Effect of protein energy malnutrition on the immediate outcome of measles

Seven hundred and seventeen children suffering from measles, comprising 2·4% of total admissions were seen at Indira Gandhi Institute of Child Health from 21st March, 1983 to 20th March, 1985. Three hundred and seventy three children (52%) of them were under 2 years of age of which 111 were below one year of age. All the children except 41 had one or more than one complications. Bronchopneumonia was commonest (69·9%) followed by diarrhea (34·8%), layringitis (12·1%), conjunctivitis (7·5%) etc. Overall mortality was high, as 104 (14·5%) children died. Mortality under one year of age accounted for 21·6% of total deaths. Deaths amongst children with severe protein energy malnutrition (Grades III and IV) was very high as 90 of 199 (45·2%) children died. It was also observed that mortality among these children increased significantly with increasing severity of malnutrition. It is strongly recommended that measles vaccination should be undertaken between 6–8 months of age wherever measles is common under one year of age.     

Epidemiological study of measles in slum areas of Kolkata

Objective : An epidemiological study on measles was conducted among the under five children in slum areas of Kolkata to assess the incidence of measles.Methods : 20 cluster sampling technique was followed and in each cluster 250 under five children were covered. Paramedical workers identified children of the target of age group who had history of measles in past one year and the medical officer confirmed the diagnosis following standard case definition.Results : Incidence of measles was found as 5.76%. Incidence was equal in both the sex groups, but found more among infants. The incidence of measles gradually declined with the increase of age strengthening the view in favor of early immunization. Amongst the measles cases only 19.7% were immunized with measles vaccine. 100% of measles cases gave history of rash, 98.9% had history of fever, 82.8% reported that the rash started from face and progressed downwards to abdomen and leg. Cough, redness of eye and discoloration of skin were reported by 97.5%, 83.8% and 65.2% measles cases respectively. Only 16.9% and 8.6% children received Vitamin A oil before and after the illness respectively. 49% gave history of exposure to measles cases and 46.6% cases had measles within 2 weeks incubation period.Conclusion : The study highlighted the necessity of timely measles vaccine coverage, additional dose at a higher age and Vitamin A supplementation through IEC activities     

Measles revaccination. Persistence and degree of antibody titer by type of immune response

During a measles immunization campaign 203 children were enrolled in an antibody response study. Of this group, follow-up clinical data and sera samples were available from 125 children three weeks after immunization and from 90 children ten months later. Seventy-six of the children had been previously vaccinated, ten had a history of measles and 39 denied vaccination or illness. Twenty-six of the children had prevaccination hemagglutination inhibiting antibody titers of less than 5. Of this group 12 had a primary immune response (IgM measles antibody) with geometric mean titers (GMT) of 90 and 40 three weeks and ten months respectively after vaccination. In contrast, the other 14 children with initial titers of less than 5 had secondary immune responses (only IgG measles antibody) with GMTs of 28 and 9 three weeks and ten months after vaccination. Since the antibody responses in these children who had previously been stimulated by measles antigen were modest and transient, it is suggested that booster immunization may not be effective in preventing future secondary vaccine failures. Also noted in this study was a poor correlation between historical data and actual measles antibody.     

Age for measles immunization seroconversion after measles vaccination at 6-8 months of age--a randomized controlled trial

The objective of the study was to compare the effectiveness of measles vaccine by seroconversion in vaccinated children with non-vaccinated children of 6 to 8 months age group in a city slum community so as to study the feasibility of advancing the age of immunization. Live attenuated lyophilized Schwartz strain of measles vaccine was used. Hemagglutination inhibition (HI) antibody was estimated. Seroconversion was defined as either the conversion of negative to positive or a two fold rise in titre. One hundred and thirty two children completed the study. There was no difference in the age, sex and nutritional status between vaccinated and non-vaccinated groups (p greater than 0.7). The seroconversion rate in the vaccinated group was 65% and in the non-vaccinated group was 26%. The age, sex and nutritional status did not significantly affect the seroconversion. Our data suggest that immunization with measles vaccine may be effective as early as 6 months of age. Immunization at 6 months may be needed at least for children in densely populated areas like cities and towns.     

