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PubMedDate not supplied

Subacute measles encephalitis with AIDS diagnosed by fine needle aspiration biopsy. A case report.

BACKGROUND: Subacute measles encephalitis (SME), or measles inclusion body encephalitis (MIBE), is a rare central nervous system (CNS) complication following infection by the measles (rubeola) virus. It usually occurs in young patients with defective cellular immunity from either congenital or acquired causes. In the United States, with the resurgence of measles infection and the human immunodeficiency virus (HIV) pandemic, subacute measles encephalitis should be added to the differential diagnosis in acquired immune deficiency syndrome (AIDS) patients presenting with unexplained CNS manifestations. CASE: A 2-year-old, HIV-positive, white male was admitted for generalized convulsive seizures. Vaccination was described as "up to date." Despite treatment with anticonvulsive drugs, the child continued to develop frequent partial and generalized seizures. Cephalic computed tomography and magnetic resonance imaging revealed a hypodense area in the right parietotemporal cortex without an associated mass effect. Fine needle aspiration biopsy (FNAB) of the affected area showed neuronal reduction, degeneration with eosinophilic intranuclear inclusions, perivascular lymphoplasmacytic infiltration and gliosis. Electron microscopy of the intranuclear inclusions revealed fine, fibrillar, tubular nucleocapsids, consistent with the measles virus. CONCLUSION: Acute measles encephalitis (AME), subacute sclerosing panencephalitis (SSPE), and SME are the three CNS syndromes associated with measles infection. Serum and cerebrospinal fluid (CSF) antibody titres against measles virus are usually high and helpful in the diagnosis of AME and SSPE. In SME, neither serum nor CSF antibody titres against measles are high. Therefore, FNAB is necessary for a definitive diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed2005

A limited measles outbreak in a highly vaccinated US boarding school.

OBJECTIVES: We investigated a measles outbreak that began in March 2003 in a Pennsylvania boarding school with >600 students to identify all cases, including the source; implement outbreak control measures; and evaluate vaccine effectiveness. METHODS: Measles was suspected in any person at the school with a generalized rash and fever during March 21 to May 28, 2003 and investigated with serologic testing. We reviewed vaccination history from school records and conducted a survey to determine country of measles vaccination. Vaccine effectiveness was calculated using the cohort method. RESULTS: We identified 9 laboratory-confirmed cases at the school: 8 students and 1 staff member. Among them, 2 had never received any doses of measles-containing vaccine (MCV), 1 received 1 dose of MCV, and 6 received 2 doses of MCV. Three of the 6 who received 2 doses of MCV received both doses outside the United States. The source case had been infected in Lebanon. Two laboratory-confirmed spread cases were identified in New York City. Measles virus of genotype D4 was isolated in cases from the school and New York City. Of the 663 students in the school, 8 (1.2%) had never received any doses of MCV, 26 (3.9%) had received 1 dose, and 629 (94.9%) had received 2 doses before the outbreak. Vaccine effectiveness among students who had received 2 doses of MCV was 98.6%. However, students who received both doses outside the United States had a higher attack rate (3 of 75) than those who received both doses in the United States (3 of 509; rate ratio: 6.8; 95% confidence interval: 1.4-33.0). CONCLUSIONS: This is the largest measles outbreak to occur in a school in the United States since 1998, but it was limited to only 9 cases in a boarding school with >600 students. The limited extent of this outbreak highlights the high level of population immunity achieved in the United States through widespread implementation of a 2-dose measles-mumps-rubella vaccination strategy in school-aged children. States and schools should continue to enforce strictly the 2-dose measles-mumps-rubella vaccination requirement and, in an outbreak setting, consider revaccinating students who received measles vaccine outside of the United States. Continued vigilance by health care providers is needed to recognize measles cases.

Adolescent↗
PubMed1991

A measles outbreak at a college with a prematriculation immunization requirement.

