Childhood Measles Research Articles

Human Vaccines and Their Importance to Public Health

Few medical interventions compete with vaccines for their cumulative impact on health and well-being of entire populations. Routine immunization of children in the United States now targets 16 vaccine-preventable diseases; and vaccines are now routinely given across the lifespan. Immunization efforts achieved the global eradication of smallpox, as well as the elimination of polio, measles, and rubella from the Americas. The childhood vaccine series including DTP, polio, MMR, Hib, hepatitis B, and varicella vaccines is estimated to prevent 14 million infections, avoid 33,000 premature deaths, and save $9.9 billion in direct medical costs as well as $33 billion in indirect costs for each U.S. birth cohort fully vaccinated. Newer vaccines such as pneumococcal conjugate, rotavirus, and hepatitis A vaccines have also reduced illness and hospitalizations among the target populations but also have amplified benefits beyond their direct effects through reduced transmission from those immunized to other groups. Although for most of the 20th century there was a substantial delay between a vaccine's introduction in developed countries and its broad use in poor countries, newer global public–private partnerships and advocacy are leading to accelerated uptake of new and underutilized vaccines. Since the Measles Initiative was established in 2001, more than 700 million children worldwide have received a measles vaccination and an estimated 4.3 million childhood measles deaths have been averted. The full impact of increasing routine immunization further and implementing new vaccines against pneumonia and diarrhea agents in the poorest countries could prevent more than 2 million additional childhood deaths each year.

Review of childhood measles admissions at the National Hospital, Abuja.

The global disease burden from measles as a vaccine preventable disease remains high despite decades of interventions by various organs and agencies. To determine the prevalence and outcome of childhood cases of measles admitted into the children's emergency ward of the National hospital and highlight the possible contributing factors. Retrospective. A total number of 43 children with measles presenting at the National Hospital Abuja, seen over a 40 months period; January 2002 and April 2005. Cases-folders of patients seen at the Emergency Paediatric Unit (EPU) of the National Hospital Abuja during the period under review with the clinical diagnosis of measles were reviewed. The children were aged between seven to 12months, with 25 (58.1%) age 24months and below. Twenty three (53.5%) of the subjects had received prior measles vaccination. History of contact with cases of acute measles was present in 26 (60.5%). Associated protein energy malnutrition (PEM) was found in 30 (69.8%) with 28 (65.1 %) parents of these children being of lower social economic classes (III, IV &V). Recorded complications included gastroenteritis, bronchopneumonia, laryngo-tracheo-bronchitis as part of croup syndrome, tuberculosis, and otitis media. Three fatalities (7.0%) were record in this review, all in association with bronchopneumonia. Measles with its complications still present as a fatal illness even among vaccinated children.

