Measles Control Research Articles

Control of measles in a juvenile custodial setting in the wake of the recent US outbreak.

The recent US measles outbreak is the largest since 1992. It is just a matter of time before measles is introduced into a juvenile custodial setting. Are we prepared? Should we be prepared? This short article addresses steps institutional settings should take to prevent the spread of measles in a contained setting.

The African Region early experience with structures for the verification of measles elimination - a review.

Substantial progress has been achieved in the last two decades with the implementation of measles control strategies in the African Region. Elimination of measles is defined as the absence of endemic transmission in a defined geographical region or country for at least 12 months, as documented by a well-performing surveillance system. The framework for documenting elimination outlines five lines of evidence that should be utilized in documenting and assessing progress towards measles elimination. In March 2017, the WHO regional office for Africa developed and disseminated regional guidelines for the verification of measles elimination. As of May 2019, fourteen countries in the African Region have established national verification committees and 8 of these have begun to document progress toward measles elimination. Inadequate awareness, concerns about multiple technical committees for immunization work, inadequate funding and human resources, as well as gaps in data quality and in the implementation of measles elimination strategies have been challenges that hindered the establishment and documentation of progress by national verification committees. We recommend continuous capacity building and advocacy, technical assistance and networking to improve the work around the documentation of country progress towards measles elimination in the African Region.

Two measles clusters in connection with short inner-European air travels indicating impediments to effective measles control: A cluster analysis.

Importation and transmission of measles via air travel is a public health concern to countries, which are close to or have achieved elimination, i.e., to the majority of countries in Europe. In 2018, two measles cases occurred in Berlin residents, who flew within Europe while being infectious. In addition to contact tracing through passenger manifests, we contacted national authorities in flight destination countries or embarking countries and inquired about epidemiologically linked measles cases to the two Berlin index cases. We identified eight epidemiologically linked cases (six males, median age: 32 years) from three countries associated with three air-travels. Consequently measles was imported to Germany (Bavaria), Denmark and possibly Sweden. Our investigations revealed impediments to an effective public health response indicating the need to revisit current guidelines and methods to better control transmission of measles related to air travel.

Spatio-temporal dynamics of measles outbreaks in Cameroon

PurposeIn 2012, Cameroon experienced a large measles outbreak of over 14,000 cases. To determine the spatio-temporal dynamics of measles transmission in Cameroon, we analyzed weekly case data collected by the Ministry of Health. MethodsWe compared several multivariate time-series models of population movement to characterize the spatial spread of measles in Cameroon. Using the best model, we evaluated the contribution of population mobility to disease transmission at increasing geographic resolutions: region, department, and health district. ResultsOur spatio-temporal analysis showed that the power law model, which accounts for long-distance population movement, best represents the spatial spread of measles in Cameroon. Population movement between health districts within departments contributed to 7.6% (range: 0.4%–13.4%) of cases at the district level, whereas movement between departments within regions contributed to 16.0% (range: 1.3%–23.2%) of cases. Long-distance movement between regions contributed to 16.7% (range: 0.1%–59.0%) of cases at the region level, 20.1% (range: 7.1%–30.0%) at the department level, and 29.7% (range: 15.3%–47.6%) at the health district level. ConclusionsPopulation long-distance mobility is an important driver of measles dynamics in Cameroon. These findings demonstrate the need to improve our understanding of the roles of population mobility and local heterogeneity of vaccination coverage in the spread and control of measles in Cameroon.

Use of Social Mobilization and Community Mobilizers by Non-governmental Health Organizations in Malawi to Support the Eradication of Polio, Improve Routine Immunization Coverage, and Control Measles and Neonatal Tetanus.

