The duration and strength of postvaccinal measles immunity

A prolonged immunoepidemiological follow-up of a large group of children immunized against measles revealed a high epidemiological efficacy of a single vaccination. Cases of measles were registered only among those vaccinees in whose blood sera no specific hemagglutinins were detectable by titration with 4 hemagglutinating units of measles antigen prior to the disease. The study showed that groups of children seronegative with respect to measles appeared, as a rule, after unsatisfactory immunization and not due to loss of postvaccinal immunity with time. Properly immunized children in whom the formation of antimeasles antibodies had occurred in response to the injection of live measles vaccine retained postvaccinal immunity for more that 15 years (the term of observation).     

Immunological effectiveness of a booster inoculation against measles in children remaining seronegative after vaccination

Booster immunization against measles with a highly immunogenic vaccine leads to the development of prolonged postvaccinal immunity lasting at least 6-7 years (the term of observation) in the groups of children found to be seronegative after the titration of their blood sera with 1 hemagglutinating unit (HAU) of the antigen. The booster immunization of children in whose blood sera the minimal concentrations of antibodies can be determined in the presence of 1 HAU of the antigen (seronegative in the presence of 4 HAU) is less effective. The serological checks of immunized children entering preschool institutions and the primary grades at schools and the subsequent booster immunization of children found to be seronegative will lead to a further decrease in measles morbidity.     

Immunostructure of school-age children inoculated against measles

The mass serological survey of school children immunized against measles was carried out by means of the hemagglutination inhibition test. As a result, 20.4% of these school children were found to be seronegative, and in 9.5% of them even the minimum concentration of measles antihemagglutinins (when titrated with 1 hemagglutinating unit of the antigen) was not detected. The accumulation of a considerable seronegative (measles-susceptible) stratum among children of school age occurred due to the low immunogenic potency of some batches of live measles vaccine, used for immunization in 1973, as well as due to the formerly practiced immunization of children under 1 year of age. A direct and close dependence of focal measles morbidity among immunized children having had contacts with the source of infection on the number of children among them, found to be seronegative after titration with 1 hemagglutination unit of measles antigen, was established.     

The results of multiyear observations on the duration of the maintenance of immunity in those vaccinated and revaccinated against and recovered from measles

The results of 5-year observations on the duration of immunity to measles virus in persons vaccinated and revaccinated against measles, as well as in persons having had this infection, are presented. The intensity of immunity was determined in the same persons with the use of the passive hemagglutination test. The study revealed differences in the formation, intensity and duration of postvaccinal immunity. A significant decrease in the concentration of antibodies over the period of 5 years was established in 50.0-52.3% of vaccines. Revaccination with live measles vaccine is an effective measure for enhancing immunity to measles virus in persons with initial antibody titers less than 1:10-1:20, but revaccination made in a single injection is not sufficient for the stable maintenance of measles morbidity at the sporadic level. Postinfectious immunity is characterized by stability and has no tendency towards decrease. Persons having had measles have no need in additional measures irrespective of the time elapsed after the disease.     

Epidemiological and immunological study of the foci of measles infection

Anamnestic data in respect to measles failed to correspond to the results of serological examination of contacts at the foci of the given infection. The collective immunity level in children's institutions is inadequate for the prevention of measles outbreaks. The incidence of the disease depended both on the level of immunity among the children and on the duration of presence of the source of infection in the focus. Live measles vaccine protected 90 percent of the vaccinated children from contracting the disease in the foci. At the very beginning of the postvaccinal period immunization defects were revealed in 26.5 percent of the vaccinated children who fell ill with measles. Morbidity index among the vaccinated individuals constituted 3.8 percent. One of the causes of measles contraction by the vaccinated individuals was the loss of postvaccinal immunity. Systematic control over the antimeasles immunity level with the aid of serological investigations is necessary for the purpose of detection of persons sensitive to measles in children's collective bodies.     

Transplacental measles immunity in infants in the 1st year of life]

A total of 187 parturients (66 with a history of measles and 121 immunized with live measles vaccine, or LMV, in childhood) and their 187 newborn infants, as well as 195 children aged up to 1 year, were examined. Antimeasles antibodies in blood sera were detected in the hemagglutination inhibition test. In all mothers with a history of measles and in their newborn infants antimeasles antibodies in different titers were detected. In mothers, formerly immunized with LMV, antimeasles antibodies were absent in 5.8% and in their newborn infants, in 6.6% of the examinees. Among children aged up to 1 year, born of formerly immunized mothers, more rapid disappearance of passive antimeasles immunity was observed. In cases of contact with measles, the serological examinations of all children born of mothers immunized with LMV should be carried out in order to protect seronegative children by passive or active immunization.     

