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PubMed1999

Widespread outbreaks of measles in rural Uttar Pradesh, India, 1996: high risk areas and groups.

OBJECTIVE: To describe outbreaks of measles which affected many districts in Uttar Pradesh (UP) during 1996. DESIGN: Outbreak investigations. SETTING: The state of Uttar Pradesh, India. METHODS: The reported data on measles morbidity, mortality and vaccine coverage from 1991 through 1996 were reviewed. Reported vaccine coverage levels were compared with the results of coverage surveys carried out in UP from 1992 through 1996. Line lists on measles cases were analyzed to ascertain the age, immunization status, geographical distribution, and age and sex-specific fatality ratios during the outbreaks. A community survey was organized in 7 affected villages to estimate vaccine effectiveness. RESULTS: Fifty one of 68 districts in UP reported 6922 measles cases and 281 deaths in 1996. The majority of cases and deaths occurred in June and July which are usually low transmission months. Overall cases fatality ratio (CFR) was 4.1%. CFRs were significantly higher in females and young children. The median age of cases was found to be below 5 years. There was heavy clustering of cases and deaths in rural areas. About 85% of the cases and virtually all the measles associated deaths occurred in unvaccinated children. Published documents on statewide coverage surveys revealed that the measles vaccine coverage levels ranged between 26% and 36% during 1992-96. Large gaps were found between reported coverage and survey results. Nevertheless, epidemiological studies indicated a vaccine effectiveness of more than 90%. CONCLUSIONS: The outbreaks occurred due to poor vaccine coverage levels and an inefficient surveillance system which failed to generate early warning signals. The study highlights the urgent need to raise the vaccine coverage levels rapidly in all districts to achieve measles control and prevent future outbreaks in UP.

Age Distribution↗
PubMed2000

Persistent measles virus infection as a possible cause of otosclerosis: state of the art.

The etiopathogenesis of otosclerosis is still largely unexplained and remains controversial. Morphologic examinations have shown the presence of a chronic inflammation in otosclerotic tissue. Among the proposed explanations for this inflammation are an immunologic reaction against collagen, mutations of collagen gene 1A1, and a viral infection. In this paper, we focus on the role of measles virus in otosclerosis, and we review the current literature, devoting particular attention to a suspected paramyxoviral etiopathogenesis in Paget's disease. Our examination of footplate fragments by reverse transcription polymerase chain reaction testing in 95 patients with otosclerosis revealed the presence of measles virus RNA in 83% of cases. Quantification of measles virus immunoglobulin G (IgG) in otosclerosis patients indicated that the ratio of antimeasles virus IgG in total IgG was higher in perilymph than in serum. Furthermore, an almost identical incidence of otosclerosis and measles virus-caused mortality in women suggests that women are more susceptible to measles virus infection. Finally, since the introduction of the measles virus vaccination program in Europe, there has been a decline in the incidence of otosclerosis. Moreover, the average age of patients at diagnosis and surgery at our hospital has increased to 54 years. Our findings, when they are considered along with findings regarding the presence of paramyxoviral RNA in Paget's disease, support the hypothesis that measles virus is involved in the etiopathogenesis of otosclerosis.

Adolescent↗
PubMed2000

Immune responses to measles immunization and the impacts on HIV-infected children.

