Showing papers on "Measles published in 1992"
TL;DR: Measles is a severe illness in immunocompromised patients, and the absence of rash is frequent, while treatment is supportive, ribavirin requires further study.
Abstract: Objectives. —To describe the severity of measles in immunocompromised hosts and to assess preventive and therapeutic modalities. Data Sources. —Patients admitted to two academic medical centers between September 1989 and December 1990 and English language references obtained by MEDLINE from 1963 to 1991. Bibliographies were used to identify reports prior to 1963. Study Selection. —We identified nine immunocompromised patients with measles. Further analysis was based on 35 patients from two cohort studies of measles in oncology patients and 24 reported cases of measles in human immunodeficiency virus (HIV)—infected patients. Data Extraction. —Clinical data are presented from the nine patients we treated. Information concerning measles complications, presence of rash, use of prophylactic immunoglobulin, and therapeutic measures was extracted from the literature. Data Synthesis. —Of our nine patients, eight developed severe complications and two died. Two patients had no rash. In combining our patients with those from the literature, severe complications occurred in about 80%. The case fatality rate for severe measles was about 70% for oncology patients and about 40% for HIV-infected patients. Rash was absent in about 30%. The efficacy of prophylactic or therapeutic measures could not be assessed due to the small number of patients. However, we observed a rapid defervescence following administration of ribavirin. Vaccinated, HIV-infected patients had a lower mortality rate than those not previously vaccinated ( P =.06). Conclusions. —Measles is a severe illness in immunocompromised patients, and the absence of rash is frequent. While treatment is supportive, ribavirin requires further study. Measles vaccine may be efficacious in HIV-infected patients. Vaccination of oncology patients should be reassessed. ( JAMA . 1992;267:1237-1241)
295 citations
TL;DR: The clinical course in patients suggests that measles during pregnancy may be associated with serious complications, and an adverse fetal outcome such as abortion or prematurity was associated with their conditions.
Abstract: Twelve pregnant women and one woman who had just given birth were hospitalized with measles in Houston between 1988 and 1990. The most common and serious maternal complication was pneumonitis (seven patients). Other maternal complications included hepatitis (seven patients), premature labor (four patients), spontaneous abortion (one patient), and death (one patient). For four of 13 patients, all of whom had severe measles and pneumonitis due to measles virus, an adverse fetal outcome such as abortion or prematurity was associated with their conditions. Historical accounts describing maternal sequelae of measles have suggested more severe disease in pregnant women, although this observation has not always been confirmed by more recent reports in developed countries. The clinical course in our patients suggests that measles during pregnancy may be associated with serious complications.
124 citations
TL;DR: Findings reinforce results from animal studies that show that the pathways of vitamin A activity in decreasing morbidity and mortality are partly founded on selective immunopotentiation.
Abstract: The effect of vitamin A supplementation on selected factors of immunity was tested in African children (ages 4 to 24 months with complicated measles) during a randomized double-blind intervention trial. Placebo (n = 31) and treated groups (n = 29) had similar baseline characteristics. The supplemented group had significant reductions in morbidity (expressed as integrated morbidity scores) during the acute (Day 8, P = 0.006) and chronic (Day 42, P = 0.02; 6 months; P = 0.002) phases. In the treated group there was an increase in total number of lymphocytes (Day 42, P = 0.05) and measles IgG antibody concentrations (Day 8, P = 0.02), both of which have consistently been previously shown to correlate more closely with outcome in measles than other immunologic, clinical and radiologic factors. Interleukin 2 and plasma complement values were unaffected by vitamin A supplementation. These findings reinforce results from animal studies that show that the pathways of vitamin A activity in decreasing morbidity and mortality are partly founded on selective immunopotentiation.
118 citations
TL;DR: In this paper, the course of measles and results of MMR immunization in a cohort of human immunodeficiency virus-infected children were reported, and six cases of measles were identified.
