Measles Vaccine Efficacy Research Articles

Vaccination against Measles in Patients with Oncological Disease

Relevance. Growing distrust of vaccines around the world, a decrease in vaccination rates have led to an increase in the incidence of measles and a rise in the vulnerability of people with immunodeficiency status. The aim. To study the efficacy and safety of measles vaccination in children with oncohematological diseases. Materials & methods. The study involved 107 children: 74 of them with a history of acute lymphoblastic leukemia and 33 with solid tumors. All children had a history of receiving standardized polychemotherapy. In all the subjects, the vaccination history was studied, the titers of specific antibodies to measles were determined. Children with non-protective levels of antibodies (53 children) were subsequently vaccinated against measles. Results and discussions. Of the 107 children examined, before cancer, 99 (92.5%) were vaccinated against measles, of which 68 (68.7%) patients were only vaccinated, and 31 (31.3%) had vaccination and revaccination. Protective titers of antibodies against measles were preserved in 51 people (51.5%), and 48 (48.5%) were seronegative. When assessing immunogenicity on days 14, 45 after the introduction of the vaccine, it turned out that by day 14, 27 out of 53 children (50.9%) developed measles antibodies, and by day 45, 33 out of 53 children (62.3%), the rest of the children did not developed a protective level of antibodies, including 3 of 6 revaccinated. Conclusion. Thus, children with malignant diseases, regardless of the number of previous vaccinations and the duration of the end of therapy, become unprotected or have low titers of antibodies to measles in 83.8%, and immunization after treatment is effective in 62.3% of cases.

Comparison of the Efficacy of Intralesional Measles, Mumps, and Rubella Vaccine with Intralesional Vitamin D3 for the Treatment of Extragenital Warts in Pediatric Age Group (5–18 Years)

Introduction: Warts are benign skin growths caused by human papillomavirus. Traditional methods of treatment usually include destructive modalities which are painful and scar-forming. Such modalities have disadvantage of recurrence. Consequently, immunotherapy is introduced to overcome these problems. Aims and Objectives: To study the comparative efficacy of intralesional measles, mumps, and rubella (MMR) vaccine with intralesional Vitamin D3 for the treatment of extragenital warts in the pediatric age group (5–18 years). Materials and Methods: Seventy-two immunocompetent patients aged between 5 and 18 years with multiple extragenital warts (2 or more) were enrolled and divided randomly into two groups (Group A and Group B). Group A and Group B received intralesional MMR vaccine and Vitamin D3, respectively, in the largest wart present. The injections were repeated every 2 weeks for a maximum of four injections. Results: Complete response (CR) in injected warts in Group A is seen in 25 (83.3%) patients, partial response (PR) in 3 (10%), and no or inadequate response (NR) in 2 (6.67%) patients. CR is seen in 23 (76.66%) patients of Group B, PR in 4 (13.33%) and no or NR in 3 (10%) patients. CR in distant warts in 22 (73.33%) patients in Group A and 20 (66.66) patients in Group B. Conclusion: Both MMR vaccine and Vitamin D3 are safe, efficacious, and less traumatic to the patients for multiple warts in comparison with destructive modalities.

Comparative study on the effectiveness of intralesional Measles, Mumps, and Rubella vaccine and intralesional vitamin D3 injection in the treatment of verruca

