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PubMed1990

Immune activation during measles: interferon-gamma and neopterin in plasma and cerebrospinal fluid in complicated and uncomplicated disease.

To study T cell and macrophage activity during measles, levels of interferon-gamma (IFN-gamma) and neopterin in plasma and cerebrospinal fluid (CSF) were measured. Plasma levels of IFN-gamma were elevated in measles (1.17 +/- 0.27) compared with healthy adults (0.13 +/- 0.06, P less than .05) and children (0.14 +/- 0.06, P less than .01). Plasma levels of neopterin were elevated in measles (32.5 +/- 2.7) compared with healthy adults (5.3 +/- 2.9, P less than .0001), healthy children (12.1 +/- 4.0, P less than .001), and children with other infectious diseases (20.6 +/- 4.0, P less than .02). IFN-gamma was increased in measles primarily during rash; neopterin remained elevated for several weeks. Levels of neopterin showed a significant positive correlation with plasma levels of soluble interleukin-2 receptor and soluble CD8, two other parameters of T cell activation. Children with measles complicated by pneumonia had higher levels of neopterin in serum than those with uncomplicated disease. Children with measles complicated by autoimmune encephalomyelitis had higher levels of neopterin in CSF than those with noninflammatory neurologic disease but lower than those with central nervous system infections. Thus, IFN-gamma seems to be produced in vivo during acute measles virus infection; deficiency of this lymphokine does not appear to correlate with increased susceptibility to secondary infections.

Adolescent↗
PubMed1996

Efficacy of a single oral dose of 200,000 IU of oil-soluble vitamin A in measles-associated morbidity.

The authors assessed the efficacy of the World Health Organization (WHO) recommendation of 200,000 IU of vitamin A in oil to treat acute non-xerophthalmic measles patients. Acute measles patients who did not require hospitalization were enrolled in a randomized, double-masked, clinical trial of vitamin A (n=90) versus placebo (n=110) carried out in Ndola, Zambia, in 1991. Measles-associated morbidity was defined by the presence of signs and symptoms of acute respiratory infection. Daily evaluations for the first 3 days were followed by weekly visits for a month at urban health centers. Baseline demographic, clinical, and biochemical characteristics were similar in both groups. Cross-sectional analysis of morbidity status, by group, at each weekly evaluation showed no significant differences until week 4, when more placebo-treated patients had cough or pneumonia (p=0.005). However, longitudinal analysis, which looked at changes among individuals and controlled for initial health status, showed more equivocal results. The odds ratio for the development of pneumonia in patients with measles cough in vitamin A-treated subjects was 0.73 (95% confidence interval (Cl) 0.30-1.80). The odds ratio for the development of measles-associated cough or pneumonia in asymptomatic measles patients was 0.52 (95% Cl 0.24-1.13), in favor of vitamin A, but the odds ratio for failing to improve from pneumonia in vitamin A-treated subjects was 1.23 (95% Cl 0.68-2.3), a result in favor of placebo. These results suggest that the evidence for the efficacy of one dose of vitamin A in oil to prevent measles complications is not as strong as that previously shown for two 200,000 IU doses of water-miscible vitamin A, and that the WHO recommendation may need to be reexamined.

Anthropometry↗
PubMed1985

Measles infection and Parkinson's disease.

A case-control analysis of Parkinson's disease and infections in childhood was conducted in a cohort of 50,002 men who attended Harvard College (Cambridge, MA) or the University of Pennsylvania (Philadelphia, PA) between 1916 and 1950 and who were followed in adulthood for morbidity and mortality data. Cases of Parkinson's disease were identified from responses to mailed questionnaires and death certificates through 1978. Four controls from the same population were selected for each case. A reduced risk of Parkinson's disease was associated with most childhood viral infections. The negative association was statistically significant for a history of measles prior to college entrance (exposure odds ratio = 0.53; 95% confidence limits: 0.31, 0.93). The reduced risk of Parkinson's disease among subjects with a positive history of measles in childhood may reflect an adverse effect of measles in adulthood or of subclinical or atypical measles. Furthermore, a negative history of measles, especially if associated with a lack of other common diseases, could be a marker for negative influenza history before 1918 and thus a higher risk of infection during the 1918 influenza epidemic, because of the lack of partial influenza immunity. These data may also suggest a truly protective effect of measles, compatible with some complex interaction between measles virus and the virus of the 1918 influenza epidemic.

