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PubMed2002

The average cost of measles cases and adverse events following vaccination in industrialised countries.

BACKGROUND: Even though the annual incidence rate of measles has dramatically decreased in industrialised countries since the implementation of universal immunisation programmes, cases continue to occur in countries where endemic measles transmission has been interrupted and in countries where adequate levels of immunisation coverage have not been maintained. The objective of this study is to develop a model to estimate the average cost per measles case and per adverse event following measles immunisation using the Netherlands (NL), the United Kingdom (UK) and Canada as examples. METHODS: Parameter estimates were based on a review of the published literature. A decision tree was built to represent the complications associated with measles cases and adverse events following immunisation. Monte-Carlo Simulation techniques were used to account for uncertainty. RESULTS: From the perspective of society, we estimated the average cost per measles case to be US$276, US$307 and US$254 for the NL, the UK and Canada, respectively, and the average cost of adverse events following immunisation per vaccinee to be US$1.43, US$1.93 and US$1.51 for the NL, UK and Canada, respectively. CONCLUSIONS: These average cost estimates could be combined with incidence estimates and costs of immunisation programmes to provide estimates of the cost of measles to industrialised countries. Such estimates could be used as a basis to estimate the potential economic gains of global measles eradication.

Canada↗
PubMed2006

No evidence of persisting measles virus in peripheral blood mononuclear cells from children with autism spectrum disorder.

OBJECTIVES: Despite epidemiologic evidence to the contrary, claims of an association between measles-mumps-rubella vaccination and the development of autism have persisted. Such claims are based primarily on the identification of measles virus nucleic acids in tissues and body fluids by polymerase chain reaction. We sought to determine whether measles virus nucleic acids persist in children with autism spectrum disorder compared with control children. PATIENTS AND METHODS: Peripheral blood mononuclear cells were isolated from 54 children with autism spectrum disorder and 34 developmentally normal children, and up to 4 real-time polymerase chain reaction assays and 2 nested polymerase chain reaction assays were performed. These assays targeted the nucleoprotein, fusion, and hemagglutinin genes of measles virus using previously published primer pairs with detection by SYBR green I. Our own real-time assay targeted the fusion gene using novel primers and an internal fluorescent probe. Positive reactions were evaluated rigorously, and amplicons were sequenced. Finally, anti-measles antibody titers were measured by enzyme immunoassay. RESULTS: The real-time assays based on previously published primers gave rise to a large number of positive reactions in both autism spectrum disorder and control samples. Almost all of the positive reactions in these assays were eliminated by evaluation of melting curves and amplicon band size. The amplicons for the remaining positive reactions were cloned and sequenced. No sample from either autism spectrum disorder or control groups was found to contain nucleic acids from any measles virus gene. In the nested polymerase chain reaction and in-house assays, none of the samples yielded positive results. Furthermore, there was no difference in anti-measles antibody titers between the autism and control groups. INTERPRETATION: There is no evidence of measles virus persistence in the peripheral blood mononuclear cells of children with autism spectrum disorder.

Antibodies, Viral↗
PubMed1998

[Resurgence of the measles epidemic: situation in Minas Gerais, Brazil].

This study aims to describe the measles vaccination campaigns that have been carried out in the state of Minas Gerais, Brazil, since 1988; to highlight their importance in the control of the disease, and to pinpoint the age groups at risk during the recent epidemic, which began in 1996, spread all over the country, and declined in 1998. However, the analysis includes only data up to September 1997. The methodology used was based on the birth cohort analysis design. Data compared by cohorts included target population and vaccination coverage for each campaign, and measles incidence rates during the present epidemic. Results show that the more opportunities for exposure to vaccination campaigns, the lesser the risk for having measles in any birth cohort. In 1997, the relative risk for getting measles was 15.38 (IC 95%: 9.89 to 23.93) for the cohort under 2 years of age, which had not had the opportunity to be exposed to any vaccination campaigns, as compared to cohorts between 3 and 19 years of age with two or more opportunities of exposure to vaccination campaigns. On the basis of the experiences analyzed, catch-up measles vaccination campaigns as well as follow-up campaigns--particularly when routine vaccination did not achieve sufficient coverage--have had an outstanding role in controlling the measles epidemic in the state of Minas Gerais. We therefore suggest making the measles vaccine immediately available to all birth cohorts that did not have the opportunity for exposure to past vaccination campaigns and intensifying epidemiological surveillance. Moreover, it is necessary to find ways to improve routine vaccination coverage in order to achieve the 95% goal set by the National Plan to Eliminate Measles by the Year 2000.

