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PubMed1988

The detection of measles specific immunoglobulin M antibodies using biotinylated antigens.

The methods of reverse type enzymeimmunoassay (EIAs) with biotinylated antigens were used to determine IgM antibodies to measles virus in human sera. These antigens, either purified measles virus antigen or lysate type measles-vero antigen with lysate vero control antigen, were used in the two separate IgM-tests. Paired sera from 15 measles patients as well as 456 sera from patients with viral infections other than measles, with mycoplasma pneumoniae infections, from rheumatoid arthritis patients and blood donors, were assayed in a dilution of 1:200. Both the test systems detected all the 30 serum specimens from the measles patients as measles IgM positive, but the sera of all the other groups proved to be measles IgM negative. These tests developed for measles specific IgM antibodies, avoiding the interference of IgM-class rheumatoid factor, offer valuable tools for routine virus serology.

Antigens, Viral↗
PubMed2002

[Alterations in epidemics and vaccination for measles during a 20 year period and a strategy for elimination in Kurashiki City, Japan].

In Japan, an epidemic of measles occurs every few years. An estimated 100-200,000 people contract the disease each year and 50-100 patients die. Following the eradication of poliomyelitis, the World Health Organization made plans for global eradication of measles, and the Japanese Association of Pediatricians began advocating vaccination to eliminate measles in Japan by 2005. However, no big response has occurred nationwide. Therefore, we retrospectively look at changes in epidemics and measles vaccination during the past 20 years in Kurashiki City, Okayama Prefecture and developed a strategy for elimination through the results. The Japanese surveillance showed the numbers of measles patient in Okayama to be a few times higher than the mean number nationwide. The number of persons vaccinated was approximately 2,000-3,000 per year, while the number of births was about 6,000 per year. After passing a revised vaccination law in 1994, the number of vaccinations increased to more than 4,000, and the epidemic situation decreased to the nationwide level. However, the number of measles patients older than 15 years of age who were admitted to our hospital increased from 4% to 24% in the ratio to the whole. In the United States, school regulations require that children be vaccinated for MMR twice before admission to school, but the revised vaccination law in Japan was changed from a requirement to a recommendation. To eliminate measles, we should increase the vaccination rate for infants, and should vaccinate adolescents who have not been vaccinated or do not have a past history of measles. It is important to choose the subjects and then confirm their vaccination after the recommendation. We have developed a strategy that includes 1) advocacy for vaccination 2) selection for vaccination, 3) request for certification of vaccination, 4) convenience for vaccination. The goal after two years is for 1) a vaccination rate of more than 90% by end of one year of age, 2) a rate of vaccination and past history of measles in more than 90% of children before admission to kindergarten or public school.

Adolescent↗
PubMed1992

Secondary immune response in a vaccinated population during a large measles epidemic.

The rates of secondary immune response (SIR) and secondary vaccine failure (SVF) during a measles epidemic (10,184 notifications) were evaluated. A patient with SIR was defined as a subject for whom all sera were immunoglobulin G (IgG) positive and IgM negative with a significant increase in complement fixation titer. A patient with SVF was defined as a vaccinated symptomatic subject showing a SIR. Sequential sera from 898 subjects were tested for measles antibody by enzyme-linked immunosorbent assay (IgG and IgM) and by complement fixation. Evidence of recent anti-measles virus specific immune response was found in 496 subjects (55.5%). The vaccination rate was estimated at 74.6% (99% confidence interval [CI], 67.9 to 80.7%). The number of exposed vaccinated subjects was estimated at 370 (74.6% of 496). The SIR rate was 4.03% (20 of 496) (99% CI, 2.1 to 6.9%) among subjects with immune response. These 20 subjects were 2 with measles (Centers for Disease Control's definition), 6 with measles with rash of unknown duration, 8 with presumed measles with either rash or fever, 3 asymptomatic subjects (2 with recent contact with a measles case), and 1 undocumented subject. Since 3 patients with SIR were asymptomatic and 2 others were documented as not vaccinated, there was a maximum of 15 probable occurrences of SVF among the 20 patients with SIR. The SVF rate among exposed vaccinated subjects was estimated at 4.05% (15 of 370) (99% CI, 1.9 to 7.5%). In conclusion, neither prior vaccination nor detectable SIR ensures protective immunity. Measles virus may induce asymptomatic SIR in IgG-seropositive subjects. SVF led to typical or modified measles but did not seem to have played an important role during this epidemic.

