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PubMed2003

IgG avidity to distinguish secondary from primary measles vaccination failures: prospects for a more effective global measles elimination strategy.

The nearly 40-year long debate on the relevance of secondary measles vaccination failure has been inconclusive because a feasible method for the assessment of the duration of immunity has been lacking. Even if a two-dose measles vaccination policy is now universally endorsed, WHO still officially adheres to the view that a single successful measles vaccination, without natural boosters, induces a lifelong immunity and deems secondary failures epidemiologically irrelevant - in the belief that the latter are rare and do not participate in the transmission chain. A recently published study on measles-IgG avidity, which allows for separation of secondary from primary vaccination failures, tentatively showed that the official view does not necessarily hold true. The results may have wide implications on global measles eradication efforts. The potential of IgG avidity measurement in complex postvaccination measles epidemiology is discussed.

Antibody Affinity↗
PubMed1996

Measles vaccination levels of children enrolled in WIC during the 1991 measles epidemic in New York City.

OBJECTIVES: This study assessed measles vaccination rates and risk factors for lack of vaccination among preschool children enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC) during the 1991 measles epidemic in New York City. METHODS: Children aged 12 to 59 months presenting for WIC certification between April 1 and September 30, 1991, at six volunteer WIC sites in New York City were surveyed. RESULTS: Of the 6181 children enrolled in the study, measles immunization status was ascertained for 6074 (98%). Overall measles coverage was 86% (95% confidence interval [CI] = +/- 1%) and at least 90% by 21 months of age (95% CI = +/- 1%). Young age of the child, use of a private provider, and Medicaid as a source of health care payment were risk factors for lack of vaccination (P < .001). CONCLUSIONS: During the peak of a measles epidemic, measles immunization rates were more than 80% by 24 months of age in a sample of WIC children. The ease of ascertaining immunization status and the size of the total WIC population underscore the importance of WIC immunization initiatives.

Child, Preschool↗
PubMedDate not supplied

Genetic diversity of wild-type measles viruses: implications for global measles elimination programs.

Wild-type measles viruses have been divided into distinct genetic groups according to the nucleotide sequences of their hemagglutinin and nucleoprotein genes. Most genetic groups have worldwide distribution; however, at least two of the groups appear to have a more limited circulation. To monitor the transmission pathways of measles virus, we observed the geographic distribution of genetic groups, as well as changes in them in a particular region over time. We found evidence of interruption of indigenous transmission of measles in the United States after 1993 and identified the sources of imported virus associated with cases and outbreaks after 1993. The pattern of measles genetic groups provided a means to describe measles outbreaks and assess the extent of virus circulation in a given area. We expect that molecular epidemiologic studies will become a powerful tool for evaluating strategies to control, eliminate, and eventually eradicate measles.

Genetic Variation↗
PubMed2002

Measles vaccine effectiveness and risk factors for measles in Dhaka, Bangladesh.

OBJECTIVE: To evaluate vaccine effectiveness and to assess risk factors for measles in Dhaka, Bangladesh. METHOD: A case-control study, involving 198 cases with 783 age-matched neighbourhood controls and 120 measles cases with 365 age-matched hospital controls, was conducted in 1995-96 in three large hospitals in Dhaka. FINDINGS: Measles vaccine effectiveness was estimated at 80% (95% confidence interval (CI) = 60-90%) using neighbourhood controls; very similar results were obtained using hospital controls. Visits to a health facility 7-21 days before onset of any symptoms were associated with increased risk of measles compared with neighbourhood (adjusted odds ratio (OR) = 7.0, 95% CI = 4.2-11.6) or hospital (adjusted OR = 1.7, 95% CI = 1.01-2.8) controls. Cases were more likely than controls to come from a household where more than one child lived (adjusted OR = 1.6, 95% CI = 1.1-2.5 versus neighbourhood controls; adjusted OR = 1.8, 95% CI = 1.02-3.0 versus hospital controls). CONCLUSIONS: To improve measles control in urban Dhaka missed immunization opportunities must be reduced in all health care facilities by following WHO guidelines. For measles elimination, more than one dose of vaccine would be required.

