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PubMed2005

Measles seroepidemiology in 3 cities in Turkey.

OBJECTIVE: To evaluate immunity against measles and its relation with some variables among healthy subjects in 3 cities in Turkey. METHODS: We carried out a cross-sectional study on measles antibody titers in the serum samples of 712 people from Antalya, 696 from Diyarbakir and 667 from Samsun, Turkey using particle agglutination test between February 2000 and October 2001. The study groups, informed and asked for their consent by midwives, consisted of randomly selected subjects of all ages older than 6 months. We implemented the study in 3 steps: physical examination, interview and blood collection. RESULTS: We considered titers of > or = 1:16 as positive and we observed lower seropositivity in Diyarbakir (90.8%) than Antalya (95.9%), and Samsun (94.9%) (p=0.040). We also observed that seropositivity was lower among preschool group than older groups (p=0.006). The number of doses of measles vaccine (p=0.001) and measles infection history (p=0.003) were found as a factor increasing the seropositivity ratio. There was no statistically significant between age groups (p=0.219), gender (p=0.148), residence (p=0.537), and number per household (p=0.983) among the provinces. CONCLUSION: Based on the findings, measles infection still has a high incidence in Turkey and the second dose of measles vaccine is extremely important in the prevention of measles transmission among school children and the community. Furthermore, we must improve our regional differences in routine vaccination services.

Adolescent↗
PubMed2006

Progress in reducing global measles deaths, 1999-2004.

Measles remains a substantial cause of global childhood mortality, particularly in developing countries. In their 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 the highest measles mortality 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 vaccination. In May 2003, the World Health Assembly endorsed a resolution urging member countries to achieve a goal (adopted in 2002 by the United Nations General Assembly Special Session on Children) to reduce 1999 deaths resulting from measles by half by the end of 2005. This report updates progress toward this goal and introduces a new goal for measles mortality reduction by 2010.

Global Health↗
PubMed2006

A measles outbreak in children under 15 months of age in La Rioja, Spain, 2005-2006.

This paper describes a measles outbreak in La Rioja, Spain, which began in December 2005 and mainly affected children under 15 months of age who were not yet immunised with MMR vaccine. The measles cases were detected by the mandatory reporting system, under which laboratories must report every confirmed measles case. Cases were classified in accordance with the National Measles Elimination Plan: suspected and laboratory-confirmed. In the period 14 December 2005 to 19 February 2006, 29 suspected cases of measles were investigated, and 18 were confirmed. The mean incubation period was 13.8 days (range: 9 to 18). Of the 18 confirmed cases, only two were in adults. MMR vaccination was recommended for all household contacts, as well as for children aged 6 to 14 months who attended the daycare centres where the cases had appeared. At these centres, the second dose of MMR was administered ahead of schedule for children under three years of age. It was recommended that the first dose of MMR vaccine be administered ahead of schedule for all children aged 9 to 14 months. During an outbreak of measles, children aged 6 months or older, who have not previously been vaccinated against measles, mumps and rubella, should receive a first dose as soon as possible, and those who have had a first dose should receive a second dose as soon as possible, provided that a minimum of one month has elapsed between the two doses.

Adult↗
PubMed1999

Evaluation of the effectiveness of routine measles vaccination: case-control study.

A retrospective case-control study was conducted in two primary schools located in eastern region of Cairo to evaluate the protective value of routine measles vaccination. A total of 230 children who had a previous measles illness were identified over 3 months period. Each case was matched to two controls based on age and sex. Vaccination status of the study children was ascertained through reviewing vaccination certificates The overall measles vaccine effectiveness was estimated at 53% (95% CI 71%-26%) There was an association between age of measles vaccination and vaccine effectiveness (VE) Primary vaccination failure due to young age of measles vaccination is the likely explanation of the low measles vaccine effectiveness. Adoption of two-dose measles vaccination policy with the second dose being given at older age needs to be considered to correct the problem of vaccine failure.

Bias↗
PubMedDate not supplied

A million dollar measles outbreak: epidemiology, risk factors, and a selective revaccination strategy.

Between February 8 and April 4, 1986, an outbreak of measles occurred in the State of Arkansas. A total of 489 suspected measles cases were reported from 53 counties; 86 schools statewide reported suspected measles cases. There were 284 cases confirmed in 18 counties; 23.6 percent among students in one university and 41.2 percent among students in kindergarten through 12th grade in 32 schools. An epidemiologic investigation was carried out to evaluate risk factors for vaccine failure and to assess the effectiveness of a selective revaccination strategy in the outbreak setting. A cohort study conducted at a junior high school showed that, compared with students vaccinated against measles at ages 15 months or older, those vaccinated at ages 12-14 months had a three-fold increased risk of measles (relative risk 3.2, 95 percent confidence interval 1.5, 6.9). For schools reporting measles, the Arkansas Department of Health and the Department of Education jointly required reimmunization of students vaccinated at ages younger than 15 months and the exclusion of students not vaccinated at ages 15 months or older until they were vaccinated or until 2 weeks after the last rash onset. To implement these recommendations, more than 100,000 doses of combined measles-mumps-rubella vaccine were distributed at a cost greater than $1 million.

