Anti-measles IgM Research Articles

Differential diagnosis on measles and rubella discarded cases highlights a sharp increase in parvovirus B19 infections in Milan, Northern Italy, in the first months of 2024.

In line with European trends, since 2023 Lombardy (Northern Italy) is experiencing a resurgence of measles and an increased number of reported cases of fever and rash. Measles discarded cases observed in our region within the context of measles and rubella surveillance from the first few months of 2024 (N = 30) were investigated for parvovirus B19 (B19V) and other rash-associated viruses. Thirteen cases tested positive for B19V DNA, representing a significant increase from previous years (on average 3 cases per year, p < 0.001) and ~40% of all B19V DNA-positive patients we detected since 2017. In 2024, B19V DNA-positive subjects spanned all ages, and the virus was predominant among adolescents and adults (84.6%). Two B19V infected patients were hospitalised, and likely cross-reacting anti-measles virus IgM were found in both. Our data align with the recent reports from the ECDC and various European countries, which are experiencing a surge in B19V infections, and underline the importance of comprehensive measles and rubella surveillance systems that can adapt to changing epidemiological trends.

Epidemic management in a measles outbreak in 2023, the return of vaccine–preventable diseases: A single center, retrospective observational study

Objective: To investigate the importance of immunization in preventing measles infection and to determine the most useful laboratory tests for confirmation of measles. Methods: This study included pediatric cases evaluated with a presumed diagnosis of measles between December 2022 and June 2023, at Marmara University Pendik Training and Research Hospital. The effects of vaccination status and underlying disease on the clinical course, treatments, and complications were evaluated. Results: In total, 117 patients were enrolled in the study with a median age of 80 months (IQR: 32.5-125.0). Twelve patients with contact history were asymptomatic and had an underlying disorder, and intravenous immunoglobulin was given to them for post-exposure prophylaxis. Fifty-one patients had confirmed measles diagnosis. Ribavirin treatment was given to three patients (a newborn, a girl with rhabdomyosarcoma, and a healthy boy) with respiratory distress. Seventy-eight percent of confirmed measles cases were unvaccinated, and all hospitalized cases were unvaccinated or under-vaccinated. Four full-vaccinated children had confirmed measles infection. Measles PCR from nasopharyngeal swabs was negative in all of them, and their diagnosis was established with anti-measles IgM positivity. Conclusions: The measles vaccine is the most effective way to protect from measles and measles-related complications. Although measles can also occur in fully vaccinated patients, the disease is milder than in unvaccinated patients. Using ELISA and RT-PCR tests together may be beneficial in patients with high clinical suspicion for early diagnosis.

The Rate of Anti-measles Immunoglobulin M Positivity among Children with Skin Rash and Fever in Diyala Province

Abstract Background: Measles is an extremely contagious disease characterized by generalized maculopapular rash, fever, cough, coryza, and conjunctivitis. It is caused by the measles virus. Objective: The objective of this study was to explore the anti-measles immunoglobulin (Ig) M positivity rate among children with clinical suspicion of having measles. Subjects and Methods: This is a cross-sectional study carried out in Diyala Province, Iraq, from November/2020 to October/2021. A total of 425 blood samples were collected from children (≤14 years of age): 90 from patients who were clinically suspected as having measles (18 were vaccinated with measles vaccine and 72 were not); 270 from measles-vaccinated children, including those children who received all recommended vaccines in the Iraqi Expanded Program of Immunization (IEPI); and 65 from nonvaccinated children, including those children who received none of the vaccines in the IEPI. Enzyme-linked immunosorbent assay (ELISA) kits for the detection of anti-measles IgM were used. Results: The results found that 14 (15.6%) of clinically suspected children were positive for anti-measles IgM antibody versus 76 (84.4%) who were negative. Whereas, only one (1.5%) of the unvaccinated children was positive, and all vaccinated children were negative. Thus, clinically suspected patients had a significantly higher positivity rate compared to other study groups (P = 0.0001). Similarly, the mean ± standard deviation of anti-measles IgM concentration was significantly higher compared to other study groups (P = 0.0001). Conclusion: About one-sixth of patients clinically comparable to measles in Diyala Province actually had measles, most of them were unvaccinated, and the anti-measles IgM ELISA technique was a good marker for exploring measles cases.

