Measles, mumps and rubella vaccine 12 months after hematopoietic stem cell transplantation

ABSTRACT The measles, mumps and rubella (MMR) vaccine is usually recommended from 24 months after a hematopoietic stem cell transplant (HSCT). Some authors have demonstrated that the MMR vaccination can be safe from 12 months post-HSCT in non-immunosuppressed patients, as recommended by the Brazilian National Immunization Program/Ministry of Health, since 2006. The objectives of this study were to evaluate when patients received MMR vaccine after an HSCT in our care service and if there were reports of any side effects. We retrospectively reviewed the records of HSCT recipients who received at least one MMR dose in our care service, a quaternary teaching hospital in Sao Paulo city, Brazil, from 2017 to 2021. We identified 82 patients: 75.6% (90.1% in the autologous group and 45.1% in the allogeneic group) were vaccinated before 23 months post-transplantation. None reported side effects following the vaccination. Our data support that the MMR vaccination is safe from 12 to 23 months after HSCT.

Comparative study of scientific articles on MMR vaccines published from India over the last few decades

The MMR vaccine as we know is a vital vaccine to protect against three disease-causing microbes- measles, mumps, and rubella. To commemorate 75 years of Indian independence, the present study delves into the achievement of Indian research and lists out articles retrieved from the Web of Science Core Collection database on the domain of MMR vaccine research. The data has been restricted to the publication from India, thereby, has throwing some understanding into the MRR vaccine research in India over the last 28 years- 1994 to 2021. The data have been compared based on scientometric analysis. Qualitative and quantitative analysis have also been taken into account in order to give a comparative insight into the research. The comparison was done based on citation data, usage count data, year of publication, journals, publication media, domains focussed on the papers, and type of document. Astonishingly, in 2021, the most number of papers were published, most of them have related MMR vaccine as a potential immunity developer against COVID-19 infection. A total of 43 articles were retrieved from the search, the numbers are quite big, and the highest citation among them being 99 which was published in 2014, which is quite impressive for such a short duration of time. The comparative study suggests a positive growth of MMR vaccine research in India.

Meningitis aséptica por virus parotídeo asociada a la vacuna

Resumen Comunicamos el caso de un lactante mayor previamente sano, que luego de tres semanas de recibir la vacuna SPR (sarampión, parotiditis, rubeola) presentó fiebre, aumento de volumen parotídeo y compromiso de conciencia. Se diagnosticó una meningitis aséptica, con pleocitosis en el LCR de predominio mononuclear, detectándose virus parotídeo en LCR por biología molecular. En el Instituto de Salud Pública de Chile se realizó serología (IgM e IgG) que resultó positiva. La muestra de saliva confirmó la etiología por virus parotídeo con genotipo N. La evolución fue favorable, sin secuelas al seguimiento a seis meses. Ante esta situación clínica, se revisó la información respecto a la asociación y causalidad de esta entidad clínica y vacuna SPR, focalizado en diferentes cepas del virus parotiditis.

Abstract We report the case of an older infant with no prior morbidity that approximately 3 weeks after receiving MMR vaccination (measles, mumps, rubella) was hospitalized for feverish symptoms, increased parotid volume and compromised consciousness. Aseptic meningitis was diagnosed, detecting pleocytosis in the CSF, predominantly mononuclear, and confirming by molecular biology, presence of parotid virus in CSF. A study was carried out by the Institute of Public Health of Chile, where serology (IgM and IgG) was positive. Saliva sample confirmed the etiology of parotid virus with genotype N. The evolution was favorable and at 6-month follow-up, there were no sequelae. Given this clinical situation, information regarding the association and causality of this clinical entity and the MMR vaccine, focused on different strains of the mumps virus, was reviewed.

Global outbreak of deadly measles in 2019

Measles is an infection of the respiratory system caused by a virus, especially a Paramyxovirus of the genus Morbillivirus, a single stranded negative sense RNA virus. Infants younger than 12 months, school-aged children or young adults depending upon local immunization practice are highly susceptible for the disease.

