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PubMed1999

[Measles seroprevalence among pediatricians in a teaching hospital].

OBJECTIVE: A measles outbreak occurred in S. Paulo state, during 1996 and 1997, resulting in 20,921 cases. Forty seven percent of the cases occurred in people between 20 and 29 years of age, and one of the control strategies of the Department of Health was the vaccination of health care workers. The prevalence of antibodies against measles among the hospital pediatricians was investigated. METHODS: One hundred and fifty samples were taken from volunteer pediatricians to test for measles antibodies using ELISA. A questionnaire about their having had measles and the vaccine was filled out. RESULTS: Of the 150 doctors, 122 (81.4%) were female and 28 (18.6%) male, of between 23 and 46 years of age (mean and median 27 years). The majority (98%-147/150) had protective levels of antibodies against measles (>100 UI/ml); 118 (80.3%-118/147) without and 29 (19.7%-29/147) with a history of measles. Only 3 pediatricians (2%-3/150), had negative serology, 2 without and 1 with a history of measles. Out of the 118 without history of measles, 79 (67%-39/118) in spite of the protective level of antibodies against measles, did not know if they, had been vaccinated. Out of the 79 vaccinated pediatricians, 64 (81%-64/79), had been vaccinated 25 years before, and still maintained protective levels of antibodies. Of the 3 doctors with negative serologies only one declared that he had been vaccinated. CONCLUSIONS: Measles seroprevalence among pediatricians of this hospital is high, especially due to preceding vaccination. On the other hand, the 2% of pediatricians with negative serology, in an epidemic situation could constitute a significant population for the acquisition and dissemination of the disease.

Adult↗
PubMed1991

Measles revaccination response in a school-age population.

Due to the dramatic upsurge in the incidence of measles, the American Academy of Pediatrics and the Immunization Practices Advisory Committee of the Centers for Disease Control revised their measles immunization policies in 1989 to include a routine two-dose schedule. The objectives of this study were the following: (1) determine the prevalence of immunologically measles-susceptible subjects in a previously vaccinated, school-age, military dependent population; and (2) assess risk factors to identify immunologically measles-susceptible subjects. Serum was collected just prior to measles revaccination and again 2 weeks later. Measles-specific IgG and IgM titers were determined by enzyme-linked immunosorbent assay. Immunologically measles-susceptible subjects constituted 9.8% of the population. The interval since previous measles vaccination was significantly related to pre- and postrevaccination IgG titers in a repeated-measures analysis of variance model. The magnitude of increase in IgG titer following revaccination and analysis of trend for proportions of measles-susceptible subjects were significantly related to the age of initial vaccination. This study supports continued measles revaccination; in addition, revaccination appears to be of greater value at 11 to 12 years of age than at 4 to 6 years of age.

Adolescent↗
PubMedDate not supplied

Measles virus receptors: SLAM and CD46.

The success of vaccination against measles in developed countries has significantly reduced the incidence of measles-related morbidity and mortality. However, measles is still the leading cause of mortality in children from underdeveloped countries due to low vaccination coverage, high transmissibility of the measles virus as well as primary and secondary vaccine failure. As with any viral disease, the identification of the host molecule to which the measles virus binds and gains entry into the host cell is a major step in understanding the molecular pathology of the disease. Two cell surface receptors, CD46 and signaling lymphocyte-activation molecule (SLAM), have been identified as measles virus receptors. CD46 is ubiquitously expressed on all nucleated cells and acts as a receptor for the Edmonston strain and all vaccine strains derived from it. SLAM is selectively expressed on some T and B cells and is utilised by the Edmonston strain and wild-type strains that cannot use CD46 for cell entry. Understanding the structural and functional variations in measles virus receptors with regard to host response can facilitate the development of new vaccines as well as provide new insights into measles virus tropism and pathogenesis and, importantly, into possible mechanisms for vaccine non-response. Our review focuses on the structure of measles virus receptors, measles virus receptor function, isoforms and polymorphic forms.