Analysis of the cause of increased measles incidence in Xinjiang, China in 2004

BACKGROUND: Increased number of measles cases were reported from Xinjiang province of China in 2004, relative to previous years. This study aimed to identify the direct cause for this increase in measles morbidity and the major reason for the relatively high measles incidence rate in Xinjiang. METHODS: The epidemiologic and laboratory surveillance data for measles cases of 2004 were analyzed and a seroepidemiologic investigation involving 1024 subjects, mainly children aged less than 15 years, was conducted in Xinjiang. A questionnaire including demographic and vaccination data was completed by interview and blood samples drawn from surveillance subjects. Sera were analyzed for measles IgM (cases) and IgG (cases and surveillance). Data were assessed for their relationship with high measles incidence rate. RESULTS: 6271 measles cases were reported from Xinjiang in 2004 with a morbidity of 33.7 cases per 100,000 population. 83% of the cases were children less than 12-year-old. 50% of the serum samples were measles IgM positive and 69% were measles IgG positive. 2014 serum samples were collected in the seroepidemiologic survey. The overall IgG antibody seropositivity rate was 89%, preschool children having the lowest seropositivity rate (86%). There was a significant difference in IgG positive rates as well as IgG titers between unvaccinated and vaccinated subjects with each subsequent dose leading to further increase in titer. CONCLUSIONS: Low routine measles vaccine coverage was the major probable cause contributing to the increased measles cases in 2004 in Xinjiang and the high measles infection rate overall. The national 2-dose measles vaccination regimen is effective if delivered appropriately.     

Measles and rubella antibody response after measles-mumps-rubella vaccination in children with afebrile upper respiratory tract infection

The effect of concurrent afebrile viral upper respiratory tract infection (URI) on measles and rubella serum antibody response after measles-mumps-rubella (MMR) vaccination was determined in 580 1-year-old children, 369 with URI and 211 without URI, with the use of preimmunization and postimmunization sera. The presence of URI during the preceding 28 days, at the time of, or up to 7 days after immunization had no effect on the antibody response to either the measles or the rubella component of the vaccine. These findings support the recommendation that MMR vaccine be given to children at the recommended age regardless of the presence of afebrile viral URI. (J PEDIATR 1995;127:432-4)     

Population-based study of measles and measles immunization in human immunodeficiency virus-infected children.

This study reports the course of measles and results of measles immunization in a cohort of human immunodeficiency virus-infected children. Six cases of measles were identified. All had typical clinical manifestations, 5 of 6 developed pneumonia and 3 of 6 died. A measles intervention program consisting of serologic screening and active immunization (measles-mumps-rubella (MMR)) was instituted in 1990. Among 127 children with data available for analysis (mean age, 6.7 years), only 35% had documentation of prior immunization with MMR. Among 80 children who had preimmunization measles serology reported, 56% were measles antibody-negative and 40% were antibody-positive; following intervention 36% remained measles antibody-negative. Six children lost measles antibody over time. MMR nonresponders had lower CD4 lymphocyte counts (303 +/- 394) compared with responders (865 +/- 677; P = 0.0058). Measles is a potentially fatal illness in human immunodeficiency virus-infected children. Prevention strategies are limited by low rates of age-appropriate MMR immunization, poor antibody responses to MMR in older human immunodeficiency virus-infected children and seroreversion.     

