Measles vaccine was first licensed in the United States in 1963, after which the incidence of measles declined rapidly (Figure 1). Patel M, Lee AD, Redd SB, et al. 17. “We need to bring enough reliable information to people at the point of care. Measles runs a more devastating course in children in developing countries, a phenomenon related to undernutrition, overcrowding, and lack of access to care, with mortality as high as 1 to 15%.18 Measles infection during pregnancy is associated with an increased risk of complications, including miscarriage, preterm birth, neonatal low birth weight, and maternal death.19, Whereas a typical case of measles is easily recognized during outbreaks, the clinical diagnosis is challenging to many clinicians who have not seen measles and in patients who present before the onset of rash or whose rash is less apparent (e.g., infants with residual maternally acquired antibodies, previous receipt of immunoglobulin, or vaccination after exposure). * Information is from the Institute of Medicine35 and Pless et al.36. Measles, mumps, and rubella vaccine — adverse effects of vaccines: evidence and causality. The risk of complications is increased among infants, adults older than 20 years of age, pregnant women, undernourished children (particularly those with vitamin A deficiency), and persons with immune suppression (e.g., cancer or human immunodeficiency virus [HIV] infection). The typical measles rash may be absent in persons with impaired cell-mediated immunity.20, The differential diagnosis includes rubella, dengue fever, parvovirus B19 infection, human herpesvirus 6 infection, and other infections, as well as reactions to measles vaccine. Rubella is most dangerous for a pregnant woman's baby. 7th ed. Small white spots known as Koplik's spots may form inside the mouth two or three days after … Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery. The authorized source of trusted medical research and education for the Chinese-language medical community. Huiming Y, Chaomin W, Meng M. Vitamin A for treating measles in children. 24. There is no treatment for measles, but the measles-mumps-rubella (MMR) vaccine can prevent it. Centers for Disease Control and Prevention Recommendations for Acceptable Evidence of Immunity to Measles in the United States. July 25, 2019N Engl J Med 2019; 381:349-357 38. Cochrane Database Syst Rev 2013;8:CD001477-CD001477. The Centers for Disease Control and Prevention (CDC) reported that an important factor contributing to the outbreaks in New York is misinformation in the communities about the safety of the measles–mumps–rubella (MMR) vaccine.8, Between 2000 and 2017, the global annual incidence of reported cases of measles declined by 83%, from 145 to 25 cases per million population. Measles vaccines: WHO position paper – April 2017. Position paper on measles (April 2017) - Original English and French version; Grading of scientific evidence (effectiveness) Manual for the surveillance of vaccine-preventable diseases. Prepare to become a physician, build your knowledge, lead a health care organization, and advance your career with NEJM Group information and services. Comparison of the Risk of Complications Associated with Measles and the Risk of Serious Adverse Events after Measles Vaccination. McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Moss WJ. Evaluation of the measles clinical case definition. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. The researchers recruited volunteers from three schools in the Netherlands. Depending on the strength of your immune response and how effectively the antibodies fight off the pathogen, you may or may not get sick. Implications of the human immunodeficiency virus epidemic for control and eradication of measles. The research found that the MMR vaccine itself did not produce immune suppression, meaning that recipients get the benefit of lifelong immunity to measles infection without the damaging effects of natural infection. J Infect Dis 2019;219:1616-1623. World Health Organization. An acute progressive encephalitis (measles inclusion-body encephalitis16) and a characteristic giant-cell pneumonia (Hecht’s pneumonia17) are two especially severe complications that may occur in rare cases in persons with immune suppression. Manikkavasagan G, Ramsay M. The rationale for the use of measles post-exposure prophylaxis in pregnant women: a review. