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PubMed2006

Measles transmission following the tsunami in a population with a high one-dose vaccination coverage, Tamil Nadu, India 2004-2005.

BACKGROUND: On 26 December 2004, a tsunami struck the coast of the state of Tamil Nadu, India, where one-dose measles coverage exceeded 95%. On 29 December, supplemental measles immunization activities targeted children 6 to 60 months of age in affected villages. On 30 December, Cuddalore, a tsunami-affected district in Tamil Nadu reported a cluster of measles cases. We investigated this cluster to estimate the magnitude of the problem and to propose recommendations for control. METHODS: We received notification of WHO-defined measles cases through stimulated passive surveillance. We collected information regarding date of onset, age, sex, vaccination status and residence. We collected samples for IgM antibodies and genotype studies. We modeled the accumulation of susceptible individuals over the time on the basis of vaccination coverage, vaccine efficacy and birth rate. RESULTS: We identified 101 measles cases and detected IgM antibodies against measles virus in eight of 11 sera. Cases were reported from tsunami-affected (n = 71) and unaffected villages (n = 30) with attack rates of 1.3 and 1.7 per 1000, respectively. 42% of cases in tsunami-affected villages had an onset date within 14 days of the tsunami. The median ages of case-patients in tsunami-affected and un-affected areas were 54 months and 60 months respectively (p = 0.471). 36% of cases from tsunami-affected areas were above 60 months of age. Phylogenetic analyses indicated that the sequences of virus belonged to genotype D8 that circulated in Tamil Nadu. CONCLUSION: Measles virus circulated in Cuddalore district following the tsunami, although there was no association between the two events. Transmission despite high one-dose vaccination coverage pointed to the limitations of this vaccination strategy. A second opportunity for measles immunization may help reducing measles mortality and morbidity in such areas. Children from 6 month to 14 years of age must be targeted for supplemental immunization during complex emergencies.

Adolescent↗
PubMed2002

Rash after measles vaccination: laboratory analysis of cases reported in São Paulo, Brazil.

OBJECTIVE: The clinical differential diagnosis of rash due to viral infections is often difficult, and misdiagnosis is not rare, especially after the introduction of measles and rubella vaccination. A study to determine the etiological diagnosis of exanthema was carried out in a group of children after measles vaccination. METHODS: Sera collected from children with rash who received measles vaccine were reported in 1999. They were analyzed for IgM antibodies against measles virus, rubella virus, human parvovirus B19 (HPV B19) using ELISA commercial techniques, and human herpes virus 6 (HHV 6) using immunofluorescence commercial technique. Viremia for each of those viruses was tested using a polimerase chain reaction (PCR). RESULTS: A total of 17 cases of children with exanthema after measles immunization were reported in 1999. The children, aged 9 to 12 months (median 10 months), had a blood sample taken for laboratory analysis. The time between vaccination and the first rash signs varied from 1 to 60 days. The serological results of those 17 children suspected of measles or rubella infection showed the following etiological diagnosis: 17.6% (3 in 17) HPV B19 infection; 76.5% (13 in 17) HHV 6 infection; 5.9% (1 in 17) rash due to measles vaccine. CONCLUSIONS: The study data indicate that infection due to HPV B19 or HHV 6 can be misdiagnosed as exanthema due to measles vaccination. Therefore, it is important to better characterize the etiology of rash in order to avoid attributing it incorrectly to measles vaccine.

Antibodies, Viral↗
PubMed1997

Measles antibodies and herd immunity in 20- and 40-year-old Norwegians.

The introduction of a measles vaccination programme in Norway in 1969 using one dose of vaccine, and since 1983 two doses, was followed by a substantial decrease in the incidence of the disease. Since 1992, the annual incidence has been less than 20 cases. Small clusters and outbreaks have occasionally been observed among military personnel and unvaccinated children. This paper describes a seroepidemiological investigation of the level of immunity among 1,188 military conscripts, aged 18-28 years (mean 20.7) compared with 695 healthy 40-year-olds. The conscripts had been offered measles vaccine in infancy, in some cases also at 12-13 years of age, but they had also been exposed to wild measles virus, since the virus continued to circulate many years after the vaccination had started. The measles immunity in this group is considered to indicate the immunity level among the first 5 cohorts offered measles vaccine in Norway. The 40-year-olds had grown up in a community with no measles vaccination. Their level of immunity gives an indication of the level finally obtained when there are no vaccinations, and thus of the level that would induce herd immunity against measles in the Norwegian population. The aims of the vaccination programme must be to obtain a corresponding immunity. The results of the investigation show that the percentages with measles antibodies in the respective groups were 92.3 and 98.1. The observation of measles outbreaks among young Norwegian conscripts, as well as reports from several countries on outbreaks in university and college settings with levels of seropositivity of even more than 95%, indicate that the seropositivity in the 20-year-old group may be too low to afford protection, especially when this group is living under close conditions. Consideration should be given to the need for an intensification of the existing vaccination programme to ensure that the protection level needed for herd immunity is reached.

