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Objective and Design: Risk factors for severe measles are poorly investigated in high-income countries. The Italian Society for Paediatric Infectious Diseases conducted a retrospective study in children hospitalised for measles from January 2016 to August 2017 to investigate the risk factors for severe outcome defined by the presence of long-lasting sequelae, need of intensive care or death.Results: Nineteen hospitals enrolled 249 children (median age 14.5 months): 207 (83%) children developed a complication and 3 (1%) died. Neutropaenia was more commonly reported in children with B3-genotype compared with other genotypes (29.5% vs 7.7%, p=0.01). Pancreatitis (adjusted OR [aOR] 9.19, p=0.01) and encephalitis (aOR 7.02, p=0.04) were related to severe outcome in multivariable analysis, as well as C reactive protein (CRP) (aOR 1.1, p=0.028), the increase of which predicted severe outcome (area under the receiver operating characteristic curve 0.67, 95% CI 0.52 to 0.82). CRP values >2 mg/dL were related to higher risk of complications (OR 2.0, 95% CI 1.15 to 3.7, p=0.01) or severe outcome (OR 4.13, 95% CI 1.43 to 11.8, p<0.01).Conclusion: The risk of severe outcome in measles is independent of age and underlying conditions, but is related to the development of organ complications and may be predicted by CRP value. [ABSTRACT FROM AUTHOR]

The December 2014 outbreak of measles in California impacted over 100 children and served as a reminder that this disease still plagues the USA, even 50 years following the first licensed vaccine. Refusal of vaccination is a complicated and multifaceted issue, one that clearly demands a closer look by paediatricians and public health officials alike. While medical doctors and scientists are trained to practice ‘evidence-based medicine’, and studies of vaccine safety and efficacy speak the language of statistics, there is reason to believe that this is not the most effective strategy for communicating with all groups of parents. Herein, we consider other methods such as narrative practices that employ stories and appeal more directly to parents. We also examine how doctors are trained to disseminate information and whether there are reasonable supplementary methods that could be used to improve vaccine communication and ultimately immunisation rates. [ABSTRACT FROM AUTHOR]

The article cites research evidence indicating that, besides protecting against the target infection, live vaccines such as Bacillus Calmette Guérin (BCG) and measles enhance general resistance to infections. Inactivated vaccines such as diphtheria-tetanus-pertussis (DTP) have been found to reduce general immunity and have negative effects on child survival, indicating the need for further research. It is argued that immunisation programmes will have a bigger impact if live vaccination policies are based on their effect on child survival. Vaccine's interactions with other interventions, gender differences in vaccine effects and the sequence of vaccination are some other factors affecting the potentially beneficial non-specific effects of vaccines.

The article focuses on actions made after the exposure of a 21-year-old pregnant woman to her child with a rash. It says that information gathered when the incident occurred includes the susceptibility of the pregnant women, putative index case of the rash, and exposure's duration, timing, and nature. It states that the woman was given varicella zoster immune globulin (VZIG) and was treated with valaciclovir due to chickenpox lesions three days after her delivery of a healthy baby boy. It adds that the neonatal varicella of the infant was prevented by VZIG. INSET: Box 2 | Reducing risk of infection in future pregnancy.

Objective: To establish the most appropriate age ranges for the use of human normal immunoglobulin and MMR vaccine as postexposure prophylaxis. Design: Review of literature and of laboratory confirmed measles cases. Setting: England and Wales and countries with a similar measles epidemiological profile. Patients: Women of childbearing age and infants. Main outcome measures: The risk of measles, maternally derived measles antibody levels and the response to measles containing vaccines in infants. Results: By 4 to 5 months of age, only 28-45% of infants born to women from highly vaccinated populations have protective levels of measles antibody. In the postvaccine era, between 74% and 80% of infants vaccinated between 6 and 9 months respond to vaccine, and around 67% have clinical protection from measles vaccination. Conclusion: This study suggests that many infants being born in the UK will become susceptible to measles before 6 months and will be able to respond to vaccine between 6 and 9 months of age. It is proposed that current guidance is changed to recommend passive immunisation with human normal immunoglobulin for most infants exposed to measles below 6 months of age. For infants aged 6 months or over exposed to measles, vaccination with MMR may be given. [ABSTRACT FROM AUTHOR]