Pesquisa inmuno-epidemiológica en niños con meningoencefalitis vírica vacunados contra la parotiditis, rubeola y sarampión / Immuno-epidemiological inquiry in children suffering viral meningoncephalitis vaccinate against mumps, rubella and measles

En las meningoencefalitis de etiología viral se encuentran implicados los paramixovirus (virus de la parotiditis, sarampión y rubeola). Las vacunas combinadas trivalentes han sido utilizadas durante años en muchos países. El objetivo del trabajo es determinar la respuesta poliespecífica de anticuerpos de tipo IgG anti parotiditis, rubeola y sarampión en pacientes pediátricos con meningoencefalitis víricas agudas. Se realizó un estudio retrospectivo en el año 2018 en muestras de pacientes pediátricos con meningoencefalitis viral aguda vacunados con la triple viral, donde se utilizó el índice de anticuerpos específicos anti-parotiditis, anti-rubeola y anti-sarampión para identificar el estado de respuesta inmunológica contra dichos virus en la muestra estudiada, procedentes de la serorraquioteca de LABCEL. Las determinaciones se hicieron por ELISA. Todos los pacientes presentaron respuesta poliespecífica intratecal, disminución significativa del índice de anticuerpos IgG anti-parotiditis con respecto a la edad y al tiempo de respuesta. Se evidencia un acortamiento del tiempo de respuesta de los anticuerpos de tipo IgG específicos anti-parotiditis en relación a la edad de vacunación(AU)

Paramixovirus like mumps, rubella and measles are involved in some viral meningoencephalitis. Triple combined vaccines have been employed for several years in many countries. The aim of this work is to determine the IgG anti mumps, rubella and measles polyspecific response in pediatric patients with acute viral meningoencephalitis. A 2018 retrospective study in pediatric patients with acute viral meningoencephalitis previously vaccinated with the triple viral vaccine MMR was performed to identify the immune response status against mumps, rubella and measles in samples from LABCEL serum and cerebrospinal fluid collection. Quantification of IgG specific antibody was performed by ELISA. Intrathecal polyspecific response was present in all patients. A significant decrement of anti IgG mumps specific antibody index was observed according to age and response time. A shortage of the response time of IgG mumps specific antibodies according to the age of vaccination was demonstrated(AU)

Immunogenicity and safety of a booster dose of live attenuated measles-mumps-rubella vaccine for 4-year-old children / 中华微生物学和免疫学杂志

Objective To evaluate the immunogenicity and safety of a booster dose of live attenua-ted measles-mumps-rubella (MMR) vaccine for 4-year-old children and to provide references for reasonable arrangement of MMR immunization schedule. Methods Children aged 4 years (54-60 months) old were recruited and divided into three groups as follows: Group 8 months MR [receiving live attenuated measles and rubella(MR) vaccination at 8 months and MMR vaccination at 18 months],Group 8 months MMR(re-ceiving MMR vaccination at both 8 and 18 months) and Group 12 months MMR(receiving MMR vaccination at both 12 and 22 months). Active follow-up was conducted for safety evaluation after immunization of all subjects with the booster dose of MMR vaccine. Blood samples were collected before and 35 days after vacci-nation and analyzed by ELISA to detect serum antibodies to measles,mumps and rubella. Results A total of 514 subjects were enrolled in this study of safety evaluation and 469 of them received serologic detection of antibodies twice. The rate of adverse reactions following vaccination was 17.12% (general reactions accoun-ted for 94.21%) and no severe adverse reactions were reported. No significant difference in the rates of ad-verse reactions was found among the three groups (χ2=4.82, P=0.090). Subjects who were seropositive for measles, mumps and rubella increased after immunization with MMR vaccine, accounting for 100%, 99.79% and 99.79%,respectively. Geometric mean concentrations (GMC) against measles, mumps and rubella in all subjects were 1.35,3.05 and 2.13 times higher than what they were before the immunization. Levels of antibodies to measles,mumps and rubella were all increased significantly in the three groups after immunization with the booster dose of MMR vaccine (Fisher Exact Test, P=0.000). Conclusion The booster dose of MMR vaccine increases the levels of serum antibodies in children aged 4 years old with high safety. It suggests that two doses of MMR vaccine should be encouraged in the immunization program in China.