Adult↗
PubMed1999

Management of a measles outbreak among Old World nonhuman primates.

BACKGROUND AND PURPOSE: A measles outbreak in a facility housing Old World nonhuman primates developed over a 2-month period in 1996, providing an opportunity to study the epidemiology of this highly infectious disease in an animal-handling setting. METHODS: Serum and urine specimens were collected from monkeys housed in the room where the initial measles cases were identified, other monkeys with suspicious measles-like signs, and employees working in the affected areas. Serum specimens were tested for measles virus-specific IgG and IgM antibodies, and urine specimens were tested for measles virus by virus isolation or reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: A total of 94 monkeys in two separate facilities had evidence of an acute measles infection. The outbreak was caused by a wild-type virus that had been associated with recent human cases of acute measles in the United States; however, an investigation was unable to identify the original source of the outbreak. Quarantine and massive vaccination helped to control further spread of infection. CONCLUSIONS: Results emphasize the value of having a measles control plan in place that includes a preventive measles vaccination program involving human and nonhuman primates to decrease the likelihood of a facility outbreak.

Animals↗
PubMed2003

Passive acquired immunity against measles in infants born to naturally infected and vaccinated mothers.

BACKGROUND: Currently, the majority of newborns in Poland are born to mothers who have been immunized against measles. The aim of this study was to compare the maternal measles antibody titers of infants born to mothers who had been infected by measles wild virus (group I) with those born to mothers who had been vaccinated (group II). MATERIAL/METHODS: Serum samples were tested for measles antibodies from 79 infants in the 7th month of life and from 27 mothers between 17 and 41 years of age. Two commercial enzyme immunoassays (EIA) and a plaque neutralization test (PNT) were used. RESULTS: Only 12.7% of all infants showed measles antibodies in EIA. However, antibodies could be detected by PNT in all the infants, although only 36.6% showed titers of >1:8, which corresponds to protective antibody values of >0.2 IU/ml. The mean geometrical titer was significantly higher among infants from group I than in group II (1:7.16 vs. 1:3.71, p=0.0038). Protective antibody titers were detected in 50% of infants from group I and only 18.2% in group II (p<0.02). CONCLUSIONS: Passive acquired immunity in infants born to mothers who have had measles lasts longer than in infants born to vaccinated mothers. Nearly two thirds of infants (65.4%) in the 7th month of life did not have sufficient maternally derived neutralizing antibodies to protect against measles. Our data suggest that the recommended age for the first dose of measles vaccine during measles epidemics should be lowered to 9 months, with re-vaccination at 12-15 months.

Adolescent↗
PubMed1989

Measles active and passive immunity in a worldwide perspective.

