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Measles and Measles Vaccine

Measles. Highly contagious viral illness First described in 7th century Near universal infection of childhood in prevaccination era Frequent and often fatal in developing areas. Paramyxovirus (RNA)One antigenic typeHemagglutinin important surface antigenRapidly inactivated by heat and light

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Measles and Measles Vaccine

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    1. Measles and Measles Vaccine

    2. Measles Highly contagious viral illness First described in 7th century Near universal infection of childhood in prevaccination era Frequent and often fatal in developing areas

    3. Paramyxovirus (RNA) One antigenic type Hemagglutinin important surface antigen Rapidly inactivated by heat and light Measles Virus

    4. Measles Pathogenesis Respiratory transmission of virus Replication in nasopharynx and regional lymph nodes Primary viremia 2-3 days after exposure Secondary viremia 5-7 days after exposure with spread to tissues

    5. Measles Clinical Features Incubation period 10-12 days Stepwise increase in fever to 103 F or higher Cough, coryza, conjunctivitis Koplik spots

    6. Measles Clinical Features 2-4 days after prodrome, 14 days after exposure Maculopapular, becomes confluent Begins on face and head Persists 5-6 days Fades in order of appearance

    7. Condition Diarrhea Otitis media Pneumonia Encephalitis Death Hospitalization Measles Complications

    8. Measles Complications by Age Group

    9. Measles Laboratory Diagnosis Isolation of measles virus from a clinical specimen (e.g., nasopharynx, urine) Significant rise in measles IgG by any standard serologic assay (e.g., EIA, HA) Positive serologic test for measles IgM antibody

    10. Measles Epidemiology Reservoir Human Transmission Respiratory Airborne Temporal pattern Peak in late winter and spring Communicability 4 days before to 4 days after rash onset

    11. Vaccine Licensed

    12. Measles – United States, 1980-2001*

    13. Age Distribution of Reported Measles, 1975-2000

    14. Measles Resurgence – United States, 1989-1991 Cases 55,622 Age group affected Children <5 yrs Hospitalizations >11,000 Deaths 123 Direct medical costs >$150 million

    15. Measles 1993-2001 Endemic transmission interrupted Record low annual total in 2000 (86 total cases) Many cases among adults Many cases due to importation 86 cases reported for 2000. 108 provisional total in 2001. Endemic transmission believed to have been interrupted in 1996 or earlier.86 cases reported for 2000. 108 provisional total in 2001. Endemic transmission believed to have been interrupted in 1996 or earlier.

    16. Measles Clinical Case Definition Generalized rash lasting >3 days, and Temperature >38.3 C (101 F), and Cough, coryza, or conjunctivitis

    17. Measles Vaccines

    18. Measles Vaccine Composition Live virus Efficacy 95% (range, 90%-98%) Duration of Immunity Lifelong Schedule 2 doses Should be administered with mumps and rubella as MMR

    19. Measles, mumps, or rubella disease (or lack of immunity) in a previously vaccinated person 2%-5% of recipients do not respond to the first dose Caused by antibody, damaged vaccine, record errors Most persons with vaccine failure will respond to second dose MMR Vaccine Failure

    20. Measles (MMR) Vaccine Indications All infants >12 months of age Susceptible adolescents and adults without documented evidence of immunity

    21. 12 months is the recommended and minimum age MMR given before 12 months should not be counted as a valid dose Revaccinate at >12 months of age Measles Mumps Rubella Vaccine

    22. Second Dose of Measles Vaccine Intended to produce measles immunity in persons who failed to respond to the first dose (primary vaccine failure) May boost antibody titers in some persons

    23. Second Dose Recommendation First dose of MMR at 12-15 months Second dose of MMR at 4-6 years Second dose may be given any time >4 weeks after the first dose

    24. ACIP Recommendations All states ensure that 2 doses of MMR required for school entry All children in kindergarten through grade 12 have 2 doses of MMR by 2001

    25. College students International travelers Health-care personnel Adults at Increased Risk of Measles

    26. Measles Immunity in Health Care Personnel All persons who work in medical facilities should be immune to measles

    27. Born before 1957 Documentation of physician-diagnosed measles Serologic evidence of immunity Documentation of receipt of measles-containing vaccine Measles Immunity

    28. Measles Vaccine Indications for Revaccination Vaccinated before the first birthday Vaccinated with killed measles vaccine Vaccinated prior to 1968 with an unknown type of vaccine Vaccinated with IG in addition to a further attenuated strain or vaccine of unknown type

    29. MMR Adverse Reactions Fever 5%-15% Rash 5% Joint symptoms 25% Thrombocytopenia <1/30,000 doses Parotitis rare Deafness rare Encephalopathy <1/1,000,000 doses

    30. MMR Vaccine and Autism Measles vaccine connection first suggested by British gastroenterologist Diagnosis of autism often made in second year of life Multiple studies have shown no association

    31. MMR Vaccine and Autism “The evidence favors a rejection of a causal relationship at the population level between MMR vaccine and autism spectrum disorders (ASD).” - Institute of Medicine, April 2001

    32. Severe allergic reaction to prior dose or vaccine component Pregnancy Immunosuppression Moderate or severe acute illness Recent blood product MMR Vaccine Contraindications and Precautions

    33. Measles and mumps viruses grown in chick embryo fibroblast culture Studies have demonstrated safety of MMR in egg allergic children Vaccinate without testing Measles and Mumps Vaccines and Egg Allergy

    34. MMR recommended for persons with asymptomatic and mildly symptomatic HIV infection NOT recommended for those with evidence of severe immuno- suppression Prevaccination HIV testing not recommended Measles Vaccine and HIV Infection

    35. PPD and Measles Vaccine Apply PPD at same visit as MMR Delay PPD >4 weeks if MMR given first Apply PPD first - give MMR when skin test read

    36. National Immunization Program Hotline 800.232.2522 Email nipinfo@cdc.gov Website www.cdc.gov/nip

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