Rotavirus and Triple Viral Vaccine Losses in Vaccination Rooms: a Cross-Sectional Study / Perda de vacina anti rotavírus e viral tripla em salas de vacinação: estudo transversal

OBJECTIVE: This study aimed to analyze Rotavirus (ROTA) and Measles, Mumps and Rubella (MMR) vaccine wastage in vaccination rooms of Juiz de Fora city, MG, Brazil, to identify factors related to this wastage. METHODS: The study had a cross-sectional design, based on spreadsheets reporting monthly vaccine use in a year; and based on questionnaires applied to 45 urban vaccination rooms. A linear regression model was developed, endeavoring to predict vaccine loss rates using variables related to vaccination room infrastructure/operational conditions. RESULTS: Statistical significance was detected for ROTA loss variables: vaccine knowledge, health unit type and number of personnel in the vaccination room (R2=0.33; p = 0.001). It was also found that 1,254 ROTA and 33,762 MMR doses were wasted during the period. Concerning ROTA, 331 (26.4%) were technical losses, and 923 (73.6%) miscellaneous losses; for the MMR vaccine, these numbers were 23,281 (68.96%) for technical losses and 10,481 (31.04%) for miscellaneous losses. CONCLUSION: The percentage losses in the period were significant, which should induce the production of health protocols to facilitate the correction of weaknesses in the studied vaccine cold chain.

RESUMO: Este estudo analisou as perdas vacinais das vacinas contra o Rotavírus (ROTA) e contra o Sarampo, Caxumba e Rubéola (VTV) em salas de vacinação de Juiz de Fora, MG, a fim de identificar os fatores relacionados a essas perdas. MÉTODO: Tratou-se de um estudo transversal, baseado na análise dos movimentos mensais das vacinas estudadas durante um ano, por meio de planilhas e de questionários aplicados em 45 salas de vacinação urbanas. Um modelo de regressão linear foi desenvolvido, tentando prever perdas vacinais por meio de variáveis de infra-estrutura e funcionamento das salas. RESULTADOS: Foi detectada significância estatística para o modelo ROTA, variáveis: conhecimento sobre vacinas, tipo de unidade e número de funcionários que atuam na sala de vacina (R2=0,33; p = 0,001). Constatou-se 1254 doses perdidas de ROTA e 33762 de VTV durante o período pesquisado. Das 1254 doses perdidas de ROTA, 331 (26,4%) foram devidas a Perdas Técnicas, e 923 (73,6%) a Perdas Diversas. Para a vacina VTV, das 33762 doses perdidas, 23281 (68,96%) foram por Perdas Técnicas, e 10481 (31,04%) por Perdas Diversas. CONCLUSÃO: Conclui-se que as perdas percentuais, no período, foram significantes, podendo instigar a produção de protocolos de saúde para auxiliar a eliminação dos pontos frágeis na cadeia de aplicação das vacinas.

Estudo colaborativo nacional para o estabelecimento do material de referência de trabalho da vacina contra sarampo, caxumba e rubéola: evolução para a autossuficência na produção nacional da vacina tríplice viral / National collaborative study for establishing the working reference material of the vaccine against measles/mumps and rubella: evolution to the self-sufficiency in the national production of triple viral vaccine

