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PubMed1985

Severe measles: a reappraisal of the role of nutrition, overcrowding and virus dose.

The factors predisposing to severe measles, which accounts for a considerable fraction of the high infant and child mortality in the third world, are re-examined. The conviction that protein-energy-malnutrition (PEM) aggravates measles is challenged by findings of prospective community-based studies. It was found that severe measles was not associated with PEM but frequently accompanied overcrowding in Guinea-Bissau. Secondary cases fared worse than index patients. Among adequately nourished hospitalised African children, immunological and radiological parameters, together with the effects of age and HLA antigens, were closely related to sickness and death in measles. This variation in case fatality rate does not appear to be simply explained by age-dependent host reactions or differences in medical care. The hypothesis which fits most of the observed facts postulates that the transmission of a large inoculum of virus particles to susceptible children is an important cause of severe disease. The implication of this interpretation is that specific measles control, and not only improvements in nutrition, is important in high risk areas for a reduction of measles mortality. It is further suggested that health policy should promote those social changes which limit intense exposure to measles virus.

Adult↗
PubMedDate not supplied

Measles blindness.

Measles remains a major problem in developing countries, where it affects an estimated 30 million children a year and causes up to one million deaths annually. Measles blindness is the single leading cause of blindness among children in low income countries, accounting for an estimated 15,000 to 60,000 cases of blindness per year. There is a close synergism between measles and vitamin A deficiency that can result in xerophthalmia, with corneal ulceration, keratomalacia, and subsequent corneal scarring or phthisis bulbi. High-dose oral vitamin A supplementation is recommended for all children with measles in developing countries. Higher measles immunization coverage to interrupt measles transmission and interventions aimed at improving vitamin A nutriture of children are the main strategies to prevent measles blindness.

Blindness↗
PubMed2004

Prior DNA vaccination does not interfere with the live-attenuated measles vaccine.

The currently used live-attenuated measles vaccine is very effective although maternal antibody prevents its administration prior to 6 months of age. We are investigating the ability of a DNA vaccine encoding the measles viral hemagglutinin, fusion and nucleoprotein to protect newborn infants from measles. Here, we show that a measles DNA vaccine protects juvenile macaques from pathogenic measles virus challenge and that macaques primed and boosted with this DNA vaccine have anemnestic antibody and cell-mediated responses after vaccination with a live-attenuated canine distemper-measles vaccine. Therefore, this DNA vaccine administered to newborn infants may not hinder the subsequent use of live-attenuated measles vaccine.

Animals↗
PubMed2006

Prevalence of antibodies to measles and rubella in Sana'a, Yemen.

Prevalence of antibodies to measles and rubella was tested in sera collected from 1368 subjects in urban and rural Sana'a. Overall, 11.7% had no antibodies to measles and 14.6% had no antibodies to rubella, despite the fact that measles but not rubella vaccine is included in the vaccination program in Yemen. Of 89 children <5 years of age 49 (55.1%) had no detectable antibodies to measles, demonstrating that supplementary measles immunization campaigns are required to prevent virus circulation. Assessment of measles immune status among infants in the first year of life is required to determine the optimum age for measles vaccination. Rubella vaccination should be considered with care in Yemen.

Adolescent↗
PubMed1997

Measles in pregnancy: maternal morbidity and perinatal outcome.

OBJECTIVE: In this article, we studied the maternal morbidity and the perinatal outcome of 40 women who had measles in pregnancy and that was compared to 120 women who had pregnancy without measles and 37 women who had measles without pregnancy. METHOD: The medical records of all the case and control subjects were reviewed and significance was tested at the 5% level. RESULTS: The 40 cases of measles with pregnancy had significantly more hospital admission for pneumonia and fever when compared to cases of measles with no pregnancy (P < 0.001). The perinatal morbidity is significantly higher in cases of measles with pregnancy as expressed by the higher incidence of prematurity, neonatal hospital admission and length of stay in hospital (P < 0.003, P < 0.0005 and P < 0.0001, respectively). CONCLUSION: Formulation of an appropriate strategy utilizing the available resources for measles vaccination is mandatory.