Abstract: This study reports the course of measles and results of measles immunization in a cohort of human immunodeficiency virus-infected children. Six cases of measles were identified. All had typical clinical manifestations, 5 of 6 developed pneumonia and 3 of 6 died. A measles intervention program consisting of serologic screening and active immunization (measles-mumps-rubella (MMR)) was instituted in 1990. Among 127 children with data available for analysis (mean age, 6.7 years), only 35% had documentation of prior immunization with MMR. Among 80 children who had preimmunization measles serology reported, 56% were measles antibody-negative and 40% were antibody-positive; following intervention 36% remained measles antibody-negative. Six children lost measles antibody over time. MMR nonresponders had lower CD4 lymphocyte counts (303 +/- 394) compared with responders (865 +/- 677; P = 0.0058). Measles is a potentially fatal illness in human immunodeficiency virus-infected children. Prevention strategies are limited by low rates of age-appropriate MMR immunization, poor antibody responses to MMR in older human immunodeficiency virus-infected children and seroreversion.
112 citations
TL;DR: The incidence of SSPE has fallen following the reduction in measles resulting from vaccination, however, further cases arising from measles during the study period must still be expected, particularly in adolescents.
Abstract: Two hundred and ninety cases of subacute sclerosing panencephalitis (SSPE) registered in England and Wales from 1970 to 1989 were followed at 6-monthly intervals. Male to female ratio was 2.8:1. Age at onset increased significantly over the period. Measles was recorded for 81% of cases; in nearly half this had occurred under 2 years. Measles vaccine was documented in 20 cases; in 10 measles was also documented and it could not be positively excluded in the remainder. The calculated risk of SSPE following measles was 4.0/100,000 cases compared with the risk after vaccine of 0.14/100,000 doses. Measles under 1 year carried a risk 16 times greater than measles over 5 years. There was an excess of cases in third and subsequent children. The incidence was higher in the northwest than in the southeast of the country. Survival time varied from 4 weeks to 16 years and was shorter when measles had occurred over the mean age of 2.5 years. Of the cases 9% had a history of mental retardation before the onset of SSPE. The incidence of SSPE has fallen following the reduction in measles resulting from vaccination. However, because of the median 8-year interval between measles and onset of SSPE, further cases arising from measles during the study period must still be expected, particularly in adolescents.
110 citations
TL;DR: Efforts to prevent measles must be aimed at improving age-specific measles vaccination coverage among preschool-aging children, and implementation of a two-dose measles strategy among school-aged children.
Abstract: After almost a decade of relatively few reported cases, a major resurgence of measles occurred in the United States in 1989-1990. The increase primarily involved unvaccinated racial and ethnic minority children less than five years of age residing in inner-city areas. Outbreaks of measles among vaccinated school-aged children continued to occur but had less impact than outbreaks among preschool-aged children. Efforts to prevent measles must be aimed at improving age-specific measles vaccination coverage among preschool-aged children, and implementation of a two-dose measles strategy among school-aged children.
110 citations
TL;DR: This study provides 95% confidence that at least 97.5% of egg-allergic children will tolerate MMR vaccine without significant difficulty and recommends that the American Academy of Pediatrics consider revising its current policy regarding skin test response to MMR vaccine and administration of MMR vaccine to egg- allergic children.
107 citations
TL;DR: There is no mechanism similar to school immunization laws to achieve universal immunization of preschoolers; among vaccine-eligible preschoolers aged 16-59 months, 79% were unvaccinated (lOa).
Abstract: In 1978, the United States established the objective of completing the basic immunization series of at least 90% of children by age two years by the year 1990. Although state school immunization laws have led to the immunization of over 95% of school enterers (32), the situation among preschoolers is less encouraging. Recent outbreak investigations in many inner city areas have estimated that only 40-60% of children have completed the series by age two years (12, 13, 55). This low coverage among preschoolers is reflected in the recent resurgence of measles (7, 11, 57). In 1990, the number of reported measles cases (provisional total 27, 672) was the highest since 1977 (55, 201 cases reported), compared with a nadir of 1497 cases in 1983. Approximately one half of reported cases in 1990 Were among preschool children; among vaccine-eligible preschoolers aged 16-59 months, 79% were unvaccinated (lOa). There is no mechanism similar to school immunization laws to achieve universal immunization of preschoolers. State day care immunization laws only affect licensed centers, which care for an estimated 20% of children
93 citations
TL;DR: The recommended age for measles vaccination is based in part on information gathered when most mothers had natural measles but nowadays many mothers have received measles vaccine and measles antibody neutralization titers were determined for 278 mother-infant pairs.
