Showing papers on "Measles published in 1983"

Vaccination against rubella and measles: quantitative investigations of different policies.

Abstract: This paper uses relatively simple and deterministic mathematical models to examine the impact that different immunization policies have on the age-specific incidence of rubella and measles. Following earlier work by Knox (1980) and others, we show that immunization programmes can, under some circumstances, increase the total number of cases among older age groups; the implications for the overall incidence of measles encephalitis and of congenital rubella syndrome are examined, paying attention both to the eventual equilibrium and to the short-term effect in the first few decades after immunization is initiated. Throughout, we use data (from the U.K., and U.S.A. and other countries) both in the estimation of the epidemiological parameters in our models, and in comparison between theoretical predictions and observed facts. The conclusions defy brief summary and are set out at the end of the paper.

Successful immunization of children with and without maternal antibody by aerosolized measles vaccine. I. Different results with undiluted human diploid cell and chick embryo fibroblast vaccines.

Abstract: Inhalation of undiluted, aerosolized measles vaccine was immunogenic in 100% of 4- to 6-month-old and older children with and without residual maternal antibody when the human diploid cell (HDC) vaccine containing the Ikic (Edmonston-Zagreb) strain and 1% human albumin was used but in a smaller percentage of infants given a chick embryo fibroblast (CEF) vaccine, which contained the Edmonston-Schwarz strain, ten times more virus, and hypertonic sugar solution but no added protein. Prevaccination residual placentally transmitted plaque-neutralizing antibody titers of 25 to 512 that can prevent an immune response after subcutaneous injection of measles vaccine did not prevent an immune response after inhalation of aerosolized vaccine. There were no immediate clinical reactions in the 160 children who inhaled the aerosolized vaccines, and no significant subsequent reactions among the 96 children who were successfully immunized. There were no contact infections. (JAMA1983;249:2651-2662)

Comparison of an active and passive surveillance system of primary care providers for hepatitis, measles, rubella, and salmonellosis in Vermont.

Abstract: Between June 1, 1980 and May 31, 1981, the Vermont Health Department telephoned a randomly chosen half of the state's primary care offices for surveillance reports of hepatitis, measles, rubella, and salmonellosis. No reports were actively solicited from the other half of the primary-care practices in the state. Active-surveillance units made more reports and more complete reports of diseases and had twice the number of reports per patient seen by the practice than did passive-surveillance units. (Am J Public Health 1983; 73:795-797.)

Further-Attenuated Measles Vaccine: Characteristics and Use

Abstract: Further-attenuated strains of measles virus may be distinguished from virulent strains by the following characteristics. Unlike virulent strains, attenuated strains of measles virus can be propagated in chick embryo fibroblast cultures, induce production of interferon in tissue culture cells, and produce plaques that can be distinguished from those produced by virulent strains. Unlike virulent measles virus, attenuated strains induce an inapparent infection in approximately 85% of vaccines. Symptoms such as fever, cough and rash, if present, are usually transient. Bacterial and central nervous system complications associated with natural measles infection are extremely rare after immunization. A 16-year, prospective study of immunologic response of 47 children who had natural measles and of 70 children immunized with live, further-attenuated measles vaccine revealed (1) that all 47 children with natural measles infection had high titers of hemagglutination-inhibiting (HAI) antibody (greater than or equal to 1:64) one month after vaccination and 15% had low titers (1:2-1:4) 16 years after vaccination; and (2) that all 70 children who received live, further-attenuated measles vaccine had high titers of HAI antibody (greater than or equal to 1:64) one month after vaccination, but in 36% of the group the titers declined to less than 1:8 16 years later. Neutralizing antibody was detectable in convalescent sera that had lost detectable HAI antibody. Reimmunization of children with undetectable HAI antibody induced a classic booster response. These prospective immunologic studies confirmed that immunity persists after immunization as well as after natural measles infection.

