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Immunization against measles in children at risk for severe disease
Insights
Measles vaccination in children with protein-calorie-malnutrition (PCM) shows delayed antibody response but can be safe. Passive immunization is recommended for severely malnourished hospitalized children.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- Protein-calorie-malnutrition (PCM) can impact immune responses.
- Measles vaccination is crucial for child health.
- Assessing vaccine efficacy and safety in vulnerable populations is essential.
Purpose of the Study:
- To evaluate the efficacy and safety of live measles vaccine in children with PCM.
- To compare measles vaccination in malnourished versus healthy children.
- To assess the role of passive immunization in PCM.
Main Methods:
- Administered live measles vaccine to children with PCM and healthy controls.
- Monitored antibody levels and vaccine-related symptoms.
- Assessed antibody levels after passive immunization with human measles hyperimmune globulin.
Main Results:
- Live measles vaccine induced protective antibody levels in 70% of PCM children within 21 days, potentially reaching 90% by 42 days.
- Vaccine response was delayed and side effects were more frequent (64%) in PCM children.
- Human measles hyperimmune globulin maintained adequate antibody levels in 75% of PCM children for 3-4 weeks.
- Measles vaccination was protective in 83% of healthy children under 10 months.
- Significant vaccine wastage (40-70%) noted in children with pre-existing immunity.
Conclusions:
- Malnourished children in the community and the very young can be safely vaccinated against measles.
- Passive immunization is preferred for severely malnourished hospitalized children due to higher infection risk.
- Vaccination strategies should consider pre-existing immunity and nutritional status.
Abstract:
Live measles vaccine induced protective levels of antibody in 70% of children with protein-calorie-malnutrition (PCM) within 21 days and possibly in 90% by 42 days. The development of specific antibody was delayed and symptoms due to the vaccine more frequent (64%) in these children than in healthy children. Administration of measles vaccine may have predisposed to an associated fatal pneumonia in one malnourished child. Human measles hyperimmune globulin can maintain adequate antibody levels in most children with PCM (75%) for at least three to four weeks. Vaccination induced protective levels of measles antibody in 83% of healthy children under 10 months of age, which compared well with 86% of successful immunizations done at 10 months or later. There was wastage of vaccine in 40 to 70% of children who, despite a negative history of measles, had protective levels of antibody when admitted to the study. It is suggested that malnourished children in the community or the very young can be safely and effectively vaccinated against measles. But passive immunization is preferred in children with PCM severe enough to be admitted to hospital and thereby at increased risk of exposure to measles and other infections.