39 Severe Illness (Atypical Exanthem) Following Exposure to Natural Measles. 11 Cases in Children Previously Inoculated with Killed Vaccine

Abstract

A cluster of cases of an unusual exanthem with high fever, myalgia, tachypnea and prostration occurred in children in R verton, Wyoming, in the spring of 1966. The initial macular rash characteristically began on the lower extremities and progressed cephalad. Most cases also developed vesicular lesions which were larger and less discrete than those seen in varicella and did not crust. A purpuric rash was noted in one instance. One child developed pneumonia and another had generalized edema. Epidemiologic investigation revealed that all 11 cases occurred among a group of 97 children who had received three injections of inactivated measles vaccine in 1962. All had a recent exposure to natural measles, their first, known exposure since receiving the inactivated vaccine four years previously. Of 31 children in this group who subsequently received live vaccine, two developed local reactions at the site of injection of live vaccine. Viral isolation attempts in four of the cases were negative. Serial serologic specimens from five atypical cases showed a greater than fourfold rise in CF and HAI measles antibodies in one case and a greater than fourfold fall in four cases. Initial samples in these four cases were obtained one to three weeks after onset of rash. CF antibodies to varicella and herpes simplex remained stable at low or undetectable levels. (APS)