Animals↗
PubMed1982

Characterization of a hamster brain cell line persistently infected with measles virus.

A persistent infection of measles virus in hamster brain cell cultures was established. Hamster brain cells were transformed with a human papovavirus strain BK and infected with a wild-type measles virus in order to get the cell line persistently infected with measles virus. About 75 per cent of these M-HB/MVB-cells were measles virus-infected. The cells released only small amount of infectious virus and produced low levels of interferon-like activity into the growth medium. During the first 50 passages no large syncytia typical of a lytic measles virus infection were seen. The products of measles virus infection in the cells and in cell culture fluids were followed at two temperatures. Another cell line persistently infected with measles virus (Lu-carrier-cells, 28) was investigated in parallel. In both cell lines measles antigens were cytoplasmic, but during the observation period large amounts of measles nucleocapsid accumulated in the nuclei of the M-HB/MVB-cells. The virus-specific protein synthesis in M-HB/MVB-cells was weak and the intracellular amount of immunoreactive measles nucleocapsid was only 50 per cent (600 ng/10(5) infected cells) of the (1200 ng/10(5) cells) found in Lu-carrier-cells. Also the release of nucleocapsid was minimal in hamster brain cells. The decreased temperature had no clear-cut effect on virus-specific protein synthesis or on the release of the virus-specific products.

Animals↗
PubMed1984

Measles vaccination and reduction in child mortality: a community study from Guinea-Bissau.

Earlier studies have suggested that general measles vaccination programmes should not be made a priority in developing countries because the presumably malnourished children saved from measles are likely to die from something else. Recent community studies indicate, however, that malnutrition is not the cause of high measles mortality. In an urban community in Guinea-Bissau, child mortality has been registered for a period of 3 years; 1 year before and 2 years after the introduction of a general measles vaccination program. In the years following the introduction of measles vaccination, mortality for children aged 6 to 35 months has significantly diminished. Though this is not a controlled study of vaccinated and unvaccinated children, much of the reduced mortality can apparently be attributed to the protective effect of measles vaccination. Children with a history of earlier measles infection had a significantly higher mortality rate than children vaccinated against measles. Rather than being a mechanism of natural selection taking the weakest children, measles apparently aggravates the condition of many children, leading to delayed excess mortality. In areas where the case fatality rate is high, vaccination against measles should be made an indispensable part of primary health care.

Child↗
PubMed2003

The cost of measles in industrialised countries.

The aim of this study is to estimate the costs of measles and measles control in 11 industrialised countries with varying levels of measles vaccine coverage. Country-specific annual incidence of measles, measles immunization policy, coverage and costs data were collected. The average societal costs of measles cases and immunisation programme per capita were calculated. These 11 countries spend together over US$ 151 million every year to treat and control measles. Per capita costs of measles control tend to be higher in countries with poorer measles control programmes (for instance, Italy has the highest incidence and highest overall costs), though many other factors, such as the number of antigens given per clinic visit and the local price of MMR also affect the efficiency of the programme. The costs estimates presented here can be used to estimate potential savings that might accrue from changes to measles control programmes.

Costs and Cost Analysis↗
PubMed2002

African-American children are at risk of a measles outbreak in an inner-city community of Chicago, 2000.

