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PubMed1975

Inhibition of lymphocyte stimulation by measles virus.

The effect of measles virus on phytohemagglutinin-(PHA) induced stimulation of human peripheral blood mononuclear cells was investigated to delineate possible mechanisms for viral suppression of cell-mediated immunity (CMI). it was noted that medium which had several days contact with uninfected monolayers as well as unpurified measles virus preparations produced significant inhibition of 3H-thymidine incorporation by PHA-stimulated lymphocytes. When partially purified measles virus preparations were used, however, marked inhibition was observed and the inhibitory effect of cell-derived factors could be separated easily from the virus-induced inhibition. Experiments to determine the mechanisms of this virus-induced inhibition of 3H-thymidine incorporation showed the following: 1) live measles virus and not UV-irradiated or heat-inactivated virus produced inhibition; 2) the inhibitory effect observed was not the result of a viral-induced inhibitor being released from measles-infected lymphocytes; and 3) monocyte depletion had no effect on the ability of measles virus to inhibit 3H-thymide incorporation by PHA-stimulated lymphocytes. Since it was found that measles virus-infected lymphocytes display an impaired response to in vitro PHA stimulation, perhaps this dysfunction may be extended to mediator release and other functions associated with delayed cutaneous hypersensitivity (DCH) in vivo.

Animals↗
PubMedDate not supplied

Failure to vaccinate children against measles during the second year of life. An analysis of immunization practices in two Tennessee county health departments.

In many Tennessee counties, children under the care of health departments have low measles vaccination levels. An immunization survey and a health department record audit of 2-year-olds were undertaken in two counties to determine the reasons for this situation. The results indicated that faulty clinic procedures played a large part in the failure to vaccinate against measles. Nearly half of the unvaccinated 2-year-olds with health department records had been present in the health department clinic at the appropriate age for measles vaccination; the remainder had dropped out of the well-child program before their first birthday. Emphasis on tuberculin skin testing and delay in the administration of the basic series of DTP immunizations correlated with the failure to vaccinate against measles. For more than half of the children who attended the clinic after their first birthday, no reason was recorded for the failure to vaccinate them against measles. Improved clinic procedures could bring measles vaccination levels within the acceptable range. These procedures would include new methods for correcting immunization delinquency, simultaneous tuberculin skin testing and measles vaccination of children without a history of tuberculosis exposure, emphasis on vaccinating at-risk groups, and more convenient vaccination clinic hours.

Age Factors↗
PubMed1996

Survey of immunity to measles in schoolchildren in Cork.

Surveillance of measles in the Republic of Ireland has relied until now on notifications of clinically diagnosed infections and a manual system for monitoring coverage. In the light of a measles epidemic predicted in the United Kingdom in 1995, it was considered timely to review the epidemiology of measles and obtain baseline seroepidemiological data on measles immunity in Cork City in the Republic of Ireland. The age specific prevalence of measles IgG in saliva from 2000 schoolchildren aged 5 to 15 years was determined. The study also compared susceptibility rates in children with and without a history of measles vaccination or infection. Histories provided by parents were found to be unreliable in informing vaccination practice, as 79 of the 102 seronegative children would have been classified as immune. The proportion of children immune to measles, as gauged by seropositivity, was 91.9% in children aged 5 to 10 years and 95.8% in 11 to 15 year olds. The implications of the study results are discussed in relation to future prevention and control strategies.

Adolescent↗
PubMed1998

Challenges posed by changes in measles transmission patterns.