'The simplest of all virus disease is measles' said Kenneth Maxy 40 years ago in a chapter on epidemiology. I hope that the data set out here provide the reader with a sufficiently complete and clear picture of the factors that determine measles epidemiology, that he or she will agree with Maxy's prescient words. Measles is an antigenically complex virus, but few components of the immune response to this virus are epidemiologically relevant. The relevant components are durable for a lifetime. They can be conveniently measured by serological tests, and the results of these tests correlate well with measles immunity. The tests show that measles is an extremely infectious disease, and that very high antibody prevalence rates are needed for herd protection. The currently available measles vaccine is capable of yielding adequate antibody prevalence rates for herd immunity, but to achieve this, immunization procedural flaws and faulty records must be kept to very low levels. The greatest obstacle to worldwide control of measles is a failure of vaccination programs to produce adequate herd immunity levels in less-developed countries. There, vaccine must be given promptly after passive immunity wanes, because the level of endemicity is so high. It is difficult to determine just what age is optimal, because it varies from one country to another. Premature vaccination not only fails to immunize, but also interferes with subsequent re-immunization. Because we now know this, further direct tests of vaccine effectiveness in very young children are ethically undesirable, and methods that use determination of passively acquired antibody are to be preferred. The levels of antibody that mothers have to pass to their children vary considerably. These differences are important in comparisons of South Asian countries with others, but not elsewhere. Differences in efficiency of transport of antibody across the placenta also play a role, but usually a minor one. Most important seems to be variation in antibody durability in the infant. Where families are poor, the children acquire many infections at an early age, and passively acquired antibody is swept out. These children who are least able to withstand the effects of measles infection, are hit at the earliest age. To provide protection for them, the vaccine must be given at a carefully determined age, specific for each community. Only when this is done can we hope to reduce measles worldwide to a sufficiently low level that it will be removed as a threat to persons in the United States, or anywhere else.

Antibodies, Viral↗
PubMed1986

Appropriate age for measles vaccination in the United States.

The appropriate age for measles vaccination is determined by weighing the risk of measles disease and complications at a given age with vaccine efficacy at that age. In the United States, measles vaccine was initially used in children as young as 9 months of age because the disease was common and complications were greatest in persons less than 1 year of age. In 1965, when it became apparent that vaccine failure was unacceptably high in children less than 1 year and when epidemiologic analysis indicated that children greater than or equal to 1 year, particularly schoolchildren, were the primary focus of measles transmission, the vaccination age was raised to 12 months. In 1976, further studies showed efficacy was slightly higher at 15 months of age versus 12 months or 12-14 months of age. Because the risk of acquiring measles in children less than 15 months was low, the age for routine vaccination was increased to 15 months. This age recommendation may be appropriate for developed countries where the epidemiology of measles may be similar to the epidemiology in the United States. However, this age is inappropriate for many countries in the developing world where the risks of measles and complications from measles are high in young preschool children. In those countries, the recommended age for routine vaccination against measles is generally 9 months.

Age Factors↗
PubMed1984

Ineffectiveness of historical data in predicting measles susceptibility.

The Immunization Practices Advisory Committee ( ACIP ) has devised noninvasive, historical criteria for determining individuals who are susceptible to measles. These criteria, which involve proof of vaccination, are incorporated into school entrance regulations and are used to indicate people who require vaccination during outbreaks. In a recent measles epidemic in El Paso , TX, 120,000 records were screened using these criteria, and as a result 13,000 students were vaccinated. During this outbreak, 91 adolescents, who were susceptible to measles by ACIP criteria, were serologically tested for measles antibody. Although none of these students had documentation of vaccination, only 11.0% of them lacked measles hemagglutination-inhibiting (HAI) antibody at a titer of 5. Assuming a minimum cost for vaccine of +2.60 per dose, a conservative estimate of the cost to the El Paso Health Department for 20,000 doses of measles vaccine would be +52,000. If these data can be extrapolated to the total student population, then upwards of 85% of vaccinated students were already immune. Thus, +44,200 was spent unnecessarily. In addition, as the ACIP criteria did not select for measles susceptibility, an estimated 12,000 students in El Paso were not protected against measles. Other methods to determine measles susceptibility should be developed for optimal control of future outbreaks.

Adolescent↗
PubMed1975

Antibody-mediated cytotoxicity after measles virus infection.

Antibody cytotoxicity in the presence of complement to measles virus-infected cells was determined in sera of individuals at various stages of measles virus infection. A measles virus carrier cell line, which possessed viral antigens on the cell membrane, was employed as target cells. The cytotoxic effect was measured by 51-Cr release from the measles virus-infected cells. A microtiter method was used to determine the titer of antibody cytotoxicity. Cytotoxic antibodies could be detected in serum specimens from individuals after natural measles virus infection and vaccination. Sera from subacute sclerosing panencephalitis (SSPE) patients had only slightly higher titers than were found in sera obtained from individuals 1 week to 3 months after measles virus infection. Sera from children inoculated with measles virus vaccine lost their ability to react in hemagglutination inhibition, neutralization (NT) and cytotoxicity (CT) tests after absorption with the hemagglutinin from measles virus. SSPE sera treated in a similar manner retained their activity in NT and CT tests. Cytotoxic antibody was, therefore, shown to be directed against the hemagglutinin and some other antigen of measles virus.

