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Kushner LE, Kamens J, Bertaina A, Shyr D, Gans HA. Vaccine Associated Measles Complicated by Suspected Measles Inclusion Body Encephalitis in a Pediatric Leukemia Patient and Stem Cell Transplant Recipient: A Focus on Clinical Evolution and Management. Pediatr Infect Dis J 2024; 43:582-586. [PMID: 38380931 DOI: 10.1097/inf.0000000000004299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Immunocompromised individuals are at increased risk for severe disease and complications from viral infections, highlighting the importance of vaccination. However, in extremely rare situations, vaccine associated viral infections can be associated with disseminated disease and complications in immunocompromised hosts. CASE Herein, we present a case of a 1-year-old child diagnosed with acute myeloid leukemia less than 2 weeks after receiving live viral vaccines who developed acute vaccine-strain measles virus disease, later complicated by central nervous system involvement following hematopoietic stem cell transplantation. A brain biopsy specimen was positive for vaccine-strain measles virus detected by reverse transcriptase polymerase chain reaction. MANAGEMENT AND OUTCOME She was treated with intravenous ribavirin, inosine pranobex, intrathecal interferon-alpha and donor lymphocyte infusion following measles-mumps-rubella vaccine boost. Despite these measures, the patient suffered neurologic decline and dysautonomia, expiring after compassionate extubation. Management and ideal risk mitigation strategies are discussed within the context of existing literature for this rare complication.
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Affiliation(s)
| | - Jennifer Kamens
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Alice Bertaina
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - David Shyr
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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2
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Statler VA, Fox T, Ardura MI. Spotting a potential threat: Measles among pediatric solid organ transplantation recipients. Pediatr Transplant 2023; 27:e14502. [PMID: 36919399 DOI: 10.1111/petr.14502] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Low-vaccination rates worldwide have led to the re-emergence of vaccine-preventable infections, including measles. Immunocompromised patients, including pediatric solid organ transplant (SOT) recipients, are at risk for measles because of suboptimal vaccination, reduced or waning vaccine immunity, lifelong immunosuppression, and global re-emergence of measles. OBJECTIVES To review published cases of measles in pediatric SOT recipients to heighten awareness of its clinical manifestations, summarize diagnostic and treatment strategies, and identify opportunities to optimize prevention. METHODS We conducted a literature review of published natural measles infections in SOT recipients ≤21 years of age, summarizing management and outcomes. We describe measles epidemiology, recommended diagnostics, treatment, and highlight prevention strategies. RESULTS There are seven published reports of measles infection in 12 pediatric SOT recipients, the majority of whom were unvaccinated or incompletely vaccinated. Subjects had atypical or severe clinical presentations, including lack of rash and complications, most frequently with encephalitis and pneumonitis, resulting in 33% mortality. Updated recommendations on testing and vaccination are provided. Treatment options beyond supportive care and vitamin A are limited, with no approved antivirals. CONCLUSION While measles is infrequently reported in pediatric SOT recipients, morbidity and mortality remain significant. A high index of suspicion is warranted in susceptible SOT recipients with clinically compatible illness or exposure. Providers must recognize this risk, educate families, and be aware of both classic and atypical presentations of measles to rapidly identify, isolate, and diagnose measles in pediatric SOT recipients. Continued efforts to optimize measles vaccination both pre- and post-SOT are warranted.
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Affiliation(s)
- Victoria A Statler
- Department of Pediatrics, Pediatric Infectious Diseases, Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Thomas Fox
- Department of Pediatrics, Division of Infectious Disease, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Monica I Ardura
- Department of Pediatrics, Infectious Diseases & Host Defense, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
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3
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Ishige T, Shimizu T, Watanabe K, Arai K, Kamei K, Kudo T, Kunisaki R, Tokuhara D, Naganuma M, Mizuochi T, Murashima A, Inoki Y, Iwata N, Iwama I, Koinuma S, Shimizu H, Jimbo K, Takaki Y, Takahashi S, Cho Y, Nambu R, Nishida D, Hagiwara SI, Hikita N, Fujikawa H, Hosoi K, Hosomi S, Mikami Y, Miyoshi J, Yagi R, Yokoyama Y, Hisamatsu T. Expert consensus on vaccination in patients with inflammatory bowel disease in Japan. J Gastroenterol 2023; 58:135-157. [PMID: 36629948 PMCID: PMC9838549 DOI: 10.1007/s00535-022-01953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023]
Abstract
Immunosuppressive therapies can affect the immune response to or safety of vaccination in patients with inflammatory bowel disease (IBD). The appropriateness of vaccination should be assessed prior to the initiation of IBD treatment because patients with IBD frequently undergo continuous treatment with immunosuppressive drugs. This consensus was developed to support the decision-making process regarding appropriate vaccination for pediatric and adult patients with IBD and physicians by providing critical information according to the published literature and expert consensus about vaccine-preventable diseases (VPDs) [excluding cervical cancer and coronavirus disease 2019 (COVID-19)] in Japan. This consensus includes 19 important clinical questions (CQs) on the following 4 topics: VPDs (6 CQs), live attenuated vaccines (2 CQs), inactivated vaccines (6 CQs), and vaccination for pregnancy, childbirth, and breastfeeding (5 CQs). These topics and CQs were selected under unified consensus by the members of a committee on intractable diseases with support by a Health and Labour Sciences Research Grant. Physicians should provide necessary information on VPDs to their patients with IBD and carefully manage these patients' IBD if various risk factors for the development or worsening of VPDs are present. This consensus will facilitate informed and shared decision-making in daily IBD clinical practice.
