Measles vaccine

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Vaccination coverage rates worldwide in 2007
Measles Infections in the United States. Two measles vaccines were used from 1963 onwards.
Measles infections in England and Wales. The measles vaccine was used from 1968.

A measles vaccine is a vaccine against infections with the measles virus . The measles vaccine in today's version is on the World Health Organization's list of Essential Medicines .

properties

The first approved measles vaccine was an inactivated subunit vaccine , whereas today mostly a live attenuated measles vaccine (vaccine strain Moraten of English more attenuated Edmonston / Enders strain , or black or Edmonston / Enders in Germany) is used, which is administered at most twice. The measles vaccine was first approved in the USA in 1963 for the inactivated measles vaccine and an attenuated live vaccine ( Edmonston B vaccine strain ). Approvals in other countries followed in the 1960s. The inactivated measles vaccine was used from 1963 to 1967 and replaced by the attenuated measles vaccine. From the Edmonston B strain, further vaccine strains were subsequently generated, such as Edmonston / Enders (1968), Schwarz, Connaught, AIK-C, Moraten and Edmonston-Zagreb. Measles vaccines Leningrad-16, Leningrad-Zagreb, Japan CAM-70, F22, 194 and TD 97 (derived from the Tanabe vaccine strain) and Shanghai were made from other strains. In 1971 an MMR vaccine was licensed for the first time in the USA and in 1989 two vaccinations were recommended. During production, measles viruses are cultivated in embryonic chicken cell culture ( CEF cells ), purified and diluted to the final concentration of the drug.

From 1970 there was a compulsory measles vaccination in the GDR . In the Federal Republic of Germany, inactivated vaccines against measles were approved in 1966 , while the live vaccine was approved in 1967. The then dead vaccines Fractivac (monovalent) and Quintovirelon (as a pentavalent combination vaccine DPT - IPV -M) were inferior to live vaccines, since even a triple vaccination was insufficient Conferred immunity. In addition, an atypical measles syndrome with pneumonia occurred in the case of an infection with measles viruses . As a result, they were only used until the mid-1970s, when they were eventually replaced entirely by live vaccines. In 1974, for example, the STIKO issued the first recommendation for measles vaccination; Here is a live attenuated vaccine after completion of their first year of life should be given an option nor a subunit vaccine as a pre-inoculation.

Individual vaccinations against measles are uncommon today and are still mainly given in Africa or Russia. In Europe, sales of the last single measles vaccine Mérieux by the then manufacturer Sanofi Pasteur MSD was discontinued in 2012 and was then available via parallel import by EurimPharm. As of 2017, the vaccine was no longer produced, so that although it is still approved, it can no longer be brought onto the market by the parallel importer (as of 2019).

Instead, protection against measles is recommended either through an MMR vaccine together with protection against mumps and rubella as part of a triple vaccination (approval in the USA in 1971, in Germany from 1980), or through a quadruple vaccination with MMRV vaccine (approval in the USA in 2005, Germany in 2006), which also protects against chickenpox .

In the Federal Republic of Germany, the one-off combination vaccination with mumps (MM) was recommended as a live vaccination for the first time in 1976 (from the age of 2, from 1980 widely used from the age of 15 months). The additional rubella component in the form of the MMR vaccination from the age of 15 months first found its way into the vaccination calendar in 1984. In 1991, the two-time MMR vaccination was introduced in the vaccination calendar (2nd dose from the age of 6), from 2001 the MMR first vaccination should finally be between the 11th and 14th Month, the second vaccination in the 15th - 23rd Month.

In addition, the STIKO recommends vaccination for all adults born after 1970 in certain areas of activity, such as in medical facilities according to Section 23 of the Infection Protection Act (IfSG) or care facilities according to Section 71 of the Social Security Code (SGB XI). Women should be vaccinated twice for each of the three components of the vaccine (M – M – R); men should have a single vaccination to protect against rubella.

immunology

The approved measles vaccine provides effective protection, even when administered a few days after infection. The seroconversion rate after vaccination is 95%, after revaccination it is over 99%. In 2013, around 85% of children worldwide had received a measles vaccine. In 2012, 92.4 percent of newly enrolled children in Germany were twice vaccinated against measles. The WHO estimated the measles vaccination rate in Austria for 2006 at 80% for the first and 61% for the second vaccination.

B cell immunity

In the course of an infection, neutralizing antibodies are formed against epitopes on the hemagglutinin H and the fusion protein F of the measles virus , which prevent a renewed infection with measles viruses.

T cell immunity

The protective epitopes for HLA2 -positive cytotoxic T cells are located on the hemagglutinin. There are also T cell epitopes on proteins F, N, P, C, M and L.

Contraindications

Contraindications are pregnancy and the proportion of CD4-positive T cells below 15% in HIV- infected children.