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. The most common laboratory method for confirming measles is detection of measles virus–specific IgM antibodies in a blood specimen (sensitivity, 83 to 89%; specificity, 95 to 99%). Last modified on Thu 31 Oct 2019 19.00 GMT. Patients with measles rash are shown in Panels B, C, and D. In Panel B, pigmentation and desquamation of the measles skin rash (complications that are most often seen in undernourished children) are visible; these signs are evident approximately 5 days after the onset of rash and may continue for weeks. J Infect Dis 2003;187:Suppl 1:S291-S298. Topics. Enders JF, McCarthy K, Mitus A, Cheatham WJ. 36. Measles. 15. Measles virus is one of the most highly contagious human pathogens known. Measles outbreaks are occurring in communities and on college campuses throughout the United States. The physician becomes concerned about the possibility of measles. Pless RP, Bentsi-Enchill AD, Duclos P. Monitoring vaccine safety during measles mass immunization campaigns: clinical and programmatic issues. “The more diverse range of them we have, the better,” said Petrova. A cell population that could be involved in this process is the CD8CD57 double-positive lymphocyte subset (CD8+CD57+), known to be significantly expanded in some viral infections, e.g. Both the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) released new measles updates today. Measles is an acute viral illness that starts with a prodromal phase, lasting 2 to 4 days, of fever and at least one of the “three Cs” (cough, coryza, and conjunctivitis), similar to any upper respiratory tract infection.13 The characteristic measles rash — an erythematous maculopapular exanthem — appears 2 to 4 days after the onset of fever, first on the face and head and then on the trunk and extremities; it may be confluent on the face and upper body (Figure 2). Measles, mumps, and rubella vaccine — adverse effects of vaccines: evidence and causality. 2018 Assessment report of the Global Vaccine Action Plan. Studies have shown a small increased risk of febrile seizures occurs among children who are younger than 7 years old approximately 8-14 days after vaccination for every 3,000-4,000 children vaccinated with MMR … Griffin DE. Measles position paper Measles. High doses of vitamin A have been shown to decrease mortality and the risk of complications in young children hospitalized with measles in developing countries.25 In the United States, children with measles have been found to have low levels of serum retinol, and levels tend to be lower among those with more severe illness.26 The American Academy of Pediatrics (AAP) recommends vitamin A administration for all children with severe measles (e.g., requiring hospitalization), with the use of the following age-specific doses: 200,000 IU for children 12 months of age or older; 100,000 IU for infants 6 to 11 months of age; and 50,000 IU for infants younger than 6 months.27 A third age-specific dose should be given 2 to 4 weeks later to children who have clinical signs and symptoms of vitamin A deficiency. J Infect Dis 2004;189:Suppl 1:S153-S159. All cases of suspected measles should be reported immediately — without waiting for diagnostic test results — to the local or state health department, which can assist with obtaining tests and take actions to minimize spread of virus. Chan School of Public Health provides much-needed answers. Panel E shows a patient with Koplik spots on the buccal mucosa. Elledge’s team looked at antibodies in the blood (the proteins produced by immune cells) and found that 11% to 73% of the antibody memory bank had been erased after measles. 40. Measles Outbreaks in Niger Linked to Rainfall and Temperature, Study Finds Aug. 25, 2020 — Rainfall and temperature drive agricultural activity, which, in … Rapid identification of measles virus vaccine genotype by real-time PCR. The physical examination is notable for a body temperature of 39°C, conjunctivitis, and rhonchi on chest auscultation. ‡ Risk is expressed as the number of events per number of vaccine doses administered. Estimates of measles case fatality ratios: a comprehensive review of community-based studies. 3. 1Decades of research have allowed scientists to develop an effective vaccine. Lee AD, Clemmons NS, Patel M, Gastañaduy PA. International importations of measles virus into the United States during the post-elimination era, 2001–2016. Each complication and death related to measles is a “preventable tragedy that could have been avoided through vaccination,” the authors write. The risk of complications is increased among infants, adults older than 20 years of age, pregnant women, undernourished children (particularly those with vitamin A deficiency), and persons with immune suppression (e.g., cancer or human immunodeficiency virus [HIV] infection). “Maybe after five years you would recover.”