Effect Of Measles Vaccination Research Articles

Field evaluation of measles vaccine effectiveness among children in the Democratic Republic of Congo

BackgroundLarge-scale measles outbreaks in areas with high administrative vaccine coverage rates suggest the need to re-evaluate measles prevention and control in the Democratic Republic of Congo (DRC). Monitoring of measles Vaccine Effectiveness (VE) is a useful measure of quality control in immunization programs. We estimated measles VE among children aged 12–59 months in the Democratic Republic of Congo (DRC) using laboratory surveillance data from 2010–2012. MethodsWe used the case-based surveillance system with laboratory confirmation to conduct a case-control study using the test negative design. Cases and controls were selected based on presence (n=1044) or absence (n=1335) of measles specific antibody IgM or epidemiologic linkage. Risk factors for measles were assessed using unconditional logistic regression, stratified by age. ResultsAmong children 12–59 months, measles vaccination was protective against measles [aOR (95%C)], 0.20 (0.15–0.26) and estimated VE was 80% (95% CI 74–85%). Year of diagnosis, 2011: 6.02 (4.16–8.72) and 2012; 8.31 (5.57–12.40) was a risk factor for measles when compared to 2010. Compared to Kinshasa, children in Bas-Congo, Kasai-Oriental, Maniema and South Kivu provinces all had higher odds of developing measles. Measles VE was similar for children 12–23 months and 24–59 months (80% and 81% respectively). ConclusionsRepeated occurrences of measles outbreaks and lower than expected VE estimates suggest the need to further evaluate measles vaccine efficacy and improve vaccine delivery strategies in DRC.

Measles: vaccinate, close loopholes.

1. Mobeen Rathore, MD, CPE* 2. Denise Bratcher, DO† 1. *Editorial Board member. Professor and Director, UF CARES University of Florida Center for HIV/AIDS, Jacksonville, FL. 2. †Editorial Board member. Professor, Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO. In 2000, measles was declared eliminated in the United States thanks to a high level of immunity achieved by routine receipt of 2 doses of a highly effective measles vaccine. As a result of this success, many clinicians have never seen a case of measles. In 2014, however, 644 measles cases were reported in the U.S., the most in more than two decades, and at press time 170 cases already had been reported in 2015. It is believed the index case in the current outbreak was an international traveler. …

Prevention of measles virus infection by intranasal delivery of fusion inhibitor peptides.

Measles virus (MV) infection is undergoing resurgence and remains one of the leading causes of death among young children worldwide despite the availability of an effective measles vaccine. MV infects its target cells by coordinated action of the MV H and the fusion (F) envelope glycoprotein; upon receptor engagement by H, the prefusion F undergoes a structural transition, extending and inserting into the target cell membrane and then refolding into a postfusion structure that fuses the viral and cell membranes. By interfering with this structural transition of F, peptides derived from the heptad-repeat (HR) regions of F can potently inhibit MV infection at the entry stage. We show here that specific features of H's interaction with its receptors modulate the susceptibility of MV F to peptide fusion inhibitors. A higher concentration of inhibitory peptides is required to inhibit F-mediated fusion when H is engaged to its nectin-4 receptor than when H is engaged to its CD150 receptor. Peptide inhibition of F may be subverted by continued engagement of receptor by H, a finding that highlights the ongoing role of H-receptor interaction after F has been activated and that helps guide the design of more potent inhibitory peptides. Intranasal administration of these peptides results in peptide accumulation in the airway epithelium with minimal systemic levels of peptide and efficiently prevents MV infection in vivo in animal models. The results suggest an antiviral strategy for prophylaxis in vulnerable and/or immunocompromised hosts. Measles virus (MV) infection causes an acute illness that may be associated with infection of the central nervous system (CNS) and severe neurological disease. No specific treatment is available. We have shown that parenterally delivered fusion-inhibitory peptides protect mice from lethal CNS MV disease. Here we show, using established small-animal models of MV infection, that fusion-inhibitory peptides delivered intranasally provide effective prophylaxis against MV infection. Since the fusion inhibitors are stable at room temperature, this intranasal strategy is feasible even outside health care settings, could be used to protect individuals and communities in case of MV outbreaks, and could complement global efforts to control measles.