The duration and intensity of measles immunity after a repeat inoculation against this infection

Controlled study lasting 6 years showed that booster immunization against measles was highly effective in children remaining seronegative, i. e. susceptible to this infection, after primary immunization: E = 97.5 +/- 0.12% (K = 35.7). Annual serological examination of children given booster immunization revealed that 87.6% of initially seronegative children retained specific antihemagglutinins for 5.5 years (the term of observation). The effectiveness of booster immunization against measles did not depend on the age when primary immunization had been made.     

Humoral imunity to pertussis in children with diabetes of type 1

To determine the state of humoral immunity to pertussis in children with insulin-dependent diabetes, IgG antibodies to pertussis toxin (PT) were determined in blood serum samples by means of EIA. In a group of children aged up to 6 years the highest percentage (100%) received the complete course of vaccination against pertussis with Russian adsorbed DPT vaccine, containing whole-cell pertussis monovaccine, while in a group over 6 years the complete vaccination course (3 vaccinations and 1 revaccination) had 53.4% of children. Pertussis morbidity was considerably higher in nonvaccinated subjects than in children with 4-fold vaccination (p < 0.001). The coefficient of association (Q) was 0.84. Children of all age groups were found to have low and average titers of antibodies to PT. The regressive analysis showed a decrease in antibodies in persons completely immunized against pertussis by the age of 6 years old. The presence of antibodies in nonimmunized persons showed that cases of pertussis or carrier state took place among the population. High titers of antibodies, indicative of recent cases of pertussis, were registered in all age groups, but high titers of antibodies were registered mostly in the group of children over 13 years old (p < 0.05), which confirmed an increase in pertussis morbidity in adolescents. Thus, vaccination against pertussis effectively protected children with diabetes of type 1, aged up to 6 years. For more prolonged protection the vaccination and revaccination of children aged over 4 years old is necessary.     

Immunocytochemical indices of the measles vaccinal process

To study the immune responsiveness of children in the measles vaccinal process, the cytochemical methods for the identification of immunocompetent cells have been used. The investigations have been made in children aged 1.5-4 years, immunized with live measles vaccine prepared from strain l-16. The results of these investigations indicate that the development of specific antiviral postvaccinal immunity is characterized by transitory changes in the populations of T-, B- and O-lymphocytes; such changes are accompanied by not only quantitative, but also qualitative changes of individual populations.     

Effectiveness of the selective revaccination of schoolchildren against measles

The revaccination of 70% of schoolchildren, previously immunized with measles vaccines of 26 different batches with insufficient immunogenic potency, has led to the pronounced and stable increase of immunity in the corresponding groups of children and has decreased measles morbidity among them 20 times.     

Effectiveness of measles immunoprophylaxis and the criteria for assessing its possible elimination

The study of measles morbidity in Donetsk Province in 1960-1984 and the study of antimeasles immunity in different groups of the population have shown that the problem of the liquidation of measles cannot be solved by immunizing the population in a single administration of the vaccine. To enhance the effectiveness of the immunoprophylaxis of measles and its influence on the epidemic process, a number of problems must be solved with the aim to improve the quality of the vaccine, especially its thermal stability, to establish the possibility of shifting the beginning of immunization from 15-17 months to 12 months of age, to increase the coverage of children with immunization against measles by decreasing the number of groundless exemptions from immunization and by immunizing children in risk groups according to individual schedules and dosage, to carry out selectively the booster immunization of persons who have lost their postvaccinal immunity, as revealed by laboratory test, or in whom such loss may be supposed, to introduce the objective method (indirect hemagglutination test) for controlling the state of immunity among different groups of the population into laboratory practice at sanitary and epidemiological stations. As to the possibility of the liquidation of measles, the statement of this problem is correct, but for its solution a complex of additional prophylactic and epidemic-control measures should be taken.     

Antidiphtheria immunity in children after immunization with adsorbed DPT vaccine and ADPT-M toxoid

Antidiphtheria immunity in children aged 3-15 years was evaluated, depending on their age, the vaccinal preparation chosen for immunization and the immunization schedule. Adsorbed DPT vaccine was shown to have a higher immunological activity in comparison with adsorbed DT toxoid with reduced antigen content. The relationship between the tension of antidiphtheria antitoxic immunity in children and the possibility of the formation of the clinical forms of diphtheria with different severity in the patients was established. Children aged 4-6 years were considered to be a group of high risk in diphtheria morbidity, as it was among the children of this group that toxic and subtoxic forms of diphtheria were most often registered (44.9 +/- 7.1% of the examinees); in addition, a high proportion of children seronegative to this infection (26,3 +/- 2.2%) was observed in this group.     

