Barrabeig I, Rovira A, Rius C, et al. New York: Academic Press, 1984:203-209. Ann Intern Med 2019;170:513-520. The risk of complications is increased among infants, adults older than 20 years of age, pregnant women, undernourished children (particularly those with vitamin A deficiency), and persons with immune suppression (e.g., cancer or human immunodeficiency virus [HIV] infection). Antivaccine groups continue to postulate that the MMR vaccine may be a cause of inflammatory bowel disease and autism on the basis of a case series published in 1998 that was later retracted because of falsification of clinical information.37 Subsequent laboratory and epidemiologic studies have not supported an association between the MMR vaccine and these conditions.38,39. Guidelines on post-exposure prophylaxis for measles Ref: PHE publications gateway number: GW-492 PDF , 253KB , 24 pages This file may not be suitable for users of assistive technology. From Gavi, the Vaccine Alliance, Global Health Campus, Geneva (P.M.S. 3. Evaluation of the measles clinical case definition. Health Health Care. Rubella spreads when an infected person coughs or sneezes. Measles is an acute viral illness that starts with a prodromal phase, lasting 2 to 4 days, of fever and at least one of the “three Cs” (cough, coryza, and conjunctivitis), similar to any upper respiratory tract infection.13 The characteristic measles rash — an erythematous maculopapular exanthem — appears 2 to 4 days after the onset of fever, first on the face and head and then on the trunk and extremities; it may be confluent on the face and upper body (Figure 2). Clinicians should suspect measles in persons who have a febrile illness with rash, especially if they lack documentation of measles vaccination, have recently traveled overseas, or are part of a community with low vaccine acceptance. Two studies have been cited by those claiming that the MMR vaccine causes autism. Pew Research Center does not take policy positions. Administration of immune globulin is particularly critical for patients who are at risk for severe disease, including infants younger than 12 months of age, pregnant women without evidence of measles immunity, and severely immunocompromised persons. Measles is highly contagious and can be spread when someone with the virus coughs, sneezes or exhales. DOI: 10.1056/NEJMcp1905181, Tap into groundbreaking research and clinically relevant insights. 1Decades of research have allowed scientists to develop an effective vaccine. Centers for Disease Control and Prevention Recommendations for Acceptable Evidence of Immunity to Measles in the United States. During the ensuing 3 to 5 days, the rash in different parts of the body fades in the order in which it appeared, and full recovery occurs within 7 days after rash onset in uncomplicated cases. In addition to ongoing vaccination of new birth cohorts, prevention of measles outbreaks requires the identification and vaccination of persons who are at high risk on the basis of exposure or contact frequency (e.g., school-attending children, college students, international travelers, and health care workers) and others who are more likely to have missed both vaccination and natural infection, such as persons from underserved or geographically or socially isolated communities. * Information is from the Institute of Medicine35 and Pless et al.36. No potential conflict of interest relevant to this article was reported. 32. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). Xavier S, Forgie SED. Bull N Y Acad Med 1945;21:202-222. Measles is a highly contagious infectious disease caused by measles virus. Chan School of Public Health provides much-needed answers. 33. The immune system also creates long-lived memory cells, which remain permanently in circulation, allowing the body to rapidly recognise and eliminate previously encountered infections. In: Smith RA, Knight V, Smith JAD, eds. Lee AD, Clemmons NS, Patel M, Gastañaduy PA. International importations of measles virus into the United States during the post-elimination era, 2001–2016. In: Roush SW, Baldy LM, Hall MAK, eds. Measles vaccine given within 72 hours after measles exposure, or human immune globulin given up to 6 days after exposure, can prevent or attenuate disease in susceptible persons. Reporting today in Science, the researchers show that the measles virus wipes out 11 percent to 73 percent of the different antibodies that protect against viral and bacterial strains … How should this case be further evaluated and managed? 