Measles virus genome detected up to four months in a case of congenital measles

To determine how long the measles virus genome was detected in a patient with congenital measles, the peripheral blood mononuclear cells were tested for 203 d. The measles virus genome was detected up to 140 d. Conclusion: The period for which the measles virus genome was detected in this patient with congenital measles was much longer than in normal children with measles.     

IMMUNOSUPPRESSIVE MEASLES ENCEPHALOPATHY

ABSTRACT. A Case of measles infection without a rash, which was followed by a severe encephalopathy after two months, is described in a 2½ year old boy. At the age of 8 months he had been irradiated for an inoperable intrathoracic neuroblastoma, and at the time of exposure to measles he was being treated with cyclophosphamide and vincristine. This case closely resembles other cases recently described and termed immunosuppressive measles encephalopathy. The syndrome is believed to represent the effect of measles virus in patients with deficient cellular immunity induced by antineoplastic treatment. The importance of protecting children on immunosuppressive treatment from contracting measles is stressed.     

Measles Pneumonia in a Newborn

We report a 21-day-oldpreterm infant who had severe respiratory distress of 6 days' duration and whose lungs revealed a giant cell pneumonia at necropsy. Measles antigen was demonstrated in mononuclear and multinucleated epithelial cells of the lung by immunoperoxidase staining. We recommend the immunostaming procedure to differentiate measles from other viruses, such as parainfluenza 2 or 3, and respiratory syncytial virus, all of which may produce giant cell pneumonias.     

Follow-up of the Antibody Response to Measles Vaccine in a Rural Area of Guinea-Bissau

ABSTRACT. One hundred and fourty-four children who either were already immune or had been successfully immunized against measles were reexamined after 16 months. All still had circulating Elisa antibodies at a clearly detectable level. Titres were higher in the group of children stated to have had measles prior to the immunization. None of the children had measles after immunization. Boostering by the wild virus may have occurred, whereas no evidence of a booster effect from the vaccine was found. About one third of the children were underweight. Plasmodium falciparum parasitaemia rate, and also its seasonality, varied with the location of the child's homestead. Even children exposed to mesoendemic P. falciparum malaria and moderate malnutrition can be successfully immunized with a conventional live attenuated measles vaccine from 8 months of age, which probably results in a lasting protection.     

The genetic basis for measles vaccine failure

The US measles epidemics of 1989–1991 included a series of outbreaks resulting from vaccine failure. A series of studies was launched aimed at elucidating the mechanisms of this vaccine failure. A meta-analysis of the literature examining epidemics in vaccinated populations was conducted, which showed that the secondary vaccine failure rate (development of the disease despite an initial or primary vaccine success) is no more than 0.2%. The overwhelming proportion of measles vaccine failure was due to primary vaccine failure (failure to ever generate antibody from antigenic stimulation). This comparison of two geographically distinct communities revealed that 10% of children previously vaccinated against measles lacked antibody on follow-up and that these vaccine failures clustered in families. A study of monozygotic and dizygotic twins revealed a high degree of heritability of measles vaccine antibody level. Subsequent studies found associations with both class I and class II alleles in these population-based studies. In the future, detection of the specific peptides that interact with human leukocyte antigen (HLA) molecules may serve as the basis for improved vaccines and address vaccine failure that results from cold-chain problems, immaturity of the immune system, malnutrition and maternal immunity.     

