Rational use of measles, mumps and rubella (MMR) vaccine.
Carter H, Campbell H.
Fife Health Board, Glenrothes, Scotland.
Measles, mumps, rubella (MMR) vaccine is a live vaccine preparation containing
attenuated strains of all 3 viruses. MMR vaccine is widely used throughout the
world, with the US having the widest experience with the vaccine. In countries
where the vaccine has been introduced successfully, significant reductions in
all 3 diseases for which it is protective have occurred. The vaccine has been
shown to be highly immunogenic, with seroconversion rates of 95 to 100% being
achieved for each of the 3 component vaccines. This immunity appears to be
long-lasting and may even be lifelong.
Minor adverse effects may occur approximately 1 week after immunisation.
Rarely, mumps vaccine-induced meningitis (milder than that associated with
wild mumps virus) may occur, its frequency varying with the strain of
attenuated mumps virus contained in any particular vaccine. Clinically, the
vaccine is indicated for infants aged between 12 and 15 months, and should be
administered by intramuscular or deep subcutaneous injection. A few specific
contraindications exist, including a genuine hypersensitivity to eggs, and to
the aminoglycoside antibiotics kanamycin and neomycin. An increasing number of
countries are now adopting a 2-stage MMR policy in an attempt to prevent
epidemics among those who remain unprotected, and to move towards eventual
disease eradication.
Publication Types:
Review
Review, Tutorial
PMID: 7686463 [PubMed - indexed for MEDLINE]
Welcome conjecture as opposed to unjustified assurance.
- SM
TI: Persistent measles virus infection enhances major histocompatibility
complex class I expression and immunogenicity of murine neuroblastoma cells.
AU: Gopas,-J;
Itzhaky,-D;
Segev,-Y;
Salzberg,-S;
Trink,-B;
Isakov,-N;
Rager-Zisman,-B
SO: Cancer-Immunol-Immunother.
1992; 34(5): 313-20.
JN:
Cancer-immunology,-immunotherapy-CII;
IS: 0340-7004
LA: English
MA: The effect of persistent measles virus infection on the expression of
major histocompatibility complex (MHC) class I antigens was studied. Mouse
neuroblastoma cells C1300, clone NS20Y, were persistently infected with the
Edmonston strain of measles virus. The persistently infected cell line,
NS20Y/MS, expressed augmented levels of both H-2Kk and H-2Dd MHC class I
glycoproteins. Activation of two interferon(IFN)-induced enzymes, known to be
part of the IFN system: (2'-5')oligoadenylate synthetase and
double-stranded-RNA-activated protein kinase, was detected.
Measles-virus-infected cells elicited cytotoxic T lymphocytes that
recognized and lysed virus-infected and uninfected neuroblastoma cells in an
H-2-restricted fashion. Furthermore, immunization of mice with persistently
infected cells conferred resistance to tumor growth after challenge with the
highly malignant NS20Y cells. The rationale for using measles virus for
immunotherapy is that most patients
develop lifelongimmunity
after recovery or vaccination
from this infection. Patients developing cancer are likely to have memory cells.
A secondary response induced by measles-virus-infected cells may
therefore induce an efficient immune response against non-infected tumour cells.
RO: National-Library-of-Medicine
AN: 92174232 View Complete Record
Persistent measles virus infection enhances major
histocompatibility complex class I expression and immunogenicity of murine
neuroblastoma cells.
Gopas J, Itzhaky D, Segev Y, Salzberg S, Trink B, Isakov N, Rager-Zisman B.
Department of Microbiology and Immunology, Faculty of Health Sciences, Ben
Gurion University of the Negev, Beer Sheva, Israel.
The effect of persistent measles virus infection on the expression of major
histocompatibility complex (MHC) class I antigens was studied. Mouse
neuroblastoma cells C1300, clone NS20Y, were persistently infected with the
Edmonston strain of measles virus. The persistently infected cell line,
NS20Y/MS, expressed augmented levels of both H-2Kk and H-2Dd MHC class I
glycoproteins. Activation of two interferon(IFN)-induced enzymes, known to be
part of the IFN system: (2'-5')oligoadenylate synthetase and
double-stranded-RNA-activated protein kinase, was detected.
Measles-virus-infected cells elicited cytotoxic T lymphocytes that recognized
and lysed virus-infected and uninfected neuroblastoma cells in an
H-2-restricted fashion. Furthermore, immunization of mice with persistently
infected cells conferred resistance to tumor growth after challenge with the
highly malignant NS20Y cells. The
rationale for using measles virus for immunotherapy is that most patients
develop lifelong immunity after recovery or vaccination from this infection.
Patients developing cancer are likely to have memory cells. A secondary
response induced by measles-virus-infected cells may therefore induce an
efficient immune response against non-infected tumour cells.
