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PubMed1991

Measles immunity among community hospital employees.

OBJECTIVE: To define measles immunity rates among employees at 2 hospitals during a community outbreak in 1990. DESIGN: Cohort survey using enzyme-linked immunosorbent assay (ELISA) and questionnaire. SETTING: Two community hospitals. PARTICIPANTS: Seventy-six percent of 2,060 employees. RESULTS: Seven percent (115/1566) of participants lacked ELISA-defined measles immunity. Among employees whose ages were known, 14% (64/467) of those born after 1956 and 5% (50/1086) of those born before 1957 lacked serologic evidence of immunity. Fifty-eight percent of the susceptible persons had substantial patient contact. With ELISA results as the reference for immunity, the predictive value of an undocumented positive history of measles disease or vaccination was 95%; the predictive value of a negative history of both was 52%. Measles developed in 7 employees. CONCLUSIONS: A substantial number of hospital employees lacked ELISA-defined measles immunity, including many who had patient contact or who had been born before 1957. Undocumented disease and vaccination histories were not adequate predictors of serologic status. This study supports the recommendations and suggestions of the Immunization Practices Advisory Committee that hospitals should require documented evidence of measles immunity from employees who have patient contact.

Adolescent↗
PubMed1992

Epidemiology of measles immunity in a population of healthcare workers.

OBJECTIVE: To evaluate epidemiologic factors that can be used to predict lack of measles immunity in healthcare workers. DESIGN: During mandatory screening of employees for measles antibody, a questionnaire was used to collect demographic information. SETTING: Inpatient hospital, acute care clinics, and skilled nursing facility of a health maintenance organization. PARTICIPANTS: Employees of all ages and occupations. RESULTS: Measles immunity could not be predicted from history of measles disease and vaccination, gender, or birthplace. Of nonimmune employees, 63.7% were in the 20- to 29-year-old age group and 26.5% were in the 30- to 39-year-old age group. CONCLUSIONS: Age is the most clinically significant predictor of measles antibody, especially in persons born after 1950, who make up a large group susceptible to measles.

Adolescent↗
PubMedDate not supplied

Immunization against measles by aerosol.

About 20 years ago, Japanese and American investigators found that inhalation of relatively small amounts of aerosolized, partly attenuated measles vaccines was consistently immunogenic in nearly all susceptible children. The resulting modified measles was not transmissible to susceptible children. In 1965-1966, Japanese investigators showed that levels of neutralizing antibody produced by killed measles virus vaccine, which prevented subsequent immunization when live vaccine was given subcutaneously, did not prevent the immunogenic effect of the same vaccine given by aerosol. This raised the possibility that aerosolized vaccine may be immunogenic in infants with residual maternal antibody, in whom subcutaneously injected vaccine is ineffective. In 1971, Soviet investigators reported the high effectiveness and complete lack of febrile and other clinical reactions in 3,306 children who were exposed in large groups in large tents or chambers to aerosols of the more-attenuated measles vaccines that were currently available. An inexpensive nebulizer and the procedure for administration of aerosolized vaccine to individual children are here described. If the good results reported from the USSR can also be obtained with this simple method of vaccination by aerosol, it may be possible to carry out mass vaccinations against measles with thousands of nonprofessional personnel and thereby quickly eliminate measles in countries where it is still a serious public health problem.

Adolescent↗
PubMedDate not supplied

Measles immunization: remaining needs for research.

Highly immunogenic, safe, and effective attenuated measles vaccines, stabilized to lengthen duration of potency under field conditions, are available. Measles can be controlled while studies continue to define the molecular change in the viral genome responsible for attenuation and to clone the genes that specify for the two major surface glycoprotein antigens, the hemagglutinin (HA) and fusion (F) proteins. Purification of HA and F antigens will facilitate studies of cell-mediated immunity. Elucidation of host cell-dependent lack of synthesis of the internal membrane protein in the brains of patients with subacute sclerosing panencephalitis (SSPE) is needed. Control of measles will clarify the relationship between acute measles and those chronic neurologic diseases known (e.g., SSPE) or thought (e.g., multiple sclerosis) to be caused by persistent infection with measles virus. Epidemiologic studies should determine the optimal age for immunization as age-specific morbidity and mortality are reduced and should record the subsequent course of apparent vaccine failures in children immunized from seven to 15 months of age. Behavioral and operational research must examine how best to extend measles immunization throughout the world.

