Showing papers on "Measles published in 2004"
TL;DR: A significant proportion of deaths in young children worldwide is attributable to low weight-for-age, and efforts to reduce malnutrition should be a policy priority.
1,011 citations
TL;DR: It is shown that a formal game theoretical analysis of the problem of whether a sufficient proportion of the population is already immune, either naturally or by vaccination, leads to new insights that help to explain human decision-making with respect to vaccination.
Abstract: Voluntary vaccination policies for childhood diseases present parents with a subtle challenge: if a sufficient proportion of the population is already immune, either naturally or by vaccination, then even the slightest risk associated with vaccination will outweigh the risk from infection. As a result, individual self-interest might preclude complete eradication of a vaccine-preventable disease. We show that a formal game theoretical analysis of this problem leads to new insights that help to explain human decision-making with respect to vaccination. Increases in perceived vaccine risk will tend to induce larger declines in vaccine uptake for pathogens that cause more secondary infections (such as measles and pertussis). After a vaccine scare, even if perceived vaccine risk is greatly reduced, it will be relatively difficult to restore prescare vaccine coverage levels.
704 citations
TL;DR: Complication rates are higher in those <5 and >20 years old, although croup and otitis media are more common in those<2 years old and encephalitis in older children and adults.
Abstract: Forty years after effective vaccines were licensed, measles continues to cause death and severe disease in children worldwide. Complications from measles can occur in almost every organ system. Pneumonia, croup, and encephalitis are common causes of death; encephalitis is the most common cause of long-term sequelae. Measles remains a common cause of blindness in developing countries. Complication rates are higher in those 20 years old, although croup and otitis media are more common in those <2 years old and encephalitis in older children and adults. Complication rates are increased by immune deficiency disorders, malnutrition, vitamin A deficiency, intense exposures to measles, and lack of previous measles vaccination. Case-fatality rates have decreased with improvements in socioeconomic status in many countries but remain high in developing countries.
484 citations
151 citations
TL;DR: By the late 1950s, even before the introduction of measles vaccine, measles-related deaths and case fatality rates in the United States had decreased markedly, presumably as a result of improvement in health care and nutrition.
Abstract: In 1962, immediately preceding the licensure of the first measles vaccines in the United States, when measles was a nearly universal disease, Alexander Langmuir described the medical importance of measles to the country and put forth the challenge of measles eradication [1]. Although most patients recovered without permanent sequelae, the high number of cases each year made measles a significant cause of serious morbidity and mortality. Langmuir showed that 190% of Americans were infected with the measles virus by age 15 years [1]. This equated to roughly 1 birth cohort (4 million people) infected with measles each year. Not all cases were reported to the public health system; from 1956 to 1960, an average of 542,000 cases were reported annually. By the late 1950s, even before the introduction of measles vaccine, measles-related deaths and case fatality rates in the United States had decreased markedly, presumably as a result of improvement in health care and nutrition. From 1956 to 1960, an average of 450 measles-related deaths were reported each year (∼1 death/ 1000 reported cases), compared with an average of 5300 measles-related deaths during 1912‐1916 (26 deaths/ 1000 reported cases) [2]. Nevertheless, in the late 1950s, serious complications due to measles remained frequent and costly. As a result of measles virus infections, an average of 150,000 patients had respiratory complications and 4000 patients had encephalitis each year; the latter was associated with a high risk of neurological sequelae and death. These complications and others resulted in an estimated 48,000 persons with measles being hospitalized every year [3].
146 citations
TL;DR: Despite belief in the importance of immunization by a vast majority of parents, the majority ofParents had concerns regarding vaccine safety, and strategies to address important misperceptions about vaccine safety are needed.
