Estimates of measles case fatality ratios: a comprehensive review of community-based studies

Wolfson, Lara J.; Grais, RFebecca F; Luquero, Francisco J.; Birmingham, Maureen; Strebel, Peter M.

doi:10.1093/ije/dyn224

Cited by 169 publications

(197 citation statements)

References 46 publications

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“…The highest fatality rates due to MV infection occur in infants Ͻ1 year of age (5). Ironically, increasing vaccine coverage also increases the proportion of young infants who are susceptible to MV infection.…”

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Generation of a More Immunogenic Measles Vaccine by Increasing Its Hemagglutinin Expression

Julik

Valle

2016

J Virol

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Imported measles virus (MV) outbreaks are maintained by poor vaccine responders and unvaccinated people. A convenient but more immunogenic vaccination strategy would enhance vaccine performance, contributing to measles eradication efforts. We report here the generation of alternative pediatric vaccines against MV with increased expression of the H protein in the background of the current MV vaccine strain. We generated two recombinants: MVvac2-H2, with increased full-length H expression resulting in a 3-fold increase in H incorporation into virions, and MVvac2-Hsol, vectoring a truncated, soluble form of the H protein that is secreted into the supernatants of infected cells. Replication fitness was conserved despite the duplication of the H cistron for both vectors. The modification to the envelope of MVvac2-H2 conferred upon this virus a measurable level of resistance to in vitro neutralization by MV polyclonal immune sera without altering its thermostability. Most interestingly, both recombinant MVs with enhanced H expression were significantly more immunogenic than their parental strain in outbred mice, while MVvac2-H2 additionally proved more immunogenic after a single, human-range dose in genetically modified MV-susceptible mice. IMPORTANCEMeasles incidence was reduced drastically following the introduction of attenuated vaccines, but progress toward the eradication of this virus has stalled, and MV still threatens unvaccinated populations. Due to the contributions of primary vaccine failures and too-young-to-be-vaccinated infants to this problem, more immunogenic measles vaccines are highly desirable. We generated two experimental MV vaccines based on a current vaccine's genome but with enriched production of the H protein, the main MV antigen in provoking immunity. One vaccine incorporated H at higher rates in the viral envelope, and the other secreted a soluble H protein from infected cells. The increased expression of H by these vectors improved neutralizing responses induced in two small-animal models of MV immunogenicity. The enhanced immunogenicity of these vectors, mainly from the MV that incorporates additional H, suggests their value as potential alternative pediatric MV vaccines. Despite the existence of an effective vaccine, measles virus (MV) infections remain an insidious threat to global health. After decades of reduction in measles-related mortality due to vaccination, this has stalled at between 110,000 and 120,000 deaths/year since 2012. Approximately 20 million people are infected by measles each year, with significant morbidity and up to 1% mortality (1). In 2014, the United States saw the highest number of annual measles cases since native transmission was declared locally eliminated in 2000 (2) and experienced a large multistate outbreak in the first months of 2015 (3).Protecting young infants against measles is an important goal to attain to improve the current MV vaccine (4). The highest fatality rates due to MV infection occur in infants Ͻ1 year of age (5). Ironically, incre...

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Generation of a More Immunogenic Measles Vaccine by Increasing Its Hemagglutinin Expression

Julik

Valle

2016

J Virol

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“…Other than the 2 patients misdiagnosed with Kawasaki disease, 2 other children with risk factors received this treatment (an immunocompromised condition and a 2-month-old infant); however, its use was misemployed, as is indicated for prophylactics. Contrary to the popular belief that measles is a benign illness, this disease can lead to death because the overall mortality rate is 0.03z-0.5z in infected populations and 0.97z-1.1z in hospitalized patients (31)(32)(33)(34). Before the age of 5 years and after the age of 20 years, the mortality rate of measles is higher (18) and seems to be currently higher in female patients (31,34).…”

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confidence: 87%

A Comparison of Adult and Pediatric Measles Patients Admitted to Emergency Departments during the 2008^|^ndash;2011 Outbreak in the Midi-Pyr^|^eacute;n^|^eacute;es Region of France

et al. 2014

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SUMMARY:The present French and European measles outbreaks show a bimodal distribution: the two most affected populations are infants aged less than 1 year and adults older than 20 years. The purpose of this study was to determine wether there were differences in the clinical presentation and evolution of measles between adult and pediatric patients. We performed a retrospective study of adult and pediatric measles patients admitted to three tertiary-level university hospitals between January 2008 and May 2011. Data were extracted from medical charts and positive laboratory results. Collected data were age, sex, geographical origin, vaccination status, source of exposure, overseas travel before symptom onset, clinical symptoms, risk factors for complications, severity criteria on admission, type of diagnosis, biological abnormalities, complications, and treatments. A total of 305 patients (171 children and 134 adults) were included in the study. The mean age was 4.6 ± 4.4 years in children and 26.7 ± 8.1 years in adults. Children were less often hospitalized than adults (29z vs. 66z). A comparison between hospitalized pediatric (n ＝ 49) and adult (n ＝ 89) patients revealed that the former had a higher incidence of complications ( P º 0.0001), more otorhinolaryngological complications (24z vs. 1z; P º 0.0001), and a higher incidence of severe criteria on admission ( P ＝ 0.02). Hospitalized pediatric patients differed from adults in terms of disease severity and complications.

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“…The risk of dying from malaria is five to ten times higher during an epidemic than in situations where transmission rates are stable (Kiszewski and Teklehaimanot, 2004). According to World Health Organization (WHO) estimates the case fatality rate (CFR) for measles in low-income countries ranges from 0.05 to 6 per cent, but can reach 30 per cent in certain situations, with higher measles CFRs reached during outbreaks (Wolfson et al, 2009). In Africa alone, an estimated 12.4 million cases of malaria are related to epidemics, which represents 4 per cent of all total cases of malaria reported worldwide.…”

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Policy Debate | International Responses to Global Epidemics: Ebola and Beyond

Rull¹,

Kickbusch²,

Lauer³

2015

poldev

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Estimates of measles case fatality ratios: a comprehensive review of community-based studies

Abstract: Values for measles CFRs remain imprecise, resulting in continued uncertainty about the actual toll measles exacts.

Cited by 169 publications

References 46 publications

Generation of a More Immunogenic Measles Vaccine by Increasing Its Hemagglutinin Expression

Generation of a More Immunogenic Measles Vaccine by Increasing Its Hemagglutinin Expression

A Comparison of Adult and Pediatric Measles Patients Admitted to Emergency Departments during the 2008^|^ndash;2011 Outbreak in the Midi-Pyr^|^eacute;n^|^eacute;es Region of France

Policy Debate | International Responses to Global Epidemics: Ebola and Beyond

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