Measles, rubella, mumps and Toxoplasma gondii antibodies in saliva of vaccinated students of schools and universities in São Paulo City, Brazil

ABSTRACT Introduction: Vaccines are well-established public health interventions with major impacton the prevalence of infectious diseases, but outbreaks are occurring frequently due to pri-mary and secondary failures, despite high coverage. Surveillance of efficacy and duration ofinduced immunity is a difficult task as it requires invasive blood sampling in children andteenagers. Saliva can be an acceptable alternative source of IgG to assess vaccine efficacyand toxoplasmosis incidence. We investigated IgG response for measles, mumps, rubella,and T. gondii in saliva samples of vaccinated young people. Methods: Saliva was collected from 249 public schools students from São Paulo, Brazil, aged7 to 13 years old, during an interactive exhibition on hygiene. We used S. aureus proteinA solid phase capture assay for IgG reactive to biotinylated purified proteins. Paired salivaand serum (47) were tested from young adults with serum evidence of T. gondii infectionand from negative children less than 12 month old for standardization. Reproducibility wasgreater than 98% and sensitivity and specificity of the saliva assays were greater than 95%,as well as the concordance of paired saliva and serum samples. Results: Saliva from high school students showed a prevalence of 8.5% (95% CI: 5.0-11.9%)for anti T. gondii IgG; 96.8% (94.6-99%) of anti-measles IgG; 59.1% (53-65%) of anti-rubella IgG,and 57.5% (51.3-63.6%) of anti-mumps IgG. Discussion: The prevalence of antibodies against mumps and rubella after 6-8 years of vaccination was lower than against measles among students. The findings of this study demonstrate the feasibility of saliva sampling for follow-up of vaccine immune status in teenagers. This useful approach allows for IgG detection for vaccine control or epidemio- logical studies.

Frecuencia de anticuerpos IgG a seis agentes infecciosos en los estudiantes de la carrera de Química Biológica / Frequency of IgG antibodies to six infectious agents in students of the Biological Chemistry degree

Se determinó la frecuencia de anticuerpos IgG para Toxoplasma gondii y los virus de paperas, sarampión, rubéola, varicela y hepatitis B en 90 estudiantes de la carrera de Química Biológica de la Facultad de CCQQ y Farmacia. La mayor frecuencia se encontró para rubéola y sarampión, 98.9% para cada prueba y la menor frecuencia fue para T. gondii con 23.3%. No se encontró asociación significativa entre la positividad y el género, entre la positividad a paperas, sarampión, varicela y el haber sufrido la infección o haber estado en contacto con personas infectadas y entre la positividad a T. gondii y el consumir carne roja y/o comida callejera (p > .05). Únicamente en el caso de la hepatitis B se encontró una asociación significativa entre la positividad y la edad (p = < .001), el hecho de estar vacunado (p < .001) y el ser sexualmente activo (p = .004). Los porcentajes de vacunación en la población en estudio fue alta únicamente para hepatitis B (80%), mientras que para las otras infecciones fue 35.6% para rubéola y sarampión, 22.2% para varicela y 10% para paperas. Más de 82% de los estudiantes presentaron protección a los seis agentes estudiados y se recomienda realizar encuestas sero-epidemiológicas constantes, evaluar los programas de inmunización, identificar los grupos a riesgo y que las personas que no presenten anticuerpos se vacunen.

The frequency of IgG antibodies for Toxoplasma gondii and the mumps, measles, rubella, varicella and hepa-titis B viruses was determined in 90 students of the Biological Chemistry career of the Faculty of CCQQ and Pharmacy. The highest frequency was found for Rubella and Measles, 98.9% each, and the lowest frequency was for T. gondii with 23.3%. No significant difference was found between positivity and gender, between positivity to mumps, measles, chicken pox and having suffered infection or having been in contact with infected persons and between positivity to T. gondii and consuming red meat and / or street food (p > .05). Only in the case of Hepatitis B a significant difference between positivity and age (p = .001), the fact of being vaccinated (p = .001) and being sexually active (p = .004 was found. The percentage of vaccination in the study population was high only for He-patitis B (80%), while for the other infections it was 35.6% for rubella and measles, 22.2% for varicella and 10% for mumps. More than 82% of the students presented protection to the six agents studied and it is recommended to carry out constant sero-epidemiological surveys, to evaluate the immunization programs, to identify the risk groups and that people who do not present antibodies get vaccinated.