BACKGROUND: In early 1988 an outbreak of 84 measles cases occurred at a college in Colorado in which over 98 percent of students had documentation of adequate measles immunity (physician diagnosed measles, receipt of live measles vaccine on or after the first birthday, or serologic evidence of immunity) due to an immunization requirement in effect since 1986. METHODS: To examine potential risk factors for measles vaccine failure, we conducted a retrospective cohort study among students living in campus dormitories using student health service vaccination records. RESULTS: Overall, 70 (83 percent) cases had been vaccinated at greater than or equal to 12 months of age. Students living in campus dormitories were at increased risk for measles compared to students living off-campus (RR = 3.0, 95% CI = 2.0, 4.7). Students vaccinated at 12-14 months of age were at increased risk compared to those vaccinated at greater than or equal to 15 months (RR = 3.1, 95% CI = 1.7, 5.7). Time since vaccination was not a risk factor for vaccine failure. Measles vaccine effectiveness was calculated to be 94% (95% CI = 86, 98) for vaccination at greater than or equal to 15 months. CONCLUSIONS: As in secondary schools, measles outbreaks can occur among highly vaccinated college populations. Implementation of recent recommendations to require two doses of measles vaccine for college entrants should help reduce measles outbreaks in college populations.

Adolescent↗
PubMed1998

[Anti-measles igg concentration in maternal blood and in umbilical cord blood: according to the mother's vaccination status].

A study on passive immunity against measles was conducted in four hospitals of Oporto, Portugal. The objectives were to assess whether maternal measles vaccination status was associated to the levels of measles IgG in maternal and cord sera, and with the transplacental transport efficiency. Cord and venous maternal blood samples were collected from 1539 mother-child pairs enrolled. An enzyme immunoassay was used to measure measles IgG levels in the study sera. Results were expressed in mIU/ml. Vaccination records were consulted. Geometric mean concentration of measles IgG among vaccinated mothers (730 mIU/ml; 95% CI 602 to 884 mIU/ml; n = 79) was significantly (P < 0.0001) lower than among their unvaccinated counterparts (1535 mIU/ml; 95% CI 1460 to 1613 mIU/ml; n = 1317). The same was observed in the corresponding cord sera: those born to vaccinated mothers had significantly (P < 0.0001) lower levels of measles IgG (1083 mIU/ml; 95% CI 908 to 1291) than the newborns of unvaccinated mothers (2230 mIU/ml; 95% CI 2119 to 2347). Transplacental transport efficiency was not related with maternal vaccination status (P = 0.67). Measles IgG levels observed in this Portuguese study were similar to those observed in a study conducted in South Africa, but higher than those reported in a British study. The differences in measles IgG levels between vaccinated and unvaccinated mothers (and corresponding newborns) are consistent with similar findings already published in different countries. The lower levels of measles IgG among children born to vaccinated mothers may lead to the anticipation of the recommended age to vaccinate against measles in Portugal.

Female↗
PubMed1999

Progress toward measles elimination--Southern Africa, 1996-1998.

Despite routine measles vaccination coverage of >70% in southern Africa during the early 1990s, low-level endemic transmission and periodic epidemics of measles continued. Since 1995, six southern African nations (Botswana, Malawi, Namibia, South Africa, Swaziland, and Zimbabwe) have launched measles-elimination initiatives in accordance with the recommendations of the World Health Organization (WHO) African Regional Office (AFR). Strategies include programs to 1) achieve routine vaccination coverage of > or =95% with one dose of measles vaccine administered at age 9 months; 2) implement a one-time national catch-up measles vaccination campaign to interrupt indigenous transmission of measles; 3) implement periodic national follow-up measles campaigns to maintain interruption of measles transmission; and 4) establish case-based measles surveillance with laboratory confirmation. This report presents preliminary data about the progress toward measles elimination in the six southern Africa countries.

Adolescent↗
PubMed1999

Measles epidemiology and outbreak response immunization in a rural community in Peru.