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Affiliation(s)
- Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenji Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Makoto Naganuma
- Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center of Child Health and Development, Tokyo, Japan
| | - Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Sachi Koinuma
- Japan Drug Information Institute in Pregnancy, National Center of Child Health and Development, Tokyo, Japan
| | - Hirotaka Shimizu
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Keisuke Jimbo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yugo Takaki
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shohei Takahashi
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | - Yuki Cho
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Daisuke Nishida
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin-Ichiro Hagiwara
- Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Norikatsu Hikita
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Fujikawa
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Hosoi
- Division of Gastroenterology, Tokyo Metro Children's Medical Center, Tokyo, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yohei Mikami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Jun Miyoshi
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryusuke Yagi
- Department of Pediatrics, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Yoko Yokoyama
- Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
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Amurri L, Reynard O, Gerlier D, Horvat B, Iampietro M. Measles Virus-Induced Host Immunity and Mechanisms of Viral Evasion. Viruses 2022; 14:v14122641. [PMID: 36560645 PMCID: PMC9781438 DOI: 10.3390/v14122641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
The immune system deploys a complex network of cells and signaling pathways to protect host integrity against exogenous threats, including measles virus (MeV). However, throughout its evolutionary path, MeV developed various mechanisms to disrupt and evade immune responses. Despite an available vaccine, MeV remains an important re-emerging pathogen with a continuous increase in prevalence worldwide during the last decade. Considerable knowledge has been accumulated regarding MeV interactions with the innate immune system through two antagonistic aspects: recognition of the virus by cellular sensors and viral ability to inhibit the induction of the interferon cascade. Indeed, while the host could use several innate adaptors to sense MeV infection, the virus is adapted to unsettle defenses by obstructing host cell signaling pathways. Recent works have highlighted a novel aspect of innate immune response directed against MeV unexpectedly involving DNA-related sensing through activation of the cGAS/STING axis, even in the absence of any viral DNA intermediate. In addition, while MeV infection most often causes a mild disease and triggers a lifelong immunity, its tropism for invariant T-cells and memory T and B-cells provokes the elimination of one primary shield and the pre-existing immunity against previously encountered pathogens, known as "immune amnesia".
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Affiliation(s)
- Lucia Amurri
- Centre International de Recherche en Infectiologie (CIRI), Team Immunobiology of Viral infections, Univ Lyon, Inserm, U1111, CNRS, UMR5308, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, 21 Avenue Tony Garnier, 69007 Lyon, France
| | - Olivier Reynard
- Centre International de Recherche en Infectiologie (CIRI), Team Immunobiology of Viral infections, Univ Lyon, Inserm, U1111, CNRS, UMR5308, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, 21 Avenue Tony Garnier, 69007 Lyon, France
| | - Denis Gerlier
- Centre International de Recherche en Infectiologie (CIRI), Team Neuro-Invasion, TROpism and VIRal Encephalitis, Univ Lyon, Inserm, U1111, CNRS, UMR5308, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, 69007 Lyon, France
| | - Branka Horvat
- Centre International de Recherche en Infectiologie (CIRI), Team Immunobiology of Viral infections, Univ Lyon, Inserm, U1111, CNRS, UMR5308, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, 21 Avenue Tony Garnier, 69007 Lyon, France
| | - Mathieu Iampietro
- Centre International de Recherche en Infectiologie (CIRI), Team Immunobiology of Viral infections, Univ Lyon, Inserm, U1111, CNRS, UMR5308, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, 21 Avenue Tony Garnier, 69007 Lyon, France
- Correspondence:
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5
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Krupka M, Matusu T, Sutova H, Wezdenkova K, Vecerova R, Smesna Y, Kolar M, Frankova HB, Krivankova J, Jorenek M, Novak Z, Raska M, Holy O. Seroprevalence of Measles Antibodies in the Population of the Olomouc Region, Czech Republic—Comparison of the Results of Four Laboratories. Vaccines (Basel) 2022; 10:vaccines10020185. [PMID: 35214643 PMCID: PMC8880731 DOI: 10.3390/vaccines10020185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 01/06/2023] Open
Abstract
Objectives: Although the incidence of measles has decreased globally since the introduction of regular vaccination, its frequency has increased again in recent years. The study is focused on data from the Olomouc Region in the Czech Republic analyzed in four laboratories. The obtained results were compared with already published data. Methods: The data were provided by individual laboratories in an anonymized form—age at the time of the examination, sex, and result of test. Samples were collected between June 2018 and September 2019 and evaluated on the scale positive–borderline–negative. Results: A total of 7962 sera samples were evaluated using three different methods—two types of ELISA tests and CLIA. Positive result was issued in a total of 62.6 percent of samples, but the results of individual laboratories varied widely from 55.5 to 70.8 percent. However, the same trend with the highest levels of antibodies in people born before beginning of vaccination was observed. Conclusions: Data show significantly different results depending on the individual laboratories and the detection kits used. The underestimation of the proportion of positive results can cause problems in selecting individuals for revaccination with a live vaccine, which may fail in weakly positive individuals.