Adolescent↗
PubMed1996

The N-glycan of the SCR 2 region is essential for membrane cofactor protein (CD46) to function as a measles virus receptor.

Membrane cofactor protein (MCP) (CD46), a complement-regulatory protein, serves as a cellular receptor for measles virus. Its amino-terminal portion is composed of four short consensus repeats (SCR), three of which (SCR1, SCR2, and SCR4) carry an N-linked oligosaccharide. In order to determine the importance of the three N-glycans for the function of MCP as a measles virus receptor, we established Chinese hamster ovary (CHO) cell lines that stably express mutant MCPs lacking one of the three motifs for N glycosylation (NQ1, NQ2, and NQ4). In an additional mutant (NQ1-2), two glycosylation motifs were altered, allowing the addition of an N-linked oligosaccharide only in SCR4. The abilities of the mutant MCPs to function as measles virus receptors were analyzed with three different assays: (i) binding of measles virus hemagglutinin to MCP immobilized on nitrocellulose; (ii) binding of measles virus to CHO cells expressing wild-type or mutant MCP; and (iii) infection of the transfected CHO cells by measles virus. In all three assays, the abilities of the NQ2 and NQ1-2 mutants to serve as measles virus receptors were drastically impaired. The NQ1 and NQ4 mutants were recognized by measles virus almost as efficiently as the wild-type protein. These results indicate that the N-glycan attached to SCR2 is essential for MCP to serve as a measles virus receptor, while the oligosaccharides attached to SCR1 and SCR4 are of only minor importance.

Animals↗
PubMed1987

Swedish experience of two dose vaccination programme aiming at eliminating measles, mumps, and rubella.

In 1982 a two dose regimen was introduced in Sweden for the combined vaccination against measles, mumps, and rubella of children aged 18 months and 12 years. Since 1977 about half of the preschool children were vaccinated against measles annually, and since 1974 about 80% of 12 year old girls were vaccinated against rubella. During the period 1982 to 1985 90-93% of the eligible age cohorts of 18 month old children and 88-91% of the 12 year old children were immunised with the new combined vaccine. A study in 1982 of about 140 18 month old children who were nearly all seronegative before vaccination showed that 96%, 92%, and 99% seroconverted against measles, mumps, and rubella, respectively. A second study was carried out in 1983 of 247 12 year old children, of whom 11% lacked antibodies to measles, 27% to mumps, and 45% to rubella. This showed seroconversion in 82% and 80% against measles and mumps, respectively, and all children seroconverted against rubella. In the latest study in 1985 of 496 12 year olds 9% and 13% were seronegative against measles and mumps before vaccination, and 41% against rubella. Of these, 88% seroconverted to measles and 80% to mumps, and all converted to rubella when sera were tested by the haemolysis in gel method. After a neutralisation test against measles as well all children showed immunity to the disease. A low incidence of measles and declining figures for mumps and rubella were reported in 1984 to 1986. An outbreak of rubella during 1985 affected mainly boys in age cohorts in which only the girls had been vaccinated during the 1970s.

Child↗
PubMed1995

Persistent measles virus infection of the intestine: confirmation by immunogold electron microscopy.

