The Experts below are selected from a list of 252 Experts worldwide ranked by ideXlab platform
May-lill Garly - One of the best experts on this subject based on the ideXlab platform.
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a randomized trial of a standard dose of edmonston zagreb Measles Vaccine given at 4 5 months of age effect on total hospital admissions
The Journal of Infectious Diseases, 2014Co-Authors: Cesario Martins, Peter Aaby, Christine Stabell Benn, Andreas Andersen, Carlito Bale, Frederik Schaltzbuchholzer, Amabelia Rodrigues, Henrik Ravn, Hilton Whittle, May-lill GarlyAbstract:Observational studies and trials from low-income countries indicate that Measles Vaccine has beneficial nonspecific effects, protecting against non–Measles-related mortality. It is not known whether Measles Vaccine protects against hospital admissions. Between 2003 and 2007, 6417 children who had received the third dose of diphtheria, tetanus, and pertussis Vaccine were randomly assigned to receive Measles Vaccine at 4.5 months or no Measles Vaccine; all children were offered Measles Vaccine at 9 months of age. Using hospital admission data from the national pediatric ward in Bissau, Guinea-Bissau, we compared admission rates between enrollment and the 9-month vaccination in Cox models, providing admission hazard rate ratios (HRRs) for Measles Vaccine versus no Measles Vaccine. All analyses were conducted stratified by sex and reception of neonatal vitamin A supplementation (NVAS). Before enrollment the 2 groups had similar admission rates. Following enrollment, the Measles Vaccine group had an admission HRR of 0.70 (95% confidence interval [CI], .52–.95), with a ratio of 0.53 (95% CI, .32–.86) for girls and 0.86 (95% CI, .58–1.26) for boys. For children who had not received NVAS, the admission HRR was 0.53 (95% CI, .34–.84), with an effect of 0.30 (95% CI, .13–.70) for girls and 0.73 (95% CI, .42–1.28) for boys (P= .08, interaction test). The reduction in admissions was separately significant for Measles infection (admission HRR, 0 [95% CI, 0–.24]) and respiratory infections (admission HRR, 0.37 [95% CI, .16–.89]). Early Measles Vaccine may have major benefits for infant morbidity patterns and healthcare costs. Clinical trials registration. NCT00168558.
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non specific effects of standard Measles Vaccine at 4 5 and 9 months of age on childhood mortality randomised controlled trial
BMJ, 2010Co-Authors: Peter Aaby, May-lill Garly, Cesario Martins, Christine Stabell Benn, Andreas Andersen, Carlito Bale, Amabelia Rodrigues, Henrik Ravn, Ida Maria Lisse, Hilton WhittleAbstract:Objective To examine in a randomised trial whether a 25% difference in mortality exists between 4.5 months and 3 years of age for children given two standard doses of Edmonston-Zagreb Measles Vaccines at 4.5 and 9 months of age compared with those given one dose of Measles Vaccine at 9 months of age (current policy). Design Randomised controlled trial. Setting The Bandim Health Project, Guinea-Bissau, which maintains a health and demographic surveillance system in an urban area. Participants 6648 children aged 4.5 months of age who had received three doses of diphtheria-tetanus-pertussis Vaccine at least four weeks before enrolment. A large proportion of the children (80%) had previously taken part in randomised trials of neonatal vitamin A supplementation. Intervention Children were randomised to receive Edmonston-Zagreb Measles Vaccine at 4.5 and 9 months of age (group A), no Vaccine at 4.5 months and Edmonston-Zagreb Measles Vaccine at 9 months of age (group B), or no Vaccine at 4.5 months and Schwarz Measles Vaccine at 9 months of age (group C). Mainoutcomemeasure Mortality rate ratio between 4.5 and 36 months of age for group A compared with groups B and C. Secondary outcomes tested the hypothesis that