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Affiliation(s)
- Michal Krupka
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, 775 15 Olomouc, Czech Republic; (M.K.); (M.R.)
| | - Tereza Matusu
- Mikrochem Laboratories a.s., 779 00 Olomouc, Czech Republic; (T.M.); (H.S.); (K.W.)
| | - Helena Sutova
- Mikrochem Laboratories a.s., 779 00 Olomouc, Czech Republic; (T.M.); (H.S.); (K.W.)
| | - Katerina Wezdenkova
- Mikrochem Laboratories a.s., 779 00 Olomouc, Czech Republic; (T.M.); (H.S.); (K.W.)
| | - Renata Vecerova
- Department of Microbiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 775 15 Olomouc, Czech Republic; (R.V.); (Y.S.); (M.K.)
| | - Yvona Smesna
- Department of Microbiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 775 15 Olomouc, Czech Republic; (R.V.); (Y.S.); (M.K.)
| | - Milan Kolar
- Department of Microbiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 775 15 Olomouc, Czech Republic; (R.V.); (Y.S.); (M.K.)
| | | | - Jana Krivankova
- Šumperk Hospital, 787 01 Šumperk, Czech Republic; (J.K.); (M.J.)
| | - Miroslav Jorenek
- Šumperk Hospital, 787 01 Šumperk, Czech Republic; (J.K.); (M.J.)
| | - Zdenek Novak
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Milan Raska
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, 775 15 Olomouc, Czech Republic; (M.K.); (M.R.)
| | - Ondrej Holy
- Science and Research Centre, Faculty of Health Sciences, Palacky University Olomouc, Hněvotínská 3, 775 15 Olomouc, Czech Republic
- Correspondence: ; Tel.: +420-585-632-818
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6
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Martinez-Cabriales SA, Kirchhof MG, Constantinescu CM, Murguia-Favela L, Ramien ML. Recommendations for Vaccination in Children with Atopic Dermatitis Treated with Dupilumab: A Consensus Meeting, 2020. Am J Clin Dermatol 2021; 22:443-455. [PMID: 34076879 PMCID: PMC8169786 DOI: 10.1007/s40257-021-00607-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
Dupilumab is the only biologic therapy currently approved in Europe and the United States for severe atopic dermatitis in patients 6 years of age or older. Off-label use is rationalized in younger children with severe atopic dermatitis. Decisions about vaccination for children on dupilumab are complex and depend on both the child’s current treatment and the type of vaccination required. To achieve consensus on recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab, a review of the literature and a modified-Delphi process was conducted by a working group of 5 panelists with expertise in dermatology, immunology, infectious diseases and vaccination. Here, we provide seven recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab. These recommendations serve to guide physicians’ decisions about vaccination in children with atopic dermatitis treated with dupilumab. Furthermore, we highlight an unmet need for research to determine how significantly dupilumab affects cellular and humoral immune responses to vaccination with live attenuated and inactivated vaccines.
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Affiliation(s)
- Sylvia A Martinez-Cabriales
- Section of Community Pediatrics, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada
| | - Mark G Kirchhof
- Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Cora M Constantinescu
- Section of Infectious Diseases, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada
| | - Luis Murguia-Favela
- Section of Hematology and Immunology, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada
| | - Michele L Ramien
- Section of Community Pediatrics, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada.
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
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7
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Misin A, Antonello RM, Di Bella S, Campisciano G, Zanotta N, Giacobbe DR, Comar M, Luzzati R. Measles: An Overview of a Re-Emerging Disease in Children and Immunocompromised Patients. Microorganisms 2020; 8:E276. [PMID: 32085446 PMCID: PMC7074809 DOI: 10.3390/microorganisms8020276] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/15/2020] [Accepted: 02/16/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the availability of a safe and effective vaccine, in 2018, around 350,000 measles cases were reported worldwide, which resulted in an estimate of 142,300 deaths from measles. Additionally, in 2017, global measles cases spiked, causing the death of 110,000 people, mostly children under the age of 5 years and immunocompromised adults. The increase in measles incidence is caused by the ongoing reduction of vaccination coverage. This event has triggered public and scientific interest. For this reason, we reviewed the pathophysiology of measles infection, focusing on mechanisms by which the virus spreads systemically through the host organism. By reaching the lymphocytes from the airways through a "trojan horse" strategy, measles induces an immunosuppression status. H and F glycoproteins, both expressed in the envelope, ensure attachment of the virus to host cells and spreading from one cell to another by binding to several receptors, as described in detail. The severity of the disease depends both on the age and underlying conditions of patients as well as the social and health context in which epidemics spread, and is often burdened by sequelae and complications that may occur several years after infection. Particular attention was paid to special groups that are more susceptible to severe or atypical measles. An overview of microbiology, symptoms, diagnosis, prevention, and treatment completes and enriches the review.
