunisations on measles control in displaced populations in Gulu district, northern Uganda.

OBJECTIVE: To assess the impact of supplemental mass measles immunisations. DESIGN: Retrospective study of hospital and health centre records. SETTING: Gulu district, Northern Uganda, having approximately 81% of the population living in internally displaced persons' (IDPs) camps. RESULTS: The mean age in months for 4,812 measles cases seen was 28.2 +/- 46.0 (p < 0.0001). Supplemental mass immunisations in 1997 and 2000 caused a 91% reduction of measles cases, 93% reduction of mortality, 91% reduction of bed-days and 79% reduction of outpatient cases. There was a 67% reduction in mean measles case admissions, 63% reduction in mean measles mortality, and 73% reduction in mean measles bed-days following district mass measles immunisations in 1997. However, following IDPs camps supplemental immunisations in 2000; there was 82% reduction of mean measles case admissions, 80% reduction of mean measles mortality and 88% reduction of mean measles bed-days. CONCLUSIONS: In similar situations, supplemental mass measles immunisations should be focused on IDPs camps with a wide age group in addition to improved routine immunization activities in the entire district.

Adult↗
PubMedDate not supplied

The 1991 measles epidemic in Israel.

INTRODUCTION AND METHODS. Prior to the institution of universal childhood vaccination against measles in Israel in 1967, large outbreaks occurred in epidemic cycles at intervals of 2-4 years. The mean annual incidence in the pre-vaccination period, 1950-66, was 470/100,000 per year. With the institution of routine measles vaccination, incidence rates fell, and since 1970 measles incidence has averaged less than one-tenth the pre-vaccination incidence rate, although epidemics occurred in 1975, 1982, 1984-85, and 1991. In this report, based upon cases of measles reported to and investigated by the Ministry of Health, we present an analysis of the 1991 measles epidemic, the measures taken to contain it, and an overview of the prospects for measles control in Israel in the future. RESULTS AND CONCLUSIONS. The 1991 measles epidemic, 1036 reported cases (incidence: 20.0/100,000), began in the south of the country among underimmunized Beduin children and spread to the Jewish population in the south and then to the rest of the country. The highest incidence was in children aged 12-23 months, followed by children less than 12 months of age and children aged 2-4 years. In the main, cases occurred in persons never immunized in the past, but in 37% of cases vaccine failure seems to have occurred. Control measures included mass vaccination of children in the south and lowering the age for routine measles vaccination nationwide to 12 months. Despite very substantial gains towards measles control in Israel, elimination of the disease is not a realistic goal, mainly because the transmission potential of the disease is too high and vaccine coverage and efficacy are not high enough. Trends in measles incidence over the last four decades allow a cautious optimism that measles containment can be achieved.

Age Factors↗
PubMed1997

Trends in importation of measles to the United States, 1986-1994.

OBJECTIVES: To describe patterns among imported measles cases to the United States. DESIGN: Descriptive analysis of national case-based surveillance data on measles cases. SETTING: United States in the period 1986 through 1994. PATIENTS: All reported confirmed cases of measles. MAIN OUTCOME MEASURES: Demographic variables, immunization history, country of exposure, and reporting state. RESULTS: The number of reported imported cases of measles to the United States has dropped from an average of 99 cases annually in 1986 through 1988 and 190 cases in 1989 through 1991 to 61 cases in 1992 through 1994. Since 1990, the number of imported cases originating in Latin America declined by 98%, despite continued increase in the number of travelers to this region; cases from other regions remained relatively constant. This decrease paralleled the rapid decrease in measles incidence in the Western Hemisphere associated with national measles elimination programs. Most imported cases occurred among children, although 22% of cases occurred among young adults. Rates of measles cases per 1 million travelers are higher among non-US citizens than among US citizens. CONCLUSIONS: The sharp decline in importations into the United States from Latin America since 1991 provides evidence of the success of measles control efforts undertaken there. The decrease in imported cases has been associated with a decline in total measles cases in the United States. Sustained elimination of measles in the United States will require improved measles control in other countries in addition to a high level of population immunity.

Adult↗
PubMed1997

Experimental measles. I. Pathogenesis in the normal and the immunized host.