Actualización situacion sarampion y acciones intensificadas de vigilancia y control / Update to measles situation and intensified actions on surveillance and control

El 28 de marzo de 2018 se confirmó un caso de sarampión en un bebe de 8 meses, residente de la Ciudad de Buenos Aires. En función de ello, y teniendo como escenario posible lo que está ocurriendo en la actualidad, desde el Ministerio de Salud de la CABA, se comenzaron a diseñar estrategias de abordaje de carácter preventivo, para promover el control de este evento en la población en general y, en particular, en los niños susceptibles: por un lado, todos los menores de 6 años que cuentan -o deberían contar- con al menos una dosis de triple viral (entre el año de vida y el inicio escolar) y, principalmente, aquellos que por calendario, no les corresponde vacunación (los menores de un año). El 19 de julio de 2018, a poco menos de 3 meses del caso confirmado previo (categorizado como "relacionado con la importación", luego de haber hallado la fuente de infección proveniente de Asia), se notificaron dos casos confirmados que se atendieron en efectores públicos de la Ciudad de Buenos Aires, un residente de CABA y otro de Provincia de Buenos Aires. En este apartado se actualiza la situación epidemiológica a la fecha y se detallan las acciones realizadas y por realizar para la prevención y control de este evento.(AU)

Humoral immune response to measles and varicella vaccination in former very low birth weight preterm infants

ABSTRACT Introduction: Immune response to vaccination in infants born prematurely may be lower than in infants born at full-term. Some clinical factors might be associated with humoral immune response. Objectives: The objectives of this study were to compare the immune response to measles and varicella vaccination in infants born prematurely with those born at full-term and to analyze factors associated with measles and varicella antibody levels. Methods: Prospective study including two groups of infants aged 12 months. One group of infants born prematurely with birth-weight <1500 g and who were in follow-up at the outpatient clinic for preterm infants at the institution and other group of infants born at full-term. Infants with malformations, primary immunodeficiency diseases, born to HIV-positive mothers or who had received plasma or immunoglobulin transfusions five months before or three weeks after vaccination were excluded. Plasma antibodies were measured by ELISA and factors associated with antibody levels were assessed by linear regression. Results: Sixty-five premature and 56 full-term infants were included. The percentage of immune individuals after vaccination against measles (100% vs. 100%) and varicella (92.5% vs. 93.2%) were similar in both groups, as well as the antibody levels against measles (2.393 vs. 2.412 UI/mL; p = 0.970) and varicella (0.551 vs. 0.399 UI/mL; p = 0.114). Use of antenatal corticosteroids decreased measles antibody levels whereas breastfeeding for more than six months increased varicella antibody levels. Conclusions: Humoral responses to measles and varicella were similar between infants born prematurely and full-term infants. Measles antibody levels were negatively associated with antenatal corticosteroid use; varicella antibodies were positively associated with prolonged breastfeeding.

Polyspecific antibodies without persisting antigen in multiple sclerosis, neurolupus and Guillain-Barré syndrome: immune network connectivity in chronic diseases / Anticorpos poliespecíficos sem antígeno persistente em esclerose múltipla, neurolupus e síndrome de Guillain-Barré: conectividade imunológica em doenças crônicas

ABSTRACT The polyspecific antibody synthesis in multiple sclerosis (MS) gained diagnostic relevance with the frequent combination of measles-, rubella- and varicella zoster antibodies (MRZ-antibody reaction) but their pathophysiological role remains unknown. This review connects the data for intrathecal polyspecific antibody synthesis in MS and neurolupus with observations in the blood of patients with Guillain-Barré syndrome (GBS). Simultaneously increased antibody and autoantibody titers in GBS blood samples indicate that the polyspecific antibodies are based on a general property of an immune network, supported by the deterministic day-to-day concentration variation of antibodies in normal blood. Strongly correlated measles- and rubella- antibody variations point to a particular connectivity between the MRZ antibodies. The immune network, which provides serological memory in the absence of an antigen, implements the continuous change of the MRZ pattern in blood, not followed by the earlier immigrated B cells without corresponding connectivity in the brain. This may explain the different antibody patterns in cerebrospinal fluid, aqueous humor and blood of the individual MS patient. A complexity approach must implement a different view on causation in chronic diseases and causal therapies.