OBJECTIVE: To quantify changes in measles transmission patterns. DESIGN: Analysis of measles surveillance data. SUBJECTS: All measles cases identified in 1988. MAIN OUTCOME MEASURES: Proportion of cases in age group 60 to 119 months, proportions of vaccinated and unvaccinated cases in age group 60 to 119 months, and occurrence of cases in schools. RESULTS: Measles vaccination coverage was 91%. Incidence rate of measles was 205 per 100,000 population. The age group 60 to 119 months accounted for 49% of all reported cases and 68% of cases in this age group were vaccinated. There were measles epidemics in schools and these were associated with occurrence of secondary cases in younger siblings in the community. Case fatality rate and mortality rate were 0.4% and one per 100,000 population respectively. CONCLUSION: High measles transmission in children of school going age could spill into the community through generation of secondary cases among younger siblings and this could result in high morbidity and mortality in this vulnerable group. It is recommended that either revaccination at school entry or mass vaccination campaigns be carried out in affected age groups at schools to reduce occurrence of epidemics.

Age Distribution↗
PubMed2006

Absence of detectable measles virus genome sequence in blood of autistic children who have had their MMR vaccination during the routine childhood immunization schedule of UK.

Leukocyte preparations from children with documented evidence of MMR vaccination and confirmed diagnosis of autism were examined by several assays designed to target multiple regions of the measles virus genome sequence. No sample was found positive by any method. The assays applied were highly sensitive, specific and robust in nature, and were based on the amplification of measles virus RNA transcripts by real-time quantitative RT-PCR (QRT-PCR) as well as by conventional RT-PCR-nested PCR. The assays applied were potentially able to detect measles virus RNA down to single figure copy numbers per reaction. The amount of total nucleic acid extract of leukocytes subjected to various measles virus-specific investigations was several fold higher than minimally required of a sample where measles virus persistence is well documented. This study failed to substantiate reports of the persistence of measles virus in autistic children with development regression.

Adolescent↗
PubMed2004

Risk factors for undervaccination against measles in a large sample of preschool children from rural Bavaria.

BACKGROUND: Due to insufficient vaccination rates, measles outbreaks still pose a threat to public health in Germany. The purpose of this study was to identify risk factors for undervaccination against measles. PATIENTS AND METHODS: Datasets from two cross-sectional surveys were analyzed by logistic regression models. The surveys had been done prior to and after an intervention aiming to raise measles, mumps, and rubella vaccination rates among children entering primary school in five Bavarian counties. Subjects were 9,582 children aged 6 to 7 years and their parents. RESULTS: Main independent predictors of non-immunization were doctors advising against vaccination (OR 84.8; 95% CI 19.9-360.4), doctors abstaining from advice (OR 6.3; 95% CI 4.8-8.4), and parental reservations due to alternative health beliefs (OR 27.9; 95% CI 17.6-44.1). CONCLUSION: Doctors advising against measles vaccination and doctors not giving any advice proved to be important risk factors for childhood undervaccination against measles. Future strategies to increase measles vaccination rates in Germany should focus more on family doctors.

Adult↗
PubMedDate not supplied

Protective efficacy of high-titre measles vaccines administered from the age of five months: a community study in rural Senegal.

Using data on incidence and secondary attack rates, we examined the protective efficacy of high-titre Edmonston-Zagreb (EZ) and Schwarz (SW-HT) measles vaccines administered at 5 months. Control children were assigned to placebo at age 5 months and standard Schwarz (SW-std) measles vaccine at 9-10 months of age. A large proportion of measles cases was verified serologically. Though high-titre vaccines seemed to be protective before 10 months of age, a significant reduction in disease could not be demonstrated due to low incidence of measles. After 10 months of age, SW-std given at 10 months gave a vaccine efficacy of 100% and induced better protection than SW-HT (P = 0.030) and EZ-HT (P = 0.128) administered at 5 months. In studies of secondary attack rates in the compound, vaccine efficacy was 91% (75%-97%) for EZ-HT, 85% (40%-96%) for SW-HT, and 100% for SW-std. Attack rates were correlated with intensity of exposure (P = 0.0006), being much higher for children exposed in the same hut than for those living in the same compound but in a different household (relative risk = 3.36 [1.32-8.57]). The attack rate was significantly lower among vaccinated than unvaccinated children with no detectable measles antibody (relative risk = 0.41 [0.18-0.93]). In rural areas with a high coverage in the surrounding community, a single dose at 9-10 months may provide sufficient protection. Since high-titre vaccines have been associated with higher mortality than SW-std, further improvements in measles control before 9 months may require two-dose strategies with standard vaccines.