A monografia farmacopeica da vacina tríplice viral (sarampo/caxumba/rubéola) exige a validação de desempenho do ensaio de potência utilizando-se apropriado material de referência (MR). Com o intuito de estabelecer o primeiro MR de trabalho (MRT) nacional para a vacina tríplice viral, foi realizado o estudo colaborativo nacional com a participação de duas únicas instituições que executam o ensaio de potência desta vacina, o Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos, produtor nacional) e o Instituto Nacional de Controle de Qualidade em Saúde.O material candidato (cMRTBio), preparado pelo produtor, foi avaliado pelos laboratórios participantes utilizando-se as respectivas metodologias in-house de determinação de potência. O cMRTBio foi considerado apropriado como MR in-house por estar em concordância com as especificações recomendadas nas normativas de compêndios, a saber: variações intra- (< 5 %), inter-ensaios (< 10 %) e entre laboratórios (< 10 %) abaixo dos limites aceitáveis; e potência estimada (log10 CCID50/DH) em 3,72 para sarampo, 4,80 para caxumba e 3,70 para rubéola. Este trabalho reflete o compromisso do único produtor nacional da vacina tríplice viral com a saúde pública, descrevendo-se a expansão da tecnologia, o cumprimento às diretrizes internacionais, o cuidado com o controle da qualidade e culminância para a autossuficiência nacional na produção de vacinas.

The pharmacopoeia monograph for the measles/mumps and rubella (MMR) triple vaccine demands to perform the validation of the potency assay by using the suitable reference material (MR). Aiming at establishing the firstwork MR (MRT) for the MMR triple vaccine, a national collaborative study was performed with the participation of the two unique national institutions working on the vaccine potency evaluation test, the Imunobiological Technology Institute (Bio-Manguinhos, national manufacturer) and the National Institute for Quality Control in Health. The candidate product (cMRTBio) prepared by the manufacturer was evaluated by the participant laboratories by employing the respective in-house methodologies for determining the potency. The cMRTBio was considered suitable as in-house MR, according to the specifications based on the normative compendia, being the intra-assay (< 5 %), inter-assay(< 10 %) and between laboratories variations (< 10 %) below the acceptable limits, and the estimate potency(log10 CCID50/DH) in 3.72 for measles, 4.80 for mumps and 3.70 for rubella. This study reflects the commitment of the unique national MMR vaccine producer to the public health, describing the expansion of technology,the compliance with international guidelines and the careful quality control, leading to the national self-sufficiency in the vaccine production.

Indian Academy of Pediatrics (IAP) Recommended Immunization Schedule for Children Aged 0 through 18 years – India, 2014 and Updates on Immunization.

Justification: There is a need to review/revise recommendations about existing vaccines in light of recent developments in the field of vaccinology. Process: Following an IAP ACVIP meeting on April 19 and 20, 2014, a draft of revised recommendations for the year 2014 and updates on certain vaccine formulations was prepared and circulated among the meeting participants to arrive at a consensus. Objectives: To review and revise recommendations for 2014 Immunization timetable for pediatricians in office practice and issue statements on certain new and existing vaccine formulations. Recommendations: The major changes in the 2014 Immunization Timetable include two doses of MMR vaccine at 9 and 15 months of age, single dose recommendation for administration of live attenuated H2 strain hepatitis A vaccine, inclusion of two new situations in ‘high-risk category of children’ in context with ‘pre-exposure prophylaxis’ of rabies, creation of a new slot at 9-12 months of age for typhoid conjugate vaccine for primary immunization, and recommendation of two doses of human papilloma virus vaccines with a minimum interval of 6 months between doses for primary schedule of adolescent/ preadolescent girls aged 9-14 years. There would not be any change to the committee’s last year’s (2013) recommendations on pertussis vaccination and administration schedule of monovalent human rotavirus vaccine. There is no need of providing additional doses of whole-cell pertussis vaccine to children who have earlier completed their primary schedule with acellular pertussis vaccine-containing products. A brief update on the new Indian Rotavirus vaccine, 116E is also provided. The committee has reviewed and offered its recommendations on the currently available pentavalent vaccine (DTwP+Hib+Hepatitis-B) combinations in Indian market. The comments and footnotes for several vaccines are also updated and revised.