Abstract: Objectives To identify parental perceptions regarding vaccine safety and assess their relationship with the immunization status of children. Design, Setting, and Participants Case-control study based on a survey of a sample of households participating in the 2000-2001 National Immunization Survey, a quarterly random-digit-dialing sample of US children aged 19 to 35 months. Three groups of case children not up-to-date for 3 vaccines were compared with control children who were up-to-date for each respective vaccine. Main Outcome Measure Measles-containing or measles-mumps-rubella, diphtheria and tetanus toxoids and pertussis or diphtheria and tetanus toxoids with acellular pertussis, and hepatitis B vaccination coverage. Results Among those sampled from the 2000-2001 National Immunization Survey, the household response rate was 2315 (52.1%) of 4440. Most respondents (>90%) in all groups believed vaccinations are important. In each case-control group, there was no significant difference between the percentage of case and control parents expressing general vaccine safety (range, 53.5%-64.1%). However, case parents were more likely to have asked that their child not be vaccinated for reasons other than illness (range, 10.2%-13.7% vs range, 2.9%-5.3%, respectively) and to believe their children received too many vaccinations (range, 3.4%-7.6% vs range, 0.8%-1.0%, respectively). Among the case-control group receiving a measles-containing or measles-mumps-rubella vaccination, only a small percentage of parents knew about the alleged association between autism and measles-mumps-rubella vaccinations (8.2%), and case parents were more likely to believe it than control parents (4.4% vs 1.5%, respectively; χ 2 P = .04). Conclusions Despite belief in the importance of immunization by a vast majority of parents, the majority of parents had concerns regarding vaccine safety. Strategies to address important misperceptions about vaccine safety as well as additional research assessing vaccine safety are needed to ensure public confidence.
115 citations
TL;DR: To address the possibility of worldwide control of measles, efforts to ensure high immunization rates among people in both developed and developing countries must be sustained.
Abstract: The annual number of reported measles cases in the United States has declined from between 3 million and 4 million in the prevaccine era to <100 cases in association with the highest recorded immunization rates in history. Because of continued importation of measles into the United States, young children who are not vaccinated appropriately may experience more than a 60-fold increase in risk of disease. Unsubstantiated claims suggesting an association between measles vaccine and neurologic disorders have led to reduced vaccine use and a resurgence of measles in countries where immunization rates have declined below the level needed to maintain herd immunity. To address the possibility of worldwide control of measles, efforts to ensure high immunization rates among people in both developed and developing countries must be sustained.
106 citations
TL;DR: The data suggest that currently recommended routine vaccinations are not a risk factor for asthma or eczema, and an association between vaccination and the development of allergic disease is found.
Abstract: Objectives. We examined the effect of vaccination for diphtheria; polio; pertussis and tetanus; or measles, mumps, and rubella on the incidence of physician-diagnosed asthma and eczema.Methods. We used a previously established birth cohort in the West Midlands General Practice research database.Results. We found an association between vaccination and the development of allergic disease; however, this association was present only among children with the fewest physician visits and can be explained by this factor.Conclusions. Our data suggest that currently recommended routine vaccinations are not a risk factor for asthma or eczema.
99 citations
TL;DR: Measles vaccination elicits T cell responses in infants as young as 6 months old, which may prime the humoral response to the second dose of vaccine, which is likely to have clinical benefits in developed and developing countries.
Abstract: Background Shifts in peak measles incidence to children Methods Fifty-five infants were vaccinated with measles vaccine at age 6 (n=32) or 9 (n=23) months, followed by measles-mumps-rubella (MMR)-II vaccine at age 12 months. A control group received MMR-II only at age 12 months. Measles-specific humoral and cell-mediated immunity were evaluated before, 12 weeks after measles immunization, and 24 weeks after MMR-II. Results Measles-specific T cell proliferation after both doses of vaccine was equivalent, regardless of age or the presence of passive antibodies. Seroconversion rates, geometric mean titers, and the percentage of infants with antibody titers >120 mIU after the first measles vaccine were lower in infants vaccinated at age 6 months, regardless of the presence of passive antibodies, but measles humoral responses increased after the administration of MMR-II vaccine in children initially vaccinated at age 6 or 9 months. Conclusion Measles vaccination elicits T cell responses in infants as young as 6 months old, which may prime the humoral response to the second dose. Initiating measles vaccination as an early 2-dose regimen results in an immunologic response that is likely to have clinical benefits in developed and developing countries.
95 citations
TL;DR: No significant association between AD births and exposure to population rates of measles infections, and no ‘step-up’ increase in AD births associated with the introduction of monovalent measles and MMR vaccines, and changing mumps strain are found.
