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Measles virus nucleocapsid protein can function in Sendai virus defective interfering particle genome synthesis in vitro.

The Sendai virus P and L proteins, the viral RNA polymerase, and the nucleocapsid protein, NP, synthesized in a transient mammalian expression system support the replication of Sendai virus defective interfering particle (DI) genome RNA in vitro. We have shown that the measles virus nucleocapsid protein, N, can substitute for the Sendai NP protein in genome synthesis. The chimeric product nucleocapsids, which contained Sendai RNA encapsidated with measles N protein, were atypical since they were sensitive to micrococcal nuclease digestion, unlike wild-type Sendai or measles nucleocapsids. The utilization of measles N protein required the endogenous Sendai virus RNA polymerase, since DI nucleocapsids free of polymerase were not replicated. Although both Sendai virus NP and P proteins and measles N and P proteins formed complexes when they were coexpressed, sedimentation analysis showed that measles N protein self-assembled and did not form a complex when expressed with the Sendai P protein. Furthermore, when the Sendai P-L polymerase complex was provided separately, measles N protein alone synthesized DI genome RNA in the absence of Sendai P protein. These data suggest that the self-assembled form of measles N protein functions in Sendai DI genome synthesis.

Capsid↗

Vaccination against measles, mumps and rubella (MMR): a comparison between the antibody responses at the ages of 18 months and 12 years and between different methods of antibody titration.

In connection with the introduction of the trivalent vaccine against measles, mumps and rubella at 18 months and 12 years of age, an evaluation of the seroconversion and booster effects in the two age-groups was carried out. This also comprised different laboratory-test methods appropriate for follow-up studies after large-scale, vaccination studies. The measles, mumps and rubella antibodies were measured by the haemolysis-in-gel (HIG) method. Measles antibodies were also measured by the haemagglutination-inhibition (HI) test. Borderline values or samples negative to measles or mumps were also tested by the serum-neutralization (SN) test. All but four of 150 18-month-old children lacked antibodies against measles by the HI test and one of these by the HIG method. Against mumps, 99% were seronegative in the HIG test and 97% in the SN test and two against rubella prior to vaccination. Among 247 schoolchildren, 60 (24%) lacked antibodies in the HI test and 28 (11%) of these also in the HIG test. Sixty-six schoolchildren (25%) were negative to mumps and 45% to rubella prior to vaccination. The seroconversion rate for the 18-month-old children was 96% against measles, 93% against mumps and 99% against rubella. The figure for the schoolchildren was 82% against measles, 80% against mumps and 100% against rubella. On comparing the titre levels in seroconverting children, the measles-antibody levels were found to be lower among older children, compared with younger, while the opposite was true for rubella.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

Immunogenicity of second dose measles-mumps-rubella (MMR) vaccine and implications for serosurveillance.

Measles and mumps, but not rubella, outbreaks have been reported amongst populations highly vaccinated with a single dose of measles-mumps-rubella (MMR) vaccine. Repeated experience has shown that a two-dose regime of measles vaccine is required to eliminate measles. This paper reports the effect of the first and second MMR doses on specific antibody levels in a variety of populations.2-4 years after receiving a first dose of MMR vaccine at age 12-18 months, it was found that a large proportion of pre-school children had measles (19.5%) and mumps (23.4%) IgG antibody below the putative level of protection. Only a small proportion (4.6%) had rubella antibody below the putative protective level. A total of 41% had negative or equivocal levels to one or more antigens. The proportion measles antibody negative (but not rubella or mumps) was significantly higher in children vaccinated at 12 months of age than at 13-17 months. There was no evidence for correlation of seropositivity to each antigen, other than that produced by a small excess of children (1%) negative to all three antigens. After a second dose of MMR, the proportion negative to one or more antigens dropped to <4%. Examination of national serosurveillance data, found that following an MR vaccine campaign in cohorts that previously received MMR, both measles and rubella antibody levels were initially boosted but declined to pre-vaccination levels within 3 years. Our study supports the policy of administering a second dose of MMR vaccine to all children. However, continued monitoring of long-term population protection will be required and this study suggests that in highly vaccinated populations, total measles (and rubella) IgG antibody levels may not be an accurate reflection of protection. Further studies including qualitative measures, such as avidity, in different populations are merited and may contribute to the understanding of MMR population protection.

Antibodies, Viral↗

Cytokine production patterns and antibody response to measles vaccine.