Reappraisal of MMR vaccines currently used in Korea

Background: Although MMR vaccine is widely used in Korea, there are limited studies on the currently used vaccines. We evaluated the immunogenicity and safety of MMR vaccines in Korean children. Methods: For first and second dose immunization, children aged 12–23 months and 4–6 years were enrolled. All subjects received a single dose of either Priorix? (Glaxo Smithkline Biologicals, Rixensart, Belgium) or MMRII® (Merck & Co., Inc., West Point, PA, USA). Pre‐ and postvaccine sera were collected from all participants. Antibody levels were determined by ELISA (Enzygnost®; Dade Behring, Schwalbach, Germany). Safety monitoring included local adverse events for 5 days and systemic adverse events for 42 days following vaccination. Results: One hundred twenty‐one subjects were enrolled in the 12–23 months age group and 39 in the 4–6 years age group. The seroconversion rate in the 12–23 months age group was 97.9–100.0% for measles, 85.1–88.9% for mumps and 100.0% for rubella. All children 4–6 years of age previously seronegative showed seroconversion for measles, mumps and rubella. Local adverse events were reported in 8.3–16.1% (12–23 months age) and 27.8–31.6% (4–6 years age), and 40.0–48.2% (12–23 months age) and 42.1–61.1% (4–6 years age) experienced at least more than 1 systemic adverse reaction. No vaccine‐related serious adverse events were reported. Among the same age groups, there was no significant difference in adverse events between the two vaccines. Conclusion: The MMR vaccines are safe and show good immunogenic responses in children. These data will be invaluable when we introduce diverse vaccines in the following future.     

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

OBJECTIVE: 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. METHODOLOGY: 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. RESULTS: 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. CONCLUSIONS: Liver involvement in childhood measles is rare and transient but it may be severe in children receiving hepatotoxic drugs.     

COMPARISON OF THE URABE AM 9-SCHWARZ AND JERYL LYNN-MORATEN COMBINATIONS OF MUMPS-MEASLES VACCINES IN YOUNG CHILDREN

ABSTRACT. Two mumps-measles vaccine combinations were evaluated for their reactogenicity and immunogenicity in children aged 14 to 20 months. The Urabe Am 9-Schwarz combination vaccine was given to 108 double seronegative children. The seroconversion rate at six weeks after vaccination was 99.1% for measles (haemagglutination-inhibition test) and 92.6% for mumps (neutralization and haemolysis-in-gel tests). The Jeryl Lynn-Moraten vaccine was administered to 85 double seronegative children; the seroconversion rates were 95.3% for measles and 83.5% for mumps. The reported post-vaccination signs and symptoms resembled those seen after monovalent measles vaccine but were more accentuated. Fever over 37.5C° was reported in 66.7% and unusual restlessness and irritability in 68.5% of the Urabe Am 9-Schwarz double seronegative vaccinees compared to 55.3% ( p <0.05) and 54.1 % ( p <0.05), respectively, in the recipients of the Jeryl Lynn-Moraten vaccine. These relatively high reaction rates probably reflect the close observation of the children by their parents during the study. Nevertheless, the tendency towards increased reaction rate and, possibly, reduced immunogenicity of bivalent mumps-measles vaccines as compared to the corresponding single vaccines should be taken into account in the planning of large scale vaccination of young children.     

Safety of measles immunization in egg-allergic children

Measles vaccines are prepared in chick embryo fibroblast culture and used throughout the world. Since 1963 dramatic reductions in the incidence of measles have been observed where the vaccination was extensively applied in the pediatric population. The best results were observed when the target population in the initial phase was that which produced over 90% of cases in the pre-vaccinal era. A possible limiting factor to the diffusion of measles vaccination is the assumption that allergy to egg proteins is a contraindication. In this paper current knowledge about the safety of measles immunization in children with egg allergy is discussed.     

Immunosuppression after measles vaccination

The influence of conventional live attenuated measles vaccine on cellular immune responsiveness was investigated in Sweden and Guinea-Bissau. Sixteen children in a residential area in Bissau and 16 living in southern Stockholm were examined before and 8–10 days after vaccination. Lymphoproliferation was measured to concanavalin A (con-A), PPD and tetanus toxoid (TT) using a whole-blood ³H-thymidine incorporation assay. Stimulation indices were significantly lower after vaccination than before, in the case of con-A ( p = 0.03) and TT ( p = 0.01) in the Guinean children and in the case of PPD ( p = 0.009) and TT ( p = 0.03) in the Swedish children. Stimulation of lymphocytes from measles-immune children with measles antigens resulted in weak lymphoproliferative responses. These observations may be relevant to the increased mortality found in children immunized with high-titre measles vaccines, as compared to controls, in recent studies. The study confirms the applicability and usefulness under field conditions of the whole blood version of the thymidine incorporation assay.     