BACKGROUND: Since the measles resurgence of 1989-1991, which affected predominantly inner-city preschoolers, national vaccination rates have risen to record-high levels, but rates among inner-city, preschool-aged, African-American children lag behind national rates. The threat of measles importations from abroad exists and may be particularly important in large U.S. cities. To stop epidemic transmission, measles vaccination coverage should be at least 80%. OBJECTIVE: To determine measles vaccination rates and predictors for having received a dose of measles-containing vaccine by age 19 to 35 months among children in an inner-city community of Chicago. METHODS: We used a cross-sectional survey with probability proportional to size cluster sampling. Immunization histories from parent-held records and providers were combined to establish a complete vaccination history. RESULTS: A total of 2545 households were contacted, and 170 included a resident child aged 12 to 35 months. Of these, 97% (N=165 children) agreed to participate. Immunization history from a parent or provider was not available for 20 children. Among children aged 19 to 35 months with available immunization histories, 74% received measles vaccine (n=100); of these, 84% received the vaccine as recommended at ages 12 to 15 months. However, when including children without immunization histories, measles coverage levels among children aged 19 to 35 months were 64% (n=114). Among children with records, predictors for receipt of measles vaccine by age 19 to 35 months were possessing a hand-held immunization card (odds ratio [OR]=16.8; 95% confidence interval [CI]=4.2-67.1); utilizing a public health department provider for a usual source of care (OR=8.9; 95% CI=1.6-47.2); and being up-to-date for vaccines at 3 months of age (OR=5.0; 95% CI=1.8-14.1). CONCLUSIONS: Optimistically assuming that children without immunization histories are as well immunized as children with immunization histories, the measles vaccination rate among Englewood's children aged 19 to 35 months is too low to maintain immunity (74%). Measles coverage levels lagged behind coverage reported in a national survey in Chicago (86%) and the nation as a whole (92%). Efforts to raise and sustain coverage should be undertaken.

Black or African American↗
PubMed1999

Measles among adults, United States, 1985-1995.

OBJECTIVE: To report the incidence and characteristics of adult measles cases in the United States and address the adequacy of current vaccination policies to eliminate measles transmission. METHODS: Confirmed measles cases reported to the Centers for Disease Control and Prevention (CDC) from 1985 through 1995 were reviewed. Demographic data, exposure setting, and vaccination status of cases were analyzed and incidence rates calculated based on U.S. census data. MAIN OUTCOME MEASURES: Age-specific incidence rates of measles and exposure setting. RESULTS: Of the 75,204 reported measles cases of known age, 16,006 (21.3%) occurred in adults (persons > 19 years of age). The incidence in persons < 19 years of age (7.8/100,000) was 9.6 times that of all adults. Of 11,520 adult measles cases for whom vaccination status was reported, 8,055 (69.9%) indicated no prior receipt of measles vaccine. Exposure setting was unknown for the majority of adult measles cases (8,475, 52.9%); most frequently reported were college or school (2840, 17.7%), home (1443, 9.0%), or a medical setting (1286, 8.0%). International travel was associated with 289 (1.8%) adult cases. From 1993 to 1995, incidence rates in all age groups were at record low levels, with adults contributing 29.5% (467/1584) of reported cases. CONCLUSION: Although adults accounted for a steadily increasing proportion of measles cases during the study period, incidence rates in all age groups have decreased. Most adults who had measles were susceptible because of lack of vaccination rather than vaccine failure. This analysis supports current strategies to ensure the immunity of school/college-aged populations, and health care workers.

Adolescent↗
PubMed1992

Possible influence of measles virus infection of cynomolgus monkeys on the outcome of the neurovirulence test for oral poliovirus vaccine.

Macaque monkeys are susceptible to measles infection which triggers temporary immuno-depression similar to the well known phenomenon in humans. It is known that feral monkeys become infected with measles virus when they are exposed to humans. Since Macaca mulatta and M. fascicularis are species used to assay the neurovirulence of oral poliovirus vaccine, the immunodepression caused by measles infection of the test monkeys could significantly alter the results of the neurovirulence test. The serum titers of measles-neutralizing antibodies were studied in over 1500 monkeys used for neurovirulence tests. A high proportion of the feral monkeys had measles antibodies (51-100%); in contrast, none of 493 M. fascicularis monkeys which had been bred in a primate colony under strict isolation measures was found positive for measles antibodies. An increase in the prevalence of measles in the population of Ontario and Quebec provinces was accompanied with an increase in the proportion of measles-positive monkey and their serum antibody titers were found higher. It was observed that monkeys used in tests that had been performed during high measles prevalence presented with a poliomyelitis of more pronounced severity clinically and histologically. The analysis of 29 tests conducted on type 1 vaccines over several years showed a positive correlation (correlation coefficient = 0.5141, P less than 0.0022) between severity of poliomyelitis and the presence of measles serum antibodies in test monkeys (some animals seroconverted during the test). A similar observation, when type 3 Sabin vaccines were tested in M. fascicularis, was recently reported from another laboratory in Ontario.

