Measles vaccine

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Measles vaccine
Providing vaccinations to protect against disease after Typhoon Haiyan (11352296333).jpg
A child is given a measles vaccine.
Vaccine description
Target disease Measles
Type Attenuated virus
Clinical data
MedlinePlus a601176
Identifiers
CAS Registry Number  YesY
ATC code J07BD01
 N (what is this?)  (verify)

Measles vaccine is a vaccine that is very effective at preventing measles.[1] After one dose 85% of children nine months of age and 95% over twelve months of age are immune.[2] Nearly all of those who do not develop immunity after a single dose develop it after a second dose. When rates of vaccination within a population are greater than 93% outbreaks of measles typically no longer occur; however, they may occur again if rates of vaccination decrease. The vaccine's effectiveness lasts many years. It is unclear if it becomes less effective over time. The vaccine may also prevent against the disease if given within a couple of days of being exposed.[1]

The vaccine is generally safe including in those with HIV infections. Side effects are usually mild and short lived. This may include pain at the site of injection or mild fever. Anaphylaxis has been documented in about one per hundred thousand people. Rates of Guillian-Barre syndrome, autism and inflammatory bowel disease do not appear to be increased.[1]

The vaccine is available both by itself and in combination with other vaccines including rubella vaccine, mumps vaccine, and varicella vaccine (the MMR vaccine and MMRV vaccine). The vaccine works equally well in all formulations. The World Health Organization recommends it be given at nine months of age in areas of the world where the disease is common. In areas where the disease is very uncommon giving it at twelve months is reasonable. It is a live vaccine. It comes as a dried powder which needs to be mixed before being given either just under the skin or into a muscle. Verification that the vaccine was effective can be determined by blood tests.[1]

About 85% of children globally have received this vaccine as of 2013.[3] In 2008 at least 192 countries offered two doses.[1] It was first introduced in 1963.[2] The combination measles-mumps-rubella (MMR) vaccine first became available in 1971.[4] The chickenpox vaccine was added to these three in 2005 giving the MMRV vaccine.[5] It is on the World Health Organization's List of Essential Medicines, the most important medication needed in a basic health system.[6] The vaccine is not very expensive.[1]

Effectiveness[edit]

Measles cases 1944-1964 follow a highly variable epidemic pattern, with 150,000-850,000 cases per year. A sharp decline followed introduction of the vaccine in 1963, with fewer than 25,000 cases reported in 1968. Outbreaks around 1971 and 1977 gave 75,000 and 57,000 cases, respectively. Cases were stable at a few thousand per year until an outbreak of 28,000 in 1990. Cases declined from a few hundred per year in the early 1990s to a few dozen in the 2000s.
Measles cases reported in the United States before and after introduction of the vaccine.
Measles cases reported in England and Wales.

Before the widespread use of the measles vaccine, its incidence was so high that infection with measles was felt to be "as inevitable as death and taxes."[7] In the United States, reported cases of measles fell from hundreds of thousands to tens of thousands per year following introduction of the vaccine in 1963 (see chart at right). Increasing uptake of the vaccine following outbreaks in 1971 and 1977 brought this down to thousands of cases per year in the 1980s. An outbreak of almost 30,000 cases in 1990 led to a renewed push for vaccination and the addition of a second vaccine to the recommended schedule. Fewer than 200 cases were reported each year from 1997 to 2013, and the disease was believed no longer endemic in the United States.[8][9][10] In 2014, 610 cases were reported.[11] Roughly 30 cases were diagnosed in January 2015, likely originating from exposure near Anaheim, California in late December 2014.

The benefit of measles vaccination in preventing illness, disability, and death has been well documented. The first 20 years of licensed measles vaccination in the U.S. prevented an estimated 52 million cases of the disease, 17,400 cases of mental retardation, and 5,200 deaths.[12] During 1999–2004, a strategy led by the World Health Organization and UNICEF led to improvements in measles vaccination coverage that averted an estimated 1.4 million measles deaths worldwide.[13] The vaccine for measles has led to the near-complete elimination of the disease in the United States and other developed countries.[14] It was introduced in 1963.[15] These impressive reductions in death and long-range after-effectiveness were initially achieved with a live virus version of the vaccine that itself caused side effects, although these are far fewer and less serious than the sickness and death caused by measles itself. While preventing many deaths and serious illnesses, the live virus version of the vaccine did cause side effects in a small percentage of recipients, ranging from rashes to, rarely, convulsions.[16]

Measles is common worldwide. Although it was declared eliminated from the U.S. in 2000, high rates of vaccination and excellent communication with those who refuse vaccination are needed to prevent outbreaks and sustain the elimination of measles in the U.S.[17] Of the 66 cases of measles reported in the U.S. in 2005, slightly over half were attributable to one unvaccinated individual who acquired measles during a visit to Romania.[18] This individual returned to a community with many unvaccinated children. The resulting outbreak infected 34 people, mostly children and virtually all unvaccinated; 9% were hospitalized, and the cost of containing the outbreak was estimated at $167,685. A major epidemic was averted due to high rates of vaccination in the surrounding communities.[17]

The live vaccine has non specific effects such as preventing respiratory infections that may be greater than those of measles prevention. These benefits were greater when used before a year of age. A high titre vaccine resulted in worse outcomes in girls and thus is no longer recommended by the world health organization.[19] As measles causes upper respiratory disease that leads to complications of pneumonia and bronchitis, measles vaccine is beneficial to reduce exacerbations of chronic obstructive pulmonary disease (COPD) and asthma.