Antibodies, Viral↗
PubMed1990

Measles incidence, vaccine efficacy, and mortality in two urban African areas with high vaccination coverage.

Measles incidence, vaccine efficacy, and mortality were examined prospectively in two districts in Bissau where vaccine coverage for children aged 12-23 months was 81% (Bandim 1) and 61% (Bandim 2). There was little difference in cumulative measles incidence before 9 months of age (6.1% and 7.6%, respectively). Between 9 months and 2 years of age, however, 6.1% contracted measles in Bandim 1 and 13.7% in Bandim 2. Even adjusting for vaccination status, incidence was significantly higher in Bandim 2 (relative risk 1.6, P = .04). Even though 95% of the children had measles antibodies after vaccination, vaccine efficacy was not more than 68% (95% confidence interval [CI] 39%-84%) and was unrelated to age at vaccination. Unvaccinated children had a mortality hazard ratio of 3.0 compared with vaccinated children (P = .002), indicating a protective efficacy against death of 66% (CI 32%-83%) of measles vaccination. These data suggest that it will be necessary to vaccinate before age 9 months to control measles in hyperendemic urban African areas.

Age Factors↗
PubMed1999

Measles epidemic in Romania, 1996-1998: assessment of vaccine effectiveness by case-control and cohort studies.

A measles epidemic occurred in Romania with 32,915 cases and 21 deaths reported between November 1996 and June 1998, despite high vaccination coverage since the early 1980s. Most cases were unvaccinated children aged <2 years and vaccinated school-aged children. A case-control study among preschool children and a cohort study among primary-school children were conducted to estimate effectiveness of Romanian-produced measles vaccine, and to evaluate age at vaccination and waning immunity as risk factors for vaccine failure. Both studies indicated that measles vaccine was highly effective. One dose reduced the risk for measles by 89% (95% confidence interval (CI) 85, 91); two doses reduced the risk by 96% (95% CI 92, 98). Children vaccinated at <1 year of age were not at increased risk for measles compared with children vaccinated at > or =1 year. Waning immunity was not identified as a risk factor since vaccine effectiveness was similar for children vaccinated 6-8, 9-11, and 12-14 years in the past. Because specific groups were not at risk for vaccine failure, an immunization campaign that targets all school-aged children who lack two doses may be an effective strategy for preventing outbreaks. A mass campaign followed by increased first-dose coverage should provide the population immunity required to interrupt indigenous measles virus transmission in Romania.

Adolescent↗
PubMed1993

Measles virus nucleocapsid protein expressed in insect cells assembles into nucleocapsid-like structures.

The gene encoding the major nucleocapsid, N, protein of measles virus has been inserted into a baculovirus vector under the control of the polyhedrin promoter. Insect cells infected with this recombinant baculovirus synthesize high levels of measles N protein, up to 40% of total soluble cell protein. The recombinant protein is recognized by sera from convalescent patients, vaccinees and patients with subacute sclerosing panencephalitis and thus could form the basis of a simple diagnostic assay. Nucleocapsid-like structures, similar to those found in mammalian cells infected with measles virus, can be observed in both the nucleus and cytoplasm of the infected insect cells. These have many structural features in common with nucleocapsids found in measles virus-infected cells, but are longer (up to 2 microns) and have a lower buoyant density. Measles N protein thus appears to be capable of assembling into nucleocapsid-like structures in the absence of measles virion RNA or other viral proteins.

Animals↗
PubMed1980

Antibodies against the measles matrix polypeptide after clinical infection and vaccination.