Side effects

Adverse drug effects are fever (15 to 20% in small children), non- infectious vaccine measles (3 to 5%), pain and redness at the injection site (10%), morbiliform or rubelliform exanthema (about 1 to 5% each), rarely also a reddish one Discoloration ( thrombocytopenic purpura , 1: 30,000) or febrile seizures (1: 3,000).

There are no known safety concerns about further MMR vaccination (s) with existing immunity to one of the components (“over-vaccination”).

controversy

The use of measles vaccines is undisputed among medical professionals, but is rejected by the anti-vaccination scene. For March 2020, a legal vaccination for measles has been prepared in Germany - parents must provide evidence for their children when entering a day care center or school that there is sufficient vaccination against measles or immunity against measles. An immunity to measles is documented by a medical certificate. Any contraindications (e.g. allergy to components of the vaccine sera) must also be certified by the doctor. Such a certificate must then be presented in place of the vaccination certificate. The obligation to provide evidence also exists for educators, teachers, child minders and other employees in (medical) community facilities as well as for residents in holiday camps or asylum and refugee accommodation.

Vaccination refusals deny the need for measles vaccination in view of the supposed side effects and misunderstanding of the health risks of a measles infection. The vaccine fatigue and Impfangst and misinformation have led to a decline in herd immunity led to measles virus and an increase in measles infection and measles deaths in Germany, Austria and Switzerland, while measles have been largely eradicated in most of Europe. In areas with a high vaccination coverage, measles infections only occur as introductions from other areas or when the vaccination coverage drops.

history

The first measles vaccines were developed by Thomas Chalmers Peebles and Nobel Prize winner John Franklin Enders . The MMR vaccine was developed by Maurice Hilleman .

Trade names

Trade names for mono measles vaccines are e.g. B. Attenuvax (discontinued), measles vaccine Mérieux (Germany), Measles Vaccine (live) (Switzerland).

