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PubMedDate not supplied

Immunity against measles in school-aged children: implications for measles revaccination strategies.

Measles serum antibody levels were determined by plaque reduction neutralization (PRN) test in 1,075 children in the age bracket of 5 to 17 years who received a single dose of measles-mumps-rubella (MMR II) vaccine at one year of age. Of these, 297 children (28%) had measles PRN titres < 120 which may not be protective against measles infection. The proportion of susceptible children by age ranged from 14 to 35%; however, there was no consistent age-dependent trend in susceptibility rates. The study data indicate the decline in protective immunity occurs before five years of age, and the proportion susceptible increases only slightly thereafter. This supports the current move towards a two-dose immunization strategy in the control and elimination of measles, with the second dose being given before school entry. The present data also underscore the need to consider a mass catch-up immunization program in the interim to prevent potential outbreaks of measles in school settings. The combination of the above approaches, if implemented as soon as possible, can potentially eliminate indigenous measles in Canada by the year 2000, the target date set by the Pan American Health Organization.

Adolescent↗
PubMed2003

Cellular and humoral immune responses to measles in immune adults re-immunized with measles vaccine.

The objective of this study was to characterize the kinetics of the cellular and humoral immune responses elicited by measles vaccine given to previously immune adults. The cellular and humoral immune responses to measles were measured in seven healthy adults, before vaccination and at 1, 2, 3, and 4 weeks and 3 months after vaccination, using measles-specific T-cell proliferation and plaque reduction neutralization assays. All study subjects had detectable measles antibodies, but only six (85%) showed protective titers, defined as >1:120, before immunization. However measles-specific T-cell proliferation was not detectable before vaccination in any of the subjects. The six subjects with protective titers showed a positive stimulation index (SI) of >3.0 within the first 4 weeks after vaccination, an SI of 5 at the 4th week, and an SI of 3 at 3 months after vaccination. The subject with a low antibody titer (1:99) before vaccination developed a high SI at 3 months after vaccination. This subject was the only participant whose neutralizing antibody titers increased more than 4-fold by 3 months after vaccination. No significant increases in geometric mean titers were detected in the other six subjects during the follow-up period. These data suggest that high measles antibody titers interfere with the humoral response in subjects who receive a booster immunization, whereas the cellular response is boosted at least transiently, after revaccination.

Adult↗
PubMed2004

Laboratory investigations are indispensable to monitor the progress of measles elimination--results of the German Measles Sentinel 1999-2003.

BACKGROUND: The elimination of measles is a goal set by the World Health Organisation to be reached by 2010 in the European region. OBJECTIVES: To enhance the measles surveillance in Germany, a country-wide laboratory supported a sentinel was established. STUDY DESIGN: A network of >1200 representatively distributed practitioners reported detailed data on all clinically diagnosed cases and provided specimens for laboratory diagnosis. RESULTS: A total of 3225 suspected cases were reported between October 1999 and December 2003. The incidence in Western Germany decreased from >15 cases per 100,000 population to one case in 2003, while in Eastern Germany <1 case per 100,000 population was observed during these years. Laboratory investigations were undertaken in 40% of cases in 2000/2001. This rate increased to 79% in 2003. Simultaneously, the rate of confirmed cases dropped from 60% in the former years to 23% in 2003. Measles virus (MV) detection by serology and by PCR revealed concordant results in 92%. Most suspected cases (85%) were unvaccinated with 66% being laboratory confirmed. Only 10% of suspected cases occurred in vaccinated individuals and very few (22%) could be confirmed. Analyses of confirmed measles in vaccinated patients (n = 49) revealed 24.5% primary vaccine failures, 24.5% reinfections after successful vaccination and 31% MV infection before or shortly after vaccination. The genetic characterisation of 389 MV isolates identified eight genotypes: B3, C2, D4, D5, D6, D7, G2 and H1. Only the C2, D6 and D7 MV genotypes circulated endemically in Western Germany. The newly emerged MV D7 almost completely replaced the pre-existing C2 and D6 MVs in 2001. The few measles cases detected in Eastern Germany were mostly caused by imported MVs. CONCLUSION: The data demonstrate that laboratory investigations including molecular methods are an indispensable tool for surveillance in all countries advanced in measles elimination.

