Panorama atual do sarampo no mundo: Risco de surtos nos grandes eventos no Brasil / Current landscape of measles in the world: risk of outbreaks in major events in Brazil

O sarampo é considerado uma das doenças infecciosas mais contagiosas do mundo (1), capaz de atingir todos os grupos etários, com risco particular em menores de cinco e naqueles entre 15 e 29 anos de idade (2), sendo uma das principais causas de morte evitáveis por vacina entre crianças (3). Frente aos recentes surtos de sarampo ocorridos no mundo, estaria o Brasil, que desde 2000 conseguiu eliminar a circulação do sarampo e na atualidade vem lidando apenas com surtos de pequena monta de casos importados, sob risco de grandes surtos durante a Copa do Mundo de 2014 e as Olimpíadas de 2016? Através de análises dos últimos surtos ocorridos em todo o mundo e pesquisa da cobertura vacinal no Brasil, os autores respondem a estas questões.

Measles is considered one of the most contagious diseases in the world (1). It’s able to reach all of age groups with particular risk in under five and 15-29 years old (2). It’s one of the main causes for evitable deaths for vaccine between children (3). According to recents measles outbreaks occurred in the world, Brazil is included in it, since 2000 has eliminated measles circulation and actually has been dealing with outbreaks of little dimension of imported cases, at risk of large outbreak during the World Cup 2014 and The Olympics Games 2016? Through analysis of the latest outbreaks ocurred all over the world and research of vaccine coverage in Brazil, the authors will answer to these questions.

Evaluación de la seroprotección contra sarampión, rubéola y hepatitis B en niños menores de cinco años del Perú, 2011 / Evaluation of the seroprotection against measles, rubella and hepatitis B in children under 5 years of age in Peru, 2011

Objetivos. Estimar la prevalencia de anticuerpos contra sarampión, rubéola y hepatitis B en niños de 1 a 4 años del Perú. Materiales y métodos. Se realizó una encuesta nacional basada en la aplicación de un cuestionario y obtención de muestra de sangre capilar en papel de filtro para el estudio de anticuerpos contra sarampión, rubéola y hepatitis B en niños de 1 a 4 años. Se utilizó un muestreo probabilístico, estratificado y multietápico con inferencia a nivel nacional y siete ámbitos de estudio: Lima metropolitana, resto de costa urbana, costa rural, sierra urbana, sierra rural, selva urbana y selva rural. Las muestras de sangre capilar fueron procesadas siguiendo protocolos estandarizados para la determinación de anticuerpos mediante técnica de ELISA utilizando reactivos comerciales. Resultados. Se encontró una prevalencia nacional de 91,6% (IC95%: 90,6-92,7%), 91,3% (IC 95%: 90,3-92,4%) y 95,9% (IC 95%: 95,0-96,8%) para anticuerpos contra sarampión, rubéola y hepatitis B respectivamente. No se evidenció diferencias significativas de las prevalencias entre los diferentes ámbitos de estudio y en los diferentes estratos socioeconómicos de los conglomerados. Conclusiones. En niños de 1 a 4 años se ha estimado una prevalencia nacional de anticuerpos contra sarampión y rubéola entre 90-93%, mientras que para anticuerpos contra hepatitis B (anti-HBsAg) entre 95-97%.

Objectives. To estimate the prevalence of antibodies against measles, rubella and hepatitis B in children aged between 1 and 4 years in Peru. Materials and methods. A national survey was conducted based on a questionnaire and capillary blood sample taken on filter paper in order to study antibodies against measles, rubella and hepatitis B in children from 1 to 4 years of age. A stratified, multistage, probability sampling design was used to be representative at the national level and at level of seven ambits, including the Metropolitan Lima Area, the rest of the urban coast, the rural coast, the urban highlands, the rural highlands, the urban jungle and the rural jungle. The capillary blood samples were processed according to the standardized protocols for detection of antibodies using the ELISA technique and commercial reagents. Results. The survey showed a national prevalence of antibodies against measles, rubella and hepatitis B of 91.6% (CI 95%: 90.6%; 92.7%), 91.3% (CI 95%: 90.3%; 92.4%) and 95.9% (CI 95%: 95.0%; 96.8%) respectively. There was no evidence of significant differences in the prevalence among the ambits of study or among the socioeconomic strata of the conglomerates for any of the three types of antibodies. Conclusions. In children from 1 to 4 years of age, the national prevalence of antibodies against measles and Rubella was between 90-93%, while the prevalence of antibodies against Hepatitis B (anti-HBsAg) was between 95-97%.