Case-Control Studies↗
PubMed1997

A case-control study of measles vaccination and inflammatory bowel disease. The East Dorset Gastroenterology Group.

BACKGROUND: The cause of inflammatory bowel disease (IBD) remains to be established. Evidence has linked measles infection in early childhood with the subsequent risk of developing IBD, particularly Crohn's disease. A cohort study raised the possibility that immunisation with live attenuated measles vaccine, which induces active immunity to measles infection, might also predispose to the later development of IBD, provoking concerns about the safety of the vaccine. METHOD: We report a case-control study of 140 patients with IBD (including 83 with Crohn's disease) born in or after 1968, and 280 controls matched for age, sex and general practitioner (GP) area, designed to assess the influence of measles vaccination on later development of IBD. Documentary evidence of childhood vaccination history was sought from GP and community health records. FINDINGS: Crude measles vaccination rates were 56.4% in patients with IBD and 57.1% among controls. Matched odds ratios for measles vaccination were 1.08 (95% CI 0.62-1.88) in patients with Crohn's disease, 0.84 (0.44-1.58) in patients with ulcerative colitis, and 0.97 (0.64-1.47) in all patients with IBD. INTERPRETATION: These findings provide no support for the hypothesis that measles vaccination in childhood predisposes to the later development of either IBD overall or Crohn's disease in particular.

Adult↗
PubMed2003

Measles infection in pregnancy.

OBJECTIVES: Measles during pregnancy has deleterious effects on both the perinatal outcome and the mother. However, in-depth knowledge about gestational measles is lacking. The objectives of this study were to describe the clinical course of eight cases of gestational measles and to study the effect of measles and pregnancy on each other. METHODS: From late 2000 to early 2001, we experienced a measles outbreak with eight infected pregnant women. The clinical course of each case is described in detail. RESULT: Three of the four cases before 24 weeks of gestation ended in spontaneous abortion or stillbirth. The clinical course of the three abortions and stillbirth were singular because of the sudden onset of the abortion and the spontaneous pregnancy termination. In contrast, the four pregnancies after 25 weeks of gestation ended in live-term delivery and two out of the four neonates were diagnosed with congenital measles. There was no maternal death, instead two pneumonia cases and one hemorrhagic shock case. CONCLUSIONS: Gestational measles may potentially damage the fetus and is one of the serious complications that can occur during pregnancy.

Abortion, Spontaneous↗
PubMed2003

High-titer measles vaccination before 9 months of age and increased female mortality: do we have an explanation?

In 1989, high-titer (HT) Edmonston-Zagreb measles vaccine with a titer more than 10(4.7) plaque-forming-units was recommended by the World Health Organization for use in areas with a high incidence of measles in children younger than 9 months. In 1992, the recommendation was rescinded following reports from Guinea-Bissau, Senegal, and Haiti showing an increased incidence of female mortality occurring after administration of HT Edmonston-Zagreb vaccination. We reviewed 9 studies of HT measles vaccines that reported data on mortality. These reports included 4 randomized trials comparing HT vaccine administered to children younger than 9 months with standard-titer (ST) vaccines (10(3.0) to 10(4.0) plaque-forming-units) given at 9 months of age. Five studies from Zaire, Haiti, Senegal, Rwanda, and Zaire had no control group receiving ST vaccine at 9 months of age, but investigators were able to examine the female-to-male mortality ratio within these HT studies. Investigators have hypothesized that HT vaccine had caused immune suppression similar to that of measles infection. The present review suggests first that the HT vaccine itself is unlikely to be the cause because the effect was not found in all studies. Second, the increased mortality started only after 9 to 10 months of age when controls received ST measles vaccine, and HT groups received the "control vaccine." It was not found in the studies that provided another measles vaccine instead of control vaccine. Third, because the HT studies with excess mortality rates showed increased female mortality rates, we need to find environmental or contextual conditions associated with increased female mortality rates in some studies to explain the problem associated with HT measles vaccination.