literature

Individual evidence

  1. ↑ WHO Model List of Essential Medicines . In: World Health Organization . October 2013. Retrieved April 22, 2014.
  2. ↑ a b c Chapter 10: Measles . P. 193.
  3. ↑ Centers for Disease Control and Prevention : Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP) .
  4. ↑ Centers for Disease Control, Prevention: CDC health information for international travel 2014 the yellow book 2014, ISBN 978-0-19-994850-5 , p. 250.
  5. ↑ Herwig Kollaritsch, Gerhard Wiedermann: Guide for protective vaccinations. ISBN 3211834486 , p. 120.
  6. ↑ a b c d Pinkbook Measles - Epidemiology of Vaccine Preventable Diseases. In: CDC. September 25, 2019, Retrieved April 27, 2020 (American English).
  7. ^ A b S. Klein et al .: From compulsory smallpox vaccination to the national vaccination plan . In: Federal Health Gazette - Health Research - Health Protection . tape 55 , no. 11 , November 1, 2012, p. 1512-1523 , doi : 10.1007 / s00103-012-1539-7 .
  8. ^ A b c Robert Koch Institute: Communication from the Standing Vaccination Commission at the Robert Koch Institute: Recommendation and scientific justification for the harmonization of the professionally indicated measles, mumps, rubella (MMR) and varicella vaccinations . In: Epidemiological Bulletin . No. 2 , January 9, 2020, p. 3–22 ( rki.de [PDF]).
  9. ↑ STIKO: STIKO recommendation for measles vaccination . Robert Koch Institute, Infection Epidemiology, September 20, 1974 ( rki.de [accessed April 4, 2020]).
  10. ↑ Andrea Misin et al .: Measles: An Overview of a Re-Emerging Disease in Children and Immunocompromised Patients . In: Microorganisms . tape 8 , no. 2 , February 18, 2020, doi : 10.3390 / microorganisms8020276 , PMID 32085446 , PMC 7074809 (free full text).
  11. ↑ Discussion about measles vaccination. In: Medicinal Telegram . October 11, 2013, accessed April 14, 2020 .
  12. ↑ Measles Vaccines. on measles vaccine Mérieux : "will not be marketed". In: Paul Ehrlich Institute. March 23, 2020, accessed April 14, 2020 .
  13. ↑ Diana Moll: Measles: Compulsory vaccination is coming - but no single vaccine in sight? In: Deutsche Apothekerzeitung . August 20, 2019, accessed April 14, 2020 .
  14. ^ Vaccine Timeline . Retrieved February 10, 2015.
  15. ↑ Quadruple vaccine: First MMRV vaccine approved. In: deutsche-apotheker-zeitung.de. August 21, 2019, accessed April 4, 2020 .
  16. ^ Deborah Mitchell, The Essential Guide to Children's Vaccines . St. Martin's Press, New York 2013, ISBN 978-1-4668-2750-9 , p. 127.
  17. ↑ STIKO: STIKO recommendations 1976 . Robert Koch Institute, August 1, 1976 ( rki.de [accessed April 4, 2020]).
  18. ^ STIKO: STIKO recommendations 1980 . Robert Koch Institute, September 1, 1980 ( rki.de [accessed April 4, 2020]).
  19. ↑ An overview of vaccination recommendations. (PDF) In: RKI. December 13, 2018, accessed April 4, 2020 .
  20. ↑ STIKO: STIKO recommendations 1984 . Robert Koch Institute, October 1, 1984 ( rki.de [accessed April 4, 2020]).
  21. ↑ STIKO: STIKO recommendations 1991 . Robert Koch Institute, August 1, 1991 ( rki.de [accessed April 4, 2020]).
  22. ↑ Epidemiological Bulletin 28/2001. In: RKI. July 13, 2001, pp. 204–205 , accessed April 4, 2020 .
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  24. ↑ a b c d e f g h Dietrich Reinhardt: Therapy of diseases in childhood and adolescence. Springer-Verlag, 2014. ISBN 978-3-642-41814-3 . P. 234.
  25. ↑ Measles Fact sheet N ° 286 . November 2014. Retrieved February 4, 2015.
  26. ↑ Epidemiological Bulletin No. 16/2014 RKI , April 22, 2014.
  27. ^ WHO: Reported estimates of MCV coverage
  28. ↑ OT Ertl et al .: Immunodominant domains of the Measles virus hemagglutinin protein eliciting a neutralizing human B cell response . In: Archives of Virology . tape 148 , no. 11 , November 2003, p. 2195-2206 , doi : 10.1007 / s00705-003-0159-9 , PMID 14579178 .
  29. ↑ SF Atabani et al .: Identification of an immunodominant neutralizing and protective epitopes from measles virus fusion protein by using human sera from acute infection . In: Journal of Virology . tape 71 , no. 10 , October 1997, p. 7240-7245 , PMID 9311797 , PMC 192064 (free full text).
  30. ^ E. Malvoisin, F. Wild: Contribution of measles virus fusion protein in protective immunity: anti-F monoclonal antibodies neutralize virus infectivity and protect mice against challenge. In: Journal of virology. Volume 64, Number 10, October 1990, pp. 5160-5162, PMID 2398539 , PMC 248009 (free full text).
  31. ↑ a b Martin O. Ota et al .: Hemagglutinin protein is a primary target of the measles virus-specific HLA-A2-restricted CD8 + T cell response during measles and after vaccination . In: The Journal of Infectious Diseases . tape 195 , no. 12 , June 15, 2007, p. 1799-1807 , doi : 10.1086 / 518006 , PMID 17492596 .
  32. ^ Guidelines for Vaccinating Pregnant Women
  33. ↑ Chart of Contraindications and Precautions to Commonly Used Vaccines
  34. ↑ RKI - Navigation - Are vaccine measles infectious? August 20, 2007. Retrieved July 26, 2019 .
  35. ↑ Measles. RKI Guide to Infectious Diseases - Leaflets for Doctors. Robert Koch Institute. Status 09/2010.
  36. ↑ Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C: Vaccines for measles, mumps and rubella in children . In: Cochrane Database Syst Rev . 2, 2012, p. CD004407. doi : 10.1002 / 14651858.CD004407.pub3 . PMID 22336803 .
  37. ↑ https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/Gesetze_und_Verordnung/GuV/M/Maserschutzgesetz_Kabinett.pdf
  38. ^ P. Carrillo-Santisteve, PL Lopalco: Measles still spreads in Europe: who is responsible for the failure to vaccinate? In: Clinical Microbiology and Infection . Volume 18 Suppl 5, October 2012, pp. 50-56, doi: 10.1111 / j.1469-0691.2012.03982.x , PMID 23051058 .
  39. ↑ Frank Patalong: The number of measles cases increases due to abstinence from vaccinations , Spiegel.de on May 20, 2013.
  40. ↑ Page no longer available , search in web archives: BAG, New measles outbreaks in Switzerland and one death , February 4, 2009@1@ 2Template: Dead Link / www.bag.admin.ch
  41. ↑ Tages-Anzeiger of February 23, 2015 : In Berlin, a toddler dies of measles
  42. ^ Measles cases hit record high in the European Region. In: euro.who.int. April 4, 2020, accessed April 4, 2020 .
  43. ↑ Wolfram Gerlich: Medical Virology. ISBN 978-3-131-53562-7 . P. 49.
  44. ↑ Swissmedic: Swissmedic releases batch of the monovalent measles vaccine “Measles Vaccine (live)”. April 25, 2008, accessed March 5, 2020 .