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Blood, 1 January 2002, Vol. 99, No. 1, pp. 83-87
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Measles in bone marrow transplant recipients during an
outbreak in São Paulo, Brazil
Clarisse M. Machado,
Flávio B. Gonçalves,
Cláudio S. Pannuti,
Frederico L. Dulley, and
Vanda
A. U. F. de Souza
From the Virology Laboratory, Instituto de
Medicina Tropical de São Paulo, University of São Paulo
Medical School, and the BMT Program, Fundação Pro Sangue
Hemocentro de São Paulo and Discipline of Hematology, University
of São Paulo Medical School, São Paulo, SP, Brazil.
In 1997, a measles outbreak was identified in São
Paulo. Between February and December, 20 185 cases were confirmed.
From April to July 1997, a seroepidemiologic survey was conducted to identify the recipients of bone marrow (BM) transplants who were susceptible to measles and the occurrence of measles in this
population. A total of 156 patients were screened by enzyme
immunoassay (EIA). Patients with IgG titers more than 100 mIU/mL were
considered immune. Measles reimmunization records were also reviewed.
Thirty-two vaccinated patients underwent serologic evaluation. Six of
22 patients (27.3%) within 3 years after vaccination lost measles immunity, in contrast to 7 of 10 patients (70%) vaccinated longer than
3 years previously (P = .049). Among the 122 nonvaccinated patients, 41 (33.6%) were susceptible to measles: 4 of 47 patients (8.5%) within the first year after BM transplantation
(BMT), and 37 of the 75 patients (49.3%) after the first year after
BMT (P < .001). Eight recipients acquired measles,
confirmed by serology (EIA). High-avidity IgG antibodies were
observed in the acute phase of measles, suggesting a secondary immune
response. Measles interstitial pneumonia was observed in one patient.
Seven patients had mild symptoms. Exanthema was present in all
patients. All but one patient had fever and nonproductive cough.
Koplik spots could be observed in 5 patients. Measles can be mild in
BM transplant recipients. Exanthema is frequently present but not often
typical. Immunity to measles decreases after day +365 after BMT.
Additional studies are needed to evaluate the safety of measles vaccine
after the first year of BMT, mostly during outbreaks.
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