Endemic measles in Karachi, Pakistan and validation of IMCI criteria for measles

Aim: To estimate the incidence of measles in Karachi, Pakistan and to determine the proportion of children with measles based on the WHO integrated management of childhood illness (IMCI) criteria with a positive IgM for measles or dengue.
Methods: Patients up to 14 years old were screened for febrile rash illnesses at five Karachi hospitals. Active measles cases were classified as measles, measles with eye and mouth complications, or severe complicated measles using IMCI criteria.
Results: Screening 1 219 061 patients over a 39-month period identified 3503 qualified children. Most (76.8%) measles cases occurred in children under five years of age. The average annual incidence rate was 0.68 per 1000 in year 1; 0.19 in year 2 and 0.08 in year 3 of surveillance. Pneumonia and diarrhoea were the most common complications. Of 18.1% hospitalized, 1.6% died. Of 2286 children tested, 1599 (69.9%) were measles IgM positive. Of 542 measles IgM negative children, 66 (12%) were dengue IgM positive. The predictive positive value for the IMCI case definition was 75%.
Conclusion: The IMCI case definitions for measles is reasonable but may overestimate measles incidence. Measles continues to be a public health problem in Pakistan; increased efforts to control measles are urgently needed.     

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。     

Immune status following measles vaccination in infants and evaluation for the need of revaccination

In this prospective study, immune status of children vaccinated in infancy was determined at age 12-18 months. In 200 children, preimmunization protective measles hemagglutination (HI) antibody titres (greater than or equal to 1:8) were present in 38.5% of children of 6-8 months, the frequency decreased to 17.6 and 14.3% in age groups 9-11 and 12-18 months, respectively followed by an increasing incidence of 52.5% in those more than 18 months of age. Paired measles HI titre was estimated in 56 children, the post vaccination sample was taken at age 12-18 months, 3-9 months after measles vaccination. Most of the children (98.0%), with no detectable antibody titre, had a protective titre. Again a significant number (p less than 0.001) of children aged 12-18 months had protective HI titres compared to non-vaccinated. These findings suggest that when vaccinated at 9-11 months in our country, there is no need for revaccination later.     

Antibody response of children to measles vaccine mixed with diphtheria-pertussis-tetanus or diphtheria-pertussis-tetanus-poliomyelitis vaccine

The feasibility of giving measles vaccine mixed with either diphtheria-pertussis-tetanus (DPT) or DPT-poliomyelitis (DPTP) vaccine was investigated to simplify the routine immunization schedule. Children 12 to 18 months of age, due for measles immunization, were given measles vaccine alone or mixed with DPT or DPTP. Their prevaccination and four-weeks postvaccination serum samples were tested for the measles virus hemagglutination-inhibition antibody titer. Although 191 children completed the study, only 160 were initially seronegative. The seroconversion rates and geometric mean antibody titers in children given measles vaccine alone, mixed with DPT, or mixed with DPTP were 98%, 96.3%, and 96.4% and 41, 53, and 53, respectively. Local and systemic reactions were no more frequent in children given the mixture of vaccines than in children given DPTP alone. In summary, injecting measles vaccine mixed with DPT or DPTP did not diminish its immunogenic potency or increase adverse reactions. We believe that freshly mixed measles and DPT or DPTP vaccines can be given together, thus avoiding two separate injections.     

Serum levels of measles IgG antibody activity in children under 5 years in Dar-es-Salaam, Tanzania

Measles IgG antibody levels were estimated in sera from 685 Tanzanian children, 374 (54.6%) boys and 311 (45.4%) girls aged 18 months to 5 years, using an enzyme-linked immunosorbent assay (ELISA). The children were screened for HIV-1 and 2 antibodies using ELISA, and reactive sera were confirmed by Western blot. Nutritional status was assessed by anthropometry. Overall measles vaccination coverage was 98.8%. Measles antibody activity was not detected in 41 (6.0%) children, and ten (1.5%) had antibody levels below 200 mIU/ml, the cut-off level considered to be protective. The non-reactive samples were from one unvaccinated child, one child with unknown vaccination status and 39 vaccinated children. Measles IgG antibody levels were higher in girls (3452.1 mIU/ml) than in boys (2928.2 mIU/ml) (p = 0.02). Higher mean levels were found in children with a history of low birthweight (< 2.5 kg) (p = 0.03). There were no significant differences in measles antibody levels with regard to variations in nutritional status. No correlation (r2 = 0.002) was found between antibody levels and time elapsed since vaccination. In a multivariable logistic regression analysis, children who were HIV-seropositive (n = 9) were more likely to have non-protective antibody levels < 200 mIU/ml (OR = 5.85; 95% CI: 1.37-24.93).     