Adolescent↗
PubMed1993

Preschool children at high risk for measles: opportunities to vaccinate.

OBJECTIVES: In 1989 and 1990 the United States experienced a measles epidemic with more than 18,000 and 27,000 reported cases, respectively. Nearly half of all persons with measles were unvaccinated preschool children under 5 years of age. We sought to identify potential sites for vaccine delivery. METHODS: Preschool children with measles were surveyed in five inner cities with measles outbreaks in 1989 to 1990 to assess the children's use of health care services and federal assistance programs before contracting measles. RESULTS: Of 972 case children surveyed, 618 (64%) were eligible for measles vaccination at measles onset. Of those, 93% had previously visited a health care provider (private physician, public clinic, hospital emergency department, or hospital outpatient department) and 65% were enrolled in a federal assistance program (AFDC, WIC, or food stamps). Based on parent-reported reasons for health care visits, in Dallas and New York City, health care providers of 24% of 172 children may have missed at least one opportunity to administer measles vaccine. CONCLUSIONS: Many potential opportunities exist to raise the vaccination coverage of unvaccinated preschool children. These opportunities depend on (1) health care providers taking advantage of all opportunities to vaccinate, and (2) immunization services being linked to federal assistance programs.

Child Health Services↗
PubMed2006

Nosocomial and community transmission of measles virus genotype D8 imported by a returning traveller from Nepal.

Measles is uncommon in Australia due to effective national vaccination strategies. In mid-2003, a cluster of nine cases of measles occurred in western Sydney. The index case was a 29-year-old traveller recently returned from Nepal. The case presented to hospital and transmitted the disease to two others in the Emergency Department. Further cases resulted from both community and nosocomial transmission. The median age of cases was 24 years, with three cases in children aged under four years. Only one person had a documented history of measles vaccination, a child who had received one dose of vaccine overseas. One case was a 2-month-old infant whose mother was immune and two cases were hospital staff members. Molecular analysis of measles virus isolates from four cases revealed the same D8 genotype, a strain previously identified in Nepal. Staff vaccination strategies implemented as a result of the outbreak were poorly patronised despite nosocomial transmission. As diseases such as measles become rare it is important to thoroughly investigate any outbreaks, and to maintain a high index of suspicion of measles, particularly in travellers presenting with a rash having returned from measles-endemic areas. Genetic analysis is important in tracing the origins of an outbreak, and to confirm relatedness between cases. The highly infectious nature of measles virus also underscores the need for appropriate infection control in minimising risk of nosocomial transmission. Such policies are of increasing importance with the emergence of novel viruses or the threat of pandemic influenza.

Adolescent↗
PubMed2003

Short report: assessing field vaccine efficacy for measles in famine-affected rural Ethiopia.

Measles is a major cause of mortality in complex emergencies. Both high vaccination coverage and vaccine efficacy are required to prevent major epidemics of measles in such situations. Evaluation of field vaccine efficacy is a critical but underutilized component of program monitoring in emergencies, and is particularly important in rural areas where the integrity of the cold chain is difficult to guarantee. In July 2000, we evaluated the field vaccine efficacy for measles vaccination by comparing the incidence of cases in vaccinated and unvaccinated groups during a two-stage cluster survey of 563 children in Ethiopia. Approximately 30% of the measles cases occurred in vaccinated children. Estimated field vaccine efficacy for measles was 66.9% in children 9-36 months old. The finding of a field vaccine efficacy for measles less than 80% warrants formal assessment of measles vaccine efficacy, particularly in famine emergencies where measles is associated with a high case fatality rate.

Age Factors↗
PubMedDate not supplied

[Measles outbreak in the province of Córdoba, Argentina, in 1998].

