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PubMed2006

Young children non-immunized against measles: characteristics and programmatic implications.

AIM: To examine the presenting characteristics, including nutritional status, of young children without measles immunization and to suggest appropriate public health measures to improve immunization status. METHODS: In this retrospective case-control analysis, we studied 4075 children aged 12-23 mo of either sex, who attended ICDDR,B's Dhaka hospital during 1994-2003. Cases included children who reported to this facility without receiving measles vaccine, and the control children were those who received the vaccine. RESULTS: 3181 of 4075 (78%) children, including 1227 (39%) girls and 1954 (61%) boys, received measles immunization. The proportion of vaccinated children increased from 74% in 1997 to 82% in 2001. Some non-specific effects of measles immunization were observed. Fifty-one per cent of the children without measles immunization were stunted, 76% were underweight, and 48% were wasted. The non-immunized children were twice as likely to be stunted, underweight, and wasted than the immunized children; they were more often dehydrated (some or severe dehydration) (28% vs 22%, p<0.001), required longer duration (>72 h) of hospitalization (15% vs 10%, p<0.001), did not receive vitamin A capsule in the previous 6 mo (56% vs 36%, p<0.001), and had more frequent abnormal lung auscultation indicative of acute lower respiratory tract infections (8% vs 5%, p<0.001). Female children, illiterate mother, lack of vitamin A supplementation, and history of measles were significantly associated with non-immunization against measles after controlling for co-variables. Results were similar when different nutritional indicators (underweight, stunting, or wasting) were added separately to logistic regression models. CONCLUSION: Intervention strategies to enhance immunization coverage in infants should target illiterate mothers and their children, particularly the females and malnourished ones, provide them with measles immunization and vitamin A capsule, and encourage their periodic follow-up visits as part of a preventive nutritional programme.

Bangladesh↗
PubMed2003

Interruption of measles transmission in Brazil, 2000-2001.

In 1992, Brazil adopted the goal of measles elimination by the year 2000; however, in 1997, after a 4-year period of good control, there was a resurgence of measles in Brazil. In 1999, to achieve the elimination goal, Brazil implemented the Supplementary Emergency Measles Action plan, with one measles surveillance technician designated to each state. Of 10,007 suspected measles cases reported during 1999, 908 (9.1%) were confirmed, and of them 378 (42%) were confirmed by laboratory analysis. Of 8358 suspected measles cases reported in 2000, 36 (0.4%) were confirmed (30 [83%] by laboratory); 92% of the discarded cases were classified on the basis of laboratory testing. In 2001, only 1 of 5599 suspected measles cases was confirmed, and it was an imported case from Japan. The last outbreak occurred in February 2000, with 15 cases. Current data suggest interruption of indigenous measles transmission in Brazil.

Adolescent↗
PubMed2004

Has surveillance been adequate to detect endemic measles in the United States?

Evidence that endemic measles has been eliminated in the United States rests on the performance of the surveillance system. Information from national surveillance data allows us to evaluate the adequacy of national surveillance to detect the circulation of endemic measles. Sources of data include measles report dates, international importation status, and the size of chains of measles transmission. The proportion of chains of measles transmission that can be epidemiologically linked to international importations is high (62%), as would be expected if measles is no longer circulating; the number of imported cases, although lower than estimated expected values, is within a reasonable range of expectation. National surveillance detects even small outbreaks, so larger outbreaks that are the marker for endemic transmission would almost certainly be detected. Few unreported cases of measles are detected when health departments conduct careful investigations in response to reports of an index case. Surveillance appears to be adequate to support the contention that measles is no longer endemic in the United States.

Disease Notification↗
PubMed1990

Isolation of measles virus in primary rhesus monkey cells from a child with acute interstitial pneumonia who cytologically had giant-cell pneumonia without a rash.