A young man who kept falling over

In January, 2005, an 18-year-old student was referred to us, by a private neurologist, for investigation of a movement disorder. 4 months previously, the patient had begun to have episodic, involuntary, single “jerks” of the trunk and limbs; after each jerk, he had to support himself with his hands, to avoid falling. Since the jerks began, his academic performance had deteriorated. His medical and family histories were unremarkable. We observed sudden, stereotyped, involuntary movements, consisting of truncal myoclonus and limb extension, accompanied by tongue protrusion and momentary speech arrest. Each episode lasted 1 s, and was succeeded by a loss of muscle tone of about 0∙5 s, which caused the patient to fall. Blood tests showed no abnormalities: notably, concentrations of caeruloplasmin, creatine kinase, thyroid hormones, and autoantibodies were normal. MRI of the brain showed nothing of note. Cerebrospinal fl uid (CSF) concentrations of protein and glucose were normal; microscopy and culture of CSF gave negative results. Video-electroencephalography (EEG) showed periodic discharges of generalised, large-amplitude, slow-wave complexes, coinciding with myoclonus (fi gure). Measles antibody titres, measured by complement fi xation assay, were high in CSF and serum, at 1:64 and 1:320 respectively. We identifi ed a positive IgG oligoclonal band, consistent with infl ammation, in the CSF. The parents revealed that the patient had had measles in 1988, before scheduled immunisation at 12 months. We diagnosed subacute sclerosing panencephalitis (SSPE). We prescribed inosine pranobex to treat the infection, and clonazepam and levetiracetam to counteract myoclonus. However, 3 months later, the CSF measles antibody titre had not decreased, and myoclonus persisted. Intraventricular inter feron was declined by the patient and his parents, because they felt that the risks of implanting an Ommaya reservoir outweighed the likely benefi ts. A trial of subcutaneous interferon β was initiated, but stopped owing to intolerable adverse eff ects. Despite continuing treatment with inosine pranobex, clonazepam, and levetiracetam, the patient’s condition continued to deteriorate. When last seen, in December, 2005, he was heavily dependent on his parents, and had frequent, violent myoclonus. 1 week later, he was found unconscious in bed by his parents, and was certifi ed dead on arrival at hospital. SSPE is a neurodegenerative disorder, caused by measles virus infection persisting in the CNS. The diagnostic criteria of SSPE are clinical presentation, EEG changes, positive CSF oligoclonal bands, high measles antibody titres in CSF or serum, and positive fi ndings on biopsy of the brain; biopsy is rarely needed when the clinical picture supports the diagnosis. The median incubation period is 6–8 years. Although observational studies suggest that treatment with inosine pranobex, an immunomodulating agent, combined with intra ventri cular interferon, might temporarily delay progress of the disease, such treatment does not improve prognosis, which is uniformly poor: the patient is expected to survive 1–3 years after diagnosis. The risk of developing SSPE after childhood measles is estimated to be 1 in 25 000, but only 1 in 5500 if infection occurs before the patient is 1 year old. SSPE, like other complications of measles, is rare in affl uent societies— including Hong Kong, where a measles vaccination programme began in 1967. World wide, numbers of deaths from measles fell by more than half between 2000 and 2005; the decline is attributed to vaccination. In the UK, a decreased rate of MMR vaccination, in recent years, has coincided with an increased rate of infection; it has become a challenge for health profes sionals to clarify parental beliefs about vaccine safety. Of the seven cases of SSPE reported in Hong Kong between 1988 and 2002, fi ve were attributed to a measles outbreak in 1988; our patient’s history indicates that his SSPE was also caused by this outbreak—with an incubation period of nearly 17 years.

Lung involvement in childhood measles: severe immune dysfunction revealed by quantitative immunohistochemistry

Measles, accounting for nearly 1 million deaths each year, presents intense involvement of lymphoid organs and the lungs. The immune response in situ in the lungs was determined in blocks recovered from 42 necropsies of children who died from measles determined by immune cell phenotype (CD4, CD8, CD20, CD45RO, CD68, natural killer [NK], and antigen S-100 B [S100]) and cytokine production (interferon, tumor necrosis factor, interleukin [IL]-1, IL-2, IL-4, IL-10, and IL-12). Compared with the lungs of age-paired controls, patients with measles presented severe depletion of CD4+, CD20+, CD68+, NK+, and S100+ cells in alveolus- and bronchus-associated lymphoid tissue without depletion of CD8+ cells. Most of these features were similar in both forms of measles lung involvement, Hecht giant cell, or interstitial pneumonia, but S100+ cells were depleted in bronchus-associated lymphoid tissue from patients with Hecht pneumonia, which also occurs more frequently in malnourished children. IL-10- and IL-12-producing cells were depleted in patients with measles, whereas IL-1-, interferon-, and IL-4-producing cells were more frequently seen in the alveolus of patients with measles compared with controls. Quantitative in situ immune cell phenotype and function in the lung in measles demonstrated severe immune dysfunction, with loss of key cells, such as dendritic, CD4+, and NK+ cells, and deficient cytokine production, which allows for a better comprehension of local reactions in this process.

Frequency of allergic diseases following measles

Objective Viral and bacterial infections in childhood decrease the likelihood of allergic diseases in later life. The frequency of allergic diseases in patients with a histor of measles has been reported to be low but some studies still suggest that measles can increase the frequency of allergic diseases. The aim of this study was to investigate the frequency of allergic diseases following measles in childhood. Methods Fifty-two children hospitalized in our clinic with measles were compared with 51 children without measles. Allergic diseases were investigated in both groups by using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. In all children, allergy skin tests were performed with the four most common allergens. Results Sensitivity to Dermatophagoides pteronyssinus was less frequent in children with measles than in those without (p < 0.05). A history of nebulized salbutamol use in the emergency room in the previous 12 months was also less frequent in the measles group (p < 0.05). Inhaled corticosteroid use was more common in the group without measles (p < 0.05). Conclusion The results of this study indicate that findings of allergic disease are less frequent in children with a history of measles. These children were less sensitive to D. pteronyssinus.