RESUMO A síntese de anticorpos poliespecíficos em esclerose múltipla (EM) ganhou relevância diagnóstica com a combinação frequente de anticorpos contra sarampo, rubéola e varicela-zoster (reação de anticorpos MRZ), mas seu papel fisiopatológico permanece desconhecido. Esta revisão relaciona os dados da síntese intratecal de anticorpos poliespecíficos em EM e Neurolupus com observações no sangue de pacientes com síndrome de Guillain Barré (SGB). Simultaneamente, os títulos aumentados de anticorpos e autoanticorpos em amostras de sangue de SGB indicam que os anticorpos poliespecíficos se baseiam numa propriedade geral de uma rede imunitária, suportada pela variação determinística da concentração diária de anticorpos no sangue normal. As variações fortemente correlacionadas de anticorpos contra sarampo e rubéola apontam para uma conectividade particular entre os anticorpos MRZ. A rede imunitária, que fornece memória sorológica na ausência de um antígeno, implementa a mudança contínua do padrão MRZ no sangue, não seguida pelas células B que imigraram anteriormente sem conectividade no cérebro. Isto pode explicar os diferentes padrões de anticorpos no LCR, humor aquoso e sangue do paciente individual de EM. Uma abordagem complexa deve implementar uma visão diferente sobre a causalidade em doenças crônicas e terapias causais.

Inmunidad humoral a tétanos, sarampión y rubéola en niños con leucemia linfoblástica aguda luego del tratamiento quimioterápico / Humoral immunity to tetanus, measles and rubella in children with acute lymphoblastic leukemia after chemotherapy

Los regímenes de quimioterapia y los avances en el soporte clínico han mejorado la supervivencia de los niños con leucemia linfoblástica aguda. Son temas de preocupación las secuelas del tratamiento, entre ellas, el daño inmunológico inducido por la terapia inmunosupresora, que se refleja en la pérdida de niveles protectores de anticuerpos provistos por inmunizaciones previas. Nuestro objetivo fue evaluar la presencia de títulos protectores de anticuerpos para sarampión, rubéola y tétanos en pacientes con leucemia linfoblástica aguda luego de haber finalizado el tratamiento quimioterápico. Se incluyeron 61 niños con leucemia linfoblástica aguda asistidos en el Hospital Garrahan, que habían finalizado el tratamiento, como mínimo, 6 meses antes y con vacunación completa previa al diagnóstico. Las tasas de anticuerpos protectores fueron sarampión: 46% (IC 32-59); tétanos: 53% (IC 40-67); rubéola: 60% (IC 47-63). Estos resultados refuerzan la necesidad de reconsiderar la revacunación en este grupo de pacientes.

Chemotherapy regimens and clinical support advances have improved survival in children with acute lymphoblastic leukemia. The after-effects of treatment are a reason for concern, including damage to the immune system induced by immunosuppressive therapy which is reflected in the loss of antibody protection provided by prior immunizations. Our goal was to assess the presence of measles, rubella, and tetanus protective antibody titers among patients with acute lymphoblastic leukemia after completing chemotherapy. Sixty-one children with acute lymphoblastic leukemia seen at the Hospital Garrahan were included; patients had finished their chemotherapy at least 6 months earlier and had a complete immunization schedule before diagnosis. The rates of protective antibodies were 46% (CI: 32-59) for measles, 53% (CI 40-67) for tetanus, and 60% (CI 47-63) for rubella. These results strengthen the need to reconsider revaccination in this group of patients.

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.

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.

Clinical profile of subacute sclerosing panencephalitis

To describe the clinical manifestations of subacute sclerosing panencephalitis in children. Case series. This study was conducted in the Department of Neurology at The Children's Hospital and the Institute of Child Health, Lahore, from April 2005 to April 2007. Fifty patients were diagnosed as subacute sclerosing panencephalitis during the study period. Their diagnosis was based on a detailed history, clinical examination, presence of antimeasles antibodies in Cerebrospinal Fluid [CSF] and typical electroencephalogram [EEG]. The findings were described as average, mean and percentages. Fifty patients were included in this study. The average age of the patients was 8 years. Thirty-eight [76%] were males and 12 [24%] were females. The average duration of symptoms before presentation was 66.72 days. History of measles infection was present in 31 patients [62%] and measles vaccination in 43 patients [86%]. Motor regression was present in all [100%] patients and cognition decline in 43 patients [86%]. Seizures were focal [10%], generalized tonic-clonic [16%] and myoclonic [74%]. Burst-suppression pattern Electroencephalogram [EEG] and the antimeasles antibody in CSF were positive in 100% of patients. SSPE is an indicator of high incidence of measles infection among the paediatric population even among vaccinated children. Males are more common sufferers. SSPE can present with different types of seizures, cognition decline and motor regression being supported by suggestive EEG and presence of anti-measles antibodies in CSF