Seroprevalencia contra agentes ToRCH en mujeres indígenas en edad fértil, estado Zulia, Venezuela / Prevalence of infectious agents in indigenous women of childbearing age in Venezuela

Introducción. El termino ToRCH comprende a los patógenos Toxoplasma gondii, virus de la rubéola, citomegalovirus y virus herpes simple 1 y 2. En mujeres embarazadas expuestas pueden ser causa de abortos y malformaciones congénitas en el neonato. Objetivo. Determinar la seroprevalencia de infección por los agentes causantes del síndrome ToRCH en mujeres en edad fértil de algunas comunidades indígenas yukpa de Venezuela. Materiales y métodos. En el año 2007 fueron seleccionadas 109 muestras de 151 mujeres, en edades comprendidas entre 14 y 40 años. La detección de anticuerpos se hizo por el método de inmunoensayo enzimático indirecto o ELISA de Smartest Diagnostics™. Resultados. El 85,5 % presentó anticuerpos contra T. gondii, el 95,4 % para rubéola, el 75,2 % para citomegalovirus y el 97,2 % para el virus herpes simple 1 y 2. Se observa que el 21,1 % y el 30,2 % presentaron relación entre la variable aborto y las infecciones por citomegalovirus y virus herpes simple 1 y 2, respectivamente. Conclusiones. Existe alta seroprevalencia de infecciones por los agentes causantes del síndrome ToRCH en mujeres en edad fértil de la etnia indígena yukpa. Las condiciones sanitarias precarias y el consumo de agua contaminada con ooquistes, favorecen la adquisición de la infección por T. gondii. El hacinamiento, el inicio a temprana de edad de la actividad sexual y el número de parejas, pueden incidir en la presencia de citomegalovirus y virus herpes simple 1 y 2.

Introduction. The ToRCH syndrome includes the following infectious pathogens: Toxoplasma gondii, rubella, cytomegalovirus and herpes simplex virus 1 and 2. In susceptible pregnant women, these pathogens can cause abortions and congenital malformation in the newborn babies. Objective. The seroprevalence of infection by ToRCH agents was determined in women of childbearing age in several Venezuelan Yukpa indigenous communities. Material and methods. In 2007, 109 samples were selected from 151 women with an age range of 14 to 40 years old. The determination of antibodies against ToRCH agents was carried out through the indirect enzyme immunoassay technique by ELISA´s technique of Smartest Diagnostics. Results. Of the 109 samples, 85.5% presented antibodies against T. gondii, 95.4% for rubella, 75.2% for cytomegalovirus and 97.2% for and herpes simplex virus 1 and 2. A relationship between abortion and infection by cytomegalovirus and herpes simplex virus 1and 2 was noted in 21.1% and 30.2% of women presented, respectively. Conclusions. The findings show a high prevalence of ToRCH agents in women in childbearing age in Yukpa indigenous communities in Venezuela. Poor sanitary conditions and consumption of water contaminated with oocysts may be an important way of transmission of T. gondii. Overcrowding in the communities, sexual activity at an early age and number of partners and may be related to the presence of cytomegalovirus and herpes simplex virus HSV-1 and 2.

Investigation of measles IgM-seropositive cases of febrile rash illnesses in the absence of documented measles virus transmission, State of São Paulo, Brazil, 2000-2004 / Investigação dos casos de doenças febris exantemáticas com IgM reagente contra o sarampo na ausência de transmissão documentada do vírus do sarampo, Estado de São Paulo, 2000-2004

