Dose Of Measles Vaccine Research Articles

Impact of mother\u2019s education on full immunization of children aged 12\u201323\u2009months in Eritrea: population and health survey 2010 data analysis

BackgroundAlthough vaccination coverage in Eritrea has improved in recent years, some children are still missing out, and it’s important to identify risk factors for lower coverage in order to target campaigns and interventions. The objective of this study was to assess: (1) the impact of maternal education on full immunization of children aged 12–23 months, and (2) whether the association was confounded or modified by other factors.MethodsThis study was a secondary data analysis of the Eritrean Population and Health Survey 2010 (EPHS 2010). In this analysis 1323 mothers of children aged 12–23 months were included. The outcome of the study was full immunization, defined as receiving all the WHO recommended basic vaccines: one dose of Bacillus Calmette-Gué rin (BCG), three doses of diphtheria-pertussis-tetanus(DPT), three doses of polio, and one dose of measles vaccine. The primary exposure was maternal education. Data on immunization coverage came from vaccination cards and from mothers’ or caretakers’ verbal reports. Bivariate and multivariable logistic regression analyses were performed.ResultFull vaccination coverage among children aged 12–23 months was 83%. Most children received BCG (95%), DPT1 (97%), DPT2 (96%), DPT3 (93%), polio1 (97%), polio2 (97%), polio3 (91%) and measles (92%). In unadjusted analyses, children of mothers with primary (OR = 2.75, 95% CI 1.74–4.37), and middle or above (OR = 3.16, 95% CI 2.09–4.78) education were more likely to be fully immunised. However, after adjusting for wealth, region, ANC visit, and vaccination card ownership, only the effect for primary education remained significant (OR = 2.34, 95% CI 1.30–4.21).ConclusionThe result of this study suggested that children of mothers who attained primary level were more likely to be fully vaccinated than children of mothers with no education. The association was influenced by wealth index of household, mothers ANC visit, region, and possession of vaccination card. The Expanded Program on Immunization of the Ministry of Health should target strategies to enhance full immunization among children of mothers with no education.

Temporal trend of measles cases and impact of vaccination on mortality in Jigawa State, Nigeria, 2013-2017: a secondary data analysis.

IntroductionMeasles is a highly infectious vaccine-preventable viral disease that mostly affects children less than five years old. Jigawa located in the north-west zone has the highest burden of measles in Nigeria. We reviewed Jigawa State measles surveillance data to identify measles trend and factors associated with mortality.MethodsWe conducted a secondary data analysis of measles specific integrated disease surveillance and response data for Jigawa State from January 2013 to December 2017. We extracted relevant variables and analyzed data using descriptive statistics and logistic regression model (α = 0.05). We estimated seasonal variation using an additive time series model.ResultsA total of 6,214 cases were recorded with 1038 (16.7%) confirmed by laboratory investigation. Only 1,185 (19.7%) had at least one dose of measles vaccine. Age specific attack and fatality rates were highest among children under the age of five years (503/100,000 and 1.8% respectively). The trend showed a decrease in number of cases across all the years. Seasonal variation existed with cases peaking in the first quarter. The likelihood of mortality associated with measles was higher among cases who had no vaccination (AOR = 4.7, 95% CI: 2.9-7.5) than those who had at least one dose of measles vaccine.ConclusionThere was a decrease in the trend of measles cases, however, the vaccination coverage was very low in Jigawa State. Receiving at least one dose of measles vaccine reduces mortality among the cases. Strengthening routine immunization will reduce number of cases and mortality associated with the disease.