the beneficial effect was stronger in the 4.5 to 9 months age group, in girls, and in the dry season, but the study was not powered to test whether effects differed significantly between subgroups. Results In the intention to treat analysis of mortality between 4.5 and 36 months of age the mortality rate ratio of children who received two doses of Edmonston-Zagreb Vaccine at 4.5 and 9 months of age compared with those who received a single dose of Edmonston-Zagreb Vaccine or Schwarz Vaccine at 9 months of age was 0.78 (95% confidence interval 0.59 to 1.05). In the analyses of secondary outcomes, the intention to treat mortality rate ratio was 0.67 (0.38 to 1.19) between 4.5 and 9 months and 0.83 (0.83 to 1.16) between 9 and 36 months of age. The effect on mortality between 4.5 and 36 months of age was significant for girls (intention to treat mortality rate ratio 0.64 (0.42 to 0.98)), although this was not significantly different from the effect in boys (0.95 (0.64 to 1.42)) (interaction test, P=0.18). The effect did not differ between the dry season and the rainy season. As neonatal vitamin A supplementation is not WHO policy, the analyses were done separately for the 3402 children who did not receive neonatal vitamin A. In these children, the two dose Edmonston-Zagreb Measles Vaccine schedule was associated with a significantly lower mortality between 4.5 and 36 months of age (intention to treat mortality rate ratio 0.59 (0.39 to 0.89)). The effect was again significant for girls but not statistically significant from the effect in boys. When Measles cases were censored, the intention to treat mortality rate ratio was 0.65 (0.43 to 0.99). Conclusions Although the overall effect did not reach statistical significance, the results may indicate that a two dose schedule with Edmonston-Zagreb Measles Vaccine given at 4.5 and 9 months of age has beneficial non-specific effects on children’s survival, particularly for girls and for children who have not received neonatal vitamin A. This should be tested in future studies in different locations. Trial registration Clinical trials NCT00168558.
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The challenge of improving the efficacy of Measles Vaccine.
Acta tropica, 2003Co-Authors: May-lill Garly, Peter AabyAbstract:Despite a safe and effective Measles Vaccine, Measles still claims an estimated 800 000 lives per year mostly among children in developing countries. This paper deals with strategies to improve Vaccine efficacy and prevent unnecessary deaths, including considerations of one dose at 9 months strategy for developing countries, strain of Vaccine, potency and number of doses of Measles Vaccine. After more than 20 years of Measles immunisation in the developing world, the epidemiology of Measles is radically changed, and the absence of Measles epidemics might lead to waning immunity due to less clinical and subclinical infections boosting the antibody level. An increasing proportion of mothers are vaccinated, thus transferring a lower maternal antibody level to their infants who will be susceptible to Measles at a younger age. The strategies to limit nosocomial Measles infection and spread of Measles epidemics are reviewed. Though the Measles elimination programmes have been very effective in the Americas, it seems unlikely that they will be equally effective in the rest of the world. Even if eradication should be possible, it might be unwise to stop Measles vaccination because the Vaccine apparently has beneficial effects and because it would make Measles a likely weapon for bio-terrorism. If we are unlikely to get rid of Measles and Measles Vaccine, it might be wise to study further some of the many unanswered questions regarding the long-term effects of Measles and Measles vaccination.
Peter Aaby - One of the best experts on this subject based on the ideXlab platform.