Animals↗
PubMed1981

Cell-mediated immune responsiveness to measles. Its occurrence as a result of naturally acquired or vaccine-induced infection and in infants of immune mothers.

Studies of cell-mediated immunity (CMI) to measles were carried out in patients with natural measles infection, in recipients of live measles vaccine, and in umbilical cord blood specimens from infants of mothers who were seropositive for measles. Evidence of CMI to measles was found in 100% of patients with natural infection but in only 62% of vaccine recipients and, interestingly, in 40% of umbilical cord blood specimens. Eight of these infants were subsequently studied at 4 to 5 months of age, at which time evidence of measles CMI was still detectable in three. Sufficient stimulation of cell-mediated immune mechanisms may be a prerequisite for the development of life-long immunity to measles. The effect of congenitally acquired CMI to measles on the outcome of immunization or of exposure to natural measles during the first year of life remains to be determined.

Adolescent↗
PubMed1994

Detection of measles virus from clinical samples using the polymerase chain reaction.

OBJECTIVE: To evaluate the usefulness of the polymerase chain reaction to detect the measles virus sequence using clinical samples. DESIGN: Centers for Disease Control and Prevention case definition of measles with or without IgM serology as a standard. SETTING: A laboratory in the Department of Pediatrics of the Hokkaido University Hospital, Sapporo, Japan. PATIENTS: Thirty-two serum samples, 16 throat swab samples, and nine cerebrospinal fluid samples from 32 patients with measles, including four patients with central nervous system involvement, and one serum sample and two throat swab samples from two patients with modified courses of measles were obtained. Ten serum samples, 10 throat swab samples, and 10 cerebrospinal fluid samples were obtained from patients without apparent measles infection as negative controls. MEASUREMENTS AND MAIN RESULTS: Sensitivity and specificity were comparable with those as obtained by culture or other methods reported in the literature. The polymerase chain reaction was positive in 24 (75.0%) of 32 by serum samples and in 13 (81.3%) of 16 by throat swab samples from the patients with measles, in contrast to none within the negative control group. In three of the four patients with central nervous system involvement, the measles virus sequence was detected in cerebrospinal fluid samples obtained within 1 day following the onset of the manifestations. All three samples from the patients with modified measles yielded positive results. CONCLUSIONS: The polymerase chain reaction can be used with sufficient sensitivity and specificity to detect the measles virus sequence using clinical samples. Transient and direct invasion of the central nervous system by this virus at the initial stage of the central nervous system involvement was strongly suggested.

Adolescent↗
PubMed1994

Measles antibody titers in early infancy.

OBJECTIVE: To determine the prevalence of measles seronegativity among infants younger than 6 months and to ascertain their serologic response to measles vaccine. DESIGN: Cross-sectional measles antibody survey during the 1989 measles epidemic in Chicago, Ill. SETTING: Inner-city perinatal center. PARTICIPANTS: Two hundred three infants younger than 6 months who had been admitted to the neonatal intensive care unit at birth; 130 (64%) of these infants were premature. Transplacental antibody transfer was evaluated in a subset of 89 mother-newborn pairs. INTERVENTION: Administration of measles monovalent vaccine to seronegative infants. MEASUREMENTS/RESULTS: Measles IgG antibody was measured using indirect fluorescent assay. At birth, 19 (38%) of 50 neonates born at less than 37 weeks' gestation had antibody titers that were twofold to fourfold lower than those of their mothers compared with three (8%) of 39 neonates born at more than 37 weeks' gestation (P < .01). Of the 203 study infants, fewer than 4% were seronegative at birth, while 74% of these infants aged 4 to 5 months were seronegative. Univariate logistic regression analysis indicated that the independent variables related to seronegativity were as follows: gestational age at birth (P = .007), chronological age (P < .001), history of having received three or more packed red blood cell transfusions (P < .001), and maternal age at delivery (P = .001). Multiple logistic regression analysis confirmed the association of seronegativity with chronological age (P < .001), gestational age (P < .02) and maternal age at delivery (P < .001). Seroconversion following administration of the measles vaccine was documented in 11 (79%) of 14 infants. CONCLUSION: A significant proportion of 4- to 5-month-old infants who had been admitted to the neonatal intensive care unit at birth lack measurable measles antibody; this population should be taken into account when strategies to control measles are considered.