Adolescent↗
PubMed1993

Routine high-dose vitamin A therapy for children hospitalized with measles.

Measles is without specific therapy and remains important globally as a cause of childhood death. In controlled studies, high-dose vitamin A therapy (Hi-VAT)--with 400,000 IU vitamin A--has been demonstrated to markedly reduce measles-associated morbidity and mortality. We performed a retrospective study of the hospital records of 1720 children < 15 years of age who were hospitalized for measles, to determine the extent to which these findings, in research settings, are applicable to the case management of measles under conditions of routine hospital practice. The outcomes were studied of children hospitalized during two non-consecutive 2 year periods (1985-6 and 1989-90). A policy of Hi-VAT for all children hospitalized with measles was started during the intervening period. As compared with the group of children on standard therapy (n = 1061), children receiving Hi-VAT (n = 651) had a shorter hospital stay (mean 10 versus 13 days; P < 0.001), a lower requirement for intensive care (4.3 versus 10.5 per cent; P < 0.001), and a lower death rate (1.6 versus 5 per cent; P < 0.001). No adverse effects of Hi-VAT therapy were observed. We conclude that a policy of high dose oral vitamin A (400,000 IU) supplementation in measles provides benefits which are equivalent to those previously observed only in controlled research trials, that it is highly cost effective, and that it should form part of the routine case management of all children hospitalized with measles.

Administration, Oral↗
PubMed1992

Reduced measles immunity in infants in a well-vaccinated population.

The recommended age for measles vaccination is based in part on information gathered when most mothers had natural measles. Nowadays many mothers have received measles vaccine. To assess this change measles antibody neutralization titers (NT) were determined for 278 mother-infant pairs. One hundred sixty-four mothers, born before 1958, likely had had natural measles (Group 1). Sixty mothers received one to three killed plus one attenuated measles vaccination (Group 2) and 54 received 1 attenuated measles vaccination only (Group 3). NT were determined for the mother and for the infant at birth and in the infant during the fourth and sixth months. Group 1 mothers and infants at every age had higher geometric mean NT than those in Groups 2 or 3 (P less than 0.05). By 7 months 65% of Group 1 infants and greater than 90% of Group 2 and 3 infants had an NT less than 1:10. The rate of antibody decay was significantly faster for Group 1 infants (P less than 0.05). Earlier vaccination in the infant should be considered.

Adult↗
PubMed1992

Risk factors associated with severe measles in Puerto Rico.

From January to April, 1990, 695 measles cases were reported to the Puerto Rico Health Department; there were 12 measles-associated deaths (case fatality ratio, 17/1000), more than in any year since 1967. We conducted a case-control study of risk factors for severe measles. We identified 16 children (ages 5 to 34 months) with severe measles and selected children with nonsevere measles as controls (39 hospitalized and 38 nonhospitalized). Controls were frequency matched to severe measles cases by region of residence. One case and two controls had been vaccinated. An underlying illness was present in 50% of cases and 16% of nonhospitalized controls (Mantel-Haenszel weighted odds ratio 5.3; 95% confidence interval 1.4, 20.2). In a multivariate analysis cases were significantly more likely than hospitalized controls to be from families with an annual income of < $5000 (odds ratio (OR), 26.9), to have a mother without a high school degree (OR 11.1), to be anemic (hemoglobin < 10 g/dl) (OR 15.9) and have an underlying illness (OR 18.3). During measles outbreaks preventing severe illness requires aggressive control measures and strategies to increase vaccine coverage of children with underlying illnesses and of low socioeconomic status.

Child, Preschool↗
PubMed1993

High attack rates and case fatality during a measles outbreak in groups with religious exemption to vaccination.

Beginning in October, 1990, a large measles outbreak involving predominantly unvaccinated preschool age children occurred in Philadelphia. By June, 1991, 938 measles cases had been reported to the Philadelphia Health Department. In addition to these cases, 486 cases and 6 measles-associated deaths occurred between November 4, 1990, and March 24, 1991, among members of 2 Philadelphia church groups that do not accept vaccination. We identified measles cases and collected information on symptoms and potential risk factors for complications. Telephone interviews were conducted to collect demographic and clinical information on measles cases in church member households. We identified 486 measles cases among 892 mostly unvaccinated church members. Age-specific attack rates were highest among children 1 to 4 years of age (94%) and 5 to 14 years of age (91%). Five (83%) of the 6 deaths occurred in females, 3 of whom had underlying illnesses. The overall case-fatality rate was 1.2%. The case-fatality rate was 2% for females, 0.4% for males (P = 0.22), 1.7% for primary cases and 0.7% for secondary household cases (P = 0.67). Only one of the children who died had received medical care. Measles spread rapidly in this group, sparing few susceptible individuals. Lack of medical care and underlying disease appear to have contributed to the high case-fatality rate in the church communities.