An animal model to study measles pathogenesis and the correlates of protective immunity was established using rhesus monkeys. A measles isolate, obtained during an epidemic of measles in the primate colony at the University of California, Davis, was passaged through rhesus monkeys and amplified in rhesus mononuclear cells to create a pathogenic virus stock. Sequence analysis of the nucleoprotein and hemagglutinin genes of this isolate revealed strong homology with the Chicago 89 strain of measles virus. Conjunctival/intranasal inoculation of juvenile rhesus monkeys with this virus resulted in skin rash, pneumonia, and systemic infection with dissemination to other mucosal sites and to the lymphoid tissues. Inflammation and necrosis occurred in the lungs and lymphoid tissues and many cell types were infected with measles virus on Day 7 postinoculation (p.i.). The most commonly infected cell type was the B lymphocyte in lymphoid follicles. Measles antigen was found in follicular dendritic cells on Day 14 p.i. In contrast to naive monkeys infected with measles virus, animals vaccinated with the attenuated Moraten strain did not develop clinical or pathologic signs of measles after challenge. However, moderate to marked hyperplasia occurred in the lymph nodes and spleen of a vaccinated animal on Day 7 after pathogenic virus challenge, suggesting that an effective measles vaccine limits but does not prevent infection with wild-type measles virus.

Animals↗
PubMed1995

Towards eradication of measles virus: global progress and strategy evaluation.

Despite an increase in global measles vaccine coverage from under 20% in 1980 to around 80% in 1990, measles remains a major cause of morbidity and mortality world-wide. This paper addresses a number of issues relating to efforts to control measles, namely, (i) at the global level, how might we assess the impact of measles vaccination on the incidence of infection and associated disease, and, (ii), at the strategic level, how can we utilise an understanding of the transmission dynamics of childhood viral infections to aid the design of optimal immunisation programmes? Based on WHO vaccine coverage data, and organising countries according to similarities in demographic and epidemiological parameters, an age-structured model of measles transmission is used to capture the non-linear dynamics of infection and mass vaccination and to generate projections of the impact of measles immunization world-wide. The results provide a crude indication of the percentage reduction in measles cases by year 2000 (compared with no immunization) and suggest an approximately 70% reduction in cases over all ages, and 77% reduction in cases under 5 years (where there is the greatest risk of case fatality); these suggest that WHO targets for 1995 are unlikely to be achieved. In the second part of the paper, examples are given to illustrate the usefulness of a modelling approach in evaluating measles immunization policy. The introduction of MMR vaccine in the UK in 1988 has resulted in measles incidence falling to an all time low and attention has turned to the requirements of elimination. A realistic age structured model, validated using extensive serological data, is used to compare the merits of single or two dose strategies. Based upon recent estimates of vaccine efficacy (90%) and coverage (92% by end of second year of life) it is suggested that a two-dose policy with a pre-school second dose given irrespective of vaccine history is required to prevent the build up of susceptibles to epidemic proportions in the longer term. In a second example, prompted by the success of the campaign approach to polio and measles elimination in Central and South America, simple models are used to explore and quantify the process by which pulse vaccination programmes (i.e. repeated application across a wide age range) act to control transmission.

England↗
PubMed2005

Measles in Minsk, Belarus, 2001-2003: clinical, virological and serological parameters.

BACKGROUND: A number of cases of measles have been reported in the Republic of Belarus despite vaccine coverage of 98%. The absence of information on measles virus genotypes circulating in the Republic of Belarus has made it difficult to asses the situation. OBJECTIVES: The purpose of this study was to isolate and sequence measles virus strains from clinical cases in Minsk, Belarus, and to estimate the role of vaccine failure in those cases. STUDY DESIGN: Between 2001 and 2003 years, 14 measles cases admitted to the Hospital of Infectious Diseases of Minsk were enrolled in our study. Clinical, routine laboratory, as well as serological and virological examinations were carried out. Detection of measles antibodies and IgG avidity testing was performed using commercial test kits. All measles cases were confirmed by RT-PCR and phylogenetically characterized. RESULTS: Only 42.9% of the cases met the WHO laboratory criteria for measles, however, all cases were confirmed by RT-PCR. Most of the measles cases were attributed to secondary vaccine failure (SVF). Phylogenetic analysis revealed the presence of genotype A virus strains in 2001 and 2002 with D6 and D7 genotypes in 2003. CONCLUSIONS: For the first time, MVs were genetically characterized in Belarus. Our results suggest that in a highly vaccinated population, most of measles cases represent vaccine failures and are vaccine-modified. Our results also indicate that confirmation of a clinical diagnosis of vaccine-modified measles requires a combination of serological and virological tests.