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a randomized trial of a standard dose of edmonston zagreb Measles Vaccine given at 4 5 months of age effect on total hospital admissions
The Journal of Infectious Diseases, 2014Co-Authors: Cesario Martins, Peter Aaby, Christine Stabell Benn, Andreas Andersen, Carlito Bale, Frederik Schaltzbuchholzer, Amabelia Rodrigues, Henrik Ravn, Hilton Whittle, May-lill GarlyAbstract:Observational studies and trials from low-income countries indicate that Measles Vaccine has beneficial nonspecific effects, protecting against non–Measles-related mortality. It is not known whether Measles Vaccine protects against hospital admissions. Between 2003 and 2007, 6417 children who had received the third dose of diphtheria, tetanus, and pertussis Vaccine were randomly assigned to receive Measles Vaccine at 4.5 months or no Measles Vaccine; all children were offered Measles Vaccine at 9 months of age. Using hospital admission data from the national pediatric ward in Bissau, Guinea-Bissau, we compared admission rates between enrollment and the 9-month vaccination in Cox models, providing admission hazard rate ratios (HRRs) for Measles Vaccine versus no Measles Vaccine. All analyses were conducted stratified by sex and reception of neonatal vitamin A supplementation (NVAS). Before enrollment the 2 groups had similar admission rates. Following enrollment, the Measles Vaccine group had an admission HRR of 0.70 (95% confidence interval [CI], .52–.95), with a ratio of 0.53 (95% CI, .32–.86) for girls and 0.86 (95% CI, .58–1.26) for boys. For children who had not received NVAS, the admission HRR was 0.53 (95% CI, .34–.84), with an effect of 0.30 (95% CI, .13–.70) for girls and 0.73 (95% CI, .42–1.28) for boys (P= .08, interaction test). The reduction in admissions was separately significant for Measles infection (admission HRR, 0 [95% CI, 0–.24]) and respiratory infections (admission HRR, 0.37 [95% CI, .16–.89]). Early Measles Vaccine may have major benefits for infant morbidity patterns and healthcare costs. Clinical trials registration. NCT00168558.
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non specific effects of standard Measles Vaccine at 4 5 and 9 months of age on childhood mortality randomised controlled trial
BMJ, 2010Co-Authors: Peter Aaby, May-lill Garly, Cesario Martins, Christine Stabell Benn, Andreas Andersen, Carlito Bale, Amabelia Rodrigues, Henrik Ravn, Ida Maria Lisse, Hilton WhittleAbstract:Objective To examine in a randomised trial whether a 25% difference in mortality exists between 4.5 months and 3 years of age for children given two standard doses of Edmonston-Zagreb Measles Vaccines at 4.5 and 9 months of age compared with those given one dose of Measles Vaccine at 9 months of age (current policy). Design Randomised controlled trial. Setting The Bandim Health Project, Guinea-Bissau, which maintains a health and demographic surveillance system in an urban area. Participants 6648 children aged 4.5 months of age who had received three doses of diphtheria-tetanus-pertussis Vaccine at least four weeks before enrolment. A large proportion of the children (80%) had previously taken part in randomised trials of neonatal vitamin A supplementation. Intervention Children were randomised to receive Edmonston-Zagreb Measles Vaccine at 4.5 and 9 months of age (group A), no Vaccine at 4.5 months and Edmonston-Zagreb Measles Vaccine at 9 months of age (group B), or no Vaccine at 4.5 months and Schwarz Measles Vaccine at 9 months of age (group C). Mainoutcomemeasure Mortality rate ratio between 4.5 and 36 months of age for group A compared with groups B and C. Secondary outcomes tested the hypothesis that the beneficial effect was stronger in the 4.5 to 9 months age group, in girls, and in the dry season, but the study was not powered to test whether effects differed significantly between subgroups. Results In the intention to treat analysis of mortality between 4.5 and 36 months of age the mortality rate ratio of children who received two doses of Edmonston-Zagreb Vaccine at 4.5 and 9 months of age compared with those who received a single dose of Edmonston-Zagreb Vaccine or Schwarz Vaccine at 9 months of age was 0.78 (95% confidence interval 0.59 to 1.05). In the analyses of secondary outcomes, the intention to treat mortality rate ratio was 0.67 (0.38 to 1.19) between 4.5 and 9 months and 0.83 (0.83 to 1.16) between 9 and 36 months of age. The effect on mortality between 4.5 and 36 months of age was significant for girls (intention to treat mortality rate ratio 0.64 (0.42 to 0.98)), although this was not significantly different from the effect in boys (0.95 (0.64 to 1.42)) (interaction test, P=0.18). The effect did not differ between the dry season and the rainy season. As neonatal vitamin A supplementation is not WHO policy, the analyses were done separately for the 3402 children who did not receive neonatal vitamin A. In these children, the two dose Edmonston-Zagreb Measles Vaccine schedule was associated with a significantly lower mortality between 4.5 and 36 months of age (intention to treat mortality rate ratio 0.59 (0.39 to 0.89)). The effect was again significant for girls but not statistically significant from the effect in boys. When Measles cases were censored, the intention to treat mortality rate ratio was 0.65 (0.43 to 0.99). Conclusions Although the overall effect did not reach statistical significance, the results may indicate that a two dose schedule with Edmonston-Zagreb Measles Vaccine given at 4.5 and 9 months of age has beneficial non-specific effects on children’s survival, particularly for girls and for children who have not received neonatal vitamin A. This should be tested in future studies in different locations. Trial registration Clinical trials NCT00168558.
