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• W2029679354 abstract "A single case of measles occurred recently at a children's nursery in the UK. A 17-month-old boy who had not received the measles, mumps, and rubella (MMR) vaccine presented to the Accident and Emergency department in the morning with an erythematous maculopapular rash on his face and upper body. He had been unwell for 72 h with coryza, cough, conjunctivitis, and diarrhoea. Measles was laboratory-confirmed within 3 h by virus-specific immunofluorescence of a nasopharyngeal aspirate. However, since the history and rash were virtually pathognomonic of measles, the nursery was contacted as soon as a clinical diagnosis was made. The child had been in close contact with six other children (ages 15–24 months) during the entire coryzal period. None of these children had received MMR despite all being eligible. Since current advice indicates that MMR given within 3 days of exposure might modify or abort an attack of measles,1Salisbury DM Begg NT Immunisation against infectious disease. The Stationery Office, London1996Google Scholar, 2Watson GI Protection after exposure to measles by attenuated vaccine without gamma-globulin..BMJ. 1963; 1: 860-861Crossref PubMed Scopus (25) Google Scholar, 3Ruuskanen O Salmi TT Halonen P Measles vaccination after exposure to natural measles..J Pediatr. 1978; 93: 43-46Summary Full Text PDF PubMed Scopus (36) Google Scholar we advised the parents to have their children immunised immediately. The severity of the illness in the index case ensured that four of the six sets of parents had their children immunised with MMR the same day. Despite doing so, all six children developed prodromal symptoms of measles, on average 8 days after the onset of such symptoms in the index case. 2–3 days later, they all developed a typical measles rash. Measles-specific IgM was detected in oral fluids from all six secondary cases and viral nucleic acid was detected by PCR in the index case and from two secondary cases (one of whom had been immunised after exposure). Sequencing showed all three isolates to be genotype D8, the strain circulating currently in south London, UK. We have shown that, despite rapid diagnosis, measles transmission and clinical infection was not preventable by post-exposure immunisation. This finding contrasts with accepted guidance in this area. Only two studies have shown that live measles vaccine alone can prevent secondary cases after exposure: Watson2Watson GI Protection after exposure to measles by attenuated vaccine without gamma-globulin..BMJ. 1963; 1: 860-861Crossref PubMed Scopus (25) Google Scholar was able to prevent infection in a single household when vaccine was given to family contacts one day after appearance of the rash and 96 h after onset of coryzal symptoms in the index case, and Ruuskanen and colleagues3Ruuskanen O Salmi TT Halonen P Measles vaccination after exposure to natural measles..J Pediatr. 1978; 93: 43-46Summary Full Text PDF PubMed Scopus (36) Google Scholar reported protection from vaccination in children vaccinated after exposure in a school setting. However, the first study was conducted with a very early vaccine that contained a high dose of a different measles virus strain (Edmonston). Subsequently, all monovalent measles and MMR vaccines used in the UK have contained lower doses of Schwartz or Moraten strains. The lack of efficacy we saw might have been due to delay in administration or to differences in the vaccine formulation. Alternatively, the interpretation of the original observations made on small numbers of cases might have been incorrect. If parents continue to decline MMR immunisation, once measles is introduced into a home, nursery, school, or hospital ward, our observations suggest that administration of MMR vaccine as early as possible might not prevent infection in those children already exposed. The only reliable way to prevent measles is to maintain high MMR uptake rates in the community." @default.
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• W2029679354 date "2004-02-01" @default.
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• W2029679354 title "MMR immunisation after contact with measles virus" @default.
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• W2029679354 doi "https://doi.org/10.1016/s0140-6736(04)15553-0" @default.
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