Adolescent↗
PubMed2003

A role for nonprotective complement-fixing antibodies with low avidity for measles virus in atypical measles.

In the 1960s, a formalin-inactivated measles vaccine (FIMV) predisposed recipients to atypical measles, an immune complex-mediated disease. To identify characteristics of the immune priming that leads to atypical measles, responses of monkeys to FIMV were compared with responses to live attenuated virus (LAV) and hemagglutinin (H-DNA) vaccines that do not prime for atypical measles. Antibodies induced by FIMV were transient and avidity did not mature. Antibodies induced by LAV and H-DNA vaccines were sustained and avidity matured over time. After challenge with measles virus, FIMV and H-DNA recipients developed high titers of complement-fixing antibodies. In FIMV recipients, the antibodies were of low avidity, whereas in H-DNA vaccine recipients, the antibodies were of high avidity. Neutralizing capacity in B958 cells correlated with avidity. Only FIMV recipients had immune complex deposition. Failure of FIMV to induce affinity maturation results in anamnestic production of nonprotective, complement-fixing antibodies, immune complex deposition and atypical measles.

Animals↗
PubMed2004

Global measles elimination efforts: the significance of measles elimination in the United States.

Lessons learned from the successful end of endemic measles virus transmission (i.e., elimination) in the United States include the critical roles of strong political commitment, a regionwide initiative, adequate funding, and a broad coalition of partners. Implications of measles elimination in the United States for global measles control and regional elimination efforts include demonstration of the high vaccination coverage and, in turn, population immunity needed for elimination; the importance of accurate monitoring of vaccination coverage at local, state, and national levels; a vaccination strategy that includes at least 2 opportunities for measles immunization; and the essential role of integrated epidemiological and laboratory surveillance. The United States, with a population of 288 million, is, to our knowledge, the largest country to have ended endemic measles transmission. This experience provides evidence that sustained interruption of transmission can be achieved in large geographic areas, suggesting the feasibility of global eradication of measles.

Global Health↗
PubMed1997

Recombinant bacille Calmette-Guérin expressing the measles virus nucleoprotein protects infant rhesus macaques from measles virus pneumonia.

Measles virus infection continues to be a major cause of infant mortality. There is a need for a measles vaccine that can be administered at birth in the presence of maternal neutralizing antibody. Infant rhesus monkeys were immunized with recombinant bacille Calmette-Guérin expressing the full-length measles virus nucleoprotein (BCG-N) and subsequently challenged with measles virus. Nucleoprotein-specific lymphocyte proliferative responses were detected in the absence of anti-N antibody after vaccination. Vaccination with BCG-N did not prevent systemic measles virus infection; however, there was a significant reduction of lung inflammation after challenge. Virus titers in lymph nodes were significantly lower, and the duration of nasopharyngeal viral shedding was shorter in some vaccinated monkeys after challenge. These results suggest that measles virus-specific T cells were primed by BCG-N vaccination and that they prevented virus-induced lung pathology.

Animals↗
PubMed1995

Reasons for non-uptake of measles, mumps, and rubella catch up immunisation in a measles epidemic and side effects of the vaccine.

