Measles vaccine

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Measles vaccine
Providing vaccinations to protect against disease after Typhoon Haiyan (11352296333).jpg
A child is given a measles vaccine.
Vaccine description
Target Measles virus
Vaccine type Attenuated
Clinical data
AHFS/Drugs.com Monograph
MedlinePlus a601176
ATC code
Legal status
Legal status
Identifiers
CAS Number
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Measles vaccine protects against becoming infected with measles. [1] Nearly all of those who do not develop immunity after a single dose develop it after a second dose. [1] When the rate of vaccination within a population is greater than 92%, outbreaks of measles typically no longer occur; however, they may occur again if the rate of vaccination decreases. [1] The vaccine's effectiveness lasts many years. [1] It is unclear if it becomes less effective over time. [1] The vaccine may also protect against measles if given within a couple of days after exposure to measles. [2] [1] [3] [4]

Contents

The vaccine is generally safe, even for those infected by HIV. [1] [5] Most children do not experience any side effects; [6] those that do occur are usually mild, such as fever, rash, pain at the site of injection, and joint stiffness; and are short-lived. [1] [6] Anaphylaxis has been documented in about 3.5–10 cases per million doses. [1] Rates of Guillain–Barré syndrome, autism and inflammatory bowel disease do not appear to be increased by measles vaccination. [1] [7]

The vaccine is available both by itself and in combinations such as the MMR vaccine (a combination with the rubella vaccine and mumps vaccine) [1] or the MMRV vaccine (a combination of MMR with the chickenpox vaccine). [8] [9] [10] The measles vaccine is equally effective for preventing measles in all formulations, but side effects vary for different combinations. [1] [11] The World Health Organization (WHO) recommends measles vaccine be given at nine months of age in areas of the world where the disease is common, or at twelve months where the disease is not common. [12] [1] Measles vaccine is based on a live but weakened strain of measles. [1] It comes as a dried powder which is mixed with a specific liquid before being injected either just under the skin or into a muscle. [1] Verification that the vaccine was effective can be determined by blood tests. [1]

The measles vaccine was first introduced in 1963. [13] In that year, the Edmonston-B strain of measles virus was turned into a vaccine by John Enders and colleagues and licensed in the United States. [14] [15] In 1968, an improved and even weaker measles vaccine was developed by Maurice Hilleman and colleagues, and began to be distributed, becoming the only measles vaccine used in the United States since 1968. [16] [14] [15] About 86% of children globally had received at least one dose of the vaccine as of 2018. [17] In 2021, at least 183 countries provided two doses in their routine immunization schedule. [18] It is on the World Health Organization's List of Essential Medicines. [19] As outbreaks easily occur in under-vaccinated populations, non-prevalence of disease is seen as a test of sufficient vaccination within a population. [20] [21]

Effectiveness

Measles cases reported in the United States before and after introduction of the vaccine. Measles US 1938-2019.png
Measles cases reported in the United States before and after introduction of the vaccine.
Measles cases reported in Canada before and after introduction of the vaccine. Between 1959 and 1968 measles was not nationally reportable, hence there are no data are this period. Measles Canada 1924-2018.png
Measles cases reported in Canada before and after introduction of the vaccine. Between 1959 and 1968 measles was not nationally reportable, hence there are no data are this period.
Measles cases reported in England and Wales. Measles incidence England&Wales 1940-2007.png
Measles cases reported in England and Wales.