有无疫苗接种史麻疹患儿心肌酶谱变化的意义

目的了解有无麻疹疫苗接种史麻疹患儿急性期心肌酶谱变化及临床意义,探讨疫苗接种对麻疹患儿心肌的保护作用。方法对71例住院麻疹患儿按有无麻疹疫苗接种史分为有疫苗接种史组23例（有接种组）和无疫苗接种史组48例（无接种组）,并设健康对照组30例。分别检测各组血清肌酸激酶（CK）及其同工酶（CK-MB）,乳酸脱氢酶（LDH）及其同工酶1（LDH1）,α-羟丁酸脱氢酶（α-HBD）水平,同时行心电图检查。结果无接种组与有接种组比较,CK-MB、LDH1及α-HBD明显升高（Pa〈0.05）,并肺炎增多（P〈0.05）,平均住院天数增加（P〈0.01）。二组分别与健康对照组比较,CK-MB、LDH、LDH1及α-HBD均明显升高（Pa〈0.01）。结论麻疹患儿急性期存在心肌酶谱升高,接种麻疹疫苗对急性期麻疹患儿心肌有一定保护作用,可减少合并症。     

Measles: a rare communicable disease in a child with renal transplantation

Measles is a rare communicable disease which may be fatal in renal transplant patients. Herein we present a patient with renal transplantation who had measles and who subsequently developed subacute measles encephalitis 4 months later. We recommend all children with chronic renal failure be vaccinated against measles before transplantation.     

Differential modulation of the immune response by breast- or formula-feeding of infants

Spontaneous integrin expression on CD4+, CD8+ and CD19+ lymphocytes at 6 months was significantly lower in breastfed than formula-fed infants ( p < 0.05). In another study of 59 formula-fed and 64 breastfed 12-month-old children blast transformation and cytokine production by lymphocytes, and T cell changes were measured before and after measles-mumps-rubella vaccination (MMR). Before vaccination, lymphocytes of breastfed children had lower levels of blast transformation without antigen ( p < 0.001), with tetanus toxoid ( p < 0.02) or Candida ( p < 0.04), and lower interferon-γ production ( p < 0.03). Fourteen days after the live viral vaccination, only the breastfed children had increased production of interferon-γ ( p < 0.02) and increased percentages of CD56+ ( p < 0.022) and CD8+ cells ( p < 0.004). These findings are consistent with a Thl type response by breastfed children, not evident in formula-fed children. Feeding mode has an important long-term immunomodulating effect on infants beyond weaning.     

长春地区319例儿童麻疹临床分析

我国自20世纪60年代广泛接种麻疹疫苗以来,麻疹发病率显著下降,但近年来,尤其是近二年麻疹在本地区发病率有所增加,1年内收治的患儿数量远远超过过去12年(1992年～2004年)的总和(92例),部分城市呈暴发趋势。为探究疫苗广泛推广后麻疹的流行病学、临床症状及转归,现对我院2005年     

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??Abstract: Objective??Evaluate the level of measles’ IgG in healthy lying-in mothers and non-measles infants to assess their protective competence to measles. Methods??We collected blood samples from 100 healthy lying-in mothers?? 52 non-measles newborns and 52 non-measles infants of 2??6 months old?? and Enzyme Linked ImmunoSorbent Assay ??ELISA?? was applied to detect the levels of MV IgG. Results??Totally 47 out of the 100 ??47.0%?? healthy lying-in mothers had protective competence and only 9 of them ??9.0%?? had the obvious protective competence. In the 52 newborns and 52 infants of 2??6 month 20 ??38.46%?? and 6 ??11.54%?? cases respectively had protective competence and only 5 of the newborns ??9.61%?? had the obvious protective competence to prevent them from being infected by measles virus. Conclusion??The levels of measles’ IgG in these people are low. There is some kind of correlation between lying-in mothers and newborns and the levels in 2??6-month old infants are lower.     

