Sample records for measles vaccination laboratory

  1. Measles vaccination before the measles-mumps-rubella vaccine.

    PubMed

    Hendriks, Jan; Blume, Stuart

    2013-08-01

    At the beginning of the 1960s, it was clear that a vaccine against measles would soon be available. Although measles was (and remains) a killer disease in the developing world, in the United States and Western Europe this was no longer so. Many parents and many medical practitioners considered measles an inevitable stage of a child's development. Debating the desirability of measles immunization, public health experts reasoned differently. In the United States, introduction of the vaccine fit well with Kennedy's and Johnson's administrations' political commitments. European policymakers proceeded cautiously, concerned about the acceptability of existing vaccination programs. In Sweden and the Netherlands, recent experience in controlling polio led researchers to prefer an inactivated virus vaccine. Although in the early 1970s attempts to develop a sufficiently potent inactivated vaccine were abandoned, we have argued that the debates and initiatives of the time during the vaccine's early history merit reflection in today's era of standardization and global markets.

  2. Decline of measles-specific immunoglobulin M antibodies after primary measles, mumps, and rubella vaccination.

    PubMed

    Helfand, R F; Gary, H E; Atkinson, W L; Nordin, J D; Keyserling, H L; Bellini, W J

    1998-03-01

    Detection of measles-specific immunoglobulin M (IgM) has become the standard diagnostic method for laboratory confirmation of measles. In outbreaks, the interpretation of an IgM-positive result can be complicated when persons with suspected measles receive a dose of measles vaccine as part of outbreak control measures. This investigation evaluated the decay of measles-specific IgM antibodies 1 to 4 months after primary vaccination with measles, mumps, and rubella vaccine (MMRII). Serum samples were obtained from 536 infants vaccinated when they were 15 months old as part of a study to assess primary and secondary measles vaccine failure. Sixty serum specimens per week were selected from specimens collected between 4 and 9 weeks after MMRII vaccination; all 176 available serum specimens collected between 10 and > or = 16 weeks were included. Specimens were tested for the presence of measles-specific IgM by an antibody-capture enzyme immunoassay. The proportion of IgM-positive specimens dropped from 73% at 4 weeks after vaccination to 52% at 5 weeks after vaccination and then declined to 7% by 8 weeks after vaccination. Less than 10% of children remained IgM positive between 9 and 11 weeks. An IgM-negative result helps rule out the diagnosis of measles in a person with suspected infection and a history of recent vaccination. The interpretation of a positive IgM result from a person with a clinically suspected case of measles and a recent history of measles vaccination (especially within 8 weeks) is problematic, and the diagnosis of measles should be based on epidemiologic linkage to a confirmed case or on detection of wild-type measles virus.

  3. [Measles vaccination].

    PubMed

    Floret, Daniel

    2010-12-20

    France is facing since 2008 a re-emerging measles outbreak affecting a high proportion of adults currently not or not correctly vaccinated. The non application since 30 years of the immunization program on measles mumps and rubella is the cause of this situation, despite the efficacy and the good tolerance of this vaccine has been demonstrated. The present epidemic is expected to go on, as long as the millions of measles susceptible people have not been either affected or vaccinated. A 95% protection rate is needed to interrupt the circulation of the virus. So, the objective of the French Plan for elimination of measles and congenital rubella is to reach at least a 95% vaccination coverage for the first dose and 80% for the second dose. The immunization recommendations should be strictly respected: first dose of MMR vaccine at 12 months and second dose within the second year of life. In this context, catch up immunization of children, adolescents and young adults (up to 30 year) not or not correctly vaccinated is particularly important, as well as the post exposure prophylactic measures, including vaccination.

  4. Is early measles vaccination better than later measles vaccination?

    PubMed

    Aaby, Peter; Martins, Cesário L; Ravn, Henrik; Rodrigues, Amabelia; Whittle, Hilton C; Benn, Christine S

    2015-01-01

    WHO recommends delaying measles vaccination (MV) until maternal antibody has waned. However, early MV may improve child survival by reducing mortality from conditions other than measles infection. We tested whether early MV improves child survival compared with later MV. We found 43 studies comparing measles-vaccinated and measles-unvaccinated children; however, only 16 studies had specific information that MV had been provided at 4-13 months of age, many before 9 months of age. In the 10 best studies (4 randomized trials and 6 observational studies) control children did not receive MV during follow-up. In eight of these studies the vaccine efficacy against death (VED) was 60% or more. In four studies with information on MV provided both before and after 12 months of age, the all-cause mortality reduction was significantly larger for children vaccinated in infancy (VED=74%; 95% CI 51-86%) than for children vaccinated after 12 months of age (VED=29%; CI 8-46%). Prevention of measles explained little of the reduction in mortality. In five studies with information on measles infection, VED was 67% (51-78%) and when measles deaths were excluded, VED was only reduced to 65% (47-77%). One natural experiment compared MV at 4-8 months versus MV at 9-11 months of age and found significantly lower all-cause mortality with early vaccination, the difference being 39% (8-60%). Child mortality may be reduced if MV is given earlier than currently recommended by international organizations. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Laboratory confirmation of rubella infection in suspected measles cases.

    PubMed

    Vaidya, Sunil R; Raut, Chandrashekhar G; Jadhav, Santoshkumar M

    2016-10-01

    As a part of measles outbreak based surveillance undertaken by the World Health Organization India, suspected measles cases were referred for the laboratory diagnosis at National Institute of Virology (NIV) Pune and NIV Unit Bengaluru. Altogether, 4,592 serum samples were referred during 2010-2015 from the States of Karnataka (n = 1,173), Kerala (n = 559), and Maharashtra (n = 2,860). Initially, serum samples were tested in measles IgM antibody EIA and samples with measles negative and equivocal results (n = 1,954) were subjected to rubella IgM antibody detection. Overall, 62.9% (2,889/4,592) samples were laboratory confirmed measles, 27.7% (542/1,954) were laboratory confirmed rubella and remaining 25.2% (1,161/4,592) were negative for measles and rubella. The measles vaccination status was available for 1,206 cases. Among the vaccinated individuals, 50.7% (612/1,206) were laboratory confirmed measles. The contribution of laboratory confirmed measles was 493 (40.8%) from Maharashtra, 90 (7.5%) from Karnataka, and 29 (2.4%) from Kerala. Since, 1/3rd of suspected measles cases were laboratory confirmed rubella, an urgent attention needed to build rubella surveillance in India. Additional efforts are required to rule out other exanthematous disease including Dengue and Chikungunya in measles and rubella negatives. J. Med. Virol. 88:1685-1689, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  6. Measles epidemic from 1951 to 2012 and vaccine effectiveness in Guangzhou, Southern China

    PubMed Central

    Yang, Zhicong; Xu, Jianxiong; Wang, Ming; Di, Biao; Tan, Huifeng; He, Qing; Cai, Yanshan; Liang, Jianhua; Hu, Wensui; Dong, Zhiqiang; Yang, Yunqing; Fu, Chuanxi

    2014-01-01

    Background Since the National Expanded Program on Immunization was implemented in China, considerable progress has been made in reducing the incidence of measles. However, the incidence of measles increased again in 2004. Few post-marketing studies on measles vaccine effectiveness were reported in China. In this study, we aimed to describe the measles epidemic and to evaluate the effectiveness of the measles vaccine in Guangzhou, southern China. Methods Based on the surveillance data for measles, we investigated the epidemiology during different periods between 1951 and 2012. We analyzed the clinical characteristics of laboratory-confirmed cases of measles between 2009 and 2012 and conducted a case-control study using test-negative cases as controls. We determined the protective effect of measles vaccine. Results The highest annual incidence in Guangzhou was 2187.15/100 000 in 1964, and the lowest was 0.32/100 000 in 2011. The average incidence of measles from 1951 to 2012 was 306.27/100 000. There was a significant tendency of decline in recent years. From 2009 to 2012, there are 700 laboratory-confirmed cases reported with an average onset age of 2.5 (median) years. The non-vaccinated target population (age <8 months and ≥15 years) accounted for 56.7% of the cases. The transient (non-resident) population accounted for 51.3% of the cases. Fewer cases were observed in the population targeted for measles vaccine (aged 8 months to 14 years). The effectiveness of a single dose of the measles vaccine was 89.1% (95% confidence interval (CI), 44.5–97.9), and the effectiveness of ≥2 doses of the measles vaccine was 97.8% (95% CI, 88.3–99.6) in children aged 8 months to 14 years old. Conclusions There is a significant overall decline in the incidence of measles (including clinical and laboratory confirmed cases) in the measles vaccine targeted population in Guangzhou. Two doses of measles vaccine are more effective than one dose in preventing measles in China

  7. Clinical safety issues of measles, mumps and rubella vaccines.

    PubMed Central

    Afzal, M. A.; Minor, P. D.; Schild, G. C.

    2000-01-01

    The clinical safety of measles and measles-mumps-rubella vaccines has been questioned in recent reports that propose a possible link between measles virus or measles vaccines and the occurrence of juvenile Crohn disease and autism. This article reviews the outcomes of several laboratory investigations which were carried out independently to identify the presence or absence of measles virus in the intestinal tissues derived from cases of inflammatory bowel disease. One research group reported the presence of measles virus particles and genomic RNA in inflammatory bowel disease tissues, but this could not be confirmed by other groups, despite use of techniques that are highly specific and sensitive for the detection of measles virus nucleic acid in clinical specimens down to the molecular level. Based on the published data reviewed here, it can be concluded that there is no direct association between measles virus or measles vaccines and the development of Crohn disease, a conclusion which is supported by most epidemiological findings. PMID:10743285

  8. MMR Vaccine (Measles, Mumps, and Rubella)

    MedlinePlus

    Attenuvax® Measles Vaccine ... R-Vax® II (as a combination product containing Measles Vaccine, Rubella Vaccine) ... M-R® II (as a combination product containing Measles Vaccine, Mumps Vaccine, Rubella Vaccine)

  9. Measles, immune suppression and vaccination: direct and indirect nonspecific vaccine benefits.

    PubMed

    Mina, Michael J

    2017-06-01

    The measles virus is among the most transmissible viruses known to infect humans. Prior to measles vaccination programs, measles infected over 95% of all children and was responsible for over 4 million deaths each year. Measles vaccination programs have been among the greatest public health achievements reducing, eliminating endemic measles in the whole of the Americas and across much of the globe. Where measles vaccines are introduced, unexpectedly large reductions in all-cause childhood mortality have been observed. These gains appear to derive in part from direct heterologous benefits of measles vaccines that enhance innate and adaptive immune responses. Additionally, by preventing measles infections, vaccination prevents measles-associated short- and long-term immunomodulating effects. Before vaccination, these invisible hallmarks of measles infections increased vulnerability to non-measles infections in nearly all children for weeks, months, or years following acute infections. By depleting measles incidence, vaccination has had important indirect benefits to reduce non-measles mortality. Delineating the relative importance of these two modes of survival benefits following measles vaccine introduction is of critical public health importance. While both support continued unwavering global commitments to measles vaccination programs until measles eradication is complete, direct heterologous benefits of measles vaccination further support continued commitment to measles vaccination programs indefinitely. We discuss what is known about direct and indirect nonspecific measles vaccine benefits, and their implications for continued measles vaccination programs. © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  10. Epidemiology of measles in vaccinated people, Spain 2003-2014.

    PubMed

    Risco-Risco, Carlos; Masa-Calles, Josefa; López-Perea, Noemí; Echevarría, Juan Emilio; Rodríguez-Caravaca, Gil

    2017-11-01

    During the final phase of measles elimination rigorous investigation of each individual case becomes fundamental to confirm or discard cases, particularly among vaccinated people, since they experience a milder disease, and laboratory diagnosis is more complex. Our study focused in the epidemiology of measles in vaccinated people. Longitudinal study on measles cases in two dose vaccinated people in Spain from 2003 to 2014. We confirmed 138 measles cases (90 of them, laboratory confirmed) in people with two doses of vaccine. The median of time from last vaccination to rash onset showed a lineal trend (P<.001), in parallel with the number of doses of vaccine received (0, 1, 2 doses). Among confirmed cases, the hospitalization risk decreased inversely proportional to the number of administered vaccine doses (linear trend, P<.001). Only in 23.9% of confirmed cases and 50% of discarded cases the guidelines about sample taking were fulfilled. 50% of samples in two dose vaccinated people were taken without fulfilling time delay criteria. 16.7% (36/215) of discarded cases with a negative IgM result did correspond to samples taken early (first 72h after rash) and could represent false negatives. Our results highlight the importance of fulfilling properly the guidelines for laboratory diagnosis in order to confirm or discard every measles case, especially in two dose vaccinated people. When a negative IgM result is obtained in early samples a new IgM test should be practiced, as well as a PCR test, in order to avoid infra-detection of cases. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  11. Measles Vaccine.

    PubMed

    Griffin, Diane E

    2018-03-01

    Measles remains an important cause of child morbidity and mortality worldwide despite the availability of a safe and efficacious vaccine. The current measles virus (MeV) vaccine was developed empirically by attenuation of wild-type (WT) MeV by in vitro passage in human and chicken cells and licensed in 1963. Additional passages led to further attenuation and the successful vaccine strains in widespread use today. Attenuation is associated with decreased replication in lymphoid tissue, but the molecular basis for this restriction has not been identified. The immune response is age dependent, inhibited by maternal antibody (Ab) and involves induction of both Ab and T cell responses that resemble the responses to WT MeV infection, but are lower in magnitude. Protective immunity is correlated with levels of neutralizing Ab, but the actual immunologic determinants of protection are not known. Because measles is highly transmissible, control requires high levels of population immunity. Delivery of the two doses of vaccine needed to achieve >90% immunity is accomplished by routine immunization of infants at 9-15 months of age followed by a second dose delivered before school entry or by periodic mass vaccination campaigns. Because delivery by injection creates hurdles to sustained high coverage, there are efforts to deliver MeV vaccine by inhalation. In addition, the safety record for the vaccine combined with advances in reverse genetics for negative strand viruses has expanded proposed uses for recombinant versions of measles vaccine as vectors for immunization against other infections and as oncolytic agents for a variety of tumors.

  12. 9 CFR 113.313 - Measles Vaccine.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Measles Vaccine. 113.313 Section 113... Vaccines § 113.313 Measles Vaccine. Measles Vaccine shall be prepared from virus-bearing cell culture... for preparing the production seed virus for vaccine production. All serials of vaccine shall be...

  13. 9 CFR 113.313 - Measles Vaccine.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Measles Vaccine. 113.313 Section 113... Vaccines § 113.313 Measles Vaccine. Measles Vaccine shall be prepared from virus-bearing cell culture... for preparing the production seed virus for vaccine production. All serials of vaccine shall be...

  14. 9 CFR 113.313 - Measles Vaccine.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Measles Vaccine. 113.313 Section 113... Vaccines § 113.313 Measles Vaccine. Measles Vaccine shall be prepared from virus-bearing cell culture... for preparing the production seed virus for vaccine production. All serials of vaccine shall be...

  15. 9 CFR 113.313 - Measles Vaccine.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Measles Vaccine. 113.313 Section 113... Vaccines § 113.313 Measles Vaccine. Measles Vaccine shall be prepared from virus-bearing cell culture... for preparing the production seed virus for vaccine production. All serials of vaccine shall be...

  16. 9 CFR 113.313 - Measles Vaccine.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Measles Vaccine. 113.313 Section 113... Vaccines § 113.313 Measles Vaccine. Measles Vaccine shall be prepared from virus-bearing cell culture... for preparing the production seed virus for vaccine production. All serials of vaccine shall be...

  17. Measles Vaccination

    MedlinePlus

    ... World Health Organization Pan American Health Organization Measles Vaccination Pronounced (MEE-zills) Recommend on Facebook Tweet Share ... also be up to date on their MMR vaccination. The MMR vaccine is very safe and effective. ...

  18. Prior DNA vaccination does not interfere with the live-attenuated measles vaccine.

    PubMed

    Premenko-Lanier, Mary; Rota, Paul; Rhodes, Gary; Bellini, William; McChesney, Michael

    2004-01-26

    The currently used live-attenuated measles vaccine is very effective although maternal antibody prevents its administration prior to 6 months of age. We are investigating the ability of a DNA vaccine encoding the measles viral hemagglutinin, fusion and nucleoprotein to protect newborn infants from measles. Here, we show that a measles DNA vaccine protects juvenile macaques from pathogenic measles virus challenge and that macaques primed and boosted with this DNA vaccine have anemnestic antibody and cell-mediated responses after vaccination with a live-attenuated canine distemper-measles vaccine. Therefore, this DNA vaccine administered to newborn infants may not hinder the subsequent use of live-attenuated measles vaccine.

  19. Perspective on Global Measles Epidemiology and Control and the Role of Novel Vaccination Strategies.

    PubMed

    Coughlin, Melissa M; Beck, Andrew S; Bankamp, Bettina; Rota, Paul A

    2017-01-19

    Measles is a highly contagious, vaccine preventable disease. Measles results in a systemic illness which causes profound immunosuppression often leading to severe complications. In 2010, the World Health Assembly declared that measles can and should be eradicated. Measles has been eliminated in the Region of the Americas, and the remaining five regions of the World Health Organization (WHO) have adopted measles elimination goals. Significant progress has been made through increased global coverage of first and second doses of measles-containing vaccine, leading to a decrease in global incidence of measles, and through improved case based surveillance supported by the WHO Global Measles and Rubella Laboratory Network. Improved vaccine delivery methods will likely play an important role in achieving measles elimination goals as these delivery methods circumvent many of the logistic issues associated with subcutaneous injection. This review highlights the status of global measles epidemiology, novel measles vaccination strategies, and describes the pathway toward measles elimination.

  20. Perspective on Global Measles Epidemiology and Control and the Role of Novel Vaccination Strategies

    PubMed Central

    Coughlin, Melissa M.; Beck, Andrew S.; Bankamp, Bettina; Rota, Paul A.

    2017-01-01

    Measles is a highly contagious, vaccine preventable disease. Measles results in a systemic illness which causes profound immunosuppression often leading to severe complications. In 2010, the World Health Assembly declared that measles can and should be eradicated. Measles has been eliminated in the Region of the Americas, and the remaining five regions of the World Health Organization (WHO) have adopted measles elimination goals. Significant progress has been made through increased global coverage of first and second doses of measles-containing vaccine, leading to a decrease in global incidence of measles, and through improved case based surveillance supported by the WHO Global Measles and Rubella Laboratory Network. Improved vaccine delivery methods will likely play an important role in achieving measles elimination goals as these delivery methods circumvent many of the logistic issues associated with subcutaneous injection. This review highlights the status of global measles epidemiology, novel measles vaccination strategies, and describes the pathway toward measles elimination. PMID:28106841

  1. Global Measles and Rubella Laboratory Network Support for Elimination Goals, 2010-2015.

    PubMed

    Mulders, Mick N; Rota, Paul A; Icenogle, Joseph P; Brown, Kevin E; Takeda, Makoto; Rey, Gloria J; Ben Mamou, Myriam C; Dosseh, Annick R G A; Byabamazima, Charles R; Ahmed, Hinda J; Pattamadilok, Sirima; Zhang, Yan; Gacic-Dobo, Marta; Strebel, Peter M; Goodson, James L

    2016-05-06

    In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP)* with the objective to eliminate measles and rubella in five World Health Organization (WHO) regions by 2020. In September 2013, countries in all six WHO regions had established measles elimination goals, and additional goals for elimination of rubella and congenital rubella syndrome were established in three regions (1). Capacity for surveillance, including laboratory confirmation, is fundamental to monitoring and verifying elimination. The 2012-2020 Global Measles and Rubella Strategic Plan of the Measles and Rubella Initiative(†) calls for effective case-based surveillance with laboratory testing for case confirmation (2). In 2000, the WHO Global Measles and Rubella Laboratory Network (GMRLN) was established to provide high quality laboratory support for surveillance (3). The GMRLN is the largest globally coordinated laboratory network, with 703 laboratories supporting surveillance in 191 countries. During 2010-2015, 742,187 serum specimens were tested, and 27,832 viral sequences were reported globally. Expansion of the capacity of the GMRLN will support measles and rubella elimination efforts as well as surveillance for other vaccine-preventable diseases (VPDs), including rotavirus, and for emerging pathogens of public health concern.

  2. Accuracy of parent-reported measles-containing vaccination status of children with measles.

    PubMed

    Liu, G; Liao, Z; Xu, X; Liang, Y; Xiong, Y; Ni, J

    2017-03-01

    The validity of parent-reported measles-containing vaccination history in children with measles has not been assessed. This study evaluated the accuracy of parental recall of measles-containing vaccination histories in Shenzhen, China. A retrospective study was performed to compare the data from the electronic records with parental recall. The electronic records were regarded as accurate data about the children's measles-containing vaccination status. We collected data from the National Notifiable Diseases Surveillance System and the Immunization Program Information Management System in Shenzhen city, China. Between 2009 and 2014, there were 163 children with measles who had electronic vaccination records; the vaccination status of these cases was reported by the parents in the field epidemiological investigation. We validated parental recall with electronic records. The agreement between parental recall and electronic records was 78.7%. The kappa value was 0.57. The parent-reported measles-containing vaccination rate was higher than the electronic record (48.5% vs 41.7%, χ 2  = 53.64, P < 0.001). The true positive rate for parental recall was 82.4%, and the true negative rate was 75.8%. The positive predictive value was 70.9%, and the negative predictive value was 76.6%. In children with measles, parental recall slightly overestimated the measles vaccination rate, and the vaccination status recalled by parents was in moderate agreement with the electronic record. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  3. Immune response to measles vaccine in Peruvian children.

    PubMed Central

    Bautista-López, N. L.; Vaisberg, A.; Kanashiro, R.; Hernández, H.; Ward, B. J.

    2001-01-01

    OBJECTIVE: To evaluate the immune response in Peruvian children following measles vaccination. METHODS: Fifty-five Peruvian children received Schwarz measles vaccine (about 10(3) plaque forming units) at about 9 months of age. Blood samples were taken before vaccination, then twice after vaccination: one sample at between 1 and 4 weeks after vaccination and the final sample 3 months post vaccination for evaluation of immune cell phenotype and lymphoproliferative responses to measles and non-measles antigens. Measles-specific antibodies were measured by plaque reduction neutralization. FINDINGS: The humoral response developed rapidly after vaccination; only 4 of the 55 children (7%) had plaque reduction neutralization titres <200 mlU/ml 3 months after vaccination. However, only 8 out of 35 children tested (23%) had lymphoproliferative responses to measles antigens 3-4 weeks after vaccination. Children with poor lymphoproliferative responses to measles antigens had readily detectable lymphoproliferative responses to other antigens. Flow cytometric analysis of peripheral blood mononuclear cells revealed diffuse immune system activation at the time of vaccination in most children. The capacity to mount a lymphoproliferative response to measles antigens was associated with expression of CD45RO on CD4+ T-cells. CONCLUSION: The 55 Peruvian children had excellent antibody responses after measles vaccination, but only 23% (8 out of 35) generated detectable lymphoproliferative responses to measles antigens (compared with 55-67% in children in the industrialized world). This difference may contribute to the less than uniform success of measles vaccination programmes in the developing world. PMID:11731811

  4. The challenge of improving the efficacy of measles vaccine.

    PubMed

    Garly, May-Lill; Aaby, Peter

    2003-01-01

    Despite a safe and effective measles vaccine, measles still claims an estimated 800,000 lives per year mostly among children in developing countries. This paper deals with strategies to improve vaccine efficacy and prevent unnecessary deaths, including considerations of one dose at 9 months strategy for developing countries, strain of vaccine, potency and number of doses of measles vaccine. After more than 20 years of measles immunisation in the developing world, the epidemiology of measles is radically changed, and the absence of measles epidemics might lead to waning immunity due to less clinical and subclinical infections boosting the antibody level. An increasing proportion of mothers are vaccinated, thus transferring a lower maternal antibody level to their infants who will be susceptible to measles at a younger age. The strategies to limit nosocomial measles infection and spread of measles epidemics are reviewed. Though the measles elimination programmes have been very effective in the Americas, it seems unlikely that they will be equally effective in the rest of the world. Even if eradication should be possible, it might be unwise to stop measles vaccination because the vaccine apparently has beneficial effects and because it would make measles a likely weapon for bio-terrorism. If we are unlikely to get rid of measles and measles vaccine, it might be wise to study further some of the many unanswered questions regarding the long-term effects of measles and measles vaccination. Copyright 2002 Elsevier Science B.V.

  5. The laboratory confirmation of suspected measles cases in settings of low measles transmission: conclusions from the experience in the Americas.

    PubMed Central

    Dietz, Vance; Rota, Jennifer; Izurieta, Héctor; Carrasco, Peter; Bellini, William

    2004-01-01

    The Americas have set a goal of interrupting indigenous transmission of measles using a strategy developed by the Pan American Health Organization (PAHO). This strategy includes recommendations for vaccination activities to achieve and sustain high immunity in the population and is complemented by sensitive epidemiological surveillance systems developed to monitor illnesses characterized by febrile rash, and to provide effective virological and serological surveillance. A key component in ensuring the success of the programme has been a laboratory network comprising 22 national laboratories including reference centres. Commercially available indirect enzyme immunoassay kits (EIA) for immunoglobulin M (IgM)-class antibodies are currently being used throughout the region. However, because there are few or no true measles cases in the region, the positive predictive value of these diagnostic tests has decreased. False-positive results of IgM tests can also occur as a result of testing suspected measles cases with exanthemata caused by Parvovirus B19, rubella and Human herpesvirus 6, among others. In addition, as countries maintain high levels of vaccination activity and increased surveillance of rash and fever, the notification of febrile rash illness in recently vaccinated people can be anticipated. Thus, managers in the measles elimination programme must be prepared to address the interpretation of a positive result of a laboratory test for measles IgM when clinical and epidemiological data may indicate that the case is not measles. The interpretation of an IgM-positive test under different circumstances and the definition of a vaccine-related rash illness in a setting of greatly reduced, or absent, transmission of measles is discussed. PMID:15640921

  6. Measles, mumps, and rubella vaccines.

    PubMed

    Wharton, M; Cochi, S L; Williams, W W

    1990-03-01

    With widespread use of the live virus vaccines for measles, mumps, and rubella, there has been a dramatic decrease in the incidence of all three diseases. At the same time, an increasing proportion of the remaining cases are occurring in adolescents and adults. Thus, vaccinations for these three diseases of childhood must be included in a comprehensive program for adult immunization. The vaccines have a proven history of safety and efficacy and are usually administered together as combined measles-mumps-rubella (MMR) vaccine. Vaccination for measles, mumps, and rubella is particularly important for susceptible adults likely to come in contact with infected children. Adults at particularly high risk for exposure may include daycare center workers, teachers and other school employees, college students, medical personnel, and those planning to travel outside the United States.

  7. Measles lessons in an anti-vaccination era: public health is a social duty, not a political option.

    PubMed

    Lancella, L; Di Camillo, C; Vittucci, A C; Boccuzzi, E; Bozzola, E; Villani, A

    2017-11-15

    Measles virus, member of the genus Morbillivirus in the family Paramyxoviridae, is a highly contagious human pathogen. An effective live-attenuated vaccine is available and its use has the potential to eradicate the disease from the human population. Although the vaccine was introduced in national vaccination schedules, several measles outbreaks have occurred because of insufficient vaccination coverage. Since early January 2017, a new outbreak of measles in Italy has been observed. We analyzed all the patients admitted to the Emergency Department of Bambino Gesù Children Hospital of Rome from the 1st of January 2017 to the end of May 2017 and discharged with diagnosis of suspected or confirmed measles or admitted to the Pediatric and Infectious Disease Unit. For each confirmed case, demographic data, vaccination history, exposure to source case, clinical presentation, date of onset of symptoms, hospitalization, laboratory test results, complications and therapy were collected. From the 1st of January 2017 to the 31st of May 2017, we enrolled 139 patients who were conducted to the Emergency Department of Bambino Gesù Children's Hospital because of measles: 33 patients were discharged with the diagnosis of suspected measles by clinical manifestations; 33 discharged with the diagnosis of confirmed measles by laboratory tests and 73 were admitted to the Pediatric and Infectious Disease Unit. Seven patients, who were exposed to mothers with measles, were admitted to receive treatment with Measles Immune Globulin intravenously. Among the 66 patients admitted to the hospital with measles, 31 cases (47%) occurred in unvaccinated individuals who were age-eligible for measles vaccination; 29 (44%) were infants too young to be vaccinated; only five patients (8%) received one dose of measles-containing vaccine. Out of the 66 patients, 35 (53%) developed complications. Acute respiratory failure was the most reported complications (20%). Death, due to multiorgan failure by

  8. Vaccine platform recombinant measles virus.

    PubMed

    Mühlebach, Michael D

    2017-10-01

    The classic development of vaccines is lengthy, tedious, and may not necessarily be successful as demonstrated by the case of HIV. This is especially a problem for emerging pathogens that are newly introduced into the human population and carry the inherent risk of pandemic spread in a naïve population. For such situations, a considerable number of different platform technologies are under development. These are also under development for pathogens, where directly derived vaccines are regarded as too complicated or even dangerous due to the induction of inefficient or unwanted immune responses causing considerable side-effects as for dengue virus. Among platform technologies are plasmid-based DNA vaccines, RNA replicons, single-round infectious vector particles, or replicating vaccine-based vectors encoding (a) critical antigen(s) of the target pathogens. Among the latter, recombinant measles viruses derived from vaccine strains have been tested. Measles vaccines are among the most effective and safest life-attenuated vaccines known. Therefore, the development of Schwarz-, Moraten-, or AIK-C-strain derived recombinant vaccines against a wide range of mostly viral, but also bacterial pathogens was quite straightforward. These vaccines generally induce powerful humoral and cellular immune responses in appropriate animal models, i.e., transgenic mice or non-human primates. Also in the recent first clinical phase I trial, the results have been quite encouraging. The trial indicated the expected safety and efficacy also in human patients, interestingly independent from the level of prevalent anti-measles immunity before the trial. Thereby, recombinant measles vaccines expressing additional antigens are a promising platform for future vaccines.

  9. Synergizing vaccinations with therapeutics for measles eradication.

    PubMed

    Plemper, Richard K; Hammond, Anthea L

    2014-02-01

    The measles virus is a major human pathogen responsible for approximately 150,000 deaths annually. The disease is vaccine preventable and eradication of the virus is considered feasible, in principle. However, a herd immunity exceeding 95% is required to prevent sporadic viral outbreaks in a population. Declining disease prevalence, combined with public anxiety over the vaccination's safety, has led to increased vaccine refusal, especially in Europe. This has led to the resurgence of measles in some areas. This article discusses whether synergizing effective measles therapeutics with the measles vaccination could contribute to finally eradicating measles. The authors identify key elements in a desirable drug profile and review current disease management strategies and the state of experimental inhibitor candidates. The authors also evaluate the risk associated with viral escape from inhibition, and consider the potential of measles therapeutics in the management of persistent central nervous system (CNS) viral infection. Finally, the authors contemplate the possible impact of therapeutics in controlling the threat imposed by closely related zoonotic pathogens of the same genus as measles. Efficacious therapeutics used for post-exposure prophylaxis of high-risk social contacts of confirmed index cases may aid measles eradication by closing herd immunity gaps; this is due to vaccine refusal or failure in populations with overall good vaccination coverage. The envisioned primarily prophylactic application of measles therapeutics to a predominantly pediatric and/or adolescent population, dictates the drug profile. It also has to be safe and efficacious, orally available, shelf-stable at ambient temperature and amenable to cost-effective manufacturing.

  10. Root-Cause Analytical Survey for Measles Outbreak: Vaccination or Vaccine?- A Study From Madhepura District, Bihar, India.

    PubMed

    Basa, Sudipta; Das, Rashmi Ranjan; Khan, Javed Akhtar

    2015-06-01

    Though measles is a vaccine preventable disease, outbreaks still continue to occur because of poor immunization coverage rate at the national level. To report the survey results of an outbreak of measles in Puraini village of Madhepura district in Bihar, India. This cross-sectional survey was conducted among children aged 6 months to 12 years during an outbreak of measles in December 2008. WHO case definition criteria was used to define active measles cases. Demographic data, immunization status, and disease outcome among the cases was obtained by pre-structured questionnaires. Blood samples from 5 cases were sent for laboratory confirmation. A total of 52 cases and 8 deaths were reported with an attack rate of 28% and case fatality rate of 15.4%. Out of 35% cases of post-measles complications, dysentery with pneumonia was the most common. Anti-measles IgM antibody tested positive in all the 5 serum samples sent for confirmation. No child had received measles vaccination in the past, and the reasons were lack of awareness, lack of faith on vaccination, and unavailability of health workers. This survey calls for strengthening of disease surveillance and routine immunization coverage to achieve measles control in these communities. This has important public health implication for the whole country regarding measles elimination in near-future.

  11. Mothers' concept of measles and attitudes towards the measles vaccine in Ile-Ife, Nigeria.

    PubMed

    Odebiyi, A I; Ekong, S C

    1982-09-01

    The attitude of Nigerian mothers, mainly Yoruba, towards measles vaccine and other aspects of prevention are influenced by different perceptions of the cause of measles. There is a significant correlation between the literacy of mothers and their belief in the efficacy of measles vaccine but not between their ages and belief. The mothers' perception of measles is a function of their socioeconomic characteristics, with the lower socioeconomic group tending more to define measles within the supernatural context. The findings indicate the necessity for health education to be based on local culture when promoting vaccination.

  12. Measles, mumps, rubella vaccine induced subacute sclerosing panencephalitis.

    PubMed

    Belgamwar, R B; Prasad, S; Appaya, P

    1997-11-01

    The incidence of subacute sclerosing panencephalitis (SSPE), a progressive and fatal neurodegenerative disease caused by the measles virus, has declined with widespread use of measles vaccine. The risk of SSPE after measles vaccination has been estimated at 0.7/million doses. This paper reports the case of a 15-year-old girl from India who developed SSPE presumably as a result of a delayed effect of measles, mumps, and rubella (MMR) vaccine. She presented with a 2-month history of behavioral disturbances, a deterioration in school performance, forgetfulness, silly smiling, handwriting changes, social withdrawal, and ataxia. The girl had received MMR vaccine at 9 months of age and had no past history of measles. Her measles antibody titre was 1:625 in both serum and cerebrospinal fluid.

  13. Measles seroprevalence, outbreaks, and vaccine coverage in Rwanda.

    PubMed

    Seruyange, Eric; Gahutu, Jean-Bosco; Mambo Muvunyi, Claude; Uwimana, Zena G; Gatera, Maurice; Twagirumugabe, Theogene; Katare, Swaibu; Karenzi, Ben; Bergström, Tomas

    2016-01-01

    Measles outbreaks are reported after insufficient vaccine coverage, especially in countries recovering from natural disaster or conflict. We compared seroprevalence to measles in blood donors in Rwanda and Sweden and explored distribution of active cases of measles and vaccine coverage in Rwanda. 516 Rwandan and 215 Swedish blood donors were assayed for measles-specific immunoglobulin G (IgG) by enzyme-linked immunosorbent assay (ELISA). Data on vaccine coverage and acute cases in Rwanda from 1980 to 2014 were collected, and IgM on serum samples and polymerase chain reaction (PCR) on nasopharyngeal (NPH) swabs from suspected measles cases during 2010-2011 were analysed. The seroprevalence of measles IgG was significantly higher in Swedish blood donors (92.6%; 95% CI: 89.1-96.1%) compared to Rwandan subjects (71.5%; 95% CI: 67.6-75.4%) and more pronounced <35 years of age. The OD values were significantly lower in the Rwandan blood donors as compared to Swedish subjects (p < 0.00001). However, effective measles vaccine coverage was concomitant with decrease in measles cases in Rwanda, with the exception of an outbreak in 1995 following the 1994 genocide. 76/544 serum samples were IgM positive and 21/31 NPH swabs were PCR positive for measles, determined by sequencing to be of genotype B3. Measles seroprevalence was lower in Rwandan blood donors compared to Swedish subjects. Despite this, the number of reported measles cases in Rwanda rapidly decreased during the study period, concomitant with increased vaccine coverage. Taken together, the circulation of measles was limited in Rwanda and vaccine coverage was favourable, but seroprevalence and IgG levels were low especially in younger age groups.

  14. Variability in Humoral Immunity to Measles Vaccine: New Developments

    PubMed Central

    Haralambieva, Iana H.; Kennedy, Richard B.; Ovsyannikova, Inna G.; Whitaker, Jennifer A.; Poland, Gregory A.

    2015-01-01

    Despite the existence of an effective measles vaccine, resurgence in measles cases in the United States and across Europe has occurred, including in individuals vaccinated with two doses of the vaccine. Host genetic factors result in inter-individual variation in measles vaccine-induced antibodies, and play a role in vaccine failure. Studies have identified HLA and non-HLA genetic influences that individually or jointly contribute to the observed variability in the humoral response to vaccination among healthy individuals. In this exciting era, new high-dimensional approaches and techniques including vaccinomics, systems biology, GWAS, epitope prediction and sophisticated bioinformatics/statistical algorithms, provide powerful tools to investigate immune response mechanisms to the measles vaccine. These might predict, on an individual basis, outcomes of acquired immunity post measles vaccination. PMID:26602762

  15. Decreased measles antibody response after measles-mumps-rubella vaccine in infants with colds.

    PubMed

    Krober, M S; Stracener, C E; Bass, J W

    1991-04-24

    We examined the possibility that the common cold or afebrile upper respiratory tract infection might interfere with successful immunization in children who receive standard measles-mumps-rubella vaccine. Infants 15 to 18 months of age presenting at our well-child clinics for routine examination and immunizations were divided into two groups. Those infants with a history and physical findings of upper respiratory tract infection were compared with healthy control group infants who did not have upper respiratory tract infections, and who did not have a history of upper respiratory tract infection symptoms within the previous month. Both groups were studied for their serologic response to measles-mumps-rubella vaccination. Prevaccination serum samples were obtained prior to vaccine administration and postvaccination serum samples were obtained 6 to 8 weeks later. Measles antibody was measured in these serum samples by an indirect fluorescein-tagged antibody test. Ten (21%) of 47 infants with colds failed to develop measles antibody, while only one (2%) of 51 well infants failed to develop antibody. We conclude that infants with colds have a significant seroconversion failure rate associated with measles vaccine administration and that this may be the cause of some primary measles vaccine failures.

  16. Expansion of syndromic vaccine preventable disease surveillance to include bacterial meningitis and Japanese encephalitis: evaluation of adapting polio and measles laboratory networks in Bangladesh, China and India, 2007-2008.

    PubMed

    Cavallaro, Kathleen F; Sandhu, Hardeep S; Hyde, Terri B; Johnson, Barbara W; Fischer, Marc; Mayer, Leonard W; Clark, Thomas A; Pallansch, Mark A; Yin, Zundong; Zuo, Shuyan; Hadler, Stephen C; Diorditsa, Serguey; Hasan, A S M Mainul; Bose, Anindya S; Dietz, Vance

    2015-02-25

    Surveillance for acute flaccid paralysis with laboratory confirmation has been a key strategy in the global polio eradication initiative, and the laboratory platform established for polio testing has been expanded in many countries to include surveillance for cases of febrile rash illness to identify measles and rubella cases. Vaccine-preventable disease surveillance is essential to detect outbreaks, define disease burden, guide vaccination strategies and assess immunization impact. Vaccines now exist to prevent Japanese encephalitis (JE) and some etiologies of bacterial meningitis. We evaluated the feasibility of expanding polio-measles surveillance and laboratory networks to detect bacterial meningitis and JE, using surveillance for acute meningitis-encephalitis syndrome in Bangladesh and China and acute encephalitis syndrome in India. We developed nine syndromic surveillance performance indicators based on international surveillance guidelines and calculated scores using supervisory visit reports, annual reports, and case-based surveillance data. Scores, variable by country and targeted disease, were highest for the presence of national guidelines, sustainability, training, availability of JE laboratory resources, and effectiveness of using polio-measles networks for JE surveillance. Scores for effectiveness of building on polio-measles networks for bacterial meningitis surveillance and specimen referral were the lowest, because of differences in specimens and techniques. Polio-measles surveillance and laboratory networks provided useful infrastructure for establishing syndromic surveillance and building capacity for JE diagnosis, but were less applicable for bacterial meningitis. Laboratory-supported surveillance for vaccine-preventable bacterial diseases will require substantial technical and financial support to enhance local diagnostic capacity. Published by Elsevier Ltd.

  17. Progress towards Rapid Detection of Measles Vaccine Strains: a Tool To Inform Public Health Interventions

    PubMed Central

    2016-01-01

    ABSTRACT Rapid differentiation of vaccine from wild-type strains in suspect measles cases is a valuable epidemiological tool that informs the public health response to this highly infectious disease. Few public health laboratories sequence measles virus-positive specimens to determine genotype, and the vaccine-specific real-time reverse transcriptase PCR (rRT-PCR) assay described by F. Roy et al. (J. Clin. Microbiol. 55:735–743, 2017, https://doi.org/10.1128/JCM.01879-16) offers a rapid, easily adoptable method to identify measles vaccine strains in suspect cases. PMID:28003421

  18. Progress towards Rapid Detection of Measles Vaccine Strains: a Tool To Inform Public Health Interventions.

    PubMed

    Hacker, Jill K

    2017-03-01

    Rapid differentiation of vaccine from wild-type strains in suspect measles cases is a valuable epidemiological tool that informs the public health response to this highly infectious disease. Few public health laboratories sequence measles virus-positive specimens to determine genotype, and the vaccine-specific real-time reverse transcriptase PCR (rRT-PCR) assay described by F. Roy et al. (J. Clin. Microbiol. 55:735-743, 2017, https://doi.org/10.1128/JCM.01879-16) offers a rapid, easily adoptable method to identify measles vaccine strains in suspect cases. Copyright © 2017 American Society for Microbiology.

  19. Epidemiology of laboratory confirmed measles virus cases in the southern nations of Ethiopia, 2007-2014.

    PubMed

    Getahun, Mekonen; Beyene, Berhane; Ademe, Ayesheshem; Teshome, Birke; Tefera, Mesfin; Afework, Aklog; HaileMariam, Yoseph; Assefa, Esete; Hailegiorgis, Yonas; Asha, Anjelo

    2017-01-19

    In Ethiopia, measles case-based surveillance was introduced in 2004 as one strategy for measles control by laboratory confirmation of suspected cases. In this article, epidemiological distribution of laboratory-confirmed measles cases were reported from the Southern Nation Nationalities and Peoples Region (SNNPR) of Ethiopia between 2007 and 2014, as the region is one of the highly measles affected areas in Ethiopia. A serum sample was collected from all measles suspected cases, and patient information was captured by case reporting format (CRF). Samples were transported to the National Measles Laboratory for Measles IgM testing by ELISA technique. Data entry and analysis were done using Epi-Info 3.5.4 software. A total of 4810 samples were tested for measles IgM using ELISA technique and 1507 (31.3%) were found positive during 2007-2014 in SNNPR of Ethiopia. Patients with age 1-4 years were the most affected regardless of sex. The incidence of measles confirmed cases increased from 15 in 2007 to 180 in 2013 per million population. The highest percentage of laboratory-confirmed cases were found in 2014. Measles was found distributed throughout the regional state. Measles was found a public health important disease in SNNPR of Ethiopia, mostly affecting children 1-4 years. The incidence of measles cases is increasing from time to time. Additional research to determine the genotype of circulating measles virus, knowledge, attitude and practice of professionals and the population for measles vaccination and infection in the region is important. A wide age group measles vaccination campaign is highly recommended.

  20. Global and national laboratory networks support high quality surveillance for measles and rubella.

    PubMed

    Xu, Wenbo; Zhang, Yan; Wang, Huiling; Zhu, Zhen; Mao, Naiying; Mulders, Mick N; Rota, Paul A

    2017-05-01

    Laboratory networks are an essential component of disease surveillance systems because they provide accurate and timely confirmation of infection. WHO coordinates global laboratory surveillance of vaccine preventable diseases, including measles and rubella. The more than 700 laboratories within the WHO Global Measles and Rubella Laboratory Network (GMRLN) supports surveillance for measles, rubella and congenial rubella syndrome in 191 counties. This paper describes the overall structure and function of the GMRLN and highlights the largest of the national laboratory networks, the China Measles and Rubella Laboratory Network. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  1. Survival of previously measles-vaccinated and measles-unvaccinated children in an emergency situation: an unplanned study.

    PubMed

    Aaby, Peter; Garly, May-Lill; Balé, Carlitos; Martins, Cesario; Jensen, Henrik; Lisse, Ida; Whittle, Hilton

    2003-09-01

    Previous studies have suggested that standard measles vaccine may reduce mortality by more than the number of deaths thought to be caused by measles infection in areas with high mortality. However, these observations have not been based on randomized trials. During the recent war in Guinea-Bissau, most children fled from the city of Bissau and immunization services in the country broke down for several months. We were performing a trial in which children were randomized at 6 months of age to receive either measles vaccine or inactivated polio vaccine. Because of the war many children did not receive the dose of measles vaccine planned for 9 months of age. We were able to monitor mortality during the war and after. Included in the study were 433 children 6 to 11 months of age. Fifteen children died (3.6%) during the first 3 months of the war before vaccination programs were resumed, 4 of 214 measles-vaccinated children and 11 of 219 children who had received inactivated polio vaccine. The effect of measles vaccine was marked for girls [mortality rate ratio (MR), 0.00; 95% confidence limits, 0.0 to 0.37], whereas there was no difference for boys (MR = 1.02; 95% confidence limits, 0.25 to 3.88). In a combined analysis controlling for factors that differed between the two groups, the MR for measles-vaccinated children was 0.30 (95% confidence limits, 0.08 to 0.87). Prolonging the period of observation to the end of 1998 or including the prewar period did not modify the significant beneficial effect of measles vaccine for girls. Twenty-two of the children in the cohort were reported to have had measles, 8 cases occurring during the 3 months of the war. Exclusion of measles cases in the analysis did not change the results; children who had received measles vaccine had a MR of 0.28 (95% confidence limits, 0.06 to 0.89) during the first 3 months of the war. Consistent with previous observational studies, measles vaccination was associated with a reduction in mortality that

  2. Measles.

    PubMed

    Rota, Paul A; Moss, William J; Takeda, Makoto; de Swart, Rik L; Thompson, Kimberly M; Goodson, James L

    2016-07-14

    Measles is an infectious disease in humans caused by the measles virus (MeV). Before the introduction of an effective measles vaccine, virtually everyone experienced measles during childhood. Symptoms of measles include fever and maculopapular skin rash accompanied by cough, coryza and/or conjunctivitis. MeV causes immunosuppression, and severe sequelae of measles include pneumonia, gastroenteritis, blindness, measles inclusion body encephalitis and subacute sclerosing panencephalitis. Case confirmation depends on clinical presentation and results of laboratory tests, including the detection of anti-MeV IgM antibodies and/or viral RNA. All current measles vaccines contain a live attenuated strain of MeV, and great progress has been made to increase global vaccination coverage to drive down the incidence of measles. However, endemic transmission continues in many parts of the world. Measles remains a considerable cause of childhood mortality worldwide, with estimates that >100,000 fatal cases occur each year. Case fatality ratio estimates vary from <0.01% in industrialized countries to >5% in developing countries. All six WHO regions have set goals to eliminate endemic transmission of MeV by achieving and maintaining high levels of vaccination coverage accompanied by a sensitive surveillance system. Because of the availability of a highly effective and relatively inexpensive vaccine, the monotypic nature of the virus and the lack of an animal reservoir, measles is considered a candidate for eradication.

  3. Expansion of syndromic vaccine preventable disease surveillance to include bacterial meningitis and Japanese encephalitis: Evaluation of adapting polio and measles laboratory networks in Bangladesh, China and India, 2007–2008

    PubMed Central

    Cavallaro, Kathleen F.; Sandhu, Hardeep S.; Hyde, Terri B.; Johnson, Barbara W.; Fischer, Marc; Mayer, Leonard W.; Clark, Thomas A.; Pallansch, Mark A.; Yin, Zundong; Zuo, Shuyan; Hadler, Stephen C.; Diorditsa, Serguey; Hasan, A.S.M. Mainul; Bose, Anindya S.; Dietz, Vance

    2016-01-01

    Background Surveillance for acute flaccid paralysis with laboratory confirmation has been a key strategy in the global polio eradication initiative, and the laboratory platform established for polio testing has been expanded in many countries to include surveillance for cases of febrile rash illness to identify measles and rubella cases. Vaccine-preventable disease surveillance is essential to detect outbreaks, define disease burden, guide vaccination strategies and assess immunization impact. Vaccines now exist to prevent Japanese encephalitis (JE) and some etiologies of bacterial meningitis. Methods We evaluated the feasibility of expanding polio–measles surveillance and laboratory networks to detect bacterial meningitis and JE, using surveillance for acute meningitis-encephalitis syndrome in Bangladesh and China and acute encephalitis syndrome in India. We developed nine syndromic surveillance performance indicators based on international surveillance guidelines and calculated scores using supervisory visit reports, annual reports, and case-based surveillance data. Results Scores, variable by country and targeted disease, were highest for the presence of national guidelines, sustainability, training, availability of JE laboratory resources, and effectiveness of using polio–measles networks for JE surveillance. Scores for effectiveness of building on polio–measles networks for bacterial meningitis surveillance and specimen referral were the lowest, because of differences in specimens and techniques. Conclusions Polio–measles surveillance and laboratory networks provided useful infrastructure for establishing syndromic surveillance and building capacity for JE diagnosis, but were less applicable for bacterial meningitis. Laboratory-supported surveillance for vaccine-preventable bacterial diseases will require substantial technical and financial support to enhance local diagnostic capacity. PMID:25597940

  4. Measles-mumps-rubella vaccination and respiratory syncytial virus-associated hospital contact.

    PubMed

    Sørup, Signe; Benn, Christine Stabell; Stensballe, Lone Graff; Aaby, Peter; Ravn, Henrik

    2015-01-01

    The live measles vaccine has been associated with lower non-measles mortality and admissions in low-income countries. The live measles-mumps-rubella vaccine has also been associated with lower rate of admissions with any type of infection in Danish children; the association was strongest for admissions with lower respiratory infections. To examine whether measles, mumps, and rubella (MMR) vaccination was associated with reduced rate of hospital contact related to respiratory syncytial virus (RSV) in a high-income country. Nationwide cohort study of laboratory-confirmed RSV hospital contacts at age 14-23 months in all children born in Denmark 1997-2002 who had already received the vaccine against diphtheria, tetanus, pertussis (acellular), polio, and Haemophilus influenzae type b (DTaP-IPV-Hib) at the recommended ages of 3, 5, and 12 months. The study included 888 RSV hospital contacts in 128,588 person years of follow up (rate 6.8/1000 person years). Having MMR as the most recent vaccine was associated with a reduced rate of RSV hospital contacts compared with having DTaP-IPV-Hib as the most recent vaccine (Incidence rate ratio (IRR), 0.75; 95% confidence interval (CI), 0.63-0.89). After adjustment for potential confounders including exact age in days the IRR was 0.78 (95% CI, 0.66-0.93). The adjusted IRR was 0.74 (95% CI, 0.60-0.92) in males and 0.84 (95% CI, 0.66-1.06) in females (P Interaction, 0.42). There was no association in the first month after MMR vaccination (adjusted IRR, 0.97; 95% CI, 0.76-1.24) but the adjusted IRR was 0.70 (95% CI, 0.58-0.85) from one month after MMR vaccination. MMR vaccination was associated with reduced rate of hospital contacts related to laboratory-confirmed RSV infection. Further research on the association between MMR vaccination and other unrelated pathogens are warranted. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Isolation of vaccine-derived measles viruses from children with acute respiratory infection.

    PubMed

    Aoki, Yoko; Mizuta, Katsumi; Ikeda, Tatsuya; Abiko, Chieko; Itagaki, Tsutomu; Ahiko, Tadayuki

    2013-06-01

    The measles elimination project led by the World Health Organization (WHO) has been moving toward the target of eliminating measles in the WHO Western Pacific Region. In Japan, prefectural public health institutes play a key role for the laboratory diagnosis of measles virus (MV) infection, which is based on PCR, virus isolation, and genotyping. Microscopic examination of viral-sensitive cell lines during routine virus isolation from nasopharyngeal specimens has been used to detect the morphological changes typical for the growth of respiratory viruses. Here, we describe the unexpected isolation of vaccine-derived MVs from the two unrelated 1-year-old boys with acute respiratory infection. The nasopharyngeal specimens were obtained from one patient in February 2007 and from another in December 2012. Incidentally, the two children had received measles-rubella vaccination 9 or 11 days before the sampling. The isolates from two children induced morphological changes of the viral-sensitive cell lines, such as syncythia formation (cell fusion). We finally identified the isolates as vaccine-derived MVs by sequence analysis and immunological methods with anti-measles nucleoprotein antibodies. As no typical symptoms of MV infection were observed in either patient, the vaccine-derived MVs were isolated not as causative pathogens but by chance. In fact, there was no suspected case of secondary MV infection in either patient, thereby excluding the possibility that vaccine-derived MVs spread from human to human. Our experiences suggest the possibility of vaccine-derived MV isolation by cell cultures and the difficulty in identifying MVs in specimens from patients other than clinically suspected measles cases.

  6. Measles, Mumps, and Rubella (MMR) Vaccination: What Everyone Should Know

    MedlinePlus

    ... rubella combination vaccine Measles=Rubeola Measles=”10-day”, “hard” and “red” measles MMRV=measles, mumps, rubella, and varicella combination vaccine File Formats Help: How do I view different file formats ( ...

  7. Measles vaccination using a microneedle patch☆

    PubMed Central

    Edens, Chris; Collins, Marcus L.; Ayers, Jessica; Rota, Paul A.; Prausnitz, Mark R.

    2013-01-01

    Measles vaccination programs would benefit from delivery methods that decrease cost, simplify logistics, and increase safety. Conventional subcutaneous injection is limited by the need for skilled healthcare professionals to reconstitute and administer injections, and by the need for safe needle handling and disposal to reduce the risk of disease transmission through needle re-use and needlestick injury. Microneedles are micron-scale, solid needles coated with a dry formulation of vaccine that dissolves in the skin within minutes after patch application. By avoiding the use of hypodermic needles, vaccination using a microneedle patch could be carried out by minimally trained personnel with reduced risk of blood-borne disease transmission. The goal of this study was to evaluate measles vaccination using a microneedle patch to address some of the limitations of subcutaneous injection. Viability of vaccine virus dried onto a microneedle patch was stabilized by incorporation of the sugar, trehalose, and loss of viral titer was less than 1 log10(TCID50) after storage for at least 30 days at room temperature. Microneedle patches were then used to immunize cotton rats with the Edmonston-Zagreb measles vaccine strain. Vaccination using microneedles at doses equaling the standard human dose or one-fifth the human dose generated neutralizing antibody levels equivalent to those of a subcutaneous immunization at the same dose. These results show that measles vaccine can be stabilized on microneedles and that vaccine efficiently reconstitutes in vivo to generate a neutralizing antibody response equivalent to that generated by subcutaneous injection. PMID:23044406

  8. Effectiveness of Early Measles, Mumps, and Rubella Vaccination Among 6-14-Month-Old Infants During an Epidemic in the Netherlands: An Observational Cohort Study.

    PubMed

    Woudenberg, Tom; van der Maas, Nicoline A T; Knol, Mirjam J; de Melker, Hester; van Binnendijk, Rob S; Hahné, Susan J M

    2017-04-15

    Routinely, the first measles, mumps, and rubella (MMR) vaccine dose is given at 14 months of age in the Netherlands. However, during a measles epidemic in 2013-2014, MMR vaccination was also offered to 6-14-month-olds in municipalities with <90% MMR vaccination coverage. We studied the effectiveness of the early MMR vaccination schedule. Parents of all infants targeted for early MMR vaccination were asked to participate. When parent(s) suspected measles, their infant's saliva was tested for measles-specific antibodies. The vaccine effectiveness (VE) against laboratory-confirmed and self-reported measles was estimated using Cox regression, with VE calculated as 1 minus the hazard ratio. Three vaccinated and 10 unvaccinated laboratory-confirmed cases occurred over observation times of 106631 and 23769 days, respectively. The unadjusted VE against laboratory-confirmed measles was 94% (95% confidence interval [CI], 79%-98%). After adjustment for religion and sibling's vaccination status, the VE decreased to 71% (-72%-95%). For self-reported measles, the unadjusted and adjusted VE was 67% (40%-82%) and 43% (-12%-71%), respectively. Infants vaccinated between 6 and 14 months of age had a lower risk of measles than unvaccinated infants. However, part of the effect was caused by herd immunity, since vaccinated infants were more likely to be surrounded by other vaccinated individuals. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  9. Laboratory confirmation of measles in elimination settings: experience from the Republic of the Marshall Islands, 2003.

    PubMed

    Hyde, Terri B; Nandy, Robin; Hickman, Carole J; Langidrik, Justina R; Strebel, Peter M; Papania, Mark J; Seward, Jane F; Bellini, William J

    2009-02-01

    To highlight the complications involved in interpreting laboratory tests of measles immunoglobulin M (IgM) for confirmation of infection during a measles outbreak in a highly vaccinated population after conducting a mass immunization campaign as a control measure. This case study was undertaken in the Republic of the Marshall Islands during a measles outbreak in 2003, when response immunization was conducted. A measles case was defined as fever and rash and one or more of cough, coryza or conjunctivitis. Between 13 July and 7 November 2003, serum samples were obtained from suspected measles cases for serologic testing and nasopharyngeal swabs were taken for viral isolation by reverse transcriptase polymerase chain reaction (RT-PCR). Specimens were collected from 201 suspected measles cases (19% of total): of the ones that satisfied the clinical case definition, 45% were IgM positive (IgM+) and, of these, 24% had received measles vaccination within the previous 45 days (up to 45 days after vaccination an IgM+ result could be due to either vaccination or wild-type measles infection). The proportion of IgM+ results varied with clinical presentation, the timing of specimen collection and vaccination status. Positive results on RT-PCR occurred in specimens from eight IgM-negative and four IgM+ individuals who had recently been vaccinated. During measles outbreaks, limiting IgM testing to individuals who meet the clinical case definition and have not been recently vaccinated allows for measles to be confirmed while conserving resources.

  10. Utility of a stressed-SNP real-time PCR assay for the rapid identification of measles vaccine strain in patient samples.

    PubMed

    Tran, Thomas; Kostecki, Renata; Catton, Michael; Druce, Julian

    2018-05-09

    Rapid differentiation of wild-type measles virus from measles vaccine strains is crucial during a measles outbreak and in a measles elimination setting. A real-time RT-PCR for the rapid detection of measles vaccine strains was developed with high specificity and greater sensitivity than when compared to traditional measles genotyping methods. The "stressed" minor grove binder TaqMan probe design approach achieves specificity to vaccine strains only, without compromising sensitivity. This assay has proven to be extremely useful in outbreak settings, without requiring sequence genotyping, for over 4 years at the Regional Measles Reference Laboratory for the Western Pacific Region. Copyright © 2018 Tran et al.

  11. Adding interventions to mass measles vaccinations in India

    PubMed Central

    Verguet, Stéphane; Morris, Shaun K; Sharma, Jitendar K; Ram, Usha; Gauvreau, Cindy; Jones, Edward; Jha, Prabhat; Jit, Mark

    2016-01-01

    Abstract Objective To quantify the impact on mortality of offering a hypothetical set of technically feasible, high-impact interventions for maternal and child survival during India’s 2010–2013 measles supplementary immunization activity. Methods We developed Lives Saved Tool models for 12 Indian states participating in the supplementary immunization, based on state- and sex-specific data on mortality from India’s Million Deaths Study and on health services coverage from Indian household surveys. Potential add-on interventions were identified through a literature review and expert consultations. We quantified the number of lives saved for a campaign offering measles vaccine alone versus a campaign offering measles vaccine with six add-on interventions (nutritional screening and complementary feeding for children, vitamin A and zinc supplementation for children, multiple micronutrient and calcium supplementation in pregnancy, and free distribution of insecticide-treated bednets). Findings The measles vaccination campaign saved an estimated 19 016 lives of children younger than 5 years. A hypothetical campaign including measles vaccine with add-on interventions was projected to save around 73 900 lives (range: 70 200–79 300), preventing 73 700 child deaths (range: 70 000–79 000) and 300 maternal deaths (range: 200–400). The most effective interventions in the whole package were insecticide-treated bednets, measles vaccine and preventive zinc supplementation. Girls accounted for 66% of expected lives saved (12 712/19 346) for the measles vaccine campaign, and 62% of lives saved (45 721/74 367) for the hypothetical campaign including add-on interventions. Conclusion In India, a measles vaccination campaign including feasible, high-impact interventions could substantially increase the number of lives saved and mitigate gender-related inequities in child mortality. PMID:27843161

  12. Will Synergizing Vaccination with Therapeutics Boost Measles Virus Eradication?

    PubMed Central

    Plemper, Richard K; Hammond, Anthea L

    2014-01-01

    Introduction Measles virus is a major human pathogen responsible for approximately 150,000 measles deaths annually. The disease is vaccine preventable and eradication of the virus is considered feasible in principle. However, a herd immunity exceeding 95% is required to prevent sporadic viral outbreaks in a population. Declining disease prevalence combined with public anxieties about vaccination safety has increased vaccine refusal especially in the European region, which has resulted in measles resurgence in some areas. Areas covered Here, we discuss whether synergizing effective measles therapeutics with vaccination could contribute to solving an endgame conundrum of measles elimination by accelerating the eradication effort. Based on an anticipated use for protection of high-risk contacts of confirmed measles cases through post-exposure prophylaxis, we identify key elements of the desirable drug profile, review current disease management strategies and the state of experimental inhibitor candidates, evaluate the risk associated with viral escape from inhibition, and consider the potential of measles therapeutics for the management of persistent viral infection of the CNS. Assuming a post-measles world with waning measles immunity, we contemplate the possible impact of therapeutics on controlling the threat imposed by closely related zoonotic pathogens of the same genus as measles virus. Expert opinion Efficacious therapeutics given for post-exposure prophylaxis of high-risk social contacts of confirmed index cases may aid measles eradication by closing herd immunity gaps due to vaccine refusal or failure in populations with overall good vaccination coverage. The envisioned primarily prophylactic application of measles therapeutics to a predominantly pediatric and/or adolescent patient population dictates the drug profile; the article must be safe and efficacious, orally available, shelf-stable at ambient temperature, and amenable to cost-effective manufacture

  13. [Effectiveness of a combined live mumps-measles vaccine].

    PubMed

    Unanov, S S; Korzh, Iu N; Dorofeev, V M; Iuminova, N V; Myshliaeva, L A

    1987-01-01

    The reactogenic and areactogenic properties of a live combined mumps-measles vaccine (MMV) prepared in primary cultures of Japanese quail embryo cells from attenuated strains of mumps (L-3) and measles (L-16) viruses were under study. The observations involved 648 infants varying in ages from 1 to 3 years, seronegative to measles and mumps viruses, without the history of the disease and vaccinations against these infections or contraindications to vaccinations. The infants were vaccinated with 5 batches of MMV with different portions of the mumps and measles components. The vaccinees and controls (placebo injections) were observed for 30 days postvaccination. The live MMV was shown to be a safe, well tolerated preparation with low reactogenicity and a high antigenic activity.

  14. Measles vaccination response during Kosi floods, Bihar, India 2008.

    PubMed

    Varkey, Sherin; Krishna, Gopal; Pradhan, Narottam; Gupta, Satish Kumar; Caravotta, Jorge; Hombergh, Henri Vanden; Hoekstra, Edward; Askari, Sufia; Kansal, O P

    2009-11-01

    The Kosi floods of Bihar in 2008 led to initial rapid displacement followed by rehabilitation of the affected population. Strategically planned phase-wise activity of supplementary as well as primary measles vaccination combined with a variety of other interventions proved to be successful in preventing outbreaks and deaths due to measles. While 70% supplementary measles vaccination coverage was achieved in relief camps, the coverage of primary measles doses in the latter phases was dependant on accessibility of villages and previous vaccination status of eligible beneficiaries. The integrated diseases surveillance system, which became operational during the floods, also complemented the vaccination efforts by providing daily figures of cases with fever and rash. The overall response was not only successful in terms of preventing measles mortality, but also provided vital lessons that may be useful for planning future vaccination responses in emergency settings.

  15. Local measles vaccination gaps in Germany and the role of vaccination providers.

    PubMed

    Eichner, Linda; Wjst, Stephanie; Brockmann, Stefan O; Wolfers, Kerstin; Eichner, Martin

    2017-08-14

    Measles elimination in Europe is an urgent public health goal, yet despite the efforts of its member states, vaccination gaps and outbreaks occur. This study explores local vaccination heterogeneity in kindergartens and municipalities of a German county. Data on children from mandatory school enrolment examinations in 2014/15 in Reutlingen county were used. Children with unknown vaccination status were either removed from the analysis (best case) or assumed to be unvaccinated (worst case). Vaccination data were translated into expected outbreak probabilities. Physicians and kindergartens with statistically outstanding numbers of under-vaccinated children were identified. A total of 170 (7.1%) of 2388 children did not provide a vaccination certificate; 88.3% (worst case) or 95.1% (best case) were vaccinated at least once against measles. Based on the worst case vaccination coverage, <10% of municipalities and <20% of kindergartens were sufficiently vaccinated to be protected against outbreaks. Excluding children without a vaccination certificate (best case) leads to over-optimistic views: the overall outbreak probability in case of a measles introduction lies between 39.5% (best case) and 73.0% (worst case). Four paediatricians were identified who accounted for 41 of 109 unvaccinated children and for 47 of 138 incomplete vaccinations; GPs showed significantly higher rates of missing vaccination certificates and unvaccinated or under-vaccinated children than paediatricians. Missing vaccination certificates pose a severe problem regarding the interpretability of vaccination data. Although the coverage for at least one measles vaccination is higher in the studied county than in most South German counties and higher than the European average, many severe and potentially dangerous vaccination gaps occur locally. If other federal German states and EU countries show similar vaccination variability, measles elimination may not succeed in Europe.

  16. The genetic basis for interindividual immune response variation to measles vaccine: new understanding and new vaccine approaches

    PubMed Central

    Haralambieva, Iana H; Ovsyannikova, Inna G; Pankratz, V Shane; Kennedy, Richard B; Jacobson, Robert M; Poland, Gregory A

    2013-01-01

    The live-attenuated measles vaccine is effective, but measles outbreaks still occur in vaccinated populations. This warrants elucidation of the determinants of measles vaccine-induced protective immunity. Interindividual variability in markers of measles vaccine-induced immunity, including neutralizing antibody levels, is regulated in part by host genetic factor variations. This review summarizes recent advances in our understanding of measles vaccine immunogenetics relative to the perspective of developing better measles vaccines. Important genetic regulators of measles vaccine-induced immunity, such as HLA class I and HLA class II genotypes, single nucleotide polymorphisms in cytokine/cytokine receptor genes (IL12B, IL12RB1, IL2, IL10) and the cell surface measles virus receptor CD46 gene, have been identified and independently replicated. New technologies present many opportunities for identification of novel genetic signatures and genetic architectures. These findings help explain a variety of immune response-related phenotypes and promote a new paradigm of ‘vaccinomics’ for novel vaccine development. PMID:23256739

  17. [Are measles and mumps vaccinations worth while in Switzerland?].

    PubMed

    Just, M

    1978-11-11

    Cost-benefit analyses have been performed in investigating the usefulness of general vaccination against measles and mumps in all children. Even by a conservative reckoning the cost of general measles immunization for all children in the second year of life is much lower than the financial effects of the disease. In the case of general mumps vaccination, cost-benefit analyses fo not give so significant an outweight of financial benefit as for measles vaccination. If only for economic reasons, however, general immunization against mumps is recommended for all children in the second year of life. From the economic viewpoint, general immunization programs for teenagers do not pay either with regard to mumps or measles. Such vaccinations may of course be recommended on an individual basis, especially for teenagers with a negative measles history.

  18. Laboratory confirmation of measles in elimination settings: experience from the Republic of the Marshall Islands, 2003

    PubMed Central

    Nandy, Robin; Hickman, Carole J; Langidrik, Justina R; Strebel, Peter M; Papania, Mark J; Seward, Jane F; Bellini, William J

    2009-01-01

    Abstract Objective To highlight the complications involved in interpreting laboratory tests of measles immunoglobulin M (IgM) for confirmation of infection during a measles outbreak in a highly vaccinated population after conducting a mass immunization campaign as a control measure. Methods This case study was undertaken in the Republic of the Marshall Islands during a measles outbreak in 2003, when response immunization was conducted. A measles case was defined as fever and rash and one or more of cough, coryza or conjunctivitis. Between 13 July and 7 November 2003, serum samples were obtained from suspected measles cases for serologic testing and nasopharyngeal swabs were taken for viral isolation by reverse transcriptase polymerase chain reaction (RT–PCR). Findings Specimens were collected from 201 suspected measles cases (19% of total): of the ones that satisfied the clinical case definition, 45% were IgM positive (IgM+) and, of these, 24% had received measles vaccination within the previous 45 days (up to 45 days after vaccination an IgM+ result could be due to either vaccination or wild-type measles infection). The proportion of IgM+ results varied with clinical presentation, the timing of specimen collection and vaccination status. Positive results on RT–PCR occurred in specimens from eight IgM-negative and four IgM+ individuals who had recently been vaccinated. Conclusion During measles outbreaks, limiting IgM testing to individuals who meet the clinical case definition and have not been recently vaccinated allows for measles to be confirmed while conserving resources. PMID:19274360

  19. Measles inclusion-body encephalitis caused by the vaccine strain of measles virus.

    PubMed

    Bitnun, A; Shannon, P; Durward, A; Rota, P A; Bellini, W J; Graham, C; Wang, E; Ford-Jones, E L; Cox, P; Becker, L; Fearon, M; Petric, M; Tellier, R

    1999-10-01

    We report a case of measles inclusion-body encephalitis (MIBE) occurring in an apparently healthy 21-month-old boy 8.5 months after measles-mumps-rubella vaccination. He had no prior evidence of immune deficiency and no history of measles exposure or clinical disease. During hospitalization, a primary immunodeficiency characterized by a profoundly depressed CD8 cell count and dysgammaglobulinemia was demonstrated. A brain biopsy revealed histopathologic features consistent with MIBE, and measles antigens were detected by immunohistochemical staining. Electron microscopy revealed inclusions characteristic of paramyxovirus nucleocapsids within neurons, oligodendroglia, and astrocytes. The presence of measles virus in the brain tissue was confirmed by reverse transcription polymerase chain reaction. The nucleotide sequence in the nucleoprotein and fusion gene regions was identical to that of the Moraten and Schwarz vaccine strains; the fusion gene differed from known genotype A wild-type viruses.

  20. A Recombinant Measles Vaccine with Enhanced Resistance to Passive Immunity.

    PubMed

    Julik, Emily; Reyes-Del Valle, Jorge

    2017-09-21

    Current measles vaccines suffer from poor effectiveness in young infants due primarily to the inhibitory effect of residual maternal immunity on vaccine responses. The development of a measles vaccine that resists such passive immunity would strongly contribute to the stalled effort toward measles eradication. In this concise communication, we show that a measles virus (MV) with enhanced hemagglutinin (H) expression and incorporation, termed MVvac2-H2, retained its enhanced immunogenicity, previously established in older mice, when administered to very young, genetically modified, MV-susceptible mice in the presence of passive anti-measles immunity. This immunity level mimics the sub-neutralizing immunity prevalent in infants too young to be vaccinated. Additionally, toward a more physiological small animal model of maternal anti-measles immunity interference, we document vertical transfer of passive anti-MV immunity in genetically-modified, MV susceptible mice and show in this physiological model a better MVvac2-H2 immunogenic profile than that of the parental vaccine strain. In sum, these data support the notion that enhancing MV hemagglutinin incorporation can circumvent in vivo neutralization. This strategy merits additional exploration as an alternative pediatric measles vaccine.

  1. A Recombinant Measles Vaccine with Enhanced Resistance to Passive Immunity

    PubMed Central

    Julik, Emily; Reyes-del Valle, Jorge

    2017-01-01

    Current measles vaccines suffer from poor effectiveness in young infants due primarily to the inhibitory effect of residual maternal immunity on vaccine responses. The development of a measles vaccine that resists such passive immunity would strongly contribute to the stalled effort toward measles eradication. In this concise communication, we show that a measles virus (MV) with enhanced hemagglutinin (H) expression and incorporation, termed MVvac2-H2, retained its enhanced immunogenicity, previously established in older mice, when administered to very young, genetically modified, MV-susceptible mice in the presence of passive anti-measles immunity. This immunity level mimics the sub-neutralizing immunity prevalent in infants too young to be vaccinated. Additionally, toward a more physiological small animal model of maternal anti-measles immunity interference, we document vertical transfer of passive anti-MV immunity in genetically-modified, MV susceptible mice and show in this physiological model a better MVvac2-H2 immunogenic profile than that of the parental vaccine strain. In sum, these data support the notion that enhancing MV hemagglutinin incorporation can circumvent in vivo neutralization. This strategy merits additional exploration as an alternative pediatric measles vaccine. PMID:28934110

  2. Waning of vaccine-induced immunity to measles in kidney transplanted children.

    PubMed

    Rocca, Salvatore; Santilli, Veronica; Cotugno, Nicola; Concato, Carlo; Manno, Emma Concetta; Nocentini, Giulia; Macchiarulo, Giulia; Cancrini, Caterina; Finocchi, Andrea; Guzzo, Isabella; Dello Strologo, Luca; Palma, Paolo

    2016-09-01

    Vaccine-preventable diseases are a significant cause of morbidity and mortality in solid organ transplant recipients who undergo immunosuppression after transplantation. Data on immune responses and long-term maintenance after vaccinations in such population are still limited.We cross-sectionally evaluated the maintenance of immune response to measles vaccine in kidney transplanted children on immunosuppressive therapy. Measles-specific enzyme-linked immunosorbent assay and B-cell enzyme-linked immunosorbent spot were performed in 74 kidney transplant patients (Tps) and in 23 healthy controls (HCs) previously vaccinated and tested for humoral protection against measles. The quality of measles antibody response was measured by avidity test. B-cell phenotype, investigated via flow cytometry, was further correlated to the ability of Tps to maintain protective humoral responses to measles over time.We observed the loss of vaccine-induced immunity against measles in 19% of Tps. Nonseroprotected children showed signs of impaired B-cell distribution as well as immune senescence and lower antibody avidity. We further reported as time elapsed between vaccination and transplantation, as well as the vaccine administration during dialysis are clinical factors affecting the maintenance of the immune memory response against measles.Tps present both quantitative and qualitative alterations in the maintenance of protective immunity to measles vaccine. Prospective studies are needed to optimize the vaccination schedules in kidney transplant recipients in order to increase the immunization coverage over time in this population.

  3. Short report: assessing field vaccine efficacy for measles in famine-affected rural Ethiopia.

    PubMed

    Talley, Leisel; Salama, Peter

    2003-05-01

    Measles is a major cause of mortality in complex emergencies. Both high vaccination coverage and vaccine efficacy are required to prevent major epidemics of measles in such situations. Evaluation of field vaccine efficacy is a critical but underutilized component of program monitoring in emergencies, and is particularly important in rural areas where the integrity of the cold chain is difficult to guarantee. In July 2000, we evaluated the field vaccine efficacy for measles vaccination by comparing the incidence of cases in vaccinated and unvaccinated groups during a two-stage cluster survey of 563 children in Ethiopia. Approximately 30% of the measles cases occurred in vaccinated children. Estimated field vaccine efficacy for measles was 66.9% in children 9-36 months old. The finding of a field vaccine efficacy for measles less than 80% warrants formal assessment of measles vaccine efficacy, particularly in famine emergencies where measles is associated with a high case fatality rate.

  4. Measles resurgence following a nationwide measles vaccination campaign in Nigeria, 2005-2008.

    PubMed

    Weldegebriel, Goitom G; Gasasira, Alex; Harvey, Pauline; Masresha, Balcha; Goodson, James L; Pate, Muhammad A; Abanida, Emmanuel; Chevez, Ana

    2011-07-01

    From 1990 through 2008, routine immunization coverage of measles vaccine in Nigeria ranged from 35% to 70%. Nigeria conducted a nationwide measles vaccination campaign in 2 phases during 2005-2006 that targeted children aged 9 months to 14 years; in 2008, a nationwide follow-up campaign that targeted children aged 9 months to 4 years was conducted in 2 phases. Despite these efforts, measles cases continued to occur. This is a descriptive study that reviewed the measles immunization coverage data from administrative, World Health Organization, United Nations Children's Fund, survey, and supplemental immunization activities data. Measles surveillance data were analyzed from case-based surveillance reports. Confirmed measles cases increased from 383 in 2006 to 2542 in 2007 and to 9510 in 2008. Of the confirmed cases in 2008, 717 (30%) occurred in children <2 years of age, 1145 (48%) in children 2-4 years of age, and 354 (14%) were in children 5-14 years of age. In 2008, the measles case fatality rate was 1.2%. Suboptimal routine coverage and the wide interval between the catch-up and follow-up campaigns likely led to an accumulation of children susceptible to measles. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

  5. Effect of second dose of measles vaccine on measles antibody status: a randomized controlled trial.

    PubMed

    Fazilli, Anjum; Mir, Abid Ali; Shah, Rohul Jabeen; Bhat, Imtiyaz Ali; Fomda, Bashir Ahmad; Bhat, Mushtaq Ahmad

    2013-05-08

    To evaluate the effect of the second dose of measles vaccine on measles antibody status during childhood. Immunization centre of Under-five Clinic of the Department of Community Medicine at a tertiary-hospital. Randomized Controlled trial. Children from 6 years to 17 year old. 188 with simple obesity, and 431 with obesity and metabolic abnormalities. 274 age and gender-matched healthy children as controls. Blood samples were collected from all subjects for baseline measles serology by heel puncture at 9-12 months of age. All subjects were given the first dose of measels vaccine. At second visit (3-5 months later), after collecting the blood sample from all, half the children were randomized to receive the second dose of measles vaccine (study group), followed by collection of the third sample six weeks later in all the subjects. A total of 78 children were enrolled and 30 children in each group could be analyzed. 11(36.6%) children in the study group and 13 (43.3%) children in the control group had protective levels of measles IgG at baseline. Around 93.3% of children in the study group had protective measles antibody titers as against 50% in the control group at the end of the trial. The Geometric Mean Titre (GMT) of measles IgG increased from 14.8 NTU/mL to 18.2 NTU/mL from baseline to six weeks following receipt of the second dose of the vaccine in the study group, as compared to a decrease from 16.8 NTU/mL to 12.8 NTU/mL in the control group. A second dose of measles vaccine boosts the measles antibody status in the study population as compared to those who receive only a single dose.

  6. Determinants of apparent rural-urban differentials in measles vaccination uptake in Indonesia.

    PubMed

    Fernandez, Renae C; Awofeso, Niyi; Rammohan, Anu

    2011-01-01

    Regional differences in vaccination uptake are common in both developed and developing countries, and are often linked to the availability of healthcare services and socioeconomic factors. In 2007, 0.9 million eligible Indonesian children missed measles vaccination, and 19 456 cases of measles were documented among Indonesian children. The authors investigated rural-urban differentials in measles vaccination coverage among young Indonesian children, and sought to identify key factors influencing the probability of a child receiving the first dose of measles vaccination in Indonesia. Data used in the analyses were sourced from the nationally representative Indonesia Demographic and Health Survey 2007. The influence of location of residence, household wealth, maternal and paternal education, total children ever born and use of skilled birth attendants on measles vaccination coverage was investigated using bivariate analysis and chi-square tests. The independent effects of these variables were established using binomial logistic regression analysis. Indonesia's 2007 first-dose measles national vaccination coverage was, at 72.8%, lower than the 2008 global first-dose measles vaccination average coverage of 82%. Bivariate analysis revealed that the first-dose measles vaccination coverage in rural areas of Indonesia was 68.5%, compared with 80.1% in urban regions (p < 0.001). The apparent significance of rural residence in impairing vaccination coverage was marginal after controlling for the sex of the child, maternal age, maternal and paternal education, wealth, and access to skilled health workers. Apart from sustainable initiatives to increase measles vaccination coverage globally, it is important to close the rural-urban gap in Indonesia's measles vaccination uptake. Addressing critical determinants of inferior measles vaccination coverage in Indonesia's rural regions will facilitate major improvements in Indonesia's child health trends. This article suggests

  7. Measles in Poland in 2012.

    PubMed

    Rogalska, Justyna; Karasek, Ewa; Paradowska-Stankiewicz, Iwona

    2014-01-01

    In 1998 Poland, along with all other Member States in the WHO European Region, implemented Measles Elimination Program coordinated by WHO. It requires achieving and maintaining very high vaccine coverage (>95%), recording all cases and suspected cases of measles, and laboratory testing of all suspected measles cases in the WHO Reference Laboratory. In Poland it is a Laboratory of Department of Virology, NIPH-NIH. To assess epidemiological situation of measles in Poland in 2012, including vaccination coverage in Polish population, and Measles Elimination Program implementation status. The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins "Infectious diseases and poisonings in Poland in 2012" and "Vaccinations in Poland in 2012", and measles case-based reports from 2012 sent to the Department of Epidemiology NIPH-NIH by Sanitary-Epidemiological Stations. In total, there were 70 measles cases registered in Poland in 2012 (incidence 0.18 per 100 000). The highest incidence rate was observed among infants (2.08 per 100 000) and children aged 1 year (2.47 per 100 000). In 2012, 37 cases (52,9%) were hospitalized due to measles. No deaths from measles were reported. Vaccination coverage of children and youth aged 2-11 years ranged from 83.6% do 99.6% (primary vaccination in children born in 2011-2006) and from 76.6% do 96.7% (booster dose in children born in 2003-2001). Performance of the surveillance system was insufficient with only 127 measles-compatible cases reported in 2012 (33% of expected reports). Fifty cases (71%) were confirmed by IgM ELISA test. The epidemiological situation of measles deteriorated in 2012 in comparison to proceding year. The results indicate a need to further promote Measles Elimination Program in Poland, maintain the high immunisation coverage and improve measles surveillance system.

  8. Measles in Poland in 2013.

    PubMed

    Rogalska, Justyna

    2015-01-01

    Since 1998, Poland has been actively participating in the Measles Elimination Program, coordinated by the World Health Organization (WHO). It requires achieving and maintaining very high vaccine coverage (>95%), recording all cases and suspected cases of measles, and laboratory testing of all suspected measles cases in the WHO Reference Laboratory. In Poland it is a Laboratory of Department of Virology, NIPH-NIH. In order to confirm or exclude the case of measles specific measles IgM antibodies should be measured using Elisa test, or molecular testing (PCR) should be performed to detect the presence measles virus RNA in biological material. To assess epidemiological situation of measles in Poland in 2013, including vaccination coverage in Polish population, and Measles Elimination Program implementation status. The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins "Infectious diseases and poisonings in Poland in 2013" and "Vaccinations in Poland in 2013", and measles case-based reports from 2013 sent to the Department of Epidemiology NIPH-NIH by Sanitary-Epidemiological Stations. In total, there were 84 measles cases registered in Poland in 2013 (incidence 0.22 per 100,000). The highest incidence rate was observed among infants (2.18 per 100,000) and children aged 1 year (1.27 per 100,000). In 2013, 56 cases (66.7%) were hospitalized due to measles. No deaths from measles were reported. Vaccination coverage of children and youth aged 2-11 years ranged from 82.8% do 99.5% (primary vaccination in children born in 2012-2007) and from 73.6% to 93.2% (booster dose in children born in 2004-2001). In 2013, 127 measles-compatible cases were reported (67% of expected reports). Two hundred seven cases (80%) were confirmed by IgM ELISA test. In 2013, the epidemiological situation of measles deteriorated in comparison to proceding year. The sensitivity of measles surveillance improved but is still

  9. Multigenic Control of Measles Vaccine Immunity Mediated by Polymorphisms in Measles Receptor, Innate Pathway, and Cytokine Genes

    PubMed Central

    Kennedy, Richard B.; Ovsyannikova, Inna G.; Haralambieva, Iana H.; O’Byrne, Megan; Jacobson, Robert M.; Pankratz, V. Shane; Poland, Gregory A.

    2012-01-01

    Measles infection and vaccine response are complex biological processes that involve both viral and host genetic factors. We have previously investigated the influence of genetic polymorphisms on vaccine immune response, including measles vaccines, and have shown that polymorphisms in HLA, cytokine, cytokine receptor, and innate immune response genes are associated with variation in vaccine response but do not account for all of the inter-individual variance seen in vaccinated populations. In the current study we report the findings of a multigenic analysis of measles vaccine immunity, indicating a role for the measles virus receptor CD46, innate pattern-recognition receptors (DDX58, TLR2, 4, 5,7 and 8) and intracellular signaling intermediates (MAP3K7, NFKBIA), and key antiviral molecules (VISA, OAS2, MX1, PKR) as well as cytokines (IFNA1, IL4, IL6, IL8, IL12B) and cytokine receptor genes (IL2RB, IL6R, IL8RA) in the genetic control of both humoral and cellular immune responses. This multivariate approach provided additional insights into the genetic control of measles vaccine responses over and above the information gained by our previous univariate SNP association analyses. PMID:22265947

  10. Household experience and costs of seeking measles vaccination in rural Guinea-Bissau.

    PubMed

    Byberg, S; Fisker, A B; Rodrigues, A; Balde, I; Enemark, U; Aaby, P; Benn, C S; Griffiths, U K

    2017-01-01

    Children younger than 12 months of age are eligible for childhood vaccines through the public health system in Guinea-Bissau. To limit open vial wastage, a restrictive vial opening policy has been implemented; 10-dose measles vaccine vials are only opened if six or more children aged 9-11 months are present at the vaccination post. Consequently, mothers who bring their child for measles vaccination can be told to return another day. We aimed to describe the household experience and estimate household costs of seeking measles vaccination in rural Guinea-Bissau. Within a national sample of village clusters under demographic surveillance, we interviewed mothers of children aged 9-21 months about their experience with seeking measles vaccination. From information about time and money spent, we calculated household costs of seeking measles vaccination. We interviewed mothers of 1308 children of whom 1043 (80%) had sought measles vaccination at least once. Measles vaccination coverage was 70% (910/1308). Coverage decreased with increasing distance to the health centre. On average, mothers who had taken their child for vaccination took their child 1.4 times. Mean costs of achieving 70% coverage were 2.04 USD (SD 3.86) per child taken for vaccination. Half of the mothers spent more than 2 h seeking vaccination and 11% spent money on transportation. We found several indications of missed opportunities for measles vaccination resulting in suboptimal coverage. The household costs comprised 3.3% of the average monthly income and should be taken into account when assessing the costs of delivering vaccinations. © 2016 John Wiley & Sons Ltd.

  11. Acute measles encephalitis in partially vaccinated adults.

    PubMed

    Fox, Annette; Hung, Than Manh; Wertheim, Heiman; Hoa, Le Nguyen Minh; Vincent, Angela; Lang, Bethan; Waters, Patrick; Ha, Nguyen Hong; Trung, Nguyen Vu; Farrar, Jeremy; Van Kinh, Nguyen; Horby, Peter

    2013-01-01

    The pathogenesis of acute measles encephalitis (AME) is poorly understood. Treatment with immune-modulators is based on theories that post-infectious autoimmune responses cause demyelination. The clinical course and immunological parameters of AME were examined during an outbreak in Vietnam. Fifteen measles IgM-positive patients with confusion or Glasgow Coma Scale (GCS) score below 13, and thirteen with uncomplicated measles were enrolled from 2008-2010. Standardized clinical exams were performed and blood collected for lymphocyte and measles- and auto-antibody analysis. The median age of AME patients was 21 years, similar to controls. Eleven reported receiving measles vaccination when aged one year. Confusion developed a median of 4 days after rash. Six patients had GCS <8 and four required mechanical ventilation. CSF showed pleocytosis (64%) and proteinorrhachia (71%) but measles virus RNA was not detected. MRI revealed bilateral lesions in the cerebellum and brain stem in some patients. Most received dexamethasone +/- IVIG within 4 days of admission but symptoms persisted for ≥3 weeks in five. The concentration of voltage gated calcium channel-complex-reactive antibodies was 900 pM in one patient, and declined to 609 pM ∼ 3 months later. Measles-reactive IgG antibody avidity was high in AME patients born after vaccine coverage exceeded 50% (∼ 25 years earlier). AME patients had low CD4 (218/µl, p = 0.029) and CD8 (200/µl, p = 0.012) T-cell counts compared to controls. Young adults presenting with AME in Vietnam reported a history of one prior measles immunization, and those aged <25 years had high measles-reactive IgG avidity indicative of prior vaccination. This suggests that one-dose measles immunization is not sufficient to prevent AME in young adults and reinforces the importance of maintaining high coverage with a two-dose measles immunization schedule. Treatment with corticosteroids and IVIG is common practice, and should be assessed in

  12. [Vaccination against rubella, measles, chickenpox, and mumps in nursing students].

    PubMed

    Tashiro, Takayoshi; Urata, Hideko; Okada, Junya; Iwanaga, Kikuko; Tokunaga, Mizuko; Matsumoto, Tadashi

    2004-05-01

    The past history of infection and vaccination, and serum antibodies against rubella, measles, chickenpox, and mumps were investigated, before vaccine was inoculated in the susceptible nursing students. The subjects were 221 nursing students (208 women, 13 men, the average age 18.4 +/- 1.8 years old) who entered Nagasaki University from 2001 to 2003. The positive rates of the past history of rubella, measles, chickenpox, and mumps were 49.8%, 28.1%, 86.4%, 50.7%, and that of previous vaccination were 31.7%, 69.2%, 10.9%, 5.3%, respectively. The serum antibody was measured with HI assay for rubella, or with EIA assay for measles, chickenpox, and mumps. The positive rates for the antibodies against rubella, measles, chickenpox, and mumps were 92.8%, 90.0%, 82.3%, and 85.0%, respectively. The rates for vaccine inoculation to the students without antibody were 92.8% in rubella, 100.0% in measles, 66.7% in chickenpox, 85.0% in mumps, and that to the low titer antibody (2.0 < or = EIA-IgG < 4.0) students were 70.6% in measles, 48.0% in chickenpox, 93.8% in mumps, respectively. Susceptible nursing students, as well as the medical stuff, should be vaccinated in order to prevent hospital infection of rubella, measles, chickenpox, and mumps.

  13. [Effectiveness, population-level effects, and heath economics of measles and rubella vaccination].

