Atypical measles infections in leukaemic children on immunosuppressive treatment.

One case of giant-cell pneumonia and two of encephalopathy, all due to measles infection in children in leukaemic remission on immunosuppressive treatment, were seen recently. The clinical syndromes were variable and atypical and the antibody responses unpredictable. Conventional doses of pooled immunoglobulin failed to protect the two children to whom it was given. Degeneration rather than inflammation seems to characterise the encephalopathy in immunosuppressed children infected with measles virus.     

Vitamin A supplements and mortality related to measles: a randomised clinical trial.

One hundred and eighty children admitted with measles were randomly allocated to receive routine treatment alone or with additional large doses of vitamin A (200,000 IU orally immediately and again the next day). Baseline characteristics of the two groups were virtually identical for age, severity of measles, and vitamin A and general nutritional states. In 91% of the children serum vitamin A concentrations were less than 0.56 mumol/l. Of the 88 subjects given vitamin A supplements, six (7%) died; of the 92 controls, 12 (13%) died (p = 0.13). This difference in mortality was most obvious for children aged under 2 years (one death out of 46 children receiving supplements versus seven deaths out of 42 controls; p less than 0.05) and for cases complicated by croup or laryngotracheobronchitis. Mortality was several times higher in marasmic than in better nourished children, regardless of study allocation (p less than 0.01).     

Abnormal measles-mumps-rubella antibodies and CNS autoimmunity in children with autism

Autoimmunity to the central nervous system (CNS), especially to myelin basic protein (MBP), may play a causal role in autism, a neurodevelopmental disorder. Because many autistic children harbor elevated levels of measles antibodies, we conducted a serological study of measles-mumps-rubella (MMR) and MBP autoantibodies. Using serum samples of 125 autistic children and 92 control children, antibodies were assayed by ELISA or immunoblotting methods. ELISA analysis showed a significant increase in the level of MMR antibodies in autistic children. Immunoblotting analysis revealed the presence of an unusual MMR antibody in 75 of 125 (60%) autistic sera but not in control sera. This antibody specifically detected a protein of 73-75 kD of MMR. This protein band, as analyzed with monoclonal antibodies, was immunopositive for measles hemagglutinin (HA) protein but not for measles nucleoprotein and rubella or mumps viral proteins. Thus the MMR antibody in autistic sera detected measles HA protein, which is unique to the measles subunit of the vaccine. Furthermore, over 90% of MMR antibody-positive autistic sera were also positive for MBP autoantibodies, suggesting a strong association between MMR and CNS autoimmunity in autism. Stemming from this evidence, we suggest that an inappropriate antibody response to MMR, specifically the measles component thereof, might be related to pathogenesis of autism.     

Surveillance of antibody to measles,mumps, and rubella by age.

Before the introduction of measles, mumps, and rubella vaccine a survey was carried out to measure antibody prevalence to the three viruses by age. A total of 8716 samples of serum collected by five public health laboratories in different parts of England during 1986-7 were tested. Despite the current measles vaccination programme 60% of children aged 1-2 years did not have measles antibody and over 80% did not have antibodies to mumps and rubella. In the 3-4 year age group 17% of the children were susceptible to measles, 55% to mumps, and 73% to rubella. The results suggest that vaccinating children early in the second year of life will be necessary to eliminate the three diseases. The survey provides baseline data for continuing surveillance of the immediate and long term effects of the new vaccination strategy.     

Effectiveness of revaccination against measles]

The authors studied the efficacy of measles revaccination in children in whose serum no specific antihemagglutinins were revealed in titration with 1 GAE antigen (the first group) and having no specific antibodies in titration with 4 GAE antigen (the second group). Investigations demonstrated that children in whose blood serum no measles antibodies were revealed in the presence of 1 GAE antigen were subject of vaccination. Repeated vaccination used at present in persons who produced minimal antibody concentrations in response to vaccination is not recommended.     

Reduced secretory antibody response to live attenuated measles and poliovirus vaccines in malnourished children.

Serum and nasopharyngeal IgA antibody levels were estimated in 20 malnourished children and 20 matched healthy controls after immunization with a single dose of live attenuated measles or poliovirus vaccine. Seroconversion and serum neutralizing antibody titres were comparable in the two groups. Secretory IgA antibody was detected significantly less often in undernourished children; the time of its first appearance was delayed-and its maximum level was significantly lower. Impaired secretory antibody response in malnourished children may contribute to slow inadequate recovery from viral and enterobacterial infections and predispose to lifethreatening complications.     