The isolation of measles virus in primary Rhesus monkey kidney cells (PRMK) in patients with documented giant-cell pneumonia who have presented without a rash is limited. The diagnosis usually is made by cytologic examination of nasal or bronchial secretions in which characteristic multinucleated giant cells with intranuclear and intracytoplasmic inclusion bodies are observed. The diagnosis of giant-cell pneumonia has been associated with measles virus but not exclusively. Canine distemper, herpes group viruses, and parainfluenza infections have been associated with these cells. In addition, vitamin A deficiency also has been cytologically associated with multinucleated giant cells. The authors describe the isolation of measles virus from bronchial washing and sputum in PRMK cells at 4 days from an 11-year-old child with acute interstitial pneumonia who was in remission for acute lymphocytic leukemia. Classic cytopathologic effect (CPE) consisting of syncytial and hole formation on the PRMK monolayer was apparent. In addition, a foamy appearance of the monolayer was noted in an otherwise clean lot of monkey cells. Confirmatory testing with measles antibody of the infected areas of the monolayer by indirect immunofluorescence (IFA) was positive for measles antigen and negative for mumps, parainfluenza (types I, II, and III) and influenza A and B virus. Serologic studies for measles antibody revealed an IFA IgG titer of greater than 1:10,240, and an IgM titer of 1:128. Cytologic examination of the same bronchial fluid revealed the typical giant cells with characteristic inclusions associated with measles virus. Because this disease usually is severe, and often fatal, prompt recognition of this virus is essential, not only to the patient, who can be treated with immunoglobulin and/or antiviral therapy, but also to prevent the spread of the virus to other patients and medical personnel. These findings also support direct evidence for the etiologic role of measles virus in giant-cell pneumonia that has been detected either histologically or cytologically and in tissue culture at autopsy.

Animals↗
PubMed1994

Progressive immunodeficiency due to infection with human immunodeficiency virus does not lead to waning immunity to measles in a cohort of homosexual men.

The relationship between progressive immunodeficiency related to infection with human immunodeficiency virus (HIV) and waning immunity to measles was investigated in this retrospective cohort study. Titers of serum antibodies to measles virus were measured by enzyme immunoassay of stored sera from a cohort of homosexual men who were studied at San Francisco General Hospital. Subjects underwent a baseline and follow-up measure of measles antibodies. High levels of antibodies to measles virus were maintained in the HIV-positive and negative groups. One (2%) of the 50 HIV-negative controls was seronegative for the measles virus, and no controls evidenced seroreversal (decline in antibody to a level at which protection is not provided) during the study. Two (1.4%) of the 145 HIV-positive subjects were measles-seronegative, and two others evidenced seroreversal. Analysis with Spearman's rank correlation revealed no relationship between changes in the CD4 cell count and measles antibody level. Thus we conclude that waning measles immunity is not greatly accelerated in HIV-infected adults despite progressive HIV-related immunodeficiency.

Adult↗
PubMedDate not supplied

Impact of measles in Canada.

The reported incidence of measles in Canada in 1981 was reduced 97% from the average annual rates during the prevaccine period, 1949-1958. Throughout recent years the age-specific incidence of reported cases of measles has remained highest in the group five to nine years of age, but there has been a definite increase in the proportion of cases of measles in persons greater than 10 years of age. During the extensive measles epidemic in Alberta in 1979, a high proportion of the reported cases occurred in adolescents and young adults previously vaccinated with killed vaccine, and the majority of these developed atypical measles syndrome. In Canada, from five to 36 patients per 100,000 population have required hospitalization annually for complications due to measles over the past 16 years. Measles-related deaths have declined in a pattern similar to that for reported incidence. Despite favorable trends in the control of measles in Canada, the social and economic impacts of this disease remain substantial and warrant a nationwide effort to eliminate indigenous infection.

Adolescent↗
PubMed1993

Infection of monocytes during measles.

Immune suppression has long been recognized to be a consequence of measles and a likely contributor to the secondary complications of this infection. Since measles virus can be isolated from peripheral blood leukocytes during the early phases of infection, it has been widely assumed that measles virus suppresses the immune system by replicating in and damaging T lymphocytes. A reverse transcriptase-polymerase chain reaction (RT-PCR) assay able to detect wild-type strains of measles virus was applied to the study of peripheral blood mononuclear cells (PBMC) during natural measles virus infection. Measles virus RNA was detected by RT-PCR in monocyte-enriched adherent cells up to 6 days after the appearance of the rash. No viral RNA was detected in the lymphocyte-enriched nonadherent cell fraction. The numbers of virus-infected PBMC detected by in situ hybridization ranged from 1 in 125 to 1 in 2500. Dual staining identified infected cells as monocytes. It is concluded that the primary leukocytes infected during measles are monocytes, not lymphocytes. This cellular tropism has implications for understanding the immune suppression associated with measles.

Adolescent↗
PubMed1991

Mathematical modeling and attempts to eliminate measles: a tribute to the late Professor George Macdonald.

