Forty years after effective vaccines were licensed, measles continues to cause death and severe disease in children worldwide. Complications from measles can occur in almost every organ system. Pneumonia, croup, and encephalitis are common causes of death; encephalitis is the most common cause of long-term sequelae. Measles remains a common cause of blindness in developing countries. Complication rates are higher in those 20 years old, although croup and otitis media are more common in those <2 years old and encephalitis in older children and adults. Complication rates are increased by immune deficiency disorders, malnutrition, vitamin A deficiency, intense exposures to measles, and lack of previous measles vaccination. Case-fatality rates have decreased with improvements in socioeconomic status in many countries but remain high in developing countries.

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The Clinical Significance of Measles: A Review

Safe and effective vaccines are available that could be used to eradicate measles, which is a primary cause of childhood vaccine-preventable deaths worldwide. This article reviews the pathogenesis of this deadly disease and the prospects for its elimination. Measles remains a leading vaccine-preventable cause of child mortality worldwide, particularly in sub-Saharan Africa where almost half of the estimated 454,000 measles deaths in 2004 occurred. However, great progress in measles control has been made in resource-poor countries through accelerated measles-control efforts. The global elimination of measles has been debated since measles vaccines were first licensed in the 1960's, and this debate is likely to be renewed if polio virus is eradicated. This review discusses the pathogenesis of measles and the likelihood of the worldwide elimination of this disease.

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Global measles elimination.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(03)12661-X.pdf

Measles: not just another viral exanthem

This paper reviews the English language literature on the safety, immunogenicity and effectiveness in children infected with the human immunodeficiency virus (HIV) of vaccines currently recommended by WHO for use in national immunization programmes. Immunization is generally safe and beneficial for children infected with HIV, although HIV-induced immune suppression reduces the benefit compared with that obtained in HIV-uninfected children. However, serious complications can occur following immunization of severely immunocompromised children with bacillus Calmette-Guerin (BCG) vaccine. The risk of serious complications attributable to yellow fever vaccine in HIV-infected persons has not been determined. WHO guidelines for immunizing children with HIV infection and infants born to HIV-infected women differ only slightly from the general guidelines. BCG and yellow fever vaccines should be withheld from symptomatic HIV-infected children. Only one serious complication (fatal pneumonia) has been attributed to measles vaccine administered to a severely immunocompromised adult. Although two HIV-infected infants have developed vaccine-associated paralytic poliomyelitis, several million infected children have been vaccinated and the evidence does not suggest that there is an increased risk. The benefits of measles and poliovirus vaccines far outweigh the potential risks in HIV-infected children. The policy of administering routine vaccines to all children, regardless of possible HIV exposure, has been very effective in obtaining high immunization coverage and control of preventable diseases. Any changes in this policy would have to be carefully examined for a potential negative impact on disease control programmes in many countries. Keywords HIV infections/immunology; BCG vaccine/immunology/adverse effects; Measles vaccine/immunology; Poliovirus vaccine, Oral/immunology; Yellow fever vaccine/immunology/adverse effects; Diphtheria-tetanus-pertussis vaccine/immunology; Hepatitis B vaccines/immunology; Haemophilus vaccines/immunology; Infant; Immunization programs; Guidelines; World Health Organization; Review literature (source: MeSH, NLM ). Mots clesHIV, Infection/immunologie; Vaccin BCG/immunologie/effets indesirables; Vaccin antimorbilleux/immunologie; Vaccin antipoliomyelitique Sabin/immunologie; Vaccin anti-fievre jaune/immunologie/effets indesirables; Vaccin diphter ie-tet anos- coqueluche/immunologie; Vaccin antihepatite B/immunologie; Vaccin antihemophilus/immunologie; Enfant; Nourrisson; Programmes de vaccination; Lignes directrices; Organisation mondiale de la Sante ´ ; Revue de la litterature (source: MeSH, INSERM ). Palabras clave Infecciones por VIH/inmunologo´a; Vacuna BCG/inmunologo´a/efectos adversos; Vacuna antisarampion/inmunologo´a; Vacuna antipolio oral/inmunologo´a; Vacuna contra la fiebre amarilla/inmunologo´a/efectos adversos; Vacuna difteria-tetano-pertussis/ inmunologo´a; Vacunas contra hepatitis B//inmunologo´a; Vacunas contra haemophilus/inmunologo´a; Vacunas bacterianas/inmunologo´a; Vacunas virales/inmunologo´a; Vacunas atenuadas/inmunologo´a; Nino; Lactante; Programas de inmunizacion; Pautas; Organizacion Mundial de la Salud; Literatura de revision (fuente: DeCS, BIREME ).

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Immunization of children at risk of infection with human immunodeficiency virus

Objective To achieve high and equitable coverage of insecticide-treated bednets by integrating their distribution into a measles vaccination campaign. Methods In December 2002 in the Lawra district in Ghana, a measles vaccination campaign lasting 1 week targeted all children aged 9 months–15 years. Families with one or more children less than five years old were targeted to receive a free insecticide-treated bednet. The Ghana Health Service, with support from the Ghana Red Cross and UNICEF, provided logistical support, volunteer workers and social mobilization during the campaign. Volunteers visited homes to inform caregivers about the campaign and encourage them to participate. We assessed pre-campaign coverage of bednets by interviewing caregivers leaving vaccination and distribution sites. Five months after distribution, a two-stage cluster survey using population-proportional sampling assessed bednet coverage, retention and use. Both the pre-campaign and post-campaign survey assessed household wealth using an asset inventory. Findings At the campaign exit interview 636/776 (82.0%) caregivers reported that they had received a home visit by a Red Cross volunteer before the campaign and that 32/776 (4.1%) of the youngest children in each household who were less than 5 years of age slept under an insecticide-treated bednet. Five months after distribution caregivers reported that 204/219 (93.2%) of children aged 9 months to 5 years had been vaccinated during the campaign; 234/248 (94.4%) of households were observed to have an insecticide-treated bednet; and 170/249 (68.3%) were observed to have a net hung over a bed. Altogether 222/248 (89.5%) caregivers reported receiving at least one insecticide-treated bednet during the campaign, and 153/254 (60.2%) said that on the previous night their youngest child had slept under a bednet received during the campaign. For households in the poorest quintile, post-campaign coverage of insecticide-treated bednets was 10 times higher than pre-campaign coverage of households in the wealthiest quintile (46/51 (90.2%) versus 14/156 (9.0%)). The marginal operational cost was US$ 0.32 per insecticide-treated bednet delivered. Conclusion These findings suggest that linking bednet distribution to measles vaccination campaigns may provide an important opportunity for achieving high and equitable coverage of bednets.

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Erica Kufa

Papers

First 5 years of measles elimination in southern Africa: 1996-2000.