Background: Human papillomavirus (HPV) is the causative agent of verruca and is contagious, recurrent, and recalcitrant due to defects in cell-mediated immunity. No single mode of treatment is completely effective. The most commonly used treatment options are destructive and lead to scarring. The emerging new modality of treatment is immunotherapy, which acts by enhancing cell-mediated immunity (CMI) against HPV to clear treated as well as remote warts. Objectives: The objective was to compare the efficacy of intralesional Measles, Mumps, and Rubella (MMR) vaccine and intralesional vitamin D3 in cutaneous warts. Materials and Methods: A randomized, hospital-based, single-blind study on forty patients divided into two groups (groups A and B), comprising twenty patients each, was conducted. In group A, intralesional MMR vaccine 0.5 mL was injected into the base of warts. In group B, intralesional vitamin D3 0.5 mL was injected into the base of warts after achieving local anesthesia. Sessions were performed in two-week intervals for a maximum number of five sessions. The patients were followed for sixteen weeks. Results: In group A (MMR vaccine), a complete response was seen in 75% (15/20) of the patients, a moderate response in 15% (3/20), a partial response in 5% (1/20), and no response in 5% (1/20). In group B (vitamin D3), a complete response was seen in 65% (13/20) of the patients, a moderate response in 15% (3/20), a partial response in 10% (2/20), and no response in 10% (2/20). No recurrence was noticed after follow-up in either of the two groups. Conclusion: Immunotherapy is an option that is easy, safe, cost-effective, and well-tolerated with minimal side effects. Key words: Verruca; Intralesional MMR; Intralesional vitamin D3; Immunotherapy

Evaluation of catastrophic health expenditure risk due to measles in Nigeria

ABSTRACT Measles can have a substantial negative impact not only on people’s health but also on their finances, especially in developing countries. This study evaluates the household risk of catastrophic health expenditure (CHE) due to measles, according to regions and wealth quintiles. The CHE risk due to measles was computed based on (1) the likelihood of health service utilization to treat measles, (2) out-of-pocket (OOP) expenditure and indirect costs associated with disease treatment, and (3) household consumption expenditures. I derived the CHE risk associated with measles, conditional on contracting the disease, across regions and wealth quintiles in Nigeria, using secondary data sources for health-care utilization, OOP expenditures, and consumption expenditures. There was a large variation in CHE risk according to regions and wealth quintiles. Among the poorest households, those in the northeast and northwest would have the highest risk of CHE, up to 17%, while those in the southwest would have the lowest risk of 5%. For all regions, as the wealth increases, the CHE risk would decrease. There would be zero or very little CHE risk among the richest households in any regions. Given the proven efficacy of measles vaccines, immunizations can prevent households, especially poorer households in northeast and northwest regions, from facing the CHE risk due to measles.

Measles epidemiology and vaccination coverage in Oromia Region, Ethiopia: Evidence from surveillance, 2011–2018

Despite a reported high coverage of measles-containing vaccine (MCV), low-income countries including, Ethiopia, have sustained high measles transmission with frequent outbreaks. We investigated the distribution of measles infection and vaccination in Oromia Regional State, Ethiopia. According to the World Health Organization (WHO) and the Ethiopian measles case classification guidelines, measles cases were classified as laboratory-confirmed, clinically compatible, and epidemiologically linked. We derived measles vaccination coverage estimates using reported measles vaccine efficacy and, the proportion of measles cases vaccinated with measles vaccine at least once from the surveillance data. We calculated measles effective reproduction number (Re) in the region. Almost twenty-five thousand measles cases were reported through the surveillance system, with more than 50% of the suspected and confirmed measles cases reported in 2015. Measles had sustained and high transmission rate with uneven distribution among the zones. Children between 1 and 4 years of age and MCV unvaccinated individuals were the most affected groups. In all the zones, the average surveillance-estimated MCV coverage among both infants and under-five children was significantly lower than the WHO recommended minimum 90% threshold herd-immunity. With this level of vaccination coverage, an infected case can transmit to more than four individuals. Nevertheless, the administrative coverage reports for the concurrent period were consistently above 90%. The estimated MCV coverage across the Oromia region was well below the recommended herd-immunity threshold. It partly explains the apparent mismatch of sustained measles transmission and outbreaks despite the very high administrative coverage estimates. Oromia regional health bureau, in collaboration with key stakeholders, should make a concerted effort to increase the effective-coverage of MCV to at least 90%. Additionally, multiple-dose MCV has to be scaled-up and accompanied with appropriate geographic and age targeting using evidence from surveillance data. Immediate programmatic action is needed to improve the quality of measles surveillance.