Age Factors↗
PubMed1991

Changes of the immunological patterns against measles, mumps and rubella. A vaccination programme studied 3 to 7 years after the introduction of a two-dose schedule.

A two-dose vaccination programme using a combined measles, mumps and rubella vaccine (MMR) and administration at the ages of 18 months and 12 years was introduced in 1982. The 12-year-old schoolchildren were tested yearly from 1985 to 1989 on serum samples obtained prior to and after vaccination. Each year between 420 and 756 children were tested. The method used for antibody testing was the haemolysis-in-gel (HIG) assay. For measles also the enzyme-linked immunosorbent assay (ELISA) and the neutralization titre (NT) were applied. Only minor variations of the prevaccination immunity to measles were seen during the period 3-7 years after introduction of the programme. The age groups studied had partly been vaccinated against measles earlier. Between 12 and 16% lacked prevaccination immunity. In contrast the immunity to mumps and rubella of the 12-year-old children decreased considerably during the study period. No general vaccination against these diseases had been performed. Thus the susceptibility to mumps increased from 14% in 1985 to 39% in 1989 and to rubella from 41 to 57%. The seroconversion rate of children seronegative for measles was high, i.e. 100% in 1985 and later varied between 96 and 97%. For mumps, the seroconversion rate was lower and varied between 72 and 88%. All sera converted to rubella. During the follow-up period there was a declining incidence of measles, mumps and rubella. The relationship between the vaccination and reduction of disease and natural immunity strongly suggests that the association is causal and that this vaccination policy reduced the transmission of infection.

Antibodies, Viral↗
PubMed2006

The changing epidemiology of hospitalized pediatric patients in three measles outbreaks.

OBJECTIVES: To assess the demographic and clinical findings of measles patients during three epidemics from 1989 to 2001. METHODS: A total 520 medical records of measles patients were analyzed retrospectively and divided into three groups; those who were admitted during 1989-1990 (group I, 116 patients), those admitted during 1993-1994 (group II, 127 patients), and those admitted during 2000-2001 (group III, 277 patients). RESULTS: For the age distribution, there was no difference in the proportion of < 2 years of age (61%, 58% and 57%, respectively) for the three groups. However, in each outbreak, there were significant differences in the distribution of > or = 2 years children who had mostly received one-dose measles-mumps-rubella (MMR) vaccination. The age distribution had changed with a significant increase in older children in subsequent outbreaks. In the last 2000-2001 outbreak, there was a pattern for increased attack rates with increasing interval since the initial vaccination. There was no statistical difference between the three groups in gender ratio, MMR vaccination rate in > or = 2 years of age, duration of fever, and complications. No difference was found in all the clinical and laboratory parameters between the anti-measles IgM antibody negative patients and the positive patients. CONCLUSIONS: The age distribution of admitted children with measles in each outbreak has changed over time since the introduction of one-dose MMR vaccination. This finding suggests that the secondary vaccine failure may have played a large role in the last measles outbreak.

Adolescent↗
PubMed2001

Prevention of measles in Sudan: a prospective study on vaccination, diagnosis and epidemiology.

Despite the availability of safe and effective live attenuated vaccines, measles continues to be endemic in many developing countries. Control and elimination of measles will be especially difficult in East Africa, because of its limited infrastructure and political instability. We have studied diagnostic and epidemiological aspects of measles in suburban Khartoum, Sudan. Prospective studies were carried out in a cohort of clinically diagnosed measles cases and in a cohort of newborns, which were both followed up for 2 years. The studies intended to provide a rational basis for improvement of measles vaccination strategies, and strengthen measles research infrastructure in Khartoum.

Antibodies, Viral↗
PubMedDate not supplied

A benefit-cost analysis of two-dose measles immunization in Canada.