Evaluation of a rapid diagnostic test for measles IgM detection; accuracy and the reliability of visual reading using sera from the measles surveillance programme in Brazil, 2015.

Laboratory-based case confirmation is an integral part of measles surveillance programmes; however, logistical constraints can delay response. Use of RDTs during initial patient contact could enhance surveillance by real-time case confirmation and accelerating public health response. Here, we evaluate performance of a novel measles IgM RDT and assess accuracy of visual interpretation using a representative collection of 125 sera from the Brazilian measles surveillance programme. RDT results were interpreted visually by a panel of six independent observers, the consensus of three observers and by relative reflectance measurements using an ESEQuant Reader. Compared to the Siemens anti-measles IgM EIA, sensitivity and specificity of the RDT were 94.9% (74/78, 87.4-98.6%) and 95.7% (45/47, 85.5-99.5%) for consensus visual results, and 93.6% (73/78, 85.7-97.9%) and 95.7% (45/47, 85.5-99.5%), for ESEQuant measurement, respectively. Observer agreement, determined by comparison between individuals and visual consensus results, and between individuals and ESEQuant measurements, achieved average kappa scores of 0.97 and 0.93 respectively. The RDT has the sensitivity and specificity required of a field-based test for measles diagnosis, and high kappa scores indicate this can be accomplished accurately by visual interpretation alone. Detailed studies are needed to establish its role within the global measles control programme.

Sero-survey of measles virus antibodies among symptomatic children attending Abuja Teaching Hospital, Nigeria.

Background: Nigeria is one of the countries with a high prevalence of measles outbreak in children under 5 years old, despite a history of vaccination. This study aims to determine the prevalence of anti-measles virus IgM and IgG among children under 5 years attending the University of Abuja Teaching Hospital (UATH), Gwagwalada, FCT Abuja, Nigeria.Materials and methods: Whole blood was collected, centrifuged, and serum anti-IgM and anti-IgG against measles virus was analysed using ELISA. Sociodemographic variables and vaccination history of subjects were obtained by interview-based questionnaires.Results: The overall anti-Measles virus IgG and IgM seroprevalences were 29.2% and 14.6%, respectively. The prevalence of measles IgG was significantly associated with the parent’s employment status (X2=11.67, p=0.008). However, the prevalence of measles virus IgM was significantly associated with children’s age (X2=16.62, p=0.002), parents’ employment status and children’s vaccination status (X2 =7.72, p=0.02).Conclusion: A majority of study participants were not immunised against measles, and a significant number of participants had serological evidence of acute measles virus infection. There is a need for more concerted and massive measles vaccination of children.

The Resurgence of Measles Infection and its Associated Complications in Early Childhood at a Tertiary Care Hospital in Peshawar, Pakistan.

Measles infection is of substantial interest to immunologists due to its paradoxical interaction with the immune system. After the acquisition of the measles infection, secondary infection plays a pivotal role in measles-related deaths. A cross-sectional study conducted between December 2018 and July 2019 is presented here. A total of one hundred children of both genders presented with measles complications were included following WHO criteria. Measles confirmation was done by quantitative determination of anti-measles antibodies (IgM) in patients’ sera while patient-related demographic data, vaccination status, and other clinical information were obtained on a separate form. The number of female patients (52%) slightly exceeded the number of males (48%). 43% of patients’ parents were illiterate, and half of the patients (50%) were from a poor background. The majority of children (76%) who presented with the complications did not receive a measles vaccine. 56% of children were breastfed while 58% received vitamin A supplements but developed complications. The elevated levels of anti-measles IgM were observed in 77% of cases. In both genders, the major complications were pneumonia, lower respiratory tract infection (LRTI), acute diarrhea, diarrhea and LRTI, pneumonia and diarrhea, otitis media and pneumonia, myocarditis and LRTI, and pneumothorax. The majority of the infected children (n = 48) under 12 months of age had associated complications. It has been observed that the measles virus strikes early age children in the northwestern region of Pakistan, which is an alarming situation and is associated with the aforementioned complications, especially in unvaccinated children. Anti-measles IgM is an important serological parameter for early diagnosis of measles infection.