Animal Husbandry↗
PubMed2003

Impact of mass measles campaigns among children less than 5 years old in Uganda.

In 1999-2001, a national measles control strategy was implemented in Uganda, including routine immunization and mass vaccination campaigns for children aged 6 months to 5 years. This study assesses the impact of the campaigns on measles morbidity and mortality. Measles cases reported from 1992 through 2001 were obtained from the Health Management Information System, and measles admissions and deaths were assessed in six sentinel hospitals. Measles incidence declined by 39%, measles admissions by 60%, and measles deaths by 63% in the year following the campaigns, with impact lasting 15 to 22 months. Overall, 64% of measles cases were among children <5 years of age, and 93% were among children </=15 years old. The cost per child vaccinated was $0.86. Routine immunization coverage remained low, at 61% in 2001. To eliminate measles in Uganda, routine immunization should be strengthened, campaigns should be conducted among those <15 years of age, and nationwide case-based measles surveillance should be put in place.

Antibodies, Viral↗
PubMed2003

Immunogenicity of measles and rubella vaccines in Oman: a prospective clinical trial.

A prospective immunogenicity trial of measles and rubella vaccines was conducted in Oman. Children received measles vaccine at age 9 months and measles-rubella vaccine at age 15 months. Serum specimens were tested for measles-specific IgG and rubella-specific IgG. Of 1025 eligible infants, 881 (86.0%) returned for all five visits and had adequate serum samples for testing. Seroconversion to measles after vaccination at 9 months was 98.1%. At 15 months, 47 (5.3%) of the 881 children were seronegative for measles; of these, 44 (93.6%) seroconverted. At 16 months, 99% of the children seronegative at age 9 months seroconverted after receiving two doses of measles vaccine. At age 15 months, 684 (77.6%) children were seronegative for rubella. Of these, 676 (98.8%) seroconverted by age 16 months. One dose of measles vaccine at age 9 months was highly immunogenic. One dose of measles-rubella vaccine at age 15 months closed the remaining measles immunogenicity gap and resulted in a high rate of rubella seroconversion.

Antibodies, Viral↗
PubMed2004

Vaccination levels associated with lack of measles transmission among preschool-aged populations in the United States, 1989-1991.

Knowledge of the minimum level of vaccination capable of preventing measles transmission in an age group is helpful for establishing program targets for measles elimination. In 1990, during the measles resurgence in the United States, one-half of cases occurred in children aged <5 years. Although estimated population immunity among persons >or=6 years of age was 93%, immunity was lower and varied widely among preschool-aged children. To examine the association of vaccine coverage at 2 years of age and measles incidence among preschool-aged children, we analyzed ecological studies of measles incidence in Milwaukee (Wisconsin) census tracts, Dallas (Texas) ZIP code areas, and selected cities during the 1989-1991 measles resurgence. In each study area, measles incidence decreased rapidly with increasing measles vaccine coverage and became low or negligible when coverage was >or=80%. Regression analysis also suggested that measles would not be transmitted when vaccine coverage was at least 79%. A minimum vaccine coverage of approximately 80% at the second birthday in census tracts, ZIP code areas, and cities in the United States may be sufficient to prevent measles transmission among preschool-aged children if population immunity is >or=93% among persons >or=6 years of age.

Adolescent↗
PubMedDate not supplied

Epidemiology and specific prophylaxis of measles.