Measles Exposure throughout a University Hospital Medical Center

ISSUE: With universal childhood measles immunization, measles virus infections are very rare in the United States and are due to importation from other countries. Due to the unfamiliarity of frontline clinicians with the clinical presentation of measles, the identification of the disease may be challenging and lead to delays in the institution of isolation precautions. We highlight the impact of exposure to a case of measles at a tertiary care facility. PROJECT: Within 5 days of returning from China, a 24 year old Caucasian male developed a fever and was evaluated in a medical clinic. Two days later he developed a rash, pharyngitis and cough and was referred to the Infectious Disease clinic. A diagnostic evaluation was begun; however, the patient's symptoms worsened prompting evaluation in the Emergency Department. At this time the patient was admitted to acute care and while the diagnosis of measles was considered, the patient was placed on droplet instead of airborne precautions. This was corrected when Infection Control became aware of the situation. The diagnosis of measles was confirmed by serology and investigation revealed an incomplete vaccination history. Infection Control staff met to assess the situation and identify exposures to staff and patients. RESULTS: Isolation precautions were nonexistent or improper in 6 clinical areas. A total of 65 employees were exposed to the patient, 15 of whom were placed on provisional furlough until a measles IgG was obtained; 12 of these employees were subsequently seropositive and returned to duty. The remaining 3 were seronegative and furloughed from days 5 through 21 post exposure and were offered vaccination. There were 154 patients exposed mainly from waiting areas. Of these, 104 were contacted by phone. The remaining 50 were unreachable. Measles information was sent to the medical center faculty while the state health department sent information to the surrounding counties. No secondary cases of measles occurred. LESSONS LEARNED: Measles is not endemic to the United States and presentations of symptoms are not readily recognized. Identified areas of concern include: education of clinic and hospital staff regarding presentation of patients with fever and rash having recent travel outside of the United States; initiation of appropriate isolation precautions; a multi-bed exam room in the Emergency Department utilized for patients with fever and rash; and assurance of all employees' immune status against measles.

Commentary on varicella vaccination of children in the United States: Assessment after the first decade 1995–2005

1 d own 75% by 2001(Seward et al., 2002). A recent paper in the ew England Journal of Medicine reinforced these achieveents, reporting a significant decline in mortality due to variella since the inception of the vaccine programme (Nguyen t al., 2005). Given these successes, why have we not inroduced this vaccine here, in the UK? Well for a start, the ntroduction of the varicella vaccine programme in the USA oincided with the furore in the UK 2 years later, around he spurious association of autism with childhood measles, umps, rubella (MMR) immunisation (Horton, 2004). In his climate, introduction of a new childhood vaccine, esecially against varicella, an infection perceived by many arents in the UK as innocuous, would have been virtually mpossible. Health economic studies did not support the benfits of varicella vaccination in childhood in Canada (Brisson nd Edmunds, 2002) or the UK (Brisson and Edmunds, prevents 96% of severe chickenpox, are justification enough for the programme. Grose also refers to the concerns about herpes zoster. It is comforting to know that there has not been an increase in shingles in vaccinated children, which bears out the experience from pre-licensing studies in leukaemic children (LaRussa et al., 1996). However, the real concern in the UK lies with the possibility that a reduction in circulating varicella will reduce immune boosting of latently infected individuals, leading to a rise in adult wild type zoster (Garnett and Grenfell, 1992; Ferguson et al., 1996). Such concerns are based not only on hypothesis but also on the observations by two independent groups (Thomas et al., 2002; Brisson et al., 2002). Thomas et al.’s case control study showed significantly increased protection against zoster in subjects who had known contact with varicella in the previous 10 years and this association remained after adjusting for confounding vari003). Added to this, concerns about waning immunity Brisson et al., 2000) and the costs which would be associted with a potential rise in wild type zoster among adults as aricella transmission declines (Brisson and Edmunds, 2002, 003; Edmunds et al., 2001), have been used to justify the ables. The data were supported by Brisson and co-workers’ study showing that exposure to varicella is greater in adults living with children and that this exposure is highly protective against zoster (incidence ratio = 0.75; 95% CI, 0.63–0.89). Within the constraints of their model Edmunds estimated t 5 p i v d e o c K’s conservative stance (Breuer, 2003). To some extent, the data presented in Grose’s paper vinicate this stance. Breakthough infections are more common n children immunised 3 or more years previously (Galil et l., 2002; Lee et al., 2004) and the obvious explanation for his is waning immunity. As a result, strong consideration is