Adolescent↗
PubMed1993

Clinical presentations and complications of suspected measles in hospitalized children.

We evaluated clinical presentations and complications retrospectively in 48 pediatric patients hospitalized for suspected measles during a measles epidemic in Chicago. Fifty-one percent were < 15 months of age and 75% were < 4 years of age. Measles, diagnosed in 44 patients, was culture-proved in 18. Presentations were not always classic. Respiratory complications, otitis media, hepatitis, preterm labor, keratitis and central nervous system involvement were reported. The presence of stomatitis and hypotension in some patients raised the differential diagnoses of Kawasaki disease and toxic shock syndrome. Six patients with stomatitis, admitted with a measles-like illness, fulfilled the Centers for Disease Control and Prevention criteria for Kawasaki disease. Three were diagnosed with Kawasaki disease and 3 with measles. In addition to serology and echocardiographic changes, the platelet count and the erythrocyte sedimentation rate may be useful in distinguishing between measles and Kawasaki disease. Two of 10 patients with hypotension met the Centers for Disease Control and Prevention criteria for toxic shock syndrome. The diagnosis of measles, solely on clinical grounds, may therefore not be as straightforward as is generally accepted.

Adolescent↗
PubMed1996

Thrombocytopenic purpura after measles, mumps and rubella vaccination: a retrospective survey by the French regional pharmacovigilance centres and pasteur-mérieux sérums et vaccins.

BACKGROUND: Thrombocytopenic purpura (TP) after vaccination with measles, mumps and rubella has occasionally been reported. OBJECTIVES: To evaluate the incidence and characteristics of thrombocytopenic purpura reported in France after measles, mumps or rubella vaccination with monovalent or multivalent vaccines. METHODS: A retrospective epidemiologic survey was conducted. All confirmed cases of TP reported spontaneously either to the French Regional Pharmacovigilance Centres or to the manufacturer (Pasteur-Mérieux Sérums et Vaccins) between 1984 and June 30, 1992, were reviewed. RESULTS: Sixty cases of TP in children between 1 and 11 years of age occurred 2 to 45 days after administration of 1 of 7 vaccines. The reported incidence of TP varied from 0.17 and 0.23/100,000 doses of measles or rubella vaccines, respectively, given alone to 0.87/100,000 doses of combined measles-rubella vaccines and 0.95/100,000 doses of the measles-mumps-rubella vaccine. The mean platelet count was 8000 +/- 6000/mm3 and was lower than 10,000/mm3 in 58% of cases. The immediate outcome was favorable in 89.5% of cases. CONCLUSIONS: According to the clinical course and biologic findings, vaccine-associated TP appears to be similar to that occurring after natural measles or rubella infections and is not distinguishable from acute childhood idiopathic thrombocytopenic purpura not associated with vaccination. Such observations, combined with a clear temporal relationship between measles-mumps-rubella vaccination and the occurrence of TP, make a causal relationship highly plausible. Nevertheless the incidence of these events remains relatively low with a favorable immediate outcome.

Child↗
PubMed2006

Prevalence of protective antibody against measles in HIV-infected children with immune recovery after highly active antiretroviral therapy.

OBJECTIVES: This study was conducted to determine the prevalence of measles-protective antibody in HIV-infected children with immune recovery after highly active antiretroviral therapy (HAART). METHODS: Ninety-six HIV-infected children were enrolled in the study. Their mean age was 9.7+/-2.6 years, 47% were boys, and 47% were in Centers for Disease Control and Prevention (CDC) clinical category C. All participants had been treated with HAART until they achieved a CD4 cell percentage > or =15%. Three children with a history of clinical measles infection were not included in the data analysis. RESULTS: Only 39 out of 93 children (42%) had a measles-protective antibody level, defined as an anti-measles immunoglobulin G (IgG) level > or =320 mIU/mL. There was no significant difference between the groups with and without protective levels of measles antibody in gender, clinical category, age at which HAART was started, duration of severe immune suppression, CD4 cell count and percentage, or plasma HIV RNA level before and after HAART. CONCLUSIONS: We conclude that, despite a history of measles immunization and evidence of immune reconstitution after HAART, many healthy HIV-infected children are still susceptible to measles.