    PubMed

    Wichmann, O; Ultsch, B

    2013-09-01

    Vaccination against measles and rubella has been included in national immunization programs worldwide for several decades. In this article, we present the evidence related to the effectiveness of measles and rubella vaccination based on published systematic reviews, and we describe the epidemiological and health economic effects of vaccination at a population level. Several observational studies demonstrate the high effectiveness (> 90 %) of both measles and rubella vaccination. The global measles mortality reduction and the dramatic decrease in rubella and measles incidences after introduction of routine immunization contribute to the very high quality of evidence. The countries of the Americas have proved that it is feasible to eliminate measles and rubella by strengthening infant immunization through routine vaccination services and by conducting supplemental immunization activities in other childhood age groups so as to close immunity gaps. An economic evaluation of measles and rubella vaccination specifically for the healthcare system in Germany does not exist. However, we conducted a systematic review and identified 11 health-economic studies from other industrialized countries and one for a hypothetical industrialized country. Results indicate that vaccination against measles and rubella had either a cost-effective or even a cost-saving potential, which could be assumed with some limitations also for the German setting. In conclusion, there is compelling evidence that the available vaccines are very effective and that measles and rubella elimination is feasible if adequate vaccination strategies are implemented. In Germany, catch-up vaccination programs are urgently needed for children, adolescents, and young adults specifically in the western federal states.

  14. Reactogenicity and immunogenicity of measles-rubella combined vaccine in school-entry-aged subjects with naturally acquired measles immunity.

    PubMed

    Kumagai, Takuji; Ihara, Toshiaki; Nakayama, Tetsuo; Nagata, Nobuo; Kamiya, Hitoshi

    2015-08-01

    The reintroduction of measles-rubella combined (MR) vaccination to Japan raised concerns about adverse events as well as immunogenicity related to booster immunization in subjects with naturally acquired immunity to measles or rubella. The time course of reactogenicity and antibody responses in recipients with pre-existing immunity to measles through natural infection was observed. Eighteen children aged 80-104 months received MR booster vaccination; 16 of them had had previous rubella vaccination. There were virtually no clinical reactions related to booster vaccination, and a highly significant antibody response to rubella antigen, whereas the antibody rise to measles was statistically significant but poor. Vaccination of individuals already immune is not harmful. Booster immunization to rubella for Japanese children is vitally important. © 2015 Japan Pediatric Society.

  15. Measles trends and vaccine effectiveness in Nairobi, Kenya.

    PubMed

    Borus, P K; Cumberland, P; Sonoiya, S; Kombich, J; Tukei, P M; Cutts, F T

    2003-07-01

    To determine morbidity and mortality from measles and to estimate measles vaccine effectiveness among children hospitalised with measles in two hospitals in Nairobi. A review of hospital records (index cards). Kenyatta National Hospital and Mbagathi District Hospitals covering the years 1996-2000. A review of index cards for measles morbility and mortality was undertaken in the two hospitals. Measles data at the Kenya Expanded Programme on Immunisation covering both hospitals was analysed for vaccine effectiveness. The incidence of measles was unusually high in 1998 between July and November (monthly range 130-305), reflecting on the occurrence of an outbreak at that time. There was no definite monthly incidence trend of measles in 1996,1997, 1999 and 2000. The median age of cases was 13 months (range 0-420 months) for Kenyatta hospital and 18 months (range 1-336 months) for Mbagathi Hospital. Significantly, 29.8% of all cases were aged below nine months when routine immunisation for measles had not begun. The median number of days spent in hospital were five days (range 0-87 days) for Kenyatta and four days (range 1-13 days) for Mbagathi. The overall case fatality rate was 5.6% and was similar for both males and females. The overall measles vaccine effectiveness among measles cases admitted to Kenyatta and Mbagathi Hospitals was 84.1%. The case admissions in Kenyatta and Mbagathi Hospitals suggest measles was prevalent in Nairobi over the latter half decade of the 1990's. Apart from 1998 when there was an outbreak, the seasonality of measles was dampened. The 1998 outbreak suggests a build up of susceptible children the majority of whom were born in the last quarter of 1996. The high mortality may have had to do with the majority of cases presenting late when symptoms were already complicated and severe.

  16. A Global Perspective of Vaccination of Healthcare Personnel against Measles: Systematic Review

    PubMed Central

    Fiebelkorn, Amy Parker; Seward, Jane F.; Orenstein, Walter

    2015-01-01

    Measles transmission has been well documented in healthcare facilities. Healthcare personnel who are unvaccinated and who lack other evidence of measles immunity put themselves and their patients at risk for measles. We conducted a systematic literature review of measles vaccination policies and their implementation in healthcare personnel, measles seroprevalence among healthcare personnel, measles transmission and disease burden in healthcare settings, and impact/costs incurred by healthcare facilities for healthcare-associated measles transmission. Five database searches yielded 135 relevant articles; 47 additional articles were found through cross-referencing. The risk of acquiring measles is estimated to be 2 to 19 times higher for susceptible healthcare personnel than for the general population. Fifty-three articles published worldwide during 1989–2013 reported measles transmission from patients to healthcare personnel; many of the healthcare personnel were unvaccinated or had unknown vaccination status. Eighteen articles published worldwide during 1982–2013 described examples of transmission from healthcare personnel to patients or to other healthcare personnel. Half of European countries have no measles vaccine policies for healthcare personnel. There is no global policy recommendation for the vaccination of healthcare personnel against measles. Even in countries such as the United States or Finland that have national policies, the recommendations are not uniformly implemented in healthcare facilities. Measles serosusceptibility in healthcare personnel varied widely across studies (median 6.5%, range 0%-46%) but was consistently higher among younger healthcare personnel. Deficiencies in documentation of two doses of measles vaccination or other evidence of immunity among healthcare personnel presents challenges in responding to measles exposures in healthcare settings. Evaluating and containing exposures and outbreaks in healthcare settings can be

  17. Measles in Poland in 2014

    PubMed

    Paradowska-Stankiewicz, Iwona; Rogalska, Justyna

    Since 1998, Poland has been actively participating in the Measles Elimination Program, coordinated by the World Health Organization (WHO). It requires achieving and maintaining very high vaccine coverage (>95%), recording all cases and suspected cases of measles, and laboratory testing of all suspected measles cases in the WHO Reference Laboratory. In Poland it is a Laboratory of Department of Virology, NIPHNIH. In order to confirm or exclude the case of measles specific measles IgM antibodies should be measured using Elisa test, or molecular testing (PCR) should be performed to detect the presence measles virus RNA in biological material. To assess epidemiological situation of measles in Poland in 2014, including vaccination coverage in Polish population, and Measles Elimination Program implementation status. The descriptive analysis was based on data retrieved from routine mandatory surveillance system, measles case-based reports from 2014 sent to the Department of Epidemiology NIPH-NIH by Sanitary-Epidemiological Stations and data published in the annual bulletins “Infectious diseases and poisonings in Poland in 2014” and “Vaccinations in Poland in 2014” (MP Czarkowski et all., Warszawa 2015, NIZP-PZH, GIS). In total, there were 110 measles cases registered in Poland in 2014 (incidence 0.29 per 100,000), from which 87 cases (79%) were confirmed with laboratory test. That was more than in 2013 - when 84 cases were reported and incidence was 0,22. The highest incidence rate was observed among children aged 1 year (3,43 per 100,000). In 2014, 76 cases (69%) were hospitalized due to measles. No deaths from measles were reported. Vaccination coverage of children and youth aged 2-11 years ranged from 79.7% do 94.8% (primary vaccination in children born in 2004-2013) and from 77.7% to 85.8% (booster dose in children born in 2005-2011). In 2013, 127 measles-compatible cases were reported (67% of expected reports). In whole country the total number of suspects

  18. Development of the Global Measles Laboratory Network.

    PubMed

    Featherstone, David; Brown, David; Sanders, Ray

    2003-05-15

    The routine reporting of suspected measles cases and laboratory testing of samples from these cases is the backbone of measles surveillance. The Global Measles Laboratory Network (GMLN) has developed standards for laboratory confirmation of measles and provides training resources for staff of network laboratories, reference materials and expertise for the development and quality control of testing procedures, and accurate information for the Measles Mortality Reduction and Regional Elimination Initiative. The GMLN was developed along the lines of the successful Global Polio Laboratory Network, and much of the polio laboratory infrastructure was utilized for measles. The GMLN has developed as countries focus on measles control activities following successful eradication of polio. Currently more than 100 laboratories are part of the global network and follow standardized testing and reporting procedures. A comprehensive laboratory accreditation process will be introduced in 2002 with six quality assurance and performance indicators.

  19. Measles in Morocco: epidemiological profile and impact of vaccination strategy.

    PubMed

    Cheikh, Amine; Ziani, Mouncif; Cheikh, Zakia; Barakat, Amina; El Menzhi, Omar; Braikat, Mohammed; Benomar, Ali; Cherrah, Yahya; El Hassani, Amine

    2015-02-01

    Measles continues to persist as one of the leading causes of infant mortality due to preventable diseases through vaccination. This study aims to highlight measles in Morocco, and to present the vaccination strategy implemented to control and eliminate the disease in this country. Throughout this study, and based on data from the Directorate of Epidemiology and Control of Diseases and those of the Directorate of Population, we present an overview on the epidemiological trends of measles from 1997 to 2012, while evoking the plans established by the Ministry of Health (MoH) for the control and elimination of this disease. The number of measles cases has decreased in Morocco between 1997 and 2012 (2574-720 reported cases per year) as a result of four important steps: first, increasing the routine vaccination coverage (73-94%); second, the introduction of the second dose of the combined vaccine against measles and rubella in schools (children aged 6 years) since 2003; third, the first catch-up campaign of vaccination in Morocco in 2008, for which coverage was highly satisfactory (96% and 100% for age groups 5-59 months and 5-14 years, respectively); and fourth, the organization of a mass vaccination campaign in 2013 that targeted children from aged 9 months to 19 years. The vaccination plan and the surveillance system executed in Morocco within the framework of the regional project implemented by the World Health Organization (WHO) to eliminate measles has given remarkable results regarding the reduction of measles cases and mortality due to this disease. According to the data from MoH and WHO, the number of reported and confirmed measles cases decreased drastically during 2014. However, these efforts are still unsatisfactory compared to the prospective of eliminating the disease by 2015.

  20. Randomized Trials Comparing Inactivated Vaccine After Medium- or High-titer Measles Vaccine With Standard Titer Measles Vaccine After Inactivated Vaccine: A Meta-analysis.

    PubMed

    Aaby, Peter; Ravn, Henrik; Benn, Christine S; Rodrigues, Amabelia; Samb, Badara; Ibrahim, Salah A; Libman, Michael D; Whittle, Hilton C

    2016-11-01

    Observational studies have suggested that girls have higher mortality if their most recent immunization is an inactivated vaccine rather than a live vaccine. We therefore reanalyzed 5 randomized trials of early measles vaccine (MV) in which it was possible to compare an inactivated vaccines [after medium-titer MV (MTMV) or high-titer MV (HTMV)] and a live standard titer MV (after an initial inactivated vaccine). The trials were conducted in Sudan, Senegal, The Gambia and Guinea-Bissau. The intervention group received live MTMV or HTMV from 4 to 5 months and then an inactivated vaccine from 9 to 10 months of age; the control children received inactivated vaccine/placebo from 4 to 5 months and standard titer MV from 9 to 10 months of age. We compared mortality from 9 months until end of study at 3 to 5 years of age for children who received inactivated vaccine (after MTMV or HTMV) and standard titer MV (after inactivated vaccine), respectively. The original datasets were analyzed using a Cox proportional hazards model stratified by trial. The mortality rate ratio (MRR) was 1.38 (95% confidence interval: 1.05-1.83) after an inactivated vaccine (after MTMV or HTMV) compared with a standard titer MV (after inactivated vaccine). Girls had a MRR of 1.89 (1.27-2.80), whereas there was no effect for boys, the sex-differential effect being significant (P = 0.02). Excluding measles cases did not alter these conclusions, the MRR after inactivated vaccines (after MTMV or HTMV) being 1.40 (1.06-1.86) higher overall and 1.92 (1.29-2.86) for girls. Control for variations in national immunization schedules for other vaccines did not modify these results. After 9 months of age, all children had been immunized against measles, and mortality in girls was higher when they had received inactivated vaccines (after MTMV or HTMV) rather than live standard titer MV (after an inactivated vaccine).

  1. Measles vaccination in the presence or absence of maternal measles antibody: impact on child survival.

    PubMed

    Aaby, Peter; Martins, Cesário L; Garly, May-Lill; Andersen, Andreas; Fisker, Ane B; Claesson, Mogens H; Ravn, Henrik; Rodrigues, Amabelia; Whittle, Hilton C; Benn, Christine S

    2014-08-15

    Measles vaccine (MV) has a greater effect on child survival when administered in early infancy, when maternal antibody may still be present. To test whether MV has a greater effect on overall survival if given in the presence of maternal measles antibody, we reanalyzed data from 2 previously published randomized trials of a 2-dose schedule with MV given at 4-6 months and at 9 months of age. In both trials antibody levels had been measured before early measles vaccination. In trial I (1993-1995), the mortality rate was 0.0 per 1000 person-years among children vaccinated with MV in the presence of maternal antibody and 32.3 per 1000 person-years without maternal antibody (mortality rate ratio [MRR], 0.0; 95% confidence interval [CI], 0-.52). In trial II (2003-2007), the mortality rate was 4.2 per 1000 person-years among children vaccinated in presence of maternal measles antibody and 14.5 per 1000 person-years without measles antibody (MRR, 0.29; 95% CI, .09-.91). Possible confounding factors did not explain the difference. In a combined analysis, children who had measles antibody detected when they received their first dose of MV at 4-6 months of age had lower mortality than children with no maternal antibody, the MRR being 0.22 (95% CI, .07-.64) between 4-6 months and 5 years. Child mortality in low-income countries may be reduced by vaccinating against measles in the presence of maternal antibody, using a 2-dose schedule with the first dose at 4-6 months (earlier than currently recommended) and a booster dose at 9-12 months of age. NCT00168558. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

  2. Measles Vaccination in the Presence or Absence of Maternal Measles Antibody: Impact on Child Survival

    PubMed Central

    Aaby, Peter; Martins, Cesário L.; Garly, May-Lill; Andersen, Andreas; Fisker, Ane B.; Claesson, Mogens H.; Ravn, Henrik; Rodrigues, Amabelia; Whittle, Hilton C.; Benn, Christine S.

    2014-01-01

    Background. Measles vaccine (MV) has a greater effect on child survival when administered in early infancy, when maternal antibody may still be present. Methods. To test whether MV has a greater effect on overall survival if given in the presence of maternal measles antibody, we reanalyzed data from 2 previously published randomized trials of a 2-dose schedule with MV given at 4–6 months and at 9 months of age. In both trials antibody levels had been measured before early measles vaccination. Results. In trial I (1993–1995), the mortality rate was 0.0 per 1000 person-years among children vaccinated with MV in the presence of maternal antibody and 32.3 per 1000 person-years without maternal antibody (mortality rate ratio [MRR], 0.0; 95% confidence interval [CI], 0–.52). In trial II (2003–2007), the mortality rate was 4.2 per 1000 person-years among children vaccinated in presence of maternal measles antibody and 14.5 per 1000 person-years without measles antibody (MRR, 0.29; 95% CI, .09–.91). Possible confounding factors did not explain the difference. In a combined analysis, children who had measles antibody detected when they received their first dose of MV at 4–6 months of age had lower mortality than children with no maternal antibody, the MRR being 0.22 (95% CI, .07–.64) between 4–6 months and 5 years. Conclusions. Child mortality in low-income countries may be reduced by vaccinating against measles in the presence of maternal antibody, using a 2-dose schedule with the first dose at 4–6 months (earlier than currently recommended) and a booster dose at 9–12 months of age. Clinical Trials Registration. NCT00168558. PMID:24829213

  3. Measles resurgence in southern Africa: challenges to measles elimination.

    PubMed

    Shibeshi, Messeret E; Masresha, Balcha G; Smit, Sheilagh B; Biellik, Robin J; Nicholson, Jennifer L; Muitherero, Charles; Shivute, Nestor; Walker, Oladapo; Reggis, Katsande; Goodson, James L

    2014-04-01

    In seven southern African countries (Botswana, Lesotho, Malawi, Namibia, South Africa, Swaziland and Zimbabwe), following implementation of a measles mortality reduction strategy starting in 1996, the number of annually reported measles cases decreased sharply to less than one per million population during 2006-2008. However, during 2009-2010, large outbreaks occurred in these countries. In 2011, a goal for measles elimination by 2020 was set in the World Health Organization (WHO) African Region (AFR). We reviewed the implementation of the measles control strategy and measles epidemiology during the resurgence in the seven southern African countries. Estimated coverage with routine measles vaccination, supplemental immunization activities (SIA), annually reported measles cases by country, and measles surveillance and laboratory data were analyzed using descriptive analysis. In the seven countries, coverage with the routine first dose of measles-containing vaccine (MCV1) decreased from 80% to 65% during 1996-2004, then increased to 84% in 2011; during 1996-2011, 79,696,523 people were reached with measles vaccination during 45 SIAs. Annually reported measles cases decreased from 61,160 cases to 60 cases and measles incidence decreased to <1 case per million during 1996-2008. During 2009-2010, large outbreaks that included cases among older children and adults were reported in all seven countries, starting in South Africa and Namibia in mid-2009 and in the other five countries by early 2010. The measles virus genotype detected was predominantly genotype B3. The measles resurgence highlighted challenges to achieving measles elimination in AFR by 2020. To achieve this goal, high two-dose measles vaccine coverage by strengthening routine immunization systems and conducting timely SIAs targeting expanded age groups, potentially including young adults, and maintaining outbreak preparedness to rapidly respond to outbreaks will be needed. Published by Elsevier Ltd.

  4. A randomized, controlled trial of an aerosolized vaccine against measles.

    PubMed

    Low, Nicola; Bavdekar, Ashish; Jeyaseelan, Lakshmanan; Hirve, Siddhivinayak; Ramanathan, Kavitha; Andrews, Nicholas J; Shaikh, Naseem; Jadi, Ramesh S; Rajagopal, Arunachalam; Brown, Kevin E; Brown, David; Fink, James B; John, Oommen; Scott, Pippa; Riveros-Balta, A Ximena; Greco, Michel; Dhere, Rajeev; Kulkarni, Prasad S; Henao Restrepo, Ana Maria

    2015-04-16

    Aerosolized vaccine can be used as a needle-free method of immunization against measles, a disease that remains a major cause of illness and death. Data on the immunogenicity of aerosolized vaccine against measles in children are inconsistent. We conducted an open-label noninferiority trial involving children 9.0 to 11.9 months of age in India who were eligible to receive a first dose of measles vaccine. Children were randomly assigned to receive a single dose of vaccine by means of either aerosol inhalation or a subcutaneous injection. The primary end points were seropositivity for antibodies against measles and adverse events 91 days after vaccination. The noninferiority margin was 5 percentage points. A total of 1001 children were assigned to receive aerosolized vaccine, and 1003 children were assigned to receive subcutaneous vaccine; 1956 of all the children (97.6%) were followed to day 91, but outcome data were missing for 331 children because of thawed specimens. In the per-protocol population, data on 1560 of 2004 children (77.8%) could be evaluated. At day 91, a total of 662 of 775 children (85.4%; 95% confidence interval [CI], 82.5 to 88.0) in the aerosol group, as compared with 743 of 785 children (94.6%; 95% CI, 92.7 to 96.1) in the subcutaneous group, were seropositive, a difference of -9.2 percentage points (95% CI, -12.2 to -6.3). Findings were similar in the full-analysis set (673 of 788 children in the aerosol group [85.4%] and 754 of 796 children in the subcutaneous group [94.7%] were seropositive at day 91, a difference of -9.3 percentage points [95% CI, -12.3 to -6.4]) and after multiple imputation of missing results. No serious adverse events were attributable to measles vaccination. Adverse-event profiles were similar in the two groups. Aerosolized vaccine against measles was immunogenic, but, at the prespecified margin, the aerosolized vaccine was inferior to the subcutaneous vaccine with respect to the rate of seropositivity. (Funded by the

  5. Emergency department vaccination of preschool-age children during a measles outbreak.

    PubMed

    Schlenker, T L; Risk, I; Harris, H

    1995-09-01

    To determine the effectiveness of an emergency department vaccination program for preschool-age children during a measles outbreak. Cross-section study. Urban pediatric ED with an annual census of 24,000. Children, 12 to 59 months old, who presented to our ED between April 1 and April 30, 1994. Staff trained in rationale for and protocol of ED vaccination offered measles-mumps-rubella (MMR) vaccine, free of charge, to all eligible children. Of the 541 children seen, 7% lacked measles vaccination; MMR vaccination status could not be determined in 10%. From history it was determined that all the others had been vaccinated. Of the vaccination-eligible children, 25% were vaccinated in the ED. Of the eligible children who were not vaccinated, parents declined in half of the cases and physicians did not offer vaccination in the other half. Eligible children with physical injury were more likely to be vaccinated, and those with upper respiratory tract infections were less likely to be vaccinated than were eligible children with other diagnoses (P < .05). During a measles outbreak, few children receiving care at a busy pediatric ED were definitively identified as vaccination eligible. Only a few children identified as eligible for vaccination were vaccinated. Significant logistic barriers to effective ED vaccination exist.

  6. Vaccine-Preventable Diseases In Pediatric Patients: A Review Of Measles, Mumps, Rubella, And Varicella.

    PubMed

    Levine, Deborah A

    2016-12-01

    Vaccine-preventable diseases such as measles, mumps, rubella, and varicella continue to plague children and adults worldwide. Although public health programs have helped decrease the prevalence and sequelae of these diseases, outbreaks still occur. To limit the spread of these diseases, emergency clinicians must be able to readily identify the characteristic presentations of the rashes associated with measles, rubella, and varicella, as well as the common presenting features associated with mumps. Diagnostic laboratory studies are not usually necessary, as a complete history and physical examination usually lead to an accurate diagnosis. Treatment for these vaccine-preventable diseases usually consists of supportive care, but, in some cases, severe complications and death may occur. This issue provides a review of the clinical features, differential diagnoses, potential complications, and treatment options for measles, mumps, rubella, and varicella.

  7. Expansion of Surveillance for Vaccine-preventable Diseases: Building on the Global Polio Laboratory Network and the Global Measles and Rubella Laboratory Network Platforms.

    PubMed

    Mulders, Mick N; Serhan, Fatima; Goodson, James L; Icenogle, Joseph; Johnson, Barbara W; Rota, Paul A

    2017-07-01

    Laboratory networks were established to provide accurate and timely laboratory confirmation of infections, an essential component of disease surveillance systems. The World Health Organization (WHO) coordinates global laboratory surveillance of vaccine-preventable diseases (VPDs), including polio, measles and rubella, yellow fever, Japanese encephalitis, rotavirus, and invasive bacterial diseases. In addition to providing high-quality laboratory surveillance data to help guide disease control, elimination, and eradication programs, these global networks provide capacity-building and an infrastructure for public health laboratories. There are major challenges with sustaining and expanding the global laboratory surveillance capacity: limited resources and the need for expansion to meet programmatic goals. Here, we describe the WHO-coordinated laboratory networks supporting VPD surveillance and present a plan for the further development of these networks. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  8. Simultaneous co-detection of wild-type and vaccine strain measles virus using the BD MAX system.

    PubMed

    Thapa, Kiran; Ellem, Justin A; Basile, Kerri; Carter, Ian; Olma, Tom; Chen, Sharon C-A; Dwyer, Dominic E; Kok, Jen

    2018-06-01

    Despite the reported elimination of measles virus in Australia, importation of cases from endemic countries continues to lead to secondary local transmission and outbreaks. Rapid laboratory confirmation of measles is paramount for individual patient management and outbreak responses. Further, it is important to rapidly distinguish infection from wild-type virus or vaccine strains to guide public health responses. We developed a high throughput, TaqMan-based multiplex reverse-transcription-polymerase chain reaction (PCR) assay using the BD MAX platform (Becton Dickinson) that simultaneously detects measles virus and differentiates between wild-type and vaccine strains without the need for sequencing. Copyright © 2018 Royal College of Pathologists of Australasia. Published by Elsevier B.V. All rights reserved.

  9. Age-appropriate vaccination against measles and DPT-3 in India – closing the gaps

    PubMed Central

    2013-01-01

    Background In 2010, India accounted for 65,500 (47%) of the 139,300 measles-related deaths that occurred globally. Data on the quality of age-appropriate measles vaccination in rural India is sparse. We explored the following issues: (i) What proportion of Indian children were appropriately vaccinated against measles at 9 months of age, and DPT-3 at 4 months? (ii) Which health facilities administered measles vaccine to children prior to 9 months of age and DPT-3 prior to 14 weeks? Methods We analyzed data from the 2008 Indian District Level Health Survey (DLHS-3) to determine the extent of age-appropriate measles and DPT-3 vaccinations. Among 192,969 households in the dataset, vaccination cards with detailed records were available for 18,670 children aged between 12 and 23 months. Results Among this cohort, 72.4% (13,511 infants) had received the first dose of measles vaccine. Only 30% of vaccinated infants received the measles vaccine at the recommended age of 9 months. Similarly, only 31% of infants in the cohort received DPT-3 vaccine at the recommended age of 14 weeks. About 82% of all prematurely vaccinated children were vaccinated at health sub-centres, ICDS and Pulse Polio centres. Conclusions Age-inappropriate vaccination impacts adversely on the effectiveness of India’s measles immunisation program due to sub-optimal seroconversion, if premature, and increased vulnerability to vaccine preventable diseases, if delayed. Capacity building approaches to improve age-appropriate vaccination are discussed. PMID:23594400

  10. Experience with live rubella virus vaccine combined with live vaccines against measles and mumps*

    PubMed Central

    Smorodintsev, A. A.; Nasibov, M. N.; Jakovleva, N. V.

    1970-01-01

    Vaccination of pre-school children in the 1-7-years age-group for the specific prophylaxis of mumps and rubella is often difficult to arrange because of the already large number of inoculations given to these children. Combined vaccines to protect against measles, mumps and rubella should therefore be a valuable development. The existence of effective live vaccines for each of these 3 diseases makes possible the production of a single preparation suitable for subcutaneous inoculation. Tests on vaccine strains of measles (Leningrad-16), mumps (Leningrad-3) and rubella (Leningrad-8) viruses in various combinations have established that divalent or trivalent vaccines remain clinically harmless, highly immunogenic and epidemiologically effective. Single subcutaneous administrations of live measles vaccine combined with mumps or rubella vaccines or both, when given to children aged 1-8 years, brough about a high percentage of serological conversions and an increase in antibodies to a level comparable with that achieved with the corresponding monovalent vaccines. Morbidity from the 3 diseases was reduced among those vaccinated with the trivalent vaccine by 10 or more times, i.e., by about the same factor as when monovalent or divalent vaccines were used. PMID:5310140

  11. Challenges of measles and rubella laboratory diagnostic in the era of elimination.

    PubMed

    Hübschen, J M; Bork, S M; Brown, K E; Mankertz, A; Santibanez, S; Ben Mamou, M; Mulders, M N; Muller, C P

    2017-08-01

    The Member States of the WHO European Region adopted the goal of measles and rubella elimination more than 10 years ago, but so far only 21 of 53 countries have reached this target. Laboratory investigation of suspected cases is essential to support disease elimination efforts. Therefore, WHO maintains a network of accredited laboratories providing high-quality testing. Laboratory investigation heavily relies on specific IgM serology and increasingly on virus detection by reverse transcription (RT)-PCR, but other methods such as IgG avidity testing and genetic characterization of virus strains have gained in importance. In elimination settings, often few samples from suspected cases are available for testing, but testing proficiency must be maintained. The predictive value of an IgM-positive result decreases and other rash-fever disease aetiologies become more important. In addition, cases with a rash after measles/rubella vaccination or with mild disease after waning of vaccine-induced antibodies are seen more often. Thus, it is necessary to perform comprehensive and potentially time-consuming and costly investigations of every suspected case using quality-controlled laboratory methods. At the same time rapid feedback to public health officers is required for timely interventions. The introduction of new laboratory methods for comprehensive case investigations requires training of staff under the supervision of WHO-accredited reference laboratories and the definition of appropriate test algorithms. Clinical, laboratory, and epidemiological data are essential for final case classification and investigation of chains of transmission in the endgame of measles and rubella elimination. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. All rights reserved.

  12. Transport networks and inequities in vaccination: remoteness shapes measles vaccine coverage and prospects for elimination across Africa.

    PubMed

    Metcalf, C J E; Tatem, A; Bjornstad, O N; Lessler, J; O'Reilly, K; Takahashi, S; Cutts, F; Grenfell, B T

    2015-05-01

    Measles vaccination is estimated to have averted 13·8 million deaths between 2000 and 2012. Persisting heterogeneity in coverage is a major contributor to continued measles mortality, and a barrier to measles elimination and introduction of rubella-containing vaccine. Our objective is to identify determinants of inequities in coverage, and how vaccine delivery must change to achieve elimination goals, which is a focus of the WHO Decade of Vaccines. We combined estimates of travel time to the nearest urban centre (⩾50 000 people) with vaccination data from Demographic Health Surveys to assess how remoteness affects coverage in 26 African countries. Building on a statistical mapping of coverage against age and geographical isolation, we quantified how modifying the rate and age range of vaccine delivery affects national coverage. Our scenario analysis considers increasing the rate of delivery of routine vaccination, increasing the target age range of routine vaccination, and enhanced delivery to remote areas. Geographical isolation plays a key role in defining vaccine inequity, with greater inequity in countries with lower measles vaccine coverage. Eliminating geographical inequities alone will not achieve thresholds for herd immunity, indicating that changes in delivery rate or age range of routine vaccination will be required. Measles vaccine coverage remains far below targets for herd immunity in many countries on the African continent and is likely to be inadequate for achieving rubella elimination. The impact of strategies such as increasing the upper age range eligible for routine vaccination should be considered.

  13. Factors affecting compliance with measles vaccination in Lao PDR.

    PubMed

    Phimmasane, Maniphet; Douangmala, Somthana; Koffi, Paulin; Reinharz, Daniel; Buisson, Yves

    2010-09-24

    In line with WHO objectives, the Lao Government is committed to eliminate measles by 2012. Yet from 1992 to 2007, the annual incidence of measles remained high while the vaccination coverage showed a wide diversity across provinces. A descriptive study was performed to determine factors affecting compliance with vaccination against measles, which included qualitative and quantitative components. The qualitative study used a convenience sample of 13 persons in charge of the vaccination program, consisting of officials from different levels of the health care structure and members of vaccination teams. The quantitative study performed on the target population consisted of a matched, case-control survey conducted on a stratified random sample of parents of children aged 9-23 months. Overall, 584 individuals (292 cases and 292 controls) were interviewed in the three provinces selected because of low vaccination coverage. On the provision of services side (supply), the main problems identified were a lack of vaccine supply and diluent, a difficulty in maintaining the cold chain, a lack of availability and competence among health workers, a lack of coordination and a limited capacity to assess needs and make coherent decisions. In the side of the consumer (demand), major obstacles identified were poor knowledge about measles immunization and difficulties in accessing vaccination centers because of distance and cost. In multivariate analysis, a low education level of the father was a factor of non-immunization while the factors of good compliance were high incomes, spacing of pregnancies, a feeling that children must be vaccinated, knowledge about immunization age, presenting oneself to the hospital rather than expecting the mobile vaccination teams and last, immunization of other family members or friends' children. The main factors affecting the compliance with vaccination against measles in Laos involve both the supply side and the demand side. Obtaining an effective

  14. Vaccine-associated measles in an immunocompetent child.

    PubMed

    Sood, Shawn B; Suthar, Krishna; Martin, Kimberly; Mather, Keith

    2017-11-01

    We present a rare case of vaccine-associated measles infection in an immunocompetent, HIV-negative patient in the United States. This case depicts the impressive rash our patient manifested and highlights the importance of reviewing public health interventions to determine epidemiological links in geographical areas with low incidence of measles.

  15. The impact of declining vaccination coverage on measles control: a case study of Abia state Nigeria.

    PubMed

    Umeh, Chukwuemeka Anthony; Ahaneku, Hycienth Peterson

    2013-01-01

    Efforts at immunizing children against measles was intensified in Nigeria with nation-wide measles vaccination campaigns in 2005-2006, 2008 and 2011 targeting children between 9 and 59 months. However, there were measles outbreaks in 2010 and 2011 in Abia state Nigeria. This study seeks to find out if there is any association between measles immunization coverage and measles outbreak. This is a descriptive analysis of the 2007 to 2011 Abia state measles case-based surveillance data supplied to Abia state World Health Organization office and Abia State Ministry of Health by the disease surveillance and notification officers. As the proportion of cases with febrile rash who were immunized decreased from 81% in 2007 to 42% in 2011, the laboratory confirmed cases of measles increased from two in 2007 to 53 in 2011.Of the laboratory confirmed cases of measles, five (7%) occurred in children < 9 months, 48 (64%) occurred in children 9-59 months and 22 (29%) occurred in children < 59 months old. Seventy five percent of all laboratory confirmed cases of measles occurred in rural areas. Efforts should be made to increase measles immunization in children between 9 and 59 months as most cases of measles occurred in this age group as immunization coverage dropped. In addition, further studies should be carried out to determine the cause of the disproportional incidence of measles in rural areas in Abia state bearing in mind that measles immunization coverage in urban and rural areas was not markedly different.

  16. Measles Outbreak in a Vaccinated School Population: Epidemiology, Chains of Transmission and the Role of Vaccine Failures.

    ERIC Educational Resources Information Center

    Nkowane, Benjamin M.; And Others

    1987-01-01

    An outbreak of measles occurred in a high school with a documented vaccination level of 98 percent. When measles is introduced in a highly vaccinated population, vaccine failures may play some role in transmission but such transmission is not usually sustained. (Author/LHW)

  17. Epidemiological characteristics of measles from 2000 to 2014: Results of a measles catch-up vaccination campaign in Xianyang, China.

    PubMed

    Zhang, Rong-Qiang; Li, Hong-Bing; Li, Feng-Ying; Han, Li-Xin; Xiong, Yong-Min

    This study was a cross-sectional case-control study aimed at (1) identifying risk factors contributing to the measles epidemic and (2) evaluating the impacts of measles-containing vaccines (MCVs), with the goal of providing evidence-based recommendations for measles elimination strategies in China. Data on measles cases from 2000 to 2014 were obtained from a passive surveillance system at the Center for Diseases Prevention and Control in Xianyang. The effectiveness of MCVs was evaluated in 357 patients with a vaccination history and 503 healthy randomly selected controls. Patient data were subjected to multivariable logistic regression modeling. From 2005 to 2014, the average incidence of measles in Xianyang was 5.42 cases per 100,000 people. The second MCV dose was highly protective in 8-month-old infants. MCVs in general have been highly protective in 8-month-old infants. Multivariable logistic regression modeling indicated that age (≥2 years vs. <2years), MCV dose 2 vaccination, and MV vaccination were each independently associated with measles case status. In conclusions: A MCV should be administered on time to all age-eligible children, reproductive-age women, and migrant populations, to maximize herd immunity to measles. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. Difficulties in eliminating measles and controlling rubella and mumps: a cross-sectional study of a first measles and rubella vaccination and a second measles, mumps, and rubella vaccination.

    PubMed

    Wang, Zhifang; Yan, Rui; He, Hanqing; Li, Qian; Chen, Guohua; Yang, Shengxu; Chen, Enfu

    2014-01-01

    The reported coverage of the measles-rubella (MR) or measles-mumps-rubella (MMR) vaccine is greater than 99.0% in Zhejiang province. However, the incidence of measles, mumps, and rubella remains high. In this study, we assessed MMR seropositivity and disease distribution by age on the basis of the current vaccination program, wherein the first dose of MR is administered at 8 months and the second dose of MMR is administered at 18-24 months. Cross-sectional serological surveys of MMR antibodies were conducted by collecting epidemiological data in Zhejiang province, China in 2011. In total, 1015 participants were randomly selected from two surveillance sites. Serum MMR-specific immunoglobulin G levels were tested by enzyme-linked immunosorbent assay. The geometric mean titers and seroprevalence with 95% confidence intervals (CIs) were calculated by age and gender. Proportions of different dose of vaccine by age by vaccine were also identified. Statistically significant differences between categories were assessed by the Chi-square test. Over 95% seroprevalence rates of measles were seen in all age groups except <7 months infants. Children aged 5-9 years were shown lower seropositivity rates of mumps while elder adolescences and young adults were presented lower rubella seroprevalence. Especially, rubella seropositivity was significantly lower in female adults than in male. Nine measles cases were unvaccinated or unknown vaccination history. Among them, 66.67% (6/9) patients were aged 20-29 years while 33.33% (3/9) were infants aged 8-12 months. In addition, 57.75% (648/1122) patients with mumps were children aged 5-9 years, and 50.54% (94/186) rubella cases were aged 15-39 years. A timely two-dose MMR vaccination schedule is recommended, with the first dose at 8 months and the second dose at 18-24 months. An MR vaccination speed-up campaign may be necessary for elder adolescents and young adults, particularly young females.

  19. [The knowledge of pediatricians in Salvador, Brazil about measles vaccine].

    PubMed

    Moreira, L A; Carvalho, F M; Silvany-Neto, A M; Peres, M F

    1997-12-01

    The success of international initiatives for the eradication of measles depends in large part on knowledge about vaccination. In 1992, a cross-sectional study was carried out to evaluate knowledge about measles vaccine among pediatricians in the Brazilian city of Salvador, Bahia. Of the 506 pediatricians residing in the city, 299 (59%) could be located and responded to a questionnaire containing 15 questions that posed hypothetical situations regarding indications and contraindications for this vaccine. The average number of correct responses was 9.3 out of 15, which illustrates the pediatricians' poor knowledge of measles vaccine. Conditions commonly seen in pediatric practice in Brazil--malnutrition, upper respiratory tract infection, diarrhea, and prematurity--were often erroneously considered contraindications for immunization. More than half (62%) of the pediatricians did not know the correct way to administer the vaccine. Knowledge about the vaccine did not differ according to the length of time that had elapsed since the physicians' university training in pediatrics or as a result of working in health centers operated by the State Health Secretariat. University professors, pediatricians with a postgraduate degree, and those pursuing postgraduate studies scored slightly higher than the rest. These results point to the need to strengthen training on measles vaccination in medical schools and programs of continuing education for pediatricians.

  20. An increasing, potentially measles-susceptible population over time after vaccination in Korea.

    PubMed

    Kang, Hae Ji; Han, Young Woo; Kim, Su Jin; Kim, You-Jin; Kim, A-Reum; Kim, Joo Ae; Jung, Hee-Dong; Eom, Hye Eun; Park, Ok; Kim, Sung Soon

    2017-07-24

    In Korea, measles occurs mainly in infants <12months of age, who are unvaccinated. In addition, vaccine populations, including adolescents and young adults, can become infected though importation. Thus, the question arises whether the current level of herd immunity in Korea is now insufficient for protecting against measles infection. Age-specific measles seroprevalence was evaluated by performing enzyme immunoassays and plaque reduction-neutralization tests on 3050 subjects aged 0-50years (birth cohort 1964-2014) and 480 subjects aged 2-30years (birth cohort 1984-2012). The overall seropositivity and measles antibody concentrations were 71.5% and 1366mIU/mL, respectively. Progressive decline in antibody levels and seropositivity were observed over time after vaccination in infants, adolescents, and young adults. The accumulation of potentially susceptible individuals in the population was confirmed by comparing data from 2010 and 2014 seroprevalence surveys. The statistical correlation between measles incidence and measles seronegativity was determined. Waning levels of measles antibodies with increasing time post-vaccination suggests that measles susceptibility is potentially increasing in Korea. This trend may be related to limitations of vaccine-induced immunity in the absence of natural boosting by the wild virus, compared to naturally acquired immunity triggered by measles infection. This study provides an important view into the current measles herd immunity in Korea. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Marked increase in measles vaccination coverage among young adults in Switzerland: a campaign or cohort effect?

    PubMed

    Altpeter, Ekkehardt; Wymann, Monica N; Richard, Jean-Luc; Mäusezahl-Feuz, Mirjam

    2018-06-01

    To evaluate the impact of the Swiss measles elimination strategy-including a mass media campaign-on vaccination coverage and awareness among young adults aged 20-29 years. Comparison of the results of two cross-sectional population surveys in 2012 and 2015. Documented vaccination coverage increased from 77 to 88% for two doses of measles vaccine. Major determinants of complete vaccination were survey year, birth cohort, sex and the absence of prior measles disease. If birth cohort and prior history of measles disease are included as factors in a multivariate model, the difference between 2012 and 2015 vanishes. The marked increase in complete measles vaccination coverage is due to a cohort effect, owing to the introduction of the second dose of vaccine in 1996. Most of the vaccinations were administered before the national strategy was implemented and vaccination catch-ups did not increase during the campaign in young adults. Nevertheless, this study provides evidence of an improvement in the awareness of measles and measles vaccination in young adults, which may result in an impact on measles vaccination coverage in the near future.

  2. Measles susceptibility in young Thai men suggests need for young adult measles vaccination: a cross sectional study.

    PubMed

    Gonwong, Siriphan; Chuenchitra, Thippawan; Khantapura, Patchariya; Islam, Dilara; Mason, Carl J

    2016-04-11

    Measles remains a major public health concern in Thailand despite the introduction of vaccination since 1984. Similar to other countries, Thailand has experienced numerous measles outbreaks including adult communities such as university student dormitories, prisons, refugee camps, and military recruit camps. These outbreaks raise questions on the seroprotective antibody level in Thai adults. To better understand measles susceptibility in young Thai adults, a retrospective measles seroprevalence study on repository serum specimens obtained with informed consent from young Thai men entering the Royal Thai Army (RTA) during 2007-2008 was conducted. A total of 7760 stratified randomized samples were chosen by residence province. Measles IgG titer was measured using a commercial IgG quantitative ELISA kit following the manufacturer's instructions. An antibody level ≥ 250 International Units per Liter (IU/L) was interpreted as seropositive. The overall measles seroprevalence was 78.5 % (95 % Confidence Interval: 77.6-79.4 %) with geometric mean titer of 738 IU/L (95 % Confidence Interval: 716-760 IU/L). The measles seroprevalence by province ranged from 59.6 % to 93.1 %. A trend of decreasing seroprevalence in the younger cohorts despite increasing immunization coverage was found. Lower seroprevalence than vaccination coverage was observed in the youngest age group. To achieve long term measles control and elimination, an integrated two doses vaccination strategy has been implemented in children in Thailand. This nationwide measles seroprevalence study in young adult RTA recruits found a measles seroprevalence lower than WHO's recommendation for measles outbreak prevention and elimination. These results raise concerns for measles control in Thailand. Supplementary immunization in young adults is essential especially in high-risk and densely populated communities to establish herd immunity for outbreak prevention and elimination.

  3. Multicenter Safety and Immunogenicity Trial of an Attenuated Measles Vaccine for NHP

    PubMed Central

    Yee, JoAnn L; McChesney, Michael B; Christe, Kari L

    2015-01-01

    Measles is a highly contagious viral disease in NHP. The infection can range from asymptomatic to rapidly fatal, resulting in significant morbidity and mortality in captive populations. In addition to appropriate quarantine practices, restricted access, the immunization of all personnel in contact with NHP, and the wearing of protective clothing including face masks, measles immunization further reduces the infection risk. Commercially available measles vaccines are effective for use in NHP, but interruptions in their availability have prevented the implementation of ongoing, consistent vaccination programs. This need for a readily available vaccine led us to perform a broad, multicenter safety and immunogenicity study of another candidate vaccine, MVac (Serum Institute of India), a monovalent measles vaccine derived from live Edmonston–Zagreb strain virus that had been attenuated after 22 passages on human diploid cells. PMID:26473350

  4. A systematic review of human-to-human transmission of measles vaccine virus.

    PubMed

    Greenwood, Kathryn P; Hafiz, Radwan; Ware, Robert S; Lambert, Stephen B

    2016-05-17

    Measles is one of the most contagious human diseases. Administration of the live attenuated measles vaccine has substantially reduced childhood mortality and morbidity since its licensure in 1963. The live but attenuated form of the vaccine describes a virus poorly adapted to replicating in human tissue, but with a replication yield sufficient to elicit an immune response for long-term protection. Given the high transmissibility of the wild-type virus and that transmission of other live vaccine viruses has been documented, we conducted a systematic review to establish if there is any evidence of human-to-human transmission of the live attenuated measles vaccine virus. We reviewed 773 articles for genotypic confirmation of a vaccine virus transmitted from a recently vaccinated individual to a susceptible close contact. No evidence of human-to-human transmission of the measles vaccine virus has been reported amongst the thousands of clinical samples genotyped during outbreaks or endemic transmission and individual case studies worldwide. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Knowledge synthesis of benefits and adverse effects of measles vaccination: the Lasbela balance sheet.

    PubMed

    Ledogar, Robert J; Fleming, John; Andersson, Neil

    2009-10-14

    In preparation for a cluster-randomized controlled trial of a community intervention to increase the demand for measles vaccination in Lasbela district of Pakistan, a balance sheet summarized published evidence on benefits and possible adverse effects of measles vaccination. The balance sheet listed: 1) major health conditions associated with measles; 2) the risk among the unvaccinated who contract measles; 3) the risk among the vaccinated; 4) the risk difference between vaccinated and unvaccinated; and 5) the likely net gain from vaccination for each condition. Two models revealed very different projections of net gain from measles vaccine. A Lasbela-specific combination of low period prevalence of measles among the unvaccinated, medium vaccination coverage and low vaccine efficacy rate, as revealed by the baseline survey, resulted in less-than-expected gains attributable to vaccination. Modelled on estimates where the vaccine had greater efficacy, the gains from vaccination would be more substantial. Specific local conditions probably explain the low rates among the unvaccinated while the high vaccine failure rate is likely due to weaknesses in the vaccination delivery system. Community perception of these realities may have had some role in household decisions about whether to vaccinate, although the major discouraging factor was inadequate access. The balance sheet may be useful as a communication tool in other circumstances, applied to up-to-date local evidence.

  6. Measles vaccination improves the equity of health outcomes: evidence from Bangladesh.

    PubMed

    Bishai, David; Koenig, Michael; Ali Khan, Mehrab

    2003-05-01

    This paper asks whether measles vaccination can reduce socioeconomic differentials in under five mortality rates (U5MR) in a setting characterized by extreme poverty and high levels of childhood mortality. Longitudinal cohort study based on quasi experimental design. Data come from the phased introduction of a measles vaccine intervention in Matlab, Bangladesh in 1982. There were 16 270 Bangladeshi children aged 9-60 months. The intervention cohort received measles vaccine. Socioeconomic differentials in U5MR between the lowest and highest socioeconomic status (SES) quintiles in a cohort of 8135 vaccinated children and a cohort of unvaccinated age matched controls. Mantel-Haenszel rate ratios for the lowest to highest SES quintile were computed. SES was measured by factor analysis of maternal schooling, land holdings, dwelling size, and number of rooms. The U5MR ratio of lowest SES to highest was 2.27 (95% CI=1.62-3.19) in the unvaccinated population and 1.42 (95%CI=0.94-2.15) in the vaccinated population. The difference between unvaccinated and vaccinated U5MR ratios was statistically significant (p<0.10) and robust across alternative measures of SES. Children from the poorest quintile were more than twice as likely to die as those from the least quintile in the absence of measles vaccination. Universal distribution of measles vaccination largely nullified SES related mortality differentials within a high mortality population of children. Copyright 2002 John Wiley & Sons, Ltd.

  7. Measles eradication: experience in the Americas.

    PubMed Central

    de Quadros, C. A.; Hersh, B. S.; Nogueira, A. C.; Carrasco, P. A.; da Silveira, C. M.

    1998-01-01

    In 1994, the Ministers of Health from the Region of the Americas targeted measles for eradication from the Western Hemisphere by the year 2000. To achieve this goal, the Pan American Health Organization (PAHO) developed an enhanced measles eradication strategy. First, a one-time-only "catch-up" measles vaccination campaign is conducted among children aged 9 months to 14 years. Efforts are then made to vaccinate through routine health services ("keep-up") at least 95% of each newborn cohort at 12 months of age. Finally, to assure high population immunity among preschool-aged children, indiscriminate "follow-up" measles vaccination campaigns are conducted approximately every 4 years. These vaccination activities are accompanied by improvements in measles surveillance, including the laboratory testing of suspected measles cases. The implementation of the PAHO strategy has resulted in a marked reduction in measles incidence in all countries of the Americas. Indeed, in 1996 the all-time regional record low of 2109 measles cases was reported. There was a relative resurgence of measles in 1997 with over 20,000 cases, due to a large measles outbreak among infants, preschool-aged children and young adults in São Paulo, Brazil. Contributing factors for this outbreak included: low routine infant vaccination coverage, failure to conduct a "follow-up" campaign, presence of susceptible young adults, and the importation of measles virus, apparently from Europe. PAHO's strategy has been effective in interrupting measles virus circulation. This experience demonstrates that global measles eradication is an achievable goal using currently available measles vaccines. PMID:10063674

  8. Evaluation of measles-rubella vaccination for mothers in early puerperal phase.

    PubMed

    Hisano, Michi; Kato, Tatsuo; Inoue, Eisuke; Sago, Haruhiko; Yamaguchi, Koushi

    2016-02-24

    The postpartum period is an ideal opportunity to vaccinate mothers with inadequate immunity to vaccine-preventable diseases including measles and rubella. A prospective study of measles-rubella (MR) vaccination in the early puerperal phase was conducted in 171 mothers, who had insufficient antibody titers when screened for immunity to measles (≤ 1:4 on the neutralization test [NT]) or rubella (≤ 1:16 on the hemagglutination inhibition [HI] test) during pregnancy. To evaluate the efficacy of MR vaccination in the postpartum period, we determined their post-vaccination antibody titers and immune responses to vaccination, and investigated the association between these and their prolactin (PRL) levels and Th1/Th2 ratios at the time of vaccination. We also examined the passage of viral RNA and antigen into breast milk. Of the 169 participants who completed the study schedule, 117 and 101 had low antibody titers against measles and rubella, respectively. In the measles-seronegative group, the antibody-positive rate was 87% on the NT assay, and the NT geometric mean antibody titer was 11.4 (95% confidence interval [CI], 10.0-13.0). In the rubella-seronegative group, the antibody-positive rate was 88% on the HI test assay, and the HI geometric mean antibody titer was 64.0 (95% CI, 53.9-76.0). There was no association between the post-vaccination antibody titers and the PRL levels or Th1/Th2 ratios at the time of vaccination. In the rubella-seronegative group, subjects with higher Th1/Th2 ratios showed higher rates of responsiveness than those with lower ratios (P=0.045). Although measles virus RNA was isolated from the breast milk of two vaccinated mothers, breastfeeding was not associated with clinical disease in any infants. MR vaccination in the early puerperal phase is considered an effective way to prevent the diseases, regardless of the mother's immunological status and hormonal milieu. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures.

    PubMed

    Klein, Nicola P; Fireman, Bruce; Yih, W Katherine; Lewis, Edwin; Kulldorff, Martin; Ray, Paula; Baxter, Roger; Hambidge, Simon; Nordin, James; Naleway, Allison; Belongia, Edward A; Lieu, Tracy; Baggs, James; Weintraub, Eric

    2010-07-01

    In February 2008, we alerted the Advisory Committee on Immunization Practices to preliminary evidence of a twofold increased risk of febrile seizures after the combination measles-mumps-rubella-varicella (MMRV) vaccine when compared with separate measles-mumps-rubella (MMR) and varicella vaccines. Now with data on twice as many vaccine recipients, our goal was to reexamine seizure risk after MMRV vaccine. Using 2000-2008 Vaccine Safety Datalink data, we assessed seizures and fever visits among children aged 12 to 23 months after MMRV and separate MMR + varicella vaccines. We compared seizure risk after MMRV vaccine to that after MMR + varicella vaccines by using Poisson regression as well as with supplementary regressions that incorporated chart-review results and self-controlled analyses. MMRV vaccine recipients (83,107) were compared with recipients of MMR + varicella vaccines (376,354). Seizure and fever significantly clustered 7 to 10 days after vaccination with all measles-containing vaccines but not after varicella vaccination alone. Seizure risk during days 7 to 10 was higher after MMRV than after MMR + varicella vaccination (relative risk: 1.98 [95% confidence interval: 1.43-2.73]). Supplementary analyses yielded similar results. The excess risk for febrile seizures 7 to 10 days after MMRV compared with separate MMR + varicella vaccination was 4.3 per 10,000 doses (95% confidence interval: 2.6-5.6). Among 12- to 23-month-olds who received their first dose of measles-containing vaccine, fever and seizure were elevated 7 to 10 days after vaccination. Vaccination with MMRV results in 1 additional febrile seizure for every 2300 doses given instead of separate MMR + varicella vaccines. Providers who recommend MMRV should communicate to parents that it increases the risk of fever and seizure over that already associated with measles-containing vaccines.

  10. The impact of declining vaccination coverage on measles control: a case study of Abia state Nigeria

    PubMed Central

    Umeh, Chukwuemeka Anthony; Ahaneku, Hycienth Peterson

    2013-01-01

    Introduction Efforts at immunizing children against measles was intensified in Nigeria with nation-wide measles vaccination campaigns in 2005 - 2006, 2008 and 2011 targeting children between 9 and 59 months. However, there were measles outbreaks in 2010 and 2011in Abia state Nigeria. This study seeks to find out if there is any association between measles immunization coverage and measles outbreak. Methods This is a descriptive analysis of the 2007 to 2011 Abia state measles case-based surveillance data supplied to Abia state World Health Organization office and Abia State Ministry of Health by the disease surveillance and notification officers. Results As the proportion of cases with febrile rash who were immunized decreased from 81% in 2007 to 42% in 2011, the laboratory confirmed cases of measles increased from two in 2007 to 53 in 2011.Of the laboratory confirmed cases of measles, five (7%) occurred in children < 9 months, 48 (64%) occurred in children 9 - 59 months and 22 (29%) occurred in children < 59 months old. Seventy five percent of all laboratory confirmed cases of measles occurred in rural areas. Conclusion Efforts should be made to increase measles immunization in children between 9 and 59 months as most cases of measles occurred in this age group as immunization coverage dropped. In addition, further studies should be carried out to determine the cause of the disproportional incidence of measles in rural areas in Abia state bearing in mind that measles immunization coverage in urban and rural areas was not markedly different PMID:24244791

  11. Detection of serum antibodies against measles, mumps and rubella after primary measles, mumps and rubella (MMR) vaccination in children.

    PubMed

    Rafiei Tabatabaei, Sedigheh; Esteghamati, Abdoul-Reza; Shiva, Farideh; Fallah, Fatemeh; Radmanesh, Raheleh; Abdinia, Babak; Shamshiri, Ahmad Reza; Khairkhah, Masoumeh; Shekari Ebrahimabad, Hamideh; Karimi, Abdollah

    2013-01-01

    In Iran, the measles, mumps and rubella vaccine (MMR) is administered in a two-dose protocol where the first dose is scheduled at 12 months of age. This study aims to determine the efficacy of the MMR vaccine by testing IgM and IgG antibody levels 4 - 7 weeks after primary vaccination. A single group cohort study was performed on healthy children, 12 - 15 months of age, who were vaccinated at health centers affiliated with Shahid Beheshti University of Medical Sciences in Tehran, from January to April 2009. Children with negative vaccination and/or clinical history for measles, mumps or rubella were administered the first dose of the MMR live attenuated vaccine. IgG and IgM antibodies were checked by enzyme linked immunoassay (ELISA) in serum samples 4 - 7 weeks after vaccination. A child was considered seropositive if antibody levels were higher than the assay cut-off level set by the ELISA kit. Samples from 240 children were checked for antibodies against measles and rubella. Measles serum IgM level was positive in 71.7% of samples and IgG in 75.8%. The rubella serum IgM level was positive in 71.7% of children and IgG in 73.8%. From 190 blood samples that were checked for mumps antibodies, serum IgM was positive in 68.9% and IgG in 95.3%. No significant relationship was found between seropositivity and age or gender. IgG and IgM antibody levels were below the assay cut-off levels against measles and rubella in approximately one-fourth of the children following primary MMR vaccination. A second dose was necessary to raise the level of protection against measles and rubella.

  12. Population immunity to measles virus and the effect of HIV-1 infection after a mass measles vaccination campaign in Lusaka, Zambia: a cross-sectional survey.

    PubMed

    Lowther, Sara A; Curriero, Frank C; Kalish, Brian T; Shields, Timothy M; Monze, Mwaka; Moss, William J

    2009-03-21

    Measles control efforts are hindered by challenges in sustaining high vaccination coverage, waning immunity in HIV-1-infected children, and clustering of susceptible individuals. Our aim was to assess population immunity to measles virus after a mass vaccination campaign in a region with high HIV prevalence. 3 years after a measles supplemental immunisation activity (SIA), we undertook a cross-sectional survey in Lusaka, Zambia. Households were randomly selected from a satellite image. Children aged 9 months to 5 years from selected households were eligible for enrolment. A questionnaire was administered to the children's caregivers to obtain information about measles vaccination history and history of measles. Oral fluid samples were obtained from children and tested for antibodies to measles virus and HIV-1 by EIA. 1015 children from 668 residences provided adequate specimens. 853 (84%) children had a history of measles vaccination according to either caregiver report or immunisation card. 679 children (67%) had antibodies to measles virus, and 64 (6%) children had antibodies to HIV-1. Children with antibodies to HIV-1 were as likely to have no history of measles vaccination as those without antibodies to HIV-1 (odds ratio [OR] 1.17, 95% CI 0.57-2.41). Children without measles antibodies were more likely to have never received measles vaccine than those with antibodies (adjusted OR 2.50, 1.69-3.71). In vaccinated children, 33 (61%) of 54 children with antibodies to HIV-1 also had antibodies to measles virus, compared with 568 (71%) of 796 children without antibodies to HIV-1 (p=0.1). 3 years after an SIA, population immunity to measles was insufficient to interrupt measles virus transmission. The use of oral fluid and satellite images for sampling are potential methods to assess population immunity and the timing of SIAs.

  13. Measles vaccine coverage and factors related to uncompleted vaccination among 18-month-old and 36-month-old children in Kyoto, Japan.

    PubMed

    Matsumura, Takayo; Nakayama, Takeo; Okamoto, Shigeru; Ito, Hideko

    2005-06-04

    Due to low vaccine coverage, Japan has not only experienced outbreaks of measles but has also been exporting it overseas. This study aims to survey measles vaccine coverage and the factors uncompleted vaccination among community-living children. Subjects were the parents whose children had undergone either an 18-month or a 36-month checkup publicly provided by Kyoto City during November 2001 to January 2002. An anonymous self-administered questionnaire survey was conducted. The coverage was 73.2% among the 18-month-old children (n = 2707) and 88.9% among the 36-month-old children (n = 2340), respectively. The following characteristics of mothers were related to uncompleted measles vaccination: aged below 30, working, concerned about the adverse events of the vaccine, and had insufficient knowledge. Similarly, the following characteristics among children were related to uncompleted measles vaccination: not the first-born child, interacting with other children in group settings. The coverage was the lowest among the children whose mothers were concerned about the adverse events of the vaccine without proper knowledge of measles and its vaccination. To increase vaccine coverage among children, parents' awareness about measles and vaccination against it should be promoted, especially for working mothers. Efforts to enhance access to vaccination services and to communicate with parents about changing vaccination schedules are necessary.

  14. Reasons for measles cases not being vaccinated with MMR: investigation into parents' and carers' views following a large measles outbreak.

    PubMed

    McHale, P; Keenan, A; Ghebrehewet, S

    2016-03-01

    Uptake rates for the combined measles, mumps and rubella (MMR) vaccine have been below the required 95% in the UK since a retracted and discredited article linking the MMR vaccine with autism and inflammatory bowel disease was released in 1998. This study undertook semi-structured telephone interviews among parents or carers of 47 unvaccinated measles cases who were aged between 13 months and 9 years, during a large measles outbreak in Merseyside. Results showed that concerns over the specific links with autism remain an important cause of refusal to vaccinate, with over half of respondents stating this as a reason. A quarter stated child illness during scheduled vaccination time, while other reasons included general safety concerns and access issues. Over half of respondents felt that more information or a discussion with a health professional would help the decision-making process, while a third stated improved access. There was clear support for vaccination among respondents when asked about current opinions regarding MMR vaccine. The findings support the hypothesis that safety concerns remain a major barrier to MMR vaccination, and also support previous evidence that experience of measles is an important determinant in the decision to vaccinate.

  15. [The running status of Chinese Measles Laboratory Network in 2008].

    PubMed

    Zhang, Yan; Xu, Song-Tao; Jiang, Xiao-Hong

    2009-04-01

    To evaluate the running status of Measles laboratory network of China (Hong Kong, Macao and Taiwan were excluded) in 2008. To analyze the database of Measles laboratory network surveillance of the year 2008, and the database of serologic and virologic surveillance of National laboratory for Measles in Chinese Centers for Disease Control and Prevention(CCDC), then the indicators of the running of Measles laboratory network of China were analyzed. 1, serologic surveillance: 107,160 Measles sera samples were collected between Feburary and September of 2008, and the collection rate was 77.93%; 53 778 samples were qualified and positive for IgM, the positive percentage was 50.2%. 2, Virologic surveillance: 287 Measles viral isolates were isolated by 18 provincial Measles laboratories in 2008, all were certified as H1a genotype, H1a genotype was still the predominant genotype circulating in China; 29 Rubella viral isolates were isolated by 4 provincial Measles laboratories in 2008, all belonged to 1E genotype. 3, Laboratory quality control: National laboratory for Measles passed the proficiency test and on-site review in 2008; all provincial Measles laboratories passed the sera samples recheck and proficiency test hold by National laboratory for Measles in 2008; Tianjin, Shanxi, Shandong, Zhejiang, Jilin, Hubei, provincial Measles laboratory passed the on-site review by WHO. The running status of Chinese Measles laboratory network was good in 2008, and good laboratory quality control system was also set up, methods such as specimens collection, serologic detection, cell culture and viral isolation, etc, were standardized, and applied to Chinese Measles laboratory network, and it provided important scientific basis for eradication Measles in the year of 2012.

  16. Heritability of vaccine-induced measles neutralizing antibody titers.

    PubMed

    Schaid, Daniel J; Haralambieva, Iana H; Larrabee, Beth R; Ovsyannikova, Inna G; Kennedy, Richard B; Poland, Gregory A

    2017-03-07

    Understanding how genetics influences inter-individual variation of antibody titers in response to measles vaccination is vital to understanding possible sources of vaccine failure as well as improved vaccine development. Although it is recognized that both the human leukocyte antigen (HLA) genes and the immunoglobulin allotype genes play significant roles in immune response, there is significant variation in antibody titers that is not explained by these genes. To obtain a more complete estimate of the role of the entire genome, we used a large panel of single nucleotide polymorphisms to estimate the heritability of antibody response to measles vaccine. Based on 935 subjects with European ancestry, we estimated the heritability to be 49% (standard error 0.17). We also estimated the heritability attributable to each chromosome, and found a large range in chromosome-specific heritabilities. Notably, chromosome 1 had the largest estimate (28%), while chromosome 6, which harbors HLA, had an estimated heritability of 13%. Compared with a prior study of twins in the same community, which resulted in a heritability estimate of 88.5%, our study suggests there are either many rare genetic variants, or many common genetic variants of small effect sizes that contribute to variations of antibody titers in response to measles vaccine. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Increased long term mortality associated with rash after early measles vaccination in rural Senegal.

    PubMed

    Seng, R; Samb, B; Simondon, F; Cissé, B; Soumaré, M; Jensen, H; Bennett, J; Whittle, H; Aaby, P

    1999-01-01

    To examine whether clinical symptoms, including rash, were more common after measles immunization compared with placebo and to study the association between postvaccination symptoms and later mortality. Examination of side effects in the 3 weeks after immunization in a trial of high titer and standard titer measles vaccines. Two hundred twenty-four children randomly selected to be included in the surveillance for diarrhea, fever and rash. There was no difference in fever and diarrhea between recipients of high titer vaccines and recipients of placebo. However, high titer recipients tended to have more measles-like rashes than placebo recipients [relative risk, 2.12 (range, 0.90 to 5.03)]. Among recipients of high titer vaccines, children who presented a rash had higher mortality in the following 5 to 7 years than those who did not develop rash [mortality rate ratio, 3.85 (range, 1.52 to 9.79)]. High titer recipients without a rash had the same mortality as children in the placebo group who were given standard doses of measles vaccine at 10 months of age [mortality rate, 0.76 (range, 0.35 to 1.62)]. These observations suggest that in this particular study, rash after high titer measles vaccine may identify children who received a particularly high dose of vaccine or children with more severe and persistent postvaccination immunosuppression. Whether high titer vaccine is more likely than standard titer measles vaccine to provoke such reaction is not known, given that we did not compare side effects after different titers of measles vaccine. Future trials of live measles vaccine should monitor the development of rash.

  18. MEASLES IN VACCINATED CHILDREN 1.5 TO 3 YEARS OF AGE IN RURAL COMMUNITY OF DISTRICT PESHAWAR, PAKISTAN.

    PubMed

    Khan, Aftab; Ullah, Obaid; Ambreen; Ahmad, Israr; Merajuddin

    2015-01-01

    In many developing countries measles is a leading cause of childhood morbidity and mortality. Despite of vaccination thousands of children have been infected by measles virus during last couple of years in Pakistan. The objective of this study was to determine the measles vaccination coverage rate and frequency of measles among vaccinated children of age 1.5-3 years in rural community of district Peshawar. The cross-sectional study was carried out among 385 children aged 1.5-3 year of rural community of Peshawar. After taking informed consent from parents/guardians a predesigned questionnaire was filled. Evidence of vaccination and measles history was taken by vaccination card, doctor prescription and parent/guardian recall. Data was gathered and analysed by using SPSS-16. Of the 385 children, 361 (93.7%) were vaccinated against measles at 9 month. It was found that 27 (7.48%) vaccinated children had measles history of which 23 (6.74%) were infected after 9 month vaccination. One hundred and ninety-two (49.8%) children were vaccinated both at 9 and 15 months, and 14 (7.29%) dual vaccinated children had a measles history, 9 among them (4.68%) were infected after taking both measles doses. The occurrence of measles among vaccinated children and low coverage rate of second dose of measles vaccine raises many questions about vaccination program and its efficacy. Further studies are needed to evaluate the influence of other predisposing factors like vaccine quality, manufacturer, supply, cold chain, handling, nutritional status of children and technical approach, on measles vaccine efficacy.

  19. Successful respiratory immunization with dry powder live-attenuated measles virus vaccine in rhesus macaques.

    PubMed

    Lin, Wen-Hsuan; Griffin, Diane E; Rota, Paul A; Papania, Mark; Cape, Stephen P; Bennett, David; Quinn, Brian; Sievers, Robert E; Shermer, Charles; Powell, Kenneth; Adams, Robert J; Godin, Steven; Winston, Scott

    2011-02-15

    Measles remains an important cause of childhood mortality worldwide. Sustained high vaccination coverage is the key to preventing measles deaths. Because measles vaccine is delivered by injection, hurdles to high coverage include the need for trained medical personnel and a cold chain, waste of vaccine in multidose vials and risks associated with needle use and disposal. Respiratory vaccine delivery could lower these barriers and facilitate sustained high coverage. We developed a novel single unit dose, dry powder live-attenuated measles vaccine (MVDP) for respiratory delivery without reconstitution. We tested the immunogenicity and protective efficacy in rhesus macaques of one dose of MVDP delivered either with a mask or directly intranasal with two dry powder inhalers, PuffHaler and BD Solovent. MVDP induced robust measles virus (MeV)-specific humoral and T-cell responses, without adverse effects, which completely protected the macaques from infection with wild-type MeV more than one year later. Respiratory delivery of MVDP was safe and effective and could aid in measles control.

  20. How Can We Identify the Elimination of Infectious Diseases? Experience From an Active Measles Laboratory Surveillance System in the Republic of Korea.

    PubMed

    Yang, Tae Un; Kang, Hae Ji; Eom, Hye Eun; Park, Young-Joon; Park, Ok; Kim, Su Jin; Nam, Jeong-Gu; Kim, Sung Soon; Jeong, Eun Kyeong

    2015-11-01

    Global efforts have markedly decreased the disease burden of vaccine-preventable diseases. Many countries have made considerable progress toward the elimination of measles. As elimination is approached, the very low incidence achieved by high vaccination coverage has underscored the need for a sensitive and timely surveillance system. In the Republic of Korea, an active laboratory surveillance system (ALSS) was implemented to supplement the existing passive surveillance system in 2006. The ALSS connects 5 major commercial laboratories and the national measles reference laboratory, where referred samples with positive or equivocal results are retested. Annually, from 2009 to 2013, 3714 suspected cases were detected through the ALSS, an expansion of 8- to 57-fold, compared with only the passive surveillance system. The ALSS, with its sensitivity and timeliness, is a reasonable strategy to supplement the existing measles surveillance system and to help identify the elimination of measles. © 2015 APJPH.

  1. Paternal education status significantly influences infants' measles vaccination uptake, independent of maternal education status.

    PubMed

    Rammohan, Anu; Awofeso, Niyi; Fernandez, Renae C

    2012-05-08

    Despite increased funding of measles vaccination programs by national governments and international aid agencies, structural factors encumber attainment of childhood measles immunisation to levels which may guarantee herd immunity. One of such factors is parental education status. Research on the links between parental education and vaccination has typically focused on the influence of maternal education status. This study aims to demonstrate the independent influence of paternal education status on measles immunisation. Comparable nationally representative survey data were obtained from six countries with the highest numbers of children missing the measles vaccine in 2008. Logistic regression analysis was applied to examine the influence of paternal education on uptake of the first dose of measles vaccination, independent of maternal education, whilst controlling for confounding factors such as respondent's age, urban/rural residence, province/state of residence, religion, wealth and occupation. The results of the analysis show that even if a mother is illiterate, having a father with an education of Secondary (high school) schooling and above is statistically significant and positively correlated with the likelihood of a child being vaccinated for measles, in the six countries analysed. Paternal education of secondary or higher level was significantly and independently correlated with measles immunisation uptake after controlling for all potential confounders. The influence of paternal education status on measles immunisation uptake was investigated and found to be statistically significant in six nations with the biggest gaps in measles immunisation coverage in 2008. This study underscores the imperative of utilising both maternal and paternal education as screening variables to identify children at risk of missing measles vaccination prospectively.

  2. Cost-effectiveness of three different vaccination strategies against measles in Zambian children.

    PubMed

    Dayan, Gustavo H; Cairns, Lisa; Sangrujee, Nalinee; Mtonga, Anne; Nguyen, Van; Strebel, Peter

    2004-01-02

    The vaccination program in Zambia includes one dose of measles vaccine at 9 months of age. The objective of this study was to compare the cost-effectiveness of the current one-dose measles vaccination program with an immunization schedule in which a second dose is provided either through routine health services or through supplemental immunization activities (SIAs). We simulated the expected cost and impact of the vaccination strategies for an annual cohort of 400,000 children, assuming 80% vaccination coverage in both routine and SIAs and an analytic horizon of 15 years. A vaccination program which includes SIAs reaching children not previously vaccinated would prevent on additional 29,242 measles cases and 1462 deaths for each vaccinated birth cohort when compared with a one-dose program. Given the parameters established for this analysis, such a program would be cost-saving and the most cost-effective vaccination strategy for Zambia.

  3. Immunoglobulin GM and KM genes and measles vaccine-induced humoral immunity.

    PubMed

    Ovsyannikova, Inna G; Larrabee, Beth R; Schaid, Daniel J; Poland, Gregory A

    2017-10-04

    Identifying genetic polymorphisms that explain variations in humoral immunity to live measles virus vaccine is of great interest. Immunoglobulin GM (heavy chain) and KM (light chain) allotypes are genetic markers known to be associated with susceptibility to several infectious diseases. We assessed associations between GM and KM genotypes and measles vaccine humoral immunity (neutralizing antibody titers) in a combined cohort (n=1796) of racially diverse healthy individuals (age 18-41years). We did not discover any significant associations between GM and/or KM genotypes and measles vaccine-induced neutralizing antibody titers. African-American subjects had higher neutralizing antibody titers than Caucasians (1260mIU/mL vs. 740mIU/mL, p=7.10×10 -13 ), and those titers remained statistically significant (p=1.68×10 -09 ) after adjusting for age at enrollment and time since last vaccination. There were no statistically significant sex-specific differences in measles-induced neutralizing antibody titers in our study (p=0.375). Our data indicate a surprising lack of evidence for an association between GM and KM genotypes and measles-specific neutralizing antibody titers, despite the importance of these immune response genes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. High Concentrations of Measles Neutralizing Antibodies and High-Avidity Measles IgG Accurately Identify Measles Reinfection Cases

    PubMed Central

    Rota, Jennifer S.; Hickman, Carole J.; Mercader, Sara; Redd, Susan; McNall, Rebecca J.; Williams, Nobia; McGrew, Marcia; Walls, M. Laura; Rota, Paul A.; Bellini, William J.

    2016-01-01

    In the United States, approximately 9% of the measles cases reported from 2012 to 2014 occurred in vaccinated individuals. Laboratory confirmation of measles in vaccinated individuals is challenging since IgM assays can give inconclusive results. Although a positive reverse transcription (RT)-PCR assay result from an appropriately timed specimen can provide confirmation, negative results may not rule out a highly suspicious case. Detection of high-avidity measles IgG in serum samples provides laboratory evidence of a past immunologic response to measles from natural infection or immunization. High concentrations of measles neutralizing antibody have been observed by plaque reduction neutralization (PRN) assays among confirmed measles cases with high-avidity IgG, referred to here as reinfection cases (RICs). In this study, we evaluated the utility of measuring levels of measles neutralizing antibody to distinguish RICs from noncases by receiver operating characteristic curve analysis. Single and paired serum samples with high-avidity measles IgG from suspected measles cases submitted to the CDC for routine surveillance were used for the analysis. The RICs were confirmed by a 4-fold rise in PRN titer or by RT-quantitative PCR (RT-qPCR) assay, while the noncases were negative by both assays. Discrimination accuracy was high with serum samples collected ≥3 days after rash onset (area under the curve, 0.953; 95% confidence interval [CI], 0.854 to 0.993). Measles neutralizing antibody concentrations of ≥40,000 mIU/ml identified RICs with 90% sensitivity (95% CI, 74 to 98%) and 100% specificity (95% CI, 82 to 100%). Therefore, when serological or RT-qPCR results are unavailable or inconclusive, suspected measles cases with high-avidity measles IgG can be confirmed as RICs by measles neutralizing antibody concentrations of ≥40,000 mIU/ml. PMID:27335386

  5. Facebook and Twitter vaccine sentiment in response to measles outbreaks.

    PubMed

    Deiner, Michael S; Fathy, Cherie; Kim, Jessica; Niemeyer, Katherine; Ramirez, David; Ackley, Sarah F; Liu, Fengchen; Lietman, Thomas M; Porco, Travis C

    2017-11-01

    Social media posts regarding measles vaccination were classified as pro-vaccination, expressing vaccine hesitancy, uncertain, or irrelevant. Spearman correlations with Centers for Disease Control and Prevention-reported measles cases and differenced smoothed cumulative case counts over this period were reported (using time series bootstrap confidence intervals). A total of 58,078 Facebook posts and 82,993 tweets were identified from 4 January 2009 to 27 August 2016. Pro-vaccination posts were correlated with the US weekly reported cases (Facebook: Spearman correlation 0.22 (95% confidence interval: 0.09 to 0.34), Twitter: 0.21 (95% confidence interval: 0.06 to 0.34)). Vaccine-hesitant posts, however, were uncorrelated with measles cases in the United States (Facebook: 0.01 (95% confidence interval: -0.13 to 0.14), Twitter: 0.0011 (95% confidence interval: -0.12 to 0.12)). These findings may result from more consistent social media engagement by individuals expressing vaccine hesitancy, contrasted with media- or event-driven episodic interest on the part of individuals favoring current policy.

  6. Absence of endemic measles transmission in a highly vaccinated population from 1999 to 2008: implications of sustained measles elimination in Taiwan.

    PubMed

    Chang, Yu-Kang; Chen, Jacky Y H; Chang, Hsiao-Ling; Yu, Mei-Ching; Hsiao, Hsu-Feng; Hou, Ching-Cheng; Liu, Shyun-Yeu; Chen, Kow-Tong

    2010-07-19

    Measles remains a leading vaccine-preventable cause of child mortality worldwide. The impact of vaccination programs can be seen in the increasingly low incidence of measles. However, cases of measles continue to occur in low numbers every year in Taiwan. We assessed the epidemiology of measles in Taiwan from 1999 to 2008 with a focus on domestic versus imported cases. We analyzed the data reported to surveillance systems at the Taiwan Center for Disease Control, where viral isolation was performed. A total of 84 measles cases were reported from 1999 to 2008 in Taiwan with the incidence of measles varying from 0 to 1.5 per 1,000,000 people per year, peaking in 2002 and again in 2008. The incidence decreased with increasing age in both males and females. Among the 84 reported measles cases, 39 (46%) originated internationally, 8 (10%) were epidemiologically linked to imported cases and the source was unknown in 37 (44%) of the cases. The unknown-source cases were analyzed for potential evidence of endemic measles transmission. Most of the measles cases that occurred in Taiwan from 1999 to 2008 were associated with imported cases. No endemic transmission of measles in Taiwan was identified. This study suggests that maintaining the high rate of vaccination coverage is needed to prevent future outbreak and sustain the elimination of measles in Taiwan. (c) 2010 Elsevier Ltd. All rights reserved.

  7. Measles antibody levels after vaccination with Edmonston-Zagreb and Schwarz measles vaccine at 9 months or at 9 and 18 months of age: a serological study within a randomised trial of different measles vaccines.

    PubMed

    Martins, Cesario; Garly, May-Lill; Bale, Carlitos; Rodrigues, Amabelia; Benn, Christine S; Whittle, Hilton; Aaby, Peter

    2013-11-19

    Standard-titre Schwarz (SW) and Edmonston-Zagreb (EZ) measles vaccines (MV) are both used in the routine immunisation programme. Within a trial of different strains of MV, we examined antibody responses in both one-dose and two-dose schedules when the first dose was administered at 9 months. The trial was conducted in an urban area in Guinea-Bissau where we have had a health and demographic surveillance system and studied strategies to prevent measles infection since 1978. In the present study, children were randomised to SW or EZ as the first MV and furthermore randomised to a second dose of the same MV or no vaccine at 18 months of age. We obtained blood samples from 996 children at baseline; post-vaccination blood samples were collected at 18 and 24 months of age to assess measles antibody levels after one or two doses of MV. At age 18 months all had responded to the first dose and only 1% (8/699) of the children had non-protective antibody levels irrespective of vaccine type. SW was associated with significantly higher levels of measles antibodies (geometric mean titre (GMT)=2114 mIU/mL (95%CI 1153-2412)) than EZ (GMT=807 mIU/mL (722-908)) (p=0.001). Antibody concentration was significantly higher in girls than in boys after EZ but not after SW. Antibody levels were higher in the rainy than the dry season. There was no clear indication that a booster dose at 18 months increased the antibody level at 24 months of age. Maternal antibody levels have declined significantly in recent years and 99% had protective levels of measles antibody following primary MV at 9 months of age. It is unlikely that measles prevention and child health will be improved by increasing the age of MV as currently recommended. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Cluster Survey Evaluation of a Measles Vaccination Campaign in Jharkhand, India, 2012

    PubMed Central

    Scobie, Heather M.; Ray, Arindam; Routray, Satyabrata; Bose, Anindya; Bahl, Sunil; Sosler, Stephen; Wannemuehler, Kathleen; Kumar, Rakesh; Haldar, Pradeep; Anand, Abhijeet

    2015-01-01

    Introduction India was the last country in the world to implement a two-dose strategy for measles-containing vaccine (MCV) in 2010. As part of measles second-dose introduction, phased measles vaccination campaigns were conducted during 2010–2013, targeting 131 million children 9 months to <10 years of age. We performed a post-campaign coverage survey to estimate measles vaccination coverage in Jharkhand state. Methods A multi-stage cluster survey was conducted 2 months after the phase 2 measles campaign occurred in 19 of 24 districts of Jharkhand during November 2011–March 2012. Vaccination status of children 9 months to <10 years of age was documented based on vaccination card or mother’s recall. Coverage estimates and 95% confidence intervals (95% CI) for 1,018 children were calculated using survey methods. Results In the Jharkhand phase 2 campaign, MCV coverage among children aged 9 months to <10 years was 61.0% (95% CI: 54.4–67.7%). Significant differences in coverage were observed between rural (65.0%; 95% CI: 56.8–73.2%) and urban areas (45.6%; 95% CI: 37.3–53.9%). Campaign awareness among mothers was low (51.5%), and the most commonly reported reason for non-vaccination was being unaware of the campaign (69.4%). At the end of the campaign, 53.7% (95% CI: 46.5–60.9%) of children 12 months to <10 years of age received ≥2 MCV doses, while a large proportion of children remained under-vaccinated (34.0%, 95% CI: 28.0–40.0%) or unvaccinated (12.3%, 95% CI: 9.3–16.2%). Conclusions Implementation of the national measles campaign was a significant achievement towards measles elimination in India. In Jharkhand, campaign performance was below the target coverage of ≥90% set by the Government of India, and challenges in disseminating campaign messages were identified. Efforts towards increasing two-dose MCV coverage are needed to achieve the recently adopted measles elimination goal in India and the South-East Asia region. PMID:26010084

  9. Correlation between measles vaccine doses: implications for the maintenance of elimination.

    PubMed

    McKee, A; Ferrari, M J; Shea, K

    2018-03-01

    Measles eradication efforts have been successful at achieving elimination in many countries worldwide. Such countries actively work to maintain this elimination by continuing to improve coverage of two routine doses of measles vaccine following measles elimination. While improving measles vaccine coverage is always beneficial, we show, using a steady-state analysis of a dynamical model, that the correlation between populations receiving the first and second routine dose also has a significant impact on the population immunity achieved by a specified combination of first and second dose coverage. If the second dose is administered to people independently of whether they had the first dose, high second-dose coverage improves the proportion of the population receiving at least one dose, and will have a large effect on population immunity. If the second dose is administered only to people who have had the first dose, high second-dose coverage reduces the rate of primary vaccine failure, but does not reach people who missed the first dose; this will therefore have a relatively small effect on population immunity. When doses are administered dependently, and assuming the first dose has higher coverage, increasing the coverage of the first dose has a larger impact on population immunity than does increasing the coverage of the second. Correlation between vaccine doses has a significant impact on the level of population immunity maintained by current vaccination coverage, potentially outweighing the effects of age structure and, in some cases, recent improvements in vaccine coverage. It is therefore important to understand the correlation between vaccine doses as such correlation may have a large impact on the effectiveness of measles vaccination strategies.

  10. Vaccine-preventable diseases in pediatric patients: a review of measles, mumps, rubella, and varicella [digest].

    PubMed

    Levine, Deborah A; Pade, Kathryn H

    2016-12-22

    Vaccine-preventable diseases such as measles, mumps, rubella, and varicella continue to plague children and adults worldwide. Although public health programs have helped decrease the prevalence and sequelae of these diseases, outbreaks still occur. To limit the spread of these diseases, emergency clinicians must be able to readily identify the characteristic presentations of the rashes associated with measles, rubella, and varicella, as well as the common presenting features associated with mumps. Diagnostic laboratory studies are not usually necessary, as a complete history and physical examination usually lead to an accurate diagnosis. Treatment for these vaccine-preventable diseases usually consists of supportive care, but, in some cases, severe complications and death may occur. This issue provides a review of the clinical features, differential diagnoses, potential complications, and treatment options for measles, mumps, rubella, and varicella. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  11. Paternal education status significantly influences infants’ measles vaccination uptake, independent of maternal education status

    PubMed Central

    2012-01-01

    Background Despite increased funding of measles vaccination programs by national governments and international aid agencies, structural factors encumber attainment of childhood measles immunisation to levels which may guarantee herd immunity. One of such factors is parental education status. Research on the links between parental education and vaccination has typically focused on the influence of maternal education status. This study aims to demonstrate the independent influence of paternal education status on measles immunisation. Methods Comparable nationally representative survey data were obtained from six countries with the highest numbers of children missing the measles vaccine in 2008. Logistic regression analysis was applied to examine the influence of paternal education on uptake of the first dose of measles vaccination, independent of maternal education, whilst controlling for confounding factors such as respondent’s age, urban/rural residence, province/state of residence, religion, wealth and occupation. Results The results of the analysis show that even if a mother is illiterate, having a father with an education of Secondary (high school) schooling and above is statistically significant and positively correlated with the likelihood of a child being vaccinated for measles, in the six countries analysed. Paternal education of secondary or higher level was significantly and independently correlated with measles immunisation uptake after controlling for all potential confounders. Conclusions The influence of paternal education status on measles immunisation uptake was investigated and found to be statistically significant in six nations with the biggest gaps in measles immunisation coverage in 2008. This study underscores the imperative of utilising both maternal and paternal education as screening variables to identify children at risk of missing measles vaccination prospectively. PMID:22568861

  12. Parental migration and children's timely measles vaccination in rural China: a cross-sectional study.

    PubMed

    Tang, Xianyan; Geater, Alan; McNeil, Edward; Zhou, Hongxia; Deng, Qiuyun; Dong, Aihu; Li, Qiao

    2016-07-01

    With the rapid economic development in China, millions of rural residents are migrating to the cities to gain employment, resulting in numerous left-behind children (LBC). Simultaneously, outbreaks of measles continue to occur, yet the effect of parental migration on children's vaccination status is largely unknown. This study aimed to evaluate the association between parental migration and children's timely measles vaccination in rural China, after adjusting for family socio-economic status (SES) indicators. We conducted a cross-sectional survey using multistage sampling among children aged 18-54 months in rural Guangxi of China. Information on measles vaccination status was obtained from the child's vaccination certificate, and data on SES were collected by interviewing the child's primary guardian. Family SES and vaccination coverage were compared between LBC and non-left-behind children (NLBC) using weighted logistic regression, while the delay in vaccination was compared using Kaplan-Meier survival analysis. Of the 1216 study children, 46% were LBC and 54% were NLBC. Compared to NLBC, the coverage of timely measles vaccination was significantly lower, and the median delay period was longer among LBC. After adjusting for SES indicators, LBC were significantly more likely to have an untimely vaccination for their first dose of measles vaccine than NLBC (OR = 1.33, 95% CI = 1.02-1.75). Due to the negative effect of parental migration and family SES, LBC were more likely to encounter serious delays of measles vaccination in rural China. Optimising vaccination policies could facilitate timely vaccination among LBC in rural China. © 2016 John Wiley & Sons Ltd.

  13. Public Health and Economic Consequences of Vaccine Hesitancy for Measles in the United States.

    PubMed

    Lo, Nathan C; Hotez, Peter J

    2017-09-01

    Routine childhood vaccination is declining in some regions of the United States due to vaccine hesitancy, which risks the resurgence of many infectious diseases with public health and economic consequences. There are ongoing policy debates on the state and national level, including legislation around nonmedical (personal-belief) exemptions for childhood vaccination and possibly a special government commission on vaccine safety, which may affect vaccine coverage. To estimate the number of measles cases in US children and the associated economic costs under scenarios of different levels of vaccine hesitancy, using the case example of measles, mumps, and rubella (MMR) vaccination and measles. Publicly available data from the US Centers for Disease Control and Prevention were used to simulate county-level MMR vaccination coverage in children (age 2-11 years) in the United States. A stochastic mathematical model was adapted for infectious disease transmission that estimated a distribution for outbreak size as it relates to vaccine coverage. Economic costs per measles case were obtained from the literature. The predicted effects of increasing the prevalence of vaccine hesitancy as well as the removal of nonmedical exemptions were estimated. The model was calibrated to annual measles cases in US children over recent years, and the model prediction was validated using an independent data set from England and Wales. Annual measles cases in the United States and the associated public sector costs. A 5% decline in MMR vaccine coverage in the United States would result in an estimated 3-fold increase in measles cases for children aged 2 to 11 years nationally every year, with an additional $2.1 million in public sector costs. The numbers would be substantially higher if unvaccinated infants, adolescents, and adult populations were also considered. There was variation around these estimates due to the stochastic elements of measles importation and sensitivity of some model

  14. Successful respiratory immunization with dry powder live-attenuated measles virus vaccine in rhesus macaques

    PubMed Central

    Lin, Wen-Hsuan; Griffin, Diane E.; Rota, Paul A.; Papania, Mark; Cape, Stephen P.; Bennett, David; Quinn, Brian; Sievers, Robert E.; Shermer, Charles; Powell, Kenneth; Adams, Robert J.; Godin, Steven; Winston, Scott

    2011-01-01

    Measles remains an important cause of childhood mortality worldwide. Sustained high vaccination coverage is the key to preventing measles deaths. Because measles vaccine is delivered by injection, hurdles to high coverage include the need for trained medical personnel and a cold chain, waste of vaccine in multidose vials and risks associated with needle use and disposal. Respiratory vaccine delivery could lower these barriers and facilitate sustained high coverage. We developed a novel single unit dose, dry powder live-attenuated measles vaccine (MVDP) for respiratory delivery without reconstitution. We tested the immunogenicity and protective efficacy in rhesus macaques of one dose of MVDP delivered either with a mask or directly intranasal with two dry powder inhalers, PuffHaler and BD Solovent. MVDP induced robust measles virus (MeV)-specific humoral and T-cell responses, without adverse effects, which completely protected the macaques from infection with wild-type MeV more than one year later. Respiratory delivery of MVDP was safe and effective and could aid in measles control. PMID:21282608

  15. The impact of maternal measles-rubella immunization on the 12-month-old infant's immune response to measles-mumps-rubella vaccine immunogenicity.

    PubMed

    Saffar, M-J; Ajami, A; Khalilian, A-R; Saffar, H

    2009-07-01

    This study was conducted to assess the roles of maternal measles-rubella (MR) vaccination before pregnancy on the persistence of passive immunity against MR in their infant before measles-mumps-rubella (MMR) immunization and the effects on the immunogenicity of MMR vaccine. Before and 4-8 weeks after MMR immunization of all healthy 12-month-old infants, sera samples were prepared. According to their mother's history of MR vaccination, infants were divided into two groups. Anti-MR antibodies were measured by the quantitative enzyme-linked immunosorbent assay (ELISA) method. The difference in seroconversion rates and the mean concentration of antibodies (MCA) between the two groups of infants were analyzed by descriptive statistical methods. In total, 7 and 12 sera, all from infants born from MR-vaccinated mothers, were positive against measles and rubella, respectively. The seroconversion rates were 90.5 and 53% in seronegative infants against measles and rubella, respectively, without statistically significant differences between the two groups of infants. However, the MCA differences were significant; measles P = 0.000, rubella P = 0.019. The MR vaccination of mothers may cause the prolongation of passive immunity in their infants, and may influence the immunogenicity of MMR vaccination. This finding should be considered for the optimal scheduling of the first dose of MMR vaccine. Also, the results showed that the immunogenicity of the rubella component of the MMR vaccine was lower than that reported.