Measles epidemic from 1951 to 2012 and vaccine effectiveness in Guangzhou, Southern China

Background Since the National Expanded Program on Immunization was implemented in China, considerable progress has been made in reducing the incidence of measles. However, the incidence of measles increased again in 2004. Few post-marketing studies on measles vaccine effectiveness were reported in China. In this study, we aimed to describe the measles epidemic and to evaluate the effectiveness of the measles vaccine in Guangzhou, southern China.Methods Based on the surveillance data for measles, we investigated the epidemiology during different periods between 1951 and 2012. We analyzed the clinical characteristics of laboratory-confirmed cases of measles between 2009 and 2012 and conducted a case-control study using test-negative cases as controls. We determined the protective effect of measles vaccine.Results The highest annual incidence in Guangzhou was 2187.15/100 000 in 1964, and the lowest was 0.32/100 000 in 2011. The average incidence of measles from 1951 to 2012 was 306.27/100 000. There was a significant tendency of decline in recent years. From 2009 to 2012, there are 700 laboratory-confirmed cases reported with an average onset age of 2.5 (median) years. The non-vaccinated target population (age <8 months and ≥15 years) accounted for 56.7% of the cases. The transient (non-resident) population accounted for 51.3% of the cases. Fewer cases were observed in the population targeted for measles vaccine (aged 8 months to 14 years). The effectiveness of a single dose of the measles vaccine was 89.1% (95% confidence interval (CI), 44.5–97.9), and the effectiveness of ≥2 doses of the measles vaccine was 97.8% (95% CI, 88.3–99.6) in children aged 8 months to 14 years old.Conclusions There is a significant overall decline in the incidence of measles (including clinical and laboratory confirmed cases) in the measles vaccine targeted population in Guangzhou. Two doses of measles vaccine are more effective than one dose in preventing measles in China. In order to accelerate the elimination of measles, vaccination should also be given to the transient and the non-vaccine targeted population.

The effect of early measles vaccination on thymic size. A randomized study from Guinea-Bissau

In low-income countries early measles vaccine (MV) is associated with reduced child mortality which cannot be explained by prevention of measles. A large thymus gland in infancy is also associated with reduced mortality. We hypothesized that early MV is associated with increased thymic size. Within a randomized trial providing MV at age 4.5 and 9 months or MV only at age 9 months, thymic size was assessed by ultrasound at age 4.5 months, before randomization to early MV or no early MV, and 4 weeks later. Among 656 children, there was no effect of early MV on thymic size, the geometric mean size ratio being 0.99 (95% CI: 0.96–1.02). In a post hoc analysis early MV was associated with a negative effect in healthy children but a positive effect in ill children. In conclusion, early MV at age 4.5 months had no overall effect on thymus size 4 weeks later.Trial registration: http://clinicaltrials.gov, NCT01486355.

Epidemiology of a Mumps Outbreak and Effect of Measles, Mumps and Rubella Vaccination in Nan Province, Thailand, June to December 2010

In early September 2010, a nurse in Pua District Hospital observed an unusual increase in number of mumps cases and an outbreak investigation was conducted on 5 Oct 2010. This study described epidemiological characteristics of the outbreak as well as secondary attack rates and outcome of MMR vaccination campaign conducted during the outbreak. We reviewed medical records at Pua District Hospital and interviewed the cases’ family members, classmates and teachers. A clinical case was a person with acute parotitis or acute lymphadenitis at preauricular, submandibular or submental area with onset of illness from 1 Jun to 31 Dec 2010. A confirmed case was a clinical case who tested positive for mumps viral IgM by enzyme-linked immunosorbent assay (ELISA), mumps virus by polymerase chain reaction (PCR) or virus isolation. During the investigation period, we also conducted a single mass measles, mumps and rubella (MMR) vaccination campaign, targeting children aged 1-6 years in 10 sub-districts. From 1 Jun to 13 Oct 2010, 129 clinical cases (attack rate = 0.2%) were found in 11 out of 12 sub-districts. Of which, 70.4% were less than six years old children. Among 10 laboratory confirmed cases, six were positive for mumps IgM by ELISA and four positive for mumps virus by PCR, with one case revealed as genotype J. Secondary attack rate among 1-6 years old children was 31.4%. Attack rate among children aged 1-6 years during the pre-vaccination campaign period was 289.4 per 10,000 populations and decreased to 54.3 per 10,000 after the campaign. This investigation supported the Ministry of Public Health to change from using monovalent measles vaccine to MMR vaccine for 9-month old children in June 2010.