OBJECTIVE: To investigate the reasons for poor uptake of immunisation (non-immunisation) and the possible side effects of measles, mumps, and rubella vaccine in a catch up immunisation campaign during a community outbreak of measles. DESIGN: Descriptive study of reasons for non-immunisation and retrospective cohort study of side effects of the vaccine. SETTING: Secondary schools in South Glamorgan. SUBJECTS: Random cluster sample of the parents of 500 children targeted but not immunised and a randomised sample of 2866 of the children targeted. MAIN OUTCOME MEASURES: Reasons for non-immunisation; symptoms among immunised and non-immunised children. RESULTS: Immunisation coverage of the campaign was only 43.4% (7633/17,595). The practical problems experienced included non-return of consent forms (6698/17,595), refusal of immunisation (2061/10,897 forms returned), and absence from school on day of immunisation (1203/8836 children with consent for immunisation). The most common reasons cited for non-immunisation were previous measles infection (145/232), previous immunisation against measles (78/232), and concern about side effects (55/232). Symptoms were equally common among immunised and non-immunised subjects. However, significantly more immunised boys than non-immunised boys reported fever (relative risk 2.31 (95% confidence interval 1.36 to 3.93)), rash (2.00 (1.10 to 3.64), joint symptoms (1.58; 1.05 to 2.38), and headache (1.31 (1.04 to 1.65)). CONCLUSIONS: Many of the objections raised by parents could be overcome by emphasising that primary immunisation does not necessarily confer immunity and that diagnosis of measles is unreliable. Measles, mumps, and rubella vaccine is safe in children aged 11-15.

Adolescent↗
PubMedDate not supplied

Measles seroprevalence of an adolescent population vaccinated with a single dose of measles vaccine before their first birthday.

This study determined the age-specific measles seroprevalence of an adolescent population in Ankara vaccinated with a single dose of measles vaccine before their first birthday. The study sample included 440 adolescents (227 female, 213 male) aged 9-16 years admitted to the Adolescent Outpatient Clinic of Hacettepe University Faculty of Medicine. For each participant, a questionnaire was completed and measles specific IgG antibodies screened quantitatively by the enzyme linked immunosorbent assay. Of the 440 subjects screened for measles antibodies, 114 (25.9 %) were seronegative. Measles seronegativity according to sex and age groups were, 32.6, 24.7, 13.3% in females and 29.5, 30.1, 6.3% in males in the age groups of 9-11, 12-14, 15-16 years, respectively. In countries where the two dose vaccination schedule against measles has not been incorporated to the national immunization program, the adolescent health maintenance visit at age 11-12 years should serve as an opportunity to evaluate vaccination status and administer MMR vaccine to all adolescents who have not received two doses at the recommended ages.

Adolescent↗
PubMed1980

[The state of measles immunity and the success quota of measles vaccination in Basle nursery and elementary school pupils].

Measles antibody determinations in kindergarten and primary school children in Basle-City showed that today just under 10% of 10-year-olds and roughly 25% of 5-year-olds have no immunity to measles. In the 10-year-old primary school children the effects of measles immunization are not yet markedly apparent, whereas almost half the kindergarten children already owe their measles immunity to immunization. No measles antibodies could be detected in 13,7% of the subjects who, according to their official vaccination certificates, had previously been immunized against measles. Most of these failures are probably due to careless routine immunization techniques.

Antibodies, Viral↗
PubMed1995

[A study on the level of antibody against measles through maternal-fetal transfer and the immuno-response to measles vaccine among 4 to 7 month olds].

A total number of 143 infants at the age of 4 to 7 months from Yantai city-Shandong was selected for the study of antibody level against measles by maternal-fetal transfer and immuno-response to measles vaccine in October of 1993. The results showed that the negative rates of maternal-fetal antibody among infants of 4, 5, 6 and 7 month olds were 75.00%, 81.25%, 94.87% and 90.1%, respectively. The positive rates and geometric mean titers (GMTs) for immuno-response to measles vaccine were 92.86%, 84.38%, 97.44%, 100.00% and 55.17, 42.41, 69.95, 71.46, respectively. There were significant lower immune response to measles vaccine in infants who had high titer ( > 1:2) than those who had low titer ( <or= 1:2) of maternal-fetal antibody (chi 2 = 88.38, P < 0.001). In order to decrease the number of measles cases under 1 year old (especially under 9 month-old), the author suggested that the primary immunization for measles vaccine should be started at 6 month olds.

Antibodies, Viral↗
PubMed1995

Detection of acute measles infections by indirect and mu-capture enzyme immunoassays for immunoglobulin M antibodies and measles immunoglobulin G antibody avidity enzyme immunoassay.