Abstract: The recommended age for measles vaccination is based in part on information gathered when most mothers had natural measles. Nowadays many mothers have received measles vaccine. To assess this change measles antibody neutralization titers (NT) were determined for 278 mother-infant pairs. One hundred sixty-four mothers, born before 1958, likely had had natural measles (Group 1). Sixty mothers received one to three killed plus one attenuated measles vaccination (Group 2) and 54 received 1 attenuated measles vaccination only (Group 3). NT were determined for the mother and for the infant at birth and in the infant during the fourth and sixth months. Group 1 mothers and infants at every age had higher geometric mean NT than those in Groups 2 or 3 (P less than 0.05). By 7 months 65% of Group 1 infants and greater than 90% of Group 2 and 3 infants had an NT less than 1:10. The rate of antibody decay was significantly faster for Group 1 infants (P less than 0.05). Earlier vaccination in the infant should be considered.
85 citations
TL;DR: The molecular biology of measles virus (MV) and of other nonsegmented negative strand RNA viruses is currently subject to intense scrutiny for several reasons; unexpected phenomena such as biased hypermutation and RNA editing recently have been described.
Abstract: The molecular biology of measles virus (MV) and of other nonsegmented negative strand RNA viruses is currently subject to intense scrutiny for several reasons. First, acute MV infection is among the primary causes of infant death in third world countries (Bloom 1989). Second, on rare occasions, MV persistence induces lethal syndromes of the central nervous system known as subacute sclerosing panencephalitis (SSPE) and measles inclusion body encephalitis (MIBE) (reviewed in Ter Meulen et al. 1983). Third, unexpected phenomena such as biased hypermutation and RNA editing recently have been described for these viruses (reviewed in Billeter and Cattaneo 1991; Cattaneo 1990).
84 citations
TL;DR: The need for improved measles vaccination strategies in Africa and for studies to delineate the effects of HIV infection on the incidence, presentation, and sequelae of childhood infectious illnesses are highlighted.
Abstract: An increase in illness due to measles is one of the potential consequences of the human immunodeficiency virus (HIV) epidemic in Africa. During a study of perinatal HIV transmission conducted in Kenya, the risk of acquiring measles before vaccination (9 months of age) was found to be 3.8 times higher in infants born to HIV-seropositive mothers than in control infants (10 [9%] of 109 vs. 5 [3%] of 194 infants; P = .02; odds ratio, 3.8; 95% confidence interval, 1.2-13.2). The majority of infants who developed measles in this study had significant sequelae related to their measles infection. The increased risk of measles appeared to be related to relatively lower anti-measles antibody titers detected in cord blood samples of affected infants born to HIV-seropositive mothers. However, 94% of all infants were susceptible to measles on the basis of ELISA testing at age 6 months regardless of maternal HIV serology. These observations highlight the need for improved measles vaccination strategies in Africa and for studies to delineate the effects of HIV infection on the incidence, presentation, and sequelae of childhood infectious illnesses.
TL;DR: The data show that many children younger than 2 years in New York City have low vitamin A levels when ill with measles, and that such children seem to have lower measles-specific antibody levels and increased morbidity.