Formation of humoral and cellular immunity to measles vaccine in adults

Despite adherence to the policy of mass measles vaccination in the majority of countries, this infection still remains far from being fully eradicated. Measles outbreaks are reported worldwide, when the vast majority of cases are recorded in subjects of 18—35 years of age. Studies on assessing measles IgG antibody level in different regions of Russia reveal increased percentage of measles seronegative subjects among young adults. Current study was aimed at investigating formation of humoral and cellular immunity after measles vaccination in seronegative adults aged 18 to 30 years old. There were enrolled 50 measles seronegative healthy volunteers aged 18 to 30 years old. Level of anti-measles IgM and IgG antibodies was measured by ELISA (Vector-Best, Russia). Subclasses of measles specific IgG antibodies were analyzed by ELISA, by replacing IgG conjugate for IgG1, IgG2, IgG3, IgG4 conjugates, whereas measles specific IgA antibodies were estimated by ELISA with IgA conjugate (Polygnost, Russia) at a concentration of 1 μg/ml. Antibody avidity was assessed by ELISA (Euroimmun, Germany). Cell-mediated measles immunity was estimated by CD107a surface expression on CD8hi T cell subset stimulated by measles virus-derived antigens. A specific cellular response to measles antigens before vaccination was detected in 50% of examined subjects, whereas 40% samples showed no signs of cellular immune response, with 10% of remaining cases described as equivocal. It was found that 6 weeks after vaccination all vaccinated subjects developed measles specific IgG antibodies at protective level reaching 1.33 (0.85—1.82) IU/ml [Me (LQ—UQ)]. Anti-measles IgA antibodies were of 0.655 (0.423—1.208) IU/ml [Me (LQ—UQ)]. However, no measles specific IgM antibodies were detected 6 weeks after vaccination. In addition, primary type of immune response (dominant low-avidity anti-measles antibodies IgG3 subclass) to measles vaccination was observed in 24 out of 50 subjects, whereas 26 subjects developed secondary type of immune response (high-avidity anti-measles antibodies dominated by IgG1 subclass). A measles specific cellular immune response was observed in 47 of the 50 examined subjects, and in 3 volunteers it was equivocal. Further analysis revealed a cohort of subjects who were not vaccinated against measles (18 subjects), although 60% of them provided medical record on previous dual measles vaccination occurred in childhood. Another cohort consisted of subjects who had medical record of measles vaccination in childhood (32 subjects), but lost protective measles antibodies produced by plasma cells (23 subjects), and memory T cells (3 subjects), or measles antibodies and memory B cells (6 subjects) over time. Such pattern evidences that measles-specific cellular and humoral arms immune responses were developed and maintained independently of each other.

An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting

BackgroundMeasles is a recurrent health problem in both advanced and developed countries. The World Health Organization (WHO) recommends anti-measles immunoglobulin M (Ig M) as the standard method of detecting the virus; however, many areas still present the inability to perform a serology test of anti-measles IgM. Therefore, a typical clinical feature is necessary to establish the diagnosis of measles. The objective of this study was to evaluate hyperpigmented rash and other clinical features as the diagnostic tools with respect to measles, especially in an outbreak setting.MethodsIn this observational diagnostic study, the inclusion criteria were as follows: between 6 and 144 months of age, fever, maculopapular rash for 3 days or more, accompanied by a cough, or coryza, or conjunctivitis. Those with a prior history of measles vaccination (1–6 weeks) were excluded, in addition to those with histories of corticosteroid for 2 weeks or more and immunocompromised conditions. The samples were taken from Dr. Soetomo General Academic Hospital in Surabaya, Indonesia. We evaluated the sensitivity, specificity, the positive predictive value, and the negative predictive value of such clinical features. Hyperpigmented rash was validated using Kappa and Mc Nemar tests. Anti-measles Ig M was considered as the gold standard.ResultsThis study gathered 82 participants. The clinical manifestations of all subjects included fever, cough, coryza, conjunctivitis, Koplik spots, and maculopapular rash (which turns into hyperpigmented rash along the course of the illness). Most maculopapular rashes turn out to be hyperpigmented (89%). Sensitivity, specificity, positive predictive value, and negative predictive values ​​of the combination of fever, maculopapular rash, and hyperpigmented rash were found to be at 90.7, 28.6, 93.2, and 22.2%, respectively. The Mc Nemar and Kappa tests showed p values of 0.774 and 0.119, respectively.ConclusionThe combination of fever, maculopapular rash, and hyperpigmented rash can be used as a screening tool regarding measles infection in an outbreak setting, which can then be confirmed by anti-measles Ig M. Cough, coryza, and Koplik’s spot can be added to this combination, albeit with a slight reduction of sensitivity value.

