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Washam MC, Leber AL, Oyeniran SJ, Everhart K, Wang H. Shedding of measles vaccine RNA in children after receiving measles, mumps and rubella vaccination. J Clin Virol 2024; 173:105696. [PMID: 38823291 DOI: 10.1016/j.jcv.2024.105696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/15/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Measles, mumps, and rubella(MMR) vaccination is critical to measles outbreak responses. However, vaccine reactions and detection of measles vaccine RNA in recently immunized persons may complicate case classification especially in those presenting with another respiratory viral illness. We aim to characterize cases of measles vaccine shedding in recently vaccinated children presenting with respiratory viral symptoms. METHODS Children who were tested with a multiplex respiratory panel <30 days after receiving MMR were identified. Remnant nasopharyngeal(NP) samples were tested for measles vaccine by PCR. Medical records were reviewed for demographics, presenting symptoms, and test results. RESULTS From January 2022 to March 2023, 127 NP from children who received MMR were tested. Ninety-six NP were collected after the first dose, of which 33(34.4 %) were positive for vaccine RNA. The median interval between MMR and detection was 11.0 days. Thirty-one NP were collected after the second MMR and 1(3.2 %) was positive; time between the vaccination and detection was 18.9 days. Median cycle threshold(Ct) value of the measles PCR for vaccine shedding was significantly higher than median Ct in children with wild-type infection. CONCLUSION Shedding of measles vaccine RNA is not uncommon and vaccine RNA can be detected up to 29 days post MMR; the amount of vaccine RNA shedding is low indicated by high Ct values. Clinicians and public health officials should consider performing measles vaccine testing on those testing positive for measles within one month of MMR vaccination, especially if the Ct value is high and definitive epidemiological links are absent.
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Affiliation(s)
- Matthew C Washam
- Department of Pediatrics, Division of Infectious Diseases, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Amy L Leber
- Department of Pediatrics, Division of Infectious Diseases, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA; Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Sophonie J Oyeniran
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Kathy Everhart
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Huanyu Wang
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pathology, The Ohio State University, Columbus, Ohio, USA.
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Kuba Y, Nidaira M, Maeshiro N, Komase K, Kamiya H, Kyan H. Analysis of Suspected Measles Cases with Discrepant Measles-Specific IgM and rRT-PCR Test Results, Japan. Emerg Infect Dis 2024; 30:926-933. [PMID: 38579738 PMCID: PMC11060445 DOI: 10.3201/eid3005.231757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
We investigated clinically suspected measles cases that had discrepant real-time reverse transcription PCR (rRT-PCR) and measles-specific IgM test results to determine diagnoses. We performed rRT-PCR and measles-specific IgM testing on samples from 541 suspected measles cases. Of the 24 IgM-positive and rRT-PCR--negative cases, 20 were among children who received a measles-containing vaccine within the previous 6 months; most had low IgG relative avidity indexes (RAIs). The other 4 cases were among adults who had an unknown previous measles history, unknown vaccination status, and high RAIs. We detected viral nucleic acid for viruses other than measles in 15 (62.5%) of the 24 cases with discrepant rRT-PCR and IgM test results. Measles vaccination, measles history, and contact history should be considered in suspected measles cases with discrepant rRT-PCR and IgM test results. If in doubt, measles IgG avidity and PCR testing for other febrile exanthematous viruses can help confirm or refute the diagnosis.
