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POST 01405E: OPTIMUM AGE FOR MEASLES VACCINATION FOLLOW-UP ON POST 01403E 21 MARCH 2009 ****************************************** The WHO position paper on measles vaccine says that, "The optimum age for measles vaccination depends on the local epidemiological situation and on programmatic considerations. Where measles tends to occur in young infants, the age at vaccination will be a compromise between the need to vaccinate as early as possible to prevent life-threatening measles during the first months of life and the need to wait until acceptable protection (seroconversion rates) may be achieved. Given the immaturity of the immune system as well as the presence of neutralizing maternal antibodies, vaccination of infants before or at 6 months of age may often fail to induce immunity." On the other hand, in two studies in Guinea-Bissau and Senegal, it was found that immunised mothers transferred only around half the concentration of maternal antibodies, and their children lost protective levels early. A new group of children born to immunised mothers therefore exists who may lose protection by 3 to 5 months of age. (Martins CL and Cisse B.; unpublished data) A recent study in Guinea-Bissau (Martins CL et al, BMJ, 2008) found that in low income countries, maternal antibody levels against measles may be low and severe outbreaks of measles can occur in infants before the recommended age of vaccination at 9 months. They also concluded that outbreaks of measles may be curtailed by measles vaccination using the Edmonston-Zagreb vaccine as early as 4.5 months of age. Please find attached. The dose of the vaccine is of course is 0.5 ml no matter what is the age. Regarding vaccination in the first month of infancy, I think maternal antibodies will still be there and child will be protected. Regards, Prasad Kulkarni ([][/email]) Dr. Prasad Kulkarni, MD Additional Medical Director Serum Institute of India Ltd Pune-411028, INDIA ------- Hello Dr.Riadh Karem, According to some of published literature, the risk of measles infection in infants before the recommended age (9 months) is negligible in developed countries.(1) However, this is mainly dependent on whether mothers were vaccinated for measles or had natural infection of Measles (wild). Hence, to avoid infants from being at risk for measles infection, maternal vaccination can help in eliciting priming of antiviral immune responses in infants during the first year of life.(2) The other alternative is to vaccinate children born to unvaccinated mothers at an earlier age. This may be a valid option in countries with significantly poor coverage (less than 60%). In their study, Whittle and Rowland (3) have demonstrated that the Edmonston-Zagreb vaccine, given subcutaneously or by other routes at 4-6 months, may be useful in preventing measles in infants in African cities, where 15-30% of the children have measles before 9 months of age. It is not un common to see Measles in younger age groups if the overall coverage of Measles vaccine is less than optimal ()

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