Bronchiectasis in secondary care: a comprehensive profile of a neglected disease

Background: Bronchiectasis is poorly characterised in secondary care. Methods: Over 6 months, 410 bronchiectasis patients attended our clinics. One hundred randomly selected patients were characterised in detail. Results: Patients had a mean and standard error of mean (S.E.M.) age of 57 (2) years and a median and interquartile range (IQR) of three (two to four) reviews in the last 12 months. Aetiologies identified included tuberculosis ( n=15), childhood pneumonia ( n=7), fibrosis ( n=6), connective tissue disease ( n=6), whooping cough ( n=5), childhood measles ( n=4) and others ( n=5). There was widespread use of inhaled therapy. Treatments included oral antibiotics ( n=77), corticosteroid courses ( n=27) and intravenous antimicrobials ( n=27, 12 domicillary) in the last year. Thirty patients had hospital admissions (13 because of the inability to administer domicillary antibiotics). Haemophilus influenzae and Pseudomonas spp. were the commonest bacterial isolates. Patients culturing Pseudomonas spp. were older and had had more reviews and intravenous antibiotic courses. Conclusions: Bronchiectasis imposes a considerable burden on hospital services. Patients culturing Pseudomonas spp. impose a greater burden. Aetiology is often unknown. Therapies with unproven benefit are often used.

Triggering of and Interference with Immune Activation: Interactions of Measles Virus with Monocytes and Dendritic Cells

Viral ImmunologyVol. 15, No. 3 Special Focus: MeaslesTriggering of and Interference with Immune Activation: Interactions of Measles Virus with Monocytes and Dendritic CellsSibylle Schneider-Schaulies and Volker ter MeulenSibylle Schneider-SchauliesSearch for more papers by this author and Volker ter MeulenSearch for more papers by this authorPublished Online:9 Jul 2004https://doi.org/10.1089/088282402760312304AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByContribution of dendritic cells to measles virus induced immunosuppression20 December 2012 | Reviews in Medical Virology, Vol. 23, No. 2Measles virus-induced immunosuppression: from effectors to mechanisms8 April 2010 | Medical Microbiology and Immunology, Vol. 199, No. 3Lung involvement in childhood measles: severe immune dysfunction revealed by quantitative immunohistochemistry☆Human Pathology, Vol. 38, No. 8Immune synapses formed with measles virus-infected dendritic cells are unstable and fail to sustain T cell activationCellular Microbiology, Vol. 9, No. 8Dendritic Cells15 September 2006DC-virus interplay: a double edged swordSeminars in Immunology, Vol. 16, No. 3Interactions Between Dendritic Cells and Infectious AgentsBiodistribution of Oncolytic Measles Virus After Intraperitoneal Administration into Ifnar™-CD46Ge Transgenic Mice7 July 2004 | Human Gene Therapy, Vol. 14, No. 16Apoptotic Cells at the Crossroads of Tolerance and ImmunityViral Pathogenesis and Toll-Like ReceptorsInteractions Between Dendritic Cells and Infectious Agents Volume 15Issue 3Sep 2002 To cite this article:Sibylle Schneider-Schaulies and Volker ter Meulen.Triggering of and Interference with Immune Activation: Interactions of Measles Virus with Monocytes and Dendritic Cells.Viral Immunology.Sep 2002.417-428.http://doi.org/10.1089/088282402760312304Published in Volume: 15 Issue 3: July 9, 2004PDF download

Integrated Management of Childhood Illness (IMCI): a robust strategy.