The World Health Organization had the global target of reducing reported measles incidence from pre-vaccination era in American countries by 1995, to later eliminate indigenous measles transmission. The countries that have given priority to measles control have substantially reduced morbidity and mortality. Despite that, measles has continued occurring in epidemic outbreaks. This paper describes and analyses the outbreak occurred in Cordoba province, Argentina, in 1998. Out of 195 serum samples analysed from suspected cases, 28 (14.4%) were confirmed as measles by laboratory diagnosis. Of them, 25.0% occurred among vaccinated persons, 39.3% among unvaccinated ones, and 35.7% in individuals without reported vaccine status. The highest measles incidence was in the group aged 20-29 years old (60.7%), followed by the pre-school age group (1-4 years old) (21.4%), the infants under one year of age (14.3%) and finally 3.5% in the group older than 30 years old. These findings suggest a change in measles epidemiology with respect to the pre-vaccine era. The ability to prevent the next epidemic outbreaks will depend on the efficacy to prevent the accumulation of susceptible individuals and the maintenance of high measles vaccine coverage levels.

Adolescent↗
PubMedDate not supplied

[Prospects of measles and subacute sclerosing panencephalitis (SSPE) elimination in Poland].

Following the introduction of vaccinations against measles in 1975 supplemented in recent years with booster vaccinations at the age of 6 years the epidemiological situation with respect to measles and SSPE has been gradually improving, particularly recently. In the paper discussion is presented on the question in what degree the present epidemiological situation of measles, the epidemiological supervision and vaccinations against measles in Poland meet the operative aim of measles and, consequently, SSPE elimination, as recommended by the WHO Regional Bureau. Attention is called to incomplete reliability of measles diagnosis based on clinical manifestations, economic difficulties in conducting serological investigations (detection of IgM antibodies to measles) necessary for measles confirmation, and shortcomings in vaccination organization.

Child↗
PubMed2000

Measles elimination--is it achievable? Lessons from an immunisation coverage survey.

OBJECTIVE: To determine routine measles coverage at district level and to explore reasons for immunisation failure in Mpumalanga Province, South Africa. DESIGN: An adaptation of the World Health Organisation (WHO) Expanded Programme on Immunisation (EPI) cluster sampling method was used to make a random selection of 30 clusters in each of 21 health districts, 630 clusters in total. Seven individuals from the age group 12-23 months were randomly selected from each cluster and immunisation status and source were transcribed from their child health records. Where no immunisations were administered, reasons provided by parents or guardians were recorded. SETTING: Mpumalanga Province, South Africa. RESULTS: The weighted valid population coverage with measles vaccine for children aged 12-23 months in Mpumalanga Province was 71.1% (95% confidence interval 64.9-78.5%); this was the lowest of all EPI antigens. There was marked heterogeneity in measles coverage across the province, with a coefficient of variation of 22.2%. Districts with the lowest coverage shared borders with neighbouring provinces. District measles coverage was highly positively correlated with diphtheria, pertussis and tetanus (DPT3) coverage (r = 0.960, P = 0.000). There was a strong negative correlation between ranked measles campaign coverage and routine measles immunisation coverage. Obstacles to immunisation accounted for nearly half (49%) of all reasons for immunisation failure, while lack of information and lack of motivation accounted for 30% and 22%, respectively. CONCLUSIONS: Survey results highlight the need for supplementary immunisation, including non-selective campaigns, if Mpumalanga is to achieve the South African goal of measles elimination by 2002. The value of determining district resolution coverage in order to identify areas with low measles coverage requiring supplementary intervention was also demonstrated. A strong negative correlation between routine and campaign coverage deserves further study in other settings.

Data Interpretation, Statistical↗
PubMed2001

Measles in Thai adults: three case reports and management of contact cases.

We report on three adults (one nurse and two medical students) diagnosed as having measles. All the patients presented with fever, cough, conjunctival injection and rash. They contracted measles from pediatric patients who had been treated at Chulalongkorn Hospital in the previous two weeks. Physical examination revealed Koplik's spots on the oral mucosa and typical maculopapular rash. The diagnosis was confirmed by viral isolation. Measles IgG antibodies were measured in 36 medical students who were in close contact with patient 2 and measles vaccines were given. Thirty-three specimens had positive measles IgG, two had equivocal results and one had negative result. The student with negative measles IgG eventually developed measles (patient 3). Except for patient 2 and 3, no further cases of measles were seen among the contacts.