Serological response to early measles vaccination

This study compares the persistence of measles IgG antibody in 239 children vaccinated at 6-8 months of age with 76 children vaccinated after 8 months of age. Among the children vaccinated prior to 9 months, 49 per cent of the children between 16 and 44 months and 33 per cent of children over 54 months had levels of measles IgG antibody conventionally considered protective. Among the children older than 48 months, 67 per cent of children vaccinated before 9 months and 13 per cent of children vaccinated after 8 months had antibody levels below the conventionally accepted protective levels of 0.2 IU/ml. Older children had lower antibody levels than younger children. Measles immunization before 9 months with the standard titer Edmonston-Zagreb vaccine has not provided a large proportion of under-five children with protective levels of measles IgG antibody. A significant proportion of children vaccinated at the currently recommended age also had suboptimal levels. It is difficult to protect the majority of the measles-susceptible population with a single dose regardless of the immunization schedule used. A second dose of measles vaccine may be necessary to increase the herd immunity.     

Augmented antibody response to live attenuated measles vaccine in children with Plasmodium falciparum parasitaemia

The impact of malarial infection on the humoral immunological response to measles virus antigen was studied in 184 children aged 8-19 months in Guinea-Bissau. Pre- and post-immunization measles serology was performed using dried blood on absorbent paper and the ELISA technique. Blood smears obtained at the time of vaccination and 2 and 4 weeks afterwards were examined for malaria parasites. Pre-vaccination antibodies to measles were found in 44 out of 184 children (24%). Plasmodium falciparum was identified in 62 of the 132 initially non-immune children who completed the study. The rate of seroconversion was 127 out of 132 (96%). Post-immunization measles antibody titres were significantly higher in the vaccinees with P. falciparum than in those without malaria parasites in the blood.     

Responses in children to measles vaccination associated with perirenal transplantation

Background:  Measles infection can be fatal in pediatric patients with chronic renal failure or in patients who have undergone renal transplantation, both of whom are in the immunosuppressed state. The efficacy of single, live measles vaccination in preventing infection was examined.
Methods:  Of 156 children with renal failure who underwent renal transplantation, the changes in antibody titer were investigated before and after renal transplantation in 125 children whose measles antibody titer could be examined, together with disease and vaccination histories. Live measles vaccine was administered to 42 children with negative antibody titer. The antibody seroconversion rate was then investigated in these children, along with rate of antibody maintenance and degree of antibody titer elevation.
Results:  Seroconversion rate was 97.6%. Antibody titers measured on HI and EIA were 72 ± 118 fold (HI) and 36.9 ± 31.3 (EIA), respectively. The geometric mean of the increase in antibody titer 6 months after vaccination was 15. No side-effects of vaccination were observed in any of the children.
Conclusions:  Live measles vaccination of children with chronic renal failure is effective and safe, because the seroconversion rate, rate of antibody titer maintenance and degree of antibody titer elevation in children with chronic renal failure were all equivalent to those of healthy children.     

Immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children

Objective: To determine the immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children in north Queensland.
Methodology: A cross-sectional survey of immunity in a sample of children; 101 fully vaccinated Aboriginal and Torres Strait Island children, with a median age of 24.5 months, from 10 communities in North Queensland participated in this study. The main outcome measures were the prevalence of adequate antibody levels against hepatitis B, poliomyelitis and measles.
Results: Only 54% (95% Cl 44–63%) of the children had adequate immunity (10 m iu/mL) to hepatitis B, and one child had been infected despite vaccination. Although all the children (95% Cl 96–100%) had adequate immunity (i.e. neutralizing antibodies at a dilution of 1:8) to poliovirus 2, only 93% (95% Cl 86–96%) and 60% (95% Cl 50–69%) had adequate immunity to polioviruses 1 and 3, respectively. Nearly all (96%; 95% Cl 90–98%) of the children had adequate immunity (i.e. detectable IgG antibody) to measles.
Conclusions: Although a relatively low proportion of the children had adequate antibody levels against hepatitis B the clinical significance of this observation is uncertain. Further studies are needed to determine whether fully vaccinated Torres Strait Island children have been adequately protected and whether they require a booster dose of hepatitis B vaccine. A substantial proportion of fully vaccinated Aboriginal and Torres Strait Island children are inadequately protected against poliomyelitis, and therefore any such child with acute flaccid paralysis should be investigated fully for poliomyelitis. Vaccinated Aboriginal and Torres Strait Island children are well protected against measles, as are other Australian children.     

Effect of second dose of measles vaccine on measles antibody status: A randomized controlled trial

Objective

To evaluate the effect of the second dose of measles vaccine on measles antibody status during childhood.

Setting

Immunization centre of Under-five Clinic of the Department of Community Medicine at a tertiary-hospital.

Design

Randomized Controlled trial.

Methods

Blood samples were collected from all subjects for baseline measles serology by heel puncture at 9–12 months of age. All subjects were given the first dose of measels vaccine. At second visit (3–5 months later), after collecting the blood sample from all, half the children were randomized to receive the second dose of measles vaccine (study group), followed by collection of the third sample six weeks later in all the subjects.

Results

A total of 78 children were enrolled and 30 children in each group could be analyzed. 11(36.6%) children in the study group and 13 (43.3%) children in the control group had protective levels of measles IgG at baseline. Around 93.3 % of children in the study group had protective measles antibody titers as against 50% in the control group at the end of the trial. The Geometric Mean Titre (GMT) of measles IgG increased from 14.8 NTU/mL to 18.2 NTU/mL from baseline to six weeks following receipt of the second dose of the vaccine in the study group, as compared to a decrease from 16.8 NTU/mL to 12.8 NTU/mL in the control group.

Conclusions

A second dose of measles vaccine boosts the measles antibody status in the study population as compared to those who receive only a single dose.     

应用套式PCR早期快速诊断麻疹的研究

目的 建立从临床标本中快速检测麻疹病毒(MV)基因片段的方法,以便早期快速地对临床症状不典型的麻疹作出诊断。方法 收集116例疑似麻疹患儿的咽拭子标本,74例尿液标本及110例血清标本,其中73名疑似麻疹患儿同时收集了咽拭子标本与尿液标本,104名疑似麻疹患儿同时收集了咽拭子标本与血清标本。采用套式PCR扩增咽拭子和尿液标本中的MVN基因相关片段,用MV标准株进行空斑形成试验测定其敏感性,通过与常见呼吸道病毒PCR交叉扩增试验测定方法的特异性。用ELISA检测患儿血清中的MV特异性IgM抗体。结果 套式PCR可检测到0.53空斑形成单位(pfu)的病毒。所设计的引物与其他病毒株均无交叉反应。临床疑似麻疹患儿咽拭子和尿液标本中MV检测阳性率分别为60.3％(70/116)和64.9％(48/74);在同时采集到咽拭子和尿液标本的73例患儿中,检测结果一致的有71例(97.3％)。用2种ELISA试剂盒测定麻疹特异性IgM阳性率分别为59.1％(65/110)和55.5％(61/110),检测结果一致的106例(96.4％)。在同时采集到咽拭子和血液标本的104例患儿中麻疹基因检测与抗体检测结果一致的84例(80.8％)。结论 本研究建立的套式PCR检测MVN基因的方法有较好的敏感性和特异性,与血清中MV特异性IgM检测方法相比,基因检测可在临床症状出现后就检测到,并可以单份标本就进行检测,更适合作麻疹早期诊断的实验室检查依据。     