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The challenge of improving the efficacy of Measles Vaccine.
Acta tropica, 2003Co-Authors: May-lill Garly, Peter AabyAbstract:Despite a safe and effective Measles Vaccine, Measles still claims an estimated 800 000 lives per year mostly among children in developing countries. This paper deals with strategies to improve Vaccine efficacy and prevent unnecessary deaths, including considerations of one dose at 9 months strategy for developing countries, strain of Vaccine, potency and number of doses of Measles Vaccine. After more than 20 years of Measles immunisation in the developing world, the epidemiology of Measles is radically changed, and the absence of Measles epidemics might lead to waning immunity due to less clinical and subclinical infections boosting the antibody level. An increasing proportion of mothers are vaccinated, thus transferring a lower maternal antibody level to their infants who will be susceptible to Measles at a younger age. The strategies to limit nosocomial Measles infection and spread of Measles epidemics are reviewed. Though the Measles elimination programmes have been very effective in the Americas, it seems unlikely that they will be equally effective in the rest of the world. Even if eradication should be possible, it might be unwise to stop Measles vaccination because the Vaccine apparently has beneficial effects and because it would make Measles a likely weapon for bio-terrorism. If we are unlikely to get rid of Measles and Measles Vaccine, it might be wise to study further some of the many unanswered questions regarding the long-term effects of Measles and Measles vaccination.
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randomised trial of effect of vitamin a supplementation on antibody response to Measles Vaccine in guinea bissau west africa
The Lancet, 1997Co-Authors: Christine Stabell Benn, Peter Aaby, Carlitos Bale, Jorn Olsen, Kim F Michaelsen, Elisha George, Hilton WhittleAbstract:Summary Background WHO has recommended vitamin A supplementation for children aged 6 months or older in developing countries at the same time as immunisation. One study has reported significantly lower seroconversion ratios among children who have received vitamin A supplements with Measles Vaccine at age 6 months. The aim of our study was to assess the effect of vitamin A supplementation on antibody response to Measles vaccination at age 9 months, which is the more common age for immunisation in developing countries. Methods In an urban community in Guinea-Bissau, we did a randomised, double-blind, placebo-controlled study of the effect of simultaneous vaccination and vitamin A supplementation in 462 children who received either a two-dose schedule of Measles Vaccine at the ages of 6 months and 9 months (150 infants) or one dose of Measles Vaccine at age 9 months (312 infants). Children were followed up to the age of 18 months and a blood sample was then collected to assess the antibody response. Findings 397 (86%) of the children took part in the follow-up (52 [11%] had moved and 13 [3%] had died). Among children who received a two-dose Vaccine schedule, seroconversion was 98%. There was no difference in seroconversion or geometric mean titre (GMT) for children receiving vitamin A compared with children receiving no supplement. Among children receiving only one dose of Measles Vaccine at age 9 months, seroconversion was 95%. The GMT was significantly higher in children receiving vitamin A than in those receiving no supplement (3704 vs 2439 mlU; GMT ratio 1·52 [1·22–1·88]). The effect on plasma antibody concentration in the blood was stronger for boys (3902 vs 1916 mlU; GMT ratio 2·04 [1·53–2·72]) than for girls (3502 vs 3017 mlU; GMT ratio 1·16 [0·85–1·58]) who had received vitamin A with Measles Vaccine. In a multivariate analysis of variance adjusted for sex, vitamin A supplementation was associated with higher antibody titres (p Interpretation There is no indication that simultaneous administration of Measles Vaccine and vitamin A supplements has a negative effect on Measles immunity. Among the children who had received two doses of Measles Vaccine at the ages of 6 months and 9 months, supplements of vilamin A had no significant effect. Among children only receiving one dose of Measles Vaccine at age 9 months, 100000 IU vitamin A increased antibody concentrations, especially for boys.