Bangladesh↗
PubMed1989

Measles outbreak among unvaccinated preschool-aged children: opportunities missed by health care providers to administer measles vaccine.

A measles outbreak in an inner-city area primarily involved preschool-aged children younger than 5 years of age. The reasons why 31 unvaccinated preschool children with measles disease had not been vaccinated were investigated. For some patients, health care providers missed opportunities to vaccinate eligible patients against measles. Of the 26 patients whose full immunization status was known, ten (38%) were vaccinated with diphtheria and tetanus toxoids and pertussis vaccine and/or oral poliovirus vaccine at a time when they could have received measles vaccine simultaneously, according to recommendations of the Immunization Practices Advisory Committee and the American Academy of Pediatrics. In addition, five of ten health care providers interviewed missed at least one opportunity to administer measles vaccine because of a minor illness that was not a contraindication to vaccination. Unvaccinated patients were more likely to receive health care in the public sector, have single mothers, and have parents who had no knowledge of existing vaccines; they were less likely to be age-appropriately immunized with other antigens. If measles immunization levels among preschool children in the United States are to be increased, education of both health care providers and parents, coupled with innovative strategies targeted to preschool children, particularly of low socioeconomic groups in inner cities, are needed.

Adolescent↗
PubMed1995

Measles in Jordan: a prototype of the problems with measles in developing countries.

Until recently measles was a very severe illness of infancy and early childhood in Jordan. Incidence rates were estimated to be as high as 500 to 1000/100,000 and case fatality rates were as high as 10%. Since 1981 mandatory and routine vaccination was introduced by the Ministry of Health. Because infants accounted for the most severe cases and almost all mortality, measles vaccine was given at 9 months of age. No booster doses were recommended. Since 1981 there has been a steady shift in the age distribution of cases toward the older age group. In recent years children > 5 years of age accounted for > 60% of cases. Commensurate with that the mortality rate has decreased to almost nil in recent years. There is also evidence of a marked decrease of inpatient admission of measles cases to one of the largest hospitals, the Jordan University Hospital. Despite high immunization rates in excess of 88%, however, outbreaks of measles continue to occur. To evaluate the impact of measles vaccination on outbreaks, a study in one village in 1987 showed that there was almost no protective efficacy in children > 5 years of age (relative risk 0.80 and confidence interval 0.06 to 0.67 vs. relative risk 0.73 and confidence interval 0.54 to 1.15). Although the current measles immunization strategy has decreased the mortality and morbidity rates, we propose that the continuing occurrence of outbreaks necessitates the addition of a booster dose after 15 months of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1993

Measles vaccination in pediatric emergency departments during a measles outbreak.

OBJECTIVE: To determine the proportion of preschool-aged patients attending two inner-city hospital pediatric emergency departments (EDs) who were eligible for measles vaccination, to describe their demographic and clinical characteristics, and to assess the performance of the ED immunization programs that were implemented during a measles outbreak in vaccinating eligible children. DESIGN: Cross-sectional study. SETTING: Pediatric EDs of two urban hospitals in Chicago, Ill, in 1989. PARTICIPANTS: Children 6 months to 5 years of age seen in the EDs. INTERVENTION: None. MAIN OUTCOME MEASURES: The proportion of preschool-aged patients attending the two EDs who were eligible for measles vaccination and the proportion of vaccine-eligible children who were given measles vaccine. RESULTS: Of 508 ED patients at hospital A and 255 patients at hospital B, 18% and 29%, respectively, were considered to be vaccine eligible. The most common discharge diagnoses of eligible patients were viral syndrome, otitis media, and minor trauma. Of vaccine-eligible patients, 59% at hospitals A and B were not vaccinated in the ED. At hospital B, patients with an infectious or respiratory disease diagnosis were less likely to be vaccinated than those with other diagnoses (P < .05). CONCLUSIONS: Many children seen in these EDs were eligible for measles vaccination, and many eligible patients were not vaccinated. During community outbreaks of measles, optimal vaccination programs in pediatric EDs could increase vaccination coverage among inner-city preschool-aged children who may have limited access to health care.

Chicago↗
PubMedDate not supplied

Serologic responses to measles, mumps, and rubella (MMR) vaccine in healthy infants: failure to respond to measles and mumps components may influence decisions on timing of the second dose of MMR.