35. Hutchins SS, Papania MJ, Amler R, et al. Each complication and death related to measles is a “preventable tragedy that could have been avoided through vaccination,” the authors write. This could even mean that children who become infected with measles may need to be revaccinated for previous diseases. Use of concentrated human serum γ-globulin in the prevention and attenuation of measles. Koplik spots revisited. A large measles outbreak in Ukraine has infected more than 25,000 people and is connected to growing outbreaks in Europe and the record-setting one in the United States. About two to four days later, red spots appear. 2004 (https://www.who.int/immunization/programmes_systems/interventions/TreatingMeaslesENG300.pdf). 4. The MMR vaccine is widely available from your healthcare provider or local health department. The Advisory Committee on Immunization Practices recommends a dose of 0.5 ml per kilogram of body weight administered intramuscularly for persons with a body weight of up to 30 kg and a dose of 400 mg per kilogram intravenously for persons weighing more than 30 kg.29 Because the immunity to measles conferred by administration of immune globulin is temporary, persons who receive immune globulin should subsequently receive MMR vaccine, administered no earlier than 6 months after intramuscular immune globulin or 8 months after intravenous immune globulin. Last modified on Thu 31 Oct 2019 19.00 GMT. Since January 2019, increased numbers of measles cases have been reported to the U.S. Centers for Disease Control and Prevention (CDC). Conjunctivitis (pink eye) Feeling achy and run down. Measles vaccine was first licensed in the United States in 1963, after which the incidence of measles declined rapidly (Figure 1). In general, numbers of reported cases are an underestimate of true numbers of cases because of underdiagnosis and underreporting. CMAJ 2015;187:600-600. The researchers recruited volunteers from three schools in the Netherlands. 22. J Infect Dis 2004;189:Suppl 1:S43-S47. A cell population that could be involved in this process is the CD8CD57 double-positive lymphocyte subset (CD8+CD57+), known to be significantly expanded in some viral infections, e.g. Measles starts with fever, cough, nose cold and eye inflammation. Panel A shows an infant with measles conjunctivitis and rash. Washington, DC: National Academy Press, 2001. Moss WJ, Cutts F, Griffin DE. Clemmons NS, Wallace GS, Patel M, Gastañaduy PA. Antiviral agents (e.g., ribavirin and interferon) have been used to treat severely affected and immunocompromised patients with measles, and positive outcomes have been reported.41 However, randomized controlled trials are lacking, and ribavirin is not licensed by the Food and Drug Administration for the treatment of measles. How measles leaves a body vulnerable to infections. The recommendations in the present article are concordant with these guidelines. Recommendations regarding acceptable evidence of immunity are available to guide decisions about who should or should not be vaccinated against measles (Table 3). Although measles meets the criteria for a disease that can be eradicated, strategies are needed to increase and maintain uptake of recommended vaccine schedules. Measles-related articles published in CDC’s Morbidity and Mortality Weekly Report (MMWR). 3rd ed. All cases of suspected measles should be reported immediately — without waiting for diagnostic test results — to the local or state health department, which can assist with obtaining tests and take actions to minimize spread of virus. Between Jan 1 and Jul 31, 2019, 182 countries reported 364,808 measles cases to the WHO. In 2014, a survey from the World Health Organization reported that measles causes about 314 deaths every day. 39. Measles can be prevented with vaccination. This article was published on July 10, 2019, at NEJM.org. Elledge’s team looked at antibodies in the blood (the proteins produced by immune cells) and found that 11% to 73% of the antibody memory bank had been erased after measles. Conditions. Immunization safety review: measles-mumps-rubella vaccine and autism. Valuable tools for building a rewarding career in health care. 18. The MMR vaccine has an acceptable side-effect profile. Measles vaccine given within 72 hours after measles exposure, or human immune globulin given up to 6 days after exposure, can prevent or attenuate disease in susceptible persons.29 In household or classroom settings in which the timing of first exposure can be determined, prophylaxis has been shown to be highly effective (up to 90% after vaccine30 and 95% after immune globulin31). ... demographic research, media content analysis and other empirical social science research. High doses of vitamin A have been shown to decrease mortality and the risk of complications in young children hospitalized with measles in developing countries.25 In the United States, children with measles have been found to have