Adult↗
PubMed2003

[Must we expect an epidemic of measles in the near future in Southern Tyrol?].

Measles, Mumps and Rubella (MMR) vaccination is recommended in Italy. A country-wide study of the 1996 birth cohort revealed that coverage with MMR vaccine in the autonomous Province of Bolzano is the third lowest in Italy (after Campania and Calabria). The aim of the study was to evaluate the situation regarding measles in order to plan and implement necessary strategies. To assess MMR vaccine coverage, routine vaccination data were evaluated for quality and validity, and subsequently MMR coverage rates were calculated by birth cohort (1996-99) and commune. In addition, a descriptive epidemiologic analysis of all reported measles cases was performed. Hospital discharge records were used to estimate the complications and costs of hospital admitted measles cases. MMR vaccine coverage rates vary between rural (40%) and urban (80%) areas. Furthermore, communes with more than 50% Italian speaking inhabitants have higher MMR vaccine coverage than communes mainly populated by German speaking persons. In 1997 and 1999, epidemics with 1,889 and 992 cases, respectively, were reported. Five- to nine-year-old children were the most affected age group. Most cases were reported from communes with vaccine coverage rates below 40%. Six percent of measles cases, reported between January 1996 and October 2001 were admitted to hospital. The mean period of admission for measles cases was 4.6 days (range 1 to 84 days), the mean estimated costs 1,987.18 Euro per patient. The total amount of direct costs was estimated to be 386,437.72 Euros. Due to low vaccine coverage rates, especially in rural areas, and the ongoing circulation of the measles virus in the population, it is likely that an extensive measles epidemic will occur in the near future, resulting in evitable suffering of patients and extensive costs for the public health system. Only an effective immunization campaign will be able to prevent a future epidemic.

Adolescent↗
PubMed2004

[Measles antibodies concentration in vaccinated children and adolescents with autoimmune hepatitis].

UNLABELLED: Etiology and pathogenesis of autoimmune hepatitis (AIH) is still unknown. In several studies significantly increased antibody titers to measles virus in the sera of patients with AIH and chronic active hepatitis as compared to healthy people were observed. Aim of the study was to evaluate the humoral immunity against measles in children and adolescent with AIH after measles vaccination. MATERIAL AND METHODS: 110 subjects of both sexes aged 6-22 year (19 patients with AIH, 41 children with chronic hepatitis B and C (CH) and 50 healthy persons (HP) were tested to measles antibodies. Moreover mumps antibodies were examined for humoral immunity defects exclusion. All subjects were vaccinated against measles but none of them with mumps vaccine. Antibody were tested by enzyme immunoassays (EIA) and standardized by calibration against the International Standard. Geometrical mean concentration (GMC) of antibodies and the number of seropositive patients were calculated. RESULTS: Measles antibodies were found in all AIH patients (GMC 1.33 IU/ml (range 0.5-21.1 IU/ml)), in 85.4% of patients with CH (GMC 1.68 IU/ml (0.5-4.9 IU/ml)) and in 78% of HP (GMC 1.62 IU/ml (0.41-10 IU/ml)). The differences between the number of seropositive patients and between antibody concentrations in three groups were not significant. Mumps antibodies were detected in 82% AIH patients, 70% patients with CH and 76% HP. In AIH group higher antibody titer was observed than in patients with CH (p=0.047). CONCLUSIONS: The vaccination with measles vaccine does not lead to immunoregulation disturbances in AIH patients in contrary to natural measles infection.

Adolescent↗
PubMed2005

Serosurvey of measles, mumps and rubella antibodies in Saudi children.