Model Matematika Untuk Kontrol Campak Menggunakan Vaksinasi

Measles (also known as Rubeola, measles 9 day) is a highly contagious virus infection, characterized by fever, cough, conjunctiva (inflammation of the tissue lining of the eye) and skin rash. The disease is caused by infection of measles virus paramyxovirus cluster. It is a deadly disease. Vaccination is the most effective strategy to prevent the disease. It is generally given to children. This research aims to establish a model of the effect of measles vaccination, forming the point of equilibrium and analyze the stability, create a simulation model and interpret them, and to know the design to optimize the vaccination coverage required, so it can reduce the spread of this disease. This research was conducted by the method of literature study. It is expected to provide an overview of the mathematical model used to control measles vaccination with division of classes SEIR. The steps taken is identifying the problem, formulating assumptions to simplifying the model, making the transfer diagram, defining parameters, determining the equilibrium points and analyzing the stability, simulating the model, and forming the design to optimize the vaccination. Then from this research can be obtained free balance point of endemic and diseases and their stability. Based on the results obtained, the simulation is done by taking the data in Yogyakarta, and obtained vaccination coverage with two doses that can increase the herd immunity with lower vaccination coverage.

Measles outbreak spreading from the community to an anthroposophic school, Berlin, 2011.

Between April and July 2011 there was an outbreak of measles virus, genotype D4, in Berlin, Germany. We identified 73 case-patients from the community and among students of an anthroposophic school, who participated in a 4-day school trip, as well as their family and friends. Overall, 27% were aged ≥ 20 years, 57% were female and 15% were hospitalized. Of 39 community case-patients, 38% were aged ≥ 20 years, 67% were female and 63% required hospitalization. Unvaccinated students returning from the school trip were excluded from school, limiting transmission. Within the group of 55 school-trip participants, including 20 measles case-patients, a measles vaccine effectiveness of 97.1% (95% confidence interval 83.4-100) for two doses was estimated using exact Poisson regression. Our findings support school exclusions and the recommendation of one-dose catch-up vaccination for everyone born after 1970 with incomplete or unknown vaccination status, in addition to the two-dose routine childhood immunization recommendation.

Effect of early measles vaccination (AIK‐C strain) for preterm infants

The level of maternal antibodies decreases more quickly in preterm than term infants, leaving them unprotected against measles. To protect premature infants from measles, an early vaccination trial was investigated. Changes in the serum measles neutralization test (NT) antibody titer were examined in 152 infants (average gestational period, 29 weeks; average birthweight, 1203 g). The average antibody titer (2(n)) was 2(3.5) at birth and 2(2.2) at 1-3 months of age, and in all cases, NT antibody titer decreased to <1:4 (150 IU/mL). The AIK-C measles vaccine was given to 17 preterm infants at the age of 6 months, and induced sufficient serological responses without any serious adverse events. NT antibody level did not decay during 12 months after vaccination. Early immunization at 6 months of age is effective to protect preterm infants in the outbreak setting.