Introducing Combined Measles, Mumps and Rubella Vaccine in Chandigarh, India: Issues and Concerns.

Cyclical outbreaks of mumps have been noticed across Chandigarh city during winter months. Chandigarh does not provide measles, mumps and rubella (MMR) vaccination in the State immunization schedule. Epidemiological shift in age at diagnosis of mumps was noticed with higher incidence in older children and adults. Increased occurrence of complications can be predicted with this age shift. Silent burden of rubella with serious outcomes in newborns further strengthen the case for MMR vaccine inclusion in routine immunization program of Chandigarh.

Immune response to the mumps component of the MMR vaccine in the routine of immunisation services in the Brazilian National Immunisation Program

A non-controlled longitudinal study was conducted to evaluate the combined vaccine against measles, mumps and rubella (MMR) immunogenicity in 150 children vaccinated in the routine of three health units in the city of Rio de Janeiro, Brazil, 2008-2009, without other vaccines administered during the period from 30 days before to 30 days after vaccination. A previous study conducted in Brazil in 2007, in 1,769 children ranging from 12-15 months of age vaccinated against yellow fever and MMR simultaneously or at intervals of 30 days or more between doses, had shown low seroconversion for mumps regardless of the interval between administration of the two vaccines. The current study showed 89.5% (95% confidence interval: 83.3; 94.0) seroconversion rate for mumps. All children seroconverted for measles and rubella. After revaccination, high antibody titres and seroconversion rates were achieved against mumps. The results of this study and others suggest that two MMR doses confer optimal immunoresponses for all three antigens and the possible need for additional doses should be studied taking into account not only serological, but also epidemiological data, as there is no serological correlate of protection for mumps.

Low vaccine efficacy of mumps component among MMR vaccine recipients in Chennai, India.

introduction of MMR vaccine was believed to have resulted in a decline in the incidence of measles, mumps and rubella infections. However, recent reports suggest the re-emergence of mumps infection worldwide in the vaccinated populations. Iit was proposed that the reason for this re-emergence was poor efficacy of MMR vaccine. The present study was aimed to investigate mumps infection in MMR vaccinated and non-vaccinated populations in Chennai, Iindia. Blood samples were collected from acute mumps cases (n=74, 42<12 yr age, 54% males) and investigated for IgM antibody against mumps, IgG antibody against measles, mumps and rubella viruses by ELISA. Sixty seven (91%) patients had received MMR vaccine. All the 67 vaccinated cases were positive for parotitis, and mumps IgM. However, only 10 (15%) were positive for IgG. All samples (100%) were positive for rubella and measles IgG. These findings showed the occurrence of mumps infection among MMR vaccinated individuals in Chennai, India. The MMR vaccine failed to generate anti-mumps IgG. The reason may be low vaccine efficacy of the mumps component of the MMR vaccine used.

A Clinical Study of Intralesional Immunotherapy Using Measles, Mumps, and Rubella Vaccine in Various Warts / 대한피부과학회지

BACKGROUND: Although several methods have been attempted in the treatment of warts, the traditional destructive method may be painful or ineffective and induce disfiguring scars. Therefore, a more tolerable method with fewer drawbacks is needed. OBJECTIVE: We studied the therapeutic effect of intralesional immunotherapy using the Measles, Mumps, and Rubella (MMR) vaccine and factors affecting it in patients with warts. METHODS: A retrospective study was performed in 207 patients with various types of warts, who did not meet the exclusion criteria for treatment and were followed-up from January 2011 to December 2013. Patients with warts were treated at 2-week intervals, and the therapeutic effect was evaluated 1 month after the final treatment. RESULTS: Overall, 123 (59.5%) patients experienced a greater than half reduction in the size and number of warts. In addition, younger patients (under the age of 20) (p=0.008) and those with common warts (including periungual warts) (p=0.02) showed significantly higher treatment responses. All patients complained of transient mild pain during the intralesional injections, but other side effects were rarely observed. Only 3.2% of patients who experienced a complete response had a recurrence more than 6 months after the final treatment. CONCLUSION: We suggest that intralesional immunotherapy with MMR vaccine can be considered as a primary remedy for patients who are sensitive to pain, especially children with multiple lesions, are concerned about serious side effects, or have common warts, and that treatment response will be improved by increasing the number of applications.

