Showing papers on "Measles published in 1986"

Varicella: Complications and Costs

Abstract: Varicella (chickenpox) has long been considered a benign, inevitable disease of childhood. Complications are generally mild and rarely severe, and virtually every individual is infected by adulthood. Infection is associated, however, with a high risk of serious complications in certain high-risk groups, such as leukemic children. Concerns about the severity of varicella in this population have led to the development and testing of a live, attenuated vaccine. Because of the favorable results thus far available, the vaccine may soon be licensed for use in high-risk individuals. The fact that a vaccine may soon be available has led to an increased interest in the potential benefits of a childhood varicella vaccine program. The costs associated with varicella infection in normal persons without a varicella vaccination program have been estimated to be approximately $400 million, 95% of which is the cost of caring for a child at home. Vaccination of normal 15-month-old children with a safe and effective vaccine with long-lasting immunity could reduce the cost by 66% and result in a savings of $7 for every dollar spent on the vaccination program. This assumes that vaccine would be administered only once with measles, mumps, and rubella vaccine, that there would be no increase in the number of varicella cases in older persons who are at increased risk for complications, and that there would be no deleterious effect on the occurrence and severity of herpes zoster.(ABSTRACT TRUNCATED AT 250 WORDS)

Vaccinated Children Get Milder Measles Infection: A Community Study from Guinea-Bissau

Abstract: We studied the occurrence of measles in vaccinated children from an urban area of Guinea-Bissau where measles causes high mortality. Vaccinated children who developed measles required more-intense exposure to become infected (they had a higher ratio of secondary cases [infected in the house] to index cases [infected outside the house]), had a lower mortality among secondary cases, and were less infectious (they generated fewer secondary cases than did unvaccinated children with measles). The attack rate among vaccinated children was significantly higher in households in which someone died of measles. Both severity of infection and development of measles in vaccinated children were related to intensity of exposure. Vaccine efficacy was 72%, and 33% of cases occurred among vaccinated children; however, most mothers remained confident that vaccinated children get milder measles. Moreover, there was significantly greater vaccination coverage among younger siblings of vaccinated children who had contracted measles than among other children in the community.

Geographic variation in infant loss of maternal measles antibody and in prevalence of rubella antibody

Abstract: Maternal and cord measles and rubella antibodies were compared in 15 populations from Brazil, Ecuador, Chile, India, Jordan, Nigeria, South Africa, Taiwan, and the United States. Review of the literature concerning these countries showed that a higher proportion of children 6-12 months of age responded immunologically to measles vaccine in areas with low per capita product than in wealthier populations. The authors show that this difference reflects differences in maternal antibody titer and differences in efficiency of transport of measles immunity across the placenta. No variation in the half-life of passive measles immunity in the infant was found in comparing three geographic areas. When these biologic factors are fully evaluated, it should be possible to predict the response to be expected from vaccination at any particular age without directly testing the vaccine in children below and above generally recommended ages for vaccination. With regard to rubella, high antibody prevalence rates were found in most of the developing countries, as well as in the United States, and these countries are therefore unlikely to encounter widespread problems with congenital rubella. However, Taiwan, and all of four areas of Brazil have prevalence rates which are no higher than those which pertained in the United States prior to establishment of the rubella immunization program. The authors believe that protection of the infants in these countries is a matter of high priority, but that, if approached hastily, it could exacerbate the problem.

Appropriate age for measles vaccination in the United States.

Abstract: The appropriate age for measles vaccination is determined by weighing the risk of measles disease and complications at a given age with vaccine efficacy at that age. In the United States, measles vaccine was initially used in children as young as 9 months of age because the disease was common and complications were greatest in persons less than 1 year of age. In 1965, when it became apparent that vaccine failure was unacceptably high in children less than 1 year and when epidemiologic analysis indicated that children greater than or equal to 1 year, particularly schoolchildren, were the primary focus of measles transmission, the vaccination age was raised to 12 months. In 1976, further studies showed efficacy was slightly higher at 15 months of age versus 12 months or 12-14 months of age. Because the risk of acquiring measles in children less than 15 months was low, the age for routine vaccination was increased to 15 months. This age recommendation may be appropriate for developed countries where the epidemiology of measles may be similar to the epidemiology in the United States. However, this age is inappropriate for many countries in the developing world where the risks of measles and complications from measles are high in young preschool children. In those countries, the recommended age for routine vaccination against measles is generally 9 months.