Seroprevalence to Measles Virus after Vaccination or Natural Infection in an Adult Population, in Italy

An increase in measles cases worldwide, with outbreaks, has been registered in the last few years, despite the availability of a safe and highly efficacious vaccine. In addition to an inadequate vaccination coverage, even in high-income European countries studies proved that some vaccinated people were also found seronegative years after vaccination, thus increasing the number of people susceptible to measles infection. In this study, we evaluated the immunization status and the seroprevalence of measles antibodies among 1092 healthy adults, either vaccinated or naturally infected, in order to investigate the persistence of anti-measles IgG. Among subjects who received two doses of measles vaccine, the neutralizing antibody titer tended to decline over time. In addition, data collected from a neutralization assay performed on 110 healthy vaccinated subjects suggested an inverse correlation between neutralizing antibody titers and the time elapsed between the two vaccinations, with a significant decline in the neutralizing titer when the interval between the two doses was ≥11 years. On the basis of these results, monitoring the serological status of the population 10–12 years after vaccination could be important both to limit the number of people who are potentially susceptible to measles, despite the high efficacy of MMR vaccine, and to recommend a booster vaccine for the seronegatives.

A health benefit and cost-effectiveness analysis of pneumococcal conjugate vaccination program in Nigeria

Background: Nigeria ranks third just behind India and China in the global disease burden of pneumococcal disease. The current sustainability approach for an affordable pneumococcal conjugate vaccine (PCV) for the national immunization program from 2014 till 2025 involves a cost sharing plan funded with a 75% financial support from GAVI and a subsidy from Pfizer pharmaceuticals. There is a strong need to generate evidence on the cost-effectiveness of the national PCV program in Nigeria from 2014-2025 and beyond 2025.Methods: The following parameters (demography, disease burden, health services utilization and costs, vaccination coverage, vaccine efficacy, and vaccination costs) were used in a static cohort model to estimate the total cost, health and economic benefit, and cost-effectiveness of the implementation of PCV vaccination program, compared with no PCV vaccination among under-five children in Nigeria from 2014-2025 and from 2026-2033. A sensitivity analysis was conducted to evaluate the robustness of the data used.Results: The national PCV vaccination program would have an approximated 31.4% and 30% reduction of the total burden of pneumococcal diseases over the period of 2014-2025 and 2026-2033 respectively. One-way sensitivity analysis reveals vaccine efficacy as most sensitive parameter followed by disease incidence rate and treatment cost. Removal and addition of DTP3 and 3+1 (measles vaccine) dose respectively resulted to a similar ICER from both.Conclusions: The estimated ICER suggests that the national PCV program in Nigeria will be cost-effective post 2025 era. In addition, it is recommended for policy-makers adoption considering the budget and equity impact of the intervention in Nigeria.

Socio-Economic Determinants of Routine Immunization Coverage in Dutse, Jigawa State, Northern Nigeria, May 2018

Immunization is a cost-effective public health intervention to reduce morbidity and mortality associated with infectious diseases. The Nigeria Demographic and Health Survey of 2018 indicated that only 5.4% of children aged 12-23 months in Dutse, Jigawa State was fully immunized. The study was conducted to identify the determinants of routine immunization coverage in Dutse area of Jigawa state. The study adopted a cross-sectional method.450 children aged 12-23 months were sampled. Interviews of mothers of these children were carried out using a structured questionnaire to collect data on socio-demographic characteristics, knowledge of immunization, vaccination status of children and reasons for non-vaccination. The study defined a fully immunized child as a child who had received one dose of BCG, three doses of the oral polio vaccine, three doses of Diptheria-Pertussis-Tetanus vaccine and one dose of measles vaccine by 12 months of age. The study performed bivariate analysis and logistic regression using Epi-info software. The findings of the study reveal that the mean age of mothers and children were 27 years (standard error (SE): 0.27 year) and 17 months (SE: 0.8 months) respectively. 79% of mothers had no formal education while 84% did not possess satisfactory knowledge of immunization. Only 7.6% of children were fully immunized. Logistic regression showed that possessing satisfactory knowledge (Adjusted OR=18.4, 95% CI=3.6-94.7) and at least second¬ary education (Adjusted OR=3.6, 95% CI=1.2-10.6) were significantly correlated with full immunization. The major determinants of immunization coverage were maternal knowledge and educational status. Raising the level of maternal knowledge and increasing maternal literacy level is essential to improve immunization coverage in this community.

Progress towards measles elimination in Eritrea: 2003 - 2018.