Measles outbreak in Burkina Faso, 2009: A case–control study to determine risk factors and estimate vaccine effectiveness

ObjectiveWe investigated a large measles outbreak that occurred in 2009 in Burkina Faso in order to describe the epidemic, assess risk factors associated with measles, and estimate measles vaccine effectiveness. MethodsWe reviewed national surveillance and measles vaccine coverage data, and conducted a case–control study in three geographic areas. Case-patients were randomly selected from the national case-based measles surveillance database or, when a case-patient could not be traced, were persons in the same community who experienced an illness meeting the WHO measles clinical case definition. Controls were matched to the same age stratum (age 1–14 years or age 15–30 years) and community as case-patients. Risk factors were assessed using conditional logistic regression. ResultsLack of measles vaccination was the main risk factor for measles in all three geographic areas for children aged 1–14 years (adjusted matched odds ratio [aMOR] [95% confidence interval (CI)], 19.4 [2.4–155.9], 5.9 [1.6–21.5], and 6.4 [1.8–23.0] in Bogodogo, Zorgho, and Sahel, respectively) and persons aged 15–30 years (aMOR [95% CI], 3.2 [1.1–9.7], 19.7 [3.3–infinity], 8.0 [1.8–34.8] in Bogodogo, Zorgho, and Sahel, respectively). Among children aged 1–14 years, VE of any measles vaccination prior to 2009 was 94% (95% CI, 45–99%) in Bogodogo, 87% (95% CI, 37–97%) in Zorgho, and 84% (95% CI, 41–96%) in Sahel. Main reasons for not receiving measles vaccination were lack of knowledge about vaccination campaigns or need for measles vaccination and absence during vaccination outreach or campaign activities. ConclusionThese results emphasize the need for improved strategies to reduce missed opportunities for vaccination and achieve high vaccination coverage nationwide in order to prevent large measles outbreaks and to continue progress toward measles mortality reduction.

Field Effectiveness of Live Attenuated Measles-Containing Vaccines: A Review of Published Literature

Information on measles vaccine effectiveness (VE) is critical to help inform policies for future global measles control goals. We reviewed results of VE studies published during 1960-2010. Seventy papers with 135 VE point estimates were identified. For a single dose of vaccine administered at 9-11 months of age and ≥12 months, the median VE was 77.0% (interquartile range [IQR], 62%-91%) and 92.0% (IQR, 86%-96%), respectively. When analysis was restricted to include only point estimates for which vaccination history was verified and cases were laboratory confirmed, the median VE was 84.0% (IQR, 72.0%-95.0%) and 92.5% (IQR, 84.8%-97.0%) when vaccine was received at 9-11 and ≥12 months, respectively. Published VE vary by World Health Organization region, with generally lower estimates in countries belonging to the African and SouthEast Asian Regions. For 2 doses of measles-containing vaccine, compared with no vaccination, the median VE was 94.1% (IQR, 88.3%-98.3%). The VE of the first dose of measles-containing vaccine administered at 9-11 months was lower than what would be expected from serologic evaluations but was higher than expected when administered at ≥12 months. The median VE increased in a subset of articles in which classification bias was reduced through verified vaccination history and laboratory confirmation. In general, 2 doses of measles-containing vaccine provided excellent protection against measles.

An evaluation of respiratory administration of measles vaccine for prevention of acute lower respiratory infections in children

BackgroundMeasles was responsible for an estimated 100,000 deaths worldwide in 2008. Despite being a vaccine-preventable disease, measles remains a major cause of morbidity and mortality in young children. Although a safe and effective injectable measles vaccine has been available for over 50 years it has not been possible to achieve the uniformly high levels of coverage (required to achieve measles eradication) in most parts of the developing world. Aerosolised measles vaccines are now under development with the hope of challenging the delivery factors currently limiting the coverage of the existing vaccine.MethodsWe used a modified CHNRI methodology for setting priorities in health research investments to assess the strengths and weaknesses of this emerging intervention to decrease the burden of childhood pneumonia. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging aerosol vaccines against measles relevant to several criteria of interest. Although there are a number of different aerosol vaccine approaches under development, for the purpose of this exercise, all were considered as one intervention. The criteria of interest were: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to the sensitive nature of their involvement in such exercises. They answered questions from the CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%.ResultsThe panel of experts expressed mixed feelings about an aerosol measles vaccine. The group expressed low levels of optimism regarding the criteria of likelihood of efficacy and low cost of development (scores around 50%); moderate levels of optimism regarding answerability, low cost of production, low cost of implementation and affordability (score around 60%); and high levels of optimism regarding deliverability, impact on equity and acceptability to health workers and end-users (scores over 80%). Finally, the experts felt that this intervention will have a modest but nevertheless important impact on reduction of burden of disease due to childhood pneumonia (median: 5%, interquartile range 1-15%, minimum 0%, maximum 45%).ConclusionAerosol measles vaccine is at an advanced stage of development, with evidence of good immunogenicity. This new intervention will be presented as a feasible candidate strategy in the campaign for global elimination of measles. It also presents an unique opportunity to decrease the overall burden of disease due to severe pneumonia in young children.

