Most of the facts regarding measles aerosol vaccination have been quite thoroughly dealt with in
the book by S. Plotkin, Mass Vaccination: Global Aspects—Progress and Obstacles (2006 Ed) [1]. However,
there are some aspects mentioned there that should perhaps have been emphasized more
strongly and others that have emerged as relevant issues since then. We shall start with the quite
important point that in the Sabin et al. [2] first study made in Monterrey, N. L., México [3], antibody
reaction for recipients of respiratory-route Edmonston-Zagreb vaccines was not fully developed
(100%) until six months after aerosol inhalation. At six weeks, only 90% had increased blood
levels of antibody, a fact for which there is no easy explanation, but one which should be considered
when dealing with serologic evaluation of measles vaccines given by aerosol in which shortterm
results less than encouraging. Results of the second study performed by Sabin et al. in Monterrey
[2] establish that the percentage of sero-responses is directly dose-dependent. In turn, the
dose itself depends on at least three facts: 1) concentration of virus in the vaccine used; 2) kind of
nebulizer used; and 3) time of exposure. Another point to be stressed is that the vaccine used in
the first trials [1]-[3], as well in the aerosol mass vaccination in México, though originally the Ickic
strain attenuated in HDP, was also grown for final harvesting in HDP (MRC-5), whereas current
Edmonston-Zagreb vaccines are obtained by final culture in chick embryo fibroblasts that provide
1 log more final product, more beneficial from an economic point of view, but not for adaptation to
human tissues. A crucial consideration in aerosol measles mass campaigns is the lack of electricity/
energy supply, particularly in rural communities. To deal with these issues, a rudimentary assembly
was utilized to produce the aerosol for mass vaccinations performed during the serious
Mexican epidemic of 1990-1991: a tire pump connected to a Clay-Adams nebulizer. As this equipment
works only with direct current, a car battery was used to supply sufficient energy to vaccinate
thousands of children.
References
[1]
Plotkin, S.A. Mass Vaccination: Global Aspects—Progress and Obstacles. Springer, Berlin, Heidelberg.
[2]
Sabin, A.B., Flores, A.A., Fernandez de Castro, J., Sever, J.L., Madden, D.L., Shekarchi, I., et al. (1984) Successful Immunization of Children with and without Maternal Antibody by Aerosolized Measles Vaccine. II. Vaccine Comparisons and Evidence for Multiple Antibody Response. JAMA, 251, 2363-2371.
[3]
Sabin, A.B., Flores, A.A., Fernandez de Castro, J., Sever, J.L., Madden, D.L., Shekarchi, I., et al. (1983) Successful Immunization of Children with and without Maternal Antibody by Aerosolized Measles Vaccine. I. Different Results with Undiluted Human Diploid Cell and Chick Embryo Fibroblast Vaccines. JAMA, 249, 2651-2662.
[4]
Low, N., Bavdekar, A., Jeyaseelan, L., Hirve, S., Ramanathan, K., Andrews, N.J., Shaikh, N., Jadi, R.S., Rajagopal, A., Brown, K.E., Brown, D., Fink, J.B., John, O., Scott, P., Riveros-Balta, A.X., Greco, M., Dhere, R., Kulkarni, P.S. and Henao Restrepo, A.M. (2015) A Randomized, Controlled Trial of an Aerosolized Vaccine against Measles. The New England Journal of Medicine.
[5]
Dilraj, A., Sukhoo, R., Cutts, F.T. and Bennett, J.V. (2007) Aerosol and Subcutaneous Measles Vaccine: Antibody Responses 6 Years after Re-Vaccination. Vaccine, 25, 4170-4174. http://dx.doi.org/10.1016/j.vaccine.2007.03.003
[6]
Wong-Chew, R.M., Islas-Romero, R., Garcia-Garcia, M.L., Beeler, J.A., Audet, S., Santos-Preciado, J.I., et al. (2004) Induction of Cellular and Humoral Immunity after Aerosol Orsubcutaneous Administration of Edmonston-Zagreb Measles Vaccine as Primary Dose to 12-Month-Old Children. The Journal of Infectious Diseases, 189, 254-257.
[7]
Wong-Chew, R.M., Islas-Romero, R., Garcia-Garcia, M.L., Beeler, J.A., Audet, S., Santos-Preciado, J.I., et al. (2005) Immunogenicity of Aerosol Measles Vaccine Given as the Primary Measles Immunization to 9-Month-Old Mexican Children.Vaccine, 24, 683-690.
[8]
Fernández de Castro, J., Kumate, J., Sepúlveda, J., Ramírez-Isunza, J.M. and Valdespino-Gómez, J.L. La vacunación anti-sarampionosa en México por el método de aerosol. Salud Publica Mex, 39, 53-60.
[9]
Fernández de Castro, J.V., Bennett, H., Gallardo-Rincon, M.T., Munoz, L.A., Sanchez, L.A.E.P. and Santos, J.I. (2005) Evaluation of Immunogenicity and Side Effects of Triple Viral Vaccine (MMR) in Adults, Given by Two Routes: Subcutaneous and Respiratory (Aerosol). Vaccine, 23, 1079-1084. http://dx.doi.org/10.1016/j.vaccine.2004.08.018
[10]
Diaz-Ortega, J.L., Bennett, J.V., Castaneda, D., Vieyrac, J.-R., Valdespino-Gomez, J.L. and de Castro, J.F. (2010) Successful Seroresponses to Measles and Rubella Following Aerosolized Triviraten Vaccine, but Poor Response to Aerosolized Mumps (Rubini) Component: Comparisons with Injected MMR. Vaccine, 28, 692-698. www.elsevier.com/locate/vaccine
[11]
Diaz-Ortega, J.-L., Bennett, J.V., Castaneda, D., Arellano, D.M., Martinez, D. and de Castro, J.F. (2012) Safety and Antibody Responses to Aerosolized MMR II Vaccine in Adults: An Exploratory Study. World Journal of Vaccines, 2, 55-60. http://dx.doi.org/10.4236/wjv.2012.22008