All Children Must be Immunised Against Measles

Some health care professionals have been reluctant to immunise infants or children against measles if there is a history of egg allergies or even if the child has not yet eaten an egg before. As a result, many parents and care-givers of children with egg allergies have chosen not to immunise their children against measles, putting these children at risk of contracting measles and reducing the immunity in the community as a whole.

Egg allergy is one of the most frequent food allergies in children below the age of three. The egg white is the major source of allergens in egg. The most common symptoms of egg allergy are abdominal pain, vomiting, hives and an eczema rash. Severe allergic reactions such as anaphylaxis are rare.

The virus strain currently used in the measles vaccine is prepared in a chick-embryo cell culture and does not contain significant amounts of egg cross-reacting proteins.

Studies performed over the past 15 years provide compelling evidence about the safety of measles immunisation in egg-allergic children. Adverse reactions to the vaccine occur rarely, are usually minor, and present as a local reaction (wheel and flare) at the injection site. These reactions have been attributed to trace amounts of vaccine components such as neomycin (antibiotic used to treat infections caused by a wide range of bacteria) and gelatine. Anaphylaxis is extremely rare. In fact, the majority of anaphylactic reactions to the measles vaccine have been reported in children who were not allergic to egg.

Most children with a history of egg allergy do not have untoward reactions to measles or the MMR vaccine. Therefore, children with egg allergies should be vaccinated in the usual manner and without any delay or deferment. Prior skin testing with the vaccine is unnecessary and the vaccine should be given in a single injection rather than in series of gradually increasing concentration doses. Children who have had an anaphylactic reaction to a prior vaccination should be immunised only in settings in which resuscitation facilities are available. Persons who have experienced anaphylactic reactions to neomycin or gelatine should not receive the measles vaccine.

The Campaign is scheduled as follows:

Round 1: 12 - 23 April 2010:
Polio (drops) will be given to children 0 to 59 months
Measles (injection) all children 6 months to under 15 years

Round 2: 24 - 28 May 2010:
Polio (drops) to all children 0 - 59 months
Deworming tablet (Albendazole) to children 12 to 59 months
Vitamin A (drops) to children 12 to 59 months

Children with milder forms of allergy to egg, even an itchy rash can be safely vaccinated without additional precautions. The only children that need to be vaccinated under conditions where they could be observed for about two hours and be effectively resuscitated are those with an allergy to egg in whom previous exposure led to cardio respiratory reactions and those with egg allergy and coexisting asthma (mainly older children).

Sources:

• Current Childhood Immunisation; SA Fam Pract 2003; 45 (9)
• Safe administration of the measles vaccine to children allergic to eggs; PubMed; 1995 May 11; 332 (19): 1262-6
• Du Toit and Weinberg "Egg-Allergy and MMR Vaccination", SAMJ 2003;93(2):113-4.

Issued by:
Directorate for Communications
Western Cape Department of Health