[Vaccination against measles. The situation in Mexico and
America. Advances in the method of aerosol immunization]
[Article in Spanish]
Fernandez de Castro J, Kumate J.
Direccion General de Medicina Preventiva, Mexico, D.F.
We present general comments on the epidemiology of measles considering the
pre-vaccine era as well as the post-vaccine period in which some changes can
be observed: the decrease in morbidity and mortality, the extension of the
inter-epidemic interval, the increase in the mean age of infection, etc. We
make some estimations about the vaccine coverage and the ideal age of
immunization for the goal of eradication (assuming
a lifelong immunity for the
vaccinees). The technical problems in measles immunization are also
revised explaining why no continental country has been able to eliminate the
disease. We describe the epidemiological situation in North America, Mexico
and Latin American countries. Lastly we present the Mexican experience with
the inhaled aerosolised vaccine: the studies in Monterrey (Sabin et al, 1982),
other investigation in Mexico, D.F. and in the State of Jalisco, as well as
the mass campaigns in Aguascalientes in 1988 and in Coahuila and Nuevo Leon in
1989. We propose it as an effective, harmless, simple, inexpensive and
practical method.
Duration of live measles vaccine-induced immunity.
Markowitz LE, Preblud SR, Fine PE, Orenstein WA.
Division of Immunization, Centers for Disease Control, Atlanta, GA 30333.
Publication Types:
Review
Review, Tutorial
From the article:
Similar to immunity after natural measles infection, live measles
vaccine-induced immunity has been thought to be lifelong. Vaccinees
who subsequently develop measles have been considered primary vaccine
failures, defined as the failure of the initial vaccination to elicit an
appropriate immune response. Primary vaccine failures are believed to be
caused by (1) interference by maternal antibody when vaccination occurs at a
young age, (2) technical problems, such as improper vaccine storage or
administration, or (2) other unknown reasons. Transmission of measles
among older children in the United States, most of whom have been
appropriately vaccinated, has raised the question of whether waning
vaccine-induced immunity may also be responsible for some vaccine failures.
Current vaccination policy as well as mathematical models assume that
vaccine-induced immunity is life-long. If waning vaccine-induced
immunity does occur, changes in measles vaccination strategies might be
necessary. The purpose of this paper is to review information concerning
the duration and quality of measles vaccine-induced immunity.
Discussion: Several types of
studies have been applied to evaluate the duration and quality of measles
vaccine-induced immunity. The few reports of measles disease in persons
who had seroconverted after vaccination document that secondary vaccine
failure can occur. In addition two studies provide data on the potential
magnitude of the risk of secondary vaccine failure. However, most data
suggest that waning immunity is uncommon.
Many questions concerning the
duration of vaccine-induced immunity remain to be answered, including what
percentage of cases reported in previously vaccinated persons in the United
States is caused by primary or secondary vaccine failure, whether different
measles vaccine strains produce immunity which is more or less "durable",
whether reexposure to wild measles virus is important for maintenance of
vaccine-induced immunity and whether it is possible to identify individuals at
risk for waning immunity.
The consequences of waning measles
vaccine-induced immunity may be minor for individuals if secondary vaccine
failure is associated with mild disease. However, waning vaccine-induced
immunity could be of greater consequence to a population. Although
persons with subclinical reinfection have not been shown to transmit virus, it
is not known whether this is true for persons with secondary vaccine failure.
If these individuals are able to transmit disease to other susceptibles,
waning immunity, even in a small percentage of persons, may impede realization
of the goal of measles elimination. Revaccination may be successful in
decreasing the number of persons who become susceptible due to waning
immunity. However, it is not known whether revaccination of such persons
will result in sustained immunity.
Questions concerning duration of
vaccine-induced immunity and secondary vaccine failure were raised at the time
of vaccine licensure and discussed 10 to 15 years later when outbreaks
occurred in vaccinated children. Now, 26 years after licensure, many of
the same issues remain unresolved. Although waning immunity has been
documented to occur in a small proportion of vaccinees, the epidemiologic
significance of this is still unclear.
[Elimination of measles, mumps and rubella in Switzerland]
[Article in German]
Herzog C.
The combined measles, mumps and
rubella live vaccine nowadays available is very well tolerated and confers
lifelong immunity. A complete immunization coverage among toddlers,
schoolchildren and adolescents should nearly eliminate these three childhood
diseases in a given population. The cost/benefit ratio of the immunization is
for all three diseases rewarding in Switzerland. Reactions expected to the
combined vaccine are mild and complications negligible in comparison to the
diseases prevented. Starting in 1987 a nationwide campaign will begin in
Switzerland; the aim is to vaccinate next to toddlers all so far
non-vaccinated 6-7 years old and 14-15 years old schoolchildren respectively
for a period of 8 years.