. Between Jan 1 and Jul 31, 2019, 182 countries reported 364,808 measles cases to the WHO. To receive the MMR vaccine, contact your primary care provider, local pharmacy or reach out to your local health department or community clinic. No potential conflict of interest relevant to this article was reported. All suspected cases of measles should be reported immediately to the local or state health department without waiting for diagnostic test results. From there, the virus replicates and spreads to immune cells throughout the body. Wkly Epidemiol Rec 2017;92:205-227. The measles epidemic in the Netherlands provides an opportunity for research. How effective is the vaccine? Clemmons NS, Wallace GS, Patel M, Gastañaduy PA. Increase in measles cases — United States, January 1–April 26, 2019. Summary of Measles Vaccination Recommendations in the United States. Information and tools for librarians about site license offerings. Measles is highly contagious and can be spread when someone with the virus coughs, sneezes or exhales. Further research is needed to determine the benefits and risks of antiviral agents in the treatment of severe cases of measles. Recommendations regarding acceptable evidence of immunity are available to guide decisions about who should or should not be vaccinated against measles (Table 3). “We shouldn’t think that scientific data is enough to convince people,” she said. Hviid A, Hansen JV, Frisch M, Melbye M. Measles, mumps, rubella vaccination and autism: a nationwide cohort study. A real-time polymerase-chain-reaction (PCR) assay for measles virus RNA in urine, blood, oral fluid, or nasopharyngeal specimens can identify infection with a sensitivity of 94% and a specificity of 99%23 before measles IgM antibodies are detectable, and it allows genotyping of the measles virus, which is useful for tracking virus importations and spread.24 All cases of suspected measles should be reported immediately — without waiting for diagnostic test results — to the local or state health department, which can assist with obtaining tests and take actions to minimize spread of virus. However, after measles, the children had a far more restricted range. Retraction — Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. 22. Lancet 2017;390:2490-2502. With the increasing spread of inaccurate information regarding vaccine-associated risks on social media, clinicians play a key role in responding to questions from patients regarding the rationale for, and safety of, the MMR vaccine, as well as in maintaining trust in vaccination among their patients and their families. Serious adverse events are rare and much less common than the risks associated with natural measles infection; these include anaphylaxis (2 to 14 cases per million doses), febrile seizures (1 case per 3000 doses), thrombocytopenic purpura (1 case per 30,000 doses), and measles inclusion-body encephalitis in persons with demonstrated immunodeficiencies (. Progress toward regional measles elimination — worldwide, 2000–2017. Incidence of measles in the United States, 2001-2015. Lancet 2010;375:445-445. Adverse events include fever (<15% of recipients), transient rashes occurring 7 to 12 days after vaccination (5%), transient lymphadenopathy (5% of children and 20% of adults), parotitis (<1%), and aseptic meningitis (1 to 10 per million).33,34 Serious adverse events are rare and much less common than the risks associated with natural measles infection; these include anaphylaxis (2 to 14 cases per million doses), febrile seizures (1 case per 3000 doses), thrombocytopenic purpura (1 case per 30,000 doses), and measles inclusion-body encephalitis in persons with demonstrated immunodeficiencies (Table 1).35,36 The rubella component of MMR can cause transient arthralgia or arthritis, primarily in susceptible postpubertal female patients. N Engl J Med 1959;261:875-881. Washington, DC: National Academies Press, 2012:103-237. Measles-control programs throughout the world have shown that measles is eliminated if national immunization schedules are fully implemented and high vaccination coverage is achieved and maintained, whereas measles outbreaks occur when populations are not adequately vaccinated. Scientists say threat posed by measles is ‘much greater than we previously imagined’, Thu 31 Oct 2019 18.00 GMT Atlanta: Centers for Disease Control and Prevention, 2019 (https://www.cdc.gov/measles/cases-outbreaks.html). 3rd ed. Vaccines. Measles eliminated between 11% and 73% of children’s protective antibodies, the research found. CMAJ 2015;187:600-600. 