This prospective cohort study was conducted to determine the seroconversion rate and the pattern of antibody response to measles vaccine administered at age 9 months in HIV infected and non-infected children born to HIV-1 seropositive mothers. Thirty children born to HIV-1 seropositive mothers and 3 born to HIV-1 seronegative mothers were recruited. One single dose of Schwarz strain of measles virus vaccine (Rouvax) was given to every child at 9 months of age. Clinical status and measles antibody levels were evaluated at the time just before vaccination, 2 and 12 weeks post-vaccination. Antibody was measured by an enzyme immunoassay commercial kit (Enzygnost, Dade Behring Manufacturer, Germany). Children were classified into 3 groups, groups 1 and 2 were children with and without HIV infection respectively. Group 3 children were those born to HIV-1 seronegative mothers. Of the 33 enrolled children, 16, 14 and 3 were classified as groups 1, 2 and 3 respectively. Four children, 2 of each, in groups 1 and 3 did not complete the study. Group 3 was excluded due to the small number of children recruited. There was no short term complication and no measles infection noted during the course of study. None of the children had pre-existing antibodies. The median (range) of CD4 count and CD4/CD8 ratio measured at the time of vaccination were statistically different between groups 1 and 2 children. Group 2 children had better antibody response than group 1 in terms of seroconversion rate and median of antibody levels at 12 weeks post-vaccination. Only 7 of 29 children (24.1%) had detectable measles antibodies at 2 weeks post-vaccination. A decrease in antibody was noted in 2 symptomatic HIV infected children as their disease had progressed. Various potential predictors of measles vaccine responses in HIV infected children including CD4 count and CD4/CD8 ratio were not statistically different between the responders and non-responders. All 4 asymptomatic HIV infected children were responders. This study demonstrated that all of the children had already lost their maternal acquired antibodies at age 9 months. HIV infected children had a poorerantibody response to measles vaccine than the non-infected children.

Antibodies, Viral↗
PubMed2001

Measles antibody in the children in Ubon Ratchathani province.

Measles is a highly contagious disease, preventable by vaccine. Measles epidemics have been dramatically controlled since the introduction of live attenuated measles vaccine. Measles antibody is used as an indicator of previous natural infection or vaccination, and also as a marker of protective immunity. The authors determined measles IgG levels in 1,176 children in Ubon Ratchathani province by ELISA from September 1998 to January 1999. Two- hundred and sixty- five cases (22.5%) had antibodies below the protective level (< 320 mIU/ml). Antibodies were high during the neonatal period, then declined to below the protective level at 4-6 months of age, and were negative at age 7-11 months. An increase in antibody level after 1 year old might be the result of measles immunization at 9-12 months of age, then antibodies decreased to the lowest level at 3-5 years after immunization or 4-6 years of age. A second dose of immunization will increase the number of children who have antibodies above the protective level better than one dose of immunization and it is recommended to revaccinate at 4-6 years of age. There was no statistical difference of measles antibody between boys and girls in all age groups.

Adolescent↗
PubMed2001

Evaluating the benefits of increasing measles immunization rates.

OBJECTIVE: To calculate the cost-effectiveness, expressed in dollars per quality-adjusted life years (QALY), of increasing measles immunization rates. DATA SOURCES/STUDY DESIGN: Published data were supplemented by expert opinion. We determined the cost savings and value of the health benefits from averting a single case of measles. Next we examined the U. S. data regarding the relationship between pre-school measles immunization and incidence rates. Finally, we calculated the cost-effectiveness of a program that would increase a locality's immunization rate to the point of disease elimination. PRINCIPAL FINDINGS: Averting a single case of measles, using "base case" assumptions, yields societal cost savings of $2,089 and an increase of 0.086 QALYs. Using a very low discount rate increases the total benefits to $2,251 in societal cost savings and 0.150 QALYs in health benefits. In general, programs to raise measles immunization rates are not cost-effective, except possibly during an outbreak of the disease or in areas with very low immunization rates. The extremely low measles incidence rates in the mid-1990s result in such programs having extremely high costs per QALY gained. CONCLUSIONS: Programs that are narrowly designed to increase immunization rates alone are not likely to be cost-effective. Yet these programs do have the potential to be cost-effective if the program design and evaluation also recognize the benefits associated with the primary and preventive care that can accompany immunizations. Such programs may also be cost-effective if they are components of a global eradication of measles.

Cost Savings↗
PubMed2003

Accelerated measles control--Cambodia, 1999-2002.