One dose is about 93% effective while two doses of the vaccine are about 97% effective at preventing measles. [5] Before the widespread use of the vaccine, measles was so common that infection was considered "as inevitable as death and taxes." [22] In the United States, reported cases of measles fell from 3 to 4 million with 400 to 500 deaths to tens of thousands per year following introduction of two measles vaccines in 1963 (both an inactivated and a live attenuated vaccine (Edmonston B strain) were licensed for use, see chart at right). [5] [23] Increasing uptake of the vaccine following outbreaks in 1971 and 1977 brought this down to thousands of cases per year in the 1980s. An outbreak of almost 30,000 cases in 1990 led to a renewed push for vaccination and the addition of a second vaccine to the recommended schedule. No more than 220 cases were reported in any year from 1997 to 2013, and the disease was believed no longer endemic in the United States. [24] [25] [26] In 2014, 667 cases were reported. [27]

The benefits of measles vaccination in preventing illness, disability, and death have been well documented. Within the first 20 years of being licensed in the U.S., measles vaccination prevented an estimated 52 million cases of the disease, 17,400 cases of intellectual disability, and 5,200 deaths. [28] From 1999 to 2004 a strategy led by the WHO and UNICEF led to improvements in measles vaccination coverage that averted an estimated 1.4 million measles deaths worldwide. [29] The vaccine for measles led to the near-complete elimination of the disease in the United States and other developed countries. [30] While the vaccine is made with a live virus which can cause side effects, these are far fewer and less serious than the sickness and death caused by measles itself; side effects ranging from rashes to, rarely, convulsions, occur in a small percentage of recipients. [31]

Measles is common worldwide. Although it was declared eliminated from the U.S. in 2000, high rates of vaccination and excellent communication with those who refuse vaccination are needed to prevent outbreaks and sustain the elimination of measles. [32] Of the 66 cases of measles reported in the U.S. in 2005, slightly over half were attributable to one unvaccinated teenager who became infected during a visit to Romania. [33] This individual returned to a community with many unvaccinated children. The resulting outbreak infected 34 people, mostly children and virtually all unvaccinated; three of them were hospitalized. The public health response required making almost 5,000 phone calls as part of contact tracing, arranging and performing testing as needed, and arranging emergency vaccination for at-risk people who had had contact with this person. [32] Taxpayers and local healthcare organizations likely paid more than US$167,000 in direct costs to contain this one outbreak. [32] A major epidemic was averted due to high rates of vaccination in the surrounding communities. [32]

The vaccine has non specific effects such as preventing respiratory infections, that may be greater than those of measles prevention alone. [34] These benefits are greater when the vaccine is given before one year of age. [35] A high-titre vaccine resulted in worse outcomes in girls, and consequently is not recommended by the World Health Organization. [36]

Schedule

The World Health Organization (WHO) recommends two doses of vaccine for all children. [1] In countries with high risk of disease the first dose should be given around nine months of age. [1] Otherwise it can be given at twelve months of age. [1] The second dose should be given at least one month after the first dose. [1] This is often done at age 15 to 18 months. [1] After one dose at the age of nine months 85% are immune, while a dose at twelve months results in 95% immunity. [13]

In the United States, the Centers for Disease Control and Prevention (CDC) recommends that children aged six to eleven months traveling outside the United States receive their first dose of MMR vaccine before departure [37] and then receive two more doses; one at 12–15 months (12 months for children in high-risk areas) and the second as early as four weeks later. [38] Otherwise the first dose is typically given at 12–15 months and the second at 4–6 years. [38]

In the UK, the National Health Service (NHS) recommendation is for a first dose at around 13 months of age and the second at three years and four months old. [39] [40]

In Canada, Health Canada recommends that children traveling outside North America should receive an MMR vaccine if they are aged six to 12 months. However, after the child is 12 months old they should receive two additional doses to ensure long-lasting protection. [41]

Adverse effects

Adverse effects associated with the MMR vaccine include fever, rash, injection site pain and, in rare cases, red or purple discolorations on the skin known as thrombocytopenic purpura, or seizures related to fever (febrile seizure). [42] [43]

Numerous studies have found no relationship between MMR vaccine and autism. [44] [45] [46] [43]

Contraindications

It is inadvisable for some people to receive the measles or MMR vaccine, including cases of:

History

Cases of measles and deaths per 100000, per year, in the United States over the 20th century Measles cases graph.svg
Cases of measles and deaths per 100000, per year, in the United States over the 20th century