潍坊市健康人群麻疹、风疹、流行性腮腺炎抗体水平调查

目的了解潍坊市健康人群麻疹、风疹、流行性腮腺炎血清抗体水平,为消除麻疹、控制风疹及腮腺炎疫情提供依据。方法 2011年8月,采集昌乐、潍城2个县区<2、2～5、5～8、8～11、11～15、15～20、20～40、>40岁健康人群血标本,应用酶联免疫吸附试验检测麻疹、风疹、腮腺炎IgG抗体。结果检测总数320人,其中昌乐县健康人群的麻疹抗体阳性率为98.75%、潍城为96.25%;风疹抗体阳性率昌乐县健康人群为89.38%、潍城区为91.88%。昌乐、潍城两地区健康人群麻疹、风疹的抗体阳性率差异均无统计学意义(χ2=1.15、0.59,P>0.05);昌乐县健康人群腮腺炎抗体阳性率为84.38%、潍城区健康人群为66.25%,两者差异有统计学意义(χ2=14.14,P<0.01);8组不同年龄健康人群的麻疹抗体阳性率为92.50%～100%,风疹抗体阳性率为87.50%～92.50%,腮腺炎抗体阳性率为67.50%～85.00%,各年龄组间均无统计学意义(χ2=13.49、1.58、5.23,P>0.05)。结论潍坊市麻疹抗体阳性率较高,风疹、腮腺炎抗体阳性率相对偏低,今后须要积极开展学龄儿童麻腮风三联疫苗的查漏补种工作。     

Haemagglutination inhibition antibody levels one year after natural measles infection and vaccination.

An assessment of haemagglutination inhibition antibody (HAI) titres of 1,163 children, comprising 739 recipients of live measles vaccines and 424 patients with natural measles infection after 1 year was made in this investigation. Statistical analysis revealed a significant difference in the levels of HAI antibodies. Of the vaccinated children a significant 67.45% showed antibody titres of less than or equal to 1:16, while only 23.48% of children with natural measles showed these antibody titres. The importance and implication of such HAI antibody titres is discussed.     

Rapid serological screening of human sera for the presence of measles virus antibodies in solid-phase immunoenzyme analysis

A single dilution technique has been used for the determination of antimeasles antibody titer. The method involved the plotting of the calibration curve and the characterization of the serum by arbitrary "evaluation units" in comparison with the specially selected positive serum whose titer was taken to be equal to 100 "evaluation units". By means of this method 57 sera obtained from children immunized against measles and 118 sera from non-vaccinated adults aged 18-22 years were examined. The values of the calculated titers were similar to those determined experimentally. This recommends this method for seroepidemiological investigations aimed at determining the level of herd immunity to measles.     

Several physiologic features of the body and their role in the process of vaccination against measles]

The work was carried out under conditions of mass measles immunization at the polyclincs of Moscow and Dushanbe. The role of the macroorganism at the time of vaccination on the measles vaccination process was investigated. A thorough study of the anamnesis, its allergic predisposition was conducted; blood and C-RB were examined, and the content of serum immunoglobulins was determined by Macini's method. The results obtained pointed to the insufficiently complete detection of children with an altered reactivity by a simple examination by the physician alone. It was revealed that children suffering from various forms of allergy having in the anamnesis hypotrophy rickets and frequent acute respiratory diseases and chronic foci of infections had decreased indice of nonsecific immunological reactivity even at the period of clinical well-being, and could be detected only by means of laboratory methods of study. To the administration of measles vaccine such children responded not only by the development of clinical reactions of different intensity, but also by a significant reduction of antibody formation. All the aforesaid indicates a necessity of further study of the mechanism of establishment of postvaccinal measles immunity with consideration to the individual reactivity of the child organism.     

中山市2011年健康儿童脊髓灰质炎、麻疹和乙型肝炎抗体水平监测

目的了解中山市1~14岁健康儿童脊髓灰质炎(脊灰)病毒、麻疹病毒和乙型肝炎(乙肝)病毒抗体水平状况,为维持无脊灰、消除麻疹和控制乙肝提供依据。方法采用多阶段整群抽样方法,随机选择220名1~14岁健康儿童抽取静脉血,采用ELISA法检测麻疹病毒抗体Ig G、乙肝病毒表面抗原和抗体;用中和试验检测脊灰(Ⅰ、Ⅱ、Ⅲ)型病毒中和抗体。结果脊灰、麻疹和乙肝病毒抗体阳性率分别为91.36%、93.18%和66.36%,脊灰病毒Ⅰ、Ⅱ、Ⅲ型和麻疹病毒抗体几何平均滴度(GMT)分别为1∶215.90、1∶119.05、1∶31.40和1∶1 254.45;乙肝病毒表面抗原阳性率为1.36%。结论中山市1~14岁健康儿童对脊灰病毒具有较高的免疫水平,已形成对脊灰病毒有效的免疫屏障;乙肝得到有效控制;但麻疹未能形成有效的免疫屏障。     

Salivary diagnosis of measles: a study of notified cases in the United Kingdom, 1991-3.