IntroductionThe Expanded Program on Immunisation (EPI) has been operational in Eritrea since 1980. Eritrea has endorsed the resolution of the Regional Committee of the World Health Organisation African region, committing to a measles elimination goal for 2020 in the African Region. The country is implementing the recommended strategies.MethodsWe reviewed administrative coverage and WHO UNICEF coverage estimates for Diphtheria-Pertussis-Tetanus (DPT) and measles routine vaccination, as well as for measles supplemental immunization activities. We reviewed national surveillance performance and analyzed the epidemiological trends of measles as reported in the case-based surveillance database.ResultsEritrea has maintained more than 90% coverage with the first dose of measles vaccine at national level since 2001 and 88% MCV2 coverage from 2015 - 2017 according to the WHO-UNICEF coverage estimates. Since 2011, the country has not met the surveillance performance target of at least 80% districts reporting suspected measles cases with blood specimen. Measles incidence was between 16.8 - 24.7 cases per million population in the period 2015 - 2018. The mean and median age of confirmed measles cases was more than 10 years in 8 of the 14 years covered by the analysis. In 2017, Eritrea reported 1,199 cases of measles which differs significantly from the 185 suspected cases in the case based surveillance database for the same year. Eritrea has maintained high coverage for MCV1 and MCV2 and made progress towards measles elimination. However, the country has gaps in surveillance performance which may mask the true incidence of measles.ConclusionIn order to attain elimination of measles, Eritrea needs to implement measures to improve surveillance quality, to conduct regular risk assessment and implement targeted measures to close immunity gaps. In addition, setting up a national committee for the verification of measles elimination will help the country document progress and also to highlight and advocate for addressing issues related to data quality and performance gaps.

Madagascar 2018-2019 measles outbreak response: main strategic areas.

Introductionon October 4th, 2018, a measles outbreak was declared in Madagascar. This study describes the outbreak response in terms of coordination, case management, vaccination response and epidemiological surveillance.Methodsdata were collected using a line list and vaccination tally sheet. Serum samples were collected within 30 days of rash onset for laboratory testing; confirmation was made by detection of measles immunoglobulin M antibody.Resultsfrom September 2018 to May 2019, a total of 146,277 measles cases were reported which included 1394 (1%) laboratory-confirmed cases and 144,883 (99%) epidemiological link-confirmed cases. The outbreak affected equally males (72,917 cases; 49.85%) and females (73,233 cases; 50.06%). The sex was not specified for 127 (0.09%) cases. Case fatality rate and attack rate were high among children less than 5 years. Responses interventions include effective coordination, free of charge case management, reactive vaccination, strengthened real-time surveillance, communication and community engagement and the revitalization of the routine immunization. Reactive vaccination was implemented in different phases. A total of 7,265,990 children aged from 6 months to 9 years were vaccinated. Post campaign survey coverage was 95%, 96% and 97% for phase 1, 2, 3 respectively.Conclusionelimination of measles will be challenging in Madagascar because of low routine immunization coverage and the absence of a second dose of measles vaccine in the routine immunization schedule.

Prevalence of Maternal Measles Antibody and Its Associated Factors among Infants in Coastal Karnataka, India.

Background:The current recommendation in India to commence first dose of measles immunization is at 9 months of age. The effectiveness of measles vaccination is greatly impacted by the level of maternal measles antibody (MMA) during infancy.Objectives:To find the prevalence of MMA and to study the maternal and infant factors associated with persistence of MMA among the infants in a Indian rural community.Methodology:Dried blood spot sample was collected before vaccination among infants aged 9 months and above when they came for first dose of measles vaccine to assess measles-specific maternal IgG antibody titers by enzyme immunoassay. Maternal and child factors influencing persistence of MMA were collected by interviewing the mothers. Association between various factors affecting seropositivity was tested using univariate logistic regression analysis and strength of association is reported as risk ratio with 95% confidence interval.Results:Based on the qualitative estimation among all the recruited children (250) in the study, 4 (1.6%) infants showed the presence of MMA whereas 25 (10%) of children had MMA on quantitative estimation. The effect of maternal factors, child nutrition, and sociodemographic factors on the presence of MMA was not found to be statistically significant.Conclusion:The prevalence of persistent MMA (IgG titer ≥200 mIU/ml) among the infants aged 9–12 months was 10%. The choice of vaccinating infants at the end of 9 months for the first dose of measles vaccine is justified as the remaining (90%) of infants were susceptible for measles infection at this age.

