Measles — the more dangerous disease, or complications from the vaccine?

Aim of the study: Understanding the safety of vaccines is critical to inform decisions about vaccination. Our objective was to conduct a systematic review of the safety of vaccines recommended for children, adults, and pregnant women in the United States.

Results: Of 56,603 reviewed citations, 338 studies reported in 518 publications met inclusion criteria. For children, SoE was high for no increased risk of autism following measles, mumps, and rubella (MMR) vaccine. SoE was high for increased risk of febrile seizures with MMR. There was no evidence of increased risk of intussusception with rotavirus vaccine at the latest follow-up (moderate SoE), nor of diabetes (high SoE). There was no evidence of increased risk or insufficient evidence for key adverse events for newer vaccines such as 9-valent human papillomavirus and meningococcal B vaccines. For adults, there was no evidence of increased risk (varied SoE) or insufficient evidence for key adverse events for the new adjuvanted inactivated influenza vaccine and recombinant adjuvanted zoster vaccine. We found no evidence of increased risk (varied SoE) for key adverse events among pregnant women following tetanus, diphtheria, and acellular pertussis vaccine, including stillbirth (moderate SoE).

Aim of the study: Lowering the age for receiving the first dose of a measles-containing vaccine (MCV1) has been suggested to close the emerging immunity gap in infants. However, tolerability remains one of the main concerns for vaccine-hesitant parents. We conducted a systematic review and meta-analysis of reactogenicity following MCV1 in infants under 12 months of age.

Results: We included 24 studies for analysis: 18 randomized controlled trials (RCTs), three interventional studies, and three observational studies. Only one RCT was placebo-controlled. Commonly reported AEs were injection site reactions, fever, rash, gastrointestinal symptoms, respiratory tract symptoms, conjunctivitis, and symptoms related to the general condition of the infant. The frequency of any AE was generally <10 %; however, the placebo-controlled trial showed no difference between MCV1 and placebo-injected infants. Edmonston B strains and measles-mumps-rubella-varicella vaccine (MMRV) were associated with a higher rate of high fever >39 °C. Most AEs occurred in <10 % of infants receiving MCV1 at < 12 months of age. The placebo-controlled trial suggested no excess reactogenicity following early MCV.

Aim of the study: Measles, mumps, rubella and varicella are viral infections which can implicate seriously long-term sequelae of infected individuals or even the unborn child. Vaccines against the individual diseases have long been available.

Results: These are today known as immunogenic and safe. MMRV had similar immunogenicity and overall safety profiles to MMR administered with or without varicella vaccine. This issue provides a review of the different vaccines, mode of administration, catch up immunization and postexposure prophylaxis as well as contraindications and adverse effects of the immunization against measles, mumps, rubella, and varicella. The article presents an overview of important information of preventing these diseases with a focus on the existing combination vaccines.

Aim of the study: To provide an overview of measles and vaccination for health care professionals.

Results: Seven systematic reviews, 15 reviews, 15 observational studies, 1 qualitative study, 5 epidemiologic reports, and 2 books were included, in addition to World Health Organization and Centers for Disease Control and Prevention data, position papers, and statements. Transmission of measles is dependent on person-to-person spread through respiratory droplets or direct contact. Diagnosis is based on recognizing the clinical picture and can be confirmed with results of laboratory testing, such as serologic tests or polymerase chain reaction. Measles infection leads to immune suppression for weeks to months. Complications of measles are of high frequency and severity. There is no specific antiviral treatment for measles; treatment with vitamin A is recommended for younger children to decrease mortality from measles. Vaccination against measles is effective, cost-effective, and safe. There is no link between the measles vaccination and autism.

Aim of the study: The purpose of this review is to summarize important papers concerning measles disease and measles-containing vaccines published in 2004.

Results: Endemic measles has been successfully controlled in the Americas and, to a lesser extent, in Europe. This has been achieved with a high uptake of two doses of a measles-containing vaccine. Even in industrialized countries, where vaccine uptake is poor, for example Japan, the disease is still a significant cause of morbidity and mortality. Vaccine failure is predominantly due to primary vaccine failure, which may, in part, be genetic in origin and related to HLA type. Measles-containing vaccines have been shown to be associated with febrile convulsions, but there is no strong evidence of a link with atopy. There is considerable evidence that there is no causal relationship with autistic disorders. In spite of this, many parents and some professionals have concerns about the safety of the vaccines, which may lead to their underuse.

Results: In clinically stable children with juvenile idiopathic arthritis, the available evidence supports the cautious use of MMR booster/revaccination and varicella vaccination under specialist supervision. The main residual concern is not a consistent safety signal but incomplete or less durable protection in selected biologic-treated patients, particularly for measles and rubella 5 years after MMR booster and for varicella in low responders. These findings support individualized vaccine timing and consideration of post-vaccination serology in selected higher-risk children.

Aim of the study: The US Food and Drug Administration recommends deferring administration of live vaccines during dupilumab treatment owing to lack of data on safety and efficacy. Understanding the safety profile of measles, mumps, and rubella (MMR) and varicella administration in children taking dupilumab is important to promote appropriate vaccination.

Results: Of the 19 patients who received MMR and varicella immunization while taking dupilumab, none experienced severe vaccine-associated events or vaccine-associated infections. One patient reported fever and injection site reaction, and 5 reported a flare of atopic dermatitis (AD). In all, administration of 21 varicella boosters (9.7%) and 25 MMR boosters (11.5%) were delayed because the children were taking dupilumab. There was a significant delay in the age of administration of MMR boosters and varicella boosters when before- and after-dupilumab therapy rates were compared. MMR and varicella immunization may be safe to administer to children undergoing dupilumab therapy. Pausing dupilumab therapy for administration of live vaccines may lead to flare of underlying AD. Further, dupilumab treatment in early childhood may result in decreased and/or delayed vaccination rates for MMR and varicella.

Aim of the study: Two-dose childhood vaccination against measles, mumps, rubella, and varicella is widely recommended. Quadrivalent (MMRV) vaccines can be used for one or both immunizations against these diseases.

Results: At least one SAE (none considered vaccine-related) occurred in each group. Except for one reported fatality, all SAEs resolved. Compared to the licensed standard-of-care MMRV vaccine, the investigational MMRVNS formulations generated comparable immune responses and had a similarly acceptable safety profile, when administered as second dose. These results support further clinical development of MMRVNS.