The laboratory investigation of a measles outbreak in the eve of its elimination in Sri Lanka

BackgroundMeasles is highly contagious and cause significant morbidity and mortality. Sri-Lanka has the goal to eliminate endogenous measles by 2020 in par with WHO. ObjectiveTo describe laboratory confirmation and genotype distribution of measles cases during the outbreak occurred from mid-March to May 2019, Sri-Lanka Study designThis retrospective study was conducted at National Measles Reference Laboratory (NMRL), Sri-Lanka. All samples received were tested according to the testing flow chart at NMRL with WHO recommended kits. Blood samples were tested for anti-measles IgM and IgG with IgG avidity for IgG positives. Samples within 5days post-onset rash were tested with measles real-time RT-PCR. Products of genotyping PCR were sent to Regional Reference Laboratory, Thailand for sequencing. Subsequent phylogenetic analysis was done at NMRL. Data were analyzed by descriptive statistics. ResultsA total of 182 blood and 46 throat/nasopharyngeal swabs were received from 195 suspected cases and 37(19 %) were positive for measles by anti-measles IgM, rRT-PCR or both. Majority was females, with mean age of 20 years. Cases represented three main geographical areas; Western-35 %, Central-32 % and Southern-27 %. High avidity IgG was detected in 27/37(73 %). Sequencing data of six cases (4 from Western and 2 from Central province) revealed genotype D8. ConclusionNineteen percent of the suspected patients were measles positive with 73 % having re-infections. Majority were 22 years or over. Measles genotype was D8 in two provinces, suggesting the spread of virus within the country. Laboratory confirmation with measles PCR; IgG avidity and sequencing/genetic analysis is critical in the verge of measles elimination.

Measles in pregnancy: a threat for Italian women?

ABSTRACT Measles in pregnancy may lead to serious sequelae for newborns and mothers. In Italy assessment of immunity against measles is not recommended as pregnancy screening. This study aimed to assess the immunity against measles in pregnant women from Apulia Region in Southern Italy between 2016 and 2017. Overall, 96.9% of pregnant women were positive for anti-measles IgG, younger women aged 19–29 years had a seroprevalence below 90%. No samples were positive for anti-measles IgM. In conclusion, younger pregnant women showed to be at higher risk of contracting measles during pregnancy. These findings have implication for measles vaccination policy and highlight the need for measles antibody testing in pregnancy screening in Italy.

Progress towards elimination of measles in Kenya, 2003-2016.

IntroductionMeasles is targeted for elimination in the World Health Organization African Region by the year 2020. In 2011, Kenya was off track in attaining the 2012 pre-elimination goal. We describe the epidemiology of measles in Kenya and assess progress made towards elimination.MethodsWe reviewed national case-based measles surveillance and immunization data from January 2003 to December 2016. A case was confirmed if serum was positive for anti-measles IgM antibody, was epidemiologically linked to a laboratory-confirmed case or clinically compatible. Data on case-patient demographics, vaccination status, and clinical outcome and measles containing vaccine (MCV) coverage were analyzed. We calculated measles surveillance indicators and incidence, using population estimates for the respective years.ResultsThe coverage of first dose MCV (MCV1) increased from 65% to 86% from 2003-2012, then declined to 75% in 2016. Coverage of second dose MCV (MCV2) remained < 50% since introduction in 2013. During 2003-2016, there were 26,188 suspected measles cases were reported, with 9043(35%) confirmed cases, and 165 deaths (case fatality rate, 1.8%). The non-measles febrile rash illness rate was consistently > 2/100,000 population, and “80% of the sub-national level investigated a case in 11 of the 14 years. National incidence ranged from 4 to 62/million in 2003-2006 and decreased to 3/million in 2016. The age specific incidence ranged from 1 to 364/million population and was highest among children aged < 1 year.ConclusionKenya has made progress towards measles elimination. However, this progress remains at risk and the recent declines in MCV1 coverage and the low uptake in MCV2 could reverse these gains.