Adolescent↗
PubMed1991

Duration of immunity following immunization with live measles vaccine: 15 years of observation in Zhejiang Province, China.

The duration of immunity following measles vaccination of 2882 immunized children has been investigated in a closed region of China for 15 years. A total of 1002 of the children were treated as primary immunization subjects, and 1547 as reimmunization subjects. These two cohorts were not in contact with known wild measles virus over the whole observation period, and the results obtained probably reflected the antibody responses to measles vaccine alone. The remaining 333 vaccinees came into contact with wild measles virus, and this permitted evaluation of the protective effect of the measles vaccines tested: 4 children experienced very mild clinical measles, and 329 experienced subclinical infection, including 12 who had had undetectable haemagglutination-inhibition antibodies for 9-10 years. These results indicate that the immunity induced by successful primary immunization may persist for at least 15 years. Within this period, a second dose of vaccine only induces low antibody responses which decrease rapidly to their original levels. This provides strong evidence that the immunity produced by primary immunization is long-lasting. However, there were some indications that reimmunization might produce better effects if live attenuated measles virus were used with a longer interval between doses.

Adolescent↗
PubMed1977

Immune responses during measles infection in immunosuppressed Rhesus monkeys.

Rhesus monkeys immunosuppressed with horse anti-human thymocyte gamma-globulin (ATG) were infected with measles and simultaneously inoculated with sheep erythrocytes (SRBC), a thymus-dependent antigen, and with pneumococcal polysaccaride type III (SSS-III), a thymus-independent antigen. ATG treatment alone suppressed SRBC antibody production, had no effect on SSS-III antibody production, and effectively eliminated circulating T cells compared to nonsuppressed monkeys. ATG treatment of measles-infected monkeys resulted in delayed virus clearance and delayed antibody production compared to nonsuppressed infected monkeys. After cessation of ATG treatment, measles antibodies and T cells reached normal levels, and measles virus was eliminated. Thus, immune clearance of measles virus is T cell-dependent, but the relative roles of cellular- and humoral-mediated immunity in vivo could not be clearly separated. Also, measles infection was associated with a decreased T cell mitogen responsiveness of circulating lymphocytes but not of lymph node lymphocytes, suggesting an altered circulating pattern of the cells responsible for delayed hypersensitivity. Also, measles infection had no effect on T-dependent antibody production to SRBC.

Animals↗
PubMed1991

Principles of measles control.

WHO's Expanded Programme on Immunization has significantly helped to reduce global morbidity and mortality from measles. Recently, some African countries with high vaccine coverage levels have reported measles outbreaks in children above the current target age group for immunization. Outbreaks such as these are to be expected, unless close to 100% of the population are immunized with a vaccine which is 100% effective. Success of an immunization programme requires identification of the distribution and ages of susceptible children and reduction of their concentration throughout the community. Priority should be given to urban and densely populated rural areas. In large urban areas, high coverage of infants must be achieved soon after the age at which they lose their maternal antibodies and become susceptible. This will be facilitated by the introduction of high-dose measles vaccines which can be given at 6 months of age. Where measles incidence is increasing among children aged over 2 years, immunization of older children may be considered during contacts with the health care system, or at primary school entry, if this does not divert resources from immunization of younger children. Health workers should be informed of the predicted changes in measles epidemiology following immunization. The collection, analysis and use of data on measles (vaccine coverage, morbidity and mortality) should be improved at all levels of the health care system in order to monitor the immunization programme's overall impact, identify pockets of low coverage, and allow early detection of and response to measles outbreaks.

Africa↗
PubMed1991

Measles among under-9-month-olds in rural Bangladesh: its significance for age at immunization.

Any decision to modify measles immunization strategies away from the use of the conventional vaccine given to children at 9 months of age to the adoption of recently proposed vaccine strains that can be given to 4-6-month-olds will depend on the age distribution of severe cases of measles in the community. Reported are the results of an analysis of two community-based measles surveillance systems in rural Bangladesh, which found that 17% of all measles cases reported for under-5-year-olds in a nonvaccinated population involved infants aged less than 9 months. In a vaccinated population from the same area, 31% of all measles cases reported for under-5-year-olds occurred among under-9-month-olds. Using a rather restrictive definition for measles-related deaths (those occurring within 6 weeks of the onset of the rash), the proportion of measles-related deaths that occurred before 9 months of age was 13% of all such deaths that were reported.

Age Factors↗
PubMed1989

Measles immunization research: a review.

