Vaccine‐associated measles in an immunocompetent child

Abstract

Key Clinical MessageWe present a rare case of vaccine‐associated measles infection in an immunocompetent, HIV‐negative patient in the United States. This case depicts the impressive rash our patient manifested and highlights the importance of reviewing public health interventions to determine epidemiological links in geographical areas with low incidence of measles.

Pediatric patient with a rash

“…In Finland,1.5 million children were vaccinated without any cases reported 2 . This is particularly true in immunocompetent hosts, with <10 case reports present in the literature 3‐5 . Vaccine‐induced measles presents similarly with fever, rash, and mucus membrane involvement (ie, Koplik spots).…”

Measles: a disease often forgotten but not gone

“…7,21 Typically, morbilliform exanthem appears 3 to 4 days after the onset of fever and peaks with the appearance of exanthem, 11 which consists of blanching, erythema, macules, and papules that classically begin on the face, around the hairline, on the sides of neck, and behind the ears. 11,25 The rash becomes more confluent as it spreads downwards to the trunk and extremities (Figs 2 to 4). 1,9 The lesions are more tense around the shoulders.…”

“…37 Measles vaccines in current use contain live attenuated measles strains that replicate within the host to induce both humoral and cellular immunity. 2,25 A single dose of measles vaccine given at or after age 1 year is 93% to 95% effective at protecting against measles, whereas two doses given at appropriate intervals are nearly 100% effective. 7,11,21 However, measles vaccine given at age 9 months is only 85% protective.…”

“…Adverse effects usually occur 5 to 12 days post-vaccination and consist mainly of fever, rash, and arthralgia. 11,25 There is a possible association between measles vaccine and acute disseminated encephalomyelitis, but the excess risk is not likely to be more than 1.16 cases of acute disseminated encephalomyelitis per million vaccines administered. 40 The accusation that MMR vaccine may lead to autism spectrum disorders is baseless.…”

“…42 Contra-indications for measles vaccination include hypersensitivity to any component of the vaccine, including gelatine and neomycin; confirmed history of an anaphylactic reaction to a previous measles-containing vaccine; cellular immune deficiency; moderate or severe illness; any febrile illness; and pregnancy. 7,9,11,25 Measles vaccination should be deferred in individuals who have recently used high-dose corticosteroids, immunoglobulin, or blood products. 9 Almost all states in the US require children to have two doses of measles-containing vaccine to enrol in public school kindergartens.…”