This study sought to investigate persistent measles virus infection of the intestine: a novel protocol for immunogold electron microscopy was developed using a polyclonal anti-measles nucleoprotein antibody on reprocessed, formalin fixed paraffin wax embedded tissue sections. Antibody binding was detected using both immunoperoxidase and light microscopy on tissue sections, and 10 nm gold conjugated secondary antibody and electron microscopy on ultrathin sections. The techniques were validated using both measles infected vero cells and human tissues with established measles infection: these included brain affected by subacute sclerosing panencephalitis and acute measles appendicitis. The technique was applied subsequently to six untreated cases of granulomatous Crohn's disease, and two cases of ileocaecal tuberculosis, a granulomatous control. Mumps primary antibody--applied to both mumps infected vero cells, and measles infected vero cells and tissues studied by immunoperoxidase, and measles antibody on mumps infected cells studied by immunoperoxidase and immunogold--were used as specificity controls: the primary antibodies identified their respective target antigen and there was no antibody cross reactivity. Measles virus nucleocapsids labelled with gold conjugated antibody in both infected cells and tissues, including foci of granulomatous inflammation in five of six cases of Crohn's disease: in the fifth case, the granuloma could not be identified in ultrathin section. In one of the tuberculosis cases, a low level of signal was noted while the second case was negative. Labelling adopted a characteristic pattern in all infected tissues, strengthening the specificity of these findings. This study provides the first direct confirmation of persistent measles virus infection of the intestine.

Animals↗
PubMedDate not supplied

Frequency of allergic diseases following measles.

OBJECTIVE: Viral and bacterial infections in childhood decrease the likelihood of allergic diseases in later life. The frequency of allergic diseases in patients with a history of measles has been reported to be low but some studies still suggest that measles can increase the frequency of allergic diseases. The aim of this study was to investigate the frequency of allergic diseases following measles in childhood. METHODS: Fifty-two children hospitalized in our clinic with measles were compared with 51 children without measles. Allergic diseases were investigated in both groups by using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. In all children, allergy skin tests were performed with the four most common allergens. RESULTS: Sensitivity to Dermatophagoides pteronyssinus was less frequent in children with measles than in those without (p < 0.05). A history of nebulized salbutamol use in the emergency room in the previous 12 months was also less frequent in the measles group (p < 0.05). Inhaled corticosteroid use was more common in the group without measles (p < 0.05). CONCLUSION: The results of this study indicate that findings of allergic disease are less frequent in children with a history of measles. These children were less sensitive to D. pteronyssinus.

Administration, Inhalation↗
PubMed1998

Measles, immunisation and disease: situation analysis in a resettlement area of northern India.

India has a goal of covering all infants with measles immunization between 9-12 months. The present study was conducted in a resettlement area of east Delhi, with a population of nearly one lac, to assess the extent of measles immunization and infection among children aged under three years. All the 21 blocks of the area were covered and 10% households were selected by systematic random sampling from each of the blocks to provide 944 households and 517 under-3 children, who were individually examined by a doctor. Two hundred and eighty one children aged 12 months or above were immunized at or after 9 months giving a coverage of 74.14%. Among the immunized children 7.78% and 8.36% were vaccinated before and after the recommended age-range (9-12 months) respectively. One fifth of the children aged 12 months or above were not immunized against measles at all. Among the surviving under-3 children, no child suffered measles before 6 months but 11.86% of the children had measles between 6-8 months. Six children were vaccinated even after measles episode and seven children had measles even after immunization. Systematic community contact and special attention to resistant and hostile parents is important in order to accomplish 100% coverage. In view of the sizeable proportion of measles infection among the age group of 6-8 months, there is a case for bringing forward the recommended age for measles immunization, if we are to eradicate the disease.

Age Distribution↗
PubMed2006

Assessment of routine surveillance data as a tool to investigate measles outbreaks in Mozambique.

