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COVID-19 and MIS-C
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
Jordan E. Roberts, Mary Beth Son
Along with booster doses for all adults, the Food and Drug Administration recently announced an Emergency Use Authorization for the Pfizer vaccine for children aged five to eleven. Vaccination is already available for adolescents aged twelve to seventeen in the United States. However, recent reports of myocarditis, particularly in young men, after the second mRNA dose have raised concern (Gargano, Montgomery, Dionne), and several countries have either selected a one-dose regimen for youth (United Kingdom) or recommended against use of the mRNA-1273 vaccine in boys and young men (Norway, Sweden, Denmark, Finland, and Ontario, Canada). The extent to which these concerns may slow vaccine uptake in children and adolescents is unknown, and it remains to be seen if the availability of vaccines for children will be enough to reduce or eliminate MIS-C. As of December 2021, the CDC recommends a complete primary series of mRNA vaccines (i.e., two doses) against SARS CoV-2 for all currently approved age groups in the United States. Following universal vaccination for measles, the devastating postinfectious neurologic disease subacute sclerosing panencephalitis has been essentially eliminated (Campbell H). However, the measles vaccination campaign has been highly successful, reaching immunization levels adequate for herd immunity in most of the developed world. At the present time, this level of COVID-19 vaccine uptake appears unlikely in most developed countries, and supply and logistic challenges limit distribution in the developing world.
Answers
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Koplik’s spots are pathognomonic of measles. They may be difficult to spot, and disappear as the illness progresses. There have been recent outbreaks of measles due to a lack of uptake of the measles, mumps and rubella vaccine in the last decade, because of unfounded fears of its link with autism. The child is usually very unwell and irritable with a high-grade fever. There is a high complication rate and may involve the lungs, eyes, ears, central nervous system and gastrointestinal tract. Subacute sclerosing panencephalitis is a rare complication of measles in which the virus survives in the cerebrum, only to be reactivated years later. It presents with behavioural change and a drop in intellectual level. This then progresses to movement disorders and mental deterioration. Severe dementia, seizures and eventually coma may follow.
Neurology and neurosurgery
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
Degenerative brain diseases are usually recessive. Most infants are normal at birth. There is progressive loss of previously acquired motor, sensory and intellectual functions. Measles virus has been grown from cerebral lesions of patients with subacute sclerosing panencephalitis which may appear many years after the initial infection. Heterozygotes for Tay Sachs disease can be identified by serum assay of hexosaminidase A. Prenatal diagnosis of metachromatic leukodystrophy is possible by measurement of arylsulphatase A in cultured amniotic cells.
Adult-onset subacute sclerosing panencephalitis presenting with tonic motor seizures
Published in International Journal of Neuroscience, 2021
Ozge Yagcioglu Yassa, Gulay Kenangil, Ayse Destina Yalcin
Subacute sclerosing panencephalitis (SSPE) is a degenerative disease of the brain caused by a persistent measles virus infection occurring mostly in childhood or early adolescence [1, 2]. It is characterized by cognitive and mental deterioration with prominent myoclonic jerks and poor prognosis. The diagnosis depends on the characteristic EEG pattern and presence of a high titre of Anti-Measles IgG in serum and CSF. The incidence of SSPE has markedly decreased in developed countries since the introduction of live attenuated measles vaccine [3]. Although the number of cases also decreased (0.461 per million in Turkey), it is still not a rarity for pediatric neurologists in developing countries such as Turkey and India [3, 4]. The incidence of SSPE in Istanbul (Turkey) was found as 2 per million and measles vaccine was found to be highly protective against SSPE [5].
Current perspectives in assessing humoral immunity after measles vaccination
Published in Expert Review of Vaccines, 2019
Iana H. Haralambieva, Richard B. Kennedy, Inna G. Ovsyannikova, Daniel J. Schaid, Gregory A. Poland
Long-term sequelae of measles are more serious and common than previously thought. A recent study assessing national-level information from England, Wales, the United States, and Denmark, from both the pre- and the post-vaccine era, provided statistical/modeling evidence for the association of measles with the long-term increase (approximately 2- to 3-year observed impact) of non-measles infectious disease mortality in children [7]. These non-specific effects of measles on immunity to other pathogens are likely due to measles-induced immunosuppression from lymphocyte depletion of memory B and T lymphocytes and/or from measles-related functional immune impairment [8–11]. Recent research also re-estimates the rate of developing subacute sclerosing panencephalitis/SSPE, a fatal progressive inflammation of the brain resulting from persistent measles virus (MV) infection, to be 1 in 609 after measles disease occurring in infancy [12].
In vivo nose-to-brain delivery of the hydrophilic antiviral ribavirin by microparticle agglomerates
Published in Drug Delivery, 2018
Alessandro Giuliani, Anna Giulia Balducci, Elisa Zironi, Gaia Colombo, Fabrizio Bortolotti, Luca Lorenzini, Viola Galligioni, Giampiero Pagliuca, Alessandra Scagliarini, Laura Calzà, Fabio Sonvico
Viral diseases are considered a major global threat to human and veterinary public health (Howard & Fletcher, 2012). As emerging viral infections, they frequently originate from an animal host and many involve the central nervous system (CNS) causing encephalitis, meningitis and consequent acute flaccid paralysis/poliomyelitis, as in the case of West Nile Virus and others (Tyler, 2009). Also measles was recently added to the NIAID's list of emerging virus infections and may cause CNS complications soon after infection (Garg, 2008) or few years later, as a result of viral persistence that leads to subacute sclerosing panencephalitis (Mahajan et al., 2014). The treatment and control of viral infections in the CNS is a therapeutic challenge because of the blood–brain barrier (BBB) and the blood–cerebrospinal fluid barrier. The extensive tight junctions between the endothelial cells of brain capillaries, the lack of paracellular transport, and limited pinocytosis, together with active efflux transporters, result in low cerebrospinal fluid-plasma ratios for most of the antiviral drugs (Wong et al., 2012; Comfort et al., 2015).