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Affiliation(s)
| | - Minoru Nidaira
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
| | - Noriyuki Maeshiro
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
| | - Katsuhiro Komase
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
| | - Hajime Kamiya
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
| | - Hisako Kyan
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
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Aizawa Y, Katsuta T, Sakiyama H, Tanaka-Taya K, Moriuchi H, Saitoh A. Changes in childhood vaccination during the coronavirus disease 2019 pandemic in Japan. Vaccine 2021; 39:4006-4012. [PMID: 34059371 PMCID: PMC8139263 DOI: 10.1016/j.vaccine.2021.05.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 12/17/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has greatly affected daily life. COVID-19 often causes asymptomatic or mild disease in children; however, delayed routine childhood immunization is a concern, as it could increase the risk of vaccine-preventable disease. No study has evaluated the status of childhood vaccinations in Japan during the COVID-19 pandemic. Methods This retrospective observational study evaluated the number of vaccine doses administered to children in 4 Japanese cities (2 cities in the Tokyo metropolitan area and 2 cities far from Tokyo) during the period from 2016 to 2020. Vaccine doses administered between January and September 2020 during the COVID-19 pandemic were compared, by month, with those given during 2016–2019. Age-stratified demographic data were collected to determine whether factors other than change in the child population over time affected vaccination trends. Results In all cities the decrease in vaccine doses administered was most apparent in March and April 2020, i.e., just before or coincident with the declaration of a nationwide COVID-19 emergency on April 7, 2020. The decrease started as early as February in the Tokyo metropolitan area. As child age increased, the decrease became more apparent. Before the lift of national emergency on May 25, catch-up of the vaccination was observed in all age groups in all cities. Vaccine doses persistently increased in older age groups but not in infants. The overall vaccination trends did not differ significantly among the 4 cities. Conclusions The COVID-19 pandemic significantly affected routine childhood immunization in Japan. Thus, a nationwide electronic surveillance system and announcements for guardians to encourage timely routine immunization are warranted.
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Affiliation(s)
- Yuta Aizawa
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; The Committee on Immunization, Medical Association of Niigata City, Niigata, Japan
| | - Tomohiro Katsuta
- Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan; The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan
| | - Hiroshi Sakiyama
- Department of Pediatrics, Sakiyama Children's Clinic, Tokyo, Japan
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan; The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan.
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Schwob JM, Samer CF, Lalive PH, Eperon GA. Live vaccines and immunosuppressive monoclonal antibodies: weighing up the benefit-risk assessment for natalizumab. J Travel Med 2021; 28:6050939. [PMID: 33367888 DOI: 10.1093/jtm/taaa235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Jean-Marc Schwob
- Division of Tropical and Humanitarian Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Caroline F Samer
- Division of Clinical Pharmacology and Toxicology, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Swiss Centre for Applied Human Toxicology, Geneva, Switzerland
| | - Patrice H Lalive
- Department of Neurosciences, Division of Neurology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Diagnostic, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Gilles A Eperon
- Division of Tropical and Humanitarian Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
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Measles Vaccine-Associated Rash Illness in China: an Emerging Issue in the Process of Measles Elimination. J Clin Microbiol 2020; 58:JCM.01472-20. [PMID: 32878947 DOI: 10.1128/jcm.01472-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/24/2020] [Indexed: 11/20/2022] Open
Abstract
Along with the implementation of measles case-based surveillance, measles vaccine-associated rash illness (VARI) cases were detected in China. To better understand the characteristics of VARI, 101 VARI cases confirmed by measles virus genotyping in 2011 to 2018 were analyzed in this study. With the decrease in measles incidence, the detection rate of VARI cases increased among the cases confirmed by genotyping. Compared with genotype H1 wild-type measles, VARI occurred throughout the year, without obvious seasonal distribution. Infants and children of ages 8 to 23 months were the main population of VARI. VARI mainly occurred within 14 days after measles vaccination. The number of VARI cases peaked on the 8th day after measles vaccination, which was later than that of genotype H1 wild-type measles cases with a measles vaccination history. VARI presents clinical symptoms similar to those of measles. The frequencies of the "3Cs" (cough, coryza, and conjunctivitis), Koplik spots, and complications in VARI cases were significantly lower than those in wild-type measles cases. In total, 94.06% of sequences from VARI cases were identical to measles vaccine strain S191 in the C-terminal 450-nucleotide sequence of the nucleoprotein (N-450) gene. A few substitutions were found in N-450 sequences of the VARI cases. The confirmation of VARI has become an emerging issue in the process of measles elimination. Rapid confirmation of VARI is critical for measles surveillance and will help to determine the response measures for measles, especially in measles preelimination and elimination settings. The suspected measles cases with measles-containing vaccine (MCV) vaccination were recommended to be tested by the laboratory to identify wild-type measles or VARI.
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