Ana Maria Henao Restrepo - One of the best experts on this subject based on the ideXlab platform.
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immunogenicity and safety of aerosolized Measles Vaccine systematic review and meta analysis
Vaccine, 2008Co-Authors: Nicola Low, Sibylle Kraemer, Martin Schneider, Ana Maria Henao RestrepoAbstract:Aerosols are the most promising non-injectable method of Measles vaccination studied so far and their efficacy is thought to be comparable to injected Vaccine. We conducted a systematic review up to May 2006 to examine the immunogenicity and safety of aerosolized Measles Vaccine (Edmonston-Zagreb or Schwarz strains) 1 month or more after vaccination. Where possible we estimated pooled serological response rates and odds ratios (with 95% confidence intervals, CI) comparing aerosolized and subcutaneous Vaccines in children in three age groups and adults. We included seven randomized trials, four non-randomized trials and six uncontrolled studies providing serological outcome data on 2887 individuals. In children below 10 months, the studies were heterogeneous. In four comparative studies, seroconversion rates were lower with aerosolized than with subcutaneous Vaccine and in two of these the difference was unlikely to be due to chance. In children 10-36 months, the pooled seroconversion rate with aerosolized Vaccine was 93.5% (89.4-97.7%) and 97.1% (92.4-100%) with subcutaneous Vaccine (odds ratio 0.27, 0.04-1.62). In 5-15-year olds the studies were heterogeneous. In all comparative studies aerosolized Vaccine was more immunogenic than subcutaneous. Reported side effects were mild. Aerosolized Measles Vaccine appears to be equally or more immunogenic than subcutaneous Vaccine in children aged 10 months and older. Large randomized trials are needed to establish the efficacy and safety of aerosolized Measles Vaccine as primary and booster doses.
Gregory A. Poland - One of the best experts on this subject based on the ideXlab platform.
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genome wide associations of cd46 and ifi44l genetic variants with neutralizing antibody response to Measles Vaccine
Human Genetics, 2017Co-Authors: Iana H. Haralambieva, Richard B. Kennedy, Inna G. Ovsyannikova, Daniel J Schaid, Beth R Larrabee, Michael T Zimmermann, Diane E Grill, Gregory A. PolandAbstract:Population-based studies have revealed 2–10% Measles Vaccine failure rate even after two Vaccine doses. While the mechanisms behind this remain unknown, we hypothesized that host genetic factors are likely to be involved. We performed a genome-wide association study of Measles specific neutralizing antibody and IFNγ ELISPOT response in a combined sample of 2872 subjects. We identified two distinct chromosome 1 regions (previously associated with MMR-related febrile seizures), associated with Vaccine-induced Measles neutralizing antibody titers. The 1q32 region contained 20 significant SNPs in/around the Measles virus receptor-encoding CD46 gene, including the intronic rs2724384 (p value = 2.64 × 10−09) and rs2724374 (p value = 3.16 × 10−09) SNPs. The 1q31.1 region contained nine significant SNPs in/around IFI44L, including the intronic rs1333973 (p value = 1.41 × 10−10) and the missense rs273259 (His73Arg, p value = 2.87 × 10−10) SNPs. Analysis of differential exon usage with mRNA-Seq data and RT-PCR suggests the involvement of rs2724374 minor G allele in the CD46 STP region exon B skipping, resulting in shorter CD46 isoforms. Our study reveals common CD46 and IFI44L SNPs associated with Measles-specific humoral immunity, and highlights the importance of alternative splicing/virus cellular receptor isoform usage as a mechanism explaining inter-individual variation in immune response after live Measles Vaccine.