Evaluation of the Efficacy of Intralesional Measles, Mumps, and Rubella Vaccine with Intralesional Vitamin D3 as Immunotherapies in the Treatment of Recalcitrant Cutaneous Warts in Adult- A Randomized Placebo-Controlled Study.

Introduction:Currently, various destructive and ablative treatment options are conventionally used for warts, but all of them are limited in some form by their adverse effects, high recurrences, suboptimal effectiveness, and the need to treat every wart. Lately, immunotherapy has emerged as a safe treatment relying on biological substances that modulate the immune system to achieve disease control.Aims and Objectives:We aimed at conducting a placebo-controlled study to compare the rate of efficacy of intralesional MMR vaccine with vitamin D3 in the management of recalcitrant extragenital warts in immune-competent adults. Follow-up was done at third and sixth month.Materials and Methods:Patients were divided into three groups, namely, group A, B, and C. Groups A, B, and C received intralesional MMR vaccine, vitamin D3 and normal saline, respectively, in the largest wart. The injections were repeated every 2 weeks, for a maximum of four injections.Results:Among injected warts, in group A, complete clearance was seen in 29 (87.8%) patients, partial clearance in two (6.1%) and no response in two (6.1%) patients. In group B, 24 (77.4%) patients, five (16.1%) patients, and two (6.5%) patients showed signs of complete, partial, and no clearance, respectively, in injected warts. Complete response in distant warts was seen in 25 (75.7%) patients in group A and 20 (64.5%) patients in group B. There was no statistically significant difference between responses of the two groups. In group C, only three (12.5%) patients had complete clearance in injected warts, and none in distant warts. Recurrence was seen in two (6.4%) patients, each in group B and C. However, for management of verruca plana MMR was found to be superior to vitamin D3.Limitations:Our study was limited by a small sample size, absence of immunological analysis, and limited follow-up period.Conclusion:MMR vaccine and vitamin D3 are equally effective and safe treatment option for multiple, recalcitrant warts, as well as warts on difficult to treat sites with minimal recurrence.

Measles, the need for a paradigm shift.

Measles vaccination schedules and targets of herd immunity have been designed according to the paradigm that the vaccine is as protective as natural infection, and the virus has remained of a single serotype over many decades. As a result, ongoing measles resurgence is mostly attributed to gaps in immunization. Using official data, we investigated the correlation between the rate of vaccine coverage reported and aggregated at the national level, and the incidence of cases. We discussed the limits of this indicator considered in isolation. We provide a literature overview of measles vaccine efficacy and failures. We questioned whether measles strains could escape the vaccine. Immunization tools and strategies for measles control deserve to be optimized in the current context.

Measles Vaccines in Iran: A 50-Year Review of Vaccine Development, Production and Effectiveness (1967 - 2017)

Context: Information on the measles vaccine is important for future measles control policies. Vaccination history and laboratory confirmation during the development of the AIK measles vaccine in Iran is surveyed in this article. In addition, the production results and effectiveness of the Razi AIK-C/MRC-5 measles strain are compared with other vaccine strains. Evidence Acquisition: The current study was carried out to aim local measles vaccine manufacturing and consequences of that in Iran, using various search engines. Almost complete search carried out in medical databases including PubMed, Scopus, Web of Science, Scientific Information Database, IranMedex, Magiran and Google Scholar. Results: The morbidity rate of measles during the pre-vaccine era of this disease was 10,000 cases/year in 1970 - 1972. In 1997, the rate was 24 in 1000 cases. After using the high quality Razi measles vaccine between 1995 and 2013, the number of measles-positive cases declined to a maximum of 35 cases per year, while the country’s population increased by more than 2.5 times. The median of the Razi measles vaccine efficacy (VE) was > 92.1% compared with that of the pre-vaccine era. For patients who received 2 doses of the measles vaccine at either 6 and 12 months or 9 and 18 months of age, the median VEs were > 90.0% (interquartile range [IQR], 83% - 97%) and 92.0% (IQR, 86% - 98%), respectively. The age at vaccination and strain type used in the vaccines are reviewed in this article. Conclusions: The effectiveness of the local Razi measles vaccine resulted in a significant decline in measles mortality and morbidity in Iran. Two doses of the Razi measles (MR) or measles combination (MMR) vaccine provided excellent protection against measles. The seroprevalance of the measles vaccine in Iran revealed that more than 90% of Iranians are seropositive for the measles virus.

