Combined Measles Research Articles

Can varicella be eliminated by vaccination? Potential clinical and economic effects of universal childhood varicella immunisation in Germany.

Varicella is a potentially serious infection not only in immunocompromised individuals but also in otherwise healthy adults and children. Vaccination plays an important role in preventing the disease and its sequelae. A universal vaccination in childhood is expected to reduce substantially the number of uncomplicated cases of varicella and decrease the number of complicated cases requiring hospitalisation. To generate data as basis for decisions of the health authorities concerning prevention of varicella, epidemiological and health-economic data were collected in two studies. Using an age-structured decision analytic model the benefits, costs and cost effectiveness of a varicella immunisation program for a period of 30 years were assessed. It was shown that after the first year of life seroprevalence rates increased steadily and reached 62% among the 4- to 5-year olds and 94% among the 10- to 11-year olds, respectively; 90% of varicella patients were younger than 12 years. A severe course was assessed for 16.3% of the cases. Overall incidence of complications was estimated to be 5.7%. A routine varicella vaccination program targeting healthy children could prevent 82.7% of varicella cases and over 4,700 major complications per year provided the coverage level was 85%. Under these conditions the elimination of varicella is predicted to be achievable within 18 years. It is expected that a combined measles, mumps, rubella and varicella vaccine could provide the required coverage. Average yearly discounted net cost savings of universal childhood vaccination are 51 million Euro with a benefit-cost ratio of 4.12. Childhood vaccination with catch-up of adolescents provides additional clinical benefits. The break-even point indicating first net savings could be achieved already 3 years after the implementation of the vaccination program. In summary, routine childhood varicella vaccination appears to be a highly efficient strategy to significantly reduce the sizeable burden of varicella and would lead to net savings from both the societal but also the payer perspective.

A randomized trial demonstrating successful boosting responses following simultaneous aerosols of measles and rubella (MR) vaccines in school age children

The reactogenicity and immunogenicity of combined measles and rubella (MR) booster vaccination, via aerosol and subcutaneous routes, was assessed in 562 healthy children. Rates of rubella seroconversion and geometric mean titers (GMT) were similar for both routes. Rates of measles PN seroconversion, GMT and measles ELISA post-vaccination seropositivity and seroconversion rate were each higher for aerosol vaccine (54%, 3928 IU/l, 99.6 and 98.8%), than for subcutaneous vaccine (7%, 866 IU/l, 92.2 and 82.4%) ( P<0.01). Reactogenicity was higher for subcutaneous vaccine ( P<0.05). This study demonstrates that aerosol vaccine was more immunogenic for measles antibodies, and equally immunogenic for rubella antibodies. Aerosol vaccine was less reactogenic.

Measles, mumps and rubella (MMR) vaccine

In the UK, although few immunisations are given to neonates, midwives are asked by some pregnant women and new mothers for their advice about childhood immunisations (Health Promotion England, 2001). Over the last 3–4 years there has been a lot of publicity around the combined measles, mumps and rubella (MMR) vaccine, much of it adverse and misleading, and so it is likely that mothers will seek views on this vaccine, in particular, from their midwife.

Mumps: The risks of non-prevention

Dr Jean Watkins explains how to recognize mumps, an illness whose suffering and potentially serious complications can be prevented by vaccinating children with the combined measles, mumps and rubella vaccine.

Serum antibodies to HIV-1 are produced post-measles virus infection: evidence for cross-reactivity with HLA.

Convalescent sera obtained from patients who were recently recovered from an acute measles virus infection were tested for the presence of anti-HIV-1 antibodies by Western blot analysis. While 16% (17/104) of control sera displayed reactive bands to a variety of HIV proteins, 62% (45/73) of convalescent sera demonstrated immunoreactive bands corresponding to HIV-1 Pol and Gag, but not Env antigens. This cross-reactivity appears to be the result of an active measles infection. No HIV-1 immunoblot reactivity (0/10) was observed in sera obtained from young adults several weeks after a combined measles, mumps, and rubella (MMR) vaccination. Interestingly, examination of anti-HLA typing sera specific for either class I and class II molecules revealed that 46% (19/41) of these sera contained cross-reactive antibodies to HIV-1 proteins. Absorption of measles sera with mixed lymphocyte reaction (MLR)-activated lymphocytes and/or HIV-1 recombinant proteins significantly decreased or removed the presence of these HIV-1-immunoreactive antibodies. Together, these findings suggest that the immune response to a natural measles virus infection results in the production of antibodies to HIV-1 and possibly autoantigens.