Antiretroviral Therapy, Highly Active↗
PubMed1991

Early signal transduction in measles virus-infected lymphocytes is unaltered, but second messengers activate virus replication.

In order to understand measles virus-lymphocyte interactions, we have started to analyze factors and events which regulate measles virus infection in peripheral blood mononuclear cells (PBMC). We analyzed the initiation of cell proliferation, induced by phytohemagglutinin, in infected and control PBMC by measuring intracellular free Ca2+ by using fura-2. Measles virus-infected and control PBMC responded similarly with an increase in the amount of cytosolic free Ca2+, indicating that the early activation events are not affected and are not involved in immunosuppression. The activation signals, Ca2+ and protein kinase C, induced specifically and independently by Ca ionophore A23187 or 12-O-tetradecanoylphorbol-13-acetate (TPA), changed the restricted measles virus infection to a productive one. The combination of TPA and A23187 was the most potent activator of measles virus replication. TPA and A23187 operate through different activation mechanisms, and it is evident that measles virus replication depends on the activation of cellular signal pathways. Depletion of adherent cells enhanced virus replication, especially at the early stage of infection, indicating the inhibitory role of monocytes. Monocytes were strongly infected, but they supported complete measles virus replication only at a very low level, and virus replication could not be enhanced with TPA and/or A23187.

Adult↗
PubMed1994

Binding of measles virus to membrane cofactor protein (CD46): importance of disulfide bonds and N-glycans for the receptor function.

Two cellular proteins, membrane cofactor protein (MCP) and moesin, were reported recently to be functionally associated with the initiation of a measles virus infection. We have analyzed the interaction of measles virus with cell surface proteins, using an overlay binding assay with cellular proteins immobilized on nitrocellulose. Among surface-biotinylated proteins from a human rectal tumor cell line (HRT), measles virus was able to bind only to a 67-kDa protein that was identified as MCP. The virus recognized different isoforms of MCP expressed from human (HRT and HeLa) and simian (Vero) cell lines. The binding of measles virus to MCP was abolished after cleavage of the disulfide bonds by reducing agents as well as after enzymatic release of N-linked oligosaccharides. By contrast, removal of sialic acid or O-linked oligosaccharides did not affect the recognition of MCP measles virus. These data indicate that the receptor determinant of MCP is dependent on a conformation of the protein that is maintained by disulfide bonds and N-glycans present in the complement binding domains. Our results are consistent with a role of MCP as primary attachment site for measles virus in the initial stage of an infection. The functional relationship between MCP and moesin in a measles virus infection is discussed.

Animals↗
PubMed1999

Requirements for measles virus induction of RANTES chemokine in human astrocytoma-derived U373 cells.

Interferons and chemokines play a critical role in regulating the host response to viral infection. Measles virus, a member of the Paramyxoviridae family, induces RANTES expression by astrocytes. We have examined the mechanism of this induction in U373 cells derived from a human astrocytoma. RANTES was induced in a dose- and time-dependent manner by measles virus infection. Inhibition of receptor binding by the anti-CD46 antibody TRA-2.10 and of virus-membrane fusion by the tripeptide X-Phe-Phe-Gly reduced RANTES expression. Formalin-inactivated virus, which can bind but not fuse, and extensively UV-irradiated virus, which can bind and fuse, were both ineffective. Therefore, virus binding to the cellular receptor CD46 and subsequent membrane fusion were necessary, but not sufficient, to induce RANTES. UV irradiation of virus for less than 10 min proportionally inhibited viral transcription and RANTES expression. RANTES induction was decreased in infected cells treated with ribavirin, which inhibits measles virus transcription. However, RANTES mRNA was superinduced by measles virus in the presence of cycloheximide. These data suggest that partial transcription of the viral genome is sufficient and necessary for RANTES induction, whereas viral protein synthesis and replication are not required. This hypothesis was supported by the fact that RANTES was induced through transient expression of the measles virus nucleocapsid gene but not by measles genes encoding P or L proteins or by leader RNA in A549 cells. Thus, transcription of specific portions of measles virus RNA, such as the nucleocapsid gene, appears able to generate the specific signaling required to induce RANTES gene expression.