Integrated Management of Childhood Illness (IMCI), a strategy fostering holistic approach to child health and development, is built upon successful experiences gained from effective child health interventions like immunization, oral rehydration therapy, management of acute respiratory infections and improved infant feeding. The core intervention of IMCI is integrated management of the five most important causes of childhood deaths-acute respiratory infections, diarrheal diseases, measles, malaria and malnutrition. Using a set of interventions for the integrated treatment and prevention of major childhood illnesses, the IMCI strategy aims to reduce death as well as the frequency and severity of illness and disability, thus contributing to improved growth and development. In health facilities, the IMCI strategy promotes the accurate identification of childhood illness (es) in the outpatient settings, ensures appropriate combined treatment of all major illnesses, strengthens the counselling of caretakers and the provision of preventive services, and speeds up the referral of severely ill children. The strategy also aims to improve the quality of care of sick children at the referral level. It also creates a scientifically sound link between the management guidelines at the community level and the management approach in a referral centre. The strategy also envisages actual situations when referral is not possible and offers the best possible options in such circumstances. In the home setting, it promotes appropriate early home care and care-seeking, improved nutrition and prevention, and the correct implementation of prescribed care. In addition to its focus on treatment of illness in the health facility as well as at home, it also provides an opportunity for important preventive interventions such as immunization and improved infant and child nutrition including breastfeeding. The IMCI strategy reduces wastage of resources and avoids duplication of efforts that may occur in a series of separate disease control programs. The essential pillars include improvement in the case management skills of health personnel, improvement in health systems, and improvement in family and community practices. IMCI has been introduced in more than 80 countries and 19 of them have already scaled up IMCI implementation Even though it is too early to relate the decrease in childhood mortality with the introduction of IMCI in these countries, there are several indirect indicators which endorse its validity as a comprehensive and effective strategy. IMCI has helped countries to revise and update their child health policies, streamline the essential drug lists for children, increase service utilization, improve quality of care and nutritional counselling, improve health systems and improved family and community practices.

Measles is more prevalent in Crohn's disease patients. A multicentre Israeli study.

The question whether there is a transmissible pathogenetic agent as a cause for Crohn's disease, remains unanswered. Measles virus has been the subject of many intensive studies, in the attempt to find a role for it in the pathogenesis of inflammatory bowel disease. Whether an early infection with measles virus may predispose to Crohn's disease in later life is still not clear. We conducted a large scale multicentre study, in order to obtain sufficient data to answer this question. To do so, we compared inflammatory bowel disease patients, with Crohn's disease or ulcerative colitis, with two matched control groups: clinical controls, and community controls. A total of 531 patients, 271 with ulcerative colitis and 260 with Crohn's disease were interviewed, as well as 903 matched controls. Blood from 104 inflammatory bowel disease patients and 50 controls was tested for antibodies to measles virus. We did not find any differences related to measles vaccination, either in Crohn's disease or in ulcerative colitis. Exposure to measles in childhood was more frequent in Crohn's disease patients than in their controls, the difference being statistically significant (p < 0.05) in relation to community controls. The presence of IgG antibodies to measles virus was higher in patients with Crohn's disease than in patients with ulcerative colitis or controls (p = 0.084). Another observation of interest was the finding that Crohn's disease patients who had measles in childhood, more frequently had large bowel disease than those who had not had measles. These data lead us to postulate that there may be a role for measles infection in Crohn's disease, even if, at present, this role remains unclear.

Hepatitis in children hospitalized with measles: the experience acquired after a Greek epidemic.

In childhood, hepatitis is an uncommon and ill-defined complication of measles. We studied prospectively the prevalence of hepatitis in 189 children with measles, admitted to hospital during a measles epidemic in Greece. Diagnosis of measles was based on clinical features and a fourfold rise of the haemagglutination inhibiting antibody titre, while liver impairment was based on a twofold or greater increase in liver enzymes. Nine children (4.8%) had increased liver enzymes. Hepatitis was not related to the duration and severity of fever or the coexistence of other complications, and in all children but one, was subclinical and resolved rapidly. One child with mental retardation who was being treated with anti-epileptic therapy and had normal liver enzymes prior to measles, developed hepatic coma from which he recovered 1 month later. Liver involvement in childhood measles is rare and transient but it may be severe in children receiving hepatotoxic drugs.

An investigation into causative factors in patients with bronchiectasis.