Aims: To ascertain the causes of blindness and severe visual impairment (BL/SVI) in schools for the blind in Java, to identify preventable and treatable causes and to evaluate temporal trends in the major causes. Methods: From a total of 504 students, 479 were examined. Data was collected using a modified World Heath Organization Prevention of Blindness (WHO/PBI) eye examination record for children. Results: The majority of the students (95%) were blind and 4.6% were severely visually impaired. The major anatomical site of BL/SVI was whole globe in 35.9%, retina in 18.9%, lens in 16.4% and cornea in 16.1%. The major underlying aetiology of BL/SVI was undetermined/unknown in 32.7% (mainly microphthalmia, anterior segment dysgenesis and cataract), hereditary factors 31.9% (mainly retinal dystrophies), and childhood disorders 28.5%. Avoidable causes of B1/SVI accounted for 59.9% of the total students, whereas measles blindness was the underlying condition for 23.1% of the preventable causes; cataract and glaucoma accounted for 15.5% and 8.2% of the treatable causes, respectively. Exploration on trends of SVI/BL among two different age groups <16 years and ≥ 16 years suggested that childhood disorders and corneal factors have declined, while hereditary disorders have increased. Optic nerve disorder, although not counted as a major cause of blindness, seems to be on the increase. Conclusions: More than half of the BL/SVI causes are potentially avoidable. Cataract and corneal disorders related to measles or vitamin A deficiency were the malor treatable and preventable causes. Declining proportions of childhood factors and corneal disorders over a period of 10-20 years could reflect improved vitamin A supplementation and measles vaccination coverage in Indonesia. This finding, and the increased proportion of hereditary disease causes, could suggest improving levels of socioeconomic development and health care services. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate whether a relationship exists between ethnicity and uptake of the first dose of mumps, measles and rubella (MMR1) vaccination, and to study important factors influencing the parental decision about vaccination. Examination of routine data on uptake of MMR1 vaccine among children living in the London borough of Brent, North West London, for associations with ethnicity was carried out. Six focus group interviews were held and a questionnaire on factors related to immunisation by convenience samples of mothers from Asian, Afro-Caribbean and White backgrounds was completed. The routine data reported MMR1 vaccine status for 6444 children living in Brent who were aged between 18 months and 3 years on 1 December 2003. A total of 37 mothers took part in the 6 focus group sessions. Significantly higher coverage by MMR1 vaccine in the Asian population (87.1%) compared with Afro-Caribbeans (74.7%) and the White group (57.5%) was noticed. The qualitative data revealed clear differences between the ethnic groups with respect to awareness of the controversy surrounding MMR vaccination (related to use of English-language media) and influence of grandparents and health professionals in decisions about immunisation. A multiple logistic regression model showed that although coverage of MMR vaccination increased with increasing socioeconomic status, there was no evidence of a statistically significant interaction between socioeconomic status and ethnicity. An important association between ethnicity and uptake of MMR1 vaccine is observed. This has implications for efforts to improve the currently inadequate levels of MMR vaccination across the population as a whole. [ABSTRACT FROM AUTHOR]

Objective: To explore how the measles, mumps, and rubella (MMR) vaccine controversy impacted on the lives of parents caring for children with autism. Design: Qualitative focus group study. Setting: United Kingdom. Patients: A purposively selected sample of 38 parents took part in 10 focus group discussions between March 2003 and May 2005. Results: Many parents felt that the MMR vaccine could be too potent for children who are susceptible to developing autism. Of the parents whose children received the MMR vaccine, many felt guilty that they may have caused or contributed to their child's autism. Some parents felt frustrated by health professionals' lack of understanding of the negative impact the MMR controversy has had on them. Some parents were anxious about subsequent MMR decision-making for their children. Conclusions: The controversy has had a negative impact on some parents of children with autism. This has implications for health professionals, who need to be particularly aware of the issues these parents face in future MMR decision-making for their affected child and younger siblings. It is anticipated that these findings will raise awareness among health professionals of the difficulties faced by such parents. More generally, there is a need to promote a greater awareness of the important role health visitors can play in parental decision-making and for research examining whether health professionals feel they receive sufficient training in communication skills. It is also essential that the latest scientific research findings are disseminated quickly to these parents and to those health professionals advising parents on matters of vaccine safety. [ABSTRACT FROM AUTHOR]