Transmission of measles in medical settings. 1980 through 1984.

Abstract: For the five-year period 1980 through 1984, a total of 241 persons with measles in 30 states were identified as probably having acquired their infection in a medical facility. The proportion of all measles cases acquired in medical settings increased from 0.7% for 1980 through 1982 to 2.9% for 1983 and 1984. Seventy-six percent of cases were found in patients or visitors, and 24% in personnel at the medical facility where transmission occurred. The highest proportion of cases occurred in children less than 5 years of age (54.3%), followed by persons 25 to 29 years of age (14.7%). Of 120 cases for whom the pattern of transmission was known, patient-to-patient spread (50.0%) and patient-to-staff spread (36.7%) were most common. Medical personnel rarely transmitted disease to others. More attention needs to be given to methods of preventing spread of measles in medical facilities, such as isolation precautions, postexposure prophylaxis of potential contacts (vaccination or immune globulin), and ensuring that medical personnel are immune to measles. ( JAMA 1986;255:1295-1298)

Maternal and child health in rural Kenya: an epidemiological study.

Abstract: This monograph reports on studies based on a demographic and disease surveillance system maintained for 8 years in a rural area of Machakos District Kenya by the Medical Research Centre in Nairobi. This surveillance system made it possible to conduct a number of population-based longitudinal studies on various aspects of maternal and child health. The studys a aims were to obtain accurate data on 1) morbidity and mortality from measles whooping cough acute respiratory infections and diarrhea in children 0-4 years old; 2) nutritional status and health behaviors and attitudes; 3) maternal and perinatal mortality in relation to delivery care; and 4) vital statistics for a vital registration system. Approximately 4000 households were visited biweekly (until September 1978) and then monthly (until April 1981). The longitudinal studies covered child growth pregnancy outcome nutritional status in pregnancy and in infants and vaccine trails for measles and diptheria pertussis and tetanus (DPT). Cross-sectional studies considered a number of environmental variables including socioeconomic status sanitation and attitudes and behavior related to pregnancy measles and diarrhea. Demographic studies examined migration patterns and the impact of urban residence on fertility. Agricultural studies focused on food production and availability. Weather stations monitored rainfall temperature and humidity. The study population comes from a Bantu tribe the Kamba; their cooperation with the study was excellent except in the taking of blood samples. 2 continual problems were the shortage of middle-level administrative staff and data processing bottlenecks.

Prevention better than cure.

Abstract: In the longer term diarrhea prevention proves of greater significance to the well-being of children than the effective treatment of diarrhea Diarrhea prevention encompasses 2 kinds of activities: measures designed to reduce the transmission of the pathogens which cause diarrhea and so to reduce the incidence rate and mortality rate; and measures which strengthen the ability of a child to cope with an infection and to reduce the risk of severe disease and death Careful analysis of the costs and effectiveness of a range of possible interventions to prevent diarrhea has made it possible to advocate a short list of interventions of known effectiveness Current evidence provides the information that improvements in water supplies sanitation and hygiene may reduce the incidence rate and mortality rate of diarrhea by 20-40% Mothers also can protect their children from diarrhea by adopting appropriate child-feeding practices Most importantly mothers can breastfeed their children exclusively for the first 4-6 months of life and partially thereafter up to 12 months or beyond Poor weaning practices are a major risk factor for diarrhea and are responsible in part for the peak in age-specific diarrhea incidence in the 6-18 months of age weaning is a combination of "the when" "the what" and "the how" Weaning foods should be introduced neither too soon nor too late; they should be nourishing; and they should be hygienically prepared and given Local or national programs of weaning education need to be designed and implemented Social scientists have a key role to play in ensuring that weaning education programs are not in conflict with deeply held convictions Parents also can protect their children from diarrhea by making sure they are vaccinated against measles Reports from various countries show that diarrhea accompanies between 20-60% of measles episodes and that 10-20% of children will have a diarrhea episode in the 6 months following a measles attack which they otherwise would not have had Some of these preventive measures are already being vigorously pursued in most countries For these the challenge is to improve their effectiveness and accelerate the growth in coverage Others are being carried out seriously in only a small minority of comuntries and much epidemiological and operational research is required Yet public health professionals and social scientists are working with communities to introduce effective and affordable interventions and it is safe to forecast that significant progress in diarrhea prevention can be realized over the next 5 years