  16. Impact of Nonmedical Vaccine Exemption Policies on the Health and Economic Burden of Measles.

    PubMed

    Whittington, Melanie D; Kempe, Allison; Dempsey, Amanda; Herlihy, Rachel; Campbell, Jonathan D

    2017-07-01

    Despite relatively high national vaccination coverage for measles, geographic vaccination variation exists resulting in clusters of susceptibility. A portion of this geographic variation can be explained by differences in state policies related to nonmedical vaccine exemptions. The objective of this analysis was to determine the magnitude, likelihood, and cost of a measles outbreak under different nonmedical vaccine exemption policies. An agent-based transmission model simulated the likelihood and magnitude of a measles outbreak under different nonmedical vaccine exemption policies, previously categorized as easy, medium, or difficult. The model accounted for measles herd immunity, infectiousness of the pathogen, vaccine efficacy, duration of incubation and communicable periods, acquired natural immunity, and the rate of recovery. Public health contact tracing was also modeled. Model outcomes, including the number of secondary cases, hospitalizations, and deaths, were monetized to determine the economic burden of the simulated outbreaks. A state with easy nonmedical vaccine exemption policies is 140% and 190% more likely to experience a measles outbreak compared with states with medium or difficult policies, respectively. The magnitude of these outbreaks can be reduced by half by strengthening exemption policies. These declines are associated with significant cost reductions to public health, the health care system, and the individual. Strengthening nonmedical vaccine exemption policies is 1 mechanism to increase vaccination coverage to reduce the health and economic effect of a measles outbreak. States exploring options for decreasing their vulnerability to outbreaks of vaccine-preventable diseases should consider more stringent requirements for nonmedical vaccine exemptions. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  17. Persistence of measles neutralizing antibody related to vaccine and natural infection acquired before HIV infection.

    PubMed

    Isa, M B; Pavan, J V; Sicilia Don, P; Grutadauria, S; Martinez, L C; Giordano, M O; Masachessi, G; Barril, P A; Nates, S V

    2014-08-01

    Little is known about long-lasting measles protective immunity when exposure to wild-type or vaccine measles virus precedes HIV infection. The results obtained suggest that measles immunity wanes and the lowest measles geometric mean titres (GMT) were significantly associated with measles vaccine-induced immunity in individuals that later developed HIV infection (86% prevalence, GMT 164 mIU/ml) compared to naturally induced immunity in HIV-infected adults (100% prevalence, GMT 340 mIU/ml, P = 0·0082) or non-HIV infected adults (100%, GMT 724 mIU/ml, P = 0·0001), and vaccine-induced immunity in non-HIV-infected adults (100%, GMT 347 mIU/ml, P = 0·017). The study was conducted in an area without wild-type virus circulation since 2000. The absence of virus circulating may alter the paradigm of lifelong immunity to measles virus after vaccination. As the proportion of HIV-infected individuals possessing only vaccine-induced immunity continues to grow, checking the status of measles immunity in this group is strongly recommended.

  18. [Measles in Poland in 2004].

    PubMed

    Czarkowski, Mirosław P; Kondej, Barbara; Paweł, Stefanoff

    2006-01-01

    In Poland 11 measles cases were registered in 2004 (0.03 per 100,000 population), of which 3 were cases imported from Chechnya. Of 8 local cases, 3 cases occurred in unvaccinated persons, 2 in persons vaccinated with one dose and 3 in vaccinated with two doses of measles vaccine (administered at the age of 13-15 months and 7 years). The most affected age groups were 1-year old children (0.29 per 100,000 population) and 6-year olds (0.25). Out of 11 reported cases 2 were hospitalized. There were no deaths attributed to measles. Poland participates in the WHO Measles Elimination Strategy. Presently, the most important is the maintenance of a sensitive and timely surveillance of measles and measles-compatible cases, with serologic testing of one suspect case per 100,000 population. The performance of the surveillance system was insufficient with only 44 measles-compatible cases reported in 2004 (12% of expected reports). Serologic confirmation of cases was also insufficient, with 5 cases confirmed in WHO accredited laboratory. These results indicate the need to maintain the high immunisation coverage and improve measles surveillance system.

  19. [Analysis on epidemiological characteristics of measles before and after measles vaccine supplement immunization activities in Changzhou municipal in 2007].

    PubMed

    Zhang, Qian; Zhang, Jian-Tao; Bian, Chen

    2010-02-01

    To analyze the epidemiological characteristics of measles before and after measles attenuated live vaccine (MV) supplementary immunization activities (SIAs) in Changzhou municipal in 2007-2008 and approach measures of measles elimination. Analyze measles epidemiology and control measures with descriptive epidemiology. After SIAs in Nov.2007, the reported measles incidence was 24.13/100000, and increased by 91.60% in 2008 than in 2007, except Jintan and Liyang town, the others were higher in 2008 than in 2007. The reported measles incidence of 5-9 years old was lower in 2008 than in 2007. However, the reported measles incidence of other age groups was higher. One incidence peak reached 216.92/100000 was found in < 1 year old group and another peak appeared at aged 20-30 years old group. The proportions of measles cases of 8 months-14 years old in 2007 and 2008 were 53.47% and 54.38%. 7.37% and 4.18% of them received MV respectively. The reported cases in 2008 increased and 68.05% of them were floating population. Low coverage of MVwas the main cause of high measles incidence. It indicated that a timely and strengthened routine vaccination, a high quality SIA, and well organized floating population management and surveillance are essential strategies to eliminate measles.

  20. Head-to-head immunogenicity comparison of Edmonston-Zagreb vs. AIK-C measles vaccine strains in infants aged 8-12 months: A randomized clinical trial.

    PubMed

    Izadi, Shahrokh; Zahraei, Seyed Mohsen; Salehi, Masoud; Mohammadi, Mahdi; Tabatabaei, Seyed Mehdi; Mokhtari-Azad, Talat

    2018-01-29

    A non-inferiority multi-centre parallel randomized double-blind trial was implemented in Zahedan district, Sistan-va-Baluchestan province, Iran, to compare the performance of the two measles vaccines which are in use in the National Immunization Programme of Iran and are of two different measles virus vaccine strains: Edmonston-Zagreb (EZ) strain vs. AIK-C strain. The main outcome measure was appearance of anti-measles antibody in sera. 200 infants, 8-12 months old, whose parents consented for their children to be included in the study, were randomized in permutation blocks of size 4-8 in four Urban Health Clinics. Having given a pre-vaccination blood sample, they received measles-rubella vaccine containing one of the vaccine strains mentioned before. After 60 days, the second blood sample was taken. The sera of the pre- and post-vaccination blood samples were tested for anti-measles antibodies in the National Reference Measles Laboratory. Parents, laboratory technicians and statistician were blind to groupings. Of the 200 children equally randomized in the two arms, 185 who were seronegative before vaccination (88 in the EZ arm and 97 in the AIK-C arm) were entered in the final analysis. The seroconversion rate in the EZ arm was 76.1% (95% CI: 60.2-85.2%), and that in the AIK-C arm was 58.7%; (95% CI: 48.8-68.7%). The absolute rate difference was 17. 4% (4.1-30.9%; P-value: .012), and the relative seroconversion rate of EZ to AIK-C was 1.3 (95% CI: 1.1-1.6; P-value: .012). No adverse events were reported during the study period. A considerable difference in the seropositivity of different measles containing vaccines could be demonstrated in the first year of life. Iranian Registry of Clinical Trials Registration Number: IRCT2016032827144N1; May 10, 2016 (www.who.int/ictrp/network/irct/en/). Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Case based measles surveillance in Pune: evidence to guide current and future measles control and elimination efforts in India.

    PubMed

    Bose, Anindya Sekhar; Jafari, Hamid; Sosler, Stephen; Narula, Arvinder Pal Singh; Kulkarni, V M; Ramamurty, Nalini; Oommen, John; Jadi, Ramesh S; Banpel, R V; Henao-Restrepo, Ana Maria

    2014-01-01

    According to WHO estimates, 35% of global measles deaths in 2011 occurred in India. In 2013, India committed to a goal of measles elimination by 2020. Laboratory supported case based measles surveillance is an essential component of measles elimination strategies. Results from a case-based measles surveillance system in Pune district (November 2009 through December 2011) are reported here with wider implications for measles elimination efforts in India. Standard protocols were followed for case identification, investigation and classification. Suspected measles cases were confirmed through serology (IgM) or epidemiological linkage or clinical presentation. Data regarding age, sex, vaccination status were collected and annualized incidence rates for measles and rubella cases calculated. Of the 1011 suspected measles cases reported to the surveillance system, 76% were confirmed measles, 6% were confirmed rubella, and 17% were non-measles, non-rubella cases. Of the confirmed measles cases, 95% were less than 15 years of age. Annual measles incidence rate was more than 250 per million persons and nearly half were associated with outbreaks. Thirty-nine per cent of the confirmed measles cases were vaccinated with one dose of measles vaccine (MCV1). Surveillance demonstrated high measles incidence and frequent outbreaks in Pune where MCV1 coverage in infants was above 90%. Results indicate that even high coverage with a single dose of measles vaccine was insufficient to provide population protection and prevent measles outbreaks. An effective measles and rubella surveillance system provides essential information to plan, implement and evaluate measles immunization strategies and monitor progress towards measles elimination.

  2. Case Based Measles Surveillance in Pune: Evidence to Guide Current and Future Measles Control and Elimination Efforts in India

    PubMed Central

    Bose, Anindya Sekhar; Jafari, Hamid; Sosler, Stephen; Narula, Arvinder Pal Singh; Kulkarni, V. M.; Ramamurty, Nalini; Oommen, John; Jadi, Ramesh S.; Banpel, R. V.; Henao-Restrepo, Ana Maria

    2014-01-01

    Background According to WHO estimates, 35% of global measles deaths in 2011 occurred in India. In 2013, India committed to a goal of measles elimination by 2020. Laboratory supported case based measles surveillance is an essential component of measles elimination strategies. Results from a case-based measles surveillance system in Pune district (November 2009 through December 2011) are reported here with wider implications for measles elimination efforts in India. Methods Standard protocols were followed for case identification, investigation and classification. Suspected measles cases were confirmed through serology (IgM) or epidemiological linkage or clinical presentation. Data regarding age, sex, vaccination status were collected and annualized incidence rates for measles and rubella cases calculated. Results Of the 1011 suspected measles cases reported to the surveillance system, 76% were confirmed measles, 6% were confirmed rubella, and 17% were non-measles, non-rubella cases. Of the confirmed measles cases, 95% were less than 15 years of age. Annual measles incidence rate was more than 250 per million persons and nearly half were associated with outbreaks. Thirty-nine per cent of the confirmed measles cases were vaccinated with one dose of measles vaccine (MCV1). Conclusion Surveillance demonstrated high measles incidence and frequent outbreaks in Pune where MCV1 coverage in infants was above 90%. Results indicate that even high coverage with a single dose of measles vaccine was insufficient to provide population protection and prevent measles outbreaks. An effective measles and rubella surveillance system provides essential information to plan, implement and evaluate measles immunization strategies and monitor progress towards measles elimination. PMID:25290339

  3. Retinopathy following measles, mumps, and rubella vaccination in an immuno-incompetent girl.

    PubMed

    Schuil, J; van de Putte, E M; Zwaan, C M; Koole, F D; Meire, F M

    1998-01-01

    We describe a 4-year-old girl with subnormal visual acuity due to a bilateral retinopathy. The child had a history of encephalitis following MMR vaccination. Temporary retinopathy associated with measles, mumps, and rubella (MMR) vaccination has been described. Recently an idiopathic CD4+ T lymphocytopenia in the child was diagnosed. This cellular immunodeficiency supports our hypothesis of measles retinopathy after vaccination of an immuno-deficient child.

  4. Subacute sclerosing panencephalitis in a tertiary care centre in post measles vaccination era.

    PubMed

    Sonia, Malik; Lalit, Dar; Shobha, Broor; Sheffali, Gulati; Amandeep, Salhotra; Veena, Kalra; Madhuri, Behari

    2009-09-01

    This study was conducted to observe the impact of measles vaccination on the epidemiology of subacute sclerosing panencephalitis (SSPE) in the post measles vaccination era. This is a retrospective study from a tertiary care hospital, covering a ten year period starting a decade after the introduction of the national measles immunization programme in India. We analyzed 458 serologically confirmed SSPE cases. These patients had a high cerebrospinal fluid: serum anti-measles antibody ratio. The male to female ratio in the present study was 4.4:1. The mean age at onset of SSPE was 13.3 years, showing an increase in mean age at onset of SSPE. Clinical and other demographic details, available from 72 in-patients, are discussed in this report. Of these, a history of measles could be elicited in 34 cases. Mean latent period between measles infection and onset of SSPE was 7.8 years. Six patients gave a history of measles vaccination. A sizable percentage (15.5 %) of the patients was > or = 18 years old and considered to have adult onset SSPE. The incidence of SSPE continues to be high and this report highlights the need for further strengthening routine measles immunization coverage.

  5. Measles control strategies in India: position paper of Indian Academy of Pediatrics.

    PubMed

    Vashishtha, V M; Choudhury, P; Bansal, C P; Gupta, S G

    2013-06-08

    Measles continues to be a major cause of childhood morbidity and mortality in India. Recent studies estimate that 80,000 Indian children die each year due to measles and its complications, amounting to 4% of under-5 deaths. Immunization against measles directly contributes to the reduction of under five child mortality and hence to the achievement of Millennium Development Goal 4 (MDG 4). The live attenuated measles vaccines are safe, effective and provide long lasting protection. The key strategies being followed globally for measles mortality reduction are high coverage of measles first dose, sensitive laboratory supported surveillance, appropriate case management, and providing second dose of measles vaccine. Prior to 2010, India was the only country in the world that had not introduced a second dose of measles vaccine in its National immunization program. We herein discuss the current status of measles vaccination along with the rationale and challenges of providing a second opportunity for measles vaccination, and the principles of measles catch-up campaigns.

  6. Protective efficacy of standard Edmonston-Zagreb measles vaccination in infants aged 4.5 months: interim analysis of a randomised clinical trial.

    PubMed

    Martins, Cesário L; Garly, May-Lill; Balé, Carlito; Rodrigues, Amabelia; Ravn, Henrik; Whittle, Hilton C; Lisse, Ida M; Aaby, Peter

    2008-07-24

    To examine the protective efficacy of measles vaccination in infants in a low income country before 9 months of age. Randomised clinical trial. 1333 infants aged 4.5 months: 441 in treatment group and 892 in control group. Urban area in Guinea-Bissau. Measles vaccination using standard titre Edmonston-Zagreb vaccine at 4.5 months of age. Vaccine efficacy against measles infection, admission to hospital for measles, and measles mortality before standard vaccination at 9 months of age. 28% of the children tested at 4.5 months of age had protective levels of maternal antibodies against measles at enrolment. After early vaccination against measles 92% had measles antibodies at 9 months of age. A measles outbreak offered a unique situation for testing the efficacy of early measles vaccination. During the outbreak, 96 children developed measles; 19% of unvaccinated children had measles before 9 months of age. The monthly incidence of measles among the 441 children enrolled in the treatment arm was 0.7% and among the 892 enrolled in the control arm was 3.1%. Early vaccination with the Edmonston-Zagreb measles vaccine prevented infection; vaccine efficacy for children with serologically confirmed measles and definite clinical measles was 94% (95% confidence interval 77% to 99%), for admissions to hospital for measles was 100% (46% to 100%), and for measles mortality was 100% (-42% to 100%). The number needed to treat to prevent one case of measles between ages 4.5 months and 9 months during the epidemic was 7.2 (6.8 to 9.2). The treatment group tended to have lower overall mortality (mortality rate ratio 0.18, 0.02 to 1.36) although this was not significant. In low income countries, maternal antibody levels against measles may be low and severe outbreaks of measles can occur in infants before the recommended age of vaccination at 9 months. Outbreaks of measles may be curtailed by measles vaccination using the Edmonston-Zagreb vaccine as early as 4.5 months of age. TRIAL

  7. Timely measles vaccination in Tianjin, China: a cross-sectional study of immunization records and mothers.

    PubMed

    Wagner, Abram L; Zhang, Ying; Montgomery, JoLynn P; Ding, Yaxing; Carlson, Bradley F; Boulton, Matthew L

    2014-08-29

    Measles is a highly infectious disease, and timely administration of two doses of vaccine can ensure adequate protection against measles for all ages in a population. This study aims to estimate the proportion of children aged 8 months to 6 years vaccinated on time with measles-containing vaccines (MCV) and vaccinated during the 2008 and 2010 measles supplementary immunization activities. This study also characterizes differences in mean age at vaccination and vaccination timeliness by demographic characteristics, and describes maternal knowledge of measles vaccination. Immunization records were selected from a convenience sample of immunization clinics in Tianjin, China. From the records, overall vaccination coverage and timely vaccination coverage were calculated for different demographic groups. Mothers were also interviewed at these clinics to ascertain their knowledge of measles vaccination. Within the 329 immunization clinic records, child's birth year and district of residence were found to be significant predictors of different measures of vaccine timeliness. Children born in 2009 had a lower age at MCV dose 2 administration (17.96 months) than children born in 2005 (22.00 months). Children living in Hebei, a district in the urban center of Tianjin were less likely to be vaccinated late than children living in districts further from the urban core of Tianjin. From the 31 interviews with mothers, most women believed that timely vaccination was very important and more than one dose was very necessary; most did not know whether their child needed another dose. When reviewing MCV coverage in China, most studies do not consider timeliness. However, this study shows that overall vaccination coverage can greatly overestimate vaccination coverage within certain segments of the population, such as young infants.

  8. Measles in suburban Khartoum: an epidemiological and clinical study.

    PubMed

    Ibrahim, S A; Mustafa, O M; Mukhtar, M M; Saleh, E A; El Mubarak, H S; Abdallah, A; El-Hassan, A M; Osterhaus, A D M E; Groen, J; De Swart, R L; Zijlstra, E E

    2002-05-01

    Clinical and epidemiological data were collected from 187 clinically diagnosed measles patients in Haj Yousif area, suburban Khartoum. Laboratory tests confirmed the diagnosis in 141 (75%) of the cases, but demonstrated that in 46 (25%) patients the clinical symptoms were not caused by an acute measles virus (MV) infection. According to their vaccination card, 59% of the laboratory-confirmed measles cases had been vaccinated for measles. Compared with non-measles rash disease cases, confirmed measles cases more often had severe illness (P < 0.0001), were dehydrated (P=0.01) at presentation and less likely to recover without complications [OR 0.19 (95% CI 0.09, 0.39)]. There was no difference in death rate (P=0.20). Underweight [weight-for-age Z score (WAZ) measles cases (those who developed diarrhoea, pneumonia, otitis media, encephalitis or haemorrhagic rash) had similar vaccination rates and time intervals since vaccination as uncomplicated measles cases. Although severe measles had lower WAZ-scores (P=0.004), none of the nutritional parameters studied were predictive of outcome. Mortality was higher in the severe measles group [OR 8.8 (95% CI 1.7, 85.2)]. In 11 of 141 confirmed measles cases serological evidence of a recent infection with another virus was found, most commonly varicella zoster virus and dengue virus; spotted fever and rubella were among the most frequent diagnoses in 17 of 47 cases of the non-measles cases.

  9. Perceptions, beliefs and practices of mothers in sub-urban and rural areas towards measles and measles vaccination in Northern Nigeria.

    PubMed

    Ambe, J P; Omotara, B A; Mandu Baba, M

    2001-04-01

    Measles is of particular concern in Nigeria because of the high fatality rate, and high morbidity rate, particularly in young children. Measles and its complications are a common reason for hospitalization, indicating very low immunization coverage. This study was carried out to elucidate the contributing factors from attitudes, beliefs and practices of mothers towards measles and its vaccination. A cross-sectional survey was conducted in Konduga Local Government Area. One per cent of the 500 mothers interviewed believed that measles is prevented by immunization, 16% that it is contagious or due to an infectious agent, 26% that it is caused by evil spirits, witchcraft and heat, and 25% had never heard of measles immunization. Twenty-seven per cent said they did not believe immunization was effective and 4% were not allowed to go for immunization by their husbands. Of those mothers whose children had developed measles, only 31% had been treated in formal health facilities. These results indicate an unfavourable attitude and practice by mothers in relation to measles and measles vaccination. There is the need for an intensive health education campaign to improve this state of affairs and to reduce the morbidity and mortality from measles.

  10. A Microneedle Patch for Measles and Rubella Vaccination Is Immunogenic and Protective in Infant Rhesus Macaques.

    PubMed

    Joyce, Jessica C; Carroll, Timothy D; Collins, Marcus L; Chen, Min-Hsin; Fritts, Linda; Dutra, Joseph C; Rourke, Tracy L; Goodson, James L; McChesney, Michael B; Prausnitz, Mark R; Rota, Paul A

    2018-04-26

    New methods to increase measles and rubella (MR) vaccination coverage are needed to achieve global and regional MR elimination goals. Here, we developed microneedle (MN) patches designed to administer MR vaccine by minimally trained personnel, leave no biohazardous sharps waste, remove the need for vaccine reconstitution, and provide thermostability outside the cold chain. This study evaluated the immunogenicity of MN patches delivering MR vaccine to infant rhesus macaques. Protective titers of measles neutralizing antibodies (>120 mIU/mL) were detected in 100% of macaques in the MN group and 75% of macaques in the subcutaneous (SC) injection group. Rubella neutralizing antibody titers were >10 IU/mL for all groups. All macaques in the MN group were protected from challenge with wild-type measles virus, whereas 75% were protected in the SC group. However, vaccination by the MN or SC route was unable to generate protective immune responses to measles in infant macaques pretreated with measles immunoglobulin to simulate maternal antibody. These results show, for the first time, that MR vaccine delivered by MN patch generated protective titers of neutralizing antibodies to both measles and rubella in infant rhesus macaques and afforded complete protection from measles virus challenge.

  11. Impact of vaccination on the incidence of measles in Mozambique in the period 2000 to 2011.

    PubMed

    Muloliwa, Artur Manuel; Camacho, Luiz Antonio Bastos; Verani, José Fernando Souza; Simões, Taynãna César; Dgedge, Martinho do Carmo

    2013-02-01

    The aim of this study was to contribute to the better planning of measles elimination actions in Mozambique, by considering the impact of vaccination actions over the period 2000 to 2011. Descriptive and ecological studies and case records made available by the Ministry of Health were used to analyze measles vaccination coverage. Statistical analysis was performed using time series and spatial analysis. Vaccine coverage rates ranged from 82% to 99%. Coverage rates in Maputo city were under 70% and in Niassa province they were over 100%. Coverage showed a clustered pattern in the districts. The measles incidence rate was 1.58 per 100,000 inhabitants (0.00-40.08 per 100,000 inhabitants); districts bordering neighboring countries presented high incidence rates. Although measles morbidity and mortality has decreased in Mozambique, vaccine coverage has been insufficient to interrupt measles transmission. Enhanced surveillance, including investigation of cases and outbreaks, and improvements in measles vaccination are recommended in order to achieve a homogenous coverage rate of ≥ 95% for both routine and mass vaccination campaigns.

  12. The causal effect of childhood measles vaccination on educational attainment: A mother fixed-effects study in rural South Africa.

    PubMed

    Anekwe, Tobenna D; Newell, Marie-Louise; Tanser, Frank; Pillay, Deenan; Bärnighausen, Till

    2015-09-11

    Because measles vaccination prevents acute measles disease and morbidities secondary to measles, such as undernutrition, blindness, and brain damage, the vaccination may also lead to higher educational attainment. However, there has been little evidence to support this hypothesis at the population level. In this study, we estimate the causal effect of childhood measles vaccination on educational attainment among children born between 1995 and 2000 in South Africa. We use longitudinal data on measles vaccination status and school grade attainment among 4783 children. The data were collected by the Wellcome Trust Africa Centre Demographic Information System (ACDIS), which is one of Africa's largest health and demographic surveillance systems. ACDIS is located in a poor, predominantly rural, Zulu-speaking community in KwaZulu-Natal, South Africa. Using mother fixed-effects regression, we compare the school grade attainment of siblings who are discordant in their measles vaccination status but share the same mother and household. This fixed-effects approach controls for confounding due to both observed and unobserved factors that do not vary between siblings, including sibling-invariant mother and household characteristics such as attitudes toward risk, conscientiousness, and aspirations for children. We further control for a range of potential confounders that vary between siblings, such as sex of the child, year of birth, mother's age at child's birth, and birth order. We find that measles vaccination on average increases school grade attainment by 0.188 grades (95% confidence interval, 0.0424-0.334; p=0.011). Measles vaccination increased educational attainment in this poor, largely rural community in South Africa. For every five to seven children vaccinated against measles, one additional school grade was gained. The presence of a measles vaccination effect in this community is plausible because (i) measles vaccination prevents measles complications including

  13. Allergic reactions to measles-mumps-rubella vaccination.

    PubMed

    Patja, A; Mäkinen-Kiljunen, S; Davidkin, I; Paunio, M; Peltola, H

    2001-02-01

    Immunization of egg-allergic children against measles, mumps, and rubella (MMR) is often deferred or even denied, although the safety of this vaccination has been clearly shown. Moreover, the majority of severe allergic reactions have occurred in egg-tolerant vaccinees. Other allergenic vaccine components have been sought, and gelatin has been suggested as one cause of allergic adverse events. The aim of this study was to further characterize the actual allergenic vaccine components. Serum samples from 36 recipients of MMR vaccine with anaphylaxis, urticaria with or without angioedema, asthmatic symptoms, or Henoch-Schönlein purpura were analyzed by CAP System radioallergosorbent test (RAST) and immunospot methods to detect the allergenic vaccine component. To evaluate the correspondence between the findings in the CAP System RAST or the immunospot and clinical symptoms, histories of allergies and present hypersensitivity symptoms were assessed. Of the 36 participants, 10 were demonstrated to be allergic to gelatin. Seven of them had persistent allergic symptoms, possibly attributable to foods containing gelatin or cross-reactive allergens. The results of the immunospot suggested concomitant allergy to gelatin and egg, chicken, and feathers, as well as cow's milk, or they reflected allergen cross-reactivity. Although severe allergic adverse events attributable to MMR vaccination are extremely rare, all serious allergic reactions should be further assessed to detect the likely causative vaccine component, including gelatin. The current recommendation for immunization of egg-allergic persons according to standard MMR vaccination schedules is reinforced. measles, mumps, and rubella vaccine, immunization, adverse effects, allergic reactions, gelatin allergy, CAP System, radioallergosorbent test, immunospot, immunoglobulin E.

  14. Effects of Interleukin-12 and Interleukin-15 on Measles-Specific T-Cell Responses in Vaccinated Infants

    PubMed Central

    YASUKAWA, LINDA L.; ZHANG, CATHRYN Z.; WAKIM, RIMA HANNA; RINKI, MARY; DEHOVITZ, ROSS; ARVIN, ANN M.

    2008-01-01

    Abstract Understanding the infant host response to measles vaccination is important because of their increased mortality from measles and the need to provide effective protection during the first year of life. Measles-specific T- and B-cell responses are lower in infants after measles vaccination than in adults. To define potential mechanisms, we investigated age-related differences in measles-specific T-cell proliferation, CD40-L expression, and IFN-γ production after measles immunization, and the effects of rhIL-12 and rhIL-15 on these responses. Measles-specific T-cell proliferation and mean IFN-γ release from infant PBMCs were significantly lower when compared with responses of vaccinated children and adults. Infant responses increased to ranges observed in children and adults when both rhIL-12 and rhIL-15 were added to PBMC cultures. Furthermore, a significant rise in T-cell proliferation and IFN-γ release was observed when infant PBMCs were stimulated with measles antigen in the presence of rhIL-12 and rhIL-15 compared to measles antigen alone. CD40-L expression by infant and adult T cells stimulated with measles antigen was comparable, but fewer infant CD40-L+ T cells expressed IFN-γ. These observations suggest that lower measles-specific T-cell immune responses elicited by measles vaccine in infants may be due to diminished levels of key cytokines. PMID:18419254

  15. Boosting effect of a second dose of measles vaccine given to 12-year-old children.

    PubMed

    Böttiger, M

    1993-01-01

    In Sweden, a two-dose programme of vaccination against measles, mumps and rubella (MMR) was introduced in 1982 and the target groups were children aged 18 months and 12 years. In 1993 the first age group of 12-year-olds that were vaccinated with MMR at 18 months will appear. The majority of the 12-year-old vaccines for many years, however, had already been vaccinated against measles and the MMR measles component was thus a booster dose. As the benefit of a booster dose against measles has been questioned, this was studied in a group of 163 12-year-old children, 122 of whom had been vaccinated against measles as young children. Of the 41 unvaccinated children, 23 had a history of clinical measles. The mean neutralizing titre level of the earlier vaccinated children, prior to the booster, was lower than that of the naturally immune children (reciprocal titre level 8 versus 20). After the booster the corresponding titre levels were 13 and 23. Among the seronegative children receiving their first dose, this figure amounted to 14. A moderate rise in titre was seen in those with low prevaccination titres. As the antibody protection afforded by vaccination was slightly lower than that of natural infection, even after a booster, follow-up studies must be recommended to evaluate the long-term protection of both a single and a two-dose programme.

  16. Genetically defined race, but not sex, is associated with higher humoral and cellular immune responses to measles vaccination

    PubMed Central

    Voigt, Emily A.; Ovsyannikova, Inna G.; Haralambieva, Iana H.; Kennedy, Richard B.; Larrabee, Beth R.; Schaid, Daniel J.; Poland, Gregory A.

    2017-01-01

    In addition to host genetic and environmental factors, variations in immune responses to vaccination are influenced by demographic variables, such as race and sex. The influence of genetic race and sex on measles vaccine responses is not well understood, yet important for the development of much-needed improved measles vaccines with lower failure rates. We assessed associations between genetically defined race and sex with measles humoral and cellular immunity after measles vaccination in three independent and geographically distinct cohorts totaling 2,872 healthy racially diverse children, older adolescents, and young adults. We found no associations between biological sex and either humoral or cellular immunity to measles vaccine, and no correlation between humoral and cellular immunity in these study subjects. Genetically defined race was, however, significantly associated with both measles vaccine-induced humoral and cellular immune responses, with subjects genetically classified as having African-American ancestry demonstrating significantly higher antibody and cell-mediated immune responses relative to subjects of Caucasian ancestry. This information may be useful in designing novel measles vaccines that are optimally effective across human genetic backgrounds. PMID:27591105

  17. Can Flanders resist the measles outbreak? Assessing vaccination coverage in different age groups among Flemish residents.

    PubMed

    Braeckman, T; Theeten, H; Roelants, M; Blaizot, S; Hoppenbrouwers, K; Maertens, K; Van Damme, P; Vandermeulen, C

    2018-05-02

    The Belgian strategic plan to eliminate measles contains several vaccination strategies including routine immunisation programmes and catch-up campaigns. A new expanded programme on immunisation-based survey (2016) assessed the uptake of the recommended measles-mumps-rubella (MMR) vaccine in three different cohorts: toddlers, adolescents and parents of toddlers. A two-stage cluster sampling technique was used to select 875 toddlers (age 18-24 months) and 1250 adolescents (born in 2000) from 107 municipalities in Flanders. After consent of the parent(s), 746 (85.2%) families of toddlers and 1012 (81.0%) families of adolescents were interviewed at home. Measles vaccination coverage was high at 18-24 months (96.2%) and 81.5% were vaccinated at recommended age. Toddlers who had two siblings or a non-working mother or changed vaccinator were more at risk for not being vaccinated. Coverage of the teenager dose reached 93.5% and was lower in adolescents with educational underachievement or whose mother was part-time working or with a non-Belgian background. Only 56.0% of mothers and 48.3% of fathers remembered having received at least one measles-containing vaccine. Although measles vaccination coverage in toddlers meets the required standards for elimination, administration of the teenager dose of MMR vaccine and parent compliance to the recent measles catch-up campaign in Flanders leave room for improvement.

  18. Australian vaccine preventable disease epidemiological review series: measles 2000-2011.

    PubMed

    Chiew, May; Dey, Aditi; Martin, Nicolee; Wang, Han; Davis, Stephanie; McIntyre, Peter B

    2015-03-31

    Since the introduction of measles vaccine to the vaccination schedule, the burden of measles has substantially fallen in Australia. Despite this, a number of recent measles outbreaks have occurred. The aim of this study was to examine the burden of measles in Australia using notification, hospitalisation and mortality data with the objectives of setting a baseline for comparison prior to the introduction of the combined measles-mumps-rubella-varicella vaccine. Data were obtained from the Australian National Notifiable Diseases Surveillance System, the National Hospital Morbidity Database and the National Mortality Database to obtain notification, hospitalisation and death data, respectively from 2000 to 2011. Rates were calculated and compared over time by age group and jurisdiction. Since 1993, measles notifications have fallen considerably in Australia. However, between 2000 and 2011, measles notification rates and hospitalisation rates fluctuated. Between 2000 and 2011, there were 990 measles notifications in Australia. The average annual notification rate was 0.4 per 100,000 population. Children aged 0-4 years were the most susceptible group, particularly infants less than 1 year of age (average annual rate, 1.6 per 100,000 population). High incidence was also observed in adolescents (average annual rate, 0.7 per 100,000 population) and young adults (average annual rate, 0.8 per 100,000 population). Jurisdictional variation occurred with differing patterns of notifications and hospitalisations. Although a marked reduction in measles notifications and hospitalisations has occurred in the past decade, susceptible individuals should be vaccinated to prevent outbreaks and to maintain a low incidence of measles and Australia's elimination status. This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your

  19. Haemagglutination inhibition antibody levels one year after natural measles infection and vaccination.

    PubMed

    Eghafona, N O; Ahmad, A A; Ezeokoli, C D; Emejuaiwe, S O

    1991-01-01

    An assessment of haemagglutination inhibition antibody (HAI) titres of 1,163 children, comprising 739 recipients of live measles vaccines and 424 patients with natural measles infection after 1 year was made in this investigation. Statistical analysis revealed a significant difference in the levels of HAI antibodies. Of the vaccinated children a significant 67.45% showed antibody titres of less than or equal to 1:16, while only 23.48% of children with natural measles showed these antibody titres. The importance and implication of such HAI antibody titres is discussed.

  20. Progress toward measles control - African region, 2001-2008.

    PubMed

    2009-09-25

    In 2001, the countries of the World Health Organization (WHO) African Region (AFR) became part of a global initiative with a goal of reducing the number of measles deaths by 50% by 2005, compared with 1999. Recommended strategies for measles mortality reduction included 1) increasing routine coverage for the first dose of measles-containing vaccine (MCV1) for all children, 2) providing a second opportunity for measles vaccination through supplemental immunization activities (SIAs), 3) improving measles case management, and 4) establishing case-based surveillance with laboratory confirmation of all suspected measles cases. Before introduction of MCV throughout AFR, approximately 1 million measles cases had been reported each year in the early 1980s. After strengthening measles-control activities, annual reported cases declined to an estimated 300,000- -580,000 during the 1990s. This report summarizes the progress made during 2001- -2008 toward improving measles control in AFR. During 2001- -2008 estimated MCV1 coverage increased from 57% to 73%, SIAs vaccinated approximately 398 million children, and reported measles cases decreased by 93%, from 492,116 in 2001 to 32,278 in 2008. By 2005, global measles deaths had decreased by 60%, and the AFR goal had been achieved; AFR adopted a new goal to reduce deaths by 90%, compared with 2000, and that goal was achieved in 2006. However, inaccuracies in reported vaccination coverage exist, surveillance is suboptimal, and measles outbreaks continue to occur in AFR countries. Further progress in measles control will require full implementation of recommended strategies, including validation of vaccination coverage.

  1. Progress Toward Measles Elimination - South-East Asia Region, 2003-2013.

    PubMed

    Thapa, Arun; Khanal, Sudhir; Sharapov, Umid; Swezy, Virginia; Sedai, Tika; Dabbagh, Alya; Rota, Paul; Goodson, James L; McFarland, Jeffrey

    2015-06-12

    In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region adopted the goal of measles elimination and rubella and congenital rubella syndrome control by 2020 after rigorous prior consultations. The recommended strategies include 1) achieving and maintaining ≥95% coverage with 2 doses of measles- and rubella-containing vaccine in every district through routine or supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely case-based measles surveillance system that meets recommended performance indicators; 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. This report updates previous reports and summarizes progress toward measles elimination in the South-East Asia Region during 2003-2013. Within the region, coverage with the first dose of a measles-containing vaccine (MCV1) increased from 67% to 78%; an estimated 286 million children (95% of the target population) were vaccinated in SIAs; measles incidence decreased 73%, from 59 to 16 cases per million population; and estimated measles deaths decreased 63%. To achieve measles elimination in the region, additional efforts are needed in countries with <95% 2-dose routine MCV coverage, particularly in India and Indonesia, to strengthen routine immunization services, conduct periodic high-quality SIAs, and strengthen measles case-based surveillance and laboratory diagnosis of measles.

  2. Framework for Optimal Global Vaccine Stockpile Design for Vaccine-Preventable Diseases: Application to Measles and Cholera Vaccines as Contrasting Examples.

    PubMed

    Thompson, Kimberly M; Duintjer Tebbens, Radboud J

    2016-07-01

    Managing the dynamics of vaccine supply and demand represents a significant challenge with very high stakes. Insufficient vaccine supplies can necessitate rationing, lead to preventable adverse health outcomes, delay the achievements of elimination or eradication goals, and/or pose reputation risks for public health authorities and/or manufacturers. This article explores the dynamics of global vaccine supply and demand to consider the opportunities to develop and maintain optimal global vaccine stockpiles for universal vaccines, characterized by large global demand (for which we use measles vaccines as an example), and nonuniversal (including new and niche) vaccines (for which we use oral cholera vaccine as an example). We contrast our approach with other vaccine stockpile optimization frameworks previously developed for the United States pediatric vaccine stockpile to address disruptions in supply and global emergency response vaccine stockpiles to provide on-demand vaccines for use in outbreaks. For measles vaccine, we explore the complexity that arises due to different formulations and presentations of vaccines, consideration of rubella, and the context of regional elimination goals. We conclude that global health policy leaders and stakeholders should procure and maintain appropriate global vaccine rotating stocks for measles and rubella vaccine now to support current regional elimination goals, and should probably also do so for other vaccines to help prevent and control endemic or epidemic diseases. This work suggests the need to better model global vaccine supplies to improve efficiency in the vaccine supply chain, ensure adequate supplies to support elimination and eradication initiatives, and support progress toward the goals of the Global Vaccine Action Plan. © 2014 Society for Risk Analysis.

  3. Evaluation of the mass measles vaccination campaign in Guangdong Province, China.

    PubMed

    Peng, Zhi Qiang; Chen, Wei Shi; He, Qun; Peng, Guo Wen; Wu, Cheng Gang; Xu, Ning; Zhao, Zhan Jie; Shu, Jun; Tan, Qiu; Zheng, Hui Zhen; Lin, Li Feng; Deng, Hui Hong; Lin, Jin Yan; Zhang, Yong Hui

    2012-02-01

    To evaluate the mass measles vaccination campaign of 2009 in Guangdong Province, China. Data on the campaign implementation, measles surveillance, and serological surveillance were reviewed and analyzed by statistical methods. Rapid coverage surveys showed that 98.09% of children were vaccinated during the campaign. The coverage of migrant children increased significantly from 67.10% to 97.32% (p<0.01). From May to December 2009, after the campaign, the number of measles cases was reduced by 93.04% compared with the same period of 2008. The antibody positive rate in children aged less than 15 years reached above 95%. More than 1 million migrant children were identified and vaccinated during the campaign. Flyers, notices of information from doctors, and television programs were the best methods to inform parents of the campaign. Awareness of the campaign by residents increased significantly from 91.86% to 97.10% (p<0.01) through the use of social mobilization materials. A massive vaccination campaign approach for controlling measles in a developing region like Guangdong Province with a vast migrant population has proved effective. Comprehensive mobilization, communication with the mass media, and support from government departments were critical to the success of the campaign. Copyright © 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  4. Predicting the impact of measles vaccination in England and Wales: model validation and analysis of policy options.

    PubMed Central

    Babad, H. R.; Nokes, D. J.; Gay, N. J.; Miller, E.; Morgan-Capner, P.; Anderson, R. M.

    1995-01-01

    Measles incidence in England and Wales has fallen to an all-time low. Attention is now focused on preventing local outbreaks, and, in the long run, on the elimination of indigenous measles. A realistic age-structured (RAS) mathematical model of measles transmission is used to reconstruct the impact of measles vaccination in England and Wales from 1968 to the present and to evaluate the merits of future policy options. In general, the predictions of the model show good agreement with long-term age stratified case reports and seroprevalence surveys. The model underestimates the proportion of cases that are notified in 0-2-year-old children. However, recent work suggests a high degree of misdiagnosis in this age group. Projections on the basis of the existing vaccination strategy in the UK suggest that the present level of measles vaccine coverage will be insufficient to eliminate small seasonal outbreaks of measles. This result is, however, sensitive to the assumed level of vaccine efficacy. Explorations of a variety of changes to current vaccination strategy favour a 2-dose schedule with the second dose administered at age 4 years irrespective of vaccination history. A vaccination campaign in school-age children, to reduce deficits in herd immunity, would accelerate progress towards measles elimination. PMID:7705494

  5. Predicting the impact of measles vaccination in England and Wales: model validation and analysis of policy options.

    PubMed

    Babad, H R; Nokes, D J; Gay, N J; Miller, E; Morgan-Capner, P; Anderson, R M

    1995-04-01

    Measles incidence in England and Wales has fallen to an all-time low. Attention is now focused on preventing local outbreaks, and, in the long run, on the elimination of indigenous measles. A realistic age-structured (RAS) mathematical model of measles transmission is used to reconstruct the impact of measles vaccination in England and Wales from 1968 to the present and to evaluate the merits of future policy options. In general, the predictions of the model show good agreement with long-term age stratified case reports and seroprevalence surveys. The model underestimates the proportion of cases that are notified in 0-2-year-old children. However, recent work suggests a high degree of misdiagnosis in this age group. Projections on the basis of the existing vaccination strategy in the UK suggest that the present level of measles vaccine coverage will be insufficient to eliminate small seasonal outbreaks of measles. This result is, however, sensitive to the assumed level of vaccine efficacy. Explorations of a variety of changes to current vaccination strategy favour a 2-dose schedule with the second dose administered at age 4 years irrespective of vaccination history. A vaccination campaign in school-age children, to reduce deficits in herd immunity, would accelerate progress towards measles elimination.

  6. Knowledge, attitudes and opinions towards measles and the MMR vaccine across two NSW cohorts.

    PubMed

    Brieger, Daniel; Edwards, Matthew; Mudgil, Poonam; Whitehall, John

    2017-12-01

    Although the number of national measles cases has greatly decreased since 1980s, there has been resurgence in disease incidence in recent years. While parental knowledge and attitudes toward both disease and vaccinations are known to influence vaccine uptake, the contribution of these factors toward vaccination rates in NSW populations has not been studied. The aim of this study was to investigate the knowledge and opinions on measles and MMR vaccine in NSW Central and North Coast regions. Parents (n=201) of children <12 years were surveyed with a purpose design survey at public beaches at the Central Coast and community markets at the North Coast. Eight per cent of respondents reported not immunising their child with MMR vaccine. Most respondents recognised that measles is a highly contagious disease. Non-immunisers were found to be older, had a lower perceived severity of measles, were less likely to agree with the efficacy and safety of the vaccine, and were more likely to have encountered someone who had suffered side-effects of the vaccine. There is considerable concern over safety of MMR vaccine among non-immunisers. Implications for public health: Improving confidence in MMR vaccine should be a target of future public health interventions. © 2017 The Authors.

  7. Clinical evaluation of a new measles-mumps-rubella combined live virus vaccine in the Dominican Republic*

    PubMed Central

    Ehrenkranz, N. Joel; Ventura, Arnoldo K.; Medler, Edward M.; Jackson, Joseph E.; Kenny, Michael T.

    1975-01-01

    Over 900 children were enrolled in a double-blind placebo-controlled clinical study of measles (Schwarz strain), mumps (Jeryl Lynn strain), and rubella (Cendehill strain) trivalent vaccine. The trivalent vaccine caused about the same degree of reactivity as is generally associated with the Schwarz strain measles vaccine. Paired sera from triplesusceptible vaccinees had seroconversion rates of 99% for measles, 94% for mumps, and 93% for rubella. The results of this study show that this trivalent vaccine is as well tolerated and as effective as its component vaccines. PMID:764997

  8. Does Measles Vaccination Reduce the Risk of Acute Respiratory Infection (ARI) and Diarrhea in Children: A Multi-Country Study?

    PubMed

    Bawankule, Rahul; Singh, Abhishek; Kumar, Kaushalendra; Shetye, Sadanand

    2017-01-01

    Pneumonia and diarrhea occur either as complications or secondary infections in measles affected children. So, the integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD) by WHO and UNICEF includes measles vaccination as preventive measure in children. The objective of the study is to examine the effect of measles vaccination on Acute Respiratory Infection (ARI) and diarrhea in children in the Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan. We analyzed data from the most recent rounds of Demographic and Health Surveys (DHS) in the selected countries. We included children age 12-59 months in the analysis. We used multivariable binary logistic regression to examine the effect of measles vaccination on ARI and diarrhea in children. We also estimated Vaccination Effectiveness (VE). More than 60 percent of the children age 12-59 months were given measles vaccine before the survey in the Democratic Republic of Congo, Ethiopia, India and Pakistan. Children who were given the measles vaccine were less likely to suffer from ARI than unvaccinated children in India and Pakistan. Children who were given the measles vaccine had a lower risk of diarrhea than those who did not receive it in all the selected countries except Ethiopia. Measles vaccination was associated with reduction in ARI cases by 15-30 percent in India and Pakistan, and diarrhea cases by 12-22 percent in the Democratic Republic of Congo, India, Nigeria and Pakistan. The receipt of the measles vaccine was associated with decrease in ARI and diarrhea in children. The immunization program must ensure that each child gets the recommended doses of measles vaccine at the appropriate age. The measles vaccination should be given more attention as a preventive intervention under the Global Action Plan for Pneumonia and Diarrhea (GAPPD) in all low and middle-income countries.

  9. Replacing the Measles Ten-Dose Vaccine Presentation with the Single-Dose Presentation in Thailand

    PubMed Central

    Lee, Bruce Y.; Assi, Tina-Marie; Rookkapan, Korngamon; Connor, Diana L.; Rajgopal, Jayant; Sornsrivichai, Vorasith; Brown, Shawn T.; Welling, Joel S.; Norman, Bryan A.; Chen, Sheng-I; Bailey, Rachel R.; Wiringa, Ann E.; Wateska, Angela R.; Jana, Anirban; Van Panhuis, Willem G.; Burke, Donald S.

    2011-01-01

    Introduced to minimize open vial wastage, single-dose vaccine vials require more storage space and therefore may affect vaccine supply chains (i.e., the series of steps and processes entailed to deliver vaccines from manufacturers to patients). We developed a computational model of Thailand’s Trang province vaccine supply chain to analyze the effects of switching from a ten-dose measles vaccine presentation to each of the following: a single-dose Measles-Mumps-Rubella vaccine (which Thailand is currently considering) and a single-dose measles vaccine. While the Trang province vaccine supply chain would generally have enough storage and transport capacity to accommodate the switches, the added volume could push some locations’ storage and transport space utilization close to their limits. Single-dose vaccines would allow for more precise ordering and decrease open vial waste, but decrease reserves for unanticipated demand. Moreover, the added disposal and administration costs could far outweigh the costs saved from preventing open vial wastage. PMID:21439313

  10. Assessing the cost-effectiveness of different measles vaccination strategies for children in the Democratic Republic of Congo.

    PubMed

    Doshi, Reena H; Eckhoff, Philip; Cheng, Alvan; Hoff, Nicole A; Mukadi, Patrick; Shidi, Calixte; Gerber, Sue; Wemakoy, Emile Okitolonda; Muyembe-Tafum, Jean-Jacques; Kominski, Gerald F; Rimoin, Anne W

    2017-10-27

    One of the goals of the Global Measles and Rubella Strategic Plan is the reduction in global measles mortality, with high measles vaccination coverage as one of its core components. While measles mortality has been reduced more than 79%, the disease remains a major cause of childhood vaccine preventable disease burden globally. Measles immunization requires a two-dose schedule and only countries with strong, stable immunization programs can rely on routine services to deliver the second dose. In the Democratic Republic of Congo (DRC), weak health infrastructure and lack of provision of the second dose of measles vaccine necessitates the use of supplementary immunization activities (SIAs) to administer the second dose. We modeled three vaccination strategies using an age-structured SIR (Susceptible-Infectious-Recovered) model to simulate natural measles dynamics along with the effect of immunization. We compared the cost-effectiveness of two different strategies for the second dose of Measles Containing Vaccine (MCV) to one dose of MCV through routine immunization services over a 15-year time period for a hypothetical birth cohort of 3 million children. Compared to strategy 1 (MCV1 only), strategy 2 (MCV2 by SIA) would prevent a total of 5,808,750 measles cases, 156,836 measles-related deaths and save U.S. $199 million. Compared to strategy 1, strategy 3 (MCV2 by RI) would prevent a total of 13,232,250 measles cases, 166,475 measles-related deaths and save U.S. $408 million. Vaccination recommendations should be tailored to each country, offering a framework where countries can adapt to local epidemiological and economical circumstances in the context of other health priorities. Our results reflect the synergistic effect of two doses of MCV and demonstrate that the most cost-effective approach to measles vaccination in DRC is to incorporate the second dose of MCV in the RI schedule provided that high enough coverage can be achieved. Published by Elsevier Ltd.

  11. [Measles vaccination campaign for vulnerable populations: lessons learned].

    PubMed

    Laurence, Sophie; Chappuis, Marielle; Lucas, Dorinela; Duteurtre, Martin; Corty, Jean-François

    2013-01-01

    Between 2008 and 2011, a measles epidemic raged in France. Immunization coverage in France, already insufficient in the general population, is even more worrying for deprived populations in whom exposure to the disease and the risk of complications are much higher. In this context, Medecins du Monde (MdM), the General Council of the Seine-Saint-Denis (CG93) and the Territorial Directorate of the Regional Health Agency (DTARS) implemented a measles vaccination campaign among the Rom population of the department. The objective was to improve coverage of this population by providing ambulatory services in collaboration between various field partners in a single public health project. Twenty-two of the known Rom settlements were selected to receive vaccination. MdM was in charge of logistics, mediation and vaccinations at 13 sites and the DTARS and CG93 were in charge of vaccination at another 9 sites with support from MdM for mediation and logistics. Between January and June 2012, 250 persons were vaccinated, 34.7% of the target population. Coverage of the population after the vaccination campaign was still very low. The partnership between MdM, DTARS and CG93 helped to create a positive mobile action experience and extended prevention actions towards the most vulnerable populations excluded from conventional health care structures.

  12. Measles-derived vaccines to prevent emerging viral diseases.

    PubMed

    Frantz, Phanramphoei N; Teeravechyan, Samaporn; Tangy, Frédéric

    2018-02-01

    Infectious disease epidemics match wars and natural disasters in their capacity to threaten lives and damage economies. Like SARS previously and Zika recently, the Ebola crisis in 2015 showed how vulnerable the world is to these epidemics, with over 11,000 people dying in the outbreak. In addition to causing immense human suffering, these epidemics particularly affect low- and middle-income countries. Many of these deadly infectious diseases that have epidemic potential can become global health emergencies in the absence of effective vaccines. But very few vaccines against these threats have been developed to create proven medical products. The measles vaccine is an efficient, live attenuated, replicating virus that has been safely administered to 2 billion children over the last 40 years, affording life-long protection after a single dose. Taking advantage of these characteristics, this attenuated virus was transformed into a versatile chimeric or recombinant vaccine vector with demonstrated proof-of-principle in humans and a preclinical track record of rapid adaptability and effectiveness for a variety of pathogens. Clinical trials have shown the safety and immunogenicity of this vaccine platform in individuals with preexisting immunity to measles. This review describes the potential of this platform to develop new vaccines against emerging viral diseases. Copyright © 2018. Published by Elsevier Masson SAS.

  13. Heterogeneity in coverage for measles and varicella vaccination in toddlers - analysis of factors influencing parental acceptance.

    PubMed

    Hagemann, Christine; Streng, Andrea; Kraemer, Alexander; Liese, Johannes G

    2017-09-19

    In 2004, routine varicella vaccination was introduced in Germany for children aged 11-14 months. Routine measles vaccination had already been introduced in 1973 for the same age group, but coverage is still too low (<95%) in some areas to eliminate measles. The present study assessed varicella and measles vaccination coverage and determinants of parental acceptance in two study regions, situated in Northern and Southern Bavaria (Germany). From 2009 to 2011, annual cross-sectional parent surveys were performed on random samples of 600 children aged 18-36 months in the Bavarian regions of both Munich and Würzburg. Logistic regression models were used to identify factors associated with varicella and measles vaccination. In 2009, 2010 and 2011, vaccination coverage was lower in Munich than in Würzburg, for both varicella (Munich 53%, 67%, 69% vs. Würzburg 72%, 81%, 83%) and for measles (Munich 88%, 89%, 91% vs. Würzburg 92%, 93%, 95%). Recommendation by the physician was the main independent factor associated with varicella vaccination in both regions (adjusted odd ratios (OR) with 95% confidence interval (CI): Munich OR 19.7, CI 13.6-28.6; Würzburg OR 34.7, CI 22.6-53.2). Attendance at a childcare unit was positively associated with a higher acceptance of varicella vaccination in Munich (OR 1.5, CI 1.1-2.2). Regarding measles vaccination, attendance at a childcare unit was positively associated in both regions (Munich OR 2.0; CI 1.3-3.0; Würzburg OR 1.8; CI 1.1-3.1), and a higher level of parental school education was negatively associated in Würzburg (OR 0.5, CI 0.3-0.9). Vaccination rates differed between regions, with rates constantly higher in Würzburg. Within each region, vaccination rates were lower for varicella than for measles. Measles vaccination status was mainly dependent upon socio-demographic factors (attendance at a childcare unit, parental school education), whereas for the more recently introduced varicella vaccination recommendation by the

  14. Acetaminophen (paracetamol) use, measles-mumps-rubella vaccination, and autistic disorder: the results of a parent survey.

    PubMed

    Schultz, Stephen T; Klonoff-Cohen, Hillary S; Wingard, Deborah L; Akshoomoff, Natacha A; Macera, Caroline A; Ji, Ming

    2008-05-01

    The present study was performed to determine whether acetaminophen (paracetamol) use after the measles-mumps-rubella vaccination could be associated with autistic disorder. This case-control study used the results of an online parental survey conducted from 16 July 2005 to 30 January 2006, consisting of 83 children with autistic disorder and 80 control children. Acetaminophen use after measles-mumps-rubella vaccination was significantly associated with autistic disorder when considering children 5 years of age or less (OR 6.11, 95% CI 1.42-26.3), after limiting cases to children with regression in development (OR 3.97, 95% CI 1.11-14.3), and when considering only children who had post-vaccination sequelae (OR 8.23, 95% CI 1.56-43.3), adjusting for age, gender, mother's ethnicity, and the presence of illness concurrent with measles-mumps-rubella vaccination. Ibuprofen use after measles-mumps-rubella vaccination was not associated with autistic disorder. This preliminary study found that acetaminophen use after measles-mumps-rubella vaccination was associated with autistic disorder.

  15. Impact of changing the measles vaccine vial size on Niger's vaccine supply chain: a computational model

    PubMed Central

    2011-01-01

    Background Many countries, such as Niger, are considering changing their vaccine vial size presentation and may want to evaluate the subsequent impact on their supply chains, the series of steps required to get vaccines from their manufacturers to patients. The measles vaccine is particularly important in Niger, a country prone to measles outbreaks. Methods We developed a detailed discrete event simulation model of the vaccine supply chain representing every vaccine, storage location, refrigerator, freezer, and transport device (e.g., cold trucks, 4 × 4 trucks, and vaccine carriers) in the Niger Expanded Programme on Immunization (EPI). Experiments simulated the impact of replacing the 10-dose measles vial size with 5-dose, 2-dose and 1-dose vial sizes. Results Switching from the 10-dose to the 5-dose, 2-dose and 1-dose vial sizes decreased the average availability of EPI vaccines for arriving patients from 83% to 82%, 81% and 78%, respectively for a 100% target population size. The switches also changed transport vehicle's utilization from a mean of 58% (range: 4-164%) to means of 59% (range: 4-164%), 62% (range: 4-175%), and 67% (range: 5-192%), respectively, between the regional and district stores, and from a mean of 160% (range: 83-300%) to means of 161% (range: 82-322%), 175% (range: 78-344%), and 198% (range: 88-402%), respectively, between the district to integrated health centres (IHC). The switch also changed district level storage utilization from a mean of 65% to means of 64%, 66% and 68% (range for all scenarios: 3-100%). Finally, accounting for vaccine administration, wastage, and disposal, replacing the 10-dose vial with the 5 or 1-dose vials would increase the cost per immunized patient from $0.47US to $0.71US and $1.26US, respectively. Conclusions The switch from the 10-dose measles vaccines to smaller vial sizes could overwhelm the capacities of many storage facilities and transport vehicles as well as increase the cost per vaccinated child. PMID

  16. Measles cases among adolescents in southern Pakistan 2012-2015: The case for revisiting vaccination strategies.

    PubMed

    Shakoor, Sadia; Khan, Erum; Rajput, Muhammad Imran; Rahimoon, Wali Muhammad

    2017-07-03

    Surveillance of adult measles in Pakistan is a challenge as it does not enjoy the status of a reportable disease unlike childhood cases and therefore cases remain undetected and unreported or misdiagnosed. Consequently no data or estimates of young adult cases, seroprevalence, or estimates of susceptible preadolescent or young adult population exist. We have presented both laboratory conformed and clinically suspected cases of measles occurring in adolescents and adults in the southern province of Sindh in Pakistan. Through an examination of 2 independent databases, i.e. a laboratory database of measles IgM positive cases and clinically detected cases on surveillance performed by the Disease Early Warning System, we have analyzed and reported age-specific positivity rates from 2012 to 2015 in Sindh, Pakistan. High rates of laboratory confirmed measles were observed in those aged 9 y and younger. Among adolescents and adults, significantly higher positivity rates were observed among those aged 10-19 y. Clinically detected cases from Sindh showed similar distribution of cases. High burden of cases among children <9 y of age confirm that supplementary immunization activities (SIAs) among this age group are inadequate and need to be strengthened. Cases among those 10-19 y further demonstrate the need for consolidating SIAs with an additional strategy to vaccinate those who remain non-immune at college entry and in institutions where outbreaks can be prevented. Such measures are essential to achieving the goal of measles elimination in the country and region.

  17. Trend of measles, mumps, and rubella incidence following the measles-rubella catch up vaccination in the Republic of Korea, 2001.

    PubMed

    Choe, Young June; Eom, Hye-Eun; Cho, Sung-Il

    2017-09-01

    Following the introduction of measles-rubella (MR) catch-up vaccination in 2001 and two dose measles-mumps-rubella (MMR2) keep-up program in 2002, the incidence of measles, mumps, and rubella was not evaluated systematically. To describe the recent changes in epidemiology, a population-based incidence study from 2001 to 2015 using national notifiable disease surveillance data was conducted. Between 2001 and 2015, there was decrease in the incidence of measles and rubella, whereas a steady increase in mump incidence was noted. The age distribution of mumps cases has shifted to the older age group, whereas rubella became more frequent in younger age group. The incidence of mumps showed an increase in every birth cohorts, except for the decrease in incidence for catch-up vaccination cohort from 131 cases in 2007-2011 to 64 cases per 100 000 in 2012-2015. Continuing in monitoring of mumps and strengthening of the high two-dose MMR vaccination coverage should be taken place in Korea. © 2017 Wiley Periodicals, Inc.

  18. Parental attitudes towards measles vaccination in the canton of Aargau, Switzerland: a latent class analysis.

    PubMed

    Weiss, Carine; Schröpfer, Daniel; Merten, Sonja

    2016-08-11

    Despite the successes of routine national childhood vaccination programmes, measles remains a public health concern. The purpose of this paper is to investigate how patterns of parental attitudes are linked to the decision-making process for or against MMR vaccination. This exploratory study was designed to identify distinct patterns of attitudes towards or against measles vaccination through Latent Class Analysis (LCA) in a sub-sample of mothers living in the canton of Aargau in Switzerland. Parents of young children below 36 months of age were randomly selected through parents' counsellors' registries. Among other questions, respondents were asked to state their agreement in response to 14 belief statements regarding measles vaccination on a 5-point Likert scale. To identify groups of parents showing distinct patterns of attitudes and beliefs regarding measles vaccination, we used Latent Class Analysis (LCA). The LCA showed three classes of parents with different attitudes and believes towards measles vaccination: The biggest group (class 1) are those having positive attitudes towards immunisation, followed by the second biggest group (class 2) which is characterised by having fearful attitudes and by showing uncertainty about immunisation. The third group (class 3) shows distinct patterns of critical attitudes against immunisation. Within this group over 90 % agree or totally agree that immunisation is an artificial intrusion into the natural immune system and therefore want to vaccinate their children only if necessary. We find that parents in the Canton Aargau who hesitate to vaccinate their children against measles, mumps and rubella show distinct opinions and attitudes. Health professionals should be aware of these perceptions to tailor their messages accordingly and positively influence these parents to vaccinate their children. Special attention needs to be given to those parents who are planning to vaccinate their children but are not following the

  19. Factors affecting the seroconversion rate of 12-month-old babies after the first injection of measles vaccine in the southeast of Iran.

    PubMed

    Zahraei, Seyed Mohsen; Izadi, Shahrokh; Mokhtari-Azad, Talat

    2016-12-01

    Within the past few years, several measles outbreaks have occurred in the southeast of Iran. To learn about the effectiveness of the immunization services for producing a serologic response against measles, this follow-up study was designed and implemented in the southeast of Iran. In Iran, all routine immunization services provided by the public sector are free of charge. The follow-up study was designed and implemented in 5 Urban Health Centers located in 3 districts of Sistan-va-BaluchestanProvince, Iran. In the pre-vaccination phase, 270 12-month-old babies were blood sampled; and in the post-vaccination phase, 4 to 7 weeks after Measles, Mumps, Rubella (MMR) vaccination, 236 of them were blood sampled (34 dropouts), and their sera were tested for IgG anti-measles antibodies, using indirect ELISA, in the National Reference Measles Laboratory. Out of the 236 participants, who had been blood sampled in the post-vaccination phase, 10 (3.7%) were excluded from the calculations of seroconversion rate, because they had protective levels of antibody before the vaccination. The seroconversion rate for the remaining 226 participants was 91.2% (95% confidence interval: 86.7 to 94.5). Among the variables studied, stunting (height-for-age z-score < -2) showed a strong relationship with the remaining seronegative after the vaccination (odds ratio = 5.6; 95% confidence interval: 1.7-18.2). The chance of seroconversion was inversely related to the mothers' levels of education (up to 9 y of education vs. above nine years) (odds ratio = 0.2; 95% confidence interval: 0.06-0.4). In the study population, the seroconversion rates for anti-measles antibodies after MMR vaccination are acceptable, even though in order to achieve the elimination goal, higher standards need to be achieved.

  20. [Measles, mumps, and rubella vaccine. Resurgence of measles in Europe].

    PubMed

    Garcés-Sánchez, María; Renales-Toboso, María; Bóveda-García, María; Díez-Domingo, Javier

    2015-12-01

    Measles is a rash illness of moderate severity and high risk of serious complications, with recovery in several weeks. It is a viral disease caused by one of the most infectious and contagious pathogens that exists, whose only known reservoir is human. In 1998, the European Region of the WHO set a target of eliminating measles by 2010. This goal has not been achieved. Furthermore, it has been observed the resurgence of the disease in some parts of Europe. We review the disease and its vaccines as well as the epidemiological and social factors that have so far prevented the total control of the disease. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  1. Generation of a More Immunogenic Measles Vaccine by Increasing Its Hemagglutinin Expression

    PubMed Central

    Julik, Emily

    2016-01-01

    ABSTRACT Imported measles virus (MV) outbreaks are maintained by poor vaccine responders and unvaccinated people. A convenient but more immunogenic vaccination strategy would enhance vaccine performance, contributing to measles eradication efforts. We report here the generation of alternative pediatric vaccines against MV with increased expression of the H protein in the background of the current MV vaccine strain. We generated two recombinants: MVvac2-H2, with increased full-length H expression resulting in a 3-fold increase in H incorporation into virions, and MVvac2-Hsol, vectoring a truncated, soluble form of the H protein that is secreted into the supernatants of infected cells. Replication fitness was conserved despite the duplication of the H cistron for both vectors. The modification to the envelope of MVvac2-H2 conferred upon this virus a measurable level of resistance to in vitro neutralization by MV polyclonal immune sera without altering its thermostability. Most interestingly, both recombinant MVs with enhanced H expression were significantly more immunogenic than their parental strain in outbred mice, while MVvac2-H2 additionally proved more immunogenic after a single, human-range dose in genetically modified MV-susceptible mice. IMPORTANCE Measles incidence was reduced drastically following the introduction of attenuated vaccines, but progress toward the eradication of this virus has stalled, and MV still threatens unvaccinated populations. Due to the contributions of primary vaccine failures and too-young-to-be-vaccinated infants to this problem, more immunogenic measles vaccines are highly desirable. We generated two experimental MV vaccines based on a current vaccine's genome but with enriched production of the H protein, the main MV antigen in provoking immunity. One vaccine incorporated H at higher rates in the viral envelope, and the other secreted a soluble H protein from infected cells. The increased expression of H by these vectors improved

  2. Difficulties in Eliminating Measles and Controlling Rubella and Mumps: A Cross-Sectional Study of a First Measles and Rubella Vaccination and a Second Measles, Mumps, and Rubella Vaccination

    PubMed Central

    Wang, Zhifang; Yan, Rui; He, Hanqing; Li, Qian; Chen, Guohua; Yang, Shengxu; Chen, Enfu

    2014-01-01

    Background The reported coverage of the measles–rubella (MR) or measles–mumps–rubella (MMR) vaccine is greater than 99.0% in Zhejiang province. However, the incidence of measles, mumps, and rubella remains high. In this study, we assessed MMR seropositivity and disease distribution by age on the basis of the current vaccination program, wherein the first dose of MR is administered at 8 months and the second dose of MMR is administered at 18–24 months. Methods Cross-sectional serological surveys of MMR antibodies were conducted by collecting epidemiological data in Zhejiang province, China in 2011. In total, 1015 participants were randomly selected from two surveillance sites. Serum MMR-specific immunoglobulin G levels were tested by enzyme-linked immunosorbent assay. The geometric mean titers and seroprevalence with 95% confidence intervals (CIs) were calculated by age and gender. Proportions of different dose of vaccine by age by vaccine were also identified. Statistically significant differences between categories were assessed by the Chi-square test. Results Over 95% seroprevalence rates of measles were seen in all age groups except <7 months infants. Children aged 5–9 years were shown lower seropositivity rates of mumps while elder adolescences and young adults were presented lower rubella seroprevalence. Especially, rubella seropositivity was significantly lower in female adults than in male. Nine measles cases were unvaccinated or unknown vaccination history. Among them, 66.67% (6/9) patients were aged 20–29 years while 33.33% (3/9) were infants aged 8–12 months. In addition, 57.75% (648/1122) patients with mumps were children aged 5–9 years, and 50.54% (94/186) rubella cases were aged 15–39 years. Conclusions A timely two-dose MMR vaccination schedule is recommended, with the first dose at 8 months and the second dose at 18–24 months. An MR vaccination speed-up campaign may be necessary for elder adolescents and young adults, particularly

  3. [A seroconversion study of the measles component of the MMR vaccine in adolescents of the town of Sabrosa].

    PubMed

    Gonçalves, G; Tavares, F; de Andrade, H R

    1998-12-01

    The Portuguese national programme of vaccination has instituted a two-dose MMR vaccine schedule. The second dose of MMR (measles-mumps-rubella combined vaccine) is given at 11-13 years of age, for both sexes. This study was conducted to evaluate the duration of immunity of the monovalent measles vaccine, and the efficacy of a second dose given as MMR. MMR (Triviraten Berna with the strain Edmonston-Zagreb) was given to the 38 participants. Blood samples were collected before and after vaccination. Thirty-six participants had been vaccinated with measles monovalent vaccine during childhood. To measure anti-measles IgG (mIgG), an enzyme immunoassay was used. Participants were classified as "susceptible" or "immune", using 200 mIU/ml (milli international units per millilitre) as the threshold for "immune". Geometric mean concentration (GMC) of mIgG was 1401 mIU/ml in prevaccination sera (n = 38). Thirty-five (92%) of the adolescents were "immune". Only the two unvaccinated had a positive measles history. GMC in the sera of the 36 vaccinated participants was 1301 mIU/ml. Neither the time since measles vaccination nor age at vaccination were correlated with the levels of mIgG. After receiving MMR, all adolescents became "immune". GMC of mIgG was 2879 mIU/ml in postvaccination sera (n = 38). In 28 (74%) participants, mIgG levels increased after receiving MMR. Mean concentration increase was 1082 mIU/ml. For measles, results support the use of a two-dose MMR vaccine schedule in Portugal.

  4. Recombinant Measles AIK-C Vaccine Strain Expressing the prM-E Antigen of Japanese Encephalitis Virus.

    PubMed

    Higuchi, Akira; Toriniwa, Hiroko; Komiya, Tomoyoshi; Nakayama, Tetsuo

    2016-01-01

    An inactivated Japanese encephalitis virus (JEV) vaccine, which induces neutralizing antibodies, has been used for many years in Japan. In the present study, the JEV prM-E protein gene was cloned, inserted at the P/M junction of measles AIK-C cDNA, and an infectious virus was recovered. The JEV E protein was expressed in B95a cells infected with the recombinant virus. Cotton rats were inoculated with recombinant virus. Measles PA antibodies were detected three weeks after immunization. Neutralizing antibodies against JEV developed one week after inoculation, and EIA antibodies were detected three weeks after immunization. The measles AIK-C-based recombinant virus simultaneously induced measles and JEV immune responses, and may be a candidate for infant vaccines. Therefore, the present strategy of recombinant viruses based on a measles vaccine vector would be applicable to the platform for vaccine development.

  5. Reaching Hard-to-Reach Individuals: Nonselective Versus Targeted Outbreak Response Vaccination for Measles

    PubMed Central

    Minetti, Andrea; Hurtado, Northan; Grais, Rebecca F.; Ferrari, Matthew

    2014-01-01

    Current mass vaccination campaigns in measles outbreak response are nonselective with respect to the immune status of individuals. However, the heterogeneity in immunity, due to previous vaccination coverage or infection, may lead to potential bias of such campaigns toward those with previous high access to vaccination and may result in a lower-than-expected effective impact. During the 2010 measles outbreak in Malawi, only 3 of the 8 districts where vaccination occurred achieved a measureable effective campaign impact (i.e., a reduction in measles cases in the targeted age groups greater than that observed in nonvaccinated districts). Simulation models suggest that selective campaigns targeting hard-to-reach individuals are of greater benefit, particularly in highly vaccinated populations, even for low target coverage and with late implementation. However, the choice between targeted and nonselective campaigns should be context specific, achieving a reasonable balance of feasibility, cost, and expected impact. In addition, it is critical to develop operational strategies to identify and target hard-to-reach individuals. PMID:24131555

  6. Modified measles versus rubella versus atypical measles: One and same thing

    PubMed Central

    Gupta, Surender Nikhil; Gupta, Naveen; Gupta, Shivani

    2015-01-01

    Introduction: In outbreak settings, more than one virus may be infecting the given population. In twin or triple outbreak of measles, German measles (rubella), and varicella in highly immunized hilly areas, maximal number of the case patients in all the hilly villages belonged to the older age group. It suggested an obvious shift to the higher age group, warranting second dose opportunity in such case scenario. The clinical presentations of viral diseases are too similar to differentiate. The aim is to clearly categorize the case patients of modified measles, rubella, and atypical measles in outbreak settings. Results: Four outbreaks are listed. In the first one, sixty case patients were identified from 1026 people in 5 villages. Of these, 41 were diagnosed by clinically, 8 were laboratory confirmed as measles and 11 were epidemiologically linked German measles case patients. Seventy percent of the cases were vaccinated for measles. In second case, we identified 29/35 measles and 6/35 were confirmed as epidemiologically linked unvaccinated chickenpox case patients. In third one, we identified 116 cases in eight villages (112/116 clinically and 04/116 laboratory confirmed). Majority of cases were immunized against measles, but only minor cases for rubella. In fourth case, we identified 505 case patients from mixed outbreaks of varicella, measles and rubella (30/505 clinically, 467/505 epidemiologically linked and 8/505 laboratory confirmed case patients from a study population of 3280). In all the four outbreaks, prima facie, the clinical presentations of both rubella and modified measles were difficult to differentiate. Discussion: On the basis of outbreak investigation and analytical inference, it has been observed that the symtomatology of modified measles and laboratory confirmed rubella case patients/epidemiologically linked cases are so similar placed that many a time, it becomes much difficult to line list the cases in one section of modified measles or

  7. Modified measles versus rubella versus atypical measles: One and same thing.

    PubMed

    Gupta, Surender Nikhil; Gupta, Naveen; Gupta, Shivani

    2015-01-01

    In outbreak settings, more than one virus may be infecting the given population. In twin or triple outbreak of measles, German measles (rubella), and varicella in highly immunized hilly areas, maximal number of the case patients in all the hilly villages belonged to the older age group. It suggested an obvious shift to the higher age group, warranting second dose opportunity in such case scenario. The clinical presentations of viral diseases are too similar to differentiate. The aim is to clearly categorize the case patients of modified measles, rubella, and atypical measles in outbreak settings. Four outbreaks are listed. In the first one, sixty case patients were identified from 1026 people in 5 villages. Of these, 41 were diagnosed by clinically, 8 were laboratory confirmed as measles and 11 were epidemiologically linked German measles case patients. Seventy percent of the cases were vaccinated for measles. In second case, we identified 29/35 measles and 6/35 were confirmed as epidemiologically linked unvaccinated chickenpox case patients. In third one, we identified 116 cases in eight villages (112/116 clinically and 04/116 laboratory confirmed). Majority of cases were immunized against measles, but only minor cases for rubella. In fourth case, we identified 505 case patients from mixed outbreaks of varicella, measles and rubella (30/505 clinically, 467/505 epidemiologically linked and 8/505 laboratory confirmed case patients from a study population of 3280). In all the four outbreaks, prima facie, the clinical presentations of both rubella and modified measles were difficult to differentiate. On the basis of outbreak investigation and analytical inference, it has been observed that the symtomatology of modified measles and laboratory confirmed rubella case patients/epidemiologically linked cases are so similar placed that many a time, it becomes much difficult to line list the cases in one section of modified measles or rubella or atypical cases. Similarities

  8. MMR (measles, mumps, and rubella) vaccine - what you need to know

    MedlinePlus

    Centers for Disease Control and Prevention website. MMR (measles, mumps, and rubella) vaccine. www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html . Updated February 12, 2018. Accessed February 14, 2018.

  9. Immunoglobulin M antibody response to measles virus following primary and secondary vaccination and natural virus infection.

    PubMed

    Erdman, D D; Heath, J L; Watson, J C; Markowitz, L E; Bellini, W J

    1993-09-01

    The use of IgM antibody detection for the classification of the primary and secondary measles antibody response in persons following primary and secondary vaccination and natural measles virus infection was examined. Of 32 nonimmune children receiving primary measles vaccination, 31 (97%) developed IgM antibodies, consistent with a primary antibody response. Of 21 previously vaccinated children with low levels of preexisting IgG antibodies who responded to revaccination, none developed detectable IgM antibodies, whereas 33 of 35 (94%) with no detectable preexisting IgG antibodies developed an IgM response. Of a sample of 57 measles cases with a prior history of vaccination, 55 (96%) had detectable IgM antibodies. Of these, 30 (55%) were classified as having a primary antibody response and 25 (45%) a secondary antibody response based on differences in their ratios of IgM to IgG antibodies. Differences in the severity of clinical symptoms between these 2 groups were consistent with this classification scheme. These findings suggest that 1) an IgM response follows primary measles vaccination in the immunologically naive, 2) an IgM response is absent on revaccination of those previously immunized, and 3) an IgM response may follow clinical measles virus infection independent of prior immunization status.

  10. Egg hypersensitivity and measles-mumps-rubella vaccine administration.

    PubMed

    Beck, S A; Williams, L W; Shirrell, M A; Burks, A W

    1991-11-01

    Because reports have described egg-sensitive individuals in whom anaphylaxis developed after measles vaccination, current recommendations include delaying administration of egg-derived vaccines until skin testing can be performed. Specifically, the 1988 Red Book recommends skin testing via scratch, prick, or puncture with 1:10 dilution of the vaccine and, if the result is negative, intradermal testing is suggested. The purpose of this study was to evaluate the likelihood of reaction to measles-mumps-rubella (MMR) vaccine in patients with documented egg sensitivity and to delineate the efficacy of skin-prick testing (SPT) to MMR as a predictor of hypersensitivity to the vaccine. Egg sensitivity was documented by initial SPT to egg and then, if possible, double-blind placebo-controlled food challenge (DBPCFC). Patients with a positive DBPCFC to egg or a history of anaphylactic egg sensitivity had a SPT with the MMR vaccine and then were given the MMR vaccine. Additionally, children with atopic dermatitis who had been previously proven egg sensitive via DBPCFCs were evaluated retrospectively for sensitivity to the MMR vaccine. Sixteen children with a history of egg sensitivity underwent SPT to egg, with a positive result 3 mm greater than the negative control found in 12 patients. Eight of these children had a positive DBPCFC to egg. The SPT to MMR vaccine was negative in all 16 children; vaccine administration followed with no resultant systemic problems. Three children had a local reaction at the site of injection. Twelve additional children with atopic dermatitis and egg sensitivity were reviewed. Each child had a positive SPT and DBPCFC to egg.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. [Drug clinics. Drug of the month. A new measles-rubella-mumps vaccine (Priorix)].

    PubMed

    Senterre, J

    1999-02-01

    A novel measles-mumps-rubella vaccine (Priorix) has been marketed by SmithKline Beecham. It contains live attenuated virus with measles and mumps strains slightly different from those present in MMR VAX (Pasteur Merieux MSD). The indications and contraindications are similar for both vaccines. Immunogenicity is also equivalent as well as general reactogenicity. By contrast local symptoms were reported significantly less frequently after Priorix.

  12. Sequence and immunogenicity of a clinically approved novel measles virus vaccine vector

    PubMed Central

    Zuniga, Amando; Liniger, Mathias; Morin, Teldja Neige Azzouz; Marty, René R.; Wiegand, Marian; Ilter, Orhan; Weibel, Sara; Billeter, Martin A.; Knuchel, Marlyse C.; Naim, Hussein Y.

    2013-01-01

    The measles virus vaccine (MVbv) is a clinically certified and well-tolerated vaccine strain that has been given both parenterally and mucosally. It has been extensively used in children and has proven to be safe and effective in eliciting protective immunity. This specific strain was therefore chosen to generate a measles viral vector. The genome of the commercial MVbv vaccine strain was isolated, sequenced and a plasmid, p(+)MVb, enabling transcription of the viral antigenome and rescue of MVb, was constructed. Phylogenic and phenotypic analysis revealed that MVbv and the rescued MVb constitute another evolutionary branch within the hitherto classified measles vaccines. Plasmid p(+)MVb was modified by insertion of artificial MV-type transcription units (ATUs) for the generation of recombinant viruses (rMVb) expressing additional proteins. Replication characteristics and immunogenicity of rMVb vectors were similar to the parental MVbv and to other vaccine strains. The expression of the additional proteins was stable over 10 serial virus transfers, which corresponds to an amplification greater than 1020. The excellent safety record and its efficient application as aerosol may add to the usefulness of the derived vectors. PMID:23324616

  13. Epidemiologic and laboratory surveillance of the measles outbreak in the Federation of Bosnia and Herzegovina, February 2014-April 2015.

    PubMed

    Salimović-Bešić, I; Šeremet, M; Hübschen, J M; Hukić, M; Tihić, N; Ahmetagić, S; Delibegović, Z; Pilav, A; Mulaomerović, M; Ravlija, J; Muller, C P; Dedeić-Ljubović, A

    2016-06-01

    A measles outbreak with two epidemic waves involving 4649 probable and laboratory-confirmed cases was recorded in six out of ten cantons of the Federation of Bosnia and Herzegovina between February 2014 and April 2015. The majority of the patients had never received measles vaccination (3115/4649, 67.00%), and the vaccination status of another 23% was unknown (1066/4649). A total of 281 blood samples were tested serologically. Virus detection was performed using 44 nasopharyngeal swabs. About 57% (161/281) of the laboratory-investigated sera were immunoglobulin M positive, and 95% (42/44) of the swabs were reverse transcriptase-PCR positive. Phylogenetic analysis of sequences obtained from 30 swab samples showed circulation of two variants of genotype D8, but no genotype D4 strains as detected in 2007. Similar involvement of all age groups indicates a problem with vaccine refusal resulting from antivaccination activities in addition to gaps in immunization coverage during the war and postwar period (1992-1998). Differences in ethnicity, vaccine coverage, compliance with review policies of vaccination records and potentially also travel habits may partially explain why only six of ten cantons were affected by the outbreak. The second epidemic wave may in part be due to large-scale migrations due to catastrophic floods in 2014. As a result of the epidemic, 6- to 12-month-old children may now be vaccinated against measles during outbreaks, and public health recommendations for interventions have been strengthened. Additional efforts are required to implement the measures throughout the cantons. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  14. Assessing the Potential Cost-Effectiveness of Microneedle Patches in Childhood Measles Vaccination Programs: The Case for Further Research and Development.

    PubMed

    Adhikari, Bishwa B; Goodson, James L; Chu, Susan Y; Rota, Paul A; Meltzer, Martin I

    2016-12-01

    Currently available measles vaccines are administered by subcutaneous injections and require reconstitution with a diluent and a cold chain, which is resource intensive and challenging to maintain. To overcome these challenges and potentially increase vaccination coverage, microneedle patches are being developed to deliver the measles vaccine. This study compares the cost-effectiveness of using microneedle patches with traditional vaccine delivery by syringe-and-needle (subcutaneous vaccination) in children's measles vaccination programs. We built a simple spreadsheet model to compute the vaccination costs for using microneedle patch and syringe-and-needle technologies. We assumed that microneedle vaccines will be, compared with current vaccines, more heat stable and require less expensive cool chains when used in the field. We used historical data on the incidence of measles among communities with low measles vaccination rates. The cost of microneedle vaccination was estimated at US$0.95 (range US$0.71-US$1.18) for the first dose, compared with US$1.65 (range US$1.24-US$2.06) for the first dose delivered by subcutaneous vaccination. At 95 % vaccination coverage, microneedle patch vaccination was estimated to cost US$1.66 per measles case averted (range US$1.24-US$2.07) compared with an estimated cost of US$2.64 per case averted (range US$1.98-US$3.30) using subcutaneous vaccination. Use of microneedle patches may reduce costs; however, the cost-effectiveness of patches would depend on the vaccine recipients' acceptability and vaccine effectiveness of the patches relative to the existing conventional vaccine-delivery method. This study emphasizes the need to continue research and development of this vaccine-delivery method that could boost measles elimination efforts through improved access to vaccines and increased vaccination coverage.

  15. Timeliness Vaccination of Measles Containing Vaccine and Barriers to Vaccination among Migrant Children in East China

    PubMed Central

    Hu, Yu; Li, Qian; Luo, Shuying; Lou, Linqiao; Qi, Xiaohua; Xie, Shuyun

    2013-01-01

    Background The reported coverage rates of first and second doses of measles containing vaccine (MCV) are almost 95% in China, while measles cases are constantly being reported. This study evaluated the vaccine coverage, timeliness, and barriers to immunization of MCV1 and MCV2 in children aged from 8–48 months. Methods We assessed 718 children aged 8–48 months, of which 499 children aged 18–48 months in September 2011. Face to face interviews were administered with children’s mothers to estimate MCV1 and MCV2 coverage rate, its timeliness and barriers to vaccine uptake. Results The coverage rates were 76.9% for MCV1 and 44.7% for MCV2 in average. Only 47.5% of surveyed children received the MCV1 timely, which postpone vaccination by up to one month beyond the stipulated age of 8 months. Even if coverage thus improves with time, postponed vaccination adds to the pool of unprotected children in the population. Being unaware of the necessity for vaccination and its schedule, misunderstanding of side-effect of vaccine, and child being sick during the recommended vaccination period were significant preventive factors for both MCV1 and MCV2 vaccination. Having multiple children, mother’s education level, household income and children with working mothers were significantly associated with delayed or missing MCV1 immunization. Conclusions To avoid future outbreaks, it is crucial to attain high coverage levels by timely vaccination, thus, accurate information should be delivered and a systematic approach should be targeted to high-risk groups. PMID:24013709

  16. Timeliness vaccination of measles containing vaccine and barriers to vaccination among migrant children in East China.

    PubMed

    Hu, Yu; Li, Qian; Luo, Shuying; Lou, Linqiao; Qi, Xiaohua; Xie, Shuyun

    2013-01-01

    The reported coverage rates of first and second doses of measles containing vaccine (MCV) are almost 95% in China, while measles cases are constantly being reported. This study evaluated the vaccine coverage, timeliness, and barriers to immunization of MCV1 and MCV2 in children aged from 8-48 months. We assessed 718 children aged 8-48 months, of which 499 children aged 18-48 months in September 2011. Face to face interviews were administered with children's mothers to estimate MCV1 and MCV2 coverage rate, its timeliness and barriers to vaccine uptake. The coverage rates were 76.9% for MCV1 and 44.7% for MCV2 in average. Only 47.5% of surveyed children received the MCV1 timely, which postpone vaccination by up to one month beyond the stipulated age of 8 months. Even if coverage thus improves with time, postponed vaccination adds to the pool of unprotected children in the population. Being unaware of the necessity for vaccination and its schedule, misunderstanding of side-effect of vaccine, and child being sick during the recommended vaccination period were significant preventive factors for both MCV1 and MCV2 vaccination. Having multiple children, mother's education level, household income and children with working mothers were significantly associated with delayed or missing MCV1 immunization. To avoid future outbreaks, it is crucial to attain high coverage levels by timely vaccination, thus, accurate information should be delivered and a systematic approach should be targeted to high-risk groups.

  17. Measles in Mexico, 1941-2001: interruption of endemic transmission and lessons learned.

    PubMed

    Santos, Jose Ignacio; Nakamura, Miguel Angel; Godoy, Miriam Veras; Kuri, Pablo; Lucas, Carlos Alvarez; Conyer, Roberto Tapia

    2004-05-01

    In Mexico, measles occurred in a cyclical endemic-epidemic pattern until the early 1970s. Beginning in 1973, routine vaccination augmented by mass vaccination campaigns led to a decrease in the incidence of measles until the 1989-1990 regional pandemic, when the measles attack rate rose to 80 cases per 100000, resulting in 5899 deaths. Since the pandemic, measles elimination efforts in Mexico have resulted in increasing coverage to >95% among children aged 1-6 years with 2 doses of either measles or measles-mumps-rubella vaccine since 1996 and in coverage of 97.6% among children aged 6-10 since 1999. Surveillance data suggest that the transmission of indigenous measles virus was interrupted in 1997. After almost 4 years without measles cases, in April 2000, measles virus was reintroduced into Mexico and 30 laboratory-confirmed cases were reported. Detection of relatively few cases in nonprogrammatic age groups affirms the high immunization coverage and the sensitivity of measles surveillance in Mexico. We conclude that the specific strategies adopted for measles elimination have enabled Mexico to eliminate the endemic transmission of measles.

  18. Eradication of measles: remaining challenges.

    PubMed

    Holzmann, Heidemarie; Hengel, Hartmut; Tenbusch, Matthias; Doerr, H W

    2016-06-01

    Measles virus (MeV) is an aerosol-borne and one of the most contagious pathogenic viruses known. Almost every MeV infection becomes clinically manifest and can lead to serious and even fatal complications, especially under conditions of malnutrition in developing countries, where still 115,000 to 160,000 patients die from measles every year. There is no specific antiviral treatment. In addition, MeV infections cause long-lasting memory B and T cell impairment, predisposing people susceptible to opportunistic infections for years. A rare, but fatal long-term consequence of measles is subacute sclerosing panencephalitis. Fifteen years ago (2001), WHO has launched a programme to eliminate measles by a worldwide vaccination strategy. This is promising, because MeV is a human-specific morbillivirus (i.e. without relevant animal reservoir), safe and potent vaccine viruses are sufficiently produced since decades for common application, and millions of vaccine doses have been used globally without any indications of safety and efficacy issues. Though the prevalence of wild-type MeV infection has decreased by >90 % in Europe, measles is still not eliminated and has even re-emerged with recurrent outbreaks in developed countries, in which effective vaccination programmes had been installed for decades. Here, we discuss the crucial factors for a worldwide elimination of MeV: (1) efficacy of current vaccines, (2) the extremely high contagiosity of MeV demanding a >95 % vaccination rate based on two doses to avoid primary vaccine failure as well as the installation of catch-up vaccination programmes to fill immunity gaps and to achieve herd immunity, (3) the implications of sporadic cases of secondary vaccine failure, (4) organisation, acceptance and drawbacks of modern vaccination campaigns, (5) waning public attention to measles, but increasing concerns from vaccine-associated adverse reactions in societies with high socio-economic standards and (6) clinical

  19. Effect of multivitamin supplementation on measles vaccine response among HIV-exposed uninfected Tanzanian infants.

    PubMed

    Sudfeld, Christopher R; Duggan, Christopher; Histed, Alex; Manji, Karim P; Meydani, Simin N; Aboud, Said; Wang, Molin; Giovannucci, Edward L; Fawzi, Wafaie W

    2013-08-01

    Immunization and nutritional interventions are mainstays of child health programs in sub-Saharan Africa, yet few published data exist on their interactions. HIV-exposed (but uninfected) infants enrolled in a randomized placebo-controlled trial of multivitamin supplements (vitamins B complex, C, and E) conducted in Tanzania were sampled for an assessment of measles IgG quantity and avidity at 15 to 18 months. Infants were vaccinated between 8.5 and 12 months of age, and all mothers received high-dose multivitamins as the standard of care. Of 201 HIV-exposed infants who were enrolled, 138 (68.7%) were seropositive for measles. There were no effects of infant multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity (P > 0.05). The measles seroconversion proportion was greater for HIV-exposed infants vaccinated at 10 to 11 months of age than for those vaccinated at 8.5 to 10 months (P = 0.032) and greater for infants whose mothers had a CD4 T-cell count of <200 cells/μl than for infants whose mothers had a CD4 T-cell count of >350 cells/μl (P = 0.039). Stunted infants had a significantly decreased IgG quantity compared to nonstunted infants (P = 0.012). As for measles avidity, HIV-exposed infants vaccinated at 10 to 11 months had increased antibody avidity compared to those vaccinated at 8.5 to 10 months (P = 0.031). Maternal CD4 T-cell counts of <200 cells/μl were associated with decreased avidity compared to counts of >350 cells/μl (P = 0.047), as were lower infant height-for-age z-scores (P = 0.016). Supplementation with multivitamins containing B complex, C, and E does not appear to improve measles vaccine responses for HIV-exposed infants. Studies are needed to better characterize the impact of maternal HIV disease severity on the immune system development of HIV-exposed infants and the effect of malnutrition interventions on vaccine responses. (This study has been registered at ClinicalTrials.gov under

  20. Identifying risk factors associated with acquiring measles in an outbreak among age-appropriately vaccinated school children: a cohort analysis.

