Search

For a number of years the measles vaccine has been tabled to be included among the compulsory vaccines with the not impossible aim of wiping out this disease. In practice, however, there have been isolated attempts to impose mass vaccination but, given that it is not compulsory, there has been a certain degree of resistance to the vaccine. In an attempt to interpret the reasons for this resistance we have identified three main causes: cultural heritage by family doctors and sometimes pediatricians ("a disease which is important to have had"). Limited information with underestimation of damaging effects of disease overemphasis of side-effects of vaccine and, among these, in particular fever which 30-35% of vaccinated children present between day 8-10, and the possible allergic reaction (chicken embryos-antibiotics). Using the latter as a starting point, we assessed the efficacy and tolerability of the Moraten Berna vaccine on 165 children aged between 10 months and 8 years. This vaccine is prepared using the Edmonston Zagreb strain cultured in diploid human cells, and does not therefore contain heterologous proteins, seroconversion was assessed in 54 of the vaccinated children (aged 10 months--3 years) by blood sample collected following an interval of between 40 and 120 days after vaccination. Anti-measles antibody titering was assayed using a neutralisation test on plates of cellular monostrate by assessing the titer (starting dilution of serum in test: 1:8). Seroconversion, as shown in table I, was obtained for all vaccinated subjects who presented a mean antibody titer of 916 mUI/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevention of measles and rubella can be obtained by a single administration of bivalent vaccine which can be added to the trivalent vaccine already practice in the USA since 1970 and in the Scandinavian Countries since 1982. We evaluated the immunological response and the clinical reactions to a bivalent vaccine against measles and rubella by the study of a control group including 29 children (17 females and 12 males) aged from a minimum of 15 months to a maximum of 9 years and 4 months. All the children who resulted not to be immune to the 2 viruses by serologic tests showed a rise in the antibody titer with 100% seroconversion, whereas in those proving to be already immune to one of the 2 viruses, a persistent antibody titer or an increase was revealed in all except one. Neither general nor local clinical reactions were observed except for two children who showed feverish measles-like reactions 8 days after the vaccine administration. These results suggest that this bivalent vaccine is highly effective, without negative effects. Furthermore associated with trivalent vaccines, it offers larger immunization opportunity mainly in children who have already been affected by mumps.

The TORCH group: toxoplasma, rubeola, cytomegalovirus (CMV), herpes virus hominis (HSV) and also the B-virus of hepatitis (HBV) determine congenital malformations in the newborns. For this reason, the Authors leaded an epidemiologic study testing with some antibodies (anti-TORCH and anti-HBV) the serum of groups of mother-newborn of the Obstetrical Clinic of Palermo. This study became manageable because now there are available high specific immunoenzymatic methods, for example ELISA, the passive haemoagglutination and the haemoagglutination-inhibition. In our people, high concentration of rubeola, HSV and CMV and very low concentration of toxoplasma and HBV are shown. The frequency of malformation is related with the subclinical infection. The Authors suggest to extend same investigation at an higher number of pregnant women to prevent these congenital malformations.

The antibodies to measles and rubella viruses were titrated in a sample of infantile population in Palermo in 1978. Measles antibodies were investigated in 900 children aged 0-15 years by the HI test; rubella antibodies in 120 girls aged 12-14 years by the hemolysis-in-gel test. A "saturation" level of immunity against measles virus as can be found in the adult population appeared to be attained at the age of 12-13 years. At this age however, about 28% of the girls were still not immunized against rubella virus.

Measles c.f.a. and h.i.e. were titrated in sera and, when possible, in the cerebrospinal fluids of 183 SM patients and in sera from a control group of subjects. No significative difference was found by the h.i. test, whereas significantly higher was the frequence of positives by the c.f. test in the SM group, with no correlation with the therapy to which the patients were subjected. The presence of c.f.a. in 13 of 48 cerebrospinal fluids tested, together with a low value of the serum/CSF antibodies ratio and with the lack of CSF antibodies against other viral antigens tested (HSV, rubeola), could indicate an intra CNS production of measles antibodies. To sum up, our results suggest an involvement of measles virus at least in some of the MS patients considered.

Following a brief introduction to measles epidemiological aspects and complications, the Authors expound on the essential characteristics of various types of vaccinations. They then synthesize the effects, indications, contraindications and duration of the immunization in relation to measles vaccinations.

Characteristics of measles virus and some aspects of virus-cell interaction are reported. For their interest, findings from recents investigations on comparison between SSPE isolates and wild strains are summarized. Both inactivated and live attenuated measles vaccines are then briefly described. The former has been used in the U.S.A. from 1963 to 1968 and discontinued thereafter mainly for safety problems, the latter, prepared with Schwarz or with Moraten strain, are in use today for the prophylaxis against measles.

Measles h.i.a. and c.f.a. were titrated in serum and cerebrospinal fluid of 12 SSPE patients. Specific IgM h.i.a. in the same specimens were also determined. Pretreatment of the sera by monkey red blood cell absorption, by kaolin or by heparin MnCl2, did not significantly affect h.i.a. titres, but h.i.a. were no more demonstrable in cerebrospinal fluids after kaolin and titres were somewhat lowered by heparin-MnCl2 treatment. By both h.i. and c.f. tests measles antibody were found at much higher titres in sera of SSPE patients than in controls of the same age. H.i.a. and, with one exception, c.f.a. were found in each of the 9 available cerebrospinal fluids from patients, but in none of the 6 specimens from non-SSPE cases. Ratio GM titers h.i.a. over GM titers c.f.a. in sera of SSPE patients was about 1, a value far from that found under different immunization conditions. In control sera, for instance, the ratio was 5.3. Specific IgM were never found in the cerebrospinal fluids and in only 2 out of the 10 sera examined.

Immunity status to measles, mumps, rubella and type B hepatitis (HB) viruses was studied in a cohort of 83 teen-agers (13-14 years). The vaccination against these agents is optional in Italy. Out of 83 subjects none had been vaccinated against measles, mumps and HB viruses, while 31 had had rubella vaccination. The percentage of seronegative adolescents was 2% for measles, 25% for mumps and 10% for rubella among unvaccinated teen-agers. These data suggest that even adolescent could be a target for rubella and mumps vaccination. On the contrary HBV does not appear to circulate extensively in the early years of life, so there is no need to extend the vaccination outside the risk groups. The presence of antibodies to measles, mumps and rubella viruses correlated very well with the anamnestic recall referred by the mothers. On the contrary for rubella and mumps viruses there was a high proportion of seropositive subjects with a negative history of disease. Therefore in the population under study asymptomatic infections with rubella and mumps viruses should have been rather frequent.