Ethical debate: Vaccination against mumps, measles, and rubella: is there a case for deepening the debate? How safe is MMR vaccine? Validity of the evidence Dealing with uncertainty GP's response

# Vaccination against mumps, measles, and rubella: is there a case for deepening the debate? {#article-title-2} Complex issues relating to ethics, values, and the nature of evidence lie behind the...

Balancing interests in autism study

Confusion and controversy loom large whenever autistic spectrum disorders are discussed. A major review commissioned by the British government should sort the facts from the legends, hopes Michael Gross.The raging debate on whether or not the combined measles, mumps and rubella (MMR) vaccine can trigger the onset of autistic spectrum disorders (latest research suggests it doesn't) has demonstrated one thing very clearly: that there is a lot of uncertainty and misinformation about autism, a condition that affects 0.1% of the population. Parents of autistic children know how difficult it is to filter any meaningful information from a stream of dubious reports on miracle cures, horrifying increases in case numbers, newly identified causes, and new theories. Short of a cure, weeding out the information jungle would be a major step to make life easier for everybody involved. Similarly, a future-oriented research policy capable of tackling the disease would need to be based on a clear understanding of what can presently count as established knowledge, and what is mythology.In response to this problem, the British government has recently commissioned the Medical Research Council (MRC) to provide a report on the present scientific knowledge about the epidemiology and causes of autism. The MRC has set up three expert panels and a ‘lay group’ consisting of people involved with autism in non-academic ways.There is first the case definition and epidemiology group. This group will have to address questions such as whether the apparent increase in case numbers over the past decade is an artefact of shifting definitions, or whether there is a real ‘epidemic’. If the increase is real, then there must be biological causes for it, which may be found in the remit of the physiology and infections group which has possibly the trickiest task, including the MMR question along with other possible environmental influences on the condition. While there is a clear genetic component to autism (around a dozen genes are thought to be involved), the disorder is also linked to bowel malfunctions, which led to theories that blame the symptoms on food ingredients such as milk proteins or gluten. Finally, there is a group dealing with psychology and behaviour. As the psychological ‘causes’ of autism postulated in the 1950s have by now been ruled out completely, and educational provision is excluded from the remit of the review, this last part of the review is likely to stir less controversy than the others.Of the six ‘lay group’ members, two are associated with each of the review groups. The panels’ membership sparked some controversy. Andrew Wakefield, the researcher who claimed that the MMR vaccine triggered autism, was said to be concerned about the fact that four members, including two academics and one lay group member serving on the physiology board, had been involved in the court case brought against manufacturers of the MMR vaccine by parents. The view that this constitutes a conflict of interest, however, did not prevail.The report should become publicly available by the end of this year. MRC research boards will consider the results with a view to convert its suggestions into actual research that will put an end to decades of confusion.Michael Gross is a science writer and consultant based at the Oxford Centre for Molecular Sciences. He can be contacted through his web page at http://www.michaelgross.co.uk.

Is the MMR vaccine safe?

Media reports in 1998 of a possible link between the combined measles, mumps, and rubella vaccine (MMR) and autism or bowel disease have made many parents question the vaccination. Understanding their concerns and being familiar with the current scientific evidence about the safety of MMR are important if physicians are to allay doubts about the vaccine. Many parents worry that MMR may cause autism or bowel disease. But the UK Department of Health, the World Health Organization, and UK medical establishments—such as the British Medical Association and the medical royal colleges—do not believe that MMR is linked to these conditions. They give several reasons.

Duration of rubella immunity induced by two-dose measles, mumps and rubella (MMR) vaccination. A 15-year follow-up in Finland

