Vaccination Strategy, Immunogencity And Safety Of Measles Vaccine: A Systematic Review

Background: Measles is highly contagious and acute infectious disease. It is spread by respiratory. The current measles epidemic is characterized by that severe cases are reduced while light cases are increased. Prevalence of latent infections are prevalent, the local outbreak is still distributed, the cases of children one year old are increased. Measles vaccine can efficiently increase the people's antibody level and reduce morbidity. But there are still two choices about domestic and imported vaccine selection. Base on ensure the immune effect, can we take combined vaccines to reduce the vaccination number, cost and vaccine management difficulty, thereby increase the immunization dependence, there are no formed conclusion.Object To eliminate the one-sideness of regitional studies and deal with new measles situation and select measles vaccine with strong security and high-performance , optimize the immunization program, efficiently prevent and control the occurrence of measles, we must carry on system evaluation on immunization effect, security ,program of existing measles vaccine or combined with orther vaccines. Then we can provide scientific basis to completely eliminate measles .Methods The PubMed, BIOSIS Previews, CDSR, Cochrane Library, CBM, CNKI and VIP were searched between Jan 1990 and April 2010. Studies were included in the review if they were randomized controlled trials (RCTs) about measles vaccine in 6-months or 8-months old infants or measles(M)– mumps(M)– rubella(R) vaccine, or measles(M)– mumps(M)– rubella(R) and varicella (V) vaccine. Trial screening, data exaction and quality assessment of included trials were conducted by method recommended by Cochrane Collaboration.Results①10 RCTs were involved. Quality evaluation on included trials was carried on by Jadad method. Among those there were 1 trials 2 points and 9 trials 1point. Meta analysis shows that to measles vaccine in 6 or 8 month-old infants. Measles antibody positive rate of 6 or 8 month-old infants before vaccination was statistically significant with RR 2.54 and 95%CI 1.80 to 3.59 (P<0.00001). Measles antibody positive rate of 6 or 8 month-old infants after vaccination was statistically significant with RR 0.97 and 95%CI 0.94 to 0.99 (P=0.01). Measles antibody immunization success rate of 6 or 8 month-old infants after vaccination was statistically significant with RR 0.92 and 95%CI 0.88 to 0.96 (P=0.0003). Measles antibody GMT of 6 or 8 month-old infants after vaccination was statistically significant with SMD -96.32, 95%CI -147.35 to -43.29 (P=0.0003).②4 RCTs were involved. Among those there were 3 trials B degree and 1 trials C degree. Meta analysis show that to different inoculation method (MMRV or MMR+V) the rate of pain was not statistically significant with RR 0.94 and 95%CI 0.83to 1.05 (P=0.28).The rate of redness was not statistically significant with RR 1.08 and 95%CI 0.90 to 1.29 (P=0.40). The rate of hardening was not statistically significant with RR 1.16 and 95%CI 0.95 to 1.43 (P=0.14). The rate of fever was statistically significant with RR 1.20 and 95%CI 1.12 to 1.29 (P<0.00001). The rate of skin rash was not statistically significant with RR 1.18 and 95%CI 1.00 to 1.41 (P=0.05). The serum measles antibody positive rate was not statistically significant with RR 1.00 and 95%CI 0.99 to 1.01 (P=0.68). The serum mumps antibody positive rate was not statistically significant with RR 0.99 and 95%CI 0.50 to 1.01 (P=0.11). The serum rubella antibody positive rate was not statistically significant with RR 1.00 and 95%CI 0.99 to 1.01 (P=0.68). The serum varicella antibody positive rate was not statistically significant with RR 1.00 and 95%CI 0.99 to 1.01 (P=0.58).③5 RCTs were involved. Among those there were 2 trials B degree and 3 trials C degree. Meta analysis show that to different inoculation method (MMRV or MMR+V) the rate of pain was not statistically significant with RR 0.94 and 95%CI 0.83to 1.05 (P=0.28).The rate of redness was not statistically significant with RR 1.08 and 95%CI 0.90 to 1.29 (P=0.40). The rate of hardening was not statistically significant with RR 1.16 and 95%CI 0.95 to 1.43 (P=0.14). The rate of fever was statistically significant with RR 1.20 and 95%CI 1.12 to 1.29 (P<0.00001). The rate of skin rash was not statistically significant with RR 1.18 and 95%CI 1.00 to 1.41 (P=0.05). The serum measles antibody positive rate was not statistically significant with RR 1.00 and 95%CI 0.99 to 1.01 (P=0.68). The serum mumps antibody positive rate was not statistically significant with RR 0.99 and 95%CI 0.50 to 1.01 (P=0.11). The serum rubella antibody positive rate was not statistically significant with RR 1.00 and 95%CI 0.99 to 1.01 (P=0.68). The serum varicella antibody positive rate was not statistically significant with RR 1.00 and 95%CI 0.99 to 1.01 (P=0.58).Conclusion Through 6 month-old immunity can decrease the infection chance and play an active role in the protection of little infants. In measles epidemic season or popular areas, the first immune time could be moved up to 6 month-old as emergency protective measures. During the areas with low incidence or not threatened by measles outbreak, we can adhere to original 8 month-old immune time to ensure the immunogenicity of vaccine.In respect of immune safety, in addition to higher rate of fever after vaccination other local or systemic reaction was good. For the role of reducing vaccination times and good performance on immune effect and safety, the MMRV vaccine can be regarded as candidate vaccine for child.Compared with MMR+V vaccine the MMRV vaccine had the same immune effect. In respect of immune safety, in addition to higher rate of fever after vaccination other local or systemic reaction was good. For the role of reducing vaccination times and good performance on immune effect and safety, the MMRV vaccine can be regarded as candidate vaccine for child.