Local public health response to vaccine-associated measles: case report

BMC Public Health

Shaun K Morris⁵  Shelley L Deeks²  Joanne Hiebert¹  Alberto Severini⁶  Jonathan B Gubbay²  Isabelle Mogck⁴  Crystal Frenette⁴  Kevin L Schwartz⁵  Monica Hau³ 

[1]National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB, R3E 3E2, Canada

[2]Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada

[3]Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th floor, Toronto, ON, M5T 3M7, Canada

[4]Peel Public Health, 7120 Hurontario St. RPO Streetsville, P.O Box 667, Mississauga, ON, L5M 2C2, Canada

[5]Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

[6]Department of Microbiology and Infectious Diseases, Faculty of Medicine, University of Manitoba, Rm 543 – 745, Bannatyne Avenue, Winnipeg, MB, R3E 0J9, Canada

关键词: Adverse event;    Contact tracing;    Vaccine strain;    Vaccine associated;    Immunization;    (3–10): measles;   

Others  :  1162411
DOI  :  10.1186/1471-2458-13-269

 received in 2012-09-18, accepted in 2013-02-13,  发布年份 2013

【 摘 要 】

Background

The most appropriate public health approach to vaccine-associated measles in immunocompromised patients is unknown, mainly because these cases are rare and transmission of vaccine-associated measles has not been previously documented. In this case report, we describe Peel Public Health’s response to a vaccine-associated measles case in an immunocompromised child in Ontario, Canada.

Case presentation

A five-year-old Canadian-born boy with a history of a hematopoetic stem cell transplant three years previously received live attenuated measles, mumps, and rubella (MMR) vaccine. Over the subsequent 7 to 14 days, he developed an illness clinically consistent with measles. There was no travel history or other measles exposure. Serology and polymerase chain reaction (PCR) testing confirmed acute measles infection. Following discussion with pediatric infectious diseases specialists, but prior to the availability of virus sequencing, it was felt that this case was most likely due to vaccine strain. Although no microbiologically confirmed secondary cases of vaccine-associated measles have been previously described, we sent notification letters to advise all contacts of measles symptoms since the likelihood of transmission from an immunocompromised patient was low, but theoretically possible. We decided to stratify contacts into immune competent and compromised and to deal with the latter group conservatively by excluding them as if they were exposed to wild-type measles because the risk of transmission of disease in this population, while presumably very low, is unknown. However, no contacts self-identified as immunocompromised and there were no secondary cases. Subsequent genotyping confirmed that this case was caused by vaccine strain measles virus.

Conclusion

The public health approach to contact tracing and exclusions for vaccine-associated measles in immunocompromised patients is unclear. The rarity of secondary cases provides further evidence that the risk to the general public is likely extremely low. Although the risk appears negligible, exclusion and administration of immune globulin may be considered for susceptible, immunocompromised contacts of cases of vaccine-associated measles in immunocompromised patients.

【 授权许可】

   
2013 Hau et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Heymann DL, American Public Health Association: Control of communicable diseases manual. 19th edition. Washington, DC: American Public Health Association; 2008.
• [2]Berggren KL, Tharp M, Boyer KM: Vaccine-associated “wild-type” measles. Pediatr Dermatol 2005, 22(2):130-132.
• [3]Kaic B, Gjenero-Margan I, Aleraj B, Vilibic-Cavlek T, Santak M, Cvitkovic A, Nemeth-Blazic T, Ivic Hofman I: Spotlight on measles 2010: excretion of vaccine strain measles virus in urine and pharyngeal secretions of a child with vaccine associated febrile rash illness, Croatia, March 2010. Euro Surveill 2010, 15(35):pii=19652. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19652 webcite
• [4]Morfin F, Beguin A, Lina B, Thouvenot D: Detection of measles vaccine in the throat of a vaccinated child. Vaccine 2002, 20(11–12):1541-1543.
• [5]Monafo WJ, Haslam DB, Roberts RL, Zaki SR, Bellini WJ, Coffin CM: Disseminated measles infection after vaccination in a child with a congenital immunodeficiency. J Pediatr 1994, 124(2):273-276.
• [6]Bitnun A, Shannon P, Durward A, Rota PA, Bellini WJ, Graham C, Wang E, Ford-Jones EL, Cox P, Becker L, Fearon M, Petric M, Tellier R: Measles inclusion-body encephalitis caused by the vaccine strain of measles virus. Clin Infect Dis 1999, 29(4):855-861.
• [7]Rota PA, Khan AS, Durigon E, Yuran T, Villamarzo YS, Bellini WJ: Detection of measles virus RNA in urine specimens from vaccine recipients. J Clin Microbiol 1995, 33(9):2485-2488.
• [8]Hummel KB, Lowe L, Bellini WJ, Rota PA: Development of quantitative gene-specific real-time RT-PCR assays for the detection of measles virus in clinical specimens. J Virol Methods 2006, 132(1–2):166-173.
• [9]Measles virus nomenclature update: 2012 Wkly Epidemiol Rec 2012, 87(9):73-81.
• [10]Speakman J, Stoltz L, Blake R: Public health law and practice in Ontario: the Health Protection and Promotion Act. Toronto: Thomson Carswell; 2008.
• [11]Ontario Public Health Standards: Infectious Disease Protocol, Appendix B: Provincial Case Definitions. Disease: Measles. Revised January 2013. [http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/measles_cd.pdf webcite]
• [12]Permar SR, Moss WJ, Ryon JJ, Monze M, Cutts F, Quinn TC, Griffin DE: Prolonged measles virus shedding in human immunodeficiency virus-infected children, detected by reverse transcriptase-polymerase chain reaction. J Infect Dis 2001, 183(4):532-538.
• [13]Turner A, Jeyaratnam D, Haworth F, Sinha MD, Hughes E, Cohen B, Jin L, Kidd IM, Rigden SP, MacMahon E: Measles-associated encephalopathy in children with renal transplants. Am J Transplant 2006, 6(6):1459-1465.
• [14]Millson D: Brother-to-Sister Transmission of Measles after Measles, Mumps, and Rubella Immunisation. Lancet 1989, 333(8632):271.
• [15]National Advisory Committee on Immunization, Public Health Agency of Canada: Canadian immunization guide. 7th edition. Ottawa: Ont.: Public Health Agency of Canada = Agence de la santé publique du Canada; 2006.
• [16]Centers for Disease Control: Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book: Course Textbook, 12th Edition Second Printing. 2012. [http://www.cdc.gov/vaccines/pubs/pinkbook/index.html webcite]
• [17]Gay NJ: The theory of measles elimination: implications for the design of elimination strategies. J Infect Dis 2004, 189:S27-S35.