Epidemic Outbreak of Measles in the Region of Plovdiv, Bulgaria (March-July 2017)

Object: To analyze the clinical, epidemiological and laboratory characteristics of the cases with measles in the Plovdiv region, Bulgaria, in the period March-July 2017. Materials and Methods: The study included 139 hospitalized patients with measles, treated in the Clinic of Infectious Diseases, University Hospital “St. George”—Plovdiv, during the observed period. Diagnosis was verified by ELISA in 133 of the patients. The following methods were used: clinical and epidemiological analysis, laboratory, microbiological and imaging tests. Results: The age distribution of the patients was: infants below 1 year were 23.8%; 1 - 3 years—24.5%; 4 - 17 years—30.9%; and over 18 years —20.8%. Ethnicity: from Roma origin were 83.5% and Bulgarians—16.5%. Most of the patients (62%) reported contact with a measles patient. Ninety eight of the patients were over 13 months of age and they should have been immunized, as the vaccine in Bulgaria is applied on the 13 month. Of these 98 patients, 49% were immunized, 28% were not, and for 23% there were not data. The most common clinical symptoms were: fever—97.1%, cough—98.6% and runny nose—82.7%. Conjunctivitis was observed in 82%, asthenia in 46%, and diarrhea in 51.1%. The rash appeared average on the 4th day of the onset of complaints. Koplik’s spots were observed in 71.9%, cervical lymphadenopathy in 56.1%, hepatomegaly—in 25.2%, and splenomegaly—in 7.9%; auscultation data for bronchitis/pneumonia—in 33.1%. Laboratory tests: leucopenia in 32.4%, leukocytosis—2.2%, normal results—in the rest 65.4%. ESR was increased in 39.1% and CRP in 76.5% of the patients. X-ray of the lung was performed under indication and was positive in 28/46. The serological test—anti-measles IgM (ELISA) was positive in 95.7% (133/139). We observed the following complications: pneumonia—12.2%, bronchitis—15.1%, laryngitis—4.3%, otitis—1.4%, gastroenteritis—14.4% and stomatitis—6.5%. The outcome was fatal for one patient. Conclusions: Measles still prevails during the age of childhood, but 20.8% of the patients were adults. The analysis of the patient’s immunity showed that the lap of immunization was the main cause for periodical arising of epidemic outbreaks, although the programs for elimination of measles in Europe until 2020. The disease ran with typical course but we observed a higher rate of complications.

Measles Oral Swab as Field-Based Screening Test in Children

BackgroundIndonesia suffered from measles outbreak for many times, especially in the last five years. Most patients were children. WHO used measles specific Ig M from the blood as a gold standard but this test is invasive. Anti measles Ig M oral swab has been used as an alternative however there has not been any study about this method in Indonesia. The objective of this study was to validate anti measles Ig M oral swab for the diagnosis of measles in children.MethodsThis study was performed in Dr. Soetomo Hospital in Surabaya for three months period. Children with fever and rash suspected having measles according to WHO criteria were used as samples. Inclusion criteria included age 6 month until 15 year-old, with maculopapular rash, fever for at least three days, and at least one of cough, coryza, and conjunctivitis. Immunocompromized children and those with history of fever and rash or measles vaccination in the last 8–12 weeks were excluded. A blood specimen for serum anti measles Ig M and oral swab using transudate in gingivo-cervicular sulcus were taken at the same time. Method for oral swab specimen was microimmune(EIA) captured antibody assay for measles IgM. Measles specific IgM antibodies from blood specimen were measured by Enzygnost anti measles IgM. Mc Nemar test and kappa were used to analyze the results with P < 0.05.ResultsThere were fifty-six children in the study. The age range was 6 – 72 months. Boys outnumbered girls with ratio 1.6:1. Most patients came on day third-sixth of illness. As much as 75.7% of the children were not immunized. Antimeasles Ig M were truly positive by both methods in fifty sampes. Detection of Ig M antibodies were similar either by using serum or oral swab (Mc Nemar, P = 1,00). The best ROC curve to detect anti measles IgM by oral swab was shown at the value of 0.2 (sensitivity 98%, specificity 60%, Kappa 0.638 with P < 0.0001, PPV 96%, and NPV 75%) For the value of 0.5 we had sensitivity 90%, specificity 80%, PPV 98%, NPV 44%, and Kappa 0.516 with P < 0.001.ConclusionAnti measles IgM oral swab is highly sensitive and can be used as a field-based alternative screening method to diagnose measles infection.Disclosures All authors: No reported disclosures.