Only limited data are available on the impact of measles outbreak response immunization (ORI) in developing countries. We conducted a community survey in Espindola, a rural border community in northern Peru, following a measles outbreak and subsequent ORI to study the epidemiology and impact of the outbreak and to evaluate the costs and benefits of measles ORI. During the outbreak, 150 of the 553 Espindola residents developed clinical cases of measles. Adults accounted for 44.0% of cases, and were frequently identified as primary cases. The attack rate among all susceptible people was 45.5% and was highest (61.2%) for the 16-20 year age group. Among adults, significant risk factors for developing measles included being aged 16-20 years (relative risk [RR] = 3.06, 95% CI = 2.08, 4.49) and being male (RR = 1.73, 95% CI = 1.11, 2.71). Among serologically confirmed cases, 60.7% developed diarrhoea and 32.1% pneumonia. The overall case-fatality rate was 3.3%, but reached 19.1% in the 0-23-month age group. Failure to reach children through either routine immunization or national campaigns made this community vulnerable to the severe and extensive impact of measles virus importation. The ORI campaign targeted non-measles case children aged 6 months to 15 years, regardless of their previous immunization status, and was effective in terminating this measles outbreak and in preventing morbidity, loss of livelihood and death despite the involvement of large numbers of adults in measles transmission. The last measles case occurred within 3 weeks of completing ORI. The ORI campaign, which would have cost approximately US$ 3000 in 1998, saved as many as 1155 person-days of work among 77 adults, prevented an estimated 87 cases of diarrhoea and 46 cases of pneumonia, and averted 5 deaths.

Adolescent↗
PubMed1999

Measles control in Israel: a decade of the two-dose policy.

BACKGROUND AND METHODS: The introduction of routine measles immunization in Israel in 1967 was followed by a 95% reduction in reported measles incidence. In 1990, a second measles immunization dose was instituted, and up until the end of 1999, 16 birth cohorts were offered the second dose. We present here changes in reported measles incidence in Israel following institution of the two-dose policy. RESULTS: First-dose coverage is 94%, and coverage for the second school-based dose exceeds 95%. A further 90% reduction in measles incidence has been observed and, following a modest national outbreak in 1994, measles incidence for 1995-99 stands at less than 3/100,000/year. CONCLUSIONS: Since measles is highly contagious, very high immunization coverage rates will be required to preserve these accomplishments, and measles elimination is still years away, but there is tentative evidence that measles containment is at hand. Even greater measles control can be anticipated as vaccine immunogenicity improves and successive cohorts of children come under the 2-dose regimen.

Disease Outbreaks↗
PubMed2004

Measles mortality reduction--West Africa, 1996-2002.

The World Health Organization (WHO) estimates that, during 2000, measles accounted for approximately 777,000 deaths worldwide, of which 452,000 (58%) occurred in Africa. In response, in 2000, WHO's African Regional Office (AFRO) adopted a plan to reduce measles mortality >50% by 2005. The plan recommended 1) increasing measles vaccination by strengthening routine health services; 2) providing a second opportunity for measles vaccination for all children, primarily through wide--age-range supplemental immunization activities (SIAs); 3) enhancing measles surveillance; and 4) improving management of measles cases. The initial wide--age-range SIA targets all children aged 9 months-14 years, regardless of history of measles disease or vaccination. Follow-up SIAs are needed 3-5 years after the initial SIA to provide a second opportunity for vaccination to children born since the previous SIA (i.e., those aged 9 months-4 years). During the 1990s, the countries of the Americas and seven countries in southern Africa used this strategy to reduce the number of measles deaths to near zero. This report describes the recent implementation of this strategy in three West African countries, where reported measles cases declined 83%-97% during the first year after SIAs. Successful implementation of this strategy by other African countries should result in achieving the goal of >50% reduction in measles mortality by 2005.

Africa, Western↗
PubMed1992

Prevalence of measles susceptibility in hospital staff. Evidence to support expanding the recommendations of the Immunization Practices Advisory Committee.