Measles Outbreak Investigation in Pweto Health Zone—Haut-Katanga Province, DR of the Congo, 2018

Background: Sub-Saharan Africa reports repeated outbreaks of measles, a vaccine-preventable disease, which is notifiable under the Integrated Disease Surveillance and Response (IDSR) strategy in Democratic Republic of Congo (DRC). DRC has reported several outbreaks of measles in the last three years. Poor immunization coverage and weak health systems have been related with measles and other vaccination-preventable diseases’ outbreaks. The DRC has committed to eliminating measles by 2020. In this respect, we investigated one of the outbreaks that occurred in Pweto health zone (HZ), Haut-Katanga province, to describe the outbreak and identify risk factors. Methods: A cross-sectional study was designed to investigate a measles outbreak in Pweto health zone (HZ), Haut-Katanga province. Data entry and analysis were performed using EPI-Info version 7.1.0.6 and MS-Microsoft Excel. Findings: In seven months’ time, four health areas affected by a measles outbreak in Pweto health zone reported 116-suspected cases and 13 deaths. The cumulative attack rate of 42.3/100,000 population and case fatality rate (CFR) of 11.2% were recorded. Of these, 112 (96.5%) cases were ≤15 years of age, and 93 (80.2%) were zero dose of measles vaccine. Although, all age groups were concerned, under five years old were the most affected with 84 cases (72.4%). In response to the outbreak, a response immunization was organized with the support of MSF at the week 25 of the epidemic, when the epidemic curve started to decline. A response immunization involving 46,205 children from 6 to 59 was implemented and overall coverage of 99% (range: 95% - 105%) was achieved. Case management with vitamin A supplementation, active case search, routine immunization improvement and health education were some of the activities carried out to curb the outbreak. Conclusion: This confirmed measles outbreak was caused by failure to vaccinate (80.2% unvaccinated cases). Poor surveillance sensitivity and the community attitude about measles contributed to its spreading. Strengthening routine immunization, improving surveillance system and communication for behaviour change are required.

Impact of COVID-19 pandemic on health system & Sustainable Development Goal 3.

Impact of COVID-19 pandemic on health system & Sustainable Development Goal 3.

Mobile outreach health services for mothers and children in conflict-affected and remote areas: a population-based study from Afghanistan

ObjectiveTo assess whether sustained, scheduled mobile health team (MHT) services increase antenatal care (ANC), postnatal care (PNC) and childhood immunisation in conflict-affected and remote regions of Afghanistan.DesignCross-sectional, population-based study from...

Progress Toward Regional Measles Elimination - Worldwide, 2000-2018.

In 2010, the World Health Assembly (WHA) set the following three milestones for measles control to be achieved by 2015: 1) increase routine coverage with the first dose of 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 less than five cases per 1 million population, and 3) reduce global measles mortality by 95% from the 2000 estimate* (1). In 2012, WHA endorsed the Global Vaccine Action Plan,† with the objective of eliminating measles§ in five of the six World Health Organization (WHO) regions by 2020. This report updates a previous report (2) and describes progress toward WHA milestones and regional measles elimination during 2000-2018. During 2000-2018, estimated MCV1 coverage increased globally from 72% to 86%; annual reported measles incidence decreased 66%, from 145 to 49 cases per 1 million population; and annual estimated measles deaths decreased 73%, from 535,600 to 142,300. During 2000-2018, measles vaccination averted an estimated 23.2 million deaths. However, the number of measles cases in 2018 increased 167% globally compared with 2016, and estimated global measles mortality has increased since 2017. To continue progress toward the regional measles elimination targets, resource commitments are needed to strengthen routine immunization systems, close historical immunity gaps, and improve surveillance. To achieve measles elimination, all communities and countries need coordinated efforts aiming to reach ≥95% coverage with 2 doses of measles vaccine (3).

