Gert van der Hoek
In Memoriam - Editor, Senior Moderator
Archive Number 20070601.1765
Published Date 01-JUN-2007
Subject PRO/EDR> Measles - China (Shanxi): RFI
MEASLES - CHINA (SHANXI): REQUEST FOR INFORMATION
*************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 31 May 2007
Source: Xinhua News Agency [in Chinese, trans. Rappt.DS, edited]
<http://www.sx.xinhuanet.com/newscenter/2007-05/30/content_10167717.htm >
Shanxi Provincial Health Bureau said on [30 May 2007], that since the
middle of May [2007], a febrile illness has occurred among students
in Qingxu Middle School in Qingxu County of Shanxi's Taiyuan
Municipality. There are now a total of 68 cases. Following treatment,
the ill students are stable and there are no patients in serious
condition. Temperatures have returned to normal in 64 students.
Health department experts have preliminarily determined that the
illness is atypical measles.
Most ill students are senior year juku students, and 59.7 percent are
in the same class. A survey shows that illness occurred among those
in the same classroom but not in the same dorm. There is no
difference in incidence between males and females. The ratio of male
to female cases is 1.71:1.
After the disease occurred, the Ministry of Health and experts from
Shanxi Province went to the site, where water sources, the cafeteria,
dorms, wastewater, and other [potential] environmental sources of
disease were investigated. In addition, students were physically
examined. Experts have already ruled out SARS (severe acute
respiratory syndrome) and avian influenza, and confirmed atypical measles.
[Byline: Xiangxiao Liu]
--
Communicated by:
ProMED-mail Rapporteur Dan Silver
[The mention of "atypical measles" brought back memories of a
syndrome seen in the early days of measles vaccination, when there
were atypical clinical presentations in individuals who had received
the killed measles vaccine.
According to Frey and Krugman (see ref.
4): '"The atypical measles syndrome is a relatively new disease that
was 1st recognized 15 years ago. Initially, it occurred in children
who were exposed to wild measles virus several years after they were
immunized with killed measles vaccine. It was characterized by a 2-
to 3-day prodrome of high fever, cough, headache, and myalgia
followed by a rash that resembled Rocky Mountain spotted fever,
scarlet fever, or varicella and associated with roentgenographic
evidence of pneumonia with or without pleural effusion."
Cherry et al (see ref. 1) described an outbreak of measles where 12
children had "atypical measles" syndrome -- 6 of whom had received
the killed measles vaccine and 6 of whom had received live attenuated
measles vaccine. In the latter group, illnesses were less severe than
in those vaccinated with the killed vaccine.
The atypical measles syndrome was felt to be an immune mediated
disorder. In recent years, Polack (see ref. 9) described the immune
mechanism associated with the development of "atypical measles
syndrome": "Atypical measles and enhanced respiratory syncytial
virus disease (ERD) were serious diseases that resulted from exposure
of children immunized with inactivated vaccines against measles virus
(MV) and respiratory syncytial virus (RSV) to the respective
wild-type agents in the 1960s.
Although the clinical manifestations
of both illnesses were different, the immune responses elicited and
primed for by the vaccines shared important similarities. Both
vaccines failed to elicit long-lived protective antibody and to
promote cytotoxic T lymphocyte responses. In both cases,
postvaccination exposure to wild type virus during community
outbreaks was associated with immune complex deposition in affected
tissues, vigorous CD4 T lymphocyte proliferative responses, and a Th2
bias of the immune response. No relapses of atypical measles or ERD
were ever reported."
Searching the internet it appears as though China has been using a
live attenuated measles vaccine since the early 1980s (see refs. 10,
11). There are a number of publications that seem to suggest that an
atypical measles syndrome classification may be given to cases of
measles that occur in previously vaccinated individuals, not just
those who have received killed vaccine (see ref. 12).