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a large population based association study between hla and kir genotypes and Measles Vaccine antibody responses
PLOS ONE, 2017Co-Authors: Inna G. Ovsyannikova, Iana H. Haralambieva, Richard B. Kennedy, Daniel J Schaid, Beth R Larrabee, Gregory A. PolandAbstract:Human antibody response to Measles Vaccine is highly variable in the population. Host genes contribute to inter-individual antibody response variation. The killer cell immunoglobulin-like receptors (KIR) are recognized to interact with HLA molecules and possibly influence humoral immune response to viral antigens. To expand on and improve our previous work with HLA genes, and to explore the genetic contribution of KIR genes to the inter-individual variability in Measles Vaccine-induced antibody responses, we performed a large population-based study in 2,506 healthy immunized subjects (ages 11 to 41 years) to identify HLA and KIR associations with Measles Vaccine-induced neutralizing antibodies. After correcting for the large number of statistical tests of allele effects on Measles-specific neutralizing antibody titers, no statistically significant associations were found for either HLA or KIR loci. However, suggestive associations worthy of follow-up in other cohorts include B*57:01, DQB1*06:02, and DRB1*15:05 alleles. Specifically, the B*57:01 allele (1,040 mIU/mL; p = 0.0002) was suggestive of an association with lower Measles antibody titer. In contrast, the DQB1*06:02 (1,349 mIU/mL; p = 0.0004) and DRB1*15:05 (2,547 mIU/mL; p = 0.0004) alleles were suggestive of an association with higher Measles antibodies. Notably, the associations with KIR genotypes were strongly nonsignificant, suggesting that KIR loci in terms of copy number and haplotypes are not likely to play a major role in antibody response to Measles vaccination. These findings refine our knowledge of the role of HLA and KIR alleles in Measles Vaccine-induced immunity.
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Variability in Humoral Immunity to Measles Vaccine: New Developments
Trends in molecular medicine, 2015Co-Authors: Iana H. Haralambieva, Richard B. Kennedy, Inna G. Ovsyannikova, Jennifer A. Whitaker, Gregory A. PolandAbstract:Despite the existence of an effective Measles Vaccine, resurgence in Measles cases in the USA and across Europe has occurred, including in individuals vaccinated with two doses of the Vaccine. Host genetic factors result in inter-individual variation in Measles Vaccine-induced antibodies, and play a role in Vaccine failure. Studies have identified HLA (human leukocyte antigen) and non-HLA genetic influences that individually or jointly contribute to the observed variability in the humoral response to vaccination among healthy individuals. In this exciting era, new high-dimensional approaches and techniques including vaccinomics, systems biology, GWAS, epitope prediction and sophisticated bioinformatics/statistical algorithms provide powerful tools to investigate immune response mechanisms to the Measles Vaccine. These might predict, on an individual basis, outcomes of acquired immunity post Measles vaccination.