Abstract: • Recent studies show that vitamin A levels decrease during measles and that vitamin A therapy can improve measles outcome in children in the developing world. Vitamin A levels of children with measles have not been studied in developed countries. We therefore measured vitamin A levels in 89 children with measles younger than 2 years and in a reference group in New York City, NY. Vitamin A levels in children with measles ranged from 0.42 to 3.0 μmol/L; 20 (22%) were low. Children with low levels were more likely to have fever at a temperature of 40°C or higher (68% vs 44%), to have fever for 7 days or more (54% vs 23%), and to be hospitalized (55% vs 30%). Children with low vitamin A levels had lower measles-specific antibody levels. No child in the reference group had a low vitamin A level. Our data show that many children younger than 2 years in New York City have low vitamin A levels when ill with measles, and that such children seem to have lower measles-specific antibody levels and increased morbidity. Clinicians may wish to consider vitamin A therapy for children younger than 2 years with severe measles. Additional studies of vitamin A in measles and other infectious diseases, and in vaccine efficacy trials, should be done. ( AJDC . 1992;146:182-186)
TL;DR: During 1989 and 1990 measles incidence increased sharply in the United States, and incidence in 1990 was the highest in more than a decade, although all ages were affected and the greatest increases were in children < 5 years and in adults.
Abstract: During 1989 and 1990 measles incidence increased sharply in the United States. We compared cases reported during these years with those reported between 1981 and 1988. Incidence increased 462% in 1989, and incidence in 1990 (11.2/100,000) was the highest in more than a decade. Although all ages were affected the greatest increases were in children < 5 years and in adults. Incidence was 7- to 10-fold higher among racial/ethnic minority preschoolers than whites, and 80% of vaccine-eligible preschool age cases were unvaccinated. Complications occurred in 9418 (20.5%) cases, most frequently in young children and adults. Large urban outbreaks affecting predominantly unvaccinated preschoolers were common; 47% of all cases reported in 1990 were associated with 5 outbreaks. Reasons for the increased incidence are not clear. Current information suggests no change in vaccination coverage among preschool age children or in vaccine efficacy. Continued surveillance and evaluation of epidemiologic and laboratory data are necessary. The most pressing need is to improve age-appropriate vaccination among preschool age children.
Journal Article•
TL;DR: Humoral immunity to measles, rubella and mumps was studied in 63, 36 and 16 patients 1, 2 and 3 years, respectively after autologous bone marrow transplantation (ABMT), finding that children who have been immunized commonly lose their immunity after ABMT.
Abstract: Humoral immunity to measles, rubella and mumps was studied in 63, 36 and 16 patients 1, 2 and 3 years, respectively after autologous bone marrow transplantation (ABMT). Serologic examination was performed using antibody-ELISA. One year after ABMT, 7/57 patients (12%) who were seropositive to measles before ABMT, became seronegative, 8/44 (18%) to rubella and 3/51 (6%) to mumps. Among patients who were retested at 2 and 3 years, three more patients became seronegative to measles, one to rubella, and three to mumps. Nine of 12 children who had previously been immunized against measles were seropositive before ABMT, 3/7 to rubella and 5/7 to mumps, respectively. After ABMT, 5/9 became seronegative to measles, none to rubella and 2/5 to mumps. Six seronegative children were immunized with a live trivalent attenuated measles, mumps, and rubella vaccine 1 to 2 years after ABMT. Two children seroconverted to measles, six to rubella, and four to mumps. No side effects were observed. Most adult patients who have had the diseases of measles, rubella, or mumps naturally remain seropositive, while children who have been immunized commonly lose their immunity after ABMT.
TL;DR: A record audit of 254 children attending a public clinic in Los Angeles was conducted to assess immunization levels prior to a measles outbreak in the community, finding coverage with all vaccines appropriate for age decreased.
Abstract: A record audit of 254 children attending a public clinic in Los Angeles was conducted to assess immunization levels prior to a measles outbreak in the community. Coverage with all vaccines appropriate for age decreased from 67% at 3 months to 25% at 19 months. Delay in initiating vaccination was associated with increasing risk for delayed measles-mumps-rubella vaccine beyond age 2 years (P less than .05). In one third of children, health care providers missed an opportunity to administer measles-mumps-rubella vaccine. Recall systems and elimination of missed opportunities may increase vaccination levels in clinic populations. Record audits should be considered for use in guiding the management of immunization programs.
TL;DR: Measles, mumps, and rubella vaccine is associated with an increased risk of episodes of joint and limb symptoms, especially in girls and children under 5, and the risk of frank arthritis is substantially less than after wild rubella infection.