INTRODUCTION: To review measles IgM-positive cases of febrile rash illnesses in the State of São Paulo, Brazil, over the five-year period following interruption of measles virus transmission. METHODS: We reviewed 463 measles IgM-positive cases of febrile rash illness in the State of São Paulo, from 2000 to 2004. Individuals vaccinated against measles < 56 days prior to specimen collection were considered to be exposed to the vaccine. Serum from the acute and convalescent phases was tested for evidence of measles, rubella, parvovirus B19 and human herpes virus-6 infection. In the absence of seroconversion to measles immunoglobulin-G, measles IgM-positive cases were considered false positives in individuals with evidence of other viral infections. RESULTS: Among the 463 individuals with febrile rash illness who tested positive for measles IgM antibodies during the period, 297 (64 percent) were classified as exposed to the vaccine. Among the 166 cases that were not exposed to the vaccine, 109 (66 percent) were considered false positives based on the absence of seroconversion, among which 21 (13 percent) had evidence of rubella virus infection, 49 (30 percent) parvovirus B19 and 28 (17 percent) human herpes virus-6 infection. CONCLUSIONS: Following the interruption of measles virus transmission, thorough investigation of measles IgM-positive cases is required, especially among cases not exposed to the vaccine. Laboratory testing for etiologies of febrile rash illness aids interpretation of these cases.

INTRODUÇÃO: Revisar os casos de doenças febris exantemáticas com IgM reagente contra o sarampo, no Estado de São Paulo, Brasil, durante os cinco anos seguidos a interrupção da transmissão do vírus do sarampo. MÉTODOS: Nós revisamos 463 casos de doenças febris exantemáticas com IgM reagente contra o sarampo, no Estado de São Paulo, Brasil, de 2000 a 2004. Indivíduos vacinados contra o sarampo 56 dias antes da coleta de amostra foram considerados expostos à vacina. Soros da fase aguda e de convalescença foram testados para a evidência de infecção de sarampo, rubéola, parvovírus B19 e herpes vírus 6. Na ausência de soroconversão para imunoglobulina G contra o sarampo, casos com IgM reagente contra o sarampo foram considerados falsos positivos em pessoas com evidência de outras infecções virais. RESULTADOS: Entre as 463 pessoas com doenças febris exantemáticas que testaram positivo para anticorpos IgM contra o sarampo durante o período, 297 (64 por cento) pessoas foram classificadas como expostas à vacina. Entre os 166 casos não expostos à vacina, 109 (66 por cento) foram considerados falsos positivos baseado na ausência de soroconversão, dos quais 21 (13 por cento) tiveram evidência de infecção por vírus da rubéola, 49 (30 por cento) parvovírus B19 e 28 (17 por cento) infecção por herpes vírus humano 6. CONCLUSÕES: Após a interrupção da transmissão do vírus do sarampo é necessária exaustiva investigação dos casos com IgM reagente contra o sarampo, especialmente dos casos não expostos à vacina. Testes laboratoriais para etiologias das doenças febris exantemáticas ajudam na interpretação destes casos.

Seroprevalence of antibodies to measles, mumps, and rubella among Thai population: evaluation of measles/MMR immunization programme.

Stored serum specimens, from four regions of Thailand, of healthy children attending well baby clinics and of healthy people with acute illnesses visiting outpatient clinics were randomly sampled and tested for IgG antibody to measles, mumps, and rubella (MMR). The immunity patterns of rubella and mumps fitted well with the history of rubella and MMR vaccination, seroprotective rates being over 85% among those aged over seven years. A high proportion of younger children acquired the infection before the age of vaccination. MMR vaccination should preferably be given to children at an earlier age. For measles, 73% seroprotective rates among children, aged 8-14 years, who should have received two doses of measles/MMR vaccine, were lower than expected. This finding was consistent with the age-group reported in outbreaks of measles in Thailand. The apparent ineffectiveness (in relation to measles) of MMR immunization of 1st grade students warrants further studies.

Use of a-interferon, amantadin and isoprinosine in subacute sclerosing panencephalitis [SSPE]: comparing the effectiveness

Sub acute Sclerosing Pan Encephalitis [SSPE], a progressive neurological disorder characterized by inflammation of the brain [encephalitis], is the result of an inappropriate immune response to the measles virus or measles vaccination. SSPE usually develops 2 to 10 years after the original viral attack. Some of the major signs and symptoms are mental deterioration, jerky movements, and seizures specially myoclonic type, involuntary movements, and/or behavioral changes, difficulty in walking, speech, and loss of cognition, respiratory distress and death. During the ten years, from July 1991 to July 2001, we admitted 45 cases of [SSPE], at different stages of the disorder. Regardless of their stage of disease, for intervention, randomly, we used one of three drugs; Amantadin, Interferon alfa and Isoprinosine, administered to the patients, for between one month to one year. Fourteen cases received Amantadin, 15 Alfa interferon, and 16 were given Isoprinosine. While the results show all three drugs to be relatively effective, Isoprinosine showed four times more effectiveness than Amantadin and twice as much as Interferon. The results showed Isoprinosine to be much more effective than Amantadin and Alfa interferon in treating the condition

Measles antibody in mothers and infants 0-2 years and response to measles vaccine at the age of 9 and 18 months.

