Combined Measles Research Articles

Joint and limb symptoms in children after immunisation with measles, mumps, and rubella vaccine.

To assess whether the combined measles, mumps, and rubella vaccine increases the incidence of joint and limb symptoms in young children. Comparison of six week recalled incidence of symptoms in two groups of children: children who had been immunised at the start of the six weeks, and children eligible for immunisation but who had not received it. South Manchester Health Authority. 2658 children immunised during July 1989-February 1990 and 2359 not yet immunised. Questionnaires were returned for 1846 immunised children and 1075 not immunised. Recalled rate of joint and limb episodes determined by postal questionnaire and later by clinical follow up. Compared with non-immunised children the immunised group had an increased incidence of new episodes (relative risk 1.6 (95% confidence interval (1.2 to 2.1)) and first ever episodes, though this was not significant (1.7 (0.3 to 3.5)). The risk of first episodes was increased in girls (3.5 (1.1 to 12.2)) but not in boys (1.0 (0.4 to 2.6)). Similarly, an increased risk was seen in children aged under 5 (12.0 (1.6 to 92.3)) but not in older children (0.7 (0.3 to 1.5)). Most episodes were mild and self limiting, but three immunised children required hospital referral. Measles, mumps, and rubella vaccine is associated with an increased risk of episodes of joint and limb symptoms, especially in girls and children under 5. The risk of frank arthritis is substantially less than after wild rubella infection.

Increase of Vaccination Coverage by Mass Media and Individual Approach: Intensified Measles, Mumps, and Rubella Prevention Program in Finland

In the 1970s, mass vaccination projects were started in various parts of the world against measles and congenital rubella, with eradication as the final goal. In many developing and industrial countries, including Finland, the elimination of measles failed because of low vaccination coverage. In Finland, a combined measles, mumps, and rubella (Virivac) vaccination program was started in 1982. Computerized recording of the vaccinated children was considered necessary and was integrated with the population registry to identify the hard-to-reach families. Several interventions improved compliance: a mass media campaign and notification of nonvaccinated children to local health professionals and parents. All successive campaigns increased vaccination coverage significantly, with the notification of parents about their nonvaccinated child being especially effective. A vaccination coverage of over 96% was achieved, which theoretically prevents measles, mumps, and rubella transmission.

Changes of the immunological patterns against measles, mumps and rubella. A vaccination programme studied 3 to 7 years after the introduction of a two-dose schedule

A two-dose vaccination programme using a combined measles, mumps and rubella vaccine (MMR) and administration at the ages of 18 months and 12 years was introduced in 1982. The 12-year-old schoolchildren were tested yearly from 1985 to 1989 on serum samples obtained prior to and after vaccination. Each year between 420 and 756 children were tested. The method used for antibody testing was the haemolysis-in-gel (HIG) assay. For measles also the enzyme-linked immunosorbent assay (ELISA) and the neutralization titre (NT) were applied. Only minor variations of the prevaccination immunity to measles were seen during the period 3–7 years after introduction of the programme. The age groups studied had partly been vaccinated against measles earlier. Between 12 and 16% lacked prevaccination immunity. In contrast the immunity to mumps and rubella of the 12-year-old children decreased considerably during the study period. No general vaccination against these diseases had been performed. Thus the susceptibility to mumps increased from 14% in 1985 to 39% in 1989 and to rubella from 41 to 57%. The seroconversion rate of children seronegative for measles was high, i.e. 100% in 1985 and later varied between 96 and 97%. For mumps, the seroconversion rate was lower and varied between 72 and 88%. All sera converted to rubella. During the follow-up period there was a declining incidence of measles, mumps and rubella. The relationship between the vaccination and reduction of disease and natural immunity strongly suggests that the association is causal and that this vaccination policy reduced the transmission of infection.

An evaluation of measles, mumps and rubella vaccine in a population of Yorkshire infants

In October 1988 combined measles, mumps and rubella (MMR) vaccination replaced monocomponent measles as part of the routine childhood vaccination programme in the United Kingdom. Prior to this policy change a study was undertaken in 335 children aged 15 months, to evaluate the clinical reactions and immunogenicity of the new combined MMR vaccine (Trimovax, Immravax, Merieux), in comparison with an established monocomponent measles vaccine (Rouvax, Merieux). Parents were asked to select whether their child should receive MMR vaccine or measles monocomponent; over 95% chose MMR. Children who were given the MMR vaccine had seroconversion rates of 96% for measles, 97% for mumps and 100% for rubella, whilst those who received monocomponent measles vaccine had a seroconversion rate of 100%. The number of side effects reported was similar with both vaccines; all were mild and self-limiting. The results from this study confirm the efficacy and low reactogenicity of MMR vaccine and support its use as part of the routine childhood immunisation programme in the United Kingdom.