    PubMed

    O'Connor, Bernadette; Doyle, Sarah

    2018-04-10

    A measles outbreak occurred in age-appropriately vaccinated children in a school in a town in the South East of Ireland in September-November 2013. The purpose of this study was to investigate the risk factors associated with catching measles during the outbreak. Ninety-five children (4-5 years) in three classes, in the first year of primary school, were included in the study. Immunisation records on the South East Child Health Information System for first Measles Mumps and Rubella (MMR) vaccine for the 95 children were reviewed. Data collected included age at MMR, date of administration of MMR, MMR brand and batch number, and the General Practice at which MMR was administered. The risk factors analysed included age at vaccination, time of vaccination, class and the GP practice where MMR was administered. Statistical analysis was performed using Epi info 7 and SPSS v24. Thirteen children in the cohort developed measles during the outbreak. All children in the cohort were age-appropriately vaccinated, with one dose of MMR vaccine. Analysis demonstrated statistically significant differences in the relative risk of developing measles according to the class a child was in, and the General Practice at which they were vaccinated. The reason for intense measles activity in one class was not established. Although a concurrent investigation into cold chain and vaccine stock management did not identify a cause for the high relative risk of measles in children vaccinated, recommendations were made for improving cold chain and vaccine stock management in General Practices.

  1. Measles Vaccination of Nonhuman Primates Provides Partial Protection against Infection with Canine Distemper Virus

    PubMed Central

    de Vries, Rory D.; Ludlow, Martin; Verburgh, R. Joyce; van Amerongen, Geert; Yüksel, Selma; Nguyen, D. Tien; McQuaid, Stephen; Osterhaus, Albert D. M. E.; Duprex, W. Paul

    2014-01-01

    ABSTRACT Measles virus (MV) is being considered for global eradication, which would likely reduce compliance with MV vaccination. As a result, children will grow up without MV-specific immunity, creating a potential niche for closely related animal morbilliviruses such as canine distemper virus (CDV). Natural CDV infection causing clinical signs has never been reported in humans, but recent outbreaks in captive macaques have shown that CDV can cause disease in primates. We studied the virulence and tropism of recombinant CDV expressing enhanced green fluorescent protein in naive and measles-vaccinated cynomolgus macaques. In naive animals CDV caused viremia and fever and predominantly infected CD150+ lymphocytes and dendritic cells. Virus was reisolated from the upper and lower respiratory tracts, but infection of epithelial or neuronal cells was not detectable at the time points examined, and the infections were self-limiting. This demonstrates that CDV readily infects nonhuman primates but suggests that additional mutations are necessary to achieve full virulence in nonnatural hosts. Partial protection against CDV was observed in measles-vaccinated macaques, as demonstrated by accelerated control of virus replication and limited shedding from the upper respiratory tract. While neither CDV infection nor MV vaccination induced detectable cross-reactive neutralizing antibodies, MV-specific neutralizing antibody levels of MV-vaccinated macaques were boosted by CDV challenge infection, suggesting that cross-reactive VN epitopes exist. Rapid increases in white blood cell counts in MV-vaccinated macaques following CDV challenge suggested that cross-reactive cellular immune responses were also present. This study demonstrates that zoonotic morbillivirus infections can be controlled by measles vaccination. IMPORTANCE Throughout history viral zoonoses have had a substantial impact on human health. Given the drive toward global eradication of measles, it is essential to

  2. Measles vaccination of nonhuman primates provides partial protection against infection with canine distemper virus.

    PubMed

    de Vries, Rory D; Ludlow, Martin; Verburgh, R Joyce; van Amerongen, Geert; Yüksel, Selma; Nguyen, D Tien; McQuaid, Stephen; Osterhaus, Albert D M E; Duprex, W Paul; de Swart, Rik L

    2014-04-01

    Measles virus (MV) is being considered for global eradication, which would likely reduce compliance with MV vaccination. As a result, children will grow up without MV-specific immunity, creating a potential niche for closely related animal morbilliviruses such as canine distemper virus (CDV). Natural CDV infection causing clinical signs has never been reported in humans, but recent outbreaks in captive macaques have shown that CDV can cause disease in primates. We studied the virulence and tropism of recombinant CDV expressing enhanced green fluorescent protein in naive and measles-vaccinated cynomolgus macaques. In naive animals CDV caused viremia and fever and predominantly infected CD150(+) lymphocytes and dendritic cells. Virus was reisolated from the upper and lower respiratory tracts, but infection of epithelial or neuronal cells was not detectable at the time points examined, and the infections were self-limiting. This demonstrates that CDV readily infects nonhuman primates but suggests that additional mutations are necessary to achieve full virulence in nonnatural hosts. Partial protection against CDV was observed in measles-vaccinated macaques, as demonstrated by accelerated control of virus replication and limited shedding from the upper respiratory tract. While neither CDV infection nor MV vaccination induced detectable cross-reactive neutralizing antibodies, MV-specific neutralizing antibody levels of MV-vaccinated macaques were boosted by CDV challenge infection, suggesting that cross-reactive VN epitopes exist. Rapid increases in white blood cell counts in MV-vaccinated macaques following CDV challenge suggested that cross-reactive cellular immune responses were also present. This study demonstrates that zoonotic morbillivirus infections can be controlled by measles vaccination. Throughout history viral zoonoses have had a substantial impact on human health. Given the drive toward global eradication of measles, it is essential to understand the

  3. A large population-based association study between HLA and KIR genotypes and measles vaccine antibody responses.

    PubMed

    Ovsyannikova, Inna G; Schaid, Daniel J; Larrabee, Beth R; Haralambieva, Iana H; Kennedy, Richard B; Poland, Gregory A

    2017-01-01

    Human antibody response to measles vaccine is highly variable in the population. Host genes contribute to inter-individual antibody response variation. The killer cell immunoglobulin-like receptors (KIR) are recognized to interact with HLA molecules and possibly influence humoral immune response to viral antigens. To expand on and improve our previous work with HLA genes, and to explore the genetic contribution of KIR genes to the inter-individual variability in measles vaccine-induced antibody responses, we performed a large population-based study in 2,506 healthy immunized subjects (ages 11 to 41 years) to identify HLA and KIR associations with measles vaccine-induced neutralizing antibodies. After correcting for the large number of statistical tests of allele effects on measles-specific neutralizing antibody titers, no statistically significant associations were found for either HLA or KIR loci. However, suggestive associations worthy of follow-up in other cohorts include B*57:01, DQB1*06:02, and DRB1*15:05 alleles. Specifically, the B*57:01 allele (1,040 mIU/mL; p = 0.0002) was suggestive of an association with lower measles antibody titer. In contrast, the DQB1*06:02 (1,349 mIU/mL; p = 0.0004) and DRB1*15:05 (2,547 mIU/mL; p = 0.0004) alleles were suggestive of an association with higher measles antibodies. Notably, the associations with KIR genotypes were strongly nonsignificant, suggesting that KIR loci in terms of copy number and haplotypes are not likely to play a major role in antibody response to measles vaccination. These findings refine our knowledge of the role of HLA and KIR alleles in measles vaccine-induced immunity.

  4. Reverse genetics of measles virus and resulting multivalent recombinant vaccines: applications of recombinant measles viruses.

    PubMed

    Billeter, M A; Naim, H Y; Udem, S A

    2009-01-01

    An overview is given on the development of technologies to allow reverse genetics of RNA viruses, i.e., the rescue of viruses from cDNA, with emphasis on nonsegmented negative-strand RNA viruses (Mononegavirales), as exemplified for measles virus (MV). Primarily, these technologies allowed site-directed mutagenesis, enabling important insights into a variety of aspects of the biology of these viruses. Concomitantly, foreign coding sequences were inserted to (a) allow localization of virus replication in vivo through marker gene expression, (b) develop candidate multivalent vaccines against measles and other pathogens, and (c) create candidate oncolytic viruses. The vector use of these viruses was experimentally encouraged by the pronounced genetic stability of the recombinants unexpected for RNA viruses, and by the high load of insertable genetic material, in excess of 6 kb. The known assets, such as the small genome size of the vector in comparison to DNA viruses proposed as vectors, the extensive clinical experience of attenuated MV as vaccine with a proven record of high safety and efficacy, and the low production cost per vaccination dose are thus favorably complemented.

  5. Comparative study and evaluation of further attenuated, live measles vaccines alone and in combination with mumps and rubella vaccines.

    PubMed

    Wegmann, A; Glück, R; Just, M; Mischler, R; Paroz, P; Germanier, R

    1986-01-01

    The further attenuated Enders (FAE) measles vaccine strain and the Edmonston B-Zagreb (EZ) measles vaccine strain were compared. In VERO-cells plaque sizes of FAE varied between 0.5 and 1 mm, those of EZ between 1 and 2 mm in diameter. The lots available in Switzerland during a 2 year period showed virus titers of 10(3.1) to 10(4.0) TCID50 per dose in the one vaccine (FAE) and of 10(3.1) to 10(4.5) TCID50 per dose in the other (EZ). Clinical investigations were performed with FAE and EZ monovalent and trivalent (measles + mumps + rubella) vaccine preparations. The virus titers of the vaccine lots used were 10(3.1) to 10(4.0) TCID50 per dose. The overall seroconversion rates of 96% to 100% indicate that both types of vaccine have comparable immunization properties. Stability tests demonstrated good stability of both the FAE and the EZ vaccines. Thus conservation at 37 degrees C was possible for 2 and 4 weeks, respectively, and at 41 degrees C for 6 and 6 days, respectively, without undue loss of live virus content (less than 1 log 10). Since the EZ vaccine is derived from human diploid cells, it is particularly suitable for the vaccination of persons with a history of allergy to avian proteins.

  6. [Measles are eliminated in Denmark].

    PubMed

    Lauridsen, Julie Aaberg; Krause, Tyra Grove; Andersen, Peter Henrik

    2018-03-19

    Measles vaccination has led to a significant fall in the number of measles cases and measles-related deaths worldwide. However, many countries still struggle to eliminate the disease. To obtain elimination, a minimum of 95% vaccination coverage for both of the measles, mumps, and rubella (MMR) vaccines is necessary as well as an efficient surveillance system and timely public health response. Presenting data on reported cases and vaccination coverage in the latest 20 years, this article describes how measles are eliminated in Denmark and recommends, how the Danish measles surveillance system can be further improved to maintain the status.

  7. Measles outbreak in a poorly vaccinated region in Cameroon: a case series study, public health challenges and recommendations.

    PubMed

    Njim, Tsi; Aminde, Leopold Ndemnge; Feteh, Fambombi Vitalis; Ngum, Joel Mbigha; Moustapha, Chandini Aliyou

    2015-01-01

    Measles is a highly contagious viral infection and still a leading cause of vaccine-preventable deaths in Africa; especially in unvaccinated populations. We reviewed the medical reports of the measles outbreak that occurred in Misaje, in the North west region of Cameroon from 11/03/2015 to 14/05/2015. Six measles cases were recorded during this period; three of them complicated by bacterial infections. Measles should be considered as a differential diagnosis for any febrile rash especially among poorly vaccinated populations. Primary preventive methods implemented by clinicians could help control outbreaks; especially with delays in public health intervention. Also, gaps in health policies in Cameroon should be addressed to scale up vaccination coverage in remote communities like Misaje to reduce the incidence of measles outbreaks.

  8. Progress Toward Measles Elimination - Nepal, 2007-2014.

    PubMed

    Khanal, Sudhir; Sedai, Tika Ram; Choudary, Ganga Ram; Giri, Jagat Narain; Bohara, Rajendra; Pant, Rajendra; Gautam, Mukunda; Sharapov, Umid M; Goodson, James L; Alexander, James; Dabbagh, Alya; Strebel, Peter; Perry, Robert T; Bah, Sunil; Abeysinghe, Nihal; Thapa, Arun

    2016-03-04

    In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR) established a goal to eliminate measles and to control rubella and congenital rubella syndrome (CRS) in SEAR by 2020. Current recommended measles elimination strategies in the region include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets minimum recommended performance indicators; 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. In 2013, Nepal, one of the 11 SEAR member states, adopted a goal for national measles elimination by 2019. This report updates a previous report and summarizes progress toward measles elimination in Nepal during 2007-2014. During 2007-2014, estimated coverage with the first MCV dose (MCV1) increased from 81% to 88%. Approximately 3.9 and 9.7 million children were vaccinated in SIAs conducted in 2008 and 2014, respectively. Reported suspected measles incidence declined by 13% during 2007-2014, from 54 to 47 cases per 1 million population. However, in 2014, 81% of districts did not meet the measles case-based surveillance performance indicator target of ≥2 discarded non-measles cases per 100,000 population per year. To achieve and maintain measles elimination, additional measures are needed to strengthen routine immunization services to increase coverage with MCV1 and a recently introduced second dose of MCV (MCV2) to ≥95% in all districts, and to enhance sensitivity of measles case-based surveillance by adopting a more sensitive case definition, expanding case-based surveillance sites nationwide, and ensuring timely transport of

  9. Combination Measles-Mumps-Rubella-Varicella Vaccine in Healthy Children

    PubMed Central

    Ma, Shu-Juan; Li, Xing; Xiong, Yi-Quan; Yao, A.-.ling; Chen, Qing

    2015-01-01

    Abstract A combined measles-mumps-rubella-varicella (MMRV) vaccine is expected to facilitate universal immunization against these 4 diseases. This study was undertaken to synthesize current research findings of the immunogenicity and safety of MMRV in healthy children. We searched PubMed, Embase, BIOSIS Previews, Web of Science, Cochrane Library, and other databases through September 9, 2014. Eligible randomized controlled trials (RCTs) were selected and collected independently by 2 reviewers. Meta-analysis was conducted using Stata 12.0 and RevMan 5.3. Twenty-four RCTs were included in qualitative synthesis. Nineteen RCTs compared single MMRV dose with measles-mumps-rubella vaccine with or without varicella vaccine (MMR + V/MMR). Similar seroconversion rates of these 4 viruses were found between comparison groups. There were comparable geometric mean titers (GMTs) against mumps and varicella viruses between MMRV group and MMR + V/MMR group. MMRV group achieved enhanced immune response to measles component, with GMT ratio of 1.66 (95% confidence interval [CI] 1.48, 1.86; P < 0.001) for MMRV versus MMR and 1.62 (95% CI 1.51, 1.70; P < 0.001) for MMRV versus MMR + V. Meanwhile, immune response to rubella component in MMRV group was slightly reduced, GMT ratios were 0.81 (95% CI 0.78, 0.85; P < 0.001) and 0.79 (95% CI 0.76, 0.83; P < 0.001), respectively. Well tolerated safety profiles were demonstrated except higher incidence of fever (relative risks 1.12–1.60) and measles/rubella-like rash (relative risks 1.44–1.45) in MMRV groups. MMRV had comparable immunogenicity and overall safety profiles to MMR + V/MMR in healthy children based on current evidence. PMID:26554769

  10. Safety and immunogenicity of live-attenuated Japanese encephalitis SA 14-14-2 vaccine co-administered with measles vaccine in 9-month-old infants in Sri Lanka.

    PubMed

    Wijesinghe, Pushpa Ranjan; Abeysinghe, M R Nihal; Yoksan, Sutee; Yao, Yafu; Zhou, Benli; Zhang, Lei; Yaich, Mansour; Neuzil, Kathleen M; Victor, John C

    2014-08-20

    To facilitate introduction of live attenuated SA 14-14-2 Japanese encephalitis vaccine (LJEV) into the National Immunization Programme of Sri Lanka, we evaluated the safety and immunogenicity of co-administration of LJEV and measles vaccine at 9 months of age. Serum immune responses were evaluated post-vaccination on days 28, 180, and 365 using JE neutralization test and anti-measles IgG ELISA. 278 infants received one dose of LJEV and measles vaccine. Of these, 257 were eligible for the per-protocol analysis. On Day 0, 14 infants (5.5%) were seropositive for JE, but none were seropositive for measles. At Day 28, seropositivity rates were 90.7% (95% CI, 86.4-93.9%) for JE and 84.8% (95% CI, 79.8-89.0%) for measles. The geometric mean titer for JE neutralizing antibodies was 111 (95% CI, 90-135), and the geometric mean concentration (GMC) for anti-measles IgG was 375 mI U/mL (95% CI, 351-400 mI U/mL). Over the next year, JE neutralizing antibody responses declined only slightly, with seropositivity at 87.4% (95% CI, 82.6-91.2%) at Day 365. In contrast, measles antibody levels continued to increase over time. Seropositivity for anti-measles IgG reached 97.2% (95% CI, 94.4-98.9%) at Day 365, and the GMC rose to 1202 mI U/mL (95% CI, 1077-1341 mI U/mL). Co-administration of LJEV and measles vaccine was also safe. Most adverse reactions were mild, and no serious adverse events were related to study vaccinations. The safety and immunogenicity of LJEV co-administered with measles vaccine in Sri Lankan infants is similar to that seen in other populations, and our results support use of LJEV at 9 months of age. Live SA 14-14-2 vaccine is now prequalified by the WHO for use in infants in Asia, and other countries may wish to introduce LJEV to combat this devastating disease. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. Measles-vaccinated Israeli boy with subacute sclerosing panencephalitis.

    PubMed

    Har-Even, Ronly; Aichenbaum, Sergio; Rabey, Jose M; Livne, Amir; Bistritzer, Tzvy

    2011-06-01

    Subacute sclerosing panencephalitis is a rare neurologic disorder of childhood and adolescence. We describe a 16-year-old boy who manifested the disease despite proper vaccinations. He was hospitalized because of bedwetting, involuntary limb movements, abnormal speech, and balance disturbances. Immunoglobulin G antibodies against measles were strongly positive, with a high relative cerebrospinal fluid/serum ratio. Polymerase chain reaction for measles produced negative results. Electroencephalography registered slow activity with high voltage discharges every few seconds, and with triphasic complex morphology. Magnetic resonance imaging revealed diffuse white matter changes, mostly around the posterior regions and lateral ventricles. Treatment with valproic acid, levetiracetam, carbamazepine, and intravenous immunoglobulin G was ineffective. Inosiplex and interferon-β-1a were also administrated. The patient became comatose, with generalized myoclonic jerks, and died 1 year later. An autopsy was not performed. This patient illustrates that subacute sclerosing panencephalitis should be suspected among young vaccinated subjects. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Seroconversion rates to combined measles-mumps-rubella-varicella vaccine of children with upper respiratory tract infection.

    PubMed

    Dennehy, P H; Saracen, C L; Peter, G

    1994-10-01

    To determine if upper respiratory tract infection (URI) affects the seroconversion rate or quantitative response to each component of a combined measles-mumps-rubella-varicella vaccine. One hundred forty-nine children between 15 and 18 months of age were prospectively divided into two groups according to the presence of URI or recent history of URI symptoms within the 4 weeks before vaccination. Once stratified, 74 children in the healthy group and 75 children in the URI group were randomly assigned to receive one of three lots of measles-mumps-rubella varicella vaccine by subcutaneous injection into the deltoid area. Serum was obtained from each child just before vaccination and 4 to 6 weeks later for measuring antibody levels against each virus. Prevaccination antibody levels against each virus in the URI and healthy groups did not differ. Nine children had pre-existing antibodies to varicella and six to mumps; no child had positive serologies for measles or rubella before vaccination. Children with pre-existing antibody were excluded from analysis of seroconversion for that virus. Seroconversion to measles, mumps, and rubella occurred in 100% of children in both groups. Mean antibody levels did not differ between the healthy and URI groups for measles (111 vs 122), mumps (97 vs 108), or rubella (96 vs 102). Three (4%) of 70 children with URIs in whom varicella serologies were available failed to seroconvert to varicella vaccine although none of the 69 healthy children had vaccine failure (P = .24). The mean varicella antibody level was 11.3 +/- 1.4 in the healthy children, which did not differ significantly from the level of 9.5 +/- 0.9 in the URI group. Seroconversion to measles, mumps, rubella, and varicella was not significantly affected by the presence of a concurrent or recent URI in 15- to 18-month-old children.

  13. [Measles-Mumps-Rubella vaccination of an egg-allergic child sensitized to gelatin].

    PubMed

    Dumortier, B; Nosbaum, A; Ponvert, C; Nicolas, J-F; Bérard, F

    2013-08-01

    The Measles-Mumps-Rubella (MMR) vaccine is often postponed in egg-allergic patients due to fear of anaphylactic reaction at the time of injection of this vaccin produced on egg derivates. However, this vaccine is recommended by health authorities, especially in case of increased measles incidence, and international recommendations indicate that there is no need for predictive allergological work-up and that the MMR vaccine is well tolerated in egg-allergic patients. We report on the case of a 12-year-old child with severe immediate-type egg allergy. Immediate-reading intradermal skin tests performed prior to the MMR vaccine were positive. Subsequent allergological work-up revealed a gelatin sensitization, and the child tolerated injections of the vaccine given according to a tolerance induction protocol. Gelatin is used as a stabilizer in numerous vaccines and may be responsible for immediate-type hypersentivity reactions to gelatin-containing vaccines. In case of reaction induced by the MMR vaccine, one needs to explore a potential gelatin sensitization/allergy. The MMR vaccine should be given and is well tolerated in patients with immediate-type egg hypersensitivity, even when gelatin sensitization is combined. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  14. Mutual interference on the immune response to yellow fever vaccine and a combined vaccine against measles, mumps and rubella.

    PubMed

    Nascimento Silva, Juliana Romualdo; Camacho, Luiz Antonio B; Siqueira, Marilda M; Freire, Marcos de Silva; Castro, Yvone P; Maia, Maria de Lourdes S; Yamamura, Anna Maya Y; Martins, Reinaldo M; Leal, Maria de Luz F

    2011-08-26

    A randomized trial was conducted to assess the immunogenicity and reactogenicity of yellow fever vaccines (YFV) given either simultaneously in separate injections, or 30 days or more after a combined measles-mumps-rubella (MMR) vaccine. Volunteers were also randomized to YFV produced from 17DD and WHO-17D-213 substrains. The study group comprised 1769 healthy 12-month-old children brought to health care centers in Brasilia for routine vaccination. The reactogenicity was of the type and frequency expected for the vaccines and no severe adverse event was associated to either vaccine. Seroconversion and seropositivity 30 days or more after vaccination against yellow fever was similar across groups defined by YFV substrain. Subjects injected YFV and MMR simultaneously had lower seroconversion rates--90% for rubella, 70% for yellow fever and 61% for mumps--compared with those vaccinated 30 days apart--97% for rubella, 87% for yellow fever and 71% for mumps. Seroconversion rates for measles were higher than 98% in both comparison groups. Geometric mean titers for rubella and for yellow fever were approximately three times higher among those who got the vaccines 30 days apart. For measles and mumps antibodies GMTs were similar across groups. MMR's interference in immune response of YFV and YFV's interference in immune response of rubella and mumps components of MMR had never been reported before but are consistent with previous observations from other live vaccines. These results may affect the recommendations regarding primary vaccination with yellow fever vaccine and MMR. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Effect of Multivitamin Supplementation on Measles Vaccine Response among HIV-Exposed Uninfected Tanzanian Infants

    PubMed Central

    Duggan, Christopher; Histed, Alex; Manji, Karim P.; Meydani, Simin N.; Aboud, Said; Wang, Molin; Giovannucci, Edward L.; Fawzi, Wafaie W.

    2013-01-01

    Immunization and nutritional interventions are mainstays of child health programs in sub-Saharan Africa, yet few published data exist on their interactions. HIV-exposed (but uninfected) infants enrolled in a randomized placebo-controlled trial of multivitamin supplements (vitamins B complex, C, and E) conducted in Tanzania were sampled for an assessment of measles IgG quantity and avidity at 15 to 18 months. Infants were vaccinated between 8.5 and 12 months of age, and all mothers received high-dose multivitamins as the standard of care. Of 201 HIV-exposed infants who were enrolled, 138 (68.7%) were seropositive for measles. There were no effects of infant multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity (P > 0.05). The measles seroconversion proportion was greater for HIV-exposed infants vaccinated at 10 to 11 months of age than for those vaccinated at 8.5 to 10 months (P = 0.032) and greater for infants whose mothers had a CD4 T-cell count of <200 cells/μl than for infants whose mothers had a CD4 T-cell count of >350 cells/μl (P = 0.039). Stunted infants had a significantly decreased IgG quantity compared to nonstunted infants (P = 0.012). As for measles avidity, HIV-exposed infants vaccinated at 10 to 11 months had increased antibody avidity compared to those vaccinated at 8.5 to 10 months (P = 0.031). Maternal CD4 T-cell counts of <200 cells/μl were associated with decreased avidity compared to counts of >350 cells/μl (P = 0.047), as were lower infant height-for-age z-scores (P = 0.016). Supplementation with multivitamins containing B complex, C, and E does not appear to improve measles vaccine responses for HIV-exposed infants. Studies are needed to better characterize the impact of maternal HIV disease severity on the immune system development of HIV-exposed infants and the effect of malnutrition interventions on vaccine responses. (This study has been registered at ClinicalTrials.gov under

  16. [Reemergence of measles in vaccinated patients: report of 6 cases and proposals for prevention].

    PubMed

    Agut-Busquet, Eugènia; Gené Tous, Emili; Navarro, Gemma; González, Araceli

    2016-06-01

    A 2014 measles outbreak in Catalonia affected 131 persons. We describe a series of 6 cases diagnosed in our emergency department. All the patients were under 31 years of age and complained of flu-like symptoms, including high fever and rash. Five had been properly vaccinated and one was a health care worker. A firm diagnosis of measles need not be made in the emergency department, but a high level of suspicion is important for ruling out complications, isolating the patient, and protecting health care staff at high risk for exposure. We found that 6% of the staff of our emergency department had a low level of immunity to measles. Given our findings, we suggest that preventive treatment is necessary when health care staff have been exposed to measles and their vaccination status is unknown.

  17. Measles Vaccination Supports Millennium Development Goal 4: Increasing Coverage and Increasing Child Survival in Northern Ghana, 1996-2012.

    PubMed

    Welaga, Paul; Hodgson, Abraham; Debpuur, Cornelius; Aaby, Peter; Binka, Fred; Azongo, Daniel; Oduro, Abraham

    2018-01-01

    Measles vaccine (MV) administered as the last vaccine after the third dose of diphtheria-tetanus-pertussis (DTP) may be associated with better child survival unrelated to prevention of measles infection. Other studies have shown that MV administered after DTP was more beneficial and was associated with lower mortality compared with DTP administered after MV or DTP administered simultaneously with MV. We compared the difference in mortality between measles vaccinated after DTP3 and measles-unvaccinated children in Navrongo, Ghana. This was a follow-up study involving annual cohort of children aged 9-23 months from 1996 to 2012. We assessed survival in relation to the measles vaccination status within the first 12 months from interview date and until 5 years of age using Cox proportional hazards models. In all, 38,333 children were included in the study. The proportion of children vaccinated with MV-after-DTP3 increased from 45% in 1996 to 95% in 2012. The adjusted hazard ratio (HR) for measles unvaccinated compared with MV-after-DTP3 vaccinated children was 1.38 (1.15-1.66) in the first 12 months after assessment of vaccination status and 1.22 (1.05-1.41) with follow-up to 5 years of age. The national immunization days campaigns with oral polio vaccine or MV might have reduced the effect of being MV-after-DTP3 vaccinated vs MV-unvaccinated. For 12 months of follow-up, the HR before a campaign for MV-unvaccinated children was 1.63 (1.23-2.17) compared to those who received MV-after-DTP3. After the campaign, the HR reduced to 1.23 (0.97-1.54). Stratifying the analysis by sex, measles-unvaccinated boys had a HR of 1.69 (1.33-2.61) compared to measles-unvaccinated girls who had a HR 1.06 (0.79-1.40) during 1-year follow-up. In 1989, only 7% of children in the area had received MV-after-DTP3; the increase in MV-after-DTP3 coverage from 1989 to 2012 may have lowered mortality rate among children aged 9 months to 3 years by 24%. Though an observational

  18. Transmission of measles among healthcare Workers in Hospital W, Xinjiang Autonomous Region, China, 2016.

    PubMed

    Jia, Haimei; Ma, Chao; Lu, Mengting; Fu, Jianping; Rodewald, Lance E; Su, Qiru; Wang, Huaqin; Hao, Lixin

    2018-01-12

    As China approaches the elimination of measles, outbreaks of measles continue to occur. Healthcare workers (HCWs) are known to be at high risk of infection and transmission of measles virus. A measles outbreak occurred in a hospital in Xinjiang Uighur Autonomous Region of the People's Republic of China. We report an investigation of this outbreak and its implications for measles elimination and outbreak preparedness. We conducted a retrospective search for measles cases using hospital records. Information on cases was collected by interview, and was used to determine epidemiological linkages. We surveyed HCWs to determine their demographic characteristics, disease history and vaccination status, and knowledge about measles. We identified 19 cases, ages 18 to 45 years, in Hospital W between December 2015 and January 2016; 14 were laboratory-confirmed, and 5 were epidemiologically linked. The primary case was a 25-year-old neurology department nurse who developed a rash on 22 December 2015 that was reported on 11 January 2016. She continued working and living with her workmates in a dormitory during her measles transmission period. Among the 19 infected HCWs, 2 had received a dose of measles-containing vaccine (MCV) before the outbreak, and 16 had unknown vaccination status. Outbreak response immunization activities were started on 8 January in a non-selective manner by offering vaccine regardless of vaccination history; 605(68%) of 890 HCWs were vaccinated. The HCW survey had a 73% response rate (646/890); 41% of HCWs reported that they had received MCV before outbreak, and 56% exhibited good knowledge of measles symptoms, transmission, complications, and vaccination. Low MCV coverage, low measles knowledge among HCWs, delayed reporting of measles cases, and absence of proper case management were associated with this outbreak. Training and vaccinating HCWs against measles are essential activities to prevent measles virus transmission among HCWs.

  19. A randomized trial of a standard dose of Edmonston-Zagreb measles vaccine given at 4.5 months of age: effect on total hospital admissions.

    PubMed

    Martins, Cesario L; Benn, Christine S; Andersen, Andreas; Balé, Carlito; Schaltz-Buchholzer, Frederik; Do, Vu An; Rodrigues, Amabelia; Aaby, Peter; Ravn, Henrik; Whittle, Hilton; Garly, May-Lill

    2014-06-01

    Observational studies and trials from low-income countries indicate that measles vaccine has beneficial nonspecific effects, protecting against non-measles-related mortality. It is not known whether measles vaccine protects against hospital admissions. Between 2003 and 2007, 6417 children who had received the third dose of diphtheria, tetanus, and pertussis vaccine were randomly assigned to receive measles vaccine at 4.5 months or no measles vaccine; all children were offered measles vaccine at 9 months of age. Using hospital admission data from the national pediatric ward in Bissau, Guinea-Bissau, we compared admission rates between enrollment and the 9-month vaccination in Cox models, providing admission hazard rate ratios (HRRs) for measles vaccine versus no measles vaccine. All analyses were conducted stratified by sex and reception of neonatal vitamin A supplementation (NVAS). Before enrollment the 2 groups had similar admission rates. Following enrollment, the measles vaccine group had an admission HRR of 0.70 (95% confidence interval [CI], .52-.95), with a ratio of 0.53 (95% CI, .32-.86) for girls and 0.86 (95% CI, .58-1.26) for boys. For children who had not received NVAS, the admission HRR was 0.53 (95% CI, .34-.84), with an effect of 0.30 (95% CI, .13-.70) for girls and 0.73 (95% CI, .42-1.28) for boys (P = .08, interaction test). The reduction in admissions was separately significant for measles infection (admission HRR, 0 [95% CI, 0-.24]) and respiratory infections (admission HRR, 0.37 [95% CI, .16-.89]). Early measles vaccine may have major benefits for infant morbidity patterns and healthcare costs. Clinical trials registration NCT00168558.

  20. Early childhood measles vaccinations are not associated with paediatric IBD: a population-based analysis.

    PubMed

    Shaw, Souradet Y; Blanchard, James F; Bernstein, Charles N

    2015-04-01

    Early childhood vaccinations have been hypothesized to contribute to the emergence of paediatric inflammatory bowel disease [IBD] in developed countries. Using linked population-based administrative databases, we aimed to explore the association between vaccination with measles-containing vaccines and the risk for IBD. This was a case-control study using the University of Manitoba IBD Epidemiology Database [UMIBDED]. The UMIBDED was linked to the Manitoba Immunization Monitoring System [MIMS], a population-based database of immunizations administered in Manitoba. All paediatric IBD cases in Manitoba, born after 1989 and diagnosed before March 31, 2008, were included. Controls were matched to cases on the basis of age, sex, and region of residence at time of diagnosis. Measles-containing vaccinations received in the first 2 years of life were documented, with vaccinations categorized as 'None' or 'Complete', with completeness defined according to Manitoba's vaccination schedule. Conditional logistic regression models were fitted to the data, with models adjusted for physician visits in the first 2 years of life and area-level socioeconomic status at case date. A total of 951 individuals [117 cases and 834 controls] met eligibility criteria, with average age of diagnosis among cases at 11 years. The proportion of IBD cases with completed vaccinations was 97%, compared with 94% of controls. In models adjusted for physician visits and area-level socioeconomic status, no statistically significant association was detected between completed measles vaccinations and the risk of IBD (adjusted odds ratio [AOR]: 1.5; 95% confidence interval [CI]: 0.5-4.4; p = 0.419]. No significant association between completed measles-containing vaccination in the first 2 years of life and paediatric IBD could be demonstrated in this population-based study. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For

  1. Lack of association between measles-mumps-rubella vaccination and autism in children: a case-control study.

    PubMed

    Mrozek-Budzyn, Dorota; Kiełtyka, Agnieszka; Majewska, Renata

    2010-05-01

    The first objective of the study was to determine whether there is a relationship between the measles-mumps-rubella (MMR) vaccination and autism in children. The second objective was to examine whether the risk of autism differs between use of MMR and the single measles vaccine. Case-control study. The 96 cases with childhood or atypical autism, aged 2 to 15, were included into the study group. Controls consisted of 192 children individually matched to cases by year of birth, sex, and general practitioners. Data on autism diagnosis and vaccination history were from physicians. Data on the other probable autism risk factors were collected from mothers. Logistic conditional regression was used to assess the risk of autism resulting from vaccination. Assessment was made for children vaccinated (1) Before diagnosis of autism, and (2) Before first symptoms of autism onset. Odds ratios were adjusted to mother's age, medication during pregnancy, gestation time, perinatal injury and Apgar score. For children vaccinated before diagnosis, autism risk was lower in children vaccinated with MMR than in the nonvaccinated (OR: 0.17, 95% CI: 0.06-0.52) as well as to vaccinated with single measles vaccine (OR: 0.44, 95% CI: 0.22-0.91). The risk for vaccinated versus nonvaccinated (independent of vaccine type) was 0.28 (95% CI: 0.10-0.76). The risk connected with being vaccinated before onset of first symptoms was significantly lower only for MMR versus single vaccine (OR: 0.47, 95% CI: 0.22-0.99). The study provides evidence against the association of autism with either MMR or a single measles vaccine.

  2. Seroprevalence of measles, mumps and rubella among young adults, after 20 years of universal 2-dose MMR vaccination in Israel.

    PubMed

    Levine, Hagai; Zarka, Salman; Ankol, Omer E; Rozhavski, Vladi; Davidovitch, Nadav; Aboudy, Yair; Balicer, Ran D

    2015-01-01

    Evidence-based vaccination policy is important for the global and local efforts of achieving control over measles. In 2007, the first Israeli birth cohort to be twice vaccinated during childhood with Measles-Mumps-Rubella vaccine reached adulthood. In parallel, Israel experienced its largest measles outbreak since 1994. We aimed to assess the seroprevalence of measles IgG antibodies and concordance with rubella and mumps seroprevalence among young Israeli adults born 1988-9 in comparison to previous birth cohorts, in order to inform evidence based prevention policy. We conducted a seroprevalence study of IgG antibodies among 439 Israeli adults born in 1988-9, based on a representative sample of sera collected at age 18-19 upon recruitment to mandatory military service in 2007. In total, 85.7% were seropositive for measles as compared with 95.6% in the 1996 recruitment (P < 0.001). The absolute decline was significant both for males (8.8%, P = 0.001) and females (12.1%, P < 0.001). There were no significant differences in seropositivity by gender, years of education, country of birth or smoking status. Rubella seropositivity among measles seropositives was 90.4%, significantly (P < 0.001) higher than 72.1% among measles seronegatives. Mumps seropositivity among measles seropositives was 87.0%, significantly (P < 0.001) higher than 62.3% among measles seronegatives. Results were similar for Israeli-born only. Our findings indicate that measles seroprevalence decreased after the last change in vaccination policy and reach sub-optimal level. Until global eradication is reached, a proactive vaccination program to supplement routine childhood vaccination program should be considered in Israel and in other countries.

  3. Spotlight on measles 2010: ongoing measles outbreak in Northern Ireland following an imported case, September-October 2010.

    PubMed

    Smithson, R; Irvine, N; Hutton, C; Doherty, L; Watt, A

    2010-10-28

    We report an ongoing outbreak of measles with five laboratory-confirmed and four epidemiologically linked cases in Northern Ireland as at 26 October 2010. The index case was an unvaccinated non-Northern Ireland resident with subsequent genotyping suggesting that infection originated in the usual country of residence of this case. Confirmed cases include one patient with a history of two measles-mumps-rubella vaccine doses.

  4. [Study on the neutralization capacity of different types of human measles virus vaccine and the epidemic strains].

    PubMed

    Feng, Yan; Lu, Yi-yu; Yan, Ju-ying; Jiang, Xiao-hui; Shi, Wen; Xu, Chang-ping; Li, Zhen

    2007-11-01

    To explore the neutralization capacities of different types of human serum to measles virus epidemic strains and vaccine strain. Neutralization antibody (NT) to Shanghai 191 and measles virus isolates in 2005 were tested using acute and convalescent serum samples from diagnosed measles patients, children serum samples collected before and after vaccination and serum samples of migrant residents, from 3 different regions. Additionally, animal immune serum referring to vaccine strain and 3 epidemic strains were prepared and used to undergo crossing neutralization test with corresponding strains mentioned-above. Antigenic ratios were calculated. GMT value of NT of after-immune serum to vaccine strains was 50.82,1.86 times higher than that to MVi/ZJ/05/7 (GMT was 27.35), whereas GMT value of convalescent serum to MVi/ZJ/05/7 (GMT was 386.95) was obviously higher than that to vaccine strain (GMT was 1:151.83),and GMT value of migrant residents' serum in 3 regions to MVi/ZJ/05/7 were 2.22-4.17 times lower than that to vaccine strain. Meanwhile,the antigenic ratios between MVi/ZJ/ 99/1, MVi/ZJ/04/1, MVi/ZJ/05/7 and vaccine strain were found to be 4.28,5.24 and 5.66 respectively. Additionally,low NT titers to vaccine strain were found in patients' acute sera and GMT value was over 1:4. There were obvious differences on neutralization antibody of different types of serum to measles vaccine strain and epidemic strains which indicating the antigenic diversity of epidemic strains had influenced the protective effectiveness of vaccine antibody to epidemic strains. It was of significance to carry on research projects on the antigenic diversity and effectiveness of measles vaccine.

  5. Global measles mortality, 2000-2008.

    PubMed

    2009-12-04

    The United Nations (UN) Millennium Development Goals include a goal (MDG 4) to achieve a two thirds overall reduction of child deaths by 2015 compared with the 1990 level. Because many unvaccinated children die from measles, routine measles vaccination coverage is used as an indicator of progress toward this goal. In 2008, all UN member states reaffirmed their commitment to achieving a 90% reduction in measles mortality by 2010 compared with 2000, from an estimated 733,000 deaths in 2000 worldwide to <73,300 by 2010. The World Health Organization (WHO) and UNICEF have identified 47 priority countries with the highest burden of measles for an accelerated strategy for measles mortality reduction. The strategy includes 1) achieving and maintaining high coverage (>or=90% nationally and >or=80% in each district) with 2 doses of measles-containing vaccine (MCV) delivered through routine services or supplemental immunization activities (SIAs) , 2) implementing effective laboratory-supported disease surveillance, and 3) providing appropriate clinical management for measles cases. This report updates a previously published report, provides details on activities implemented during 2008, assesses progress toward the 2010 goal, and evaluates the potential effects of decreased financial support. During 2000--2008, global measles mortality declined by 78%, from an estimated 733,000 deaths in 2000 to 164,000 in 2008, but the reduction in measles mortality has been leveling off since 2007. To reach the 2010 goal, India should fully implement the recommended strategies, and financial support for sustaining measles control in the other 46 priority countries should be secured.

  6. A Randomized Trial of a Standard Dose of Edmonston-Zagreb Measles Vaccine Given at 4.5 Months of Age: Effect on Total Hospital Admissions

    PubMed Central

    Martins, Cesario L.; Benn, Christine S.; Andersen, Andreas; Balé, Carlito; Schaltz-Buchholzer, Frederik; Do, Vu An; Rodrigues, Amabelia; Aaby, Peter; Ravn, Henrik; Whittle, Hilton; Garly, May-Lill

    2014-01-01

    Observational studies and trials from low-income countries indicate that measles vaccine has beneficial nonspecific effects, protecting against non–measles-related mortality. It is not known whether measles vaccine protects against hospital admissions. Between 2003 and 2007, 6417 children who had received the third dose of diphtheria, tetanus, and pertussis vaccine were randomly assigned to receive measles vaccine at 4.5 months or no measles vaccine; all children were offered measles vaccine at 9 months of age. Using hospital admission data from the national pediatric ward in Bissau, Guinea-Bissau, we compared admission rates between enrollment and the 9-month vaccination in Cox models, providing admission hazard rate ratios (HRRs) for measles vaccine versus no measles vaccine. All analyses were conducted stratified by sex and reception of neonatal vitamin A supplementation (NVAS). Before enrollment the 2 groups had similar admission rates. Following enrollment, the measles vaccine group had an admission HRR of 0.70 (95% confidence interval [CI], .52–.95), with a ratio of 0.53 (95% CI, .32–.86) for girls and 0.86 (95% CI, .58–1.26) for boys. For children who had not received NVAS, the admission HRR was 0.53 (95% CI, .34–.84), with an effect of 0.30 (95% CI, .13–.70) for girls and 0.73 (95% CI, .42–1.28) for boys (P = .08, interaction test). The reduction in admissions was separately significant for measles infection (admission HRR, 0 [95% CI, 0–.24]) and respiratory infections (admission HRR, 0.37 [95% CI, .16–.89]). Early measles vaccine may have major benefits for infant morbidity patterns and healthcare costs. Clinical trials registration NCT00168558. PMID:24436454

  7. Case-based surveillance of measles in Sicily during 2012-2017: The changing molecular epidemiology and implications for vaccine strategies

    PubMed Central

    Maida, Carmelo Massimo; Pojero, Fanny; Colomba, Giuseppina Maria Elena; Casuccio, Alessandra; Restivo, Vincenzo; Vitale, Francesco

    2018-01-01

    Following the indication of the World Health Organization, a national plan for the elimination of measles was approved in Italy and this included the improvement of the molecular surveillance of measles viruses and the interruption of indigenous transmission of the disease. Nevertheless, large outbreaks continue to occur in almost all regions of the country, including Sicily. Here we describe the epidemiology and molecular dynamics of measles viruses as a result of the measles surveillance activity carried out by the “Reference Laboratory for Measles and Rubella” in Sicily over a 5-year period. Biological samples of 259 suspected measles cases were tested for viral RNA detection and a total of 223 (86.1%) were classified as laboratory confirmed. The median age of confirmed measles cases was 21.0 years and about half of them were adults aged 19 years and older. Overall, one-third of the patients showed clinical complications and these latter were more common among adults than children (44.9% vs. 25.7%). The vast majority of measles cases were unvaccinated (94.2%, n = 210). The phylogenetic analysis of 221 measles virus nucleotide sequences revealed sporadic detections of genotypes D4 and H1, while endemic circulation of genotypes D8 and B3 was documented. Genotype D8 was associated with epidemics occurred between 2013 and 2016, whereas genotype B3 was more recently introduced into Sicily characterizing the current measles outbreak. The results of this study confirm the autochthonous co-circulation of viral variants belonging to different genotypes during the study period, and emphasizes the need of measles surveillance programmes in order to investigate the viral dynamics, the pathways of disease transmission, and to eventually adapt the development of successfull vaccine formulations. PMID:29617454

  8. Case-based surveillance of measles in Sicily during 2012-2017: The changing molecular epidemiology and implications for vaccine strategies.

    PubMed

    Tramuto, Fabio; Maida, Carmelo Massimo; Pojero, Fanny; Colomba, Giuseppina Maria Elena; Casuccio, Alessandra; Restivo, Vincenzo; Vitale, Francesco

    2018-01-01

    Following the indication of the World Health Organization, a national plan for the elimination of measles was approved in Italy and this included the improvement of the molecular surveillance of measles viruses and the interruption of indigenous transmission of the disease. Nevertheless, large outbreaks continue to occur in almost all regions of the country, including Sicily. Here we describe the epidemiology and molecular dynamics of measles viruses as a result of the measles surveillance activity carried out by the "Reference Laboratory for Measles and Rubella" in Sicily over a 5-year period. Biological samples of 259 suspected measles cases were tested for viral RNA detection and a total of 223 (86.1%) were classified as laboratory confirmed. The median age of confirmed measles cases was 21.0 years and about half of them were adults aged 19 years and older. Overall, one-third of the patients showed clinical complications and these latter were more common among adults than children (44.9% vs. 25.7%). The vast majority of measles cases were unvaccinated (94.2%, n = 210). The phylogenetic analysis of 221 measles virus nucleotide sequences revealed sporadic detections of genotypes D4 and H1, while endemic circulation of genotypes D8 and B3 was documented. Genotype D8 was associated with epidemics occurred between 2013 and 2016, whereas genotype B3 was more recently introduced into Sicily characterizing the current measles outbreak. The results of this study confirm the autochthonous co-circulation of viral variants belonging to different genotypes during the study period, and emphasizes the need of measles surveillance programmes in order to investigate the viral dynamics, the pathways of disease transmission, and to eventually adapt the development of successfull vaccine formulations.

  9. Measles high school vaccination program, 2014-2015: online survey of parents in NSW, Australia.

    PubMed

    Nicholl, Sonya; Seale, Holly; Campbell-Lloyd, Sue

    2018-06-14

    In 2014, a high school-based measles supplementary immunisation activity (SIA) took place in New South Wales (NSW), Australia, in response to a large number of adolescents being identified as undervaccinated or unvaccinated against measles. The program focused on areas of NSW where previous measles outbreaks had occurred and where large numbers of undervaccinated adolescents lived. More than 11 000 students were vaccinated in 2014, and the program continued in 2015, when more than 4000 students in Years 11 and 12 were vaccinated. Parents of students vaccinated during the program were surveyed to determine their level of satisfaction with the program. An online link to the anonymous survey with instructions was sent in a text message between August 2015 and May 2016 to parents of students who had consented or been vaccinated during the 2014 and 2015 measles, mumps and rubella (MMR) supplementary immunisation activities (SIAs). Responses were received from parents in all Local Health Districts (LHDs), and response rates ranged from <1% to 21% across different districts with 59% of the total number of complete responses from three LHDs. Overall, parents were satisfied with the MMR program, its resources and how it was implemented. Suggestions were received to improve consent processes, increase student involvement and increase school staff accountability. More than half of the parents reported difficulty finding their child's previous vaccination record. Improving vaccination record access and management was highlighted as an area of improvement in the program. Although response rates were low, the survey has generated important ideas that may help to further improve implementation of school vaccination programs, including allowing electronic consent, increasing student engagement, improving access to previous vaccination records and increasing school staff accountability.

  10. Analysis of the Auckland 2014 measles outbreak indicates that adolescents and young adults could benefit from catch-up vaccination.

    PubMed

    Reynolds, Gary; Dias, Cassandra; Thornley, Simon; King, Ronald; Morrison, Anne; Matson, Angela; Hoskins, Richard

    2015-09-25

    To analyse the epidemiology, serology and vaccine effectiveness in a recent New Zealand measles outbreak that started in Auckland, from December, 2013 to June, 2014, to guide further preventive measures. Cases had a clinically compatible illness, which was either confirmed by PCR or serology, or were linked to a laboratory confirmed case. A total of 113 cases with 3,113 contacts were traced and managed in the Auckland region. Thirteen overseas acquired cases, produced a total of 98 locally acquired secondary cases, (plus two cases with unknown travel history). The majority of cases occurred in adolescents and young adults; 68/113 cases (60.1%) were aged 10 to 19 years. Among cases, 38.9% (44/113) were unimmunised, and 31.8% (36/113) had unknown immunisation status. A further 15.0% (17/113) of cases had received one or two doses of measles, mumps, rubella (MMR) vaccine. Of the contacts who underwent serological testing for immunity (n=735), the lowest levels of serological immunity were observed in people aged 10 to 24 years. Vaccine effectiveness was calculated for the 15-24 year age cohort at 92% (95%CI; 82-97). Results suggest that an adolescent catch-up immunisation programme would prevent further outbreaks of imported measles.

  11. Measles hectic in Pakistan; Upsurge versus the lurking vaccination.

    PubMed

    2015-02-01

    Measles has claimed more lives than anticipated, as the outbreaks hit Pakistan severely in 2013 as compared to 2012. Claiming 350 lives through the year 2013, Measles became a headache for the health agencies, authorities and common people. The sudden appearance of the virus in different parts of the country both rural and urban at the same time can be linked to more than one cause. The notable being corruption in health system, poor health infrastructure, destabilized routine immunization, shortage in number of vaccinators, negligence among parents, and floods. As a consequence of these causative factors, the unclear picture of immunization coverage can be presumed as the ultimate etiology of outbreaks in such numbers. Therefore, there is an urgent need to draw out the actual data of immunisation coverage and focus on elimination of hurdles in the road to success in fully coverage with vaccines.

  12. Assessment of the Epidemiology and Burden of Measles in Southern Mozambique

    PubMed Central

    Mandomando, Inácio; Naniche, Denise; Pasetti, Marcela F.; Cuberos, Lilian; Sanz, Sergi; Vallès, Xavier; Sigauque, Betuel; Macete, Eusébio; Nhalungo, Delino; Kotloff, Karen L.; Levine, Myron M.; Alonso, Pedro L.

    2011-01-01

    Measles has been a major killer among vaccine-preventable diseases in children < 5 years of age in developing countries. Despite progress in global efforts to reduce mortality, measles remains a public health problem. Hospital-based measles surveillance was conducted in Manhica, Mozambique (July 2001–September 2004). Suspected cases and community-based controls were enrolled, and blood was collected for immunoglobulin M (IgM) confirmation. Two hundred fifty-three suspected cases and 477 controls were enrolled, with 85% (216 of 253) cases reported during a measles outbreak. Measles-IgM confirmation was 30% among suspected cases and 5% in controls. Fifty-eight percent (14 of 24) of laboratory-confirmed cases had records indicating previous measles vaccination. Mortality was 3% (8 of 246) among cases and 1% among controls (6 of 426). Forty-five percent (33 of 74) of cases were < 24 months of age and 22% occurred in infants < 9 months of age and were associated with a high case-fatality rate (25%). Our data suggest that improved diagnostics, new tools to protect infants < 9 months of age, and a supplemental dose of measles vaccine could assist measles control. PMID:21734140

  13. Assessment of the epidemiology and burden of measles in Southern Mozambique.

    PubMed

    Mandomando, Inácio; Naniche, Denise; Pasetti, Marcela F; Cuberos, Lilian; Sanz, Sergi; Vallès, Xavier; Sigauque, Betuel; Macete, Eusébio; Nhalungo, Delino; Kotloff, Karen L; Levine, Myron M; Alonso, Pedro L

    2011-07-01

    Measles has been a major killer among vaccine-preventable diseases in children < 5 years of age in developing countries. Despite progress in global efforts to reduce mortality, measles remains a public health problem. Hospital-based measles surveillance was conducted in Manhica, Mozambique (July 2001-September 2004). Suspected cases and community-based controls were enrolled, and blood was collected for immunoglobulin M (IgM) confirmation. Two hundred fifty-three suspected cases and 477 controls were enrolled, with 85% (216 of 253) cases reported during a measles outbreak. Measles-IgM confirmation was 30% among suspected cases and 5% in controls. Fifty-eight percent (14 of 24) of laboratory-confirmed cases had records indicating previous measles vaccination. Mortality was 3% (8 of 246) among cases and 1% among controls (6 of 426). Forty-five percent (33 of 74) of cases were < 24 months of age and 22% occurred in infants < 9 months of age and were associated with a high case-fatality rate (25%). Our data suggest that improved diagnostics, new tools to protect infants < 9 months of age, and a supplemental dose of measles vaccine could assist measles control.

  14. A Two-Center Randomized Trial of an Additional Early Dose of Measles Vaccine: Effects on Mortality and Measles Antibody Levels.

    PubMed

    Fisker, Ane B; Nebie, Eric; Schoeps, Anja; Martins, Cesario; Rodrigues, Amabelia; Zakane, Alphonse; Kagone, Moubassira; Byberg, Stine; Thysen, Sanne M; Tiendrebeogo, Justin; Coulibaly, Boubacar; Sankoh, Osman; Becher, Heiko; Whittle, Hilton C; van der Klis, Fiona R M; Benn, Christine S; Sie, Ali; Müller, Olaf; Aaby, Peter

    2018-05-02

    In addition to protecting against measles, measles vaccine (MV) may have beneficial nonspecific effects. We tested the effect of an additional early MV on mortality and measles antibody levels. Children aged 4-7 months at rural health and demographic surveillance sites in Burkina Faso and Guinea-Bissau were randomized 1:1 to an extra early standard dose of MV (Edmonston-Zagreb strain) or no extra MV 4 weeks after the third diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenzae type b vaccine. All children received routine MV at 9 months. We assessed mortality through home visits and compared mortality from enrollment to age 3 years using Cox proportional hazards models, censoring for subsequent nontrial MV. Subgroups of participants had blood sampled to assess measles antibody levels. Among 8309 children enrolled from 18 July 2012 to 3 December 2015, we registered 145 deaths (mortality rate: 16/1000 person-years). The mortality was lower than anticipated and did not differ by randomization group (hazard ratio, 1.05; 95% confidence interval, 0.75-1.46). At enrollment, 4% (16/447) of children in Burkina Faso and 21% (90/422) in Guinea-Bissau had protective measles antibody levels. By age 9 months, no measles-unvaccinated/-unexposed child had protective levels, while 92% (306/333) of early MV recipients had protective levels. At final follow-up, 98% (186/189) in the early MV group and 97% (196/202) in the control group had protective levels. Early MV did not reduce all-cause mortality. Most children were susceptible to measles infection at age 4-7 months and responded with high antibody levels to early MV. NCT01644721.

  15. Progress in global measles control and mortality reduction, 2000-2007.

    PubMed

    2008-12-05

    Despite the availability of a safe and effective vaccine since 1963, measles has been a major killer of children in developing countries (causing an estimated 750,000 deaths as recently as 2000), primarily because of underutilization of the vaccine. At the World Health Assembly in 2008, all World Health Organization (WHO) member states reaffirmed their commitment to achieving a 90% reduction in measles mortality by 2010 compared with 2000, a goal that was established in 2005 as part of the Global Immunization Vision and Strategy (2). This WHO-UNICEF comprehensive strategy for measles mortality reduction (1) focuses on 47 priority countries. The strategy's components include 1) achieving and maintaining high coverage (>90%) with the routinely scheduled first dose of measles-containing vaccine (MCV1) among children aged 1 year; 2) ensuring that all children receive a second opportunity for measles immunization (either through a second routine dose or through periodic supplementary immunization activities [SIAs]); 3) implementing effective laboratory-supported disease surveillance; and 4) providing appropriate clinical management for measles cases. This report updates previously published reports and describes immunization and surveillance activities implemented during 2007. Increased routine measles vaccine coverage and SIAs implemented during 2000--2007 resulted in a 74% decrease in the estimated number of measles deaths globally. An estimated 197,000 deaths from measles occurred in 2007; of these, 136,000 (69%) occurred in the WHO South-East Asian Region. Achievement of the 2010 goal will require full implementation of measles mortality reduction strategies, especially in the WHO South-East Asian Region.

  16. Non-specific effect of measles vaccination on overall child mortality in an area of rural India with high vaccination coverage: a population-based case-control study.

    PubMed Central

    Kabir, Zubair; Long, Jean; Reddaiah, Vankadara P.; Kevany, John; Kapoor, Suresh K.

    2003-01-01

    OBJECTIVE: To determine whether vaccination against measles in a population with sustained high vaccination coverage and relatively low child mortality reduces overall child mortality. METHODS: In April and May 2000, a population-based, case-control study was conducted at Ballabgarh (an area in rural northern India). Eligible cases were 330 children born between 1 January 1991 and 31 December 1998 who died aged 12-59 months. A programme was used to match 320 controls for age, sex, family size, and area of residence from a birth cohort of 15 578 born during the same time period. FINDINGS: The analysis used 318 matched pairs and suggested that children aged 12-59 months who did not receive measles vaccination in infancy were three times more likely to die than those vaccinated against measles. Children from lower caste households who were not vaccinated in infancy had the highest risk of mortality (odds ratio, 8.9). A 27% increase in child mortality was attributable to failure to vaccinate against measles in the study population. CONCLUSION: Measles vaccine seems to have a non-specific reducing effect on overall child mortality in this population. If true, children in lower castes may reap the greatest gains in survival. The findings should be interpreted with caution because the nutritional status of the children was not recorded and may be a residual confounder. "All-cause mortality" is a potentially useful epidemiological endpoint for future vaccine trials. PMID:12764490

  17. Non-specific effect of measles vaccination on overall child mortality in an area of rural India with high vaccination coverage: a population-based case-control study.

    PubMed

    Kabir, Zubair; Long, Jean; Reddaiah, Vankadara P; Kevany, John; Kapoor, Suresh K

    2003-01-01

    To determine whether vaccination against measles in a population with sustained high vaccination coverage and relatively low child mortality reduces overall child mortality. In April and May 2000, a population-based, case-control study was conducted at Ballabgarh (an area in rural northern India). Eligible cases were 330 children born between 1 January 1991 and 31 December 1998 who died aged 12-59 months. A programme was used to match 320 controls for age, sex, family size, and area of residence from a birth cohort of 15 578 born during the same time period. The analysis used 318 matched pairs and suggested that children aged 12-59 months who did not receive measles vaccination in infancy were three times more likely to die than those vaccinated against measles. Children from lower caste households who were not vaccinated in infancy had the highest risk of mortality (odds ratio, 8.9). A 27% increase in child mortality was attributable to failure to vaccinate against measles in the study population. Measles vaccine seems to have a non-specific reducing effect on overall child mortality in this population. If true, children in lower castes may reap the greatest gains in survival. The findings should be interpreted with caution because the nutritional status of the children was not recorded and may be a residual confounder. "All-cause mortality" is a potentially useful epidemiological endpoint for future vaccine trials.

  18. Seroprevalence of measles, mumps and rubella among young adults, after 20 years of universal 2-dose MMR vaccination in Israel

    PubMed Central

    Levine, Hagai; Zarka, Salman; Ankol, Omer E; Rozhavski, Vladi; Davidovitch, Nadav; Aboudy, Yair; Balicer, Ran D

    2015-01-01

    Evidence-based vaccination policy is important for the global and local efforts of achieving control over measles. In 2007, the first Israeli birth cohort to be twice vaccinated during childhood with Measles-Mumps-Rubella vaccine reached adulthood. In parallel, Israel experienced its largest measles outbreak since 1994. We aimed to assess the seroprevalence of measles IgG antibodies and concordance with rubella and mumps seroprevalence among young Israeli adults born 1988–9 in comparison to previous birth cohorts, in order to inform evidence based prevention policy. We conducted a seroprevalence study of IgG antibodies among 439 Israeli adults born in 1988–9, based on a representative sample of sera collected at age 18–19 upon recruitment to mandatory military service in 2007. In total, 85.7% were seropositive for measles as compared with 95.6% in the 1996 recruitment (P < 0.001). The absolute decline was significant both for males (8.8%, P = 0.001) and females (12.1%, P < 0.001). There were no significant differences in seropositivity by gender, years of education, country of birth or smoking status. Rubella seropositivity among measles seropositives was 90.4%, significantly (P < 0.001) higher than 72.1% among measles seronegatives. Mumps seropositivity among measles seropositives was 87.0%, significantly (P < 0.001) higher than 62.3% among measles seronegatives. Results were similar for Israeli-born only. Our findings indicate that measles seroprevalence decreased after the last change in vaccination policy and reach sub-optimal level. Until global eradication is reached, a proactive vaccination program to supplement routine childhood vaccination program should be considered in Israel and in other countries. PMID:25891446

  19. Recurring measles epidemic in Vietnam 2005-2009: implication for strengthened control strategies.

    PubMed

    Nmor, Jephtha C; Thanh, Hoang T; Goto, Kensuke

    2011-01-27

    Measles remains a serious vaccine preventable cause of mortality in developing nations. Vietnam is aiming to achieve the level of immunity required to eliminate measles by maintaining a high coverage of routine first vaccinations in infants, routine second vaccinations at school entry and supplementary local campaigns in high-risk areas. Regular outbreaks of measles are reported, during 2005-2009. National measles case-based surveillance data collected during 2005-June 2009 was analyzed to assess the epidemiological trend and risk factors associated with measles outbreak in Vietnam. Of the 36,282 measles suspected cases reported nationwide, only 7,086 cases were confirmed through laboratory examination. Although cyclical outbreaks occurred between 2005 and 2009, there was no definite trend in measles outbreaks during these periods. Overall, 2438 of measles confirmed cases were among children ≤5 years and 3068 cases were among people ≥16 years. The distribution with respect to gender skewed towards male (3667 cases) significant difference was not observed (P= 0.1693). Unsurprisingly, 4493 of the confirmed cases had no history of vaccination (X(2) <0.01). The northern and highland regions were identified as the main endemic foci and the spatial distribution changed with time. The occurrence of cases, in a considerable proportion of vaccinated population, is not only a reflection of the high vaccination coverage in Vietnam but also portrays a possibility of less than 100% vaccine efficacy. More so, in order to prevent measles in adults, high-risk groups must be identified and catch-up for selected groups selected. This study therefore reinforces the need for continued improvement of surveillance system and to probe into the possible role of changes in age-distribution of cases if the effective control of measles is to be achieved.

  20. [Surveillance Plan on Recent Outbreak of Measles and Rubella in Catalonia, Spain].

    PubMed

    Jané, Mireia; Torner, Nuria; Vidal, Ma José

    2015-01-01

    Measles and rubella are two immuno-preventive illnesses. In Catalonia, since 1988 all children are given two doses of measles and rubella vaccine with high levels of vaccination coverage. The measles elimination programme has been carried out since 1990 in Catalonia. This programme includes achieving and keeping high immunization levels among population with high vaccination coverage, intense epidemiological surveillance and an immediate response to the appearance of a case or outbreak. In 2014, the measles incidence rate was 1.9 cases/ 100,000 inhabitants. There were 4 recent outbreaks in 2006, 2011, 2013 and 2014 that affected 381, 289, 31 and 124 people respectively. All outbreaks were triggered by an imported case. In 2011 and 2014 measles outbreaks, 6% and 5.5% of affected people were health care workers. All outbreaks presented a great variety of measles genotypes. Concerning rubella elimination programme, since 2002, 68 cases of postnatal rubella and 5 cases of congenital rubella were confirmed. Regarding measles and rubella surveillance and control, in addition to strengthen vaccination coverage, it is essential immediate notification, within the first 24 hours since suspicion and laboratory confirmation. In addition there is a need to enforce vaccination among health care workers as well as in other susceptible and unvaccinated people. It is recommended to vaccinate all people who were born after 1966 and who have not been vaccinated with two doses of trivalent measles-mumps-rubella vaccine. Furthermore, we have to emphasize that the progress concerning genotypes study allows identifying various imported cases from other European countries with active outbreaks, aspect that makes easier the surveillance of these illnesses.

  1. Protection of Mice from Fatal Measles Encephalitis by Vaccination with Vaccinia Virus Recombinants Encoding Either the Hemagglutinin or the Fusion Protein

    NASA Astrophysics Data System (ADS)

    Drillien, Robert; Spehner, Daniele; Kirn, Andre; Giraudon, Pascale; Buckland, Robin; Wild, Fabian; Lecocq, Jean-Pierre

    1988-02-01

    Vaccinia virus recombinants encoding the hemagglutinin or fusion protein of measles virus have been constructed. Infection of cell cultures with the recombinants led to the synthesis of authentic measles proteins as judged by their electrophoretic mobility, recognition by antibodies, glycosylation, proteolytic cleavage, and presentation on the cell surface. Mice vaccinated with a single dose of the recombinant encoding the hemagglutinin protein developed antibodies capable of both inhibiting hemagglutination activity and neutralizing measles virus, whereas animals vaccinated with the recombinant encoding the fusion protein developed measles neutralizing antibodies. Mice vaccinated with either of the recombinants resisted a normally lethal intracerebral inoculation of a cell-associated measles virus subacute sclerosing panencephalitis strain.

  2. [Measles and pregnancy].

    PubMed

    Anselem, Olivia; Tsatsaris, Vassilis; Lopez, Emmanuel; Krivine, Anne; Le Ray, Camille; Loulergue, Pierre; Floret, Daniel; Goffinet, Francois; Launay, Odile

    2011-11-01

    Because of insufficient vaccine coverage, there is an outbreak of measles since 2008 in France with an increasing incidence of cases, most of them among children less than 1 year old or young adults. When measles occurs during pregnancy, maternal and fetal morbidity is increased. Particularly pregnant women are exposed to a higher risk of severe respiratory distress that might cause death. Measles virus can be detected in the placenta. Placental infection appears to be involved in some cases of fetal death. The virus is not responsible for congenital defects but can induce histologic damages inside the placenta which may lead to fetal death. Major perinatal risks are also miscarriage and prematurity. When measles occurs in late pregnancy, congenital infection is possible with variable expression and a risk of subacute sclerosing panencephalitis. Non immune pregnant women or neonates exposed to measles should receive an immunoglobulin prophylaxis within 6 days after contact in order to reduce the risk of infection and severe morbidity. In case of declared measles infection, symptomatic treatment can be proposed and tocolysis can be used if preterm labor is associated. Daily fetal monitoring during the 14 days following the beginning of the eruption can be offered when the fetus is viable. Vaccination is recommended for the people born in France after 1980 with 2 doses of vaccine against measles, rubeola and mumps. Measles vaccine, an attenuated living vaccine, should not be administered during pregnancy but must be proposed before pregnancy or during the post-partum period. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  3. Epidemiological analysis of measles and evaluation of measles surveillance system performance in Iraq, 2005-2010.

    PubMed

    Jasem, Jagar; Marof, Kawa; Nawar, Adnan; Monirul Islam, K M

    2012-03-01

    The objectives of this study were to identify the risk factors for measles and low vaccination rates, to evaluate the performance of surveillance, and to calculate vaccine effectiveness and failure in Iraq for the years 2005 to 2010. Logistic regression was used on measles surveillance data from Iraq obtained during the period 1 January 2005 to 31 December 2010; adjusted odds ratios were calculated. The performance of surveillance was evaluated according to World Health Organization (WHO) guidelines. Of 18,746 suspected cases, a measles diagnosis was made for 81.4%. Children aged 1-5 years were the most affected (>48%). The odds of measles were significantly higher in the central and southern provinces than in the northern provinces. Those vaccinated with at least one dose of measles-containing vaccine had a 3.7-times lower risk of contracting measles than those who were not vaccinated. Lower odds of vaccination were noted for adults aged 18 years and older and those living in central and southern provinces, as well as those living outside the capital city of a province. Three WHO performance indicators were lower than the recommended cut-off levels. A vaccine failure rate of 66.1% and effectiveness of 90.03% were estimated. Measles continues to be an important cause of morbidity in Iraq. Improvements in vaccine coverage, proper vaccine handling, and prompt reporting of suspected cases are all necessary to eliminate measles from Iraq. Copyright © 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  4. Progress toward the 2012 measles elimination goal--Western Pacific Region, 1990-2008.

    PubMed

    2009-06-26

    In 2003, the World Health Organization (WHO) Regional Committee of the Western Pacific Region (WPR) formally declared a measles elimination goal, and in 2005, the committee established a target date of 2012 for regional measles elimination. Key strategies recommended by WHO for achievement of measles elimination include 1) very high (>or=95%) vaccination coverage with 2 doses of measles-containing vaccine (MCV1 and MCV2) through routine vaccination and/or supplemental immunization activities (SIAs); 2) high-quality case-based measles surveillance; and 3) access to an accredited measles laboratory network for testing of suspected measles cases and identification of measles virus genotypes. This report describes progress toward measles elimination in the WPR through 2008. Measles likely has been eliminated or nearly eliminated in 24 of the 37 countries and areas in the WPR (referred to in this report as countries). However, large numbers of measles cases continue to be reported from several countries. During 2008, a total of 131,441 confirmed measles cases (98.4 per million population) were reported from China and 11,015 cases (86.1 per million population) from Japan, two countries that account for 82% of the region's population and >97% of its confirmed measles cases. Intensified efforts by WPR countries, particularly China and Japan, will be required to achieve the 2012 goal.

  5. A correlation of measles specific antibodies and the number of plasmacytoid dendritic cells is observed after measles vaccination in 9 month old infants

    PubMed Central

    García-León, Miguel L; Bonifaz, Laura C; Espinosa-Torres, Bogart; Hernández-Pérez, Brenda; Cardiel-Marmolejo, Lino; Santos-Preciado, José I; Wong-Chew, Rosa M

    2015-01-01

    Measles virus (MeV) represents one of the main causes of death among young children, particularly in developing countries. Upon infection, MeV controls both interferon induction (IFN) and the interferon signaling pathway which results in a severe host immunosuppression that can persists for up to 6 mo after infection. Despite the global biology of MeV infection is well studied, the role of the plasmacytoid dendritic cells (pDCs) during the host innate immune response after measles vaccination remains largely uncharacterized. Here we investigated the role of pDCs, the major producers of interferon in response to viral infections, in the development of adaptive immune response against MeV vaccine. We report that there is a strong correlation between pDCs population and the humoral immune response to Edmonston Zagreb (EZ) measles vaccination in 9-month-old mexican infants. Five infants were further evaluated after vaccination, showing a clear increase in pDCs at baseline, one week and 3 months after immunization. Three months postvaccination they showed increase in memory T-cells and pDCs populations, high induction of adaptive immunity and also observed a correlation between pDCs number and the humoral immune response. These findings suggest that the development and magnitude of the adaptive immune response following measles immunization is directly dependent on the number of pDCs of the innate immune response. PMID:26075901

  6. Perceptions of measles, pneumonia, and meningitis vaccines among caregivers in Shanghai, China, and the health belief model: a cross-sectional study.

    PubMed

    Wagner, Abram L; Boulton, Matthew L; Sun, Xiaodong; Mukherjee, Bhramar; Huang, Zhuoying; Harmsen, Irene A; Ren, Jia; Zikmund-Fisher, Brian J

    2017-06-12

    In China, the measles vaccine is offered for free whereas the pneumococcal vaccine is a for-fee vaccine. This difference has the potential to influence how caregivers evaluate whether a vaccine is important or necessary for their child, but it is unclear if models of health behavior, such as the Health Belief Model, reveal the same associations for different diseases. This study compares caregiver perceptions of different diseases (measles, pneumonia and meningitis); and characterizes associations between Health Belief Model constructs and both pneumococcal vaccine uptake and perceived vaccine necessity for pneumonia, measles, and meningitis. Caregivers of infants and young children between 8 months and 7 years of age from Shanghai (n = 619) completed a written survey on their perceptions of measles, pneumonia, and meningitis. We used logistic regression models to assess predictors of pneumococcal vaccine uptake and vaccine necessity. Only 25.2% of children had received a pneumococcal vaccine, although most caregivers believed that pneumonia (80.8%) and meningitis (92.4%), as well as measles (93.2%), vaccines were serious enough to warrant a vaccine. Perceived safety was strongly associated with both pneumococcal vaccine uptake and perceived vaccine necessity, and non-locals had 1.70 times higher odds of pneumonia vaccine necessity than non-locals (95% CI: 1.01, 2.88). Most factors had a similar relationship with vaccine necessity, regardless of disease, indicating a common mechanism for how Chinese caregivers decided which vaccines are necessary. Because more caregivers believed meningitis needed a vaccine than pneumonia, health care workers should emphasize pneumococcal vaccination's ability to protect against meningitis.

  7. Vaccination in pulses: a strategy for global eradication of measles and polio?

    PubMed

    Nokes, D J; Swinton, J

    1997-01-01

    Recent American successes against poliomyelitis and measles have been attributed to repeated 'pulse' vaccination campaigns. Whilst logistic and economic constraints will be crucial, a deeper epidemiological understanding of the mechanism, strengths and weaknesses of pulse vaccination will optimize the chances of success elsewhere in the world.

  8. The effect of heterogeneity in uptake of the measles, mumps, and rubella vaccine on the potential for outbreaks of measles: a modelling study.

    PubMed

    Glasser, John W; Feng, Zhilan; Omer, Saad B; Smith, Philip J; Rodewald, Lance E

    2016-05-01

    Vaccination programmes to prevent outbreaks after introductions of infectious people aim to maintain the average number of secondary infections per infectious person at one or less. We aimed to assess heterogeneity in vaccine uptake and other characteristics that, together with non-random mixing, could increase this number and to evaluate strategies that could mitigate their impact. Because most US children attend elementary school in their own neighbourhoods, surveys of children entering elementary school (age 5 years before Sept 1) allow assessment of spatial heterogeneity in the proportion of children immune to vaccine-preventable diseases. We used data from a 2008 school-entry survey by the Immunization Division of the California Department of Public Health to obtain school addresses; numbers of students enrolled; proportions of enrolled students who had received one or two doses of the measles, mumps, and rubella (MMR) vaccine; and proportions with medical or personal-belief exemptions. Using a mixing model suitable for spatially-stratified populations, we projected the expected numbers of secondary infections per infectious person for measles, mumps, and rubella. We also mapped contributions to this number for measles in San Diego County's 638 elementary schools and its largest district, comprising 200 schools (31%). We then modelled the effect on measles' realised reproduction number (RV) of the following plausible interventions: vaccinating all children with personal-belief exemptions, increasing uptake by 10% to 50% in all low-immunity schools (<90% of students immune) or in only influential (effective daily contact rates >3 or contacts inter-school >30%) low-immunity schools, and increasing private school uptake to the public school average. In 2008, 39 132 children began elementary school in San Diego County, CA, USA. At entry to school, 97% had received at least one dose of the MMR vaccine, with 2·5% having personal-belief exemptions. We note

  9. The sequence of vaccinations and increased female mortality after high-titre measles vaccine: trials from rural Sudan and Kinshasa.

    PubMed

    Aaby, Peter; Ibrahim, Salah A; Libman, Michael D; Jensen, Henrik

    2006-04-05

    West African studies have hypothesized that increased female mortality after high-titre measles vaccine (HTMV) was due to subsequent diphtheria-tetanus-pertussis (DTP) and inactivated polio vaccine (IPV) vaccinations. We tested two deductions from this hypothesis in HTMV studies from rural Sudan and Kinshasa; first, there should be no excess female mortality for HTMV recipients when DTP was not given after HTMV and second, excess female mortality should only be found among those children who received DTP after HTMV. The Sudanese trial randomised 510 children to Edmonston-Zagreb (EZ) HTMV, Connaught HTMV or a control vaccine (meningococcal). Both the Connaught HTMV and the control group received standard measles vaccine at 9 months. In the Kinshasa study 1023 children received one dose of HTMV at 6 months or two doses at 312 and 912 months of age. First, the Sudan trial is one of the few randomised studies of measles vaccine; the EZ HTMV group had lower mortality between 5 and 9 months of age than controls, the mortality ratio (MR) being 0.00 (p = 0.030). This effect was not due to prevention of measles infection. Second, both studies provided evidence that HTMV per se was associated with low mortality. In a combined analysis comparing both HTMV groups with controls, the HTMV groups had a MR of 0.09 (0.01-0.71) between 5 and 9 months of age. In Kinshasa, the HTMV recipients who did not receive simultaneous DTP had an annual mortality rate of only 1.0% between 6 months and 3 years of age. Third, the female-male MR was related to subsequent DTP vaccinations. In Kinshasa, the female-male MR was only 0.40 (0.13-1.27) among the HTMV recipients who did not receive further doses of DTP. In Sudan, the female-male mortality ratio in the EZ group was 3.89 (95% CI 1.02-14.83) and the female-male MR increased with number of doses of DTP likely to have been given during follow-up (trend, p = 0.043). Fourth, in Kinshasa, mortality was higher among children who had received HTMV

  10. Detection of measles, mumps, and rubella viruses.

    PubMed

    Tipples, Graham; Hiebert, Joanne

    2011-01-01

    Measles, mumps, and rubella are infections caused by RNA viruses of the same name and are vaccine preventable. The vaccines are frequently administered in a trivalent form. Laboratory diagnostic methods can include indirect detection via antibody (IgM and IgG) detection methods and direct detection by viral culture or viral genome detection. There are challenges for the laboratory in areas with low prevalence due to high vaccine uptake. In those areas, routine serological methods such as IgM detection may have a reduced positive predictive value and thus require confirmation by other methods. Direct detection of viral genomic material using reverse transcription polymerase chain reaction (RT-PCR) methodologies can play an important role for laboratory confirmation of acute infections. Furthermore, genotyping of these three viruses provides useful molecular epidemiological data for differentiating vaccine from wild-type strains, linking cases and outbreaks, and tracking geographic spread and elimination. The purpose of this chapter is to provide guidance for the laboratory diagnosis of measles, mumps, and rubella virus infections. Where assays are commercially available or previously published, the appropriate references are provided as well as brief comments on the interpretation of results. Detailed protocols are provided for the molecular assays which have been developed and more commonly applied in recent years.

  11. Humoral immune response to measles and varicella vaccination in former very low birth weight preterm infants.

    PubMed

    Ferreira, Carolina Schlindwein Mariano; Perin, Maria Cristina Abrão Aued; Moraes-Pinto, Maria Isabel de; Simão-Gurge, Raquel Maria; Goulart, Ana Lucia; Weckx, Lily Yin; Dos Santos, Amélia Miyashiro Nunes

    Immune response to vaccination in infants born prematurely may be lower than in infants born at full-term. Some clinical factors might be associated with humoral immune response. The objectives of this study were to compare the immune response to measles and varicella vaccination in infants born prematurely with those born at full-term and to analyze factors associated with measles and varicella antibody levels. Prospective study including two groups of infants aged 12 months. One group of infants born prematurely with birth-weight <1500g and who were in follow-up at the outpatient clinic for preterm infants at the institution and other group of infants born at full-term. Infants with malformations, primary immunodeficiency diseases, born to HIV-positive mothers or who had received plasma or immunoglobulin transfusions five months before or three weeks after vaccination were excluded. Plasma antibodies were measured by ELISA and factors associated with antibody levels were assessed by linear regression. Sixty-five premature and 56 full-term infants were included. The percentage of immune individuals after vaccination against measles (100% vs. 100%) and varicella (92.5% vs. 93.2%) were similar in both groups, as well as the antibody levels against measles (2.393 vs. 2.412UI/mL; p=0.970) and varicella (0.551 vs. 0.399UI/mL; p=0.114). Use of antenatal corticosteroids decreased measles antibody levels whereas breastfeeding for more than six months increased varicella antibody levels. Humoral responses to measles and varicella were similar between infants born prematurely and full-term infants. Measles antibody levels were negatively associated with antenatal corticosteroid use; varicella antibodies were positively associated with prolonged breastfeeding. Copyright © 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.

  12. Measles

    MedlinePlus

    ... it in its tracks. Doctors call this "herd immunity." Measles isn't very common, but it is ... get the vaccine get some protection through herd immunity. During a measles outbreak, some people who haven' ...

  13. Investigation of a measles outbreak in Cordillera, Northern Philippines, 2013

    PubMed Central

    Zapanta, Ma Justina; de los Reyes, Vikki Carr; Tayag, Enrique; Magpantay, Rio

    2016-01-01

    Introduction Measles is a highly infectious viral illness that remains one of the leading causes of death among children worldwide. In the Philippines, decreasing routine vaccination coverage from 2007 to 2011 led to local measles outbreaks. A team investigated a measles outbreak reported in Cordillera of the Philippines in May 2013. Methods Measles case data with symptom onset from 2 February to 27 May 2013 were obtained from official sources and verified on site. Data included age, sex, residential address, signs and symptoms and vaccination status. Active case-findings were also conducted for contacts of these cases. The living environments of the cases were investigated. A survey was conducted with the cases and caregivers to understand their knowledge and attitudes about measles. Results There were 50 measles cases identified with an age range from six months to 32 years (median: 16 years). Thirty-two were male (64%). Twenty (40%) were hospitalized with one death. Thirty-two (64%) cases were laboratory confirmed, and 36 (72%) received a single dose of measles vaccine. Overcrowded living environments were observed among many cases. The majority of respondents (46/48, 96%) knew about measles, but there were misconceptions about the cause of measles and how it can be prevented and managed. Conclusion This measles outbreak occurred in an area with low immunization coverage. Achieving 95% measles immunization coverage and strengthening routine immunization strategies to address high-risk populations are recommended. Also, we recommend health education campaigns to include components that address misconceptions about measles. PMID:27766180

  14. Investigation of a measles outbreak in Cordillera, Northern Philippines, 2013.

    PubMed

    Ching, Paola Katrina; Zapanta, Ma Justina; de Los Reyes, Vikki Carr; Tayag, Enrique; Magpantay, Rio

    2016-01-01

    Measles is a highly infectious viral illness that remains one of the leading causes of death among children worldwide. In the Philippines, decreasing routine vaccination coverage from 2007 to 2011 led to local measles outbreaks. A team investigated a measles outbreak reported in Cordillera of the Philippines in May 2013. Measles case data with symptom onset from 2 February to 27 May 2013 were obtained from official sources and verified on site. Data included age, sex, residential address, signs and symptoms and vaccination status. Active case-findings were also conducted for contacts of these cases. The living environments of the cases were investigated. A survey was conducted with the cases and caregivers to understand their knowledge and attitudes about measles. There were 50 measles cases identified with an age range from six months to 32 years (median: 16 years). Thirty-two were male (64%). Twenty (40%) were hospitalized with one death. Thirty-two (64%) cases were laboratory confirmed, and 36 (72%) received a single dose of measles vaccine. Overcrowded living environments were observed among many cases. The majority of respondents (46/48, 96%) knew about measles, but there were misconceptions about the cause of measles and how it can be prevented and managed. This measles outbreak occurred in an area with low immunization coverage. Achieving 95% measles immunization coverage and strengthening routine immunization strategies to address high-risk populations are recommended. Also, we recommend health education campaigns to include components that address misconceptions about measles.

  15. Outbreak of measles in medical students and determination of immune status to measles-mumps-rubella viruses.

    PubMed

    Yalçin, Songül S; Kanra, Güler; Pehlivan, Tamer

    2006-01-01

    We conducted an investigation after a measles outbreak in medical students to determine the immunity of the medical students, the correlation between history and seropositivity, and measles-mumps-rubella vaccine effectiveness. After a preliminary study done during measles outbreak, a cross-sectional study was planned. Serum samples from 322 medical students were tested by enzyme-linked immunosorbent assay, vaccinated volunteers, then re-tested vaccinees. Histories of measles, mumps and rubella were taken. Of 322 students, seven students (2.2%) were seronegative to measles, 13 (4.0%) to mumps, and 13 (4.0%) to rubella. Historical information revealed 30.4% of sensitivity in measles and 34.3% in mumps, whereas 5.2% in rubella. Among those seronegative on admission and vaccinated, seroconversion rates were 100% (5/5), 90.9% (10/11), 100% (8/8) in measles, mumps and rubella vaccine, respectively. Of 265 vaccinated students parotitis was detected in one female student, arthralgia was observed in three students (1.1%) and myalgia in two (0.7%), and 240 students reported no side effects. We detected the unreliable historical screening and high seroprevalence of measles, mumps and rubella in prevaccine era for mumps and rubella and, safety of MMR vaccination in medical students in Turkey.

  16. An evaluation of respiratory administration of measles vaccine for prevention of acute lower respiratory infections in children.

    PubMed

    Higginson, Daisy; Theodoratou, Evropi; Nair, Harish; Huda, Tanvir; Zgaga, Lina; Jadhav, Suresh S; Omer, Saad B; Rudan, Igor; Campbell, Harry

    2011-04-13

    Measles was responsible for an estimated 100,000 deaths worldwide in 2008. Despite being a vaccine-preventable disease, measles remains a major cause of morbidity and mortality in young children. Although a safe and effective injectable measles vaccine has been available for over 50 years it has not been possible to achieve the uniformly high levels of coverage (required to achieve measles eradication) in most parts of the developing world. Aerosolised measles vaccines are now under development with the hope of challenging the delivery factors currently limiting the coverage of the existing vaccine. We used a modified CHNRI methodology for setting priorities in health research investments to assess the strengths and weaknesses of this emerging intervention to decrease the burden of childhood pneumonia. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging aerosol vaccines against measles relevant to several criteria of interest. Although there are a number of different aerosol vaccine approaches under development, for the purpose of this exercise, all were considered as one intervention. The criteria of interest were: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to the sensitive nature of their involvement in such exercises. They answered questions from the CHNRI framework and their "collective optimism" towards each criterion was documented on a scale from 0 to 100%. The

  17. Analysis of the cause of increased measles incidence in Xinjiang, China in 2004.

    PubMed

    Yu, Xuelian; Wang, Shaohua; Guan, Jing; Mahemuti; Purhati; Gou, Aili; Liu, Quanming; Jin, Xin; Ghildyal, Reena

    2007-06-01

    Increased number of measles cases were reported from Xinjiang province of China in 2004, relative to previous years. This study aimed to identify the direct cause for this increase in measles morbidity and the major reason for the relatively high measles incidence rate in Xinjiang. The epidemiologic and laboratory surveillance data for measles cases of 2004 were analyzed and a seroepidemiologic investigation involving 1024 subjects, mainly children aged less than 15 years, was conducted in Xinjiang. A questionnaire including demographic and vaccination data was completed by interview and blood samples drawn from surveillance subjects. Sera were analyzed for measles IgM (cases) and IgG (cases and surveillance). Data were assessed for their relationship with high measles incidence rate. 6271 measles cases were reported from Xinjiang in 2004 with a morbidity of 33.7 cases per 100,000 population. 83% of the cases were children less than 12-year-old. 50% of the serum samples were measles IgM positive and 69% were measles IgG positive. 2014 serum samples were collected in the seroepidemiologic survey. The overall IgG antibody seropositivity rate was 89%, preschool children having the lowest seropositivity rate (86%). There was a significant difference in IgG positive rates as well as IgG titers between unvaccinated and vaccinated subjects with each subsequent dose leading to further increase in titer. Low routine measles vaccine coverage was the major probable cause contributing to the increased measles cases in 2004 in Xinjiang and the high measles infection rate overall. The national 2-dose measles vaccination regimen is effective if delivered appropriately.

  18. Measles Outbreak in Pediatric Hematology and Oncology Patients in Shanghai, 2015

    PubMed Central

    Ge, Yan-Ling; Zhai, Xiao-Wen; Zhu, Yan-Feng; Wang, Xiang-Shi; Xia, Ai-Mei; Li, Yue-Fang; Zeng, Mei

    2017-01-01

    Background: Despite substantial progress toward measles control are making in China, measles outbreaks in immunocompromised population still pose a challenge to interrupt endemic transmission. This study aimed to investigate the features of measles in pediatric hematology and oncology patients and explore the reasons behind the outbreak. Methods: We collected demographic, epidemiological, and clinical data of immunocompromised measles children. All suspected measles cases were laboratory-confirmed based on the presence of measles IgM and/or identification of measles RNA. The clinical data were statistically analyzed by t-test for continuous variables and Fisher's exact test for categorical variables. Results: From March 9 to July 25 in 2015, a total of 23 children with malignancies and post hematopoietic stem cell transplantation (post-HSCT) were notified to develop measles in Shanghai. Of these 23 patients with the median age of 5.5 years (range: 11 months–14 years), 20 (87.0%) had received 1–3 doses of measles vaccine previously; all patients had fever with the median fever duration of 8 days; 21 (91.3%) had cough; 18 (78.3%) had rash; 13 (56.5%) had Koplik's spot; 13 (56.5%) had complications including pneumonia and acute liver failure; and five (21.7%) vaccinated patients died from severe pneumonia or acute liver failure. Except the first patient, all patients had hospital visits within 7–21 days before measles onset and 20 patients were likely to be exposed to each other. Conclusions: The outcome of measles outbreak in previously vaccinated oncology and post-HSCT pediatric patients during chemotherapy and immunosuppressant medication was severe. Complete loss of protective immunity induced by measles vaccine during chemotherapy was the potential reason. Improved infection control practice was critical for the prevention of measles in malignancy patients and transplant recipients. PMID:28524832

  19. Monitoring progress towards the elimination of measles in China: an analysis of measles surveillance data

    PubMed Central

    Ma, Chao; Hao, Lixin; Zhang, Yan; Su, Qiru; Rodewald, Lance; An, Zhijie; Yu, Wenzhou; Ma, Jing; Wen, Ning; Wang, Huiling; Liang, Xiaofeng; Wang, Huaqing; Yang, Weizhong; Li, Li

    2014-01-01

    Abstract Objective To analyse the epidemiology of measles in China and determine the progress made towards the national elimination of the disease. Methods We analysed measles surveillance data – on the age, sex, residence and vaccination status of each case and the corresponding outcome, dates of onset and report and laboratory results – collected between January 2005 and October 2013. Findings Between 2005 and October 2013, 596 391 measles cases and 368 measles-related deaths were reported in China. Annual incidence, in cases per 100 000 population, decreased from 9.95 in 2008 to 0.46 in 2012 but then rose to more than 1.96 in 2013. The number of provinces that reported an annual incidence of less than one case per million population increased from one in 2009 to 15 in 2012 but fell back to one in 2013. Median case age decreased from 83 months in 2005 to 14 months in 2012 and 11 months in January to October 2013. Between 2008 and 2012, the incidence of measles in all age groups, including those not targeted for vaccination, decreased by at least 93.6%. However, resurgence started in late 2012 and continued into 2013. Of the cases reported in January to October 2013, 40% were aged 8 months to 6 years. Conclusion Although there is evidence of progress towards the elimination of measles from China, resurgence in 2013 indicated that many children were still not being vaccinated on time. Routine immunization must be strengthened and the remaining immunity gaps need to be identified and filled. PMID:24839323

  20. Measles Vaccine Strain Genotype A from the Skin Rash of a DiGeorge Patient on a TNF Inhibitor

    PubMed Central

    Tam, Pui-Ying Iroh; Hanisch, Benjamin R.; Klammer, Kate; DeVries, Aaron S.

