RESUMO
To assess rubella and measles susceptibility among women of childbearing age we conducted a cross-sectional seroprevalence study in four cities and one rural area in Argentina. A convenience sample of women aged 15-49 years seeking care in public health-care institutions was selected (n=2804). Serum specimens were tested for rubella and measles IgG antibody titres. The overall susceptibility to rubella and measles was 8.8 and 12.5% respectively. Seroprevalence differences were found for both rubella (P<0.001) and measles (P=0.002) across sites. Rubella seroprevalence was higher in women aged >or=40 years than in younger women (P=0.04). Measles seroprevalence tended to increase with age (P<0.001). Approximately 15% of women aged 15-29 years were not immune to measles. No risk factors were associated with rubella seronegativity; however, age (P<0.001) and having less than four pregnancies (P<0.001) were factors associated with measles seronegativity. Our findings support the introduction of supplemental immunization activities targeting adolescents and young adults to prevent congenital rubella syndrome and measles outbreaks over time.
Assuntos
Sarampo/epidemiologia , Rubéola (Sarampo Alemão)/epidemiologia , Adolescente , Adulto , Fatores Etários , Anticorpos Antivirais/análise , Argentina/epidemiologia , Estudos Transversais , Feminino , Humanos , Imunoglobulina G/imunologia , Sarampo/sangue , Sarampo/microbiologia , Sarampo/prevenção & controle , Vírus do Sarampo/imunologia , Vírus do Sarampo/isolamento & purificação , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Fatores de Risco , Rubéola (Sarampo Alemão)/sangue , Rubéola (Sarampo Alemão)/microbiologia , Rubéola (Sarampo Alemão)/prevenção & controle , Vírus da Rubéola/imunologia , Vírus da Rubéola/isolamento & purificação , Saúde da População Rural , Estudos SoroepidemiológicosRESUMO
Despite the marked reduction in the incidence of measles in Brazil, a measles epidemic occurred in this country in 1997. The measles cases observed during this epidemic began to reappear in large numbers in São Paulo, and spread to Rio de Janeiro and other Brazilian states. In the present study molecular biology techniques were used for the detection and genomic characterization of measles viruses from clinical samples such as urine and nasopharyngeal secretions collected in the states of Rio de Janeiro, Minas Gerais and Paraná, during the 1997 epidemic. RT-PCR and nucleotide sequence analysis of part of the carboxyl-terminal region of the nucleoprotein gene of measles viruses obtained directly from clinical samples or from infected cell cultures during this epidemic classified all as wild-type of genotype D6. As the genotype D6 was identified in different Brazilian states, this study demonstrated that this genotype was circulating in Brazil during the 1997 epidemic.
Assuntos
Surtos de Doenças , Genoma Viral , Sarampo/virologia , Morbillivirus/genética , Adulto , Sequência de Bases , Brasil/epidemiologia , Sequência Consenso , Genótipo , Humanos , Lactente , Sarampo/epidemiologia , Sarampo/urina , Epidemiologia Molecular , Dados de Sequência Molecular , Morbillivirus/química , Morbillivirus/classificação , Nasofaringe/virologia , Nucleoproteínas/genética , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Only limited data are available on the impact of measles outbreak response immunization (ORI) in developing countries. We conducted a community survey in Espindola, a rural border community in northern Peru, following a measles outbreak and subsequent ORI to study the epidemiology and impact of the outbreak and to evaluate the costs and benefits of measles ORI. During the outbreak, 150 of the 553 Espindola residents developed clinical cases of measles. Adults accounted for 44.0% of cases, and were frequently identified as primary cases. The attack rate among all susceptible people was 45.5% and was highest (61.2%) for the 16-20 year age group. Among adults, significant risk factors for developing measles included being aged 16-20 years (relative risk [RR] = 3.06, 95% CI = 2.08, 4.49) and being male (RR = 1.73, 95% CI = 1.11, 2.71). Among serologically confirmed cases, 60.7% developed diarrhoea and 32.1% pneumonia. The overall case-fatality rate was 3.3%, but reached 19.1% in the 0-23-month age group. Failure to reach children through either routine immunization or national campaigns made this community vulnerable to the severe and extensive impact of measles virus importation. The ORI campaign targeted non-measles case children aged 6 months to 15 years, regardless of their previous immunization status, and was effective in terminating this measles outbreak and in preventing morbidity, loss of livelihood and death despite the involvement of large numbers of adults in measles transmission. The last measles case occurred within 3 weeks of completing ORI. The ORI campaign, which would have cost approximately US$ 3000 in 1998, saved as many as 1155 person-days of work among 77 adults, prevented an estimated 87 cases of diarrhoea and 46 cases of pneumonia, and averted 5 deaths.
PIP: A community survey of the epidemiology and impact of measles outbreak response immunization (ORI) in Espindola, Peru. Blood specimens from 29 clinical cases having the onset of symptoms within 5 weeks to collection were tested for the anti-measles virus nucleoprotein antibody. Questionnaires were given to the head of the household and the 29 clinical cases to identify clinical symptoms an disease outcomes and to determine vaccination coverage. Attack rates, vaccine effectiveness, and predictive value positive was also calculated. Findings showed that primary cases were frequent among adults, who accounted for 44% of cases. The attack rate among all susceptible people was 45.5% and was highest among adults aged 16-20 (61.2%). For the serologically confirmed cases, 60.7% developed diarrhea and 32.1% pneumonia. Case fatality rate was 19.1% for children aged 0-23 months and 1.5% for adults aged 16-40 years. The lack of national campaigns or access to routine immunization caused the severe impact of measles virus outbreak. The ORI campaign targeted nonmeasles case children aged 6 months to 15 years regardless of immunization status, which was effective in terminating measles outbreak, morbidity, and mortality. This campaign cost approximately US$3000 and in 1998 saved 1155 person-days of work among 77 adults. It also prevented 87 diarrhea and 46 pneumonia cases and averted 5 deaths.
Assuntos
Surtos de Doenças/prevenção & controle , Vacina contra Sarampo , Sarampo/epidemiologia , Sarampo/prevenção & controle , Adolescente , Adulto , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Intervalos de Confiança , Análise Custo-Benefício , Feminino , Humanos , Programas de Imunização/economia , Lactente , Masculino , Vacina contra Sarampo/economia , Peru/epidemiologia , Fatores de Risco , População Rural , Estatísticas não ParamétricasRESUMO
Sera from infants aged 5 to 11 months and from their mothers were used to investigate the level and duration of transplacentally derived measles antibody. The infants of foreign-born, inner-city mothers were more likely to have measles antibody and were less likely to get measles. Infants of foreign-born mothers, because they are less likely to respond to measles vaccine, may require different vaccine strategies than infants of mothers born in the United States.
Assuntos
Anticorpos Antivirais/sangue , Vírus do Sarampo/imunologia , Sarampo/etnologia , Feminino , Georgia , Humanos , Lactente , Sarampo/imunologia , Mães , Saúde da População UrbanaRESUMO
An infant boy with a congenital immunodeficiency had fatal disseminated measles after administration of a live attenuated measles vaccine. This rare complication was confirmed with molecular virologic techniques. Although efforts to expand availability of vaccinations are critically important, caution is warranted in children with potentially severe immunologic dysfunction.