Bronchiectasis is a pathologic description of lung damage characterized by inflamed and dilated thick-walled bronchi. These findings may result from a number of possible causes and these may influence treatment and prognosis. The aim of this study was to determine causative factors in 150 adults with bronchiectasis (56 male, 94 female) identified using high-resolution computerized tomography. Relevant factors were identified in the clinical history; cystic fibrosis gene mutation analysis was performed; humoral immune defects were determined by measuring immunoglobulins, IgG subclasses and functional response to Pneumovax II vaccine; assessment was made of neutrophil function (respiratory burst, adhesion molecule expression, and chemotaxis); ciliary function was observed and those likely to have allergic bronchopulmonary aspergillosis (ABPA) were identified. Causes identified were: immune defects (12 cases), cystic fibrosis (4), Young's syndrome (5), ciliary dysfunction (3), aspiration (6), panbronchiolitis (1), congenital defect (1), ABPA (11), rheumatoid arthritis (4), and early childhood pneumonia, pertussis, or measles (44). Intensive investigation of this population of patients with bronchiectasis led to identification of one or more causative factor in 47% of cases. In 22 patients (15%), the cause identified had implications for prognosis and treatment.

A novel sensitive approach for frequency analysis of measles virus-specific memory T-lymphocytes in healthy adults with a childhood history of natural measles.

Measles virus (MV), a single-stranded negative-sense RNA virus, is an important pathogen causing almost 1 million deaths annually. Acute MV infection induces immunity against disease throughout life. The immunological factors which are responsible for protection against measles are still poorly understood. However, T-cell-mediated immune responses seem to play a central role. The emergence of new single-cell methods for quantification of antigen-specific T-cells directly ex vivo has prompted us to measure frequencies of MV-specific memory T-cells. As an indicator for T-cell activation IFN-gamma production was measured. PBMC were analysed by intracellular staining and ELISPOT assay after stimulation with MV-infected autologous B-lymphoblastoid cell lines or dendritic cells. T-cell responses were exclusively seen with PBMC from MV-seropositive healthy adults with a history of natural measles in childhood. The median frequency of MV-specific T-cells was 0.35% for CD3(+)CD4(+) and 0.24% for the CD3(+)CD8(+) T-cell subset. These frequencies are comparable with T-cell numbers reported by other investigators for persistent virus infections such as Epstein-Barr virus, cytomegalovirus or human immunodeficiency virus. Hence, this study illustrates that MV-specific CD4(+) and CD8(+) T-cells are readily detectable long after the acute infection, and thus are probably contributing to long-term immunity. Furthermore, this new approach allows efficient analysis of T-cell responses from small samples of blood and could therefore be a useful tool to further elucidate the role of cell-mediated immunity in measles as well as in other viral infections.

Reduced passive measles immunity in infants of mothers who have not been exposed to measles outbreaks.

Natural measles infection usually confers life-long immunity which is transferred from mothers to their offspring, protecting them from natural measles until the age of about 12 months. Recently, however, natural measles has been observed with increased frequency in infants under the age of 12 months. Natural measles outbreaks in the city of Sapporo have been suppressed by widely applied measles vaccination. Passive measles immunity in 160 neonates (cord blood), born during the last 17 y in Sapporo, Japan was determined by a neutralization (NT) antibody test. The mothers of these infants had had natural measles infection during childhood. Geometric mean titres (GMTs) of cord blood NT antibodies gradually decreased after 1989 and the GMTs of the most recently born infants were significantly lower than those of infants born in the first few years of the study. These observations suggest that even in mothers who experienced natural measles in childhood, recurrent exposure to natural measles is necessary in order to maintain adequate antibody levels for effective passive immunity of their infants.

Measles and malnutrition.