Sera from patients exposed to measles virus were investigated for the presence of antibodies against each of the viral antigens. All sera with measurable neutralizing titers contained antibodies against the two surface proteins (the glycoprotein and fusion protein), the nucleocapsid protein, and one of the internal proteins (P2). However, only sera from individuals with clinical symptoms of measles infection (natural measles and atypical measles) contained antibodies against the measles virus matrix protein. Levels of matrix-specific antibodies were highest in patients with atypical measles infection.

Antibodies, Viral↗
PubMed1980

Fatal measles infection in marmosets pathogenesis and prophylaxis.

Moustached marmosets (Saguinus mystax) were infected intranasally with either of two low-passaged, wildlike strains of measles virus, strain Edmonston or strain JM. The infection resulted in 25 and 100% mortality, respectively, 12 to 14 days after infection. Clinical signs, gross pathological findings, and histology lacked the characteristic features of measles in other primates. A deficient immune response and widespread gastroenterocolitis appeared to be the main causes for the fatal outcome. Fluorescent-antibody staining detected large amounts of measles antigen in lymphatic tissues, the gastrointestinal and respiratory tracts, the salivary glands, pancreas, liver, kidney, and other visceral tissues. Live attenuated or inactivated measles vaccine proved equally effective in preventing fatal measles in marmosets. Challenge with live virus of animals which were primed 1 year previously with inactivated alum-absorbed vaccine resulted in a precipitous response, with a 100- to 1,000-fold increase in antibody titers. This vigorous booster response suggests the existence of a primary deficiency in lymphocyte cooperation in marmosets, which upon adequate priming is followed by extensive clonal expansion and antibody synthesis. Marmosets appear to be the most susceptible primate species to measles infection. They are capable of distinguishing differences in virulence of virus strains with a level of sensitivity not available in other animals.

Animals↗
PubMed2003

Role of CD8(+) lymphocytes in control and clearance of measles virus infection of rhesus monkeys.

The creation of an improved vaccine for global measles control will require an understanding of the immune mechanisms of measles virus containment. To assess the role of CD8(+) cytotoxic T lymphocytes in measles virus clearance, rhesus monkeys were depleted of CD8(+) lymphocytes by monoclonal anti-CD8 antibody infusion and challenged with wild-type measles virus. The CD8(+) lymphocyte-depleted animals exhibited a more extensive rash, higher viral loads at the peak of virus replication, and a longer duration of viremia than did the control antibody-treated animals. These findings indicate a central role for CD8(+) lymphocytes in the control of measles virus infections and the importance of eliciting a cell-mediated immune response in new measles vaccine strategies.

Animals↗
PubMedDate not supplied

Measles antibody prevalence after mass immunization campaign in Niterói, state of Rio de Janeiro, Brazil.

Three months after a mass vaccination campaign (coverage: 100%) against measles a random seroepidemiological survey was carried out in students aged 1 to 19 years old in the Municipality of Niterói, State of Rio de Janeiro. Blood samples were tested for measles antibodies by enzyme immunosorbent assay (EIA) and negative cases were tested again using hemagglutination inhibition (HI) and plaque reduction neutralization (PRN). Of the 798 samples tested by EIA, 718 (90.2%) were positive for measles antibodies. PRN test was more sensitive than EIA and HI in detecting measles specific antibodies. The total antibody prevalence increased from 90.2% to 93.2% when HI was employed in EIA negative specimens and to 98.9% when PRN was used. After the mass vaccination campaign a marked decrease in measles incidence was observed in the municipality studied, showing the effectiveness of the strategy used for measles control in developing countries.

Adolescent↗
PubMed1993

Boosting effect of a second dose of measles vaccine given to 12-year-old children.