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Affiliation(s)
- Andrea Misin
- Department of Infectious Diseases, Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Via G.L. Gatteri 25/1, 34125 Trieste, Italy; (S.D.B.); (R.L.)
| | - Roberta Maria Antonello
- Faculty of Medicine and Surgery, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Stefano Di Bella
- Department of Infectious Diseases, Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Via G.L. Gatteri 25/1, 34125 Trieste, Italy; (S.D.B.); (R.L.)
| | - Giuseppina Campisciano
- SSD of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65/1, 34137 Trieste, Italy; (G.C.); (N.Z.); (M.C.)
| | - Nunzia Zanotta
- SSD of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65/1, 34137 Trieste, Italy; (G.C.); (N.Z.); (M.C.)
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino—IRCCS, L.go R. Benzi 10, 16132 Genoa, Italy;
- Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy
| | - Manola Comar
- SSD of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65/1, 34137 Trieste, Italy; (G.C.); (N.Z.); (M.C.)
- Department of Medical Sciences, University of Trieste, Piazzale Europa 1, 34127 Trieste, Italy
| | - Roberto Luzzati
- Department of Infectious Diseases, Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Via G.L. Gatteri 25/1, 34125 Trieste, Italy; (S.D.B.); (R.L.)
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8
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Scott DE. Assuring immune globulin potency in a world of changing pathogen challenges. Transfusion 2019; 58 Suppl 3:3121-3124. [PMID: 30536433 DOI: 10.1111/trf.15051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Dorothy E Scott
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
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9
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Morris SE, Yates AJ, de Swart RL, de Vries RD, Mina MJ, Nelson AN, Lin WHW, Kouyos RD, Griffin DE, Grenfell BT. Modeling the measles paradox reveals the importance of cellular immunity in regulating viral clearance. PLoS Pathog 2018; 14:e1007493. [PMID: 30592772 PMCID: PMC6310241 DOI: 10.1371/journal.ppat.1007493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/29/2018] [Indexed: 12/15/2022] Open
Abstract
Measles virus (MV) is a highly contagious member of the Morbillivirus genus that remains a major cause of childhood mortality worldwide. Although infection induces a strong MV-specific immune response that clears viral load and confers lifelong immunity, transient immunosuppression can also occur, leaving the host vulnerable to colonization from secondary pathogens. This apparent contradiction of viral clearance in the face of immunosuppression underlies what is often referred to as the 'measles paradox', and remains poorly understood. To explore the mechanistic basis underlying the measles paradox, and identify key factors driving viral clearance, we return to a previously published dataset of MV infection in rhesus macaques. These data include virological and immunological information that enable us to fit a mathematical model describing how the virus interacts with the host immune system. In particular, our model incorporates target cell depletion through infection of host immune cells-a hallmark of MV pathology that has been neglected from previous models. We find the model captures the data well, and that both target cell depletion and immune activation are required to explain the overall dynamics. Furthermore, by simulating conditions of increased target cell availability and suppressed cellular immunity, we show that the latter causes greater increases in viral load and delays to MV clearance. Overall, this signals a more dominant role for cellular immunity in resolving acute MV infection. Interestingly, we find contrasting dynamics dominated by target cell depletion when viral fitness is increased. This may have wider implications for animal morbilliviruses, such as canine distemper virus (CDV), that cause fatal target cell depletion in their natural hosts. To our knowledge this work represents the first fully calibrated within-host model of MV dynamics and, more broadly, provides a new platform from which to explore the complex mechanisms underlying Morbillivirus infection.
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Affiliation(s)
- Sinead E. Morris
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Andrew J. Yates
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Rik L. de Swart
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Rory D. de Vries
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Michael J. Mina
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashley N. Nelson
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wen-Hsuan W. Lin
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roger D. Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Diane E. Griffin
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan T. Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
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10
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Jent P, Trippel M, Frey M, Pöllinger A, Berezowska S, Langer R, Furrer H, Béguelin C. Fatal Measles Virus Infection After Rituximab-Containing Chemotherapy in a Previously Vaccinated Patient. Open Forum Infect Dis 2018; 5:ofy244. [PMID: 30397623 PMCID: PMC6209686 DOI: 10.1093/ofid/ofy244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/20/2018] [Indexed: 01/11/2023] Open
Abstract
We report the case of a young patient treated with rituximab-containing chemotherapy who was infected with measles despite previous vaccination. Treatment with vitamin A, ribavirin, and immunoglobulins was started; nevertheless he developed severe pneumonitis and deceased. Broad vaccination coverage is crucial in protecting vulnerable subjects.