Factors Associated With Measles Transmission in the United States During the Postelimination Era

Measles cases and outbreaks continue to occur in the United States after the introduction of measles from endemic settings. To discern the factors associated with measles transmission in the United States after measles had been eliminated. This cross-sectional study was conducted from January 1, 2001, to December 31, 2017, in the United States among US residents and international visitors with confirmed measles. A maximum likelihood algorithm that uses the observed dates of rash onset and the known distribution of the serial interval (time between symptom onset in related consecutive cases) was applied to outbreak notification data to estimate the effective reproduction number (R), or the mean number of new infections generated per case. Transmissibility was assessed by comparing R based on the characteristics of primary and secondary cases of measles. Measles virus. Effective reproduction number (R), or the mean number of successful transmission events per case of measles (ie, the mean number of persons to whom each patient with measles spreads measles). A total of 2218 individuals with confirmed measles cases (1025 female, 1176 male, and 17 sex not reported; median age, 15 years [range, 0-89 years]) reported from 2001 to 2017 were evaluated. Among patients who received no doses of measles vaccine, R was 0.76 (95% CI, 0.71-0.81); among patients who received 1 dose of measles vaccine, R was 0.17 (95% CI, 0.11-0.26); among patients who received 2 doses or more of measles vaccine, R was 0.27 (95% CI, 0.17-0.39); and among patients with unknown vaccination status, R was 0.52 (95% CI, 0.44-0.60). Among patients born before 1957, R was 0.35 (95% CI, 0.20-0.58), and among those born on or after 1957, R was 0.64 (95% CI, 0.61-0.68). R was higher when primary and secondary cases of measles were patients aged 5 to 17 years (0.36 [95% CI, 0.31-0.42]) compared with assortative transmission in other age groups (<1 year, 0.14 [95% CI, 0.10-0.20]; 1-4 years, 0.25 [95% CI, 0.20-0.30]; 18-29 years, 0.19 [95% CI, 0.15-0.24]; 30-49 years, 0.15 [95% CI, 0.11-0.20]; ≥50 years, 0.04 [95% CI, 0.01-0.10]). The findings of this study support having high targets for 2-dose measles vaccine coverage, particularly among school-aged children in the United States.

LB16. The Role of Adults in the Measles Outbreak in New York State Outside of New York City, 2018–2019

BackgroundThe United States is experiencing the largest measles outbreak since elimination was declared in 2000, with the majority of cases in NYS reported in undervaccinated communities. The objective of this evaluation was to describe adult measles cases in the NYS measles outbreak outside of New York City (NYC).MethodsWe included all confirmed cases aged ≥18 years in NYS residents (excluding NYC) during October 1, 2018–July 25, 2019 that met the CSTE measles case definition. We defined measles cases attributable to adults as the sum of measles cases among adults and children who contracted disease directly from adults.ResultsAmong 371 confirmed measles cases, the median age was 5.5 years (range: 1 day to 64 years); 79 (21%) were in adults, 4 (5%) of whom were born before 1957 (3 unvaccinated and 1 with unknown vaccine status). Among the 75 cases born during or after 1957, 65 (87%) were unvaccinated or had unknown vaccine status, while 3 had one dose and 7 had 2 doses of measles vaccine. Notably, 5 of 11 internationally imported measles cases were adults, and all were unvaccinated or had unknown vaccine status. During the first month of the outbreak, 26 of the 51 (51%) cases were attributable to adults; of the 26, 15 (58%) were in adults and 11 (42%) were in children who acquired infection from adults (Figure 3).ConclusionThe majority of measles cases occurred in unvaccinated children emphasizing the importance of ongoing and focused efforts on pediatric vaccination. However, measles cases in unvaccinated adults played an important role in both importations and disease transmission early in the outbreak. These data strongly support current recommendations of 1 dose of measles, mumps, rubella vaccine (MMR) for most adults and 2 doses of MMR for adults traveling internationally and at high-risk such as those in outbreak areas, as determined by local/state public health. DisclosuresKirsten St. George, MAppSc, PhD, Akonni Biosystems (Other Financial or Material Support), ThermoFisher (Grant/Research Support), Zeptometrix (Other Financial or Material Support, royalty generating collaborative agreement). .