BACKGROUND: Measles remains a major public health problem in Mozambique despite significant efforts to control the disease. Currently, health authorities base their outbreak control on data from the routine surveillance system while vaccine coverage and efficacy are calculated based on mathematical projections of the target population. The aim of this work was to assess the quality of the measles reporting system during two outbreaks that occurred in Maputo City (1998) and in Manica Province (2002). METHODS: Retrospectively, we collected data from the routine surveillance system, i.e. register books at health facilities and weekly provincial and national epidemiological reports. To test whether the provinces registered an outbreak, the distribution of measles cases was compared to an endemic level established based on cases reported in previous years. RESULTS: There was a significant under-notification of measles cases from the health facilities to the province and national level. Register books, the primary sources of information for the measles surveillance system, were found to be incomplete for two main variables: "age" and "vaccination status". CONCLUSION: The Mozambican surveillance system is based on poor quality records, receives the notification of only a fraction of the total number of measles in the country and may result in failures do detect epidemics. The measles reporting system does not provide the data needed by Expanded Program on Immunisation managers to make evidence-based decisions, nor does it allow in-depth analysis to monitor measles epidemiology in the country. The progress of Mozambique to the next stage of measles elimination will require an improvement of the routine surveillance system and a stronger Health Information System.

Adolescent↗
PubMed1998

[Eradication of measles in Cuba].

The vaccine against measles came into use in Cuba in 1971. During the seventies, a new early strategy for measles control was established, and it was followed by further efforts in the early eighties. Despite improvements to the control program, disease outbreaks continued to occur. In 1986, after examining the experience acquired through the control initiatives that were already in place, a new measles vaccination strategy was adopted. In time, the new vaccination strategy against measles came to have three main components: first, a single vaccination "catching-up" campaign targeting children 1 to 14 years of age. Second, efforts were made to achieve and maintain high vaccine coverage through mandatory vaccination services for 12-month-old children ("maintenance vaccination"). Finally, periodic "follow-up" campaigns were carried out for children 2 to 6 years of age. Steps were taken, for the purpose of monitoring the progress made so far toward eliminating measles, to strengthen disease surveillance systems, including the screening of suspected cases. The "catching-up" and "follow-up" campaigns both achieved greater than 98% coverage within targeted age groups. The routine vaccination program has also maintained high coverage. The high population immunity against measles that has been attained through these vaccination strategies has resulted in a rapid decrease in the incidence of the disease. From 1989 to 1992, less than 20 laboratory-confirmed cases were reported annually. In Cuba, the last case confirmed through serologic screening was reported in July 1993. Cuba's strategy for measles elimination has interrupted disease transmission and kept the causal virus from circulating on the island. Cuba's experience with measles elimination suggests that if an appropriate vaccination strategy is applied, measles can be globally eradicated.

Adolescent↗
PubMed2002

Effect of differing immunization policies on circulating measles antibody levels in US and Canadian children.

OBJECTIVE: To examine the effect of differing age-at-immunization policies on measles antibody levels in US children immunized at the age of 15 months compared with Canadian children immunized at the age of 12 months. SUBJECTS AND METHODS: Healthy, volunteer US and Canadian children aged 6 to 11 years who had been immunized with a single dose of the measles vaccine were enrolled from 1991 to 1993. Measles antibody was measured with a whole-virus, measles-specific IgG enzyme-linked immunoassay. Age, race, sex, country of residence, general health status, age at time of measles immunization, and time from immunization to sampling were recorded. RESULTS: Of the 1052 children enrolled in the study, US children (n=719) had a significantly higher measles seroprevalence (87%) compared with Canadian children (n=333) (76%; P<.001). After adjustment for time from immunization and age at immunization, the differences in seropositive rates were no longer significant (odds ratio [OR], 1.53; 95% confidence interval, 0.87-2.69; P=.15). We found a significant dose-response relationship between age at the time of immunization and the odds of being seropositive after immunization, with ORs varying from 1 with immunization at 13 months or younger to 2.30 with immunization at 16 months of age (P=.01). CONCLUSIONS: The current US policy of immunizing with the first dose of measles at the age of 12 months may be less effective than a policy of immunizing at 12 to 15 months of age. These findings may be highly significant as we move toward an era in which measles exposure may be rare and policies are developed to eradicate measles.

Age Factors↗
PubMedDate not supplied

Post-vaccination scenario of measles: a retrospective analysis.