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Affiliation(s)
- Philipp Jent
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mafalda Trippel
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Manuel Frey
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Pöllinger
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Rupert Langer
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Charles Béguelin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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11
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Evolution of T Cell Responses during Measles Virus Infection and RNA Clearance. Sci Rep 2017; 7:11474. [PMID: 28904342 PMCID: PMC5597584 DOI: 10.1038/s41598-017-10965-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/17/2017] [Indexed: 01/21/2023] Open
Abstract
Measles is an acute viral disease associated both with immune suppression and development of life-long immunity. Clearance of measles virus (MeV) involves rapid elimination of infectious virus during the rash followed by slow elimination of viral RNA. To characterize cellular immune responses during recovery, we analyzed the appearance, specificity and function of MeV-specific T cells for 6 months after respiratory infection of rhesus macaques with wild type MeV. IFN-γ and IL-17-producing cells specific for the hemagglutinin and nucleocapsid proteins appeared in circulation in multiple waves approximately 2-3, 8 and 18–24 weeks after infection. IFN-γ-secreting cells were most abundant early and IL-17-secreting cells late. Both CD4+ and CD8+ T cells were sources of IFN-γ and IL-17, and IL-17-producing cells expressed RORγt. Therefore, the cellular immune response evolves during MeV clearance to produce functionally distinct subsets of MeV-specific CD4+ and CD8+ T cells at different times after infection.
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12
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Montague BT, Salas CM, Montague TL, Mileno MD. The immunosuppressed patient. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Brian T. Montague
- Division of Infectious Diseases; University of Colorado; Aurora Colorado USA
| | | | | | - Maria D. Mileno
- Warren Alpert Medical School; Brown University; Providence Rhode Island USA
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13
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Griffin DE. The Immune Response in Measles: Virus Control, Clearance and Protective Immunity. Viruses 2016; 8:v8100282. [PMID: 27754341 PMCID: PMC5086614 DOI: 10.3390/v8100282] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 12/25/2022] Open
Abstract
Measles is an acute systemic viral infection with immune system interactions that play essential roles in multiple stages of infection and disease. Measles virus (MeV) infection does not induce type 1 interferons, but leads to production of cytokines and chemokines associated with nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) signaling and activation of the NACHT, LRR and PYD domains-containing protein (NLRP3) inflammasome. This restricted response allows extensive virus replication and spread during a clinically silent latent period of 10–14 days. The first appearance of the disease is a 2–3 day prodrome of fever, runny nose, cough, and conjunctivitis that is followed by a characteristic maculopapular rash that spreads from the face and trunk to the extremities. The rash is a manifestation of the MeV-specific type 1 CD4+ and CD8+ T cell adaptive immune response with lymphocyte infiltration into tissue sites of MeV replication and coincides with clearance of infectious virus. However, clearance of viral RNA from blood and tissues occurs over weeks to months after resolution of the rash and is associated with a period of immunosuppression. However, during viral RNA clearance, MeV-specific antibody also matures in type and avidity and T cell functions evolve from type 1 to type 2 and 17 responses that promote B cell development. Recovery is associated with sustained levels of neutralizing antibody and life-long protective immunity.
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Affiliation(s)
- Diane E Griffin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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14
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Clinical and immunological analysis of measles patients admitted to a Beijing hospital in 2014 during an outbreak in China. Epidemiol Infect 2016; 144:2613-20. [PMID: 27251754 DOI: 10.1017/s0950268816001114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
At the end of 2013, China reported a countrywide outbreak of measles. From January to May 2014, we investigated the clinical and immunological features of the cases of the outbreak admitted to our hospital. In this study, all 112 inpatients with clinically diagnosed measles were recruited from the 302 Military Hospital of China. The virus was isolated from throat swabs from these patients, and cytokine profiles were examined. By detecting the measles virus of 30 of the 112 patients, we found that this measles outbreak was of the H1 genotype, which is the major strain in China. The rates of complications, specifically pneumonia and liver injury, differed significantly in patients aged 18 years: pneumonia was more common in children, while liver injury was more common in adults. Pneumonia was a significant independent risk factor affecting measles duration. Compared to healthy subjects, measles patients had fewer CD4+IL-17+, CD4+IFN-γ +, and CD8+IFN-γ + cells in both the acute and recovery phases. In contrast, measles patients in the acute phase had more CD8+IL-22+ cells than those in recovery or healthy subjects. We recommend that future studies focus on the age-related distribution of pneumonia and liver injury as measles-related complications as well as the association between immunological markers and measles prognosis.
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15
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Wyplosz B, Lafarge M, Escaut L, Stern JB. Fatal measles pneumonitis during Hodgkin's lymphoma. BMJ Case Rep 2013; 2013:bcr-2013-200252. [PMID: 24105383 DOI: 10.1136/bcr-2013-200252] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The treatment of measles pneumonitis in immunocompromised adults is not established. We describe a patient with Hodgkin's lymphoma who developed acute pneumonia during a measles infection. On day 13, intravenous ribavirin and immunoglobulins were administrated. On day 18, the patient developed acute respiratory failure. An examination of transbronchial pulmonary biopsies showed Warthin-Finkeldey giant cells that are pathognomonic of measles pneumonitis. The patient died despite aggressive supportive care. Our case and a review of literature show that measles pneumonitis is routinely fatal in patients with cancer. We suggest that antiviral drugs should be considered as soon as the diagnosis has been established.