BACKGROUND: Despite the declining trends in measles cases corresponding to an increase in routine measles immunization coverage, measles outbreaks occur in some isolated areas in Nan province, northern Thailand. The primary reason for these outbreaks is inadequate vaccine coverage. Another reason is primary vaccine failure. OBJECTIVES: To study maternal and cord blood measles antibody, the kenetic change of infant measles antibody from 0-9 months and the response to measles vaccine at the age of 9 and 18 months. MATERIAL AND METHOD: A prospective cohort study for measles antibody of 1,010 mothers and infants 0-2 years was done between April 1999 and March 2001 at three hospitals in Nan province. Consecutive blood samples were drawn for measles antibody measurement by ELISA assays at Virus Research Institute, National Institute of Health, Thailand. The demographic data of mothers and infants were recorded at each visit. RESULTS: Maternal and cord blood measles antibody were high and the authors found a higher level in cord blood than in maternal level. Measles antibody level in infants declined significantly from the age of 4 months (246.4 +/- 364.2 mlU/L) to their lowest level at the age of 9 months (17.7 +/- 197.1 mlU/L). CONCLUSION: After the first dose of 9-month measles vaccination, the authors found the seroconversion rate of 82.2 percent. The seroconversion rate was significantly higher to 99.6 percent after the second dose at 18 months old.

Subacute sclerosing panencephalitis presenting as acute disseminated encephalomyelitis.

Subacute sclerosing panencephalitis (SSPE) is a chronic encephalitis of childhood and young adolescence due to persistent measles virus infection of the central nervous system. In majority of cases onset occurs from 5-15 years of age. In a nonimmunized population the average onset is 8 years. Children with SSPE had experienced natural infection with the rubeola virus at an early age, half before age 2 years. SSPE generally occurs 5-10 years after measles infection. In the early stages of the disease behavioral and personality changes is followed by myoclonic jerks and convulsions. In late stages dementia, stupor and coma develops. Diagnosis is achieved by typical clinical findings, measles antibody titer increase in cerebrospinal fluid (CSF) and serum, high amplitude, slow, sharp waves in EEG. Prognosis is poor and death ensues in about 3 yr after the diagnosis. Here it is presented a 7-years-old boy with involuntary movements in both hands, drop attacks while walking, ataxia and stupor. Due to suggestive radiological and clinical findings and a history of recent mumps infection he was thought to have acute disseminated encephalomyelitis initially and given treatment. But due to clinical deterioration and detection of anti measles IgG in serum and CSF, SSPE diagnosis was confirmed. With this SSPE case presenting initially as ADEM, the authors tried to emphasize that presentation of SSPE may clinically and radiologically be diverse and a thorough differential diagnosis is mandatory for a definite diagnosis.

Role of CSF serology in follow-up of subacute sclerosing panencephalitis patients on treatment.

Subacute sclerosing panencephalitis (SSPE) is a progressive inflammatory disease of the central nervous system with poor prognosis and high mortality. No effective treatment has a proven role; oral isoprinosine and intrathecal administration of alpha-interferon may prolong survival. We report an unusual case of adult onset SSPE patient on treatment with significant clinical improvement, even in the absence of conversion to seronegativity in either CSF or serum, on follow-up serological examination.