Abstract: OBJECTIVE--To assess whether the combined measles, mumps, and rubella vaccine increases the incidence of joint and limb symptoms in young children. DESIGN--Comparison of six week recalled incidence of symptoms in two groups of children: children who had been immunised at the start of the six weeks, and children eligible for immunisation but who had not received it. SETTING--South Manchester Health Authority. SUBJECTS--2658 children immunised during July 1989-February 1990 and 2359 not yet immunised. Questionnaires were returned for 1846 immunised children and 1075 not immunised. MAIN OUTCOME MEASURE--Recalled rate of joint and limb episodes determined by postal questionnaire and later by clinical follow up. RESULTS--Compared with non-immunised children the immunised group had an increased incidence of new episodes (relative risk 1.6 (95% confidence interval (1.2 to 2.1)) and first ever episodes, though this was not significant (1.7 (0.3 to 3.5)). The risk of first episodes was increased in girls (3.5 (1.1 to 12.2)) but not in boys (1.0 (0.4 to 2.6)). Similarly, an increased risk was seen in children aged under 5 (12.0 (1.6 to 92.3)) but not in older children (0.7 (0.3 to 1.5)). Most episodes were mild and self limiting, but three immunised children required hospital referral. CONCLUSION--Measles, mumps, and rubella vaccine is associated with an increased risk of episodes of joint and limb symptoms, especially in girls and children under 5. The risk of frank arthritis is substantially less than after wild rubella infection.
TL;DR: Modest improvements in low levels of immunization coverage among 2-year-olds confer substantial protection against measles outbreaks, and coverage of 80% or less may be sufficient to prevent sustained measles outbreaks in an urban community.
Abstract: Objective. —To examine the association between incidence of measles and immunization coverage among preschool-age children. Design. —An ecological study in which measles incidence was compared with immunization coverage among census tracts. The independent effects of race and population density were controlled for. Setting. —A recent measles outbreak in Milwaukee, Wis. Immunization coverage data were estimated from a retrospective, school-based survey of Milwaukee grade school students. Patients. —One thousand eleven persons (≤17 years) who had confirmed measles from September 1989 through June 1990. Main Outcome Measures. —Confirmed measles cases grouped by census tract, corresponding census tract preoutbreak immunization coverage, racial breakdown, and population density. Results. —Census tracts stratified into four levels, with mean immunization rates of 50.4%, 60.2%, 69.9%, and 81.0%, had respective median attack rates of 11.6, 5.0,1.7, and 0.0 cases per 1000 persons (P Conclusions. —Modest improvements in low levels of immunization coverage among 2-year-olds confer substantial protection against measles outbreaks. Coverage of 80% or less may be sufficient to prevent sustained measles outbreaks in an urban community. (JAMA. 1992;267:823-826)
TL;DR: The length of viremia and the proportion of peripheral blood mononuclear cells infected during measles were investigated in 8 adults and virus was identified by syncytia formation and confirmed by immunofluorescent staining.
Abstract: Measles viremia is thought to peak at onset of rash and diminish rapidly over the subsequent 2-3 days. The length of viremia and the proportion of peripheral blood mononuclear cells (PBMC) infected during measles were investigated in 8 adults. Blood was obtained from 7 patients between days 2 and 4 of rash. Five patients had repeat specimens obtained on day 6 or 7, and 1 patient had samples taken on days 6 and 10. Limiting dilutions of PBMC were cultivated with cord blood PBMC and stimulated with phytohemagglutinin. Virus was identified by syncytia formation and confirmed by immunofluorescent staining. Virus was isolated from all 8 patients. Four of 6 patients were still viremic at day 6 or 7 of rash. Titers ranged from 3 to 5623 TCID50/10(5) PBMC. Adults with measles may have prolonged viremia, and a large proportion of PBMC may be infected.
TL;DR: It is suggested that a small reduction in the prevalence or severity of rickets could have been critical in producing the downturn in whooping cough fatality, and that this was achieved less through dietary improvement than through changing childcare practices.