BACKGROUND: In 1989 and 1990, measles reached epidemic proportions in the United States, including several areas of California. Children's Hospital Oakland (Calif), a major health care provider for children in a measles epidemic area of California, reported 131 cases between 1989 and 1991, the largest number ever reported by that institution. In February 1990, four cases of measles were reported among hospital staff. Continued risk of nosocomial infection prompted the development of a program to ensure that all hospital staff were adequately protected against measles. METHODS: All hospital employees who were unable to document proof of measles immunity were required to be serologically screened for measles antibody and to be vaccinated against measles if they were determined to be nonimmune. Serologic screening was performed in-house with a commercially available enzyme-linked immunosorbent assay measles antibody test. Dates of birth were recorded for all employees screened. Individuals with negative or repeatedly equivocal results were considered to be nonimmune and were vaccinated with trivalent measles-mumps-rubella vaccine. RESULTS: Between March and June 1990, 1694 staff were serologically tested for measles antibody. Eighty-nine (5.3%) of the employees were considered to have inadequate immunity. Forty (45%) of these susceptible individuals were born before 1957. CONCLUSIONS: We conclude that the recommendations of the Immunization Practices Advisory Committee should be expanded to include serologic screening or vaccination of hospital personnel who were born before 1957. Serologic screening of hospital staff may be a reasonable alternative to vaccination under certain circumstances.

Cross Infection↗
PubMed1978

Frequency, serodiagnosis and epidemiological features of subacute sclerosing panencephalitis (SSPE) and epidemiology and vaccination policy for measles in the Federal Republic of Germany (FRG).

In the FRG, SSPE, a slow infection of the brain in children and young adults, known to be associated with a chronic measles virus infection, has an estimated incidence of 2.6 cases per million total population (61 million) and 9.7 cases per million population below the age of 19 years (16 million). In the 156 SSPE cases between 1968 and 1977 the characteristic clinical, epidemiological and serological features were found. Measles antibodies were present in the CSF and the serum titers as measured in conventional (CF--HI--IFA) and new (RIA and ELISA) tests were significantly higher than those in siblings, parents, age-matched controls as well as in patients with recent measles or after live measles vaccination. Only in children with recent wild virus infection after previous vaccination with inactivated Split measles vaccine were similar elevated serum antibody levels observed. In the SSPE cases as well as in the former group, antibodies of the IgM-class were seldom detectable and isolation of infectious measles virus from brain tissue and lymphnode derived cell cultures was rarely accomplished. The search for a co-factor or triggering agent of SSPE such as inactivated or live measles virus vaccination, concomitant childhood infection or vaccination with onset of measles or SSPE was inclusive. The seroepidemiological observation of higher frequency and titer levels of EBV- and toxoplasmosis antibody in SSPE patients as compared to siblings and parents and the suspicion that arbor virus infection may have some influence on triggering SSPE must be further substantiated. It appears that this relatively rare disease arises after an early, normal measles infection in an immunologically competent child without special genetic characteristics, mainly belonging to the lower socio-economic group, by a change of the measles virus and the immune response of the host.

Adolescent↗
PubMedDate not supplied

Analysis of measles cases in a university pediatric hospital during 1988 and 1993 outbreaks.

In Turkey, a mass measles immunization campaign was initiated in 1985, and the decision was made to administer the first of the measles vaccinations at nine months of age instead of 12-15 months. Following the campaign there was a decrease in the number of measles cases seen in the Outpatient Department of Istanbul University Children's Hospital in 1986 and 1987; however, after 1987 an increase was observed in measles cases, which continued until 1993. In order to investigate the current measles epidemics, we reevaluated the measles cases seen in our Outpatient Department from 1986 to 1993. We also investigated the vaccination status and the hospitalization and mortality rates of measles cases in the epidemics of 1988 and 1993. Since 1988 (except 1989) a significant increase (412-1375 percent) has been observed in measles cases, and between 1986 and 1993 more than half of all measles cases were in children older than four years of age. In 1988 and 1993 we found that most vaccinated measles cases were also in this age group, but the rate of complications and hospitalization among the vaccinated cases was lower compared to those who were not vaccinated.

Child, Preschool↗
PubMed1995

Specific T and B cell immunity to measles after allogeneic and autologous bone marrow transplantation.