OBJECTIVE: A serosurvey study to evaluate the proportion of children with antibodies against diseases targeted by the Expanded Program of Immunization in the Kingdom of Saudi Arabia. METHODS: Using multistage sampling techniques, we collected samples and sent them for laboratory assay from the following age groups; 100 samples at 6 months, 12 months, 18 months, 6 years, 13 years, and 17 years. We conducted the study from September 2001 to February 2002. We assayed sera for measles, rubella, and mumps antibodies in the measles-mumps-rubella reference laboratory in Germany, using enzyme immunoassay and plaque neutralization (PN) as a backup test for equivocal and negative samples. We only carried out a backup test for measles samples. RESULTS: The age group of 6 months had the highest proportion with negative measles antibodies. After adding the backup test (PN), the proportions of children with protective measles antibody were; 64% at 6 months, 87% at 12 months, 91% at 18 months, 75% at 6 years, 96% at 13 years, and 98% at 17 years. Rubella antibody positivity rates (>7 IU) were 28% at 6 months, 49% at 12 months, 97% at 18 months, 98% at 6 years, and 100% at 13 years. While positivity rates in mumps were 14% at 6 months, 29% at 12 months, 59% at 18 months, 64% at 6 years, and 75% at 13 years. CONCLUSION: The unexpected low proportion of children with protective level at 6 years, despite being vaccinated with 2 measle doses is an important phenomenon. This reflects the interference between the first and the second measles dose. The Ministry of Health decided to conduct a catch up campaign targeting 1st through 3rd grade primary schools, who did not catch the mass campaign conducted in 2000. Also, this supports the decision taken by the ministry to change the measles immunization schedule to MMR at 12 months and a second dose at 6 years of age.

Adolescent↗
PubMed2006

A serological survey of measles, mumps and rubella immunity among school aged children in Western Saudi Arabia.

OBJECTIVE: To evaluate the adequacy of measles, mumps and rubella (MMR) vaccination among children and to assess risk of outbreak in Jeddah, Kingdom of Saudi Arabia (KSA). METHODS: We recruited a total of 527 children from schools located at different urban regions, and preschool children from those attending the well baby clinics in Jeddah, KSA. We tested for MMR viruses antibodies using ELISA technique. RESULTS: Approximately 99% of children received MMR vaccine. Overall seropositivity for measles antibodies was 71%, mumps 65% and rubella 90%, which were elevated in vaccinated versus non-vaccinated children (p<0.000). In vaccinated children, percentage of seropositivity for MMR was higher in public school children versus private (p<0.01) or those who did not attend school (p<0.01) and in Saudi versus non-Saudi children (p<0.000). In vaccinated children, percentage of seropositivity obtained according to age groups of 4-6 years for measles was 73.7%, for mumps 66.7% and for rubella 91.7%. As for 7-11 years age group, seropositivity for measles was 72.6%, for mumps 68.1% and for rubella 93%, while for the 12-14 years, seropositivity for measles was 66.4%, mumps 59.1% and for rubella 86.1%. The prevalence of seropositivity against the above-mentioned viruses decreased with progression of age. CONCLUSION: Measles, mumps and rubella mass vaccination program achieved high coverage rate among children, in Jeddah, KSA. However, there is still a high level of sera negative children among vaccinated ones for measles and mumps. Seropositivity decreased with age, which might raise possibility of outbreaks among adolescent. Additional doses of vaccine against measles and mumps are recommended and evaluation of new MMR protocol should be made.

Adolescent↗
PubMed2006

[Study on the relative risk factors of adult measles in a case-control study in Qingdao city].

OBJECTIVE: To explore the relative risk factors of adult measles in Qingdao city. METHODS: Case-control study was used to collect the information from 70 adult measles cases and 140 controls. Information would include general social and demographic characteristics, history and times regarding measles vaccination, demography of the study of population etc. RESULTS: The case group had lower proportion of measles vaccination (chi2 = 26.88, P < 0.05, OR = 5.12, 95% CI: 2.69 - 9.73) than the control group with statistical significance. The vaccination frequencies were stratified as three ranks: 0, 1, > or = 2 times for analysis. When having 0 and 1 time measles vaccination, no statistical significance was found in these two groups (chi2 = 1.86, P = 0.173), but there were statistical significance between 0 and > or = 2 times (chi2 = 45.24, P = 0.000, OR = 13.35, 95% CI: 5.80 - 30.71), 1 and > or = 2 times (chi2 = 26.23, P = 0.000, OR = 7.91, 95% CI: 3.37 - 18.59) in the two groups. It was also found that the proportion of floating population was higher in case group than that of the control group (chi2 = 21.60, P < 0.01, OR = 4.06, 95% CI: 2.21 - 7.45). At the same time, statistically significant correlation was found between adult measles and average family incomes (chi2 = 2.23, P < 0.05, OR = 2.08, 95% CI: 1.15 - 3.76) by single-factor statistical analysis. CONCLUSION: Results showed that 'without history of measles vaccination' was key relative risk factor for the adult measles while being a part of 'floating population' and those having lower incomes were among vulnerable groups.

