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PubMed1997

Decline in measles case fatality ratio after the introduction of measles immunization in rural Senegal.

The epidemiology of measles has been investigated in Niakhar, a rural area of Senegal, during two periods, 1983-1986 and 1987-1990. Following a major increase in immunization coverage beginning in 1987, the case fatality ratio for all ages declined fourfold from the first to the second period (relative risk (RR) = 0.24, 95% confidence interval (CI) 0.13-0.46). The measles incidence for children under 10 years of age declined by 69% (95% CI 65-72) and the risk of dying of measles by 91% (95% CI 82-95). Vaccinated children who contracted measles had significantly lower case fatality ratio than unvaccinated children with measles (p = 0.038). Children infected by an immunized case tended to have lower case fatality ratio than those infected by an unimmunized index case (p = 0.104) and immunized index cases generated fewer secondary cases than unimmunized index cases (p < 0.001). Respiratory complications were more common in secondary cases infected by an index case with respiratory complications than by an index case without such complications (RR = 1.60, 95% CI 1.08-2.37), which suggests that severe cases give rise to further severe cases. As expected, there was a significant increase in the proportion of vaccinated cases in the second period (RR = 1.41, 95% CI 1.00-1.98). Mean age at infection increased from 4 to 7 years between the two periods and the change in age structure accounted for 20% of the decline in case fatality ratio. Measles immunization may contribute to lower mortality directly through reduced incidence and indirectly through increases in age at infection, less severe infection for immunized cases and changes in transmission patterns leading to reduced severity of measles.

Child↗
PubMed2005

Effectiveness of measles vaccination after household exposure during a measles outbreak: a household contact study in Coburg, Bavaria.

BACKGROUND: A measles outbreak was recently observed in Coburg, Bavaria, in a population with vaccination rates of 76.5% in 5- to 6-year-old children in the years preceding the outbreak. Only a small proportion of children had received 2 vaccinations against measles. Vaccine effectiveness is estimated in a household contact study and also by a screening method. METHODS: A household contact study was conducted in families with at least 1 measles case by standardized computer-assisted telephone interviews to assess secondary attack rate and to estimate vaccine effectiveness. Vaccine effectiveness was also estimated with Farrington's screening method with information from school entry examinations and from questionnaires of confirmed measles cases in the Coburg outbreak. RESULTS: Thirty-eight children were primary cases. Of their contacts, 20 children were included in the study as secondary cases (1 vaccinated), and 23 children were contacts who did not develop measles (12 vaccinated once and 4 vaccinated twice), resulting in a vaccine effectiveness of 90% (95% confidence interval, 35-97%) for one vaccine dose. The proportion of the population vaccinated reached 81.5% during the outbreak and the proportion of the cases vaccinated was 10.9%, resulting in a vaccine effectiveness estimated using the screening method of 97.2% (95% confidence interval, 95.7-98.3%). CONCLUSIONS: With the use of 2 approaches to estimate the effectiveness of measles vaccination, a consistently high vaccine effectiveness of 90% or above was shown during a measles outbreak in Western Europe.

Child↗
PubMed2006

Assessment of the performance of a definition of a suspected measles case: implications for measles surveillance.

OBJECTIVE: To assess the performance, in Brazil, of the definition of a suspected measles case among patients with rash diseases that has been adopted in Brazil and many other countries. METHODS: From January 1994 to December 2003, patients with acute rash were seen at two large primary health care units and a public general hospital in Niterói, a city in the metropolitan area of the city of Rio de Janeiro, Brazil. Data from clinical and serologic assessment were used to estimate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the definition of a suspected measles case that has been adopted in Brazil, as well as other combinations of signs and symptoms; serologic status was taken as the reference. Using enzyme immunoassay, serum samples were tested for immunoglobulin M (IgM) antibodies against measles virus. RESULTS: A total of 1,221 patients with an illness characterized by different combinations of rash with other signs and symptoms were studied. The suspected case definition that has been adopted in Brazil (rash, fever, and at least one of the following: cough, coryza, or conjunctivitis) had an overall sensitivity of 100%, and a specificity of 58.7%. Confirmed measles cases were 2.4 times as likely as were other rash diseases to have that combination of signs/symptoms. The suspected case definition adopted in Brazil had a 6% PPV and 100% NPV. The combination of all five signs and symptoms had the highest specificity, PPV, and likelihood ratio, for both children (< 15 years old) and adults (> or = 15 years). That was achieved at the expense of sensitivity, which dropped to 89%, but the NPV was still very high. CONCLUSIONS: Our results show that the suspected measles case definition adopted in Brazil is extremely sensitive for measles surveillance among patients with rash diseases. However, the high false-positive rates that were found may result in a substantial number of other rash diseases being misclassified as measles, leading to the misdirection of control measures and increases in their cost.