Cambodia is recovering from approximately 30 years of civil war that resulted in the breakdown of the country's public health infrastructure. In 1999, the Ministry of Health initiated a measles-control program with the goal of reducing the annual incidence of measles to <10,000 cases in 2005 by strengthening measles surveillance, improving routine vaccination coverage, implementing supplementary measles immunization activities (SIAs), and providing vitamin A during outbreak investigations and SIAs. This report summarizes measles-vaccination activities and their impact in reducing reported measles cases from 13,827 in 1999 to 1,234 in 2002 and suggests options for future measles-control efforts in postconflict situations.

Adolescent↗
PubMedDate not supplied

[The isolation of measles virus strains and the study of their hemagglutinating activity].

Three measles strains Gag, Il, and Buk, were isolated from a suspension of mononuclear cells derived from measles patients in the active stage of the disease. Continuous Vero cell cultures were used for virus isolation. In the infected cell culture, all the isolates produced symplasts of different sizes and star-shaped or spindle-shaped multinuclear cells. The specificity of the cytopathic effect was proved by the adsorption of monkey erythrocytes on the surface of virus-affected cells. The isolates were identified in neutralization and HI tests with different immune preparations: measles gamma-globulin (national standard), hyperimmune rabbit sera to measles (Edmonston strain), rubella, and mumps viruses, S. sonnei and S. flexneri, as well as with sera from measles patients and subjects vaccinated with live measles vaccine L-16. The results of identification attest to isolation of 3 measles virus strains, one of which (Buk) possesses particularly high hemagglutinating activity.

Animals↗
PubMedDate not supplied

[Age-related loss of maternal antibodies against measles in children in La Plata].

Measles outbreaks every 3-4 years have occurred in Argentina. The vaccine was introduced in 1978 as part of a regular program, and the age for the first vaccination was changed to one year old. The optimal age for first measles vaccination is defined as that age with the highest proportion of infants responding to the vaccine. It is dependent on the presence of maternal antibodies against measles virus and the maturation of the immune system. This paper reports the loss of maternal antibodies in infants from vaccinated mothers, attending at the Hospital I.A.E.P. Superiora Sor María Ludovica, La Piata, Argentina. To determine the IgG antibodies against measles virus, an ELISA test was used in a longitudinal follow up of 48 patients (4, 6 and 9 month-old infants). Only 18.7% of 4 month-old infants showed detectable levels of IgG antibodies against measles virus; this value declined to 4.2% in 6 month-old infants (p < 0.01) and measles virus antibodies were undetectable in 9 month-old infants. The extension of this study to a broader population is suggested, in order to reconsider the optimal age of the first measles vaccination.

Adult↗
PubMed2003

Measles epidemic attributed to inadequate vaccination coverage--Campania, Italy, 2002.

In Italy, measles has been a mandatory reportable disease for >100 years. During the prevaccination era, approximately 25,000-90,000 cases were reported annually. During the late 1980s and 1990s, incidence declined with increasing measles vaccination coverage, but measles epidemics continued to occur periodically, most recently during 1995-1997. In early 2002, measles incidence increased sharply; the area most affected was Campania (2001 population: approximately 5,782,000, including 1,100,000 children aged <15 years), a large region in southern Italy. In 2001, estimated measles vaccination coverage for the 1998 Campania birth cohort was 65%. Regional health authorities and the National Institute of Health investigated the measles outbreak in Campania. This report summarizes the preliminary results of the investigation, which attributed the epidemic to inadequate vaccination coverage. A coordinated effort is needed to interrupt measles transmission in Italy.

Adolescent↗
PubMed2004

Measles outbreak associated with an imported case in an infant--Alabama, 2002.

