Measles and Measles Vaccination: A Review

Johan Christiaan Bester

doi:10.1001/jamapediatrics.2016.1787

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顿别肠别尘产别谤听2016

Measles and Measles Vaccination: A Review

Johan Christiaan听Bester,听MBChB, MPhil^1,2

Author Affiliations Article Information

¹Department of Bioethics, Cleveland Clinic, Cleveland, Ohio
²Centre for Applied Ethics, University of Stellenbosch, Stellenbosch, South Africa

JAMA Pediatr. 2016;170(12):1209-1215. doi:10.1001/jamapediatrics.2016.1787

Key Points

Question听 What should primary care health care professionals know about measles and measles vaccination?

Findings听 This review provides an overview of measles for clinicians and includes information on virus basics, clinical picture and diagnosis, measles complications, vaccine efficacy, and vaccine complications. Health care professionals play important roles in vaccination uptake, diagnosis and management of acute cases of measles, and limiting spread during outbreaks.

Meaning听 Measles should be in the differential diagnosis of any child who presents with fever and erythematous rash, and the focus of the health care response to measles infection is prevention through vaccination.

Abstract

Importance听 Measles is a highly communicable viral infection with serious complications. There have been continued outbreaks of measles in countries in which measles is considered to be eliminated, such as the United States and the Netherlands, and measles remains endemic in some countries. Health care professionals play an important role in diagnosing and managing acute cases of measles, preventing spread during outbreaks, and vaccination uptake.

Objective听 To provide an overview of measles and vaccination for health care professionals.

Evidence Review听 MEDLINE and PubMed were searched from January 1, 1980, to April 30, 2016, in addition to the data repositories of the Centers for Disease Control and Prevention and World Health Organization.

Findings听 Seven systematic reviews, 15 reviews, 15 observational studies, 1 qualitative study, 5 epidemiologic reports, and 2 books were included, in addition to World Health Organization and Centers for Disease Control and Prevention data, position papers, and statements. Transmission of measles is dependent on person-to-person spread through respiratory droplets or direct contact. Diagnosis is based on recognizing the clinical picture and can be confirmed with results of laboratory testing, such as serologic tests or polymerase chain reaction. Measles infection leads to immune suppression for weeks to months. Complications of measles are of high frequency and severity. There is no specific antiviral treatment for measles; treatment with vitamin A is recommended for younger children to decrease mortality from measles. Vaccination against measles is effective, cost-effective, and safe. There is no link between the measles vaccination and autism. Measles can be eliminated from a population; this outcome requires coverage with 2 doses of vaccine at rates of 93% to 95% of the population. Countries with high rates of measles vaccination experience outbreaks by virtue of imported cases causing transmission through susceptible groups of individuals who are not immune to the measles virus. Endemic transmission can be reestablished if rates of vaccination fall below the elimination threshold.

Conclusions and Relevance听 Measles remains of high clinical importance. Health care professionals should be able to diagnose and manage an acute case and assist in prevention of the spread of measles during an outbreak. Health care professionals also play an important role in uptake of measles vaccination through establishing trusting relationships with parents, offering vaccination at indicated times, and engaging parents in discussion on facts and concerns about vaccination.

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Measles and Measles Vaccination: A Review