.Seventy-five percent of children aged 12–23 months in Malawi have received all eight basic vaccinations—still leaving many children at risk. The Malawi Expanded Program on Immunization comprehensive Multi-Year Plan 2016–2020 reveals several challenges impeding immunization and disease surveillance efforts, such as the fact that non-governmental health organizations (NGHOs) and communities are minimally included in the planning, implementation, and monitoring of these activities. This article examines the extent to which NGHOs are promoting the use of social mobilization (SM) and community mobilizers (CMs) for sharing health information related to the eradication of polio, the importance of routine immunization, and the control of measles and neonatal tetanus. Data collection involved document analysis and interviews with 11 organizations in Malawi whose work contributes to the eradication of polio and control of measles and neonatal tetanus. Content analysis was used to analyze the qualitative data, whereas descriptive statistics were used to analyze the quantitative data. Non-governmental health organizations use a variety of approaches for SM, including mass media campaigns (radio and printed booklets), local skits and dramas, and home visits. Most NGHOs use training workshops and opinion leaders to impart knowledge and skills to CMs on immunization to eradicate polio and to control measles and neonatal tetanus. Major challenges faced by the NGHOs include negative attitudes toward campaigns and demotivation of CMs due to lack of financial incentives. The article concludes with a discussion of approaches to strengthen SM and the role of CMs by NGHOs.

Measles, the need for a paradigm shift.

Measles vaccination schedules and targets of herd immunity have been designed according to the paradigm that the vaccine is as protective as natural infection, and the virus has remained of a single serotype over many decades. As a result, ongoing measles resurgence is mostly attributed to gaps in immunization. Using official data, we investigated the correlation between the rate of vaccine coverage reported and aggregated at the national level, and the incidence of cases. We discussed the limits of this indicator considered in isolation. We provide a literature overview of measles vaccine efficacy and failures. We questioned whether measles strains could escape the vaccine. Immunization tools and strategies for measles control deserve to be optimized in the current context.

ДЕЙСТВИЕ КОРЕВОЙ ВАКЦИНЫ НА СОЗРЕВАНИЕ ДЕНДРИТНЫХ КЛЕТОК ЧЕЛОВЕКА IN VITRO

The most important means of measles control is live measles vaccine, the high epidemiological effectiveness of which is confirmed by half a century of its use. There is a question of the need to further improve the effectiveness of vaccine prophylaxis, in particular, by increasing the immunogenicity of the used vaccine given the increase in the morbidity of measles in recent years. Investigation of effect features of existing vaccine variants is necessary to identify possible ways to increase their immunogenicity. We investigated the effect of measles culture live vaccine on the maturation of human dendritic cells – the most specialized antigen-presenting cells involved in the induction of an immune response. In vitro incubation of monocytic derived immature dendritic cells with the vaccine initiates the process of their partial maturation, which is manifested in an increase in the number of cells carrying molecules CD86, CD83 and ICOSL (CD275).At the same time they have a reduced expression level of the HLA-DR molecule and chemokine receptors CCR7 and CXCR5 involved in the migration of dendritic cells to peripheral lymphoid organs. In our opinion, the relative weak side of measles vaccine effect on dendritic cell maturation is a factor limiting the immunogenicity of the vaccine, which must be taken into account when developing new measles vaccines.

Measles: A dangerous vaccine-preventable disease returns.

Although a safe and effective vaccine has been available for over 6 decades, vaccine hesitancy in the United States and social and political unrest globally have led to undervaccination. As a result, in recent months, vaccine control of measles has been threatened with an alarming upswing in measles cases nationally and internationally. Here, we review the disease and its management in view of recent outbreaks.

Summary and lessons of the European and Hungarian measles situation

Measles is one of the most serious preventable infectious diseases, which in our country were among the rare diseases in the last 10 to 20 years. One of the reasons for this is that the Hungarian population born after 1969 was vaccinated in almost 99 percent. The other reason is that in the period prior to vaccination era, the often-occurring measles epidemics left life-long immunity in the affected persons. Thus, natural and artificial immunizations provided extensive herd immunity. However, the ongoing measles epidemics in Europe have highlighted the fact that the symptoms and differential diagnosis related to measles have been relegated to the negligible category for the last 20 years. In addition to reviewing the consequences of the European measles pandemics in Hungary, the purpose of this paper is to revise and summarize the clinical and laboratory knowledge required to establish a definitive epidemiological control of measles. Orv Hetil. 2019; 160(20): 767-773.

Measles Epidemics in Romania: Lessons for Public Health and Future Policy.