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Affiliation(s)
- Benjamin Wyplosz
- Assistance publique-hôpitaux de Paris, CHU Bicêtre, Service de Maladies Infectieuses et Tropicales, Le Kremlin-Bicêtre, France
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16
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Rafat C, Klouche K, Ricard JD, Messika J, Roch A, Machado S, Sonneville R, Guisset O, Pujol W, Guérin C, Teboul JL, Mrozek N, Darmon M, Chemouni F, Schmidt M, Mercier E, Dreyfuss D, Gaudry S. Severe Measles Infection: The Spectrum of Disease in 36 Critically Ill Adult Patients. Medicine (Baltimore) 2013; 92:257-272. [PMID: 23982057 PMCID: PMC4553975 DOI: 10.1097/md.0b013e3182a713c2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
France has recently witnessed a nationwide outbreak of measles. Data on severe forms of measles in adults are lacking. We sought to describe the epidemiologic, clinical, treatment, and prognostic aspects of the disease in adult patients who required admission to an intensive care unit (ICU). We performed a retrospective analysis of a cohort of 36 adults admitted to a total of 64 ICUs throughout France for complications of measles from January 1, 2009, to December 31, 2011. All cases of measles were confirmed by serologic testing and/or reverse transcription polymerase chain reaction.The cohort consisted of 21 male and 15 female patients, with a median age of 29.2 years (25th-75th interquartile range [IQR], 27.2-34.2 yr) and a median Simplified Acute Physiology Score (SAPS II) of 13 (IQR, 9-18). Among the 26 patients whose measles vaccination status was documented, none had received 2 injections. One patient had developed measles during childhood. Underlying comorbid conditions included chronic respiratory disease in 9 patients, immunosuppression in 7 patients, and obesity in 3 patients, while measles affected 5 pregnant women.Respiratory complications induced by measles infection led to ICU admission in 32 cases, and measles-related neurologic complications led to ICU admission in 2 cases. Two patients were admitted due to concurrent respiratory and neurologic complications.Bacterial superinfection of measles-related airway infection was suspected in 28 patients and was documented in 8. Four cases of community-acquired pneumonia, 6 cases of ventilator-associated pneumonia, 1 case of tracheobronchitis, and 2 cases of sinusitis were microbiologically substantiated.Of 11 patients who required mechanical ventilation, 9 developed acute respiratory distress syndrome (ARDS). Among the patients with ARDS, extraalveolar air leak complications occurred in 4 cases. Five patients died, all of whom were severely immunocompromised.On follow-up, 1 patient had severe chronic respiratory failure related to lung fibrosis, and 2 patients had mild lower limb paraparesis along with bladder dysfunction, both of which were ascribable to measles-induced encephalitis and myelitis. Among the 5 pregnant patients, the course of measles infection was uneventful, albeit 1 patient underwent emergent cesarean delivery because of fetal growth restriction.Measles is a disease with protean and potentially deceptive clinical manifestations, especially in the immunocompromised patient. Measles-associated pneumonitis and its complications, and less commonly postinfectious encephalomyelitis, are the main source of morbidity and mortality. In contrast with the usually benign course of the disease in immunocompetent patients, measles occurring in immunocompromised patients gives rise to lethal complications including ARDS, with or without bacterial superinfection. Other patients potentially at high risk for severe measles are young adults and pregnant women. Measles pneumonitis may predispose to air leak disease in patients using mechanical ventilation. To date, vaccination remains the most potent tool to control measles infection.
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Affiliation(s)
- Cédric Rafat
- From AP-HP, Service de Réanimation Médico-Chirurgicale, Université Paris Diderot, Sorbonne Paris Cité Hôpital Louis Mourier, Colombes (CR, JDR, JM, DD, SG); Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier (KK, SM); Institut National de la Santé et de la Recherche Médicale, INSERM U722, Paris (JDR, JM, DD, SG); Université Paris Diderot, Sorbonne Paris Cité, UMR 722, Paris (JDR, JM, DD, SG); AP-HP, Service de Pneumologie et Réanimation, Hôpital Tenon, Université Pierre-et-Marie-Curie, Paris (JM); Aix-Marseille Université, Faculté de Médecine, URMITE UMR CNRS 7278, Marseille, and APHM, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, Marseille (AR); AP-HP, Service de Réanimation Médicale et des Maladies Infectieuses, Université Paris Diderot, Sorbonne Paris Cité, Hôpital Bichat-Claude-Bernard, Paris (RS); Service de Réanimation Médicale, Hôpital Saint-André, CHU Bordeaux, Bordeaux (OG); Service d'Anesthésie et Réanimation, Polyclinique Bordeaux Nord Aquitaine, Bordeaux (WP); Hospices Civils de Lyon, Service de Réanimation Médicale, Hôpital de la Croix Rousse, Lyon (CG); AP-HP, Hôpital de Bicêtre, Service de Réanimation Médicale, Le Kremlin-Bicêtre (JLT); CHU Clermont-Ferrand, Unité de Réanimation Médicale, Pôle REUNNIRH, Hôpital G Montpied, Clermont-Ferrand (NM); Medical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, and Jean Monnet University, Saint-Etienne (MD); Medico-Surgical Intensive Care Unit, Avicenne Teaching Hospital, Bobigny (FC); AP-HP, Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Paris (MS); and Medical Intensive Care Unit, Tours University Hospital, Tours (EM); France
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17
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de Vries RD, de Swart RL. Evaluating measles vaccines: can we assess cellular immunity? Expert Rev Vaccines 2012; 11:779-82. [PMID: 22913254 DOI: 10.1586/erv.12.45] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Measles remains an important cause of childhood mortality, and global eradication of the disease is being seriously considered. Because of limitations of the current live-attenuated vaccines, new vaccines and routes of administration are being investigated. In the article under review, the authors have measured measles-specific humoral and cellular immune responses after two doses of live-attenuated measles vaccine and found limited correlation between the two. This study highlights an important issue, namely that we cannot assume humoral and cellular immune responses to go hand in hand. However, it remains to be determined if assays with peripheral blood lymphocytes can be used as a correlate of protection from disease.
