Organ-transplant patients at particluar risk from low MMR vacc...( A letter in this week's issue of THE LA...),Health

A letter in this week's issue of THE LANCET highlights how low uptake of the MMR vaccine could be putting patients with compromised immunity-such as those who have undergone organ transplantation-at particular risk of measles. The letter describes how two children with kidney transplants (and therefore unable to receive the second dose of MMR vaccine), developed complications of measles.

Uptake of the MMR vaccine in southeast London is among the lowest in the UK. Just over 60% of children aged 2 years in the boroughs of Lambeth, Southwark, and Lewisham had received a first dose of MMR vaccine by the end of the first quarter of 2003. Provisional data suggest there were 66 cases of measles reported in the second quarter.

Lead author, Eithne MacMahon from Guy's and St Thomas' Hospital NHS Trust, London, UK, comments: "The reappearance of measles in the community poses a severe threat to vulnerable immunocompromised individuals, including recipients of transplants. Without a substantial increase in the uptake of MMR vaccination, difficult challenges lie ahead. Measles is a notoriously infectious disease and will spread easily among those who are non-immune. Immunocompromised individuals may manifest only a non-specific illness without rash, which makes rapid diagnosis difficult and may delay measures to prevent further spread.

She concludes: "In this era of waning herd immunity [decreasing immunity in the general population], there is a need for renewed awareness of measles as a cause of non-specific, respiratory, or neurological symptoms in immunocompromised individuals. Special vigilance is needed in those individuals who have not had natural measles, are unvaccinated, or are only suboptimally protected after a single dose of vaccine. In view of our two cases, clinical colleagues should be alerted to the possibility of atypical presentations of measles in immunocompromised patients."

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Contact: Joe Santangelo
j.santangelo@elsevier.com
212-633-3810
Lancet
4-Sep-2003

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