Measles Mortality, State of Nutrition, and Family Structure: A Community Study from Guinea-Bissau

Abstract: In an urban area of Guinea-Bissau where the general state of nutrition seemed fairly good, the case fatality rate for measles among children less than three years of age who were examined clinically during an epidemic was 25.0%. Nutritional indicators (weightfor-age, height-for-age, and weight-for-height ratios) measured a few months before the epidemic were about equal both for the group of 60 children who subsequently died of measles and for the general child population. Because no community study has demonstrated that the nutritional state influences the outcome of measles, the assumed importance of the state of nutrition for measles fatality rates is questioned. Children in monogamous households had a lower risk of dying of measles. It is suggested that measles may be more severe in polygamous families because several children can have the disease simultaneously.

Measles: Summary of Worldwide Impact

Abstract: Nearly every measles infection results in well-recognized clinical disease. In nonimmunized populations almost every child will get measles early in life. The universality of the disease in nonimmunized communities, particularly those in the developing world, has led to a more or less passive acceptance of measles as an unavoidable risk of early life. The clinical spectrum of measles ranges from a mild, self-limiting illness to a fatal disease. Conditions encountered mainly in the developing world, e.g., unfavorable nutrition, high risk of concurrent infection, and inadequate case management -- particularly at home -- favor the development of complications and adverse outcome. Conversely, good clinical management of an otherwise healthy child, a situation seen mostly in the developed world, greatly influences the course of the disease. Hence many in the medical profession believe that measles is a mild disease except among populations living under particularly unfavorable conditions. Measles vaccine is effective in preventing disease in the individual and in controlling it in the community if it is given at the critical age when maternal antibodies wane and the risk of natural infection increases sharply and if a high immunization rate is maintained in the target population. The experience with immunization, particularly in sub-saharan Africa, is rewarding: mothers who had previously accepted measles as an unavoidable risk clamour for immunization of their children once its effectiveness has been demonstrated. No reason exists for measles to claim its present toll of morbidity and mortality. With extension of the Expanded Programme on Immunization of the World Health Organization, the impact of measles should progressively decline.

Interventions for the control of diarrhoeal diseases among young children: measles immunization.

Abstract: The effects of measles immunization on diarrhea morbidity and mortality are reviewed using data from field studies and theoretical calculations 2 types of measles-associated diarrhea are distinguished: with-measles diarrhea which starts between 1 week prerash-onset and 4 weeks postrash-onset and postmeasles diarrhea which starts 4-26 weeks postrash-onset The etiology of these measles-associated diarrheas is unknown but some evidence points towards a frequently severe and dysenteric form of disease with Shigella playing a major role Theoretical calculations indicate that measles immunization at the age of 9-11 months with coverage of between 45-90% can avert 44-64% of measles cases 06-38% of diarrhea episodes and 6-26% of diarrhea deaths among children under age 5 The cost of measles immunization is in the range of US$2-15 (1982 prices)/child vaccinated The impact of measles immunization on diarrhea mortality may be partly additional to the impact of oral rehydration because it averts deaths that are not prevented by oral rehydration Community research is urgently needed to confirm or reject these theoretical suppositions to clarify the etiology of measles-associated diarrhea and to determine the cost-effectiveness of measles immunizations as an intervention to reduce diarrhea mortality (authors modified)

Antibody response following measles-mumps-rubella vaccine under conditions of customary use

Abstract: A study of 301 children who had been immunized two to 19 months previously with measles, mumps, and rubella (MMR) vaccine at 36 different sites in San Antonio, Tex, including physicians' offices and clinics, revealed that 99.7% had antibody against rubella and 98.3% had antibody against measles and mumps. None of the 49 infants who were tested prior to receipt of MMR vaccine had antibody against any of these viruses, indicating that the antibody found after immunization was unlikely to be due to false-positive results. The lack of antibody in these infants confirmed that there had not been a significant number of cases of these diseases that could contribute to the high frequency of antibody found after immunization. A single dose of MMR vaccine administered under customary conditions appears to be an effective method of conferring immunity against these diseases. ( JAMA 1983;250:1409-1412)

Preliminary report of an association between measles virus and achalasia.