An avidity test for measles IgG was developed and applied to the study of IgG immunoglobulin maturation kinetics in follow-up sera from 12 patients with known acute primary and convalescent measles and sera from blood donors. The avidity of the IgG anti-measles responses was measured using the 8 M urea elution technique, the results being expressed as the percentage ratio between the test readings for eluted and noneluted samples. The IgG avidity results were compared with those of indirect and mu-capture IgM enzyme immunoassays. This test was capable of detecting low-avidity antibodies at the acute phase of measles up to 7 weeks, and increasing avidity through immunosaturation during the convalescent phase. The avidity in these samples did not reach the level found in the samples of the blood donors under the follow-up time. Although a limited number of serum samples was examined, the results suggest that the measles IgG avidity test is a powerful tool for differentiating primary measles infection from the convalescent phase.

Acute Disease↗
PubMed1977

Immunocytochemical studies for the localisation of measles antigens in multiple sclerosis plaques and measles virus-infected CNS tissue.

Actively demyelinating central nervous system (CNS) lesions from a patient with acute multiple sclerosis (MS) were tested for measles antigens using peroxidase-conjugated antimeasles antibody. No evidence of measles antigens was found. Similarly reacted tissue from 2 patients with chronic MS also revealed no evidence of measles antigens. Identically treated and simultaneously tested measles-infected CNS cultures and human SSPE brain tissue stained strongly for measles antigens. The possible reasons underlying the failure to detect measles antigens in MS are discussed.

Adult↗
PubMed2004

Sero-epidemiology of measles and mumps in Korea: impact of the catch-up campaign on measles immunity.

A catch-up campaign targeting children aged 8-16 years using measles-rubella (MR) vaccine was conducted during 2001 in Korea. To evaluate the impact of the campaign and assess mumps immunity, human IgG antibodies were detected using ELISA for measles (5826 samples) and mumps (5890 samples) in a national sample of opportunistically collected sera from a population aged 0-34 years. The measles immunity increased by 5-10% following the catch-up campaign in the targeted age group. Infants lost maternal antibodies rapidly and about 90% of infants were susceptible to measles and mumps at 6-8 months of life. The sero-prevalence of mumps antibody increased slowly with age and stabilized at a lower level when compared with that of measles. Despite an immediate reduction in susceptibility among the targeted age group of the catch-up campaign, continuous efforts to increase immunization coverage are needed to interrupt indigenous measles transmission. Furthermore, our results suggest continuous mumps outbreaks could occur because of the accumulation of susceptible individuals.

Adolescent↗
PubMed2002

Measles virus genome detected up to four months in a case of congenital measles.

UNLABELLED: To determine how long the measles virus genome was detected in a patient with congenital measles, the peripheral blood mononuclear cells were tested for 203 d. The measles virus genome was detected up to 140 d. CONCLUSION: The period for which the measles virus genome was detected in this patient with congenital measles was much longer than in normal children with measles.

Female↗
PubMed1996

Molecular epidemiology of measles virus: identification of pathways of transmission and implications for measles elimination.

The nucleotide sequences of either the hemagglutinin or nucleoprotein genes from wild type measles viruses isolated in the United States between 1989 and 1992 differed by < 0.5%. This suggests that the majority of viruses associated with resurgence of measles in the United States belonged to a single indigenous genotype. In contrast, wild type viruses isolated from sporadic outbreaks of measles in the United States during 1994 were genetically heterogeneous. These viruses were more closely related to wild type viruses previously circulating in Europe, Africa, or Japan and were epidemiologically linked to importations or no known source. In addition to demonstrating the utility of genetic analysis in understanding the epidemiology of measles, these data suggest that the transmission of the indigenous virus was interrupted after the 1989-1992 epidemic. Measures to further reduce the incidence of measles in the United States should include efforts to control importation and subsequent spread of measles.

Base Sequence↗
PubMed1999

Role of schools in the transmission of measles in rural Senegal: implications for measles control in developing countries.