low levels of serum retinol, and levels tend to be lower among those with more severe illness.26 The American Academy of Pediatrics (AAP) recommends vitamin A administration for all children with severe measles (e.g., requiring hospitalization), with the use of the following age-specific doses: 200,000 IU for children 12 months of age or older; 100,000 IU for infants 6 to 11 months of age; and 50,000 IU for infants younger than 6 months.27 A third age-specific dose should be given 2 to 4 weeks later to children who have clinical signs and symptoms of vitamin A deficiency. Ogbuanu IU, Zeko S, Chu SY, et al. If these diseases seem uncommon — or even unheard of — it's usually because these vaccines are doing their job. Katz SL, Hinman AR. 30. Complications associated with measles infection in industrialized countries include otitis media (7 to 9% of patients), pneumonia (1 to 6%), diarrhea (8%), postinfectious encephalitis (approximately 1 per 1000), subacute sclerosing panencephalitis (a progressive degenerative disease with onset usually 5 to 10 years after acute measles; approximately 1 per 10,000), and death (approximately 1 per 1000). The physician suspects bronchitis and prescribes antibiotic agents. Measles can be prevented with a vaccine that is both highly effective and safe. The CDC recommends that the MMR and varicella vaccines be administered separately for the first dose, but they can be given as the MMR-V for the second dose.29 MMR is the vaccine of choice for the prevention of measles in adolescents and adults and in infants 6 to 11 months of age who are at increased risk for exposure (e.g., during outbreaks or international travel) (Table 2). The first dose of MMR produces immunity to measles and rubella in 90 to 95 percent of recipients. Address reprint requests to Dr. Strebel at Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland, or at [email protected]. The measles virus can also cause middle ear infection and diarrhoea and in severe cases pneumonia, convulsions or cerebral inflammation. The authorized source of trusted medical research and education for the Chinese-language medical community. J Infect Dis 2019;219:1616-1623. Measles vaccines: WHO position paper – April 2017. 8. “The threat measles poses to people is much greater than we previously imagined.”. Implications of the human immunodeficiency virus epidemic for control and eradication of measles. human immunodeficiency virus (HIV) infection. Measles cases and outbreaks: measles cases in 2019. 28. ‡ Revaccination is recommended for persons with perinatal human immunodeficiency virus infection who were vaccinated before establishment of effective antiretroviral therapy (ART) with two appropriately spaced doses of MMR vaccine after effective ART has been established. Summary and conclusions: measles elimination meeting, 16-17 March 2000. Globally, measles affects more than 7 million people each year and causes more than 100,000 deaths. Learn more: Mayo Clinic facts about coronavirus disease 2019 (COVID-19) Our COVID-19 patient and visitor guidelines, plus trusted health information Latest on COVID-19 vaccination by site: Arizona patient vaccination updates Arizona, Florida patient vaccination updates Florida, Rochester patient … In the news. MMWR Morb Mortal Wkly Rep 2019;68:402-404. Two studies of unvaccinated children in an Orthodox Protestant community in the Netherlands found that measles wipes out the immune system’s memory of previous illnesses, returning it to a more baby-like state, and also leaves the body less equipped to fight off new infections. He is a father of two children, his wife is pregnant, and he has a history of recent travel outside the United States. 21. The measles epidemic in the Netherlands provides an opportunity for research. Clinical specimens (e.g., serum and nasopharyngeal swab) for laboratory confirmation should be obtained from all patients suspected to have measles at their first contact with a health care provider. See the FAQs section below for more details. To receive the MMR vaccine, contact your primary care provider, local pharmacy or reach out to your local health department or community clinic. Clinicians play a critical role in managing parental concerns about vaccination and in maintaining trust in vaccines. All suspected cases of measles should be reported immediately to the local or state health department without waiting for diagnostic test results. † Clinicians should wait at least 28 days after any dose before giving a subsequent dose. © 2021 Guardian News & Media Limited or its affiliated companies. Information and tools for librarians about site license offerings. J Infect Dis 2003;187:Suppl 1:S291-S298. Stay connected to what's important in medical research and clinical practice, Subscribe to the most trusted and influential source ofmedical knowledge. § Complication has been described in measles case reports, but the risk is not well quantified. Measles can cause serious complications, and even death. To tackle previously unseen infections, the immune system relies on constantly pumping out a diverse range of immune cells – thousands of different varieties, each with slightly different receptors on their surfaces, with a collective ability to recognise almost any pathogen. 