Measles Outbreak among Nomadic Population with Low Herd Immunity in an Eastern District of Bhutan, 2016

During September-November 2016, a number of measles cases were reported from Trashigang District, Bhutan. The outbreak was investigated to determine epidemiological characteristics and risk factors, and recommend control measures. Hospital records of measles cases were reviewed. An active case finding was conducted in the affected communities and schools. Vaccination records were also reviewed. A case-control study was conducted to determine risk factors for measles infection. Tests for measles and rubella immunoglobulin M (IgM) antibodies, viral identification in throat swabs by polymerase chain reaction, and viral genotyping were performed. Total 62 suspected cases were identified, with no reported deaths. The first case developed symptoms on 15 Sep 2016 and 72.2% of the cases occurred in October 2016. The majority (85.0%) were 14 years old and younger (median 8.2 years, interquartile range 6.5-12.0). Cases were from Sakteng (87.1%) and Merak (12.9%) Subdistricts, the latter being a common place where nomads lived. Among 40 cases tested for measles IgM and viral identification, 33 (82.5%) were found to have measles IgM antibodies. All positive samples were genotyped and 11 (33%) were identified as D8 strains which circulated in India during 2016. The measles vaccine efficacy was 82.0%. Significant risk factors were having previous contact with a measles case (OR = 8.46, 95% CI = 2.08-34.41) and not receiving measles vaccination (OR = 6.61, 95% CI = 2.60-16.82). Immunization for outbreak response, case-based investigation and supplementary immunization activities were recommended.

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.

TLR3 and RIG-I gene variants: Associations with functional effects on receptor expression and responses to measles virus and vaccine in vaccinated infants

Measles virus causes severe morbidity and mortality, despite the availability of measles vaccines. Successful defence against viral pathogens requires early recognition of virus-specific patterns by innate receptors like Toll-like receptor (TLR)3 and the RNA helicase, retinoic acid inducible gene-I (RIG-I). Genetic differences in these receptors may influence the primary immune responses to measles and the efficacy of measles vaccine. In 1-year-old Australian infants after their first measles vaccine dose, we investigated functional effects of TLR3 and RIG-I polymorphisms on intracellular protein expression using flow cytometry, cytokine responses to receptor ligands and measles lysate, and post-vaccination measles IgG levels. We found that TLR3 Leu412Phe was significantly associated with IFN-α/β response after stimulation with TLR3 ligand, poly(I:C) (P=0.024). Downregulation of TLR3 protein expression in NK cells after poly(I:C) was also associated with this variant (P=0.011). In contrast, measles-specific expression, cytokine responses and antibody responses were not associated with TLR3 polymorphisms. No associations were found with RIG-I variants. These results suggest that a TLR3 polymorphism has functional effects on receptor expression and cytokine response. However, this did not translate to an effect on specific responses to measles virus or vaccine. We found no evidence that RIG-I polymorphisms were involved in measles immune responses.

