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Rapid Responses: Rapid Responses published:
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Early Admistration of measles vaccination
- N.P. Viswanathan (28 July 2008)
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Advancement of measles vaccineto 4.5 months
- N.P. viswanathan (29 July 2008)
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Correction to my response
- N.P. Viswanathan (29 July 2008)
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Re-reevaluation of Edmonston Zagreb measles vaccine may be unethical
- Bedangshu Saikia, Jain Arvind (18 September 2008)
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N.P. Viswanathan, Family physician svclinic,gmpalya,Bangalore-560075,India
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Most infants are protected from measles by the maternally accquired antibodies until about 6-8 months of age.If measles vaccine is given in the presence of measurable titres of maternal antibody,the vaccine efficacy may be reduced.In order to acheive the best balance between these competing demands of early protection and high seroconversion,completed 9 months of age has been recommended as the appropriate age for vaccination in India.In case of outbreak the vaccine can be given as young as 6 months with the recommendation for an additional MMR/Measles vaccine at 12-15 months. Reference; IAP guide book on immunisation IAP Committe on immunisation Editors; Dr.Raju c.Shah Dr.Nitin k.Shah Dr.Shyam Kukreja Competing interests: None declared |
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N.P. viswanathan, Family physician sv clinic,gm palya, Bangalore-560075, India
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Incidence of measles below the age of 6 months is recorded in our country India, and respiratory complications are more in them. With the efficacy rate of 98% when given after 270 days, the measles vaccine with a coverage of over 85% can produce a herd effect and prevent measles in about 92% of children.T hese children develop measles within 9 months to 5 years of age. The remaining 8% below 9 months who contact the disease from old children will automatically be protected, if the contact elimination is acheived with the 9-12 months of vaccine coverage. Even though the E-Z vaccine coverage produces a better sero coversion at 6 months of age, its behaviour at community level may differ if the minimum required 10,ooo plaque units are not available as the immunising dose. Even though the WHO expert opined in the affirmative for below 6 months measles immunisation, the following facts should be borne in mind. 1.The maternal antibodies are in the child's circulation up to 3-4 months and hence it is not possible to immunise the baby at this age 2. Between 4 and 9 months if the 1st dose is given, booster at 15 months is mandatory in the form of MMR or isolated Measles vaccine. Reference; Immunisation in practice. Dr.A.Parthasarathy,Covenor.IAP committe on immunisation Indian journal of practical pedaitrics Vol.2No.3Jul-Sep 1994 Competing interests: None declared |
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N.P. Viswanathan, Family physician sv clinic,gmpalya,Bangalore-560075,India
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In my response titled advancement of measles vaccine to 4.5 months, please read the reference as: Immunisation in practice Dr.A.PARTHASARATHY,Convenor,IAP COMMITTE On Immunisation. Indian journal of practical pediatrics,Vol.2 No.3.Jul-Sep 1994 Thank you, N.P.Viswanathan Competing interests: None declared |
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Bedangshu Saikia, DNB Student, Pediatrics St Stephens Hspital, Delhi-110054, India, Jain Arvind
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We were surprised to find the article on Edmonston Zagreb measles vaccine in the BMJ 1 . It is well known from the previous studies that the Edmonston Zagreb vaccine has protective efficacy before the age of 9 months 2. However the use of the vaccine was abandoned when it was seen that it increased all- cause-mortality in girl children 3. The World Health Organization (WHO) working group on Expanded Programme on Immunization reviewing studies on the vaccine concluded that immunization programmes should no longer use the Edmonston Zagreb measles vaccine and that no more field trials of this vaccine should occur4. We wonder if it was ethical to do this study in the light of the findings in previous studies and the recommendation of the WHO. References 1. Martins CL, Garly ML, Bale C, Rodrigues A, Ravn H, Whittle HC, Lisse IM, Aaby P. Protective efficacy of standard Edmonston Zagreb measles vaccination in infants aged 4.5 months: interim analysis of a randomized clinical trial. BMJ 2008;337:a661 2. Markowitz LE, Sepulveda J, Diaz-Ortega JL, Valdespino JL, Albrecht P, Zell ER, Stewart J, Zarate ML, Bernier RH. Immunization of six-month-old infants with different doses of Edmonston-Zagreb and Schwarz measles vaccines. New Engl J Med 1990;322(9):580-7 3. Kabir Z, Aaby P. Non-specific Effect of Measles Vaccination on All- cause Child Mortality: Revisited. Indian Pediatrics 2005;42:541-544 4. Expanded programme on immunization. Safety of high titre measles vaccines. Wkly Epidemiol Rec. 1992;67:357-61 Competing interests: None declared |
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