Measles IgG sero-prevalence and its attributable factors in 5-25-year-old cases prior mass vaccination campaign in Urmia, northeastern Iran

Measles is a vaccine preventable infectious disease. Despite the widespread availability of an effective measles vaccine, the number of measles cases is noticeable in Iran. Because measles -specific antibody titer after vaccination is lower than after natural infection there is a concern that vaccinated persons may gradually lose protection from measles. This study was performed to examine the persistence of vaccine-induced antibody, participants with documented history of vaccination were assessed to determine the sero-prevalence and titer of measles antibody. This study was carried out in Urmia. Iran. Documented history of at least a single dose of live attenuated measles vaccine [at 9 or 15 month of age] was the inclusion criteria. Blood was collected from 835 subjects between 5 and 25 years old. The sera were tested for anti-measles IgG antibodies, by ELISA [IBL Germany]. Associations between predictive factors such as demographic data, vaccination status [once or twice] with IgG sero prevalence in routine vaccinated subjects were investigated by logistic regression analysis. The antibody titers in 54.76% of cases were in the range of protective level [IgG>12IU]. The mean of antibody titer significantly increased after the 16th year of life. The antibody titers were higher in participants who received one dose of measles vaccine in comparison with the persons who received a booster of measles vaccine. Antibody titers were slightly higher in men than in women. On multiple logistic regression analysis, of all variables examined, only vaccination status retained a significant association with antimeasles sero-positivity rate [estimated odds ratio = 0.395 95% CI = 0.214-0.859, P<0.05]. Elevation of antibody titer many years after vaccination is most likely due to boosting effect from repeated exposure to circulating wild virus resulting in unapparent or sub-clinical re-infection. This group of persons would be the most likely to support viral transmission in the absence of disease

Avaliação vacinal e imunológica para sarampo no paciente pediátrico portador de insuficiência renal crônica / Vaccinal an immunological measles evaluation in pediatric patients with chronic renal failure

Objetivo: avaliar a imunidade para o sarampo em crianças e adolescentes portadores de insuficiência renal crônica. Casuística e métodos: no ano 2000, foi realizado um estudo de corte transversal com os pacientes seguidos em uma unidade de nefrologia que preenchessem os critérios seletivos: idade 18 meses e 18 anos, ritmo de filtração glomerular abaixo de 70 ml/min/1,73m2, que tivessem o cartão vacinal preconizado pelo Ministério da Saúde do Brasil...

Objective: to evaluate the immune response to measles vaccination in children and adolescents with chronic renal failure (CRF). Patients and methods: a cross-sectional study was proceeded in year 2000, with registered patients in a nephrologic unit, that fulfilled the study criteria: age range between 18 months and 18 years, glomerular filtration rate...

Assessment of the performance of a definition of a suspected measles case: implications for measles surveillance

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...

Measles seroepidemiology among adolescents and young adults: response to revaccination

We evaluated the seroprevalence of measles antibody and response to measles re-immunization in 590 previously vaccinated adolescents and young adults; 263 were seronegative. To differentiate between primary and secondary vaccine failure, anti- measles IgM and IgG titres were assessed again 2- 4 weeks after revaccination in 144 [105 seronegative, 39 seropositive] individuals: 75 seronegative participants responded to revaccination anamnestically [P < 0.001] and developed immunity 11 also showed IgM response [probably primary vaccine failure immunity]; 38 seropositive participants, remained seroprotected without significant increase in antibody titre [P = 0.577]. Primary vaccine failure was 4.7%; secondary vaccine failure was 27.1%. After revaccination, 87.3% were seroprotected

Measles seroepidemiology among adolescents and young adults: Response to revaccination [SARI; 2003]