Measles, mumps, and rubella-specific IgG antibodies were evaluated in 134 healthy infants routinely immunized with trivalent live attenuated measles-mumps-rubella (MMR) vaccine at one year of age. Blood samples were collected just before, and at 1, 3, and 12 months after MMR. Specific IgG was measured by commercial enzyme immunoassays. Before vaccination, 98.5%, 99.2%, and 98.5% of the infants tested were seronegative for measles, mumps, and rubella, respectively. One year after MMR, 16.4% and 22.4% of vaccinees lacked demonstrable antibody to measles and mumps while none were found to be seronegative for rubella. Response profile analysis revealed primary failure rates of 12.1% (measles) and 8.6% (mumps) while 4% (measles) and 13.8% (mumps) of the infants responded initially but became seronegative within one year. These observations suggest that earlier administration (at age 18 months) of the second dose of MMR may be more desirable than revaccination at school entry.

British Columbia↗
PubMed2004

Measles vaccines and the potential for worldwide eradication of measles.

The annual number of reported measles cases in the United States has declined from between 3 million and 4 million in the prevaccine era to <100 cases in association with the highest recorded immunization rates in history. Because of continued importation of measles into the United States, young children who are not vaccinated appropriately may experience more than a 60-fold increase in risk of disease. Unsubstantiated claims suggesting an association between measles vaccine and neurologic disorders have led to reduced vaccine use and a resurgence of measles in countries where immunization rates have declined below the level needed to maintain herd immunity. To address the possibility of worldwide control of measles, efforts to ensure high immunization rates among people in both developed and developing countries must be sustained.

Autistic Disorder↗
PubMed1996

Measles pneumonitis following measles-mumps-rubella vaccination of a patient with HIV infection, 1993.

The Advisory Committee on Immunization Practices (ACIP) recommends measles-mumps-rubella vaccine (MMR) for all persons asymptomatically infected with human immunodeficiency virus (HIV) and recommends that MMR be considered for all symptomatic HIV-infected persons who would otherwise be eligible for measles vaccine, because measles virus infection can cause severe illness and death in such persons. Serious or unusual adverse events in HIV-infected persons after receiving MMR have not been reported previously. This report summarizes the investigation of a case of progressive vaccine-associated measles pneumonitis in a person with acquired immunodeficiency syndrome and provides interim recommendations for the use of measles-containing vaccine among HIV-infected persons.

Adult↗
PubMed1975

Measles virus antibodies in serum and cerebrospinal fluid in patients with multiple sclerosis and other neurological disorders, with special reference to measles antibody synthesis within the central nervous system.

Measles virus hemagglutination-inhibiting (HI) and gel precipitating (GP) antibodies were determined in sera and cerebrospinal fluids (CSF) from 65 patinets with multiple sclerosis (MS) and 65 patients with other neurological diseases. The serological results were correlated to content of immunoglobulin-G (IgG) and electrophoretic patterns of sera and CSF. Measles GP antibodies, identified as directed against measles virus ribonucleoprotein antigens, were detected in sera and in CSF from a significantly higher proportion of MS than of non-MS patients. No significant difference between the 2 groups of patients was found for measles HI antibodies. Reduced serum/CSF HI and/or GP antibody ratios were found in about one half of the MS patients and in 2 patients with chronic myelopathy. All patients with reduced antibody ratios had evidence of IgG synthesis within the central nervous system (CNS), as inferred from oligoclonal IgG patterns of the CSF. Reduced ratios of measles GP antibodies were 3 times as common as reduced ratios of HI antibodies. Immunoelectrophoretic assays indicated that the CSF GP antibodies were electrophoretically restricted in a number of MS patients. The results indicate that measles virus may be an active immunogen within the CNS in many MS patients and in some patients with chronic myelopathy, giving rise to an oligoclonal IgG antibody response.

Adolescent↗
PubMed1982

Distribution of measles antigen and immunoglobulin-containing cells in the CNS in subacute sclerosing panencephalitis (SSPE) and atypical measles encephalitis.