42. Lancet 2017;390:2490-2502. Measles is a highly contagious viral disease caused by an enveloped negative-strand RNA virus in the Paramyxovirus family. 13. Geneva: World Health Organization, 2018 (https://www.who.int/immunization/global_vaccine_action_plan/SAGE_GVAP_Assessment_Report_2018_EN.pdf). 23. Serious adverse events are rare and much less common than the risks associated with natural measles infection; these include anaphylaxis (2 to 14 cases per million doses), febrile seizures (1 case per 3000 doses), thrombocytopenic purpura (1 case per 30,000 doses), and measles inclusion-body encephalitis in persons with demonstrated immunodeficiencies (. World Health Organization. 31. Measles runs a more devastating course in children in developing countries, a phenomenon related to undernutrition, overcrowding, and lack of access to care, with mortality as high as 1 to 15%.18 Measles infection during pregnancy is associated with an increased risk of complications, including miscarriage, preterm birth, neonatal low birth weight, and maternal death.19, Whereas a typical case of measles is easily recognized during outbreaks, the clinical diagnosis is challenging to many clinicians who have not seen measles and in patients who present before the onset of rash or whose rash is less apparent (e.g., infants with residual maternally acquired antibodies, previous receipt of immunoglobulin, or vaccination after exposure). The typical measles rash may be absent in persons with impaired cell-mediated immunity.20, The differential diagnosis includes rubella, dengue fever, parvovirus B19 infection, human herpesvirus 6 infection, and other infections, as well as reactions to measles vaccine. MMR vaccine contains live, attenuated (or weakened) strains of the measles, mumps, and rubella viruses. 25. In: Plotkin SA, Orenstein WA, Offit PA, eds. 2. 5. Measles eliminated between 11% and 73% of children’s protective antibodies, the research found. The inset shows data from the Centers for Disease Control and Prevention (www.cdc.gov/measles/cases-outbreaks.html) on the numbers of cases of measles during the period from 2000 through June 20, 2019. Small white spots known as Koplik's spots may form inside the mouth two or three days after … Once measles is suspected, the clinician should immediately contact the state or local health department, which can provide advice regarding clinical specimens for laboratory diagnosis, treatment of household contacts, and follow-up of contacts to determine the need for vaccine or immune globulin. Clin Infect Dis 1999;29:106-112. Vaccine-induced immunity is probably lifelong in the vast majority of vaccinees.32. Measles Outbreaks in Niger Linked to Rainfall and Temperature, Study Finds Aug. 25, 2020 — Rainfall and temperature drive agricultural activity, which, in … Pless RP, Bentsi-Enchill AD, Duclos P. Monitoring vaccine safety during measles mass immunization campaigns: clinical and programmatic issues. Prepare to become a physician, build your knowledge, lead a health care organization, and advance your career with NEJM Group information and services. “Maybe after five years you would recover.”. Among children aged 24 months in England, vaccination dropped from 91.2% in 2017-18 to 90.3% in 2018-19, the lowest rate since 2010. Philadelphia: Elsevier, 2018:579-618. Hviid A, Hansen JV, Frisch M, Melbye M. Measles, mumps, rubella vaccination and autism: a nationwide cohort study. 15. Petrova said that addressing scepticism around vaccines was a complex task. Griffin DE. 40. A real-time polymerase-chain-reaction (PCR) assay for measles virus RNA in urine, blood, oral fluid, or nasopharyngeal specimens can identify infection with a sensitivity of 94% and a specificity of 99%23 before measles IgM antibodies are detectable, and it allows genotyping of the measles virus, which is useful for tracking virus importations and spread.24 All cases of suspected measles should be reported immediately — without waiting for diagnostic test results — to the local or state health department, which can assist with obtaining tests and take actions to minimize spread of virus. Studies have shown a small increased risk of febrile seizures occurs among children who are younger than 7 years old approximately 8-14 days after vaccination for every 3,000-4,000 children vaccinated with MMR … Huiming Y, Chaomin W, Meng M. Vitamin A for treating measles in children. ); and Emory University and the Emory Vaccine Center, Atlanta (W.A.O.). 