Measles has reappeared in the United Kingdom, with 449 confirmed cases to the end of May 2006 compared with 77 in 2005, and the first death since 1992.'2 Cases are occurring in inadequately vaccinated children and in young adults, leading to concerns that endemic measles could re-emerge. But, as with smallpox, measles could be eradicated. It has been eliminated in the Americas since 2002. The World Health Organization has set 2010 as the target for elimination in the European region, where 29 000 cases were reported in 2004.s Much ground will have to be regained in the United Kingdom if the 2010 target is to be met. We review the uptake of the combined measles, mumps, and rubella (MMR) vaccine in the United Kingdom and Europe, and identify susceptible groups. As clinical experience of measles has declined, doctors in the United Kingdom may not consider the diagnosis nor recognise a case. We also therefore consider the diagnosis, management, and control of measles infection. INSETS: Clinical vignette;Tips for general practitioners. [ABSTRACT FROM AUTHOR]

Clinical and laboratory characteristics of 39 patients with adult onset subacute sclerosing panencephalitis (SSPE) are described and compared to those of juvenile onset patients regarding preceding measles, age at onset, gender, interval between onset and diagnosis, clinical profile, and course during follow up. Diagnosis was based on clinical and electroencephalographic findings and raised anti-measles antibody titres in cerebrospinal fluid. Mean age at SSPE symptom onset was 20.9 ± 4.9 years and mean interval from onset to diagnosis was 6.3 ± 9.6 months. Referral diagnosis was accurate in only 12 patients. Presenting symptoms included myoclonus, behavioural changes, seizures, and cognitive, visual, and extrapyramidal disturbance. All patients received symptomatic therapy; 19 also received disease modifying agents. Five of seven pregnant women had successful deliveries. The follow-up period varied widely (maximum 60 months, median 9 months). The profile of adult onset SSPE did not differ from the rest of the cohort, except for a longer interval between measles infection and symptom onset (p

The article presents a case of Pyrexia of unknown origin. One week after receiving the measles, mumps, and rubella immunisation, 14 month old Kate developed a non-pruritic "blotchy" erythematous macular rash. The rash was present over the proximal areas of her arms and legs arid was most noticeable during the afternoon. Initially she remained otherwise well, but six days later developed coryzal symptoms and lethargy. Kate's general practitioner was consulted. He prescribed a course of amoxidilln.

Aim: To assess the impact of measles/mumps/rubella (MMR) vaccine on the epidemiology of subacute sclerosing panencephalitis (SSPE) in England and Wales. Methods: Cases of SSPE resident in England and Wales with onset between 1990 and 2002 were reviewed. Results: A total of 47 cases were identified, 31 male and 16 female. There was an average annual decline of 14% in SSPE onset over the period, consistent with the decline in notified measles over the last 20 years. A history of measles was present in 35 (median age 1 .3 years), the most recent recorded date being 1994; the interval from measles to onset of SSPE ranged from 2.7 to 23.4 years. Four children with a history of receipt of a measles containing vaccine were reported not to have had measles; two of these cases had a brain biopsy, and nucleotide sequence data confirmed wild measles infection. Brain biopsy specimens from a further three cases with a history 0f measles, of whom two had also had a history of vaccination, th showed wild-type strain. Conclusion: The prevention of endemic circulation of measles virus in England and Wales through the high coverage achieved with MMR vaccine, together with the measles/rubella vaccination campaign of 1994,. has resulted in the near elimination of SSPE. However, the recent decline in MMR vaccine coverage, with the associated increase in localised measles outbreaks and cases in young infants, is of concern. It underlines the importance of maintaining high vaccine coverage in order to protect indirectly those most vulnerable to SSPE, namely infants too young to be vaccinated. [ABSTRACT FROM AUTHOR]