1. Peter R. Belamarich, MD* 1. 2. *Albert Einstein College of Medicine Jacobi Medical Center Bronx, NY 1. Measles in Kenyan Children . O’Donovan C. East Afr Med J . 1971;48:536-542 [OpenUrl][1] 2. Malnutrition and Immunity . Puri S, Chandra RK. In: Grand RJ, Sutphen JL, Dietz WH, eds. Pediatric Nutrition . 1987:433-443 Butterworths Boston, Mass 3. Cellular Immunity and T-Lymphocyte Subsets in Young Children with Acute Measles . Dagan R, Phillip M, Sarov I, Skibin A, Epstein S, Kuperman O. J Med Virol . 1987;22:175-182 [OpenUrl][2][PubMed][3][Web of Science][4] 4. Malnutrition and Overcrowding/Intensive Exposure in Severe Infection: Review of Community Studies . Aaby P. Rev Infect Dis . 1988;10:478-491 [OpenUrl][5][PubMed][6][Web of Science][7] “Count your children after the measles has passed.”—Arabic Proverb Measles is a major cause of childhood morbidity and mortality worldwide. Case fatality rates of 5% to 25% are common in developing countries in contrast to the less than 1% case fatality rate in the United States during the epidemic of 1989 to 1990. In the developing world, epidemiologic factors associated with severe measles include younger age, overcrowding, poor access to care, pre-existing medical conditions, and malnutrition. Because these factors frequently coexist in the developing world, the relative contribution of each to measles morbidity is unclear. However, malnutrition has been implicated most markedly and repeatedly. It had been suspected that malnutrition increased the morbidity and mortality of childhood measles as early as 1885 by Drinkwater, who investigated an epidemic in Sunderland, England, that had an unusually high case fatality rate of 10%. He attributed this finding to “semi-starvation among the poor.” Drink-water’s hunch has been supported by a number of other workers on different continents who have found higher fatality rates among malnourished children who have measles. For example, O’Donovan analyzed measles mortality among 507 hospitalized children … [1]: {openurl}?query=rft.jtitle%253DEast%2BAfr%2BMed%2BJ.%26rft.volume%253D48%26rft.spage%253D536%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: {openurl}?query=rft.jtitle%253DJournal%2Bof%2Bmedical%2Bvirology%26rft.stitle%253DJ%2BMed%2BVirol%26rft.aulast%253DDagan%26rft.auinit1%253DR.%26rft.volume%253D22%26rft.issue%253D2%26rft.spage%253D175%26rft.epage%253D182%26rft.atitle%253DCellular%2Bimmunity%2Band%2BT-lymphocyte%2Bsubsets%2Bin%2Byoung%2Bchildren%2Bwith%2Bacute%2Bmeasles.%26rft_id%253Dinfo%253Apmid%252F2956361%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [3]: /lookup/external-ref?access_num=2956361&link_type=MED&atom=%2Fpedsinreview%2F19%2F2%2F70.atom [4]: /lookup/external-ref?access_num=A1987H623900008&link_type=ISI [5]: {openurl}?query=rft.jtitle%253DReviews%2Bof%2Binfectious%2Bdiseases%26rft.stitle%253DRev%2BInfect%2BDis%26rft.aulast%253DAaby%26rft.auinit1%253DP.%26rft.volume%253D10%26rft.issue%253D2%26rft.spage%253D478%26rft.epage%253D491%26rft.atitle%253DMalnutrition%2Band%2Bovercrowding%252Fintensive%2Bexposure%2Bin%2Bsevere%2Bmeasles%2Binfection%253A%2Breview%2Bof%2Bcommunity%2Bstudies.%26rft_id%253Dinfo%253Apmid%252F3287570%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/external-ref?access_num=3287570&link_type=MED&atom=%2Fpedsinreview%2F19%2F2%2F70.atom [7]: /lookup/external-ref?access_num=A1988M696500028&link_type=ISI

Current trend in childhood measles in Benin city, Nigeria

Current trend in childhood measles in Benin city, Nigeria

Thalamic Syndrome in Children With Measles Infection and Selective, Reversible Thalamic Involvement