Adolescent↗
PubMed1997

Five cases of measles secondary vaccine failure with confirmed seroconversion after live measles vaccination.

We report 5 patients with secondary vaccine failure (SVF) who were infected with natural measles 2, 5, 5, 7 and 12 years, respectively, after vaccination with further attenuated live measles vaccine during infancy. Their seroconversion had been confirmed after vaccination. Three of the 5 patients had mild (modified) measles, while the remaining 2 patients had typical measles. The hemagglutination inhibition antibody titers to measles virus in paired acute and convalescent sera showed a secondary response pattern in 4/5 patients, and a primary response pattern was present in the remaining patient. Measles IgM antibodies were present in all patients during the convalescent stage. The patient with the primary response pattern may have had a decrease in the B cell memory during the 5-year period between vaccination and infection. This may be the first SVF case report that confirms the existence of completely waning immunity in recipients of the further attenuated live measles vaccines.

Adolescent↗
PubMed2002

Genetic homogeneity of measles viruses associated with a measles outbreak, São Paulo, Brazil, 1997.

During a resurgence of measles in São Paulo, Brazil, in 1997, >40,000 cases (peak incidence rate of 246/100,000 inhabitants) and 42 measles-related deaths were reported. Reverse transcriptase-polymerase chain reaction and nucleotide sequencing were used to analyze specimens from patients who had typical clinical measles infection during this outbreak and from six patients who had had measles in 1995 and 1996. Although wild-type measles viruses (genotypes D5 and D6) were present in São Paulo before this resurgence, we detected only D6 viruses. The genotype D6 viruses isolated during this outbreak had identical sequences to genotype D6 viruses isolated in other parts of Brazil and South America in 1997 and 1998, suggesting that a single chain of transmission was responsible. We also identified genotype A viruses in two vaccine-associated cases from 1995 and 1996. Our findings extend the knowledge of the circulation patterns of measles virus in South America, contributing to measles control efforts in the Americas.

Brazil↗
PubMed1981

Antibody response to structural proteins of measles virus in patients with natural measles and subacute sclerosing panencephalitis.

By immunoprecipitation and SDS-polyacrylamide gel electrophoresis, antibody responses to the structural proteins of measles virus were examined on patients with various forms of natural measles, atypical measles, and subacute sclerosing panencephalitis (SSPE). The serum of atypical measles most strongly reacted with four structural proteins, i.e., hemagglutinin (H), nucleocapsid (NC), fusion (F), and matrix (M) proteins. In natural measles, antibodies to the four structural proteins were detected at such an early convalescent stage as one month after the onset of disease. In late convalescent serums taken 9 years after natural measles, however, only low level antibody to M protein was present, whereas antibodies to H, NC and F proteins persisted. The serums and cerebrospinal fluid of SSPE patients showed patterns similar with those of the late convalescent serums. In Vero cells infected with cell-associated SSPE viruses (Niigata-1, ZH, and SI strains), M protein was not clearly demonstrated with serum of either atypical measles or SSPE patients, whereas H protein was demonstrated.

Adult↗
PubMedDate not supplied

Herd immunity to measles virus in a population of student nurses and medical students following a widespread outbreak of clinical measles in Ibadan, Nigeria.

Following an outbreak of serologically--and virologically--confirmed measles requiring large-scale hospitalisation of children in Ibadan, Nigeria, the herd immunity to measles virus among medical students and student nurses was determined. Of the 200 students tested, none lacked haemagglutination--inhibiting antibody to measles virus. The titre of HI--antibody ranged from 2(5) to 2(10). Describing a titre of 2(9) as very high, a significantly higher proportion of student nurses than medical students (P < 0.05) had very high antibody titres to measles virus. There was however no statistical difference between the sexes (P > 0.05). Using a commercial Enzyme Immuno Assay kit (EIA), anti measles IgM could not be detected from any of the students. Thus a clear evidence of recent infection with measles virus during the outbreak could not be detected among the students, a probable indication that student nurses and medical students may not participate in the maintenance of wild measles virus within the hospital environment in developing countries like Nigeria.