The immunoperoxidase technique has been used to study the distribution of measles virus antigen and immunoglobulin (Ig)-containing cells within the CNS, in 5 cases of subacute sclerosing panencephalitis (SSPE) and 1 case of atypical measles encephalitis. Measles virus antigen was demonstrated within the brain in all cases, and in the spinal cord in 1 case of SSPE. Ig-containing cells were also demonstrated in all cases, the proportions of the different light and heavy chain types varying somewhat from case to case. In SSPE IgG constituted the major and IgA the principal minor heavy chain demonstrated. In all cases of SSPE there was significant excess of light-chain-containing over heavy-chain-containing cells. In the case of atypical measles encephalitis there was a paucity of Ig-containing cells and a relatively high proportion (39%) of these contained IgM. The case of atypical measles encephalitis differed from those of SSPE also in the presence of multinucleate giant cells, some of which contained measles virus antigen.

Adolescent↗
PubMed2002

Vitamin a supplementation of vitamin a deficient measles patients lowers the risk of measles-related pneumonia in zambian children.

This is an a posteriori analysis of previously published data to assess whether improving vitamin A (VA) status resolves measles-related pneumonia (MP). Nonhospitalized acute measles patients (2 d of rash onset) had their VA status determined based on the molar ratio of retinol-binding protein to transthyretin (RBP/TTR). Using a cutoff value of </=0.36, indicative of marginal VA deficiency, 82 children were diagnosed as marginally VA deficient and 114 were diagnosed as VA sufficient. At baseline, marginally VA-deficient patients had significantly lower serum retinol and higher serum C-reactive protein concentrations than VA-sufficient children. At the 2-wk follow-up visit, serum retinol and the RBP/TTR ratio were significantly greater in marginally VA-deficient measles patients receiving VA supplements than in those receiving placebo; whereas in VA-sufficient measles patients, retinol increased in those receiving VA supplements or placebo. Concomitantly the odds ratio of unresolved pneumonia in marginally VA-deficient measles patients receiving VA supplements compared with those receiving placebo was 0.20 (95% confidence interval, 0.05-0.71). In conclusion, VA supplements during measles infection improved VA status of VA-deficient children and helped resolve MP, demonstrating the importance of determining VA status when assessing the efficacy of VA supplements.

Child↗
PubMed1996

Changing epidemiology of measles in Turkey: need for reassessment of measles vaccination policy?

Changing epidemiology of measles in Turkey and in Izmir city, since the introduction of measles vaccine was examined in order to evaluate the need for new strategies to control measles infection. After the National Vaccination Campaign in 1985, the rates of incidence and mortality dropped to 4.2/100000 and 0/million, respectively, in 1987. When the epidemics in 1989 and 1993 were examined it was seen that more measles cases occurred in age groups 5-9 and > 15 years, and most of the cases seen in children in primary and secondary schools were in those previously immunized against measles. Future strategies for control of measles should aim at increasing the coverage rate and introducing a two-dose regimen to reduce vaccine failure.

Adolescent↗
PubMed2001

Measles antibody responses after early two dose trials in Guinea-Bissau with Edmonston-Zagreb and Schwarz standard-titre measles vaccine: better antibody increase from booster dose of the Edmonston-Zagreb vaccine.

In Guinea-Bissau, children were randomised at 6 months of age to receive either two doses of standard-titre measles vaccine at 6 and 9 months of age or an inactivated polio vaccine at 6 months and standard-titre measles vaccine at 9 months of age. During the first 5 months, children received Edmonston-Zagreb (EZ) vaccine and during the following 11 months, the Schwarz (SW) vaccine. Five percent of the mothers, 74% of children at 6 months of age, and 92% of unvaccinated children at 9 months of age had unprotective levels (<125 mIU/ml) of measles antibodies. Among children receiving EZ vaccine, 1% were unprotected at 18 months of age after either two (3/240) or one (3/211) doses of vaccine, the geometric mean measles antibody titre (GMT) being approximately 1550 mIU/ml in both groups. Among those receiving SW vaccine 9% (34/365) and 3% (9/310) were unprotected at 18 months of age in the two-dose and the one-dose groups (RR = 3.21 (95% confidence interval (CI) 1.56-6.58)), respectively. The GMT was higher after one dose of SW vaccine at 9 months of age (2491 mIU/ml) than after two doses of SW vaccine (1125 mIU) (P < 0.001). In the EZ vaccine group, there was no significant difference in antibody level for children vaccinated in the presence of high or low levels of maternal antibodies, whereas there was a marked difference in the SW group. The second EZ vaccine induced a significant antibody increase between 9 months of age (1191 mIU) and 18 months of age (1602 mIU, P=0.011), whereas antibody levels tended to decline from 9 months (1243 mIU) to 18 months of age (998 mIU, P = 0.124) after the second dose of SW vaccine. Conclusively, after two doses of EZ measles vaccine more children were protected at 18 months of age than after two doses of SW. One dose of SW provided the highest antibody response, but a higher proportion of unprotected than one or two doses of EZ. The EZ vaccine was less sensitive to maternal antibodies, and able to increase the antibody response by revaccination, while the second SW vaccine resulted in an unchanged or lower antibody response.