Abstract: Complement fixation tests were performed on sera from 18 patients with achalasia and 12 age- and sex-matched controls against a number of bacterial and viral agents in an attempt to ascertain any association with previous infection or any evidence of an altered immune response. There was a statistically significant increase of antibody titre against measles virus in the sera of 21 patients with achalasia compared with age- and sex-matched controls and this was confirmed by haemagglutination inhibition.

Hepatitis and Jaundice Associated With Measles in Young Adults: An Analysis of 65 Cases

Abstract: • We analyzed the clinical course of 65 adult patients hospitalized because of measles during the years 1975 and 1981-1982. Liver involvement was found in 80% (52/65) of the patients, five patients had clinical jaundice. The disturbances of liver function tests reached their peak values between days 5 and 10 of the disease. In this study of measles in adulthood we have three observations of unusual interest: (1) hepatitis occurs commonly in the more severely ill patients and it may manifest clinically as jaundice; (2) long-term follow-up (up to seven years) shows a clear tendency to complete resolution of the liver damage; (3) there is a clear correlation between the severity of hepatic involvement and the occurrence of secondary bacterial infections. (Arch Intern Med1983;143:674-677)

Late Morphologic Consequences of Measles: A Lethal and Debilitating Lung Disease Among the Poor

Abstract: Pneumonia that occurs within 28 days of the onset of measles rash is a common cause of severe pulmonary morbidity and/or death among poor children. The prevalence of such pneumonia can be related to the effectiveness of measles immunization programs. For 20 of 57 new cases of bronchiectasis in children undergoing bronchography, a strong causal relationship to measles was found. The lungs of 21 unselected children who died in the wake of measles were examined. Severe necrosis of bronchi and bronchioles was found in those children who had developed intercurrent adenovirus and herpesvirus infections. Bacterial suppuration produced a less severe necrosis. It is suggested that intercurrent adenovirus and herpesvirus infections that occur following measles are the most important initiating causes of follicular bronchiectasis in childhood. The severity of these supervening infections may be mediated by the transient immune suppression that occurs as a consequence of both measles and inadequate nutrition.

Mass vaccination programme aimed at eradicating measles, mumps, and rubella in Sweden: first experience.

Abstract: General vaccination with a combined measles, mumps, and rubella vaccine was introduced in Sweden in 1982 The immunisation schedule comprises two vaccine injections, given at 18 months and 12 years of age, respectively A controlled field study was carried out in 150 children aged 18 months using two different batches of the vaccine Seroconversion was seen in 96% against measles, 93% against mumps, and 99% against rubella--the same rates with both vaccine lots Nevertheless, a difference was noted between the two batches with respect to postvaccination reactions Fever and rash were recorded mainly five to 12 days after vaccination Moderate fever (385-394 degrees C) was observed in 22 children, high fever (greater than or equal to 395 degrees C) in 33, and rash in 35 Preliminary results obtained by follow up of routinely vaccinated schoolchildren aged 12 indicated considerably lower rates of fever and rash during the postvaccination period, occurring in 3-10% of cases only These findings show that complete eradication of measles, mumps, and rubella in Sweden is entirely practicable by the mass vaccination programme and that side effects of vaccination are likely to be few and mild

Immunization Against Measles by Aerosol

Abstract: About 20 years ago Japanese and American investigators found that inhalation of relatively small amounts of aerosolized partly attenuated measles vaccines was consistently immunogenic in nearly all susceptible children. The resulting modified measles was not transmissible to susceptible children. Between 1965-66 Japanese investigators showed that levels of neutralizing antibody produced by killed measles virus vaccine which prevented subsequent immunization when live vaccine was administered subcutaneously did not prevent the immunogenic effect of the same vaccine when given in an aerosol form. This raised the possibility that aerosolized vaccine may be immunogenic in infants with residual maternal antibody in whom subcutaneously injected vaccine is ineffective. In 1971 Soviet investigators reported the high effectiveness and complete absence of febrile and other clinical reactions in 3306 children who were exposed in large groups in large tents or chambers to aerosols of the more attenuated measles vaccines currently available. An inexpensive nebulizer and the procedure for administration of aerosolized vaccine to individual children are described here. If the good results reported from the USSR can also be obtained with this simple method of vaccination by aerosol it may be possible to carry out mass vaccinations against measles with thousands of nonprofessional personnel and thereby quickly eliminate measles in those countries where it is still a serious public health problem. (authors)

Measles, measles vaccination, and risk of subacute sclerosing panencephalitis (SSPE).