Antibodies, Viral↗
PubMed1989

Measles and measles immunity in children infected with human immunodeficiency virus.

The development of measles vaccination recommendations for immunodeficient children infected with human immunodeficiency virus requires assessment of disease risk and the risks and benefits of vaccination. Measles in 4 such children resulted in 3 severe pneumonias and 1 death despite previous immunization in 2. Antibody to measles as determined by enzyme-linked immunosorbent assay was present in 3 (12.5%) of 24 children studied retrospectively and developed in only 2 (25%) of 8 children immunized and followed up prospectively. The sera of 9 of 24 children had antibody when tested by sensitive hemagglutination inhibition. Measles developed in 2 of 6 children who had negative enzyme-linked immunosorbent assay results and positive hemagglutination inhibition results. No adverse consequences of measles immunization were detected. Although the immunogenicity of measles vaccine in children infected with human immunodeficiency virus was low and vaccine failure occurred, the apparent safety provides the rationale for immunization in the face of a potentially fatal disease. Since neither documented immunization nor low-level antibody guaranteed immunity to measles, we recommend passive postexposure immunoglobulin prophylaxis for all children infected with human immunodeficiency virus.

Adolescent↗
PubMed1996

Seroepidemiology of measles in southern Taiwan: two years after implementation of the measles elimination program.

The seroprevalence of the measles antibody in southern Taiwan 2 years after the launch of the two-dose measles elimination program was studied using serological surveillance. Sera from 868 healthy inhabitants were collected from January to December 1993. Measles IgG antibody was detected by enzyme-linked immunosorbent assay. Measles antibody was found in 82% of infants under 3 months of age, 26% of those between 4 and 9 months and 54% of those between 10 and 15 months of age. The most common reason for postponement of vaccination was due to concomitant illness during the scheduled vaccination period. The presence of measles antibody rose sharply in children over 15 months of age, reached 90% among preschool-aged children and was 93% in school-aged children. These data suggest that a high immunization coverage rate was achieved in children over 15 months of age (92%) and that a third measles immunization at age 12 is not necessary. Future strategies for measles control should aim at increasing the immunization coverage for children between 9 and 15 months of age.

Adolescent↗
PubMed1997

Evaluation of a measles vaccine efficacy during a measles outbreak in Mbare, City of Harare Zimbabwe.

OBJECTIVE: To determine measles vaccine efficacy. DESIGN: Between October and November 1996, during a measles outbreak in Mbare, a retrospective study through interviews with care givers was performed. Thirty clusters were randomly selected and seven or more, nine to 35 months old children in each cluster were selected. SETTING: Mbare suburb, City of Harare SUBJECTS: 294 children aged nine to 35 months. MAIN OUTCOME MEASURES: Cases were classified in a two by two contingency table based on their vaccination status and measles status during the outbreak. Vaccine coverage, attack rates and vaccine efficacy were then calculated. RESULTS: Of the 294 children selected, 83% (95% CI 78.7, 87.3) were vaccinated and 9.5% had measles. The attack rate for the vaccinated was 6.9% while that for the unvaccinated was 22%. Vaccine efficacy was 68%. CONCLUSION: Vaccine efficacy was found to be low. There is need for serological confirmation of measles cases during outbreaks; for a comprehensive evaluation of the measles vaccination programme in Mbare and for maintenance of high measles vaccine coverage rates to reduce morbidity.

Disease Outbreaks↗
PubMed1998

Uptake of measles containing vaccines in the measles, mumps, and rubella second dose catch-up programme in Wales.

A two dose schedule for measles, mumps, and rubella (MMR) vaccination was introduced in England and Wales on 1 October 1996 in order to prevent the accumulation of susceptible individuals and thus prevent future epidemics. A routine second dose of MMR vaccine is now offered with the diphtheria, tetanus and polio (DTPol) preschool booster. In addition a second dose of MMR is being offered to all children born since 1 January 1990 without documented histories of two doses of measles containing vaccine in a catch up programme due to end in March 1998. Progress in the catch up programme in Wales was assessed by examining uptake of all possible combinations of measles containing vaccines in four birth cohorts by 1 May 1997. Of 126,550 children born between January 1990 and March 1993 (aged 4 years, 1 month to 7 years, 3 months) and living in Wales on 1 May 1997, 63,855 (50.5%) had received two doses of measles containing vaccine and 120,668 (95.4%) had received at least one dose, but 5882 children (4.6%) had no record of having received any measles containing vaccine. Uptake of the preschool DTPol booster in the same cohort was 87.2%. Uptake of two measles containing vaccines varied between health authority (range: 35.4-58.3%) and between birth cohorts (range: 40.0-81.8%). Few (18.4%) previously unimmunised children had attended for the MMR catch-up dose. Successful elimination of measles may depend on targeting this group in order to improve coverage. Although this analysis was carried out during the catch-up programme, these data suggest that the programme may not reach the children who most need to be immunised.

