Measles virus (MEV)- induced neurologic disease is associated with the community acquired infection of disease, whereas most important rubella virus (RV)-induced neurologic disease is associated with congenital disease. There are lots of safe and effective vaccines exists. Mev, the etiologic agent of measles, is a member of the Morbillivirus genus of the Paramyxoviridae family of non-segmented, negative -stranded, enveloped RNA viruses. There are several morbilliviruses and each has a relatively restricted host range. Morbilliviruses have six structural proteins. MeV transmission from person to person is by the the respiratory route. The virus spreads from the from the initial site of replication in the respiratory tract to local draining lymph nodes. In 2005, a measles, mumps, rubella and varicella virus combination vaccine (MMRV) was licensed for use in the United States for children 12 months through 12 years of age. In accordance with the 2006 Advisory Committee on Immunization Practices' (ACIP) general preference for combination vaccines [1] ,MMRV use was preferred over measles, mumps, and rubella vaccine and varicella vaccine administered as separate injections (MMR+V).
Measles is a suitable candidate virus for eradication: Measles eradication defined as the interruption in the transmission of measles globally so that vaccination can be stopped is possible theoretically because no animal reservoir is known to exists and measles vaccine is highly effective. Before measles vaccine was introduced, around 5.7 million people worldwide died each year of measles by 1995 this total fallen by 88%. Eradication of the measles virus would obviate the need for the continuous monitoring of changes in measles vaccination. These epidemiology changes include shift in the age distribution of measles towards older and children and the fact the babies born to mothers whose immunity is not natural but induced by vaccine have a shorter period of passive protection. According to WHO, in Latin America, the age group 1-14 years was selected because catch-up campaigns were being carried out about 15 years after large scale of vaccination. In many countries where vaccination coverages is low and the incidence of measles is high, school children are likely to have natural immunity.
MEASLES
Measles shares these features with smallpox, which has been eradicted globally, but, as predicted, measles eradication is proving more difficult -- partly because it is much more infectious than smallpox and partly because there is a window of vulnerability between the duration of protection by maternal antibody (and concomitant resistance to measles vaccination) and attainment of the age of 12 months, at which time vaccination is assured of being effective. Because of the inevitability of repeated reintroduction of infection, countrywide elimination does not constitute a satisfactory outcome, except as a preliminary step to global eradication. Some innovative measures for improving vaccine coverage capitalize on strategies developed during the poliomyelitis eradication campaign. In addition to its intrinsic importance, a campaign to eradicate measles by mass vaccination with a combined vaccine may simplify the eradication of rubella and, potentially, mumps as well.
There are two types of measles vaccine currently available that is (MMR and MMRV). The Measles mumps rubella (MMR) vaccine offers protection against three disease - measles ,mumps and rubella in a single combined injection. This vaccine given to children as a series of 2 doses. The first dose is given at 12 month of age and the second dose ar 4to 6years of age. In the others side, MMR have side effects like minor fever and mild rash Moderate pain
And stiffness of the joints, allergic reaction which cause hives, swelling, and trouble breathing. The other one is Measles, mumps, rubella and varicella (MMRV) vaccine is given as an injection into the the top of the arm. The possible side effects pain redness and swelling, moderate or high fever – in children up to 39 degree Celsius or above as well as cough and puffy nose. Respondents were provided an informational statement on the risk of febrile seizures after MMRV compared to MMR+V in 12-15 month olds at the beginning of the survey Using yes/no questions and 4- and 5-point Likert scales, the survey assessed knowledge, beliefs, attitudes, and intended practices regarding MMRV and febrile seizures. The survey wasadministered via mail or Internet (Vovici, Dulles VA) using a tailored approach [7] .
RUBELLA
Rubella, or German measles, is an RNA virus in the genus Rubivirus within the Togaviridae family. It is a human disease with no animal reservoirs. The incidence of rubella cases is highest from late winter to early spring.3 The number of rubella cases has progressively declined in the United States since the prevaccine era due to mass immunization programs and, as of 2004, is no longer endemic.3 Rubella remains endemic in other countries with a dramatic increase in cases reported during 2009 versus during 2000. The World Health Organization reported that rubella cases in the African Region and the South-East Asian Region alone increased from 865 to 17,388 and from 1165 to 17,208 during 2000 and 2009, respectively. These regions represent a significant number of the 121,344 global cases of rubella reported by the World Health Organization during 2009; neither region has any specific goals to control rubella outbreaks. Rubella eradication will not be possible unless global immunization policies (eg, immunization registries) are implemented and enforced. Acquired rubella infection may be asymptomatic or subclinical in up to half of those exposed, especially in children.3,4,6, Of the peoplewho clinically manifest the disease, symptoms are mild and self-limiting. A prodromal stage of 1 to 5 days is represented by a low-grade fever, malaise, lymphadenopathy, and an upper respiratory infection. Forchheimer spots (petechiae on the soft palate) may precede or accompany the rash.3,6. The rash is mild and maculopapular, beginning on the face and extending downwards; it occurs approximately 14 to 17 days after exposure and typically lasts 3 days. Rubella frequently leads to arthralgia/arthritis in women (up to 70%). Although joint symptoms, along with conjunctivitis, are more common complications in the obstetric patient, encephalitis (1/6000 cases) may develop, affecting female adults more frequently than men or children.3,4. The response rate was 73% (620/849), with 76% (321/425) of pediatricians and 71% (299/424) of family physicians responding. Response rates were 72% (200/279) for the mail group and 74% (420/570) for the Internet group.
Respondents were similar to non-respondents with minor differences for family physicians in gender, practice location, and practice region. This study has limitations. First, MMRV was not available at the time of the survey; therefore, we asked physicians to answer assuming adequate supplies of MMRV, MMR, andvaricella vaccine. Second, the information provided within the survey may have resulted in a reporting bias, resulting in over-reporting in the rates of awareness of febrile seizure risk associated with MMRV. Third, we present data on self-report of intended vaccination practices and not observed practice. Finally, the physicians surveyed may not have accurately assessed parental perceptions.
Conclusion
Measles–mumps–rubella–varicella (MMRV) vaccine is associated with increased febrile seizure risk compared with measles–mumps–rubella and varicella vaccine given separately (MMR + V) in children 12–15-month old. We assessed knowledge regarding MMRV and febrile seizures, intended practices, and factors influencing the decision to recommend MMRV. After receiving data regarding febrile
seizure risk after MMRV, few physicians report they would recommend MMRV to a healthy 12–15-month-old child.
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