Immune response to second dose of MMR vaccine in Indian children.

Background & objectives: MMR vaccine in a two dose schedule has successfully eliminated measles, mumps and rubella from many developed countries. In India, it is not a part of national immunization programme but is included in the State immunization programme of Delhi as a single dose between 15-18 months. This prospective study was carried out to assess the extent of seroprotection against these three diseases in immunized children and to study the immune response to a second dose of MMR. Methods: Consecutive children aged 4-6 yr, attending the immunization clinic of a tertiary care hospital in Delhi for routine DT vaccination, were enrolled. Second dose of MMR was given and pre- and post-vaccination antibody levels were compared. Results: The pre-vaccination percentage seropositivity observed in the 103 children recruited, was 20.4 per cent for measles, 87.4 per cent for mumps and 75.7 per cent for rubella. Amongst the 84 children who were followed up after the second dose, the percentage seroprotection for measles rose from 21.4 (18/84) to 72.6 per cent (61/84) and 100 per cent became seroprotected to mumps and rubella. Interpretation & conclusions: The percentage of children protected against measles was found to be alarmingly low which needs to be investigated. Though the observed protection against mumps and rubella was adequate, its durability was not known. The need for re-appraisal of the current MMR immunization policy is called for by carrying out longitudinal studies on a larger sample.

Seroprevalence of measles and mumps antibody among preschool children in Korea, according to their vaccination history / 한국역학회지

PURPOSE: To maintain measles elimination status, we evaluated the seropositivity of measles and mumps according to time interval since the first or second dose of MMR in children aged 4 to 6 years, who are starting communal life. MATERIALS AND METHOD: 2,447 children aged 4 to 6 years were enrolled at 251 public health centers over the period of March to May 2007. Subjects were verified their date of MMR vaccination and then their blood was sampled for serologic test. Measles and mumps IgG antibody was tested by ELISA at Korea CDC. RESULTS: Vaccination coverage was 99.9% in the first dose, 64.9% in the second dose regardless of gender. Seropositivity of measles and mumps was 95.7%, 85.5% in the first dose and 98.7%, 98.1% in the second dose, respectively. The seropositivity of measles was 88.1% in 6-year-olds who did not receive the second dose of MMR. As time since receipt, seropositivity of measles tended to decrease over time and was 93.3% in vaccinees over 48 months after the first dose. CONCLUSION: A first dose MMR at 12-15 months cannot lead to herd immunity. More public information is needed to encourage second dose vaccination before admission to day-care center or kindergarten.

Associação entre meningite asséptica e uso da vacina tríplice viral(sarampo-caxumba-rubéola) durante campanha vacinal de 1997 / Association between aseptic meningitis and use of MMR vaccine, during the vaccination campaign, 1997

Em 1997 foi realizada uma campanha de vacinação em massa com a vacina tríplice víral (sarampo, caxumba, rubéola), em quatro Estados brasileiros: Rio Grande do Sul, Bahia, Piauí e Ceará. Três semanas após o principal dia de campanha, os diversos estados notificaram um aumento da incidência de casos de meningite asséptica (MA), especialmente nas capitais. Logo após, foi iniciada uma investigação desenvolvida pelos técnicos locais das Secretarias Estaduais de Saúde e por pesquisadores do Instituto de Saúde Coletiva e Faculdade de Medicina da Universidade Federal da Bahia, com apoio do Programa Nacional de Imunizações - PNI. Os resultados dessa investigação demonstram a existência de um surto de meningite asséptica que se iniciou de forma abrupta 2-3 semanas após a vacinação nas capitais estudadas, e persistiu por 4 semanas. Foi demonstrado que o maior risco após o uso da vacina correspondeu a 21-30 dias, quando comparado com o risco de MA antes da campanha. Apenas em Salvador o surto ocasionou um excessivo aumento da ocupação hospitalar. Esse texto discute os determinantes da ocorrência de um evento adverso na forma de um surto, as implicações sobre uma adequada assistência médica, e o impacto da informação sobre a adesão da população às vacinas empregadas pelo PNI