We examined the expected experience of normal individuals from a hypothetical
birth cohort of 3.5 million persons followed from birth to their 30th birthday
without and with a varicella vaccination programme. We assumed that one dose
of vaccine would be given to 15-month-old children along with the measles,
mumps and rubella vaccination to avoid a separate administration cost.
It was also assumed that 90% of children would be vaccinated, that vaccine
efficacy would be 90%, and that vaccine-induced immunity would be lifelong.
Finally, it was assumed that the programme would have no effect on
either the incidence rate or severity of zoster. For both disease and vaccine,
we measured the direct medical costs and home care costs (i.e., costs
associated with lost work time by someone other than the patient). Costs
associated with death or forgone wages to the patient were not estimated. The
reduction in costs would be 66% with a net savings of $262,050,392. The
benefit:cost ratio would be 6.9:1. If the major assumptions in this analysis
hold true, there may be substantial financial benefits from vaccinating all
children against varicella.
Measles vaccine in the People's Republic of China.
Xiang JZ, Chen ZH.
The strains of measles virus and the method used in the production of further
attenuated live-virus vaccine in the People's Republic of China were studied.
Observation of clinical reactions and serologic responses to immunization with
Shanghai-191 measles vaccine, which is produced on a large scale with a
locally isolated viral strain, revealed that this vaccine is adequately safe
and immunogenic. Epidemiologic data showed a significant decrease in
measles-associated morbidity after the introduction of mass vaccination in
1965. The duration of immunity induced by Shanghai-191 measles vaccine was
studied for eight years in a region in which interference due to natural
measles infection had been minimized by mass vaccination of children.
Although immunity appeared to persist
for at least eight years, the results suggested that primary vaccination does
not confer lifelong immunity. Reactions and antibody responses to this
vaccine were compared with those to two vaccines from abroad, the Schwarz and
Leningrad-16 strains. The hemagglutination-inhibiting (HAI) antibody titer
induced by Shanghai-191 vaccine was higher than that induced by Leningrad-16
vaccine and lower than that induced by Schwarz vaccine; however, these
differences were not significant. Preliminary studies on the preparation of
measles vaccine in human diploid cells have yielded promising results.
For tropical countries the World Health Organisation recommends a single dose
of measles vaccine, administered at a minimum age of 9 months. In some African
nations, however, up to 26% of all reported measles occurs before the age of 9
months, and many African nations have been reluctant to follow the WHO
recommendation. In 1974 the Ministry of Health of the United Republic of
Cameroon made several changes in the existing measles control strategy,
including increasing the minimum age for measles vaccination from 6 to 9
months. Surveillance of measles in Yaounde, the capital city, during the five
years after the increase in age at vaccination did not reveal a need to return
to the minimum age of 6 months. In fact, by 1979, with measles vaccination
coverage among children 12-23 months of age at 40%, there had been a 44%
decrease in reported measles among children of all ages, including a 64%
decrease in the measles attack rate among children under the age of 9 months.
These observations support the one dose, 9 month minimum age measles
vaccination policy in tropical Africa.
At least 95% of vaccine recipients
develop measles antibody following a single dose of live vaccine administered
around 15 months of age. Since evidence now extending through 16 years indicates
that the protection conferred is durable, there is no need for a "booster" dose
of vaccine
Clinical trial of live measles vaccine given alone and live
vaccine preceded by killed vaccine. Fourth report to the medical research
council by the measles sub-committee of the committee on development of
vaccines and immunisation procedures.
Follow-up of 5000 children given a single dose of live attenuated measles
vaccine (Schwarz strain) when aged 10 months to 2 years shows a high level of
protection in comparison with an unvaccinated group. This protection has been
maintained for 12 years. Measles in vaccinated children was less severe as
well as less frequent throughout the period.
There is no evidence from the
follow-up so far that a further injection of vaccine is needed; this
has been confirmed by measles haemagglutination-inhibiting antibody
estimations in a sample of the children.
Publication Types:
Clinical Trial
Controlled Clinical Trial
PMID: 71396 [PubMed - indexed for MEDLINE]
J Pediatr 1965; 66: 471-88
Studies on
immunity to measles.
Krugman
S, Giles JP, Friedman H, Stone S.
Studies on immunity to measles have been in progress since 1960.
Primary infection with measles virus was followed by evidence of detectable
antibody by the twelfth day; peak antibody titers were observed by the
twenty-first to the twenty-eighth day. Subsequently, in most instances
antibody persisted for at least four years at levels capable of completely
inhibiting measles infection. However, when antibody declined to minimal
or undetectable levels, exposure to measles virus was usually followed by an
asymptomatic infection and a booster response; under these circumstances
antibody was detectable by the seventh day and peak antibody levels were
observed by the twelfth day. These studies confirm the observation that
one attack of measles is followed by lifelong immunity.
They also provide strong support for
the prediction that one inoculation of live measles-virus vaccine will confer
permanent immunity.
ALL INFORMATION, DATA, AND
MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.
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