17. In the United States, the only measles-containing vaccines are the MMR vaccine and the combined measles–mumps–rubella–varicella (MMR-V) vaccine. 2018 Assessment report of the Global Vaccine Action Plan. However, after measles, the children had a far more restricted range. Countries with the largest numbers of reported cases over the most recent 6-month period include Madagascar, Ukraine, India, Brazil, Philippines, Venezuela, Thailand, Kazakhstan, Nigeria, and Pakistan.10 Although the vast majority of cases worldwide occur in countries with weak health systems, vaccine refusal is emerging as a risk factor for measles outbreaks, and the World Health Organization (WHO) has identified vaccine hesitancy as one of the top 10 global health threats in 2019.11, All six WHO regions have the goal of measles elimination by or before 2020. The Centers for Disease Control and Prevention (CDC) reported that an important factor contributing to the outbreaks in New York is misinformation in the communities about the safety of the measles–mumps–rubella (MMR) vaccine.8, Between 2000 and 2017, the global annual incidence of reported cases of measles declined by 83%, from 145 to 25 cases per million population. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Antibiotics, in the absence of pneumonia, sepsis, or other signs of a secondary bacterial complication, are generally not recommended.28 To prevent nosocomial transmission, patients who are suspected to have measles should be triaged in outpatient settings, and hospitalized patients with measles should be isolated with precautions to prevent airborne transmission.27 Patients with measles are infectious from 4 days before to 4 days after the onset of their rash. An acute progressive encephalitis (measles inclusion-body encephalitis16) and a characteristic giant-cell pneumonia (Hecht’s pneumonia17) are two especially severe complications that may occur in rare cases in persons with immune suppression. 10. Health Topics; All topics » ... evidence and research. Manikkavasagan G, Ramsay M. The rationale for the use of measles post-exposure prophylaxis in pregnant women: a review. 26. J Obstet Gynaecol 2009;29:572-575. o Determination of which measles antigens are required to safely elicit long-lasting, protective humoral and cellular immunity in the developing immune system of the young infant. 6. The article ends with the authors’ clinical recommendations. 34. Scientists say threat posed by measles is ‘much greater than we previously imagined’, Thu 31 Oct 2019 18.00 GMT This is a list of vaccine-related topics.. A vaccine is a biological preparation that improves immunity to a particular disease.A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed … Rubella is most dangerous for a pregnant woman's baby. Comparison of the Risk of Complications Associated with Measles and the Risk of Serious Adverse Events after Measles Vaccination. Tiny white spots inside the mouth. Pediatr Infect Dis J 2011;30:78-80. The physical examination is notable for a body temperature of 39°C, conjunctivitis, and rhonchi on chest auscultation. 38. Measles outbreaks are occurring in communities and on college campuses throughout the United States. Measles vaccines: a review of adverse events. Progress Toward Regional Measles Elimination — Worldwide, 2000–2016 MMWR Vol 66, No 42; 1148–1153 10/27/2017; Progress Toward Measles Elimination — African Region, 2013–2016 Measles virus is one of the most highly contagious human pathogens known. Geneva: World Health Organization, June 2018 (https://www.who.int/immunization/monitoring_surveillance/burden/laboratory/manual/en/). Because there is no specific antiviral medication available, treatment of measles consists of supportive therapy to prevent dehydration and, in some cases, to treat nutritional deficiencies, as well as early detection and treatment of secondary bacterial infections such as pneumonia and otitis media. The best protection against measles and mumps is to stay current on your vaccinations. Measles vaccine was first licensed in the United States in 1963, after which the incidence of measles declined rapidly (. Vaccines. Measles-control programs throughout the world have shown that measles is eliminated if national immunization schedules are fully implemented and high vaccination coverage is achieved and maintained, whereas measles outbreaks occur when populations are not adequately vaccinated.
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