Despite a high coverage with measles vaccine, outbreaks of measles occur with an increasing proportion in older children and adults who have been vaccinated. The aim of this study was to determine the anti- measles seroepidemiology in adolescents and young adults, and the responses of subjects to revaccination. Five hundred and ninty adolescents and young adults 15 to 25 years old previously received one or two doses of measles vaccine [15-19 years old subjects; 2 doses at 9 and 15 months of age and 20-25 years old subjects; one dose after 12 months of age] with no history of physician diagnosed measles were redcruited to determine the seroprevalence of IgG measles antibody. Two to six weeks after revaccination, anti measles IgM and IgG antibodies titers were assessed by ELISA methods, to differentiate between the primary and secondary vaccine failure. The results were compared and analyzed. From 590 subjects, 263 were serologically negative or susceptible. Of 105 susceptible revaccinated subjects 75 showed anamnestic IgG and 11 of them also showed IgM responses [probably primary vaccine failure]. No significant responses were observed in 39 seroprotected subjects to revaccination except one subject. The results showed that 44.6% of vaccinated adolescents and young adults were serologically susceptible to measles. The rates of primary and secondary vaccine failure, herd immunity with 95% coverage were 4.7%, 27.1% and 83%, respectively. The study showed that vaccination- induced anti-measles antibody decline overtime especially in the absence of natural boosting. Catch-up vaccination or third dose of measles vaccination is recommended

Serosurvey of measles, mumps and rubella antibodies in Saudi children

A serosurvey study to evaluate the proportion of children with antibodies against diseases targeted by the Expanded Program of Immunization in the Kingdom of Saudi Arabia. Using multistage sampling techniques, we collected samples and sent them for laboratory assay from the following age groups; 100 samples at 6 months, 12 months, 18 months, 6 years, 13 years, and 17 years. We conducted the study from September 2001 to February 2002. We assayed sera for measles, rubella, and mumps antibodies in the measles-mumps-rubella reference laboratory in Germany, using enzyme immunoassay and plaque neutralization [PN] as a backup test for equivocal and negative samples. We only carried out a backup test for measles samples. The age group of 6 months had the highest proportion with negative measles antibodies. After adding the backup test [PN], the proportions of children with protective measles antibody were; 64% at 6 months, 87% at 12 months, 91% at 18 months, 75% at 6 years, 96% at 13 years, and 98% at 17 years. Rubella antibody positivity rates [>7 IU] were 28% at 6 months, 49% at 12 months, 97% at 18 months, 98% at 6 years, and 100% at 13 years. While positivity rates in mumps were 14% at 6 months, 29% at 12 months, 59% at 18 months, 64% at 6 years, and 75% at 13 years. The unexpected low proportion of children with protective level at 6 years, despite being vaccinated with 2 measle doses is an important phenomenon. This reflects the interference between the first and the second measles dose. The Ministry of Health decided to conduct a catch up campaign targeting 1st through 3rd grade primary schools, who did not catch the mass campaign conducted in 2000. Also, this supports the decision taken by the ministry to change the measles immunization schedule to MMR at 12 months and a second dose at 6 years of age

Measles seroepidemiology in 3 cities in Turkey

To evaluate immunity against measles and its relation with some variables among healthy subjects in 3 cities in Turkey. We carried out a cross-sectional study on measles antibody titers in the serum samples of 712 people from Antalya, 696 from Diyarbakir and 667 from Samsun, Turkey using particle agglutination test between February 2000 and October 2001. The study groups, informed and asked for their consent by midwives, consisted of randomly selected subjects of all ages older than 6 months. We implemented the study in 3 steps: physical examination, interview and blood collection. We considered titers of >/= 1:16 as positive and we observed lower seropositivity in Diyarbakir [90.8%] than Antalya [95.9%], and Samsun [94.9%] [p=0.040]. We also observed that seropositivity was lower among preschool group than older groups [p=0.006]. The number of doses of measles vaccine [p=0.001] and measles infection history [p=0.003] were found as a factor increasing the seropositivity ratio. There was no statistically significant between age groups [p=0.219], gender [p=0.148], residence [p=0.537], and number per household [p=0.983] among the provinces. Based on the findings, measles infection still has a high incidence in Turkey and the second dose of measles vaccine is extremely important in the prevention of measles transmission among school children and the community. Furthermore, we must improve our regional differences in routine vaccination services

Lecciones aprendidas del brote de sarampión en Cusco-Perú, 1999: Campaña de inmunización de respueta a brotes costo-efectiva inedita en el proceso de erradicación del sarampión / Lessons learned from measles outbreak in Cusco-Peru, 1999: a cost-effective and innovative outbreak response immunization campaign to the process of measles eradication

