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Fulltext Measles-Mumps-Rubella vaccine for children with egg allergy: Is admission for inpatient vaccination necessary?

Tan MS, Teoh EJ, Hor CP, Yeoh AA

Med J Malaysia, 2016 Aug;71(4):157-160.
PMID: 27770112 MyJurnal

INTRODUCTION: Children who develop any hypersensitivity reaction to eggs are routinely referred to hospital for Measles-Mumps-Rubella (MMR) vaccination as inpatients to prevent anaphylaxis. We aimed to study the association between hypersensitivity reactions after egg exposure and similar reactions after MMR immunisation; and examine the necessity of hospital admission for vaccination.
METHODS: A prospective observational study was conducted in Paediatric Department in Bukit Mertajam Hospital, Penang, between March and December 2014. Children referred from local polyclinics for inpatient MMR vaccination because of a history of egg allergy were recruited. The children were observed in the ward for post vaccination allergic reactions. Concurrently, a group of children without egg allergy was recruited from those admitted for other illnesses but had recent MMR vaccination at polyclinics. Parents of these children were interviewed and asked if they had observed any reactions post vaccination. In both groups, sociodemographics, medical history and family history of atopy were collected.
RESULTS: Eighty-seven subjects were recruited in this study. Fifty-four infants with egg allergy had previous mild allergic reactions after exposure to eggs or egg-related products. They were associated with a family history of egg hypersensitivity, personal history of acute gastroenteritis and upper respiratory tract infections. Two of them developed cutaneous rashes post vaccination during observation, but none developed anaphylactic or anaphylactoid reactions. Two infants among those without egg allergy had post vaccination fever. There was no association between egg allergy and hypersensitivity reactions to MMR vaccine (p=0.632).
CONCLUSIONS: MMR vaccine can be safely administered to children with mild egg allergy, hence admission for vaccination in the hospital is not warranted. Risk stratification is required to ensure only infants with severe reactions will be admitted for vaccination.

Matched MeSH terms: Measles-Mumps-Rubella Vaccine*
Fulltext Measles among US-bound refugees from Malaysia to California, Maryland, North Carolina, and Wisconsin, August–September 2011

Clin Infect Dis, 2011 Dec;53(12):i.
PMID: 22080131 DOI: 10.1093/cid/cir815
Matched MeSH terms: Measles/epidemiology*
Fulltext Isolation of measles virus from clinical specimens using B95a and Vero/hSLAM cell-lines

Keniscope C, Juliana R, Subri H, Shangari SR, Wan Nor Azlina WA, Hamizah A, et al.

Med J Malaysia, 2009 Mar;64(1):37-40.
PMID: 19852319 MyJurnal

The clinical presentation of acute measles is normally quite typical, especially in the presence of Koplik's spots, that laboratory test is seldom required to confirm the diagnosis. However, with wide measles vaccination coverage and the extensive use of immunosuppressive chemotherapy, the diagnosis of atypical manifestations of acute measles may require laboratory confirmation. When compared with B95a cell-line, this study shows that the Vero/hSLAM cell-line is sensitive and is recommended for use in the primary isolation of wild-type measles virus from clinical specimens. Throat swab and urine specimens are the clinical specimens of choice and both are recommended for optimal isolation of measles virus from patients suspected of acute measles virus infection.

Matched MeSH terms: Measles virus/isolation & purification*
Fulltext Measles: a disease often forgotten but not gone