Assessment of the performance of a definition of a suspected measles case: implications for measles surveillance / Evaluación de la utilidad de una definición de "caso sospechado de sarampión": implicaciones para la vigilancia de la enfermedad

Objetivo. Evaluar la utilidad, en el Brasil, de la definición de "caso sospechado de sarampión", aplicada en pacientes con enfermedades exantemáticas, que se ha adoptado en el Brasil y en muchos otros países. Métodos. De enero de 1994 a diciembre de 2003, se examinó a pacientes con erupción cutánea aguda en dos grandes unidades de atención primaria y en un hospital general estatal en Niterói, en la zona metropolitana de la ciudad de Río de Janeiro, Brasil. Se usaron datos de la evaluación clínica y serológica para estimar la sensibilidad, especificidad, valor pronóstico de un resultado positivo (VPRP), y valor pronóstico de un resultado negativo (VPRN) aplicables a la definición de "caso sospechado de sarampión" adoptada en el Brasil, así como otras combinaciones de signos y síntomas; el resultado de pruebas serológicas se usó como parámetro de referencia. Usando la técnica de inmunoensayo enzimático, las muestras de suero se examinaron para detectar la presencia de anticuerpos de immunoglobulina M (IgM) contra el virus del sarampión. Resultados. Se estudió a un total de 1 221 pacientes con una enfermedad caracterizada por exantema cutáneo más otros signos y síntomas en diversas combinaciones. La definición de "caso sospechado" adoptada en el Brasil (erupción, fiebre y por lo menos un síntoma más, que puede ser tos, congestión nasal o conjuntivitis), tuvo una sensibilidad general de 100% y una especificidad de 58.7%. La probabilidad de encontrar esa combinación de síntomas o signos fue 2,4 mayor entre los casos confirmados de sarampión que entre los casos de otras enfermedades exantemáticas. La definición de "caso sospechado" que se ha adoptado en el Brasil tuvo un VPRP de 6% y un VPRN de 100%. La presencia combinada de todos los cinco signos y síntomas tuvo la mayor especificidad, el mayor VPRP y la mayor razón de verosimilitud, tanto en niños (< 15 años de edad) como en adultos (≥ 15 años). Eso se logró a expensas de la sensibilidad, que se redujo a 89%, pero el VPRN siguió siendo muy alto. Conclusiones. Nuestros resultados demuestran que la definición de "caso sospechado de sarampión" adoptada en el Brasil posee gran sensibilidad para la vigilancia de la enfermedad entre pacientes con enfermedades exantemáticas. No obstante, los elevados porcentajes de resultados positivos falsos que se detectaron podrían llevar a que se clasifiquen como sarampión, por error, muchas enfermedades exantemáticas de otra índole, lo que a su vez daría por resultado una mala orientación de las medidas de control y un aumento de su carestía.

Objective. To assess the performance, in Brazil, of the definition of a suspected measles case among patients with rash diseases that has been adopted in Brazil and many other countries. Methods. From January 1994 to December 2003, patients with acute rash were seen at two large primary health care units and a public general hospital in Niterói, a city in the metropolitan area of the city of Rio de Janeiro, Brazil. Data from clinical and serologic assessment were used to estimate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the definition of a suspected measles case that has been adopted in Brazil, as well as other combinations of signs and symptoms; serologic status was taken as the reference. Using enzyme immunoassay, serum samples were tested for immunoglobulin M (IgM) antibodies against measles virus. Results. A total of 1 221 patients with an illness characterized by different combinations of rash with other signs and symptoms were studied. The suspected case definition that has been adopted in Brazil (rash, fever, and at least one of the following: cough, coryza, or conjunctivitis) had an overall sensitivity of 100%, and a specificity of 58.7%. Confirmed measles cases were 2.4 times as likely as were other rash diseases to have that combination of signs/symptoms. The suspected case definition adopted in Brazil had a 6% PPV and 100% NPV. The combination of all five signs and symptoms had the highest specificity, PPV, and likelihood ratio, for both children (< 15 years old) and adults (≥ 15 years). That was achieved at the expense of sensitivity, which dropped to 89%, but the NPV was still very high. Conclusions. Our results show that the suspected measles case definition adopted in Brazil is extremely sensitive for measles surveillance among patients with rash diseases. However, the high false-positive rates that were found may result in a substantial number of other rash diseases being misclassified as measles, leading to the misdirection of control measures and increases in their cost.

Changing trend of SSPE over a period of ten years.