Abstract: Background We examined whether, in the UK, there is an increased risk of autism (AD) following exposures, in early life, to: (1) wild measles; (2) live attenuated measles, alone or in combination as MMR; and (3) the alteration of the mumps strain within MMR. Method We conducted time trend analyses of 2407 AD subjects born between 1959-93; and for comparison, 4640 Down's syndrome (DS) subjects born between 1966-93. Between 1968-86, we correlated variations in AD and DS births with wild measles incidence. Between 1959-93, we tested for abrupt changes in the long-term AD birth trend for the effects of introducing: (1) monovalent measles vaccines in 1968; (2) MMR immunization in 1988; and (3) the 'overnight switch' from mixed use of Urabe MMR to exclusive use of Jeryl-Lynn MMR in 1992. Incidence rate ratios (IRRs) were used as measures of association. Results We found no significant association between AD births and exposure (prenatal and postnatal up to 18 months age) to population rates of measles infections, and no 'step-up' increase in AD births associated with the introduction of monovalent measles and MMR vaccines, and changing mumps strain. An unexpected reduction in AD births of 21% (95% CI 6.9-33.3%; P=0.005) among the post-1987 birth cohorts was detected. Conclusion No increased risk of AD following exposures to wild measles and vaccinations with monovalent measles, and Urabe or Jeryl-Lynn variants of MMR was detected. The precise meaning of the detected AD births reduction is unclear. Our study cannot exclude rare complications of MMR, given its correlational design.
94 citations
TL;DR: Evidence is provided that measurement of IgG avidity can be used to distinguish between primary and secondary vaccine failures in vaccinated patients with measles; the method can also be a useful tool for the evaluation of measles control programs in developing countries.
Abstract: Despite almost universal use of measles vaccines in recent decades, epidemics of the disease continue to occur. Understanding the role of primary vaccine failure (failure to seroconvert after vaccination) and secondary vaccine failures (waning immunity after seroconversion) in measles epidemics is important for the evaluation of measles control programs in developing countries. After a measles epidemic in Sao Paulo, Brazil, 159 cases previously confirmed by detection of specific immunoglobulin M (IgM) antibodies were tested for IgG avidity, and a secondary immune response, defined by an IgG avidity index of at least 30%, was established in 30 of 159 (18.9%) patients. Among the 159 patients, 107 (67.3%) had not been vaccinated and 52 (32.7%) had received one or more doses of measles vaccine. Of the 107 unvaccinated patients, 104 (97.2%) showed a primary immune response, defined as an IgG avidity index of less than 30%. Among the 52 patients with documented vaccination, 25 (48.1%) showed a primary immune response and 27 (51.9%) showed a secondary immune response, thereby constituting a secondary vaccine failure. Primary vaccine failure was observed in 13 of 13 patients vaccinated prior to 1 year of age and in 43.5 and 12.5%, respectively, of patients receiving one or two doses after their first birthdays. These results provide evidence that measurement of IgG avidity can be used to distinguish between primary and secondary vaccine failures in vaccinated patients with measles; the method can also be a useful tool for the evaluation of measles control programs.
TL;DR: Middle school-entry vaccination requirements can rapidly and substantially raise vaccination coverage among students subject to the law.
Abstract: Objectives. This study assessed the effectiveness of a middle school vaccination requirement for raising second-dose measles, mumps, and rubella vaccine and hepatitis B vaccine coverage among adolescents.Methods. Random-digit-dialed telephone surveys were conducted before (1998) and after (1999) the implementation of a vaccination requirement for entry into the seventh grade in San Diego, Calif.Results. Vaccination coverage was higher among children subject to the vaccination requirement (seventh-grade students; 60%) than among fifth- and sixth-grade students 1 year before the requirement (13%, P < .001), and 8th- through 12th-grade students not subject to the requirement (27%, P < .0001).Conclusions. Middle school–entry vaccination requirements can rapidly and substantially raise vaccination coverage among students subject to the law.
TL;DR: This review focuses on the structure of measles virus receptors, measles virus receptor function, isoforms and polymorphic forms to provide new insights into measles virus tropism and pathogenesis and, importantly, into possible mechanisms for vaccine non‐response.