Africa South of the Sahara↗
PubMed1987

Tumor necrosis factor amplifies measles virus-mediated Ia induction on astrocytes.

We describe the induction of Ia on cultured astrocytes by measles virus and the amplification of this induction by tumor necrosis factor (TNF). Measles virus induces Ia on rat astrocytes by direct interaction with these cells. TNF does not induce significant levels of Ia at any dose from 1 to 10,000 units/ml. As little as 10 units of TNF per ml, however, amplifies Ia-inducing signals generated by measles virus in astrocytes. In contrast, TNF and measles virus induce class I major histocompatibility complex (MHC) antigens, when applied individually, and TNF amplification of measles virus class I MHC induction is not apparent. The induction of either Ia or class I MHC antigens on rat astrocytes by measles virus does not depend on glial-derived soluble factors generated during infection. Since brain cells are normally lacking MHC antigens upon which T cells depend for interaction with antigen presenting cells, these data indicate that the ability of measles virus to directly stimulate MHC antigen expression and the ability of TNF to amplify Ia expression locally in the brain may be important in initiating cell-mediated immune response to viral infection.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1981

Failure to cleave measles virus fusion protein in lymphoid cells.

The host-directed cleavage of measles virus fusion protein on infected lymphoid cells was studied to understand the mechanism of viral persistence in lymphoid cells in vivo. Several lymphoblastoid cell lines were infected with measles virus, and the viral glycoproteins expressed on the cell's surface were radiolabeled and analyzed for cleavage of fusion (F(0)) to F(1) by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Daudi and Ramos lymphoblastoid cells were deficient in their ability to cleave measles virus fusion protein and correspondingly produced low titers of infectious measles virus, Daudi cells being more defective than Ramos cells. In contrast, other lymphoblastoid cells studied, Victor, Raji, Wi-L2, RPMI 8866, and Seraphine, cleaved the fusion polypeptide and made significantly more infectious virus. Despite their defect in cleaving F protein, Daudi cells were able to assemble and release (noninfectious) measles virus particles into the fluid phase. The deficit in Daudi cells was corrected by fusing infected Daudi cells with cleavage-competent cells such as Victor or Raji. Furthermore, the cleavage event performed by competent cells could be mimicked at the plasma membrane by treating infected Daudi cells with trypsin, implicating the role of a plasma membrane enzyme in cleaving F(0) to F(1) during measles virus infection. Hence, lymphoid cells deficient in the plasma membrane enzyme required to cleave F protein are permissive for measles virus, maintain viral gene products, produce mostly noninfectious virus, and fail to place the biologic activity F(1) protein on their surfaces.

Antigens, Surface↗
PubMed1985

Impaired measles virus-specific cytotoxic T cell responses in multiple sclerosis.

To assess whether an virus-specific immune defect may be associated with multiple sclerosis (MS), we have examined the ability to generate measles virus-and influenza virus-specific cytotoxic T cells (CTL) in patients with MS, normal individuals, and other disease controls (ODC). The mean (+/- SEM) measles virus-specific CTL response for normal individuals and ODC was 26.9 +/- 2.9% (N = 17) and 26.7 +/- 2.8% (N = 13) specific lysis, respectively. In contrast, the capacity of MS patients to generate measles virus-specific CTL was markedly diminished. Peripheral blood lymphocytes from MS patients stimulated with measles virus lysed their measles virus-infected autologous B cell line at a group mean level of 6.0 +/- 1.4% (N = 16) specific lysis. MS patients had significantly lower measles virus-specific CTL responses than normal individuals (p less than 0.00001) or ODC (p less than 0.0001). Importantly, this lowered response did not reflect a generalized depressed cytolytic activity of MS patients, since influenza virus-specific CTL and NK activity from these patients were comparable to normals and ODC. Thus, in MS there is a significant depression of measles virus-specific CTL which suggests that this virus-specific immune dysfunction may play a role in the pathogenesis of this disorder.