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Affiliation(s)
- Rory D de Vries
- Department of Virology, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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18
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Bankamp B, Takeda M, Zhang Y, Xu W, Rota PA. Genetic characterization of measles vaccine strains. J Infect Dis 2011; 204 Suppl 1:S533-48. [PMID: 21666210 DOI: 10.1093/infdis/jir097] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The complete genomic sequences of 9 measles vaccine strains were compared with the sequence of the Edmonston wild-type virus. AIK-C, Moraten, Rubeovax, Schwarz, and Zagreb are vaccine strains of the Edmonston lineage, whereas CAM-70, Changchun-47, Leningrad-4 and Shanghai-191 were derived from 4 different wild-type isolates. Nucleotide substitutions were found in the noncoding regions of the genomes as well as in all coding regions, leading to deduced amino acid substitutions in all 8 viral proteins. Although the precise mechanisms involved in the attenuation of individual measles vaccines remain to be elucidated, in vitro assays of viral protein functions and recombinant viruses with defined genetic modifications have been used to characterize the differences between vaccine and wild-type strains. Although almost every protein contributes to an attenuated phenotype, substitutions affecting host cell tropism, virus assembly, and the ability to inhibit cellular antiviral defense mechanisms play an especially important role in attenuation.
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Affiliation(s)
- Bettina Bankamp
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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19
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Williamson D, Freeman J, Austin P, Allum C, Roberts S. Seroprevalence of measles antibodies among high-risk healthcare workers in Auckland, New Zealand: additional justification for assumption of age-determined immunity based on local data. Infect Control Hosp Epidemiol 2011; 31:1082-4. [PMID: 20804375 DOI: 10.1086/656379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An outbreak of measles in another region of New Zealand prompted our organization to review the measles immunity of healthcare workers. Some studies suggest that age-specific immunity cannot be assumed. In our local setting, however, we found that 893 (98%) of 912 healthcare workers more than 40 years old tested seropositive for measles immunoglobulin G.
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Affiliation(s)
- Deborah Williamson
- Departments of Virology and Immunology, LabPlus, Auckland City Hospital, Auckland, New Zealand.
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20
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Pasetti MF, Ramirez K, Barry EM, Kotloff K, Levine MM. Measles DNA vaccine priming for young infants. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.provac.2010.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Csomor P, Szalmás A, Kónya J, Sziklai I, Karosi T. Restriction analysis of otosclerosis-associated CD46 splicing variants. Eur Arch Otorhinolaryngol 2009; 267:219-26. [PMID: 19597833 DOI: 10.1007/s00405-009-1042-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Accepted: 06/30/2009] [Indexed: 11/29/2022]
Abstract
Otosclerosis is a primary bone remodeling disorder of the human otic capsule and is associated with persistent measles virus infection. The human cellular receptor of measles virus is the membrane cofactor protein (MCP, CD46), which has 14 well-described splicing variants. Unique CD46 expression pattern of the otic capsule and the stapes footplate may determine the susceptibility for persistent measles virus infection. A total of 51 surgically removed ankylotic stapes footplates were analyzed by histopathological and molecular biological methods, respectively. Nucleic acids were extracted. Measles virus sequences were detected by nucleoprotein RNA-specific reverse transcriptase polymerase chain reaction (RT-PCR). Alternatively spliced RNA of CD46 isoforms was amplified by RT-PCR; cDNA amplimers were separated by SDS poly-acrylamide gel electrophoresis and were purified from the gel. Complementary DNA of CD46 isoforms was restricted by endonuclease enzymes having CD46-specific recognition sites. The presence of viral RNA was associated exclusively with the histopathological diagnosis of otosclerosis; the stapes specimens with negative measles virus belonged to non-otosclerotic stapes fixations. All specimens (N = 51) were characterized by the consecutive expression of five CD46 variants (c, d, e, f and one shorter unidentified isoform). Histologically confirmed ostosclerotic specimens (N = 21) were characterized by increased expression levels of variant "f" and the unknown isoform. Increased expression levels of these isoforms and special CD46 expression pattern of the human otic capsule might produce modified or pathological intracellular signalization that could create the possibility of persistent measles virus infection.