A national two-dose vaccination program with a combined measles, mumps and rubella (MMR-II) vaccine was introduced in Finland, in 1982, immunizing children at the ages of 14–18 months and 6 years. Antibody levels were determined from serial samples from a group of originally 350 children during 15 years. The latest samples were taken 15.5 years after the first vaccination and 70% of the children could still be reached. The aim of this study was to determine the kinetics of rubella antibodies induced by the MMR-II vaccine in these individuals. Rubella antibodies were analyzed from three different cohorts: Group I seronegative children ( n=166) vaccinated at 14–18 months and 6 years, Group II seronegative children ( n=139) and Group III seropositive children ( n=16) vaccinated at 6 and 11–13 years. Samples collected 0–9 years after vaccination were analyzed by hemolysis-in-gel (HIG) and later samples by enzyme immunoassay (EIA) techniques. The primary vaccination induced 100% seropositivity in vaccinees with a mean zone diameter of 10 (±1.3), 10.2 (±1.1) and 11.5 (±0.9) mm, in Groups I, II and III, respectively. The seropositivity rate was still high at 15 years, 99%, 100% and 100% with the geometric mean titer 23, 46 and 105 IU/ml, respectively. At 15 years, antibody levels <15 IU/ml which is the suggested protective level, were found in 31, 9 and 0% of children in Groups I, II and III, respectively. Because almost a third of the individuals in Group I now, at the age of 17 years, had low levels of rubella antibodies, it is possible that rubella infections may re-emerge during pregnancy. A careful surveillance including serological follow-up is therefore very important.

Reactogenicity and immunogenicity of a new combined Measles–Mumps–Rubella vaccine: results of a multicentre trial

A large single blind, multi-centre study involving 1779 children was performed in Italy. Infants, aged between 12 and 27 months were divided between two groups: group A received a single dose of a new MMR vaccine, ‘Priorix’ 3 3 ‘Priorix’ is a trade mark of the SmithKline Beecham group of companies. , while group B received a widely used MMR vaccine, Triviraten 4 4 Triviraten is a trade mark of Berna. . Solicited local and general symptoms were recorded using diary cards and antibody levels were measured, prior to and 60 days post-vaccination, using ELISA assays. The incidence of solicited symptoms (evaluated in 1754 subjects) was comparable between groups, with the exception of fever which was significantly lower in group B. Immunogenicity was evaluated in 686 subjects. Of note, was the significantly higher anti-mumps seroconversion rate ( p<0.001) observed in group A (97.0%) compared to group B (35.4%). However the anti-measles and anti-rubella seroconversion rates were equivalent between groups. Significantly higher ( p<0.001) post-vaccination GMTs were in group A vs group B for anti-measles (2830 vs 784 IU/ml) and anti-mumps (1640 vs 469 U/ml), however the anti-rubella GMTs were significantly higher ( p<0.001) in group B (117.6 IU/ml) compared to group A (92.6 IU/ml). The persistence of antibodies in 35 subjects was assessed 1 year after vaccination and the results showed no appreciable decline in titres with either vaccine. The trial demonstrates ‘Priorix’ is well tolerated and highly immunogenic.

Surveillance of congenital rubella in Great Britain, 1971-96

Before rubella vaccine was introduced for schoolgirls and susceptible women in 1970, 200-300 babies were born annually in England and Wales with congenital defects associated with maternal rubella. In 1988...

Outbreak of mumps associated with poor vaccine efficacy - Oporto Portugal 1996.

Vaccination against mumps in Portugal began in 1987, with the introduction of the combined measles, mumps, and rubella vaccine (MMR) in the national vaccination programme (Programa Nacional de Vacinacao: PNV) for both sexes at 15 months. In November 1990,

Vaccine-induced measles virus antibodies after two doses of combined measles, mumps and rubella vaccine: a 12-year follow-up in two cohorts

In Finland, a two-dose vaccination programme against measles, mumps and rubella (MMR) was begun in 1982. The programme with high coverage (97–98%) has eliminated these three diseases from Finland. The aim of the present study was to follow up the kinetics of measles virus antibodies in MMR vaccinated cohorts. We have followed the kinetics of measles virus antibody levels induced by vaccination in the same individuals immunized with their first MMR vaccine in 1982. After 12 years 80% of the original children remained available for sampling. Antibodies to measles virus were measured by haemagglutination inhibition (HI) and plaque reduction neutralization (NT) techniques. The primary dose induced 99.4% seroconversion for measles with a geometric mean HI antibody titre (GMT) of 1 269 (±219), equivalent to 4304 mIU (milli-International Units) ml −1 in group A. The 12-year follow-up specimens showed a measles seropositivity rate of 100% as assayed with the HI and NT tests with a mean HI antibody titre of 1 39 (±54), equivalent to 624 mIU ml −1. The vaccination-induced measles virus antibodies decline in the absence of natural booster infections. It is important to follow how long the protection achieved by the present vaccine programme will last after elimination of indigenous measles.

