Lack of efficacy of the standard potency Edmonston-Zagreb live, attenuated measles vaccine in African infants.
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Abstract:
The efficacy of standard potency Edmonston-Zagreb (E-Z) measles vaccine was tested in a randomized trial of Black infants in a rural area of South Africa where a measles epidemic was occurring. The following immunization schedules were used: 48 infants aged 4-8.5 months who received 3.9 log 50 infectious units of E-Z vaccine (group A); 48 infants aged 4-8.5 months who received 3.28 log 50 infectious units of Schwarz vaccine (group B); and 28 infants aged greater than 9 months who received 3.28 log 50 infectious units of Schwarz vaccine and served as controls (group C). For infants aged less than 23 weeks who were given either the E-Z or Schwarz vaccine, the number of seropositives was low (28%), irrespective of the pre-vaccination level of measles antibody. There was a higher number of seropositives (68%) among those in the age range greater than 23 weeks to less than 36 weeks who received the E-Z vaccine rather than the Schwarz vaccine (36%). When administered to children aged greater than 36 weeks, the Schwarz vaccine produced a satisfactory, though suboptimal response rate (61%). There was no correlation between seropositivity and pre-vaccination measles antibody status. Use of the standard dose of E-Z vaccine may have been one of the factors for this poor response, and this supports the WHO recommendation that titres higher than the standard potency vaccine are needed if 6-month-old infants are to be successfully immunized against measles.Keywords:
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The measles vaccination has been introduced in Poland in 1975, and the second vaccine dose of measles vaccine in 1991. Mass immunization against measles exerted a significant impact on measles incidence, morbidity rate and mortality. The progressive increase of immunization coverage caused significant decrease of measles incidence rate among children at age below 10 years as well as among not vaccinated children up to 12 months of age. The lengthening of the interepidemic period and significant increase of morbidity rate among older children (over 10 years) and young adults were observed during the period after introduction of mass vaccination against measles. Since 1992 not a single case of death caused by measles was notified. Data on measles incidence and vaccination coverage during the period of observation will be used for development of the mathematical models for measles transmission and choice of optimal immunization strategy in Poland.
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Before the implementation of the two-dose measles immunization policy in Saudi Arabia, 50 per cent of measles cases in children below the age of one year were reported for the age group 6-8 months. In 1991 two doses of measles vaccine, at 6 months and 12 months, the second dose incorporated with MMR, were integrated into the expanded programme of immunization (EPI). Since 1993, vaccination coverage for the second dose has been above 90 per cent. While measles incidence remains stable in infants below 6 months of age, the incidence in children 9-11 months of age dropped by 50 per cent. The greatest impact was seen in the 6-8-month age group where the incidence dropped by more than 75 per cent. Moreover this two-dose strategy resulted in a situation in which 80 per cent of the measles cases were in children above the age of 5 years, mostly those who had not had two doses of measles vaccine. Further control measures should include non-selective vaccination of school children against measles. The two-dose measles vaccination policy is visualized as a necessity if the goal of measles elimination is to be achieved. Routine monthly reports validated by surveys using the WHO standard 30 cluster technique was used for the study.
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Objective To summarize and evaluate the intensified immunization effect of measles vaccine in Jishui County in 2010,and to investigate the strategy of measles control.Methods The study was conducted according to the requirement of Implementation Plan of Intensified Immunization by Measles Vaccine in Jiangxi Province in 2010.The epidemiological analysis was carried out on the related data by adopting descriptive method.Results During the implementation of intensified immunization of this year,among 23 256 children aged from 8 months to 4 years who should receive vaccination,22 896 children actually received vaccination with the rate of actual vaccination of 98.45% and the rate of rapid assessment vaccination of 97.75%.One case of suspected abnormal vaccination reaction related to measles vaccine was reported in the whole county with the incidence of 4.37/100 000.There were no mass incidents caused by intensified immunization of measles vaccine,no accident of vaccine quality and report of implementing error and accident,also no death case.After the implementation of intensified immunization by measles vaccine,the incidence of measles had been dramatically decreased.Conclusion During the implementation of intensified immunization of measles vaccine in Jishui County in 2010,the rate of measles vaccination for target children was over 95%,and reached the expected purpose.