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the genetic basis for interindividual immune response variation to Measles Vaccine new understanding and new Vaccine approaches
Expert Review of Vaccines, 2013Co-Authors: Iana H. Haralambieva, Richard B. Kennedy, Inna G. Ovsyannikova, Shane V Pankratz, Robert M Jacobson, Gregory A. PolandAbstract:The live-attenuated Measles Vaccine is effective, but Measles outbreaks still occur in vaccinated populations. This warrants elucidation of the determinants of Measles Vaccine-induced protective immunity. Interindividual variability in markers of Measles Vaccine-induced immunity, including neutralizing antibody levels, is regulated in part by host genetic factor variations. This review summarizes recent advances in our understanding of Measles Vaccine immunogenetics relative to the perspective of developing better Measles Vaccines. Important genetic regulators of Measles Vaccine-induced immunity, such as HLA class I and HLA class II genotypes, single nucleotide polymorphisms in cytokine/cytokine receptor genes (IL12B, IL12RB1, IL2, IL10) and the cell surface Measles virus receptor CD46 gene, have been identified and independently replicated. New technologies present many opportunities for identification of novel genetic signatures and genetic architectures. These findings help explain a variety of immune response-related phenotypes and promote a new paradigm of 'vaccinomics' for novel Vaccine development.
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the association of class i hla alleles and antibody levels after a single dose of Measles Vaccine
Human Immunology, 2003Co-Authors: Robert M Jacobson, Gregory A. Poland, Shane V Pankratz, Daniel J Schaid, Robert A Vierkant, Steven J Jacobsen, Jennifer L St Sauver, Breanndan S MooreAbstract:Abstract Despite the success of the current Measles Vaccine in controlling disease in industrialized countries, the importance of Vaccine failure has become increasingly apparent. Our objective was to determine if associations exist between seronegativity after Measles vaccination and class I human leukocyte antigen (HLA) alleles. We undertook a cross-sectional observational study in Rochester, Minnesota, with 242 school-age children previously recruited from a communitywide seroprevalence study. We studied two groups of subjects: 72 were seronegative (EIA ≤0.8 after a single dose of Measles Vaccine) and 170 were seropositive (enzyme immunoassy [EIA] ≥1.0 after one dose). We used the resources of Mayo Clinic’s tissue typing laboratory for serotyping class I HLA-A and HLA-B alleles via microlymphocytotoxicity assays. We found no statistically significant associations with class I HLA-A but did find associations with class I HLA-B, which includes alleles associated with seronegativity (B8, B13, and B44) and those associated with seropositivity (B7 and B51). Elucidation of the specific peptide-HLA complex interactions that lead to varying or failed immune responses may provide fertile groundwork for improved Vaccines that can overcome limitations of the current live, attenuated Measles Vaccine.
Nicola Low - One of the best experts on this subject based on the ideXlab platform.
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immunogenicity and safety of aerosolized Measles Vaccine systematic review and meta analysis
Vaccine, 2008Co-Authors: Nicola Low, Sibylle Kraemer, Martin Schneider, Ana Maria Henao RestrepoAbstract:Aerosols are the most promising non-injectable method of Measles vaccination studied so far and their efficacy is thought to be comparable to injected Vaccine. We conducted a systematic review up to May 2006 to examine the immunogenicity and safety of aerosolized Measles Vaccine (Edmonston-Zagreb or Schwarz strains) 1 month or more after vaccination. Where possible we estimated pooled serological response rates and odds ratios (with 95% confidence intervals, CI) comparing aerosolized and subcutaneous Vaccines in children in three age groups and adults. We included seven randomized trials, four non-randomized trials and six uncontrolled studies providing serological outcome data on 2887 individuals. In children below 10 months, the studies were heterogeneous. In four comparative studies, seroconversion rates were lower with aerosolized than with subcutaneous Vaccine and in two of these the difference was unlikely to be due to chance. In children 10-36 months, the pooled seroconversion rate with aerosolized Vaccine was 93.5% (89.4-97.7%) and 97.1% (92.4-100%) with subcutaneous Vaccine (odds ratio 0.27, 0.04-1.62). In 5-15-year olds the studies were heterogeneous. In all comparative studies aerosolized Vaccine was more immunogenic than subcutaneous. Reported side effects were mild. Aerosolized Measles Vaccine appears to be equally or more immunogenic than subcutaneous Vaccine in children aged 10 months and older. Large randomized trials are needed to establish the efficacy and safety of aerosolized Measles Vaccine as primary and booster doses.