Safety and characterization of the immune response engendered by two combined measles, mumps and rubella vaccines

We performed a randomized trial to compare the safety and immunogenicity of two combined measles, mumps and rubella vaccines in healthy children 14–24 months of age. Triviraten Berna ® Vaccine (Swiss Serum and Vaccine Institute), contains the Edmonston Zagreb 19 strain of measles virus, the Rubini mumps virus strain and the Wistar RA 27 3 rubella strain while MMR-Vax ® (Merck, Sharp & Dohme, West Point, PA) contains the Enders attenuated Edmonston measles strain, the Jeryl Lynn mumps strain and the Wistar RA 27 3 rubella strain. Immunization with Triviraten Berna ® was associated with a significantly lower incidence of swelling and redness at the injection site in addition to a reduced rate of fever compared with MMR-Vax. Seroconversion rates for the measles and rubella vaccine components were comparable in all tests used. However, seroconversion for the mumps vaccine component was test-dependent. Using an ELISA, the seroconversion rate following immunization with MMR-Vax was significantly ( P < 0.01) higher than for Triviraten Berna. In contrast, nearly identical rates were obtained using an indirect immunofluorescence test. Both vaccines were equally effective at engendering antibodies capable of neutralizing wild type mumps virus. Geometric mean ELISA antibody titers against measles and mumps virus were higher following immunization with MMR-Vax while that for rubella was higher after immunization with Triviraten Berna. A small number ( N = 13) of adolescents immunized either with MMR-Vax or Triviraten Berna were reimmunized with Triviraten Berna and various humoral and cellular response parameters to the measles and mumps vaccine components analyzed. While few subjects mounted a humoral antibody response to measles, most likely due to elevated baseline titers, there was a marked lymphoproliferative response. Anti-mumps virus ELISA antibody titers were higher both at baseline and after reimmunization in subjects who received MMR-Vax for primary immunization. However, there was no difference in either neutralizing titer or proliferative response in subjects primed with MMR-Vax or Triviraten Berna either before or after reimmunization.

MODIFIED VARICELLA-LIKE SYNDROME IN CHILDREN PREVIOUSLY VACCINATED WITH LIVE ATTENUATED MEASLES, MUMPS, RUBELLA AND VARICELLA VACCINE

MODIFIED VARICELLA-LIKE SYNDROME IN CHILDREN PREVIOUSLY VACCINATED WITH LIVE ATTENUATED MEASLES, MUMPS, RUBELLA AND VARICELLA VACCINE

Map of the differential segment of rat chromosome 8 in the SHR-Lx congenic strain

A randomized trial was conducted to assess the immunogenicity and reactogenicity of yellow fever vaccines (YFV) given either simultaneously in separate injections, or 30 days or more after a combined measles–mumps–rubella (MMR) vaccine. Volunteers were also randomized to YFV produced from 17DD and WHO-17D-213 substrains. The study group comprised 1769 healthy 12-month-old children brought to health care centers in Brasilia for routine vaccination. The reactogenicity was of the type and frequency expected for the vaccines and no severe adverse event was associated to either vaccine. Seroconversion and seropositivity 30 days or more after vaccination against yellow fever was similar across groups defined by YFV substrain. Subjects injected YFV and MMR simultaneously had lower seroconversion rates – 90% for rubella, 70% for yellow fever and 61% for mumps – compared with those vaccinated 30 days apart – 97% for rubella, 87% for yellow fever and 71% for mumps. Seroconversion rates for measles were higher than 98% in both comparison groups. Geometric mean titers for rubella and for yellow fever were approximately three times higher among those who got the vaccines 30 days apart. For measles and mumps antibodies GMTs were similar across groups. MMR's interference in immune response of YFV and YFV's interference in immune response of rubella and mumps components of MMR had never been reported before but are consistent with previous observations from other live vaccines. These results may affect the recommendations regarding primary vaccination with yellow fever vaccine and MMR.

Economic Benefits of a Routine Second Dose of Combined Measles, Mumps and Rubella Vaccine in Canada

To evaluate the potential economic benefits of a program for a second routine dose of combined measles, mumps and rubella (MMR) vaccine, administered to children in Canada. Both published and unpublished data from the United States and Canada were incorporated into a linear model. This information was supplemented with opinions on probability and resource use from interviews with a Canadian panel of physicians and practitioners. The province of Quebec was used as a model for resource use and costs. Data were based on a vaccination program for Canadian children at 18 months, with an estimated annual birth cohort of 400,000. Further data were also collected for the lifetime costs of complications arising from these diseases or from vaccination, for both patients and family caregivers. Outcomes were reviewed from the perspectives of a provincial ministry of health (direct medical costs) and of society (all direct and indirect medical and nonmedical costs). It was estimated that a second dose of MMR vaccine administered at 18 months of age would prevent 9200 cases of measles, 6120 cases of mumps and 1960 cases of rubella, producing a savings of $6.34 for every dollar spent from the ministry of health perspective, and $3.25 from the societal perspective. A routine second dose immunization with MMR vaccine would result in considerable cost savings in Canada.