John Franklin Enders, who had shared the 1954 Nobel Prize in Medicine for work on the polio virus, sent Thomas C. Peebles to Fay School in Massachusetts, where an outbreak of measles was underway; Peebles was able to isolate the virus from blood samples and throat swabs, and was later able to cultivate the virus and show that the disease could be passed on to monkeys inoculated with the material he had collected. [30] Enders was able to use the cultivated virus to develop a measles vaccine in 1963 by attenuation through cultured chicken embryo fibroblasts of the material isolated by Peebles. [49] [50]

In the late 1950s and early 1960s, nearly twice as many children died from measles as from polio. [51] The vaccine Enders developed was based on the Edmonston strain of attenuated live measles virus, which was named for 11-year-old David Edmonston, the Fay student from whom Peebles had taken the culture that led to the virus's cultivation. [52]

In the mid-20th century, measles was particularly devastating in West Africa, where child mortality rate was 50 percent before age 5, and the children were struck with the type of rash and other symptoms common prior to 1900 in England and other countries. The first trial of a live attenuated measles vaccine was undertaken in 1960 by the British paediatrician David Morley in a village near Ilesha, Nigeria; [53] in case he could be accused of exploiting the Nigerian population, Morley included his own four children in the study. The encouraging results led to a second study of about 450 children in the village and at the Wesley Guild Hospital in Ilesha.[ citation needed ]

Following another epidemic, a larger trial was undertaken in September and October 1962, in New York City with the assistance of the WHO: 131 children received the live Enders-attenuated Edmonston B strain plus gamma globulin, 130 children received a "further attenuated" vaccine without gamma globulin, and 173 children acted as control subjects for both groups. As also shown in the Nigerian trial, the trial confirmed that the "further attenuated" vaccine was superior to the Edmonston B vaccine, and caused significantly fewer instances of fever and diarrhea. 2,000 children in the area were vaccinated with the further-attenuated vaccine. [54] [55]

Maurice Hilleman at Merck & Co., a pioneer in the development of vaccinations, developed an improved version of the measles vaccine in 1968 and subsequently the MMR vaccine in 1971, which vaccinates against measles, mumps and rubella in a single shot followed by a booster. [14] [31] [56] One form is called "Attenuvax". [57] The measles component of the MMR vaccine uses Attenuvax, [58] which is grown in a chick embryo cell culture using the Enders' attenuated Edmonston strain. [58] Following ACIP recommendations, Merck decided not to resume production of Attenuvax as standalone vaccine on 21 October 2009. [59]

A 2022 study in the American Economic Journal found that the measles vaccine uptake led to increases in income of 1.1 percent and positive effects on employment due to greater productivity by those who were vaccinated. [60]

Types

Mumps, measles and rubella combined vaccine (MMR vaccine) Priorix.jpg
Mumps, measles and rubella combined vaccine (MMR vaccine)

Measles is seldom given as an individual vaccine and is often given in combination with rubella, mumps, or varicella (chickenpox) vaccines. [1] Below is the list of measles-containing vaccines:

Society and culture

Most health insurance plans in the United States cover the cost of vaccines, and Vaccines for Children Program may be able to help those who do not have coverage. [63] State law requires vaccinations for school children, but offer exemptions for medical reasons and sometimes for religious or philosophical reasons. [64] All fifty states require 2 doses of the MMR vaccine at the appropriate age. [65] A different vaccine distribution within a single territory by age or social class may define different general perceptions of vaccination efficacy. [66]

Related Research Articles

<span class="mw-page-title-main">Vaccination</span> Administration of a vaccine to protect against disease

Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating the body's adaptive immunity, they help prevent sickness from an infectious disease. When a sufficiently large percentage of a population has been vaccinated, herd immunity results. Herd immunity protects those who may be immunocompromised and cannot get a vaccine because even a weakened version would harm them. The effectiveness of vaccination has been widely studied and verified. Vaccination is the most effective method of preventing infectious diseases; widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the elimination of diseases such as polio and tetanus from much of the world. However, some diseases, such as measles outbreaks in America, have seen rising cases due to relatively low vaccination rates in the 2010s – attributed, in part, to vaccine hesitancy. According to the World Health Organization, vaccination prevents 3.5–5 million deaths per year.