Cytokines play an important role in the immune response to live measles virus immunization. To gain further insight into the cytokine production profile in response to measles vaccination, we studied interferon-gamma (IFN-gamma), tumor necrosis factor (TNF-alpha), soluble IL-2 receptor (sIL-2R), interleukin-2 (IL-2), interleukin-4 (IL-4), and interleukin-6 (IL-6) in both supernatants from peripheral blood mononuclear cells (PBMC) stimulated with phytohaemagglutinin (PHA), and plasma. We enrolled 57 healthy infants and children residing in an area where no measles virus circulated in their lifetimes. Overall analysis of cytokines in supernatants from PBMC showed that a predominant Th1 cytokine pattern occurs after the second dose of measles immunization. However, plasma levels of Th1 cytokines (IFN-gamma, sIL-2R and TNF-alpha) were preferentially activated by measles virus after the first dose of measles vaccination. Median IFN-gamma plasma levels were 1.73 pg/ml for infants compared to 0.63 pg/ml for older children (P = 0.003). These data suggest that after the first and the second dose of measles virus immunization, there is a predominant Th1-type directed immune response, but the Th1 cytokine pattern seems to be stronger in previously unvaccinated children. There was no correlation between cytokine production by PBMC supernatants after PHA stimulation and circulating levels of plasma cytokines. No relationship was found between any specific cytokine level and measles antibody level.

Antibodies, Viral↗

Smallpox and measles: historical aspects and clinical differentiation.

Smallpox and measles have ravaged native populations worldwide for centuries. Millions of people have succumbed to smallpox or measles or suffered from their effects. Clinicians wonder how their predecessors confused measles with smallpox. The difficulty was in differentiating smallpox and measles in their early phases, which had important public health implications. The prodromal rash of smallpox sometimes resembled measles. Clinicians through the ages learned to differentiate smallpox and measles in their early stages. Osler's careful clinical description of prodromal smallpox is a classic in infectious diseases. Koplik's appreciation of the diagnostic significance of the spots on the buccal mucosa was another advance in the early diagnosis of measles. The clinical features and effects of measles and smallpox on history are reviewed.

Diagnosis, Differential↗

Uncommon histopathological findings in fatal measles infection: pancreatitis, sialoadenitis and thyroiditis.

AIMS: We report uncommon histopathological findings in fatal measles infection. METHODS AND RESULTS: We describe the autopsies of four patients who died during a measles outbreak in São Paulo, Brazil, in 1997. Two of the patients were children receiving chemotherapy for non-Hodgkin's lymphoma, one was an adult with acquired immunodeficiency syndrome (AIDS) and the fourth was an apparently healthy woman. All patients had their deaths attributed to measles pneumonia. The autopsies revealed extensive giant cell pneumonia and diffuse alveolar damage, severe acute pancreatitis, necrotizing sialoadenitis and thyroiditis due to measles. Measles antigen was detected in lung tissue using a monoclonal anti-measles antibody. CONCLUSIONS: : Pancreatitis, thyroiditis and sialoadenitis are not previously reported histopathological findings in measles infection. Pancreatitis is a potentially severe complication and should be considered when treating patients with atypical measles.

Adolescent↗

Measles infection in hospitalized children in Lusaka, Zambia.

A 2-year hospital-based survey of measles infections were carried out at the University Teaching Hospital (UTH) in Lusaka, Zambia from January 1992 to December 1993. During this period, a total of 1066 children with a clinical diagnosis of measles were admitted to the paediatric isolation ward at UTH. Measles cases were seen throughout both 1992 and 1993. However, there was a peak from September to December, 1992. The number of cases decreased with age, and 370 (34.7%) were under 1 year old. It is noteworthy that 203 (19.0%) were less than the 9 months of age which is the recommended time for measles vaccination in Zambia. The overall case fatality rate was 12.6%, and was higher in children aged 0-3 years (14.3%) than in those aged 4 years and above (6.7%). Measles vaccination status could be checked from the child's immunization card for 343 measles cases over 9 months of age, 118 (34.4%) of these having previously received measles vaccine. Vaccinated children had a significantly lower case fatality rate (6.4%) than the unvaccinated group (17.0%). This suggests that while measles vaccine cannot prevent infection, it can reduce the severity of infection.

Adolescent↗

Measles surveillance in five major US cities: Chicago, Houston, Los Angeles, Miami, and New York.