OBJECTIVES--To validate a method for salivary diagnosis of measles and to assess the diagnostic accuracy of notified cases of measles. DESIGN--Blood and saliva samples were collected within 90 days of onset of symptoms from patients clinically diagnosed as having measles and tested for specific IgM by antibody capture radioimmunoassay. SETTING--17 districts in England and one in southern Ireland during August 1991 to February 1993. SUBJECTS--236 children and adults with measles notified by a general practitioner. RESULTS--Specific IgM was detected in serum in only 85 (36%) of the 236 cases. In cases associated with outbreaks and tested within six weeks of onset, 53/57 (93%) of samples were IgM positive, thereby confirming the sensitivity of serum IgM detection as a marker of recent infection. The serological confirmation rate was lower in cases with a documented history of vaccination (13/87; 15%) than in those without (70/149; 47%) and varied with age, being lowest in patients under a year, of whom only 4/36 (11%) were confirmed. Measles specific IgM was detected in 71/77 (92%) of adequate saliva samples collected from patients with serum positive for IgM. In cases where measles was not confirmed, 6/101 had rubella specific IgM and 5/132 had human parvovirus B19 specific IgM detected in serum. CONCLUSIONS--The existing national surveillance system for measles, which relies on clinically diagnosed cases, lacks the precision required for effective disease control. Saliva is a valid alternative to serum for IgM detection, and salivary diagnosis could play a major role in achieving measles elimination. Rubella and parvovirus B19 seem to be responsible for a minority of incorrectly diagnosed cases of measles in the United Kingdom and other infectious causes of measles-like illness need to be sought.     

枣庄市2008年麻疹减毒活疫苗强化免疫效果评价

为了评价枣庄市麻疹疫苗(MV)强化免疫的效果,于2008年在所辖区开展了流行病学调查、麻疹血清学监测和费用-效益分析等,对MV强化免疫进行了评价。枣庄市麻疹年平均报告发病率在强化免疫前为14.1/10万,对1-6岁儿童开展MV强化免疫后,2010年麻疹发病率为0.8/10万,降低了93.5%;1-6岁儿童麻疹发病构成,强化免疫前为39.87%,强化免疫后为25.90%,大大减少了5岁以下儿童的麻疹发病;强化免疫后,1-6岁儿童麻疹抗体阳性率为99.3%,抗体几何平均滴度(GMT)从强化免疫前的1∶563.0增长到强化免疫后的1∶814.9。开展MV强化免疫费用-效益比值为1∶2.23~1∶3.12。开展MV初始化强化免疫是加速麻疹控制最有效的措施之一。     

Measles in children who have malignant disease.

A review study examined the clinical course of measles diagnosed in children being treated for malignant disease in Newcastle upon Tyne during 1973-86. Of the 17 cases diagnosed, five were fatal. Factors associated with a favourable outcome were a typical rash and Koplik''s spots, which were accompanied by a detectable serum antibody response and the disappearance of measles giant cells from nasopharyngeal secretions. Pneumonitis severe enough to require assisted ventilation was invariably fatal. Pneumonitis and encephalitis were the main complications. Treatment included immunoglobulin, interferon, and ribavirin, but none could clearly be shown to be effective. The comparatively low mortality in this series may have been due to the extensive use of the fluorescent antibody technique in Newcastle during the study period and therefore detection of less severe cases as compared with other reports.     

Immune response in subacute sclerosing panencephalitis: reduced antibody response to the matrix protein of measles virus.