    2015-01-01

    Isolation of measles virus is typically from respiratory, blood or urine specimens. We describe the first known case of measles vaccine-associated disease in a patient on TNF inhibitor therapy in which genotype A Edmonston vaccine strain virus was identified from skin scrapings of the patient’s rash. PMID:24346604

  1. Cross-Sectional Surveys of Measles Antibodies in the Jiangsu Province of China from 2008 to 2010: The Effect of High Coverage with Two Doses of Measles Vaccine among Children

    PubMed Central

    Hu, Ying; Wang, Zhiguo; Deng, Xiuying; Ma, Fubao; Tao, Hong; Jia, Chengmei; Ding, Xiaoyan; Yang, Haitao; Liu, Pei; Min, Jie

    2013-01-01

    Background Changes in the epidemiological characteristics of measles since 2007 appeared in the Jiangsu province. Although the reported coverage with two doses of measles vaccine was greater than 95% in most regions of the province, measles incidence remained high across the whole province. Cross-sectional serological surveys of measles antibodies in the Jiangsu province of China were conducted from 2008 to 2010 to assess and track population immunity. Methods Measles-specific IgG levels were measured in serum samples using ELISA. GMTs and seroprevalence with 95% CIs were calculated by region, gender, and age. ANOVA and χ2 tests were used to test for statistically significant differences between groups for GMT levels and seroprevalence, respectively. Results Seroprevalence showed a significantly increasing trend annually (CMH χ2 = 40.32, p<0.0001). Although the seroprevalence among children aged 2–15 years was consistently over 95%, vaccine-induced measles antibodies may wane over time. Measles seropositivity in the Jiangsu province was 91.7% (95% CI: 90.1–93.2%) in 2010. Among adults aged 15 to 29-year-olds, the seropositivity rate was 88.4% (95% CI: 82.7–92.8%). Conclusions Vaccination strategies may need to be adjusted depending on the individual age and regions, particularly individuals between the ages of 8 months-14 years old and 20–29 years old. Additional SIAs are likely required to eliminate measles in China. PMID:23825562

  2. Measles vaccination: Threat from related veterinary viruses and need for continued vaccination post measles eradication.

    PubMed

    Cosby, Sara Louise; Weir, Leanne

    2018-01-02

    Measles virus (MV) is the only human virus within the morbillivirus genus of the Paramyxoviridae. The veterinary members are canine distemper virus (CDV), peste des petits ruminants virus (PPRV), Rinderpest Virus (RPV) as well as the marine morbilliviruses phocine distemper virus (PDV), dolphin morbillivirus (DMV) and porpoise morbillivirus (PMV). Morbilliviruses have a severe impact on humans and animal species. They confer diseases which have contributed to morbidity and mortality of the population on a global scale. There is substantial evidence from both natural and experimental infections that morbilliviruses can readily cross species barriers. Of most concern with regard to zoonosis is the more recently reported fatal infection of primates in Japan and China with strains of CDV which have adapted to this host. The close genetic relationship, shared cell entry receptors and similar pathogenesis between the morbilliviruses highlights the potential consequences of complete withdrawal of MV vaccination after eradication. Therefore, it would be prudent to continue the current MV vaccination. Ultimately development of novel, safe vaccines which have higher efficacy against the veterinary morbilliviruses is a priority. These would to protect the human population long term against the threat of zoonosis by these veterinary viruses.

  3. Think globally, act locally: the role of local demographics and vaccination coverage in the dynamic response of measles infection to control.

    PubMed

    Ferrari, M J; Grenfell, B T; Strebel, P M

    2013-08-05

    The global reduction of the burden of morbidity and mortality owing to measles has been a major triumph of public health. However, the continued persistence of measles infection probably not only reflects local variation in progress towards vaccination target goals, but may also reflect local variation in dynamic processes of transmission, susceptible replenishment through births and stochastic local extinction. Dynamic models predict that vaccination should increase the mean age of infection and increase inter-annual variability in incidence. Through a comparative approach, we assess national-level patterns in the mean age of infection and measles persistence. We find that while the classic predictions do hold in general, the impact of vaccination on the age distribution of cases and stochastic fadeout are mediated by local birth rate. Thus, broad-scale vaccine coverage goals are unlikely to have the same impact on the interruption of measles transmission in all demographic settings. Indeed, these results suggest that the achievement of further measles reduction or elimination goals is likely to require programmatic and vaccine coverage goals that are tailored to local demographic conditions.

  4. Mass Measles Vaccination Campaign in Aila Cyclone-Affected Areas of West Bengal, India: An In-depth Analysis and Experiences.

    PubMed

    Mallik, Sarmila; Mandal, Pankaj Kumar; Ghosh, Pramit; Manna, Nirmalya; Chatterjee, Chitra; Chakrabarty, Debadatta; Bagchi, Saumendra Nath; Dasgupta, Samir

    2011-12-01

    Disaster-affected populations are highly vulnerable to outbreaks of measles. Therefore, a mass vaccination against measles was conducted in Aila cyclone-affected blocks of West Bengal, India in July 2009. The objectives of the present report were to conduct an in depth analysis of the campaign, and to discuss the major challenges. A block level micro-plan, which included mapping of the villages, health facilities, temporary settlements of disaster-affected population, communications available, formation of vaccination team, information education communication, vaccine storage, waste disposal, surveillance for adverse events following immunization, supervision and monitoring was developed. The rate of six months to five years old children, who were vaccinated by measles vaccine, was 70.7% and that of those who received one dose of vitamin A was 71.3%. Wastage factor for vaccine doses and auto-disable syringes were 1.09 and 1.07, respectively. Only 13 cases of adverse events following immunization were reported. An average of 0.91 puncture-proof containers per vaccination session was used. Despite the major challenges faced due to difficult to reach areas, inadequate infrastructure, manpower and communication, problems of vaccine storage and transport, the campaign achieved a remarkable success regarding measles vaccine coverage, improvements of cold chain infrastructure, formulating an efficient surveillance and reporting system for adverse events following immunization, building self-confidence of the stakeholders, and developing a biomedical waste disposal system.

  5. Mass Measles Vaccination Campaign in Aila Cyclone-Affected Areas of West Bengal, India: An In-depth Analysis and Experiences

    PubMed Central

    Mallik, Sarmila; Mandal, Pankaj Kumar; Ghosh, Pramit; Manna, Nirmalya; Chatterjee, Chitra; Chakrabarty, Debadatta; Bagchi, Saumendra Nath; Dasgupta, Samir

    2011-01-01

    Disaster-affected populations are highly vulnerable to outbreaks of measles. Therefore, a mass vaccination against measles was conducted in Aila cyclone-affected blocks of West Bengal, India in July 2009. The objectives of the present report were to conduct an in depth analysis of the campaign, and to discuss the major challenges. A block level micro-plan, which included mapping of the villages, health facilities, temporary settlements of disaster-affected population, communications available, formation of vaccination team, information education communication, vaccine storage, waste disposal, surveillance for adverse events following immunization, supervision and monitoring was developed. The rate of six months to five years old children, who were vaccinated by measles vaccine, was 70.7% and that of those who received one dose of vitamin A was 71.3%. Wastage factor for vaccine doses and auto-disable syringes were 1.09 and 1.07, respectively. Only 13 cases of adverse events following immunization were reported. An average of 0.91 puncture-proof containers per vaccination session was used. Despite the major challenges faced due to difficult to reach areas, inadequate infrastructure, manpower and communication, problems of vaccine storage and transport, the campaign achieved a remarkable success regarding measles vaccine coverage, improvements of cold chain infrastructure, formulating an efficient surveillance and reporting system for adverse events following immunization, building self-confidence of the stakeholders, and developing a biomedical waste disposal system. PMID:23115416

  6. Measles Vaccination Coverage among Latino Children Aged 12 to 59 Months in Los Angeles County: A Household Survey.

    ERIC Educational Resources Information Center

    Ewert, Donnell P.; And Others

    1991-01-01

    Examines the results of a household survey of measles vaccination coverage among Hispanic American children aged 12 to 59 months. Between 81 percent and 91 percent of the children have been vaccinated, a percentage insufficient to stop the high rate of measles transmission within this population. Recommends that public health efforts be focused on…

  7. Stop measles in Switzerland - The importance of travel medicine.

    PubMed

    Bühler, Silja; Lang, Phung; Bally, Bettina; Hatz, Christoph; Jaeger, Veronika K

    2017-06-27

    In line with the worldwide strive to combat measles, the Swiss Federal Office of Public Heath (FOPH) launched a National Strategy for measles elimination 2011-2015. In this study, we highlight the importance of travel medicine consultations to complement measles vaccination programmes based on data from the Travel Clinic of the University of Zurich. We analysed measles vaccination data from the Zurich Travel Clinic between July 2010 and February 2016 and focused on three groups: (i) all clients who received the measles vaccination, (ii) all clients aged>two years who received the measles vaccination ("catch-up vaccination"), and (iii) all clients aged>two years and born after 1963 ("FOPH recommended catch-up vaccination"). 107,669 consultations were performed from 2010 to 2016. In 12,470 (11.6%) of these, a measles vaccination was administered; 90.9% measles vaccinations were given during a pre-travel consultation, and 99.4% were administered to individuals aged>two years ("catch-up vaccinations"). An "FOPH recommended catch-up vaccination" was received by 13.6% of all Zurich Travel Clinic clients aged >2years and born after 1963. In this study, we highlight the importance of travel medicine consultations to enhance the measles vaccination coverage in the adult Swiss population. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Predictors of measles vaccination coverage among children 6-59 months of age in the Democratic Republic of the Congo.

    PubMed

    Ashbaugh, Hayley R; Hoff, Nicole A; Doshi, Reena H; Alfonso, Vivian H; Gadoth, Adva; Mukadi, Patrick; Okitolonda-Wemakoy, Emile; Muyembe-Tamfum, Jean Jacques; Gerber, Sue K; Cherry, James D; Rimoin, Anne W

    2018-01-25

    Measles is a significant contributor to child mortality in the Democratic Republic of the Congo (DRC), despite routine immunization programs and supplementary immunization activities (SIA). Further, national immunization coverage levels may hide disparities among certain groups of children, making effective measles control even more challenging. This study describes measles vaccination coverage and reporting methods and identifies predictors of vaccination among children participating in the 2013-2014 DRC Demographic and Health Survey (DHS). We examined vaccination coverage of 6947 children aged 6-59 months. A multivariate logistic regression model was used to identify predictors of vaccination among children reporting vaccination via dated card in order to identify least reached children. We also assessed spatial distribution of vaccination report type by rural versus urban residence. Urban children with educated mothers were more likely to be vaccinated (OR = 4.1, 95% CI: 1.6, 10.7) versus children of mothers with no education, as were children in wealthier rural families (OR = 2.9, 95% CI: 1.9, 4.4). At the provincial level, urban areas more frequently reported vaccination via dated card than rural areas. Results indicate that, while the overall coverage level of 70% is too low, socioeconomic and geographic disparities also exist which could make some children even less likely to be vaccinated. Dated records of measles vaccination must be increased, and groups of children with the greatest need should be targeted. As access to routine vaccination services is limited in DRC, identifying and targeting under-reached children should be a strategic means of increasing country-wide effective measles control. Published by Elsevier Ltd.

  9. Do We Need To Give Measles Vaccine To Children Earlier Than The Currently Recommended Age?

    PubMed

    Jamal, Ammarah; SYahya, Yousuf; Karim, Muhammad Tariq

    2018-01-01

    Measles is a leading cause of death among children. No specific drug has yet been discovered to treat measles but an available vaccine can effectively prevent the infection. In Pakistan children are vaccinated against measles by two doses given at age of nine months onward. The last few years have witnessed an increasing number of measles cases at age lower than nine months. Secondary data analysis of the records of Expanded Program on Immunization from all districts of Sindh was performed from January-April 2016. Data included all patients of any age or gender, fulfilling the World Health Organization case definition of measles, along with positive IgM antibodies for measles in their blood. Data was analysed using windows SPSS version 21.0. Analysis of 658 confirmed measles cases showed an age range of 3 months to 336 months with a mean of 32.82. Most patients (41.4%) belonged to age group 10-24months. Some noteworthy18% of cases were ≤9 months old including 1.8% patients who were ≤6 months age. An unexpected 76 (11.6%) were >60 months of age. 50.6% of the cases were male while 49.4% were female. Most of the patients (73.9%) belonged to urban areas. We conclude that a sizeable number of children are infected by measles before reaching the age of first recommended inoculation against measles. It is affecting people at both extremes of life ranging from as young as three months up to 28 years of age.

  10. A chimeric alphavirus replicon particle vaccine expressing the hemagglutinin and fusion proteins protects juvenile and infant rhesus macaques from measles.

    PubMed

    Pan, Chien-Hsiung; Greer, Catherine E; Hauer, Debra; Legg, Harold S; Lee, Eun-Young; Bergen, M Jeff; Lau, Brandyn; Adams, Robert J; Polo, John M; Griffin, Diane E

    2010-04-01

    Measles remains a major cause of child mortality, in part due to an inability to vaccinate young infants with the current live attenuated virus vaccine (LAV). To explore new approaches to infant vaccination, chimeric Venezuelan equine encephalitis/Sindbis virus (VEE/SIN) replicon particles were used to express the hemagglutinin (H) and fusion (F) proteins of measles virus (MV). Juvenile rhesus macaques vaccinated intradermally with a single dose of VEE/SIN expressing H or H and F proteins (VEE/SIN-H or VEE/SIN-H+F, respectively) developed high titers of MV-specific neutralizing antibody and gamma-interferon (IFN-gamma)-producing T cells. Infant macaques vaccinated with two doses of VEE/SIN-H+F also developed neutralizing antibody and IFN-gamma-producing T cells. Control animals were vaccinated with LAV or with a formalin-inactivated measles vaccine (FIMV). Neutralizing antibody remained above the protective level for more than 1 year after vaccination with VEE/SIN-H, VEE/SIN-H+F, or LAV. When challenged with wild-type MV 12 to 17 months after vaccination, all vaccinated juvenile and infant monkeys vaccinated with VEE/SIN-H, VEE/SIN-H+F, and LAV were protected from rash and viremia, while FIMV-vaccinated monkeys were not. Antibody was boosted by challenge in all groups. T-cell responses to challenge were biphasic, with peaks at 7 to 25 days and at 90 to 110 days in all groups, except for the LAV group. Recrudescent T-cell activity coincided with the presence of MV RNA in peripheral blood mononuclear cells. We conclude that VEE/SIN expressing H or H and F induces durable immune responses that protect from measles and offers a promising new approach for measles vaccination. The viral and immunological factors associated with long-term control of MV replication require further investigation.

  11. Immunogenicity of next-generation HPV vaccines in non-human primates: Measles-vectored HPV vaccine versus Pichia pastoris recombinant protein vaccine.

    PubMed

    Gupta, Gaurav; Giannino, Viviana; Rishi, Narayan; Glueck, Reinhard

    2016-09-07

    Human papillomavirus (HPV) infection is the most common sexually transmitted disease worldwide. HPVs are oncogenic small double-stranded DNA viruses that are the primary causal agent of cervical cancer and other types of cancers, including in the anus, oropharynx, vagina, vulva, and penis. Prophylactic vaccination against HPV is an attractive strategy for preventing cervical cancer and some other types of cancers. However, there are few safe and effective vaccines against HPV infections. Current first-generation commercial HPV vaccines are expensive to produce and deliver. The goal of this study was to develop an alternate potent HPV recombinant L1-based vaccines by producing HPV virus-like particles into a vaccine that is currently used worldwide. Live attenuated measles virus (MV) vaccines have a well-established safety and efficacy record, and recombinant MV (rMV) produced by reverse genetics may be useful for generating candidate HPV vaccines to meet the needs of the developing world. We studied in non-human primate rMV-vectored HPV vaccine in parallel with a classical alum adjuvant recombinant HPV16L1 and 18L1 protein vaccine produced in Pichia pastoris. A combined prime-boost approach using both vaccines was evaluated, as well as immune interference due to pre-existing immunity against the MV. The humoral immune response induced by the MV, Pichia-expressed vaccine, and their combination as priming and boosting approaches was found to elicit HPV16L1 and 18L1 specific total IgG and neutralizing antibody titres. Pre-existing antibodies against measles did not prevent the immune response against HPV16L1 and 18L1. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. [Antibody persistence following on different vaccination strategies of domestic measles, mumps and rubella combined attenuated live vaccine: a 3-year follow-up study].

    PubMed

    He, H Q; Li, Q; Yan, R; Zhou, Y; Tang, X W; Deng, X; Xie, S Y; Chen, Z P

    2017-04-06

    Objective: To assess the 3-year antibody persistence after vaccination of domestic measles, mumps and rubella combined attenuated live vaccine (MMR) with different program. Methods: Children from three different vaccination strategies (Group 8 m MR: 8 months and 18 months vaccinated with measles-rubella combined attenuated live vaccine and domestic MMR,respectively; Group 8 m MMR: 8 months and 18 months both vaccinated with domestic MMR; Group 12 m MMR: 12 months and 22 months both vaccinated with domestic MMR ) were followed up in Zhejiang province in July 2015. There were 170 participants in Group 8 m MR, 171 participants in Group 8 m MMR and 173 participants in Group 12 m MMR selected by simple random sampling method .Blood samples (venous blood 2-3 ml) were collected 1 month after the first dose vaccination of MMR (only in Group 8 m MMR and Group 12 m MMR) and 3 years (36-38 months) after the last dose vaccination of MMR and tested for antibody IgG against Measles, Mumps and Rubella using ELISA. Seropostive rate and Geometric mean concentration (GMC) were calculated and compared among different groups by Chi-square test or Fisher exact test and Kruskal-Wallis H test. Results: A total of 514 participants (8 m MR: 170; 8 m MMR:171; 12 m MMR:173) were enrolled. The overall seropositivity rate of measles, mumps and rubella was 98.1% (504), 93.4% (480) and 88.1% (453), respectively, with corresponding GMC was 1 012.33 mU/ml, 502.87 U/ml and 50.53 U/ml respectively. There was no significant difference of seropositivity rate for measles among three groups (all groups were>97%). The highest seropositivity rate for mumps was found in the Group 12 m MMR with the rate of 98.8% (171/173), followed by Group 8 m MMR and Group 8 m MR with 93.0% (159/171) and 88.2%(150/170) respectively (Fisher exact test, P< 0.001). The highest seropositivity rate for rubella was also found in the Group 12 m MMR with the rate of 94.8% (164/173), followed by Group 8 m MMR and Group 8 m MR with

  13. Antibody persistence for 3 years following two doses of tetravalent measles-mumps-rubella-varicella vaccine in healthy children.

    PubMed

    Knuf, Markus; Zepp, Fred; Helm, Klaus; Maurer, Hartwig; Prieler, Albrecht; Kieninger-Baum, Dorothee; Douha, Martine; Willems, Paul

    2012-03-01

    Two doses of a varicella-containing vaccine in healthy children <12 years are suggested to induce better protection than a single dose. Persistence of immunity against measles, mumps, rubella, and varicella as well as varicella breakthrough cases were assessed 3 years after two-dose measles, mumps, rubella, and varicella (MMRV) vaccination or concomitant MMR (Priorix™) and varicella (Varilrix™) vaccination. Four hundred ninety-four healthy children, 12-18 months old at the time of the first dose, received either two doses of MMRV vaccine (GlaxoSmithKline Biologicals) 42-56 days apart (MMRV, N = 371) or one dose of MMR and varicella vaccines administered simultaneously at separate sites, followed by another MMR vaccination 42-56 days later (MMR + V, N = 123). Three hundred-four subjects participated in 3-year follow-up for persistence of immunity and occurrence of breakthrough varicella (MMRV, N = 225; MMR + V, N = 79). Antibodies were measured by ELISA (measles, mumps, rubella) and immunofluorescence (varicella). Contacts with individuals with varicella or zoster and cases of breakthrough varicella disease were recorded. Three years post-vaccination seropositivity rates in subjects seronegative before vaccination were: MMRV-measles, 98.5% (geometric mean titer [GMT] = 3,599.6); mumps, 97.4% (GMT = 1,754.5); rubella, 100% (GMT = 51.9); varicella, 99.4% (GMT = 225.5); MMR + V-measles, 97.0% (GMT = 1,818.8); mumps, 93.8% (GMT = 1,454.6); rubella, 100% (GMT = 53.8); and varicella, 96.8% (GMT = 105.8). Of the subjects, 15-20% reported contact with individuals with varicella/zoster each year. After 3 years, the cumulative varicella breakthrough disease rate was 0.7% (two cases) in the MMRV group and 5.4% (five cases) in the MMR + V group. Immunogenicity of the combined MMRV vaccine was sustained 3 years post-vaccination. (208136/041/NCT00406211).

  14. RESPONSE OF VOLTA CHILDREN TO JET INOCULATION OF COMBINED LIVE MEASLES, SMALLPOX AND YELLOW FEVER VACCINES.

    PubMed

    MEYER, H M; HOSTETLER, D D; BERNHEIN, B C; ROGERS, N G; LAMBIN, P; CHASSARY, A; LABUSQUIERE, R; SMADEL, J E

    1964-01-01

    An earlier study established that Upper Volta children respond to vaccination with the Enders live attenuated measles strain in the same general fashion as do children in the USA. The present report describes a second pilot project carried out in Ouagadougou, Upper Volta. During this investigation various mixtures of live measles, smallpox and 17D yellow fever vaccines were introduced into susceptible infants by jet injection. Combining the attenuated virus vaccines did not alter or accentuate the characteristic clinical reactions elicited by the individual components, nor was there evidence of significant immunological interference. From this experience it is concluded that combined vaccination with these agents may be safely and effectively employed in larger programmes as the need dictates.

  15. [Measles in Poland in 2003].

    PubMed

    Stefanoff, Paweł; Czarkowski, Mirosław P

    2005-01-01

    In Poland 48 measles cases were registered in 2003 (0.13 per 100,000 population)--of which 65% were cases imported from Chechnya and Afghanistan. Measles outbreaks occurred in 3 centers for immigrants. In total, 31 cases were reported, of which 96.8% were unvaccinated, and 93.5% were under 15 years of age. Of 17 local cases, 5 (29.4%) cases occurred in unvaccinated persons, 3 (17.6%) in persons vaccinated with one dose and 7 (41.2%) in those vaccinated with two doses of measles vaccine (administered at the age of 13-15 months and 7 years). Among 12 vaccinated cases only one 2-year old child was recently vaccinated. The remaining cases were in the 3-7 and 10-24 age ranges. The most affected were infants (incidence 0.57 per 100,000), 1-year old (0.28) and 2-year old children (incidence 0.27). Cases among adolescents and adults over 15 years of age increased from 23.5% in 2002 to 47.1% in 2003. The increasing age of locally-acquired cases, together with constantly high immunization coverage indicates high effectiveness of vaccinations in Poland. Out of all reported cases 13 (38%) were hospitalized. There were no deaths due to measles in Poland in 2003. Poland participates in the WHO Measles Elimination Strategy. Presently, the most important is the maintenance of a sensitive and timely surveillance of measles and measles-compatible cases, with serologic confirmation of one rash-like illness per 100 000 population. The performance of the surveillance system is insufficient with only 55 measles-compatible cases reported in 2003 (15% of expected reports). Serologic confirmation of cases was also insufficient, with 22 cases (40.0%) confirmed by IgM ELISA test. These results indicate the need to maintain the high immunisation coverage and improve measles surveillance system.

  16. Measles vaccination coverage estimates from surveys, clinic records, and immune markers in oral fluid and blood: a population-based cross-sectional study.

    PubMed

    Hayford, Kyla T; Shomik, Mohammed S; Al-Emran, Hassan M; Moss, William J; Bishai, David; Levine, Orin S

    2013-12-20

    Recent outbreaks of measles and polio in low-income countries illustrate that conventional methods for estimating vaccination coverage do not adequately identify susceptible children. Immune markers of protection against vaccine-preventable diseases in oral fluid (OF) or blood may generate more accurate measures of effective vaccination history, but questions remain about whether antibody surveys are feasible and informative tools for monitoring immunization program performance compared to conventional vaccination coverage indicators. This study compares six indicators of measles vaccination status, including immune markers in oral fluid and blood, from children in rural Bangladesh and evaluates the implications of using each indicator to estimate measles vaccination coverage. A cross-sectional population-based study of children ages 12-16 months in Mirzapur, Bangladesh, ascertained measles vaccination (MCV1) history from conventional indicators: maternal report, vaccination card records, 'card+history' and EPI clinic records. Oral fluid from all participants (n=1226) and blood from a subset (n=342) were tested for measles IgG antibodies as indicators of MCV1 history and compared to conventional MCV1 coverage indicators. Maternal report yielded the highest MCV1 coverage estimates (90.8%), followed by EPI records (88.6%), and card+history (84.2%). Seroprotection against measles by OF (57.3%) was significantly lower than other indicators, even after adjusting for incomplete seroconversion and assay performance (71.5%). Among children with blood results, 88.6% were seroprotected, which was significantly higher than coverage by card+history and OF serostatus but consistent with coverage by maternal report and EPI records. Children with vaccination cards or EPI records were more likely to have a history of receiving MCV1 than those without cards or records. Despite similar MCV1 coverage estimates across most indicators, within-child agreement was poor for all indicators

  17. Evaluation of Measles-Mumps-Rubella Vaccination Among Newly Arrived Refugees.

    PubMed

    Lee, Deborah; Weinberg, Michelle; Benoit, Stephen

    2017-05-01

    To assess US availability and use of measles-mumps-rubella (MMR) vaccination documentation for refugees vaccinated overseas. We selected 1500 refugee records from 14 states from March 2013 through July 2015 to determine whether overseas vaccination records were available at the US postarrival health assessment and integrated into the Advisory Committee on Immunization Practices schedule. We assessed number of doses, dosing interval, and contraindications. Twelve of 14 (85.7%) states provided data on 1118 (74.5%) refugees. Overseas records for 972 (86.9%) refugees were available, most from the Centers for Disease Control and Prevention's Electronic Disease Notification system (66.9%). Most refugees (829; 85.3%) were assessed appropriately for MMR vaccination; 37 (3.8%) should have received MMR vaccine but did not; 106 (10.9%) did not need the MMR vaccine but were vaccinated. Overseas documentation was available at most clinics, and MMR vaccinations typically were given when needed. Further collaboration between refugee health clinics and state immunization information systems would improve accessibility of vaccination documentation.

  18. Increased measles-mumps-rubella (MMR) vaccine uptake in the context of a targeted immunisation campaign during a measles outbreak in a vaccine-reluctant community in England.

    PubMed

    Le Menach, Arnaud; Boxall, Naomi; Amirthalingam, Gayatri; Maddock, Liz; Balasegaram, Sooria; Mindlin, Miranda

    2014-02-26

    Following a measles outbreak in a vaccine-rejecting community between April and September 2011 in South-East England, local health agencies implemented a two-pronged measles-mumps-rubella (MMR) immunisation campaign from August to October offered at the local general practice where most cases were registered. The campaign included (a) accelerated vaccination of children earlier than scheduled (1st dose at 6-11 months, or 2nd dose at 18-39 months), (b) catch-up of those aged over 18 months who had had no MMR immunisations or were late for second MMR. We investigated the impact of the outbreak and campaign on the number of MMR doses given. In January 2012, we collected information on MMR vaccination for children registered at the practice aged 6 months-16 years on 1 August 2011, through the child health information system. We counted the number of MMR doses administered in 2011 and compared it to 2008-2010 data. We estimated the proportion vaccinated among the children eligible for the accelerated and catch-up campaign. The local practice administered 257 MMR doses in 2011, a 114% increase on the average for 2008-2010. Among children eligible for earlier MMR vaccination 5/26 (19%) received a first dose, and 34/57 (60%) a second dose. Among children eligible for catch-up, 20/329 (6%) received their first MMR and 39/121 (32%) their second. Of 1538 children, the proportion completely unimmunised for MMR declined by 3 percentage-points after the outbreak. Uptake of MMR vaccination significantly increased during the outbreak following the immunisation campaign. Those amenable to MMR vaccination seem to have benefited from the campaign more than those with no previous vaccinations. Future evaluations should address what made a few parents change their mind and have their children vaccinated for the first time during the outbreak. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Factors associated with delayed measles vaccination among children in Shenzhen, China: A case-control study

    PubMed Central

    Lin, Weiyan; Xiong, Yongzhen; Tang, Hao; Chen, Baoli; Ni, Jindong

    2015-01-01

    A delay in the first dose of measles-containing vaccine (MCV1) may contribute to outbreaks of measles, resulting in a high age-specific incidence in infants <1 y of age. To determine the factors associated with delayed MCV1 vaccinations, we used data from the China Information Management System for Immunization Programming. Additionally, the parents/guardians of 430 children whose MCV1 vaccinations were delayed, as well as the parents/guardians of 424 children who received timely vaccinations, were surveyed by telephone. Children were less likely to receive timely MCV1 vaccinations if they belonged to an immigrant group, were male, had poor health status, had a father whose occupation e.g., a manager, had a history of delays in other Expanded Programs on Immunization (EPI) vaccinations, had parents who did not believe vaccinations were important for their children, and experienced shorter travel times to and longer waiting times in EPI clinics. The children of mothers whose occupational status (technician) were more likely to receive timely MCV1 vaccinations. The timeliness of MCV1 vaccinations should be considered as an additional indicator of the quality of vaccination programs. PMID:25668667

  20. Factors associated with delayed measles vaccination among children in Shenzhen, China: a case-control study.

    PubMed

    Lin, Weiyan; Xiong, Yongzhen; Tang, Hao; Chen, Baoli; Ni, Jindong

    2014-01-01

    A delay in the first dose of measles-containing vaccine (MCV1) may contribute to outbreaks of measles, resulting in a high age-specific incidence in infants<1 y of age. To determine the factors associated with delayed MCV1 vaccinations, we used data from the China Information Management System for Immunization Programming. Additionally, the parents/guardians of 430 children whose MCV1 vaccinations were delayed, as well as the parents/guardians of 424 children who received timely vaccinations, were surveyed by telephone. Children were less likely to receive timely MCV1 vaccinations if they belonged to an immigrant group, were male, had poor health status, had a father whose occupation e.g., a manager, had a history of delays in other Expanded Programs on Immunization (EPI) vaccinations, had parents who did not believe vaccinations were important for their children, and experienced shorter travel times to and longer waiting times in EPI clinics. The children of mothers whose occupational status (technician) were more likely to receive timely MCV1 vaccinations. The timeliness of MCV1 vaccinations should be considered as an additional indicator of the quality of vaccination programs.

  1. Two-year antibody persistence in children vaccinated at 12-15 months with a measles-mumps-rubella virus vaccine without human serum albumin.

    PubMed

    Berry, Andrea A; Abu-Elyazeed, Remon; Diaz-Perez, Clemente; Mufson, Maurice A; Harrison, Christopher J; Leonardi, Michael; Twiggs, Jerry D; Peltier, Christopher; Grogg, Stanley; Carbayo, Antonio; Shapiro, Steven; Povey, Michael; Baccarini, Carmen; Innis, Bruce L; Henry, Ouzama

    2017-07-03

    One combined measles-mumps-rubella (MMR) vaccine without Human Serum Albumin (HSA) is currently licensed in the USA (M-M-R II; Merck, USA) and another has been developed (Priorix™ [MMR-RIT, GSK, Belgium]). In this follow-up study, children from USA or Puerto Rico, who had received one dose of M-M-R II or MMR-RIT at 12-15 months of age in the primary study (NCT00861744), were followed-up for 2 y post-vaccination. Anti-measles and anti-rubella antibodies were measured using Enzyme-Linked Immunosorbent Assay (ELISA), and anti-mumps antibodies using ELISA and plaque reduction neutralization (PRN) assays. Serious adverse events (SAEs) were recorded during the entire follow-up. The according-to-protocol (ATP) persistence cohort included 752 children (M-M-R II = 186, MMR-RIT = 566), who received primary vaccination at a mean age of 12.3 ( ± 0.67) months. 104 children were revaccinated with MMR-containing vaccines; therefore, serology results for timepoints after revaccination were excluded from the analysis. Seropositivity for measles (Year 1≥ 98.3%; Year 2≥ 99.4%) and rubella (Year 1≥ 98.9%; Year 2 = 100%) remained as high at Year 2 as at Day 42. Similarly, seropositivity for mumps determined by ELISA (Year 1≥ 90.1%; Year 2≥ 94.1%) and PRN assays (Year 1≥ 87.5%; Year 2≥ 91.7%) persisted. Thirty-three SAEs were recorded in 23 children; 2 SAEs (inguinal adenitis and idiopathic thrombocytopenic purpura) and one SAE (febrile convulsion) were considered as potentially related to MMR-RIT and M-M-R II, respectively. This study showed that antibodies against measles, mumps and rubella persisted for up to 2 y post-vaccination with either MMR vaccine in children aged 12-15 months, and that both vaccines were well-tolerated during the follow-up period.

  2. Measles transmission following the tsunami in a population with a high one-dose vaccination coverage, Tamil Nadu, India 2004-2005.

    PubMed

    Mohan, Arumugam; Murhekar, Manoj V; Wairgkar, Niteen S; Hutin, Yvan J; Gupte, Mohan D

    2006-09-19

    On 26 December 2004, a tsunami struck the coast of the state of Tamil Nadu, India, where one-dose measles coverage exceeded 95%. On 29 December, supplemental measles immunization activities targeted children 6 to 60 months of age in affected villages. On 30 December, Cuddalore, a tsunami-affected district in Tamil Nadu reported a cluster of measles cases. We investigated this cluster to estimate the magnitude of the problem and to propose recommendations for control. We received notification of WHO-defined measles cases through stimulated passive surveillance. We collected information regarding date of onset, age, sex, vaccination status and residence. We collected samples for IgM antibodies and genotype studies. We modeled the accumulation of susceptible individuals over the time on the basis of vaccination coverage, vaccine efficacy and birth rate. We identified 101 measles cases and detected IgM antibodies against measles virus in eight of 11 sera. Cases were reported from tsunami-affected (n = 71) and unaffected villages (n = 30) with attack rates of 1.3 and 1.7 per 1000, respectively. 42% of cases in tsunami-affected villages had an onset date within 14 days of the tsunami. The median ages of case-patients in tsunami-affected and un-affected areas were 54 months and 60 months respectively (p = 0.471). 36% of cases from tsunami-affected areas were above 60 months of age. Phylogenetic analyses indicated that the sequences of virus belonged to genotype D8 that circulated in Tamil Nadu. Measles virus circulated in Cuddalore district following the tsunami, although there was no association between the two events. Transmission despite high one-dose vaccination coverage pointed to the limitations of this vaccination strategy. A second opportunity for measles immunization may help reducing measles mortality and morbidity in such areas. Children from 6 month to 14 years of age must be targeted for supplemental immunization during complex emergencies.

  3. CHRONOVAC VOYAGEUR: A study of the immune response to yellow fever vaccine among infants previously immunized against measles.

    PubMed

    Goujon, Catherine; Gougeon, Marie-Lise; Tondeur, Laura; Poirier, Béatrice; Seffer, Valérie; Desprès, Philippe; Consigny, Paul-Henri; Vray, Muriel

    2017-10-27

    For administration of multiple live attenuated vaccines, the Advisory Committee on Immunization Practices recommends either simultaneous immunization or period of at least 28days between vaccines, due to a possible reduction in the immune response to either vaccine. The main objective of this study was to compare the immune response to measles (alone or combined with mumps and rubella) and yellow fever vaccines among infants aged 6-24months living in a yellow fever non-endemic country who had receivedmeasles and yellow fever vaccines before travelling to a yellow fever endemic area. A retrospective, multicenter case-control study was carried out in 7 travel clinics in the Paris area from February 1st 2011 to march 31, 2015. Cases were defined as infants immunized with the yellow fever vaccine and with the measles vaccine, either alone or in combination with mumps and rubella vaccine, with a period of 1-27days between each immunization. For each case, two controls were matched based on sex and age: a first control group (control 1) was defined as infants having received the measles vaccine and the yellow fever vaccine simultaneously; a second control group (control 2) was defined as infants who had a period of more than 27days between receiving the measles vaccine and yellow fever vaccine. The primary endpoint of the study was the percentage of infants with protective immunity against yellow fever, measured by the titer of neutralizing antibodies in a venous blood sample. One hundred and thirty-one infants were included in the study (62 cases, 50 infants in control 1 and 19 infants in control 2). Of these, 127 (96%) were shown to have a protective titer of yellow fever antibodies. All 4 infants without a protective titer of yellow fever antibodies were part of control group 1. The measles vaccine, alone or combined with mumps and rubella vaccines, appears to have no influence on humoral immune response to the yellow fever vaccine when administered between 1 and 27

  4. Overview of measles and mumps vaccine: origin, present, and future of vaccine production.

    PubMed

    Betáková, T; Svetlíková, D; Gocník, M

    2013-01-01

    Measles and mumps are common viral childhood diseases that can cause serious complications. Vaccination remains the most efficient way to control the spread of these viruses. The manufacturing capability for viral vaccines produced in embryonated hen eggs and conventional/classical cell substrates, such as chicken embryo fibroblast or primary dog kidney cell substrates, is no longer sufficient. This limitation can be overcome by utilizing other recognized cell substrates such as Madin Darby Canine Kidney (MDCK), Chinese Hamster Ovary (CHO), Vero (monkey origin) cells, MRC-5 (human diploid) or as an alternative, introducing new cell substrates of human or avian origin. A very important factor in vaccine production is the safety and immunogenicity of the final vaccine, where the proper choice of cell substrate used for virus propagation is made. All substrates used in vaccine production must be fully characterized to avoid the contamination of hidden unknown pathogens which is difficult to achieve in primary cell substrates.

  5. Subacute sclerosing panencephalitis in papua new guinean children: the cost of continuing inadequate measles vaccine coverage.

    PubMed

    Manning, Laurens; Laman, Moses; Edoni, Henry; Mueller, Ivo; Karunajeewa, Harin A; Smith, David; Hwaiwhanje, Ilomo; Siba, Peter M; Davis, Timothy M E

    2011-01-04

    subacute sclerosing panencephalitis (SSPE) is a late, rare and usually fatal complication of measles infection. Although a very high incidence of SSPE in Papua New Guinea (PNG) was first recognized 20 years ago, estimated measles vaccine coverage has remained at ≤ 70% since and a large measles epidemic occurred in 2002. We report a series of 22 SSPE cases presenting between November 2007 and July 2009 in Madang Province, PNG, including localized clusters with the highest ever reported annual incidence. as part of a prospective observational study of severe childhood illness at Modilon Hospital, the provincial referral center, children presenting with evidence of meningo-encephalitis were assessed in detail including lumbar puncture in most cases. A diagnosis of SSPE was based on clinical features and presence of measles-specific IgG in cerebrospinal fluid and/or plasma. The estimated annual SSPE incidence in Madang province was 54/million population aged <20 years, but four sub-districts had an incidence >100/million/year. The distribution of year of birth of the 22 children with SSPE closely matched the reported annual measles incidence in PNG, including a peak in 2002. SSPE follows measles infections in very young PNG children. Because PNG children have known low seroconversion rates to the first measles vaccine given at 6 months of age, efforts such as supplementary measles immunisation programs should continue in order to reduce the pool of non-immune people surrounding the youngest and most vulnerable members of PNG communities.

  6. Seroprevalence of antibodies to measles and rubella eight months after a vaccination campaign in the southeast of Iran.

    PubMed

    Izadi, Shahrokh; Zahraei, Seyed Mohsen; Mokhtari-Azad, Talat

    2018-02-08

    Eight months after the mass immunization campaign of November 2015 against measles and rubella in the southeast of Iran, in order to evaluate the sero-immunity level of the people living in the mentioned region, a serosurvey study was performed. Using a multi-stage probability proportional to size cluster sampling, the sera of 1,056 participants, ranging from 15 months to 20 years old, were tested for measles and rubella IgG antibodies in the National Reference Laboratory at Tehran University of Medical Sciences, Tehran, Iran. The seroprevalence rates of antibodies against measles and rubella in the age groups below 16 years were respectively 98.4 and 93.2%. In the age group of 16 to 20 years, who was not the target of the mass immunization campaign, the said rates were respectively 91.7% and 87.4%. The herd immunity of the age groups below 16 years, who were the target of the campaign, is favourably high and reassuring both for measles and for rubella. Campaigns of supplementary vaccination play a substantial role for filling the gaps in the herd immunity.

  7. Genetic Polymorphisms in Host Antiviral Genes: Associations with Humoral and Cellular Immunity to Measles Vaccine

    PubMed Central

    Haralambieva, Iana H.; Ovsyannikova, Inna G.; Umlauf, Benjamin J.; Vierkant, Robert A.; Pankratz, V. Shane; Jacobson, Robert M.; Poland, Gregory A.

    2014-01-01

    Host antiviral genes are important regulators of antiviral immunity and plausible genetic determinants of immune response heterogeneity after vaccination. We genotyped and analyzed 307 common candidate tagSNPs from 12 antiviral genes in a cohort of 745 schoolchildren immunized with two doses of measles-mumps-rubella vaccine. Associations between SNPs/haplotypes and measles virus-specific immune outcomes were assessed using linear regression methodologies in Caucasians and African-Americans. Genetic variants within the DDX58/RIG-I gene, including a coding polymorphism (rs3205166/Val800Val), were associated as single-SNPs (p≤0.017; although these SNPs did not remain significant after correction for false discovery rate/FDR) and in haplotype-level analysis, with measles-specific antibody variations in Caucasians (haplotype allele p-value=0.021; haplotype global p-value=0.076). Four DDX58 polymorphisms, in high LD, demonstrated also associations (after correction for FDR) with variations in both measles-specific IFN-γ and IL-2 secretion in Caucasians (p≤0.001, q=0.193). Two intronic OAS1 polymorphisms, including the functional OAS1 SNP rs10774671 (p=0.003), demonstrated evidence of association with a significant allele-dose-related increase in neutralizing antibody levels in African-Americans. Genotype and haplotype-level associations demonstrated the role of ADAR genetic variants, including a non-synonymous SNP (rs2229857/Arg384Lys; p=0.01), in regulating measles virus-specific IFN-γ Elispot responses in Caucasians (haplotype global p-value=0.017). After correction FDR, 15 single-SNP associations (11 SNPs in Caucasians and 4 SNPs in African-Americans) still remained significant at the q-value<0.20. In conclusion, our findings strongly point to genetic variants/genes, involved in antiviral sensing and antiviral control, as critical determinants, differentially modulating the adaptive immune responses to live attenuated measles vaccine in Caucasians and African

  8. Measles outbreak prevention and control among adults: Lessons from an importation outbreak in Yunnan province, China, 2015.

    PubMed

    Zhao, Zhixian; Zhou, Rongrong; Yu, Wen; Li, Liqun; Li, Qiongfen; Hu, Pei

    2018-04-03

    The incidence of measles in Yunnan Province among vaccine target-age children has decreased markedly after attaining and sustaining high 2-dose coverage of measles containing vaccine (MCV) through routine immunization services and supplementary immunization activities (SIAs). Most cases of measles now occur among adults. In 2015, we investigated a measles outbreak among adults to determine transmission patterns and the potential role of nosocomial transmission. We enhanced measles surveillance using retrospective active case search. We conducted case investigations to determine sources of infection and routes of transmission; laboratory testing included serologic and molecular diagnostic methods. Twenty-two outbreak-associated cases of measles were identified; most (86.36%) were among individuals 20 to 39 years of age (range, 7 months to 43 years). We interviewed 19 individuals who had acquired measles. The first 3 cases were infected in Tibet; 12 (63%) were hospital-acquired infections; 2 (11%) were community-acquired; and 2 (11%) were family-contact cases. We conducted outbreak response immunization (ORI) that provided MCV without regard to vaccination status; 10,596 residents between 20 and 40 years of age were vaccinated. A serological survey conducted during the ORI showed that 84% of the 20-40 year-olds were immune to measles prior to vaccination. Post-vaccination serological testing showed 100% were immune. Despite high population immunity among children and adolescents, imported measles virus transmission occurred among adults in a provincial cross-border area. Nosocomial transmission and measles immunity gaps among adults poses a threat to measles elimination and highlights the strategy of targeting adults during ORI to outbreaks with adult-to-adult transmission.

  9. Enhancing global vaccine pharmacovigilance: Proof-of-concept study on aseptic meningitis and immune thrombocytopenic purpura following measles-mumps containing vaccination

    PubMed Central

    Perez-Vilar, Silvia; Weibel, Daniel; Sturkenboom, Miriam; Black, Steven; Maure, Christine; Castro, Jose Luis; Bravo-Alcántara, Pamela; Dodd, Caitlin N.; Romio, Silvana A.; de Ridder, Maria; Nakato, Swabra; Molina-León, Helvert Felipe; Elango, Varalakshmi; Zuber, Patrick L.F.

    2017-01-01

    New vaccines designed to prevent diseases endemic in low and middle-income countries (LMICs) are now being introduced without prior record of utilization in countries with robust pharmacovigilance systems. To address this deficit, our objective was to demonstrate feasibility of an international hospital-based network for the assessment of potential epidemiological associations between serious and rare adverse events and vaccines in any setting. This was done through a proof-of-concept evaluation of the risk of immune thrombocytopenic purpura (ITP) and aseptic meningitis (AM) following administration of the first dose of measles-mumps-containing vaccines using the self-controlled risk interval method in the primary analysis. The World Health Organization (WHO) selected 26 sentinel sites (49 hospitals) distributed in 16 countries of the six WHO regions. Incidence rate ratios (IRR) of 5.0 (95% CI: 2.5-9.7) for ITP following first dose of measles-containing vaccinations, and of 10.9 (95% CI: 4.2-27.8) for AM following mumps-containing vaccinations were found. The strain-specific analyses showed significantly elevated ITP risk for measles vaccines containing Schwarz (IRR: 20.7; 95% CI: 2.7-157.6), Edmonston-Zagreb (IRR: 11.1; 95% CI: 1.4-90.3), and Enders´Edmonston (IRR: 8.5; 95% CI: 1.9-38.1) strains. A significantly elevated AM risk for vaccines containing the Leningrad-Zagreb mumps strain (IRR: 10.8; 95% CI: 1.3-87.4) was also found. This proof-of-concept study has shown, for the first time, that an international hospital-based network for the investigation of rare vaccine adverse events, using common standardized procedures and with high participation of LMICs, is feasible, can produce reliable results, and has the potential to characterize differences in risk between vaccine strains. The completion of this network by adding large reference hospitals, particularly from tropical countries, and the systematic WHO-led implementation of this approach, should permit the

  10. Long-term Seroprotection Rates Following Second Dose of Measles as MMR Vaccine at 15 months in Indian Children.

    PubMed

    Hansashree, P; Verma, Sanjay; Rawat, Amit; Sankhyan, Naveen; Bharti, Bhavneet

    2018-05-15

    To find out seropositivity rates at 4-6 and 9-12 years of age; among those who received one-dose measles at 9 months and one-dose MMR at 15 months of age. 80 healthy children (53 males) at 4-6 or 9-12 years of age, attending outpatient department for vaccination were enrolled. Antibody titers were estimated using commercially available quantitative-IgG ELISA kits. The seropositivity rates against measles, mumps, rubella were 80% (40/50), 86% (43/50), and 96% (48/50), respectively at 4-6 years, and 83.3% (25/30), 96.7% (29/30) and 96.7% (29/30), respectively at 9-12 years of age. Single dose of rubella vaccine seems to provide adequate long-term protection; however, measles vaccine requires more doses for similar protection.

  11. Accelerated measles control--Cambodia, 1999-2002.

    PubMed

    2003-01-10

    Cambodia is recovering from approximately 30 years of civil war that resulted in the breakdown of the country's public health infrastructure. In 1999, the Ministry of Health initiated a measles-control program with the goal of reducing the annual incidence of measles to <10,000 cases in 2005 by strengthening measles surveillance, improving routine vaccination coverage, implementing supplementary measles immunization activities (SIAs), and providing vitamin A during outbreak investigations and SIAs. This report summarizes measles-vaccination activities and their impact in reducing reported measles cases from 13,827 in 1999 to 1,234 in 2002 and suggests options for future measles-control efforts in postconflict situations.

  12. The elimination of indigenous measles, mumps, and rubella from Finland by a 12-year, two-dose vaccination program.

    PubMed

    Peltola, H; Heinonen, O P; Valle, M; Paunio, M; Virtanen, M; Karanko, V; Cantell, K

    1994-11-24

    In the 1970s measles, mumps, and rubella were rampant in Finland, and rates of immunization were inadequate. In 1982 a comprehensive national vaccination program began in which two doses of a combined live-virus vaccine were used. Public health nurses at 1036 child health centers administered the vaccine to children at 14 to 18 months of age and again at 6 years, and also to selected groups of older children and young adults. Vaccination was voluntary and free of charge. In follow-up studies, we focused on rates of vaccination, reasons for noncompliance, adverse reactions, immunogenicity, persistence of antibody, and incidence of the three diseases. Since 1987, paired serum samples have been collected from all patients with suspected cases of measles, mumps, or rubella. Over a period of 12 years, 1.5 million of the 5 million people in Finland were vaccinated. Coverage now exceeds 95 percent. The vaccine was efficient and safe, even in those with a history of severe allergy. No deaths or persistent sequelae were attributable to vaccination. The most frequent complication requiring hospitalization was acute thrombocytopenic purpura, which occurred at a rate of 3.3 per 100,000 vaccinated persons. The 99 percent decrease in the incidence of the three diseases was accompanied by an increasing rate of false positive clinical diagnoses. In 655 vaccinated patients with clinically diagnosed disease, serologic studies confirmed the presence of measles in only 0.8 percent, mumps in 2.0 percent, and rubella in 1.2 percent. The few localized outbreaks were confined to patients in the partially vaccinated age groups. There are now fewer than 30 sporadic cases of each of the three diseases per year, and those are probably imported. Over a 12-year period, an immunization program using two doses of combined live-virus vaccine has eliminated indigenous measles, mumps, and rubella from Finland. Serologic studies show that most reported sporadic cases are now due to other causes, but

  13. Timeliness and completeness of measles vaccination among children in rural areas of Guangxi, China: A stratified three-stage cluster survey.

    PubMed

    Tang, Xianyan; Geater, Alan; McNeil, Edward; Zhou, Hongxia; Deng, Qiuyun; Dong, Aihu

    2017-07-01

    Large-scale outbreaks of measles occurred in 2013 and 2014 in rural Guangxi, a region in Southwest China with high coverage for measles-containing vaccine (MCV). This study aimed to estimate the timely vaccination coverage, the timely-and-complete vaccination coverage, and the median delay period for MCV among children aged 18-54 months in rural Guangxi. Based on quartiles of measles incidence during 2011-2013, a stratified three-stage cluster survey was conducted from June through August 2015. Using weighted estimation and finite population correction, vaccination coverage and 95% confidence intervals (CIs) were calculated. Weighted Kaplan-Meier analyses were used to estimate the median delay periods for the first (MCV1) and second (MCV2) doses of the vaccine. A total of 1216 children were surveyed. The timely vaccination coverage rate was 58.4% (95% CI, 54.9%-62.0%) for MCV1, and 76.9% (95% CI, 73.6%-80.0%) for MCV2. The timely-and-complete vaccination coverage rate was 47.4% (95% CI, 44.0%-51.0%). The median delay period was 32 (95% CI, 27-38) days for MCV1, and 159 (95% CI, 118-195) days for MCV2. The timeliness and completeness of measles vaccination was low, and the median delay period was long among children in rural Guangxi. Incorporating the timeliness and completeness into official routine vaccination coverage statistics may help appraise the coverage of vaccination in China. Copyright © 2017 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  14. Measles control in Australia - threats, opportunities and future needs.

    PubMed

    MacIntyre, C Raina; Kpozehouen, Elizabeth; Kunasekaran, Mohana; Harriman, Kathleen; Conaty, Stephen; Rosewell, Alexander; Druce, Julian; Martin, Nicolee; Heywood, Anita E; Gidding, Heather F; Wood, James; Nicholl, Sonya

    2018-06-19

    Control of measles was the focus of a national workshop held in 2015 in Sydney, Australia, bringing together stakeholders in disease control and immunisation to discuss maintaining Australia's measles elimination status in the context of regional and global measles control. The global epidemiology of measles was reviewed, including outbreaks in countries that have achieved elimination, such as the Disneyland outbreak in the United States and large outbreaks in Sydney, Australia. Transmission of measles between Australia and New Zealand occurs, but has not been a focus of control measures. Risk groups, the genetic and seroepidemiology of measles as well as surveillance, modelling and waning vaccine-induced immunity were reviewed. Gaps in policy, research and practice for maintaining measles elimination status in Australia were identified and recommendations were developed. Elimination of measles globally is challenging because of the infectiousness of measles and the need for 2-dose vaccine coverage rates in excess of 95% in all countries to achieve it. Until this occurs, international travel will continue to permit measles importation from endemic countries to countries that have achieved elimination. When measles cases are imported, failure to diagnose and isolate cases places the health system at risk of measles outbreaks. Vaccine funding models can result in gaps in vaccine coverage for adults and migrants. Australia introduced a whole-of-life immunisation register in 2016 and catch-up vaccination for at-risk communities, which will improve measles control. Research on diagnosis, immunology, case management and modelling of vaccination strategies are important to ensure continued control of measles. Copyright © 2018.

  15. Measles transmission following the tsunami in a population with a high one-dose vaccination coverage, Tamil Nadu, India 2004–2005

    PubMed Central

    Mohan, Arumugam; Murhekar, Manoj V; Wairgkar, Niteen S; Hutin, Yvan J; Gupte, Mohan D

    2006-01-01

    Background On 26 December 2004, a tsunami struck the coast of the state of Tamil Nadu, India, where one-dose measles coverage exceeded 95%. On 29 December, supplemental measles immunization activities targeted children 6 to 60 months of age in affected villages. On 30 December, Cuddalore, a tsunami-affected district in Tamil Nadu reported a cluster of measles cases. We investigated this cluster to estimate the magnitude of the problem and to propose recommendations for control. Methods We received notification of WHO-defined measles cases through stimulated passive surveillance. We collected information regarding date of onset, age, sex, vaccination status and residence. We collected samples for IgM antibodies and genotype studies. We modeled the accumulation of susceptible individuals over the time on the basis of vaccination coverage, vaccine efficacy and birth rate. Results We identified 101 measles cases and detected IgM antibodies against measles virus in eight of 11 sera. Cases were reported from tsunami-affected (n = 71) and unaffected villages (n = 30) with attack rates of 1.3 and 1.7 per 1000, respectively. 42% of cases in tsunami-affected villages had an onset date within 14 days of the tsunami. The median ages of case-patients in tsunami-affected and un-affected areas were 54 months and 60 months respectively (p = 0.471). 36% of cases from tsunami-affected areas were above 60 months of age. Phylogenetic analyses indicated that the sequences of virus belonged to genotype D8 that circulated in Tamil Nadu. Conclusion Measles virus circulated in Cuddalore district following the tsunami, although there was no association between the two events. Transmission despite high one-dose vaccination coverage pointed to the limitations of this vaccination strategy. A second opportunity for measles immunization may help reducing measles mortality and morbidity in such areas. Children from 6 month to 14 years of age must be targeted for supplemental immunization during

  16. Subacute Sclerosing Panencephalitis in Papua New Guinean Children: The Cost of Continuing Inadequate Measles Vaccine Coverage

    PubMed Central

    Manning, Laurens; Laman, Moses; Edoni, Henry; Mueller, Ivo; Karunajeewa, Harin A.; Smith, David; Hwaiwhanje, Ilomo; Siba, Peter M.; Davis, Timothy M. E.

    2011-01-01

    Introduction Subacute sclerosing panencephalitis (SSPE) is a late, rare and usually fatal complication of measles infection. Although a very high incidence of SSPE in Papua New Guinea (PNG) was first recognized 20 years ago, estimated measles vaccine coverage has remained at ≤70% since and a large measles epidemic occurred in 2002. We report a series of 22 SSPE cases presenting between November 2007 and July 2009 in Madang Province, PNG, including localized clusters with the highest ever reported annual incidence. Methodology/Principal Findings As part of a prospective observational study of severe childhood illness at Modilon Hospital, the provincial referral center, children presenting with evidence of meningo-encephalitis were assessed in detail including lumbar puncture in most cases. A diagnosis of SSPE was based on clinical features and presence of measles-specific IgG in cerebrospinal fluid and/or plasma. The estimated annual SSPE incidence in Madang province was 54/million population aged <20 years, but four sub-districts had an incidence >100/million/year. The distribution of year of birth of the 22 children with SSPE closely matched the reported annual measles incidence in PNG, including a peak in 2002. Conclusions/Significance SSPE follows measles infections in very young PNG children. Because PNG children have known low seroconversion rates to the first measles vaccine given at 6 months of age, efforts such as supplementary measles immunisation programs should continue in order to reduce the pool of non-immune people surrounding the youngest and most vulnerable members of PNG communities. PMID:21245918

  17. Genome-Wide Associations of CD46 and IFI44L Genetic Variants with Neutralizing Antibody Response to Measles Vaccine

    PubMed Central

    Haralambieva, Iana H.; Ovsyannikova, Inna G.; Kennedy, Richard B.; Larrabee, Beth R.; Zimmermann, Michael T.; Grill, Diane E.; Schaid, Daniel J.; Poland, Gregory A.

    2017-01-01

    Background Population-based studies have revealed 2 to 10% measles vaccine failure rate even after two vaccine doses. While the mechanisms behind this remain unknown, we hypothesized that host genetic factors are likely to be involved. Methods We performed a genome-wide association study of measles specific neutralizing antibody and IFNγ ELISPOT response in a combined sample of 2,872 subjects. Results We identified two distinct chromosome 1 regions (previously associated with MMR-related febrile seizures), associated with vaccine-induced measles neutralizing antibody titers. The 1q32 region contained 20 significant SNPs in/around the measles virus receptor-encoding CD46 gene, including the intronic rs2724384 (p-value = 2.64x10−09) and rs2724374 (p-value = 3.16x10−09) SNPs. The 1q31.1 region contained nine significant SNPs in/around IFI44L, including the intronic rs1333973 (p-value = 1.41x10−10) and the missense rs273259 (His73Arg, p-value = 2.87x10−10) SNPs. Analysis of differential exon usage with mRNA-Seq data and RT-PCR suggests the involvement of rs2724374 minor G allele in the CD46 STP region exon B skipping, resulting in shorter CD46 isoforms. Conclusions Our study reveals common CD46 and IFI44L SNPs associated with measles-specific humoral immunity, and highlights the importance of alternative splicing/virus cellular receptor isoform usage as a mechanism explaining inter-individual variation in immune response after live measles vaccine. PMID:28289848

  18. Epidemiology and Genetic Characterization of Measles Strains in Senegal, 2004-2013

    PubMed Central

    Dia, Ndongo; Fall, Ameth; Ka, Rouguiyatou; Fall, Amary; Kiori, David E.; Goudiaby, Deborah G.; Fall, Aichatou D.; Faye, El Hadj Abdourahmane; Dosseh, Annick; Ndiaye, Kader; Diop, Ousmane M.; Niang, Mbayame Nd.

    2015-01-01

    Background In Senegal, with the variable routine vaccination coverage, the risk for illness and death from measles still exists as evidenced by the measles epidemic episode in 2009. Since 2002 a laboratory-based surveillance system of measles was established by the Ministry of Health and the Institut Pasteur de Dakar. The present study analysed the data collected over the 10 years inclusive between 2004-2013 in order to define a measles epidemiological profile in Senegal, and we carried out a phylogenetic analysis of measles virus circulating in Senegal over the period 2009-2012. Methodology and Results A total number of 4580 samples were collected from suspected cases, with the most cases between 2008 and 2010 (2219/4580; 48.4%). The majority of suspected cases are found in children from 4-6 years old (29%). 981 (21.4%) were measles laboratory-confirmed by IgM ELISA. The measles confirmation rate per year is very high during 2009-2010 periods (48.5% for each year). Regarding age groups, the highest measles IgM-positivity rate occurred among persons aged over 15 years with 39.4% (115/292) followed by 2-3 years old age group with 30.4% (323/1062) and 30% (148/494) in children under one year old group. The majority of suspected cases were collected between February and June and paradoxically confirmed cases rates increased from July (77/270; 28.6%) and reached a peak in November with 60% (93/155). Phylogenetic analysis showed that all the 29 sequences from strains that circulated in Senegal between 2009 and 2012 belong to the B3 genotype and they are clustered in B3.1 (2011-2012) and B3.3 (2009-2011) sub-genotypes according to a temporal parameter. Conclusion Improvements in the measles surveillance in Senegal are required and the introduction of oral fluid and FTA cards as an alternative to transportation of sera should be investigated to improve surveillance. The introduction of a national vaccine database including number of doses of measles-containing vaccine

  19. The influence of prophylactic vaccination on epidemic situation of infectious diseases illustrated by the epidemiology of measles in Poland in the years 1968-1998.

    PubMed

    Kalinowski, P

    2001-01-01

    There were gathered demographic data collected by the Main Statistical Office (GUS) concerning Polish society. There were analysed the incidence, morbidity and mortality rates as well as the number of cases and number of deaths from measles in Poland in the years 1968-1998. It was stated that the introduction of prophylactic vaccinations against infectious diseases totally changed the epidemiologic situation. It was also stated that measles is a good example of the influence of prophylactic vaccinations on the course of disease. The measles vaccinations caused the elimination of periodicity of the disease, increase in the interepidemic periods, decrease in incidence rates and nearly eliminated morbidity from this disease. There is a chance of eradication of measles in Poland provided that mandatory vaccination periods are strictly kept and 99% of children at the age of two years are vaccinated.

  20. Similar Antibody Levels in 3-Year-Old Children Vaccinated Against Measles, Mumps, and Rubella at the Age of 12 Months or 18 Months.

    PubMed

    Kontio, Mia; Palmu, Arto A; Syrjänen, Ritva K; Lahdenkari, Mika; Ruokokoski, Esa; Davidkin, Irja; Vaarala, Outi; Melin, Merit

    2016-06-15

    Measles-mumps-rubella (MMR) vaccinations have been offered to Finnish children at 14-18 months and 6 years of age. In May 2011, the recommended age for the first vaccine dose was lowered to 12 months because of the European measles epidemic. Fingertip capillary blood samples were collected from 3-year-old Finnish children vaccinated once with MMR vaccine at 11-19 months of age. The immunoglobulin G (IgG) antibodies to all 3 MMR antigens were measured with enzyme-linked immunosorbent assay. Neutralizing antibodies and the avidity of antibodies were measured for measles virus. From April through October 2013, 187 children were enrolled. Equally high proportions of the samples were seropositive for measles virus, mumps virus, or rubella virus antibodies, and there were no significant differences in the IgG antibody concentrations in children vaccinated at 11-13 months of age, compared with those vaccinated at 17-19 months of age. However, among children vaccinated at 11-13 months of age, boys had lower antibody concentrations than girls. Neutralizing measles virus antibody titers were above the threshold for protective immunity in all 78 samples analyzed. The measles virus antibody avidity indexes were high for all children. MMR induces similar antibody responses in 12-month-old children as compared to 18-month-old children, but in boys increasing age appears to improve the antibody responses. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  1. [Economic evaluation on different two-dose-vaccination-strategies related to Measles, Mumps and Rubella Combined Attenuated Live Vaccine].

    PubMed

    He, H Q; Zhang, B; Yan, R; Li, Q; Fu, J; Tang, X W; Zhou, Y; Deng, X; Xie, S Y

    2016-08-10

    To evaluate the economic effect of Measles, Mumps and Rubella Combined Attenuated Live Vaccine (MMR) under different two-dose vaccination programs. A hypothetical birth cohort of 750 000 infants over their lifetime, was followed up from birth through death in Zhejiang province. The current MMR vaccination strategie would include three different ones: 1) Childlern were vaccinated with Measles-Rubella Combined Attenuated Live Vaccine and MMR, respectively at the age of 8 months and 18 months. 2) Children receive MMR at 8 months and 18 months, 3) Strategy 1 plus an additional vaccination of MMR at 4 years of age. Incremental cost-effectiveness ratio (ICER), incremental cost-benefit ratio (ICBR) and incremental net benefit (INB) were applied to calculate the health economic difference for Strategy 2 and Strategy 3 as compared to Strategy 1. Univariate sensitivity analysis was used to assess the robustness of results with main parameters, including the rate of immunization coverage, effectiveness of the vaccines, incidence and burdens of the related diseases, cost of vaccines and the vaccination program itself. ICER, ICBR and INB for Strategy 2 and Strategy 3 appeared as 2 012.51∶1 RMB Yuan per case and 4 238.72∶1 RMB Yuan per case, 1∶3.14 and 1∶1.58, 21 277 800 RMB Yuan and 9 276 500 RMB Yuan, respectively. Only slight changes (<20%) were found under the univariate sensitivity analysis, with varied values on main parameters. Based on the current national immunization program, infants vaccinated with MMR at 8 months of age, generated more health economic effects than the Strategy 3.

  2. Vaccination coverage for measles, mumps and rubella in anthroposophical schools in Gelderland, The Netherlands.

    PubMed

    Klomp, Judith H E; van Lier, Alies; Ruijs, Wilhelmina L M

    2015-06-01

    Social clustering of unvaccinated children in anthroposophical schools occurs, as inferred from various measles outbreaks that can be traced to these schools. However, accurate vaccination coverage data of anthroposophical schools are not widely available. In 2012, we performed a survey to estimate the vaccination coverage in three different grades of 11 anthroposophical schools in Gelderland, The Netherlands. We also gauged the opinion on childhood vaccination of the parents and compared these with the results of a national survey. In 2014, we were also able to obtain the registered total vaccination coverage per school from the national vaccination register to compare this with our survey data. The self-reported MMR vaccination coverage (2012) in the three grades of the schools in our study was 83% (range 45-100% per school). The registered total vaccination coverage (2014) was 78% (range 59-88% per school). The 95% confidence intervals of the two different vaccination coverages overlap for all schools. The parents in this study were less convinced about the beneficial effect of vaccinations and more worried about the possible side effects of vaccination compared with parents in general. Despite high overall vaccination coverage, the WHO goal to eliminate measles and rubella will not easily be achieved when social clustering of unvaccinated children in anthroposophical schools remains. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  3. An evaluation of the cold chain technology in South-East, Nigeria using Immunogenicity study on the measles vaccines.

    PubMed

    Oli, Angus Nnamdi; Agu, Remigius Uchenna; Ihekwereme, Chibueze Peter; Esimone, Charles Okechukwu

    2017-01-01

    Vaccines are biological products and their efficacy is affected by storage conditions. They are vital in promoting public health. Failures in immunization programmes often times are blamed on disruption in vaccine cold-chain. This study assessed the immunogenicity/potency of the measles vaccines utilized in childhood immunization in South-East, Nigeria and indirectly assessed the effectiveness of the cold-chain technology in the region. This was an experimental study carried out between December 2011 and June 2013. Antibody induction method was used to evaluate the immunogenicity/potency of the measles vaccines sourced from the central cold chain facilities in South-east, Nigeria and indirectly, the effectiveness of the cold chain technology in the zone in maintaining vaccine potency. The neutralizing antibodies in a control group (administered with measles vaccines stored at 37°C for 12 months) and in immunized group were determined after 30 days of immunization using ELISA. The mean storage temperature of the vaccines at the states vaccines central cold chain facilities was -2.4°C and before storage at study site, it was 5.8°C but at the study site it was -4.54°C. Mean ±Standard Error in the Mean (SEM) IgG titers for the measles vaccines sourced from "Open Market", Ebonyi, Enugu, Imo, Anambra and Abia States were 0.793±0.051, 1.621±0.015, 1.621±0.015, 1.715±0.081, 1.793±0.051 and 1.683±0.078 respectively while the mean ±Standard Error in the Mean (SEM) IgM titres were 0.857±0.037, 1.400±0.030, 1.391±0.032, 1.339±0.037, 1.405±0.066 and 1.279±0.025 respectively. One way analysis of variance shows that there is statistical difference in the IgG and IgM antibodies titers produced by the control compared to the vaccines (P value < 0.0001). Also, Bartlett's test for equal variances showed that there was statistical difference (P value < 0.0001 for IgG and = 0.036 for IgM). The antibodies elicited by the vaccines from the states were enough to confer

  4. Measles outbreak in the Republic of the Marshall Islands, 2003.

    PubMed

    Hyde, Terri B; Dayan, Gustavo H; Langidrik, Justina R; Nandy, Robin; Edwards, Russell; Briand, Kennar; Konelios, Mailynn; Marin, Mona; Nguyen, Huong Q; Khalifah, Anthony P; O'leary, Michael J; Williams, Nobia J; Bellini, William J; Bi, Daoling; Brown, Cedric J; Seward, Jane F; Papania, Mark J

    2006-04-01

    Measles is a highly contagious viral infection. Measles transmission can be prevented through high population immunity (>or=95%) achieved by measles vaccination. In the Republic of the Marshall Islands (RMI), no measles cases were reported during 1989-2002; however, a large measles outbreak occurred in 2003. Reported 1-dose measles vaccine coverage among children aged 12-23 months varied widely (52-94%) between 1990 and 2000. RMI is a Pacific island nation (1999 population: 50,840). A measles case was defined as fever, rash, and cough, or coryza, or conjunctivitis, in an RMI resident between July 13 and November 7, 2003. A vaccination campaign was used for outbreak control. Of the 826 reported measles cases, 766 (92%) occurred in the capital (Majuro). There were 186 (23%) cases in infants aged <1 year and 309 (37%) of cases in persons aged >or=15 years. The attack rate was highest among infants (Majuro atoll: 213 cases/1,000 infants). Among cases aged 1-14 years, 281 (59%) reported no measles vaccination before July 2003. There were 100 hospitalizations and 3 deaths. The measles H1 genotype was identified. The vaccination campaign resulted in 93% coverage among persons aged 6 months to 40 years. Interpretation Populations without endemic measles transmission can accumulate substantial susceptibility and be at risk for large outbreaks when measles virus is imported. 'Islands' of measles susceptibility may develop in infants, adults, and any groups with low vaccine coverage. To prevent outbreaks, high population immunity must be sustained by maintaining and documenting high vaccine coverage.

  5. Successful administration of measles-rubella-mumps vaccine by graded challenge in a case with anaphylaxis after prior vaccination.

    PubMed

    Tuncel, Tuba; Sancakli, Ozlem; Ozdogru, Ece

    2017-04-01

    Egg allergy is one of the most common food allergies during childhood along with cow's milk allergy. The measles-mumpsrubella (MMR) vaccine is included in the pediatric immunization schedule and contains egg protein. The currently accepted opinion is that the MMR vaccination should be done in a single dose under medical observation in patients with egg allergy. Although it is reported that the MMR vaccine is safe for that patients, there are some patients who developed anaphylaxis. Generally, the development of anaphylaxis after the previous vaccination is reported as a contraindication. We present a successful administration of MMR vaccine by gradually increased doses for a patient who developed anaphylaxis after the previous vaccination. Sociedad Argentina de Pediatría.

  6. Live attenuated measles vaccine expressing HIV-1 Gag virus like particles covered with gp160DELTAV1V2 is strongly immunogenic

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Guerbois, Mathilde; Moris, Arnaud; Combredet, Chantal

    Although a live attenuated HIV vaccine is not currently considered for safety reasons, a strategy inducing both T cells and neutralizing antibodies to native assembled HIV-1 particles expressed by a replicating virus might mimic the advantageous characteristics of live attenuated vaccine. To this aim, we generated a live attenuated recombinant measles vaccine expressing HIV-1 Gag virus-like particles (VLPs) covered with gp160DELTAV1V2 Env protein. The measles-HIV virus replicated efficiently in cell culture and induced the intense budding of HIV particles covered with Env. In mice sensitive to MV infection, this recombinant vaccine stimulated high levels of cellular and humoral immunity tomore » both MV and HIV with neutralizing activity. The measles-HIV virus infected human professional antigen-presenting cells, such as dendritic cells and B cells, and induced efficient presentation of HIV-1 epitopes and subsequent activation of human HIV-1 Gag-specific T cell clones. This candidate vaccine will be next tested in non-human primates. As a pediatric vaccine, it might protect children and adolescents simultaneously from measles and HIV.« less

  7. Description of a large measles epidemic in Democratic Republic of Congo, 2010-2013.

    PubMed

    Mancini, Silvia; Coldiron, Matthew E; Ronsse, Axelle; Ilunga, Benoît Kebela; Porten, Klaudia; Grais, Rebecca F

    2014-01-01

    Although measles mortality has declined dramatically in Sub-Saharan Africa, measles remains a major public health problem in countries like the Democratic Republic of Congo (DRC). Here, we describe the large measles epidemic that occurred in the Democratic Republic of Congo between 2010 and 2013 using data from the national surveillance system as well as vaccine coverage surveys to provide a snapshot of the epidemiology of measles in DRC. Standardized national surveillance data were used to describe measles cases from 2010 to 2013. Attack rates and case fatality ratios were calculated and the temporal and spatial evolution of the epidemic described. Data on laboratory confirmation and vaccination coverage surveys as a part of routine program monitoring are also presented. Between week 1 of 2010 and week 45 of 2013, a total of 294,455 cases and 5,045 deaths were reported. The cumulative attack rate (AR) was 0.4%. The Case Fatality Ratio (CFR) was 1.7% among cases reported in health structures through national surveillance. A total of 186,178 cases (63%) were under 5 years old, representing an estimated AR of 1.4% in this age group. Following the first mass vaccination campaigns, weekly reported cases decreased by 21.5%. Results of post-vaccination campaign coverage surveys indicated sub-optimal (under 95%) vaccination coverage among children surveyed. The data reported here highlight the need to seek additional means to reinforce routine immunization as well as ensure the timely implementation of Supplementary Immunization Activities to prevent large and repeated measles epidemics in DRC. Although reactive campaigns were conducted in response to the epidemic, strategies to ensure that children are vaccinated in the routine system remains the foundation of measles control.

  8. Measles mortality reduction--West Africa, 1996-2002.

    PubMed

    2004-01-23

    The World Health Organization (WHO) estimates that, during 2000, measles accounted for approximately 777,000 deaths worldwide, of which 452,000 (58%) occurred in Africa. In response, in 2000, WHO's African Regional Office (AFRO) adopted a plan to reduce measles mortality >50% by 2005. The plan recommended 1) increasing measles vaccination by strengthening routine health services; 2) providing a second opportunity for measles vaccination for all children, primarily through wide--age-range supplemental immunization activities (SIAs); 3) enhancing measles surveillance; and 4) improving management of measles cases. The initial wide--age-range SIA targets all children aged 9 months-14 years, regardless of history of measles disease or vaccination. Follow-up SIAs are needed 3-5 years after the initial SIA to provide a second opportunity for vaccination to children born since the previous SIA (i.e., those aged 9 months-4 years). During the 1990s, the countries of the Americas and seven countries in southern Africa used this strategy to reduce the number of measles deaths to near zero. This report describes the recent implementation of this strategy in three West African countries, where reported measles cases declined 83%-97% during the first year after SIAs. Successful implementation of this strategy by other African countries should result in achieving the goal of >50% reduction in measles mortality by 2005.

  9. Self-reported histories of disease and vaccination against measles, mumps, rubella and varicella in health care personnel in Japan.

    PubMed

    Kumakura, Shunichi; Onoda, Keiichi; Hirose, Masahiro

    2014-03-01

    Health care personnel are required to be immune against vaccine-preventable diseases, such as measles, mumps, rubella, and varicella. The aim of this study is to evaluate the accuracy of self-reported histories of disease and vaccination against measles, mumps, rubella, and varicella in order to determine the immune status of health care personnel. A self-reported questionnaire of history of previous disease and vaccination against these diseases was administered to a total of 910 health care personnel in Shimane university hospital in Japan, whose results were compared with serological evidences. There were numerous subjects who did not remember a history of disease (greater than 33% each) and of vaccination (greater than 58% each). Self-reported history of disease and vaccination had high positive predictive value against either disease for testing positive for antiviral antibodies. However, a considerable number of false-negative subjects could be found; 88.9% of subjects for measles, 89.3% for mumps, 62.2% for rubella and 96.3% for varicella in the population who had neither a self-reported history of disease nor a vaccination against each disease. In addition, regardless of the disease in question, a negative predictive value in self-reported history of disease and vaccination was remarkably low. These results suggest that self-reported history of disease and vaccination was not predictive to determine the accurate immune status of health care personnel against measles, mumps, rubella, and varicella. A seroprevalence survey, followed by an adequate immunization program for susceptible subjects, is crucial to prevent and control infection in hospital settings. Copyright © 2013 Japanese Society of Chemotherapy and the Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  10. An Outbreak of Measles in a University in Korea, 2014.

    PubMed

    Choe, Young June; Park, Young Joon; Kim, Ju Whi; Eom, Hye Eun; Park, Ok; Oh, Myoung Don; Lee, Jong Koo

    2017-11-01

    Measles has been declared eliminated from the Korea since 2006. In April 2014, a measles outbreak occurred at a University in Seoul. A total of 85 measles cases were identified. In order to estimate vaccine effectiveness of measles vaccine, we reviewed the vaccination records of the university students. The vaccine effectiveness of two doses of measles containing vaccine was 60.0% (95% CI, 38.2-74.1; P < 0.05). Transmission was interrupted after the introduction of outbreak-response immunization. The outbreak shows that pockets of under-immunity among college students may have facilitated the disease transmission despite the high 2-dose vaccination coverage in the community. © 2017 The Korean Academy of Medical Sciences.

  11. Effective Vaccine Communication during the Disneyland Measles Outbreak

    PubMed Central

    Broniatowski, David Andre; Hilyard, Karen M.; Dredze, Mark

    2016-01-01

    Vaccine refusal rates have increased in recent years, highlighting the need for effective risk communication, especially over social media. Fuzzy-trace theory predicts that individuals encode bottom-line meaning ("gist") and statistical information ("verbatim") in parallel and that articles expressing a clear gist will be most compelling. We coded news articles (n=4,686) collected during the 2014–2015 Disneyland measles for content including statistics, stories, or opinions containing bottom-line gists regarding vaccines and vaccine-preventable illnesses. We measured the extent to which articles were compelling by how frequently they were shared on Facebook. The most widely shared articles expressed bottom-line opinions, although articles containing statistics were also more likely to be shared than articles lacking statistics. Stories had limited impact on Facebook shares. Results support Fuzzy Trace Theory's predictions regarding the distinct yet parallel impact of categorical gist and statistical verbatim information on public health communication. PMID:27179915

  12. Effective vaccine communication during the disneyland measles outbreak.

    PubMed

    Broniatowski, David A; Hilyard, Karen M; Dredze, Mark

    2016-06-14

    Vaccine refusal rates have increased in recent years, highlighting the need for effective risk communication, especially over social media. Fuzzy-trace theory predicts that individuals encode bottom-line meaning ("gist") and statistical information ("verbatim") in parallel and those articles expressing a clear gist will be most compelling. We coded news articles (n=4581) collected during the 2014-2015 Disneyland measles for content including statistics, stories, or bottom-line gists regarding vaccines and vaccine-preventable illnesses. We measured the extent to which articles were compelling by how frequently they were shared on Facebook. The most widely shared articles expressed bottom-line gists, although articles containing statistics were also more likely to be shared than articles lacking statistics. Stories had limited impact on Facebook shares. Results support Fuzzy Trace Theory's predictions regarding the distinct yet parallel impact of categorical gist and statistical verbatim information on public health communication. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Seroprevalence of antibodies to measles, mumps, and rubella among Thai population: evaluation of measles/MMR immunization programme.

    PubMed

    Tharmaphornpilas, Piyanit; Yoocharean, Pornsak; Rasdjarmrearnsook, Aim-Orn; Theamboonlers, Apiradee; Poovorawan, Yong

    2009-02-01

    Stored serum specimens, from four regions of Thailand, of healthy children attending well baby clinics and of healthy people with acute illnesses visiting outpatient clinics were randomly sampled and tested for IgG antibody to measles, mumps, and rubella (MMR). The immunity patterns of rubella and mumps fitted well with the history of rubella and MMR vaccination, seroprotective rates being over 85% among those aged over seven years. A high proportion of younger children acquired the infection before the age of vaccination. MMR vaccination should preferably be given to children at an earlier age. For measles, 73% seroprotective rates among children, aged 8-14 years, who should have received two doses of measles/MMR vaccine, were lower than expected. This finding was consistent with the age-group reported in outbreaks of measles in Thailand. The apparent ineffectiveness (in relation to measles) of MMR immunization of 1st grade students warrants further studies.

  14. Effect of intermittent preventive treatment for malaria during infancy on serological responses to measles and other vaccines used in the Expanded Programme on Immunization: results from five randomised controlled trials.

    PubMed

    Crawley, Jane; Sismanidis, Charalambos; Goodman, Tracey; Milligan, Paul

    2012-09-15

    Intermittent preventive treatment for malaria during infancy (IPTi) is the administration of a full therapeutic course of antimalarial drugs to infants living in settings where malaria is endemic, at the time of routine vaccination in the first year of life. We investigated whether IPTi with sulfadoxine-pyrimethamine or other antimalarial drug combinations adversely affected serological responses to vaccines used in the Expanded Programme on Immunization (EPI). The study was done in a subset of children enrolled in five randomised controlled trials in Navrongo, Ghana; Kilimanjaro, Tanzania; Manhica, Mozambique; Kisumu, Kenya; and Bungoma, Kenya. All infants presenting for the second dose of the diphtheria-tetanus-pertussis vaccination (given at 8-10 weeks of age) were eligible, and analyses included all children who had received measles vaccination (at 9 months of age) and at least one dose of IPTi or placebo. Blood samples were collected before and after vaccination, and antibody titres were measured by plaque reduction neutralisation (measles, yellow fever), microneutralisation (polio serotypes 1 and 3), and ELISA (all other EPI antigens). Laboratory personnel were unaware of the randomisation groups. We compared the proportion of infants in the IPTi and placebo groups who did not attain protective antibody titres after vaccination, using a one-sided significance non-inferiority margin of 5% for measles (the primary endpoint) and 10% for other EPI antigens. Between September, 2000, and May, 2008, 8416 children were enrolled in the five studies. Paired samples from 2368 children from sites where sulfadoxine-pyrimethamine was compared with placebo were analysed for measles antibodies. 464 children with detectable measles antibody in their sample before vaccination were excluded, leaving 1904 individuals (934 placebo and 970 sulfadoxine-pyrimethamine) in the study. IPTi with sulfadoxine-pyrimethamine did not have a clinically significant effect on immune responses

  15. Nationwide measles vaccination campaign for children aged 6 months-12 years--Afghanistan, 2002.

    PubMed

    2003-04-25

    The public health infrastructure in Afghanistan has been devastated by 23 years of civil war, and both the infant mortality rate (165 per 1,000 live-born infants) and the mortality rate for children aged <5 years (256 per 1,000 live-born infants) are among the highest in the world. The major causes of death among children aged <10 years are diarrhea (32%), measles (25%), respiratory tract infections (13%), and other causes (30%), including malnutrition, scurvy, chronic diseases, and fever of unknown origin. Measles accounts for an estimated 30,000-35,000 deaths each year in Afghanistan. To reduce measles-related mortality, during 2002, the Ministry of Health (MoH) of the Interim Government of Afghanistan, with the support of international organizations, organized a nationwide measles vaccination campaign for children aged 6 months-12 years. This report describes the planning, implementation, and impact of this campaign. The findings suggest that the campaign had a major impact on reducing measles-related mortality. Similar campaigns might be feasible in countries affected by complex emergencies.

  16. Enhancing global vaccine pharmacovigilance: Proof-of-concept study on aseptic meningitis and immune thrombocytopenic purpura following measles-mumps containing vaccination.

    PubMed

    Perez-Vilar, Silvia; Weibel, Daniel; Sturkenboom, Miriam; Black, Steven; Maure, Christine; Castro, Jose Luis; Bravo-Alcántara, Pamela; Dodd, Caitlin N; Romio, Silvana A; de Ridder, Maria; Nakato, Swabra; Molina-León, Helvert Felipe; Elango, Varalakshmi; Zuber, Patrick L F

    2018-01-08

    New vaccines designed to prevent diseases endemic in low and middle-income countries (LMICs) are now being introduced without prior record of utilization in countries with robust pharmacovigilance systems. To address this deficit, our objective was to demonstrate feasibility of an international hospital-based network for the assessment of potential epidemiological associations between serious and rare adverse events and vaccines in any setting. This was done through a proof-of-concept evaluation of the risk of immune thrombocytopenic purpura (ITP) and aseptic meningitis (AM) following administration of the first dose of measles-mumps-containing vaccines using the self-controlled risk interval method in the primary analysis. The World Health Organization (WHO) selected 26 sentinel sites (49 hospitals) distributed in 16 countries of the six WHO regions. Incidence rate ratios (IRR) of 5.0 (95% CI: 2.5-9.7) for ITP following first dose of measles-containing vaccinations, and of 10.9 (95% CI: 4.2-27.8) for AM following mumps-containing vaccinations were found. The strain-specific analyses showed significantly elevated ITP risk for measles vaccines containing Schwarz (IRR: 20.7; 95% CI: 2.7-157.6), Edmonston-Zagreb (IRR: 11.1; 95% CI: 1.4-90.3), and Enders'Edmonston (IRR: 8.5; 95% CI: 1.9-38.1) strains. A significantly elevated AM risk for vaccines containing the Leningrad-Zagreb mumps strain (IRR: 10.8; 95% CI: 1.3-87.4) was also found. This proof-of-concept study has shown, for the first time, that an international hospital-based network for the investigation of rare vaccine adverse events, using common standardized procedures and with high participation of LMICs, is feasible, can produce reliable results, and has the potential to characterize differences in risk between vaccine strains. The completion of this network by adding large reference hospitals, particularly from tropical countries, and the systematic WHO-led implementation of this approach, should permit the

  17. Measles, mumps, rubella and VZV: importance of serological testing of vaccine-preventable diseases in young adults living with HIV in Germany.

    PubMed

    Schwarze-Zander, C; Draenert, R; Lehmann, C; Stecher, M; Boesecke, C; Sammet, S; Wasmuth, J C; Seybold, U; Gillor, D; Wieland, U; Kümmerle, T; Strassburg, C P; Mankertz, A; Eis-Hübinger, A M; Jäger, G; Fätkenheuer, G; Bogner, J R; Rockstroh, J K; Vehreschild, J J

    2017-01-01

    Measles, mumps, rubella (MMR) and varicella zoster virus (VZV) infection can cause serious diseases and complications in the HIV-positive population. Due to successful vaccination programmes measles, mumps and congenital rubella syndrome has become neglected in Germany. However, recent outbreaks of measles have occurred from import-associated cases. In this cross-sectional study the serostatus for MMR and VZV in 2013 HIV-positive adults from three different university outpatient clinics in Bonn (n = 544), Cologne (n = 995) and Munich (n = 474) was analysed. Sera were tested for MMR- and VZV-specific immunglobulin G antibodies using commercial immunoassays. Seronegativity was found in 3% for measles, 26% for mumps, 11% for rubella and 2% for VZV. Regarding MMR, 35% of patients lacked seropositivity against at least one infectious agent. In multivariable analysis younger age was strongly associated with seronegativity against all four viruses, measles, mumps, rubella (P < 0·001, P < 0·001 and P = 0·001, respectively) and VZV (P = 0·001). In conclusion, there is high need for MMR and VZV vaccination in people living with HIV in Germany born in 1970 or later. Thus, systematic MMR and VZV antibody screening and vaccination should be implemented in the HIV-positive population to prevent serious disease and complications of vaccine-preventable diseases.

  18. Progress toward measles elimination--Eastern Mediterranean Region, 2008-2012.

    PubMed

    Teleb, Nadia; Lebo, Emmaculate; Ahmed, Hinda; Hossam, Abdel Rahman; El Sayed, El Tayeb; Dabbagh, Alya; Strebel, Peter; Rota, Paul; Alexander, James

    2014-06-13

    In 1997, the 22 countries in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) adopted a goal of measles elimination by 2010. To achieve this goal, the WHO Regional Office for the Eastern Mediterranean Region (EMRO) developed a four-pronged strategy: 1) achieve ≥ 95% vaccination coverage of children with the first dose of measles-containing vaccine (MCV1) in every district of each country through routine immunization services, 2) achieve ≥ 95% vaccination coverage with the second dose of measles-containing vaccine (MCV2) in every district of each country either through a routine 2-dose vaccination schedule or through supplementary immunization activities (SIAs), 3) conduct high-quality, case-based surveillance in all countries, and 4) provide optimal clinical case management, including supplementing diets with vitamin A. Although significant progress was made toward measles elimination in the EMR during 1997-2007, the measles elimination goal was not reached by the target date of 2010, and the date was revised to 2015. This report updates previous reports and summarizes the progress made toward measles elimination in EMR during 2008-2012. From 2008 to 2012, large outbreaks occurred in countries with a high incidence of measles, and reported annual measles cases in EMR increased from 12,186 to 36,456. To achieve measles elimination in EMR, efforts are needed to increase 2-dose vaccination coverage, especially in countries with high incidence of measles and in conflict-affected countries, and to implement innovative strategies to reach populations at high risk in areas with poor access to vaccination services or with civil strife.

  19. Estimation of measles vaccination coverage using the Lot Quality Assurance Sampling (LQAS) method--Tamilnadu, India, 2002-2003.

    PubMed

    Sivasankaran, Saravanan; Manickam, P; Ramakrishnan, R; Hutin, Y; Gupte, M D

    2006-04-28

    As part of the global strategic plan to reduce the number of measles deaths in India, the state of Tamilnadu aims at > or =95% measles vaccination coverage. A study was conducted to measure overall coverage levels for the Poondi Primary Health Center (PPHC), a rural health-care facility in Tiruvallur District, and to determine whether any of the PPHC's six health subcenters had coverage levels <95%. The Lot Quality Assurance Sampling (LQAS) method was used to identify health subcenters in the PPHC area with measles vaccination coverage levels <95% among children aged 12-23 months. Lemeshow and Taber sampling plans were used to determine that the measles vaccination status of 73 children aged 12--23 months had to be assessed in each health subcenter coverage area, with a 5% level of significance and a decision value of two. If more than two children were unvaccinated, the null hypothesis (i.e., that coverage in the health subcenter was low [<95%]) was not rejected. If the number of unvaccinated children was two or fewer, the null hypothesis was rejected, and coverage in the subcenter was considered to be good (i.e., > or =95%). All data were pooled in a stratified sample to estimate overall total coverage in the PPHC area. For two (33.3%) of the six health subcenters, more than two children were unvaccinated (i.e., coverage was <95%). Combining results from all six health subcenters generated a coverage estimate of 97.7% (95% confidence interval = 95.7-98.8) on the basis of 428 (97.7%) of 438 children identified as vaccinated. LQAS techniques proved useful in identifying small health areas with lower vaccination coverage, which helps to target interventions. Monthly review of vaccination coverage by subcenter and village is recommended to identify pockets of unvaccinated children and to maintain uniform high coverage in the PPHC area.