Patterns of measles transmission at school and at home were studied in 1995 in a rural area of Senegal with a high level of vaccination coverage. Among 209 case children with a median age of 8 years, there were no deaths, although the case fatality ratio has previously been 6-7% in this area. Forty percent of the case children had been vaccinated against measles; the proportion of vaccinated children was higher among secondary cases (47%) than among index cases (33%) (prevalence ratio = 1.36, 95% confidence interval (CI) 1.04-1.76). Vaccinated index cases may have been less infectious than unvaccinated index cases, since they produced fewer clinical cases among exposed children (relative risk = 0.55, 95% CI 0.29-1.04). The secondary attack rate was lower in the schools than in the homes (relative risk = 0.31, 95% CI 0.20-0.49). The school outbreaks were protracted, with 4-5 generations of cases being seen in the two larger schools. Vaccine efficacy was found to be 57% (95% CI -23 to 85) in the schools and 74% (95% CI 62-82) in the residential compounds. Measles infection resulted in a mean of 3.8 days of absenteeism per case, though this did not appear to have an impact on the children's grades. Among the index cases, 56% of children were probably infected by neighbors in the community, and 7% were probably infected at health centers, 13% outside the community, and 24% in one of the three schools which had outbreaks during the epidemic. However, most of the school-related cases occurred at the beginning and therefore contributed to the general propagation of the epidemic. To prevent school outbreaks, it may be necessary to require vaccination prior to school entry and to revaccinate children in individual schools upon detection of cases of measles. Multidose measles vaccination schedules will be necessary to control measles in developing countries.

Absenteeism↗
PubMed2001

Impact of multiple dose measles vaccination on measles transmission patterns in Gweru, Zimbabwe.

Multiple dose measles vaccination was applied in Gweru, Zimbabwe in 1990-1996. This included (a) a vaccine administered to children at 9 months of age and revaccination of the same children at any point between the ages of 12 and 23 months, and (b) a single mass vaccination campaign targeted at children aged 12-119 months (who were vaccinated irrespective of vaccination status or disease history) run in early 1990. This study describes the impact of this schedule on measles transmission patterns. Using measles disease surveillance data the study compared measles transmission patterns under single dose vaccination in 1983-1989 and under multiple dose vaccination in 1990-1996. Median measles incidence rates were 261.0 and 19.0/100000 population in 1983-1989 and 1990-1996, respectively, and these were different (p = 0.002). Vaccinated cases (vaccine failures) among children aged 10-119 months significantly increased from 49.6 to 70.4 per cent of all reported cases in 1983-1989 and had a median incidence rate of 480.4/100000. In 1990-1996 the median incidence rate was 12.8 and these incidence rates were different (p = 0.002). Cases aged 60-119 months significantly increased from 14.3 to 62.2 per cent of all reported cases in 1983-1989 and had a median incidence rate of 654.1/100000. In 1990-1996 the median incidence rate was 21.4 and these incidence rates were different (p = 0.004). It was concluded that under multiple dose vaccination, lower measles incidence rates occurred most likely due to reduction of both vaccine failures and cases aged 60-119 months.

Age Distribution↗
PubMed1993

Measles vaccine efficacy study in a Canberra high school: a study following a measles outbreak.

An outbreak of measles which occurred in Canberra between October and December, 1991, was investigated to estimate the public health utility of the vaccine. The measles vaccine efficacy was determined for the 13-15 year old children in a selected high school. During the outbreak, at least 82 Canberra children contracted measles. Teenage males accounted for 56% of total cases, and 22% of cases were confirmed by serology. The vaccine coverage in the high school studied decreased with increasing school years, varying from 85.8% in Grade 8 to 79.2% in Grade 10. The highest attack rate occurred in Grade 10 (66/1000). The vaccine efficacy for age 13-15 was estimated to be 72% (95% Cl, 45-86%) but varied from 67 to 73%. Measles remains a serious disease of childhood in Australia. The elimination of measles is only partly dependent on the vaccine coverage of children. Issues relating to the effectiveness of vaccine are also important. A two dose vaccine strategy with the second dose of measles, mumps, rubella vaccine (MMR), given preferably in the last year of primary school or the first year of high school, is supported by the findings of this study.

Adolescent↗