Abstract: The success of vaccination against measles in developed countries has significantly reduced the incidence of measles-related morbidity and mortality. However, measles is still the leading cause of mortality in children from underdeveloped countries due to low vaccination coverage, high transmissibility of the measles virus as well as primary and secondary vaccine failure. As with any viral disease, the identification of the host molecule to which the measles virus binds and gains entry into the host cell is a major step in understanding the molecular pathology of the disease. Two cell surface receptors, CD46 and signaling lymphocyte-activation molecule (SLAM), have been identified as measles virus receptors. CD46 is ubiquitously expressed on all nucleated cells and acts as a receptor for the Edmonston strain and all vaccine strains derived from it. SLAM is selectively expressed on some T and B cells and is utilised by the Edmonston strain and wild-type strains that cannot use CD46 for cell entry. Understanding the structural and functional variations in measles virus receptors with regard to host response can facilitate the development of new vaccines as well as provide new insights into measles virus tropism and pathogenesis and, importantly, into possible mechanisms for vaccine non-response. Our review focuses on the structure of measles virus receptors, measles virus receptor function, isoforms and polymorphic forms.
TL;DR: The region of the Americas has shown extraordinary progress in its fight to interrupt measles transmission, but important challenges remain, including insufficient coverage during routine and campaign vaccination and inadequate investigation of some cases.
Abstract: The region of the Americas has shown extraordinary progress in its fight to interrupt measles transmission. The Pan American Health Organization's recommended strategy includes the following: a 1-time nationwide campaign targeting 1- to 14-year-old children; routine vaccination among 1-year-olds; and nationwide campaigns conducted every 4 years, targeting all 1- to 4-year-olds. Rapid house-to-house monitoring of vaccination and measles surveillance are other essential components of the strategy. During 2001, only 541 cases were confirmed in the region. In 2002, only Venezuela and Colombia had indigenous transmission. After important vaccination efforts in both countries, the last reported case occurred on 20 September 2002, in Venezuela. Since then, no confirmation exists of indigenous measles circulation anywhere else in the region. Nonetheless, important challenges remain, including insufficient coverage during routine and campaign vaccination and inadequate investigation of some cases.
TL;DR: Routine immunizations are effective in reducing overall mortality in young children in an area of high mortality, in contrast to findings reported from Guinea-Bissau.
Abstract: Background Non-specific beneficial as well as deleterious effects of childhood immunizations have been reported in areas of high mortality. This study aimed to determine the effects of diphtheria-tetanus-whole-cell-pertussis (DTP), BCG, hepatitis B, and measles vaccines on mortality in the highlands of Papua New Guinea (PNG). Methods Demographic events for children born in 1989‐1994 who were under monthly demographic surveillance in Tari were recorded from birth until age 2 years, outmigration, death, or the end of the study period. Data on BCG, hepatitis B, DTP, measles and pneumococcal polysaccharide vaccination were collected monthly from clinic records. To allow for different characteristics of immunized and nonimmunized children, analysis included conditioning on a propensity score for vaccination, adjusting for differences in children’s background characteristics. Results In all, 101/3502 children (3%) who had at least one vaccine died between ages 29 days and 24 months were compared to 112/546 (21%) who had none. BCG was associated with lower mortality in the 1‐5 month age group (hazard ratio [HR] = 0.17, 95% CI: 0.09, 0.34), measles vaccine with lower mortality at age 6‐11 months (HR = 0.42, 95% CI: 0.17, 1.01), and pneumococcal polysaccharide vaccine with lower mortality at age 12‐23 months (HR = 0.42, 95% CI: 0.19, 0.93). One or more doses of DTP was associated with lower overall mortality (HR = 0.27, 95% CI: 0.16, 0.44), particularly in the 1‐5 month age group (HR = 0.19, 95% CI: 0.10, 0.34), and also in those who had had prior BCG (HR = 0.45, 95% CI: 0.22, 0.91). Conclusion Routine immunizations are effective in reducing overall mortality in young children in an area of high mortality. In particular, DTP, whether considered separately or in addition to BCG, was associated with a lowering of overall mortality, in contrast to findings reported from Guinea-Bissau.
TL;DR: Neither age at infection with measles, rubella, varicella, mumps, pertussis and scarlet fever nor the cumulative number of these infections between the ages of 10 and 14 years was associated with the risk of multiple sclerosis.