  20. Observational study on immune response to yellow fever and measles vaccines in 9 to 15-month old children. Is it necessary to wait 4 weeks between two live attenuated vaccines?

    PubMed

    Michel, R; Berger, F; Ravelonarivo, J; Dussart, P; Dia, M; Nacher, M; Rogier, S; Moua, D; Sarr, F D; Diop, O M; Sall, A A; Baril, L

    2015-05-11

    The use of 2 live attenuated vaccines (LAV) is recommended to be simultaneous or after an interval of at least four weeks between injections. The primary objective of this study was to compare the humoral response to yellow fever (YF) and measles vaccines among children vaccinated against these two diseases, either simultaneously or separated by an interval of 7-28 days. A prospective, multicenter observational study was conducted among children aged 9-15 months. The primary endpoint was the occurrence of positive yellow fever antibodies after YF vaccine by estimating the titers of neutralizing antibodies from venous blood samples. Children vaccinated against YF 7-28 days after receiving the vaccine against measles (test group) were compared with children vaccinated the same day against these two diseases (referent group). Analysis was performed on 284 children. Of them, fifty-four belonged to the test group. Measles serology was positive in 91.7% of children. Neutralizing antibodies against YF were detected in 90.7% of the test group and 92.9 of the referent group (p=0.6). In addition, quantitative analysis of the immune response did not show a lower response to YF vaccination when it took place 1-28 days after measles vaccination. In 1965, Petralli showed a lower response to the smallpox vaccine when injected 4-20 days after measles vaccination. Since then, recommendations are to observe an interval of four weeks between LAV not injected on the same day. Other published studies failed to show a significant difference in the immune response to a LAV injected 1-28 days after another LAV. These results suggest that the usual recommendations for immunization with two LAV may not be correct. In low income countries, the current policy should be re-evaluated. This re-evaluation should also be applied to travelers to yellow fever endemic countries. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Serum anti-tetanus and measles antibody titres in Ugandan children aged 4 months to 6 years: implications for vaccine programme.

    PubMed

    Warrener, Lenesha; Bwogi, Josephine; Andrews, Nick; Samuel, Dhanraj; Kabaliisa, Theopista; Bukenya, Henry; Brown, Kevin; Roper, Martha H; Featherstone, David A; Brown, David

    2018-05-09

    To study the antibody response to tetanus toxoid and measles by age following vaccination in children aged 4 months to 6 years in Entebbe, Uganda. Serum samples were obtained from 113 children aged 4-15 months, at the Mother-Child Health Clinic (MCHC), Entebbe Hospital and from 203 of the 206 children aged between 12 and 75 months recruited through the Outpatients Department (OPD). Antibodies to measles were quantified by plaque reduction neutralisation test (PRNT) and with Siemens IgG EIA. VaccZyme IgG EIA was used to quantify anti-tetanus antibodies. Sera from 96 of 113 (85.0%) children attending the MCHC contained Measles PRNT titres below the protective level (120 mIU/ml). Sera from 24 of 203 (11.8%) children attending the OPD contained PRNT titres 0.15 IU/ml by EIA, a level considered protective. The overall concentration of anti-tetanus antibody was sixfold higher in children under 12 months compared with the older children, with geometric mean concentrations of 3.15 IU/ml and 0.49 IU/ml, respectively. For each doubling in age between 4 and 64 months, the anti-tetanus antibody concentration declined by 50%. As time since the administration of the third DTP vaccination doubled, anti-tetanus antibody concentration declined by 39%. The low measles antibody prevalence in the children presenting at the MCHC is consistent with the current measles epidemiology in Uganda, where a significant number of measles cases occur in children under 1 year of age and earlier vaccination may be indicated. The consistent fall in anti-tetanus antibody titre over time following vaccination supports the need for further vaccine boosters at age 4-5 years as recommended by the WHO.

  2. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP).

    PubMed

    Watson, J C; Hadler, S C; Dykewicz, C A; Reef, S; Phillips, L

    1998-05-22

    These revised recommendations of the Advisory Committee on Immunization Practices (ACIP) on measles, mumps, and rubella prevention supersede recommendations published in 1989 and 1990. This statement summarizes the goals and current strategies for measles, rubella, and congenital rubella syndrome (CRS) elimination and for mumps reduction in the United States. Changes from previous recommendations include: Emphasis on the use of combined MMR vaccine for most indications; A change in the recommended age for routine vaccination to 12-15 months for the first dose of MMR, and to 4-6 years for the second dose of MMR; A recommendation that all states take immediate steps to implement a two dose MMR requirement for school entry and any additional measures needed to ensure that all school-aged children are vaccinated with two doses of MMR by 2001; A clarification of the role of serologic screening to determine immunity; A change in the criteria for determining acceptable evidence of rubella immunity; A recommendation that all persons who work in health-care facilities have acceptable evidence of measles and rubella immunity; Changes in the recommended interval between administration of immune globulin and measles vaccination; and Updated information on adverse events and contraindications, particularly for persons with severe HIV infection, persons with a history of egg allergy or gelatin allergy, persons with a history of thrombocytopenia, and persons receiving steroid therapy.

  3. FastStats: Measles

    MedlinePlus

    ... Women’s Health State and Territorial Data Reproductive Health Contraceptive Use Infertility Reproductive Health Notice Regarding FastStats Mobile ... measles, mumps, rubella: 91.9% (2015) Percent of adolescents aged 13-17 years vaccinated against measles, mumps, ...

  4. A Measles Outbreak at a College with a Prematriculation Immunization Requirement.

    ERIC Educational Resources Information Center

    Hersh, Bradley S.; And Others

    1991-01-01

    Reports a retrospective cohort study among students living in campus dormitories to examine potential risk factors for measles vaccine failure. As in secondary schools, measles outbreaks can occur among highly vaccinated college populations. Requiring two doses of measles vaccine for college entrants should help reduce measles outbreaks in college…

  5. Seroprevalence of measles, mumps, rubella and varicella among staff of a hospital in Riyadh, Saudi Arabia.

    PubMed

    Abbas, Moustafa; Atwa, Mona; Emara, Amany

    2007-01-01

    This study aimed at screening immune status of Health Care Workers (HCWs) against measles, mumps, rubella, and varicella, and assessing the reliability of the history of previous illness due to these infections or vaccination against them as an indicator of the immune status, as checked by laboratory tests. Demographic data, history of previous illnesses and previous vaccinations were collected using a self-administered questionnaire. Also, serologic screening was done for these infections. Antibodies tested using ELISA. Among tested hospital staff, 71.8%, 60.3%, 47.9% and 68.4% reported history of infection or vaccination against measles, mumps, rubella and varicella respectively, while laboratory results proved that 4.5%, 10.8%, 12.9% and 11.3% were susceptible respectively. Susceptibility was most frequent among housekeeping staff against measles and varicella, while administrative staff were the most susceptibles to mumps, and nurses were the most susceptibles to rubella. Sensitivity of past history of illness as an indicator of the immune status, was found to be (85%, 83%, 66%, 86%); Specificity was (81%, 81%, 89%, 87%); Positive Predictive value (PV) was (99%, 98%, 98%, 98%) and Negative PV was (16%, 29%, 22%, 39%) for measles, mumps, rubella and varicella respectively. Screening for measles, mumps, rubella and varicella among hospital staff is mandatory to detect those who are susceptible for infections and should be vaccinated, and so preventing transmission of these infections to their colleagues or patients.

  6. Protection from SARS coronavirus conferred by live measles vaccine expressing the spike glycoprotein.

    PubMed

    Escriou, Nicolas; Callendret, Benoît; Lorin, Valérie; Combredet, Chantal; Marianneau, Philippe; Février, Michèle; Tangy, Frédéric

    2014-03-01

    The recent identification of a novel human coronavirus responsible of a SARS-like illness in the Middle-East a decade after the SARS pandemic, demonstrates that reemergence of a SARS-like coronavirus from an animal reservoir remains a credible threat. Because SARS is contracted by aerosolized contamination of the respiratory tract, a vaccine inducing mucosal long-term protection would be an asset to control new epidemics. To this aim, we generated live attenuated recombinant measles vaccine (MV) candidates expressing either the membrane-anchored SARS-CoV spike (S) protein or its secreted soluble ectodomain (Ssol). In mice susceptible to measles virus, recombinant MV expressing the anchored full-length S induced the highest titers of neutralizing antibodies and fully protected immunized animals from intranasal infectious challenge with SARS-CoV. As compared to immunization with adjuvanted recombinant Ssol protein, recombinant MV induced stronger and Th1-biased responses, a hallmark of live attenuated viruses and a highly desirable feature for an antiviral vaccine. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Measles, mumps and rubella (MMR) vaccination has no effect on cognitive development in children - the results of the Polish prospective cohort study.

    PubMed

    Mrozek-Budzyn, Dorota; Kiełtyka, Agnieszka; Majewska, Renata; Augustyniak, Małgorzata

    2013-05-24

    The aim of the study was to examine the hypothesis that MMR exposure has a negative influence on cognitive development in children. Furthermore, MMR was compared to single measles vaccine to determine the potential difference of these vaccines safety regarding children's cognitive development. The prospective birth cohort study with sample consisted of 369 infants born in Krakow. Vaccination history against measles (date and the type of the vaccine) was extracted from physicians' records. Child development was assessed using the Bayley Scales of Infant Development (BSID-II) up to 3rd year of life, Raven test in 5th and 8th year and Wechsler (WISC-R) in 6th and 7th year. Data on possible confounders came from mothers' interview, medical records and analyses of lead and mercury level at birth and at the end of 5th year of life. Linear and logistic regression models adjusted for potential confounders were used to assess the association. No significant differences in cognitive and intelligence tests results were observed between children vaccinated with MMR and those not vaccinated up to the end of the 2nd year of life. Children vaccinated with MMR had significantly higher Mental BSID-II Index (MDI) in the 36th month than those vaccinated with single measles vaccine (103.8±10.3 vs. 97.2±11.2, p=0.004). Neither results of Raven test nor WISC-R were significantly different between groups of children vaccinated with MMR and with single measles vaccine. After standardization to child's gender, maternal education, family economical status, maternal IQ, birth order and passive smoking all developmental tests were statistically insignificant. The results suggest that there is no relationship between MMR exposure and children's cognitive development. Furthermore, the safety of triple MMR is the same as the single measles vaccine with respect to cognitive development. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. A Measles Outbreak in an Underimmunized Amish Community in Ohio.

    PubMed

    Gastañaduy, Paul A; Budd, Jeremy; Fisher, Nicholas; Redd, Susan B; Fletcher, Jackie; Miller, Julie; McFadden, Dwight J; Rota, Jennifer; Rota, Paul A; Hickman, Carole; Fowler, Brian; Tatham, Lilith; Wallace, Gregory S; de Fijter, Sietske; Parker Fiebelkorn, Amy; DiOrio, Mary

    2016-10-06

    Although measles was eliminated in the United States in 2000, importations of the virus continue to cause outbreaks. We describe the epidemiologic features of an outbreak of measles that originated from two unvaccinated Amish men in whom measles was incubating at the time of their return to the United States from the Philippines and explore the effect of public health responses on limiting the spread of measles. We performed descriptive analyses of data on demographic characteristics, clinical and laboratory evaluations, and vaccination coverage. From March 24, 2014, through July 23, 2014, a total of 383 outbreak-related cases of measles were reported in nine counties in Ohio. The median age of case patients was 15 years (range, <1 to 53); a total of 178 of the case patients (46%) were female, and 340 (89%) were unvaccinated. Transmission took place primarily within households (68% of cases). The virus strain was genotype D9, which was circulating in the Philippines at the time of the reporting period. Measles-mumps-rubella (MMR) vaccination coverage with at least a single dose was estimated to be 14% in affected Amish households and more than 88% in the general (non-Amish) Ohio community. Containment efforts included isolation of case patients, quarantine of susceptible persons, and administration of the MMR vaccine to more than 10,000 persons. The spread of measles was limited almost exclusively to the Amish community (accounting for 99% of case patients) and affected only approximately 1% of the estimated 32,630 Amish persons in the settlement. The key epidemiologic features of a measles outbreak in the Amish community in Ohio were transmission primarily within households, the small proportion of Amish people affected, and the large number of people in the Amish community who sought vaccination. As a result of targeted containment efforts, and high baseline coverage in the general community, there was limited spread beyond the Amish community. (Funded by the

  9. Safety and immunogenicity of inactivated poliovirus vaccine when given with measles-rubella combined vaccine and yellow fever vaccine and when given via different administration routes: a phase 4, randomised, non-inferiority trial in The Gambia.

    PubMed

    Clarke, Ed; Saidu, Yauba; Adetifa, Jane U; Adigweme, Ikechukwu; Hydara, Mariama Badjie; Bashorun, Adedapo O; Moneke-Anyanwoke, Ngozi; Umesi, Ama; Roberts, Elishia; Cham, Pa Modou; Okoye, Michael E; Brown, Kevin E; Niedrig, Matthias; Chowdhury, Panchali Roy; Clemens, Ralf; Bandyopadhyay, Ananda S; Mueller, Jenny; Jeffries, David J; Kampmann, Beate

    2016-08-01

    The introduction of the inactivated poliovirus vaccine (IPV) represents a crucial step in the polio eradication endgame. This trial examined the safety and immunogenicity of IPV given alongside the measles-rubella and yellow fever vaccines at 9 months and when given as a full or fractional dose using needle and syringe or disposable-syringe jet injector. We did a phase 4, randomised, non-inferiority trial at three periurban government clinics in west Gambia. Infants aged 9-10 months who had already received oral poliovirus vaccine were randomly assigned to receive the IPV, measles-rubella, and yellow fever vaccines, singularly or in combination. Separately, IPV was given as a full intramuscular or fractional intradermal dose by needle and syringe or disposable-syringe jet injector at a second visit. The primary outcomes were seroprevalence rates for poliovirus 4-6 weeks post-vaccination and the rate of seroconversion between baseline and post-vaccination serum samples for measles, rubella, and yellow fever; and the post-vaccination antibody titres generated against each component of the vaccines. We did a per-protocol analysis with a non-inferiority margin of 10% for poliovirus seroprevalence and measles, rubella, and yellow fever seroconversion, and (1/3) log2 for log2-transformed antibody titres. This trial is registered with ClinicalTrials.gov, number NCT01847872. Between July 10, 2013, and May 8, 2014, we assessed 1662 infants for eligibility, of whom 1504 were enrolled into one of seven groups for vaccine interference and one of four groups for fractional dosing and alternative route of administration. The rubella and yellow fever antibody titres were reduced by co-administration but the seroconversion rates achieved non-inferiority in both cases (rubella, -4·5% [95% CI -9·5 to -0·1]; yellow fever, 1·2% [-2·9 to 5·5]). Measles and poliovirus responses were unaffected (measles, 6·8% [95% CI -1·4 to 14·9]; poliovirus serotype 1, 1·6% [-6·7 to 4·7

  10. Progress Toward Regional Measles Elimination - Worldwide, 2000-2016.

    PubMed

    Dabbagh, Alya; Patel, Minal K; Dumolard, Laure; Gacic-Dobo, Marta; Mulders, Mick N; Okwo-Bele, Jean-Marie; Kretsinger, Katrina; Papania, Mark J; Rota, Paul A; Goodson, James L

    2017-10-27

    The fourth United Nations Millennium Development Goal, adopted in 2000, set a target to reduce child mortality by two thirds by 2015. One indicator of progress toward this target was measles vaccination coverage (1). In 2010, the World Health Assembly (WHA) set three milestones for measles control by 2015: 1) increase routine coverage with the first dose of a measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district; 2) reduce global annual measles incidence to <5 cases per million population; and 3) reduce global measles mortality by 95% from the 2000 estimate (2).* In 2012, WHA endorsed the Global Vaccine Action Plan, † with the objective of eliminating measles in four World Health Organization (WHO) regions by 2015 and in five regions by 2020. Countries in all six WHO regions have adopted goals for measles elimination by or before 2020. Measles elimination is defined as the absence of endemic measles virus transmission in a region or other defined geographic area for ≥12 months, in the presence of a high quality surveillance system that meets targets of key performance indicators. This report updates a previous report (3) and describes progress toward global measles control milestones and regional measles elimination goals during 2000-2016. During this period, annual reported measles incidence decreased 87%, from 145 to 19 cases per million persons, and annual estimated measles deaths decreased 84%, from 550,100 to 89,780; measles vaccination prevented an estimated 20.4 million deaths. However, the 2015 milestones have not yet been met; only one WHO region has been verified as having eliminated measles. Improved implementation of elimination strategies by countries and their partners is needed, with focus on increasing vaccination coverage through substantial and sustained additional investments in health systems, strengthening surveillance systems, using surveillance data to drive

  11. Measles-mumps-rubella vaccine and autistic spectrum disorder: report from the New Challenges in Childhood Immunizations Conference convened in Oak Brook, Illinois, June 12-13, 2000.

    PubMed

    Halsey, N A; Hyman, S L

    2001-05-01

    . Most data indicate increased recognition and reporting as primary factors, but the epidemiologic data are insufficient to determine if there has been a true increase in the incidence of ASD. Increased reporting of ASD in recent years has occurred long after the introduction of MMR vaccine in the United States in 1971 and widespread use of this vaccine in the 1970s for routine immunization of children at 12 to 15 months of age. Appropriate detailed studies are needed to define the true incidence and prevalence of ASD. Epidemiologic studies in Europe indicate no association between MMR vaccine and ASD. Some children with ASD have gastrointestinal symptoms, but an increased rate of any specific gastrointestinal disorder in children with ASD has not been established. Studies to detect evidence of measles virus in intestinal tissue specimens from patients with IBD or autism with gastrointestinal symptoms have not used uniform techniques. Several laboratories have found no evidence of measles viruses in tissue specimens from patients with IBD, but 2 groups have found evidence of measles virus using different techniques. A group that found evidence of measles virus in affected tissue specimens from patients with IBD has also reported detecting portions of measles virus in peripheral blood lymphocytes and intestinal tissue specimens from patients with autism and gastrointestinal disorders. Finding a portion of a virus using molecular techniques does not constitute evidence for a causal relationship, because some viruses persist in unaffected hosts. Additional controlled studies in several laboratories are needed to determine if portions of measles virus persist in intestinal and other tissues of people with and without gastrointestinal disease and/or ASD. Although the possible association with MMR vaccine has received much public and political attention and there are many who have derived their own conclusions based on personal experiences, the available evidence does not

  12. Retrospective measles outbreak investigation: Sudan, 2004.

    PubMed

    Coronado, Fátima; Musa, Nisreen; El Tayeb, El Sayed Ahmed; Haithami, Salah; Dabbagh, Alya; Mahoney, Frank; Nandy, Robin; Cairns, Lisa

    2006-10-01

    Recent population-based studies of measles incidence and deaths in Sudan are not available. To determine the epidemiology and case-fatality rate (CFR) of measles, we conducted a retrospective outbreak investigation in two states in northern Sudan. Of 1144 case-patients identified, 92% were <15 years; 48.6% were vaccinated; and 62% received vitamin A before illness. Ten measles-associated deaths were identified (CFR 0.9%; 95% confidence interval 0.16-1.91). CFR determined by this investigation is lower than expected for the region but remains 10 times higher than that in developed countries. Measles control should be strengthened by improving vaccine coverage, measles surveillance and case-management.

  13. Differential miRNA expression in B cells is associated with inter-individual differences in humoral immune response to measles vaccination.

    PubMed

    Haralambieva, Iana H; Kennedy, Richard B; Simon, Whitney L; Goergen, Krista M; Grill, Diane E; Ovsyannikova, Inna G; Poland, Gregory A

    2018-01-01

    MicroRNAs are important mediators of post-transcriptional regulation of gene expression through RNA degradation and translational repression, and are emerging biomarkers of immune system activation/response after vaccination. We performed Next Generation Sequencing (mRNA-Seq) of intracellular miRNAs in measles virus-stimulated B and CD4+ T cells from high and low antibody responders to measles vaccine. Negative binomial generalized estimating equation (GEE) models were used for miRNA assessment and the DIANA tool was used for gene/target prediction and pathway enrichment analysis. We identified a set of B cell-specific miRNAs (e.g., miR-151a-5p, miR-223, miR-29, miR-15a-5p, miR-199a-3p, miR-103a, and miR-15a/16 cluster) and biological processes/pathways, including regulation of adherens junction proteins, Fc-receptor signaling pathway, phosphatidylinositol-mediated signaling pathway, growth factor signaling pathway/pathways, transcriptional regulation, apoptosis and virus-related processes, significantly associated with neutralizing antibody titers after measles vaccination. No CD4+ T cell-specific miRNA expression differences between high and low antibody responders were found. Our study demonstrates that miRNA expression directly or indirectly influences humoral immunity to measles vaccination and suggests that B cell-specific miRNAs may serve as useful predictive biomarkers of vaccine humoral immune response.

  14. Contrasting female-male mortality ratios after routine vaccinations with pentavalent vaccine versus measles and yellow fever vaccine. A cohort study from urban Guinea-Bissau.

    PubMed

    Fisker, Ane B; Biering-Sørensen, Sofie; Lund, Najaaraq; Djana, Queba; Rodrigues, Amabelia; Martins, Cesario L; Benn, Christine S

    2016-08-31

    In addition to protection against the target diseases, vaccines may have non-specific effects (NSEs). Measles vaccine (MV) has beneficial NSEs, providing protection against non-measles deaths, most so for girls. By contrast, though protecting against diphtheria, tetanus and pertussis, DTP vaccine is associated with increased female mortality relative to male mortality. In 2008, Guinea-Bissau replaced DTP with the DTP-containing pentavalent vaccine (Penta; DTP-H. influenza type B-Hepatitis B) at 6, 10 and 14weeks and yellow fever vaccine (YF) was to be given with MV. We investigated possible sex-differential mortality rates following Penta and MV+YF vaccination. Bandim Health Project (BHP) registers vaccines given by the three government health centres in the study area and vital status through demographic surveillance. We assessed the association between sex and mortality by vaccination status in Cox proportional hazards models with age as underlying timescale. Follow-up was censored at a subsequent vaccination contact or after 6months of follow-up. Between September 2008 and April 2011, we registered 23,448 vaccination contacts for children aged 42-365days; 17,313 were for Penta and 3028 for MV (2907 co-administered with YF). During follow-up 112 children died. The female/male mortality rate ratio was 1.73 (1.11-2.70) following Penta and 0.38 (0.12-1.19) after MV (p=0.02 for same effect). Adjusting for maternal education or weight-for-age at the time of vaccination did not change the estimates. Penta appears to have the same negative effects on mortality as those seen for DTP. Assessing post-vaccination mortality for boys and girls is necessary to improve the vaccination programme. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Development and evaluation of the TD97 measles virus vaccine

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Suzuki, K.; Morita, M.; Katoh, M.

    1990-11-01

    The TD97 strain vaccine virus was prepared from the Tanabe strain measles virus by low-temperature passages in primary cell cultures and ultraviolet (UV) mutagenesis. The TD97 strain exhibited the following characteristics: highly temperature sensitive, neither multiplying nor forming any plaques at 40 degrees C in Vero cells; genetically stable, maintaining high temperature sensitivity after ten successive passages in CE cells at 30 degrees C or 35 degrees C; and M proteins of this virus about 1 KD slower in mobility in SDS-PAGE than that of the Tanabe strain. The TD97 strain was further confirmed to be attenuated by an inoculationmore » test into primate brain. In field trials, 752 healthy children were inoculated with a live virus vaccine prepared with this strain, and the following results were obtained: the seroconversion rate was 97% (517/533), and the average HI antibody titer was 2(5.2). An antibody-increasing effect was also observed in children who were initially seropositive. In children who seroconverted, the rates of fever were 15.7% (55/351) for 37.5 degrees C or higher and 4.0% (14/351) for 39 degrees C or higher. The rash rate was 7.7% (27/351), and the incidence of local reaction was 5.4% (19/351). The TD97 strain is thus considered to be suitable in use for an attenuated measles vaccine.« less

  16. Closer look at autism and the measles-mumps-rubella vaccine.

    PubMed

    Hensley, Emily; Briars, Leslie

    2010-01-01

    To educate pharmacists regarding the hypothesis that the measles-mumps-rubella (MMR) vaccine is linked to the development of autism. Articles published from 1998 to 2009 were identified through electronic searches of Medline. Articles were included if they evaluated or reviewed a possible link between the MMR vaccine and autism or discussed MMR epidemiology, legal proceedings involving the MMR vaccine and autism, or health professionals' impact on immunization decisions. A total of 27 articles were identified. Of the articles, 74% (20 of 27) were included in the review because of their relevance to the study topic. The evidence presented does not show a causal relationship between the MMR vaccine and autism. Myths presented to potentially support any relationship between the MMR vaccine and autism have not been proven. Expert testimony refuting initial scientific theories has led to Supreme Court decisions that do not support a link between the MMR vaccine and autism. Pharmacists and all health care providers are responsible for informing and educating parents and families regarding this information so that they can make informed decisions about immunizations.

  17. A Population Profile of Measles Susceptibility in Tianjin, China

    PubMed Central

    Boulton, Matthew L.; Wang, Xiexiu; Zhang, Ying; Montgomery, JoLynn P.; Wagner, Abram L.; Carlson, Bradley F.; Ding, Yaxing; Li, Xiaoyan; Gillespie, Brenda; Su, Xu

    2016-01-01

    Background Measles is a highly infectious illness requiring herd immunity of 95% to interrupt transmission. Measles is targeted for elimination in China, which has not reached elimination goals despite high vaccination coverage. We developed a population profile of measles immunity among residents aged 0 through 49 years in Tianjin, China. Methods Participants were either from community population registers or community immunization records. Measles IgG antibody status was assessed using dried blood spots. We examined the association between measles IgG antibody status and independent variables including urbanicity, sex, vaccination, measles history, and age. Results 2,818 people were enrolled. The proportion measles IgG negative increased from 50.7% for infants aged 1 month to 98.3% for those aged 7 months. After 8 months, the age of vaccination eligibility, the proportion of infants and children measles IgG negative decreased. Overall, 7.8% of participants 9 months of age or older lacked measles immunity including over 10% of those 20–39 years. Age and vaccination status were significantly associated with measles IgG status in the multivariable model. The odds of positive IgG status were 0.337 times as high for unvaccinated compared to vaccinated (95% CI: 0.217, 0.524). Conclusions The proportion of persons in Tianjin, China immune to measles was lower than herd immunity threshold with less than 90% of people aged 20–39 years demonstrating protection. Immunization programs in Tianjin have been successful in vaccinating younger age groups although high immunization coverage in infants and children alone won’t provide protective herd immunity, given the large proportion of non-immune adults. PMID:27151881

  18. Measles and rubella vaccination coverage in Haiti, 2012: progress towards verifying and challenges to maintaining measles and rubella elimination

    PubMed Central

    Tohme, Rania A.; François, Jeannot; Wannemuehler, Kathleen; Magloire, Roc; Danovaro-Holliday, M. Carolina; Flannery, Brendan; Cavallaro, Kathleen F.; Fitter, David L.; Purcell, Nora; Dismer, Amber; Tappero, Jordan W.; Vertefeuille, John F.; Hyde, Terri B.

    2015-01-01

    Objectives We conducted a nationwide survey to assess measles containing vaccine (MCV) coverage among children aged 1–9 years in Haiti and identify factors associated with vaccination before and during the 2012 nationwide supplementary immunisation activities (SIA). Methods Haiti was stratified into five geographic regions (Metropolitan Port-au-Prince, North, Centre, South and West), 40 clusters were randomly selected in each region, and 35 households were selected per cluster. Results Among the 7000 visited households, 75.8% had at least one child aged 1–9 years; of these, 5279 (99.5%) households consented to participate in the survey. Of 9883 children enrolled, 91% received MCV before and/or during the SIA; 31% received MR for the first time during the SIA, and 50.7% received two doses of MCV (one before and one during the 2012 SIA). Among the 1685 unvaccinated children during the SIA, the primary reason of non-vaccination was caregivers not being aware of the SIA (31.0%). Children aged 1–4 years had significantly lower MR SIA coverage than those aged 5–9 years (79.5% vs. 84.8%) (P < 0.0001). A higher proportion of children living in the West (12.3%) and Centre (11.2%) regions had never been vaccinated than in other regions (4.8–9.1%). Awareness, educational level of the mother and region were significantly associated with MR vaccination during and before the SIA (P < 0.001). Conclusions The 2012 SIA successfully increased MR coverage; however, to maintain measles and rubella elimination, coverage needs to be further increased among children aged 1–4 years and in regions with lower coverage. PMID:25041586

  19. Measles and rubella vaccination coverage in Haiti, 2012: progress towards verifying and challenges to maintaining measles and rubella elimination.

    PubMed

    Tohme, Rania A; François, Jeannot; Wannemuehler, Kathleen; Magloire, Roc; Danovaro-Holliday, M Carolina; Flannery, Brendan; Cavallaro, Kathleen F; Fitter, David L; Purcell, Nora; Dismer, Amber; Tappero, Jordan W; Vertefeuille, John F; Hyde, Terri B

    2014-09-01

    We conducted a nationwide survey to assess measles containing vaccine (MCV) coverage among children aged 1-9 years in Haiti and identify factors associated with vaccination before and during the 2012 nationwide supplementary immunisation activities (SIA). Haiti was stratified into five geographic regions (Metropolitan Port-au-Prince, North, Centre, South and West), 40 clusters were randomly selected in each region, and 35 households were selected per cluster. Among the 7000 visited households, 75.8% had at least one child aged 1-9 years; of these, 5279 (99.5%) households consented to participate in the survey. Of 9883 children enrolled, 91% received MCV before and/or during the SIA; 31% received MR for the first time during the SIA, and 50.7% received two doses of MCV (one before and one during the 2012 SIA). Among the 1685 unvaccinated children during the SIA, the primary reason of non-vaccination was caregivers not being aware of the SIA (31.0%). Children aged 1-4 years had significantly lower MR SIA coverage than those aged 5-9 years (79.5% vs. 84.8%) (P < 0.0001). A higher proportion of children living in the West (12.3%) and Centre (11.2%) regions had never been vaccinated than in other regions (4.8-9.1%). Awareness, educational level of the mother and region were significantly associated with MR vaccination during and before the SIA (P < 0.001). The 2012 SIA successfully increased MR coverage; however, to maintain measles and rubella elimination, coverage needs to be further increased among children aged 1-4 years and in regions with lower coverage. © 2014 John Wiley & Sons Ltd.

  20. Implication of health care personnel in measles transmission

    PubMed Central

    Torner, Núria; Solano, Ruben; Rius, Cristina; Domínguez, Angela; Surveillance Network of Catalonia, Spain, the Measles Elimination Program

    2014-01-01

    Healthcare personnel (HCP) play an important role in transmission of highly contagious diseases such as measles. Current immunization guidelines in Catalonia include Measles-Mumps-Rubella (MMR) immunization for HCP born after 1967 without evidence of immunity. Despite high vaccination coverage (90%) a high burden of measles cases related to outbreaks have occurred. The aim of this study was to assess the implication of HCP in measles transmission related to healthcare setting. A review of surveillance case data from 2001 to 2013 gathered through the Measles Elimination Program in Catalonia was performed. Twenty six outbreaks involving 797 cases were reported, 52 (6.5%) were HCP aged 21–41 years, 72,5% (38) patient were care personnel (doctors and nurses) and 22,5% (14) other health care related personnel. Forty six 87%) were unvaccinated, 4(10%) had only one dose and 2 had two doses of MMR. In community outbreaks 30 clusters with HCP involved were observed, yet none were identified as index cases. Non-vaccinated HCPs against measles were all under 45 years of age. Vaccination is the only reliable protection against nosocomial spread of measles from HCPs. Assessing vaccination status of HCPs and implementing a 2 dose vaccination in those lacking evidence of immunity is needed in order to set to zero the risk of acquiring and spreading measles in healthcare (HC) settings. PMID:25483548

  1. Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP).

    PubMed

    Marin, Mona; Broder, Karen R; Temte, Jonathan L; Snider, Dixie E; Seward, Jane F

    2010-05-07

    This report presents new recommendations adopted in June 2009 by CDC's Advisory Committee on Immunization Practices (ACIP) regarding use of the combination measles, mumps, rubella, and varicella vaccine (MMRV, ProQuad, Merck & Co., Inc.). MMRV vaccine was licensed in the United States in September 2005 and may be used instead of measles, mumps, rubella vaccine (MMR, M-M-RII, Merck & Co., Inc.) and varicella vaccine (VARIVAX, Merck & Co., Inc.) to implement the recommended 2-dose vaccine schedule for prevention of measles, mumps, rubella, and varicella among children aged 12 months-12 years. At the time of its licensure, use of MMRV vaccine was preferred for both the first and second doses over separate injections of equivalent component vaccines (MMR vaccine and varicella vaccine), which was consistent with ACIP's 2006 general recommendations on use of combination vaccines (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2006;55;[No. RR-15]). Since July 2007, supplies of MMRV vaccine have been temporarily unavailable as a result of manufacturing constraints unrelated to efficacy or safety. MMRV vaccine is expected to be available again in the United States in May 2010. In February 2008, on the basis of preliminary data from two studies conducted postlicensure that suggested an increased risk for febrile seizures 5-12 days after vaccination among children aged 12-23 months who had received the first dose of MMRV vaccine compared with children the same age who had received the first dose of MMR vaccine and varicella vaccine administered as separate injections at the same visit, ACIP issued updated recommendations regarding MMRV vaccine use (CDC. Update: recommendations from the Advisory Committee on Immunization Practices [ACIP] regarding administration of combination MMRV vaccine. MMWR 2008;57:258-60). These updated recommendations expressed no preference for use of MMRV vaccine over

  2. Measles in Pakistan: Time to make steps towards eradication.

    PubMed

    Rehman, Inayat Ur; Bukhsh, Allah; Khan, Tahir Mehmood

    World Health Organization (WHO) measles surveillance data report a reduction in cases of measles globally from 67,524 cases in 2015 to 16,846 in 2016, and a reduction in deaths from 546,800 to 114,900 during period of 2000-14. Pakistan is among the five nations where almost a million children did not receive their first dose of measles vaccination, and outbreaks of the disease resulted in 4386 cases in 2011, 14,687 cases in 2012 with 310 deaths. In 2013, about 25,401 cases of measles were reported and 321 affected children died. The measles vaccination coverage is very low in Pakistan for both 1st dose and booster dose. To prevent outbreaks of measles in Pakistan a national vaccination program should be launched side by side with a polio eradication program in each district and township and a campaign should be launched to educate parents on measles vaccination for childrens to reduce the measles case fatality rate. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Long-term safety and serologic response to measles, mumps, and rubella vaccination in HIV-1 infected adults.

    PubMed

    Stermole, Benjamin M; Grandits, Greg A; Roediger, Mollie P; Clark, Brychan M; Ganesan, Anuradha; Weintrob, Amy C; Crum-Cianflone, Nancy F; Ferguson, Tomas M; Macalino, Grace E; Landrum, Michael L

    2011-04-05

    We analyzed HIV viral load (VL) and CD4 count changes, and antibody responses following MMR vaccination of individuals in the U.S. Military HIV Natural History Study cohort. Cases receiving at least one dose of MMR vaccine after HIV diagnosis were matched 1:2 to HIV-positive controls not receiving the vaccine. Baseline was defined as time of vaccination for cases and indexed and matched to the time post-HIV diagnosis for controls. Changes in CD4 count and VL at 6, 12, 18 and 24 months were compared between cases and controls using a general linear model. Available sera from cases were tested for MMR seropositivity at baseline and post-vaccination at 6, 12, 18, and 24 months. Overall mean CD4 count change from baseline through 24 months was 20 (±23) cells/μL greater for cases than controls (p=0.39). Similar non-significant changes in CD4 cell count were seen in the subset of those not on HAART at baseline. VL changes were small and similar between groups (mean differential change -0.04 (±0.18) log(10) copies/mL; p=0.84). Of 21 vaccinated participants with baseline serologic testing, 14 (67%) were reactive to measles, 19 (91%) to mumps, and 20 (95%) to rubella. Three (43%) of 7 participants nonreactive to measles developed measles IgG; for mumps, 1 (50%) of 2 developed mumps IgG; for rubella, 1 (100%) developed rubella IgG. MMR vaccination did not result in detrimental immunologic or virologic changes through 24 months post-vaccination. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Measles, mumps, and rubella.

    PubMed

    White, Sarah J; Boldt, Kristi L; Holditch, Sara J; Poland, Gregory A; Jacobson, Robert M

    2012-06-01

    Measles, mumps, and rubella are viral diseases that may adversely affect nonimmune pregnant women and their fetuses/neonates. Prevention of these diseases and their complications can be achieved through measles-mumps-rubella (MMR) vaccination before pregnancy. The vaccine is contraindicated during pregnancy, because it contains live, attenuated viruses that pose a theoretical risk to the fetus. However, accidental receipt of MMR vaccination is not known to cause maternal/fetal complications. MMR immunization is recommended to nonimmune obstetric patients upon completion or termination of pregnancy.

  5. Seroconversion of a trivalent measles, mumps, and rubella vaccine in children aged 9 and 15 months.

    PubMed

    Forleo-Neto, E; Carvalho, E S; Fuentes, I C; Precivale, M S; Forleo, L H; Farhat, C K

    1997-12-01

    The serological response to MMR vaccine was evaluated in 109 9-month-old infants having no history of measles vaccination, and in 98 15-month-old children who had received monocomponent measles immunisation at 9 months. The combined vaccine contained Schwarz, Urabe Am9, and Wistar RA 27/3 live attenuated virus strains. Preimmunisation antibody levels were extremely low for the 9-month-old children, indicating that maternally-transmitted antibodies do not persist at this age. In the case of mumps, preimmunisation antibody levels were significantly higher in the 15-month-old than in the 9-month-old group. A difference between groups in terms of postimmunisation antibody titres was observed only for rubella, with titres being significantly higher in the older group. Seroconversion rates were high in both groups and no serious events attributable to vaccination were observed. The MMR vaccine can thus be administered to children as young as 9 months of age. Evidence for the efficacy of a two-dose schedule, i.e. at 9 and 15 months, is presented.

  6. Prevalence of measles in district Bannu.

    PubMed

    Khan, Arshad; Khan, Rahmat Ali; Ahmed, Mushtaq; Khan, Muhammad Sadiq

    2018-03-01

    This was a cross-sectional descriptive study for determining the effect of vaccination in children suffering from measles in district Bannu and FR regions. It was conducted at the Paediatric Unit of Women and Children Teaching Hospital, Bannu Medical College Bannu, from July 2015 to June 2016.A total of 7,200 children were examined both from indoor and OPD. Among these, 3,210 (44.58%), were males and 3990 (55.42) were females. Children upto 15 years, suffering from measles were included both from indoor and outdoor departments. Vaccination drives in various main councils of District Bannu showed that out of the total 7200, 3,210 (53.13%), were males and 3990 (46.87%) were females. Hospital study showed that out of total 7200 children, 578 children were found to be measles infected. Among 578 children, 24 were under 12 months, 194 children were in the age group 1 to 3 years, 254 in the age group 3-5 years, 70 patients in the age group of 5-8 years and 36 in the age group 8-15 years were found to be measles infected. For confirmation of vaccination status the patient's parents were advised to bring along with them vaccination card. Only 67 (11.60%) showed vaccination cards while 511 (88.40%) did not provide vaccination cards showing that these children were non-vaccinated. From the present study, it is strongly recommended that all the children must be immunized against measles.

  7. Implementing the communication for development strategy to improve knowledge and coverage of measles vaccination in western Chinese immunization programs: a before-and-after evaluation.

    PubMed

    Lu, Ming; Chu, Yao-Zhu; Yu, Wen-Zhou; Scherpbier, Robert; Zhou, Yu-Qing; Zhu, Xu; Su, Qi-Ru; Duan, Meng-Juan; Zhang, Xuan; Cui, Fu-Qiang; Wang, Hua-Qing; Zhou, Yi-Biao; Jiang, Qing-Wu

    2017-04-24

    Communication for Development (C4D) is a strategy promoted by the United Nations Children's Fund to foster positive and measurable changes at the individual, family, community, social, and policy levels of society. In western China, C4D activities have previously been conducted as part of province-level immunization programs. In this study, we evaluated the association of C4D with changes in parental knowledge of immunization services, measles disease, and measles vaccine, and changes in their children's measles vaccine coverage. From April 2013 to April 2014, C4D activities were implemented as part of provincial immunization programs in the Inner Mongolia, Guangxi, Chongqing, Guizhou, Tibet, Shaanxi, Gansu, Ningxia, and Qinghai provinces. We used a before-and-after study design and employed face-to-face interviews to assess changes in parental knowledge and vaccination coverage. We surveyed 2 107 households at baseline and 2 070 households after 1 year of C4D activities. Following C4D, 95% of caregivers were aware of the vaccination record check requirement for entry into kindergarten and primary school; 80% of caregivers were aware that migrant children were eligible for free vaccination; more than 70% of caregivers knew that measles is a respiratory infectious disease; and 90% of caregivers knew the symptoms of measles. Caregivers' willingness to take their children to the clinic for vaccination increased from 51.3% at baseline to 67.4% in the post-C4D survey. Coverage of one-dose measles-containing vaccine (MCV) increased from 83.8% at baseline to 90.1% after C4D. One-dose MCV coverage was greater than 95% in the Guangxi, Shaanxi, and Gansu provinces. Two-dose MCV coverage increased from 68.5 to 77.6%. House-to-house communication was the most popular C4D activity among caregivers (91.6% favoring), followed by posters and educational talks (64.8 and 49.9% favoring). C4D is associated with increased caregiver knowledge about measles, increased willingness to

  8. Progress Toward Measles Elimination - Bangladesh, 2000-2016.

    PubMed

    Khanal, Sudhir; Bohara, Rajendra; Chacko, Stephen; Sharifuzzaman, Mohammad; Shamsuzzaman, Mohammad; Goodson, James L; Dabbagh, Alya; Kretsinger, Katrina; Dhongde, Deepak; Liyanage, Jayantha; Bahl, Sunil; Thapa, Arun

    2017-07-21

    In 2013, at the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR), a regional goal was established to eliminate measles and control rubella and congenital rubella syndrome* by 2020 (1). WHO-recommended measles elimination strategies in SEAR countries include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs) † ; 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets targets for recommended performance indicators; and 3) developing and maintaining an accredited measles laboratory network (2). In 2014, Bangladesh, one of 11 countries in SEAR, adopted a national goal for measles elimination by 2018 (2,3). This report describes progress and challenges toward measles elimination in Bangladesh during 2000-2016. Estimated coverage with the first MCV dose (MCV1) increased from 74% in 2000 to 94% in 2016. The second MCV dose (MCV2) was introduced in 2012, and MCV2 coverage increased from 35% in 2013 to 93% in 2016. During 2000-2016, approximately 108.9 million children received MCV during three nationwide SIAs conducted in phases. During 2000-2016, reported confirmed measles incidence decreased 82%, from 34.2 to 6.1 per million population. However, in 2016, 56% of districts did not meet the surveillance performance target of ≥2 discarded nonmeasles, nonrubella cases § per 100,000 population. Additional measures that include increasing MCV1 and MCV2 coverage to ≥95% in all districts with additional strategies for hard-to-reach populations, increasing sensitivity of measles case-based surveillance, and ensuring timely transport of specimens to the national laboratory will help achieve measles elimination.

  9. Progress in global measles control, 2000-2010.

    PubMed

    2012-02-03

    In 1980, before widespread global use of measles vaccine, an estimated 2.6 million measles deaths occurred worldwide. In 2001, to accelerate the reduction in measles cases achieved by vaccination, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) developed a strategy to deliver 2 doses of measles-containing vaccine (MCV) to all children through routine services and supplementary immunization activities (SIAs) and improved disease surveillance. After implementation of this strategy, the estimated number of annual measles deaths worldwide decreased from 733,000 in 2000 to 164,000 in 2008. In 2010, the World Health Assembly endorsed the following measles objectives for 2015: 1) raise routine coverage with the first dose of MCV (MCV1) for children aged 1 year to ≥90% nationally and ≥80% in every district or equivalent administrative unit, 2) reduce and maintain annual measles incidence at <5 cases per million, and 3) reduce measles mortality by ≥95% from the 2000 estimate. During 2000-2010, global MCV1 coverage increased from 72% to 85% with approximately 1 billion children vaccinated during measles SIAs. Reported measles cases decreased from 2000 to 2008, remained stable in 2009, and increased in 2010. By the end of 2010, 40% of countries still had not met the incidence target of <5 cases per million. Key challenges must be overcome to meet the 2015 objectives, including 1) declining political and financial commitments to measles control, 2) failure to reach uniform high coverage with 2 doses of MCV through routine services or SIAs, and 3) inadequate monitoring subnationally of coverage with the first and second dose of MCV to guide interventions to increase coverage.

  10. Non-specific effects of standard measles vaccine at 4.5 and 9 months of age on childhood mortality: randomised controlled trial.

    PubMed

    Aaby, Peter; Martins, Cesário L; Garly, May-Lill; Balé, Carlito; Andersen, Andreas; Rodrigues, Amabelia; Ravn, Henrik; Lisse, Ida M; Benn, Christine S; Whittle, Hilton C

    2010-11-30

    To examine in a randomised trial whether a 25% difference in mortality exists between 4.5 months and 3 years of age for children given two standard doses of Edmonston-Zagreb measles vaccines at 4.5 and 9 months of age compared with those given one dose of measles vaccine at 9 months of age (current policy). Randomised controlled trial. The Bandim Health Project, Guinea-Bissau, which maintains a health and demographic surveillance system in an urban area. 6648 children aged 4.5 months of age who had received three doses of diphtheria-tetanus-pertussis vaccine at least four weeks before enrolment. A large proportion of the children (80%) had previously taken part in randomised trials of neonatal vitamin A supplementation. Children were randomised to receive Edmonston-Zagreb measles vaccine at 4.5 and 9 months of age (group A), no vaccine at 4.5 months and Edmonston-Zagreb measles vaccine at 9 months of age (group B), or no vaccine at 4.5 months and Schwarz measles vaccine at 9 months of age (group C). Main outcome measure Mortality rate ratio between 4.5 and 36 months of age for group A compared with groups B and C. Secondary outcomes tested the hypothesis that the beneficial effect was stronger in the 4.5 to 9 months age group, in girls, and in the dry season, but the study was not powered to test whether effects differed significantly between subgroups. In the intention to treat analysis of mortality between 4.5 and 36 months of age the mortality rate ratio of children who received two doses of Edmonston-Zagreb vaccine at 4.5 and 9 months of age compared with those who received a single dose of Edmonston-Zagreb vaccine or Schwarz vaccine at 9 months of age was 0.78 (95% confidence interval 0.59 to 1.05). In the analyses of secondary outcomes, the intention to treat mortality rate ratio was 0.67 (0.38 to 1.19) between 4.5 and 9 months and 0.83 (0.83 to 1.16) between 9 and 36 months of age. The effect on mortality between 4.5 and 36 months of age was significant for

  11. Seroepidemiology and phylogenetic characterisation of measles virus in Ireland, 2004-2013.

    PubMed

    O' Riordan, Bernadette; Carr, Michael J; Connell, Jeff; Dunford, Linda; Hall, William W; Hassan, Jaythoon

    2014-08-01

    Ireland is classified as an area of high measles incidence. A World Health Organisation-European Region strategic plan exists for measles elimination by 2015. To retrospectively investigate measles outbreaks using all patient samples (sera and oral fluid) received for measles laboratory diagnosis and characterise the genetic diversity of circulating measles genotypes in Ireland. 704 cases of acute measles infection as determined by the presence of measles specific IgM in sera and oral fluids were confirmed at the National Virus Reference Laboratory. Measles positive samples (n=116) were examined by genotyping, sequence analysis and phylogenetic characterisation. Three measles outbreaks occurred over the study period: 2004, 2009/2010 and 2011. Measles IgM positivity ranged from 22-29% in outbreak years to 5-10% in the intervening years. Age profile analysis revealed that whereas individuals >10 years accounted for only 8% of cases in the 2004 outbreak, this increased to 33% and 29% in the 2009/2010 and 2011 outbreaks, respectively. The <1 year cohort accounted for 18-20% of cases in all outbreaks. Phylogenetic analysis demonstrated both indigenous transmission and also importation events. Clade D viruses were exclusively found circulating in Ireland, with autochthonous transmission of diverse genotype D4 strains associated with large outbreaks across Europe. More recently, genotype D8 was identified and these were associated with importation events. This study provides a comprehensive genetic analysis of circulating measles genotypes in Ireland and discriminated between indigenous and imported viral strains. Notably, an increase in laboratory-confirmed measles cases in the greater than 10 years of age group was seen over the study period. This information is valuable to inform vaccination strategies with a focus on those populations who remain susceptible to measles infection. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Socio-demographic determinants of timely adherence to BCG, Penta3, measles, and complete vaccination schedule in Burkina Faso.

    PubMed

    Schoeps, A; Ouédraogo, N; Kagoné, M; Sié, A; Müller, O; Becher, H

    2013-12-17

    To identify the determinants of timely vaccination among young children in the North-West of Burkina Faso. This study included 1665 children between 12 and 23 months of age from the Nouna Health and Demographic Surveillance System, born between September 2006 and December 2008. The effect of socio-demographic variables on timely adherence to the complete vaccination schedule was studied in multivariable ordinal logistic regression with 3 distinct endpoints: (i) complete timely adherence, (ii) failure, and (iii) missing vaccination. Three secondary endpoints were timely vaccination with BCG, Penta3, and measles, which were studied with standard multivariable logistic regression. Mothers' education, socio-economic status, season of birth, and area of residence were significantly associated with failure of timely adherence to the complete vaccination schedule. Year of birth, ethnicity, and the number of siblings was significantly related to timely vaccination with Penta3 but not with BCG or measles vaccination. Children living in rural areas were more likely to fail timely vaccination with BCG than urban children (OR=1.79, 95%CI=1.24-2.58 (proximity to health facility), OR=3.02, 95%CI=2.18-4.19 (long distance to health facility)). In contrast, when looking at Penta3 and measles vaccination, children living in rural areas were far less likely to have failed timely vaccinations than urban children. Mother's education positively influenced timely adherence to the vaccination schedule (OR=1.42, 95%CI 1.06-1.89). There was no effect of household size or the age of the mother. Additional health facilities and encouragement of women to give birth in these facilities could improve timely vaccination with BCG. Rural children had an advantage over the urban children in timely vaccination, which is probably attributable to outreach vaccination teams amongst other factors. As urban children rely on their mothers' own initiative to get vaccinated, urban mothers should be

  13. The 2014 measles outbreak in Osaka An epidemiological study for the elimination of measles.

    PubMed

    Yagi, Yoshina; Higashino, Hirohiko; Yoshida, Hideki; Hirokawa, Hidetetsu; Okumachi, Akinori; Takano, Masako; Nobuta, Mari; Matuoka, Taro; Sasai, Yasunori; Fukushima, Wakaba; Tanaka, Tomoyuki

    2015-01-01

    To examine and analyze the spread of measles in Osaka in 2014 and determine effective measures to prevent such occurrences. We analyzed 47 cases of measles reported in Osaka, including one measles patient living in another prefecture where there was an outbreak. We focused on age distribution, the number of patients reported each week, estimated infection routes, history of measles vaccination, detection of viruses, and number of days it took to report the case after the onset of measles. Patients aged 20-39 years accounted for 24 cases (51.1%). The number of patients reported started from 2nd week with relatively broad peak to 27(th) week, and the measles epidemic was brought under control in the 47(th) week. Among the 47 cases, no source could be identified in 16 cases (34.0%). Household exposure was the main cause of the infection (25.5%), followed by imported cases (21.3%). Eighty-three percent of the overall patients had not received a measles vaccination at all or it was unclear whether they previously had been vaccinated. Genotype B3, H1, and D8 were detected in our patients and these genotypes originated overseas. It took significantly more days, from the onset of measles, for the case to be reported in patients aged 15 years and over compared with those aged under 15 years (P=0.001). For eradicating measles in Osaka, it is important to raise awareness about this issue among medical institutions, especially institutions for adults, in order for them to report cases as soon as possible, upon discovery in their patients. In addition, "catch-up" supplementary immunizations are effective for all people, including adults who are susceptible to measles.

  14. Toward measles elimination in Bahrain--a Middle East country experience.

    PubMed

    Jawad, Jaleela S; Al-Sayyad, Adel S; Sataih, Fathiya; Naouri, Boubker; Alexander, James P

    2011-07-01

    Measles was a leading cause of infant and child morbidity and mortality in Bahrain before the introduction of measles vaccine in 1974. With the establishment of the Expanded Program on Immunization (EPI) in 1981 and the introduction of a second dose of measles vaccine in 1985, coverage for first and second doses of measles vaccine increased to 94% by 1997 and has been sustained >97% since 2001. Measles, mumps, and rubella (MMR) immunization campaigns targeting 12-year-old students were conducted annually during 1998-2006 and achieved coverage of >95%. As a result, the incidence of measles in Bahrain has declined markedly over the past 4 decades, to 2.7 cases per million persons in 2009. Recent confirmed measles cases have occurred sporadically, in undervaccinated children or in infants too young or adults too old to receive measles vaccine. Bahrain has made significant progress toward measles elimination by sustaining high immunization coverage and strengthening case-based measles surveillance activities. Further success will depend on improved identification and immunization of undervaccinated expatriate workers and their families. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2011.

  15. Vaccination policies of immigrants in the EU/EEA Member States-the measles immunization example.

    PubMed

    Bica, Mihai A; Clemens, Ralf

    2018-06-01

    In 2015-16, the European Union/European Economic Area Member States (EU/EEA MSs) experienced an unprecedented volume and rate of migration, posing serious challenges to existing national immunization systems and strategies and raising the questions of where, when and who to vaccinate. We assessed existing strategies for vaccinating immigrant populations in the EU/EEA using measles as an example of the most important vaccine-preventable diseases. In this cross-sectional study, conducted from March to May 2016, an electronic questionnaire was sent to the Heads of National Immunization Technical Advisory Groups (NITAGs) or equivalent policy-making bodies in each of the 31 EU/EEA Member States. Responses were entered into a structured database and validated by survey responders for final analysis. Validated responses from all 31 EU/EEA NITAGs or equivalents showed that there is no common measles immunization policy for European immigrants. Policies vary widely from no policy at all (9 of 31, 29%) to vaccination of all comers (2 of 31, 6%), or vaccination of selected cohorts based on vaccination history (17 of 31, 55%) or serum antibody analysis (2 of 31, 6%). Further, the operational responsibilities for immigrant vaccination and documentation methods are not unified within the EU/EEA region. With some notable exceptions immunization policies to contain spread of infectious diseases through migration are either non-existent or vary widely between countries in the EU/EEA. With freedom of movement within the EU/EEA there ought to be harmonization and a common EU/EEA vaccination strategy to replace national policies for immigrant populations.

  16. Differential miRNA expression in B cells is associated with inter-individual differences in humoral immune response to measles vaccination

    PubMed Central

    Haralambieva, Iana H.; Kennedy, Richard B.; Simon, Whitney L.; Goergen, Krista M.; Grill, Diane E.; Ovsyannikova, Inna G.

    2018-01-01

    Background MicroRNAs are important mediators of post-transcriptional regulation of gene expression through RNA degradation and translational repression, and are emerging biomarkers of immune system activation/response after vaccination. Methods We performed Next Generation Sequencing (mRNA-Seq) of intracellular miRNAs in measles virus-stimulated B and CD4+ T cells from high and low antibody responders to measles vaccine. Negative binomial generalized estimating equation (GEE) models were used for miRNA assessment and the DIANA tool was used for gene/target prediction and pathway enrichment analysis. Results We identified a set of B cell-specific miRNAs (e.g., miR-151a-5p, miR-223, miR-29, miR-15a-5p, miR-199a-3p, miR-103a, and miR-15a/16 cluster) and biological processes/pathways, including regulation of adherens junction proteins, Fc-receptor signaling pathway, phosphatidylinositol-mediated signaling pathway, growth factor signaling pathway/pathways, transcriptional regulation, apoptosis and virus-related processes, significantly associated with neutralizing antibody titers after measles vaccination. No CD4+ T cell-specific miRNA expression differences between high and low antibody responders were found. Conclusion Our study demonstrates that miRNA expression directly or indirectly influences humoral immunity to measles vaccination and suggests that B cell-specific miRNAs may serve as useful predictive biomarkers of vaccine humoral immune response. PMID:29381765

  17. Acute infectious mononucleosis and coincidental measles virus infection.

    PubMed

    Atrasheuskaya, A V; Kameneva, S N; Neverov, A A; Ignatyev, G M

    2004-10-01

    Both Epstein-Barr and measles viruses (MV) cause immune suppression, and the association of the two viruses is evaluated as life threatening. The cell immune impairment caused by simultaneous Epstein-Barr and measles viral infections was responsible for the complicated course of the disease in all described previously reports and for unfavorable outcomes in most of the cases. Timely diagnosis of coincidental viral infections could be a useful predictor for the clinical course and complications. Diagnosis must be based on an accurate assessment of clinical, hematologic, serologic manifestations and supported by appropriate laboratory methods. Recognizing the infectious etiology of concomitant infections is important for both clinicians and epidemiologists. To describe a case report of a 20-year-old woman previously vaccinated against measles infected with acute mononucleosis and coincidental measles virus infection. The clinical, routine laboratory, as well as serological and virologic findings of this patient were scrutinized. Special emphasis was placed on the use of RT-PCR/PCR for confirming the involvement of both measles virus and Epstein-Barr virus (EBV) in this patient's illness. Infectious mononucleosis was not suspected at admission to the hospital. The final diagnosis of a concomitant measles virus infection and acute infectious mononucleosis was facilitated using viral serology to detect virus-specific IgG and IgM antibodies and by RT-PCR for the detection of measles virus RNA and EBV DNA from peripheral blood monocyte cells (PBMC). The present report highlights the difficulty of diagnosing two coincidental virus infections on clinical grounds. Serological and molecular laboratory methods, specifically the PCR (RT-PCR) analysis, are found to be useful for confirming the concomitant viral infections and proper identification of the infecting pathogens.

  18. Predicting and comparing long-term measles antibody profiles of different immunization policies.

    PubMed

    Lee, M S; Nokes, D J

    2001-01-01

    Measles outbreaks are infrequent and localized in areas with high coverage of measles vaccine. The need is to assess long-term effectiveness of coverage. Since 1991, no measles epidemic affecting the whole island has occurred in Taiwan, China. Epidemiological models are developed to predict the long-term measles antibody profiles and compare the merits of different immunization policies on the island. The current measles immunization policy in Taiwan, China, is 1 dose of measles vaccine at 9 months of age and 1 dose of measles, mumps and rubella (MMR) vaccine at 15 months of age, plus a 'mop-up' of MMR-unvaccinated schoolchildren at 6 years of age. Refinements involve a change to a two-dose strategy. Five scenarios based on different vaccination strategies are compared. The models are analysed using Microsoft Excel. First, making the assumption that measles vaccine-induced immunity will not wane, the predicted measles IgG seroprevalences in preschool children range from 81% (lower bound) to 94% (upper bound) and in schoolchildren reach 97-98% in all strategy scenarios. Results are dependent on the association of vaccine coverage between the first and second dose of vaccine. Second, if it is assumed that vaccine-induced antibody titres decay, the long-term measles seroprevalence will depend on the initial titres post vaccination, decay rates of antibody titres and cut-off of seropositivity. If MMR coverage at 12 months of age can reach > 90%, it would be worth changing the current policy to 2 doses at 12 months and 6 years of age to induce higher antibody titres. These epidemiological models could be applied wherever a similar stage of measles elimination has been reached.

  19. The effectiveness of measles-mumps-rubella (MMR) vaccination in the prevention of pediatric hospitalizations for targeted and untargeted infections: A retrospective cohort study.

    PubMed

    La Torre, Giuseppe; Saulle, Rosella; Unim, Brigid; Meggiolaro, Angela; Barbato, Angelo; Mannocci, Alice; Spadea, Antonietta

    2017-08-03

    To evaluate the effectiveness of the measles-mumps-rubella (MMR) vaccine in reducing hospitalizations for infectious disease, targeted and not targeted, as well as from respiratory diseases in children in Rome. The cohort was recomposed through record linkage of 2 archives (vaccination register and hospital discharge records. The analysis included 11,004 children. 20.9% did not receive the MMR vaccination, 49% and 30.1% received one and 2 doses. There were no hospitalizations for rubella, 2 for mumps, and 12 for measles. The vaccine was highly protective against measles and mumps hospitalizations (HR = 0.10; 95% CI: 0.03.0.34). Regarding all infectious diseases there were 414 hospitalizations, and the vaccine was protective (HR = 0.29; 95% CI: 0.25 to 0.34). Concerning respiratory diseases, there were 809 admissions (7.4%), and the vaccine was highly protective (HR: 0.18; 95% CI: 0.07 to 0.48). MMR vaccination is effective for the primary prevention of target and not targeted infectious diseases and may also limit hospitalizations for respiratory diseases.

  20. Prevalence of risk factors for acquiring measles during the 2011 outbreak in Quebec and impact of the province-wide school-based vaccination campaign on population immunity.

    PubMed

    Billard, Marie-Noëlle; De Serres, Gaston; Gariépy, Marie-Claude; Boulianne, Nicole; Toth, Eveline; Landry, Monique; Skowronski, Danuta M

    2017-01-01

    A large measles outbreak occurred in Quebec, Canada, in 2011. Although nearly two-thirds of the cases occurred in only two health districts, a mass vaccination campaign targeting all Quebec elementary and high school students without valid two-dose history was undertaken to prevent future outbreaks. We compared rates of non-vaccination and age at first measles vaccine dose among students in the two most-affected districts and the rest of the province and estimated the improvement in overall student measles immunity due to the mass school-based vaccination campaign. Data were extracted from the provincial vaccination registry for students in kindergarten to grade 11 during the 2011/2012 school year. A telephone survey was conducted in three sub-groups: students whose first measles vaccine dose recorded in the vaccination registry was received during the 2011 school vaccination campaign; students with no dose recorded in the registry whose parents refused receipt during the school campaign; and students with no dose recorded in the registry and no information about parental consent/refusal during the school campaign. Neither the prevalence of being non-vaccinated nor a younger age at first pediatric dose were higher in the two most-affected districts versus the rest of the province. The school campaign vaccinated nearly 8% of all students including 7% who previously received at least one dose. Before the outbreak, 3% of students were not vaccinated and one-third of these (1%/3%) were vaccinated during the campaign. The campaign likely increased the absolute school population immunity by just 1.7%. The concentration of measles cases in the two most-affected health districts during the large Quebec outbreak is not explained by more students who were unvaccinated or who had received their first vaccine dose at a younger age. The vaccination campaign reached one-third of unvaccinated students and only marginally improved population immunity.

  1. Using cost-effectiveness analysis to support research and development portfolio prioritization for product innovations in measles vaccination.

    PubMed

    Garrison, Louis P; Bauch, Chris T; Bresnahan, Brian W; Hazlet, Tom K; Kadiyala, Srikanth; Veenstra, David L

    2011-07-01

    Several potential measles vaccine innovations are in development to address the shortcomings of the current vaccine. Funders need to prioritize their scarce research and development resources. This article demonstrates the usefulness of cost-effectiveness analysis to support these decisions. This study had 4 major components: (1) identifying potential innovations, (2) developing transmission models to assess mortality and morbidity impacts, (3) estimating the unit cost impacts, and (4) assessing aggregate cost-effectiveness in United Nations Children's Fund countries through 2049. Four promising technologies were evaluated: aerosol delivery, needle-free injection, inhalable dry powder, and early administration DNA vaccine. They are projected to have a small absolute impact in terms of reducing the number of measles cases in most scenarios because of already improving vaccine coverage. Three are projected to reduce unit cost per dose by $0.024 to $0.170 and would improve overall cost-effectiveness. Each will require additional investments to reach the market. Over the next 40 years, the aggregate cost savings could be substantial, ranging from $98.4 million to $689.4 million. Cost-effectiveness analysis can help to inform research and development portfolio prioritization decisions. Three new measles vaccination technologies under development hold promise to be cost-saving from a global perspective over the long-term, even after considering additional investment costs. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

  2. Measles: effect of a two-dose vaccination programme in Catalonia, Spain.

    PubMed Central

    Godoy, P.; Domínguez, A.; Salleras, L.

    1999-01-01

    The study reports incidences of measles in Catalonia, Spain, as detected by surveillance, and analyses the specific characteristics of the outbreaks reported for the period 1986-95. Incidences per 100,000 inhabitants were calculated for the period 1971-95. The following variables were studied: year of presentation, number of cases, median age, transmission setting, cases with a record of vaccination and preventable cases. Associations between variables were determined using odds ratios (OR). The incidence of measles declined from 306.3 cases in 1971 to 30.9 in 1995. A total of 50 outbreaks were investigated. The outbreaks that occurred in the last two years of the study had a higher likelihood of having a transmission setting other than primary school (OR = 3.9); a median case age > 10 years (OR = 7.2); and fewer than 6 cases (OR = 2.3). The characteristics of recent outbreaks, marked by a rise both in transmission outside the primary-school setting and in median age, indicate the need for the introduction of a specific vaccination programme at the end of adolescence in addition to control of school-related outbreaks. PMID:10083711

  3. Impact of measles supplementary immunization activities on reaching children missed by routine programs.

    PubMed

    Portnoy, Allison; Jit, Mark; Helleringer, Stéphane; Verguet, Stéphane

    2018-01-02

    Measles supplementary immunization activities (SIAs) are vaccination campaigns that supplement routine vaccination programs with a recommended second dose opportunity to children of different ages regardless of their previous history of measles vaccination. They are conducted every 2-4 years and over a few weeks in many low- and middle-income countries. While SIAs have high vaccination coverage, it is unclear whether they reach the children who miss their routine measles vaccine dose. Determining who is reached by SIAs is vital to understanding their effectiveness, as well as measure progress towards measles control. We examined SIAs in low- and middle-income countries from 2000 to 2014 using data from the Demographic and Health Surveys. Conditional on a child's routine measles vaccination status, we examined whether children participated in the most recent measles SIA. The average proportion of zero-dose children (no previous routine measles vaccination defined as no vaccination date before the SIA) reached by SIAs across 14 countries was 66%, ranging from 28% in São Tomé and Príncipe to 91% in Nigeria. However, when also including all children with routine measles vaccination data, this proportion decreased to 12% and to 58% when imputing data for children with vaccination reported by the mother and vaccination marks on the vaccination card across countries. Overall, the proportions of zero-dose children reached by SIAs declined with increasing household wealth. Some countries appeared to reach a higher proportion of zero-dose children using SIAs than others, with proportions reached varying according to the definition of measles vaccination (e.g., vaccination dates on the vaccination card, vaccination marks on the vaccination card, and/or self-reported data). This suggests that some countries could improve their targeting of SIAs to children who miss other measles vaccine opportunities. Across all countries, SIAs played an important role in reaching

  4. The 2011 measles outbreak in Tokyo. An analysis of surveillance data.

    PubMed

    Nadaoka, Yoko; Hayata, Noriko; Sugishita, Yoshiyuki; Kajiwara, Toshiko; Watanabe, Yu; Yoshida, Michihiko; Hasegawa, Michiya; Hayashi, Yukinao; Ochi, Masayo; Kai, Akemi; Sumitomo, Masami

    2014-01-01

    The study was conducted with the intention of establishing a strategy to eliminate measles on the basis of an analysis of the epidemiological profile of measles cases reported in Tokyo during the year 2011. We investigated measles cases reported to the Tokyo Metropolitan Government in 2011, recorded as part of the National Epidemiological Surveillance of Infectious Diseases. Factors analyzed included age, vaccination status for each patient, cases for which records were discarded after laboratory confirmation, genotype of the measles virus and relationships between dates of specimen collection and results of polymerase chain reaction (PCR) and IgM antibody tests. A total of 178 measles cases were reported in Tokyo during 2011, and the majority of cases (128, 71.9%) were reported during the peak period from epiweeks 13 to 24. The largest age group reported was one to four years of age (40, 22.5%) followed by groups of 20-29 and 30-39 years of age (both 34, 19.1%). Most cases were sporadic, with only six outbreaks occurring. Even then, the numbers of cases for each outbreak was less than five. More than half of the patients in all age groups, except for the 1-4-year-old group, had not been vaccinated or did not have a record of vaccination. Genotypes D4 and D9 of measles virus were detected in most cases. However, genotype D5, which had been circulating in Japan before 2008, was not detected. Imported viruses were the cause of measles cases reported in Tokyo during 2011. The disease control was better than that in 2007 and 2008 because of the swift and appropriate responses to the occurrences. It is also possible that there has been an increase in the proportion of people with immunity to measles. Increasing the rate of immunization, performing effective surveillance, and confirming suspicious measles cases by using molecular methods are important for achieving the elimination of measles.

  5. Evaluation of an expanded case definition for vaccine-modified measles in a school outbreak in South Korea in 2010.

    PubMed

    Choe, Young June; Hu, Jae Kyung; Song, Kyung Min; Cho, Heeyeon; Yoon, Hee Sook; Kim, Seung Tae; Lee, Han Jung; Kim, Kisoon; Bae, Geun-Ryang; Lee, Jong-Koo

    2012-01-01

    In this study, we have described the clinical characteristics of vaccine-modified measles to assess the performance of an expanded case definition in a school outbreak that occurred in 2010. The sensitivity, specificity, and the positive and negative predictive values were evaluated. Among 74 cases of vaccine-modified measles, 47 (64%) met the original case definition. Fever and rash were observed in 73% (54/74); fever was the most common (96%, 71/74) presenting symptom, and rash was noted in 77% (57/74) of the cases. The original case definition showed an overall sensitivity of 63.5% and a specificity of 100.0%. The expanded case definition combining fever and rash showed a higher sensitivity (72.9%) but a lower specificity (88.2%) than the original. The presence of fever and one or more of cough, coryza, or conjunctivitis scored the highest sensitivity among the combinations of signs and symptoms (77.0%), but scored the lowest specificity (52.9%). The expanded case definition was sensitive in identifying suspected cases of vaccine-modified measles. We suggest using this expanded definition for outbreak investigation in a closed community, and consider further discussions on expanding the case definition of measles for routine surveillance in South Korea.

  6. Can measles be eradicated globally?

    PubMed Central

    de Quadros, Ciro A.

    2004-01-01

    Measles is one of the most infectious diseases. Before measles vaccine was introduced, nearly everyone contracted the disease at some point in childhood. By the late 1980s, most countries had incorporated measles vaccine into their routine immunization programmes. Globally, about 800 000 children nevertheless still die from measles annually, half of them in Africa. Eradicating measles would therefore play an important role in improving children's survival. The 24th Pan American Sanitary Conference in 1994 established a goal of eradicating measles from the Americas. Progress to date has been remarkable and the disease is no longer endemic in the Americas, with most countries having documented interruption of transmission. As of November 2003, 12 months had elapsed since the last indigenous case was detected in Venezuela. This experience shows that measles transmission can be interrupted, and that this can be sustained over a long period of time. Global eradication is feasible if an appropriate strategy is implemented. Even under a new paradigm in which immunization is not discontinued after measles is eradicated, eradication will be a good investment to avoid expensive epidemics and save the lives of almost one million children annually. A world free of measles by 2015 is not a dream. PMID:15042236

  7. Effects of supplemental measles immunization on cases of measles admitted at the Wesley Guild Hospital, Ilesa, Nigeria.

    PubMed

    Peter, Kuti Bankole; Ademola, Adegoke Samuel; Oyeku, Oyelami Akibu

    2014-03-01

    Measles is a highly contagious vaccine-preventable infection which continues to be a significant cause of childhood morbidity and mortality in developing countries particularly those with poor routine immunisation coverage. Supplemental immunisation activities (SIAs) were thus introduced to improve vaccine coverage. This study was carried out to assess the impact of the supplemental measles vaccinations on the cases of measles admitted at a tertiary health facility in South west Nigeria. Weretrospectivelylooked at therecords of cases of measles in children admitted to the Wesley Guild Hospital, Ilesa over a ten year period (2001 - 2010); five years before and five years after the nationwide commencement of supplemental measles immunisation activities (SIAs) in the region in 2006. Measles cases were defined using the WHO case definition. Over the ten year study period, a total of 12,139 children were admitted andmanaged; out of which 302 (2.5%) were cases of complicated measles. There was no difference in the mean (SD) of children admitted in the years before and after the introduction of the SIAs {6040 (122.7) vs.6099 (120.2); t-test 0.02, p =0.988.} There was however a remarkable reduction in the proportion of the cases of measles admitted after the introduction of SIAs compared to the period before SIAs (4.3% vs. 0.6% x2=169.580; p < 0.001). SIAs have remarkably reduced morbidity and mortality associated with measles in the region. We advocate for sustenance of these efforts as well as improvement in routine immunisation coverage to avoid a backlash which can lead to devastating measles outbreak.

  8. Emergency measles control activities--Darfur, Sudan, 2004.

    PubMed

    2004-10-01

    The Darfur region of Sudan, composed of three states with a population of approximately six million, has experienced civil conflict during the previous year, resulting in the internal displacement of approximately one million residents and an exodus of an estimated 170,000 persons to neighboring Chad. The conflict has left a vulnerable population with limited access to food, health care, and other basic necessities. In addition, measles vaccination coverage has been adversely affected; in 2003, coverage was reported to be 46%, 57%, and 77% in North, West, and South Darfur, respectively. This report describes measles-control activities in Darfur region conducted by the Federal Ministry of Health (FMOH) in Sudan in collaboration with the United Nations and nongovernmental organizations (NGOs) during March-August 2004. Ongoing measles transmission in camps for internally displaced persons (IDPs) and neighboring communities in Darfur led to a regionwide measles vaccination campaign targeting all children aged 9 months-15 years, resulting in a reduction in reported measles cases. Once security is improved, ongoing efforts to increase measles vaccine coverage will be required to eliminate persistent susceptibility to measles in the Darfur population.

  9. Reduced All-cause Child Mortality After General Measles Vaccination Campaign in Rural Guinea-Bissau.

    PubMed

    Fisker, Ane B; Rodrigues, Amabelia; Martins, Cesario; Ravn, Henrik; Byberg, Stine; Thysen, Sanne; Storgaard, Line; Pedersen, Marie; Fernandes, Manuel; Benn, Christine S; Aaby, Peter

    2015-12-01

    Randomized trials have shown that measles vaccine (MV) prevents nonmeasles deaths. MV campaigns are conducted to eliminate measles infection. The overall mortality effect of MV campaigns has not been studied. Bandim Health Project (BHP) surveys children aged 0-4 years in rural Guinea-Bissau through a health and demographic surveillance system. A national MV campaign in 2006 targeted children aged 6 months to 15 years. In a Cox proportional hazards model with age as the underlying timescale, we compared mortality of children aged 6-59 months after the campaign with mortality in the same age group during the 2 previous years. Eight thousand one hundred fifty eight children aged 6-59 months were under BHP surveillance during the 2006 campaign and 7999 and 8108 during similar periods in 2004 and 2005. At least 90% of the eligible children received MV in the campaign. There were 161 nonaccident deaths in 12 months after the campaign compared with 203 and 206 deaths in the 2 previous years, the adjusted mortality rate ratio (aMRR) comparing all children in 2006 with all children in 2004 to 2005 being 0.80 (95% confidence interval: 0.66-0.96). Censoring deaths caused by measles infection, the aMRR was 0.83 (0.69-1.00). The mortality reduction was separately significant for girls [aMRR = 0.74 (0.56-0.97)] and for children who also had received routine MV [MRR = 0.59 (0.36-0.99)]. Mortality levels were stable during 2004 and 2005, but a significant drop occurred after the 2006 MV campaign and was not explained by the prevention of measles deaths. If MV campaigns reduce nonmeasles-related mortality, the policies for measles vaccination should take this into account.

  10. Lot-to-lot consistency study of the fully liquid pentavalent DTwP-HepB-Hib vaccine Quinvaxem® demonstrating clinical equivalence, suitability of the vaccine as a booster and concomitant administration with measles vaccine

    PubMed Central

    Aspinall, Sanet; Traynor, Deirdre; Bedford, Philip; Hartmann, Katharina

    2012-01-01

    This double-blind, randomized study evaluated the immunogenicity and safety of three production lots of the fully liquid combination DTwP-Hep-Hib vaccine, Quinvaxem® (Crucell, The Netherlands) in 360 healthy infants aged 42–64 d old given at 6, 10 and 14 weeks of age (Core Study). The Core Study was followed by an open-label Booster Phase evaluating immunogenicity and safety of a booster dose of Quinvaxem® given with either concomitant or deferred measles vaccine in 227 infants who completed the Core Study. One month after the third dose of Quinvaxem® immune responses reflecting seroprotection or seroconversion were observed in more than 90% of infants for all three vaccine lots. Quinvaxem® elicited a strong booster response as demonstrated by a large increase in antibodies against all antigens, which appeared to be unaffected by concomitant administration of the measles vaccine. Safety results were in line with previous reports for Quinvaxem® with no unexpected adverse events (AEs) being reported. In the Core Study and Booster Phase, Quinvaxem® was well tolerated. No study vaccine-related serious AEs were reported. Thus, Quinvaxem® was immunogenic and well-tolerated when administered to infants according to a 6–10–14 week vaccination schedule. The three production lots had consistent reactogenicity and immunogenicity profiles. The booster dose of Quinvaxem® was also immunogenic and safe, regardless of whether a monovalent measles vaccine was administered concomitantly or one month later. PMID:22854660

  11. Challenges in managing a school-based measles outbreak in Melbourne, Australia, 2014.

    PubMed

    Gibney, Katherine B; Brahmi, Aicha; O'Hara, Miriam; Morey, Rosemary; Franklin, Lucinda

    2017-02-01

    To identify barriers to control of a Victorian primary school-based measles outbreak. Confirmed measles cases notified in Victoria in 2014 were reviewed. Surveillance data, correspondence, and investigation notes for the school-based outbreak were assessed regarding timeliness of diagnosis and notification, and adequacy of school-based immunisation records. Twenty-three (31%) of the 75 measles cases notified in 2014 were school-aged (5-18 years); three had documentation of measles vaccination, 17 were unvaccinated, and three had unknown vaccination history. Eight measles outbreaks were identified, including a primary school-based outbreak with ten cases. Of the six unvaccinated pupils in the affected school, five (83%) contracted measles. The proportion of the school's prep students with documented vaccination records, as required by law, ranged from 39% in 2013 to 97% in 2014. Inadequately vaccinated students constitute a vulnerable population and schools are a potential site for measles outbreaks. Inadequate enforcement of school-based immunisation records impact the management and control of school-based measles outbreaks. Implications for Public Health: There is a need to educate clinicians on measles diagnosis and notification, and schools on the requirement to maintain up-to-date vaccination records. School entry is an opportunity to review student vaccination history and offer immunisations. © 2016 The Authors.

  12. Measles, Mumps, Rubella (MMR)

    MedlinePlus

    ... due largely to international travel. According to the Centers for Disease Control and Prevention (CDC) , in 2014, there were 23 ... effects, and who should get vaccinated About Measles Centers for Disease Control and Prevention (CDC) About Rubella (German Measles) Centers ...

  13. Attenuated Salmonella enterica serovar Typhi and Shigella flexneri 2a strains mucosally deliver DNA vaccines encoding measles virus hemagglutinin, inducing specific immune responses and protection in cotton rats.

    PubMed

    Pasetti, Marcela F; Barry, Eileen M; Losonsky, Genevieve; Singh, Mahender; Medina-Moreno, Sandra M; Polo, John M; Ulmer, Jeffrey; Robinson, Harriet; Sztein, Marcelo B; Levine, Myron M

    2003-05-01

    Measles remains a leading cause of child mortality in developing countries. Residual maternal measles antibodies and immunologic immaturity dampen immunogenicity of the current vaccine in young infants. Because cotton rat respiratory tract is susceptible to measles virus (MV) replication after intranasal (i.n.) challenge, this model can be used to assess the efficacy of MV vaccines. Pursuing a new measles vaccine strategy that might be effective in young infants, we used attenuated Salmonella enterica serovar Typhi CVD 908-htrA and Shigella flexneri 2a CVD 1208 vaccines to deliver mucosally to cotton rats eukaryotic expression plasmid pGA3-mH and Sindbis virus-based DNA replicon pMSIN-H encoding MV hemagglutinin (H). The initial i.n. dose-response with bacterial vectors alone identified a well-tolerated dosage (1 x 10(9) to 7 x 10(9) CFU) and a volume (20 micro l) that elicited strong antivector immune responses. Animals immunized i.n. on days 0, 28, and 76 with bacterial vectors carrying DNA plasmids encoding MV H or immunized parenterally with these naked DNA vaccine plasmids developed MV plaque reduction neutralizing antibodies and proliferative responses against MV antigens. In a subsequent experiment of identical design, cotton rats were challenged with wild-type MV 1 month after the third dose of vaccine or placebo. MV titers were significantly reduced in lung tissue of animals immunized with MV DNA vaccines delivered either via bacterial live vectors or parenterally. Since attenuated serovar Typhi and S. flexneri can deliver measles DNA vaccines mucosally in cotton rats, inducing measles immune responses (including neutralizing antibodies) and protection, boosting strategies can now be evaluated in animals primed with MV DNA vaccines.

  14. Evaluating the impact of the HIV pandemic on measles control and elimination.

    PubMed

    Helfand, Rita F; Moss, William J; Harpaz, Rafael; Scott, Susana; Cutts, Felicity

    2005-05-01

    To estimate the impact of the HIV pandemic on vaccine-acquired population immunity to measles virus because high levels of population immunity are required to eliminate transmission of measles virus in large geographical areas, and HIV infection can reduce the efficacy of measles vaccination. A literature review was conducted to estimate key parameters relating to the potential impact of HIV infection on the epidemiology of measles in sub-Saharan Africa; parameters included the prevalence of HIV, child mortality, perinatal HIV transmission rates and protective immune responses to measles vaccination. These parameter estimates were incorporated into a simple model, applicable to regions that have a high prevalence of HIV, to estimate the potential impact of HIV infection on population immunity against measles. The model suggests that the HIV pandemic should not introduce an insurmountable barrier to measles control and elimination, in part because higher rates of primary and secondary vaccine failure among HIV-infected children are counteracted by their high mortality rate. The HIV pandemic could result in a 2-3% increase in the proportion of the birth cohort susceptible to measles, and more frequent supplemental immunization activities (SIAs) may be necessary to control or eliminate measles. In the model the optimal interval between SIAs was most influenced by the coverage rate for routine measles vaccination. The absence of a second opportunity for vaccination resulted in the greatest increase in the number of susceptible children. These results help explain the initial success of measles elimination efforts in southern Africa, where measles control has been achieved in a setting of high HIV prevalence.

  15. Measles & rubella outbreaks in Maharashtra State, India.

    PubMed

    Vaidya, Sunil R; Kamble, Madhukar B; Chowdhury, Deepika T; Kumbhar, Neelakshi S

    2016-02-01

    Under the outbreak-based measles surveillance in Maharashtra State the National Institute of Virology at Pune receives 3-5 serum samples from each outbreak and samples from the local hospitals in Pune for laboratory diagnosis. This report describes one year data on the measles and rubella serology, virus isolation and genotyping. Maharashtra State Health Agencies investigated 98 suspected outbreaks between January-December 2013 in the 20 districts. Altogether, 491 serum samples were received from 20 districts and 126 suspected cases from local hospitals. Samples were tested for the measles and rubella IgM antibodies by commercial enzyme immunoassay (EIA). To understand the diagnostic utility, a subset of serum samples (n=53) was tested by measles focus reduction neutralization test (FRNT). Further, 37 throat swabs and 32 urine specimens were tested by measles reverse transcription (RT)-PCR and positive products were sequenced. Virus isolation was performed in Vero hSLAM cells. Of the 98 suspected measles outbreaks, 61 were confirmed as measles, 12 as rubella and 21 confirmed as the mixed outbreaks. Four outbreaks remained unconfirmed. Of the 126 cases from the local hospitals, 91 were confirmed for measles and three for rubella. Overall, 93.6 per cent (383/409) confirmed measles cases were in the age group of 0-15 yr. Measles virus was detected in 18 of 38 specimens obtained from the suspected cases. Sequencing of PCR products revealed circulation of D4 (n=9) and D8 (n=9) strains. Four measles viruses (three D4 & one D8) were isolated. Altogether, 94 measles and rubella outbreaks were confirmed in 2013 in the State of Maharasthra indicating the necessity to increase measles vaccine coverage in the State.

  16. Effect of jet injection on infectivity of measles, mumps, and rubella vaccine in a bench model.

    PubMed

    Coughlin, Melissa M; Collins, Marcus; Saxon, Gene; Jarrahian, Courtney; Zehrung, Darin; Cappello, Chris; Dhere, Rajeev; Royals, Michael; Papania, Mark; Rota, Paul A

    2015-08-26

    Disposable-syringe jet injectors (DSJIs) with single-use, auto disable, needle-free syringes offer the opportunity to avoid hazards associated with injection using a needle and syringe. Clinical studies have evaluated DSJIs for vaccine delivery, but most studies have focused on inactivated, subunit, or DNA vaccines. Questions have been raised about possible damage to live attenuated viral vaccines by forces generated during the jet injection process. This study examines the effect of jet injection on the integrity of measles, mumps, and rubella vaccine (MMR), measured by viral RNA content and infectivity. Three models of DSJIs were evaluated, each generating a different ejection force. Following jet injection, the RNA content for each of the vaccine components was measured using RT-qPCR immediately after injection and following passage in Vero cells. Jet injection was performed with and without pig skin as a simulation of human skin. There was little to no reduction of RNA content immediately following jet injection with any of the three DSJIs. Samples passaged in Vero cells showed no loss in infectivity of the measles vaccine following jet injection. Mumps vaccine consistently showed increased replication following jet injection. Rubella vaccine showed no loss after jet injection alone but some infectivity loss following injection through pig skin with two of the devices. Overall, these data demonstrated that forces exerted on a live attenuated MMR vaccine did not compromise vaccine infectivity. The bench model and protocol used in this study can be applied to evaluate the impact of jet injection on other live virus vaccines. Published by Elsevier Ltd.

  17. Global control and regional elimination of measles, 2000-2012.

    PubMed

    Perry, Robert T; Gacic-Dobo, Marta; Dabbagh, Alya; Mulders, Mick N; Strebel, Peter M; Okwo-Bele, Jean-Marie; Rota, Paul A; Goodson, James L

    2014-02-07

    In 2010, the World Health Assembly established three milestones toward global measles eradication to be reached by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) for children aged 1 year to ≥90% nationally and ≥80% in every district, 2) reduce and maintain annual measles incidence at <5 cases per million, and 3) reduce measles mortality by 95% from the 2000 estimate. After the adoption by member states of the South-East Asia Region (SEAR) of the goal of measles elimination by 2020, elimination goals have been set by member states of all six World Health Organization (WHO) regions, and reaching measles elimination in four WHO regions by 2015 is an objective of the Global Vaccine Action Plan (GVAP). This report updates the previous report for 2000-2011 and describes progress toward global control and regional elimination of measles during 2000-2012. During this period, increases in routine MCV coverage, plus supplementary immunization activities (SIAs) reaching 145 million children in 2012, led to a 77% decrease worldwide in reported measles annual incidence, from 146 to 33 per million population, and a 78% decline in estimated annual measles deaths, from 562,400 to 122,000. Compared with a scenario of no vaccination, an estimated 13.8 million deaths were prevented by measles vaccination during 2000-2012. Achieving the 2015 targets and elimination goals will require countries and their partners to raise the visibility of measles elimination and make substantial and sustained additional investments in strengthening health systems.

  18. Evaluation of nationwide supplementary immunization in Lao People's Democratic Republic: Population-based seroprevalence survey of anti-measles and anti-rubella IgG in children and adults, mathematical modelling and a stability testing of the vaccine

    PubMed Central

    Miyano, Shinsuke; Mori, Yoshio; Vynnycky, Emilia; Keungsaneth, Phath; Vongphrachanh, Phengta; Xeuatvongsa, Anonh; Sisouk, Thongchanh; Som-Oulay, Vilasak; Khamphaphongphane, Bouaphan; Sengkeopaseuth, Bounthanom; Pathammavong, Chansay; Phounphenghak, Kongxay; Kitamura, Tomomi; Takeda, Makoto; Komase, Katsuhiro

    2018-01-01

    Background Measles outbreaks have occurred in some countries despite supplementary immunization activities (SIA) using measles-containing vaccine with high vaccination coverage. We conducted a cross-sectional seroprevalence survey to estimate population immunity in Lao People's Democratic Republic where repeated mass immunization has failed to eliminate measles. Methods and findings In this nationwide multistage cluster sampling survey conducted in 2014 based on probability proportionate to size sampling, blood samples were collected from 2,135 children and adults living in 52 randomly selected villages. Anti-measles and anti-rubella IgG were measured, and IgG prevalence was calculated. We applied mathematical modelling to estimate the number of cases of congenital rubella syndrome (CRS) in 2013 that were averted by the 2011 SIA. A stability testing was applied to the MR vaccine at 4°C, 25°C, and 35°C to examine stability differences between measles and rubella vaccine components. Measles IgG prevalence was significantly lower in the target age groups (5–21 years) of the 2011 SIA using a combination vaccine for measles and rubella vaccine (MR vaccine) than in young adults (22–39 years) (86.8% [95% CI: 83.0–90.6] vs. 99.0% [98.3–99.8]; p<0.001), whereas rubella IgG prevalence was significantly higher (88.2% [84.5–91.8] vs. 74.6% [70.7–78.5]; p<0.001). In the SIA target age groups, prevalence of measles IgG, but not rubella IgG, increased with age. CRS cases prevented in 2013 ranged from 16 [0–50] to 92 [32–180] if the force of infection had remained unchanged or had been reduced by 75%, respectively. In freeze-dried conditions, the measles vaccine component was more heat sensitive than the rubella component. Conclusions Inconsistent IgG prevalence between measles and rubella in Lao PDR can be partly explained by different stability of the measles and rubella vaccine components under heat exposure. Suboptimal vaccine handling may cause insufficient

  19. Evaluation of nationwide supplementary immunization in Lao People's Democratic Republic: Population-based seroprevalence survey of anti-measles and anti-rubella IgG in children and adults, mathematical modelling and a stability testing of the vaccine.