Measles Maternal Antibodies With Low Avidity Do Not Interfere With the Establishment of Robust Quantity and Quality Antibody Responses After the Primary Dose of Measles, Mumps, and Rubella Vaccine Administered at 12-Months of Age.

In this study, we illustrate, for the first time, that preexisting low-avidity neutralizing measles maternal antibodies do not interfere with the development of high concentrations of high-avidity measles antibodies in children immunized at age 12 months. This suggests that the quality of measles maternal antibodies, rather than the quantity, impacts immunogenicity of primary measles immunization.

LB15. Measles Outbreak in New York State (NYS) Outside of New York City, 2018–2019

BackgroundThe United States is experiencing one of the largest and longest measles outbreaks since elimination was declared in 2000 and is at risk of losing this status. Most cases occurring in NYS were reported in undervaccinated communities.MethodsWe included all confirmed NYS measles cases (excluding NYC) from outbreak counties from October 1, 2018 to July 25, 2019. We used the CSTE measles case definition requiring an acute febrile rash illness and either laboratory confirmation or direct epidemiologic linkage to a lab-confirmed case. For each case, demographic and clinical characteristics were obtained. A medical record review was completed for those reported to have an encounter at a hospital, emergency department, or urgent care center.ResultsThere were 371 cases of measles reported, including 11 internationally imported cases. Most occurred in Rockland county (n = 283); followed by Orange (n = 55), Westchester (n = 18), Sullivan (n = 14) and Greene (n = 1) (Figures 1 and 2). The median age was 5.5 years; 79% of all cases occurred among children younger than 18 years of age (Figure 3). Most cases (79%) had not received any doses of measles vaccine. Of the 371 cases, 263 (71%) were children who had received 0 doses of measles, mumps, rubella vaccine (MMR), 218 (83%) of whom were over 1 year of age (Table 1). There have been no deaths or documented cases of encephalitis. Twenty-eight (8%) patients were diagnosed with pneumonia and 25 (7%) patients were hospitalized. Among 17 hospitalized children, 5 (29%) were admitted to the intensive care unit (ICU) (ages 1 day to 7 years). There were two preterm births at 34 and 25 weeks gestation to women with measles while pregnant. During October 1, 2018–July 31, 2019, providers in outbreak counties vaccinated 72,465 individuals with MMR, a 46% increase from the same period the year prior.ConclusionUnvaccinated children were identified as the largest group affected and experienced severe complications; nearly 30% of hospitalized children were admitted to an ICU. These data support the critical need for continued education and outreach on the risks of measles and the value of vaccination to prevent continued circulation in undervaccinated communities and potential further cases of severe disease. DisclosuresKirsten St. George, MAppSc, PhD, Akonni Biosystems (Other Financial or Material Support), ThermoFisher (Grant/Research Support), Zeptometrix (Other Financial or Material Support, royalty generating collaborative agreement); others, no disclosures reported..

Effect of measles vaccination in infants younger than 9 months on the immune response to subsequent measles vaccine doses: a systematic review and meta-analysis

