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1-Measles-Vaccine.ppt
- 1. Measles and Measles Vaccine Epidemiologyand Prevention of Vaccine- Preventable Diseases National Immunization Program Centers for Disease Control and Prevention Revised March 2002
- 2. Measles • Highly contagiousviral 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 • Respiratorytransmission 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 Prodrome
- 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 Rash
- 7. Condition Diarrhea Otitis media Pneumonia Encephalitis Death Hospitalization Percent reported 8 7 6 0.1 0.2 18 MeaslesComplications Based on 1985-1992 surveillance data
- 8. 0 5 10 15 20 25 30 <5 5-19 20+ Agegroup (yrs) Percent Pneumonia Hospitalization 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 • ReservoirHuman • Transmission Respiratory Airborne • Temporal pattern Peak in late winter and spring • Communicability 4 days before to 4 days after rash onset
- 11. 0 100 200 300 400 500 600 700 800 900 1950 1960 19701980 1990 2000 Cases (thousands) Vaccine Licensed Measles – United States, 1950-2001* *2001 provisional data
- 12. 0 5000 10000 15000 20000 25000 30000 80 82 8486 88 90 92 94 96 98 '00 Cases Measles – United States, 1980-2001* *2001 provisional data
- 13. 0 10 20 30 40 50 60 70 80 90 1975 1980 19851990 1995 2000 Age group (yrs) Percent Preschool-age School-age Adult 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 • Endemictransmission interrupted • Record low annual total in 2000 (86 total cases) • Many cases among adults • Many cases due to importation
- 16. Measles Clinical CaseDefinition • Generalized rash lasting >3 days, and • Temperature >38.3 C (101 F), and • Cough, coryza, or conjunctivitis
- 17. 1963 Live attenuatedand killed vaccines 1965 Live further attenuated vaccine 1967 Killed vaccine withdrawn 1968 Live further attenuated vaccine (Edmonston-Enders strain) 1971 Licensure of combined measles- mumps-rubella vaccine 1989 Two dose schedule Measles Vaccines
- 18. Measles Vaccine • CompositionLive 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) VaccineIndications • All infants >12 months of age • Susceptible adolescents and adults without documented evidence of immunity
- 21. • 12 monthsis 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 ofMeasles 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 • Allstates 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 HealthCare Personnel • All persons who work in medical facilities should be immune to measles
- 27. • Born before1957 • Documentation of physician- diagnosed measles • Serologic evidence of immunity • Documentation of receipt of measles-containing vaccine Measles Immunity
- 28. Measles Vaccine Indications forRevaccination • 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 andAutism • 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 andAutism “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 allergicreaction to prior dose or vaccine component • Pregnancy • Immunosuppression • Moderate or severe acute illness • Recent blood product MMR Vaccine Contraindications and Precautions
- 33. • Measles andmumps 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 recommendedfor 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 MeaslesVaccine • 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