Introducción: En el proceso de erradicación del sarampión, se presentaron 2 casos confirmados de Sarampión (de 23 y 26 años) y 1 caso por nexo epidemiológico (23 años) a fines de agosto y en setiembre de 1999, en el Distrito de Colquemarca, Provincia de Chumbivilcas, Región del Cusco-Perú. Se tenia coberturas vacunales ASA optimas en el PAI en los 2 años previos; y se había realizado un Barrido ASA en menores de 15 años en 1997, con resultados insuficientes en la ciudad del Cusco; que por fiestas de fin de milenio iba a ser vistado por miles de turistas del extranjero, quienes podrían traer la enfermedad-muchos países de América del Sur tenían brotes importantes desde 1997, así Brasil; por lo que se implemento una Campaña ASA en conglomerados poblacionales focalizados entre los 5 a 29 años de edad, cuyos resultados se evalúa. Metodología: Estudio de investigación de brote e investigación operativa de intervención sanitaria relacionada a inmunización de respuesta a brote de sarampión en la Región Cusco con participación multisectorial. Se sistematizó la investigación del brote y se revisaron los informes y los instrumentos utilizados en el Barrido Vacunal ASA en conglomerados poblacionales focalizados, realizado en setiembre y noviembre de 1999, en diferentes zonas de riesgo; evaluándose los resultados de coberturas vacunales alcanzados y su relación con la inversión realizada. Resultados: Se realizo la descripción del brote, el análisis retrospectivo de casos previos reportados en el sistema de vigilancia epidemiológica, la construcción de la cadena de transmisión, el censo y seguimiento de contactos, el mapa de riesgo de transmisión, la búsqueda activa en la comunidad y establecimientos de salud, determinación de la posible fuente de infección, determinación de zonas de riesgo e identificación de bolsones de susceptibles. La campaña de inmunización de respueta a brotes inicial fue a través del bloqueo vacunal en la ciudad del Cusco y en zona rural fue vacunación casa por casa. Seguidamente se realizo el Barrido ASA en conglomerados poblacionales concentrados en la ciudad del Cusco entre los 5 y 29 años de edad; llegando a vacunarse al 89.9 por ciento de la población objetivo según el Instituto Nacional de Estadística, con un costo promedio por persona vacunada de $0.23 (veintitres céntimos de dólar), que incluye costos de insumos, sueldo de personal, pago de personal de apoyo, campaña de Información Educación y Comunicación, entre otros...

Antibody response after measles immunization.

RATIONALE: Measles is still an important public health problem in Thailand despite measles vaccination being practiced since 1984. Vaccine failure is one of the suspected reasons for the high incidence of measles. OBJECTIVE: To study the seroconversion rate of 9-month-old infants and to study the antibody level in 18 month-old and 4 year-old children who had measles vaccination at 9 months of age. MATERIAL AND METHOD: Enrolled infants and children who attended the child health clinic for routine immunization at the Queen Sirikit National Institute of Child Health from March 1, 1994 to May 31, 1995. They were divided into 3 groups. Group A, 9 month-old infants who came for measles vaccination. Blood samples were drawn twice from these infants, before measles vaccination and 3 months later for measles antibody level. Group B and C were 18 month-old and 4-year-old children who came for their first and second DTP (Diphtheria, Tetanus, Pertussis vaccine) booster. One blood sample for measles antibody was drawn from the latter group of children. Measles antibody was determined by micro-neutralization technic at the National Institute of Health (NIH). The geometric mean antibody titer before and after measles vaccination was compared by using the paired t-test. RESULTS: There were 30, 31 and 34 infants/children in group A, B and C respectively. No significant measles antibody (NT antibody was less than 1:4) was detected in 93.5 per cent of 9-month-old infants. The seroconversion rate at 3 months after vaccination in group A children was 68.75 per cent while in group B, 9 months after vaccination it was 53.3 per cent. Ninety seven per cent of children in group C had NT antibody above 1:4. The geometric mean titer (GMT) of measles antibody in 9-month (before vaccination), 12-month, 18-month infants and 4 year old children was 1:2.5; 1:14.8, 1:8.2 and 1:73.8, respectively (p < 0.05). CONCLUSION: Almost 70 per cent of vaccinees at 9 months of age had seroconversion to measles vaccine with GMT of 1:14.8 while fifty three per cent of 18 month old children had an average GMT of 1:8.2. The GMT of the two groups was significantly different (p < 0.05). At 4 years of age almost all the children had NT antibody to measles with a GMT of 1:73.8 (p < 0.05) Vaccine failure is likely to be one factor responsible for the high incidence of measles after the introduction of measles vaccine into the Expanded Program of Immunization (EPI). The authors suggest giving a booster dose of measles at 15 months of age to boost the antibody level before waning of measles antibody at 18 months old, in order to protect this group of children from contracting measles.