In Sweden, a two-dose programme of vaccination against measles, mumps and rubella (MMR) was introduced in 1982 and the target groups were children aged 18 months and 12 years. In 1993 the first age group of 12-year-olds that were vaccinated with MMR at 18 months will appear. The majority of the 12-year-old vaccines for many years, however, had already been vaccinated against measles and the MMR measles component was thus a booster dose. As the benefit of a booster dose against measles has been questioned, this was studied in a group of 163 12-year-old children, 122 of whom had been vaccinated against measles as young children. Of the 41 unvaccinated children, 23 had a history of clinical measles. The mean neutralizing titre level of the earlier vaccinated children, prior to the booster, was lower than that of the naturally immune children (reciprocal titre level 8 versus 20). After the booster the corresponding titre levels were 13 and 23. Among the seronegative children receiving their first dose, this figure amounted to 14. A moderate rise in titre was seen in those with low prevaccination titres. As the antibody protection afforded by vaccination was slightly lower than that of natural infection, even after a booster, follow-up studies must be recommended to evaluate the long-term protection of both a single and a two-dose programme.

Antibodies, Viral↗
PubMed1990

Measles vaccine.

Administration of measles vaccine has sharply reduced the occurrence of measles. However, "mini epidemics" occurring at increasing intervals through 1989 brought about the need for a routine two-dose schedule of measles vaccination. The prevention of preschool cases and school-based cases are two major goals of this new schedule. A two-dose schedule will address the latter goal, however, it will not affect the more difficult problem of measles among preschoolers, a group with lower immunization rates than school-age children. The use of Edmonston-Zagreb measles vaccine in developing countries offers the promise of reducing worldwide disease rates in young infants in the future. However, the major goal in the United States and other developed countries is to increase levels of measles immunity.

Adolescent↗
PubMed1999

[Measles, mumps and rubella: vaccination rate and seroprevalence in 8th grade students of 8 different sites in Switzerland 1995/96].

In 1987, the Swiss Federal Health Office (BAG) and the Swiss cantons launched the MMR-vaccination campaign. Within the frame of the SCARPOL Study, the vaccination status of 649, 8th class students was registered and serum samples were collected. The measles, mumps and rubella specific antibody levels were determined. The vaccination rate was 84% for measles, 74% for mumps, and 62% for rubella, 55% of these children had been vaccinated with the combined vaccine MMR. The vaccination rate for the different study areas varied from 70% to 95% for measles, 42% to 94% for mumps and 18% to 89% for rubella, 92% of the children tested seropositive for measles specific antibodies, 87% for mumps and 84% for rubella. The seroprevalence for measles, mumps and rubella was significantly higher for vaccinated than for unvaccinated children. Non-Swiss children had, without exception, a higher seroprevalence rate than Swiss children. Undergoing the disease did not influence the seroprevalence for measles, but it did so for mumps and rubella, for vaccinated and unvaccinated children alike. By analysis according to study site, we observed that sites with higher vaccination rates (e.g. Grabs in Rheintal) sometimes showed a lower seroprevalence than sites with lower vaccination rates (e.g. Langnau). This was the case for all three vaccines. This, together with other observations, shows that a booster is necessary for an adequate immunisation--as a wild virus infection or as a second vaccination.

Antibodies, Viral↗
PubMed1999

[Immune status against measles and rubella among 4 Chilean groups of different ages].

BACKGROUND: Results of clinical and epidemiological studies confirm that no cases of measles have occurred in Chile since 1993. However, since covering of vaccination programs do not exceed 95%, an immunological surveillance for this disease is warranted. AIM: To know the immune status against measles and rubella in the Chilean population. MATERIAL AND METHODS: A serological census of a representative sample of communities with high (90% or more) or low immunization coverings was performed. Four sub samples along the country were selected: 122 children aged 18 months of age (stratum A), 1,276 children attending the first years of basic school (stratum B), 899 teenagers in their last high school year (stratum C) and 399 women attending a family planning clinic (stratum D). IgG antibodies against measles and rubella were measured using ELISA and hemagglutination inhibition techniques, respectively. RESULTS: Antibodies against measles and rubella were found in 96% and 94% of study subjects. No differences in these titres were found between different strata or communities with high or low vaccination covering. There is a high percentage of positive antibodies against measles among children of 18 months of age and a high percentage of antibodies against rubella among teenagers and women in family planning. Only 3% of the sample had not received any vaccine at the moment of the study. CONCLUSIONS: The high prevalence of antibodies against rubella allows to conclude that it is not necessary to consider this antigen in the next vaccination campaign. Due to the high prevalence of antibodies against measles, only the population older than 20 years old should be affected by the disease if this virus enters the country.