Leung AK, Hon KL, Leong KF, Sergi CM

Hong Kong Med J, 2018 Oct;24(5):512-520.
PMID: 30245481 DOI: 10.12809/hkmj187470

Measles (rubeola) is a highly contagious vaccine-preventable disease caused by the measles virus-a virus of the Paramyxoviridae family. The illness typically begins with fever, runny nose, cough, and pathognomonic enanthem (Koplik spots) followed by a characteristic erythematous, maculopapular rash. The rash classically begins on the face and becomes more confluent as it spreads cephalocaudally. Laboratory confirmation of measles virus infection can be based on a positive serological test for measles-specific immunoglobulin M antibody, a four-fold or greater increase in measles-specific immunoglobulin G between acute and convalescent sera, isolation of measles virus in culture, or detection of measles virus ribonucleic acid by reverse transcriptase-polymerase chain reaction. Complications occur in 10% to 40% of patients, and treatment is mainly symptomatic. Bacterial superinfections, if present, should be properly treated with antibiotics. To eradicate measles, universal childhood immunisation and vaccination of all susceptible individuals with measles vaccine would be ideal. In developed countries, routine immunisation with measles-containing vaccine is recommended, with the first and second doses at ages 12 to 15 months and 4 to 6 years, respectively. The World Health Organization recommends that the first and second doses of measles-containing vaccine be given at ages 9 months and 15 to 18 months, respectively, in countries with high rates of measles transmission.

Matched MeSH terms: Measles; Measles Vaccine; Measles virus
Fulltext Serological assessment of the establishment of herd immunity against measles in a health district in Malaysia

Hazlina Y, Marlindawati MA, Shamsuddin K

BMC Infect Dis, 2016 Dec 08;16(1):740.
PMID: 27931192

BACKGROUND: Malaysia still faces challenges optimizing resources to effectively eliminate measles through high immunization and herd immunity, with sporadic outbreaks of measles as evidence. The objective of this study is to determine the age-specific positive measles antibodies seroprevalence used for assessing the establishment of herd immunity against measles in different age groups. This is useful for identifying vulnerable age groups requiring supplementary immunization.

METHODS: A seroprevalence study was conducted among respondents aged 6-9 years, 15-24 years and 45-54 years attending government health clinics in Seremban between September 2014 and January 2015. A total of 1541 measles IgG antibody status were determined using ELISA technique (NovaTec Immundiagnostica GMBH) and assessment of establishment of herd immunity was based on indicators developed by Plans. Data on socio-demographic background as well as medical and medication history were also gathered.

RESULTS: Seropositive rate for all respondents were 87% (95% CI 85-89), while the rest had either indeterminate [6% (95% CI 5-7)] or negative titre [7% (95% CI 6-8)]. None of the factors analyzed except for age were significant predictors of positive measles antibodies. Seropositive rate differed by age with the highest rate seen in adults (94%; CI 92-96), followed by children (90%; 95% CI 87-94) and adolescents, and young adults (74%; 95% CI 70-78). Based on Plans' indicators, herd immunity was established in adults and children, but not in adolescents and young adults.

CONCLUSIONS: To tackle the most susceptible group in the present study, it is advisable to give booster vaccination to secondary school students and freshmen who enter colleges and universities in Malaysia.

Matched MeSH terms: Measles/immunology*; Measles/epidemiology*
Fulltext Poliomyelitis and measles serosurvey in northern Malaysia

Saraswathy TS, Sinniah M, Lee WS, Lye MS, Choo KE, Jusoh H

Southeast Asian J Trop Med Public Health, 1994 Sep;25(3):565-8.
PMID: 7777927

In 1990 the Institute for Medical Research carried out a serosurvey in the state of Kelantan to study the age stratified immune prevalence rates for measles and poliomyelitis. Our findings indicate that 981 out of 1,097 (89%) of the population screened had measles antibodies and more than 90% (366 out of 400) had antibodies to all three serotypes of poliovirus. The susceptible group for measles was infants below one year of age, of whom 53.3% (8/15) did not have measles antibody. Of 400 subjects, 125 (31.3%) who were either incompletely vaccinated or had not been vaccinated against poliomyelitis, had polio neutralizing antibodies to all three poliovirus serotypes, suggesting herd immunity in the population. No high risk age group could be identified for poliomyelitis.