Abstract: In the late nineteenth century, death rates for infants remained high while those for children began to decline. Infant diarrhoea helped to maintain high death-rates among children under one year, but the reduction in fatality of several of the major infectious diseases of childhood improved prospects for older children. Paradoxically, death-rates for whooping cough, which is most fatal to infants under one, began to fall after 1870, whereas those for measles, most fatal in the second year of life, remained high. In an attempt to elucidate the paradox, this paper focuses on the influence of rickets, a specific deficiency disease, in determining the different patterns of the two diseases. Rickets is primarily a disease of weanlings, and was recognized by contemporary observers to influence the outcome of infections. The factors which influenced the prevalence and severity of rickets are examined, and the contribution of the disease to fatality in whooping cough and measles assessed. It is suggested that a small reduction in the prevalence or severity of rickets could have been critical in producing the downturn in whooping cough fatality, and that this was achieved less through dietary improvement than through changing childcare practices.
01 Jan 1992
TL;DR: It is clear that tremendous progress can be made in preventing death and disease from measles with existing knowledge about the disease, and by using the presently available vaccines and applying well-tried methods of treating cases.
Abstract: Measles is a highly infectious disease which has a major impact on child survival, particularly in developing countries. The importance of understanding the epidemiology of this disease is underlined by its ability to change rapidly in the face of increasing immunization coverage. Much is still to be learned about its epidemiology and the best strategies for administering measles vaccines. However, it is clear that tremendous progress can be made in preventing death and disease from measles with existing knowledge about the disease, and by using the presently available vaccines and applying well-tried methods of treating cases. Research in the coming decade may provide more effective vaccines for use in immunization programmes. An understanding of the basic epidemiology of measles is a prerequisite for effective control measures.
20 Nov 1992
TL;DR: Although reported measles cases decreased in 1991 compared with 1989-1990, only a sustained effort to provide age-appropriate vaccination will prevent another resurgence of measles.
Abstract: A total of 9,643 measles cases was reported from the United States in 1991, a 65.3% decrease from the 27,786 cases reported in 1990. The overall incidence of measles was 3.9 cases per 100,000 population. The highest age-specific incidence was among children < 12 months of age (46.9/100,000) and 1-4 years of age (19.6/100,000). Incidence rates among American Indians, Hispanic, and black children < 5 years of age were 19, 6, and 4 times that for non-Hispanic white children, respectively. More than 61% of all cases were reported from seven large outbreaks, which involved predominantly unvaccinated preschool-age children in large urban areas. Although reported measles cases decreased in 1991 compared with 1989-1990, only a sustained effort to provide age-appropriate vaccination will prevent another resurgence of measles.
TL;DR: It is suggested that children vaccinated while undergoing dialysis be tested to confirm serological evidence of immunity and contend that the relatively poor immunocompetence of dialysis patients explains their less than optimal vaccine response.
Abstract: Ten children receiving maintenance dialysis were immunized with the standard dose of measles-mumps-rubella vacine between 15 and 33 months of age. Immune responses to vaccination were determined using commercially available enzyme-linked immunosorbent assays for measles, mumps, and rubella viruses. Eight children responded to measles vaccine, 5 to mumps vaccine, 8 to rubella vaccine, and only 3 children to all three vaccines, compared with a seroconversion rate of over 90% to all three vaccines in healthy children (P<0.0001). We contend that the relatively poor immunocompetence of our dialysis patients explains their less than optimal vaccine response and suggest that children vaccinated while undergoing dialysis be tested to confirm serological evidence of immunity.
TL;DR: It is found that 50% of children with measles in Long Beach, Calif., were vitamin A deficient, which supports evaluation of vitamin A status as a part of acute management of measles in the United States.
TL;DR: High-dose EZ measles vaccine administered at 6 months of age is safe and highly immunogenic in both HIV-infected and uninfected children.