The immune status of children in foci of measles infection studied by an immunoenzyme method

Children immunized with live measles vaccine in the foci of measles infection varying in intensity (1-9 cases per focus) have been subjected by two methods: the hemagglutination inhibition (HAI) test and the enzyme immunoassay (EIA). As shown in this study, in most cases (98% of all blood serum samples) the correlation between the results of the HAI test and EIA is not high (r = 0.5), which is linked with the detection of a wider spectrum of antibodies in EIA. The percentage of seronegative children detected by these two methods was practically the same (4.05 and 4.4, respectively). The analysis of the results obtained in this study indicates that EIA is a more informative and sensitive method, which confirms the effectiveness of its use for the determination of the level of collective immunity.     

Evaluation of postvaccinal pertussis immunity by using immunoenzyme analysis

The effectiveness of adsorbed DPT vaccine manufactured in the USSR, evaluated by its capacity of inducing the formation of the main classes of immunoglobulins and by the duration of immune response to the acellular complex of protective antigens (pertussis toxin and agglutinogen-2), was studied with the use of modified EIA. Out of 273 children immunized with adsorbed DPT vaccine in the course of this study, 87.2% had IgG-antibodies, 14.1% had IgA-antibodies and 3.2% of the children had IgM-antibodies. The level of immunity in children having received the full course of immunization with adsorbed DPT vaccine was significantly higher in comparison with children given only the primary course of immunization and nonimmunized children of the same age. Antipertussis immunity was found to decrease two years after the completion of the course of immunization with adsorbed DPT vaccine and in children over 5-6 years of age. Adsorbed DPT vaccine prevented the disease, but not infection. The level of postinfection immunity was higher than that of postvaccinal immunity.     

Swedish experience of two dose vaccination programme aiming at eliminating measles,mumps, and rubella.

In 1982 a two dose regimen was introduced in Sweden for the combined vaccination against measles, mumps, and rubella of children aged 18 months and 12 years. Since 1977 about half of the preschool children were vaccinated against measles annually, and since 1974 about 80% of 12 year old girls were vaccinated against rubella. During the period 1982 to 1985 90-93% of the eligible age cohorts of 18 month old children and 88-91% of the 12 year old children were immunised with the new combined vaccine. A study in 1982 of about 140 18 month old children who were nearly all seronegative before vaccination showed that 96%, 92%, and 99% seroconverted against measles, mumps, and rubella, respectively. A second study was carried out in 1983 of 247 12 year old children, of whom 11% lacked antibodies to measles, 27% to mumps, and 45% to rubella. This showed seroconversion in 82% and 80% against measles and mumps, respectively, and all children seroconverted against rubella. In the latest study in 1985 of 496 12 year olds 9% and 13% were seronegative against measles and mumps before vaccination, and 41% against rubella. Of these, 88% seroconverted to measles and 80% to mumps, and all converted to rubella when sera were tested by the haemolysis in gel method. After a neutralisation test against measles as well all children showed immunity to the disease. A low incidence of measles and declining figures for mumps and rubella were reported in 1984 to 1986. An outbreak of rubella during 1985 affected mainly boys in age cohorts in which only the girls had been vaccinated during the 1970s.     

The validation of the expediency of a review of the times for revaccinating children against measles

Basing on the results of seroepidemiological study, carried out in two districts of Moscow by different methods, cluster selection method including, the authors have developed the following recommendations aimed at improving the strategy of revaccination against measles: (1) selective revaccination of only seronegative children or those with poor antimeasles immunity should be carried out, thus making it possible to reduce the number of susceptible children and diminish the risk of postimmunization reactions and complications; (2) when determining the groups of children to be revaccinated and the age suitable for revaccination, one should bear in mind the specific local features of the epidemic process in measles and the morbidity values, as well as the data on antimeasles immunity in children of different age groups; (3) serologic monitoring of the quality and immunologic effectiveness of different batches of live measles vaccine permits timely removal of nonstandard batches from practical use, thus improving the efficacy of vaccinal prophylaxis of measles.     

Evaluation of influenza vaccine Vaxigrip in the combined immunization of conscripts during influenza seasons of 2002-2003

The immunization properties of the influenza vaccine Vaxigrip, used in combination with vaccines against pneunococcal infection and hepatitis A (respectively, Pneumo 23 and Avaxim), were evaluated. In Central Russia in one of the units of the internal forces of the RF Ministry of Internal Affairs 3 groups totaling 755 servicemen were formed, depending on the complex of the introduced vaccines. Active medical observation and the registration of the complaints of the vaccinees at the postvaccinal period did not reveal unusual reactions and complications in none of the groups under observation. In the evaluation of the level of specific antibodies to the circulating influenza viruses prior to vaccination the low level of collective protection to influenza B virus was determined: protective antibody levels were registered only in 14-18% of the servicemen, while the corresponding data with respect of influenza viruses A(H1N1) and A(H3N2) were 45-50% and 56-63% respectively. At the same time, in seronegative persons the vaccine Vaxigrip exhibited high immunogenic activity with respect of all 3 influenza strains; seroconversion to them was determined in 84-92% of the vaccines, and the level of protective antibody titers before the beginning of the epidemic season was 86-99% in the whole of the group. The characteristics of the prophylactic effectiveness of the vaccine Vaxigrip in relation to the influenza virus infection level 1 were 4.7 (index) and 79% (coefficient). In addition, the frequency of influenza cases, clinically pronounced and confirmed by laboratory methods, in patients who had been immunized with 3 vaccines was 6.7%, which was 10.3 times less frequent than number of cases in the groups of comparison (68.2% on the average). The coefficient of epidemiological effectiveness of the prophylaxis of influenza was 90.2%. The complex use of 3 preparations did not affect the immunization properties of the vaccine Vaxigrip.     

