Sub-acute Sclerosing Panencephalitis: More Cases of This Fatal Disease Are Prevented by Measles Immunization than Was Previously Recognized

Tuesday, 19th of November 2013

[source]Journal of Infectious Diseases[|source]

Analyses of measles virus sequences in brain tissue samples obtained from patients with SSPE have identified only wild-type measles virus, and the virus genotypes identified have been consistent with the genotype of measles virus that circulated in the area where the patients lived and to which the patients had been exposed >10 years before the onset of symptoms of SSPE. Genetic studies have supported epidemiologic evidence that measles vaccine virus does not cause SSPE. In cases of SSPE that developed in children or adults who had no history of measles but who did have a history of vaccination against measles virus, analysis of measles virus sequences derived from the patients confirmed the presence of the wild-type genome, indicating that the individuals had an undiagnosed measles virus infection. 

In this article, the authors analyzed measles virus sequences that were identified in brain biopsy specimens or in material obtained at autopsy from patients with SSPE and that were then submitted to the Centers for Disease Control and Prevention (CDC) from 1992 through 2003. Although most of the specimens were submitted to the CDC because the patients lacked a history of measles disease but had a positive history of vaccination, the authors identified only wild-type measles virus in the patients’ specimens. The article concludes that the increased risk of developing SSPE after measles virus infection in young children underscores the importance of childhood immunization programs that decrease measles virus transmission and, therefore, reduce the risk of exposure to measles among infants. More details are available at:  http://jid.oxfordjournals.org/content/192/10/1686.long

 

Abstract

Background: The most severe sequela of measles virus infection is subacute sclerosing panencephalitis (SSPE), a fatal disease of the central nervous system that generally develops 7–10 years after infection. From 1989 through 1991, a resurgence of measles occurred in the United States, with 55,622 cases of measles reported. The purpose of the present study was to identify cases of SSPE that were associated with the resurgence of measles and to calculate the risk of developing SSPE

Methods: Brain tissue samples obtained from 11 patients with a presumptive diagnosis of SSPE were tested for the presence of measles virus RNA. Measles virus genotypes were determined by reverse-transcription polymerase chain reaction (RT-PCR) and by analysis of the sequences of the PCR products. A search of the literature was conducted to identify reports of cases of SSPE in persons residing in the United States who had measles during 1989–1991

Results: The measles virus sequences derived from brain tissue samples obtained from 11 patients with SSPE confirmed the diagnosis of SSPE. For 5 of the 11 patients with SSPE who had samples tested by RT-PCR and for 7 patients with SSPE who were identified in published case reports, it was determined that the development of SSPE was associated with the measles resurgence that occurred in the United States during 1989–1991. The estimated risk of developing SSPE was 10-fold higher than the previous estimate reported for the United States in 1982

Conclusions: Vaccination against measles prevents more cases of SSPE than was originally estimated