Abstract: #x2022;Objective —To compare the reactogenicity and immunogenicity of high-dose Edmonston-Zagreb (EZ) measles vaccine in children with and without human immunodeficiency virus, type 1 (HIV-1), infection Design —Prospective cohort study Setting —General pediatric clinic and home visits in Kigali, the capital of Rwanda Participants —Infants born to HIV-1—seropositive and—seronegative mothers were vaccinated with a 105050% tissue culture infective dose of EZ measles vaccine at 6 months of age Control visits were made 10 and 14 days later to monitor local and general reactions Measles serum antibodies were measured by an enzyme-linked immunosorbent assay technique at birth and at 6 and 9 months of age Three groups were compared: infected children (n=43), uninfected children born to seropositive mothers (n = 135), and uninfected children born to seronegative mothers (n=194) Results #x2014;Three hundred twenty-three children (868%) were available for the reactogenicity study No statistically significant difference between the three groups was found in the occurrence of minor adverse reactions No severe adverse reaction was observed One hundred ninety children (511%) were available for the immunogenicity study The percentage of infants negative for measles antibody at 6 months was significantly higher (P=021) in HIV-infected children (85%) and in uninfected children born to seropositive mothers (90%) than in uninfected children born to seronegative mothers (75%) The overall seroconversion rate at 9 months was 90% (95% confidence interval, 857% to 943%), without any statistically significant difference between the three groups Conclusion —High-dose EZ vaccine administered at 6 months of age is safe and highly immunogenic in both HIV-infected and uninfected children (AJDC 1992;146:550-555)
TL;DR: The geographic distribution of measles cases in the United States by county for the 10-year period from 1980 through 1989 was analyzed in this article, where data from the 1980 and 1990 US censuses were used to produce demographic profiles.
Abstract: Objective. —To describe the geographic distribution of measles cases in the United States by county for the 10-year period from 1980 through 1989. Design. —Ecological analysis of national measles surveillance data. Methods. —Measles cases reported to theMorbidity and Mortality Weekly Reportfrom 1980 through 1989 were analyzed. Data from the 1980 and 1990 US censuses were used to produce demographic profiles for each of the 3137 counties. Outcome variables examined included mean annual incidence and number of years reporting measles, with use of Spearman's rank correlation coefficients to examine the association between the demographic and the two outcome variables. Results. —A total of 56775 measles cases were reported during the decade. Of the nation's 3137 counties, 1690 (53.9%) did not report any cases; only 17 (0.5%) reported measles in all 10 years. Counties reporting measles more frequently during the decade had higher median populations, population densities, and percentage of black and Hispanic populations than those counties reporting less frequently. Population size, population density, and percentage of Hispanic population were associated with number of years reporting measles and mean annual measles incidence rate. Measles cases in counties reporting measles every year predominately occurred in unvaccinated preschoolers; cases in counties reporting less frequently predominately occurred in vaccinated school-aged children. Conclusions. —This analysis illustrates the focal nature of measles in the United States during the past decade. Most counties have not reported a single case of measles during the entire decade, and only 17 counties reported measles every year. Targeted strategies are needed to improve age-appropriate immunization levels among preschool-aged children living in large inner-city areas. (JAMA. 1992;267:1936-1941)
TL;DR: Significantly lower parasitic prevalences and mean densities of malaria parasites were found in children up to nine years of age who had measles or influenza than in asymptomatic control children, and children with pertussis had a higher prevalence and mean density than controls.
Abstract: In tropical countries, concomitant infections are a continuous problem. In the J?Jufiji Delta, an area of Tanzania that is holoendemic for malaria, there were outbreaks of influenza A, measles, and pertussis in 1986 and 1987. Significantly lower parasitic prevalences and mean densities of malaria parasites were found in children up to nine years of age who had measles or influenza than in asymptomatic control children. In contrast. children with pertussis had a higher prevalence and mean density than controls. The clinical courses of measles. influenza. or pertussis infections did not appear to be significantly affected by concomitant malaria infections. The reasons for the suppression or Pltlsmodium .(alciparum parasitemia during these viral infections are unclear. This effect could not be explained by the presence of fever. I
Journal Article•
TL;DR: The Nigerian Expanded Programme on Immunization (EPI) was assessed with particular reference to measles immunization, where 82 children who received measles vaccine at the Institute of Child Health, University of Ibadan, Nigeria, 82 (54.7%) seroconverted.
