Download - Measles
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Measles and Measles VaccineEpidemiology and Prevention of Vaccine-Preventable Diseases
National Immunization ProgramCenters for Disease Control and PreventionRevised January 2006
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Note to presenters:
Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at http://www.vaccineinformation.org/photos/index.asp
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MeaslesHighly contagious viral illnessFirst described in 7th centuryNear universal infection of childhood in prevaccination eraCommon and often fatal in developing areas
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Measles VirusParamyxovirus (RNA)Hemagglutinin important surface antigenOne antigenic typeRapidly inactivated by heat and light
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Measles PathogenesisRespiratory transmission of virusReplication in nasopharynx and regional lymph nodesPrimary viremia 2-3 days after exposureSecondary viremia 5-7 days after exposure with spread to tissues
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Measles Clinical FeaturesIncubation period 10-12 days
Stepwise increase in fever to 103F or higherCough, coryza, conjunctivitisKoplik spotsProdrome
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Measles Clinical Features2-4 days after prodrome, 14 days after exposureMaculopapular, becomes confluentBegins on face and headPersists 5-6 daysFades in order of appearanceRash
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Measles ComplicationsConditionDiarrheaOtitis mediaPneumoniaEncephalitisHospitalizationDeath
Percent reported8760.1180.2Based on 1985-1992 surveillance data
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Measles Complications by Age Group
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Measles Laboratory DiagnosisIsolation 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
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Measles EpidemiologyReservoir Human Transmission Respiratory Airborne Temporal pattern Peak in late winterspring
Communicability 4 days before to 4 days after rash onset
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Measles 1993-2004Endemic transmission interruptedRecord low annual total in 2004 (37 total cases)Many cases among adultsMost cases imported or linked to importation
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Measles Clinical Case DefinitionGeneralized rash lasting >3 days, andTemperature 101F (>38.3C), andCough or coryza or conjunctivitis
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Measles Vaccines1963Live attenuated and killed vaccines1965Live further attenuated vaccine1967Killed vaccine withdrawn1968Live further attenuated vaccine (Edmonston-Enders strain)1971Licensure of combined measles- mumps-rubella vaccine1989Two dose schedule2005Licensure of MMRV
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Measles VaccineCompositionLive virusEfficacy95% (range, 90%-98%)Duration of ImmunityLifelongSchedule2 dosesShould be administered with mumps and rubella as MMR
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MMRV (ProQuad)Combination measles, mumps, rubella and varicella vaccineApproved children 12 months through 12 years of age (up to age 13 years)Titer of varicella vaccine virus in MMRV is more than 7 times higher than standard varicella vaccine
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MMR Vaccine FailureMeasles, mumps, or rubella disease (or lack of immunity) in a previously vaccinated person2%-5% of recipients do not respond to the first doseCaused by antibody, damaged vaccine, record errorsMost persons with vaccine failure will respond to second dose
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Measles (MMR) Vaccine IndicationsAll infants >12 months of ageSusceptible adolescents and adults without documented evidence of immunity
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Measles Mumps Rubella Vaccine12 months is the recommended and minimum ageMMR given before 12 months should not be counted as a valid doseRevaccinate at >12 months of age
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Second Dose of Measles VaccineIntended to produce measles immunity in persons who failed to respond to the first dose (primary vaccine failure)May boost antibody titers in some persons
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Second Dose RecommendationFirst dose of MMR at 12-15 monthsSecond dose of MMR at 4-6 yearsSecond dose may be given any time >4 weeks after the first dose
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Adults at Increased Risk of MeaslesCollege studentsInternational travelersHealthcare personnel
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Measles Immunity in Healthcare PersonnelAll persons who work in medical facilities should be immune to measles
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Measles ImmunityBorn before 1957Documentation of physician-diagnosed measlesSerologic evidence of immunityDocumentation of receipt of measles-containing vaccine
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Measles VaccineIndications for RevaccinationVaccinated before the first birthdayVaccinated with killed measles vaccineVaccinated prior to 1968 with an unknown type of vaccineVaccinated with IG in addition to a further attenuated strain or vaccine of unknown type
- MMR Adverse ReactionsFever 5%-15%Rash 5%Joint symptoms 25%Thrombocytopenia
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MMR Vaccine and AutismMeasles vaccine connection first suggested by British gastroenterologistDiagnosis of autism often made in second year of lifeMultiple studies have shown no association
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MMR Vaccine and AutismThe 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
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MMR VaccineContraindications and PrecautionsSevere allergic reaction to vaccine component or following prior dosePregnancyImmunosuppressionModerate or severe acute illnessRecent blood product
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Measles and Mumps Vaccines and Egg AllergyMeasles and mumps viruses grown in chick embryo fibroblast cultureStudies have demonstrated safety of MMR in egg allergic childrenVaccinate without testing
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Measles Vaccine and HIV InfectionMMR recommended for persons with asymptomatic and mildly symptomatic HIV infectionNOT recommended for those with evidence of severe immuno- suppressionPrevaccination HIV testing not recommendedMMRV not approved for use in persons with HIV infection
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PPD and Measles VaccineApply PPD at same visit as MMRDelay PPD >4 weeks if MMR given firstApply PPD firstgive MMR when skin test read
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Vaccine Storage and HandlingMMR VaccineStore 35o - 46oF (2o - 8oC) (may be stored in the freezer)Store diluent at room temperature or refrigerateProtect vaccine from lightDiscard if not used within 8 hours reconstitution
- Vaccine Storage and HandlingMMR VaccineMust be shipped to maintain a temperature of