Abstract: Between the years 1968 and 1979, 87 cases of subacute sclerosing panencephalitis (SSPE) appeared among the Israeli-born population. The incidence of SSPE dropped sharply in 1977, 10 years (the median age at onset of SSPE) after introduction of mass antimeasles vaccination, and remained low in 1978 and 1979. Most of the SSPE cases reported measles at an age significantly younger than that of the general population. This pattern did not change after introduction of antimeasles vaccination. Incidence was significantly lower (p less than 10(-9) in the vaccinated population than in the unvaccinated population. Occurrence of SSPE in some children who were vaccinated against measles could be explained by incomplete vaccine efficacy, or by older age at vaccination, which allows the possibility of prior exposure to measles. There was no indication that measles vaccine can induce SSPE.

Specific and non-specific B cell activation in measles and varicella.

Abstract: Lymphocytes from eight patients with measles and six patients with varicella were studied during the acute phase (first week) of illness and after recovery for spontaneous and pokeweed mitogen (PWM)-induced production of immunoglobulins (Ig) and viral antibodies by an enzyme linked immunosorbent assay (ELISA). In both infections acute phase lymphocytes showed increased spontaneous in vitro IgM and IgG productions including IgM and IgG antibodies to the aetiological virus as well as IgG antibodies to unrelated viruses (varicella, measles, rubella and mumps) to which the patient had serum antibodies. PWM induced no further Ig synthesis in the acute phase. In the convalescent phase viral antibody production could be demonstrated only in PWM stimulated cultures. In four patients the spontaneous synthesis of antibodies to a non-aetiological virus seemed to precede the production of IgG antibodies to the aetiological virus. All patients showed an increase of ELISA determined serum antibodies to the aetiological virus from the acute to the convalescent phase. Three of seven measles patients also showed a minor but significant increase or decrease of serum IgG antibodies to varicella and one of six varicella patients a significant rise of serum IgG antibodies to measles. Thus both measles and varicella infections were associated with non-specific as well as specific B cell activation. The non-specific B cell activation may be induced by non-specific helper factors from activated T cells.

Measles Vaccines Used in Japan

Abstract: The history of the research and development of measles vaccines is described and the efficacy of and adverse reactions to the Japanese licensed vaccines are discussed. The 10-year follow-up studies revealed that the incidence of clinical measles was 11.5% among those inoculated with live vaccines in combination with killed vaccines, whereas it was only 1.9% among those given live vaccines attenuated to the level of the Schwarz vaccine. Use of the Schwarz and Biken-CAM vaccines resulted in satisfactory antibody responses in greater than or equal to 97% of vaccinees. However, these vaccines caused a febrile reaction of greater than or equal to 37.5 C in 50% of vaccinees and one of greater than or equal to 39 C in 15% of vaccinees. On the other hand, a febrile reaction was observed in 20% and 5%, respectively, of children immunized with the AIK-C vaccine or the further-attenuated Schwarz vaccine, both of which were developed in Japan. The worldwide use of further-attenuated vaccines is strongly recommended. The system of fixed surveillance stations, which was started in 1981 by the Japanese government with the voluntary cooperation of pediatricians and ophthalmologists, is described. This system proved effective in obtaining information about the prevalence of communicable diseases, including measles, in childhood and about the efficacy of vaccines.

