Measles-containing vaccine

The vaccine should not be given to immunosuppressed patients (except those infected with HIV) or pregnant women. HIV-infected persons who have never had measles or have never been vaccinated should be given measles-containing vaccine unless there is evidence of severe immunosuppression. The vaccine should not be given within 1 month of any other live vaccine unless the vaccine is given on the same day (as with the MMR vaccine). Measles vaccine is indicated in all persons born after 1956 or in those who lack documentation of wild virus infection either by history or antibody titers. 

After the publication of the Institute of Medicine report, a literature search for adverse events after measles immunization, limited to publications published in 1994— 98, unearthed a considerable amount of data that strengthened the rare association of measles-containing vaccines with postinfectious encephalomyelitis (6). The report has also been criticized as an attempt to establish an adverse event of a vaccine, without a specific laboratory... 

TABLE 1 22-1. Suggested Intervals Between Administration of Antibody-Containing Products for Different Indications and Measles-Containing Vaccine and Varicella Vaccine ... 

L. Withhold MMR or other measles containing vaccines from HIV-infected persons with evidence of severe immunosuppression. hAhAWR 1998 47 (RR-8) 21-22 MMWR 2002 51 (RR-02) 22-24. 

Most health care workers are at risk for exposure to many diseases in the normal course of their work. Additionally, health care workers may transmit vaccine-preventable diseases to their patients. At the time of employment and on a regular basis, health care workers should be screened for immunity to measles, rubella, and varicella if found to be non-immune, the measles, mumps, and rubella, and varicella vaccines should be administered. The hepatitis B series should be given if not already completed. Tetanus should be updated and given every 10 years. Health care personnel in hospitals and ambulatory settings with direct patient contact should receive Tdap if not already received an interval as short as 2 years from the last tetanus-containing vaccine should be used. Priority for receiving Tdap should be given to personnel with direct contact with infants less than 12 months of age. 

An example of the use of an attenuated virus is the administration of the measles vaccine to an individual who has not had measles. The m easles (rubeola) vaccine contains the live, attenuated measles virus. The individual receiving the vaccine develops a mild or modified measles infection, which then produces immunity against the rubeola virus. The measles vaccine protects 95% of the recipients for several years or, for some individuals, for life. An example of a killed virus used for immunization is the cholera vaccine. This vaccine protects those who receive the vacdne for about 3 to 6 months. 

The single-component viral vaccines are listed in Table 15.2 with notes similar to those provided with the bacterial vaccines. The only eombined viral vaeeine that is widely used is the measles, mumps and rubella vaccine (MMR Vac). In a sense, however, both the inactivated (Salk) poliovaccine (PoWac (inactivated)) and the live (Sabin) poliovaccine (PolWac (oral)) are combined vaccines in that they are both mixtures of vims of each of the three serotypes of poliovims. Influenza vaeeines, too, are eombined vaccines in that many contain components fiom as many as three vims strains, usually fiom two strains of influenza A and one strain of influenza B. 

There are several combination vaccines available in the United States. One of the most popular pediatric combinations is Pediarix a combination of diphtheria and tetanus toxoids, acellular pertussis, inactivated poliovirus, and hepatitis B vaccines. ComVax is a combination of Haemophilus influenzae type b and hepatitis B vaccines. The most recent combination is ProQuad which contains measles, mumps, rubella, and varicella vaccines. The only combination available for adults is Twinrix which has hepatitis A and hepatitis B vaccines. 

Each mL of the Measles, Mumps, and Rubella (MMR) virus vaccine contains not less than 2,000 TCID50 of the US Reference Measles virus 10,000 TCID50 of the US Reference Mumps virus and 2,000 TCID50 of the US Reference Rubella virus. The first dose (half mL SC) of this vaccine is recommended at the age of 12 to 15 months. What is the dose strength for the Measles virus ... 

Each mL of the Measles, Mumps, and Rubella (MMR) virus vaccine contains not less than 2,000 TCID50 of the US Reference Measles virus ... 