Adolescent↗
PubMed2003

Integrating measles and rubella surveillance: the experience in the Caribbean.

In 1988, the Ministers of Health in the Caribbean Community resolved to eliminate cases of indigenous measles. Specific performance indicators were developed to regularly monitor the program. In 1998, selected countries in the Caribbean elected to accelerate rubella control. As a first step, surveillance for both measles and rubella was integrated, using the measles eradication system as a template. Between 1995 and 2000, 98%-99% of the surveillance sites reported weekly. During that time, the number of suspected measles and rubella cases that were disqualified by laboratory testing remained relatively constant at 94%-99%; however, the indicator for suspected cases investigated within 48 h improved from 89% in 1996 to 95% in 2000. This integrated surveillance system has thus proven to be as effective and efficient as the measles surveillance system alone. Limited changes were made to the initial measles system, and the transition was relatively smooth. The integrated system has been crucial to the control of rubella and for the maintenance of measles elimination in the Caribbean.

Caribbean Region↗
PubMed2003

Development of the Global Measles Laboratory Network.

The routine reporting of suspected measles cases and laboratory testing of samples from these cases is the backbone of measles surveillance. The Global Measles Laboratory Network (GMLN) has developed standards for laboratory confirmation of measles and provides training resources for staff of network laboratories, reference materials and expertise for the development and quality control of testing procedures, and accurate information for the Measles Mortality Reduction and Regional Elimination Initiative. The GMLN was developed along the lines of the successful Global Polio Laboratory Network, and much of the polio laboratory infrastructure was utilized for measles. The GMLN has developed as countries focus on measles control activities following successful eradication of polio. Currently more than 100 laboratories are part of the global network and follow standardized testing and reporting procedures. A comprehensive laboratory accreditation process will be introduced in 2002 with six quality assurance and performance indicators.

Clinical Laboratory Techniques↗
PubMed2004

Completeness of measles case reporting: review of estimates for the United States.

Measles surveillance is complex: the patient must seek health care, the diagnosis must be recognized by the physician, and the case must be reported to health departments. The portion of total (incident) measles cases that is reported to health departments is termed "completeness of reporting." Few studies describe this measure of the quality of surveillance in the United States; these studies use different methods, but they are all limited because the actual number of measles cases needed to derive completeness of reporting could not be determined. Estimates of completeness of reporting from the 1980s and 1990s vary widely, from 3% to 58%. One study suggests that 85% of patients with measles sought health care, the proportion of compatible illnesses for which measles was considered varied from 13% to 75%, and the proportion of suspected cases that were reported varied from 22% to 67%. Few cases were laboratory-confirmed, but all were reported. Surveillance in the United States is responsive, and its sensitivity likely increases when measles is circulating. Continued efforts to reinforce the clinical recognition and reporting of measles cases are warranted.

Disease Notification↗
PubMed2004

Acute measles mortality in the United States, 1987-2002.

We used capture-recapture methodology to estimate total deaths and efficiency of reporting for 2 systems. During 1987-1992, there were 165 measles-associated deaths in the multiple-cause mortality database at the National Center for Health Statistics (NCHS) and 184 reported to the measles surveillance system at the National Immunization Program (NIP). We estimated that 259 measles deaths actually occurred; the reporting efficiencies were 64% for the NCHS and 71% for the NIP. Overall the death-to-case ratio was 2.54 and 2.83 deaths/1000 reported cases, using the NCHS and NIP data, respectively. Pneumonia was a complication among 67% of measles-related deaths in the NCHS data and 86% of deaths in the NIP data. Encephalitis was reported in 11% of deaths in both databases. Preexisting conditions related to immune deficiency were reported for 16% of deaths in the NCHS system and 14% in the NIP; the most common was human immunodeficiency virus infection. Overall, 90% of deaths reported to the NIP occurred in persons who had not been vaccinated against measles. During 1993-1999, only 1 acute measles-related death was reported to the NCHS and no deaths were reported to the NIP. This is consistent with the extremely low reported incidence of measles in the United States during these years.