Abstract: Multiple sclerosis has been hypothesized to be the result from an aberrant immune response possibly triggered by delayed exposure to a common childhood infection. Because the vast majority of previous studies testing this hypothesis have been based on a history of childhood infections recalled years to decades later in adulthood, we investigated whether age at six common childhood infections was associated with risk of multiple sclerosis, using information recalled in the childhood of a historical cohort of school children in Denmark. Cases included all individuals with multiple sclerosis in the country born between 1940 and 1975, who had attended school in the capital, Copenhagen. Controls were age- and sex-matched peers. School health records were obtained for all subjects. The records contained information on measles, pertussis, scarlet fever, birth order, sibship size, social class of the father, school years, and name of school and attended school classes for children born since 1940 (n(cases) = 455, n(controls) = 1801). For children born since 1950, the records also contained information on rubella, varicella and mumps (n(cases) = 182, n(controls) = 690). Neither age at infection with measles, rubella, varicella, mumps, pertussis and scarlet fever (upper age limit, 14 years) nor the cumulative number of these infections between the ages of 10 and 14 years was associated with the risk of multiple sclerosis. In addition, the risk of multiple sclerosis was not associated with birth order or social class. No clustering of multiple sclerosis in school classes was observed. Our findings suggest that measles, rubella, mumps, varicella, pertussis and scarlet fever, even if acquired late in childhood, are not associated with increased risk of multiple sclerosis later in life.
TL;DR: The article by Hviid et al. (April 1 issue) that suggests no link between childhood vaccination against measles, mumps, and rubella and type 1 diabetes has an important limitation that is all too common in clinical research.
Abstract: To the Editor: The article by Hviid et al. (April 1 issue)1 that suggests no link between childhood vaccination against measles, mumps, and rubella and type 1 diabetes has an important limitation t...
TL;DR: There have been 3 efforts to eliminate measles from the United States since the introduction of measles vaccine in 1963 and 10 major lessons have been learned from elimination efforts.
Abstract: There have been 3 efforts to eliminate measles from the United States since the introduction of measles vaccine in 1963. To date, 10 major lessons have been learned from elimination efforts. First, elimination requires very high vaccination-coverage levels by age 2 years. Second, school immunization requirements ensure high coverage rates among schoolchildren. Third, a second dose of measles vaccine is needed to achieve satisfactory levels of immunity. Fourth, school immunization requirements can also ensure delivery of a second dose. Fifth, coverage assessment is crucial. Sixth, measles surveillance is critical for developing, evaluating, and refining elimination strategies. Seventh, surveillance requires laboratory backup to confirm a diagnosis. Eighth, tracking measles virus genotypes is critical to determining if an endemic strain is circulating. Ninth, once endemic transmission has been interrupted, internationally imported measles cases will continue and will cause small outbreaks. Tenth, collaborative efforts with other countries are essential to reduce imported measles cases.
TL;DR: Although the current measles vaccine is very effective, knowledge of the molecular basis of the immune responses to measles virus could contribute to the development of a safer, more immunogenic measles vaccine.
TL;DR: Empirical and virological evidence suggests that endemic transmission of measles has been mostly interrupted since 1998 and multiple chains of transmission occurred in religious communities that actively oppose or resist immunization efforts.
Abstract: To describe the progress and challenges in achieving measles elimination in Canada, we analyzed national data on measles cases for 1998-2001. To assess the status of measles elimination in Canada, we estimated the effective reproductive number, R. Measles elimination was defined as the interruption of endemic transmission and failure to reestablish endemic transmission after importation. Twelve isolated cases, 29 cases (72.4% were linked to 2 outbreaks), 199 cases (96.9% were linked to 4 outbreaks of 2, 6, 30, and 155 cases), and 34 cases (73.5% were linked to 8 outbreaks of 2, 2, 2, 2, 3, 3, 3, and 8 cases) were reported in 1998, 1999, 2000, and 2001, respectively. R ranged from 0.58 to 0.95. Multiple chains of transmission occurred in religious communities that actively oppose or resist immunization efforts. Epidemiological and virological evidence suggests that endemic transmission of measles has been mostly interrupted since 1998.
TL;DR: Both magnitude of transplacental antibody passage and cord blood antibody values correlated with gestational age, and the decay of maternally acquired antibodies during infancy was studied.
Abstract: IgG antibody values against measles, mumps, rubella and varicella-zoster virus in 71 full term and 101 preterm infants and their 152 mothers and the decay of maternally acquired antibodies during infancy were studied. Both magnitude of transplacental antibody passage and cord blood antibody values correlated with gestational age. After 6 months preterm infants born before 32 weeks of gestation had lost maternal antibodies.