Measles, mumps, and rubella: the need for a change in immunisation policy.

Abstract: There is growing evidence that the present policy of childhood immunisation in the United Kingdom is inadequate. It is unlikely ever to achieve complete eradication of the congenital rubella syndrome and measles, and the problem of mumps has not even begun to be addressed. After a coordinated campaign to increase uptake of immunisation in Fife the uptake of rubella immunisation in teenage girls increased from 75% in 1981 to 94% in 1985 and the uptake of measles vaccination in preschool children from 55% in 1981 to 81% in 1985. There are a few girls each year who do not accept rubella immunisation, whose immune state is unknown, and who are consequently at risk of rubella during future pregnancies. Despite the increased uptake of measles vaccine over the past four years there is currently an epidemic of measles in Fife, with 544 notified cases in the first quarter of 1986. In 1984, 19 Fife residents were admitted to hospital because of complications of mumps. The time is ripe for a complete reassessment of the national immunisation policy.

Severe Measles in Sunderland, 1885: A European—African Comparison of Causes of Severe Infection

Abstract: On the basis of research in Guinea-Bissau, this paper re-analyses a severe measles epidemic which occurred in 1885 in Sunderland (England). In both England and Guinea-Bissau, acute measles mortality was higher in households with multiple cases than in families with only a single case of measles. Secondary cases (infected in the house) had higher mortality and higher frequency of severe complications than index and single cases. In Sunderland, severe complications were associated with a history of previous respiratory infection and with greater number of siblings. Since cases with severe complications had significantly prolonged prodromal symptoms and shorter periods of incubation, it is suggested that high dose of infection may be an essential mechanism in the pathogenesis of severe disease. Overcrowding may be a major determinant of severe measles because it increases the risks of intensive exposure, intercurrent infections, and previous respiratory infection.

Cross-Sex Transmission of Infection and Increased Mortality Due to Measles

Abstract: In an urban and a rural area of Guinea-Bissau, the incidence of and mortality due to measles were followed over four years. Significantly higher case-fatality ratios among secondary cases occurred when infection was transmitted across sexes than within the same sex. The case-fatality ratio was highest for girls infected by boys and lowest for girls infected by girls. Published reports of cases of fatal measles indicate a similar tendency. Apparently, no general background factor or difference in social interaction between children can explain this variation in severity of infection. It is therefore hypothesized that cross-sex transmission of measles virus produces infections of greater severity. These observations may suggest that measles virus incorporates host-specific cellular characteristics that interfere with the immune responses of persons infected by a member of the opposite sex.

A controlled trial for evaluating two live attenuated mumps-measles vaccines (Urabe Am 9-Schwarz and Jeryl Lynn-Moraten) in young children.

Abstract: A prospective, randomised clinical trial was conducted to evaluate the efficacy of two live attenuated mumps-measles vaccines, the Urabe Am 9-Schwarz and the Jeryl Lynn-Moraten vaccine, in 400 young children aged 9 months-4.5 years (median 13.4 months). Antibody responses to both vaccine components were measured by the enzyme-linked immunosorbent assay (ELISA); 96.9% of the seronegative children who received the Urabe Am 9-Schwarz vaccine showed satisfactory mumps antibody responses compared to 90% of the Jeryl Lynn-Moraten vaccine recipients (P less than .01). Similar proportions of both groups, 98.5% and 96.8%, respectively, developed measles virus specific antibodies. Both vaccines were equally well tolerated and clinically acceptable.