Acute Disease↗
PubMed2004

Can a minimum rate of investigation of measleslike illnesses serve as a standard for evaluating measles surveillance?

To determine whether measles case finding is sensitive, we developed a standard by which to evaluate measles surveillance. We compiled data on the incidence of measleslike illnesses (MLIs) from multiple, diverse sources and used the distribution of these values to determine the minimum level of measles case-finding activity that could be expected in a given region. Among surveillance programs in the United States, other countries in the Americas, and other World Health Organization regions, the median annual rates for rash investigations that were ruled out for measles were 4.3, 4.1, and 1.8/100000 population, respectively. The annual rates of measles IgM testing in the United States in public laboratories and commercial laboratories were 1.6 and 9.2/100000 population, respectively. In total, we collected data on annual MLI incidence from >80 sources. Values ranged from 0.1 to 22.6 cases of MLI per 100000 population, and 90% of values were >or=1.0/100000 population. On the basis of these findings, we propose that programs attempting measles elimination consider evaluating surveillance by comparing the annual rate of suspected measles investigations against a minimum standard of 1/100000 population.

Americas↗
PubMed1989

Loss of maternal measles antibody during infancy in an African city.

Measles epidemics with 20% of the cases under nine months of age continue to occur in Brazzaville, Congo, even though measles vaccination coverage was 77% in the 12- to 23-month age group in 1986. In order to estimate the duration of passive immunity against measles, we conducted a serologic survey of infants aged 2 to 9 months. Measles antibody was measured from capillary blood with the plaque inhibition test. An antibody titre of 40 milli-International Reference Units per ml of serum (mIRU/ml) or less was defined as seronegative. Among the 252 infants studied, the proportion with detectable antibody dropped from 95.8% at 2 months of age to 48.5% at 4 months of age, and to 8.2% in the 7-8 month age group. A simple logistic model with age as the only variable provided an excellent fit to the observed values. Between the ages of 8 and 28 weeks, there was an almost steady decline of approximately 4.7% per week in the proportion of infants who were seropositive. These findings suggest that loss of maternal measles antibody during infancy might be faster than reported in other African populations. Giving measles vaccine to infants before the age of nine months currently recommended by the Expanded Programme on Immunization may be useful in some populations. Further studies of seroconversion and impact on measles are needed.

Age Factors↗
PubMed1993

Excess mortality after early exposure to measles.

The impact of exposure to measles before 6 months of age has been investigated by comparing survival to 5 years of age for exposed children and controls in an urban (Bandim) and a rural (Quinhamel) area of Guinea-Bissau. In Bandim, cumulative mortality from time of exposure to age 5 years was 34.4% among exposed children and 9.3% among controls. In a matched pair analysis, exposed children had a mortality ratio (MR) of 3.80 (95% confidence interval [CI]: 1.42-10.18) compared with controls. In an unpaired analysis using Cox' regression model to standardize for background variables (sex, measles infection, age at exposure, exposure from own household, measles vaccination), there was little change in the MR (3.84, CI: 1.55-9.48). Even after 2 years of age, the exposed children tended to have higher mortality (MR = 7.96, CI: 0.98-64.74). In the rural area, the MR between exposed children and controls was 11.39 (CI: 1.42-91.51). Limited serological data suggest that at least some of the exposed had subclinical measles. In the urban area, where two studies of early exposure have been carried out, excess mortality among exposed children corresponds to 40% and 52%, respectively, of the acute measles mortality. Since these deaths would not be associated with measles in a study of protection against death after vaccination, measles immunization may have a much greater effect on childhood mortality than has previously been assumed.

Age Factors↗