Study of combined vaccination against yellow fever and measles in infants from six to nine months

A study has been carried out in the Ivory Coast to assess the efficacy of a combined vaccine against yellow fever and measles relative to that of each vaccine administered separately. Healthy children aged six to nine months were recruited and divided into two age groups: less than seven months (group I) and more than eight months (group II). In each group, they were randomly assigned to receive either yellow fever vaccine only (A), measles vaccine only (B), or the combined vaccine (C). The serological responses to measles and yellow fever were assessed in 219 initially seronegative children 45 days after immunization. More than 90% of the children developed yellow fever haemagglutination inhibiting antibodies. Neither age nor combination with measles vaccine influenced the responses to yellow fever vaccine. Measles haemagglutinational inhibiting antibodies were found in 97% of the children and the seroconversion rate was influenced neither by age nor by combination with yellow fever vaccine. Younger infants had lower titres of measles antibody. No particular adverse reactions were notified during the follow up. This study shows that combined yellow fever and measles vaccines are immunogenic in infants from the age of six months. Controlling yellow fever in endemic areas and the prevention of measles in young infants may greatly benefit by this combination.

Combined Vaccine Against Measles, Mumps, Rubella, and Varicella

A combined measles, mumps, rubella, and varicella vaccine produced seroconversions for all four components similar to that found if measles, mumps, and rubella vaccine or live varicella vaccine were given separately. In addition, those exposed to varicella were completely protected or had only a mild rash. Moreover, the reaction rates were not increased if the vaccines were combined. The somewhat lower and delayed serologic response to live varicella vaccine as compared with the combined measles, mumps, rubella, and varicella may have been due to the small amount of varicella vaccine virus used or to its degree of attenuation. Persistence of antibody was observed 1 year postimmunization.

MATERNAL RUBELLA AT ST THOMAS' HOSPITAL IN 1978 AND 1986: SUPPORT FOR AUGMENTING THE RUBELLA VACCINATION PROGRAMME

The effects of the rubella epidemics in 1978 and 1986 among patients attending antenatal clinics at St Thomas' Hospital were compared. Although many pregnant women who had been exposed to rubella-like illnesses were investigated in both 1978 (269) and 1986 (160), the number of cases of maternal rubella was substantially lower in 1986 (1) than in 1978 (17). Rubella vaccination of 11-14-year-old girls was introduced in the United Kingdom in 1970, but 10% of our patients were susceptible and only 36% gave a definite history of vaccination. Despite the smaller number of maternal rubella cases, substantial resources were expended on assessing patients who had been exposed to or who presented with rubella-like illnesses. In 1978 an intensification of the selective rubella vaccination campaign was recommended, but experience in the 1986 epidemic supports the view that the programme should be augmented by vaccination of preschool children with a combined measles, mumps, and rubella vaccine, with a view to rubella eradication.

1056 ADVANCES KITH THE VARICELLA VACCINE: A TRIAL OF THE TETRAVAIENT VACCINE (MMRV) AND A POST EXPOSURE PROPHYLAXIS STUDY

A combination varicella, measles, mumps, and rubella vaccine was tested in 17 healthy children aged 15-18 months. The seroconversion rates were 100% for varicella (FAMA), 100% for measles (Micro HI), 93.7% for mumps (EIA) and 100% for rubella (FIAX). In addition, 3/4 vaccinees who were low titer seropositive on day 0 for anti-varicella antibody had a 1 ≥ 4 fold increase in titer. Rashes occurred in 7/17, 5 morbilliform and 2 had rashes similar to varicella vaccine rashes as previously described. None had vesicular eruption. Three children had temperature above 38.3°C, 2 with morbilliform rashes, 1 with varicella vaccine like rash.In another study, the varicella vaccine was administered in a double blind placebo controlled trial of post exposure prophylaxis. Within 5 days of a sibling household exposure, 13 children received vaccine and 13 children received placebo. Twelve of 13 placebo recipients developed varicella (60-600 lesions) while 4 of 13 vaccinees developed mild varicella (2-50 lesions). Three of 4 vaccinees who developed mild varicella were immunized > 3 days after exposure. The protective efficacy was 67%, p < 0.003; protection plus modification efficacy was 100%, p, 0.000003.These data indicate that the varicella vaccine is immunogenic in combination with the MMR and is successful when given separately for post exposure prophylaxis.