Adverse effects[edit]

Adverse effects associated with the MMR vaccine include fever, injection site pain and, in rare cases, red or purple discolorations on the skin known as thrombocytopenic purpura, or seizures related to fever (febrile seizure).[20] Serious side effects are extremely rare.

There is no evidence of a link between the MMR vaccine and autism.[21][22][23][24] The MMR vaccine does not appear to cause subacute sclerosing panencephalitis.[25]

Contraindications[edit]

  • Pregnancy: MMR vaccine and its components should not be administered to pregnant women.[26]
  • HIV-infected children may receive measles vaccines if their CD4+ lymphocyte count is greater than 15%.[27]

History[edit]

As a fellow at Children's Hospital Boston, Dr. Thomas C. Peebles worked with Dr. John Franklin Enders. Dr. Enders became known as "The Father of Modern vaccines", and Enders shared the Nobel Prize in 1954 for his research on cultivating the polio virus that led to the development of a vaccination for the disease. Switching to study measles, Enders sent Peebles to Fay School in Massachusetts, where an outbreak of the disease was under way, and there Peebles was able to isolate the virus from some of the blood samples and throat swabs he had taken from the students. Even after Enders had taken him off the study team, Peebles was able to cultivate the virus and show that the disease could be passed on to monkeys inoculated with the material he had collected.[14] Enders was able to use the cultivated virus to develop a measles vaccine in 1963 based on the material isolated by Peebles.[28] In the late 1950s and early 1960s, nearly twice as many children died from measles as from polio.[29] The vaccine Enders developed was based on the Edmonston strain of attenuated live measles virus, which was named for the Fay student from whom Peebles had taken the culture that led to the virus's cultivation.[30]

The first ever trials of measles vaccine were undertaken by David Morley at the Wesley Guild Hospital in Ilesha, Nigeria[31] on his own children.

Dr. Maurice Hilleman at Merck & Co., a pioneer in the development of vaccinations, developed the MMR vaccine in 1971, which treats measles, mumps and rubella in a single shot followed by a booster.[16][32] One form is called "Attenuvax" with more than 40 peptide sequences.[33] The measles component of the MMR vaccine uses Attenuvax, which is grown in a chick embryo cell culture using the Enders' attenuated Edmonston strain. Merck decided not to resume production of attenuvax on October 21, 2009.[34]

Types[edit]

Measles is seldom given as individual vaccine nowadays and is often given in combination with mumps and rubella. Two types of measles vaccines are currently available.

  • Mumps Measles Rubella vaccine, live (MMR-II)
  • Mumps Measles Rubella and varicella virus vaccine (Proquad)

Measles mumps rubella vaccine (MMR-II); MMR vaccine is a live attenuated viral vaccine used to induce immunity against measles, mumps and rubella.

Dosing[edit]

MMR is not generally given to children less than 12 months of age. However, the CDC recommends that infants aged 6 to 12 months traveling outside the United States receive their first dose of MMR vaccine.[35] Pediatric dosing is 0.5 ml subcutaneously (often between 12–18 months). A second dose is given by 7 years (on or before last day of year 6) or by Kindergarten entry.[36] Vaccine is administered in the outer aspect of the upper arm. In adults, 0.5 mL subcutaneously and a second dose 28 days apart is given. In adults greater than 50 years, only one dose is needed.

See also[edit]

References[edit]