<span class="mw-page-title-main">Vaccine</span> Pathogen-derived preparation that provides acquired immunity to an infectious disease

A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and recognize further and destroy any of the microorganisms associated with that agent that it may encounter in the future.

<span class="mw-page-title-main">Measles</span> Viral disease affecting humans

Measles is a highly contagious, vaccine-preventable infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea, middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression. Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses.

<span class="mw-page-title-main">Mumps</span> Human disease caused by paramyxovirus

Mumps is a viral disease caused by the mumps virus. Initial symptoms of mumps are non-specific and include fever, headache, malaise, muscle pain, and loss of appetite. These symptoms are usually followed by painful swelling of the parotid glands, called parotitis, which is the most common symptom of a mumps infection. Symptoms typically occur 16 to 18 days after exposure to the virus and resolve within two weeks. About one third of infections are asymptomatic.

<span class="mw-page-title-main">MMR vaccine</span> Any of several combined vaccines against measles, mumps, and rubella

The MMR vaccine is a vaccine against measles, mumps, and rubella, abbreviated as MMR. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, with at least four weeks between the doses. After two doses, 97% of people are protected against measles, 88% against mumps, and at least 97% against rubella. The vaccine is also recommended for those who do not have evidence of immunity, those with well-controlled HIV/AIDS, and within 72 hours of exposure to measles among those who are incompletely immunized. It is given by injection.

<span class="mw-page-title-main">Rubella</span> Human viral disease

Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and last for three days. It usually starts on the face and spreads to the rest of the body. The rash is sometimes itchy and is not as bright as that of measles. Swollen lymph nodes are common and may last a few weeks. A fever, sore throat, and fatigue may also occur. Joint pain is common in adults. Complications may include bleeding problems, testicular swelling, encephalitis, and inflammation of nerves. Infection during early pregnancy may result in a miscarriage or a child born with congenital rubella syndrome (CRS). Symptoms of CRS manifest as problems with the eyes such as cataracts, deafness, as well as affecting the heart and brain. Problems are rare after the 20th week of pregnancy.

<span class="mw-page-title-main">Vaccination schedule</span> Series of vaccinations

A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence. A vaccine is an antigenic preparation used to produce active immunity to a disease, in order to prevent or reduce the effects of infection by any natural or "wild" pathogen. Vaccines go through multiple phases of trials to ensure safety and effectiveness.

<span class="mw-page-title-main">Childhood immunizations in the United States</span>

The schedule for childhood immunizations in the United States is published by the Centers for Disease Control and Prevention (CDC). The vaccination schedule is broken down by age: birth to six years of age, seven to eighteen, and adults nineteen and older. Childhood immunizations are key in preventing diseases with epidemic potential.

The MMRV vaccine combines the attenuated virus MMR vaccine with the addition of the varicella (chickenpox) vaccine. The MMRV vaccine is typically given to children between one and two years of age.

<span class="mw-page-title-main">Mumps vaccine</span> Vaccine which prevents mumps

Mumps vaccines are vaccines which prevent mumps. When given to a majority of the population they decrease complications at the population level. Effectiveness when 90% of a population is vaccinated is estimated at 85%. Two doses are required for long term prevention. The initial dose is recommended between 12 and 18 months of age. The second dose is then typically given between two years and six years of age. Usage after exposure in those not already immune may be useful.

A breakthrough infection is a case of illness in which a vaccinated individual becomes infected with the illness, because the vaccine has failed to provide complete immunity against the pathogen. Breakthrough infections have been identified in individuals immunized against a variety of diseases including mumps, varicella (Chickenpox), influenza, and COVID-19. The characteristics of the breakthrough infection are dependent on the virus itself. Often, infection of the vaccinated individual results in milder symptoms and shorter duration than if the infection were contracted naturally.