Aims: To determine the causes of morbilliform rash and fever in a population with high vaccination coverage for measles and rubella. Methods: Comprehensive laboratory investigation additional to routine oral fluid testing of children presenting to primary care physicians in East Anglia, England. Results: Laboratory confirmation of infection was obtained in 93 (48%) of 195 children: parvovirus B19 in 34 (17%); group A streptococcus in 30 (15%); human herpesvirus type 6 in 11 (6%); enterovirus in nine (5%); adenovirus in seven (4%); and group C streptococcus in six (3%) (four individuals tested positive for two agents). None had measles or rubella. Conclusions: Oral fluid testing to cover infections additional to measles and rubella aids clinical management and is likely to maintain uptake of testing, which is essential for measles and rubella surveillance in highly immunised Iow incidence populations. [ABSTRACT FROM AUTHOR]

Background: It has been proposed that early age at exposure to common childhood infections is associated with a decreased risk of allergy. Previous studies on the possible association between allergy and infection with measles, mumps, rubella, and varicella have not been conclusive as most did not include information on exact age at exposure. The objective of our study was to investigate whether early age at exposure to these infections was associated with a decreased risk of atopy using information on exact age at infection.Methods: The study population consisted of 889 pregnant women who participated in a national birth cohort study in Denmark and for whom detailed information on history of measles, rubella, varicella, and mumps before school entry (age 7 years) was available from school health records from Copenhagen. Atopic status was assessed serologically by a specific response to 11 common inhalant allergens using serum samples obtained from the women during pregnancy.Results: Measles in the first year of life was associated with a higher risk of atopy than no measles before age 7 years (OR 3.36, 95% CI 1.47 to 7.68). There was no association between atopy and mumps, rubella, or varicella in the first 7 years of life or with measles acquired after the first year of life. The risk of atopy increased significantly with increasing number of childhood infections in the first 2 years of life (p(trend)=0.01).Conclusions: These findings do not support the suggestion that childhood exposure to measles, rubella, varicella, or mumps protects against atopy, even if acquired very early in life. [ABSTRACT FROM AUTHOR]

Since the introduction of measles vaccine in 1968 and then measles, mumps and rubella (MMR) vaccine in 1988, measles, mumps and rubella have become rare diseases. However, on the basis of research, primarily from one unit, some parents and health professionals have become concerned about the safety of MMR vaccine. This has led to a decline in uptake and fears of impending outbreaks. This paper reviews the background to these concerns and examines the evidence to date. Since 1998 several studies have been published which specifically set out to investigate the link between MMR vaccine, autism and bowel disease and have found no association between the vaccine and these conditions.

Investigates the factors influencing the decline in measles mortality among children in Bandim, Guinea-Bissau. Introduction of a vaccination program; Reduction of the age of infection; Impact of endemic transmission of measles.

Examines the clinical course of measles in children with malignant disease in Great Britain. Diseases that complicates measles; Effects of the treatment on measles; Complications of pneumonitis; Results and discussions of the study.

Focuses on various articles in the field of medicine. Concept of type A behavior; Consensus on AIDS screening; Campaign on measles immunization; Launched on the national survey of medical archives and manuscripts; Illustration on British Medical Association news.

Reports medical issues happening around the world. Recalculation on the effects of radiation on the bomb victims of Hiroshima bombing in Hiroshima, Japan; Statistics of United States citizens unable to afford medical care; Epidemic of measles in Canada.

Presents several unreviewed reports related to medicine. Relationship between acceptance of measles and pertussis immunizations; Exacerbation of hypersensitivity by hydrocortisone; Examination on the gastric outlet obstruction caused by pericholecystic abscess.

Examines the epidemiology of measles in Southern Health Board. Implication for the resources; Treatment and prevention of the disease; Efficacy of vaccines for the measle virus.