Matched MeSH terms: Measles/epidemiology*; Measles/virology
Natural virus infections in cynomolgus monkeys

Suzuki M

Jpn. J. Med. Sci. Biol., 1981 Aug;34(4):261-3.
PMID: 7321300
Matched MeSH terms: Measles/epidemiology; Measles/veterinary
The value of potency testing of poliomyelitis and measles vaccines as an integral part of cold chain surveillance

Saraswathy TS, Sinniah M, Lee WS, Lee PC

Southeast Asian J Trop Med Public Health, 1993 Jun;24(2):265-8.
PMID: 8266228

The Virology Division in the Institute for Medical Research, Kuala Lumpur, Malaysia performs potency tests on oral polio vaccines and live attenuated measles vaccines. Since these potency tests were introduced in 1981 a total of 752 tests have been performed on vaccine samples from peripheral immunization centers. Of 165 representative vaccine samples sent for potency evaluation after a cold chain breakdown 154 (87%) passed minimum potency requirements recommended for immunization of infants. In the absence of potency evaluation, those vaccines exposed to temperatures higher than the recommended storage range would be discarded, perhaps resulting in unnecessary wastage and economic loss. Results of the vaccine potency evaluation has enabled health authorities to indirectly monitor cold chain efficiency and ensure the high quality of viral vaccines used in our childhood immunization program.

Matched MeSH terms: Measles Vaccine/immunology*; Measles Vaccine/standards
Measles surveillance in Taiwan, 2012-2014: Changing epidemiology, immune response, and circulating genotypes

Cheng WY, Wang HC, Wu HS, Liu MT

J Med Virol, 2016 May;88(5):746-53.
PMID: 26400063 DOI: 10.1002/jmv.24392

In Taiwan, although the coverage rate of two doses of measles-containing vaccine has been maintained at over 95% since 2001, measles outbreaks occurred in 2002, 2009, and 2011. The present study reports that 43 cases were confirmed by laboratory testing in Taiwan in 2012-2014 and that adults have emerged as one of groups susceptible to measles virus (MV) infection, who may have discrepant humoral immune reactions-indicated by the level of IgM and IgG antibodies compared to a naïve, susceptible measles case. Thirty-seven of 43 cases confirmed by RT-PCR were further characterized by genotyping. In Taiwan, genotype H1 was the major strain in circulation prior to 2010, while D9 was the most frequently detected MV genotype between 2010 and 2011. The genotyping data collected between 2012 and 2014 revealed that H1 rebounded in 2012 after an absence in 2011 and was imported from China and Vietnam. In 2014, genotype B3 first appeared in Taiwan following import from the Philippines and became the most frequently detected strain. Genotype D8, linked to importation from various countries, including India, Indonesia, Thailand, and Vietnam, showed sequence divergence. D9 was imported from Malaysia in 2014. The MV genotypes detected in Taiwan reflected the genotypes of circulating endemic measles strains in neighboring countries. A significant rise in the number of measles cases and in measles with genotypes imported from surrounding countries indicated that measles resurged in Asia in 2014. J. Med. Virol. 88:746-753, 2016. © 2015 Wiley Periodicals, Inc.

Matched MeSH terms: Measles; Measles Vaccine; Measles virus
Influenza vaccine concurrently administered with a combination measles, mumps, and rubella vaccine to young children

Lum LC, Borja-Tabora CF, Breiman RF, Vesikari T, Sablan BP, Chay OM, et al.

Vaccine, 2010 Feb 10;28(6):1566-74.
PMID: 20003918 DOI: 10.1016/j.vaccine.2009.11.054

Children aged 11 to <24 months received 2 intranasal doses of live attenuated influenza vaccine (LAIV) or placebo, 35+/-7 days apart. Dose 1 was administered concomitantly with a combined measles, mumps, and rubella vaccine (Priorix). Seroresponses to measles and mumps were similar between groups. Compared with placebo, response rates to rubella in LAIV+Priorix recipients were statistically lower at a 15 IU/mL threshold (83.9% vs 78.0%) and the prespecified noninferiority criteria were not met. In a post hoc analysis using an alternate widely accepted threshold of 10 IU/mL, the noninferiority criteria were met (93.4% vs 89.8%). Concomitant administration with Priorix did not affect the overall influenza protection rate of LAIV (78.4% and 63.8% against antigenically similar influenza strains and any strain, respectively).