13. J Infect Dis 2004;189:Suppl 1:S1-S3. To minimize the risk of new cases and outbreaks, clinicians should advise patients who are planning international travel about indications for measles vaccination. Clinicians should suspect measles in an infant, child, adolescent, or adult who has a febrile rash illness, especially if the person lacks documentation of measles vaccination, has traveled overseas (as the patient described in the vignette did) or is part of a community with low vaccine acceptance. It can cause miscarriage or birth defects. Measles is an acute viral illness that starts with a prodromal phase, lasting 2 to 4 days, of fever and at least one of the “three Cs” (cough, coryza, and conjunctivitis), similar to any upper respiratory tract infection.13 The characteristic measles rash — an erythematous maculopapular exanthem — appears 2 to 4 days after the onset of fever, first on the face and head and then on the trunk and extremities; it may b… Address reprint requests to Dr. Strebel at Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland, or at [email protected]. Sometimes measles can lead to serious problems. A 38-year-old man presents to his primary care physician with a 3-day history of fever and cough. Kabra SK, Lodha R. Antibiotics for preventing complications in children with measles. The MMR vaccine is widely available from your healthcare provider or local health department. Previously, scientists had inferred a longer-term impact on the immune system because deaths from other infections were seen to go up after a measles outbreak, and because the virus directly attacks the immune system. See the FAQs section below for more details. This page contains information about two studies, BMR -0 and BMR-1. MMWR Morb Mortal Wkly Rep 2019;68:402-404. The number of cases reported so far this year (1077 as of June 20, 2019) is greater than the number reported in any entire year since measles was declared eliminated in 2000 and, in fact, exceeds the number of cases in any entire year since 1992 (Figure 1). Katz SL, Hinman AR. This could even mean that children who become infected with measles may need to be revaccinated for previous diseases. This Journal feature begins with a case vignette highlighting a common clinical problem. 39. New York: Academic Press, 1984:203-209. Globally, coverage of the first dose of measles-containing vaccine (MCV1) has not improved for a decade. Philadelphia: Elsevier, 2018:579-618. The content of this site is intended for health care professionals. Geneva: World Health Organization, June 2018 (https://www.who.int/immunization/monitoring_surveillance/burden/laboratory/manual/en/). The UK recently lost its measles-free status because of the fall in rates of MMR (measles, mumps and rubella) immunisation. In 2014, a survey from the World Health Organization reported that measles causes about 314 deaths every day. The Americas is the only region that had been verified to be free of endemic measles. U.S. travelers to other countries account for a high proportion of imported cases of measles, which emphasizes the importance of measles vaccination of U.S. residents who are 6 months of age or older before international travel. 34. § Complication has been described in measles case reports, but the risk is not well quantified. Clin Infect Dis 2014;58:1086-1092. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. 29. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). Atlanta: Centers for Disease Control and Prevention (https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html). Immunization, vaccines and biologicals: new measles surveillance data for 2019 (https://www.who.int/immunization/newsroom/measles-data-2019/en/). MMR vaccine contains live, attenuated (or weakened) strains of the measles, mumps, and rubella viruses. Strategic Advisory Group of Experts on Immunization. Measles was certified as eliminated in the United States (i.e., no sustained transmission for >1 year) in 2000.3 Strategies for elimination included achieving and maintaining very high coverage with two doses of measles-containing vaccine, implementation of vaccination requirements for school attendance in every state, sensitive laboratory-supported surveillance, and rapid outbreak detection and response.4, Although the incidence of measles has remained lower than 1 case per million population, an analysis of confirmed cases in the United States between 2001 and 2015 showed that importations were leading to progressively more transmission in the United States, particularly among unvaccinated persons.5 From 2001 to 2016, a median of 28 imported cases of measles were documented each year (range, 18 to 80); among the persons with imported cases, 62% were U.S. residents and 87% were unvaccinated or had an unknown vaccination status.6 Since 2016, a year in which 86 cases of measles were confirmed in the United States, the annual number of cases has increased.