Adolescent↗
PubMed1997

Randomised trial of effect of vitamin A supplementation on antibody response to measles vaccine in Guinea-Bissau, west Africa.

BACKGROUND: WHO has recommended vitamin A supplementation for children aged 6 months or older in developing countries at the same time as immunisation. One study has reported significantly lower seroconversion ratios among children who have received vitamin A supplements with measles vaccine at age 6 months. The aim of our study was to assess the effect of vitamin A supplementation on antibody response to measles vaccination at age 9 months, which is the more common age for immunisation in developing countries. METHODS: In an urban community in Guinea-Bissau, we did a randomised, double-blind, placebo-controlled study of the effect of simultaneous vaccination and vitamin A supplementation in 462 children who received either a two-dose schedule of measles vaccine at the ages of 6 months and 9 months (150 infants) or one dose of measles vaccine at age 9 months (312 infants). Children were followed up to the age of 18 months and a blood sample was then collected to assess the antibody response. FINDINGS: 397 (86%) of the children took part in the follow-up (52 [11%] had moved and 13 [3%] had died). Among children who received a two-dose vaccine schedule, seroconversion was 98%. There was no difference in seroconversion or geometric mean titre (GMT) for children receiving vitamin A compared with children receiving no supplement. Among children receiving only one dose of measles vaccine at age 9 months, seroconversion was 95%. The GMT was significantly higher in children receiving vitamin A than in those receiving no supplement (3704 vs 2439 mIU; GMT ratio 1.52 [1.22-1.88]). The effect on plasma antibody concentration in the blood was stronger for boys (3902 vs 1916 mIU; GMT ratio 2.04 [1.53-2.72]) than for girls (3502 vs 3017 mIU; GMT ratio 1.16 [0.85-1.58]) who had received vitamin A with measles vaccine. In a multivariate analysis of variance adjusted for sex, vitamin A supplementation was associated with higher antibody titres (p < 0.001). There was a significant interaction between vitamin A supplementation and sex (p = 0.02). INTERPRETATION: There is no indication that simultaneous administration of measles vaccine and vitamin A supplements has a negative effect on measles immunity. Among the children who had received two doses of measles vaccine at the ages of 6 months and 9 months, supplements of vitamin A had no significant effect. Among children only receiving one dose of measles vaccine at age 9 months, 100,000 IU vitamin A increased antibody concentrations, especially for boys.

Antibodies, Viral↗
PubMed1999

Cell-mediated and antibody immune responses to AIK-C and Connaught monovalent measles vaccine given to 6 month old infants.

Measles vaccination of infants younger than 1 year of age should be successful in populations with a high proportion of measles vaccinated mothers. Infants whose mothers were vaccinated are born with less maternal antibody which can interfere with vaccination compared with infants whose mothers had measles. AIK-C or Connaught (CLL) measles vaccine was given to 300 6 month infants born to mothers who had measles (group 1) or who were vaccinated against measles (group 2). Pre- and post-vaccination measles antibody was measured by EIA and PRN and cell mediated immunity (CMI) by blast transformation and production of interferon-gamma and interleukin-10. After vaccination, mean antibody level, seroconversion and blastogenesis were significantly lower for group 1 than group 2 (p < 0.05). Post-vaccination measles IgG was significantly higher for group 2 CLL vaccinees compared with group 2 AIK-C (p < 0.05); seroconversion rates were 73 and 63%, respectively. More than 93% of group 2 infants had elevated measles IgG after vaccination. About 89% of all children had some evidence of a blastogenic response. Lymphoproliferation correlated strongly with cytokine production and weakly with IgG. Not all seroresponders had a CMI response and vice versa. AIK-C and CLL vaccines induce strong measles specific T and B immunity in most 6 month infants of vaccinated mothers.