In 1992, because of the limitations of the one-dose measles immunization program, the National Advisory Committee on Immunization (NACI) recommended a two-dose measles immunization program to eliminate measles. More recently, NACI recommended also a special catch-up program to prevent predicted measles outbreaks and to achieve an earlier elimination of measles. The objective of this study was to complete a benefit-cost analysis of a two-dose immunization program with and without a mass catch-up compaign compared with the current one-dose program. The resulting benefit: cost ratios vary between 2.61:1 and 4.31:1 depending on the strategy used and the age of the children targeted. Given the parameters established for this analysis, the benefits of a second-dose vaccination program against measles far outweight the costs of such a program under all scenarios.

Adolescent↗
PubMed2000

Measles vaccine immunogenicity and antibody persistence in 12 vs 15-month old infants.

HYPOTHESIS: Maternal measles immunity in the United States today is primarily vaccine induced, with corresponding lower antibody titers in infants, as compared to infants born in an earlier era to mothers with naturally acquired measles immunity. We hypothesized that, due to lower titer of passively transferred maternal measles antibody, administration of measles vaccine at 12 months of age would result in seroconversion and antibody persistence comparable to vaccination at 15 months of age. POPULATION: Children at both an urban hospital and a suburban clinic. METHODS: Informed consent was obtained from mothers for the infants to receive M-M-R(R)II vaccine at either 12 or 15 months and to have serum samples obtained before vaccination and 4 weeks post-vaccination (PV). Between 9 and 39 months PV, a third serum sample was obtained from 28% of seroconverters. A diary of adverse experiences was kept for 3 weeks PV. Sera were assayed by a microneutralization assay (NT) and an enzyme immunoassay (EIA) for measles antibody. RESULTS: Both age groups tolerated vaccination well with minor and transient side effects. Forty-four of 47 (94%) 12-month-old infants seroconverted by NT, compared to 45 of 46 (98%) 15-month-olds (p=NS). There was no statistically significant decline in median NT titers or EIA titers in nineteen 12-month-olds and thirteen 15-month olds followed for 9-39 months PV. CONCLUSION: This study showed comparable serologic responses in 12- vs 15-month-old infants born to measles vaccine-immune mothers; however, the sample size was too small to have adequate power and further study is indicated. Titers of antibody were constant in both the 12-month-old and the 15-month-old infants, over a 9-39 month period, suggesting that waning immunity over this period of time is not a problem in either age group.

Age Factors↗
PubMed1985

Response to measles vaccine in Haitian infants 6 to 12 months old. Influence of maternal antibodies, malnutrition, and concurrent illnesses.

To study the factors affecting the serologic response to measles vaccination, we evaluated 595 Haitian infants from 6 through 12 months of age, and their mothers, at the beginning of an immunization program. Thirty-four per cent of the infants had preexisting serologic evidence of measles infections by 11 months of age. Among infants more than nine months of age, those who had had measles had a significantly lower nutritional status than those who had not (P less than 0.01). After vaccination, seroconversion rates increased from 45 per cent at 6 months to 100 per cent at 12 months. The lowest rate of vaccine failure compatible with acceptably low rates of natural infections could be achieved by vaccination after eight months of age. Infants born to mothers with low levels of antibody to measles (hemagglutination-inhibition antibody titers less than 1:40) were significantly more likely to have had natural measles (P less than 0.01) or to have seroconversion after vaccination (P less than 0.001) at 6 to 10 months of age than were infants born to mothers with higher of age than were infants born to mothers with higher titers. Malnutrition and acute infections did not affect seroconversion rates. These data support the World Health Organization recommendation to administer measles vaccine in under-developed countries as soon after nine months of age as possible, regardless of nutritional status or the presence of minor illnesses.

Age Factors↗
PubMed2005

Emerging diseases: measles.