Matched MeSH terms: Measles/prevention & control; Measles-Mumps-Rubella Vaccine/administration & dosage; Measles-Mumps-Rubella Vaccine/immunology*
Vaccine update: the association between measles-mumps-rubella vaccination (MMR) and onset of autism and inflammatory bowel disease

Lee, E.L.

Malaysian Journal of Paediatrics and Child Health, 2001;13(1):1-12.
MyJurnal

Vaccines, used appropriately and efficiently, have changed the landscape of infectious diseases. Poliomyelitis is almost completely eliminated globally. In many industrialised countries, there has been over 99 percent reduction in incidence of diphtheria, tetanus, measles, mumps, rubella, Haemophilus in-fluenzae b meningitis and over 97 percent reduction in whooping cough.',2Unlike anti-biotics, most vaccines have remained equally effective despite years of continuous usage.

Matched MeSH terms: Measles
Fulltext [Study of pathogenicity of Nipah virus and its vaccine development]

Yoneda M

Uirusu, 2014;64(1):105-12.
PMID: 25765986 DOI: 10.2222/jsv.64.105

Nipah virus (NiV), a paramyxovirus, was first discovered in Malaysia in 1998 in an outbreak of infection in pigs and humans, and incurred a high fatality rate in humans. We established a system that enabled the rescue of replicating NiVs from a cloned DNA. Using the system, we analyzed the functions of accessory proteins in infected cells and the implications in in vivo pathogenicity. Further, we have developed a recombinant measles virus (rMV) vaccine expressing NiV envelope glycoproteins, which appeared to be an appropriate to NiV vaccine candidate for use in humans.

Matched MeSH terms: Measles Vaccine/genetics; Measles virus/genetics
Fulltext Evaluation of Measles-Mumps-Rubella Vaccination Among Newly Arrived Refugees

Lee D, Weinberg M, Benoit S

Am J Public Health, 2017 05;107(5):684-686.
PMID: 28323479 DOI: 10.2105/AJPH.2017.303698

OBJECTIVES: To assess US availability and use of measles-mumps-rubella (MMR) vaccination documentation for refugees vaccinated overseas.
METHODS: We selected 1500 refugee records from 14 states from March 2013 through July 2015 to determine whether overseas vaccination records were available at the US postarrival health assessment and integrated into the Advisory Committee on Immunization Practices schedule. We assessed number of doses, dosing interval, and contraindications.
RESULTS: Twelve of 14 (85.7%) states provided data on 1118 (74.5%) refugees. Overseas records for 972 (86.9%) refugees were available, most from the Centers for Disease Control and Prevention's Electronic Disease Notification system (66.9%). Most refugees (829; 85.3%) were assessed appropriately for MMR vaccination; 37 (3.8%) should have received MMR vaccine but did not; 106 (10.9%) did not need the MMR vaccine but were vaccinated.
CONCLUSIONS: Overseas documentation was available at most clinics, and MMR vaccinations typically were given when needed. Further collaboration between refugee health clinics and state immunization information systems would improve accessibility of vaccination documentation.