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Background. An Expanded Programme on Immunization was started in late 1987 in Niger, including vaccination against measles with one dose of standard titer Schwarz vaccine given to infants after 9 months of age. During epidemics an early two-dose strategy was implemented (one dose between 6 and 8 months and one dose after 9 months). From January 1, 1995, until May 7, 1995, 13 892 measles cases were reported in Niamey, Niger. Methods. A retrospective cohort study was conducted in a crowded area of Niamey at the end of the outbreak to assess the effectiveness of measles vaccine in standard (after 9 months) and early (before 9 months) immunization strategies under field conditions. Results. Highest measles incidence rates were observed among children <1 year of age. Vaccine effectiveness estimates increased with age at vaccination from 78% with a single dose administered at 6 months of age to 95% at 9 months. Vaccine effectiveness with the early two dose strategy was 93%. Conclusions. Immunization with a single dose of standard titer Schwarz vaccine before 9 months of age provided higher clinical protection than expected from seropositivity studies. The early two dose strategy is justified in contexts where measles incidence is high before 9 months of age. Our results raise the issue of lowering the recommended age for measles vaccination in developing countries.
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Aim
Since 1985, Indian infants receive measles vaccine at 9 months of age. This age was chosen to balance the disappearance of maternal (transplacental) antibodies with the increasing risk of developing measles. However, 10%–15% measles infections may occur before the age of vaccination, necessitating earlier vaccination. This randomized controlled trial was designed to compare the safety and efficacy of anticipating measles vaccination in Indian infants.Methods
In this prospective, randomized controlled trial, infants were randomized at 6 months of age as follows: Group A: measles vaccination at 6 and 9 months; Group B: vaccination at 7.5 and 9 months; and Group C: vaccination at 9 months of age (current practice). IgG anti-measles antibody level (AMAL) was measured by ELISA just prior to vaccination and six weeks after each vaccination. The primary outcome was sero-protection defined as anti-measles antibody level >12 U/ml.Results
The proportion of susceptible infants in each group pre-vaccination was 95.2%, 100%, 97.1%, confirming the need for anticipating the vaccination schedule. Six weeks after vaccination, the proportion of protected infants was 23.8%, 57.8% and 71.4% in Groups A, B and C respectively (p<0.05 for comparison of Group A vs B and Group A vs C). An additional dose after the primary dose in Groups A and B resulted in 83.3% and 90.9% protected infants respectively at 1 year of age. No adverse events were noted after any of the vaccination doses.Conclusion
Anticipated vaccination is safe in infants. However, the efficacy is least for vaccination at 6 months and highest for at 9 months. Second dose of vaccine given at 9 months in first two groups resulted in sero-protection among 83.3% and 90.9% respectively. Infants who received a single dose of vaccine at 9 months of age are not fully protected and may require a closely spaced second dose of vaccine. This suggests that early vaccination should be followed by an additional dose of measles vaccine.Vaccination schedule
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Because measles causes an estimated 2 million deaths per year among children in developing countries, including a substantial proportion of infants less than nine months old — the age at which vaccination is recommended — there has been interest in using different strains of vaccine and higher doses to achieve immunization of younger infants.
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To describe measles vaccination patterns in a cohort of Swiss children aged up to 3 years insured with a single health insurer.A dynamic cohort study evaluating measles immunizations patterns in children born between 2006 and 2008 was conducted. Time-to-event analysis was used to describe timing of measles immunization. Effective vaccine coverage was calculated by using an area under the curve approach.In the study cohort, 62.6% of 13-month-old children were up-to-date for the first measles immunization (recommended at 12 months of age). Approximately 59% of 25-month-old children were up-to-date for the second measles immunization (recommended at 15-24 months of age). Most doses were delivered during months in a child's life when well-child visits are recommended (eg, 12 months of age). For second measles vaccine dose, accelerations in vaccine delivery occurred at time points for well-child visits during the months 19 and 25 of age but with lower final uptake than for the first measles vaccine dose. Until their second birthday, children in our cohort spent on average 177 days and 89 days susceptible to measles due to policy recommendations and additional delays, respectively. In a group of children aged 6 months to 2 years reflecting the age distribution in our cohort, effective vaccine coverage was only 48.6%.Timing and timeliness of measles immunizations influence effective population vaccine coverage and should be routinely reported in addition to coverage whenever possible. Proposed timing and relation of recommended vaccinations to well-child visits could be relevant aspects in optimizing measles vaccine coverage to reach measles elimination.