* Abbreviations: CNS = : central nervous system • MV = : measles virus • CSF = : cerebrospinal fluid • MRI = : magnetic resonance imaging • DCVT = : deep cerebral vein thrombosis • IgM = : immunoglobulin M • IgG immunoglobulin G; CFT = : complement fixation test • PCR = : polymerase chain reaction • ELISA = : enzyme-linked immunosorbent assay • LA = : lupus anticoagulant • APTT activated partial thromboplastin time; MRA = : magnetic resonance angiography • ER = : emergency room • PCUC = : Pediatric Clinic University of Catania • EEG = : electroencephalogram • FSIQ = : full scale IQ • VIQ = : verbal IQ • PIQ = : performance IQ • TS = : thalamic syndrome • aPL = : antiphospholipid antibodies • CDV = : canine distemper virus Neurologic complications are more common in measles than in the other exanthems.1-3 The incidence of acute encephalomyelitis, the most frequent central nervous system (CNS) complication of measles virus (MV) infection, is estimated to be 1 to 2 in 1000 reported cases of measles.1 2 Considerable controversy relates to the mechanisms in acute measles encephalitis:1-3 there is little evidence for detectable MV in the CNS either as assessed directly by virus isolation or by techniques to detect viral antigen or RNA or indirectly by the appearance of MV-specific antibody or MV-induced interferon in the cerebrospinal fluid (CSF).4 These findings, together with pathologic evidence of perivenular demyelination,2 4support hypotheses of an indirect, immune-mediated demyelinating disease not requiring virus invasion of the CNS.5 6Guillain-Barre syndrome, isolated retrobulbar neuritis, cerebellar ataxia, and encephalitis lethargica are other rarer neurologic complications of measles.1-3 7 8Thrombophlebitis of the cerebral veins has been rarely mentioned in measles infection,1 7 and it is of note that in the series of Tyler,7 reported in the era when the infection was so common and ubiquitous among US children, no patients had such a complication. In some unexplained cases of childhood cerebral stroke, measles, or other exanthems in the past history, have been considered to be possible antecedent factors.9 10 To the best of our knowledge, however, none of the reported cases with measles cerebrovascular complications had selective and reversible thalamic involvement or thalamic symptomatology.1-3 7 9 10 We describe 4 children who developed thalamic pain and thalamic analgetic syndromes11-13 during measles infection in association with magnetic resonance imaging (MRI) evidence of deep cerebral vein thrombosis (DCVT) and reversible lesions localized selectively to both capsulothalamic regions. Table 1 summarizes the main clinical features of all 4 of … Address correspondence to: Martino Ruggieri, MD, Division of Pediatric Neurology, Pediatric Clinic, University of Catania, 95125 Catania, Italy.

Subacute Sclerosing Panencephalitis Manifesting as Viral Retinitis: Clinical and Histopathologic Findings

To describe the clinical and histopathologic features of a patient with viral retinitis secondary to subacute sclerosing panencephalitis. The patient was a human immunodeficiency virus-negative intravenous drug abuser with an acute retinitis that later progressed to encephalitis despite aggressive treatment for possible viral, protozoal, bacterial, and rickettsial infections. The patient had many of the characteristic findings of subacute sclerosing panencephalitis, including a history of measles in early childhood, myoclonus, periodic complexes on electroencephalographic testing, persistently elevated serum and cerebrospinal fluid antimeasles immunoglobulin G (IgG) titers, and a cerebrospinal fluid oligoclonal IgG gammopathy. Ultrastructural examination demonstrated numerous filamentous microtubular intranuclear viral inclusions in the nuclear layers of the retina consistent with the measles virus. This case is unusual in that our patient developed subacute sclerosing panencephalitis later in life and because there was an 8-year period between presumed viral infections in the two eyes. An acute retinitis in an intravenous drug abuser is not always caused by human immunodeficiency virus-related infections; not all viral retinitis responds to therapy; and mortality as well as the usual morbidity may be associated with viral retinitis. One might consider the diagnosis of subacute sclerosing panencephalitis in a young person with an acute retinitis with little or no vitreal inflammation and lack of response to anticytomegalovirus and antitoxoplasmosis therapy.

Measles Vaccination During the Respiratory Virus Season and Risk of Vaccine Failure

To determine whether measles vaccine failure is more common in persons who were vaccinated during the respiratory virus season, when they were more likely to have had concurrent minor illnesses. Population-based case series and case-control study. Wisconsin and Ohio. The case series included all 545 of the states' residents who had confirmed measles reported during 1985 through 1990 and a history of receiving a single dose of measles vaccine during 1975 through 1988 at 15 to 59 months of age. In a case-control study restricted to 1984 through 1988 vaccinees, season of vaccination was compared in 170 case children and 6070 control students. Risk of clinical vaccine failure after measles vaccination during the respiratory virus season (September through May) or the peak season (November through March) compared with summertime (June through August), after adjustment for age at vaccination and place of residence. In the case series of persons with vaccine failure, the proportion who had been vaccinated during the respiratory virus season (74.7%) was no greater than expected (September through May = 74.8% of the year). In the case-control study, vaccination during the respiratory virus season (odds ratio, 0.92; 95% confidence interval, 0.66 to 1.30) or the peak season (odds ratio, 0.93) did not increase the risk of vaccine failure. Despite the high and strongly seasonal prevalence of viral respiratory illness in young children, routine childhood measles vaccination during the respiratory virus season does not increase their risk of vaccine failure. Findings provide epidemiologic support for recently strengthened recommendations that measles vaccination not be deferred in children with minor respiratory illnesses.