Matched MeSH terms: Measles-Mumps-Rubella Vaccine/administration & dosage*
Serologic survey with the sera of monkeys in regard to their natural infection with measles virus

Yamanouchi K, Fukuda A, Kobune F, Hikita M, Shishido A

Jpn. J. Med. Sci. Biol., 1969 Apr;22(2):117-21.
PMID: 4981321
Matched MeSH terms: Measles/veterinary*
Entero-and myxoviral infections of the central nervous system

Tan DS

Med J Malaya, 1968 Dec;23(2):140-5.
PMID: 4308419
Matched MeSH terms: Measles/complications
Corticosteroid rescue in late paediatric acute respiratory distress syndrome

Goh AY, Sekaran D, Roziah M

Respirology, 1999 Sep;4(3):295-7.
PMID: 10489678

Late acute respiratory distress syndrome (ARDS) is associated with a mortality of more than 80%. Recent reports in adults have shown improved survival in late ARDS treated with prolonged course of steroids, however little data are available in children concerning its safety and efficacy. We report the successful treatment of a child dying from refractory late ARDS using a prolonged course of high-dose methylprednisolone instituted after 12 days of advanced mechanical ventilation. Progressive improvement was seen from days 3, 7, 10 and 14 after treatment with improvement in PaO2/fraction of inspired oxygen (FiO2) ratios, lung injury score and chest radiographical score. Treatment was complicated by a fungal urinary tract infection that was easily controlled. There were no major metabolic side effects. Steroid therapy can be considered in the treatment of children with refractory late ARDS but larger prospective studies are needed to define indications, timing, dosing and safety of this mode of treatment in children.

Matched MeSH terms: Measles/complications
Fulltext A point-of-care test for measles diagnosis: detection of measles-specific IgM antibodies and viral nucleic acid

Warrener L, Slibinskas R, Chua KB, Nigatu W, Brown KE, Sasnauskas K, et al.

Bull World Health Organ, 2011 Sep 01;89(9):675-82.
PMID: 21897488 DOI: 10.2471/BLT.11.088427

OBJECTIVE: To evaluate the performance of a newly developed point-of-care test (POCT) for the detection of measles-specific IgM antibodies in serum and oral fluid specimens and to assess if measles virus nucleic acid could be recovered from used POCT strips.
METHODS: The POCT was used to test 170 serum specimens collected through measles surveillance or vaccination programmes in Ethiopia, Malaysia and the Russian Federation: 69 were positive for measles immunoglobulin M (IgM) antibodies, 74 were positive for rubella IgM antibodies and 7 were positive for both. Also tested were 282 oral fluid specimens from the measles, mumps and rubella (MMR) surveillance programme of the United Kingdom of Great Britain and Northern Ireland. The Microimmune measles IgM capture enzyme immunoassay was the gold standard for comparison. A panel of 24 oral fluids was used to investigate if measles virus haemagglutinin (H) and nucleocapsid (N) genes could be amplified by polymerase chain reaction directly from used POCT strips.
FINDINGS: With serum POCT showed a sensitivity and specificity of 90.8% (69/76) and 93.6% (88/94), respectively; with oral fluids, sensitivity and specificity were 90.0% (63/70) and 96.2% (200/208), respectively. Both H and N genes were reliably detected in POCT strips and the N genes could be sequenced for genotyping. Measles virus genes could be recovered from POCT strips after storage for 5 weeks at 20-25 °C.
CONCLUSION: The POCT has the sensitivity and specificity required of a field-based test for measles diagnosis. However, its role in global measles control programmes requires further evaluation.

Matched MeSH terms: Measles/diagnosis*; Measles/epidemiology
Fulltext Knowledge on immunisation among nurses in Malaysia