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Affiliation(s)
- Péter Csomor
- Department of Otolaryngology Head and Neck Surgery, University of Debrecen Medical and Health Science Center, Nagyerdei krt. 98, Debrecen, 4032, Hungary
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22
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Abstract
For infectious diseases where immunization can offer lifelong protection, a variety of simple models can be used to explain the utility of vaccination as a control method. However, for many diseases, immunity wanes over time and is subsequently enhanced (boosted) by asymptomatic encounters with the infection. The study of this type of epidemiological process requires a model formulation that can capture both the within-host dynamics of the pathogen and immune system as well as the associated population-level transmission dynamics. Here, we parametrize such a model for measles and show how vaccination can have a range of unexpected consequences as it reduces the natural boosting of immunity as well as reducing the number of naive susceptibles. In particular, we show that moderate waning times (40-80 years) and high levels of vaccination (greater than 70%) can induce large-scale oscillations with substantial numbers of symptomatic cases being generated at the peak. In addition, we predict that, after a long disease-free period, the introduction of infection will lead to far larger epidemics than that predicted by standard models. These results have clear implications for the long-term success of any vaccination campaign and highlight the need for a sound understanding of the immunological mechanisms of immunity and vaccination.
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Affiliation(s)
- J M Heffernan
- Department of Mathematics, York University, N520 Ross Building, 4700 Keele Street, Toronto, Ontario, Canada M3J 1P3.
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23
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Heffernan JM, Keeling MJ. An in-host model of acute infection: measles as a case study. Theor Popul Biol 2007; 73:134-47. [PMID: 18048070 DOI: 10.1016/j.tpb.2007.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 09/28/2007] [Accepted: 10/02/2007] [Indexed: 10/22/2022]
Abstract
The epidemiology of acute infections is strongly influenced by the immune status of individuals. In-host models can provide quantitative predictions of immune status and can thus offer valuable insights into the factors that influence transmission between individuals and the effectiveness of vaccination protocols with respect to individual immunity. Here we develop an in-host model of measles infection. The model explicitly considers the effects of immune system memory and CD8 T-cells, which are key to measles clearance. The model is used to determine the effects of waning immunity through vaccination and infection, the effects of booster exposures or vaccines on the level of immunity, and the immune system characteristics that result in measles transmission (R(0)>1) even if an individual has no apparent clinical symptoms. We find that the level of immune system CD8 T-cells at the time of exposure to measles determines whether an individual will experience a measles infection or simply a boost in immunity. We also find that the infected cell dynamics are a good indicator of measles transmission and the degree of symptoms that will be experienced. Our results indicate that the degree of immunity in adults is independent of the source of exposure in early childhood, be it vaccine or natural infection.
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Affiliation(s)
- J M Heffernan
- Department of Mathematics and Statistics, York University, N520 Ross Building, 4700 Keele Street, Toronto, Ont., Canada M3J 1P3.
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Rodeheffer C, von Messling V, Milot S, Lepine F, Manges AR, Ward BJ. Disease manifestations of canine distemper virus infection in ferrets are modulated by vitamin A status. J Nutr 2007; 137:1916-22. [PMID: 17634264 DOI: 10.1093/jn/137.8.1916] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The measles virus (MV) causes half a million childhood deaths annually. Vitamin A supplements significantly reduce measles-associated mortality and morbidity. The mechanisms whereby vitamin A acts against MV are not understood and currently there is no satisfactory small animal model for MV infection. We report on the development of a ferret model to study antiviral activity of vitamin A against canine distemper virus (CDV). CDV is closely related to MV at the molecular level and distemper in ferrets mimics measles in humans. We infected vitamin A-replete (control) and vitamin A-depleted ferrets with CDV and assessed the ability of high-dose vitamin A supplements to influence CDV disease. In control ferrets, CDV infection caused fever, rash, conjunctivitis, cough, coryza, and diarrhea. In contrast, control ferrets that were given 30 mg of vitamin A did not develop typical distemper after infection and exhibited only a mild rash. The supplement did not negatively affect ferret health and resulted in a 100% increase in serum and liver vitamin A concentrations. We also found that profound vitamin A deficiency is inducible in ferrets and can be rapidly reversed upon high-dose vitamin A supplementation. Vitamin A deficiency caused anorexia, diarrhea, cataracts, behavioral abnormalities, and ultimately death, with or without CDV infection. All ferrets that received vitamin A supplements, however, recovered uneventfully from CDV infection. These results replicate many aspects of the observations of vitamin A therapy in humans with measles and suggest that CDV infection in ferrets is an appropriate model for the study of the antiviral mechanism of vitamin A.
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Affiliation(s)
- Carey Rodeheffer
- McGill University Health Centre Research Institute, Faculty of Medicine, Division of Infectious Diseases, Montreal General Hospital, Montreal, QC, Canada
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