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Respiratory Administration of Measles Vaccine for Prevention of ALRI

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Higginson D, Theodoratou E, Nair H, Huda T, Zgaga L, Jadhav SS, Omer SB, Rudan I, and Campbell H.  An evaluation of respiratory administration of measles vaccine for prevention of acute lower respiratory infections (ALRI) in children. BMC Public Health 2011 11 (Suppl 3):S31.


  • Although coverage of the first dose of measles vaccine improved dramatically in the twenty first century, it is estimated that 100,000 deaths in children aged less than 5 years was attributable to measles in 2008 (1, 2).
  • Failure to achieve universal coverage for at least one dose of measles vaccine remains the key reason for these deaths.  Pneumonia is one of the most common fatal complications of measles (3).  In 2007, measles-containing vaccine (MCV1) coverage in WHO Africa and South East Asia regions was 74% and 73% respectively (4) – two regions particularly vulnerable to disease outbreaks.
  • Higginson et al. summarized findings from a modified Child Health and Nutrition Research Initiative (CHNRI) process whereby a systematic literature review related to emerging aerosol measles vaccines was conducted, and the findings were presented to a group of 20 experts who then rated their degree of optimism (0-100%) on several criterion.

CHNRI Criterion

Answerability: production of an effective aerosolized measles vaccine that can be fitted into the routine Expanded Programme of Immunization (EPI) schedule within 10 years.

  • Moderate levels of optimism (~60%)

Efficacy: the impact of the vaccines under ideal conditions

  • Low to moderate levels of optimism (~50%)

Low Cost of Development 

  • Low to moderate levels of optimism (~50%)

Low Cost of Production and Implementation 

  • Moderate levels of optimism (~60%)
  • The low pricing should also be sustainable, given the high level of commitment of many donors towards measles elimination programme.

Disease Burden Reduction (median potential effectiveness)

  • Aerosolized measles vaccine would have modest levels of maximum impact on overall pneumonia disease burden when compared to the existing measles vaccine
  • 5% reduction (IQR: 1-15%, min 0%, max 45%)

Acceptability: among end-users and health workers 

  • Very high levels of optimism (80%)

Equity: impact on decreasing child health inequity

  • Very high levels of optimism (>90%)

Intervention Recommendation

  • While it is important to strengthen the investments in existing vaccination programs, investment in novel vaccinations may offer a promising mode of challenging currently limiting deliverability factors.
  • Although there has been considerable progress in achieving the vision of effectively delivering measles vaccine through the respiratory route, it will be a few years before such a vaccine is ready to be incorporated into the routine EPI programs in high disease burden areas.

References from Higginson Paper Cited Here

  1. Measles vaccines: WHO position paper. Wkly Epidemiol Rec. 2009; 84(35):349–360. 
  2. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C. Global, Regional and National Causes of Child Mortality, 2008. Lancet. 2010. in press.
  3. Duke T, Mgone CS. Measles: not just another viral exanthem. Lancet. 2003; 361(9359):763–773.
  4. Progress in global measles control and mortality reduction, 2000-2007. Wkly Epidemiol Rec. 2008; 83(49):441–448.

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