Endemic measles, if it occurs in the United States, will likely be found in cities, because large populations are required to sustain transmission and importations of measles virus are most frequent in cities. We investigated measles surveillance systems in 5 cities (Chicago, Houston, Los Angeles, Miami, New York City) during 1995-1999. The passive reporting of a measles case activated the systems to look for more cases and to intervene to prevent more cases. During 1995-1999, 1363 suspected measles cases were investigated. Only 58 of these were confirmed as measles (0.24 cases/100000 people), and the majority (57%) of confirmed cases were imported or linked to an importation. Most (83%) suspected cases that met the case definition had a complete case investigation, including a laboratory test for measles. We conclude that surveillance in these 5 cities shows no evidence of endemic measles transmission.

Chicago↗

Prevalence of measles, rubella, mumps, and varicella antibodies among healthcare workers in Japan.

OBJECTIVES: To evaluate the immune status of healthcare workers (HCWs) against measles, rubella, mumps, and varicella in Japan, and to promote an adequate vaccination program among HCWs. SETTING: University of Tokyo Hospital. PARTICIPANTS: Eight hundred seventy-seven HCWs. DESIGN: Serologic screening for measles, rubella, mumps, and varicella was performed on HCWs. Antibodies against measles, rubella, and mumps were detected using hemagglutination inhibition (HI) assay ($4.20 per test). If serum was negative by HI assay, enzyme-linked immunosorbent assay (EIA) was performed ($12.60 per test). Anti-varicella antibodies were detected by EIA only. RESULTS: Among tested HCWs, 98.5%, 90.4%, 85.8%, and 97.2% had immunity to measles, rubella, mumps, and varicella, respectively. All those born before 1970 were seropositive for measles. However, individuals susceptible to rubella, mumps, and varicella were present in all age groups. The sensitivities and negative predictive values of HI assay compared with EIA were 86.6% and 11.3% for measles, 99.1% and 92.2% for rubella, and 47.8% and 24.1% for mumps, respectively. For measles and mumps, prevaccination screening by HI assay in combination with EIA led to significant savings compared with EIA only. In contrast, it was estimated that prevaccination screening using only HI assay would be more economical for rubella. CONCLUSIONS: Aggressive screening and vaccination of susceptible HCWs was essential regardless of age. Prevaccination serologic screening using a combination of HI assay and EIA was more economical for measles and mumps.

Adult↗

The epidemiology and control of measles in Yaoundé, Cameroun, 1968-1975.

Surveillance data on measles in Yaoundé during the 8 years from 1968-1975 have been reviewed. Measles epidemics occurred in every year except 1969-1970, the period of the attach phase of the Smallpox Eradication and Measles Control Programme. Subsequent biennial mass measles immunisation campaigns and maintenance measles immunisation at the child health centre failed to interrupt epidemic transmission. 70-80% of cases were under 24 months of age. Annual outbreaks occurred during the first half of each year, but smaller numbers of cases continued throughout the year. The outbreaks came to an end despite 32-41% of 6 through 36 month old children remaining susceptible. The seasonality of measles was not simply related to the annual rainfall pattern. Rather it is hypothesised that measles seasonality depends on the movement of young children with their mothers during the annual agricultural cycles. Measles immunisation programmes must be adapted to local epidemiological and cultural conditions in order to interrupt transmission.

Age Factors↗

Increased childhood morbidity after measles is short-term in urban Bangladesh.

In a 1995-1996 cohort study in the city of Dhaka, Bangladesh, morbidity in 117 hospitalized and 137 acute measles cases compared with age-matched children without measles (unexposed) was determined by weekly interview for 6 months. Compared with unexposed children, there were higher incidences of hospitalization (adjusted rate ratio (RR) = 3.1, 95% confidence interval (CI): 1.3, 7.6) and bloody diarrhea (adjusted RR = 2.7, 95% CI: 1.4, 5.1) in hospital measles cases during the 6 weeks after recruitment. Among community cohorts, there were higher incidences of bloody diarrhea (adjusted RR = 4.1, 95% CI: 1.1, 14.6), watery diarrhea (adjusted RR = 1.6, 95% CI: 0.9, 2.7), fast breathing (adjusted RR = 3.8, 95% CI: 2.1, 6.9), and the weekly point prevalence of pneumonia (adjusted prevalence ratio = 3.1, 95% CI: 1.0, 9.8) in measles cases during the same period. All measles cases regained lost weight within about 6 weeks. The prevalence of anergy to seven recall antigens 6 weeks after recruitment was higher in both hospital (adjusted odds ratio = 2.8, 95% CI: 1.2, 6.4) and community (adjusted odds ratio = 3.1, 95% CI: 1.1, 8.9) measles cases. Morbidity increased during the first 6-8 weeks after measles, but the authors found no consistent evidence of longer-term morbidity or wasting. The results support recent findings that measles is not associated with increased delayed mortality.