Local transmission of measles is rare in the United States. Since 1997, the majority of measles outbreaks have been caused by imported cases. During October 19-November 15, 2002, an outbreak of 13 confirmed cases of measles occurred, with exposure in Alabama; 11 cases were among day care attendees who had not yet been vaccinated for measles. This was the largest outbreak of measles in the United States since 1999. In response to this outbreak, the Alabama Department of Public Health (ADPH) and CDC conducted an epidemiologic investigation that determined the outbreak was initiated by an imported case in an infant aged 9 months who had returned recently from the Philippines. Health-care providers should continue to include measles in differential diagnoses for febrile rash illnesses in infants, particularly those with recent travel to areas where measles is endemic.

Adult↗
PubMedDate not supplied

The evaluation of vaccination against measles at nine months of age (report of an epidemic).

Sixteen measles cases were studied during an epidemic that broke out in Etimesgut district of Ankara. Eight of these children had never been vaccinated against measles while the remainder had been vaccinated at nine months of age. In the sera obtained during the course of the illness, anti-measles antibody was not detectable in six vaccinated children and in four unvaccinated children. Upon observing the siblings of the subjects, it was determined that one out of three who had not been vaccinated against measles and three out of seven who had been vaccinated at nine months of age contracted the disease within a month. However none of the siblings who had been vaccinated against measles at 15 months contracted the disease. In our cases, although vaccination at nine months of age could not prevent measles, it resulted in a milder form of the disease. It seems that measles vaccine administered to infants at around nine months of age does not prevent the occurrence of the disease in many children.

Age Factors↗
PubMed2004

Progress toward measles elimination--region of the Americas, 2002-2003.

In 1994, countries in the Region of the Americas adopted the goal of eliminating endemic measles transmission in the Western hemisphere by 2000. Since 1994, rapid progress has been made. The number of measles cases has declined >99%, from approximately 250,000 in 1990 to 105 confirmed cases reported in six countries in 2003. During 2003, only Mexico and the United States reported outbreaks. The three chains of transmission in Mexico and two U.S. outbreaks were import-related; a third U.S. outbreak was of unknown source. Since November 2002, no transmission of the D6 and D9 genotypes has been reported; these genotypes were responsible for several large outbreaks in the region during 1997-2002. This report summarizes the epidemiology of measles in the Americas during 2002-2003 and highlights progress toward measles elimination, including the lowest ever number of reported measles cases in the region. Because the region is under constant threat of measles importation from regions where the disease is endemic, countries must maintain high population immunity to measles and sensitive surveillance to ensure the timely detection of imported cases and allow for rapid implementation of control measures.

Americas↗
PubMed2004

Progress toward sustainable measles mortality reduction--South-East Asia Region, 1999-2002.

Substantial progress has been made toward meeting the 2003 World Health Assembly goal to reduce measles deaths 50% by the end of 2005, compared with deaths in 1999. Although measles remains the leading cause of vaccine-preventable deaths among children, the World Health Organization (WHO) estimates that, during 1999-2002, global measles mortality decreased 29%, including a 19% decline among South-East Asia Region (SEAR) member countries. In June 2003, the SEAR Regional Technical Advisory Group on Immunization endorsed a Regional Strategic Plan for Measles Mortality Reduction (2003-2005). This report summarizes progress in measles control in SEAR during 1999-2002 and outlines plans for future activities in the region, which include strengthening measles surveillance, improving access to routine vaccination, and providing a second opportunity for measles immunization.

Adolescent↗
PubMedDate not supplied

[A survey on measles vaccination policies in Italian Regions].

In this article we report the results of a survey conducted in early 2002, in order to describe the measles vaccination policies implemented in the Italian Regions. All the twenty-one Regions returned the questionnaire, which included information on measles vaccination coverage and vaccination strategies. Up to now, all the Regions provide measles vaccine free of charge, but the year of free offer introduction ranges from early 1980's to 2000. Despite measles vaccination coverage by 2 years of age is improving, none of the Regions has reached the 95% goal yet. Eighteen Regions do offer measles vaccination to older unvaccinated children, and 10 Regions actively offer a 2nd dose. Most of the Regions conducted special catch-up campaigns; nevertheless these activities took place in different years and targeted different age-groups. These results, along with the evidence of high measles incidence in Italy, underline the need of a coordinated national strategy, in order to reach measles elimination.

