Between and , there were less than annual cases in the United States. Measles became no longer endemic in the United States; molecular studies showed all cases to be due to imported measles from Europe, Asia, and the Middle East. Beginning in , an increase in measles began to occur in the United States. Many cases were related to travel in European and Asian countries, where there were many unvaccinated individuals. The increase in measles therefore was mainly ascribed to the failure of many parents to immunize their healthy infants, mainly from fear that MMR might be a cause of autism.
Others refused vaccination, citing philosophical or religious objections. As many of 15 studies worldwide have failed to demonstrate a causal relationship between MMR vaccine and autism. Today, cases of measles are on the increase in the United States, with reported mini-epidemics among unvaccinated and too-young-to-be-vaccinated children.
In , a record cases of measles were reported in 27 states, the highest number of cases in many years. Most of the cases were unvaccinated. Largely due to refusal of parents to immunize their children.
In , 11 measles outbreaks in the US were reported by the CDC, and in 23 outbreaks were reported. In December an outbreak began at a large California amusement park, leading to reported measles cases in 7 states, Mexico and Canada. There were no fatalities, but a number of patients were hospitalized. Measles cases today are mostly ascribed to reluctance of some parents to vaccinate their children for fear of harm from the vaccine, and importations of measles cases from other countries where vaccination is not practiced.
Measles in hospitalized patients requires strict isolation with proper hand-washing, gowns, masks, and gloves. Hospitalized patients should be in a negative pressure room, if possible.
Airborne transmission precautions are indicated until 4 days after rash onset in otherwise healthy patients and for the duration of illness in the immunocompromised. The incubation period is days after exposure. Measles cases should be reported to the local Department of Health. Second doses of measles-containing vaccines should be at least 1 month apart. Healthy child or adult susceptibles should also be immunized.
Exposure to measles in the unvaccinated is not a contraindication to immunization; control of epidemics in schools or other institutions is by immunization. During an outbreak, infants as young as 6 months of age can be vaccinated; such children should eventually receive a total of three doses of measles vaccine. Health care workers should be required to demonstrate proof of measles immunity before being hired. Adverse events after measles vaccine include fever up to Transient thrombocytopenia and anaphylaxis occur rarely.
Measles vaccine considered to be extremely safe. Although pre-formed antibodies are useful for passive immunization and play a significant role in preventing recurrent infections, cellular immunity appears more important in host defense against measles than humoral immunity. In general, CD4 T-cells help to control the virus by secretion of cytokines, whereas CD 8 T-cells directly eliminate cells infected with measles virus.
Some CD4 T-cells are also cytotoxic for measles virus infected cells. Unvaccinated patients at high risk to develop severe measles include infants younger than 6 months of age and immunocompromised individuals, such as those with congenital or acquired defects in cellular immunity, as well as children being treated for malignant disease or following transplantation.
Such individuals should receive passive immunization after a recognized exposure. Exposed HIV-infected children should receive passive immunization whether or not they were immunized. Passive immunization is accomplished with Immune Globulin IG within 6 days after exposure. The dose is 0. Passive immunization is not required for healthy household members who have received at least 1 dose of vaccine.
Measles disease is the main manifestation of infection with rubeola virus. Patients with the prodrome of measles have non-specific respiratory symptoms for about 3 days. Koplik spots appear during and following this prodrome. In the next phase, patients complain of influenza-like symptoms, such as fever, cough, conjunctivitis, and coryza.
After a few more days, the typical maculopapular, erythematous, non-pruritic rash begins on the head and face and progresses down the body. Rash first appears behind the ears and on the hairline. The rash, which blanches on pressure, appears last on the extremities, including the palms and soles. The rash may become confluent, especially on the face and neck. It clears first on the face and then on the body.
Involved skin may desquamate except on the palms and soles during the healing phase. The rash lasts about 5 days; the patient usually feels worst on the first or second day after rash onset. Differentiation between measles and Kawasaki disease in children may be difficult, but it is clinically important because there is a specific treatment for Kawasaki disease IV immunoglobulin.
Because the rash of measles is immunologically mediated, immunocompromised patients, including those with HIV infection, may have measles with no rash and may present with unexplained encephalitis. Immunocompromised patients may also have poor antibody responses to measles. When measles is suspected in such a patient, RT-PCR on body fluids or tissues becomes extremely important to rule in the diagnosis of measles.
Although measles in pregnancy does not cause congenital abnormalities, the disease may be more severe in pregnant women, especially in the last trimester, than in women who are not pregnant. Maternal measles early in pregnancy may result in fetal loss. In general, as with many so called childhood infections, measles is more severe in adults than in children.
Measles in newborn infants of women with measles at delivery may also be a severe illness. Possibly because measles virus induces a period of immunosuppression, tuberculosis may be aggravated in patients with measles. A positive tuberculin test in a patient with measles may revert to negative for a month or so after recovery from measles,. In addition to Kawasaki syndrome, other illnesses included in the differential diagnosis of measles include rubella; scarlet fever; roseola; infectious mononucleosis; infections with rickettsiae, enteroviruses, and adenoviruses; Parvovirus B19; meningococcal infection; toxic shock syndrome; mycoplasma infections; and drug eruptions.