Strategy for rapid elimination and continuing control of poliomyelitis and other vaccine preventable diseases of children in developing countries.

Abstract: Estimates of a recent yearly incidence of 400 000 cases of paralytic poliomyelitis, 2.5 million deaths from measles and its complications, over 1 million deaths from neonatal tetanus, and 735 000 deaths from pertussis in Asia, Africa, and Latin America now pose a greater challenge for new action than did the worldwide eradication of smallpox several years ago. By virtue of the conditions obtaining in the developing countries mere expansion or acceleration of what is being done now--even with modifications that may achieve a temporary increase in vaccine coverage--cannot achieve the desired rapid elimination and continuing control of these diseases. A new strategy--namely, bringing the vaccine to the people during annual national days of vaccination--has already been used successfully in some small and large developing countries of Latin America for the rapid elimination and continuing control of polio. This strategy could be adapted to include vaccination against measles, pertussis, and neonatal tetanus by additional training of community volunteers in the large auxiliary health armies that work with the existing health services each year.

Virus-induced Autoimmune Demyelinating Disease of the Central Nervous System

Abstract: Acute perivenular demyelinating disease of the brain and spinal cord can complicate a number of human viral infections. It has been most frequent late in the course of the exanthematous viral infections, particularly measles and vaccinia, and, to a lesser extent, varicella and rubella. The discontinuation of vaccination against smallpox and the successful immunization against measles and rubella in the United States have decreased the incidences of these infections and their parainfectious complications. Currently, postinfectious encephalomyelitis in the United States is most frequent after varicella, where mortality and morbidity rates are low, and after upper respiratory infections, where the etiologic agent is usually undetermined [1].

Measles pneumonia: lung puncture findings in 56 cases related to chest X-ray changes and clinical features.

Abstract: Fifty-six African children with pneumonia following measles were investigated. Lung puncture identified bacteria by culture or countercurrent immune electrophoresis in 38% and blood culture with blood countercurrent immune electrophoresis (CIE) identified a further 17%, a bacterial diagnosis being made in a total 55%. Pneumococcus was the most common organism found, occurring in 30% of all measles pneumonias. More severe changes on chest X-ray at presentation were associated with higher rates of bacterial identification and worse outcome at 2 weeks. Chest X-ray changes were worse and bacterial identification was more common in poorly nourished children. Pneumothoraces occurred following lung puncture in 21% and surgical drainage was needed in 11%.

Immunity against measles and rubella in Massachusetts schoolchildren.

Abstract: A statewide serosurvey was conducted among 6th, 10th and 12th grade Massachusetts schoolchildren in 1982. Sera were screened using a standard measles hemagglutination inhibition (HI) assay, a sensitive measles plaque neutralization assay, and four rubella assays with corresponding sensitivity limits of approximately 15, 10, 7.5, and 5 international units (IU) of rubella antibody/ml respectively. Using the most sensitive assays, seroprevalence was 98.6% for measles antibodies and 93.1% for any rubella antibodies. For persons who received single doses of either combined measles and rubella vaccines or separate single vaccinations at different times, there were no significant differences in seroprevalence using sensitive assays. Of persons who received combined vaccines, 99.3% had antibody against measles compared to 98.4% of single antigen recipients. For rubella, 98.6% of combined vaccine recipients had antibody compared to 95.7% of single antigen recipients. These seroprevalence data indicate the effectiveness of a combined vaccination program and support epidemiologic data indicating virtual elimination of these diseases in Massachusetts schoolchildren.

Subacute sclerosing panencephalitis: detection of measles virus RNA in appendix lymphoid tissue before clinical signs.

Abstract: An appendix removed 15 days before onset of symptoms of subacute sclerosing panencephalitis was examined retrospectively for measles virus ribonucleic acid (RNA). Tissue sections hybridised in situ to a cloned measles virus probe of deoxyribonucleic acid specific for nucleocapsid protein showed that many cells of the lymphoid tissue contained measles virus RNA. In contrast, only a few infected lymphoid cells were detected in three out of six seropositive controls and none in three seronegative infants. A widespread chronic viral infection of the immune system, established after measles, may promote or even initiate nerve cell infection in subacute sclerosing panencephalitis.