SummaryBackgroundVaccinating infants with a first dose of measles-containing vaccine (MCV1) before 9 months of age in high-risk settings has the potential to reduce measles-related morbidity and mortality. However, there is concern that early vaccination might blunt the immune response to subsequent measles vaccine doses. We systematically reviewed the available evidence on the effect of MCV1 administration to infants younger than 9 months on their immune responses to subsequent MCV doses.MethodsFor this systematic review and meta-analysis, we searched for randomised and quasi-randomised controlled trials, outbreak investigations, and cohort and case-control studies without restriction on publication dates, in which MCV1 was administered to infants younger than 9 months. We did the literature search on June 2, 2015, and updated it on Jan 14, 2019. We included studies reporting data on strength or duration of humoral and cellular immune responses, and on vaccine efficacy or vaccine effectiveness after two-dose or three-dose MCV schedules. Our outcome measures were proportion of seropositive infants, geometric mean titre, vaccine efficacy, vaccine effectiveness, antibody avidity index, and T-cell stimulation index. We used random-effects meta-analysis to derive pooled estimates of the outcomes, where appropriate. We assessed the methodological quality of included studies using Grading of Recommendation Assessment, Development and Evaluation (GRADE) guidelines.FindingsOur search retrieved 1156 records and 85 were excluded due to duplication. 1071 records were screened for eligibility, of which 351 were eligible for full-text screening and 21 were eligible for inclusion in the review. From 13 studies, the pooled proportion of infants seropositive after two MCV doses, with MCV1 administered before 9 months of age, was 98% (95% CI 96–99; I2=79·8%, p<0·0001), which was not significantly different from seropositivity after a two-dose MCV schedule starting later (p=0·087). Only one of four studies found geometric mean titres after MCV2 administration to be significantly lower when MCV1 was administered before 9 months of age than at 9 months of age or later. There was insufficient evidence to determine an effect of age at MCV1 administration on antibody avidity. The pooled vaccine effectiveness estimate derived from two studies of a two-dose MCV schedule with MCV1 vaccination before 9 months of age was 95% (95% CI 89–100; I2=12·6%, p=0·29). Seven studies reporting on measles virus-specific cellular immune responses found that T-cell responses and T-cell memory were sustained, irrespective of the age of MCV1 administration. Overall, the quality of evidence was moderate to very low.InterpretationOur findings suggest that administering MCV1 to infants younger than 9 months followed by additional MCV doses results in high seropositivity, vaccine effectiveness, and T-cell responses, which are independent of the age at MCV1, supporting the vaccination of very young infants in high-risk settings. However, we also found some evidence that MCV1 administered to infants younger than 9 months resulted in lower antibody titres after one or two subsequent doses of MCV than when measles vaccination is started at age 9 months or older. The clinical and public-health relevance of this immunity blunting effect are uncertain.FundingWHO.

Characteristics of the Epidemiological Situation of Measles in the Period of its Elimination in Republic of Moldova

Relevance Measles continues to be one of the priorities of health care worldwide, due to it high contagiosity, still widespread, severity of the disease and complications. A high degree of population migration contributes to the spread of infection, i.e. global measles virus circulation, clinical change and late diagnosis, inadequate immunization coverage. Aim. Analysis of measles incidence in the Republic of Moldova in 2000–2018. and features of the epidemic process. Materials and Methods. Statistics on measles incidence and immunization coverage in 2000–2018 were used. 340 cases of measles registered in the country in 2018 were subjected to a detailed analysis Results There is a decrease in measles vaccination coverage, in 2017–87.1%. In the same year, the coverage with the first revaccination at 6–7 years was 92.4% and the second at 14–15 years is 94.9%, which is not enough to maintain epidemiological well-being. There are territorial differences in vaccination coverage. In 2018, imported cases of measles were in 62.5% from Ukraine, 25.0% from Russia and 12.5% from Romania. There have been isolated measles cases (14), and epidemic foci or outbreaks (7), with from 2 to 252 cases of measles. The largest measles outbreak in 2018 was registered among those who rest in a religious camp unvaccinated against measles. The average age of the diseased is 14 years, and in outbreaks with a significant number of cases (9 and more) within 7.9–14.9 years. In the age structure of the diseased, children from 1 to 10 years old prevail (66.1%), children under one year old make up 8,2%, teenagers 17,5% and adults 8.2%. Only 11.0% received one dose of measles vaccine, and 3.6% of the relevant age groups received two doses of vaccine. The reason is the refusal of vaccination for religious motive. In 196 (57.6%) cases, the diagnosis was confirmed by laboratory methods, and in the remaining 144 (42.4%) by clinical and epidemiological data. Conclusions Measles remains a childhood infection, but cases of the disease occur among adolescents (17.5%) and adults (8.2%). The uneven of vaccination coverage throughout the country, the low level of responsibility of the population, the increased incidence of measles in neighboring countries, the high level of population migration are risk factors for the importation and spread of measles.