BACKGROUND: Routine vaccination against measles was introduced in India during 1985-86 through the Universal Immunization Programme. Its effect on the current prevalence of measles is not known. METHODS: Information on the total number of patients admitted and deaths due to measles from January 1982 to December 1997 were obtained from the records of the Institute of Tropical Medicine, Hyderabad, the only infectious diseases hospital in the city. Details on age, sex, number of complications, duration of hospital stay, vaccination status and information on vitamin A administration in the hospital were collected from the case records. RESULTS: A total of 20,926 cases of measles were admitted from 1982 to 1997. There was a 69% reduction in hospital admissions from the pre-vaccination to the post-vaccination period, and deaths due to measles decreased by 90%. Over the years, a rise in the age of children admitted with measles was observed. Boys were admitted more frequently to the hospital (p < 0.001) than girls. All the children showed one or more complications. From 1992 onwards, vitamin A was administered to 45.4% of the children admitted. CONCLUSION: A significant reduction was observed in the number of cases admitted to the hospital as well as deaths due to measles. Apart from the effect of the vaccination programme, this could also be due to increased awareness and availability of better health care facilities in the hospital and peripheral health clinics. Administration of vitamin A to children with measles as recommended by the World Health Organization needs to be implemented. A significant increase in the number of older children (> 5 years) with no significant reduction in the infants affected by measles indicates inadequate vaccine coverage and accumulation of susceptible older children.

Adolescent↗
PubMed2000

[Measles epidemiology in the Netherlands: a exploratory analysis of notification].

OBJECTIVE: Explorative analysis of the effects of vaccination policy on measles incidence. DESIGN: Retrospective study and mathematical modelling. METHOD: Analysis of national and regional case notifications of measles provided by the Inspectorate of Health in the Netherlands over the period from January 1976 (when vaccination was started) through September 1999. Also computer simulations with a mathematical epidemic model of measles were used to calculate the incidence of measles from 1976 onwards. RESULTS: According to the model results, measles should not persist with the current vaccination programme. However, the case notification data showed that measles appeared to persist at a nation-wide level. At a regional level, measles did not persist, not even in regions with low vaccine coverage. A possible cause of the unexpected persistence at the national level is the asynchronous regional course of the 6-year epidemic cycle of measles, where measles infection 'jumps' from one region to the other.

Child↗
PubMed2000

Clinical safety issues of measles, mumps and rubella vaccines.

The clinical safety of measles and measles-mumps-rubella vaccines has been questioned in recent reports that propose a possible link between measles virus or measles vaccines and the occurrence of juvenile Crohn disease and autism. This article reviews the outcomes of several laboratory investigations which were carried out independently to identify the presence or absence of measles virus in the intestinal tissues derived from cases of inflammatory bowel disease. One research group reported the presence of measles virus particles and genomic RNA in inflammatory bowel disease tissues, but this could not be confirmed by other groups, despite use of techniques that are highly specific and sensitive for the detection of measles virus nucleic acid in clinical specimens down to the molecular level. Based on the published data reviewed here, it can be concluded that there is no direct association between measles virus or measles vaccines and the development of Crohn disease, a conclusion which is supported by most epidemiological findings.

Humans↗
PubMed1998

American Academy of Pediatrics. Committee on Infectious Diseases. Age for routine administration of the second dose of measles-mumps-rubella vaccine.

The purpose of this statement is to inform physicians of a modification in the recommendation of the appropriate age for routine administration of the second dose of measles-mumps-rubella (MMR) vaccine. The implementation of the two-dose measles vaccine schedule has improved the control of measles, but some outbreaks continue to occur in school children, although >/= to 95% of children in school have received one dose of vaccine. Because most measles vaccine failures are attributable to failure to respond to the first dose, that all children receive two doses of measles-containing vaccine is essential for the control of measles. Routine administration of the second dose of MMR vaccine at school entry (4 to 6 years of age) will help prevent school-based outbreaks. Physicians should continue to review the records of all children 11 to 12 years of age to be certain that they have received two doses of MMR vaccine after their first birthday. Documenting that all school children have received two doses of measles-containing vaccine by the year 2001 will help ensure the elimination of measles in the United States and contribute to the global effort to control and possible eradicate measles.