A trivalent vaccine containing the live attenuated viruses for measles, mumps and rubella was first introduced in the United States in the early 1970s by Merck and Co Inc. Since that time, other triple vaccines have been developed using various different viral strains and many coim-tiies have licensed them either as the sole vaccine... 

Many of the more prominent vaccine preparations in current medical use consist of attenuated viral particles (Table 10.11). Mumps vaccine consists of live attenuated strains of Paramyxovirus parotitidis. In many world regions, it is used to routinely vaccinate children, often a part of a combined measles, mumps and rubella (MMR) vaccine. Several attenuated strains have been developed for use in vaccine preparations. The most commonly used is the Jeryl Linn strain of the mumps vaccine, which is propagated in chick embryo cell culture. This vaccine has been administered to well over 50 million people worldwide and, typically, results in seroconversion rates of over 97%. The Sabin (oral poliomyelitis) vaccine consists of an aqueous suspension of poliomyelitis virus, usually grown in cultures of monkey kidney tissue. It contains approximately 1 million particles of poliomyelitis strains 1, 2 or 3 or a combination of all three strains. 

The controversy has reappeared with the introduction of a five component children s vaccine containing diphtheria, polio, measles, mumps, and rubella although this should be much more convenient and contains a killed polio instead of an attenuated virus which is known to occasionally revert to the active form, albeit in single numbers per million injections. In this case the children s vaccine should be safer and more convenient. 

Three cases within a week in the same neighborhood means that the disease is spreading. The doctor fears an epidemic is under way. She immediately calls city health officials and tells them the problem. The health commissioner faxes a request to the Centers for Disease Control (CDC) in Atlanta for ten thousand doses of measles vaccine. The plan is to initiate a crash program of vaccinations in the immediate neighborhood so that spread of the disease will be damped. Infected children will be quarantined after the outbreak is contained, an educational program will be initiated to alert parents to the abiding... 

Persons who have experienced anaphylactic reactions to measles vaccine or neomycin (measles vaccine contains a small amount of neomycin) should not be immunized (137). 

Dourado 1, Cunha S, Teixerra MG, Farrington CP, Melo A, Lucena R, Barreto ML. Outbreak of aseptic meningitis associated with mass vaccination with a urabe-containing measles-mumps-rubella vaccine implications for immunization programs. Am J Epidemiol 2000 151(5) 524-30. 

III. Vaccines containing measles, mumps, and rubella viruses in any combination (for example MMR, MR, M, R) A. Anaphylaxis or anaphylactic shock B. Encephalopathy (or encephalitis) C. Any acute complication or sequel (including death) of the above events 0-4 hours 5-15 days Not applicable... 

Mumps is a viral iUness that classically causes bilateral parotitis 16 to 18 days after exposure. Fever, headache, malaise, myalgia, and anorexia may precede the parotitis. Serious compfications are rare, although more common in adults. The mumps vaccine is a lyophifized live attenuated vaccine prepared from chick embryo cultures. Each 0.5-mL dose of the vaccine also contains 25 meg neomycin. The vaccine is available alone or in combinations with measles and rubella vaccines. 

Rubella vaccine contains lyophiUzed live attenuated rubella virus grown in human diploid cell culture. The vaccine is available alone or in combination with measles or mumps vaccine or both. Each 0.5-mL dose also contains 25 meg neomycin. 

L]Vc attenuated vaccines contain living version.s of a disease-causing vims that have been weakened m the laboratory. The Sabin polio vaccine and the vaccines against mumps, measles, and rubella are live attenuated. 

The majority of experimental vaccines containing ISCOMs as adjuvants have been directed toward viral diseases such as HIV-1, influenza, rotavirus, rabies and measles. Intranasal and oral vaccination using these agents have been variable and disappointing. Intramuscular and subcutaneous administration of these vaccines has produced more consistent results [97]. The complex composition of ISCOMs leads to some difficult isolation and development problems that center on quantitative analysis of their components and product consistency. Moreover, there is no information about the stability of the quillaja saponins incorporated into ISCOMs, which are apparently buffered at pH 7.4 [97]. Thus, it is unclear from many of the reports whether ISCOMs offer any medical or manufacturing advantages over the use of purified saponins alone. 

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