  1. ^ a b c d e f "Measles vaccines: WHO position paper." (PDF). Weekly epidemiological record 84 (35): 349–60. 28 August 2009. PMID 19714924. 
  2. ^ a b Control, Centers for Disease; Prevention (2014). CDC health information for international travel 2014 the yellow book. p. 250. ISBN 9780199948505. 
  3. ^ "Measles Fact sheet N°286". who.int. November 2014. Retrieved 4 February 2015. 
  4. ^ "Vaccine Timeline". Retrieved 10 February 2015. 
  5. ^ Mitchell, Deborah (2013). The essential guide to children's vaccines. New York: St. Martin's Press. p. 127. ISBN 9781466827509. 
  6. ^ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014. 
  7. ^ Babbott FL Jr, Gordon JE (1954). "Modern measles". Am J Med Sci 228 (3): 334–61. PMID 13197385. 
  8. ^ Centers for Disease Control and Prevention Summary of notifable diseases—United States, 1993 Published October 21, 1994 for Morbidity and Mortality Weekly Report 1993; 42 (No. 53)
  9. ^ Centers for Disease Control and Prevention Summary of notifable diseases—United States, 2007 Published July 9, 2009 for Morbidity and Mortality Weekly Report 2007; 56 (No. 53)
  10. ^ Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Wolfe S, Hamborsky J, McIntyre L, eds. 11th ed. Washington DC: Public Health Foundation, 2009
  11. ^ [1]
  12. ^ Bloch AB, Orenstein WA, Stetler HC et al. (1985). "Health impact of measles vaccination in the United States". Pediatrics 76 (4): 524–32. PMID 3931045. 
  13. ^ Centers for Disease Control and Prevention (CDC) (2006). "Progress in reducing global measles deaths, 1999–2004". MMWR Morb Mortal Wkly Rep 55 (9): 247–9. PMID 16528234. 
  14. ^ a b Martin, Douglas. "Dr. Thomas C. Peebles, Who Identified Measles Virus, Dies at 89", The New York Times, August 4, 2010. Accessed August 4, 2010.
  15. ^ Hayden GF (March 1979). "Measles vaccine failure. A survey of causes and means of prevention". Clin Pediatr (Phila) 18 (3): 155–6, 161–3, 167. doi:10.1177/000992287901800308. PMID 371890. 
  16. ^ a b Collins, Huntly. "The Man Who Saved Your Life - Maurice R. Hilleman - Developer of Vaccines for Mumps and Pandemic Flu: Maurice Hilleman's Vaccines Prevent Millions of Deaths Every Year", copy of article from The Philadelphia Inquirer, August 30, 1999. Accessed August 4, 2010.
  17. ^ a b Parker AA, Staggs W, Dayan GH et al. (2006). "Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States". N Engl J Med 355 (5): 447–55. doi:10.1056/NEJMoa060775. PMID 16885548. 
  18. ^ Centers for Disease Control and Prevention (CDC) (2006). "Measles—United States, 2005". MMWR Morb Mortal Wkly Rep 55 (50): 1348–51. PMID 17183226. 
  19. ^ Sankoh O, Welaga P, Debpuur C, Zandoh C, Gyaase S, Poma MA, Mutua MK, Hanifi SM, Martins C, Nebie E, Kagoné M, Emina JB, Aaby P (2014). "The non-specific effects of vaccines and other childhood interventions: the contribution of INDEPTH Health and Demographic Surveillance Systems". Int J Epidemiol 43 (3): 645–53. doi:10.1093/ije/dyu101. PMC 4052142. PMID 24920644. 
  20. ^ Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C (2012). "Vaccines for measles, mumps and rubella in children". Cochrane Database Syst Rev 2: CD004407. doi:10.1002/14651858.CD004407.pub3. PMID 22336803. 
  21. ^ "Measles, mumps, and rubella (MMR) vaccine". Centers for Disease Control and Prevention. 2008-08-22. Archived from the original on 2008-10-08. Retrieved 2008-12-21. 
  22. ^ Immunization Safety Review: Vaccines and Autism. From the Institute of Medicine of the National Academy of Sciences. Report dated May 17, 2004; accessed June 13, 2007.
  23. ^ MMR Fact Sheet, from the United Kingdom National Health Service. Accessed June 13, 2007.
  24. ^ Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C (2012). "Vaccines for measles, mumps and rubella in children". Cochrane Database Syst Rev 2: CD004407. doi:10.1002/14651858.CD004407.pub3. PMID 22336803. 
  25. ^ http://www.cdc.gov/measles/about/complications.html "Complications of Measles."
  26. ^ Guidelines for Vaccinating Pregnant Women
  27. ^ Chart of Contraindications and Precautions to Commonly Used Vaccines
  28. ^ Staff. "Work by Enders Brings Measles Vaccine License", The Hartford Courant, March 22, 1963. Accessed August 4, 2010. "A strain of measles virus isolated in 1954 by Dr. Thomas C. Peebles, instructor in pediatrics at Harvard, and Enders, formed the basis for the development of the present vaccine".
  29. ^ Staff. "The Measles Vaccine", The New York Times, March 28, 1963. Accessed August 4, 2010.
  30. ^ Hilleman, Maurice R. "Past, Present, and Future of Measles, Mumps, and Rubella Virus Vaccines", Pediatrics (journal), Vol. 90 No. 1 July 1992, pp. 149-153. Accessed August 4, 2010.
  31. ^ Pritchard, John (13 November 1997). "Obituary: Dr C. A. Pearson". The Independent. Retrieved 29 January 2014. 
  32. ^ Sullivan, Patricia (2005-04-13). "Maurice R. Hilleman Dies; Created Vaccines (washingtonpost.com)". The Washington Post. Retrieved 2009-07-21. 
  33. ^ Ovsyannikova IG, Johnson KL, Naylor S, Poland GA (February 2005). "Identification of HLA-DRB1-bound self-peptides following measles virus infection". J. Immunol. Methods 297 (1-2): 153–67. doi:10.1016/j.jim.2004.12.020. PMID 15777939. 
  34. ^ Q & As about Monovalent M-M-R Vaccines
  35. ^ "Measles and the Vaccine (Shot) to Prevent It". http://www.cdc.gov/vaccines/vpd-vac/measles/fs-parents.html. Centers for Disease Control. 
  36. ^ Washington Stat Dept of Health
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