Measles seroprevalence in Izmir with special emphasis on measles vaccination policy for Turkey

BACKGROUND: Measles outbreaks seem to occur every 2- to 3-year intervals in Turkey. However, sero-epidemiological studies are limited. Knowing the prevalence of measles susceptibility as measured either by serologic markers of immunity or surveys of vaccination coverage is an important tool to assess the risk for measles outbreaks. METHODS: In order to determine the seroprevalence of measles antibodies among a 1 to 29-year-old population in Izmir (Turkey) and to develop the best vaccination policy for measles, a total of 600 people aged from 1 to 29 were selected for the study with cluster sampling. The information on sociodemographic characteristics, vaccination status and measles history was gathered for each participant. Measles-specific IgG antibodies were screened qualitatively by using microenzyme immune assay for 595 subjects. RESULTS: Of the 595 participants screened for the measles antibodies, 56 (9.4%) were seronegative. The proportion of the susceptible individuals in the age groups of 1-4, 5-9, 10-14, 15-19 and 20-29 was 20.0, 10.4, 6.0, 10.3 and 3.0%, respectively. The logistic regression analysis showed that none of the independent characteristics (sex, socioeconomic status, past measles history, vaccination status) with the exception of age group, was significantly associated with measles seronegativity. CONCLUSION: The optimal measles vaccination policy for Turkey may be to increase vaccination coverage above 90%, to conduct a catch-up campaign covering persons aged 1-19, regardless of previous vaccination status. Another factor to consider is to adopt a routine two-dose vaccination, giving the first dose at 12-15 months of age and the second dose at school entry.     

麻疹感染的临床特征及诊断

目的研究广泛麻疹疫苗接种后儿童麻疹的临床特点及诊断。方法研究对象来自2001年4～7月我院隔离门诊的可疑麻疹病例。所有病例就诊时静脉采集全血2.0 mL,分离血清,-20℃保存。用间接ELISA方法检测血清麻疹IgM抗体.若麻疹IgM抗体阴性,同时检测风疹IgM抗体。结果本文共收集85份临床可疑病例,男56例,女29例;年龄46 d～8个月13例.>8个月72例。85份血清麻疹抗体IgM阳性44例,阳性率51.76%,其中年龄46 d～8个月10例,占22 7%;>8个月34例,占77.3%。41份麻疹IgM阴性血清中检测风疹IgM,阳性9例,阳性率为21.95%:占总病例的10. 59%.麻疹和风疹皆阴性32例,占37.65%。麻疹44例中,出疹前发热<3 d 28例(63.6%),≥3 d为16例(36.4%);有Koplik斑35例; 95.5%麻疹病例有结膜炎。风疹9例中,出疹前发热<3 d 8例(89.9%).≥3 d 1例(11.1%):全部风疹病例无Koplik斑;而22.2%风疹病例有结膜炎。结论小儿麻疹的发病年龄及临床表现己发生变化,单凭临床特征易造成较多的漏诊和误诊,血清麻疹IgM抗体检测麻疹病例实用、特异、敏感。     

Live virus immunization after orthotopic liver transplantation

Viral infection is a recognized and potentially serious complication in children following solid organ transplantation. The risks of viral infection are particularly important for infants who may not have completed standard childhood immunizations at the time of transplantation and are therefore at risk for otherwise preventable infections. The general practice of withholding live virus immunization from transplant recipients has been questioned and several small studies have looked at MMR and/or Varivax administration in children following transplantation. This retrospective study analyzes the response to primary MMR and varicella immunization in selected pediatric liver transplant recipients in the largest such study to date. Nineteen of 26 children (73%) developed serologic immunity for measles following MMR (although 18 required multiple doses). Similarly, varicella immunization resulted in seroconversion in 20 of 31 children (64.5%; seven required multiple doses). Only minor adverse effects reported in the general population were observed. Live virus immunization with MMR and Varivax was safe and immunogenic in this selected population of liver transplant recipients.