In 1983, 5 years after the inception of an aggressive national measles elimination strategy, the United States experienced its lowest level of reported numbers of cases of measles. This accomplishment was the result of an effective vaccination strategy coupled with surveillance and control efforts by local, state, and national public health agencies. After 1983, however, the reported number of measles cases slowly increased until 1989, when the number exceeded that of 1979, the first full year of the National Measles Elimination Program. In 1990, we are experiencing epidemics throughout the United States and expect the reported number of cases of measles to exceed that of 1989. In this context, we felt it was timely to reflect on this experience in light of previous measles control efforts. In particular, we looked back to the contributions of Professor George Macdonald, which were critical to the successful elimination of measles from The Gambia in 1969. As we enter the last decade of this century, the sensible merging of mathematics and epidemiology in useful models, and the appropriate use of such models for planning, offers the best hope for achieving the elimination of measles either in this or the next century.

Child↗
PubMed1995

Serologic status and measles attack rates among vaccinated and unvaccinated children in rural Senegal.

During a measles vaccine trial in a rural area of Senegal, antibody status was examined within 10 days of exposure for 228 previously vaccinated and 313 unvaccinated children more than 12 months old who were exposed to measles at home. Thirty-six percent of the children developed clinical measles, the clinical diagnosis being confirmed for 135 of the 137 children from whom 2 blood samples were collected. Vaccine efficacy was 90% (95% confidence interval, 83 to 94%). The hemagglutinin-inhibiting antibodies (HI) or plaque neutralizing antibodies (PN) assays were equally efficient in predicting susceptibility and protection against measles. Vaccinated children who had no detectable HI or PN antibodies at exposure had significant protection against measles compared with seronegative unvaccinated children (HI vaccine efficacy, 49% (95% confidence interval, 21 to 68%); PN vaccine efficacy, 43% (95% confidence interval, 12 to 62%)). The attack rate was high for children with a titer of 40 to 125 mIU) 67% (4 of 6) of those with a positive hemagglutinin-inhibiting antibody test and 36% (13 of 36) of those with a positive PN test developed measles. Attack rates among children with HI or PN titers above 125 mIU were 2% (6 of 295) and 3% (7 of 258), respectively. Because titers of < or = 120 mIU have been found to offer little protection in another study, this antibody level may be the best screening value for assessing susceptibility and protection against measles. However, it should be noted that many seronegative vaccinated children are protected against measles infection.

Adolescent↗
PubMed1998

Measles outbreaks in Micronesia, 1991 to 1994.

BACKGROUND: Several islands in Micronesia experienced large measles outbreaks, during 1991 through 1994. Except for Guam, none of the islands had reported measles outbreaks during the previous 20 years. METHODS: To characterize the outbreaks, measles surveillance data, hospital records and death certificates were reviewed. Preoutbreak vaccination coverage rates were assessed by reviewing public health vaccination records. Viral isolates were genetically sequenced to determine the source of transmission. Linear regression analysis was performed to assess the effectiveness of outbreak control measures. RESULTS: Between 1991 and 1994 more than 1300 measles cases and 16 measles-related deaths were reported in Micronesia. Preoutbreak vaccination coverage rates among 2-year-old children were 55 to 94%. Genetic sequencing of the viral isolates and epidemiologic investigations suggested transmission between islands and new importations from outside of Micronesia. The highest attack rates were among children ages < 5 years (20/1000) and 10 to 19 years (38/1000). Compared with attack rates among children ages < 1 and 10 to 19 years, attack rates were lower among those ages 5 to 9 years, in whom 2-dose vaccination coverage rates were highest (P < 0.001). Early and rapid implementation of mass vaccination campaigns was significantly associated with shorter duration of outbreaks (P = 0.049). CONCLUSION: The measles outbreaks in Micronesia show that island populations may be highly susceptible to measles. High two-dose vaccination coverage levels must be maintained to prevent such outbreaks. Early and rapidly implemented mass measles vaccination campaigns were effective in control of island outbreaks. Strengthening public health infrastructure and surveillance is necessary for early identification of outbreaks and rapid implementation of mass campaigns.

Adolescent↗
PubMed1998

Loss maternally derived measles immunity in Argentinian infants.

BACKGROUND: Measles immunization of children at 1 year of age with a single dose of the current vaccine has successfully reduced measles incidence in Argentina. However, the optimal schedule of measles vaccination of young infants would balance the risk of early loss of maternal antibody in the majority of infants with the risk of primary vaccine failure because of passive measles immunity. This study is the first to document a significant association between loss of passive measles antibody and age among infants born in 1995 and 1996 in Córdoba City, Argentina. METHODS: This is a seroprevalence study of 340 infants to investigate the duration of transplacentally derived measles antibody, assayed by a neutralization test, during the first 8 months of age in Córdoba City, Argentina. RESULTS: The proportion with detectable neutralizing measles antibodies decreased from 85% at 1 month of age to 8% at 8 months of age. The simple logistic model with age (in weeks) as the only variable showed that the decline in the proportion of infants with a positive antibody titer was sharpest during the second and fifth months of age (6.6 and 6.8% per week during a 4-week period, respectively). CONCLUSIONS: These findings suggest that 80% of infants are susceptible to measles infection for at least 3 months before routine immunization at 12 months of age.