Adolescent↗
PubMed1999

Health consequences of religious and philosophical exemptions from immunization laws: individual and societal risk of measles.

CONTEXT: All US states require proof of immunization for school entry. Exemptions are generally offered for medical, religious, or philosophical reasons, but the health consequences of claiming such exemptions are poorly documented. OBJECTIVES: To quantify the risk of contracting measles among individuals claiming religious and/or philosophical exemptions from immunization (exemptors) compared with vaccinated persons, and to examine the risk that exemptors pose to the nonexempt population. DESIGN, SETTING, AND PARTICIPANTS: Population-based, retrospective cohort study of data from 1985 through 1992, collected by the Measles Surveillance System of the Centers for Disease Control and Prevention, as well as from annual state immunization program reports on prevalence of exemptors and vaccination coverage. The study group was restricted to individuals aged 5 to 19 years. To empirically determine and quantify community risk, a mathematical model was developed that examines the spread of measles through communities with varying proportions of exemptors and vaccinated children. MAIN OUTCOME MEASURES: Relative risk of contracting measles for exemptors vs vaccinated individuals based on cohort study data. Community risk of contracting measles derived from a mathematical model. RESULTS: On average, exemptors were 35 times more likely to contract measles than were vaccinated persons (95% confidence interval, 34-37). Relative risk varied by age and year. Comparing the incidence among exemptors with that among vaccinated children and adolescents during the years 1985-1992 indicated that the 1989-1991 measles resurgence may have occurred 1 year earlier among exemptors. Mapping of exemptors by county in California indicated that exempt populations tended to be clustered in certain geographic regions. Depending on assumptions of the model about the degree of mixing between exemptors and nonexemptors, an increase or decrease in the number of exemptors would affect the incidence of measles in nonexempt populations. If the number of exemptors doubled, the incidence of measles infection in nonexempt individuals would increase by 5.5%, 18.6%, and 30.8%, respectively, for intergroup mixing ratios of 20%, 40%, and 60%. CONCLUSIONS: These data suggest the need for systematic review of vaccine-preventable incidents to examine the effect of exemptors, increased surveillance of the number of exemptors and cases among them, and research to determine the reasons why individuals claim exemptions.

Adolescent↗
PubMed1978

Solid-phase radioimmunoassay determination of virus-specific IgM antibody levels in a follow-up patients with naturally acquired measles infections.

The question of the exact disappearance time or possible persistence of measles-specific IgM antibodies after naturally acquired measles virus infections was studied with a sensitive solid-phase radioimmunoassay (RIA) method. A total of 30 patients were analyzed with follow-up times varying from 4.5 to 8 months; all were measles IgM positive in the first serum specimen obtained after the onset of rash. In 29 of 30 patients, the measles IgM declined to undetectable levels by approximately 90 days. The remaining patient developed postmeasles encephalitis, however, and was found to have a prolonged measles IgM antibody response. For comparison, the measles-specific IgG response was also studied and was found to develop only slightly later than the IgM response, with levels then remaining high and stable up to 8 months later. Although apparent measles IgM antibodies were found in 1 of 64 nonmatched adult controls, they were due to the presence of high levels of IgM-class rheumatoid factor. The data presented indicate that measles IgM antibodies begin to decline soon after the onset of rash and reach negative levels 1 to 3 months later; in complicated infections, however, measles IgM antibody synthesis may not terminate normally.

Adolescent↗
PubMed2005

Immunologic significance of HLA class I genes in measles virus-specific IFN-gamma and IL-4 cytokine immune responses.