Child↗
PubMed1994

Measles antibody: comparison of long-term vaccination titres, early vaccination titres and naturally acquired immunity to and booster effects on the measles virus.

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 into Sweden in 1982. Since the combined MMR vaccine was introduced, a yearly evaluation of the immunity patterns and seroconversion rates in 12-year-old children has been carried out. This study includes three study groups. All groups consisted of pre- and postvaccination samples from 12-year-old children taken in connection with the MMR immunization. There were 332 paired samples from children who 8-10 years previously had received live measles vaccine. Prevaccination sera from these children represent late postvaccination titres. The postvaccination sera of 49 children seronegative to measles before vaccination, obtained 2 months after vaccination, represent early postvaccination immunity. Ninety-five children who had not been vaccinated earlier and who were seropositive to measles represent naturally acquired immunity. All samples were studied by an enzyme-linked immunosorbent assay (ELISA). Sera from children with late postvaccination immunity had significantly lower titres than children in group 2, who represented early postvaccination sera (p < 0.001). Children with naturally acquired immunity had significantly higher titres than children with vaccine-induced immunity titres (p < 0.001). After revaccination of the previously vaccinated children, a significant booster rise was seen (p < 0.001). After revaccination of children with naturally acquired immunity, no significant booster effect was observed. Sixty-five children of the 332 (20%) previously vaccinated children had no or borderline measles titres prior to the booster. The study suggests that the vaccine-induced measles antibodies decline with time and may fall under the protective level.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Viral↗
PubMed1991

Decreased measles antibody response after measles-mumps-rubella vaccine in infants with colds.

We examined the possibility that the common cold or afebrile upper respiratory tract infection might interfere with successful immunization in children who receive standard measles-mumps-rubella vaccine. Infants 15 to 18 months of age presenting at our well-child clinics for routine examination and immunizations were divided into two groups. Those infants with a history and physical findings of upper respiratory tract infection were compared with healthy control group infants who did not have upper respiratory tract infections, and who did not have a history of upper respiratory tract infection symptoms within the previous month. Both groups were studied for their serologic response to measles-mumps-rubella vaccination. Prevaccination serum samples were obtained prior to vaccine administration and postvaccination serum samples were obtained 6 to 8 weeks later. Measles antibody was measured in these serum samples by an indirect fluorescein-tagged antibody test. Ten (21%) of 47 infants with colds failed to develop measles antibody, while only one (2%) of 51 well infants failed to develop antibody. We conclude that infants with colds have a significant seroconversion failure rate associated with measles vaccine administration and that this may be the cause of some primary measles vaccine failures.

Antibodies, Viral↗
PubMed1994

Measles vaccine failures: lack of sustained measles-specific immunoglobulin G responses in revaccinated adolescents and young adults.

The measles-specific antibody responses of seronegative adolescents and young adults were evaluated after revaccination. Of 1650 previously vaccinated healthy volunteers between the ages of 10 and 30 years, 4.4% were found to be seronegative for measles antibodies and 9.9% had equivocal titers. Seronegative volunteers were revaccinated to measles and followed serially for development of measles-specific IgG. Of 43 subjects followed for at least 1 year, only 58% developed and maintained positive antibody titers; 12% never developed positive titers and 30% initially developed titers that fell below positive levels within 1 year. The peak titers achieved by those subjects who responded transiently were lower than those achieved by subjects who developed sustained responses. Thus even after the recommended two dose schedule of the current measles vaccine, some adolescents and young adults lack protective titers of measles-specific antibody.

Adolescent↗
PubMed2006

Measles supplemental immunization activities improve measles vaccine coverage and equity: Evidence from Kenya, 2002.