TL;DR: To evaluate the impact of actions taken in Italy since 1998 to improve vaccination coverage, a national EPI-survey was performed in 2003, and pertussis coverage reached the 95% target, and Hib is close to target.
TL;DR: In this article, the authors investigated the possibility of endemic transmission of measles in the United States during 1997-2001 and found that the remaining 178 (33%) "unknown-source" cases were analyzed as potential evidence of endemic measles transmission.
Abstract: Of the 540 measles cases (annual incidence, less than 1/million population) reported during 1997-2001 in the United States, 362 (67%) were associated with international importation: 196 imported cases, 138 cases epidemiologically linked to imported cases, and 28 cases associated with an imported measles virus genotype The remaining 178 (33%) "unknown-source" cases were analyzed as potential evidence of endemic measles transmission A total of 83 counties (26% of the 3140 US counties) in 27 states reported unknown-source cases; 49 counties reported only 1 unknown-source case, and the maximum reported by any county was 10 Nationally, unknown-source cases were reported in 103 of the 260 weeks The largest unknown-source outbreak included 13 cases and lasted 5 weeks The rarity of unknown-source cases, wide gaps in geographic and temporal distribution, and the short duration of the longest unknown-source outbreak indicate that endemic transmission of measles was not sustained in the United States during this period
TL;DR: The low positive predictive value of the clinical case definition in settings of low incidence demonstrates that serological confirmation is essential to ensure an accurate diagnosis of measles when measles is rare.
Abstract: An accurate system of identifying and classifying suspected measles cases is critical for the measles surveillance system in the United States. To examine the performance of the clinical case definition in predicting laboratory confirmation of suspected cases of measles, we reviewed 4 studies conducted between 1981 and 1994. A clinical case definition was examined that included a generalized maculopapular rash, fever (>or=38.3 degrees C, if measured), and either a cough, coryza, or conjunctivitis. Serological confirmation of measles was done either by hemagglutination inhibition assay, complement fixation assay, or enzyme immunoassays. The positive predictive value of the clinical case definition decreased from 74% to 1% as incidence decreased from 171 cases/100000 population to 1.3 cases/100000 population. Sensitivity was high, and for the larger studies with the most precise estimates, sensitivity was 76%-88%. The low positive predictive value of the clinical case definition in settings of low incidence demonstrates that serological confirmation is essential to ensure an accurate diagnosis of measles when measles is rare.
TL;DR: Persistence of antibody in these primarily 2-dose recipients supports the current elimination strategy to achieve and sustain high population immunity with a 2- dose schedule.
Abstract: Because measles-specific antibody titer after vaccination is lower than after natural infection, there is concern that vaccinated persons may gradually lose protection from measles. To examine the persistence of vaccine-induced antibody, participants of a vaccine study in 1971, with documentation of antibody 1-7 years after vaccination, were followed up in 1997-1999 to determine the presence and titer of measles antibody. Of the 56 participants (77% were 2-dose recipients), all had antibodies detected by the plaque reduction neutralization (PRN) antibody assay an average of 26-33 years after the first or second dose of measles vaccine; 92% had a PRN titer considered protective (>1 : 120). Baseline hemagglutination inhibition antibody titer in 1971 strongly predicted follow-up PRN antibody titer (P<.001). Persistence of antibody in these primarily 2-dose recipients supports the current elimination strategy to achieve and sustain high population immunity with a 2-dose schedule.
Journal Article•
TL;DR: Comparisons suggested changes in the mortality pattern after the introduction of HBV, particularly for girls, in areas with high mortality, HBV may affect girls’ and boys’ susceptibility to infections differently.
