Arch Dis Child. 2004 Dec;89(12):1145-8. The epidemiology of subacute sclerosing panencephalitis in England and Wales 1990-2002.
Miller C, Andrews N, Rush M, Munro H, Jin L, Miller E.
Immunisation Department, Communicable Disease Surveillance Centre, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK. email@example.com
AIM: To assess the impact of measles/mumps/rubella (MMR) vaccine on the epidemiology of subacute sclerosing panencephalitis (SSPE) in England and Wales. METHODS: Cases of SSPE resident in England and Wales with onset between 1990 and 2002 were reviewed. RESULTS: A total of 47 cases were identified, 31 male and 16 female. There was an average annual decline of 14% in SSPE onset over the period, consistent with the decline in notified measles over the last 20 years. A history of measles was present in 35 (median age 1.3 years), the most recent recorded date being 1994; the interval from measles to onset of SSPE ranged from 2.7 to 23.4 years. Four children with a history of receipt of a measles containing vaccine were reported not to have had measles; two of these cases had a brain biopsy, and nucleotide sequence data confirmed wild measles infection. Brain biopsy specimens from a further three cases with a history of measles, of whom two had also had a history of vaccination, showed wild-type strain. CONCLUSION: The prevention of endemic circulation of measles virus in England and Wales through the high coverage achieved with MMR vaccine, together with the measles/rubella vaccination campaign of 1994, has resulted in the near elimination of SSPE. However, the recent decline in MMR vaccine coverage, with the associated increase in localised measles outbreaks and cases in young infants, is of concern. It underlines the importance of maintaining high vaccine coverage in order to protect indirectly those most vulnerable to SSPE, namely infants too young to be vaccinated.
2: J Med Virol. 2002 Sep;68(1):105-12. Molecular analysis of measles virus genome derived from SSPE and acute measles patients in Papua, New Guinea.
Miki K, Komase K, Mgone CS, Kawanishi R, Iijima M, Mgone JM, Asuo PG, Alpers MP, Takasu T, Mizutani T.
Department of Neurology, Nihon University School of Medicine, Tokyo, Japan. firstname.lastname@example.org
A very high annual incidence of 56 per million population below the age of 20 years for subacute sclerosing panencephalitis (SSPE) has been reported from Papua New Guinea (PNG). In a more recent study, we have confirmed this unusual high incidence for Eastern Highlands Province (EHP) of PNG. In the study, it was observed that the vaccination rate among SSPE patients registered at Goroka Base General Hospital (GBGH) in EHP was higher than that of other infants in the province in recent years. To identify the measles virus (MV) responsible for SSPE in EHP, sequence analysis of hypervariable region of the N gene was performed from 13 MV genomes: 2 amplified from clinical specimens of SSPE patients and 11 from acute measles patients. In 2 cases among the 11 with acute measles, nucleotide sequence of the entire H gene derived from isolated viruses was determined. Both nucleotide sequence and phylogenetic tree analyses showed that the amplified MV cDNAs were closely related to one another and belonged to the D3 genotype though they were different from any previously reported MV sequences. No genome sequences of vaccine strains were detected. These findings suggest that the MV strains prevailing in the highlands of PNG belong to genotype D3 of the MV and this wild-type MV rather than the vaccine strains was likely to be responsible for SSPE in these patients. Copyright 2002 Wiley-Liss, Inc.
3: Clin Diagn Virol. 1996 Feb;5(1):37-42. Detection by polymerase chain reaction of wild-type measles virus genome in the cerebrospinal fluid of a patient with SSPE who had received measles vaccine.
Suga S, Miyahara M, Obata M, Higashigawa M, Ito M, Ihara T, Kamiya H, Sheng J, Ueda S, Sakurai M.
Department of Pediatrics, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514, Japan.
BACKGROUND: Previous studies have reported that approximately 4-5% of patients with subacute sclerosing panencephalitis (SSPE) were given measles vaccination but had no history of natural measles. However, in the case who received measles vaccine, it has been extremely difficult to determine whether the actual cause of SSPE is the inoculated vaccine virus or not. OBJECTIVES: To detect the measles virus genome in a patient with SSPE and to analyze its nucleotide and deduced amino acid sequence. STUDY DESIGN: We applied the polymerase chain reaction (PCR) to detect the measles virus genome in specimens from a 12-year-old boy with SSPE who had received measles vaccine 10 years before and had no history of apparent natural measles. The oligonucleotide primers for PCR were prepared based on the nucleotide sequence of the F and NP genes of the measles virus Edmonston strain. RESULTS: F and NP genes were detected in both the cerebrospinal fluid and peripheral blood lymphocytes. Nucleotide and deduced amino acid sequence analysis of the F gene showed that the patient's virus was different from that of the vaccine strain. Judging from these results, it was likely that the SSPE-associated strain in this case was derived from the wild-type rather than the vaccine strain. CONCLUSIONS: PCR is a useful method to establish a definitive diagnosis of SSPE and to study the nature of the SSPE-associated virus.