IJE Advance Access published online on November 23, 2007
International Journal of Epidemiology, doi:10.1093/ije/dym207
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Review of the effect of measles vaccination on the epidemiology of SSPE
1 Immunisation Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK.
2 Statistics Unit, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK.
3 Immunisation and Diagnosis Unit, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK.
* Corresponding author. Head, Immunisation Department, Health Protection Agency, Centre for Infections, Immunisation Department, 61 Colindale Avenue, London NW9 5EQ, UK. E-mail: liz.miller{at}hpa.org.uk
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Abstract |
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Background When measles vaccines were widely introduced in the 1970s, there were concerns that they might cause subacute sclerosing panencephalitis (SSPE): a very rare, late-onset, neurological complication of natural measles infection. Therefore, SSPE registries and routine measles immunization were established in many countries concurrently. We conducted a comprehensive review of the impact of measles immunization on the epidemiology of SSPE and examined epidemiological evidence on whether there was any vaccine-associated risk.
Methods Published epidemiological data on SSPE, national SSPE incidence, measles incidence and vaccine coverage, reports of SSPE in pregnancy or shortly post partum were reviewed. Potential adverse relationships between measles vaccines and SSPE were examined using available data.
Results Epidemiological data showed that successful measles immunization programmes protect against SSPE and, consistent with virological data, that measles vaccine virus does not cause SSPE. Measles vaccine does not: accelerate the course of SSPE; trigger SSPE or cause SSPE in those with an established benign persistent wild measles infection. Evidence points to wild virus causing SSPE in cases which have been immunized and have had no known natural measles infection. Perinatal measles infection may result in SSPE with a short onset latency and fulminant course. Such cases are very rare. SSPE during pregnancy appears to be fulminant. Infants born to mothers with SSPE have not been subsequently diagnosed with SSPE themselves.
Conclusions Successful measles vaccination programmes directly and indirectly protect the population against SSPE and have the potential to eliminate SSPE through the elimination of measles. Epidemiological and virological data suggest that measles vaccine does not cause SSPE.
Keywords SSPE, subacute sclerosing panencephalitis, epidemiology, measles, measles vaccine, MMR vaccine, genotype, vaccination
Accepted 6 September 2007