Root-Cause Analytical Survey for Measles Outbreak: Vaccination or Vaccine?- A Study From Madhepura District, Bihar, India.

Though measles is a vaccine preventable disease, outbreaks still continue to occur because of poor immunization coverage rate at the national level. To report the survey results of an outbreak of measles in Puraini village of Madhepura district in Bihar, India. This cross-sectional survey was conducted among children aged 6 months to 12 years during an outbreak of measles in December 2008. WHO case definition criteria was used to define active measles cases. Demographic data, immunization status, and disease outcome among the cases was obtained by pre-structured questionnaires. Blood samples from 5 cases were sent for laboratory confirmation. A total of 52 cases and 8 deaths were reported with an attack rate of 28% and case fatality rate of 15.4%. Out of 35% cases of post-measles complications, dysentery with pneumonia was the most common. Anti-measles IgM antibody tested positive in all the 5 serum samples sent for confirmation. No child had received measles vaccination in the past, and the reasons were lack of awareness, lack of faith on vaccination, and unavailability of health workers. This survey calls for strengthening of disease surveillance and routine immunization coverage to achieve measles control in these communities. This has important public health implication for the whole country regarding measles elimination in near-future.

Measles elimination in Italy: data from laboratory activity, 2011–2013

BackgroundThe European Regional Office of the World Health Organization developed a strategic approach to halt the indigenous transmission of measles in its 53 Member States by 2015, World Health Organization [1]. Many European countries, including Italy began the implementation of national programs to reach this goal. ObjectivesTo describe and discuss the results of laboratory activity in measles surveillance, performed from January 2011 to December 2013 by the Italian National Reference Laboratory for Measles and Rubella. Study designSamples of suspected measles cases were collected from different Italian regions to confirm clinical diagnosis. Anti-measles IgM antibodies detection by Enzyme-Linked Immunosorbent Assay and/or molecular detection by Reverse Transcriptase-Polymerase Chain Reaction assay were performed. Positive samples were sequenced for viral characterization. Results and conclusionsAccording to results from the National Reference Laboratory’s activity urine and blood seem to be the best specimens for measles laboratory surveillance. Phylogenetic analysis revealed a co-circulation of the genotypes D4 and D8 during the reviewed period, a cluster of B3 and sporadic cases of D9 and H1.

Measles virus genotyping an important tool in measles outbreak investigation in Norway, 2011

This study describes 33 laboratory-confirmed cases of measles that occurred in Norway in 2011, mainly among unvaccinated children between seven months and 10 years of age. Laboratory testing included detection of anti-measles IgM- and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) and molecular detection and characterisation of measles virus by polymerase chain reaction (PCR) and sequencing. Epidemiological data and genotyping revealed that the measles cases originated from eight separate importations, resulting in four outbreaks and four sporadic cases. Except for the first outbreak which affected 18 cases, limited secondary spread occurred in each of the three other outbreaks. The outbreaks were caused by measles virus genotypes B3, D4 and D9, whereas genotypes D8 and B3 were detected in the sporadic cases. This study highlights that genetic characterisation of measles virus is an essential tool in the laboratory surveillance of measles, especially in countries like Norway which are approaching the measles elimination goal. The investigation revealed that importation of measles resulted in subsequent transmission within Norway to non-vaccinated individuals, and twelve cases occurred in healthcare settings, involving both staff and children. The four cases detected among healthcare workers (HCWs) emphasised that the coverage of measles-mumps-rubella (MMR) vaccination among healthcare personnel needs to be improved and both primary and secondary vaccine failure was demonstrated in two fully immunised HCWs.

1823 The Evaluation of Antibody Responses in Steroid Sensitive Children with Nephrotic Syndrome

Nephrotic syndrome is characterized by massive proteinüria, hypoalbuminemia, and edema. Immunoglobulin changes, T lymphocyte function disorders, and the reduction in complement levels in the nephrotic syndrome cause an increase in...