In studies in the USSR, a single dose of Leningrad-16 live measles vaccine induced sero-conversion in at least 90% of vaccinees, with a mean titer of serum antibody of 1:32 and high antibody levels throughout the 15 years after vaccination. When the vaccine was correctly stored, transported, and used for mass vaccination, measles-associated morbidity decreased and the circulation of measles virus was interrupted in some towns for several years. However, childhood vaccination over a long period changed the immunologic age of the population and resulted in increased measles-associated morbidity in adults. A program for eradication of measles virus in some areas of the USSR has thus been developed. The ultimate aim of this program is the total eradication of measles. This goal can be achieved only after attainment of a high level of collective immunity (95%) through increased efficacy and quality of the vaccine. The international program of measles eradication should be based on the experiences gained through immunization programs in various countries. The key issues are (1) the elimination of measles epidemics and mortality, (2) the maintenance of a low incidence of measles over a long period, (3) the prevention of measles virus importation through epidemiologic surveillance, and (4) the maintenance of a high level of collective immunity in the total population.

Adolescent↗
PubMed2002

Impact of the 1996-1997 supplementary measles vaccination campaigns in South Africa.

BACKGROUND: In South Africa, as part of an effort to eliminate indigenous measles by 2002, vaccination campaigns were conducted in 1996-1997 targeting all children aged 9 months to 14 years; coverage was estimated at 85%. The impact of the campaigns on measles disease burden was evaluated in 1999. METHODS: We analysed routine measles surveillance data and undertook a retrospective review of hospital registers in two of South Africa's nine provinces. RESULTS: In Mpumalanga in the pre-campaign years (1992-1996), 4,498 measles cases and 6 deaths were reported; 182 cases and no deaths were reported in 1997-1998. Hospital registers showed 1,647 measles hospitalizations and 11 deaths in the pre-campaign period, and 60 hospitalizations and no deaths after the campaign (1997-April 1999). In Western Cape in pre-campaign years (1992-1997), 5,164 measles cases and 19 deaths were reported; 132 cases and no deaths were reported in 1998. Hospital registers showed 736 measles hospitalizations and 23 deaths in the pre-campaign period, and 29 measles hospitalizations and no deaths post-campaign (1998-July 1999). CONCLUSIONS: Study findings indicate that reported measles cases, measles-related hospitalizations and deaths were considerably reduced in both provinces after the campaign compared with the pre-campaign period. Longer observation is needed to evaluate the long-term impact of the campaigns.

Adolescent↗
PubMed1988

The epidemiology of measles in a partially vaccinated population in an African city: implications for immunization programs.

A large outbreak of measles was reported in Pointe-Noire, Congo, between October 1984 and March 1985. An investigation was conducted to determine the epidemiology of measles in this community in which, in 1985, 54% of the children 12-23 months of age had documented evidence of vaccination against measles. The investigation included hospital and clinic record reviews and a community survey. Measles has been continuously transmitted in Pointe-Noire since at least 1979, with seasonal epidemics. In early 1984, the expected epidemic did not occur, and at least 1,000 measles hospital admissions and 100 measles deaths were prevented. Between October 1984 and March 1985, 1,942 measles cases were hospitalized, of which 306 (15.8%) died. During the epidemic, the proportion of nonpreventable cases (cases occurring before nine months of age) was 17%, reflecting the change in age distribution of measles cases in childhood since the immunization program started in Pointe-Noire in 1982. From the community survey, it was estimated that 13% of all children under age five years acquired measles in Pointe-Noire in 1985. Vaccine efficacy was calculated from community and hospital samples to be between 78% and 87%. Our findings suggest that increasing vaccination coverage levels to well above 50% is necessary to substantially reduce measles morbidity and mortality in African cities.

Child↗
PubMed1992

Increased risk of death from measles in children with a sibling of opposite sex in Senegal.