Measles Virus Hemagglutinin: Structural Insights into Cell Entry and Measles Vaccine

Measles is one of the most contagious viral diseases, and remains a major cause of childhood morbidity and mortality worldwide. The measles virus (MV), a member of the family Paramyxoviridae, enters cells through a cellular receptor, the signaling lymphocyte activation molecule (SLAM), CD46 or nectin-4. Entry is mediated by two MV envelope glycoproteins, the hemagglutinin (H) and the fusion (F) protein. The H protein mediates receptor attachment, while the F protein causes membrane fusion. The interaction between the H and F proteins is essential to initiate the cell entry process. Recently determined crystal structures of the MV-H protein unbound and bound to SLAM or CD46 have provided insights into paramyxovirus entry and the effectiveness of measles vaccine.

EFFECTIVENESS OF MEASLES VACCINATION FOR CONTROL OF EXPOSED CHILDREN

The effectiveness of measles vaccine for postexposure prophylaxis at educational centers was investigated. A total of 166 children who shared the classroom with 10 confirmed cases during the infectious period of cases were studied. Of total susceptible exposed children, 72% (54/75) were vaccinated and 25 contracted measles. Vaccine effectiveness in children vaccinated within 72 hours of exposure was 90.5% (95% confidence interval, 34%-99%).

Non-specific effects of standard measles vaccine at 4.5 and 9 months of age on childhood mortality: randomised controlled trial

Objective To examine in a randomised trial whether a 25% difference in mortality exists between 4.5 months and 3 years of age for children given two standard doses of Edmonston-Zagreb...

Knowledge synthesis of benefits and adverse effects of measles vaccination: the Lasbela balance sheet

BackgroundIn preparation for a cluster-randomized controlled trial of a community intervention to increase the demand for measles vaccination in Lasbela district of Pakistan, a balance sheet summarized published evidence on benefits and possible adverse effects of measles vaccination.MethodsThe balance sheet listed: 1) major health conditions associated with measles; 2) the risk among the unvaccinated who contract measles; 3) the risk among the vaccinated; 4) the risk difference between vaccinated and unvaccinated; and 5) the likely net gain from vaccination for each condition.ResultsTwo models revealed very different projections of net gain from measles vaccine. A Lasbela-specific combination of low period prevalence of measles among the unvaccinated, medium vaccination coverage and low vaccine efficacy rate, as revealed by the baseline survey, resulted in less-than-expected gains attributable to vaccination. Modelled on estimates where the vaccine had greater efficacy, the gains from vaccination would be more substantial.ConclusionSpecific local conditions probably explain the low rates among the unvaccinated while the high vaccine failure rate is likely due to weaknesses in the vaccination delivery system. Community perception of these realities may have had some role in household decisions about whether to vaccinate, although the major discouraging factor was inadequate access. The balance sheet may be useful as a communication tool in other circumstances, applied to up-to-date local evidence.

Comparative analysis of measles genome between vaccine strain and wild-type strain in Zhejiang province of China

To explore the distinction between wild-type strain MVi/Zhejiang, CHN/7.05/4 and vaccine strain Shanghai-191 at genome level. After sequencing of measles wild-stain MVi/Zhejiang. CHN/7.05/4, the distinction between the wild-type strain and the vaccine strain was analysed by MEGA 3.1 software at genome level, and the antigen variation was studied by means of combining the epidemiological data. There were 822 nucleotide differences (5.17%) and 161 amino acid differences between these two strains, including three glycosylation sites variation found. Meanwhile, the antigen ratio between wild-type strain and vaccine strain was found to be 5.66. There should be certain differences between the contemporary wild-type strain MVi/Zhejiang, CHN/7.05/4 and vaccine strain Shanghai-191 at genome level, and the protective effects of measles vaccine should be studied further.

