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Measles vaccine
Vaccine description
Target disease Measles
Type Attenuated virus
Clinical data
MedlinePlus a601176
Legal status
?
Identifiers
CAS number  YesY
ATC code J07BD01
 N (what is this?)  (verify)

Measles vaccine is a highly effective vaccine used against measles.[1] The measles-mumps-rubella-varicella combo (MMRV vaccine) vaccine has been available since 2005. The vaccine acts by stimulating the adaptive immune response and provides long term protection against the disease. The onset of the protection is slow but the effect is long lasting. It is on the World Health Organization's List of Essential Medicines, a list of the most important medication needed in a basic health system.[2]

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 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.[3] Enders was able to use the cultivated virus to develop a measles vaccine in 1963 based on the material isolated by Peebles.[4] In the late 1950s and early 1960s, nearly twice as many children died from measles as from polio.[5] The vaccine Enders developed was based on the Edmonston strain of attenuated live measles virus, which was named for the Fay student from which Peebles had taken the culture that led to the virus' cultivation.[6]

The first ever trials of measles vaccine were undertaken by David Morley at the Wesley Guild Hospital in Ilesha, Nigeria[7] 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.[8][9] One form is called "Attenuvax" with more than 40 peptide sequences.[10] The measles component of the MMR vaccine uses Attenuvax, which is grown in a chick embryo cell culture using the Enders' attenuated Edmonston strain.

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.

Before the widespread use of a vaccine against measles, its incidence was so high that infection with measles was felt to be "as inevitable as death and taxes."[11] Today, the incidence of measles has fallen to less than 1% of people under the age of 30 in countries with routine childhood vaccination.[citation needed] 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 have been reported each year since 1997, and the disease is no longer considered endemic in the United States.[12][13][14]

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.[15] 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.[16] The vaccine for measles has led to the near-complete elimination of the disease in the United States and other developed countries.[3] It was introduced in 1963.[17] 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.[8]

Measles is endemic worldwide. Although it was declared eliminated from the U.S. in 2000, high rates of vaccination and good communication with persons who refuse vaccination are needed to prevent outbreaks and sustain the elimination of measles in the U.S.[18] 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.[19] 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.[18]

Adverse Effects[edit]

Adverse effects associated with the MMR vaccine include fever, injection site pain, and rarely, febrile seizure or thrombocytopenic purpura.[20] Serious side effects are extremely rare. There is strong evidence against any association of MMR vaccination with autism.[21] The current body of evidence from MMR vaccine research suggests that the MMR vaccine does not cause SSPE.[22]

Contraindications[edit]

  • Pregnancy: MMR vaccine comes under Pregnancy category C; Animal studies have shown adverse effects in animals but adequate studies on humans are not available. Potential benefits may outweigh the risks
  • HIV or other immunocompromised conditions

Important drug interactions[edit]

  • Patients on monoclonal antibodies of all kinds (Belimumab, certolizumab pegol are absolute contraindications), those on anticancer/immunomodulator drugs (methotrexate and hydroxyurea are absolute contraindications) should not take the vaccine.[medical citation needed]
  • Patients who have received any Immunoglobulin treatments for any disease should also be closely monitored for any ADRs.[medical citation needed]
  • Allergy to neomycin or gelatin

Types[edit]

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

  • 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 given to children less than 12 months age. Pediatric dosing is 0.5 ml subcutaneously (often between 12–18 months). A second dose is given on the 11th or 12th birthday. 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. ^ Ruigrok RW, Gerlier D (December 2007). "Structure of the measles virus H glycoprotein sheds light on an efficient vaccine". Proc. Natl. Acad. Sci. U.S.A. 104 (52): 20639–40. doi:10.1073/pnas.0709995105. PMC 2409202. PMID 18087048. 
  2. ^ "WHO Model List of EssentialMedicines". World Health Organization. October 2013. Retrieved 22 April 2014. 
  3. ^ 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.
  4. ^ 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".
  5. ^ Staff. "The Measles Vaccine", The New York Times, March 28, 1963. Accessed August 4, 2010.
  6. ^ 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.
  7. ^ Pritchard, John (13 November 1997). "Obituary: Dr C. A. Pearson". The Independent. Retrieved 29 January 2014. 
  8. ^ 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.
  9. ^ Sullivan, Patricia (2005-04-13). "Maurice R. Hilleman Dies; Created Vaccines (washingtonpost.com)". The Washington Post. Retrieved 2009-07-21. 
  10. ^ 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. 
  11. ^ Babbott FL Jr, Gordon JE (1954). "Modern measles". Am J Med Sci 228 (3): 334–61. PMID 13197385. 
  12. ^ 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)
  13. ^ 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)
  14. ^ 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
  15. ^ 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. 
  16. ^ 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. 
  17. ^ 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. 
  18. ^ 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. 
  19. ^ Centers for Disease Control and Prevention (CDC) (2006). "Measles—United States, 2005". MMWR Morb Mortal Wkly Rep 55 (50): 1348–51. PMID 17183226. 
  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. ^ Maglione MA, Das L, Raaen L, et al. (August 2014). "Safety of vaccines used for routine immunization of U.S. children: a systematic review". Pediatrics 134 (2): 325–37. doi:10.1542/peds.2014-1079. PMID 25086160. 
  22. ^ http://www.cdc.gov/measles/about/complications.html "Complications of Measles."
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