    PubMed

    Hachiya, Masahiko; Miyano, Shinsuke; Mori, Yoshio; Vynnycky, Emilia; Keungsaneth, Phath; Vongphrachanh, Phengta; Xeuatvongsa, Anonh; Sisouk, Thongchanh; Som-Oulay, Vilasak; Khamphaphongphane, Bouaphan; Sengkeopaseuth, Bounthanom; Pathammavong, Chansay; Phounphenghak, Kongxay; Kitamura, Tomomi; Takeda, Makoto; Komase, Katsuhiro

    2018-01-01

    Measles outbreaks have occurred in some countries despite supplementary immunization activities (SIA) using measles-containing vaccine with high vaccination coverage. We conducted a cross-sectional seroprevalence survey to estimate population immunity in Lao People's Democratic Republic where repeated mass immunization has failed to eliminate measles. In this nationwide multistage cluster sampling survey conducted in 2014 based on probability proportionate to size sampling, blood samples were collected from 2,135 children and adults living in 52 randomly selected villages. Anti-measles and anti-rubella IgG were measured, and IgG prevalence was calculated. We applied mathematical modelling to estimate the number of cases of congenital rubella syndrome (CRS) in 2013 that were averted by the 2011 SIA. A stability testing was applied to the MR vaccine at 4°C, 25°C, and 35°C to examine stability differences between measles and rubella vaccine components. Measles IgG prevalence was significantly lower in the target age groups (5-21 years) of the 2011 SIA using a combination vaccine for measles and rubella vaccine (MR vaccine) than in young adults (22-39 years) (86.8% [95% CI: 83.0-90.6] vs. 99.0% [98.3-99.8]; p<0.001), whereas rubella IgG prevalence was significantly higher (88.2% [84.5-91.8] vs. 74.6% [70.7-78.5]; p<0.001). In the SIA target age groups, prevalence of measles IgG, but not rubella IgG, increased with age. CRS cases prevented in 2013 ranged from 16 [0-50] to 92 [32-180] if the force of infection had remained unchanged or had been reduced by 75%, respectively. In freeze-dried conditions, the measles vaccine component was more heat sensitive than the rubella component. Inconsistent IgG prevalence between measles and rubella in Lao PDR can be partly explained by different stability of the measles and rubella vaccine components under heat exposure. Suboptimal vaccine handling may cause insufficient immunogenicity for measles, which subsequently leads to an

  20. Measles

    MedlinePlus

    ... protects against measles, mumps, and rubella, can cause autism. Parents and caregivers should know that: Large studies ... no connection between this or any vaccine and autism. Reviews by all major health organizations in the ...

  1. Deciphering the relative weights of demographic transition and vaccination in the decrease of measles incidence in Italy.

    PubMed

    Merler, Stefano; Ajelli, Marco

    2014-02-22

    In Italy, during the course of the past century to the present-day, measles incidence underwent a remarkable decreasing trend that started well before the introduction of the national immunization programme. In this work, we aim at examining to what extent both the demographic transition, characterized by declining mortality and fertility rates over time, and the vaccination programme are responsible for the observed epidemiological pattern. Making use of a non-stationary, age-structured disease transmission model, we show that in the pre-vaccination era, from 1901 to 1982, the decline in birth rates has resulted in a drastic decrease in the effective transmission rate, which in turn has determined a declining trend of measles incidence (from 25.2 to 10.3 infections per 1000 individuals). However, since 1983, vaccination appears to have become the major contributing factor in the decrease of measles incidence, which otherwise would have remained stable as a consequence of the nearly constant birth rates. This led to a remarkable decrease in the effective transmission rate, to a level well below the critical threshold for disease persistence. These findings call for the adoption of epidemiological models, which deviate the age structure from stationary equilibrium solutions, to better understand the biology of infectious diseases and evaluate immunization programmes.

  2. Measles

    MedlinePlus

    ... Bangladesh Rohingya Democratic Republic of the Congo Iraq Nigeria Somalia South Sudan Syrian Arab Republic Yemen All ... children to receive measles vaccine in north-eastern Nigeria 16 January 2017 WHO strengthens South Sudan’s disease ...

  3. External Quality Assessment for the Detection of Measles Virus by Reverse Transcription-PCR Using Armored RNA

    PubMed Central

    Jia, Tingting; Zhang, Lei; Wang, Guojing; Zhang, Rui; Zhang, Kuo; Lin, Guigao; Xie, Jiehong; Wang, Lunan; Li, Jinming

    2015-01-01

    In recent years, nucleic acid tests for detection of measles virus RNA have been widely applied in laboratories belonging to the measles surveillance system of China. An external quality assessment program was established by the National Center for Clinical Laboratories to evaluate the performance of nucleic acid tests for measles virus. The external quality assessment panel, which consisted of 10 specimens, was prepared using armored RNAs, complex of noninfectious MS2 bacteriophage coat proteins encapsulated RNA of measles virus, as measles virus surrogate controls. Conserved sequences amplified from a circulating measles virus strain or from a vaccine strain were encapsulated into these armored RNAs. Forty-one participating laboratories from 15 provinces, municipalities, or autonomous regions that currently conduct molecular detection of measles virus enrolled in the external quality assessment program, including 40 measles surveillance system laboratories and one diagnostic reagent manufacturer. Forty laboratories used commercial reverse transcription-quantitative PCR kits, with only one laboratory applying a conventional PCR method developed in-house. The results indicated that most of the participants (38/41, 92.7%) were able to accurately detect the panel with 100% sensitivity and 100% specificity. Although a wide range of commercially available kits for nucleic acid extraction and reverse transcription polymerase chain reaction were used by the participants, only two false-negative results and one false-positive result were generated; these were generated by three separate laboratories. Both false-negative results were obtained with tests performed on specimens with the lowest concentration (1.2 × 104 genomic equivalents/mL). In addition, all 18 participants from Beijing achieved 100% sensitivity and 100% specificity. Overall, we conclude that the majority of the laboratories evaluated have reliable diagnostic capacities for the detection of measles virus

  4. External Quality Assessment for the Detection of Measles Virus by Reverse Transcription-PCR Using Armored RNA.

    PubMed

    Zhang, Dong; Sun, Yu; Jia, Tingting; Zhang, Lei; Wang, Guojing; Zhang, Rui; Zhang, Kuo; Lin, Guigao; Xie, Jiehong; Wang, Lunan; Li, Jinming

    2015-01-01

    In recent years, nucleic acid tests for detection of measles virus RNA have been widely applied in laboratories belonging to the measles surveillance system of China. An external quality assessment program was established by the National Center for Clinical Laboratories to evaluate the performance of nucleic acid tests for measles virus. The external quality assessment panel, which consisted of 10 specimens, was prepared using armored RNAs, complex of noninfectious MS2 bacteriophage coat proteins encapsulated RNA of measles virus, as measles virus surrogate controls. Conserved sequences amplified from a circulating measles virus strain or from a vaccine strain were encapsulated into these armored RNAs. Forty-one participating laboratories from 15 provinces, municipalities, or autonomous regions that currently conduct molecular detection of measles virus enrolled in the external quality assessment program, including 40 measles surveillance system laboratories and one diagnostic reagent manufacturer. Forty laboratories used commercial reverse transcription-quantitative PCR kits, with only one laboratory applying a conventional PCR method developed in-house. The results indicated that most of the participants (38/41, 92.7%) were able to accurately detect the panel with 100% sensitivity and 100% specificity. Although a wide range of commercially available kits for nucleic acid extraction and reverse transcription polymerase chain reaction were used by the participants, only two false-negative results and one false-positive result were generated; these were generated by three separate laboratories. Both false-negative results were obtained with tests performed on specimens with the lowest concentration (1.2 × 104 genomic equivalents/mL). In addition, all 18 participants from Beijing achieved 100% sensitivity and 100% specificity. Overall, we conclude that the majority of the laboratories evaluated have reliable diagnostic capacities for the detection of measles virus.

  5. Impact of an Intervention to Use a Measles, Rubella, and Polio Mass Vaccination Campaign to Strengthen Routine Immunization Services in Nepal.

    PubMed

    Wallace, Aaron S; Bohara, Rajendra; Stewart, Steven; Subedi, Giri; Anand, Abhijeet; Burnett, Eleanor; Giri, Jagat; Shrestha, Jagat; Gurau, Suraj; Dixit, Sameer; Rajbhandari, Rajesh; Schluter, W William

    2017-07-01

    The potential to strengthen routine immunization (RI) services through supplementary immunization activities (SIAs) is an important benefit of global measles and rubella elimination and polio eradication strategies. However, little evidence exists on how best to use SIAs to strengthen RI. As part the 2012 Nepal measles-rubella and polio SIA, we developed an intervention package designed to improve RI processes and evaluated its effect on specific RI process measures. The intervention package was incorporated into existing SIA activities and materials to improve healthcare providers' RI knowledge and practices throughout Nepal. In 1 region (Central Region) we surveyed the same 100 randomly selected health facilities before and after the SIA and evaluated the following RI process measures: vaccine safety, RI planning, RI service delivery, vaccine supply chain, and RI data recording practices. Data collection included observations of vaccination sessions, interviews with the primary healthcare provider who administered vaccines at each facility, and administrative record reviews. Pair-matched analytical methods were used to determine whether statistically significant changes in the selected RI process measures occurred over time. After the SIA, significant positive changes were measured in healthcare provider knowledge of adverse events following immunization (11% increase), availability of RI microplans (+17%) and maps (+12%), and awareness of how long a reconstituted measles vial can be used before it must be discarded (+14%). For the SIA, 42% of providers created an SIA high-risk villages list, and >50% incorporated this information into RI outreach session site planning. Significant negative changes occurred in correct knowledge of measles vaccination contraindications (-11%), correct definition for a measles outbreak (-21%), and how to treat a child with a severe adverse event following immunization (-10%). Twenty percent of providers reported cancelling ≥1 RI

  6. A cluster of measles linked to an imported case, Finland, 2017.

    PubMed

    Seppälä, Elina; Zöldi, Viktor; Vuorinen, Sakari; Murtopuro, Satu; Elonsalo, Ulpu; van Beek, Janko; Haveri, Anu; Kontio, Mia; Savolainen-Kopra, Carita; Puumalainen, Taneli; Sane, Jussi

    2017-08-17

    One imported and five secondary cases of measles were detected in Finland between June and August 2017. The measles sequences available for five laboratory-confirmed cases were identical and belonged to serotype D8. The large number of potentially exposed Finnish and foreign individuals called for close cooperation of national and international public health authorities and other stakeholders. Raising awareness among healthcare providers and ensuring universally high vaccination coverage is crucial to prevent future clusters and outbreaks. This article is copyright of The Authors, 2017.

  7. A large observational study to concurrently assess persistence of measles specific B-cell and T-cell immunity in individuals following two doses of MMR vaccine

    PubMed Central

    Haralambieva, Iana H.; Ovsyannikova, Inna G.; O’Byrne, Megan; Pankratz, V. Shane; Jacobson, Robert M.; Poland, Gregory A.

    2011-01-01

    The measurement of measles-specific neutralizing antibodies, directed against the surface measles virus hemagglutinin and fusion proteins, is considered the gold standard in measles serology. We assessed functional measles-specific neutralizing antibody levels in a racially diverse cohort of 763 young healthy adolescents after receipt of two doses of measles-mumps-rubella vaccine, by the use of an automated plaque reduction microneutralization (PRMN) assay, and evaluated their relevance to protective antibody levels, as well as their associations with demographic and clinical variables. We also concurrently assessed measles-specific IFNγ Elispot responses and their relation to the observed antibody concentrations. The geometric mean titer for our cohort was 832 mIU/mL (95% CIs: 776; 891). Sixty-eight subjects (8.9%) had antibody concentrations of less than the protective threshold of 210 mIU/mL (corresponding to PRMN titer of 120; suggesting protection against symptomatic disease), and 177 subjects (23.2%) demonstrated persisting antibody concentrations above 1,841 mIU/mL (corresponding to PRMN titer of 1,052; suggesting total protection against viral infection), 7.4 years after vaccination, in the absence of wild-type virus boosting. The mean measles-specific IFNγ Elispot response for our cohort was 46 (95% CIs: 43; 49) IFNγ-positive spots per 200,000 cells with no relation of cellular immunity measures to the observed antibody concentrations. No significant associations between antibody titers and demographic and clinical variables, including gender and race, were observed in our study. In conclusion, in a large observational study of measles immunity, we used an automated high-throughput measles virus-specific neutralization assay to measure humoral immunity, and concurrently determined measles-specific cellular immunity to aid the assessment of potential susceptibility to measles in vaccinated populations. PMID:21539880

  8. The epidemiological and serological characteristics of measles in Dongguan, China, 2005-2014.

    PubMed

    Han, Ke; Chen, Shaoli; Tang, Cuifei; Wen, Jinjun; Li, Jingquan; Ni, Jindong; Zheng, Xueli

    2016-08-02

    This study examined the epidemiological and serological characteristics of measles in Dongguan, China. From 2005 to 2014, a total of 8,224 measles cases were reported in Dongguan, 33.5% of which were aged <1 y and 30.6% >14 y. From 2005 to 2014, the proportion of the <1 y measles cases increased year by year from 24.3% to 47.9%. Of the cases aged ≥8 months (n = 6,768 cases), only 11.6% had been immunized with at least one dose of measles vaccine. Of the 2,213 cases who had never been immunized with measles vaccine, immigrants accounted for 82.4%. 52.4% of the measles cases were diagnosed with pneumonia, and 12 cases died from respiratory failure. Seroprevalence rate in women and their newborns was 86.0% and 82.5%, respectively. Measurement of serum measles antibody levels for infants aged less than 8 months indicated that seroprevalence rate dramatically declined from 97.3% at birth to 9.3% and 13.2% at 6- and 7- month old. The existence of a sufficient pool of unvaccinated people (especially immigrants) and decreased level of passively transferred measles antibodies in infants from vaccinated mothers contributed to the sustained transmission observed in Dongguan. In addition to high routine vaccination coverage, new strategies and innovations for measles vaccination are needed to eliminate measles.

  9. [Circulating pattern analysis for endemic measles viruses in mainland of China].

    PubMed

    Zhang, Yan; Ji, Yi-Xin; Zhu, Zhen

    2009-04-01

    To analysis of the circulating pattern for endemic measles viruses in mainland of China (Hong Kong, Macao and Taiwan were excluded) between 1993 and 2006. To analyze the database of Measles laboratory network surveillance, and the database of virology surveillance of National laboratory for Measles in Chinese Centers for Disease Control and Prevention (CCDC). Total 748 positive measles isolates were available from 29 provinces of China. 743 were H1 genotypes, 1 was H2 genotype, 1 was A genotype and 3 were vaccine like A genotypes. Among H1 genotype, 684 were H1a subgenotypes, 50 were H1b subgenotypes, 9 were H1c subgenotypes. H1a was isolated from 29 provinces (Tibet and Hubei did not carry out virus isolation), H1b was isolated from 10 provinces, H1c was isolated from 4 provinces during 1993-1994. H1a became predominant subgenotype since 2000; H1b shrink annually, its circulating has been interrupted since 2006; H1c circulating has been interrupted since 1995. Molecular epidemiology of measles viruses between 1993 and 2006 showed the character of genetic variation and the geographic distribution of the measles viruses in different years, and revealed that genotype H1 was the predominant indigenous measles virus genotype in mainland China and H1a became the predominant subgenotype in recent years.

  10. Measles Elimination Activities in the Western Pacific Region: Experience from the Republic of Korea

    PubMed Central

    Choe, Young June; Jee, Youngmee; Oh, Myoung-don

    2015-01-01

    We describe the global status of measles control and elimination, including surveillance and vaccination coverage data provided by the World Health Organization (WHO). Since 2000, two doses of measles vaccine (MCV2) became recommended globally and the achievement of high vaccination coverage has led to dramatic decrease in the measles incidence. Our finding indicates that, in the Western Pacific Region (WPR), substantial progress has been made to control measles transmission in some countries; however, the measles virus continues to circulate, causing outbreaks. The Republic of Korea (ROK) experienced a series of resurgence of measles due to the importation and healthcare-associated transmission in infants, however overall incidence and surveillance indicators met the WHO criteria for measles elimination. The ROK was verified to be measles-free along with Australia, Mongolia, and Macau, China in 2014. One of the effective elimination activities was the establishment of solid keep-up vaccination system in school settings. The lessons learnt from the measles elimination activities in Korea may contribute to enhancing the surveillance schemes and strengthening of vaccination programs in member countries and areas of WPR. PMID:26617443

  11. Measles Elimination Activities in the Western Pacific Region: Experience from the Republic of Korea.

    PubMed

    Choe, Young June; Jee, Youngmee; Oh, Myoung-don; Lee, Jong-Koo

    2015-11-01

    We describe the global status of measles control and elimination, including surveillance and vaccination coverage data provided by the World Health Organization (WHO). Since 2000, two doses of measles vaccine (MCV2) became recommended globally and the achievement of high vaccination coverage has led to dramatic decrease in the measles incidence. Our finding indicates that, in the Western Pacific Region (WPR), substantial progress has been made to control measles transmission in some countries; however, the measles virus continues to circulate, causing outbreaks. The Republic of Korea (ROK) experienced a series of resurgence of measles due to the importation and healthcare-associated transmission in infants, however overall incidence and surveillance indicators met the WHO criteria for measles elimination. The ROK was verified to be measles-free along with Australia, Mongolia, and Macau, China in 2014. One of the effective elimination activities was the establishment of solid keep-up vaccination system in school settings. The lessons learnt from the measles elimination activities in Korea may contribute to enhancing the surveillance schemes and strengthening of vaccination programs in member countries and areas of WPR.

  12. Progress in measles control--Kenya 2002-2007.

    PubMed

    2007-09-21

    In 2000, countries represented by the World Health Organization (WHO) Regional Office for Africa established a goal to reduce, by the end of 2005, measles mortality to 50% of the 506,000 deaths from measles estimated in 1999. Strategies adopted included strengthening routine vaccination, providing a second opportunity for measles vaccination through supplemental immunization activities (SIAs), monitoring disease trends, and improving measles case management. In Kenya, an east African country with a population estimated at 33.4 million in 2005, the Kenya Expanded Programme on Immunization (KEPI) in the Ministry of Health began implementing these strategies in 2002 with a wide age range catch-up SIA and reduced the number of reported measles cases by >99%, from 11,304 in 2001 to 20 in 2004. A follow-up SIA, initially scheduled for July 2005, was postponed to 2006 to include concurrent distribution of long-lasting insecticide-treated bednets (LLINs). This report documents progress made in reducing measles morbidity and mortality in Kenya and describes the consequences of a large measles outbreak, beginning in September 2005, on the integrated measles follow-up SIA.

  13. Measles & rubella outbreaks in Maharashtra State, India

    PubMed Central

    Vaidya, Sunil R.; Kamble, Madhukar B.; Chowdhury, Deepika T.; Kumbhar, Neelakshi S.

    2016-01-01

    Background & objectives: Under the outbreak-based measles surveillance in Maharashtra State the National Institute of Virology at Pune receives 3-5 serum samples from each outbreak and samples from the local hospitals in Pune for laboratory diagnosis. This report describes one year data on the measles and rubella serology, virus isolation and genotyping. Methods: Maharashtra State Health Agencies investigated 98 suspected outbreaks between January-December 2013 in the 20 districts. Altogether, 491 serum samples were received from 20 districts and 126 suspected cases from local hospitals. Samples were tested for the measles and rubella IgM antibodies by commercial enzyme immunoassay (EIA). To understand the diagnostic utility, a subset of serum samples (n=53) was tested by measles focus reduction neutralization test (FRNT). Further, 37 throat swabs and 32 urine specimens were tested by measles reverse transcription (RT)-PCR and positive products were sequenced. Virus isolation was performed in Vero hSLAM cells. Results: Of the 98 suspected measles outbreaks, 61 were confirmed as measles, 12 as rubella and 21 confirmed as the mixed outbreaks. Four outbreaks remained unconfirmed. Of the 126 cases from the local hospitals, 91 were confirmed for measles and three for rubella. Overall, 93.6 per cent (383/409) confirmed measles cases were in the age group of 0-15 yr. Measles virus was detected in 18 of 38 specimens obtained from the suspected cases. Sequencing of PCR products revealed circulation of D4 (n=9) and D8 (n=9) strains. Four measles viruses (three D4 & one D8) were isolated. Interpretation & conclusions: Altogether, 94 measles and rubella outbreaks were confirmed in 2013 in the State of Maharasthra indicating the necessity to increase measles vaccine coverage in the State. PMID:27121521

  14. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality

    PubMed Central

    Mina, Michael J.; Metcalf, C. Jessica E.; de Swart, Rik L.; Osterhaus, A. D. M. E.; Grenfell, Bryan T.

    2016-01-01

    Immunosuppression after measles is known to predispose people to opportunistic infections for a period of several weeks to months. Using population-level data, we show that measles has a more prolonged effect on host resistance, extending over 2 to 3 years. We find that nonmeasles infectious disease mortality in high-income countries is tightly coupled to measles incidence at this lag, in both the pre- and post-vaccine eras. We conclude that long-term immunologic sequelae of measles drive interannual fluctuations in nonmeasles deaths. This is consistent with recent experimental work that attributes the immunosuppressive effects of measles to depletion of B and T lymphocytes. Our data provide an explanation for the long-term benefits of measles vaccination in preventing all-cause infectious disease. By preventing measles-associated immune memory loss, vaccination protects polymicrobial herd immunity. PMID:25954009

  15. Four years of measles elimination in the Czech Socialist Republic.

    PubMed

    Sejda, J

    1987-01-01

    In 1982, Czechoslovakia succeeded in eliminating measles infection throughout the country. The paper describes the strategy of the measles immunization program following its introduction in 1969, showing it to reflect the objective epidemiological situation as revealed by the regular immunological surveys carried out in a broad population sample. As it turned out, decisive for achieving and maintaining a permanent measles elimination in the country was the introduction of second vaccination into the regular immunization schedule. Since 1982, its timing of is from 6 to 10 months after primary immunization. Over the 4-year period between 1982 and 1985, confirmed measles occurred only sporadically in the CSR, 115 cases altogether, and of these as many as 67 were classified as imported or their immediate contacts (38 measles patients were tourists from abroad). Of these 115 measles cases, 52 had had vaccination prior to acquiring the disease, 46 were individuals who had never before been vaccinated and in the remaining 17 patients no vaccination data were available. The vaccine failures, at least in 18 cases, could have been explained by the primary immunization prior to reaching 15 months of age. According to the estimates, at least 670 thousand cases of measles, 470 deaths, 100 thousand complications and some 33 thousand hospitalizations had been averted between 1972 and 1985 on the territory of CSR as a result of the introduction of the measles immunization program in Czechoslovakia.

  16. [Measles in France].

    PubMed

    Mortamet, G; Dina, J; Freymuth, F; Guillois, B; Vabret, A

    2012-11-01

    Measles is one of the most contagious diseases implicated in an outbreak in Western Europe for a few years. In France, the outbreak began in 2008, especially in the southern regions. Most of the cases are mild but deleterious effects can occur in infants, during the pregnancy, or in immunosuppressive patients. Pneumonia and encephalitis are the major complications in these patients. Measles illness during pregnancy results in a higher risk of premature labor, spontaneous abortion, and low-birthweight infants. Death from measles was reported in approximately 0.3% of cases. The National Reference Center for measles and paramyxoviridae is implicated in biological confirmation of cases and epidemiologic surveillance. Virologic diagnosis consists in a direct detection of viral RNA (real time PCR), or indirect detection of the immune response (IgM and IgG) in saliva samples. The measles genotype is determined by sequencing a 450 nucleotids fragment of the N gene, as the World Health Organization (WHO) recommendation. This molecular analysis helps determine the geographic origin of the virus and the viral strains circulating in the country. In 2011, 3105 specimens were received. PCR was positive for 1990 patients (64%), with a large majority of children younger than 2 years of age and young adults. The most important cause of measles resurgence is low vaccination coverage. The role of pediatricians is important in order to achieve the goal of 95% of vaccination coverage established by the WHO. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  17. Measles epidemic in Brazil in the post-elimination period: Coordinated response and containment strategies.

    PubMed

    Lemos, Daniele Rocha Queiroz; Franco, Aidée Ramirez; de Sá Roriz, Maria Lúcia Feitosa; Carneiro, Ana Karine Borges; de Oliveira Garcia, Márcio Henrique; de Souza, Fábia Lidiana; Duron Andino, Regina; de Góes Cavalcanti, Luciano Pamplona

    2017-03-23

    The measles virus circulation was halted in Brazil in 2001 and the country has a routine vaccination coverage against measles, mumps and rubella higher than 95%. In Ceará, the last confirmed case was in 1999. This article describes the strategies adopted and the effectiveness of surveillance and control measures implemented during a measles epidemic in the post-elimination period. The epidemic started in December 2013 and lasted 20 months, reaching 38 cities and 1,052 confirmed cases. The D8 genotype was identified. More than 50,000 samples were tested for measles and 86.4% of the confirmed cases had a laboratory diagnosis. The beginning of an campaign vaccination was delayed in part by the availability of vaccine. The classic control measures were not enough to control the epidemic. The creation of a committee of experts, the agreement signed between managers of the three spheres of government, the conducting of an institutional active search of suspected cases, vaccination door to door at alternative times, the use of micro planning, a broad advertising campaign at local media and technical operative support contributed to containing the epidemic. It is important to recognize the possibility of epidemics at this stage of post-elimination and prepare a sensitive surveillance system for timely response. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Progress toward measles elimination--Western Pacific Region, 2009-2012.

    PubMed

    2013-06-07

    In 2005, the World Health Organization (WHO) Regional Committee for the Western Pacific Region (WPR) resolved that WPR should aim to eliminate measles by 2012. The recommended measles elimination strategies in WPR include 1) achieving and maintaining high (≥95%) coverage with 2 doses of measles-containing vaccine (MCV) through routine immunization services and by implementing supplementary immunization activities (SIAs), when required; 2) conducting high-quality, case-based measles surveillance; 3) ensuring high-quality laboratory surveillance, with timely and accurate testing of specimens to confirm or discard suspected cases and detect measles virus for genotyping and molecular analysis; and 4) establishing and maintaining measles outbreak preparedness for rapid response and ensuring appropriate case management. This report updates the previous report and describes progress toward eliminating measles in WPR during 2009-2012. During this period, measles incidence reached a historic low, decreasing by 83%, from 34.0 to 5.9 cases per million population. However, to achieve measles elimination in WPR, additional efforts are needed to strengthen routine immunization services in countries and areas with <95% coverage with the routine first (MCV1) or second dose of MCV (MCV2), to introduce a MCV2 dose in the four remaining countries and areas that do not yet have a routine 2-dose MCV schedule, and to use SIAs to close immunity gaps among measles-susceptible populations in countries and areas that have ongoing measles virus transmission.

  19. Measles transmission from an anthroposophic community to the general population, Germany 2008

    PubMed Central

    2011-01-01

    Background In Germany, measles vaccination coverage with two doses is not yet sufficient to prevent regional outbreaks. Among the 16 German federal states, vaccination coverage was lowest in Bavaria with 85% in 2008. From March to mid-April 2008, four neighbouring Bavarian counties reported 55 measles-cases mostly linked to an ongoing measles outbreak in an anthroposophic school in Austria. We investigated this outbreak to guide future public health action. Methods We applied the German national case-definition for measles and collected data using the national surveillance system and a questionnaire. Measles cases with disease onset a maximum of 18 days apart and spatial contact (e.g. same household, same school) were summed up in clusters. Two different interventions, which were implemented in schools and kindergartens in Bavaria, were compared by their impact on the size and duration of measles clusters. Susceptible persons were excluded from schools or kindergartens either with the first (intervention A) or second (intervention B) measles case occurring in the respective institution. Results Among the 217 Bavarian measles cases identified from March-July 2008, 28 (13%) cases were attendees of the anthroposophic school in Austria. In total, vaccination status was known in 161 (74%) cases and 156 (97%) of them were not vaccinated. The main factor for non-vaccination was "fear of vaccine-related adverse events" (33%). Twenty-nine (18%) of 161 cases suffered complications. Exclusively genotype D5 was detected. Overall, 184 cases could be epidemiologically grouped into 59 clusters. Of those, 41 clusters could be linked to households and 13 to schools or kindergartens. The effect of intervention A and B was analysed in 10 school or kindergarten clusters. Depending on the respective intervention A or B, the median number of cases per cluster was 3 versus 13 (p = 0.05), and the median duration of a cluster was 3 versus 26 days (p = 0.13). Conclusions Introduction of

  20. Maintaining high rates of measles immunization in Africa.

    PubMed

    Lessler, J; Moss, W J; Lowther, S A; Cummings, D A T

    2011-07-01

    Supplementary immunization activities (SIAs) are important in achieving high levels of population immunity to measles virus. Using data from a 2006 survey of measles vaccination in Lusaka, Zambia, we developed a model to predict measles immunity following routine vaccination and SIAs, and absent natural infection. Projected population immunity was compared between the current programme and alternatives, including supplementing routine vaccination with a second dose, or SIAs at 1-, 2-, 3-, 4- and 5-year intervals. Current routine vaccination plus frequent SIAs could maintain high levels of population immunity in children aged <5 years, even if each frequent SIA has low coverage (e.g. ≥ 72% for bi-annual 60% coverage SIAs vs. ≥ 69% for quadrennial 95% coverage SIAs). A second dose at 12 months with current coverage could achieve 81% immunity. Circulating measles virus will only increase population immunity. Public health officials should consider frequent SIAs when resources for a two-dose strategy are unavailable.

  1. Reemergence of Measles in the Americas: The Genotype B3 2011-2012 Outbreak in Ecuador.

    PubMed

    Le, Nicole K; Mhaskar, Rahul; Hoare, Ismael; Espinel, Mauricio; Fernanda Rivadeneira, María; Malavade, Sharad; Izurieta, Ricardo

    2017-06-02

    This study characterizes a measles outbreak which occurred in Ecuador in 2011-2012, analyzing data from 3700 suspected cases of measles reported to Ecuador's Ministry of Public Health. The study population had a large age range and included 333 confirmed cases of measles. The greatest number of cases were found in the <1 year (32.43%, n = 108) and 1-4 year (30.03%, n = 100) age-groups. Compared to Mestizos, indigenous people had the highest number of cases (68.2%, n = 227), as well as a higher risk of infection (OR 7.278 (CI 5.251-10.087)). The greatest protection from measles was observed in individuals who received two doses of the measles vaccine. Residents of Pastaza (OR 6.645 CI (3.183-13.873)) and Tungurahua (OR 8.346 CI (5.570-12.507)) had a higher risk of infection than the other provinces. Of the 17 laboratory confirmed cases, all were identified as genotype B3. Age-group, ethnicity, measles vaccinations, and residence in Tungurahua and Pastaza were correlated with rates of measles infection in the outbreak. Tungurahua and Pastaza, where the outbreak originated, have large indigenous populations. Indigenous children <1 year of age showed the highest incidence. It is likely that indigenous women do not have immunity to the virus, and so are unable to confer measles resistance to their newborns.

  2. Reduced immunity to measles in adults with major depressive disorder.

    PubMed

    Ford, Bart N; Yolken, Robert H; Dickerson, Faith B; Teague, T Kent; Irwin, Michael R; Paulus, Martin P; Savitz, Jonathan

    2018-03-19

    Depression can impair the immunogenicity of vaccine administration in adults. Whereas many vaccinations are administered in childhood, it is not known whether adolescent or adult onset depression is associated with impairments in the maintenance of protection of childhood vaccines. This study tested the hypothesis that individuals with adolescent or adult onset mood disorders would display compromised immunity to measles, a target of childhood vaccination. IgG antibodies to measles were quantified using a solid phase immunoassay in volunteers with bipolar disorder (BD, n = 64, mean age of onset = 16.6 ± 5.6), currently depressed individuals with major depressive disorder (cMDD, n = 85, mean age of onset = 17.9 ± 7.0), remitted individuals with a history of MDD (rMDD, n = 82, mean age of onset = 19.2 ± 8.6), and non-depressed comparison controls (HC, n = 202), all born after the introduction of the measles vaccine in the USA in 1963. Relative to HC, both the cMDD group (p = 0.021, adjusted odds ratios (OR) = 0.47, confidence interval (CI) = 0.24-0.90), and the rMDD group (p = 0.038, adjusted OR = 0.50, CI = 0.26-0.97) were less likely to test seropositive for measles. Compared with unmedicated MDD participants, currently medicated MDD participants had a longer lifetime duration of illness and were less likely to test seropositive for measles. Individuals with adolescent or adult onset MDD are less likely to test seropositive for measles. Because lower IgG titers are associated with increased risk of measles infection, MDD may increase the risk and severity of infection possibly because of impaired maintenance of vaccine-related protection from measles.

  3. Progress toward measles elimination--European Region, 2005--2008.

    PubMed

    2009-02-20

    In 2002, the World Health Organization (WHO) Regional Committee for the European Region (EUR) revised earlier targets to eliminate indigenous measles and achieve rubella control by resolving to 1) eliminate both diseases in EUR member states by 2010, using a combination of routine and supplementary immunization strategies, and 2) monitor progress toward this goal through improved surveillance. This report summarizes progress toward measles elimination during 2005--2008 and updates a previous report from 2005. In 2005 and 2006, large-scale outbreaks occurred in the eastern EUR member states. However, in 2007 and 2008, overall measles incidence in EUR declined to a historic low of <10 cases per 1 million population, with the majority of cases reported from Western Europe. During 2005-2007, routine vaccination coverage with 1 dose of measles-containing vaccine (MCV) among children aged 12--23 months in EUR reached a high of 93%-94%, up from 90%-91% during 2000-2004. Nevertheless, two major challenges to measles elimination remain: 1) suboptimal vaccination coverage in many countries, which has led to continued outbreaks and the resurgence of indigenous measles in some Western European countries, and 2) setbacks with implementation of supplementary immunization activities (SIAs) in Eastern Europe in 2008. Achieving the measles elimination goal by 2010 will require 1) development of approaches to sustain and increase vaccination coverage, 2) promotion of effective outbreak prevention and control measures, and 3) further strengthening of surveillance.

  4. The epidemiological characteristics of measles and difficulties of measles elimination in Hang Zhou, China

    PubMed Central

    Liu, Shijun; Xu, Erping; Zhang, Xiaoping; Liu, Yan; Du, Jian; Wang, Jun; Che, Xinren; Gu, Wenwen

    2013-01-01

    Objective: Following the national proclaim of Measles Elimination 2012, plenty of activities for controlling the incidence had practiced in Hangzhou. However, the incidence did not decrease to low degree and remained perform as gap to the elimination target. The present study aimed to describe the epidemiological characteristics of measles, and proposed reasonable method to the target in Hangzhou.  Method: Cases were collected by the National Notifiable Diseases Surveillance System (NNDSS) from 2004 to 2011. The descriptive epidemiology was employed to analyze characteristics of measles.  Results: A total of 4712 confirmed cases were enrolled by the NNDSS with 7.87 per 100,000 people of incidence rate on average from 2004 to 2011. Individuals lived urban districts had higher risk of measles than counties. Infants aged <1 year observed the highest incidence rate with 239.35/100,000, and the age-specific incidence rate declined along with aged-group but reversed at adults. 52.20% of cases were floating cases and the measles vaccination was significantly different from the local cases (χ2=51.65,p <0.001). February to June was the epidemic period for measles incidence with 81.88% of cases reported in cluster.  Conclusion: The descriptive characteristics of measles suggested that factors included infant and adult individual, floating population, and living urban area might be relate to the elimination target. More efforts were need to ensure susceptible population had accepted qualified measles vaccination.  PMID:23732896

  5. Challenges to global measles eradication: is it all in the timing?

    PubMed

    Davis, Robert; Mbabazi, William Baguma

    2017-01-01

    The case for global eradication of measles was first made in 1982. Since then, technical aspects of measles eradication have concluded that measles satisfied all criteria required for eradication. To date, only smallpox, among human diseases, has been eradicated, with polio, the next eradication candidate. In all previous eradication programmes, the pattern of slow implementation and missed deadlines is similar. Lessons from these past eradication programs should inform development of a time-limited measles eradication program. Notably, no measles eradication resolution is likely until member states are satisfied that polio eradication is accomplished. However, there is an impetus for measles eradication from the western hemisphere, where governments continue to pay the high costs of keeping their region measles free until global measles eradication is achieved. While previous vaccine preventable diseases eradications have depended on supplemental immunizations (SIAs), measles eradication will have to build both on SIAs and routine immunization systems strengthening. This article reviews non-technical considerations that could facilitate the delivery of a time-limited measles eradication initiative. The issues discussed are categorized as a) specificities of measles disease; b) specifics of measles vaccine/vaccination; c) special considerations for endemic countries and d) organization of international partnerships. The disease and vaccine specific issues are not insurmountable. The introduction of routine measles second dose, in the context of EPI systems strengthening, is paramount to endemic developing countries. In the international partnerships, it should be noted that i) Measles eradication will be easier and cheaper; ii) the return on investment is compelling; iii) leverage is feasible on the experiences of the Measles/Rubella initiative; iv) two disease eradication targets in one initiative are feasible and v) for the first time, an eradication investment

  6. Challenges to global measles eradication: is it all in the timing?

    PubMed Central

    Davis, Robert; Mbabazi, William Baguma

    2017-01-01

    The case for global eradication of measles was first made in 1982. Since then, technical aspects of measles eradication have concluded that measles satisfied all criteria required for eradication. To date, only smallpox, among human diseases, has been eradicated, with polio, the next eradication candidate. In all previous eradication programmes, the pattern of slow implementation and missed deadlines is similar. Lessons from these past eradication programs should inform development of a time-limited measles eradication program. Notably, no measles eradication resolution is likely until member states are satisfied that polio eradication is accomplished. However, there is an impetus for measles eradication from the western hemisphere, where governments continue to pay the high costs of keeping their region measles free until global measles eradication is achieved. While previous vaccine preventable diseases eradications have depended on supplemental immunizations (SIAs), measles eradication will have to build both on SIAs and routine immunization systems strengthening. This article reviews non-technical considerations that could facilitate the delivery of a time-limited measles eradication initiative. The issues discussed are categorized as a) specificities of measles disease; b) specifics of measles vaccine/vaccination; c) special considerations for endemic countries and d) organization of international partnerships. The disease and vaccine specific issues are not insurmountable. The introduction of routine measles second dose, in the context of EPI systems strengthening, is paramount to endemic developing countries. In the international partnerships, it should be noted that i) Measles eradication will be easier and cheaper; ii) the return on investment is compelling; iii) leverage is feasible on the experiences of the Measles/Rubella initiative; iv) two disease eradication targets in one initiative are feasible and v) for the first time, an eradication investment

  7. Comparison of LiST measles mortality model and WHO/IVB measles model.

    PubMed

    Chen, Wei-Ju

    2011-04-13

    The Lives Saved Tool (LiST) has been developed to estimate the impact of health interventions and can consider multiple interventions simultaneously. Given its increasing usage by donor organizations and national program planner, we compare the LiST measles model to the widely used World Health Organization's Department of Immunization, Vaccines and Biologicals (WHO/IVB) measles model which is used to produce estimates serving as a major indicator of monitoring country measles epidemics and the progress of measles control. We analyzed the WHO/IVB models and the LiST measles model and identified components and assumptions held in each model. We contrasted the important components, and compared results from the two models by applying historical measles containing vaccine (MCV) coverages and the default values of all parameters set in the models. We also conducted analyses following a hypothetical scenario to understand how both models performed when the proportion of population protected by MCV declined to zero percent in short time period. The WHO/IVB measles model and the LiST measles model structures differ: the former is a mixed model which applies surveillance data adjusted for reporting completeness for countries with good disease surveillance system and applies a natural history model for countries with poorer disease control program and surveillance system, and the latter is a cohort model incorporating country-specific cause-of-death (CoD) profiles among children under-five. The trends of estimates of the two models are similar, but the estimates of the first year are different in most of the countries included in the analysis. The two models are comparable if we adjust the measles CoD in the LiST to produce the same baseline estimates. In addition, we used the models to estimate the potential impact of stopping using measles vaccine over a 7-year period. The WHO/IVB model produced similar estimates to the LiST model with adjusted CoD. But the LiST model

  8. Comparison of LiST measles mortality model and WHO/IVB measles model

    PubMed Central

    2011-01-01

    Background The Lives Saved Tool (LiST) has been developed to estimate the impact of health interventions and can consider multiple interventions simultaneously. Given its increasing usage by donor organizations and national program planner, we compare the LiST measles model to the widely used World Health Organization's Department of Immunization, Vaccines and Biologicals (WHO/IVB) measles model which is used to produce estimates serving as a major indicator of monitoring country measles epidemics and the progress of measles control. Methods We analyzed the WHO/IVB models and the LiST measles model and identified components and assumptions held in each model. We contrasted the important components, and compared results from the two models by applying historical measles containing vaccine (MCV) coverages and the default values of all parameters set in the models. We also conducted analyses following a hypothetical scenario to understand how both models performed when the proportion of population protected by MCV declined to zero percent in short time period. Results The WHO/IVB measles model and the LiST measles model structures differ: the former is a mixed model which applies surveillance data adjusted for reporting completeness for countries with good disease surveillance system and applies a natural history model for countries with poorer disease control program and surveillance system, and the latter is a cohort model incorporating country-specific cause-of-death (CoD) profiles among children under-five. The trends of estimates of the two models are similar, but the estimates of the first year are different in most of the countries included in the analysis. The two models are comparable if we adjust the measles CoD in the LiST to produce the same baseline estimates. In addition, we used the models to estimate the potential impact of stopping using measles vaccine over a 7-year period. The WHO/IVB model produced similar estimates to the LiST model with adjusted

  9. Risk factors and familial clustering for fever 7-10days after the first dose of measles vaccines.

    PubMed

    Klein, Nicola P; Lewis, Edwin; McDonald, Julia; Fireman, Bruce; Naleway, Allison; Glanz, Jason; Jackson, Lisa A; Donahue, James G; Jacobsen, Steven J; Weintraub, Eric; Baxter, Roger

    2017-03-14

    Seven to ten days after a first dose of a measles-containing vaccine (MCV; i.e., MMR or MMRV), children have elevated fever risk which can be associated with febrile seizures. This study investigated individual and familial factors associated with fever 7-10days after MCV. Retrospective cohort study among children who were <36months of age at receipt of MCV in six sites of the Vaccine Safety Datalink from 1/1/2000 to 12/31/2012. We evaluated medically-attended clinic or emergency department visits with a code for fever 7-10days after any MCV ("MCV- associated"). We evaluated factors associated with MCV-associated fever using χ 2 and multivariable logistic regression analyses. Among 946,806 children vaccinated with MCV, we identified 7480 (0.8%) MCV-associated fever visits. Compared with children without fever after MCV, children with MCV-associated fever were more likely to have received MMRV than MMR (OR 1.3 95% CI 1.2, 1.5), have had medically attended fever both following previous vaccines (OR 1.3 95% CI 1.1, 1.6) and at any other previous time (OR 1.7 95% CI 1.6, 1.8), have had at least 1 prior seizure (OR 2.2 95% CI 1.7, 2.7), and have had >3 medical visits within the 6months before MCV (OR 1.7 95% CI 1.6, 1.8). In families with multiple MCV-immunized children, after adjusting for healthcare seeking behavior care for fever, those whose siblings had MCV-associated fever were more likely to also have MCV-associated fever (OR 3.5 95% CI 2.5, 4.8). Children who received MMRV vaccine or who had prior medically-attended fevers and seizures during the first year of life had increased risk of fever after a first dose of measles vaccine. After adjusting for familial propensity to seek care, MCV-associated fever still clustered within families, suggesting a possible genetic basis for susceptibility to developing fever due to measles vaccines. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Measles in Ibadan: a continuous scourge.

    PubMed

    Lagunju, I A; Orimadegun, A E; Oyedemi, D G

    2005-12-01

    Measles remains one of the leading causes of childhood mortality in the world, despite the availability of a safe, effective, relatively inexpensive vaccine. It is also one of the leading causes of childhood blindness in the developing world. We reviewed the records of cases of measles admitted into Oni Memorial Children's Hospital, Ibadan over a 5-year period, January 2000 to December 2004; to evaluate any changes in the pattern of the disease. A total of 666 cases of measles were admitted comprising of 347 males and 319 females, giving a male to female ratio of 1.1:1. The yearly incidence of measles remained fairly the same from January 2000 to December 2002. There was a marked increase in yearly incidence in the year 2003. The majority of the affected children (74.1%) were 2 years and below. One hundred and thirty-six (20.4%) cases developed measles before the age of 9 months, the recommended age for measles vaccination in Nigeria. The peak incidence occurred in the months February and March. The commonest complication was bronchopneumonia, seen in 45.2% of cases. Other complications include protein-energy malnutrition, tuberculosis, croup, keratopathy, otitis media, heart failure and tension pneumothorax. Fifty-six patients died giving a case fatality rate of 8.4%. Factors associated with increased mortality were young age (<2years) and malnutrition. Measles remains a major threat to the health of the Nigerian child. A significant number of children developed measles before receiving the required vaccination at the recommended age of 9 months. There is a need to review the current immunisation policy, strengthen immunisation practices and improve the living standards in order to make the eradication of measles a reality.

  11. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality.

    PubMed

    Mina, Michael J; Metcalf, C Jessica E; de Swart, Rik L; Osterhaus, A D M E; Grenfell, Bryan T

    2015-05-08

    Immunosuppression after measles is known to predispose people to opportunistic infections for a period of several weeks to months. Using population-level data, we show that measles has a more prolonged effect on host resistance, extending over 2 to 3 years. We find that nonmeasles infectious disease mortality in high-income countries is tightly coupled to measles incidence at this lag, in both the pre- and post-vaccine eras. We conclude that long-term immunologic sequelae of measles drive interannual fluctuations in nonmeasles deaths. This is consistent with recent experimental work that attributes the immunosuppressive effects of measles to depletion of B and T lymphocytes. Our data provide an explanation for the long-term benefits of measles vaccination in preventing all-cause infectious disease. By preventing measles-associated immune memory loss, vaccination protects polymicrobial herd immunity. Copyright © 2015, American Association for the Advancement of Science.

  12. [Microbiological Surveillance of Measles and Rubella in Spain. Laboratory Network].

    PubMed

    Echevarría, Juan Emilio; Fernández García, Aurora; de Ory, Fernando

    2015-01-01

    The Laboratory is a fundamental component on the surveillance of measles and rubella. Cases need to be properly confirmed to ensure an accurate estimation of the incidence. Strains should be genetically characterized to know the transmission pattern of these viruses and frequently, outbreaks and transmission chains can be totally discriminated only after that. Finally, the susceptibility of the population is estimated on the basis of sero-prevalence surveys. Detection of specific IgM response is the base of the laboratory diagnosis of these diseases. It should be completed with genomic detection by RT-PCR to reach an optimal efficiency, especially when sampling is performed early in the course of the disease. Genotyping is performed by genomic sequencing according to reference protocols of the WHO. Laboratory surveillance of measles and rubella in Spain is organized as a net of regional laboratories with different capabilities. The National Center of Microbiology as National Reference Laboratory (NRL), supports regional laboratories ensuring the availability of all required techniques in the whole country and watching for the quality of the results. The NRL is currently working in the implementation of new molecular techniques based on the analysis of genomic hypervariable regions for the strain characterization at sub-genotypic levels and use them in the surveillance.

  13. Biological Feasibility of Measles Eradication

    PubMed Central

    Strebel, Peter

    2011-01-01

    Recent progress in reducing global measles mortality has renewed interest in measles eradication. Three biological criteria are deemed important for disease eradication: (1) humans are the sole pathogen reservoir; (2) accurate diagnostic tests exist; and (3) an effective, practical intervention is available at reasonable cost. Interruption of transmission in large geographical areas for prolonged periods further supports the feasibility of eradication. Measles is thought by many experts to meet these criteria: no nonhuman reservoir is known to exist, accurate diagnostic tests are available, and attenuated measles vaccines are effective and immunogenic. Measles has been eliminated in large geographical areas, including the Americas. Measles eradication is biologically feasible. The challenges for measles eradication will be logistical, political, and financial. PMID:21666201

  14. Measles and Rubella Global Strategic Plan 2012-2020 midterm review.

    PubMed

    Orenstein, W A; Hinman, A; Nkowane, B; Olive, J M; Reingold, A

    2018-01-11

    1. Measles eradication is the ultimate goal but it is premature to set a date for its accomplishment. Existing regional elimination goals should be vigorously pursued to enable setting a global target by 2020. 2. The basic strategic approaches articulated in the Global Measles and Rubella Strategic Plan 2012-2020 are valid to achieve the goals but have not been fully implemented (or not appropriately adapted to local situations). 3. The report recommends a shift from primary reliance on supplementary immunization activities (SIAs) to assure two doses of measles-containing vaccine (MCV) are delivered to the target population to primary reliance on ongoing services to assure administration of two doses of MCV. Regular high quality SIAs will still be necessary while ongoing services are being strengthened. 4. The report recommends a shift from primary reliance on coverage to measure progress to incorporating disease incidence as a major indicator. 5. The report recommends that the measles/rubella vaccination program be considered an indicator for the quality of the overall immunization program and that measles/rubella incidence and measles and rubella vaccination coverage be considered as primary indicators of immunization program performance. 6. Polio transition presents both risks and opportunities: risks should be minimized and opportunities maximized. 7. A school entry immunization check could contribute significantly to strengthening overall immunization services with assurance that recommended doses of measles and rubella vaccines as well as other vaccines have been delivered and providing those vaccines at that time if the child is un- or under-vaccinated. 8. Program decisions should increasingly be based on good quality data and appropriate analysis. 9. The incorporation of rubella vaccination into the immunization program needs to be accelerated - it should be accorded equivalent emphasis as measles. 10. Outbreak investigation and response are critical but

  15. [Comparison of serological procedures used for the diagnosis of viral exanthema in laboratories participating in the measles elimination plan].

    PubMed

    de Ory, Fernando; Sanz, Juan Carlos; Echevarría, Juan Emilio; Mosquera, María del Mar; Guisasola, María Eulalia

    2004-01-01

    The comparison of serological methods used by the laboratories participating in the Network for the Elimination of Measles to diagnose measles virus infection as well as differential diagnosis with other exanthematic diseases are compared. One panel of 20 serum samples including measles (12), rubella (4), parvovirus B19 (2) and dengue (2) infections was established. All cases were diagnosed by detection of specific IgM. The panel was sent to the laboratories of the Network. The results were compared with those obtained at the reference laboratory. Regarding measles, IgM response from 20 laboratories (19 by ELISA and 1 by indirect immunofluorescence) was obtained, with an agreement of 91.5%. Related to rubella IgM, replay from 6 laboratories, using ELISA, was received, with an agreement of 98.7%. With respect to parvovirus B19 IgM, response from 10 laboratories (8 by ELISA and 2 by indirect immunofluorescence) was obtained, with an agreement of 94.6%. Results about dengue virus were not reported by any laboratory. Some laboratories from the network should review the methods used for the diagnosis of measles and other exanthematic diseases. The results reassert the need for a reference laboratory to support confirmation of the results.

  16. Predictive power of Koplik's spots for the diagnosis of measles.

    PubMed

    Zenner, Dominik; Nacul, Luis

    2012-03-12

    Measles is a major cause of mortality globally. In many countries, management of measles is based on clinical suspicion, but the predictive value of clinical diagnosis depends on knowledge and population prevalence of measles. In the pre-vaccine era with high measles incidence, Koplik's spots (KS) were said to be "pathognomonic". This study prospectively evaluated test properties and diagnostic odds ratios (OR) of KS. Data including KS status were prospectively collected for a six-month period on all suspected measles cases reported to the North-West London Health Protection Unit. Saliva test kits were sent to all cases and KS test properties were analysed against measles confirmation by PCR or IgM testing (gold standard). The positive predictive value (PPV) of clinically suspecting measles was 50%. Using KS as diagnostic tool improved the PPV to 80% and the presence of KS was associated with confirmed measles in the multi-variable analysis (OR 7.2, 95% Confidence Interval 2.1-24.9, p=0.001). We found that Koplik's spots were highly predictive of confirmed measles and could be a good clinical tool to enable prompt measles management and control measures, as action often needs to be taken in the absence of laboratory confirmation. We suggest that current clinical case definitions might benefit from the inclusion of KS.

  17. Influences on immunization rates: Vaccination coverage of mumps, measles, rubella and varicella before and after the STIKO intervention 2011 - A retrospective study.

    PubMed

    Sanftenberg, Linda; Schrörs, Hans-Jürgen; Schelling, Jörg

    2016-07-25

    In September 2011, the German Standing Committee on Vaccinations (STIKO) changed their recommendation regarding the mumps-measles-rubella-varicella vaccination (MMRV). We compared the immunization rates against MMRV in Germany before and after the STIKO intervention. We recorded the immunization status of children born between 09/2008 and 08/2012 in 35 selected doctor's surgeries in Germany. After the STIKO intervention, the ratio of the combined MMRV vaccine as the first dose immunization was reduced to approximately 25% of the initial value. A slight increase in the number of children not sufficiently vaccinated against varicella (1.2%) was observed, but the immunization rates against measles, mumps, rubella and varicella did not significantly decrease. The STIKO intervention led to a significant change in physicians' vaccination procedures. The separate administration MMR+V vaccination may be a helpful option to improve the immunization rates in general. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Epidemic of measles following the nationwide mass immunization campaign

    PubMed Central

    2013-01-01

    Background A prolonged measles epidemic occurred in Wenzhou City, China after a nationwide measles mass immunization campaign (MMIC) in 2010. We conducted an investigation to identify factors contributing to this epidemic and to provide evidence-based recommendations for measles elimination strategies in China. Methods Measles was diagnosed using the national standard case-definitions. We estimated the population vaccination coverage based on the proportion of measles patients that had been vaccinated. In a case–control investigation, all measles patients who received treatment in The Second Affiliated Hospital of Wenzhou Medical College (Hospital S) during November 1 to December 31, 2010 served as cases; controls were randomly selected among all other patients who received treatment in Hospital S during the same time period, frequency matched by month of hospital visit. We reviewed medical records of case- and control-patients to compare their exposure history at Hospital S and to its intravenous rehydration room (IV room) during the incubation period (7–21 days before their illness onset). Results The attack rate of measles in Wenzhou City was 3.3/100,000 during September 1, 2010 to January 11, 2011. Children aged 8-11 m had the highest attack rate (171/100,000) of all age groups. In children not age-eligible for the MMIC but should have been routinely vaccinated after the MMIC, the vaccination rate was only 52%. In the case–control investigation, 60% (25/42) of case-patients compared with 21% (35/168) of control-patients had visited Hospital S (adjusted ORM-H = 5.5, 95% CI = 2.7–11). Among unvaccinated children who had received treatment in Hospital S, 84% (21/25) of case-patients compared 38% (11/29) of control-patients had visited the IV room (adjusted ORM-H = 9.2, 95% CI = 1.5–59). Conclusion Relaxed routine measles vaccination among children after the MMIC was the main factor responsible for this epidemic. Exposure in the IV room

  19. Epidemic of measles following the nationwide mass immunization campaign.

    PubMed

    Gao, Jie; Chen, Enfu; Wang, Zhigang; Shen, Jichuan; He, Hanqing; Ma, Huilai; Zeng, Guang; Zhu, Bao-Ping

    2013-03-18

    A prolonged measles epidemic occurred in Wenzhou City, China after a nationwide measles mass immunization campaign (MMIC) in 2010. We conducted an investigation to identify factors contributing to this epidemic and to provide evidence-based recommendations for measles elimination strategies in China. Measles was diagnosed using the national standard case-definitions. We estimated the population vaccination coverage based on the proportion of measles patients that had been vaccinated. In a case-control investigation, all measles patients who received treatment in The Second Affiliated Hospital of Wenzhou Medical College (Hospital S) during November 1 to December 31, 2010 served as cases; controls were randomly selected among all other patients who received treatment in Hospital S during the same time period, frequency matched by month of hospital visit. We reviewed medical records of case- and control-patients to compare their exposure history at Hospital S and to its intravenous rehydration room (IV room) during the incubation period (7-21 days before their illness onset). The attack rate of measles in Wenzhou City was 3.3/100,000 during September 1, 2010 to January 11, 2011. Children aged 8-11 m had the highest attack rate (171/100,000) of all age groups. In children not age-eligible for the MMIC but should have been routinely vaccinated after the MMIC, the vaccination rate was only 52%. In the case-control investigation, 60% (25/42) of case-patients compared with 21% (35/168) of control-patients had visited Hospital S (adjusted ORM-H = 5.5, 95% CI = 2.7-11). Among unvaccinated children who had received treatment in Hospital S, 84% (21/25) of case-patients compared 38% (11/29) of control-patients had visited the IV room (adjusted ORM-H = 9.2, 95% CI = 1.5-59). Relaxed routine measles vaccination among children after the MMIC was the main factor responsible for this epidemic. Exposure in the IV room at Hospital S facilitated the epidemic. To reach the goal of

  20. Delayed measles vaccination of toddlers in Canada: Associated socio-demographic factors and parental knowledge, attitudes and beliefs.

    PubMed

    Périnet, Simone; Kiely, Marilou; De Serres, Gaston; Gilbert, Nicolas L

    2018-04-03

    Delaying vaccination increases the period of vulnerability of children against vaccine-preventable diseases. We used a nationally representative sample of Canadian two-year-old children to explore factors associated with delays in the uptake of the first dose of measles-containing vaccine, recommended in Canada for children at 12 months of age. Distribution of delays was determined using data from the 2013 Childhood National Immunization Coverage Survey. Logistic regression was used to examine sociodemographic factors and knowledge, attitudes and beliefs (KAB) associated with the two outcomes of interest: delays of one to six months (vaccination at 13 to 18 months of age) and delays of seven to 18 months (vaccination at 19 to 23 months of age). Overall, 69% (95% confidence interval [CI] 67-71) of children received their first valid dose on time. Twenty-nine percent (95% CI 27-31) and 11% (95% CI 9-12) of children were unvaccinated before turning 13 and 16 months of age, respectively. Factors associated with delays of one to six months were being a girl, being born outside Canada, and the jurisdiction of residence. Being from a single-parent family, being born outside Canada and the jurisdiction of residence were associated with delays of seven to 18 months, suggesting that potential barriers might be at play. Associations between KAB and vaccination delays indicate that vaccine hesitancy could contribute to measles vaccination delays in Canada. Barriers in accessing vaccination services and the role of vaccine hesitancy in timely vaccination must be better understood to reduce vaccination delays in toddlers in Canada.

  1. Susceptibility to measles, rubella, mumps, and varicella-zoster viruses among healthcare workers.

    PubMed

    Aypak, Cenk; Bayram, Yasemin; Eren, Hayriye; Altunsoy, Adalet; Berktaş, Mustafa

    2012-01-01

    It is important to identify and immunize susceptible healthcare workers to prevent and control hospital infections. Our aim was to evaluate the specific antibodies against the measles, mumps, and rubella viruses and the varicella zoster virus among healthcare workers in a tertiary-care hospital. A total of 284 healthcare workers (89 men and 195 women; mean age, 33.5 ± 11 years), including 111 nurses, 87 physicians, 34 laboratory technicians, and 52 members of the housekeeping staff, of Van Training and Research Hospital were enrolled in this study. Antibodies were detected with an enzyme-linked immunosorbent assay. The numbers of workers with serological susceptibility to mumps, measles, rubella, or chicken pox were 26 (9.2%), 18 (6.3%), 7 (2.5%), and 5 (1.8%), respectively. Although the difference was not statistical significant, the rate of seroprevalence of antibodies was lowest for measles (90.8%; p>0.05). Susceptibility to measles, mumps, and rubella, and chicken pox was more prevalent among young healthcare workers (p<0.001). Not all healthcare workers born before 1957 were immune to these vaccine-preventable diseases. These data confirm that screening and vaccination of susceptible healthcare workers is essential regardless of age.

  2. EpiReview: Measles in NSW, 2002-2011.

    PubMed

    Rosewell, Alexander; Reinten-Reynolds, Tracie; Spokes, Paula J

    2012-12-01

    Measles has been eliminated in NSW for more than a decade; however outbreaks associated with international travel do occur. This EpiReview describes the epidemiology of measles in NSW from 2002-2011. A total of 281 cases of measles were notified during the period, an average annual notification rate of 0.41 notifications per 100 000 population (range: 0.06-1.25). There were 139 hospitalisations recorded with a measles diagnosis in the 10-year reporting period, corresponding to a rate of 0.20 hospitalisations per 100 000 population. Of the 80 measles virus specimens genotyped, five genotypes were identified: D9 (38%), D8 (24%), D4 (16%), D5 (14%) with H1 identified less frequently (9%). No single genotype was associated with local transmission across successive years. To sustain good measles control, children should be vaccinated against measles on time through routine childhood immunisation, and all young adults who travel internationally should be vaccinated. Clinician awareness remains important in the early identification and control of measles to avoid further transmission during outbreaks and to enable the timely implementation of public health measures.

  3. Evaluation of Measles Vaccine Virus as a Vector to Deliver Respiratory Syncytial Virus Fusion Protein or Epstein-Barr Virus Glycoprotein gp350

    PubMed Central

    Mok, Hoyin; Cheng, Xing; Xu, Qi; Zengel, James R; Parhy, Bandita; Zhao, Jackie; Wang, C. Kathy; Jin, Hong

    2012-01-01

    Live attenuated recombinant measles vaccine virus (MV) Edmonston-Zagreb (EZ) strain was evaluated as a viral vector to express the ectodomains of fusion protein of respiratory syncytial virus (RSV F) or glycoprotein 350 of Epstein-Barr virus (EBV gp350) as candidate vaccines for prophylaxis of RSV and EBV. The glycoprotein gene was inserted at the 1st or the 3rd position of the measles virus genome and the recombinant viruses were generated. Insertion of the foreign gene at the 3rd position had a minimal impact on viral replication in vitro. RSV F or EBV gp350 protein was secreted from infected cells. In cotton rats, EZ-RSV F and EZ-EBV gp350 induced MV- and insert-specific antibody responses. In addition, both vaccines also induced insert specific interferon gamma (IFN-γ) secreting T cell response. EZ-RSV F protected cotton rats from pulmonary replication of RSV A2 challenge infection. In rhesus macaques, although both EZ-RSV F and EZ-EBV gp350 induced MV specific neutralizing antibody responses, only RSV F specific antibody response was detected. Thus, the immunogenicity of the foreign antigens delivered by measles vaccine virus is dependent on the nature of the insert and the animal models used for vaccine evaluation. PMID:22383906

  4. Progress toward measles elimination—Philippines, 1998-2014.

    PubMed

    Takashima, Yoshihiro; Schluter, W William; Mariano, Kayla Mae L; Diorditsa, Sergey; de Quiroz Castro, Maricel; Ou, Alan C; Ducusin, Maria Joyce U; Garcia, Luzviminda C; Elfa, Dulce C; Dabbagh, Alya; Rota, Paul; Goodson, James L

    2015-04-10

    In 2005, the Regional Committee for the World Health Organization (WHO) Western Pacific Region (WPR) established a goal to eliminate measles by 2012.The recommended elimination strategies in WPR include 1) ≥95% 2-dose coverage with measles-containing vaccine (MCV) through routine immunization services and supplementary immunization activities (SIAs); 2) high-quality case-based measles surveillance; 3) laboratory surveillance with timely and accurate testing of specimens to confirm or discard suspected cases and detect measles virus genotypes; and 4) measles outbreak preparedness, rapid response, and appropriate case management. In the WPR, the Philippines set a national goal in 1998 to eliminate measles by 2008. This report describes progress toward measles elimination in the Philippines during 1998-2014 and challenges remaining to achieve the goal. WHO-United Nations Children's Fund (UNICEF)-estimated coverage with the routine first dose of MCV (MCV1) increased from 80% in 1998 to 90% in 2013, and coverage with the routine second dose of MCV (MCV2) increased from 10% after nationwide introduction in 2010 to 53% in 2013. After nationwide SIAs in 1998 and 2004, historic lows in the numbers and incidence of reported measles cases occurred in 2006. Despite nationwide SIAs in 2007 and 2011, the number of reported cases and incidence generally increased during 2007-2012, and large measles outbreaks occurred during 2013-2014 that affected infants, young children, older children, and young adults and that were prolonged by delayed and geographically limited outbreak response immunization activities during 2013-2014. For the goal of measles elimination in WPR to be achieved, sustained investments are required in the Philippines to strengthen health systems, implement the recommended elimination strategies, and develop additional strategies to identify and reduce measles susceptibility in specific geographic areas and older age groups.

  5. Measles related complications and the role of vitamin A supplementation.

    PubMed

    Mishra, Ashok; Mishra, Subodh; Jain, Pankaj; Bhadoriya, Rahul Singh; Mishra, Rakesh; Lahariya, Chandrakant

    2008-09-01

    Measles is associated with high rate of complications and contributes to a major proportion of childhood morbidity and mortality. The role of vit A supplementation (VAS) in the case management of measles and prevention of complications is partially understood and not sufficiently supported by epidemiological data. This paper analyses the possible role of vit A supplementation in prevention of measles related complications and associated fatality. A cross sectional study was carried out during an outbreak of measles in Shivpuri, India. A total population of 193,000 was covered by house to house visit and, the caregivers of total 1204 measles cases, including 214 cases with complications, were interviewed using a semi structured interview schedule. The analysis of data was done using Epi Info. The attack rate of 6.7% and rate of complications at 17.8% were found in this investigation. The coverage with routine measles vaccine and the vit A supplementation was 18.3% and 28.9% respectively. The management of measles cases was poor with only 15.8% cases receiving therapeutic doses of vit A. Both complications and case fatality rate was higher amongst children who had not received vit A supplementation in previous 6 months (p<0.05). Measles vaccine also found to have preventive effect on development of complications (p<0.05). Routine vit A supplementation and measles vaccination reduce the chances of complications amongst cases of measles. The role of VAS becomes more important when the case management is poor. While, measles is frequently associated with complications in the Indian setting, there is a need of enhancing the efforts to improve the delivery of vit A supplementation and measles vaccine to the children in rural areas.

  6. Towards eradication of measles virus: global progress and strategy evaluation.

    PubMed

    Nokes, D J; Williams, J R; Butler, A R

    1995-05-01

    Despite an increase in global measles vaccine coverage from under 20% in 1980 to around 80% in 1990, measles remains a major cause of morbidity and mortality world-wide. This paper addresses a number of issues relating to efforts to control measles, namely, (i) at the global level, how might we assess the impact of measles vaccination on the incidence of infection and associated disease, and, (ii), at the strategic level, how can we utilise an understanding of the transmission dynamics of childhood viral infections to aid the design of optimal immunisation programmes? Based on WHO vaccine coverage data, and organising countries according to similarities in demographic and epidemiological parameters, an age-structured model of measles transmission is used to capture the non-linear dynamics of infection and mass vaccination and to generate projections of the impact of measles immunization world-wide. The results provide a crude indication of the percentage reduction in measles cases by year 2000 (compared with no immunization) and suggest an approximately 70% reduction in cases over all ages, and 77% reduction in cases under 5 years (where there is the greatest risk of case fatality); these suggest that WHO targets for 1995 are unlikely to be achieved. In the second part of the paper, examples are given to illustrate the usefulness of a modelling approach in evaluating measles immunization policy. The introduction of MMR vaccine in the UK in 1988 has resulted in measles incidence falling to an all time low and attention has turned to the requirements of elimination. A realistic age structured model, validated using extensive serological data, is used to compare the merits of single or two dose strategies. Based upon recent estimates of vaccine efficacy (90%) and coverage (92% by end of second year of life) it is suggested that a two-dose policy with a pre-school second dose given irrespective of vaccine history is required to prevent the build up of susceptibles to

  7. Comparing the health and social protection effects of measles vaccination strategies in Ethiopia: An extended cost-effectiveness analysis.

    PubMed

    Driessen, Julia; Olson, Zachary D; Jamison, Dean T; Verguet, Stéphane

    2015-08-01

    Vaccination coverage rates often mask wide variation in access, uptake, and cost of providing vaccination. Financial incentives have been effective at creating demand for social services in a variety of settings. Using methods of extended cost-effectiveness analysis, we compare the health and economic implications of three different vaccine delivery strategies for measles vaccination in Ethiopia: i) routine immunization, ii) routine immunization with financial incentives, and iii) mass campaigns, known as supplemental immunization activities (SIAs). We examine annual birth cohorts of almost 3,000,000 births over a ten year period, exploring variation in these outcomes based on economic status to understand how various options may improve equity. SIAs naturally achieve higher levels of vaccine coverage, but at higher costs. Routine immunization combined with financial incentives bolsters demand among more economically vulnerable households. The relative appeal of routine immunization with financial incentives and SIAs will depend on the policy environment, including short-term financial limitations, time horizons, and the types of outcomes that are desired. While the impact of financial incentives has been more thoroughly studied in other policy arenas, such as education, consideration of this approach alongside standard vaccination models such as SIAs is timely given the dialog around measles eradication. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Immunogenicity and safety of early vaccination with two doses of a combined measles-mumps-rubella-varicella vaccine in healthy Indian children from 9 months of age: a phase III, randomised, non-inferiority trial.

    PubMed

    Lalwani, Sanjay; Chatterjee, Sukanta; Balasubramanian, Sundaram; Bavdekar, Ashish; Mehta, Shailesh; Datta, Sanjoy; Povey, Michael; Henry, Ouzama

    2015-09-11

    This study (NCT00969436) compared the immunogenicity and safety of measles-mumps-rubella (MMR) followed by MMR+varicella (V) vaccines to (1) 2 doses of combined MMRV and (2) MMR followed by MMRV, in Indian children. Phase III, open, randomised, non-inferiority study. 6 tertiary care hospitals located in India. Healthy participants aged 9-10 months not previously vaccinated against/exposed to measles, mumps, rubella and varicella or without a history of these diseases. Participants were randomised (2:2:1) to receive 2 doses of either MMRV (MMRV/MMRV group) or MMR followed by MMRV (MMR/MMRV group) or MMR followed by MMR+V (MMR/MMR+V, control group) at 9 and 15 months of age. Antibody titres against measles, mumps and rubella were measured using ELISA and against varicella using an immunofluorescence assay. To demonstrate non-inferiority of the 2 vaccination regimens versus the control in terms of seroconversion rates, defined as a group difference with a lower bound of the 95% CI >-10% for each antigen, 43 days postdose 2. Parents/guardians recorded solicited local and general symptoms for a 4-day and 43-day period after each vaccine dose, respectively. Seroconversion rates postdose 1 ranged from 87.5% to 93.2% for measles, 83.3% to 86.1% for mumps and 98.7% to 100% for rubella across the 3 vaccine groups. The seroconversion rates postdose 2 were 100% for measles, mumps and rubella and at least 95.8% for varicella across the 3 vaccine groups. Non-inferiority of MMRV/MMRV and MMR/MMRV to MMR/MMR+V was achieved for all antigens, 43 days postdose 2. The 3 vaccination regimens were generally well tolerated in terms of solicited local and general symptoms. The immune responses elicited by the MMRV/MMRV and MMR/MMRV vaccination regimens were non-inferior to those elicited by the MMR/MMR+V regimen for all antigens. The 3 vaccination schedules also exhibited an acceptable safety profile in Indian children. NCT00969436. Published by the BMJ Publishing Group Limited

  9. Public health significance of immunization and epidemic occurrence of measles.

    PubMed

    Čalkić, Lejla; Skomorac, Muhamed; Tandir, Salih; Sivić, Suad; Bajramović Omeragić, Lejla

    2018-02-01

    Aim To investigate epidemiological characteristics of the measles epidemic (risk factors and reasons for its emergence) in order to establish better control and prevention of future epidemics as well as to determine an influence of poor collective immunization of children against measles on appearance of epidemic disease. Methods An open retrospective epidemiological study of measles infection was conducted during the epidemic in Zenica-Doboj Canton (ZDC) in the period 2014-2015. Disease reports, Disease Reporting Forms for measles and rubella cases and the Bulletin of the Institute for Health and Food Safety Zenica were used for data collection. Results A total of 325 patients with the diagnosis of measles were registered, 262 (80.61%) in 2014 and 63 (19.39%) in 2015 resulting in overall incidence of 81.25/100.000. The majority of patients were aged 0-6 (p<0.05). Of the total number of patients, only 13 (4.73%) were orderly vaccinated (p <0.05). In the period 2009- 2015 in ZDC 25.444 (83.34%) children (p <0.05) were vaccinated with measles, mumps, rubella (MMR) vaccine. Conclusion Results of the study show that the low level of vaccination of children continues to a risk of the emergence of epidemics of measles and other infectious diseases. Therefore, in order to prevent the disease there is a need for a better vaccination campaign. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

  10. Case-based surveillance enhanced with measles virus detection/genotyping is essential to maintain measles elimination in Aichi Prefecture, Japan.

    PubMed

    Minagawa, Hiroko; Yasui, Yoshihiro; Adachi, Hirokazu; Ito, Miyabi; Hirose, Emi; Nakamura, Noriko; Hata, Mami; Kobayashi, Shinichi; Yamashita, Teruo

    2015-11-09

    Japan was verified as having achieved measles elimination by the Measles Regional Verification Commission in the Western Pacific Region in March 2015. Verification of measles elimination implies the absence of continuous endemic transmission. After the last epidemic in 2007 with an estimated 18,000 cases, Japan introduced nationwide case-based measles surveillance in January 2008. Laboratory diagnosis for all suspected measles cases is essentially required by law, and virus detection tests are mostly performed by municipal public health institutes. Despite relatively high vaccination coverage and vigorous response to every case by the local health center staff, outbreak of measles is repeatedly observed in Aichi Prefecture, Japan. Measles virus N and H gene detection by nested double RT-PCR was performed with all specimens collected from suspected cases and transferred to our institute. Genotyping and further molecular epidemiological analyses were performed with the direct nucleotide sequence data of appropriate PCR products. Between 2010 and 2014, specimens from 389 patients suspected for measles were tested in our institute. Genotypes D9, D8, H1 and B3 were detected. Further molecular epidemiological analyses were helpful to establish links between patients, and sometimes useful to discriminate one outbreak from another. All virus-positive cases, including 49 cases involved in three outbreaks without any obvious epidemiological link with importation, were considered as import-related based on the nucleotide sequence information. Chain of transmission in the latest outbreak in 2014 terminated after the third generations, much earlier than the 2010-11 outbreak (6th generations). Since 2010, almost all measles cases reported in Aichi Prefecture are either import or import-related, based primarily on genotypes and nucleotide sequences of measles virus detected. In addition, genotyping and molecular epidemiological analyses are indispensable to prove the interruption

  11. Supplementary immunization activities to achieve measles elimination: experience of the European Region.

    PubMed

    Khetsuriani, Nino; Deshevoi, Sergei; Goel, Ajay; Spika, John; Martin, Rebecca; Emiroglu, Nedret

    2011-07-01

    Supplementary immunization activities (SIAs) using measles-containing vaccine (MCV) have had a substantial impact on reducing mortality associated with measles worldwide. To assess impact of SIAs on measles incidence in the World Health Organization European Region and their role at the final stages of measles elimination efforts in Europe, we reviewed information on SIAs, measles surveillance, and routine vaccination coverage during 2000-2009. During 2000-2009, >57 million persons received MCV through SIAs in 16 countries. The Region primarily focused on catch-up campaigns with wider target age groups than in other regions and subsequently relied on routine vaccination rather than periodic follow-up SIAs for the second MCV dose. In addition, the concept of SIAs has been expanded from short-term (<30 days) mass campaigns implemented in other regions to incorporate vaccination efforts over longer periods and outbreak response vaccination. In 2009, 14 of 16 countries that conducted SIAs reported no measles cases or <1 case per 1,000,000 population, reflecting the post-SIA decrease in incidence. SIAs have made a substantial contribution to the success of measles elimination efforts and will likely remain an important strategy for interrupting measles virus transmission in the European Region, although specific approaches will vary by country. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2011.

  12. Geospatial characteristics of measles transmission in China during 2005-2014.

    PubMed

    Yang, Wan; Wen, Liang; Li, Shen-Long; Chen, Kai; Zhang, Wen-Yi; Shaman, Jeffrey

    2017-04-01

    Measles is a highly contagious and severe disease. Despite mass vaccination, it remains a leading cause of death in children in developing regions, killing 114,900 globally in 2014. In 2006, China committed to eliminating measles by 2012; to this end, the country enhanced its mandatory vaccination programs and achieved vaccination rates reported above 95% by 2008. However, in spite of these efforts, during the last 3 years (2013-2015) China documented 27,695, 52,656, and 42,874 confirmed measles cases. How measles manages to spread in China-the world's largest population-in the mass vaccination era remains poorly understood. To address this conundrum and provide insights for future public health efforts, we analyze the geospatial pattern of measles transmission across China during 2005-2014. We map measles incidence and incidence rates for each of the 344 cities in mainland China, identify the key socioeconomic and demographic features associated with high disease burden, and identify transmission clusters based on the synchrony of outbreak cycles. Using hierarchical cluster analysis, we identify 21 epidemic clusters, of which 12 were cross-regional. The cross-regional clusters included more underdeveloped cities with large numbers of emigrants than would be expected by chance (p = 0.011; bootstrap sampling), indicating that cities in these clusters were likely linked by internal worker migration in response to uneven economic development. In contrast, cities in regional clusters were more likely to have high rates of minorities and high natural growth rates than would be expected by chance (p = 0.074; bootstrap sampling). Our findings suggest that multiple highly connected foci of measles transmission coexist in China and that migrant workers likely facilitate the transmission of measles across regions. This complex connection renders eradication of measles challenging in China despite its high overall vaccination coverage. Future immunization programs should

  13. Sub-national variation in measles vaccine coverage and outbreak risk: a case study from a 2010 outbreak in Malawi.

    PubMed

    Kundrick, Avery; Huang, Zhuojie; Carran, Spencer; Kagoli, Matthew; Grais, Rebecca Freeman; Hurtado, Northan; Ferrari, Matthew

    2018-06-15

    Despite progress towards increasing global vaccination coverage, measles continues to be one of the leading, preventable causes of death among children worldwide. Whether and how to target sub-national areas for vaccination campaigns continues to remain a question. We analyzed three metrics for prioritizing target areas: vaccination coverage, susceptible birth cohort, and the effective reproductive ratio (R E ) in the context of the 2010 measles epidemic in Malawi. Using case-based surveillance data from the 2010 measles outbreak in Malawi, we estimated vaccination coverage from the proportion of cases reporting with a history of prior vaccination at the district and health facility catchment scale. Health facility catchments were defined as the set of locations closer to a given health facility than to any other. We combined these estimates with regional birth rates to estimate the size of the annual susceptible birth cohort. We also estimated the effective reproductive ratio, R E , at the health facility polygon scale based on the observed rate of exponential increase of the epidemic. We combined these estimates to identify spatial regions that would be of high priority for supplemental vaccination activities. The estimated vaccination coverage across all districts was 84%, but ranged from 61 to 99%. We found that 8 districts and 354 health facility catchments had estimated vaccination coverage below 80%. Areas that had highest birth cohort size were frequently large urban centers that had high vaccination coverage. The estimated R E ranged between 1 and 2.56. The ranking of districts and health facility catchments as priority areas varied depending on the measure used. Each metric for prioritization may result in discrete target areas for vaccination campaigns; thus, there are tradeoffs to choosing one metric over another. However, in some cases, certain areas may be prioritized by all three metrics. These areas should be treated with particular concern

  14. The epidemiological and serological characteristics of measles in Dongguan, China, 2005–2014

    PubMed Central

    Han, Ke; Chen, Shaoli; Tang, Cuifei; Wen, Jinjun; Li, Jingquan; Ni, Jindong; Zheng, Xueli

    2016-01-01

    ABSTRACT This study examined the epidemiological and serological characteristics of measles in Dongguan, China. From 2005 to 2014, a total of 8,224 measles cases were reported in Dongguan, 33.5% of which were aged <1 y and 30.6% >14 y. From 2005 to 2014, the proportion of the <1 y measles cases increased year by year from 24.3% to 47.9%. Of the cases aged ≥8 months (n = 6,768 cases), only 11.6% had been immunized with at least one dose of measles vaccine. Of the 2,213 cases who had never been immunized with measles vaccine, immigrants accounted for 82.4%. 52.4% of the measles cases were diagnosed with pneumonia, and 12 cases died from respiratory failure. Seroprevalence rate in women and their newborns was 86.0% and 82.5%, respectively. Measurement of serum measles antibody levels for infants aged less than 8 months indicated that seroprevalence rate dramatically declined from 97.3% at birth to 9.3% and 13.2% at 6- and 7- month old. The existence of a sufficient pool of unvaccinated people (especially immigrants) and decreased level of passively transferred measles antibodies in infants from vaccinated mothers contributed to the sustained transmission observed in Dongguan. In addition to high routine vaccination coverage, new strategies and innovations for measles vaccination are needed to eliminate measles. PMID:27003239

  15. Measles case fatality ratio in India a review of community based studies.

    PubMed

    Sudfeld, C R; Halsey, N A

    2009-11-01

    Measles remains a major cause of child mortality in India. Measles case fatality ratios (CFRs) vary substantially between countries and even within the same community over time. We present a review of Indian community-based measles CFR studies conducted from 1975 to 2008. PubMed, Cochrane Libraries, and all WHO databases were searched using a combination of terms. All community-based studies were abstracted into a database. We identified 25 studies with data on 27 communities. The median CFR was 1.63 per 100 cases (Q1= 0.00 and Q3= 5.06). Studies conducted after 1994 had significantly lower CFRs (P=0.031). Studies in rural settings had significantly higher CFRs compared to urban studies (P=0.015). No differences were found by study design or outbreak/endemic setting. This review suggests measles CFR may be declining in India. We hypothesize that increased measles vaccination coverage is the main factor contributing to the decline. Widespread vaccination increases both the average age of infection and the proportion of total measles cases previously vaccinated. Vitamin A treatment/supplementation is also likely to have contributed. In order to further reduce measles burden in India, vaccination and vitamin A treatment/supplementation coverage should be increased and a two dose vaccine strategy should be implemented in all areas.

  16. Measles, mumps, and rubella antibody patterns of persistence and rate of decline following the second dose of the MMR vaccine.

    PubMed

    Seagle, Emma E; Bednarczyk, Robert A; Hill, Tenisha; Fiebelkorn, Amy Parker; Hickman, Carole J; Icenogle, Joseph P; Belongia, Edward A; McLean, Huong Q

    2018-02-01

    Antibodies to measles, mumps, and rubella decline 3% per year on average, and have a high degree of individual variation. Yet, individual variations and differences across antigens are not well understood. To better understand potential implications on individual and population susceptibility, we reanalyzed longitudinal data to identify patterns of seropositivity and persistence. Children vaccinated with the second dose of measles, mumps, rubella vaccine (MMR2) at 4-6 years of age were followed up to 12 years post-vaccination. The rates of antibody decline were assessed using regression models, accounting for differences between and within subjects. Most of the 302 participants were seropositive throughout follow-up (96% measles, 88% mumps, 79% rubella). The rate of antibody decline was associated with MMR2 response and baseline titer for measles and age at first dose of MMR (MMR1) for rubella. No demographic or clinical factors were associated with mumps rate of decline. One month post-MMR2, geometric mean titer (GMT) to measles was high (3892 mIU/mL), but declined on average 9.7% per year among those with the same baseline titer and <2-fold increase post-MMR2. Subjects with ≥2-fold experienced a slower decline (≤7.4%). GMT to rubella was 149 one month post-MMR2, declining 2.6% and 5.9% per year among those who received MMR1 at 12-15 months and >15 months, respectively. GMT to mumps one month post-MMR2 was 151, declining 9.2% per year. Only 14% of subjects had the same persistence trends for all antigens. The rate of antibody decay varied substantially among individuals and the 3 antigen groups. A fast rate of decline coupled with high variation was observed for mumps, yet no predictors were identified. Future research should focus on better understanding waning titers to mumps and its impacts on community protection and individual susceptibility, in light of recent outbreaks in vaccinated populations. Copyright © 2018 Elsevier Ltd. All rights

  17. [Investigation of a measles outbreak caused by genotype D8 virus in Pinghu city of Zhejiang province, 2017].

    PubMed

    Yan, R; He, B; Yao, F Y; Xiang, Z L; He, H Q; Xie, S Y; Feng, Y

    2018-03-10

    Objective: To investigate the epidemiological characteristics of measles outbreak caused by genotype D8 virus in Pinghu city of Zhejiang province, and provide evidence for the control of the outbreak. Methods: The measles outbreak data were collected through National Measles Surveillance System. The outpatient records and admission records were checked, field investigation and outbreak response were conducted. Blood samples in acute phase and swab specimens were collected from the patients for laboratory testing, including serology test, RNA extraction and amplification, measles virus isolation and genotype identification. Software SPSS 17.0 and Excel 2016 were used for data analysis. Results: A total of 10 confirmed measles cases were reported in Pinghu city, and 8 cases were aged >40 years. Six blood samples were collected, in which 5 were measles D8 virus positive and 1 was negative in measles virus detection. There were epidemiological links among 10 cases which occurred in a factory, a hospital and a family at the same time. There was no statistical difference in symptoms among cases caused by D8 virus and H1a virus. After the emergent measles vaccination, the measles outbreak was effectively controlled. Conclusion: Untimely response due to the uneasy detection of measles cases in the early stage, nosocomial infection and weak barrier of measles immunity in adults might be the main reasons for this outbreak. Measles vaccination is effective in the prevention of measles D8 virus infection. It is necessary to strengthen measles genotype monitoring for the tracing of infection source and control of outbreaks.

  18. Measles-Mumps-Rubella vaccine for children with egg allergy: Is admission for inpatient vaccination necessary?

    PubMed

    Tan, M S; Teoh, E J; Hor, C P; Yeoh, A A C

    2016-08-01

    Children who develop any hypersensitivity reaction to eggs are routinely referred to hospital for Measles-Mumps-Rubella (MMR) vaccination as inpatients to prevent anaphylaxis. We aimed to study the association between hypersensitivity reactions after egg exposure and similar reactions after MMR immunisation; and examine the necessity of hospital admission for vaccination. A prospective observational study was conducted in Paediatric Department in Bukit Mertajam Hospital, Penang, between March and December 2014. Children referred from local polyclinics for inpatient MMR vaccination because of a history of egg allergy were recruited. The children were observed in the ward for post vaccination allergic reactions. Concurrently, a group of children without egg allergy was recruited from those admitted for other illnesses but had recent MMR vaccination at polyclinics. Parents of these children were interviewed and asked if they had observed any reactions post vaccination. In both groups, sociodemographics, medical history and family history of atopy were collected. Eighty-seven subjects were recruited in this study. Fifty-four infants with egg allergy had previous mild allergic reactions after exposure to eggs or egg-related products. They were associated with a family history of egg hypersensitivity, personal history of acute gastroenteritis and upper respiratory tract infections. Two of them developed cutaneous rashes post vaccination during observation, but none developed anaphylactic or anaphylactoid reactions. Two infants among those without egg allergy had post vaccination fever. There was no association between egg allergy and hypersensitivity reactions to MMR vaccine (p=0.632). MMR vaccine can be safely administered to children with mild egg allergy, hence admission for vaccination in the hospital is not warranted. Risk stratification is required to ensure only infants with severe reactions will be admitted for vaccination.

  19. When, and how, should we introduce a combination measles-mumps-rubella (MMR) vaccine into the national childhood expanded immunization programme in South Africa?

    PubMed

    Cameron, Neil A

    2012-09-07

    This article briefly reviews the history and epidemiology of measles, mumps and rubella disease and the case for introducing combination measles-mumps-rubella (MMR) vaccine into the national childhood immunization schedule in South Africa. Despite adopting the World Health Organization's Measles Elimination strategy in 1996 and achieving a significant decrease the incidence of measles, added effort is needed in South and southern Africa to reach the goal to eliminate endogenous spread measles. Mumps is still common disease of childhood and while there are few sequelae, even the rare complications are important in large populations. Congenital rubella syndrome is seldom reported, but it is estimated that of the million or so children born every year in South Africa over 600 infants are affected to some degree by rubella infection. The naturally acquired immunity to rubella in women of childbearing age in South Africa has been estimated at over 90%, so that introducing a rubella containing vaccine in childhood may paradoxically increase the proportion of girls reaching puberty still susceptible to rubella. The elimination of endogenous measles and rubella is being achieved in many countries in South America, and despite the recent measles epidemic, must still be seriously considered for South and southern Africa. Current constraints and potential steps needed to reach the goal in South Africa are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Timeliness of MMR vaccination and barriers to vaccination in preschool children.

    PubMed

    Jeong, Y W; Park, B H; Kim, K H; Han, Y R; Go, U Y; Choi, W S; Kong, K A; Park, H

    2011-02-01

    The documented vaccine coverage rate of measles-mumps-rubella (MMR) vaccination is almost 99% in Korea, but measles cases are constantly being reported. This study evaluated the vaccine coverage, timeliness, and barriers to immunization of measles vaccination in preschool children in Korea. We assessed 452 children aged 15-23 months and 300 children aged 4-6 years in September 2007. Questionnaires were administered in order to estimate measles vaccination rate, its timeliness and barriers to vaccine uptake. Being unaware of the necessity for vaccination and its schedule, child being sick during the recommended vaccination period, and recommended vaccination period not being over were significant preventive factors to timely vaccination (P < 0·05). Children with working mothers, single parents, those not being cared for by their parents, and those younger among siblings were at a higher risk of not being vaccinated on time. In order to increase timely vaccination, accurate information should be delivered and a systematic approach should be targeted to high-risk groups.

  1. A 60-year review on the changing epidemiology of measles in capital Beijing, China, 1951-2011

    PubMed Central

    2013-01-01

    Background China pledged to join the global effort to eliminate measles by 2012. To improve measles control strategy, the epidemic trend and population immunity of measles were investigated in 1951–2011 in Beijing. Methods The changing trend of measles since 1951 was described based on measles surveillance data from Beijing Centre of Disease Control and Prevention (CDC). The measles vaccination coverage and antibody level were assessed by routinely reported measles vaccination data and twenty-one sero-epidemiological surveys. Results The incidence of measles has decreased significantly from 593.5/100,000 in 1951 (peaked at 2721.0/100,000 in 1955), to 0.5/100,000 in 2011 due to increasing vaccination coverage of 95%-99%. Incidence rebounded from 6.6/100,000 to 24.5/100,000 since 2005 and decreased after measles vaccine (MV) supplementary immunization activities (SIAs) in 2010. Measles antibody positive rate was 85%-95% in most of years since 1981. High-risk districts were spotted in Chaoyang, Fengtai and Changping districts in recent 15 years. Age-specific incidence and proportion of measles varied over time. The most affected population were younger children of 1–4 years before 1978, older children of 5–14 years in 1978–1996, infant of <1 years and adults of ≥15 years in period of aim to measles elimination. Conclusion Strategies at different stages had a prevailing effect on the epidemic dynamics of measles in recent 60 years in Beijing. It will be essential to validate reported vaccination coverage, improve vaccination coverage in adults and strengthen measles surveillance in the anticipated elimination campaign for measles. PMID:24143899

  2. What Obstetric Health Care Providers Need to Know About Measles and Pregnancy

    PubMed Central

    Rasmussen, Sonja A.; Jamieson, Denise J.