Acute Disease↗

Polymorphonuclear and monocyte functions in measles.

The depression of immune responses during measles infection has been recognized since the early 20th century. Acute bacterial infections are the most common cause of morbidity and mortality in measles. This study investigated the phagocytic and bactericidal or fungicidal capacities of polymorphonuclear cells (PMN) and monocytes during measles infections. When 14 children with measles were compared with 25 healthy controls, a significant depression in PMN and monocyte function was found. Of these 14 children, seven developed acute bacterial infections. These seven children were compared with 11 children who had acute bacterial infections without measles. It was found that PMN in patients with measles did not achieve an activated state, as expected with acute infections. Serum immunoglobulins were not altered in these patients. These results confirm previous reports of depressed phagocytic and bactericial capacities of PMN in measles, and further document that peripheral blood monocyte functions are also depressed in measles.

Acute Disease↗

C-reactive protein in measles.

Seventy-two children with early measles (1st-3rd day of rash), presenting at two centres in Santiago, Chile, were classified as having mild ('ordinary measles', n = 50), or moderate to severe measles ('primarily severe measles', n = 22). The level of serum C-reactive protein (CRP) was determined by nephelometry from a finger prick sample. The mean CRP value in ordinary measles, 19 mg/l, was significantly lower (P less than 0.001) than in primarily severe measles where the mean CRP was 65 mg/l. During late measles (5th-8th day of rash), the mean CRP was 19 mg/l if the child recovered uneventfully (n = 35), whereas the mean level of 123 mg/l (P less than 0.001) was encountered when the child suffered from complicating pneumonia (n = 22). We conclude that the simple quantitative CRP determination is a useful alarm signal during the course of measles: elevated levels point to severity or complications in recovery.

Amoxicillin↗

Measles vaccination of infants in a well-vaccinated population.

During outbreaks of measles, measles vaccine is recommended for infants considered to be at risk who are 6 months of age and older. In a prospective trial the serologic response to early measles immunization has been evaluated in 125 infants given monovalent measles vaccine at 6 to 8.5 months of age and measles-mumps-rubella at 15 months. The response to vaccination was measured by plaque reduction neutralization (PRN) assay and enzyme immunoassay. Infants were grouped by the mother's immunization history: natural immunity (n = 60, Group 1); killed followed by live, further attenuated vaccine (n = 22, Group 2); and live, further attenuated vaccine only (n = 43, Group 3). The prevaccination geometric mean titer (GMT) by PRN for Group 1 (GMT = 69) was significantly higher than that of Group 2 (GMT = 18) or 3 (GMT = 13). Seroconversion (4-fold increase in PRN titer) rates after monovalent vaccine were 31, 71 and 76% for Groups 1, 2 and 3, respectively. Seroconversion percentages were higher when measured 6 to 8 weeks after vaccination compared with 4 to 5 weeks. After measles-mumps-rubella > or = 97% of all infants had PRN titers > 120 and were measles IgG-positive by enzyme immunoassay. These data show that as demographics shift to a well-vaccinated maternal population and susceptibility in younger infants, measles vaccination before the currently recommended age will be effective.

Age Factors↗

No persistent T lymphocyte immunosuppression or increased mortality after measles infection: a community study from Guinea-Bissau.

BACKGROUND: Because measles immunization is reducing overall childhood mortality in addition to mortality from acute measles infection, it has been suggested that postmeasles cases have excess mortality, possibly related to persistent immunosuppression after measles infection. After an epidemic in 1988 in Guinea-Bissau, we therefore examined T lymphocyte subsets and long term survival among measles cases and controls. METHODS: We examined 69 children < 3 years of age with a median delay of 2 months after measles infection and 71 controls who did not contract measles. The immunoalkaline method was used to determine T lymphocyte subsets. The children were followed for 5 years. RESULTS: Compared with controls, there were no significant differences in white blood cell count, absolute lymphocyte count, CD4 percentage, CD8 percentage, total CD4 count and total CD8 count, although measles cases examined > 2 months after infection had slightly higher CD4 counts than controls (P = 0.06). Adjusted for age, sex and immunization status, postmeasles cases had a mortality rate ratio of 0.50 (95% confidence interval, 0.22 to 1.16) (P = 0.11) compared with controls. CONCLUSIONS: There is no indication of persistent suppression of T cell subsets after measles infection, and postmeasles cases did not have higher mortality than uninfected community controls.