That being said/speculated, this moderator would greatly appreciate
receiving more information on the atypical measles syndrome described
in this current outbreak of measles in Shanxi, including information
on the vaccination status of the cases (including type of vaccine
received and number of doses received) and a description of the
clinical syndrome that is being referred to as "atypical measles".
http://www.promedmail.org/pls/prome..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,37652
Published Date 01-JUN-2007
Subject PRO/EDR> Measles - China (Shanxi): RFI
MEASLES - CHINA (SHANXI): REQUEST FOR INFORMATION
*************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 31 May 2007
Source: Xinhua News Agency [in Chinese, trans. Rappt.DS, edited]
<http://www.sx.xinhuanet.com/newscenter/2007-05/30/content_10167717.htm >
Shanxi Provincial Health Bureau said on [30 May 2007], that since the
middle of May [2007], a febrile illness has occurred among students
in Qingxu Middle School in Qingxu County of Shanxi's Taiyuan
Municipality. There are now a total of 68 cases. Following treatment,
the ill students are stable and there are no patients in serious
condition. Temperatures have returned to normal in 64 students.
Health department experts have preliminarily determined that the
illness is atypical measles.
Most ill students are senior year juku students, and 59.7 percent are
in the same class. A survey shows that illness occurred among those
in the same classroom but not in the same dorm. There is no
difference in incidence between males and females. The ratio of male
to female cases is 1.71:1.
After the disease occurred, the Ministry of Health and experts from
Shanxi Province went to the site, where water sources, the cafeteria,
dorms, wastewater, and other [potential] environmental sources of
disease were investigated. In addition, students were physically
examined. Experts have already ruled out SARS (severe acute
respiratory syndrome) and avian influenza, and confirmed atypical measles.
[Byline: Xiangxiao Liu]
--
Communicated by:
ProMED-mail Rapporteur Dan Silver
[The mention of "atypical measles" brought back memories of a
syndrome seen in the early days of measles vaccination, when there
were atypical clinical presentations in individuals who had received
the killed measles vaccine.
According to Frey and Krugman (see ref.
4): '"The atypical measles syndrome is a relatively new disease that
was 1st recognized 15 years ago. Initially, it occurred in children
who were exposed to wild measles virus several years after they were
immunized with killed measles vaccine. It was characterized by a 2-
to 3-day prodrome of high fever, cough, headache, and myalgia
followed by a rash that resembled Rocky Mountain spotted fever,
scarlet fever, or varicella and associated with roentgenographic
evidence of pneumonia with or without pleural effusion."
Cherry et al (see ref. 1) described an outbreak of measles where 12
children had "atypical measles" syndrome -- 6 of whom had received
the killed measles vaccine and 6 of whom had received live attenuated
measles vaccine. In the latter group, illnesses were less severe than
in those vaccinated with the killed vaccine.
The atypical measles syndrome was felt to be an immune mediated
disorder. In recent years, Polack (see ref. 9) described the immune
mechanism associated with the development of "atypical measles
syndrome": "Atypical measles and enhanced respiratory syncytial
virus disease (ERD) were serious diseases that resulted from exposure
of children immunized with inactivated vaccines against measles virus
(MV) and respiratory syncytial virus (RSV) to the respective
wild-type agents in the 1960s.
Although the clinical manifestations
of both illnesses were different, the immune responses elicited and
primed for by the vaccines shared important similarities. Both
vaccines failed to elicit long-lived protective antibody and to
promote cytotoxic T lymphocyte responses. In both cases,
postvaccination exposure to wild type virus during community
outbreaks was associated with immune complex deposition in affected
tissues, vigorous CD4 T lymphocyte proliferative responses, and a Th2
bias of the immune response. No relapses of atypical measles or ERD
were ever reported."
Searching the internet it appears as though China has been using a
live attenuated measles vaccine since the early 1980s (see refs. 10,
11). There are a number of publications that seem to suggest that an
atypical measles syndrome classification may be given to cases of
measles that occur in previously vaccinated individuals, not just
those who have received killed vaccine (see ref. 12).
That being said/speculated, this moderator would greatly appreciate
receiving more information on the atypical measles syndrome described
in this current outbreak of measles in Shanxi, including information
on the vaccination status of the cases (including type of vaccine
received and number of doses received) and a description of the
clinical syndrome that is being referred to as "atypical measles".
http://www.promedmail.org/pls/prome..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,37652