The variability of immune responses modulated by human leukocyte antigen (HLA) genes and secreted cytokines is a significant factor in the development of a protective effect of measles vaccine. We studied the association between type 1 helper T cells (Th1)- and Th2-like cytokine immune responses and HLA class I alleles among 339 schoolchildren who previously received two doses of the measles vaccine. Median values for measles-specific interferon gamma (IFN-gamma) and interleukin-4 (IL-4) cytokines were 40.7 pg/ml [interquartile range (IQR) 8.1-176.7] and 9.7 pg/ml (IQR 2.8-24.3), respectively. Class I HLA-A (*0101 and *3101) and HLA-Cw (*0303 and *0501) alleles were significantly associated with measles-virus-induced IFN-gamma secretion. HLA-A*3101 and Cw*0303 were associated with a higher median IFN-gamma response, while A*0101 and Cw*0501 were associated with lower measles-specific IFN-gamma response. We found limited associations between HLA class I gene polymorphisms and Th2-like (IL-4) immune responses after measles vaccination, indicating that HLA class I molecules may have a limited effect on measles-vaccine-induced IL-4 secretion. Understanding the genetic factors that influence variations in cytokine secretion following measles vaccination will provide insight into the factors that influence both cell-mediated and humoral immunity to measles.

Adolescent↗
PubMed2005

Improved measles surveillance in Cameroon reveals two major dynamic patterns of incidence.

OBJECTIVE: To characterize the province-specific incidence patterns of measles in Cameroon and determine if an increase in measles incidence during the period January 2000-June 2001 is consistent with coincident epidemics in several regions with different inter-epidemic periods. METHOD: Periodic behavior of the monthly measles incidence time-series from each province of Cameroon was analyzed using time-series analysis and cluster techniques. Cumulative incidence in each province of Cameroon over a five-year period was associated with birth rates, and vaccination coverage. RESULTS: Distinct patterns of measles incidence were found in two different areas of Cameroon. The three northern-most provinces experience major epidemics every year. Seven southern provinces show evidence of experiencing major epidemics every third year. In January 2000, Cameroon experienced coincident peaks in these two cycles and thus an increase in measles incidence countrywide over the previous year. Higher cumulative province-specific incidence rates were associated with higher birth rates and lower routine vaccination coverage rates. CONCLUSION: Within one country, two dramatically different dynamic patterns of measles incidence were observed. Long-term surveillance data is crucial to the evaluation of measles immunization campaigns. The availability of a five-year record of measles incidence in Cameroon reveals an interesting dynamic pattern of measles incidence that accounts for the increase in countrywide incidence in 2000-2001.

Cameroon↗
PubMed1993

Interference of immune globulin with measles and rubella immunization.

Passively acquired antibody may interfere with the active antibody response to live viral vaccines such as measles and rubella. To evaluate the duration of this inhibitory effect, we measured the measles and rubella antibody responses of Apache children immunized with measles, mumps, and rubella vaccine at varying intervals after administration of an immune globulin termed bacterial polysaccharide immune globulin (BPIG). This specific immune globulin contained measles and rubella antibody titers similar to those in standard intramuscularly and intravenously administered immune globulins. Antibody responses to measles vaccine were inhibited for up to 5 months after a BPIG dose of 80 mg IgG per kilogram of body weight, but responses to rubella vaccine were inhibited for only 2 months. Most children who had a decreased measles antibody response to primary measles, mumps, and rubella immunization given 1 1/2 to 4 months after BPIG administration responded to a booster immunization given 6 months after their last BPIG dose. We conclude that high doses of immune globulin (> 10 mg/kg) may inhibit the antibody response to measles for more than 3 months. We propose that the interval between administration of immune globulin and measles and rubella immunization be adjusted on the basis of the dose of immune globulin.

Antibodies, Viral↗
PubMedDate not supplied

Measles control in Yaounde: justification of a one dose, nine month minimum age vaccination policy in tropical Africa.

For tropical countries the World Health Organisation recommends a single dose of measles vaccine, administered at a minimum age of 9 months. In some African nations, however, up to 26% of all reported measles occurs before the age of 9 months, and many African nations have been reluctant to follow the WHO recommendation. In 1974 the Ministry of Health of the United Republic of Cameroon made several changes in the existing measles control strategy, including increasing the minimum age for measles vaccination from 6 to 9 months. Surveillance of measles in Yaounde, the capital city, during the five years after the increase in age at vaccination did not reveal a need to return to the minimum age of 6 months. In fact, by 1979, with measles vaccination coverage among children 12-23 months of age at 40%, there had been a 44% decrease in reported measles among children of all ages, including a 64% decrease in the measles attack rate among children under the age of 9 months. These observations support the one dose, 9 month minimum age measles vaccination policy in tropical Africa.

Acute Disease↗