<span class="mw-page-title-main">Varicella vaccine</span> Vaccine to prevent chickenpox

Varicella vaccine, also known as chickenpox vaccine, is a vaccine that protects against chickenpox. One dose of vaccine prevents 95% of moderate disease and 100% of severe disease. Two doses of vaccine are more effective than one. If given to those who are not immune within five days of exposure to chickenpox it prevents most cases of disease. Vaccinating a large portion of the population also protects those who are not vaccinated. It is given by injection just under the skin. Another vaccine, known as zoster vaccine, is used to prevent diseases caused by the same virus – the varicella zoster virus.

Immunization during pregnancy is the administration of a vaccine to a pregnant individual. This may be done either to protect the individual from disease or to induce an antibody response, such that the antibodies cross the placenta and provide passive immunity to the infant after birth. In many countries, including the US, Canada, UK, Australia and New Zealand, vaccination against influenza, COVID-19 and whooping cough is routinely offered during pregnancy.

An attenuated vaccine is a vaccine created by reducing the virulence of a pathogen, but still keeping it viable. Attenuation takes an infectious agent and alters it so that it becomes harmless or less virulent. These vaccines contrast to those produced by "killing" the pathogen.

Claims of a link between the MMR vaccine and autism have been extensively investigated and found to be false. The link was first suggested in the early 1990s and came to public notice largely as a result of the 1998 Lancet MMR autism fraud, characterised as "perhaps the most damaging medical hoax of the last 100 years". The fraudulent research paper authored by Andrew Wakefield and published in The Lancet falsely claimed the vaccine was linked to colitis and autism spectrum disorders. The paper was retracted in 2010 but is still cited by anti-vaxxers.

<span class="mw-page-title-main">Rubella vaccine</span> Vaccine used to prevent rubella

Rubella vaccine is a vaccine used to prevent rubella. Effectiveness begins about two weeks after a single dose and around 95% of people become immune. Countries with high rates of immunization no longer see cases of rubella or congenital rubella syndrome. When there is a low level of childhood immunization in a population it is possible for rates of congenital rubella to increase as more women make it to child-bearing age without either vaccination or exposure to the disease. Therefore, it is important for more than 80% of people to be vaccinated. By introducing rubella containing vaccines, rubella has been eradicated in 81 nations, as of mid-2020.

<span class="mw-page-title-main">Vaccines for Children Program</span>

The Vaccines for Children Program (VFC) is a federally funded program in the United States providing no-cost vaccines to children who lack health insurance or who otherwise cannot afford the cost of the vaccination. The VFC program was created by the Omnibus Budget Reconciliation Act of 1993 and is required to be a new entitlement of each state's Medicaid plan under section 1928 of the Social Security Act. The program was officially implemented in October 1994 and serves eligible children in all U.S. states, as well as the Commonwealth of Puerto Rico, the U.S. Virgin Islands, American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands.

In early months of 2019, a measles outbreak occurred in the Portland metropolitan area, including the Clark County, Washington suburbs, in the United States. At the time, the outbreak was the largest outbreak in more than two decades; outbreaks in 2019 in areas including Brooklyn and Rockland County, New York have since seen far greater numbers of cases.

Extensive investigation into vaccines and autism spectrum disorder has shown that there is no relationship between the two, causal or otherwise, and that the vaccine ingredients do not cause autism. Vaccinologist Peter Hotez researched the growth of the false claim and concluded that its spread originated with Andrew Wakefield's fraudulent 1998 paper, with no prior paper supporting a link.

<span class="mw-page-title-main">Measles resurgence in the United States</span> Sharp increase in measles cases between 2010 and 2019

Measles was declared eliminated from the United States in 2000 by the World Health Organization due to the success of vaccination efforts. However, it continues to be reintroduced by international travelers, and in recent years, anti-vaccination sentiment has allowed for the reemergence of measles outbreaks.

References

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