Child↗
PubMed2004

Emergency measles control activities--Darfur, Sudan, 2004.

The Darfur region of Sudan, composed of three states with a population of approximately six million, has experienced civil conflict during the previous year, resulting in the internal displacement of approximately one million residents and an exodus of an estimated 170,000 persons to neighboring Chad. The conflict has left a vulnerable population with limited access to food, health care, and other basic necessities. In addition, measles vaccination coverage has been adversely affected; in 2003, coverage was reported to be 46%, 57%, and 77% in North, West, and South Darfur, respectively. This report describes measles-control activities in Darfur region conducted by the Federal Ministry of Health (FMOH) in Sudan in collaboration with the United Nations and nongovernmental organizations (NGOs) during March-August 2004. Ongoing measles transmission in camps for internally displaced persons (IDPs) and neighboring communities in Darfur led to a regionwide measles vaccination campaign targeting all children aged 9 months-15 years, resulting in a reduction in reported measles cases. Once security is improved, ongoing efforts to increase measles vaccine coverage will be required to eliminate persistent susceptibility to measles in the Darfur population.

Adolescent↗
PubMed2005

Progress in reducing measles mortality--worldwide, 1999-2003.

Measles remains an important cause of childhood mortality, especially in developing countries. In the joint Strategic Plan for Measles Mortality Reduction, 2001-2005, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) targeted 45 priority countries with high measles burden for implementation of a comprehensive strategy for accelerated and sustained measles mortality reduction. Components of this strategy include achieving high routine vaccination coverage (>/=90%) in every district and ensuring that all children receive a second opportunity for measles immunization. In May 2003, the World Health Assembly endorsed a resolution urging member countries to reduce deaths attributed to measles by half (compared with 1999 estimates) by the end of 2005. This report updates progress toward this goal and summarizes recent recommendations on methods to estimate global measles mortality.

Global Health↗
PubMed1992

A new look at measles.

Since the measles vaccine was licensed in the United States in 1963, the number of measles cases has declined by 98%. Nevertheless, measles has not been eliminated as had been hoped, and, in fact, has started to increase in incidence. The increase in the number of cases has been accompanied by a change in measles epidemiology; the highest attack rate now occurs in preschool-age children and in older school-age and college students. The latter is the basis for the adoption of a two-dose measles immunization schedule by the ACIP and AAP. In preschool-age children, however, the problem is more disturbing and reflects low rates of immunization, particularly among inner-city populations. A major public health effort must be directed to achieve and maintain high vaccination rates if measles elimination is to be accomplished. Otherwise, measles outbreaks, with their accompanying morbidity and mortality, will continue to occur.

Adolescent↗
PubMed1992

Public-sector vaccination efforts in response to the resurgence of measles among preschool-aged children--United States, 1989-1991.

From 1989 through 1991, in the United States, the incidence of reported measles increased sixfold to ninefold over the median annual incidence (1.3 per 100,000 population) reported from 1981 through 1988. In 1990, the peak of the resurgence, the incidence of measles among children aged less than 5 years was 15-fold higher than the median 1981-1988 incidence (4.8 per 100,000) (1). During 1991, approximately 9500 cases were reported (Figure 1), including 4662 cases among children aged less than 5 years (CDC, unpublished data). The measles epidemic is a consequence primarily of the failure to vaccinate preschool-aged children at appropriate ages (2); among children aged 16-59 months who developed measles during this resurgence, only 15% had received measles vaccine as recommended (CDC, unpublished data). This report compares the number of public clinic vaccinations* (i.e., all measles-containing vaccines [MCV], diphtheria-tetanus-pertussis vaccine [DTP], and oral polio vaccine [OPV]) for 1988 with that for 1989-1991 in response to the measles resurgence.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