Clinical and Serologic Evaluation of Measles, Mumps, and Rubella (HPV-77: DE-5 and RA 27/3) Virus Vaccines, Singly and in Combination

A double-blind, placebo-controlled comparison of single component and combination measles, mumps, and rubella (HPV-77:DE-5 and RA 27/3) virus vaccines involving 502 young children was conducted. The rubella antibody response was similar with RA 27/3 rubella and measles-mumps-rubella (RA 27/3) vaccines, but was diminished with the combination vaccine that incorporated HPV-77:DE-5 rubella. There was no evidence of enhanced clinical reactivity with either of the measles-mumps-rubella vaccines.

Is Adult Immunization More Appropriate Than Immunization of Infants?

To the Editor: The report of Weibel et al. (Pediatrics 56:380, September 1975)concerning long-term antibody levels after monovalent or combined measles,mumps, and rubella virus vaccines presents numerous observations, but leaves one of the more interesting ones incompletely explored. Of particular interest to us is an apparent disparity in levels of rubella antibody five years after rubella immunization of seronegative children and adult women. Among 74 children followed up for duration and level of

Combined live measles-rubella vaccine.

To the Editor .—In a previous publication we described the immunological response of 40 seronegative infants following inoculation of combined live measles, mumps, and rubella virus vaccine. 1 A summary of the results is shown in the Table. The antibody responses to the three viruses were excellent and the combined measles, mumps, rubella vaccine was well tolerated. Subsequent to the above publication, an additional 37 seronegative infants were immunized with combined live attenuated measles virus vaccine (Moraten) and HPV-77 duck rubella virus vaccine. The results are shown in the Table. The combined live measles-rubella vaccine was immunogenic, well tolerated, and there was no evidence of interference. These findings confirm similar studies by Villarejos et al. 2

Trivalent Combined Measles-Mumps-Rubella Vaccine

Four lots of combined trivalent Moraten measles, Jeryl Lynn mumps, and HPV-77 duck rubella vaccine were administered to a total of 715 children, 7 months to 7 years of age, who were initially without antibody against any of the three viruses. Overall, 96% of the children developed measles hemagglutination-inhibiting, 95% developed mumps neutralizing, and 94% developed rubella hemagglutination-inhibiting antibodies. The most important clinical reaction to the trivalent vaccine was mild fever in a portion of the children, such as is expected following administration of Moraten measles vaccine alone. Joint involvement was notably absent during the six-to-nine week follow-up. The combined measles-mumps-rubella vaccine provides a simple means for immunizing against all three of these diseases without impairment of antibody response and without significant increase in clinical reaction.

Combined Live Measles, Mumps, and Rubella Virus Vaccines

Combined trivalent Moraten measles, Jeryl Lynn mumps, and HPV-77 duck embryo rubella vaccine, as well as combined bivalent Moraten measles and Jeryl Lynn mumps vaccine were each administered to children in a single injection. The antibody responses to the three viruses were not significantly altered, and the clinical reactions were no greater than those following measles vaccine given alone. Choice of strain was important, since less favorable results were obtained when the original Enders' measles and Merck C level rubella vaccines were substituted for those mentioned previously. Twenty and forty 50% tissue culture infective doses of Moraten measles and HPV-77 duck rubella viruses, respectively, sufficed to immunize all seronegative persons. All the viruses induced persistent antibody and were sufficiently stable on drying and rehydration to permit use in routine practice. Present evidence indicates that the mumps and rubella vaccines may be given together with the measles vaccine in a single dose without impairing the immune response and without added clinical reaction.

Letters to the Editor

In the introduction to our article (Pediatrics, 34:795, 1964) it is clearly stated that one inoculation of live measles vaccine is the immunization of choice for infants over 9 months of age. This regimen has obvious advantages over the combined inactivated-live measles vaccination procedures which entail multiple inoculations. On the other hand, live vaccine is not consistently immunogenic for younger infants because of the potential suppressive effect of residual passive antibody. Passively acquired measles antibody may disappear as early as 3 months or as late as 11 months.

FIELD EXPERIENCE WITH COMBINED LIVE MEASLES, SMALLPOX AND YELLOW FEVER VACCINES.

FIELD EXPERIENCE WITH COMBINED LIVE MEASLES, SMALLPOX AND YELLOW FEVER VACCINES.

The Responses of Children to Combined Measles-Poliomyelitis Vaccine

Vaccine combining inactivated, concentrated measles and poliovirus antigens was prepared and administered to children in 3 doses of 0.5 ml each, 1 month apart. The neutralizing antibody responses to both antigens were determined in a group of 133 persons. The combination vaccine produced as high a percentage and titer of seroconversions as did the individual antigens alone, appeared to be stable for prolonged periods, and caused only minimal reactions upon injection. Although positive seroconversions were less in infants under 4 months of age, combined measles and polio vaccines should be considered for augmenting diphtheria-pertussis-tetanus vaccine to confer basic primary sensitization in young children.