Adult↗
PubMed1989

Measles prevention and control in emergency settings.

Outbreaks of measles continue to be a common occurrence among refugee and famine-affected children in emergency relief camps. Extremely high measles-associated mortality rates have been reported from refugee camps--where undernutrition is common--in several countries over the past 10 years. Mortality from measles is, however, preventable, and immunization against the disease is a high priority in emergency relief programmes, second only in importance to the provision of adequate food rations. All children aged 6 months to 5 years should be immunized with measles vaccine as soon as they enter an organized camp or settlement. Should supplies of measles vaccine be inadequate, children in feeding centres, or those otherwise identified as undernourished, are the top priority for immunization. The occurrence of measles in a camp is not a contraindication to conducting an immunization campaign. Strong coordination by a designated lead agency is needed if such campaigns are to be successful; however, cooperation with the local expanded programme on immunization is essential to ensure that existing cold chain equipment, training protocols, and management manuals are used. If additional equipment is necessary, a complete immunization kit developed by the Office of the United Nations High Commissioner for Refugees, the World Health Organization, and Oxfam can be procured from Oxfam headquarters in the United Kingdom. Vitamin A supplements should be given routinely at the time of measles immunization in situations where malnutrition is severe. Mortality and morbidity in children with clinical measles can be reduced by administering high doses of vitamin A.

Child, Preschool↗
PubMed1987

Four years of measles elimination in the Czech Socialist Republic.

In 1982, Czechoslovakia succeeded in eliminating measles infection throughout the country. The paper describes the strategy of the measles immunization program following its introduction in 1969, showing it to reflect the objective epidemiological situation as revealed by the regular immunological surveys carried out in a broad population sample. As it turned out, decisive for achieving and maintaining a permanent measles elimination in the country was the introduction of second vaccination into the regular immunization schedule. Since 1982, its timing of is from 6 to 10 months after primary immunization. Over the 4-year period between 1982 and 1985, confirmed measles occurred only sporadically in the CSR, 115 cases altogether, and of these as many as 67 were classified as imported or their immediate contacts (38 measles patients were tourists from abroad). Of these 115 measles cases, 52 had had vaccination prior to acquiring the disease, 46 were individuals who had never before been vaccinated and in the remaining 17 patients no vaccination data were available. The vaccine failures, at least in 18 cases, could have been explained by the primary immunization prior to reaching 15 months of age. According to the estimates, at least 670 thousand cases of measles, 470 deaths, 100 thousand complications and some 33 thousand hospitalizations had been averted between 1972 and 1985 on the territory of CSR as a result of the introduction of the measles immunization program in Czechoslovakia.

Adolescent↗
PubMed1979

Immune response in subacute sclerosing panencephalitis: reduced antibody response to the matrix protein of measles virus.

Immune precipitation was used to study the humoral immune response of patients with subacute sclerosing panencephalitis (SSPE). Patients with SSPE have a progressive infection of the CNS by measles or a measles variant despite high serum antibody levels to measles virus as measured by standard serologic techniques. However, when the antibody response to individual measles virus proteins was measured, we found a striking reduction in the ability of sera from patients with SSPE to precipitate the matrix (M) protein as compared to the precipitation of the M protein by sera from normal adults who had natural measles infection in childhood, or by convalescent sera obtained 3 to 5 weeks after a naturally occurring measles infection. The decreased antibody response to the M protein in sera from patients with SSPE occurred despite a vigorous antibody response to the other viral proteins, suggesting a selective defect in the production of antibody to a single viral protein. The reduced anti-M antibody in sera from patients with SSPE was demonstrated whether immune precipitation was performed with wild-type measles virus or SSPE virus proteins. These results suggest that in SSPE only small amounts of the M protein are produced. This result may help explain how measles virus persists in the central nervous system of patients with SSPE.

Antibodies, Viral↗