Astrocytoma↗
PubMed1983

Fate of microfilaments in vero cells infected with measles virus and herpes simplex virus type 1.

In herpes simplex virus type 1-infected Vero cells, reorganization of microfilaments was observed approximately 4 h postinfection. Conversion of F (filamentous) actin to G (globular) actin, as assessed by a DNase I inhibition assay, was continuous over the next 12 to 16 h, at which time a level of G actin of about twice that observed in uninfected cells was measured. Fluorescent localization of F actin, using 7-nitrobenz-2-oxa-1,3-diazole (NBD)-phallacidin, demonstrated that microfilament fibers began to diminish at about 16 to 18 h postinfection, roughly corresponding to the time that G actin levels peaked and virus-induced cytopathology was first observable. In measles virus-infected cells, no such disassembly of microfilaments occurred. Rather, there was a modest decrease in G actin levels. Fluorescent localization of F actin showed that measles virus-infected Vero cells maintained a complex microfilament network characterized by fibers which spanned the entire length of the newly formed giant cells. Disruption of microfilaments with cytochalasin B, which inhibits measles virus-specific cytopathology, was not inhibitory to measles virus production at high multiplicities of infection (MOI) but was progressively inhibitory as the MOI was lowered. The carbobenzoxy tripeptide SV-4814, which inhibits the ability of Vero cells to fuse after measles virus infection, like cytochalasin B, inhibited measles virus production at low MOI but not at high MOI. Thus, it appears that agents which affect the ability of Vero cells to fuse after measles virus infection may be inhibitory to virus production and that the actin network is essential to this process.

Actins↗
PubMed1983

Lymphocyte subsets in measles. Depressed helper/inducer subpopulation reversed by in vitro treatment with levamisole and ascorbic acid.

Lymphocyte subsets were assessed in patients with measles using the OKT range of monoclonal antibodies. A significant decrease in cells reacting with the OKT3 and OKT4 monoclonal antibodies was observed. When the tests were repeated 3 wk after the acute infection, significant recovery of these subsets was observed. The abnormality in lymphocyte subsets could be reproduced by treating normal lymphocytes with measles virus in vitro. When lymphocytes from patients with measles or when normal cells infected with measles virus in vitro were treated with either levamisole or L-ascorbic acid for 15 min and then retested with the OKT antisera, restoration of the previously depleted OKT3+ and OKT4+ cell population was observed. Ascorbic-acid treatment also, to a certain extent, reversed the inability of measles mononuclear cells to produce lymphocyte mitogenic factor (helper factor for B cells) after pokeweed mitogen activation. This abnormality, however, could not be reversed by in vitro treatment with levamisole. Measles patients treated with L-ascorbic acid demonstrated no accelerated recovery in either their lymphocyte subset profile or their ability to produce lymphocyte mitogenic factor. Although the cause of the depressed OKT3+ and OKT4+ lymphocyte subpopulations in patients with measles is not clear, the results suggest that the effect is not due to an aberration of protein synthesis, but rather to a blocking or steric change produced by the virus on the cell membrane. It is likely that both ascorbic acid and levamisole have the ability to reverse this effect by virtue of their antioxidant properties.

Acute Disease↗
PubMed2003

Production and expression of Gro-alpha and RANTES by peripheral blood mononuclear cells isolated from patients with Kawasaki disease and measles.

We investigated whether the production and gene expression of Gro-alpha and RANTES in Kawasaki disease differ in measles. Forty-two samples from 14 patients in different clinical stages of Kawasaki disease, eight samples from 8 patients in the acute stage of measles and seven samples from 7 healthy children were collected. The present study was performed using ELISA and RT-PCR for the productions and gene expression of the chemokines. The production of Gro-alpha was markedly elevated during the acute stage of measles compared with Kawasaki disease. Moreover, the expression of Gro-alpha was increased in every case of measles, but not in Kawasaki disease. The production of RANTES was elevated in the acute stage of both diseases when compared to the healthy control. However, the plasma RANTES level did not change significantly according to the clinical stages of Kawasaki disease. A correlation between the production and gene expression of RANTES and Gro-alpha was not found in Kawasaki disease. These results suggest that Kawasaki disease differs from measles with regard to Gro-alpha production and expression, but not RANTES. Gro-alpha might play an important role in the acute stage of measles, however not in Kawasaki disease. Further studies are needed to clarify the efficacy of Gro-alpha as a marker in measles.