In 1997 a mass vaccination campaign with the measles, mumps and rubella vaccine was carried out in four Brazilian states: Rio Grande do Sul, Bahia, Piauí and Ceará. Three weeks after the special vaccination day, an increase was observed in the number of cases of aseptic meningitis in the capitals of the four states. An investigation was undertaken by health professionals from the State Health Secretaries, professionals from the Institute of Collective Health and the Medical School of the Federal University of Bahia with the support of the National Immunization Program. The results of the investigation demonstrated the occurrence of an outbreak of aseptic meningitis which initiated abruptly two to three weeks after the special vaccination day, with a total duration of four week. It was also shown that the risk of aseptic meningitis was greater 21-30 days after exposure to the vaccine when compared to the risk before the campaign. Only in Salvador the outbreak caused an excess of cases that extrapolated the admission capability of the reference hospital for infectious diseases. This work discusses the determinants of the outbreak, the implications for adequate medical assistance and the implications regarding societal credibility of the safety of the vaccines used in the routine vaccination calendar.

Two Children With Egg Allergy Who Developed Systemic Side Reaction with MMR Vaccine / 소아알레르기및호흡기학회지

There has been continued controversy as to the safety of egg-based MMR vaccine in egg-allergic children. Many studies have dealt with MMR administrations to egg-allergic patients focusing on the systemic side reactions. It has been found that most egg-allergic patients do not react to MMR vaccine but to other vaccine components. Therefore, most authors conclude that if an individual can eat eggs without ill effects, he or she can take the MMR vaccine without skin testing. In this regard, this study describes two cases of systemic side reactions after injection of MMR vaccine to egg-allergic patients. In a case with a history of systemic reaction from egg ingestion, it is still recommended that skin testing with the vaccine be carried out. If the skin test result shows positive, incremental doses of the vaccine in every 15-20 minutes are suggested.

Epidemiologic Study of Measles Outbreak in School-Aged Children in East KyongGi-Do Area

PURPOSE: There was marked decline of measles outbreak in the world since the first measles vaccine had been introduced. Recently, however, measles outbreak in the vaccinated children have been reported worldwide, which was ascribed to the possibilities of primary or secondary vaccine failure. We investigated the incidence in the school-aged children in the Kyong-gi Do area, the larger district which covers the urban and rural area, by the questionnaire. METHODS: The questionnaires which were asked to the students' parents of 14 elementary schools in and nearest Sungnam city, Kyong-Gi Do for their present age, experience of measles attack and vaccination, and the age of measles attack. The answers of this questionnaire were analysed by SAS computer program. RESULTS: 1) Measles vaccination rate at 9 months was 70.5% and MMR vaccination rate at 15 months was 91.3%. 2) Measles attack rate among unvaccinated group was 53.8%, and 16.1% in vaccinated group. There was significant low risk of measles attack among vaccinated group than unvaccinated group(relative risk=3.35, p<0.001). 3) Vaccine efficacy of measles in this age group was 69%. 4) Age distribution of measles outbreak reveals bimodal pattern, the graph shows two peak incidence of 1 year-old and 6 years-old. 5) There were no significant differences of measles incidence in the different medical care service center that measles vaccination had been done. CONCLUSIONS: Despite high rate of measles vaccine coverage in Sungnam, the attack rate of measles in the vaccinated population was relatively high. There may be due to primary, secondary vaccine failure or the other factors. The policy of measles vaccination in Korea should be reestablished as soon as possible.