Symptoms of encephalitis usually develop during the first week after rash onset. Measles encephalitis ranges from mild to severe.
Survivors frequently have neurologic sequelae. Because measles encephalitis is thought to result from infection of the central nervous system CNS , steroids are not recommended for its treatment.
This content does not have an Arabic version. Overview Measles Open pop-up dialog box Close. Measles Measles causes a red, blotchy rash that usually appears first on the face and behind the ears, then spreads downward to the chest and back and finally to the feet.
Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Goodson JL, et al. Measles 50 years after use of measles vaccine. Infectious Disease Clinics of North America. Goldman L, et al. In: Goldman-Cecil Medicine. Philadelphia, Pa. Accessed March 2, Gans H, et al. Measles: Epidemiology and transmission. Rochester, Minn. Kliegman RM, et al. In: Nelson Textbook of Pediatrics. Reye's syndrome information page. National Institute of Neurological Disorders and Stroke.
Measles: Clinical manifestations, diagnosis, treatment, and prevention. Tannous LK, et al. A short clinical review of vaccination against measles. Journal of the Royal Society of Medicine Open. Measles rubeola. For healthcare professionals. To specifically infect and destroy cancer cells was illusive for long time, however, methods to engineer viruses, with intrinsic cytolytic function, to specifically target cancer cells is now at reach.
The swap of the viral envelope glycoproteins F and H by an envelope glycoprotein of a different virus VSV-G was practically efficient and the novel chimeric virus MV-VSV replicated in a variety of cells including cells lines that are not susceptible to MV, indicating a change in the tropism of MV. In addition, the chimeric virus induced protective immunity to VSV susceptible mice. A heterologous challenge of these animals with fold lethal dose of VSV was not effective.
Indeed, researchers at Mayo Clinic were able to generate various mutant-MVs that target specific cells. This review is dedicated to the memory of my father who was a source of inspiration. In remembrance of my colleague and friend Steve Udem, for his documented input in the field of Mononegavirales reverse genetics. I would like to thank all members of my Group who contributed to the success of MV vector.
National Center for Biotechnology Information , U. Journal List Hum Vaccin Immunother v. Hum Vaccin Immunother. Published online Aug 5. Author information Article notes Copyright and License information Disclaimer. Received Aug 4; Accepted Aug 4. This article has been cited by other articles in PMC. Abstract Measles was an inevitable infection during the human development with substantial degree of morbidity and mortality.
Keywords: measles, pathogenesis, SSPE, vaccine, live viral vaccine, viral vectors, recombinant vaccines. Introduction Measles, also known as morbilli, is an infection of the respiratory system, immune system and skin caused by measles virus MV , a paramyxovirus of the genus Morbillivirus. Complications with pregnancy Measles remains a rare event in pregnancy in developing countries since most women of child-bearing age acquired measles at a young age.
Measles Vaccine MV vaccines were prepared from live wild type strains that have been cultured under conditions that caused them to lose virulence without losing their ability to induce immunity. Impact of vaccination Vaccination against MV has had a major impact on the epidemiology of measles. Reported measles cases according to WHO statistics. Open in a separate window. Immunogenicity of measles vaccine The vaccine is highly immunogenic when it is given in the correct dose to children of appropriate age.
Development of techniques that allow the rescue of MV from cDNA The twentieth century saw the introduction of several successful vaccines, including those against Diphtheria, Measles, Mumps, Rubella, Influenza, Hepatitis B, and yellow fever that saved millions of lives worldwide in addition to the eradication of smallpox.
Insights on the genomic modification of MV and its biology One of the driving forces behind the reverse genetics of Mononegavirales was to gain better insight into the biology of this viral order. Insertion of marker gene sequences to allow virus localization Insertion of reading frames encoding various marker proteins is useful for monitoring the pathway of MV spread and replication in cells and in the organs of infected animals.
Development of multivalent recombinant and chimeric vaccine candidates The modification of MV genome by enrichment of its genome by additional genes and the modification of its tropism was established upon proof-of-concept to determine: 1 the capacity of MV-genome to accommodate large inserts exceeding 6 kb of marker genes expressed simultaneously by the same virus GFP, LacZ, CAT ; 55 and 2 to stably express large gene inserts of other pathogens, and that the recombinant MV induces quantitative immune response against itself and the cloned gene products.
Engineering of candidate oncolytic MVs against cancer To specifically infect and destroy cancer cells was illusive for long time, however, methods to engineer viruses, with intrinsic cytolytic function, to specifically target cancer cells is now at reach. Disclosure of Potential Conflicts of Interest No potential conflicts of interest were disclosed.
Acknowledgment This review is dedicated to the memory of my father who was a source of inspiration. References 1. In: Infectious diseases of Children ; 8th edn. Mosby, St Louis, Cover illustration. Abu Bakr Razi. The epidemiology of measles: thirty years of vaccination.
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