Most global estimates indicate that more than 1 million children a year die from acute measles. The actual number of deaths may, however, be considerably higher than this. In addition, the impact of delayed mortality as a result of measles infection is only now being realized. Many months after they contract measles, children continue to experience higher levels of mortality and morbidity than those who do not. Immunization of children against measles therefore prevents mortality and morbidity not only during the acute phase but also during subsequent months. The impact of measles immunization programmes may therefore have generally been underestimated. The effects of measles infection on children during the early months of life are more damaging than those experienced by older children. Children should therefore be immunized against measles as early in life as possible, given the limitations of existing vaccines.

Child↗
PubMed1985

Measles virus encephalitis in ferrets as a model for subacute sclerosing panencephalitis.

Young adult ferrets were used as experimental animals to study subacute sclerosing panencephalitis (SSPE). When cells infected with cell-associated measles virus strains isolated from SSPE patients were inoculated intracerebrally (i.c.) into ferrets, they developed an acute encephalitis and died within 1 to 3 weeks without detectable antibody formation. Immunization with live measles vaccine 5 weeks before i.c. inoculation changed the course of the infection in about 50% of the ferrets. These animals developed a subacute encephalitis within weeks or months after inoculation. Cell-associated measles virus was isolated from their brains and high measles antibody titers were found in their sera, comparable to those in sera of SSPE patients. Measles virus specific immunoglobulins (IgG) were present in their brains and determination of IgG/albumin ratios indicated that antibodies were synthesized in the brain in response to the persistent measles virus infection. Measles specific oligoclonal IgG bands were found in the sera and spinal fluids of these animals. Therefore, subacute ferret encephalitis has virological and immunological characteristics in common with SSPE, indicating that it may serve as a model for the human disease. Other animal models of SSPE are described briefly.

Animals↗
PubMed1985

Optimum age for measles immunization in Malaysia.

A study was carried out at the University Hospital, Kuala Lumpur, Malaysia to determine the age-specific prevalence of measles infection by serology and the age specific-seroconversion rates following measles vaccination. The results show that the percentage of children with passively acquired measles antibodies decreased with increasing age till 3 to 5 months of age. From 12 months of age, the percentage of positivity increased sharply due probably to natural infection. The geometric mean antibody titre was low at birth, but from 6 months it started to increase. These results indicate that measles infection is common in Malaysia and a small number of children began to acquire natural measles infection from 6 to 8 months of age; however the peak age for the acquisition of measles infection was from 12 months to 5 years of age. Seroconversion rates following vaccination from 9 months of age, ranged from 94% to 99%. However, the rates and the geometric mean titre were higher among those vaccinated at 11 months of age or older compared with those vaccinated at 9 or 10 months of age. Basing on the above results, it was concluded that the optimum age for measles immunization in Malaysia should be 11 months.

Adult↗
PubMed1982

Measles immunity after revaccination: results in children vaccinated before 10 months of age.

Measles immunity was studied in children in a private pediatric practice who had been revaccinated because they had received their primary measles vaccination before 1 year of age. Antibody was measured in 72 of these children who had received the first injection of live measles virus vaccine at less than 10 months of age, and the second at greater than 1 year of age. Of the 72 children, 29 (40%) had no detectable antibody and the geometric mean titer for the group was approximately 1:4. Of the children with low antibody titers, 15 were given a third injection of measles vaccine and five (33%) still did not respond. Cell-mediated immunity as indicated by lymphocyte transformation to measles antigen was measured in 11 of the children. Five (45%) had responses to measles antigen, but the responses did not correlate with the presence or absence of antibody. This study confirms the observation that revaccination is unsuccessful in many children who received measles vaccine in the first year of life, and shows that even a third injection of vaccine may fail to produce a significant antibody response.

Age Factors↗
PubMed1982

[Relation between psoriasis and measles (author's transl)].

A measles rash may abolish psoriatic lesions. Therefore, the titer of measles antibodies in the blood of psoriatics were examined. Psoriatics with measles in the history had a light type of psoriasis and low titers of measles antibodies, psoriatic without measles in the history, however, had severe types of psoriasis, and the titers of measles antibodies were high. Psoriatics were treated with three times the dosage of measles vaccine. The lesions disappeared in 60% of the psoriatics within 4-5 weeks, 40% improved; the local therapy, however was continued.

Antibodies, Viral↗
PubMed1994

CD4+ T cells are essential in overcoming experimental murine measles encephalitis.