Estimation of measles vaccine efficacy and critical vaccination coverage in a highly vaccinated population

Measles is a highly infectious disease that has been targeted for elimination from four WHO regions. Whether and under which conditions this goal is feasible is, however, uncertain since outbreaks have been documented in populations with high vaccination coverage (more than 90%). Here, we use the example of a large outbreak in a German public school to show how estimates of key epidemiological parameters such as the basic reproduction number (R(0)), vaccine efficacy (VE(S)) and critical vaccination coverage (p(c)) can be obtained from partially observed outbreaks in highly vaccinated populations. Our analyses rely on Bayesian methods of inference based on the final size distribution of outbreak size, and use data which are easily collected. For the German public school the analyses indicate that the basic reproduction number of measles is higher than previously thought (R(0) = 30.8, 95% credible interval: 23.6-40.4), that the vaccine is highly effective in preventing infection (VE(S) = 0.997, 95% credible interval: 0.993-0.999), and that a vaccination coverage in excess of 95 per cent may be necessary to achieve herd immunity (p(c) = 0.971, 95% credible interval: 0.961-0.978). We discuss the implications for measles elimination from highly vaccinated populations.

Efficacy of measles vaccine in study among primary school children during measles outbreak in Iraqi for the year 2004

efficacy of measles vaccine in study among primary school children during measles outbreak in Iraqi for the year 2004

Protective efficacy of standard Edmonston-Zagreb measles vaccination in infants aged 4.5 months: interim analysis of a randomised clinical trial

Objective To examine the protective efficacy of measles vaccination in infants in a low income country before 9 months of age.Design Randomised clinical trial.Participants 1333 infants aged 4.5 months: 441...

Editorial: ‘Non‐specific effects of vaccines’– an important analytical insight, and call for a workshop

keywords vaccines, mortality, analysis, bias, non-specificThis issue of the TMIH journal carries two papers by Aabyand his colleagues on the ‘non-specific effects’ of vaccines.They discuss a methodological issue that might explaininconsistent findings in papers published in recent yearswith respect to non-specific effects of DPT vaccination onchild mortality. In particular they point out that somecommonly applied methods of analysis may introducesubstantial bias in the estimation of such effects.It has long been known that vaccines can have effectsother than reducing the risk of the disease against whichthey are targeted. Perhaps most obvious are the adversereactions that, albeit rarely, can occur as a consequence ofvaccination – ranging from anaphylaxis attributable toparticular components (e.g. egg albumen) to pericarditisfrom smallpox vaccines. The pathogenesis of many of theseadverse effects is reasonably well understood, and warn-ings regarding the risk of such effects are described inpackage inserts of all vaccines. Less widely appreciated isthe fact that vaccines may have unanticipated beneficialeffects, other than on the target disease. For example, BCGvaccines, originally given for their protective effect againsttuberculosis, also protect against a variety of mycobacterialinfections (including Mycobacterium leprae and Myco-bacterium intracellulare). Beyond these examples is thepossibility that some vaccines may have less preciselydefined effects, perhaps mediated through the immunesystem, that manifest as a general increase, or decrease, inmorbidity or mortality attributable to a variety of causes ordiseases. It is with reference to such effects of vaccines thatthe term ‘non-specific’ is increasingly used.A striking example of an apparent non-specific effectwas described 15 years ago in the context of studiesevaluating the efficacy of high titre measles vaccines. Thesevaccines, carrying more than 10

Aerosol measles vaccination in macaques: Preclinical studies of immune responses and safety

The comparative efficacy and safety of measles vaccination via the aerosol route versus subcutaneous injection has not been fully resolved. We vaccinated cynomolgus monkeys ( Macaca fascicularis) with the live-attenuated Edmonston–Zagreb measles virus (MV) vaccine and compared different routes of administration in the immunocompetent and the immunocompromised host. Immunogenicity and protective efficacy of aerosol vaccination using devices similar to those previously used in humans were comparable to those in animals vaccinated by injection. No evidence for a safety hazard associated with the route of vaccination was detected. The results of this study support further clinical evaluation of aerosol vaccination for measles.

Evaluating the impact of the HIV pandemic on measles control and elimination.