OBJECTIVES: To compare the measles vaccine coverage achieved through the routine vaccination program with that achieved during the 2002 supplemental immunization activity (SIA) at the national and provincial level, the percentage of previously unvaccinated children (zero-dose children) reached during the SIA, and the equity of measles vaccine coverage among children aged 9-23 months in Kenya. METHODS: Using data from a post-SIA coverage survey conducted in Kenya, we compute routine and SIA measles vaccine coverage and the percent of zero-dose children vaccinated during the SIA at the national and provincial level. Nationwide and for each province, we use the concentration index (CI) to measure equity of measles vaccine coverage. RESULTS: The SIA improved both coverage and equity, achieving significantly higher coverage in all provinces with routine measles vaccination coverage less than 80%, reached a large percentage of zero-dose children in these provinces, and reached more children belonging to the poorest households. CONCLUSION: Overall, by improving both measles vaccine coverage and equity in Kenya, the 2002 SIA reduced the gap in immunity between rich and poor households. Measles SIAs provide an ideal platform for delivering other life-saving child health interventions.

Data Collection↗
PubMed1994

Reversal of the measles virus-mediated increase of phosphorylating activity in persistently infected mouse neuroblastoma cells by anti-measles virus antibodies.

To investigate the effect of persistent measles virus infection on signal transduction in cells of neuronal origin, the mouse neuroblastoma cell line NS20Y/MS, which is persistently infected with measles virus, was used. The results demonstrate an approximate 50% increase in total phosphorylation and a similar increase in protein kinase C (PKC) activity. Western blot analysis with anti-total PKC or anti-PKC-alpha antibodies revealed a significant increase in the level of an 80K immunoreactive PKC in NS20Y/MS cells. Following incubation of NS20Y/MS cells with polyclonal anti-measles virus antibodies, which down-regulate the level of measles virus proteins, total and PKC-mediated phosphorylation returned to the basal level of uninfected cells. This effect was reversible and removal of the antibodies resulted in restoration of the high level of total and PKC-mediated phosphorylation. The release of infectious measles virus was strongly inhibited by incubation of NS20Y/MS cells with the PKC inhibitor, 1-(5-isoquinolinylsulphonyl)-2-methylpiperazine (H-7). These results demonstrate that measles virus induces elevation in cellular phosphorylation which is essential for measles virus production.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
PubMed2003

[Clinical investigation on adult inpatients contracted measles; comparing with pediatric measles inpatients].

Age distribution, history of vaccination against measles, clinical signs and symptoms were investigated among a total of 113 adult measles patients admitted in our hospital between January, 2000 and December, 2002. The maximum body temperature, duration of fever, presence of Koplik spot and exanthema among these adult inpatients were compared with those among 1-to-5-year-old inpatients having measles. Concerning age distribution, the peak was found at the age of 20-24 years. Most of adult inpatients had not contracted measles until then and had not been vaccinated against measles. The infection route was unknown except a small number of inpatients. Clinical signs and symptoms among adult inpatients were about the same of those in pediatric inpatients except a sore throat. Complications occurred in 17 cases out of 113 adult inpatients, 4 of them had encephalitis or acute disseminated encephalomyelitis and the other 4 cases contracted pneumonia. Among the 45 child inpatients, whereas, 23 had complications, 13 of them had pneumonia, 3 contracted otitis media, and an additional 3 suffered from both pneumonia and otitis media. From the results it is reasonably concluded that clinical signs and symptoms among adults impatients with measles are comparable with those of pediatric measles inpatients or slightly severer.

Adolescent↗
PubMed1993

Unsustainability of a measles immunisation campaign--rise in measles incidence within 2 years of the campaign.

The 1990 national mass measles immunisation campaign resulted in a marked reduction in measles incidence in Natal/KwaZulu in the first 6 months after the campaign. Data from the measles ward admissions book at Clairwood Hospital were collated for the period 1 January 1989 to 31 May 1992 to assess the sustainability of the effects of the campaign. For the first 12 months after the campaign, measles admissions were consistently low. Thereafter, the number increased steadily, rising sharply to above pre-campaign levels 21 months after the campaign. The age distribution of measles patients indicated that the initial fall in the 10-12-month age group had been reversed in the second year after the campaign, suggesting that the high vaccination coverage achieved for this age group during the campaign had not been maintained. Measles admissions to Clairwood Hospital indicate that the effect of the measles immunisation campaign has not been sustained and that urgent action is required to avert a possible epidemic.

Child↗