Adolescent↗
PubMed2004

[Epidemiological analysis of cases with rash and fever illness after measles vaccine inoculation during 1999 to 2002 in Shandong province, China].

OBJECTIVE: To study the incidence of cases with rash and fever illness (RFIs) after measles vaccine (MV) inoculation. METHODS: During 1999 to 2002, 150 RFIs cases reported by the special measles surveillance system in Shandong province, China, were investigated and analyzed epidemiologically. RESULTS: 7 674 690 ml MV were distributed during 1999 to 2002 and the annual average incidence of RFIs cases after MV inoculation was 0.20/10 000 ml (0.2 ml per dose). There was significant difference of incidences each year (chi(2) = 10.13, P < 0.05). All RFIs cases were sporadically distributed without epidemiological links. Clinical symptoms showed that 88.67% of the 150 RFIs cases having > 38.5 degrees C fever and 75.33% of all cases appeared typical rash after 4 to 11 days (the medium was 8 days) after MV inoculation. The order of rash onset among RFIs cases was consistent with that of regular measles cases caused by wild virus. 68.67% of the RFIs cases had first MV inoculation and 94.71% were 8 to 12 month-olds. IgM sera antibody test from RFIs cases were rubella negative and 45.65% positive for measles. CONCLUSION: RFIs due to allergic reaction or measles vaccine virus infection might occur after MV inoculation. There seemed to be a correlation between RFIs incidence and the doses of MV. Measles virus genotype analysis needs to be carried out to confirm if the onset of some RFIs cases is aetiologically associated to MV vaccine virus infection.

Exanthema↗
PubMedDate not supplied

[Serologic assessment of measles herd immunity in the north-western region of Romania].

The most objective analysis of measles herd immunity could be made by sero-epidemiological study. In the population of North-West area of Romania we have evaluated the measles immune protection through a seroprevalence study, using an age stratified sample of population in witch the subjects from Cluj and Bistriţa-Năsăud counties were voluntarily involved. The measles antibody concentration was determined by immunoassay method using Hycor test. The database was performed in Microsoft Access and the statistics in Epi Info 2000. Levels higher then 40 arbitrary units (the cut-off of protection) of the measles antibody were met in 80% (IC95% : 75.09-84.01) of all subjects, 82.4% of the females and 84.9% of the urban area peoples. 98.3% of all subjects had detectable antibody levels. The protection increased by age: the adults had protective levels in at least 90% of cases. Global vaccine efficacy was 64.7% (IC95 % : 56.5 - 72.9), moderately decreasing with increasing age (the correlation coefficient--58.1%). In the assessed sample, the measles protection was the highest in adults, women and subjects from urban areas. The vaccine efficacy was relatively small, but the majority of subjects had detectable titers of measles antibody.

Adolescent↗
PubMed1990

[The results of multiyear observations on the duration of the maintenance of immunity in those vaccinated and revaccinated against and recovered from measles].

The results of 5-year observations on the duration of immunity to measles virus in persons vaccinated and revaccinated against measles, as well as in persons having had this infection, are presented. The intensity of immunity was determined in the same persons with the use of the passive hemagglutination test. The study revealed differences in the formation, intensity and duration of postvaccinal immunity. A significant decrease in the concentration of antibodies over the period of 5 years was established in 50.0-52.3% of vaccines. Revaccination with live measles vaccine is an effective measure for enhancing immunity to measles virus in persons with initial antibody titers less than 1:10-1:20, but revaccination made in a single injection is not sufficient for the stable maintenance of measles morbidity at the sporadic level. Postinfectious immunity is characterized by stability and has no tendency towards decrease. Persons having had measles have no need in additional measures irrespective of the time elapsed after the disease.

Antibodies, Viral↗