Lymphocyte stimulation with measles virus antigen (MLY) and ELISA for measles IgG antibodies were performed on 60 patients after allogeneic bone marrow transplantation (BMT), and on 59 patients after autologous bone marrow transplantation (ABMT). The T cell response was significantly higher in the 75 measles seropositive patients than in the 29 seronegative patients (P < 0.001), but not significantly different from the MLY in the 15 patients with uncertain serologic reactivity. When the patient group was divided according to type of transplant, the T cell response to measles was also significantly higher in seropositive patients than in seronegative patients after both ABMT (P < 0.001) and after BMT (P < 0.05). Twenty-three seronegative children who were measles vaccinated after BMT had a significantly higher T cell response to measles (7100 c.p.m.) than 17 seronegative non-vaccinated children (100 c.p.m.; P < 0.01). No significant difference was seen in the T cell response in 12 seronegative children vaccinated after ABMT (2500 c.p.m.) compared to seven children not vaccinated (2800 c.p.m.; NS). Seroconversion after vaccination was more frequent in children after BMT (20/23; 87%) compared to ABMT (5/12; 42%; P < 0.05) but no significant difference was found in the T cell response. Therefore, most patients who lost IgG antibodies to measles after bone marrow transplantation also lost their T cell response to measles. A T cell response to measles developed in most patients who seroconverted after vaccination. Failure to develop antibodies to measles in ABMT patients after revaccination may depend on a persisting T cell immunity.

Adult↗
PubMed1997

Seroepidemiological study of measles after the 1992 nationwide MMR revaccination program in Taiwan.

The incidence of measles declined rapidly in Taiwan after the introduction of the measles vaccine into the routine immunization schedule in 1978. However, an epidemic still occurred every 3-5 years until recently. A nationwide measles-mumps-rubella (MMR) revaccination program for school and preschool children has been in place since 1992 to control the indigenous transmission of measles. In order to understand the current immune status after this recent nationwide revaccination program, we determined the presence of measles IgG antibodies by enzyme-linked immunosorbent assay (ELISA) in 1,281 blood samples from healthy persons aged from 2 months to above 30 years collected between 1993 and 1995, and also in another batch of 90 sera samples from children aged 2 years collected before 1992. The results showed that 1) the measles antibody seropositive rate (36.4%) was lowest in children aged 5-7 months and rose to an unexpectedly high level of 85.8% at the age of 12-14 months, 2) the seropositive rate rose further to between 85.9% and 95.1% after 2 years of age and remained high in adults and pregnant women, and 3) the seropositive rate of the 2-year-old children collected before 1992 was 61.4%, which was significantly lower than the rate of the same age group collected after the nationwide MMR revaccination program. We conclude that the national revaccination program has promoted effectively measles immunity in Taiwan. This immunity explains the rarity of reported measles cases since the last epidemic in 1989. This revaccination program should continue and be extended to all preschool children and young adults so that indigenous measles can be eliminated by the year 2000.

Adult↗
PubMed1992

Vitamin A levels and severity of measles. New York City.

Recent studies show that vitamin A levels decrease during measles and that vitamin A therapy can improve measles outcome in children in the developing world. Vitamin A levels of children with measles have not been studied in developed countries. We therefore measured vitamin A levels in 89 children with measles younger than 2 years and in a reference group in New York City, NY. Vitamin A levels in children with measles ranged from 0.42 to 3.0 mumol/L; 20 (22%) were low. Children with low levels were more likely to have fever at a temperature of 40 degrees C or higher (68% vs 44%), to have fever for 7 days or more (54% vs 23%), and to be hospitalized (55% vs 30%). Children with low vitamin A levels had lower measles-specific antibody levels. No child in the reference group had a low vitamin A level. Our data show that many children younger than 2 years in New York City have low vitamin A levels when ill with measles, and that such children seem to have lower measles-specific antibody levels and increased morbidity. Clinicians may wish to consider vitamin A therapy for children younger than 2 years with severe measles. Additional studies of vitamin A in measles and other infectious diseases, and in vaccine efficacy trials, should be done.

Antibodies, Viral↗
PubMed1982

Imported measles in the United States.

In the period 1980-1981, two hundred nine imported measles cases were reported in the United States. These cases represent 1.3% of the total of 16,630 cases of measles reported to the Centers for Disease Control (CDC) during that period. An average of two imported measles cases were reported each week. The travelers with imported measles were United States citizens and foreign nationals who arrived from 47 different countries throughout the world. However, returning United States citizens have accounted for a rising proportion of imported measles cases. Approximately half (49.3%) of the imported cases were reported by four areas: California, New York State exclusive of New York City, New York City, and Florida. Seven measles outbreaks occurring following importations during the two-year period were identified. In addition to 114 imported measles cases reported to the CDC in 1981, 437 measles cases were reported to be caused directly or indirectly by those importations. The actual number of import-associated cases may have been considerably higher. Imported measles and associated cases together accounted for at least 17% (551/3,124) of reported measles cases in 1981.

