1 measles vaccine

8/19/2019 1 Measles Vaccine

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Measles andMeasles Vaccine

Epidemiology and Prevention of Vaccine-Preventable Diseases

National Immunization ProgramCenters for Disease Control and Prevention

Revised Marc !""!


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Measles

• #igly contagious viral illness

• $irst described in %t century

• Near universal infection ofcildood in prevaccination era

• $re&uent and often fatal indeveloping areas


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• Paramy'ovirus (RN)*

•

+ne antigenic type

• #emagglutinin important surface

antigen

• Rapidly inactivated by eat and ligt

Measles Virus


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Measles Patogenesis

• Respiratory transmission of virus

• Replication in nasoparyn' and regional

lymp nodes

• Primary viremia !-, days after e'posure

• econdary viremia .-% days aftere'posure /it spread to tissues


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Measles Clinical $eatures

• Incubation period 0"-0! days

• tep/ise increase in fever to0", $ or iger

• Coug1 coryza1 con2unctivitis

• 3opli4 spots

Prodrome


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Measles Clinical $eatures

• !-5 days after prodrome1 05 daysafter e'posure

• Maculopapular1 becomesconfluent

• 6egins on face and ead• Persists .-7 days

• $ades in order of appearance

Ras


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ConditionDiarrea+titis mediaPneumoniaEncepalitis

Deat#ospitalization

Percent reported8%7

"90

"9!08

Measles Complications

6ased on 0:8.-0::! surveillance data


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Pneumonia #ospitalization

Measles Complications by )ge =roup


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Measles >aboratory Diagnosis

• Isolation of measles virus from aclinical specimen (e9g91 nasoparyn'1urine*

• ignificant rise in measles Ig= by anystandard serologic assay (e9g91 EI)1 #)*

• Positive serologic test for measles IgMantibody


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Measles Epidemiology

• Reservoir #uman

• ?ransmission Respiratory

)irborne

• ?emporal pattern Pea4 in late /inter and spring

• Communicability 5 days before to 5 days after

ras onset


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Measles @ Anited tates1 0:."-!""0B

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Measles @ Anited tates1 0:8"-!""0B

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)ge Distribution of ReportedMeasles1 0:%.-!"""


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Measles Resurgence @ Anitedtates1 0:8:-0::0

• Cases ..17!!

• )ge group affected Cildren ;. yrs

• #ospitalizations 001"""

• Deats 0!,

• Direct medical costs 0." million


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Measles 0::,-!""0

• Endemic transmission interrupted

•

Record lo/ annual total in !"""(87 total cases*

•

Many cases among adults

• Many cases due to importation


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Measles Clinical Case Definition

• =eneralized ras lasting , days1 and

•

?emperature ,89, C (0"0 $*1 and

• Coug1 coryza1 or con2unctivitis


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0:7, >ive attenuated and 4illed vaccines

0:7. >ive furter attenuated vaccine

0:7% 3illed vaccine /itdra/n

0:78 >ive furter attenuated vaccine

(Edmonston-Enders strain*

0:%0 >icensure of combined measles- mumps-rubella vaccine

0:8: ?/o dose scedule

Measles Vaccines


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Measles Vaccine

• Composition >ive virus

• Efficacy :.F (range1 :"F-:8F*

• Duration of Immunity >ifelong

• cedule ! doses

• ould be administered /it mumps andrubella as MMR


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• Measles1 mumps1 or rubella disease (or lac4 ofimmunity* in a previously vaccinated person

• !F-.F of recipients do not respond to te first

dose

• Caused by antibody1 damaged vaccine1 recorderrors

• Most persons /it vaccine failure /ill respondto second dose

MMR Vaccine $ailure


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Measles (MMR* Vaccine Indications

• )ll infants 0! monts of age

• usceptible adolescents andadults /itout documentedevidence of immunity


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• 0! monts is te recommendedand minimum age

• MMR given before 0! montssould not be counted as a validdose

• Revaccinate at 0! monts of age

Measles Mumps Rubella Vaccine


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econd Dose of Measles Vaccine

• Intended to produce measlesimmunity in persons /o failed torespond to te first dose (primaryvaccine failure*

•

May boost antibody titers in somepersons


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econd Dose Recommendation

• $irst dose of MMR at 0!-0. monts

•

econd dose of MMR at 5-7 years

• econd dose may be given any

time 5 /ee4s after te first dose


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)CIP Recommendations

• )ll states ensure tat ! doses ofMMR re&uired for scool entry

• )ll cildren in 4indergartentroug grade 0! ave ! doses of

MMR by !""0


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• College students

• International travelers

• #ealt-care personnel

)dults at IncreasedRis4 of Measles


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Measles Immunity in

#ealt Care Personnel• )ll persons /o /or4 in

medical facilities souldbe immune to measles


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• 6orn before 0:.%

• Documentation of pysician-

diagnosed measles

• erologic evidence of immunity

• Documentation of receipt ofmeasles-containing vaccine

Measles Immunity


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Measles VaccineIndications for Revaccination

• Vaccinated before te first birtday

• Vaccinated /it 4illed measles vaccine

• Vaccinated prior to 0:78 /it an un4no/ntype of vaccine

• Vaccinated /it I= in addition to a furterattenuated strain or vaccine of un4no/ntype


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MMR )dverse Reactions

• $ever .F-0.F

• Ras .F

•

Goint symptoms !.F• ?rombocytopenia ;0H,"1""" doses

• Parotitis rare

• Deafness rare

• Encepalopaty ;0H01"""1""" doses


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MMR Vaccine and )utism

• Measles vaccine connection firstsuggested by 6ritisgastroenterologist

• Diagnosis of autism often made insecond year of life

• Multiple studies ave so/n noassociation


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MMR Vaccine and )utism

?e evidence favors a re2ectionof a causal relationsip at tepopulation level bet/een MMRvaccine and autism spectrumdisorders ()D*9J

- Institute of Medicine1 )pril !""0


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• evere allergic reaction to prior

dose or vaccine component

• Pregnancy

• Immunosuppression

• Moderate or severe acute illness• Recent blood product

MMR VaccineContraindications and Precautions


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• Measles and mumps virusesgro/n in cic4 embryo fibroblastculture

• tudies ave demonstrated safetyof MMR in egg allergic cildren

• Vaccinate /itout testing

Measles and Mumps Vaccinesand Egg )llergy


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• MMR recommended for persons /itasymptomatic and mildly symptomatic#IV infection

• N+? recommended for tose /itevidence of severe immuno-suppression

• Prevaccination #IV testing notrecommended

Measles Vaccine and #IV Infection


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PPD and Measles Vaccine

• )pply PPD at same visit as MMR

•

Delay PPD 5 /ee4s if MMR givenfirst

• )pply PPD first - give MMR /ens4in test read


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National Immunization Program

• #otline 8""9!,!9!.!!

• Email nipinfoKcdc9gov

• Lebsite ///9cdc9govHnip

1 measles vaccine

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