Herd Immunity and Measles

Abstract: The basic concept of herd immunity is directly applicable only under very special conditions. The agents of disease must be restricted to a single host species within which transmission occurs by relatively direct contact, and infection induces solid immunity. Also outbreaks must occur only in randomly mixing populations. In free-living populations, susceptibles are not distributed homogeneously but tend to cluster in subgroups defined by age and by such factors as ethnicity and socioeconomic status. The requisite for occurrence of epidemics, namely a large enough number of susceptibles in frequent contact with each other, exists in virtually all large populations, regardless of the total proportion of the population that is immune. Experience with measles illustrates these conditions. Total prevalence of immunity of greater than or equal to 90% in developing countries does not prevent annual epidemics among the susceptibles, most of whom are children younger than three years of age. Where vaccination is widely practiced, as in the United States since 1962, measles has continued to occur in poorly immunized subgroups that are characterized by low educational level and economic status, very young age, or religious beliefs forbidding acceptance of vaccine. Ultimate success of a systematic immunization program requires knowledge of distribution of susceptibles by age and subgroup and maximal effort to reduce the concentration of susceptibles throughout the community rather than aiming to reach any specific proportion of the overall population.

Impact of Measles in the United States

Abstract: Measles has had a severe impact on children in the United States since colonial times. In the early decades of the 20th century, thousands of fatal measles infections were reported each year. During the 1950s an annual average of greater than 500,000 cases of measles and nearly 500 deaths due to measles were reported in the United States. Surveys indicated that 95% of the population had been infected with measles by the age of 15 years. The introduction of measles vaccine and its widespread use, which began in 1963, has had a major impact on the occurrence of measles in the United States. Reported numbers of cases, deaths due to measles, and complications of measles (e.g., encephalitis) have declined dramatically. Accompanying the decline in reported incidence of measles and following it by approximately seven years, has been a decline in the reported incidence of subacute sclerosing panencephalitis (SSPE). In recent years, the incidence of measles has dropped to levels that are less than 1% of those seen in the prevaccine era. In 1981, provisional figures indicated that only 10% of counties in the United States reported any cases of measles. The reported incidence in 1981 was 1.3 cases per 100,000 population, compared with an average incidence of 336.3 cases per 100,000 population in the decade 1950-1959. Thus, the impact of measles in the United States has been markedly reduced, and it is anticipated that indigenous transmission will be eliminated entirely from the country within the year.

Post-measles corneal ulceration in children in northern Nigeria: the role of vitamin A, malnutrition and measles.

Abstract: This work was prompted by the observation that corneal ulceration was apparently more common in young children in the guinea savannah area of northern Nigeria than in children in the tropical rainforest areas of southern Nigeria, where the intake of vitamin A, as the provitamin in red palm oil, is higher. Since corneal ulceration was usually seen in association with measles, a study was carried out to clarify the relationship between nutritional status, measles infection and vitamin A status in young children. The concentration of total retinol was measured in the plasma of well-nourished and malnourished children under three years of age, with or without a clinical record of recent measles. One hundred and twenty children were studied of whom 17 had corneal lesions. Malnutrition and measles were both found to depress the plasma concentrations of retinol and albumin. Measles depressed retinol levels (-20 to -30%) more than did malnutrition (-4 to -12%) while malnutrition had a greater depressing effect on albumin concentration (-23 to -30%) than did measles (-11 to -23%). The results support the hypothesis that corneal ulceration found in association with measles in northern Nigeria, although clinically similar to xerophthalmia, is not simply mediated through an effect of measles on the concentrations of vitamin A in plasma.

Selective Primary Health Care: Strategies for Control of Disease in the Developing World. IV. Measles

Abstract: young children yearly. Essentially all children will become infected; at least 1 %7 of those living in developing countries will die unless protected by immunization. In urban areas, peak incidence occurs in those younger than three years. The youngest and most undernourished children suffer the most severe complications and the highest risk of death. Diarrhea, malnutrition, pneumonia, and blindness associated with vitamin A deficiency are the worst complications. The infection is preventable by the timely administration of a potent vaccine. This endeavor requires a well-managed technical and administrative network that remains difficult to organize in many areas of the world. The vaccine is efficacious and has few adverse effects but must be provided to children during the short interval between loss of transplacentally acquired antibodies and the acquisition of natural infection. The improvements in heat stability of the vaccine increase the likelihood of providing potent vaccine, but a well-managed cold chain remains a prerequisite for any successful immunization program. Health education, improved management skills, publicity, and community support are all important factors for ultimately preventing the morbidity and mortality from this disease.