Rubella Antibody Titers in Vaccinated and Nonvaccinated Women and Results of Vaccination during Pregnancy

Abstract: In the Federal Republic of Germany (FRG), the selective rubella vaccination strategy used in the United Kingdom was followed until 1980, when vaccination of children was introduced. According to surveys in the Stuttgart area, so far no significant reduction in the rate of seronegativity (10%) among postpubertal women has occurred. However, among women with a history of vaccination, the rate of seronegativity has decreased to 2.4%o. For the vaccinated group the percentage of women with low levels of rubella antibody (23%) is significantly higher than for women without a history of vaccination (9.5%). In the study of the outcome of accidental vaccination during pregnancy or shortly before conception, which has followed up 365 women so far, 194 infants have been born without signs of congenital rubella syndrome (CRS). Also no cases of CRS were noted in 98 infants born to women known to be susceptible to rubella at the time of vaccination. When the data obtained in the United States and Stuttgart on the outcome of accidental vaccination are combined, the theoretical maximum risk of CRS calculated is as low as 1.2%. In the Federal Republic of Germany (FRG), rubella vaccination commenced in 1969 with use of the Cendehill vaccine. The vaccine was administered on an individual basis among seronegative, postpubertal women. In 1971 prenatal screening for rubella antibody and postpartum vaccination were introduced. In 1974-1975 the FRG, following the strategy of the United Kingdom, introduced in most states the vaccination of 10-14-year-old schoolgirls with Cendehill or HPV-77 DE-5 vaccine without assessing immune status before or after vaccination. The upper age limit of 14 years was chosen to avoid vaccinating girls who might be pregnant. Mostly schoolgirls ages 12-13 years were vaccinated. When the trivalent (measles, mumps,

Reimmunization following early immunization with measles vaccine: a prospective study.

Abstract: A prospective study was designed to determine the response of previously immunized infants following administration of measles vaccine at 15 to 18 months of age. Upon entry into the study at 7 to 12 months of age, 14 of 127 infants had measles antibody. Measles vaccine was administered to infants in the experimental group on the day of entry into the study. Prior to measles, mumps, and rubella vaccine administration at 15 to 18 months of age, six of 23 infants in the control group and 80 of 90 infants in the experimental group had detectable antibodies. Following the (re)vaccination at 15 to 18 months of age, 20 of 21 infants in the control group and 49 of 52 infants in the experimental group had detectable antibody. Early measles immunization in this study did not interfere with the ultimate response to immunization at 15 to 18 months of age. These results support the policy of early immunization for those infants at risk for exposure to measles and reimmunization at 15 months of age.

Immune response in malnourished children with measles.

Abstract: Measles is one of the important exanthematous viral infections of childhood the outcome of which depends on the cell-medicated immune system of the host. Several clinical studies have highlighted the synergistic effects of measles and malnutrition. Based in a slum area of Hyderbad India this study investigated the effect of protein energy malnutrition on the clinical course outcome and immune status of children suffering from measles. 273 children under 5 years old were registered for the study. Their nutritional status was assessed in a baseline survey conducted 3-4 months before the peak season of measles and they were classified into various nutritional grades according to weight/age standards. The nutritional status was reassessed during the acute phase. Measles was diagnosed by characteristic features and antibody titres. The duration and complications of measles were similar between well-nourished and malnourished children. Cell-mediated immune response was low in children with measles irrespective of their nutritional status indicating the effect of measles per se on the immune status. Severe malnutrition did not have additional adverse effects. Specific lymphocyte proliferative response to measles antigen was satisfactory and similar in children belonging to all nutritional grades. Hemagglutination inhibition titers of measles antibodies were above protective levels in all the children with measles. These observations indicate that malnutrition per se may not influence the course and outcome of measles among the children in the present study. The differences in the responses and outcome of measles reported from African and Asian countries might be due to factors other than malnutrition. Further studies are needed to understand the racial and genetic factors involved in the differential host response to the virus which until now has been known to belong to only 1 strain worldwide.