Antibodies, Viral↗
PubMed2005

Subacute sclerosing panencephalitis: more cases of this fatal disease are prevented by measles immunization than was previously recognized.

BACKGROUND: The most severe sequela of measles virus infection is subacute sclerosing panencephalitis (SSPE), a fatal disease of the central nervous system that generally develops 7-10 years after infection. From 1989 through 1991, a resurgence of measles occurred in the United States, with 55,622 cases of measles reported. The purpose of the present study was to identify cases of SSPE that were associated with the resurgence of measles and to calculate the risk of developing SSPE. METHODS: Brain tissue samples obtained from 11 patients with a presumptive diagnosis of SSPE were tested for the presence of measles virus RNA. Measles virus genotypes were determined by reverse-transcription polymerase chain reaction (RT-PCR) and by analysis of the sequences of the PCR products. A search of the literature was conducted to identify reports of cases of SSPE in persons residing in the United States who had measles during 1989-1991. RESULTS: The measles virus sequences derived from brain tissue samples obtained from 11 patients with SSPE confirmed the diagnosis of SSPE. For 5 of the 11 patients with SSPE who had samples tested by RT-PCR and for 7 patients with SSPE who were identified in published case reports, it was determined that the development of SSPE was associated with the measles resurgence that occurred in the United States during 1989-1991. The estimated risk of developing SSPE was 10-fold higher than the previous estimate reported for the United States in 1982. CONCLUSIONS: Vaccination against measles prevents more cases of SSPE than was originally estimated.

Adolescent↗
PubMed1994

Quality standard for assurance of measles immunity among health care workers. The Infectious Diseases Society of America.

OBJECTIVE: The objective of this quality standard is to prevent nosocomial transmission of measles by assuring universal measles-mumps-rubella (MMR) vaccination of all health care workers who lack immunity to measles. Although the primary emphasis is on health care workers in hospitals, those at other sites, such as clinics, nursing homes, and schools, are also included. It will be the responsibility of designated individuals at these institutions to implement the standard. OPTIONS: We considered advocating the use of measles vaccine rather than MMR but chose the latter because it also protects against mumps and rubella and because it is more readily available. OUTCOMES: The desired outcome is a reduction in the nosocomial transmission of measles. EVIDENCE: Although direct comparative studies are lacking, nosocomial outbreaks of measles have been reported (as recently as 1992) in institutions where measles immunization of nonimmune health care workers is not universal, whereas such outbreaks have not been reported in institutions with universal immunization. VALUES AND VALIDATION: We consulted more than 50 infectious-disease experts in epidemiology, government, medicine, nursing, obstetrics and gynecology, pediatrics, and surgery. In light of disagreement regarding the implementation of the standard, we used group discussions to reach a consensus. BENEFITS, HARMS, AND COSTS: The consequences of the transmission of measles (and of mumps and rubella) in a health care institution include not only the morbidity and mortality attributable to the disease, but also the significant cost of evaluating and containing an outbreak and the serious disruption of regular hospital routines when control measures are instituted. The potential harm to health care workers after the implementation of the standard consists of untoward effects of MMR vaccine, although the reactions of vaccines should be minimal with adherence to recommended vaccination procedures. Implementation of the standard should entail no expense to health care workers; the precise cost to institutions is unknown, but the expense would be mitigated by prevention of measles outbreaks. RECOMMENDATIONS: We recommend MMR vaccination of all health care workers who lack immunity to measles. SPONSORS: The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Diseases Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. The standard is endorsed by the IDSA.

Cross Infection↗
PubMed1997

Immunoglobulin M antibody response to measles virus following natural virus infection, primary vaccination, and reexposure to the virus.