Biomarkers↗
PubMed2005

A meta-analysis of studies comparing the respiratory route with the subcutaneous route of measles vaccine administration.

The respiratory tract has been suggested as an optimal alternative site to target measles vaccine delivery. We performed a meta-analysis to evaluate the efficacy of measles vaccine administered through the respiratory route compared to the subcutaneous route. We analyzed 20 reported results from 16 eligible studies. Seroresponse was 4% higher amongst vaccinees in the respiratory group compared to the subcutaneous group (M-H pooled RR = 1.04; 95% CI = 0.98-1.10). For vaccinees over 9 months of age, seroresponse was 15% higher in the respiratory group (M-H pooled RR = 1.15; 95% CI = 1.08 to 1.17). When Edmonston Zagreb (EZ) strain was used, the vaccine was found to be neither more nor less efficacious when administered through respiratory route (M-H pooled RR=1.00; 95% CI = 0.94 to 1.08). Seroresponse in the vaccinees receiving aerosol measles vaccine was 10% higher (M-H pooled RR = 1.10, 95% CI = 1.04-1.17) compared to those who received measles vaccine through the subcutaneous route. Seroresponse due to aerosolized EZ vaccine was 9% higher than subcutaneous EZ vaccine (M-H pooled RR = 1.09; 95% CI = 1.02-1.16). The seroresponse among seropositive vaccinees was 60% higher (M-H RR = 1.60; 95% CI = 1.40 to 1.80). The results suggest that the respiratory route of delivery of measles vaccine is at least as efficacious as measles vaccine administered through the subcutaneous route. However, more research is required on standardization of dosage, administration equipments, efficacy, and safety of respiratory (aerosol) route of administration of measles vaccine.

Administration, Inhalation↗
PubMed1999

[Seroprevalence of antibodies against measles, rubella, mumps and varicella among school children in Madrid].

OBJECTIVE: The aim of this study was to assess the seroprevalence of antibodies against MMR and varicella in a population of children between 6 and 7 years of age vaccinated against measles, mumps and rubella at 15 months of age. PATIENTS AND METHODS: This cross-sectional study was carried out in a group of healthy children (6-7 years of age) of the Autonomous Community of Madrid, Spain. Vaccination against MMR at 15 months of age was documented for all children included in the study. Blood samples were drawn from all participants and sera were stored at -20C until they were tested at the end of the study. Measles, mumps, rubella and varicella antibody levels were measured by means of the enzyme linked immunosorbent assay (ELISA) method (IgG Genzyme Virotech GmbH). Positive values were defined as optical density values of > or = 0.20 for measles, > or = 0.30 for mumps, > or = 0.40 for rubella and > or = 0.36 for varicella. Prevalence (and the corresponding 95% confidence limits) assessed by the presence of anti-measles, anti-mumps, anti-rubella and anti-VZV antibodies on the study population were calculated. The Chi-squared test was used to evaluate differences in prevalence between sexes. The Chi-squared test was used to evaluate differences in prevalence between the sexes. RESULTS: A total of 174 children were recruited between October and November 1997. The mean age (SD) and male/female ratio were 6.4 (0.5) years and 0.8 (45.6%/54.5%), respectively. Prevalence of antibodies against measles, rubella, mumps and varicella were 92% (88-96%), 95% (92-98%), 81% (76-86%) and 85% (90-90%), respectively. There were no significant differences between the sexes in relationship to the prevalence of measles, mumps, rubella or varicella antibodies. CONCLUSIONS: Approximately 20% of these 6 to 7 year old children vaccinated at 15 months of age were unprotected against the mumps. Eight percent and 5% were sero-negative for measles and rubella, respectively. Administration of the second dose of MMR vaccine at 4 to 6 years of age instead of at 11 years would contribute to avoid the accumulation of non-immune children. Eighty-five percent of the study population was sero-positive for VZV. These data suggest that, in Spain, VZV infections commonly affect children younger than 5 years of age.

Antibodies, Viral↗