Sub acute sclerosing pan-encephalitis (SSPE) is a slowly progressive inflammatory disorder of the central nervous system. A decline in frequency has been noticed in most of the developed countries, whereas it continues to be high in developing countries. Though a number of studies have been carried out, the exact trend of SSPE is still not clear. Hence the present study was carried out to analyze the trend of SSPE over the past ten years in and around Chandigarh. A total of 205 patients with clinical features suggestive of SSPE were enrolled for the study during Jan'92 to Dec. 2001. Measles specific antibodies were detected in blood and CSF by HAI method. 114 patients were found to be positive for measles specific HAI antibody with a male preponderance. The number of SSPE cases were found to be more during the period 1992-95 in comparison to the next 6 years (p < 0.05). The high incidence of SSPE in our country could be due to improper vaccine coverage, poor cold chain maintenance or circulation of atypical measles virus strain.

[Measles antibody in previously two dose immunized and reimmunized in school age children]

The aim of this study was to determine measles antibody titer in children who received two doses of vaccine and were reimmunized at 7 years of age. The school children were randomly choosen from various areas of Tehran who had received two doses of measles vaccine at 9 and 15 months of age and reimmunized at 7 years of age. Measles antibody was measured in children aged 7 years and 4-6 weeks after reimmunization by Enzyme-linked immunosorbent assay [ELISA]. A total of 339 children were evaluated. Antibody titers in 132 [38.9%] children were more than 10 IU/ml [mean 68.3 IU/ml] and 207 [61.1%] less than 10 IU/ml. Antibody titers in 32 of 42 children who had been reimmunized were less than 10 IU/ml. In two [6.3%] of 32 children antibody titers did not rise after reimmunization and the mean antibody titer in remainder [30] of the children was 71.3 IU/ml. Antibody titers in 10 [23.8%] of 42 children before and after reimmunization were 58 and 168.5 IU/ml respectively. After reimmunization, the mean antibody titer in children with high titer before reimmunization was higher than those with low antibody titer. This study indicates that children with two dose measles immunization before and after the first year of age are still immunologically resistant against measles at 7 years of age. Immunization is the most efficacious and cost effective intervention available to improve the health and wellbeing of children and prevention of the infectious disease

[Evaluation of the response to vaccination against poliomyelitis and measles in malnourished children in Morocco]

We made a comparative survey of the poliovirus antibodies [anti-poliovirus type 1, anti-poliovirus type 2 and anti-poliovirus type 3] and the measles antibodies in malnourished but completely vaccinated children [37] and control children [34].The age range was 10 months to 5 years. Immunization in children with protein-energy malnutrition was low for both vaccines. Seroprevalence rates of the polio 1, polio 2, polio 3 antibodies and the measles antibodies in the control group were 94.1%, 97.1%, 91.2% and 82.4% respectively. In malnourished children the respective rates were in some cases significantly lower being: 40.5% [P = 0.001], 59.5% [P = 0.001], 40.5% and 35.1%. Malnutrition is a major determinant of the humoral response to oral polio and measles vaccines and must be given due consideration to prevent vaccination failure

Enfermedades virales: vigilancia epidemiológica basada en síndromes en pediatría / Viral illnesses: epidemiologic vigilance based on pediatric syndromes

Las enfermedades virales ocupan el primer lugar de morbilidad en la población pediatrica en Venezuela. El propósito de este estudio fue establecer las bases para la Vigilancia Epidemiológica de Enfermedades Virales basada en Síndromes en el Servicio de Pediatía del Hospital Universitario de Caracas. Se incluyeron pacientes entre 0 y 11 años con los síndromes: respiratorio, febril por dengue, exantema febril y neurológico febril. se realizó encuesta epidemiológica y clínica y se tomaron las muestras para estudios virales: hisopado nasofaríngeo (aislamiento de virus respiratorios), suero (determinación de IgM rubéola, sarampion y dengue) líquido cefalorraquídeo (PCR y cultivo). Durante 1 año se evaluaron 200 niños. de 131 niños son síndrome respiratorio, el aislamiento fue positivo en 21,37 por ciento correspondiendo 89,39 por ciento al virus Parainfluenza 1. de los 21 casos sospechosos de dengue, el 28,57 por ciento resultó positivo y en 1 se aisló el serotipo Dengue III. De los examenes febriles (n=38), hubo 2 casos de rubéola, 1 dengue y nínguno de sarampión. De los niños con síndrome neurológico (n=10) hubo 2 casos por Enterovirus. Se inició la vigilancia epidemiológica y el trabajo en equipo multidisciplinario. Los hallazgos coinciden con la epidemiología en el país el período del estudio. Se demostró la circulación de Parainfluencia 1 e Influenza A, Dengue y aparición del serotipo III y presencia de Enterovirus en meningitis aséptica. no hubo circulación de Sarampion. se confirma la tendencia actual de la disminución de casos de sarampion y rubéola en exantemas febriles.