Safety and Immunogenicity of a Combined Live Attenuated Measles, Mumps, Rubella, and Varicella Vaccine (MMRIIV) in Healthy Children

An investigational tetravalent combined measles, mumps, rubella, and varicella vaccine and measles-mumps-rubella and varicella vaccines at separate injection sites given at the same visit were evaluated with respect to safety and cell-mediated and humoral immune responses at 6 weeks and 1 year after vaccination. Varicella seroconversion rates and lymphocyte proliferation responses were 100% for both vaccine groups at 6 weeks and 1 year. However, the antibody titer to varicella was lower in the combined vaccine group at 6 weeks, but there was no statistical difference in cell-mediated immune responses. One-year geometric mean titers were not statistically different. Seroconversion rates for measles, mumps, and rubella were 100% for both vaccine at 6 weeks and 1 year. Long-term follow-up of these immune responses is planned.

Prevalence of Hepatitis B Markers and Measles, Mumps, and Rubella Antibodies Among Jewish Refugees From the Former Soviet Union

To assess the prevalence of hepatitis B virus (HBV) infection and immunity to measles, mumps, and rubella among refugees from the former Soviet Union (FSU). Descriptive study. Soviet Immigrant Health Care Program, Sinai Samaritan Hospital, Milwaukee, Wis. Consecutive sample of 496 Jewish refugees from the FSU presenting for new arrival screening from December 1, 1990, through January 11, 1993. Hepatitis B surface antigen (HBsAg), hepatitis B core antibody, hepatitis B surface antibody, and measles, mumps, and rubella antibodies. At least one hepatitis B marker was detected in 22% of the refugees, and HBsAg was detected in 0.4%. The rate of HBV infection (any marker present) increased with increasing age, ranging from 4% among those aged 0 through 19 years to 31% among those aged 50 through 59 years (chi 2 test for trend, 13.5; P < .001). Among those aged 0 through 19 years, 19% lacked antibody to measles, 8% lacked antibody to mumps, and 13% lacked antibody to rubella. Refugees who were less than 30 years of age were more than twice as likely to lack antibodies to measles, mumps, or rubella compared with those who were 30 years of age or older (relative risk, 2.8; 95% confidence interval, 1.8 to 4.2; P < .001). In our sample of Jewish refugees from the FSU (primarily Ukraine, Russia, and Belorussia), the rate of HBsAg positivity was low, suggesting that routine screening for HBV infection is not needed. Seronegativity to measles, mumps, and rubella was relatively common among those less than 30 years old. Those refugees who were born after 1957 should be given combined measles, mumps, and rubella vaccine unless their written documentation indicates previous receipt of these antigens according to the immunization schedule recommended in the United States.

Immune response to simultaneous administration of a combined measles, mumps and rubella vaccine with booster doses of diphtheria-tetanus and poliovirus vaccine.

A combined vaccine against measles (Edmonston-Zagreb 19 strain), mumps (Rubini strain) and rubella (Wistar RA 27/3 strain) was administered to a group of 46 children aged 10-12 months simultaneously with booster doses of compulsory diphtheria-tetanus toxoid and oral poliovirus vaccine. A second group of 53 children aged 15-24 months who had received booster doses of the compulsory vaccines 5 to 12 months before was also vaccinated. The same seroconversion rates (100%) and similar antibody titers for rubella were observed in both groups. The same seroconversion rates for mumps (93%) and similar rates for measles (98 and 94%) were observed in the two groups. Significantly lower antibody titers for measles and mumps were found in the first group, but they were compensated by an earlier protection, a reduction of number of visits for immunization, costs for the community, and improvement in parental compliance. These results confirm that Edmonston-Zagreb 19 and Rubini strains are still immunogenic even when they are combined with Wistar RA 27/3 strain. Moreover, a long term follow-up in order to verify the persistence of protective antibody levels in both groups of children, could suggest that combined measles, mumps and rubella vaccine could be given earlier (at 10-12 months of age), simultaneously with booster doses of diphtheria and tetanus toxoid and of trivalent oral poliovirus vaccine.