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Journal Article Antibody Response to Measles Immunization in Rural Ghanaian Infants Get access H. Sakatoku, MD, H. Sakatoku, MD Noguchi Memorial Institute for Medical Research (NMIMR), University of GhanaP.O. Box 25, Legon, Ghana Correspondence: Dr H. Sakatoku, Pediatric Hematology/Oncology Services, Hurley Medical Center, One Hurley Plaza, Flint, Michigan, 48502, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar T. Nakano, MD, T. Nakano, MD Noguchi Memorial Institute for Medical Research (NMIMR), University of GhanaP.O. Box 25, Legon, Ghana Search for other works by this author on: Oxford Academic PubMed Google Scholar S. Arai, MD, S. Arai, MD Noguchi Memorial Institute for Medical Research (NMIMR), University of GhanaP.O. Box 25, Legon, Ghana Search for other works by this author on: Oxford Academic PubMed Google Scholar E. A. Afari, MD E. A. Afari, MD Noguchi Memorial Institute for Medical Research (NMIMR), University of GhanaP.O. Box 25, Legon, Ghana Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Tropical Pediatrics, Volume 40, Issue 5, October 1994, Pages 291–293, https://doi.org/10.1093/tropej/40.5.291 Published: 01 October 1994
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During a large outbreak of measles in Ohio in 1976 it was possible to measure measles vaccine efficacy by age at time of vaccination and number of years since vaccination. Using a summed incidence method to control for the confounding variable introduced by mass immunization clinics held during the outbreak, vaccine efficacy was greater than 95% for children vaccinated at 12, 13, and 14 or more months of age. Vaccine efficacy for those vaccinated at 12 months of age was notably better than for those vaccinated at younger ages but not different from those vaccinated at older ages. Although recently administered vaccine appeared more efficacious than vaccine administered in the past, this difference was not significant when controlled for age at vaccination. Evaluation of the mass clinics held during the outbreak demonstrated that 59.6% of the inadequately immunized children attended the clinics, but this was not substantially different from the proportion of adequately immunized who attended (52.4%). Recommendations for measles revaccination need not include children previously vaccinated at 12 months of age or greater.
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Objective To evaluate the control effects of intervention for supplemental immunization activities and immunization enhancement activities of measles vaccination among children and adults. Methods The changes of incidence and effect of interference for measles in children and adults before and after intervention for supplemental immunization activities and immunization enhancement activities of measles vaccination were evaluated. Results Of 729 cases of measles reported,56.10% of the cases were adults.The measles cases of babies aged less than 8 months who did not reach the age of primary measles vaccination accounted for 27.69% in the measles cases of children aged under 5 years. Totally 60,189 children vaccinated vaccine of measles during supplemental immunization activities and immunization enhancement activities of measles vaccination during the period of 2006～2009.The incidence of measles dropped from 196.66 per 100,000 children in 2006 to 8.55 per 100,000 children in 2009(P 0.01).Totally 697,054 adults vaccinated vaccine of measles during immunization enhancement activities of measles vaccination from 2005 to 2009.The incidence of measles dropped from 13.15 per 100,000 adults in 2005 to 1.57 per 100,000 adults in 2009(P0.01).The incidence of measles among staff members of Foxconn was 50.55 per 100,000 persons during a lack of intervention for measles vaccination in 2005.After carrying out immunization enhancement activities of measles vaccination among new employees of Foxconn on four successive years,the incidence of measles was 2.61 per 100,000 persons in 2009,and the incidence of measles among new employees of Foxconn was decreased by 94.84%(P0.01).After carrying out immunization enhancement activities of measles among the children in each age group,the incidence of measles among the children dropped from 111.22/100,000 in 2008 to 8.55/100,000 in 2009,with a decline of 92.31%.The high peak of measles incidence in summer was eliminated after adopting the intervention measures. Conclusions The intervention effect of immunization enhancement activities of measles vaccination is superior to that of supplemental immunization activities of measles vaccination among the children.The immunization enhancement activities of measles vaccination are the important measures in significantly reducing the measles incidence of both children and adults in the immigration city.Continuously carrying out intervention for strengthening the immunization of measles vaccination among children and adults is the key strategy to achieve the goal of measles elimination in China in 2012.
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