Serological Response to Measles Revaccination in a Small Population After a Mass Measles Revaccination Program

Background: In spite of vaccination, outbreaks of measles occur in many countries, and measles remains the most frequent cause of death among vaccine preventable diseases. Objectives: To compare anti-measles antibody titer between revaccinated and non-revaccinated medical students 2 years after the National MR (Measles, Rubella) Vaccination Program, which was implemented in 2002-2003 for individuals aged 5 to 25 years in Iran. Patients and Methods: This stratified cross-sectional study was conducted on 78 revaccinated and unvaccinated for national MMR vaccination (2002) medical students aged 22-25 years, who attended our Markaz Tebi Children Hospital in Tehran for their pediatric rotation from summer to winter in 2005. The revaccinated group was selected by simple random sampling from a list of names of the students and the non-revaccinated group included all the non-revaccinated students. Serum IgG and IgM anti-measles antibody titers of the subjects were measured using indirect enzyme-linked immunosorbent assay (ELISA), and the levels were compared between the 2 groups of students. Data were analyzed using chi square test and independent samples t test. Statistical significance was defined as P values of < 0.05 by SPSS ver.13 Software. Results: Overall, we recruited 45 subjects with a mean age of 23.7 ± 0.12 years in the revaccinated group and 33 subjects with a mean age of 24 ± 0.25 years in the non-revaccinated group (P = 0.2). The mean anti-measles IgG antibody titer was 31.8 ± 21.2 IU/mL (range, 1-190 IU/mL) in the revaccinated group and 6.12 ± 8.8 IU/mL (range, 1-45 IU/mL) in the non-revaccinated group (P < 0.001). The mean anti-measles IgM antibody titers were 2.6 ± 6.7 IU/mL (range, 1-45 IU/mL) and 1 ± 0 IU/mL (range, 0-1 IU/mL) in the revaccinated and non-revaccinated groups, respectively (P = 0.1). Anti-measles IgG was present (serum titer ≥ 13 IU/mL) in 46.7% of the individuals of the revaccinated group and 6% of the individuals of the non-revaccinated group (P < 0.001). Conclusions: The results of this study indicate that although the percentage of individuals with protective levels of anti-measles antibody increased to 46.7% after revaccination, the protection was inadequate in more than 50% of vaccine recipients, thereby, emphasizing the need for checking antibody levels after revaccination.

Serological Response to Measles Revaccination in a Small Population After a Mass Measles Revaccination Program

Background: In spite of vaccination, outbreaks of measles occur in many countries, and measles remains the most frequent cause of death among vaccine preventable diseases. Objectives: To compare anti-measles antibody titer between revaccinated and non-revaccinated medical students 2 years after the National MR (Measles, Rubella) Vaccination Program, which was implemented in 2002-2003 for individuals aged 5 to 25 years in Iran. Patients and Methods: This stratified cross-sectional study was conducted on 78 revaccinated and unvaccinated for national MMR vaccination (2002) medical students aged 22-25 years, who attended our Markaz Tebi Children Hospital in Tehran for their pediatric rotation from summer to winter in 2005. The revaccinated group was selected by simple random sampling from a list of names of the students and the non-revaccinated group included all the non-revaccinated students. Serum IgG and IgM anti-measles antibody titers of the subjects were measured using indirect enzyme-linked immunosorbent assay (ELISA), and the levels were compared between the 2 groups of students. Data were analyzed using chi square test and independent samples t test. Statistical significance was defined as P values of < 0.05 by SPSS ver.13 Software. Results: Overall, we recruited 45 subjects with a mean age of 23.7 ± 0.12 years in the revaccinated group and 33 subjects with a mean age of 24 ± 0.25 years in the non-revaccinated group (P = 0.2). The mean anti-measles IgG antibody titer was 31.8 ± 21.2 IU/mL (range, 1-190 IU/mL) in the revaccinated group and 6.12 ± 8.8 IU/mL (range, 1-45 IU/mL) in the non-revaccinated group (P < 0.001). The mean anti-measles IgM antibody titers were 2.6 ± 6.7 IU/mL (range, 1-45 IU/mL) and 1 ± 0 IU/mL (range, 0-1 IU/mL) in the revaccinated and non-revaccinated groups, respectively (P = 0.1). Anti-measles IgG was present (serum titer ≥ 13 IU/mL) in 46.7% of the individuals of the revaccinated group and 6% of the individuals of the non-revaccinated group (P < 0.001). Conclusions: The results of this study indicate that although the percentage of individuals with protective levels of anti-measles antibody increased to 46.7% after revaccination, the protection was inadequate in more than 50% of vaccine recipients, thereby, emphasizing the need for checking antibody levels after revaccination.

Subacute Sclerosing Panencephalitis Presenting as Mania

Subacute Sclerosing Panencephalitis Presenting as Mania