OBJECTIVE: To examine whether contracting measles from a sibling of the opposite sex affects mortality. DESIGN: Prospective registration during 15-20 years of all births and deaths, including 243 measles related deaths. Measles infection was not registered; however, as in fatal cases measles was probably contracted from a maternal sibling the risk of dying during measles outbreaks was examined in families with two boys, two girls, or a boy and a girl. SETTING: 31 small villages in two rural areas of eastern Senegal. SUBJECTS: 766 children living in families with two children aged under 10 years during outbreaks of measles, 107 (14%) of whom died of measles. MAIN OUTCOME MEASURE: Deaths from measles, size of village, age and sex of maternal siblings. RESULTS: The interval between outbreaks in the same village was greater than 10 years. The risk of dying of measles was significantly related to age, increasing with the age difference between siblings and decreasing with the size of village. In a multiple logistic regression analysis adjusting for these background factors, children in families with a boy and a girl had a significantly higher mortality than children in families with two boys or two girls (odds ratio = 1.81, 95% confidence interval 1.17 to 2.82). The increase in risk was the same for boys and girls in families with two children one of whom was a boy and one a girl. CONCLUSION: Cross sexual transmission may be an important determinant of severity of measles infection.

Age Factors↗
PubMed1994

Salivary diagnosis of measles: a study of notified cases in the United Kingdom, 1991-3.

OBJECTIVES: To validate a method for salivary diagnosis of measles and to assess the diagnostic accuracy of notified cases of measles. DESIGN: Blood and saliva samples were collected within 90 days of onset of symptoms from patients clinically diagnosed as having measles and tested for specific IgM by antibody capture radioimmunoassay. SETTING: 17 districts in England and one in southern Ireland during August 1991 to February 1993. SUBJECTS: 236 children and adults with measles notified by a general practitioner. RESULTS: Specific IgM was detected in serum in only 85 (36%) of the 236 cases. In cases associated with outbreaks and tested within six weeks of onset, 53/57 (93%) of samples were IgM positive, thereby confirming the sensitivity of serum IgM detection as a marker of recent infection. The serological confirmation rate was lower in cases with a documented history of vaccination (13/87; 15%) than in those without (70/149; 47%) and varied with age, being lowest in patients under a year, of whom only 4/36 (11%) were confirmed. Measles specific IgM was detected in 71/77 (92%) of adequate saliva samples collected from patients with serum positive for IgM. In cases where measles was not confirmed, 6/101 had rubella specific IgM and 5/132 had human parvovirus B19 specific IgM detected in serum. CONCLUSIONS: The existing national surveillance system for measles, which relies on clinically diagnosed cases, lacks the precision required for effective disease control. Saliva is a valid alternative to serum for IgM detection, and salivary diagnosis could play a major role in achieving measles elimination. Rubella and parvovirus B19 seem to be responsible for a minority of incorrectly diagnosed cases of measles in the United Kingdom and other infectious causes of measles-like illness need to be sought.

Adolescent↗
PubMed1995

Non-specific beneficial effect of measles immunisation: analysis of mortality studies from developing countries.

OBJECTIVE: To examine whether the reduction in mortality after standard titre measles immunisation in developing countries can be explained simply by the prevention of acute measles and its long term consequences. DESIGN: An analysis of all studies comparing mortality of unimmunised children and children immunised with standard titre measles vaccine in developing countries. STUDIES: 10 cohort and two case-control studies from Bangladesh, Benin, Burundi, Guinea-Bissau, Haiti, Senegal, and Zaire. MAIN OUTCOME MEASURES: Protective efficacy of standard titre measles immunisation against all cause mortality. Extent to which difference in mortality between immunised and unimmunised children could be explained by prevention of measles disease. RESULTS: Protective efficacy against death after measles immunisation ranged from 30% to 86%. Efficacy was highest in the studies with short follow up and when children were immunised in infancy (range 44-100%). Vaccine efficacy against death was much greater than the proportion of deaths attributed to acute measles disease. In four studies from Guinea-Bissau, Senegal, and Burundi vaccine efficacy against death remained almost unchanged when cases of measles were excluded from the analysis. Diphtheria-tetanus-pertussis and polio vaccinations were not associated with reduction in mortality. CONCLUSION: These observations suggest that standard titre measles vaccine may confer a beneficial effect which is unrelated to the specific protection against measles disease.

Bangladesh↗