The programme of measles elimination in the WHO African region: current state of the problem

In the WHO African region (AFR), measles is characterized by severe complications with a high risk of death due to malnutrition, vitamin А deficiency, concomitant infections. Measles viruses of genotype B (B1, B2, B3) are the endemic viruses in the African region (47 countries). The strategy for the elimination of measles in AFR was based on the combination of supplementary immunization programmes (SIAs) for children under 14 years of age and routine vaccination of at least 90% of children 9-15 months of age. It was recommended to repeat the SIAs every 3-5 years. The number of measles cases decreased by 83-97% during the first year due to the strategy. The recommended age of routine vaccination in AFR is 9 months — this is a way to reduce measles-caused infant mortality. However, the level of seroconversion is not sufficient (85%). To eliminate measles completely by 2020, it’s recommended the use of two-dose regimens — vaccination and revaccination. Vaccination coverage with a single dose of measles vaccine in the African region increased to 74% in 2015, but the high incidence of measles in the region persists. In 2013-2016 there are 103,161 cases of measles among children under 6 years of age in AFR ; 79% of which were not vaccinated (or had unknown vaccination status). In 2013, the measles vaccine program in several AFR countries was disrupted by the epidemic of Ebola. In countries where the epidemic has ended, the vaccination was recommended to be resumed for persons who may have missed routine immunization. There are problems in the implementation of measles elimination in AFR: insufficient equipment of medical centers and lack of qualified personnel, poor population awareness, poorly developed communication system, military conflicts.

Age-appropriate vaccination coverage and its associated factors for pentavalent 1-3 and measles vaccine doses, in northeast Ethiopia: A community-based cross-sectional study.

BackgroundIn Ethiopia, there are limited studies on age-appropriate vaccinations that children received at the recommended specific ages. Therefore, we assessed age-appropriate vaccinations coverage and its associated factors among children 12 to 23 months of age in Menz Lalo district, northeast Ethiopia.MethodsA community-based cross-sectional study was conducted in Menz Lalo district from March to April/2018 among 417 mothers/caregivers with children 12 to 23 months of age using simple random sampling technique. Data were collected using a pretested structured questionnaire. Information about children’s vaccination status was collected from vaccination cards. Age-appropriate vaccination coverage was measured using World Health Organization vaccination schedule recommendation. Data was entered into Epi-Info7 software and exported to SPSS-20 for analysis. Four consecutive logistic regression models were performed to identify factors associated with age-inappropriate vaccinations. A P-value of ≤ 0.05 was considered to state statistically significant associations.ResultsAge-appropriate vaccination coverage was 39.1% (95% CI: 34.3 to 44) for pentavalent 1, 36.3% (95% CI: 31.6 to 41.5) for pentavalent 2, 30.3% (95% CI: 25.6 to 35) for pentavalent 3 and 26.4% (95% CI: 21.7 to 31) for measles vaccine doses. Age-inappropriate pentavalent 1–3 vaccinations was associated with being male sex (AOR: 0.47, 95% CI: 0.29–0.74), lack of telephone (AOR: 2.2, 95% CI: 1.4–3.6), lack of usual caretaker (AOR: 2.6, 95% CI: 1.3–5.2), unplanned pregnancy (AOR: 1.9, 95% CI: 1.1–3.5), missing pregnant women’s conference (AOR: 2.7, 95% CI: 1.3–5.7), decreasing birth order (AOR: 0.34, 95% CI: 0.17–0.68) and insufficient knowledge (AOR: 2.7, 95% CI: 1.6–4.4).ConclusionThe proportions of age-appropriate vaccination coverage were low in the study area. Modifiable factors were associated with age-inappropriate vaccinations. Vaccination interventions should consider identified modifiable factors to improve age-appropriate vaccinations coverage.