Immune response to measles vaccine in 6 month old infants in Papua New Guinea

To assess the efficacy of the current measles immunization schedule in Papua New Guinea, which is to give the first dose at 6 months of age and the second at 9 months. Humoral immune response study of 140 Papua New Guinean infants at 6 months of age, measuring measles IgG antibodies by enzyme immunoassay before and 85 days after the 6-month dose of measles vaccine. After vaccination at 6 months, 35.7% of infants developed a level of measles antibodies consistent with protection (IgG >330 IU/ml); 17.7% had an antibody response (150-330 IU/ml) that is likely to afford some protection; 46.8% had no detectable antibody response (IgG <150 IU/ml). Among 53 infants with no antibody response, 37 (69.5%) developed an antibody response, while 42.4% (37/87) of those with maternal antibodies sero-converted (P = 0.002). Antibody response to measles vaccine was lower than expected at 6 months. While the presence of maternally derived antibodies accounted for some of the limited seroconversion in young infants, other factors are involved. Issues to be considered in determining the value of the first dose of measles vaccination in mid infancy in poor countries are complex and antibody responses are only one factor. Others, such as cell mediated immune responses, the non-specific protective effect of measles vaccine in preventing illness and death and the practicalities of uptake of vaccines at different ages, are also important.

Ongoing measles and rubella transmission in Georgia, 2004-05: implications for the national and regional elimination efforts

In 2004-05, Georgia experienced large-scale concurrent measles and rubella outbreaks. We analysed measles and rubella epidemiology in Georgia to describe disease trends, determine the cause of the outbreaks, identify challenges to achieving disease elimination goals and propose interventions to overcome them. We reviewed national measles and rubella surveillance and vaccination coverage data, focusing on the 2004-05 outbreaks, and conducted a measles vaccine effectiveness (VE) study using data from a 2004 school-based outbreak. Before 2004, the last large measles outbreak after measles vaccination was introduced (in 1966) in Georgia, was in 1988 (incidence rate, 36/100 000); the highest year for rubella was 1985 (110/100 000). During 2004-05, 8391 measles cases and 5151 rubella cases were reported (most of them diagnosed clinically). Of 358 suspected measles cases tested, 181 (51%) were positive for measles-IgM antibody; of 240 suspected rubella cases tested, 50 (21%) were positive for rubella-IgM antibody. Over 90% of measles cases were in persons born after 1979; 90% of rubella cases were in persons born after 1987. Approximately 41% of measles cases and 88% of rubella cases were unvaccinated. Estimated measles VE (>/=1 vs 0 doses) was 86% (95% CI, 58-96%). The outbreak likely resulted from failure to vaccinate rather than vaccine failure. Susceptible persons likely accumulated due to the long absence of large outbreaks and decreased coverage after the collapse of Soviet Union. To interrupt measles and rubella transmission in Georgia and achieve disease elimination goals by 2010, supplementary immunization activities should target children and young adults.

Effect of mass measles vaccination on numbers of measles cases: A hospital experience

Background Low measles vaccine coverage has been a characteristic of child health indices in Uganda. Country-wide mass measles vaccination involving children 6 months to 15 years old was undertaken in October 2003 and repeated in October 2006. Objective To describe the effect of mass measles vaccination on number of measles cases admitted to Mulago hospital, Kampala, Uganda. Methods This was a study involving review of documents including ward admission books, patients’ case notes, discharge summaries, measles surveillance records, and laboratory reports. Measles cases admitted during the study period were identified using the clinical case definition of measles. The number of measles cases admitted before and after the Measles mass was documented. Results Before mass measles campaigns, the mean number of measles cases admitted to Mulago hospital was 120 per month. 73% of the cases were between 9 and 60 months of age. The number of measles cases started falling two weeks after the campaigns. Four months after each of the mass campaign, there was not a single case of measles case admitted in Mulago hospital for a period of two years. Conclusion Mass measles appeared to significantly reduce the number of measles case admitted to Mulago referral hospital. The results need confirmation with prospective studies.