Adolescent↗
PubMed1993

Clinical and laboratory features of measles in hospitalized adults.

PURPOSE: Description of the epidemiology, morbidity, and mortality of hospitalized adults with typical measles. PATIENTS AND METHODS: Retrospective case analysis of 33 adults who required acute care for complications of measles in a public hospital in Los Angeles, California. The diagnosis of measles was established on standard clinical or serologic grounds. RESULTS: Of 68 patients (age greater than 14) with signs and symptoms of measles who presented for medical care, 33 (19 males and 14 females) required hospitalization; 18 were natives of the United States. The patient age was 26.1 +/- 7.3 (mean +/- SD) years; four patients, all natives of the U.S., were born before 1957. The duration of hospitalization was 6.8 +/- 8.8 days for all patients and 13.4 +/- 14.2 days for the nine patients who required intensive care unit (ICU) care. Six of the ICU patients required mechanical ventilation for 11.0 +/- 15.0 days; two deaths occurred among these patients. During the course of their illness, 7 of 25 (28%), 11 of 28 (39%), 6 of 28 (21%), and 5 of 16 patients (31%) had peak lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and creatine kinase values, respectively, that were greater than 5 times the upper limit of normal. Fifteen of 28 patients (54%) developed total serum calcium levels less than or equal to 2.0 mmol/L. Ten cases were serologically confirmed; 23 cases were diagnosed as probable measles on clinical grounds. There were no significant demographic, clinical, or laboratory differences between patients with confirmed and probable measles. No patients had characteristic manifestations of atypical measles. The sole immunocompromised patient died. CONCLUSIONS: Measles in adults may result in severe, life-threatening complications that utilize substantial medical resources. Physicians need to appreciate the clinical presentations and manifestations of severe measles in adults and to provide measles vaccine to nonimmune adults during community-wide outbreaks.

Adolescent↗
PubMed1985

Measles virus infection without rash in childhood is related to disease in adult life.

The presence of measles specific antibodies is usually taken as evidence of typical measles in the past; in the present study it was regarded as evidence of infection with measles virus, but not necessarily of the common disease accompanied by a typical rash. The association between a negative history of measles in childhood and certain diseases later in life was investigated by a historical prospective method, based on school health records combined with self-reporting in adulthood, and tests for specific IgG measles antibody. There was evidence of association between a negative history of measles, exposure in early life (possibly injection of immune serum globulin after exposure), and development of immunoreactive diseases, sebaceous skin diseases, degenerative diseases of bone and cartilage, and certain tumours. It is suggested that the presence of measles virus specific antibodies at the time of acute infection interferes with development of specific cytolytic reactions, and enables intracellular measles virus to survive the acute infection. If this hypothesis is verified, use of immune serum globulin after measles exposure has to be of immune serum globulin after measles exposure has to be reconsidered.

Adult↗
PubMed1994

Household-acquisition of measles and illness severity in an urban community in the United States.

Studies from developing countries suggest that persons with household-acquired (HA) measles are at greater risk of severe illness than persons with community-acquired (CA) infection. Reported measles cases occurring among Milwaukee residents from May 1989 to June 1990 were used to assess whether household-acquisition was a risk factor for severe measles in the United States. A case was classified as HA if onset of rash occurred 7-18 days after onset of rash in another case in the same household. Hospitalization rates were similar for 128 patients with HA measles (27%) and for 1004 patients with CA measles (26%). Multiple logistic regression was used to evaluate the association between hospitalization and household-acquisition after controlling for socioeconomic status, measles vaccination history, age, race, and date of onset of rash. Patients with HA measles were no more likely to be hospitalized than patients with CA measles (odds ratio 0.9, 95% confidence interval 0.6, 1.5). HA measles cases were not more severe than CA measles cases during this urban outbreak in the United States.

Adolescent↗