Immune precipitation was used to study the humoral immune response of patients with subacute sclerosing panencephalitis (SSPE). Patients with SSPE have a progressive infection of the CNS by measles or a measles variant despite high serum antibody levels to measles virus as measured by standard serologic techniques. However, when the antibody response to individual measles virus proteins was measured, we found a striking reduction in the ability of sera from patients with SSPE to precipitate the matrix (M) protein as compared to the precipitation of the M protein by sera from normal adults who had natural measles infection in childhood, or by convalescent sera obtained 3 to 5 weeks after a naturally occurring measles infection. The decreased antibody response to the M protein in sera from patients with SSPE occurred despite a vigorous antibody response to the other viral proteins, suggesting a selective defect in the production of antibody to a single viral protein. The reduced anti-M antibody in sera from patients with SSPE was demonstrated whether immune precipitation was performed with wild-type measles virus or SSPE virus proteins. These results suggest that in SSPE only small amounts of the M protein are produced. This result may help explain how measles virus persists in the central nervous system of patients with SSPE.     

Correlation of titers of antibodies to the measles virus by an immunoenzyme method and in the hemagglutination inhibition reaction

The authors analyze the results of comparative studies on 15 paired sera from children with suspected measles, of 32 sera from children and adolescents aged 1.5 to 16 immunized against measles, and of 21 sera from adults aged 19 to 86 with a history of the disease. EIA proved to be more sensitive than HAIT: the detection rate of positive sera was higher, as were the titers of antibodies detected by it, in examinations of the sera from vaccinated children and the adults. Analysis of the distribution of sera with different titers of antibody to measles virus in EIA and HAIT has revealed a correlation between the titers in the sera with high antibody levels. In the cases with low antihemagglutinin titers, no correlation between the titers determined in the two tests has been observed.     

A long-term follow-up study on the efficacy of further attenuated live measles vaccine, Biken CAM vaccine

Antibody persistence was measured in 39 children in an open community 12-13 years after immunization against measles with further attenuated live vaccine, Biken CAM. Serum samples of the children taken every two or three years after vaccination had higher, lower, or the same HI antibody titers as those in samples taken 6 weeks after vaccination. These differences reflected a decrease in the titer in some children and subclinical natural reinfection in others. However, all the children still retained detectable antibody in 12 or 13 years after vaccination, indicating long-term persistence of immunity after immunization with Biken CAM vaccine. For evaluation of the protective efficacy of the vaccine, matched controls were studied during the same period. Serological examination revealed that 97.5% of the controls were infected with measles and contracted the disease. In contrast, none of the vaccinees developed clinical infection after close contact with measles patients.     

梅州市两次麻疹疫苗强化免疫效果分析

目的综合评估分析梅州市两次麻疹疫苗强化免疫效果,为消除麻疹提供科学依据。方法综合分析麻疹疫苗强化免疫现场调查资料、评估法定传染病报告系统中麻疹发病率的变化;随机对辖区内1～12岁健康儿童216名,采用酶联免疫吸附试验(ELISA)进行强化免疫前及完成二次强化免疫后麻疹lgG抗体水平监测。结果监测人群完成二次强化免疫后麻疹IgG抗体阳性率达100.00%(216/216),2009年强化组、2010年强化组麻疹IgG抗体保护率和几何平均滴度(GMT)分别为82.08%、87.62%和1958.83、2050.26,均显著高于强化免疫前;2009年强化免疫后麻疹年发病率由强化免疫前五年平均发病率1.71/10万下降至0.22/10万,下降率87.13%,2010年强化后麻疹年发病率再次下降(0.039/10万),下降率82.27%。结论梅州市两次麻疹疫苗强化免疫效果显著,均大幅度降低了麻疹发病率、提高了人群麻疹抗体水平。     

Selected immunological reactions to measles virus in immunosuppressed guinea pigs

Cyclophosphamide and hydrocortisone treatment of measles virus infected guinea pigs resulted in suppression of cele- and antibody mediated immune reactions although a high dose of measles virus (10(5.5) TCID50) was used for infection: MIT was delayed and depressed; HI serum antibody response was almost completely inhibited.     

Immunoglobulin Classes of Serum Antibodies Formed in Response to Natural Infections with Myxo- and Pseudomyxoviruses among Infants and Children

The occurrence of immunoglobulin classes of serum antibody in response to natural infections with myxo- and pseudomyxoviruses among infants and children was investigated. Two types of the 19S antibody response have been demonstrated. In the first type, in which are included the measles and mumps virus infections, the 19S antibody appeared dominantly as a primary response to the virus infection. In the second type, which includes the influenza, parainfluenza and RS virus infections, the 19S antibody was either not detectable or produced in a limiting amount in infants even at an early stage of the illnesses. A possibility was discussed that production of the 19S antibody in response to the infection with myxo- and pseudomyxoviruses may be primarily determined by the nature of virus infection itself, particularly the presence or absence of a viremia.