James. D. Cherry

Measles is a vaccine-preventable illness. Nevertheless, in recent years, measles is still endemic and epidemic in both the developed world and the developing world. The public perception of measles in the past was that it was not a big deal. However, measles is associated with a number of complications which can be places in three categories which are: acute(diarrhea, otitis media, pneumonia, encephalitis, seizures, and death) and delayed-subacute sclerosing panencephalitis (SSPE) and post-measles immune amnesia. Contrary to the beliefs of the anti-vaccine lobby, measles is bad. In acute measles, the death rate is 1–3 per 1000 and the risk of encephalitis is 1 per 1000. Relatively recent investigations indicate that SSPE is considerably more common than previously believed. The worldwide contribution of post-measles immune amnesia to morbidity and mortality is likely to be huge. In exposure situations, two doses of measles vaccine will prevent 99% of cases. Presently in the United States, the first dose is given at 12 through 15 months of age. The second dose is most often administered at 4 through 6 years of age. In my opinion, the second dose of measles vaccine should be given 4–6 weeks after the first dose rather than at 4–6 years of age. Children who don’t have antibody to measles should not travel to risk areas.

Background: Recent studies suggest measles-induced immune amnesia could have long-term immunosuppressive effects via preferential depletion of memory CD150+ lymphocytes, and associations with a 2–3 year period of increased mortality and morbidity from infectious diseases other than measles has been shown in children from wealthy and low-income countries. To further examine the associations previous measles virus infection may have on immunologic memory among children in the Democratic Republic of the Congo (DRC), we assessed tetanus antibody levels among fully vaccinated children, with and without a history of measles. Methods: We assessed 711 children 9–59 months of age whose mothers were selected for interview in the 2013–2014 DRC Demographic and Health Survey. History of measles was obtained by maternal report and classification of children who had measles in the past was completed using maternal recall and measles IgG serostatus obtained from a multiplex chemiluminescent automated immunoassay dried blood spot analysis. Tetanus IgG antibody serostatus was similarly obtained. A logistic regression model was used to identify association of measles and other predictors with subprotective tetanus IgG antibody. Results: Subprotective geometric mean concentration tetanus IgG antibody values were seen among fully vaccinated children 9–59 months of age, who had a history of measles. Controlling for potential confounding variables, children classified as measles cases were less likely to have seroprotective tetanus toxoid antibody (odds ratio: 0.21; 95% confidence interval: 0.08–0.55) compared with children who had not had measles. Conclusions: History of measles was associated with subprotective tetanus antibody among this sample of children in the DRC who were 9–59 months of age and fully vaccinated against tetanus.

Purpose of review: Pertussis is a vaccine preventable cough illness. It can be controlled by universal pertussis vaccination. Recent findings: Pertussis cases and deaths in children are at a record low number. More complete use of adolescent/adult vaccine can further reduce morbidity and mortality. Summary: Considerable progress in the control of pertussis has occurred over the last 75 years. The universal use of Tdap vaccines in all pregnant women will prevent virtually all pertussis deaths.

Skepticism and misinformation relating to vaccines is not new. The benefits of all our present routinely used vaccines outweigh any risks. In relatively recent times there has been a ‘war on science' and relating to this, is the present antivaccine movement. Today, social media is a major contributor to vaccine misinformation. A recent Gallup poll noted that public support for vaccines today is significantly lower than it was in 2001. Social scientists have presented the problem of the antivaccine movement quite well; but mechanisms for addressing it are far from clear. We suggest that physicians and other health care workers should not use social media for vaccine messages. A long-term approach would be to introduce science/epidemiological education in grade school and high school as well as in college.

Background: In utero transmission of Zika virus (ZIKV) can lead to adverse infant outcomes, but vertical transmission rates are unknown. Methods: Antenatally ZIKV-exposed children were followed prospectively since the time of the Rio de Janeiro epidemic in 2015-16. Serum and urine specimens were collected from infants from birth throughout the first year of life. Specimens were tested by quantitative reverse transcriptase polymerase chain reaction (PCR) and/or IgM antibody capture Zika MAC-ELISA. Infants had neurodevelopmental evaluations, brain imaging, eye examinations, and hearing assessments. Results: Over time 130 in utero ZIKV-exposed (mothers PCR+) children were tested with 407 specimens evaluated: 161 sera were tested by PCR and IgM assays, 85 urines by PCR; 84 children (65%) were positive in at least one assay. Among 94 children tested within 3 months of age, 70% were positive (39% serum PCR, 48% urine PCR, 39% IgM). After 3 months, 33% were positive by any laboratory method. Five children were intermittently PCR+ beyond 200 days of life. Concordance between IgM and PCR results was 52%, sensitivity 65%, specificity 40% (with any positive PCR result as the gold standard); IgM and serum PCR were 61% concordant; serum and urine PCR 55%. Most children (65%) were clinically normal. Positive results were seen in 29 of 45 children (64%) with abnormal findings and 55 of 85 normal children (65%), p=0·98. Earlier maternal trimester of infection was associated with positive infant laboratory results but not infant clinical disease (p=0·04). Conclusions: ZIKV has a high in utero transmission rate. Laboratory confirmed infection is not necessarily associated with abnormal infant findings.

Introduction: Today, in the developed world, virtually all deaths due to Bordetella pertussis illnesses occur in young infants. Therefore, it is important to discuss severe pertussis and its prevention. Areas Covered: These infant deaths are frequently misdiagnosed. Pertussis in young infants is characterized by an afebrile cough illness with coryza, apnea, seizures, cyanosis and emesis. Severe illness is associated with high leukocyte and lymphocyte counts, rapid respiratory and cardiac rates and pneumonia. The main treatment for severe pertussis in young infants is exchange blood transfusion. Many routine intensive care treatment procedures are detrimental: these include steroids and nitric oxide. Preventative measures include: quarantine, prophylactic antimicrobial agents and immunizations of the mother to be with Tdap between 27 and 36 weeks gestation. Expert Opinion: Infants deaths are due to the irreversible pulmonary hypertension which is caused by aggregates of leukocytes in the small vessels in the lung. The leukocytosis with lymphocytosis is due to pertussis toxin. It can be treated by exchange blood transfusions. However for this to be successful it needs to be started before shock or organ failure has occurred. To prevent pertussis in young infants, attention needs to be directed to the diagnosis and treatment of pertussis in adolescents and adults. Also important in prevention of infant pertussis are antimicrobial prophylaxis in the infant and the immunization of mothers to be with Tdap vaccine during all pregnancies.

Measles vaccine failure was first described in 1972. Over the next 20 years, vaccine failure was extensively studied, but during the last 25 years few investigations have been performed. We describe the clinical characteristics of measles in previously vaccinated and unvaccinated patients in California. All confirmed measles cases reported to the California Department of Public Health from 1 January 2000 through 31 December 2015 were reviewed. Clinical characteristics (rates of hospitalization, cough, coryza, conjunctivitis, and fever) were compared between the previously unvaccinated, those who had had 1 dose of vaccine, and those who had had ≥2 doses of measles vaccine. There were 232 confirmed measles cases in whom vaccination status was verified; 80% were unvaccinated, 9% had had 1 dose of measles vaccine, and 11% had had ≥2 doses of measles vaccine. Subjects who had had ≥2 doses of measles vaccine had lower rates of hospitalization, cough, coryza, conjunctivitis, and fever than subjects who had 1 dose of measles vaccine or who were unimmunized. Vaccine failure measles cases were less ill than cases that occurred in unvaccinated patients. Nevertheless, these cases still required the same amount of public health effort in tracing contacts as in cases who were unvaccinated.