Abstract: The Nigerian Expanded Programme on Immunization (EPI) was assessed with particular reference to measles immunization. Of 150 children who received measles vaccine at the Institute of Child Health, University of Ibadan, Nigeria, 82 (54.7%) seroconverted. The immune response was directly related to the titre of the vaccines used. Vaccines whose titres were 10(-1) to 10(1.7) stimulated immune responses in 0-25% of vaccinees, those with titres in the range 10(-2.1) to 10(-2.5) stimulated responses in 12-47.6%, while those with titres of 10(-2.7) to 10(-3.4) stimulated responses in 87.5-100% of vaccinees. Only one of the vaccines used had a titre that met the minimum WHO required standard of log 10(-3) TCID50 at the point of vaccination.
TL;DR: Neither prior vaccination nor detectable SIR ensures protective immunity, and Measles virus may induce asymptomatic SIR in IgG-seropositive subjects.
Abstract: The rates of secondary immune response (SIR) and secondary vaccine failure (SVF) during a measles epidemic (10,184 notifications) were evaluated. A patient with SIR was defined as a subject for whom all sera were immunoglobulin G (IgG) positive and IgM negative with a significant increase in complement fixation titer. A patient with SVF was defined as a vaccinated symptomatic subject showing a SIR. Sequential sera from 898 subjects were tested for measles antibody by enzyme-linked immunosorbent assay (IgG and IgM) and by complement fixation. Evidence of recent anti-measles virus specific immune response was found in 496 subjects (55.5%). The vaccination rate was estimated at 74.6% (99% confidence interval [CI], 67.9 to 80.7%). The number of exposed vaccinated subjects was estimated at 370 (74.6% of 496). The SIR rate was 4.03% (20 of 496) (99% CI, 2.1 to 6.9%) among subjects with immune response. These 20 subjects were 2 with measles (Centers for Disease Control9s definition), 6 with measles with rash of unknown duration, 8 with presumed measles with either rash or fever, 3 asymptomatic subjects (2 with recent contact with a measles case), and 1 undocumented subject. Since 3 patients with SIR were asymptomatic and 2 others were documented as not vaccinated, there was a maximum of 15 probable occurrences of SVF among the 20 patients with SIR. The SVF rate among exposed vaccinated subjects was estimated at 4.05% (15 of 370) (99% CI, 1.9 to 7.5%). In conclusion, neither prior vaccination nor detectable SIR ensures protective immunity. Measles virus may induce asymptomatic SIR in IgG-seropositive subjects. SVF led to typical or modified measles but did not seem to have played an important role during this epidemic.
Journal Article•
TL;DR: Between February 8 and April 4, 1986, an outbreak of measles occurred in the State of Arkansas and more than 100,000 doses of combined measles-mumps-rubella vaccine were distributed at a cost greater than $1 million.
Abstract: Between February 8 and April 4, 1986, an outbreak of measles occurred in the State of Arkansas. A total of 489 suspected measles cases were reported from 53 counties; 86 schools statewide reported suspected measles cases. There were 284 cases confirmed in 18 counties; 23.6 percent among students in one university and 41.2 percent among students in kindergarten through 12th grade in 32 schools. An epidemiologic investigation was carried out to evaluate risk factors for vaccine failure and to assess the effectiveness of a selective revaccination strategy in the outbreak setting. A cohort study conducted at a junior high school showed that, compared with students vaccinated against measles at ages 15 months or older, those vaccinated at ages 12-14 months had a three-fold increased risk of measles (relative risk 3.2, 95 percent confidence interval 1.5, 6.9). For schools reporting measles, the Arkansas Department of Health and the Department of Education jointly required reimmunization of students vaccinated at ages younger than 15 months and the exclusion of students not vaccinated at ages 15 months or older until they were vaccinated or until 2 weeks after the last rash onset. To implement these recommendations, more than 100,000 doses of combined measles-mumps-rubella vaccine were distributed at a cost greater than $1 million.