Aging↗
PubMed1999

Increased long term mortality associated with rash after early measles vaccination in rural Senegal.

OBJECTIVES: To examine whether clinical symptoms, including rash, were more common after measles immunization compared with placebo and to study the association between postvaccination symptoms and later mortality. DESIGN: Examination of side effects in the 3 weeks after immunization in a trial of high titer and standard titer measles vaccines. PATIENTS: Two hundred twenty-four children randomly selected to be included in the surveillance for diarrhea, fever and rash. RESULTS: There was no difference in fever and diarrhea between recipients of high titer vaccines and recipients of placebo. However, high titer recipients tended to have more measles-like rashes than placebo recipients [relative risk, 2.12 (range, 0.90 to 5.03)]. Among recipients of high titer vaccines, children who presented a rash had higher mortality in the following 5 to 7 years than those who did not develop rash [mortality rate ratio, 3.85 (range, 1.52 to 9.79)]. High titer recipients without a rash had the same mortality as children in the placebo group who were given standard doses of measles vaccine at 10 months of age [mortality rate, 0.76 (range, 0.35 to 1.62)]. CONCLUSIONS: These observations suggest that in this particular study, rash after high titer measles vaccine may identify children who received a particularly high dose of vaccine or children with more severe and persistent postvaccination immunosuppression. Whether high titer vaccine is more likely than standard titer measles vaccine to provoke such reaction is not known, given that we did not compare side effects after different titers of measles vaccine. Future trials of live measles vaccine should monitor the development of rash.

Cause of Death↗
PubMed2005

Codetection of measles virus and tumor necrosis factor-alpha mRNA in otosclerotic stapes footplates.

HYPOTHESIS: Otosclerosis is a disease of unknown etiology causing conductive or sensorineural hearing loss. Persistent measles virus infection of the otic capsule is considered to be one of the etiologic factors in otosclerosis. BACKGROUND: Determinants of measles virus infection and reactive inflammation were studied in otosclerosis. The presence of measles virus was shown in otosclerotic patients by reverse-transcription polymerase chain reaction (RT-PCR) amplification of the viral RNA. No report is available, however, on the types and features of paracrine cytokines in otosclerosis. METHODS: Nucleic acid was extracted from stapes footplate samples of clinically otosclerotic patients. Measles virus nucleoprotein RNA was amplified by seminested RT-PCR. Tumor necrosis factor (TNF)-alpha mRNA expression was detected by RT-PCR in otosclerotic bone and was correlated with preoperative audiologic findings and measles virus positivity. RESULTS: Among 154 clinically otosclerotic patients, 99 stapes footplate specimens contained measles virus RNA. TNF-alpha mRNA was detectable in 88 virus-positive and in 6 virus-negative stapes footplates. There was no detectable TNF-alpha mRNA expression in virus negative cases. CONCLUSION: The etiologic role of measles virus in the pathogenesis of otosclerosis should be considered. Detection of TNF-alpha mRNA demonstrates activated osteoclast functions and inflammatory pathways in otosclerotic stapes footplates associated with measles virus presence. Virus-associated and virus-negative pathomechanisms of otosclerosis should be distinguished.

Adult↗
PubMed1990

Aberrant IgG subclass distribution to measles in healthy seropositive individuals, in patients with SSPE and in immunoglobulin-deficient patients.

Sera from healthy seropositive donors, patients with acute measles, subacute sclerosing panencephalitis, common variable immunodeficiency, and CH gene deletions were analysed for anti-measles IgG1-4. Compared with other anti-viral immune responses of IgG1 and IgG3, an unusual predominance of specific IgG1 prevailed; only four out of a total of 68 patients showed anti-measles IgG3. Of the 17 healthy, measles seropositive serum donors, all showed specific IgG1, none showed IgG3 and six had IgG4. Eight out of 10 patients with SSPE showed an anti-measles IgG1 and IgG4 response while IgG3 was not seen. The IgG1 and IgG4 subclass patterns had some exceptions. Anti-measles IgG3 was found in five out of five patients with deletion of the gamma-1 encoding gene segments and in four out of 15 patients with recent measles antigen stimulation. The subclass pattern was suggested to reflect the immunological compromise associated with measles infections.

Adolescent↗
PubMed2005

Monitoring measles elimination in Victoria.