To estimate the impact of the HIV pandemic on vaccine-acquired population immunity to measles virus because high levels of population immunity are required to eliminate transmission of measles virus in large geographical areas, and HIV infection can reduce the efficacy of measles vaccination. A literature review was conducted to estimate key parameters relating to the potential impact of HIV infection on the epidemiology of measles in sub-Saharan Africa; parameters included the prevalence of HIV, child mortality, perinatal HIV transmission rates and protective immune responses to measles vaccination. These parameter estimates were incorporated into a simple model, applicable to regions that have a high prevalence of HIV, to estimate the potential impact of HIV infection on population immunity against measles. The model suggests that the HIV pandemic should not introduce an insurmountable barrier to measles control and elimination, in part because higher rates of primary and secondary vaccine failure among HIV-infected children are counteracted by their high mortality rate. The HIV pandemic could result in a 2-3% increase in the proportion of the birth cohort susceptible to measles, and more frequent supplemental immunization activities (SIAs) may be necessary to control or eliminate measles. In the model the optimal interval between SIAs was most influenced by the coverage rate for routine measles vaccination. The absence of a second opportunity for vaccination resulted in the greatest increase in the number of susceptible children. These results help explain the initial success of measles elimination efforts in southern Africa, where measles control has been achieved in a setting of high HIV prevalence.

A Meta-Analysis of Studies Comparing the Respiratory Route with the Subcutaneous Route of Measles Vaccine Administration

The respiratory tract has been suggested as an optimal alternative site to target measles vaccine delivery. We performed a meta-analysis to evaluate the efficacy of measles vaccine administered through the respiratory route compared to the subcutaneous route. We analyzed 20 reported results from sixteen eligible studies. Seroresponse was 4% higher amongst vaccinees in the respiratory group compared to the subcutaneous group (M-H pooled RR = 1.04; 95% CI = 0.98–1.10). For vaccinees over 9 months of age, seroresponse was 15% higher in the respiratory group (M-H pooled RR = 1.15; 95% CI = 1.08 to 1.17). When Edmonston Zagreb (EZ) strain was used, the vaccine was found to be neither more nor less efficacious when administered through respiratory route (M-H pooled RR=1.00; 95% CI = 0.94 to 1.08). Seroresponse in the vaccinees receiving aerosol measles vaccine was 10% higher (M-H pooled RR = 1.10, 95% CI = 1.04–1.17) compared to those who received measles vaccine through the subcutaneous route. Seroresponse due to aerosolized EZ vaccine was 9% higher than subcutaneous EZ vaccine (M-H pooled RR = 1.09; 95% CI = 1.02–1.16). The seroresponse among seropositive vaccinees was 60 % higher (M-H RR = 1.60; 95 % CI = 1.40 to 1.80). The results suggest that the respiratory route of delivery of measles vaccine is at least as efficacious as measles vaccine administered through the subcutaneous route. However, more research is required on standardization of dosage, administration equipments, efficacy, and safety of respiratory (aerosol) route of administration of measles vaccine.

Measles outbreak casts doubt on efficacy of post-exposure measles vaccination

A new report has cast doubt on the value of measles vaccine for post-exposure prophylaxis.

Measles vaccine efficacy during an epidemic in 1998 in the highly vaccinated population of Poland

A measles epidemic with 2255 reported cases occurred in Poland between November 1997 and July 1998, despite high vaccination coverage since the 1980s. Cases occurred at all ages less than 30 years but showed two distinct peaks: young, unvaccinated children born in 1996–1997 and once vaccinated young adults born 1976–1982. The 60% of cases were among persons aged 15 years or more. A cohort study was used to investigate measles vaccine efficacy. The efficacy of a single dose of vaccine exceeded 90% and the efficacy of two doses exceeded 99% in all age-groups. These results demonstrate both the high efficacy of the monovalent measles vaccines used in Poland and the benefit of a second dose of vaccine.