    2015-01-01

    From January 1 to April 3, 2015, 159 people from 18 states and the District of Columbia were reported as having measles. Most cases are part of an outbreak linked to a California amusement park. Because measles was eliminated in the United States in 2000, most U.S. clinicians are unfamiliar with the condition. We reviewed information on the current outbreak, measles manifestations, diagnostic methods, treatment, and infection-control recommendations. To identify information on measles and pregnancy, we reviewed reports with 20 or more measles cases during pregnancy that included data on effects on pregnant women or pregnancy outcomes. These reports were identified through MEDLINE from inception through February 2015 using the following strategy: (((pregnan*) AND measles) AND English[Language]) NOT review[Publication Type]. Reference lists also were reviewed to identify additional articles. Pregnant women infected with measles are more likely to be hospitalized, develop pneumonia, and die than nonpregnant women. Adverse pregnancy outcomes, including pregnancy loss, preterm birth, and low birth weight, are associated with maternal measles; however, the risk of congenital defects does not appear to be increased. No antiviral therapy is available; treatment is supportive. Early identification of possible cases is needed so that appropriate infection control can be instituted promptly. The recent measles outbreak highlights the role that obstetric health care providers play in vaccine-preventable illnesses; obstetrician–gynecologists should ensure that patients are up to date on all vaccines, including measles-containing vaccines, and should recommend and ideally offer a measles-containing vaccine to women without evidence of measles immunity before or after pregnancy. PMID:25899422

  3. Measles outbreak in Northern Central African Republic 3 years after the last national immunization campaign.

    PubMed

    Tricou, Vianney; Pagonendji, Marilou; Manengu, Casimir; Mutombo, Jeff; Mabo, Rock Ouambita; Gouandjika-Vasilache, Ionela

    2013-02-26

    Despite huge efforts to promote widespread vaccination, measles remains an important cause of morbidity and mortality worldwide, especially in African children. In March 2011, an abnormally high number of cases were reported from the Ouham Prefecture, Central African Republic to the national measles case-based surveillance system. In response, reactive vaccination activities were implemented. The aims of this study were to investigate this outbreak and describe the response. Measles cases were defined according to WHO recommendations. In the first weeks of the outbreak, blood samples were collected and sent to the Institut Pasteur in Bangui for laboratory confirmation by detection of IgM antibodies against measles virus. In addition, a portion of viral RNA was amplified from 5 IgM positive patient samples and the amplicons were sequenced for phylogenetic analysis. Between March and September 2011, 723 clinical cases originated from the Ouham Prefecture, including 2 deaths, were reported. Amongst 59 blood samples collected, 49 were positive for the detection of IgM. A high number of self-declared vaccinated subjects (31%) were found amongst the cases. Most of the cases were under 5 years. The causative virus was found to belong to genotype B3.1. In response, 2 sub-national supplementary immunization activities were quickly conducted and limited this outbreak to mainly 2 sub-prefectures. This outbreak was the largest epidemic of measles in CAR since 2002. Its occurrence, 3 years after the last national immunization campaign, highlights the necessity to pursue efforts and improve and extend immunization programs in order to reach measles elimination goal in Africa.

  4. Monitoring progress toward measles elimination by genetic diversity analysis of measles viruses in China 2009-2010.

    PubMed

    Zhang, Y; Wang, H; Xu, S; Mao, N; Zhu, Z; Shi, J; Huang, G; Liu, C; Bo, F; Feng, D; Lu, P; Liu, Y; Wang, Y; Lei, Y; Chen, M; Chen, H; Wang, C; Fu, H; Li, C; He, J; Gao, H; Gu, S; Wang, S; Ling, H; Liu, Y; Ding, Z; Ba, Z; Feng, Y; Zheng, H; Tang, X; Lei, Y; Xiong, Y; Bellini, W J; Rota, P A; Jee, Y; Xu, W

    2014-09-01

    With the achievement of high coverage for routine immunization and supplementary immunization activities (SIAs), measles incidence in mainland China reached its lowest level in 2010. The proportion of measles cases in the vaccination-targeted population decreased during 2007-2010 after the SIAs. More than 60% of measles cases were in adults or infants, especially in the coastal and eastern provinces during 2009 and 2010. A total 567 isolates of measles virus were obtained from clinical specimens from 27 of 31 provinces in mainland China during 2009 and 2010. Except for two vaccine-associated cases, one genotype D4 strain, two genotype D9 strains, and four genotype D11 strains, the other 558 strains were genotype H1 cluster H1a. Genotype H1 has been the only endemic genotype detected in China since surveillance began in 1993. Only genotype H1 was found in mainland China during 1993-2008, except for one detection of genotype H2. More recently, multiple genotypes of imported measles were detected even with the background of endemic genetotype H1 viruses. Analysis of the 450-nucleotide sequencing window of the measles virus N gene showed that the overall genetic diversity of the recent geneotype H1 strains decreased between 2008 and 2010. The lower genetic diversity of H1 strains suggested that enhanced vaccination may have reduced the co-circulating lineages of endemic genotype H1 strains in mainland China. © 2014 The Authors Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology and Infectious Diseases.

  5. Prevalence of measles antibodies among health care workers in Catalonia (Spain) in the elimination era

    PubMed Central

    2013-01-01

    Background Interruption of measles transmission was achieved in Catalonia (Spain) in 2000. Six years later, a measles outbreak occurred between August 2006 and June 2007 with 381 cases, 11 of whom were health care workers (HCW). The objective was to estimate susceptibility to measles in HCW and related demographic and occupational characteristics. Methods A measles seroprevalence study was carried out in 639 HCW from six public tertiary hospitals and five primary healthcare areas. Antibodies were tested using the Vircell Measles ELISA IgG Kit. Data were analyzed according to age, sex, type of HCW, type of centre and vaccination history. The odds ratios (OR) and their 95% CI were calculated to determine the variables associated with antibody prevalence. OR were adjusted using logistic regression. Positive predictive values (PPV) and the 95% confidence intervals (CI) of having two documented doses of a measles containing vaccine (MCV) for the presence of measles antibodies and of reporting a history of measles infection were calculated. Results The prevalence of measles antibodies in HCW was 98% (95% CI 96.6-98.9), and was lower in HCW born in 1981 or later, after the introduction of systematic paediatric vaccination (94.4%; 95% CI 86.4-98.5) and higher in HCW born between 1965 and 1980 (99.0%; 95% CI 97.0-99.8). Significant differences were found for HCW born in 1965–1980 with respect to those born in 1981 and after (adjusted OR of 5.67; 95% CI: 1.24-25.91). A total of 187 HCW reported being vaccinated: the proportion of vaccinated HCW decreased with age. Of HCW who reported being vaccinated, vaccination was confirmed by the vaccination card in 49%. Vaccination with 2 doses was documented in only 50 HCW, of whom 48 had measles antibodies. 311 HCW reported a history of measles. The PPV of having received two documented doses of MCV was 96% (95% CI 86.3-99.5) and the PPV of reporting a history of measles was 98.7% (95% CI 96.7-99.6). Conclusions Screening to detect

  6. Measles antibody in the children in Ubon Ratchathani province.

    PubMed

    Saipan, P; Jiwapaisarnpong, T; Pattanadilok, S; Loyha, Y; Janggajit, T

    2001-04-01

    Measles is a highly contagious disease, preventable by vaccine. Measles epidemics have been dramatically controlled since the introduction of live attenuated measles vaccine. Measles antibody is used as an indicator of previous natural infection or vaccination, and also as a marker of protective immunity. The authors determined measles IgG levels in 1,176 children in Ubon Ratchathani province by ELISA from September 1998 to January 1999. Two- hundred and sixty- five cases (22.5%) had antibodies below the protective level (< 320 mIU/ml). Antibodies were high during the neonatal period, then declined to below the protective level at 4-6 months of age, and were negative at age 7-11 months. An increase in antibody level after 1 year old might be the result of measles immunization at 9-12 months of age, then antibodies decreased to the lowest level at 3-5 years after immunization or 4-6 years of age. A second dose of immunization will increase the number of children who have antibodies above the protective level better than one dose of immunization and it is recommended to revaccinate at 4-6 years of age. There was no statistical difference of measles antibody between boys and girls in all age groups.

  7. Seroprevalence of transplacentally acquired measles antibodies in HIV-exposed versus HIV-unexposed infants at six months of age

    PubMed Central

    Jain, Sneha; Seth, Anju; Khare, Shashi; Chandra, Jagdish

    2017-01-01

    Background & objectives: Measles infection is reported to be more severe, prolonged and associated with a higher complication rate in children with HIV infection. Reports indicate that infants born to HIV-infected women [HIV exposed infants (HEI)] may be more vulnerable to measles. The World Health Organization recommends measles vaccination starting at six months of age in these infants who may be HIV-infected themselves. However, in India, they are given measles vaccination at nine months of age like all other infants. In this study, the seroprevalence of transplacentally acquired measles antibodies was compared in HEI and unexposed infants (HUnI) at six months of age and the proportion of HEI undergoing seroconversion after immunization with measles vaccine was assessed. Methods: In this prospective longitudinal study, measles IgG antibodies were estimated in serum of 49 HEI and 50 HUnI aged 6-7 months. Measles vaccine was then administered to HEI. Assessment for measles IgG antibodies was repeated 8-12 wk post-immunization. Results: Measles IgG antibodies were detected in two of 49 (4.1%) HEI and 16 of 50 (32%) HUnI. HEI were 11 times more likely to lack measles antibodies as compared to HUnI (odds ratio=11.05, 95% confidence interval=2.989-40.908). Post-vaccination, seroprevalence of measles antibodies increased to 38.5 per cent (P< 0.001) in HEI compared to 4 per cent at baseline. Interpretation & conclusions: Most HEI lacked measles antibodies at six months age and were, therefore, more vulnerable to measles than HUnI. Seroconversion in response to a single dose of measles vaccine administered at six months age was low in these infants, signifying the need of additional dose(s) of measles/measles-containing vaccine. PMID:28862187

  8. Risk factors for measles death: Kyegegwa District, western Uganda, February-September, 2015.

    PubMed

    Mafigiri, Richardson; Nsubuga, Fred; Ario, Alex Riolexus

    2017-07-03

    On 18 August 2015, Kyegegwa District reported eight deaths during a measles outbreak to the Uganda Ministry of Health (MoH). We investigated this death cluster to verify the cause, identify risk factors, and inform public health interventions. We defined a probable measles case as onset of fever and generalised rash in a Kyegegwa District resident from 1 February - 15 September 2015, plus ≥1 of the following: coryza, conjunctivitis, and cough. A confirmed measles case was a probable case with measles-specific IgM positivity. A measles death was a death of a probable or confirmed case-person. We conducted an active case-finding to identify measles patients who survived or died. In a case-control study, we compared risk factors between 16 measles patients who died (cases) and 48 who survived (controls), matched by age (±4 years) and village of residence. We identified 94 probable measles cases, 10 (11%) were confirmed by positive measles-specific IgM. Of the 64 probable measles patients aged <5 years, 16 died (case-fatality rate = 25%). In the case-control study, no history of vaccination against measles was found in 94% (15/16) among the case-persons (i.e., measles patients who died) and 54% (26/48) among the controls (i.e., measles patients who survived) (OR M-H  = 12; 95% CI = 1.6-104), while 56% (9/16) of case-persons and 67% (17/48) of controls (OR M-H  = 2.3; 95% CI =0.74-7.4) did not receive vitamin A supplementation during illness. 63% (10/16) among the case-persons and 6.3% (3/48) of the controls (OR M-H  = 33; 95% CI = 6.8-159) were not treated for measles illness at a health facility (a proxy for more appropriate treatment), while 38% (6/16) of the case-persons and 25% (12/48) of the controls (OR M-H  = 2.5; 95% CI = 0.67-9.1) were malnourished. Lack of vaccination and no treatment in a health facility increased the risk for measles deaths. The one-dose measles vaccination currently in the national vaccination schedule had a protective

  9. Association between seroprevalence of measles and various social determinants in the year following a measles outbreak in Turkey.

    PubMed

    Emek, M; Islek, D; Atasoylu, G; Ozbek, O A; Ceylan, A; Acikgoz, A; Tay, Z; Demiral, Y; Oktem, M A; Unal, B

    2017-06-01

    Despite an ongoing measles elimination programme, a measles outbreak occurred in 2013 in Turkey. Population-based seroprevalence studies are needed to determine seronegativity and explore the reasons for this outbreak. This study aimed to explore the seroprevalence of measles and its association with various social determinants in a provincial population in Turkey in the year following a measles outbreak. Cross-sectional study. This study was conducted in Manisa Province in 2014 in a sample of 1740 people aged >2 years. The dependent variable was the seroprevalence of measles. Independent variables were sex, age, migration, household size, household density, income, education level, existence of chronic disease and occupational class. Blood samples were collected from participants at family health centres. The presence of specific measles antibodies in serum samples was determined using an anti-measles virus IgG enzyme-linked immunosorbent assay test. Chi-squared test and logistic regression analysis were performed. Overall, data from 1250 people were analysed. The seroprevalence of measles in the whole study population was 82.2% (95% confidence interval 80.0-84.2). Seroprevalence was 55.4% among subjects aged 2-9 years, 48.7% among subjects aged 10-19 years, 74.1% among subjects aged 20-29 years and 93.6% among subjects aged 30-39 years (P < 0.01). Seroprevalence in subjects aged >40 years was >95%. The lowest seroprevalence was found in primary school children (40.2%), followed by those below the age for primary education (69.8%) and secondary school graduates (75.1%). The prevalence of measles seronegativity was not associated with any of the social determinants when adjusted for age. The seroprevalence of measles was lower than expected in the study population and was particularly low in subjects aged <30 years of age despite previous vaccination. Seroprevalence was not associated with social determinants of health that confirmed either an even distribution

  10. Measles epidemics and seroepidemiology of population in Wujin, Changzhou city, Jiangsu province, China 2015.

    PubMed

    Tang, Lingyan; Zhou, Yihong; Pan, Yingzi; Zhu, Hongming

    2017-05-19

    The measles epidemic was rather severe in Wujin 2015, and a seroprevalence survey of measles antibody was conducted during June to September 2015 in Wjin district of Changzhou city. Blood samples were collected from community health population and convenient samples of residual blood from hospitals. Measles-specific IgG levels were measured by ELISA assay. A total of 122 measles cases were reported 2015 in Wujin district with an incidence of 8.31 per 100000 populations. A large proportion of measles cases were adults ≥20years (62.30%) and infants aged <18months (28.69%). Floating population accounted for 68.57% of all cases. 1070 blood samples aged from 9months to 49years old were collected and the overall seroprevalence and geometric mean titer (GMT) of measles were 82.71% and 551.19mIU/ml, respectively. Although the seroprevalence among children aged 9months to 4years was consistently over 90%, it began to decrease since 24months, and till the age of ≥10years, the seroprevalences were all <80%, however, the seroprevalence rised to above 80% in people over 40years. There were no significant differences between the two blood sample sources in the level of seroprevalence and GMT. Also no significant differences were observed in the seroprevalence of measles and GMT levels between genders. The seroprevalence and GMT in people with measles vaccination were higher than those without measles vaccination or people whose measles vaccination are unknown (P<0.001). Our study indicated that the adult measles cases have become a serious problem in Wujin district, which may mainly relate to the increasing size of the floating population with low measles vaccine coverage. The seroprevalence of measles decreased dramatically with increasing age since teenagers, which may mainly caused by waning vaccine-induced immunity. Therefore, it is necessary to strengthen measles vaccine in these people especially floating population. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. An expensive adult measles outbreak and response in office buildings during the era of accelerated measles elimination, Beijing, China.

    PubMed

    Ma, Rui; Lu, Li; Suo, Luodan; Li, Xiaomei; Yang, Fan; Zhou, Tao; Zhai, Lijun; Bai, Hongwei; Pang, Xinghuo

    2017-02-22

    Few measles outbreaks among adults are reported in China, and outbreak response costs are seldom documented. We report an adult measles outbreak and response in 4 linked office buildings in Beijing and its associated costs. The World Health Organization measles case definitions were used to determine suspected and confirmed measles cases. Surveillance data were used to describe the outbreak, and records and interviews of response staff were used to describe the response. Costs were determined by use of retrospective surveys of cases, review of records, and interviews of staff. The outbreak lasted 19days, and involved 22 cases aged 23-49years. Nineteen cases had a local household registration. All cases were employed by 8 companies in 4 linked office buildings. Among the 22 cases, 8 had temperature less than 38.5 degree, 18 had no Koplik spots and none had complications or hospitalizations. A total of 7930 contacts were identified, and of these, 6869 were employees in the office buildings. All the child contacts aged 8months-14years had been up-to-date for measles-containing vaccine (MCV); no adult could document their vaccination or measles history. Of contacts, about 96% were offered post-exposure vaccination. The total household costs were $13,298, or $605 per case. Control costs were $384,594, or $17,481 per case. Involved companies paid for 90.7% of control costs. Office buildings provide a mechanism for measles transmission. Timely control activities were challenged by the highly infectious nature of measles and mild presentations of cases. The outbreak response was very costly. Financial support by involved companies can provide needed resources for outbreak management. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Case-fatality rate during a measles outbreak in eastern Niger in 2003.

    PubMed

    Nandy, Robin; Handzel, Thomas; Zaneidou, Maman; Biey, José; Coddy, Rene Z; Perry, Robert; Strebel, Peter; Cairns, Lisa

    2006-02-01

    The World Health Organization (WHO) estimates that the case-fatality rate (CFR) for measles in West Africa is 4%-6%. In Niger, 50,138 measles cases and 201 deaths (CFR, 0.4%) were reported in 2003. We conducted an investigation to determine the epidemiology and the true CFR of measles in the Mirriah district in Niger. Twenty-two villages from the Mirriah district that reported measles cases in 2003 were included in the investigation. A comprehensive household search for measles cases and deaths was conducted, and serum samples from 12 villages were collected for laboratory confirmation. A measles case was defined as illness characterized by fever, rash, and either cough, coryza, or conjunctivitis, with rash onset during the period from 1 January 2003 to 15 April 2003. Deaths occurring within 30 days after rash onset were attributed to measles unless they were obviously due to other causes. Measles was confirmed serologically in all villages from which samples were collected. Of 945 case patients identified, 900 (95.2%) were aged <15 years, 114 (12.3%) were vaccinated, and 789 (83.5%) sought treatment at a health care facility. A total of 92 deaths were attributed to measles (CFR, 9.7%; 95% confidence interval, 7.9%-11.5%). The CFR was highest in infants aged <1 year (15.6%). Households with >or=2 case patients had a higher CFR (10.8%) than that of households with only 1 case patient (6.0%). Households consisting of >or=8 members had a CFR of 12.8%, whereas the CFR of smaller households was 7.1%. This investigation suggests that the measles CFR in the Mirriah district may be 2-fold higher than the WHO regional estimate and 20-fold higher than the estimate derived from routine surveillance. Reducing measles mortality in Niger will require wide-age-range vaccination campaigns, improvement in routine immunization services, and periodic "follow-up" campaigns.

  13. Assessment and possible control of endemic measles in urban Nigeria.

    PubMed

    Byass, P; Adedeji, M D; Mongdem, J G; Zwandor, A C; Brew-Graves, S H; Clements, C J

    1995-06-01

    Measles remains as a serious problem of infancy and childhood in the developing world, despite the availability of a vaccine. Increasing urbanization is changing patterns of endemicity. A survey of measles in an urban area of Nigeria, using a rapid assessment approach, was carried out to characterize measles in this community. An annual incidence rate of 11.8% among under-fives was found, associated with an acute case fatality rate of 3.3%. This level of endemicity was two orders of magnitude greater than that suggested by official case reports. An endemic, rather than epidemic, pattern was found over the six-month period of the study. Vaccine efficacy was estimated at 26%. Risk factor analyses showed the major risks for measles to be clinic attendance in the month preceding disease, households with more than one mother, and having under-five siblings. Measles itself was the principal risk factor for malnutrition and against survival. Improved understanding of measles epidemiology and risk factors are prerequisites for effective control. Possible strategies should include vertical vaccination efforts in addition to routine programmes.

  14. Intervene before leaving: clustered lot quality assurance sampling to monitor vaccination coverage at health district level before the end of a yellow fever and measles vaccination campaign in Sierra Leone in 2009.

    PubMed

    Pezzoli, Lorenzo; Conteh, Ishata; Kamara, Wogba; Gacic-Dobo, Marta; Ronveaux, Olivier; Perea, William A; Lewis, Rosamund F

    2012-06-07

    In November 2009, Sierra Leone conducted a preventive yellow fever (YF) vaccination campaign targeting individuals aged nine months and older in six health districts. The campaign was integrated with a measles follow-up campaign throughout the country targeting children aged 9-59 months. For both campaigns, the operational objective was to reach 95% of the target population. During the campaign, we used clustered lot quality assurance sampling (C-LQAS) to identify areas of low coverage to recommend timely mop-up actions. We divided the country in 20 non-overlapping lots. Twelve lots were targeted by both vaccinations, while eight only by measles. In each lot, five clusters of ten eligible individuals were selected for each vaccine. The upper threshold (UT) was set at 90% and the lower threshold (LT) at 75%. A lot was rejected for low vaccination coverage if more than 7 unvaccinated individuals (not presenting vaccination card) were found. After the campaign, we plotted the C-LQAS results against the post-campaign coverage estimations to assess if early interventions were successful enough to increase coverage in the lots that were at the level of rejection before the end of the campaign. During the last two days of campaign, based on card-confirmed vaccination status, five lots out of 20 (25.0%) failed for having low measles vaccination coverage and three lots out of 12 (25.0%) for low YF coverage. In one district, estimated post-campaign vaccination coverage for both vaccines was still not significantly above the minimum acceptable level (LT = 75%) even after vaccination mop-up activities. C-LQAS during the vaccination campaign was informative to identify areas requiring mop-up activities to reach the coverage target prior to leaving the region. The only district where mop-up activities seemed to be unsuccessful might have had logistical difficulties that should be further investigated and resolved.

  15. Economic analysis of measles elimination program in the Republic of Korea, 2001: a cost benefit analysis study.

    PubMed

    Bae, Geun-Ryang; Choe, Young June; Go, Un Yeong; Kim, Yong-Ik; Lee, Jong-Koo

    2013-05-31

    In this study, we modeled the cost benefit analysis for three different measles vaccination strategies based upon three different measles-containing vaccines in Korea, 2001. We employed an economic analysis model using vaccination coverage data and population-based measles surveillance data, along with available estimates of the costs for the different strategies. In addition, we have included analysis on benefit of reduction of complication by mumps and rubella. We evaluated four different strategies: strategy 1, keep-up program with a second dose measles-mumps-rubella (MMR) vaccine at 4-6 years without catch-up campaign; strategy 2, additional catch-up campaign with measles (M) vaccine; strategy 3, catch-up campaign with measles-rubella (MR) vaccine; and strategy 4, catch-up campaign with MMR vaccine. The cost of vaccination included cost for vaccines, vaccination practices and other administrative expenses. The direct benefit of estimated using data from National Health Insurance Company, a government-operated system that reimburses all medical costs spent on designated illness in Korea. With the routine one-dose MMR vaccination program, we estimated a baseline of 178,560 measles cases over the 20 years; when the catch-up campaign with M, MR or MMR vaccines was conducted, we estimated the measles cases would decrease to 5936 cases. Among all strategies, the two-dose MMR keep-up program with MR catch-up campaign showed the highest benefit-cost ratio of 1.27 with a net benefit of 51.6 billion KRW. Across different vaccination strategies, our finding suggest that MR catch-up campaign in conjunction with two-dose MMR keep-up program was the most appropriate option in terms of economic costs and public health effects associated with measles elimination strategy in Korea. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Co-administration of live measles and yellow fever vaccines and inactivated pentavalent vaccines is associated with increased mortality compared with measles and yellow fever vaccines only. An observational study from Guinea-Bissau.

    PubMed

    Fisker, Ane Bærent; Ravn, Henrik; Rodrigues, Amabelia; Østergaard, Marie Drivsholm; Bale, Carlito; Benn, Christine Stabell; Aaby, Peter

    2014-01-23

    Studies from low-income countries indicate that co-administration of inactivated diphtheria-tetanus-pertussis (DTP) vaccine and live attenuated measles vaccine (MV) is associated with increased mortality compared with receiving MV only. Pentavalent (DTP-H. Influenza type B-Hepatitis B) vaccine is replacing DTP in many low-income countries and yellow fever vaccine (YF) has been introduced to be given together with MV. Pentavalent and YF vaccines were introduced in Guinea-Bissau in 2008. We investigated whether co-administration of pentavalent vaccine with MV and yellow fever vaccine has similar negative effects. In 2007-2011, we conducted a randomised placebo-controlled trial of vitamin A at routine vaccination contacts among children aged 6-23 months in urban and rural Guinea-Bissau. In the present study, we included 2331 children randomised to placebo who received live vaccines only (MV or MV+YF) or a combination of live and inactivated vaccines (MV+DTP or MV+YF+pentavalent). Mortality was compared in Cox proportional hazards models stratified for urban/rural enrolment adjusted for age and unevenly distributed baseline factors. While DTP was still used 685 children received MV only and 358 MV+DTP; following the change in programme, 940 received MV+YF only and 348 MV+YF+pentavalent. During 6 months of follow-up, the adjusted mortality rate ratio (MRR) for co-administered live and inactivated vaccines compared with live vaccines only was 3.24 (1.20-8.73). For MV+YF+pentavalent compared with MV+YF only, the adjusted MRR was 7.73 (1.79-33.4). In line with previous studies of DTP, the present results indicate that pentavalent vaccine co-administered with MV and YF is associated with increased mortality. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Successful public health response to four cases of imported measles in Panama.

    PubMed

    Sosa, Nestor; Guerra, Ilka; Abrego, Leyda; Cisneros, Julio; Castillo, Juan; Nieto-Guevara, Javier; Gálvez, Carlos; Moltó, Yadira; Smith, Rebecca E; Pascale, Juan Miguel

    2012-08-21

    In Panama, the last endemic cases of measles occurred in 1995. In this paper, we report four cases of imported measles in three girls and one boy after they returned from a trip to Poland and Israel between 28 April and 11 May 2011. The etiologic diagnosis of the four cases was confirmed by detection of IgM antibodies against measles virus and positive polymerase chain reaction using measles-specific primers. All cases had genotype D4 with close genetic similarity to virus reported from Poland. Public health interventions included isolation of the cases in their homes and an extensive search for and vaccination of contacts of the four cases, regardless of their vaccination status. A nationwide vaccination campaign was also implemented after the first case was identified. A total of 70,950 measles vaccine doses were administered in Panama in the two months following the identification of these cases. In addition, 94,179 persons were confirmed to have their immunization schedule up-to-date and did not receive the vaccine. No secondary cases were detected in Panama in the following six months.

  18. Large measles outbreak introduced by asylum seekers and spread among the insufficiently vaccinated resident population, Berlin, October 2014 to August 2015

    PubMed Central

    Werber, Dirk; Hoffmann, Alexandra; Santibanez, Sabine; Mankertz, Annette; Sagebiel, Daniel

    2017-01-01

    The largest measles outbreak in Berlin since 2001 occurred from October 2014 to August 2015. Overall, 1,344 cases were ascertained, 86% (with available information) unvaccinated, including 146 (12%) asylum seekers. Median age was 17 years (interquartile range: 4–29 years), 26% were hospitalised and a 1-year-old child died. Measles virus genotyping uniformly revealed the variant ‘D8-Rostov-Don’ and descendants. The virus was likely introduced by and initially spread among asylum seekers before affecting Berlin’s resident population. Among Berlin residents, the highest incidence was in children aged < 2 years, yet most cases (52%) were adults. Post-exposure vaccinations in homes for asylum seekers, not always conducted, occurred later (median: 7.5 days) than the recommended 72 hours after onset of the first case and reached only half of potential contacts. Asylum seekers should not only have non-discriminatory, equitable access to vaccination, they also need to be offered measles vaccination in a timely fashion, i.e. immediately upon arrival in the receiving country. Supplementary immunisation activities targeting the resident population, particularly adults, are urgently needed in Berlin. PMID:28857043

  19. Measles Humoral and Cell-Mediated Immunity in Children Aged 5–10 Years After Primary Measles Immunization Administered at 6 or 9 Months of Age

    PubMed Central

    Gans, Hayley A.; Yasukawa, Linda L.; Sung, Phillip; Sullivan, Barbara; DeHovitz, Ross; Audet, Susette; Beeler, Judy; Arvin, Ann M.

    2013-01-01

    Background. Given the high infant measles mortality rate, there is interest in whether a measles immunization regimen beginning at <12 months of age provides lasting immunity. Methods. Measles-specific immune responses were evaluated in 70 children aged 5–10 years after primary measles vaccine administered at 6, 9, or 12 months. Results. At 5–10 years of age, the stimulation index for measles T-cell proliferation was 11.4 (SE, 1.3), 10.9 (SE, 1.5), and 14.4 (SE 2.1) when the first measles dose was given at 6, 9, or 12 months, respectively. Neutralizing antibody concentration (geometric mean titer [GMT]) in those immunized at 6 months of age was 125 mIU/mL (95% confidence interval [CI], 42–377) in the presence of passive antibodies (PAs) and 335 mIU/mL (95% CI, 211–531) in those without PAs; in those immunized at 9 months, GMTs were 186 mIU/mL (95% CI, 103–335) and 1080 mIU/mL (95% CI, 642–1827) in the presence and absence of PAs, respectively. The GMT was 707 mIU/mL (95% CI, 456–1095) when vaccine was administered at 12 months (P ≤ .04). Conclusions. Measles-specific T-cell responses were sustained at 5–10 years of age regardless of age at time of primary measles immunization. Neutralizing antibody concentrations were lower in cohorts given the first vaccine dose at 6 months of age and in the presence of PAs; however, responses could be boosted by subsequent doses. Starting measles vaccination at <12 months of age may be beneficial during measles outbreaks or in endemic areas. PMID:23300162

  20. Reemergence of Measles in the Americas: The Genotype B3 2011–2012 Outbreak in Ecuador

    PubMed Central

    Le, Nicole K.; Mhaskar, Rahul; Hoare, Ismael; Espinel, Mauricio; Fernanda Rivadeneira, María; Malavade, Sharad; Izurieta, Ricardo

    2017-01-01

    This study characterizes a measles outbreak which occurred in Ecuador in 2011–2012, analyzing data from 3700 suspected cases of measles reported to Ecuador’s Ministry of Public Health. The study population had a large age range and included 333 confirmed cases of measles. The greatest number of cases were found in the <1 year (32.43%, n = 108) and 1–4 year (30.03%, n = 100) age-groups. Compared to Mestizos, indigenous people had the highest number of cases (68.2%, n = 227), as well as a higher risk of infection (OR 7.278 (CI 5.251–10.087)). The greatest protection from measles was observed in individuals who received two doses of the measles vaccine. Residents of Pastaza (OR 6.645 CI (3.183–13.873)) and Tungurahua (OR 8.346 CI (5.570–12.507)) had a higher risk of infection than the other provinces. Of the 17 laboratory confirmed cases, all were identified as genotype B3. Age-group, ethnicity, measles vaccinations, and residence in Tungurahua and Pastaza were correlated with rates of measles infection in the outbreak. Tungurahua and Pastaza, where the outbreak originated, have large indigenous populations. Indigenous children <1 year of age showed the highest incidence. It is likely that indigenous women do not have immunity to the virus, and so are unable to confer measles resistance to their newborns. PMID:28574449

  1. Geospatial characteristics of measles transmission in China during 2005−2014

    PubMed Central

    Wen, Liang; Li, Shen-Long; Chen, Kai; Zhang, Wen-Yi

    2017-01-01

    Measles is a highly contagious and severe disease. Despite mass vaccination, it remains a leading cause of death in children in developing regions, killing 114,900 globally in 2014. In 2006, China committed to eliminating measles by 2012; to this end, the country enhanced its mandatory vaccination programs and achieved vaccination rates reported above 95% by 2008. However, in spite of these efforts, during the last 3 years (2013–2015) China documented 27,695, 52,656, and 42,874 confirmed measles cases. How measles manages to spread in China—the world’s largest population—in the mass vaccination era remains poorly understood. To address this conundrum and provide insights for future public health efforts, we analyze the geospatial pattern of measles transmission across China during 2005–2014. We map measles incidence and incidence rates for each of the 344 cities in mainland China, identify the key socioeconomic and demographic features associated with high disease burden, and identify transmission clusters based on the synchrony of outbreak cycles. Using hierarchical cluster analysis, we identify 21 epidemic clusters, of which 12 were cross-regional. The cross-regional clusters included more underdeveloped cities with large numbers of emigrants than would be expected by chance (p = 0.011; bootstrap sampling), indicating that cities in these clusters were likely linked by internal worker migration in response to uneven economic development. In contrast, cities in regional clusters were more likely to have high rates of minorities and high natural growth rates than would be expected by chance (p = 0.074; bootstrap sampling). Our findings suggest that multiple highly connected foci of measles transmission coexist in China and that migrant workers likely facilitate the transmission of measles across regions. This complex connection renders eradication of measles challenging in China despite its high overall vaccination coverage. Future immunization programs

  2. Determining infants' age for measles vaccination based on persistence of protective level of maternal measles antibody.

    PubMed

    Shilpi, Tanjida; Sattar, Humayun; Miah, Md Ruhul Amin

    2009-12-01

    The present study was conducted over a period of one year to find the right time for measles vaccination when maternal antibody titer in infants was decayed rendering them susceptible to wild virus infection. Blood samples were collected from the cord of new born (147), 2-5 months (47) and 5 to 7.5 months (24) of age. The mean measles IgG antibody titer detected in cord blood at birth (0 months) was 348.8 mlU/mL which steeply decreased to 155.6 mlU/mL by the age of 2-3 months. After that the fall in antibody becomes relatively slower and decreased to 101.6 mIU/mL by the age of 3-5 months and 38.8 mlU/mL by the age of 5-6 months and to 19.2 mIU/mL between the age of 6 to 7.5 months. The fall in antibody level with the advance of age was statistically significant (p < 0.001 ). Majority of the subjects (97.6%) exhibited protective level of antibody at birth. But only a little above one-quarter (25.5%) of them persisted the protective level between the age of 2-5 months and none had protective level from 5 months onwards.

  3. Measles case fatality rate in Bihar, India, 2011-12.

    PubMed

    Murhekar, Manoj V; Ahmad, Mohammad; Shukla, Hemant; Abhishek, Kunwar; Perry, Robert T; Bose, Anindya S; Shimpi, Rahul; Kumar, Arun; Kaliaperumal, Kanagasabai; Sethi, Raman; Selvaraj, Vadivoo; Kamaraj, Pattabi; Routray, Satyabrata; Das, Vidya Nand; Menabde, Nata; Bahl, Sunil

    2014-01-01

    Updated estimates of measles case fatality rates (CFR) are critical for monitoring progress towards measles elimination goals. India accounted for 36% of total measles deaths occurred globally in 2011. We conducted a retrospective cohort study to estimate measles CFR and identify the risk factors for measles death in Bihar-one of the north Indian states historically known for its low vaccination coverage. We systematically selected 16 of the 31 laboratory-confirmed measles outbreaks occurring in Bihar during 1 October 2011 to 30 April 2012. All households of the villages/urban localities affected by these outbreaks were visited to identify measles cases and deaths. We calculated CFR and used multivariate analysis to identify risk factors for measles death. The survey found 3670 measles cases and 28 deaths (CFR: 0.78, 95% confidence interval: 0.47-1.30). CFR was higher among under-five children (1.22%) and children belonging to scheduled castes/tribes (SC/ST, 1.72%). On multivariate analysis, independent risk factors associated with measles death were age <5 years, SC/ST status and non-administration of vitamin A during illness. Outbreaks with longer interval between the occurrence of first case and notification of the outbreak also had a higher rate of deaths. Measles CFR in Bihar was low. To further reduce case fatality, health authorities need to ensure that SC/ST are targeted by the immunization programme and that outbreak investigations target for vitamin A treatment of cases in high risk groups such as SC/ST and young children and ensure regular visits by health-workers in affected villages to administer vitamin A to new cases.

  4. Innovations in communication technologies for measles supplemental immunization activities: lessons from Kenya measles vaccination campaign, November 2012

    PubMed Central

    Mbabazi, William B; Tabu, Collins W; Chemirmir, Caleb; Kisia, James; Ali, Nasra; Corkum, Melissa G; Bartley, Gene L

    2015-01-01

    Background To achieve a measles free world, effective communication must be part of all elimination plans. The choice of communication approaches must be evidence based, locally appropriate, interactive and community owned. In this article, we document the innovative approach of using house visits supported by a web-enabled mobile phone application to create a real-time platform for adaptive management of supplemental measles immunization days in Kenya. Methods One thousand nine hundred and fifty-two Red Cross volunteers were recruited, trained and deployed to conduct house-to-house canvassing in 11 urban districts of Kenya. Three days before the campaigns, volunteers conducted house visits with a uniform approach and package of messages. All house visits were documented using a web-enabled mobile phone application (episurveyor®) that in real-time relayed information collected to all campaign management levels. During the campaigns, volunteers reported daily immunizations to their co-ordinators. Post-campaign house visits were also conducted within 4 days, to verify immunization of eligible children, assess information sources and detect adverse events following immunization. Results Fifty-six per cent of the 164 643 households visited said that they had heard about the planned 2012 measles vaccination campaign 1–3 days before start dates. Twenty-five per cent of households were likely to miss the measles supplemental dose if they had not been reassured by the house visit. Pre- and post-campaign reasons for refusal showed that targeted communication reduced misconceptions, fear of injections and trust in herbal remedies. Daily reporting of immunizations using mobile phones informed changes in service delivery plans for better immunization coverage. House visits were more remembered (70%) as sources of information compared with traditional mass awareness channels like megaphones (41%) and radio (37%). Conclusions In high-density settlements, house-to-house visits

  5. Biosafety considerations for attenuated measles virus vectors used in virotherapy and vaccination

    PubMed Central

    Baldo, Aline; Galanis, Evanthia; Tangy, Frédéric; Herman, Philippe

    2016-01-01

    ABSTRACT Attenuated measles virus (MV) is one of the most effective and safe vaccines available, making it attractive candidate vector to prevent infectious diseases. Attenuated MV have acquired the ability to use the complement regulator CD46 as a major receptor to mediate virus entry and intercellular fusion. Therefore, attenuated MV strains preferentially infect and destroy a wide variety of cancer cells making them also attractive oncolytic vectors. The use of recombinant MV vector has to comply with various regulatory requirements, particularly relating to the assessment of potential risks for human health and the environment. The present article highlights the main characteristics of MV and recombinant MV vectors used for vaccination and virotherapy and discusses these features from a biosafety point of view. PMID:26631840

  6. Biosafety considerations for attenuated measles virus vectors used in virotherapy and vaccination.

    PubMed

    Baldo, Aline; Galanis, Evanthia; Tangy, Frédéric; Herman, Philippe

    2016-05-03

    Attenuated measles virus (MV) is one of the most effective and safe vaccines available, making it attractive candidate vector to prevent infectious diseases. Attenuated MV have acquired the ability to use the complement regulator CD46 as a major receptor to mediate virus entry and intercellular fusion. Therefore, attenuated MV strains preferentially infect and destroy a wide variety of cancer cells making them also attractive oncolytic vectors. The use of recombinant MV vector has to comply with various regulatory requirements, particularly relating to the assessment of potential risks for human health and the environment. The present article highlights the main characteristics of MV and recombinant MV vectors used for vaccination and virotherapy and discusses these features from a biosafety point of view.

  7. Changes in Measles Serostatus Among HIV-Infected Zambian Children Initiating Antiretroviral Therapy Before and After the 2010 Measles Outbreak and Supplemental Immunization Activities

    PubMed Central

    Rainwater-Lovett, Kaitlin; Nkamba, Hope C.; Mubiana-Mbewe, Mwangelwa; Bolton-Moore, Carolyn; Moss, William J.

    2013-01-01

    Background. In 2010, Zambia had a large measles outbreak, providing an opportunity to measure changes in measles serostatus following highly active antiretroviral therapy (HAART), exposure to measles virus, and revaccination among children infected with human immunodeficiency virus (HIV). Methods. A prospective cohort study of 169 HIV-infected Zambian children aged 9–60 months with a history of measles vaccination was conducted to characterize the effects of HAART and revaccination on measles immunoglobulin G (IgG) serostatus by enzyme immunoassay. Results. Prior to the measles outbreak, only 23% of HIV-infected children were measles IgG seropositive at HAART initiation. After adjusting for 6-month changes in baseline age and 5% changes in nadir CD4+ T-cell percentage, HAART was not associated with measles IgG seroconversion. However, 18 of 19 children seroconverted after revaccination. Eight children seroconverted during the outbreak without revaccination and were likely exposed to wild-type measles virus, but none were reported to have had clinical measles. Conclusions. Immune reconstitution after HAART initiation did not restore protective levels of measles IgG antibodies, but almost all children developed protective antibody levels after revaccination. Some previously vaccinated HIV-infected children had serological evidence of exposure to wild-type measles virus without a reported history of measles. PMID:23911708

  8. Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States

    PubMed Central

    Phadke, Varun K.; Bednarczyk, Robert A.; Salmon, Daniel A.; Omer, Saad B.

    2016-01-01

    IMPORTANCE Parents hesitant to vaccinate their children may delay routine immunizations or seek exemptions from state vaccine mandates. Recent outbreaks of vaccine-preventable diseases in the United States have drawn attention to this phenomenon. Improved understanding of the association between vaccine refusal and the epidemiology of these diseases is needed. OBJECTIVE To review the published literature to evaluate the association between vaccine delay, refusal, or exemption and the epidemiology of measles and pertussis, 2 vaccine-preventable diseases with recent US outbreaks. EVIDENCE REVIEW Search of PubMed through November 30, 2015, for reports of US measles outbreaks that have occurred since measles was declared eliminated in the United States (after January 1, 2000), endemic and epidemic pertussis since the lowest point in US pertussis incidence (after January 1, 1977), and for studies that assessed disease risk in the context of vaccine delay or exemption. FINDINGS We identified 18 published measles studies (9 annual summaries and 9 outbreak reports), which described 1416 measles cases (individual age range, 2 weeks-84 years; 178 cases younger than 12 months) and more than half (56.8%) had no history of measles vaccination. Of the 970 measles cases with detailed vaccination data, 574 cases were unvaccinated despite being vaccine eligible and 405 (70.6%) of these had nonmedical exemptions (eg, exemptions for religious or philosophical reasons, as opposed to medical contraindications; 41.8%of total). Among 32 reports of pertussis outbreaks, which included 10 609 individuals for whom vaccination status was reported (age range, 10 days-87 years), the 5 largest statewide epidemics had substantial proportions (range, 24%–45%) of unvaccinated or undervaccinated individuals. However, several pertussis outbreaks also occurred in highly vaccinated populations, indicating waning immunity. Nine reports (describing 12 outbreaks) provided detailed vaccination data on

  9. Critical prevalence of antibodies minimizing vaccination costs for hepatitis A, hepatitis B, varicella, measles and tetanus in adults and adolescents in Catalonia, Spain.

    PubMed

    Plans-Rubió, Pedro

    2004-09-28

    The prevalence of seropositive individuals that makes costs of vaccinating all individuals equal to that for screening and vaccination of susceptible individuals is defined as the critical prevalence of antibodies (p*). Screening and vaccination is more efficient when the prevalence of seropositive individuals (p) in the population is higher than p*. In this study, the formula to obtain p* was derived from the cost-effectiveness equations, showing that it depends on screening and vaccination costs, programme compliance, screening test performance, vaccine efficacy and disease costs. The formula was used to determine the least costly vaccination strategy for hepatitis A and B, varicella, measles and tetanus in adults and adolescents in Catalonia. The least costly vaccination strategy was vaccination without screening (since p was lower than p*) for hepatitis B, measles and tetanus in adults and adolescents (5-14 years) and for hepatitis A in individuals aged 5-24 years, and screening and vaccination (since p was higher than p*) for varicella in adults and adolescents and for hepatitis A in adults aged >24 years. Vaccination strategies based on the critical prevalence of antibodies could maximize the immunity level in the community from available resources.

  10. Measles and Rubella Seroprevalence Among HIV-infected and Uninfected Zambian Youth.

    PubMed

    Sutcliffe, Catherine G; Searle, Kelly; Matakala, Hellen K; Greenman, Michelle P; Rainwater-Lovett, Kaitlin; Thuma, Philip E; Moss, William J

    2017-03-01

    Measles and congenital rubella syndrome remain significant causes of morbidity and mortality despite available vaccines. HIV-infected youth may be at increased risk of measles because of greater waning immunity after vaccination. At a population level, they constitute a potentially large pool of susceptibles to measles and rubella. More data among HIV-infected youth in sub-Saharan Africa are needed to guide vaccination policy and control strategies. This cross-sectional study was nested within 2 ongoing studies of malaria and HIV in Zambia. Dried blood spot cards from youth (5-15 years) in these studies from 2009 to 2013 were tested for IgG antibodies to measles and rubella viruses. HIV-uninfected youth, HIV-infected treatment-naive youth and HIV-infected youth receiving antiretroviral therapy (ART) were compared. A total of 617 HIV-uninfected, 144 HIV-infected treatment-naive and 128 HIV-infected youth receiving ART were included in this study. The proportion seropositive for measles virus was significantly higher among HIV-uninfected youth (92.5%) compared with HIV-infected treatment-naive youth (74.1%) and HIV-infected youth receiving ART (71.9%). No differences by age were observed. The proportion seropositive for rubella virus was significantly higher among HIV-uninfected youth (54.7%) compared with HIV-infected treatment-naive youth (41.7%) and HIV-infected youth receiving ART (49.6%), with increases observed by age for all groups. Measles seroprevalence was lower among HIV-infected than uninfected youth, consistent with waning immunity after measles vaccination. HIV-infected youth would benefit from revaccination. Half of all youth in rural Zambia were susceptible to rubella and may need targeting for catch-up rubella campaigns when measles-rubella vaccine is introduced.

  11. A review of measles control in Kenya, with focus on recent innovations.

    PubMed

    Manakongtreecheep, Kasidet; Davis, Robert

    2017-01-01

    Despite the existence of a highly effective measles vaccine and the decrease in worldwide deaths from measles by more than 79% from the 2000 baseline levels, measles today remains one of the leading causes of vaccine-preventable deaths in the world. The African region is a key player in the global fight against measles. Africa has made tremendous progress in its effort to immunize children and to control the disease, increasing its regional measles vaccination coverage from 56% in 2001 to 85% in 2010. The Republic of Kenya has been a strong follower of the World Health Assembly and Measles Elimination 2020 resolutions, which aims to eliminate measles from the country. Since the beginning of the 21st century, Kenya has faced many challenges, but also aid, in the form of new innovations, in their fight against measles. In 2002, Kenya started its first SIA using A-D syringes, and from 2003-2005, GAVI funded injection safety support (INS) to Kenya, as an effort to scale-up safe injection in sub-Saharan Africa. In 2016, the Kenya introduced Measles-Rubella (MR) combined vaccine in its nationwide SIA campaign, after recognizing that rubella is a disease that must be controlled along with measles. In 2009 and 2012 SIAs, Red Cross volunteers conducted H2H visits to promote immunization as well as document information from the community with regards to immunization, including the current coverage, to campaign management levels. Case-based surveillance, using real-time PCR, measles-specific IgM detection and Epi-link were used to confirm and map measles infection during outbreaks. Alternative serosurveys such as Dried Blood Spot and Urine sample surveys were also tested in Kenya. In 2013 and 2016, two studies were also conducted in Kenya on the use of SMS reminder system for routine immunization. These studies, which showed SMS to significantly improve the vaccination coverage, paved way for use of SMS in a larger scale in Kenya.

  12. A review of measles control in Kenya, with focus on recent innovations

    PubMed Central

    Manakongtreecheep, Kasidet; Davis, Robert

    2017-01-01

    Despite the existence of a highly effective measles vaccine and the decrease in worldwide deaths from measles by more than 79% from the 2000 baseline levels, measles today remains one of the leading causes of vaccine-preventable deaths in the world. The African region is a key player in the global fight against measles. Africa has made tremendous progress in its effort to immunize children and to control the disease, increasing its regional measles vaccination coverage from 56% in 2001 to 85% in 2010. The Republic of Kenya has been a strong follower of the World Health Assembly and Measles Elimination 2020 resolutions, which aims to eliminate measles from the country. Since the beginning of the 21st century, Kenya has faced many challenges, but also aid, in the form of new innovations, in their fight against measles. In 2002, Kenya started its first SIA using A-D syringes, and from 2003-2005, GAVI funded injection safety support (INS) to Kenya, as an effort to scale-up safe injection in sub-Saharan Africa. In 2016, the Kenya introduced Measles-Rubella (MR) combined vaccine in its nationwide SIA campaign, after recognizing that rubella is a disease that must be controlled along with measles. In 2009 and 2012 SIAs, Red Cross volunteers conducted H2H visits to promote immunization as well as document information from the community with regards to immunization, including the current coverage, to campaign management levels. Case-based surveillance, using real-time PCR, measles-specific IgM detection and Epi-link were used to confirm and map measles infection during outbreaks. Alternative serosurveys such as Dried Blood Spot and Urine sample surveys were also tested in Kenya. In 2013 and 2016, two studies were also conducted in Kenya on the use of SMS reminder system for routine immunization. These studies, which showed SMS to significantly improve the vaccination coverage, paved way for use of SMS in a larger scale in Kenya. PMID:29296150

  13. Immunogenicity and safety of measles-mumps-rubella vaccine delivered by disposable-syringe jet injector in healthy Brazilian infants: a randomized non-inferiority study.

    PubMed

    de Menezes Martins, Reinaldo; Curran, Birute; Maia, Maria de Lourdes Sousa; Ribeiro, Maria das Graças Tavares; Camacho, Luiz Antonio Bastos; da Silva Freire, Marcos; Yamamura, Anna Maya Yoshida; Siqueira, Marilda Mendonça; Lemos, Maria Cristina F; de Albuquerque, Elizabeth Maciel; von Doellinger, Vanessa dos Reis; Homma, Akira; Saganic, Laura; Jarrahian, Courtney; Royals, Michael; Zehrung, Darin

    2015-03-01

    This study aimed to determine if immunogenicity to measles-mumps-rubella vaccine delivered to infants via a disposable-syringe jet injector (DSJI) was non-inferior to that administered by needle and syringe (NS). Vaccination safety was evaluated, as were the use, performance, and acceptability of each delivery method. The DSJI was the PharmaJet 2009 generation-1 device (G1) and the vaccine was measles-mumps-rubella vaccine from Bio-Manguinhos. Five hundred eighty-two healthy Brazilian infants were randomized to receive vaccine via G1 or NS. Seroconversion rates against measles and mumps viruses in the G1 treatment group did not meet non-inferiority criteria when compared with the NS group; however, responses in the G1 group to rubella virus were non-inferior to those of NS vaccinees. Most adverse events were mild or moderate. Crying after injection was more frequent in the NS group, and local skin reactions were more common in the G1 group. Five serious adverse events were judged causally unrelated to treatment and all resolved. Parents/guardians expressed a strong preference for G1 over NS for their children. Vaccinators found the G1 easy to use but noted incomplete vaccine delivery in some cases. Although the G1 has been superseded by an updated device, our results are important for the continued improvement and evaluation of DSJIs, which have the potential to overcome many of the challenges and risks associated with needle-based injections worldwide. Recommendations for future DSJI clinical studies include rigorous training of vaccinators, quantitative measurement of wetness on the skin following injection, and regular monitoring of device and vaccinator performance. Copyright © 2014. Published by Elsevier Inc.

  14. Towards ambient temperature-stable vaccines: the identification of thermally stabilizing liquid formulations for measles virus using an innovative high-throughput infectivity assay.

    PubMed

    Schlehuber, Lisa D; McFadyen, Iain J; Shu, Yu; Carignan, James; Duprex, W Paul; Forsyth, William R; Ho, Jason H; Kitsos, Christine M; Lee, George Y; Levinson, Douglas A; Lucier, Sarah C; Moore, Christopher B; Nguyen, Niem T; Ramos, Josephine; Weinstock, B André; Zhang, Junhong; Monagle, Julie A; Gardner, Colin R; Alvarez, Juan C

    2011-07-12

    As a result of thermal instability, some live attenuated viral (LAV) vaccines lose substantial potency from the time of manufacture to the point of administration. Developing regions lacking extensive, reliable refrigeration ("cold-chain") infrastructure are particularly vulnerable to vaccine failure, which in turn increases the burden of disease. Development of a robust, infectivity-based high throughput screening process for identifying thermostable vaccine formulations offers significant promise for vaccine development across a wide variety of LAV products. Here we describe a system that incorporates thermal stability screening into formulation design using heat labile measles virus as a prototype. The screening of >11,000 unique formulations resulted in the identification of liquid formulations with marked improvement over those used in commercial monovalent measles vaccines, with <1.0 log loss of activity after incubation for 8h at 40°C. The approach was shown to be transferable to a second unrelated virus, and therefore offers significant promise towards the optimization of formulation for LAV vaccine products. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Live attenuated measles virus vaccine induces apoptosis and promotes tumor regression in lung cancer.

    PubMed

    Zhao, Danhua; Chen, Ping; Yang, Huiqiang; Wu, Yonglin; Zeng, Xianwu; Zhao, Yu; Wen, Yanjun; Zhao, Xia; Liu, Xiaolin; Wei, Yuquan; Li, Yuhua

    2013-01-01

    Although the treatment of lung carcinoma has improved, at least 65% of patients with this tumor succumb to progressive disease. Measles virus oncolytic therapy has been reported to be effective in reducing tumor burden in immunocompetent or nude mice; however, its potential to reduce tumor burden in lung carcinoma remains to be determined. Herein, we report the potent antitumor effects of a live attenuated measles vaccine virus Hu-191 strain (MV) against lung carcinoma. Immunocompetent C57BL/6 mice bearing Lewis lung carcinoma (LLC) cells were treated with MV (1x104 to 1x106 CCID50/ml) once every other day for 10 days. Our results showed that treatment with MV effectively suppressed tumor growth and significantly prolonged the survival time of tumor-bearing animals. Histological examination revealed that the antitumor effects of MV therapy may result from increased induction of apoptosis, tumor necrosis and elevated lymphocyte infiltration. Our data suggest that MV, one of the widely used vaccines in China, has the ability to inhibit the growth of mouse lung carcinoma and may prove useful in the further exploration of the application of this approach in the treatment of human advanced lung cancer.

  16. Antibody neutralization of retargeted measles viruses

    PubMed Central

    Lech, Patrycja J.; Pappoe, Roland; Nakamura, Takafumi; Tobin, Gregory J.; Nara, Peter L.; Russell, Stephen J.

    2014-01-01

    The measles virus (MV) vaccine lineage is a promising oncolytic but prior exposure to the measles vaccine or wild-type MV strains limits treatment utility due to the presence of anti-measles antibodies. MV entry can be redirected by displaying a polypeptide ligand on the Hemagglutinin (H) C-terminus. We hypothesized that retargeted MV would escape neutralization by monoclonal antibodies (mAbs) recognizing the H receptor-binding surface and be less susceptible to neutralization by human antisera. Using chimeric H proteins, with and without mutations that ablate MV receptor binding, we show that retargeted MVs escape mAbs that target the H receptor-binding surface by virtue of mutations that ablate infection via SLAM and CD46. However, C-terminally displayed domains do not mediate virus entry in the presence of human antibodies that bind to the underlying H domain. In conclusion, utility of retargeted oncolytic measles viruses does not extend to evasion of human serum neutralization. PMID:24725950

  17. Measles Antibodies in Mother-Infant Dyads in Tianjin, China.

    PubMed

    Boulton, Matthew L; Wang, Xiexiu; Wagner, Abram L; Zhang, Ying; Carlson, Bradley F; Gillespie, Brenda W; Ding, Yaxing

    2017-11-27

    Many measles cases in Tianjin, China, occur in infants whose mothers were born after widespread vaccination programs. We assessed age-specific decreases in maternal measles antibodies in infants and examined maternal and infant characteristics in relation to infant antibody titers. Infant and mother dyads were enrolled from a sample of immunization clinics in all Tianjin districts. Participants' antibody titers were measured from dried blood spots. A multivariable log-linear model regressed infant antibody titers onto infant and mother characteristics. Among 551 infants aged ≤8 months, protective levels of measles antibodies were observed in infants whose mothers had measles titers ≥800 IU/mL (mean antibody titer, 542.5 IU/mL) or 400 to <800 IU/mL (mean, 202.2 IU/mL). Compared with infants whose mothers had no history of disease or vaccination, those with a history of disease had 1.60 times higher titers (95% confidence interval, 1.06-2.43). Limited vaccination programs in the 1980s have resulted in many Chinese women with inadequate protection against measles and an accordingly low efficiency of transplacental transmission to a fetus. Current vaccination programs, which target children aged 8 months through adolescence may be ineffective in controlling transmission of measles to infants. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  18. Assessing age-dependent susceptibility to measles in Japan.

    PubMed

    Kinoshita, Ryo; Nishiura, Hiroshi

    2017-06-05

    Routine vaccination against measles in Japan started in 1978. Whereas measles elimination was verified in 2015, multiple chains of measles transmission were observed in 2016. We aimed to reconstruct the age-dependent susceptibility to measles in Japan so that future vaccination strategies can be elucidated. An epidemiological model was used to quantify the age-dependent immune fraction using datasets of vaccination coverage and seroepidemiological survey. The second dose was interpreted in two different scenarios, i.e., booster and random shots. The effective reproduction number, the average number of secondary cases generated by a single infected individual, and the age at infection were explored using the age-dependent transmission model and the next generation matrix. While the herd immunity threshold of measles likely ranges from 90% to 95%, assuming that the basic reproductive number ranges from 10 to 20, the estimated immune fraction in Japan was below those thresholds in 2016, despite the fact that the estimates were above 80% for all ages. If the second dose completely acted as the booster shot, a proportion immune above 90% was achieved only among those aged 5years or below in 2016. Alternatively, if the second dose was randomly distributed regardless of primary vaccination status, a proportion immune over 90% was achieved among those aged below 25years. The effective reproduction number was estimated to range from 1.50 to 3.01 and from 1.50 to 3.00, respectively, for scenarios 1 and 2 in 2016; if the current vaccination schedule were continued, the reproduction number is projected to range from 1.50 to 3.01 and 1.39 to 2.78, respectively, in 2025. Japan continues to be prone to imported cases of measles. Supplementary vaccination among adults aged 20-49years would be effective if the chains of transmission continue to be observed in that age group. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. High seroprevalence of varicella, measles, mumps, rubella and pertussis antibodies in first-grade medical students.

    PubMed

    Socan, Maja; Berginc, Natasa

    2008-01-01

    The aim of the study was to investigate seropositivity for five vaccine-preventable communicable diseases - varicella, measles, mumps, rubella and pertussis - in a sample of first-grade medical students. A total of 256 students were tested for varicella IgG antibodies. In addition, 138 of the students were serologically screened for measles, mumps, rubella and pertussis antibodies. Data on vaccination and history of measles, mumps, rubella and pertussis were collected. Immunity to varicella, measles, mumps and rubella was established in 97.6%, 96.4%, 97.8% and 99.3% participants, respectively. Anti-pertussis toxin antibodies were detected in 81.2% of the students. The rates of varicella, measles, mumps and rubella immunity in first-grade medical students are very high. To identify those students who need vaccination before commencing practical work in healthcare facilities, a meticulous disease and vaccination history should be taken and medical records should be reviewed. Medical students providing no written evidence of adequate vaccination status should be serologically tested and vaccinated if necessary.

  20. Immunogenicity of recombinant measles vaccine expressing fusion protein of respiratory syncytial virus in cynomolgus monkeys.

    PubMed

    Sawada, Akihito; Yunomae, Kiyokazu; Nakayama, Tetsuo

    2018-02-01

    Respiratory syncytial virus (RSV) is a common cause of respiratory infections in infants. Effective vaccines are currently being sought, but no vaccine is thus far available. In our previous study, recombinant AIK-C measles vaccine expressing the RSV fusion protein (MVAIK/RSV/F) was developed and protective immunity against RSV demonstrated in cotton rats. In the present study, the immunogenicity and protective effects were investigated in three cynomolgus monkeys immunized with MVAIK/RSV/F. Neutralizing test antibodies against RSV were detected and no infectious virus was recovered from the lungs of monkeys immunized with MVAIK/RSV/F after challenge. MVAIK/RSV/F has the potential to inhibit RSV infection. © 2018 The Societies and John Wiley & Sons Australia, Ltd.

  1. Imported case of measles in a university setting leading to an outbreak of measles in Edinburgh, Scotland from September to December 2016.

    PubMed

    Kirolos, A; Waugh, C; Templeton, K; McCormick, D; Othieno, R; Willocks, L J; Stevenson, J

    2018-04-01

    In September 2016, an imported case of measles in Edinburgh in a university student resulted in a further 17 confirmed cases during October and November 2016. All cases were genotype D8 and were associated with a virus strain most commonly seen in South East Asia. Twelve of the 18 cases were staff or students at a university in Edinburgh and 17 cases had incomplete or unknown measles mumps rubella (MMR) vaccination status. The public health response included mass follow-up of all identified contacts, widespread communications throughout universities in Edinburgh and prompt vaccination clinics at affected campuses. Imported cases of measles pose a significant risk to university student cohorts who may be undervaccinated, include a large number of international students and have a highly mobile population. Public health departments should work closely with universities to promote MMR uptake and put in place mass vaccination plans to prevent rapidly spreading measles outbreaks in higher educational settings in future.

  2. Measles virus infection of human keratinocytes: Possible link between measles and atopic dermatitis.

    PubMed

    Gourru-Lesimple, Geraldine; Mathieu, Cyrille; Thevenet, Thomas; Guillaume-Vasselin, Vanessa; Jégou, Jean-François; Boer, Cindy G; Tomczak, Katarzyna; Bloyet, Louis-Marie; Giraud, Celine; Grande, Sophie; Goujon, Catherine; Cornu, Catherine; Horvat, Branka

    2017-05-01

    Measles virus (MV) infection is marked with a skin rash in the acute phase of the disease, which pathogenesis remains poorly understood. Moreover, the association between measles and progression of skin diseases, such as atopic dermatitis (AD), is still elusive. We have thus analysed the susceptibility of human keratinocytes to MV infection and explore the potential relationship between MV vaccination and the pathogenesis the AD. We performed immunovirological characterisation of MV infection in human keratinocytes and then tested the effect of live attenuated measles vaccine on the progression of AD in adult patients, in a prospective, double-blind study. We showed that both human primary keratinocytes and the keratinocyte cell line HaCaT express MV receptors and could be infected by MV. The infection significantly modulated the expression of several keratinocyte-produced cytokines, known to be implicated in the pathogenesis of inflammatory allergic diseases, including AD. We then analysed the relationship between exposure to MV by vaccination and the progression of AD in 20 adults during six weeks. We found a significant decrease in CCL26 and thymic stromal lymphopoietin (TSLP) mRNA in biopsies from acute lesions of vaccinated patients, suggesting MV-induced modulation of skin cytokine expression. Clinical analysis revealed a transient improvement of SCORAD index in vaccinated compared to placebo-treated patients, two weeks after vaccination. Altogether, these results clearly demonstrate that keratinocytes are susceptible to MV infection, which could consequently modulate their cytokine production, resulting with a beneficial effect in the progression of AD. This study provides thus a proof of concept for the vaccination therapy in AD and may open new avenues for the development of novel strategies in the treatment of this allergic disease. Copyright © 2017 Japanese Society for Investigative Dermatology. Published by Elsevier B.V. All rights reserved.

  3. The optimal age of measles immunisation in low-income countries: a secondary analysis of the assumptions underlying the current policy

    PubMed Central

    Martins, Cesário L; Garly, May-Lill; Rodrigues, Amabelia; Benn, Christine S; Whittle, Hilton

    2012-01-01

    Objective The current policy of measles vaccination at 9 months of age was decided in the mid-1970s. The policy was not tested for impact on child survival but was based on studies of seroconversion after measles vaccination at different ages. The authors examined the empirical evidence for the six underlying assumptions. Design Secondary analysis. Data sources and methods These assumptions have not been research issues. Hence, the authors examined case reports to assess the empirical evidence for the original assumptions. The authors used existing reviews, and in December 2011, the authors made a PubMed search for relevant papers. The title and abstract of papers in English, French, Portuguese, Spanish, German and Scandinavian languages were assessed to ascertain whether the paper was potentially relevant. Based on cumulative measles incidence figures, the authors calculated how many measles cases had been prevented assuming everybody was vaccinated at a specific age, how many ‘vaccine failures’ would occur after the age of vaccination and how many cases would occur before the specific age of vaccination. In the combined analyses of several studies, the authors used the Mantel–Haenszel weighted RR stratifying for study or age groups to estimate common trends. Setting and participants African community studies of measles infection. Primary and secondary outcomes Consistency between assumptions and empirical evidence and the predicted effect on mortality. Results In retrospect, the major assumptions were based on false premises. First, in the single study examining this point, seronegative vaccinated children had considerable protection against measles infection. Second, in 18 community studies, vaccinated measles cases (‘vaccine failures’) had threefold lower case death than unvaccinated cases. Third, in 24 community studies, infants had twofold higher case death than older measles cases. Fourth, the only study examining the assumption that ‘vaccine

  4. Measles, mumps, and rubella virus vaccine (M-M-R™II): a review of 32 years of clinical and postmarketing experience.

    PubMed

    Lievano, Fabio; Galea, Susan A; Thornton, Michele; Wiedmann, Richard T; Manoff, Susan B; Tran, Trung N; Amin, Manisha A; Seminack, Margaret M; Vagie, Kristen A; Dana, Adrian; Plotkin, Stanley A

    2012-11-06

    M-M-R™II (measles, mumps, and rubella virus vaccine live; Merck, Sharp, & Dohme Corp.) is indicated for simultaneous vaccination against measles, mumps, and rubella in individuals ≥ 12 months of age. Before the vaccine era, these viruses infected most exposed individuals, with subsequent morbidity and mortality. One of the greatest achievements of public health has been to eliminate these 3 diseases in large geographic areas. The safety profile of M-M-R™II is described using data from routine global postmarketing surveillance. Postmarketing surveillance has limitations (including incomplete reporting of case data), but allows collection of real-world information on large numbers of individuals, who may have concurrent medical problems excluding them from clinical trials. It can also identify rare adverse experiences (AEs). Over its 32-year history, ≈ 575 million doses of M-M-R™II have been distributed worldwide, with 17,536 AEs voluntarily reported for an overall rate of 30.5 AEs/1,000,000 doses distributed. This review provides evidence that the vaccine is safe and well-tolerated. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Social regulations predispose people to complete vaccination for vaccine-preventable diseases.

    PubMed

    Takeuchi, Jiro; Goto, Masashi; Kawamura, Takashi; Hiraide, Atsushi

    2014-11-01

    Japan experienced measles outbreaks in both 2006 and 2007 mainly among university students. Improvement of vaccine coverage against vaccine-preventable viral infections is the prime task for preventing outbreaks of viral infections. To elucidate the promoting factors for complete vaccination against measles, rubella, mumps, and varicella-zoster viruses, we conducted a case-control study among single university students in Japan. Information on vaccinations and clinico-demographical factors were collected using a self-administered questionnaire and a photocopy of the Maternal and Child Health Handbook. Logistic regression analysis was performed to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) for two-time vaccination against measles and rubella viruses as mandatory vaccinations and at least one-time vaccination against mumps and varicella-zoster viruses as optional vaccinations. A total of 1,370 (744 medical, 508 paramedical, and 118 pharmaceutical) students were invited to participate, 960 (70.1%) of whom were enrolled in the study. Students aged < 20 years had a greater propensity for measles and rubella vaccinations (OR 7.8 [95% CI, 5.1-11.8] and OR 6.1 [95% CI, 3.7-10.0], respectively) compared with those aged ≥ 20 years. Students with a history of living over-seas for 1 month or longer were more likely to complete vaccination for measles (OR 4.4 [95% CI, 1.4-13.5] compared with those without such history. This significantly high vaccination coverage was attributed to the measles-rubella catch-up campaign by the Japanese government and the immunization regulations by foreign countries. These findings suggest that social regulations would predispose people to complete vaccination.

  6. Priming T-cell responses with recombinant measles vaccine vector in a heterologous prime-boost setting in non-human primates.

    PubMed

    Bolton, Diane L; Santra, Sampa; Swett-Tapia, Cindy; Custers, Jerome; Song, Kaimei; Balachandran, Harikrishnan; Mach, Linh; Naim, Hussein; Kozlowski, Pamela A; Lifton, Michelle; Goudsmit, Jaap; Letvin, Norman; Roederer, Mario; Radošević, Katarina

    2012-09-07

    Licensed live attenuated virus vaccines capable of expressing transgenes from other pathogens have the potential to reduce the number of childhood immunizations by eliciting robust immunity to multiple pathogens simultaneously. Recombinant attenuated measles virus (rMV) derived from the Edmonston Zagreb vaccine strain was engineered to express simian immunodeficiency virus (SIV) Gag protein for the purpose of evaluating the immunogenicity of rMV as a vaccine vector in rhesus macaques. rMV-Gag immunization alone elicited robust measles-specific humoral and cellular responses, but failed to elicit transgene (Gag)-specific immune responses, following aerosol or intratracheal/intramuscular delivery. However, when administered as a priming vaccine to a heterologous boost with recombinant adenovirus serotype 5 expressing the same transgene, rMV-Gag significantly enhanced Gag-specific T lymphocyte responses following rAd5 immunization. Gag-specific humoral responses were not enhanced, however, which may be due to either the transgene or the vector. Cellular response priming by rMV against the transgene was highly effective even when using a suboptimal dose of rAd5 for the boost. These data demonstrate feasibility of using rMV as a priming component of heterologous prime-boost vaccine regimens for pathogens requiring strong cellular responses. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Measles and Rubella Seroprevalence Among HIV- Infected And Uninfected Zambian Youth

    PubMed Central

    Sutcliffe, Catherine G.; Searle, Kelly; Matakala, Hellen K.; Greenman, Michelle; Rainwater-Lovett, Kaitlin; Thuma, Philip E.; Moss, William J.

    2016-01-01

    Background Measles and congenital rubella syndrome remain significant causes of morbidity and mortality despite available vaccines. HIV-infected youth may be at increased risk of measles because of greater waning immunity following vaccination. At a population level, they constitute a potentially large pool of susceptibles to measles and rubella. More data among HIV-infected youth in sub-Saharan Africa are needed to guide vaccination policy and control strategies. Methods This cross-sectional study was nested within two ongoing studies of malaria and HIV in Zambia. Dried blood spot cards from youth (5–15 years) in these studies from 2009–2013 were tested for IgG antibodies to measles and rubella viruses. HIV-uninfected youth, HIV-infected treatment-naïve youth, and HIV-infected youth receiving antiretroviral therapy (ART) were compared. Results 617 HIV-uninfected, 144 HIV-infected treatment-naïve, and 128 HIV-infected youth receiving ART were included in the study. The proportion seropositive for measles virus was significantly higher among HIV-uninfected youth (92.5%) compared to HIV-infected treatment-naïve youth (74.1%) and HIV-infected youth receiving ART (71.9%). No differences by age were observed. The proportion seropositive for rubella virus was significantly higher among HIV-uninfected youth (54.7%) compared with HIV-infected treatment-naïve youth (41.7%) and HIV-infected youth receiving ART (49.6%), with increases observed by age for all groups. Conclusions Measles seroprevalence was lower among HIV-infected than uninfected youth, consistent with waning immunity following measles vaccination. HIV-infected youth would likely benefit from revaccination. Half of all youth in rural Zambia were susceptible to rubella and may need targeting for catch-up rubella campaigns when measles-rubella vaccine is introduced. PMID:27879554

  8. Children and Adolescents Unvaccinated Against Measles: Geographic Clustering, Parents' Beliefs, and Missed Opportunities

    PubMed Central

    Marcuse, Edgar K.; Seward, Jane F.; Zhao, Zhen; Orenstein, Walter A.

    2015-01-01

    Objective We evaluated the extent to which children and adolescents were not vaccinated against measles (“unvaccinated”), clustering within U.S. counties, and factors associated with unvaccination, including parents' vaccine-related beliefs and missed opportunities. Methods We analyzed data from the 2010–2013 National Immunization Survey (NIS) and NIS-Teen Survey of households with 19- to 35-month-old children and 13- to 17-year-old adolescents, respectively. We used provider-reported vaccination histories to assess measles vaccination status. Results In 2013, 7.5% of children and 4.5% of adolescents were unvaccinated against measles. Four-fifths (80.0%) of unvaccinated children lived in counties containing 41.9% of the nation's children, and 80.0% of unvaccinated adolescents lived in counties containing 30.4% of the nation's adolescents. Multivariable statistical analyses found that 74.6% of children who were unvaccinated against measles missed being vaccinated for reasons other than parents' negative vaccine-related beliefs, and 89.6% could be deemed as having at least one missed opportunity for being vaccinated against measles because they were administered at least one dose of other recommended vaccines after 12 months of age. Among adolescents, multivariable analyses found that only demographic factors, not vaccine-related parental beliefs, were independently associated with being unvaccinated. Conclusions Reasons other than negative vaccine-related beliefs, including missed opportunities, accounted for the vast majority of unvaccinated children and adolescents. PMID:26327727

  9. Measles outbreaks in displaced populations: a review of transmission, morbidity and mortality associated factors.

    PubMed

    Kouadio, Isidore K; Kamigaki, Taro; Oshitani, Hitoshi

    2010-03-19

    Measles is a highly contagious infectious disease with a significant public health impact especially among displaced populations due to their characteristic mass population displacement, high population density in camps and low measles vaccination coverage among children. While the fatality rate in stable populations is generally around 2%, evidence shows that it is usually high among populations displaced by disasters. In recent years, refugees and internally displaced persons have been increasing. Our study aims to define the epidemiological characteristics and risk factors associated with measles outbreaks in displaced populations. We reviewed literature in the PubMed database, and selected articles for our analysis that quantitatively described measles outbreaks. A total of nine articles describing 11 measles outbreak studies were selected. The outbreaks occurred between 1979 and 2005 in Asia and Africa, mostly during post-conflict situations. Seven of eight outbreaks were associated with poor vaccination status (vaccination coverage; 17-57%), while one was predominantly due to one-dose vaccine coverage. The age of cases ranged from 1 month to 39 years. Children aged 6 months to 5 years were the most common target group for vaccination; however, 1622 cases (51.0% of the total cases) were older than 5 years of age. Higher case-fatality rates (>5%) were reported for five outbreaks. Consistent factors associated with measles transmission, morbidity and mortality were vaccination status, living conditions, movements of refugees, nutritional status and effectiveness of control measures including vaccination campaigns, surveillance and security situations in affected zones. No fatalities were reported in two outbreaks during which a combination of active and passive surveillance was employed. Measles patterns have varied over time among populations displaced by natural and man-made disasters. Appropriate risk assessment and surveillance strategies are essential

  10. Measles outbreak in Dublin, 2000.

    PubMed

    McBrien, Jacqueline; Murphy, John; Gill, Denis; Cronin, Mary; O'Donovan, Catherine; Cafferkey, Mary T

    2003-07-01

    An outbreak of measles occurred in Ireland between December 1999 and July 2000. The majority of cases were in north Dublin, the catchment area of The Children's University Hospital (TCUH). Details of all of the 111 children attending the hospital with a diagnosis of measles between December 1999 and July 2000 were prospectively entered into a database. Charts were subsequently reviewed to extract epidemiologic and clinical details. National figures were obtained from the National Disease Surveillance Centre. In the study period 355 attended TCUH with a serologic or clinical diagnosis of measles, and 111 were admitted (47% female, 53% male). The main indications for admission were dehydration in 79%, pneumonia or pneumonitis in 47% and tracheitis in 32%. Thirteen children (11.7% of those admitted) required treatment in the intensive care unit, and in 7 of these mechanical ventilation was necessary. There were 3 deaths as a result of measles. Public health measures to curb spread of the disease included promotion of immunization for susceptible children nationally and recommending administration of measles-mumps-rubella vaccine (MMR) from the age of 6 months, in North Dublin. This outbreak of measles posed a major challenge to the hospital and the community for the first half of 2000. The national MMR immunization rate before the outbreak was gravely suboptimal at 79%, whereas the rate in North Dublin, the catchment area of TCUH, was <70%. Three children died as a result of a vaccine-preventable illness.

  11. Mumps Outbreak in a Highly Vaccinated University-Affiliated Setting Before and After a Measles-Mumps-Rubella Vaccination Campaign-Iowa, July 2015-May 2016.

    PubMed

    Shah, Minesh; Quinlisk, Patricia; Weigel, Andrew; Riley, Jacob; James, Lisa; Patterson, James; Hickman, Carole; Rota, Paul A; Stewart, Rebekah; Clemmons, Nakia; Kalas, Nicholas; Cardemil, Cristina

    2018-01-06

    In response to a mumps outbreak at the University of Iowa and surrounding community, university, state, and local health officials implemented a vaccination campaign targeting students <25 years of age with an additional dose of measles-mumps-rubella (MMR) vaccine. More than 4700 vaccine campaign doses were administered; 97% were documented third doses. We describe the epidemiology of the outbreak before and after the campaign, focusing on cases in university students. Mumps cases were identified from reportable disease databases and university health system records. Detailed information on student cases was obtained from interviews, medical chart abstractions, university and state vaccination records, and state public health laboratory results. Pre- and postcampaign incidence among students, university faculty/staff, and community members <25 vs ≥25 years old were compared using Fisher exact test. Multivariable regression modeling was performed to identify variables associated with a positive mumps polymerase chain reaction test. Of 453 cases in the county, 301 (66%) occurred in university students. Student cases were primarily undergraduates (90%) and highly vaccinated (86% had 2 MMR doses, and 12% had 3 MMR doses). Fewer cases occurred in students after the campaign (75 [25%]) than before (226 [75%]). Cases in the target group (students <25 years of age) declined 9% postcampaign (P=.01). A positive mumps polymerase chain reaction test was associated with the presence of parotitis and early sample collection, and inversely associated with recent receipt of MMR vaccine. Following a large additional dose MMR vaccination campaign, fewer mumps cases occurred overall and in the target population. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  12. Pattern of susceptibility to measles in Italy. Serological Study Group.

    PubMed Central

    Salmaso, S.; Gabutti, G.; Rota, M. C.; Giordano, C.; Penna, C.; Mandolini, D.; Crovari, P.

    2000-01-01

    On the basis of seroprevalence and incidence data we describe the distribution of individuals susceptible and immune to measles in Italy in 1996-97. In regions where vaccination coverage was at least 70%, approximately 10% of 3-year-old children were susceptible to measles, whereas 40% were in this category in regions with lower vaccination coverage. Seroprevalence among children older than 4 years was similar for the two groups of regions; in the age group 20-39 years it was approximately 95%. During 1990-96 in the regions with lower vaccination coverage the incidence was highest among children aged 4-6 years, and the median age of cases was 7 years; in the regions with higher vaccination coverage, however, the incidence remained at around 5% for the age group 4-16 years, and the overall median age was 10 years. These data confirm the partial reduction in measles incidence in Italy, although transmission has still not been interrupted. The size and geographical distribution of the current pool of susceptible individuals can be expected to present an obstacle to measles elimination if appropriate vaccination strategies, such as catch-up campaigns, are not adopted. PMID:10994277

  13. Measles burden in urban settings: characteristics of measles cases in Addis Ababa city administration, Ethiopia, 2004-2014.

    PubMed

    Mersha, Amare Mengistu; Braka, Fiona; Gallagher, Kathleen; Tegegne, Aysheshim Ademe; Argay, Aron Kassahun; Mekonnen, Mekonnen Admassu; Aragaw, Merawi; Abegaz, Debritu Mengesha; Worku, Etsehiwot Zeamlak; Baynesagn, Mekonen Getahun

    2017-01-01

    In developing countries, measles was a major cause of morbidity and mortality before the wide spread use of measles vaccine. The purpose of this study was to describe measles burden in an urban setting, Addis Ababa- since the implementation of measles case-based surveillance in Ethiopia. We analyzed measles surveillance data for 2004 -2014. Incidence of measles was described by sub city, by year and by age groups. Age specific incidence rate were calculated. Logistic regression was used to identify the predictors of confirmed measles cases. Of 4220 suspected measles cases 39% were confirmed cases. Males and females were equally affected. The mean affected age was 7.59 years. Measles cases peaked in 2010 and 2013-2014. Incidence of measles is higher among children less than five years old. Outer sub cities were more affected by measles in all years. Sub cities bordering with Oromia Regional State were more affected by measles. Older age groups were more affected than younger age groups (age ≤ five years old). Efforts to close immunity gaps against measles and further strengthen surveillance in urban settings, particularly among children below five years old, should be prioritized.

  14. Measles burden in urban settings: characteristics of measles cases in Addis Ababa city administration, Ethiopia, 2004-2014

    PubMed Central

    Mersha, Amare Mengistu; Braka, Fiona; Gallagher, Kathleen; Tegegne, Aysheshim Ademe; Argay, Aron Kassahun; Mekonnen, Mekonnen Admassu; Aragaw, Merawi; Abegaz, Debritu Mengesha; Worku, Etsehiwot Zeamlak; Baynesagn, Mekonen Getahun

    2017-01-01

    Introduction In developing countries, measles was a major cause of morbidity and mortality before the wide spread use of measles vaccine. The purpose of this study was to describe measles burden in an urban setting, Addis Ababa- since the implementation of measles case-based surveillance in Ethiopia. We analyzed measles surveillance data for 2004 -2014. Methods Incidence of measles was described by sub city, by year and by age groups. Age specific incidence rate were calculated. Logistic regression was used to identify the predictors of confirmed measles cases. Results Of 4220 suspected measles cases 39% were confirmed cases. Males and females were equally affected. The mean affected age was 7.59 years. Measles cases peaked in 2010 and 2013-2014. Incidence of measles is higher among children less than five years old. Outer sub cities were more affected by measles in all years. Conclusion Sub cities bordering with Oromia Regional State were more affected by measles. Older age groups were more affected than younger age groups (age ≤ five years old). Efforts to close immunity gaps against measles and further strengthen surveillance in urban settings, particularly among children below five years old, should be prioritized. PMID:28890752

  15. Measles Case Fatality Rate in Bihar, India, 2011–12

    PubMed Central

    Murhekar, Manoj V.; Ahmad, Mohammad; Shukla, Hemant; Abhishek, Kunwar; Perry, Robert T.; Bose, Anindya S.; Shimpi, Rahul; Kumar, Arun; Kaliaperumal, Kanagasabai; Sethi, Raman; Selvaraj, Vadivoo; Kamaraj, Pattabi; Routray, Satyabrata; Das, Vidya Nand; Menabde, Nata; Bahl, Sunil

    2014-01-01

    Background Updated estimates of measles case fatality rates (CFR) are critical for monitoring progress towards measles elimination goals. India accounted for 36% of total measles deaths occurred globally in 2011. We conducted a retrospective cohort study to estimate measles CFR and identify the risk factors for measles death in Bihar–one of the north Indian states historically known for its low vaccination coverage. Methods We systematically selected 16 of the 31 laboratory-confirmed measles outbreaks occurring in Bihar during 1 October 2011 to 30 April 2012. All households of the villages/urban localities affected by these outbreaks were visited to identify measles cases and deaths. We calculated CFR and used multivariate analysis to identify risk factors for measles death. Results The survey found 3670 measles cases and 28 deaths (CFR: 0.78, 95% confidence interval: 0.47–1.30). CFR was higher among under-five children (1.22%) and children belonging to scheduled castes/tribes (SC/ST, 1.72%). On multivariate analysis, independent risk factors associated with measles death were age <5 years, SC/ST status and non-administration of vitamin A during illness. Outbreaks with longer interval between the occurrence of first case and notification of the outbreak also had a higher rate of deaths. Conclusions Measles CFR in Bihar was low. To further reduce case fatality, health authorities need to ensure that SC/ST are targeted by the immunization programme and that outbreak investigations target for vitamin A treatment of cases in high risk groups such as SC/ST and young children and ensure regular visits by health-workers in affected villages to administer vitamin A to new cases. PMID:24824641

  16. Spotlight on measles 2010: An epidemiological overview of measles outbreaks in Poland in relation to the measles elimination goal.

    PubMed

    Rogalska, J; Santibanez, S; Mankertz, A; Makowka, A; Szenborn, L; Stefanoff, P

    2010-04-29

    The objective of this study was to describe transmission chains of measles observed in Poland during 2008-2009. A decade ago, the incidence of measles in Poland declined and approached one case per million inhabitants one of the World Health Organization's criteria for measles elimination. Following a period of very few reported measles cases (2003 to 2005), an increase in incidence was observed in 2006. Since then, the incidence has constantly exceeded one case per million inhabitants. Of 214 measles cases reported in 2008 and 2009 in Poland, 164 (77%) were linked to 19 distinct outbreaks, with 79% of cases belonging to the Roma ethnic group. Outbreaks in the non-Roma Polish population had different dynamics compared to those in the Roma population. On average, measles outbreaks in Roma communities involved 10 individuals, seven of whom were unvaccinated, while outbreaks in the non-Roma Polish population involved five individuals, half of whom were incompletely vaccinated. The majority of outbreaks in Roma communities were related to importation of virus from the United Kingdom. In six outbreaks, the epidemiologic investigation was confirmed by identification of genotype D4 closely related to measles viruses detected in the United Kingdom and Germany. Our data indicate that Poland is approaching measles elimination, but measles virus circulation is still sustained in a vulnerable population. More efforts are needed to integrate the Roma ethnic group into the Polish healthcare system and innovative measures to reach vulnerable groups should be explored.

  17. Live vaccine against measles, mumps, and rubella and the risk of hospital admissions for nontargeted infections.

    PubMed

    Sørup, Signe; Benn, Christine S; Poulsen, Anja; Krause, Tyra G; Aaby, Peter; Ravn, Henrik

    2014-02-26

    In low-income countries, live measles vaccine reduces mortality from causes other than measles infection. Such nonspecific effects of vaccines might also be important for the health of children in high-income settings. To examine whether the live vaccine against measles, mumps, and rubella (MMR) is associated with lower rates of hospital admissions for infections among children in Denmark. Population-based cohort study of Danish children born 1997-2006 and followed up from ages 11 months to 2 years (last follow-up, August 31, 2008). Nationwide Danish registers provided data on vaccinations and hospital admissions. The recommended vaccination schedule was inactivated vaccine against diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b (DTaP-IPV-Hib) administered at ages 3, 5, and 12 months and MMR at age 15 months. Incidence rate ratios (IRRs) of hospital admissions for any infection, comparing receipt of MMR vs DTaP-IPV-Hib as the most recent vaccine. Risks, risk difference, and number needed to vaccinate were calculated for receiving MMR on time. The study included 495,987 children contributing with 56,889 hospital admissions for any type of infection during 509,427 person-years (rate, 11.2 per 100 person-years). For the 456,043 children who followed the recommended schedule and received MMR after the third dose of DTaP-IPV-Hib, MMR (rate, 8.9 per 100 person-years) vs the third dose of DTaP-IPV-Hib (rate, 12.4 per 100 person-years) as the most recent vaccine was associated with an adjusted IRR of 0.86 (95% CI, 0.84-0.88) for any admission for infection. There were 19,219 children immunized out of sequence. The adjusted IRR was 0.87 (95% CI, 0.80-0.95) for those receiving MMR (rate, 9.9 per 100 person-years) after the second dose of DTaP-IPV-Hib (rate, 15.1 per 100 person-years). However, in the 1981 children who subsequently received the third dose of DTaP-IPV-Hib (rate, 12.8 per 100 person-years) after MMR, the IRR for hospital admissions for

  18. Assessment of measles incidence, measles-related complications and hospitalisations during an outbreak in a southern Italian region.

    PubMed

    Ciofi Degli Atti, Marta Luisa; Filia, Antonietta; Massari, Marco; Pizzuti, Renato; Nicoletti, Loredana; D'Argenzio, Angelo; de Campora, Enrico; Marchi, Antonella; Lombardo, Assunta; Salmaso, Stefania

    2006-02-27

    A large measles epidemic occurred in 2002 in Campania, a region of southern Italy with inadequate vaccination coverage. We evaluated the burden of the outbreak in children <15 years of age using different data sources. The measles standardized incidence rate was 5,757/100,000, corresponding to 63,368 estimated cases (95% CI: 59,544--67,373). Measles virus strains were identified as belonging to the D7 genotype. The estimated complication rate was 7.6%. A total of 972 measles hospitalisations were detected, giving a hospitalisation rate of 88.3/100,000. Three deaths occurred. These results show that measles can still represent a serious health threat even in industrialized countries.

  19. Removal of gelatin from live vaccines and DTaP-an ultimate solution for vaccine-related gelatin allergy.

    PubMed

    Kuno-Sakai, Harumi; Kimura, Mikio

    2003-12-01

    From the early 1990s infants started to receive acellular pertussis vaccine combined with diphtheria and tetanus toxoids (DTaP) before live vaccines such as measles, rubella, and mumps vaccines, which contained gelatin as a stabilizer. Then, an increasing number of cases of anaphylactic/allergic reactions to those live vaccines were reported. Almost all these cases had a previous history of receiving three or four doses of DTaP containing gelatin.Anaphylactic/allergic reactions to live measles vaccine were analyzed using information obtained from the Reporting System, a retrospective study, as well as from the Monitoring System, a prospective study. Dramatic decreases in anaphylactic/allergic reactions to live measles vaccines were observed immediately after each manufacturer marketed gelatin-free or gelatin (hypo-allergic)-containing live measles vaccine, and since the end of 1998 reports on anaphylactic/allergic reactions to live measles vaccine have almost ceased.

  20. Measles control in developing and developed countries: the case for a two-dose policy.

    PubMed

    Tulchinsky, T H; Ginsberg, G M; Abed, Y; Angeles, M T; Akukwe, C; Bonn, J

    1993-01-01

    Despite major reductions in the incidence of measles and its complications, measles control with a single dose of the currently used. Schwarz strain vaccine has failed to eradicate the disease in the developed countries. In developing countries an enormous toll of measles deaths and disability continues, despite considerable efforts and increasing immunization coverage. Empirical evidence from a number of countries suggests that a two-dose measles vaccination programme, by improving individual protection and heard immunity can make a major contribution to measles control and elimination of local circulation of the disease. Cost-benefit analysis also supports the two-dose schedule in terms of savings in health costs, and total costs to society. A two-dose measles vaccination programme is therefore an essential component of preventive health care in developing, as well as developed countries for the 1990s.