OBJECTIVES: To weigh the evidence from outbreak data that Victoria has achieved, and is maintaining, elimination of measles. To identify age groups that measles vaccination has not protected adequately. METHODS: Data on observed measles outbreaks in Victoria since the start of 1998 are used to estimate the reproduction number of cases, and the probability that it is maintained below unity, its threshold value for elimination. The relative susceptibility to measles is estimated as a function of age, with confidence intervals. RESULTS: Seventeen measles introductions led to secondary cases, while 22 were single-case introductions. From these, the probability that the reproduction number for cases exceeds unity is estimated to be 0.044, or less, depending on assumptions made. There is no evidence that the reproduction number increased over time. Those aged between 19 and 32 years were most susceptible, followed by those in the first and second year of life. CONCLUSIONS: The data provide strong evidence that Victoria has maintained elimination of measles over the period 1998 to mid-2003. There is scope to improve the immunisation coverage. It is not clear how much outbreak intervention is contributing to the success in achieving apparent elimination. IMPLICATIONS: To prevent importations from causing a major epidemic of measles, Victoria must maintain its immunisation coverage and outbreak control at current levels, or better. It is important to monitor the control of measles even when elimination is achieved.

Adolescent↗
PubMed2003

[Change in the age-distribution of measles patients admitted to our hospital from 1981 to 2002].

A marked change in age distribution of measles inpatients from 1981 to 2002, namely the increase in number of infants under one year of age and that of young adult of 20-24 years were observed. Recent decrease in number of measles inpatients of 2-4 years of age seemed to result from the effect of vaccination against measles given to young children over 12 months of age. Relative increase of infant patients younger than 1 year of age appeared to result form the decrease in number of patients over 1 year old or from the absolute increase in number of infant patients below 1 year of age which arisen from decreased level of anti-measles antibody transferred from their mothers. To clarify which is the more important cause, however, further investigations will be necessary. Relative increase in adult inpatients of measles is speculated to result from the increase in number of adult susceptible to measles because they were not vaccinated against measles and did not contracted measles.

Adolescent↗
PubMed1995

Measles control in the United States: problems of the past and challenges for the future.

Elimination of indigenous measles from the United States has been a public priority since 1978. To assess the progress made toward this goal, we review the epidemiology of measles from 1963 to the present. From the 1970s through early into the recent measles epidemic, the majority of measles cases were in highly vaccinated, school-age children. This was due primarily to a 1 to 5% primary measles-mumps-rubella vaccine failure rate and nonrandom mixing patterns among school-age populations. To eliminate susceptible individuals in the school-age populations, a second dose of measles vaccine is now recommended between 5 and 6 years or 11 and 12 years by both the Advisory Committee on Immunization Practices and the American Academy of Pediatrics. Later in the epidemic, measles cases surged among unimmunized preschool children, especially among the poor in inner-city areas. Immunization rates have been documented to be low among preschool populations because of missed opportunities to administer vaccines at all health visits and barriers to access to immunizations. To raise immunization rates, the age for the first measles-mumps-rubella immunization was lowered to 12 to 15 months of age, federal immunization funding has increased, and new standards for immunization delivery have been developed and promulgated.

Child↗
PubMed2002

Simultaneous detection of measles virus, rubella virus, and parvovirus B19 by using multiplex PCR.

We describe here a multiplex reverse transcription-PCR (RTMNPCR) assay designed to detect and differentiate measles virus, rubella virus, and parvovirus B19. Serial dilution experiments with vaccine strains that compared cell culture isolation of measles in B95 cells and rubella in RK13 cells showed sensitivity rates of 0.004 50% tissue culture infective dose (TCID(50)) for measles virus and 0.04 TCID(50) for rubella virus. This RTMNPCR can detect as few as 10 molecules for measles virus and rubella virus and one molecule for parvovirus B19 in dilution experiments with plasmids containing inserts of the primary reaction amplification products. Five pharyngeal exudates from measles patients and 2 of 15 cerebrospinal fluid samples from measles-related encephalitis were found to be positive for measles virus by this RTMNPCR. A total of 3 of 27 pharyngeal exudates from vaccinated children and 2 pharyngeal exudates, plus one urine sample from a case of congenital rubella syndrome, were found to be positive for rubella virus by RTMNPCR, whereas 16 of 19 sera from patients with erythema infectiosum were determined to be positive for parvovirus B19 by RTMNPCR. In view of these results, we can assess that this method is a useful tool in the diagnosis of these three viruses and could be used as an effective surveillance tool in measles eradication programs.

Child↗