Evaluation of the measles virus ELISA kit (Merck) to detect specific IgM as an indicator of primary measles antibody response was carried out. A modification of the manufacturer's cutoff value interpretation was introduced to allow for equivocal results in addition to positive and negative ones. With this modification, the test assayed gave an overall reproducibility of 96.16%. The IgM seropositivity rate for seroneutralization-confirmed measles cases was 100% for naturally infected measles subjects and 90% for primary measles vaccinated subjects. Individuals with positive neutralizing antimeasles antibodies in close contact with a confirmed measles case gave the following measles IgM ELISA results: 54.54% negative, 9.09% positive, and 36.36% equivocal, showing a booster with IgM antibody response on reexposure to the virus. Positive subjects with neutralizing antimeasles antibodies without recent contact with a measles case gave negative IgM results. IgM seropositivity was strongly associated with IgG seroconversion and clinical measles (p < 0.0001). The technique assayed performed adequately for the confirmation of both measles natural infection and primary vaccination and for the differentiation of primary and secondary antibody response, taking into account the modification in the cutoff value interpretation introduced and providing that the serum samples are obtained between days 5 and 30 after onset of rash.

Adolescent↗
PubMed1994

Quality standard for assurance of measles immunity among health care workers. Infectious Diseases Society of America.

OBJECTIVE: The objective of this quality standard is to prevent nosocomial transmission of measles by assuring universal measles-mumps-rubella (MMR) vaccination of all health care workers who lack immunity to measles. Although the primary emphasis is on health care workers in hospitals, those at other sites, such as clinics, nursing homes, and schools, are also included. It will be the responsibility of designated individuals at these institutions to implement the standard. OPTIONS: We considered advocating the use of measles vaccine rather than MMR vaccine but chose the latter because it also protects against mumps and rubella and because it is more readily available. OUTCOMES: The desired outcome is a reduction in the nosocomial transmission of measles. EVIDENCE: Although direct comparative studies are lacking, nosocomial outbreaks of measles have been reported (as recently as 1992) in institutions where measles immunization of nonimmune health care workers is not universal, whereas such outbreaks have not been reported in institutions with universal immunization. VALUES AND VALIDATION: We consulted more than 50 infectious-disease experts from the fields of epidemiology, government, medicine, nursing, obstetrics and gynecology, pediatrics, and surgery. In light of disagreement regarding the implementation of the standard, we used group discussions to reach a consensus. BENEFITS, HARMS, AND COSTS: The consequences of the transmission of measles (and of mumps and rubella) in a health care institution include not only the morbidity and mortality attributable to the disease but also the significant cost of evaluating and containing an outbreak and the serious disruption of regular hospital routines when control measures are instituted. The potential harm to health care workers after the implementation of the standard consists of untoward effects of MMR vaccine, although the reactions of vaccinees should be minimal with adherence to recommended vaccination procedures. Implementation of the standard should entail no expense to health care workers; the precise cost to institutions is unknown, but the expense would be mitigated by the prevention of measles outbreaks. RECOMMENDATIONS: We recommend MMR vaccination of all health care workers who lack immunity to measles. SPONSORS: The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (P.A.G. and J.E.M.), the Society for Hospital Epidemiology of America (R.P.W.), the Surgical Infection Society (E.P.D.), the Pediatric Infectious Diseases Society (P.J.K.), the Centers for Disease Control and Prevention (W.J.M.), the Obstetrics and Gynecology Infectious Diseases Society (R.L.S.), and the Association of Practitioners of Infection Control (T.L.B.). Funding was provided by the IDSA and the other cooperating organizations. The standard is endorsed by the IDSA.

Cross Infection↗
PubMed1991

Prevalence of measles antibodies in asymptomatic human immunodeficiency virus-infected adults.

One hundred five asymptomatic human immunodeficiency virus-seropositive adults were screened for measles antibody. Ages ranged from 21 to 59 years (mean, 35.7). CD4+ lymphocyte counts (range, 76-1137/mm3), percentage of CD4+ cells (6-42), CD4:CD8 ratio (0.08-1.3), measles antibody titers by EIA, and undocumented history of prior measles or immunization were obtained. Forty-six patients gave a history of measles but no immunization, 18 of immunization but no measles, 26 of immunization and measles, and 15 of neither measles nor vaccination. Only one patient (less than 1%) lacked levels of antibody considered protective. Neither the presence nor the level of antibody were predictable from patient age, history of measles or immunization, CD4+ lymphocyte count, percentage of CD4+ cells, or CD4:CD8 ratio. Nearly all subjects had antibody to measles, regardless of immunization or measles history. Whether these antibodies are truly protective is unknown.

Adult↗