Lidwina Edwin Amir

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):21-21.
MyJurnal

Introduction: The National Immunization Program in Malaysia began in the 1950s and was integrated into the Ma-ternal and Child Health Program. Administrative data showed that coverage for all vaccinations was more than 95% except for measles vaccination. Despite the high coverage, there were clusters of outbreaks of vaccine preventable diseases. One of the reasons is the increasing phenomena of vaccines refusals following the rapid spread of negative perception and concerns through social media. Nurses as front liners play an important role to communicate on vac-cine safety and adverse events (AEFI). A survey was conducted to identify the level of knowledge among nurses who deal with immunisation programme. Methods: Nurses from all states attending a National seminar on immunisation communication in Putrajaya were asked to answer a Digital online questionnaire. They were asked to answer 12 questions on knowledge of vaccines, immunization schedule and cold chain management. Results: A total of 74% (429) of the seminar participants responded to the questionnaire, of which 85% were from the government sector and 15% from private. Findings showed that although about 75% of the nurses had formal training on immunisation, 50% had lack of knowledge about vaccination schedule for defaulters and 63.2% (268) had knowledge gaps related to questions on vaccines and handling of vaccines. Conclusion: In view of the knowledge gap from this survey, there is a need for ongoing training for the nurses and evaluation by supervisors on the knowledge and practices among nurses.

Matched MeSH terms: Measles
Universal child immunization coverage in Kuala Lumpur

Sinniah, D., Rajeswari, B., Koh, S., George, J., Sundari, J., Sosapillai, J.N., et al.

Malaysian Journal of Child Health, 1991;3(1):23-28.
MyJurnal

To verify the actual immunisation coverage in Kuala Lumpur, City Hall Health Department and the Malaysian Paediatric Association (NGO ) carried out a survey. The survey revealed that the immunisation coverage determined at the child's first birthday for BCG was 95%, DPT 3 94%, OPV 3 94%, and measles = 27% (59% at 2 years). These figures correspond closer to City Hall's estimated coverage rather than the rates projected by the Ministry of Health. The main reasons for immunisation failure were, child ill 31.8% (not brought = 20.1%, brought but not given vaccine 11.7%), lack of information 28.6%, lack of motivation 9.1%, mother too busy 9.1%. Measles immunisation coverage at 1 year was low because of wrong information on schedules. Tetanus toxoid immunisation coverage of pregnant women was low. Only 27% of children were protected against neonatal tetanus although 97% of pregnant women received antenatal care and 50% had attended other health facilities as well during pregnancy. Private medical practitioners were responsible for more than 40% of all immunisations but were not submitting returns to the Health Department. Recommendations to improve immunisation coverage include education and motivation of the public and also doctors and health personnel on prevention of missed opportunities, contraindictions to immunisation and correct schedules. (Copied from article).

Matched MeSH terms: Measles
Fulltext Rubella and scarlet fever outbreak among trainees at a training camp in Mersing, Johor

Mohamad Nizam Subahir, Suraiti Hasim, Mohd. Badri Yacob, Mohd Rohaizat Hassan

Malaysian Journal of Public Health Medicine, 2014;14(2):50-55.
MyJurnal

Rubella is an acute and contagious disease which is mainly characterized by fever, rash, and cervical lymphadenopathy. This contagious disease spreads easily through nasopharyngeal secretions, droplet or direct contact with patients. Meanwhile clinical features of scarlet fever include a sore throat, skin rash and strawberry tongue. A descriptive study was conducted to describe the epidemiological characteristic of diseases at a Training Camp in Mersing. Data obtained on demographic details, onset and time of fever and rash or contact with ill person 14 to 21 days prior to symptoms. Screening and interview conducted for all suspected cases of Rubella. 47.4% of the cases presented on 5th June 2012 followed by 15.8% on 11th June 2012 and 13.5% on 12th June 2012. Maculo papular rash was the predominant presenting symptom among students with acute infection in this outbreak (100%) followed by fever (36.8%). Measles specific IgM was not detected in the serum taken but rubella specific IgM was detected in 66.7% (6/19) of samples. 55% (11/20) were positive for ASOT. 4 trainees had Rubella and Scarlet Fever co-infection. It was found out that the outbreak occurred among 391 residents in the camp who shared common places for activities such as lecture, physical activity and meal. Rapid dissemination was due to overcrowded environment and close contact during common activities of the residents. Theoretically co-infection would be presented with severe clinical symptoms but not in this outbreak where all affected trainees only presented with mild fever and rashes.

Matched MeSH terms: Measles

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