MEASLES,MUMPS, AND RUBELLA ANTIBODY STATUS AND RESPONSE TO IMMUNIZATION IN CHILDREN AFTER THERAPY FOR ACUTE LYMPHOBLASTIC LEUKEMIA

Seventy-seven patients with acute lymphoblastic leukemia (ALL) who were in complete remission and whose therapies had been stopped for at least 6 months before enrollment in this study were retrospectively analyzed regarding their antibody status for measles, mumps, and rubella, with the aim to demonstrate the seropositivity rate after treatment in the authors’ group. Each patient's serum samples were analyzed by enzyme-linked immunosorbent assay (ELISA) method to determine the antibody titers before and after immunization. Measles serology was available in 77 children; 45 (58%) were seronegative. Initial ages of measle-seronegative patients were statistically lower than those of seropositive cases (median 3.29 versus 4.91 years, respectively). Mumps serology was available in 76 children; 36 (47%) were seronegative. Mumps-seropositive cases tended to have more frequent previous history of infection than seronegative cases (55.0% versus 28.6%, respectively, P = .05). Rubella serology was available in 76 children, and 20 (26.3%) were seronegative. It was determined that initial ages of rubella-seronegative patients were statistically lower than those of seropositive cases (median 3.03 versus 4.32 years, respectively). The authors concluded based on the results of their study that at a median of 3.31 years after completion of chemotherapy for ALL, the majority of cases had antibody levels lower than protective values for measles (58.4%); however, these values were 47.3% for mumps and 26.3% for rubella. Seroconversion rates after measles (55%) and mumps vaccination (57.1%) were still low. However, in the available cases, relatively adequate response to rubella vaccination (92.3%) was observed.     

Humoral immunity to diphtheria,tetanus, measles,and hemophilus influenzae type b in children with acute lymphoblastic leukemia and response to re‐vaccination

Objective

Loss of immunity to previous vaccination and timing of re‐vaccination in children receiving chemotherapy remains controversial. The aim of this study was to investigate the immunity to vaccine preventable diseases in children with acute lymphoblastic leukemia (ALL).

Procedure

Sixty‐one patients with ALL and 13 healthy siblings were enrolled. Three study groups included newly diagnosed patients (group 1), patients on maintenance chemotherapy (group 2), and patients that completed chemotherapy (group 3). Blood samples for baseline antibody titers were obtained from all the patients and controls. Patients in group 2 were vaccinated with diphtheria, tetanus, and hemophilus influenzae type b (Hib). Patients in group 3 and controls received the measles vaccine in addition to all the above vaccines. In groups 2 and 3, post‐vaccination antibody titers were also obtained.

Results

Patients and controls had no Hib vaccine during primary vaccination. After chemotherapy median antibody levels against diphtheria, tetanus, measles, and Hib were decreased but tetanus antibodies were still at the protective levels. Proportions of the patients with protective levels were 11.1%, 83.3%, 16.7%, and 16.7% for diphtheria, tetanus, Hib, and measles, respectively. Vaccination achieved protective antibody levels in 81%, 100%, 89.5%, and 70% of the patients for diphtheria, tetanus, Hib, and measles, respectively. Vaccine responses during maintenance were also satisfying.

Conclusion

We recommend re‐vaccination after 3 months of cessation of chemotherapy. Administration of Hib vaccine may be beneficial after the first 3 months of maintenance chemotherapy especially in children with no primary vaccination followed by a second booster dose after cessation of therapy to increase immunity. Pediatr Blood Cancer 2009;53:967–972. © 2009 Wiley‐Liss, Inc.