Age Factors↗
PubMed2004

The largest outbreak of measles in the United States during 1999: imported measles and pockets of susceptibility.

The largest measles outbreak in the United States during 1999 was traced to a 34-year-old minister with an undocumented history of vaccination, infected while traveling outside the United States. Local health departments in the Central Virginia Health District performed an epidemiological and laboratory investigation that identified 14 additional confirmed cases of measles, including 2 in health care providers and 5 in congregation members. Eight cases (53%) occurred among adults aged 30-35 years and 7 (47%) among children aged 13 months to 8 years. Although no religious exemptions were cited, only 2 case patients had documented proof of vaccination. This outbreak demonstrates the potential for limited indigenous spread of measles that occurs when imported cases expose susceptible groups. Almost half of the imported measles cases in the United States occur in US residents returning from foreign travel. Vaccination is highly recommended for all overseas travelers who are without documented proof of adequate immunization or measles immunity.

Adult↗
PubMed1999

Measles inclusion-body encephalitis caused by the vaccine strain of measles virus.

We report a case of measles inclusion-body encephalitis (MIBE) occurring in an apparently healthy 21-month-old boy 8.5 months after measles-mumps-rubella vaccination. He had no prior evidence of immune deficiency and no history of measles exposure or clinical disease. During hospitalization, a primary immunodeficiency characterized by a profoundly depressed CD8 cell count and dysgammaglobulinemia was demonstrated. A brain biopsy revealed histopathologic features consistent with MIBE, and measles antigens were detected by immunohistochemical staining. Electron microscopy revealed inclusions characteristic of paramyxovirus nucleocapsids within neurons, oligodendroglia, and astrocytes. The presence of measles virus in the brain tissue was confirmed by reverse transcription polymerase chain reaction. The nucleotide sequence in the nucleoprotein and fusion gene regions was identical to that of the Moraten and Schwarz vaccine strains; the fusion gene differed from known genotype A wild-type viruses.

Encephalitis, Viral↗
PubMed2002

Will the current measles vaccines ever eradicate measles?

Measles virus is the most infectious transmissible agent causing human disease and has probably been responsible for the deaths of more children than any other single cause. In addition, infection with the natural virus causes many severe complications, including encephalitis, deafness and pneumonia. The introduction of live attenuated vaccines, either singly or as the measles-mumps-rubella combined vaccine, has dramatically reduced the occurrence of disease and in countries where vaccine uptake is high, indigenous disease has been virtually eliminated. Even though the current vaccines are very efficient, they do have their limitations. Children are most at risk during the first year of life and for most of this period, maternal antibodies prevent effective immunization. In addition, the current measles vaccines are relatively heat labile which causes difficulty in tropical areas. In recent years, vaccination rates in some industrial countries have been adversely affected by fears that measles vaccines are linked to inflammatory bowel diseases and autism. Although there is no conclusive evidence to support these fears, they still remain and probably contribute to poor vaccine uptake in some regions and sections of society. Although severe complications from vaccination are extremely rare, mild local reactions are more common. Consequently, in countries where measles is declining or has been eliminated, the fear of side effects of vaccination may encourage the development of vaccines that do not rely on virus replication to take effect.

Autistic Disorder↗