Clinical observations and experimental animal models have stressed the importance of the cellular immune response in the recovery from measles virus infection. However, the relative contribution of different T-cell subsets to viral elimination is controversial. The aim of the present study was to define the components of the immune system which contribute to the control of measles virus infection. For this purpose the effect of in vivo depletion of CD4+ and/or CD8+ T lymphocytes in the murine model of experimental acute measles encephalitis was monitored with respect to disease manifestation, survival, neuropathological changes, virus elimination from brain, and antiviral antibody titre. In measles virus-resistant BALB/c mice removal of the CD8+ T-cell subset did not interfere with the clearance of virus from the brain. In contrast, depletion of CD4+ T cells rendered BALB/c mice susceptible to infection. Also, in measles virus-susceptible C3H mice CD4+ T cells played a role in recovery from measles infection, but seemed not to be as effective as CD4+ T cells from resistant BALB/c mice. The data indicate that CD4+ T cells are essential for protection against measles virus-infection of the central nervous system.

Animals↗
PubMed1993

[Immunity coverage against measles, rubella and parotiditis viruses in a juvenile population in Leon, Spain].

BACKGROUND: The immunity coverage, seroprevalence of IgG antibodies against infection by measles, rubella and parotiditis viruses in a juvenile population (50,398 children) was studied. METHODS: Systematic sampling was performed among children from 5-14 years of age who had undergone clinical analysis in the health care area of Leon. The hypothesis of sampling was the most unfavorable (p = q = 0.5) and the size of the sample of 600 children. Information was collected on vaccination state, previous history of disease and place of residence. The presence/absence of IgG antibodies was investigated by a commercial immunoenzymatic technique (EIA-Stat Measles, Mumps, Rubella, Whittaker Bioproducts, USA). RESULTS: Sixty percent of the children studied had IgG antibodies against the three virus, 27% against two and 9% against only one with absence of antibodies against the three virus in 3%. The seroprotection observed was significantly higher (p < 0.05) for measles (87% +/- 3%) that for the other two diseases (rubella 80% +/- 3% and parotiditis 77% +/- 3%). In the group of children with previous history of measles and parotiditis a higher percentage of antibodies (p < 0.01) was observed than in the group with previous history of vaccination (measles: 94% versus 84%, parotiditis: 90% versus 75%). No difference was observed in the case of rubella. CONCLUSIONS: Vaccination is still the principal conditioning factor of the state of immunity of the juvenile population in Leon in relation with the diseases studied (measles, rubella, parotiditis). The place of residence (rural or urban) did not condition different immunity coverage in the sample studied. The susceptibility of infection for some of these virus continues to be high: measles 13%, rubella 20% and parotiditis 23%).

Antibodies, Viral↗
PubMed1993

Antibody response to measles and rubella vaccine by children with HIV infection.

To determine the immunogenicity of the measles and rubella components of the measles, mumps, and rubella virus (MMR) vaccine in human immunodeficiency virus (HIV)-infected children, we compared their response to that of uninfected controls. Sera were collected from HIV-infected patients and HIV seroreverters followed in our clinic and tested as close to 2 months post-MMR vaccination as possible. Specific IgG to both rubella and measles were measured by enzyme-linked immunosorbent assay. Of 20 children with HIV, 11 responded with adequate levels of antibody to measles. In the seroreverters, 12 of 13 responded. Of the measles responders, the median antibody level was significantly lower in the HIV-infected group than in the seroreverter group. In addition, HIV-infected responders tested at 9-15 months after vaccination demonstrated a significant decline in measles antibody levels. Although there was not a difference between the two cohorts in the proportion of patients who responded to the rubella component of the vaccine, there was a significant difference in the median antibody level of the responders of the two groups. We did not find a statistical difference in CD4 counts between responders and nonresponders. Alternate strategies will need to be established to prevent measles in HIV-infected children.

Antibodies, Viral↗
PubMed1997

Surveillance of measles in England and Wales: implications of a national saliva testing programme.

The impact of a mass vaccination campaign against measles-rubella in England and Wales was assessed using the results of a saliva test for measles-specific IgM, which was offered to all notified cases of measles. By means of clinical data supplied by the reporting doctors, we estimated the sensitivity and specificity of various clinical case definitions in predicting a confirmed case. A saliva sample was obtained within the appropriate time period for 3442/7574 (45.4%) of notified cases; the proportion confirmed by saliva testing was low and fell from 67/681 (9.8%) at the start of the campaign to 1/373 (0.3%) after 35 weeks. The specificity of all clinical case definitions was low, but was highest at 41.1% (95% confidence interval, 39.2-43.0%) for the definition similar to that recommended in the USA. Extrapolating from cases observed during ongoing surveillance permits estimation of an annual notification rate for nonmeasles rash and fever illness. For countries with good measles control, a clinical case definition is too nonspecific for accurate surveillance. Laboratory confirmation of suspected measles cases is required and saliva testing is an acceptable method. The continued sensitivity of measles surveillance in England and Wales requires that the incidence of notified rash and fever illness and the proportion of cases in which measles infection was excluded by laboratory testing be monitored.

Adolescent↗