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[Immune response and reactions to simultaneous administration of hepatitis B vaccine with routine vaccine in children. II. Immune response and reactions to simultaneous administration of hepatitis B vaccine with Japanese B encephalitis vaccine and measles vaccine].

This paper reports the result of the immune response and reactions to simultaneous administration of Japanese B encephalitis vaccine, measles and hepatitis B vaccine. 215 children (0-9 months of age) were divided into three groups. Group one was vaccinated with hepatitis B vaccine alone, group two was vaccinated with Japanese B encephalitis vaccine, measles vaccine, and group three was Vaccinated with hepatitis B vaccine, Japanese B encephalitis vaccine and measles vaccine simultaneously. The result of the immune response to the combination of hepatitis B vaccine with Japanese B encephalitis vaccine were similar to that observed after immunization with each vaccine alone. But the result of the immune response to the combination of hepatitis B vaccine with measles vaccine were lower than to that observed after immunization with measles vaccine alone. The general reaction of all vaccine were mild, no significant difference between each group was noted. The study demonstrated that children can not be immunized with hepatitis B vaccine and measles vaccine simultaneously but can be immunized with hepatitis B Vaccine and Japanese B encephalitis vaccine.

Encephalitis Virus, Japanese↗

The burden of acute respiratory infection due to measles in developing countries and the potential impact of measles vaccine.

Measles is a major cause of acute lower respiratory infection (ALRI) in developing countries. Hospital and community-based studies of ALRI have found that measles accounts for 6%-21% of the morbidity and 8%-93% of the mortality due to ALRI. Although live attenuated measles vaccine is one of the most effective vaccines in use today, measles has not been controlled in many parts of the world, primarily because the levels of vaccine coverage required to interrupt measles transmission have not been achieved. In addition, in some areas, a large percentage of cases of measles occur in infants who are younger than the age recommended for vaccination. Recent studies suggest that the Edmonston-Zagreb measles vaccine may be more immunogenic than other vaccine strains in young infants. A substantial proportion of ALRI could be prevented by increasing measles vaccine coverage and by the use of particular vaccine strains in younger children.

Acute Disease↗

[Recurrence of febrile convulsions after the first diphtheria-pertussis-tetanus vaccination and measles vaccination in children with febrile convulsions: a questionnaire survey in Takamatsu City].

A questionnaire about convulsions and other adverse events after vaccination was sent to doctors who administered a diphtheria-pertussis-tetanus (DPT) vaccine (the first dose) or a measles vaccine between April 1, 1995 and December 31, 1997 in Takamatsu City to children with convulsions. DPT and measles vaccines were administered to 300 and 339 such children, respectively. Many of them had febrile seizures, the last of which had occurred before more than 1 year. Among them, 175 cases were administered with DPT and 180 with measles vaccine. There were recurrences of febrile convulsions after immunization in 2 (1.1%) of the cases given DPT and 3 (1.7%) of those given measles vaccination. According to the data of the Monitoring System for Adverse Events Following Immunization (the Ministry of Health and Welfare of Japan), the incidence of convulsion after immunization in healthy children between April 1, 1996 and September 30, 1997 was 0.4% after the first dose of DPT vaccination and 0.3% after measles vaccination. In comparison, the incidence was higher in children who had had febrile convulsions before more than one year. Especially, the rate of convulsions after measles vaccinations was significantly higher (p < 0.05) in children with febrile convulsions. These results suggest that the measles vaccination should be administered with caution to the children with previous febrile convulsions.

Child↗

Measles vaccines.

Measles vaccine is one of the safest and most effective vaccines currently available. Use of the vaccine has decreased the incidence of measles in both developed and developing countries. Nevertheless, preventable morbidity and mortality continue to occur. In the United States, the measles problem differs when it occurs among preschool-aged children or school-aged children. The former is a due to insufficient vaccine delivery. For measles in school-aged and college students, the problem is primarily vaccine failure, which should eventually be solved by a two-dose schedule. In developing countries, the major problem is vaccine delivery. Use of Edmonston-Zagreb measles vaccine in developing countries offers the promise of reducing disease rates in young infants; however, in both the United States and in developing countries, increasing immunization levels is essential.

Child↗

RESPONSE OF ADULTS IN ICELAND TO LIVE ATTENUATED MEASLES VACCINE.

Measles has had particularly serious effects when epidemics have occurred in isolated susceptible adult populations and hence the newly developed measles vaccines may be of special importance to these groups. This paper reports on one of the first sizeable trials of live-virus vaccine (Enders Edmonston B strain) in a group of measles-susceptible adults. Over 700 persons, mostly adults, were vaccinated in Iceland in 1962. Detailed records of the reactions in the vaccinated and control groups were obtained and serological tests were made on paired serum specimens. The reactions in all age-groups were basically similar and showed only minor differences in severity. The incubation period was found to increase progressively with age. As well as confirming the general safety of the Enders live measles virus vaccine in adults, this study provides new information on the nature of the reactions induced by measles vaccine and on the comparative immunological response of various age-groups.