Adolescent↗
PubMed2004

Can measles be eradicated globally?

Measles is one of the most infectious diseases. Before measles vaccine was introduced, nearly everyone contracted the disease at some point in childhood. By the late 1980s, most countries had incorporated measles vaccine into their routine immunization programmes. Globally, about 800 000 children nevertheless still die from measles annually, half of them in Africa. Eradicating measles would therefore play an important role in improving children's survival. The 24th Pan American Sanitary Conference in 1994 established a goal of eradicating measles from the Americas. Progress to date has been remarkable and the disease is no longer endemic in the Americas, with most countries having documented interruption of transmission. As of November 2003, 12 months had elapsed since the last indigenous case was detected in Venezuela. This experience shows that measles transmission can be interrupted, and that this can be sustained over a long period of time. Global eradication is feasible if an appropriate strategy is implemented. Even under a new paradigm in which immunization is not discontinued after measles is eradicated, eradication will be a good investment to avoid expensive epidemics and save the lives of almost one million children annually. A world free of measles by 2015 is not a dream.

Contact Tracing↗
PubMed2005

[Measles in Poland in 2003].

In Poland 48 measles cases were registered in 2003 (0.13 per 100,000 population)--of which 65% were cases imported from Chechnya and Afghanistan. Measles outbreaks occurred in 3 centers for immigrants. In total, 31 cases were reported, of which 96.8% were unvaccinated, and 93.5% were under 15 years of age. Of 17 local cases, 5 (29.4%) cases occurred in unvaccinated persons, 3 (17.6%) in persons vaccinated with one dose and 7 (41.2%) in those vaccinated with two doses of measles vaccine (administered at the age of 13-15 months and 7 years). Among 12 vaccinated cases only one 2-year old child was recently vaccinated. The remaining cases were in the 3-7 and 10-24 age ranges. The most affected were infants (incidence 0.57 per 100,000), 1-year old (0.28) and 2-year old children (incidence 0.27). Cases among adolescents and adults over 15 years of age increased from 23.5% in 2002 to 47.1% in 2003. The increasing age of locally-acquired cases, together with constantly high immunization coverage indicates high effectiveness of vaccinations in Poland. Out of all reported cases 13 (38%) were hospitalized. There were no deaths due to measles in Poland in 2003. Poland participates in the WHO Measles Elimination Strategy. Presently, the most important is the maintenance of a sensitive and timely surveillance of measles and measles-compatible cases, with serologic confirmation of one rash-like illness per 100 000 population. The performance of the surveillance system is insufficient with only 55 measles-compatible cases reported in 2003 (15% of expected reports). Serologic confirmation of cases was also insufficient, with 22 cases (40.0%) confirmed by IgM ELISA test. These results indicate the need to maintain the high immunisation coverage and improve measles surveillance system.

Adolescent↗
PubMed2005

[Measles and rubella].

Measles and rubella should be considered as infectious diseases to be prevented through vaccination rather than as diseases to be treated. If measles and rubella live vaccines are used appropriately, it is possible not only to prevent children contracting measles and rubella but also to prevent outbreaks of these diseases, and to eradicate newborns with congenital rubella syndrome. Changes in the epidemic situation of measles resulting from both vaccination and genetic alteration of the virus have caused new problems such as modified measles and adult measles. To resolve these problems it is necessary to maintain an adequate coverage with the measles vaccination. On the other hand, rubella outbreaks have been controlled by vaccinations and newborns with congenital rubella syndrome are rarely reported. However, the vaccination coverage against rubella has decreased in recent years, and the reoccurrence of the congenital rubella syndrome has already been reported in some regions. The introduction of the measles-rubella combined vaccine and twice vaccination schedule is indispensable in maintaining adequate vaccination coverage and keeping antibody levels against measles and rubella sufficiently high.

Adult↗