High vaccination coverage rates and the administration of a second dose of measles vaccine have resulted in a significant decline in the incidence of measles and neurologic diseases due to measles in many countries. However, intermittent outbreaks of measles still occur even in countries with excellent vaccination coverage, suggesting the existence of high rates of measles virus introduction from endemic regions and/or waning of vaccine-induced immunity. Strategies to sustain high levels of global immunity to measles virus by increasing vaccine coverage with routine and supplementary vaccination campaigns must be supported.

Communicable Diseases, Emerging↗
PubMed2003

The elimination of indigenous measles transmission in England and Wales.

Following a school-based measles-rubella vaccination campaign in November 1994, enhanced surveillance of measles, including IgM antibody testing of oral fluid from clinically diagnosed case-patients, was introduced in England and Wales. Between 1995 and 2001, 665 cases of measles were confirmed, including 371 (56%) confirmed only by IgM detection in oral fluid. Two hundred thirty-nine cases (36%) were sporadic and 426 (64%) were associated with 61 clusters. Fifty-four (23%) of the 239 sporadic cases and 26 (43%) of the 61 clusters were associated with a probable or possible importation of infection from overseas, and a wide variety of genotypes were identified in each calendar year. The effective reproduction number for measles over the period was estimated to be below 0.7. These data suggest that most measles in the UK is acquired following limited transmission from an imported infection, and they confirm that measles elimination has been achieved and sustained over this period.

Adolescent↗
PubMed2003

Progress toward measles eradication in the region of the Americas.

Since 1994, when the goal of interrupting indigenous measles transmission was adopted, important progress has been made toward the control of measles in the Americas. Thirty-nine (95%) of 41 countries reporting to the Pan American Health Organization (PAHO) conducted catch-up vaccination campaigns during 1989-1995 and follow-up measles campaigns every 4 years. Routine (keep-up) vaccination coverage in the Region increased from 80% in 1994 to 94% in 2000. Measles vaccination coverage ranged between 75% and 99% in 2000 and between 53% and 99% in 2001. As a result, in 2001, the total number of confirmed measles cases reached a record low of 537, 99% lower than the number reported in 1990. In 2002, only Venezuela and Colombia had known indigenous transmission. As of January 2003, no known indigenous measles transmission had occurred in the Region since November 2002. This is due to high political commitment and implementation of PAHO's recommendations, including strengthened supervision and monitoring to improve accountability at the local level.

Adolescent↗
PubMed2003

The global burden of measles in the year 2000--a model that uses country-specific indicators.

The estimation of the global burden of measles is challenging in the absence of reliable and comparable surveillance systems worldwide. A static model is described that enables estimation of measles morbidity, mortality, and disability for the year 2000 on the basis of country-specific information (i.e., demographic profile, vaccine coverage, and estimates of case-fatality ratios). This approach estimated a global incidence of 39.9 million measles cases, 777,000 deaths, and 28 million disability-adjusted life years. The World Health Organization regions of Africa and Southeast Asia had 70% of incident cases and 84% of measles-related deaths; 11 countries alone (Afghanistan, Burkina Faso, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Niger, Nigeria, Pakistan, Somalia, Uganda) account for 66% of deaths. This approach quantifies the measles burden by considering country-specific indicators, which can be updated, permitting an assessment of country, regional, and global changes in the burden associated with measles infection.

Adolescent↗
PubMed2004

International importation of measles virus--United States, 1993-2001.

To determine trends in international importations of measles, data from the National Notifiable Diseases Surveillance System were analyzed. Of the 2632 measles cases reported between 1993 and 2001, 449 cases (17%) were internationally imported. An additional 186 cases (7%) resulted from spread of measles virus from these imported cases, and 388 cases (15%) had virological evidence of importation. The number of imported cases averaged 50 per year (range, 26-79 cases). The proportion of cases imported increased from an average of 14% in 1993-1996 to an average of 35% in 1997-2001. Imported measles cases were acquired in 63 countries, with 6 countries (Japan, Germany, China, the Philippines, Italy, and the United Kingdom) accounting for 44% of all imported cases. Further reduction of measles in the United States requires international cooperation and improved global surveillance and control of measles.

Adolescent↗