The effect of immunotherapy with the VP-4 multicomponent vaccine in children with frequent acute respiratory diseases and obstructive bronchitis

The results of prolonged observations on children with frequent acute respiratory diseases (ARD), subject to immunoprophylaxis with the use of polycomponent vaccine (VP-4), prepared from the antigens of opportunistic microorganisms, are presented. The vaccine was introduced to 30 children in 3 intranasal administrations and 6-8 oral administrations. The morbidity rate of the children was registered and their clinical status was evaluated for a year after the introduction of vaccine VP-4. As revealed in these observations, the frequency of ARD cases among the immunized children decreased 3 times or more in comparison with that among the same children, registered during a year prior to the introduction of the vaccine. In addition to a decrease in the frequency of ARD cases, a decrease in their duration and in the number of antibiotic administrations, as well as in the necessity of hospitalization, were also registered.     

Total immunization of children against influenza decreases morbidity in a number of diseases among elderly persons during influenza epidemic

Immunization of children aged 3-6 years in kindergartens and school children aged 7-17 years against influenza with inactivated influenza vaccine was carried out in two districts of the Moscow region. The comparison of morbidity in influenza-like diseases among the immunized children with that among nonimmunized children in control districts revealed that the effectiveness of immunization was 60.9% in kindergartens and 68.8% in schools. The analysis of morbidity in a number of diseases among 158,451 elderly persons not immunized against influenza demonstrated that, in comparison with the control districts, in those districts where mass immunization of children was carried out morbidity in influenza-like diseases among elderly persons was 3.4 times lower and, out of other 10 diseases under study, morbidity in 8 diseases was 1.5-2.6 times lower. As indicated by the data obtained in this study, total anti-influenza immunization of children in organized groups not only essentially decreased influenza morbidity among children, but also greatly decreased morbidity in influenza and a number of diseases, appearing as complications of influenza infection, among nonimmunized elderly persons during influenza epidemic.     

Diphtheria morbidity in Russia today

The data on diphtheria morbidity and the occurrence of carrier state for its causative agent at the period of 2001-2002 were analyzed. The rates of morbidity and detected carrier state for these years were 0.63-0.55 and 0.65-0.64 respectively. Nevertheless, in spite of the relatively low morbidity rates the presence of the toxic forms of diphtheria (400 patients for two years) and lethal cases (with lethality rate reaching 5.4%) indicated that the epidemic situation in diphtheria remained tense. The most unfavorable situation was observed in the North-Western and Central regions of Russia. In urban areas morbidity rates were still 2- to 3-fold higher in than in rural ones, but the latter showed a higher percentage of severe cases (46.6% in 2001 and 39.7% in 2002) and lethal outcomes (13.6% and 19.2%). The latter was indicative of drawbacks in the immunoprophylaxis, diagnostics and treatment of diphtheria in rural areas. In the total structure of diphtheria patients adults prevailed: 75%. The highest morbidity rates were registered among children aged 3-6 years, among adults in the age groups of 18-19 years and 50-59 years. The epidemic process developed mainly among the immunized population, which was indicated by a high proportion of vaccinated persons among those affected by this infection (62.8-66.6%) and a mild course of the disease in the majority of them. The present epidemiological situation in diphtheria was determined by patients not vaccinated against this infection. The proportion of severe cases among nonvaccinated children was 42.4-51.6% and lethal outcomes, 12.9-15.1%. Among nonimmunized adults these figures were equal to 43.1% and 9.3% respectively. The highest percentage of children, not vaccinated during the first years of their life, was registered among those in the asocial families, refugees and homeless persons. Among adults these were persons above 50 years old, as well as jobless persons of working age, pensioners and invalids, who had limited possibilities of undergoing vaccination due to their social position. It was these social and age groups that should be regarded as risk groups with respect to the severity of the course of diphtheria and lethality. To stabilize diphtheria morbidity, the full complex of prophylactic and antiepidemic measures, and primarily the immunization of the population, should be systematically carried out.