Abstract: Objective: Studies from high mortality areas have suggested that diphtheria-tetanus-pertussis may be associated with an increase in the mortality of girls relative to boys. We therefore examined whether hepatitis B vaccine (HBV) was associated with sex-specific differences in mortality. Design: As part of a randomized trial of measles vaccine a subcohort of 876 children was offered HBV at 7½ 9 and 10½ months of age. We examined whether this cohort differed in mortality rate and female-male mortality ratio compared with previous and subsequent birth cohort enrolled in the same trial. Setting: Four districts in Bissau the capital of Guinea-Bissau. Subjects: Six annual birth cohorts of 8906 children registered in the study area and followed from 1½ to 12 months of age between March 1995 and February 2001. Of these children 6399 took part in a 2-dose measles vaccination trial; of those born between March 1996 and February 1997 876 received HBV. Main Outcome Measures: (1) The mortality rate ratio (MR) between 7½ and 12 months and 1½ and 7½ months old children; (2) the female-male MR among trial children having received HBV plus measles vaccine or only measles vaccine. Results: In cohorts not receiving HBV the MR for children 7½-12 and 1½-7½ months of age was 0.97 [95% confidence interval (95% CI). 0.79- 1.24] whereas the MR was 1.62 (95% CI 1.09-2.41) in the cohort receiving HBV at 7½ months (test of homogeneity P = 0.030). Among children enrolled in the measles vaccination trial HBV-vaccinated children 7½-12 months of age had higher mortality than both prior and subsequent cohorts who had not received HBV (MR = 1.81; 95% CI 1.19-2.75) the difference being particularly strong for girls (MR=2.27; 95% CI 1.31-3.94). In the cohort who had received both HBV and measles vaccine the female-male MR between 9 and 24 months of age was 2.20 (95% CI 1.07-4.54) compared with 0.96 (95% CI 0.70-1.32) in trial participants who had received measles vaccine only (test for homogeneity P = 0.040). With longer follow-up these tendencies remained the same. Conclusions: These comparisons suggested changes in the mortality pattern after the introduction of HBV particularly for girls. Hence in areas with high mortality. HBV may affect girls and boys susceptibility to infections differently. (authors)
TL;DR: The recommended age for first vaccination with measles-mumps-rubella at 12-15 months is supported, and the seroconversion rate of rubella paralleled that of measles, with the lowest rates in children vaccinated at 9 months of age whose mothers were born in or before 1963.
Abstract: To determine seroconversion rates with measles-mumps-rubella vaccine administered to children at 9, 12, or 15 months of age, we undertook a prospective randomized trial. Among children vaccinated at 15 months of age, 98% seroconverted to measles, compared with 95% of those vaccinated at 12 months of age and 87% of those vaccinated at 9 months of age. In each age group, children of mothers born in or before 1963 had lower rates of seroconversion against measles, with the lowest rate in children vaccinated at 9 months. The seroconversion rate of rubella paralleled that of measles, with the lowest seroconversion rates in children vaccinated at 9 months of age whose mothers were born in or before 1963. The response to mumps varied little by age of the child or birth year of the child's mother. These results support the recommended age for first vaccination with measles-mumps-rubella at 12-15 months.
TL;DR: Data on the genetic determinants of immune responses to the measles vaccine support the importance of HLA genes in determining the variation in vaccine response, and may provide important insights for the design and development of new peptide-based vaccines against measles and other pathogens.
Abstract: Genetic polymorphisms of the human leukocyte antigen (HLA) system significantly influence the variation in immune responses to viral vaccines. Considerable data on the genetic determinants of immune responses to the measles vaccine support the importance of HLA genes in determining the variation in vaccine response. HLA class I and class II, TAP, and HLA-DM allele associations with measles-specific antibody levels following measles vaccination have revealed, in part, the immunologic basis for mechanisms of measles immunity variation. Associations between HLA genotype and immune responses have also been reported for other vaccines and infectious diseases, such as hepatitis B and C, human papillomaviruses, and influenza. Vaccine pharmacogenomics may provide important insights for the design and development of new peptide-based vaccines against measles and other pathogens.
TL;DR: The United States experience provides evidence that sustained interruption of transmission can be achieved in large geographic areas, suggesting the feasibility of global eradication of measles.
Abstract: Lessons learned from the successful end of endemic measles virus transmission (i.e., elimination) in the United States include the critical roles of strong political commitment, a regionwide initiative, adequate funding, and a broad coalition of partners. Implications of measles elimination in the United States for global measles control and regional elimination efforts include demonstration of the high vaccination coverage and, in turn, population immunity needed for elimination; the importance of accurate monitoring of vaccination coverage at local, state, and national levels; a vaccination strategy that includes at least 2 opportunities for measles immunization; and the essential role of integrated epidemiological and laboratory surveillance. The United States, with a population of 288 million, is, to our knowledge, the largest country to have ended endemic measles transmission. This experience provides evidence that sustained interruption of transmission can be achieved in large geographic areas, suggesting the feasibility of global eradication of measles.