Levels of serum vascular cell adhesion molecule-1 in measles.

While the levels of serum vascular cell adhesion molecule-1 (VCAM-1) have been investigated in many diseases, they have not, to our knowledge, been studied in patients with measles. Serum VCAM-1 and creatinine levels were determined in six adolescent and adult Japanese patients with measles in the acute febrile phase and defervescent afebrile phase. Serum VCAM-1 levels were significantly higher in the acute febrile phase than in the convalescent afebrile phase, but no significant difference between the serum creatinine levels was shown in the two phases. Our study revealed that the high serum VCAM-1 level in the acute febrile phase later decreased in the afebrile convalescent phase. The measurement of circulating VCAM-1 may be useful for the assessment of convalescence in patients with measles.

Comparison of two blood collection techniques for measles antibody detection in children.

BACKGROUND & OBJECTIVES: Though several seroprevalence and seroconversion studies have been conducted for measles using the filter paper haemagglutination inhibition (FPHAI), very few studies have compared the conventional serum HAI with the FPHAI. The present study was aimed at the evaluation of whole blood samples on filter paper as an alternative to serum specimens for detection of antibodies to measles virus. METHODS: Serum and whole blood samples soaked on filter paper were collected from 165 randomly selected healthy children in the age groups of 1-2 yr. HAI test was performed on both sets of samples and the results compared. RESULTS: Ninety samples that gave a titre of 8 or more by serum HAI also had titres of > or = 8 by FPHAI showing 100 per cent agreement between the two assays. Seventeen samples that had a serum HAI titre of 2 and 4 were missed by FPHAI due to the starting dilution of 8 of the latter. However, FPHAI gave no false positive results compared with serum HAI. INTERPRETATION & CONCLUSION: Collection of the FP samples by finger prick is more acceptable and requires less expertise than venepuncture. Thus, in spite of the small percentage of missed cases by the filter paper method, this technique of sampling was found to be a convenient and reliable alternative to venepuncture, for detection of measles virus antibody especially in large scale seroepidemiological studies.

Influence of placental malaria infection and maternal hypergammaglobulinaemia on materno-foetal transfer of measles and tetanus antibodies in a rural west African population.

Placental malaria infection jeopardizes pregnancy outcome, and its influence may also impair the transplacental transfer of some antibodies. Two hundred and thirteen Gambian mother-baby pairs were studied to determine the influence of placental malaria infection and maternal hypergammaglobulinaemia on transplacental transfer of measles and tetanus antibodies in Gambian population. Placental blood and tissue were collected for placental malaria diagnosis. Cord and maternal sera were tested for total IgG concentration by laser nephelometry and for IgG antibody to tetanus toxoid and measles by ELISA. The prevalence of placental malaria infection was 51.1%. Mothers whose placentae were parasitized had a significantly higher mean total serum IgG (22.0 g/L vs 11.3 g/L, p < 0.001) and measles antibody level (4.02 IU/mL vs 1.21 IU/mL, p < 0.01), but not tetanus antibody, than mothers with non-parasitized placentae. Results of multiple regression analysis showed that placental malaria infection and maternal hypergammaglobulinaemia were associated with the reduction of 72% (95% CI 67.84) and 86% (95% CI 76.91) in transplacental transfer of measles antibody respectively but did not influence the transfer of tetanus antibody. It is concluded that the combined influence of placental malaria infection and maternal hypergammaglobulinaemia is significantly associated with the transfer of impaired measles antibody in this population.

Measles immunization in Saudi Arabia: the need for change

This paper describes the measles immunization programme in Saudi Arabia and the change from the single-dose schedule with the Schwartz vaccine to the double-dose schedule with the Edmonston-Zagreb vaccine. The recent measles-mumps-rubella school campaign is also described