Biomedical Research↗

Changes within T cell receptor V beta subsets in infants following measles vaccination.

Measles produces immune suppression which contributes to an increased susceptibility to other infections. Recently, high titered measles vaccines have been linked to increased long-term mortality among some female recipients. Because the mechanisms by which wild-type or attenuated live-vaccine strains of measles virus alter subsequent immune responses are not fully understood, this prompted an examination of the changes within the peripheral blood T cell receptor V beta repertoire following measles immunization. Twenty-four 6- and 9-month-old infants were studied at 2 weeks and 3 months following immunization by semiquantitative reverse transcription-polymerase chain reaction. There was a significant increase in V beta 2 expression (P less than 0.05), and a decrease in the V beta 4 subset (P less than 0.03) 2 weeks following vaccination with subsequent return to baselines at 3 months in vaccine recipients who seroconverted. These data suggest that measles virus may affect immune responses in part by altering the T cell receptor repertoire.

Base Sequence↗

Antibody persistence in Gambian children after high-dose Edmonston-Zagreb measles vaccine.

Measles antibody concentrations in Gambian children immunised at 4 months of age with a high-dose Edmonston-Zagreb (EZ) measles vaccine or at 9 months with conventional Schwarz vaccine were measured 5 months after vaccination, and at 18 and 36 months of age. Schwarz vaccinees produced, on average, a 2.4-fold higher concentration of measles haemagglutinin inhibiting (HAI) antibody than EZ vaccinees, but at 36 months of age 82 of 93 (88%) EZ vaccinees and 83 of 87 (95%) Schwarz vaccinees had measles plaque-neutralising antibody concentrations above the assumed protective level of 200 mIU/ml (p greater than 0.1). HAI antibody concentrations 5 months after vaccination were inversely related to the presence of maternal antibody at vaccination, but above protective levels; at 18 and 36 months of age there was no relation to antibody concentration at vaccination, and decay of HAI antibody between 18 and 36 months of age was similar for EZ and Schwarz vaccinees.

Age Factors↗

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↗

Arthritis after mumps and measles vaccination.

Measles, mumps, and rubella vaccine carries a risk of joint symptoms particularly in children under 5 years. A boy who presented with an inflamed knee after measles and mumps vaccination is reported; synovial fluid aspirated from the joint contained 4.3 x 10(9)/l leucocytes. It is thought that the mumps component is the aetiological cause of acute monoarthritis.

Acute Disease↗

Methodologic issues in the evaluation of vaccine effectiveness: measles vaccine at 12 vs. 15 months.

Initial studies of vaccine effectiveness are usually controlled clinical trials. Subsequent serologic and epidemiologic investigations cannot be as carefully controlled, and methodologic rigor must be considered when evaluating their results. The authors reviewed the methodologic features of greatest importance in the design of field investigations of vaccine efficacy and examined how different methodologic approaches may have influenced the results of studies of measles vaccine efficacy at 12 vs. 15 months of age. Among the serologic studies, time since vaccination was not controlled, so that children vaccinated several years ago at 12 months of age may have been compared with children vaccinated much more recently at later ages. Most studies included children vaccinated at several years of age as controls rather than children vaccinated only at the pivotal ages of 13-15 months. Finally, studies using a single clinic as their vaccine source found smaller differences in efficacy than studies using multiple vaccine sources, suggesting that variation in handling and storage may affect the results. Among the epidemiologic studies, no single methodologic feature clearly influenced whether there was significantly improved vaccine efficacy with increasing age at vaccination. However, studies differed with respect to intensity of effort to detect cases unreported through the usual channels; definition of what constituted a case of measles; whether the effect of midoutbreak clinics on overall estimates of vaccine efficacy was considered; and inclusion of revaccinated children in the analysis. These methodologic variations can make it extremely difficult to evaluate the size and clinical importance of relatively small differences in vaccine efficacy. Greater attention to the methodologic features discussed here will be needed in future studies of vaccine efficacy.

Epidemiologic Methods↗

Use of computerised records to ensure optimum measles vaccination.

Measles immunisations in Grampian were studied using the computerised Grampian Immunisation Record System. Records of children who were shown to have been immunised under 12 months of age were re-checked. This served as an audit of Grampian Health Board's centralised computer system and General Practice records, and as an educational exercise for the health professionals involved.

Forms and Records Control↗