Measles is a highly infectious viral disease that continues to be a challenge for many countries worldwide. Although significant improvements have been observed since the introduction of vaccines, measles remains endemic in Romania. Contributing factors include vaccine hesitancy, difficulties in delivering doses to the population, and even the lack of sufficient vaccine supplies. These problems are further exacerbated by an inadequate implementation of public health measures, ranging from inefficient communication programs to the absence of a legislative framework concerning immunization. Moreover, many of the recent outbreaks were associated with chains of transmission in other countries, thus making the control of measles in Romania relevant at an international level. As many difficulties exist, understanding the key factors that limit the success of public health programs may provide guidance in shaping future strategies. Because similar issues are being faced in various other countries, the management of measles in Romania offers valuable lessons for researchers and policy-makers alike.

What will it take to end fatalities from measles?

What will it take to end fatalities from measles?

Estimates of case-fatality ratios of measles in low-income and middle-income countries: a systematic review and modelling analysis

SummaryBackgroundIn the 21st century, increases in immunisation coverage and decreases in under-5 mortality have substantially reduced the global burden of measles mortality. However, the assessment of measles mortality burden is highly dependent on estimates of case-fatality ratios for measles, which can vary according to geography, health systems infrastructure, prevalence of underlying risk factors, and measles endemicity. With imprecise case-fatality ratios, there is continued uncertainty about the burden of measles mortality and the effect of measles vaccination. In this study, we aimed to update the estimations of case-fatality ratios for measles, to develop a prediction model to estimate case-fatality ratios across heterogeneous groupings, and to project future case-fatality ratios for measles up to 2030.MethodsWe did a review of the literature to identify studies examining measles cases and deaths in low-income and middle-income countries in all age groups from 1980 to 2016. We extracted data on case-fatality ratios for measles overall and by age, where possible. We developed and examined several types of generalised linear models and determined the best-fit model according to the Akaike information criterion. We then selected a best-fit model to estimate measles case-fatality ratios from 1990 to 2015 and projected future case-fatality ratios for measles up to 2030.FindingsWe selected 124 peer-reviewed journal articles published between Jan 1, 1980, and Dec 31, 2016, for inclusion in the final review—85 community-based studies and 39 hospital-based studies. We selected a log-linear prediction model, resulting in a mean case-fatality ratio of 2·2% (95% CI 0·7–4·5) in 1990–2015. In community-based settings, the mean case-fatality ratio was 1·5% (0·5–3·1) compared with 2·9% (0·9–6·0) in hospital-based settings. The mean projected case-fatality ratio in 2016–2030 was 1·3% (0·4–3·7).InterpretationCase-fatality ratios for measles have seen substantial declines since the 1990s. Our study provides an updated estimation of case-fatality ratios that could help to refine assessment of the effect on mortality of measles control and elimination programmes.FundingBill & Melinda Gates Foundation.

Measles in Bamako: Epidemiological, Clinical and Therapeutic Features of Patients Hospitalized at University Teaching Hospital of Point "G"

Measles is a highly contagious acute febrile eruptive disease. It can be prevented through vaccination. The aim of this study was to determine the epidemiological, clinical, and therapeutic features of measles cases hospitalized at Point "G" University Teaching Hospital. It was a retrospective study to review the medical files of patients hospitalized for measles between January 2010 and May 2011 at the Infectious Diseases Department of the Point "G" University Teaching Hospital. During the study period, 31 patients (6.4%) were treated for measles, and the majority of cases were seen in April months (20 cases) and May months (5 cases). The most affected age group was 9 - 59 months (58.1%) with a sex ratio of 1.38. The majority of patients (64.5%) consulted at least two health facilities before their hospitalization in Point “G” with an average of 5.3 ± 3.6 days from unset to the hospitalization. Measles immunization was not effective in 16 out of 26 patients and nearly one-third (29.0%) had familial contact measles case. Febrile rash, present in all patients, was associated with cough (96.8%), rhinitis (77.4%) and/or conjunctivitis (77.4%). Pneumonia was the most common complication (83.9%) followed by comorbidities such as gastroenteritis (29%), malnutrition (9.7%) and oral candidiasis (9.7%). Amoxicillin and ceftriaxone were the antibiotics frequently used against complications. Patients were hospitalized for an average of 6.9 ± 4.2 days, and no death was recorded. This study revealed that pneumonia was the main complication leading to hospitalization of patients. For a better control of measles, we need to fully respect the immunization schedule which is a guarantee for vaccine efficacy.