Measles immunisation: why have we failed?

Abstract: Measles is still a significant cause of illness in British children although a safe and effective vaccine has been available here since 1968. 1982 was a particularly bad year with a steep increase in the notification rate of measles that probably represents only a fraction of the real incidence. Thousands of children have been ill; many have had troublesome complications; and a few may even have died or suffered permanent damage, all quite unnecessarily. If we consider the extra demands placed on the medical and nursing services by such epidemics, not to mention the countless hours of anxiety for parents, it is surprising that this continuing problem has not attracted greater medical, public, or political attention. Is this dismal picture just an unfortunate side effect of the ill-judged and ill-informed publicity that accompanied the recent campaign for compensation for infants damaged by pertussis vaccine? For a number of reasons this is unlikely.' Undoubtedly there has been some erosion of public confidence. Many doctors and nurses have become less enthusiastic in promoting immunisation and have chosen to practise defensively by finding all kinds of excuses to postpone or avoid it because of anxiety about the medical (and legal) consequences of a vaccine reaction. All this notwithstanding, our overall record (and that of some other western European countries) has never been as good as that of the USA where, if anything, patients (and parents) are much more litigious. It is more likely that our poor performance reflects differences in attitude that are most apparent in public and professional apathy and in national immunisation policies.

Measles in England and Wales—III: Assessing Published Predictions of the Impact of Vaccination on Incidence

Abstract: Published predictions of the impact which different levels of vaccination should have on measles incidence are discussed in the context of observed data on vaccine uptake and measles incidence in England and Wales. Discrepancies are noted between prediction and observation with regard to the effect of vaccination on epidemic periodicity, epidemic size, age distribution of cases, and the disappearance of measles from communities. These errors are attributable to failures to recognize the implications of seasonal trends in incidence, age dependence of risk, and the non-homogeneity of human populations. Predictive models are useful hypotheses, but should be assessed critically against observation.

Status of Measles in The Gambia, 1981

Abstract: Measles registries were instituted in all rural health facilities in The Gambia during January through December 1981. House-to-house surveillance of three infected villages revealed a 7% acute case-fatality rate. Infected villages were followed up until December 1981. Finger-prick specimens of blood, complete measles history, and vaccination status of 380 children aged six months to five years were studied. Data on children from the area with the lowest coverage for measles vaccination in 1980 were collected and analyzed. Of the 60% of children who were vaccinated, 75% seroconverted, while 8% reported measles infection after immunization. The Gambia's immunization program is composed of static immunization units with outreach stations and rural health workers in immunization services. The strong faith of mothers in the maternal and child health services coupled with the commitment of the health workers in The Gambia is helping to provide important leadership in the struggle to attain global control and eradication of measles by the year 2000.

Measles Vaccine in the People's Republic of China

Abstract: The strains of measles virus and the method used in the production of further attenuated live-virus vaccine in the People's Republic of China were studied. Observation of clinical reactions and serologic responses to immunization with Shanghai-191 measles vaccine, which is produced on a large scale with a locally isolated viral strain, revealed that this vaccine is adequately safe and immunogenic. Epidemiologic data showed a significant decrease in measles-associated morbidity after the introduction of mass vaccination in 1965. The duration of immunity induced by Shanghai-191 measles vaccine was studied for eight years in a region in which interference due to natural measles infection had been minimized by mass vaccination of children. Although immunity appeared to persist for at least eight years, the results suggested that primary vaccination does not confer lifelong immunity. Reactions and antibody responses to this vaccine were compared with those to two vaccines from abroad, the Schwarz and Leningrad-16 strains. The hemagglutination-inhibiting (HAI) antibody titer induced by Shanghai-191 vaccine was higher than that induced by Leningrad-16 vaccine and lower than that induced by Schwarz vaccine; however, these differences were not significant. Preliminary studies on the preparation of measles vaccine in human diploid cells have yielded promising results.