Measles is the most transmissible human disease known to date. In the prevaccine era, virtually every member of each birth cohort was infected with this virus, leading to substantial morbidity and mortality, with millions of deaths on a global scale. At the current time, measles causes an estimated 1 to 1.5 million deaths per year world-wide. Since the advent of live, attenuated measles vaccines measles has been controlled, but not eradicated. Central to the goal of measles eradication are data relating to the influence of immunogenetics on vaccine immunogenicity. In this paper, the results of studies are reviewed executed in my laboratory examining the role of the class I and II HLA genes on the antibody response to measles vaccine.
Before the widespread use of the measles vaccine, measles was so common that infection was felt to be "as inevitable as death and taxes." In the United States, reported cases of measles fell from hundreds of thousands to tens of thousands per year following introduction of the vaccine in 1963 (see chart at right). Increasing uptake of the vaccine following outbreaks in 1971 and 1977 brought this down to thousands of cases per year in the 1980s. An outbreak of almost 30,000 cases in 1990 led to a renewed push for vaccination and the addition of a second vaccine to the recommended schedule. Fewer than 200 cases were reported each year from 1997 to 2013, and the disease was believed no longer endemic in the United States. In 2014, 610 cases were reported. Roughly 30 cases were diagnosed in January 2015, likely originating from exposure near Anaheim, California in late December 2014.
The benefit of measles vaccination in preventing illness, disability, and death have been well documented. The first 20 years of licensed measles vaccination in the U.S. prevented an estimated 52 million cases of the disease, 17,400 cases of mental retardation, and 5,200 deaths. During 1999–2004, a strategy led by the World Health Organization and UNICEF led to improvements in measles vaccination coverage that averted an estimated 1.4 million measles deaths worldwide. The vaccine for measles has led to the near-complete elimination of the disease in the United States and other developed countries. While the vaccine is made with a live virus which can cause side effects, these are far fewer and less serious than the sickness and death caused by measles itself. While preventing many deaths and serious illnesses, the vaccine does cause side effects in a small percentage of recipients, ranging from rashes to, rarely, convulsions.
Measles is common worldwide. Although it was declared eliminated from the U.S. in 2000, high rates of vaccination and excellent communication with those who refuse vaccination are needed to prevent outbreaks and sustain the elimination of measles in the U.S. Of the 66 cases of measles reported in the U.S. in 2005, slightly over half were attributable to one unvaccinated individual who acquired measles during a visit to Romania. This individual returned to a community with many unvaccinated children. The resulting outbreak infected 34 people, mostly children and virtually all unvaccinated; 9% were hospitalized, and the cost of containing the outbreak was estimated at $167,685. A major epidemic was averted due to high rates of vaccination in the surrounding communities.
The vaccine has non specific effects such
as preventing respiratory infections that may be greater than those of measles
prevention. These benefits were greater when used before a year of age. A high
titre vaccine resulted in worse outcomes in girls and thus is no longer
recommended by the World Health Organization. As measles causes upper
respiratory disease that leads to complications of pneumonia and bronchitis,
measles vaccine is beneficial to reduce exacerbations of chronic
obstructive pulmonary disease (COPD) and asthma.
Check with your doctor immediately if any of the following side effects occur:
Symptoms of allergic reaction
Check with your doctor as soon as possible if any of the following side effects occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
The above side effects (especially aches or pain in joints) are more likely to occur in adults, particularly women.
Other side effects not listed may also occur in
some patients. If you notice any other effects, check with your healthcare
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this vaccine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Receiving this vaccine with any of the following medicines is not recommended. Your doctor may decide not to use this vaccine or change some of the other medicines you take.
Receiving this vaccine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Receiving this vaccine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Certain medicines should not be used at or around
the time of eating food or eating certain types of food since interactions may
occur. Using alcohol or tobacco with certain medicines may also cause
interactions to occur. Discuss with your healthcare professional the use of
your medicine with food, alcohol, or tobacco.
Do not become pregnant for 3 months after receiving measles, mumps, and rubella vaccine. There is a chance that this vaccine may cause birth defects.
Tell your doctor that you have received this vaccine:
In deciding to use a vaccine, the risks of taking the vaccine must be weighed against the good it will do. This is a decision you and your doctor will make. For this vaccine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Use is not recommended for infants younger than 12 months of age, unless the risk of measles infection is high. Waiting until children are at least 12 months of age is important because antibodies that infants receive from their mothers before birth may interfere with the effectiveness of the vaccine. There may be special reasons why children between 6 months and 12 months of age also may require measles vaccination.
Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.
Studies in women suggest that this medication poses minimal risk
to the infant when used during breastfeeding.