Strengthening immunization service delivery post Ebola virus disease (EVD) outbreak in Liberia 2015-2017.

IntroductionThe Ebola virus disease (EVD) outbreak in Liberia from 2014-2015 setback the already fragile health system which was recovering from the effects of civil unrest. This led to significant decline in immunization coverage and key polio free certification indicators. The Liberia investment plan was developed to restore immunization service delivery and overall health system.MethodsWe conducted a desk review to summarize performance of immunization coverage, polio eradication, measles control, new vaccines and technologies. Data sources include program reports, scientific and grey literature, District Health Information System (DHIS2), Integrated Diseases Surveillance and Response (IDSR) database, auto visual AFP detection and reporting (AVADAR) and ONA Servers. Data analysis was done using Microsoft excel spreadsheets, ONA software and Arc GIS.ResultsThere was a 36% increase in national coverage for Penta 3 in 2017 compared to 2014 from WUENIC data. Penta 3 dropout rate reduced by 2.5 fold from 15.3% in 2016 to 6.4% in 2017; while MCV1 coverage improved by 23% from 64% in 2015 to 87% in 2017. There was a rebound of non-polio AFP rate (NPAFP) rate from 1.2 in 2015 to 4.3 in 2017. Furthermore, there was a 2-fold increase in the number of AFP cases receiving 3 or more doses of OPV from 36% in 2015 to 61% in 2017.ConclusionLiberia demonstrated strong rebound of immunization services following the largest and most devastating EVD outbreak in West Africa in 2014 - 2015. Immunization coverage improved and dropout rates reduced. However, there are still opportunities for improvement in the immunization program both at national and sub-national levels.

Prediction of Measles Epidemic Trend in China

Measles is an acute respiratory disease with high mortality and strong infectivity. Based on the national measles report from 1950 to 2014, this paper established a measles incidence prediction model to provide reference for measles prevention and control decision-making. We selected the incidence data from 1996 to 2014 as the training sample, while data of 2015 as the test sample. A forecasting model of annual measles incidence in China was established by time series analysis, and the incidence of measles in 2016-2018 in China was forecasted. Finally, the changes of measles incidence over time and its distribution in different regions were discussed. It was found that the incidence of measles was higher in western Region before 2004, while the incidence of measles in eastern and northeastern regions was lower, but the measles epidemic in eastern region began to recover in 2005, and the reasons of regional difference were excavated. The result showed that the ARIMA (1,2,1) model was feasible and effective in predicting the incidence rate of measles.

Mathematical model for the study of transmission and control of measles with immunity at initial stage

Mathematical model for the study of transmission and control of measles with immunity at initial stage

Targeting Adults for Supplementary Immunization Activities of Measles Control in Central China: A Mathematical Modelling Study

Routine immunizations and supplementary immunization activities (SIAs) have significantly improved measles control over the past two decades in China. Progress towards eliminating measles currently faces multiple challenges as the infection age increases, and adult-targeted SIA strategies are being considered. This study developed an age-stratified susceptible-exposed-infectious-recovered model using a recently published contact matrix to depict measles transmissions between individuals in seven age groups. Hubei, a high measles-incidence province in central China, was the selected setting. The baseline scenario was calibrated by fitting with the 2012–2015 age-stratified incidence data. SIAs targeting multiple age groups were simulated. Adult-targeted (>29 years) two-year SIA cycles produced the greatest annual incidence rate decrease, reducing incidences by half over a long timespan with 90% coverage levels. Incidences could remain below 10/100,000 until 2030 if SIAs were provided to individuals ≥6 years old with at least 50% coverage. These findings will help officials prioritize supplementary vaccination strategies. Public health officials in China should consider adult-to-adult transmissions and provide adult-targeted SIAs. Although officials have reported approximately 90% SIA coverage in the past, SIAs for the adult population should be provided on shorter intervals, particularly for the aging population with decreased immunity.

Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016

We describe a measles outbreak and control measures implemented at a privately operated detention facility housing US Immigration and Customs Enforcement detainees in 2016. Case-patients reported fever and rash and were either laboratory-confirmed or had an epidemiological link to a laboratory-confirmed case-patient. Immunoglobulin G (IgG) avidity and plaque reduction neutralization tests distinguished between primary acute and reinfection case-patients. Measles-specific IgG was measured to assess detainee immunity levels. We compared attack rates (ARs) among detainees and staff, between IgG-negative and IgG-positive detainees, and by detainee housing units and sexes. We identified 32 measles case-patients (23 detainees, 9 staff); rash onsets were during 6 May-26 June 2016. High IgG avidity and neutralizing-antibody titers >40000 to measles (indicating reinfection) were identified in 18 (95%) and 15 (84%) of 19 tested case-patients, respectively. Among 205 unit A detainees tested for presumptive immunity, 186 (91%) had detectable IgG. Overall, the AR was 1.65%. ARs were significantly higher among detainees in unit A (7.05%) compared with units B-F (0.59%), and among male (2.33%) compared with female detainees (0.38%); however, ARs were not significantly different between detainees and staff or between IgG-negative and IgG-positive detainees. Control measures included the vaccination of 1424 of 1425 detainees and 190 of 510 staff, immunity verification for 445 staff, case-patient isolation, and quarantine of affected units. Although ARs were low, measles outbreaks can occur in intense-exposure settings, despite a high population immunity, underscoring the importance of high vaccination coverage and containment in limiting measles transmission.

Evaluation of measles surveillance system in Oyo State, Nigeria from 2011 - 2016

Background: In Nigeria, measles control is at the mortality reduction phase and surveillance is designed to raise routine immunization coverage. The evaluation of the measles surveillance system in Oyo state-Nigeria from 2011–2016 was conducted in January 2017. The objectives of the evaluation include: a) to describe the attributes and the process of operation of measles surveillance system in Oyo State- Nigeria; b) to determine whether the set objectives for establishing measles surveillance are being met or not; c) to determine the efficiency and effectiveness of the measles surveillance system and d) to make appropriate recommendations for improving the surveillance system. Methods & Materials: The evaluation was conducted using the CDC's Updated Guidelines for Evaluating Public Health Surveillance System, 2001. Interview of various stakeholders, review of relevant documents and resource materials and the analysis of January 2011–December 2016 data from the Oyo state Ministry of health measles surveillance system was done. Results: Findings from the evaluation revealed that the Measles surveillance system in Oyo State is still meeting its objective of identifying high risk population/areas. Data from the Measles Surveillance System has guided some public health interventions including targeted immunization activities aimed at hard-to-reach community. The Measles Surveillance System in Oyo State is simple, flexible and sensitive (in 2016, the Non-Measles Febrile Rash Illness (NMFRI) detection rate was 9.4/100,000). The detection rates ranged from 3.4–11.0 per 100,000 from 2011–2015. In the six-year period, Oyo State achieved NMFRI detection rate of ≥ 2 cases/100, 000. The system is representative, stable and generates high quality data. The system is acceptable to stakeholders but has a low positive predictive value ranging from 30.2% in 2011 to 2.05% in 2014. The annualized measles dose coverage ranged from 40.4% to 74.4% from 2012 to 2016 Conclusion: Based on the findings, we recommend that stakeholders continue to utilize the quality data generated from the effective measles surveillance system in Oyo State. This will guide appropriate public health interventions and address the challenges of measles morbidity and mortality in Oyo state which includes weak Routine Immunization System and poor-quality rounds of Supplemental Immunization Activities (SIAs).

Epidemiological Outbreaks of Measles Virus in Kazakhstan during 2015.

This study involved epidemiological surveillance of the measles virus (MV) in the territory of the Republic of Kazakhstan during 2015-2016. We detected MV genotype D8 in this season of measles outbreak. A total of 2,341 cases were registered and 19 were identified by genotyping. Sixteen of these samples were attributed to subgroup A of genotype D8, while 3 imported cases were represented by genotypes B3 and H1. Analysis of vaccination coverage showed that a large group of infected people were not vaccinated or did not have a reliable report on their vaccination status. This issue might increase the morbidity rate among the healthy population in outbreak seasons. To prevent the incidence caused by this problem, we have successfully introduced epidemiologic measures for the control of measles.