Child, Preschool↗

Hospitalizations during a measles epidemic in the Netherlands, 1999 to 2000.

BACKGROUND: A measles epidemic occurred in the Netherlands in 1999 to 2000. We collected data on hospitalized and deceased cases to inform the public about the risks associated with measles infection. METHODS: From the National Medical Registration we extracted hospital discharge diagnoses for measles-related hospitalizations (International Classification of Diseases, 9th revision, Clinical Modification Code 055) during the measles epidemic (April 1999 to May 2000). We also reviewed hospital records to assess reasons for hospitalization and severity of disease as a result of measles infection during this epidemic. In addition we estimated the total number of hospitalized cases by a capture-recapture approach using two surveillance sources. RESULTS: Measles without mention of complication (39%) and postmeasles pneumonia (33%) were most often registered as main discharge diagnoses for the 130 cases in the National Medical Registration. Forty-seven (96%) of the 49 patients whose hospital charts were reviewed were not vaccinated. Median admission period was 5 (range, 1 to 26) days, 19 (38%) required mechanical ventilation and 14 (29%) had sequelae at the time of discharge but none was permanent. Three patients died as a result of complications. No association was observed between preexisting illness and either reason for admission (P = 0.5) or residual symptoms at discharge (P = 0.5). The estimated total number of hospitalized measles patients was 157 (95% confidence interval, 145 to 179), leading to an estimated 825 admission days during an epidemic in which 3,292 cases were reported. CONCLUSIONS: Measles infection can still run a severe course even in a prosperous country.

Adolescent↗

Changes in the virus-host cell relationship in a stable non-virogenic cell line persistently infected with measles virus (BGM/MV).

A non-virogenic African green monkey kidney cell line BGM/MV persistently infected with a neurotropic mouse brain-adapted strain of measles virus, was found to have undergone significant changes in the virus-host cell relationship between passages 35 and 119. Rather than the stable non-cytopathic relationship previously reported in which approximately 100% of the cells contained measles antigens and less than 1% of the cells expressed cell surface measles antigen, we observed cyclic manifestations of c.p.e. together with changes in the percentage of cells expressing intracellular and cell surface measles antigens. Treatment of BGM/MV cells with actinomycin D effected an increase in the percentage of cells expressing cell surface virus haemagglutinin (HA) at times when the percentage of cells with surface HA was less than the percentage of cells with intracellular measles antigens. Superinfection studies employing measles virus and vesicular stomatitis virus revealed a consonant cyclic refractivity and essentially no refractivity, respectively. Endogenous, infectious measles virus was not detected nor was interferon. It was concluded that a host cell factor other than interferon was modulating the cyclic expression of the measles virus infection.

Animals↗

Measles virus RNA detected in Paget's disease bone tissue by in situ hybridization.

Morphological and immunocytological studies have demonstrated the presence of paramyxovirus antigens in Paget's bone disease tissue and in particular antigens related to measles virus and respiratory syncytial virus. To examine the relationship between measles virus and Paget's bone disease we used in situ hybridization and a cloned measles virus DNA probe specific for the nucleocapsid protein to detect and locate measles virus RNA sequences in Paget's bone tissue. In five patients with the disease, measles virus RNA sequences were detected not only in 80 to 90% of the multinucleated osteoclasts where there is morphological and immunocytological evidence of measles virus activity but also in 30 to 40% of mononucleated bone cells, mainly osteoblasts, osteocytes, fibroblasts and lympho-monocytes. In contrast, no hybridization was observed in bone tissue from three control patients without signs of Paget's bone disease. These results indicate that the host cell range for measles virus in Paget's disease is more widespread than has been supposed. They also demonstrate the usefulness of the in situ hybridization method to detect viral genetic information in cells where viral antigenic activity is not detectable. These observations further support the hypothesis that measles virus is involved in the pathogenesis of Paget's bone disease.

Bone and Bones↗