Dose Of MMR Research Articles

Vital Signs: Trends and Disparities in Childhood Vaccination Coverage by Vaccines for Children Program Eligibility - National Immunization Survey-Child, United States, 2012-2022.

The Vaccines for Children (VFC) program was established in 1994 to provide recommended vaccines at no cost to eligible children and help ensure that all U.S. children are protected from life-threatening vaccine-preventable diseases. CDC analyzed data from the 2012-2022 National Immunization Survey-Child (NIS-Child) to assess trends in vaccination coverage with ≥1 dose of measles, mumps, and rubella vaccine (MMR), 2-3 doses of rotavirus vaccine, and a combined 7-vaccine series, by VFC program eligibility status, and to examine differences in coverage among VFC-eligible children by sociodemographic characteristics. VFC eligibility was defined as meeting at least one of the following criteria: 1) American Indian or Alaska Native; 2) insured by Medicaid, Indian Health Service (IHS), or uninsured; or 3) ever received at least one vaccination at an IHS-operated center, Tribal health center, or urban Indian health care facility. Overall, approximately 52.2% of U.S. children were VFC eligible. Among VFC-eligible children born during 2011-2020, coverage by age 24 months was stable for ≥1 MMR dose (88.0%-89.9%) and the combined 7-vaccine series (61.4%-65.3%). Rotavirus vaccination coverage by age 8 months was 64.8%-71.1%, increasing by an average of 0.7 percentage points annually. Among all children born in 2020, coverage was 3.8 (≥1 MMR dose), 11.5 (2-3 doses of rotavirus vaccine), and 13.8 (combined 7-vaccine series) percentage points lower among VFC-eligible than among non-VFC-eligible children. Although the VFC program has played a vital role in increasing and maintaining high levels of childhood vaccination coverage for 30 years, gaps remain. Enhanced efforts must ensure that parents and guardians of VFC-eligible children are aware of, have confidence in, and are able to obtain all recommended vaccines for their children.

Persistence of Antibodies against Measles, Mumps, and Rubella after the Two-Dose MMR Vaccination: A 7-Year Follow-Up Study.

In 2014, the Expanded Program on Immunization of Thailand changed the timing of the second dose of the measles-mumps-rubella (MMR) vaccine from 4-6 years to 2.5 years, while maintaining the first dose at 9 months of age. This study aimed to examine the dynamics and durability of immune responses induced by the two-dose MMR vaccine in a group of 169 Thai children from 4 to 7 years of age (4.5 years after the second MMR dose). We followed a cohort of healthy children from a clinical trial (ClinicalTrials.gov NCT02408926) where they were administered either the Priorix vaccine (GlaxoSmithKline Biologicals, Rixensart, Belgium) or M-M-RII (Merck & Co., Kenilworth, NJ, USA) at 9 months and 2.5 years of age. Blood samples were collected annually from ages 4 to 7 years. Anti-measles, -mumps, and -rubella IgG levels were evaluated using the enzyme-linked immunosorbent assay (EUROIMMUN, Lubeck, Germany). A total of 169 children completed this study. Over the 4.5 years following the two-dose MMR vaccination, we observed a decline in the seroprotection rates against measles and mumps, but not rubella. Longitudinal monitoring of antibody persistence, among other strategies, will help predict population-level immunity and inform public health interventions to address potential future outbreaks.

Struggling to resume childhood vaccination during war in Myanmar: evaluation of a pilot program

BackgroundAfter the military coup in Myanmar in February 2021, the health system began to disintegrate when staff who called for the restoration of the democratic government resigned and fled to states controlled by ethnic minorities. The military retaliated by blocking the shipment of humanitarian aid, including vaccines, and attacked the ethnic states. After two years without vaccines for their children, parents urged a nurse-led civil society organization in an ethnic state to find a way to resume vaccination. The nurses developed a vaccination program, which we evaluated.MethodsA retrospective cohort study and participatory evaluation were conducted. We interviewed the healthcare workers about vaccine acquisition, transportation, and administration and assessed compliance with WHO-recommended practices. We analyzed the participating children’s characteristics. We calculated the proportion of children vaccinated before and after the program. We calculated the probability children would become up-to-date after the program using inverse survival.ResultsSince United Nations agencies could not assist, private donations were raised to purchase, smuggle into Myanmar, and administer five vaccines. Cold chain standards were maintained. Compliance with other WHO-recommended vaccination practices was 74%. Of the 184 participating children, 145 (79%, median age five months [IQR 6.5]) were previously unvaccinated, and 71 (41%) were internally displaced. During five monthly sessions, the probability that age-eligible zero-dose children would receive the recommended number of doses of MMR was 92% (95% confidence interval [CI] 83–100%), Penta 87% (95% CI 80%–94%); BCG 76% (95% CI 69%–83%); and OPV 68% (95% CI 59%–78%). Migration of internally displaced children and stockouts of vaccines were the primary factors responsible for decreased coverage.ConclusionsThis is the first study to describe the situation, barriers, and outcomes of a childhood vaccination program in one of the many conflict-affected states since the coup in Myanmar. Even though the proportion of previously unvaccinated children was large, the program was successful. While the target population was necessarily small, the program’s success led to a donor-funded expansion to 2,000 children. Without renewed efforts, the proportion of unvaccinated children in other parts of Myanmar will approach 100%.

Early B cell transcriptomic markers of measles-specific humoral immunity following a 3rd dose of MMR vaccine.

B cell transcriptomic signatures hold promise for the early prediction of vaccine-induced humoral immunity and vaccine protective efficacy. We performed a longitudinal study in 232 healthy adult participants before/after a 3rd dose of MMR (MMR3) vaccine. We assessed baseline and early transcriptional patterns in purified B cells and their association with measles-specific humoral immunity after MMR vaccination using two analytical methods ("per gene" linear models and joint analysis). Our study identified distinct early transcriptional signatures/genes following MMR3 that were associated with measles-specific neutralizing antibody titer and/or binding antibody titer. The most significant genes included: the interleukin 20 receptor subunit beta/IL20RB gene (a subunit receptor for IL-24, a cytokine involved in the germinal center B cell maturation/response); the phorbol-12-myristate-13-acetate-induced protein 1/PMAIP1, the brain expressed X-linked 2/BEX2 gene and the B cell Fas apoptotic inhibitory molecule/FAIM, involved in the selection of high-affinity B cell clones and apoptosis/regulation of apoptosis; as well as IL16 (encoding the B lymphocyte-derived IL-16 ligand of CD4), involved in the crosstalk between B cells, dendritic cells and helper T cells. Significantly enriched pathways included B cell signaling, apoptosis/regulation of apoptosis, metabolic pathways, cell cycle-related pathways, and pathways associated with viral infections, among others. In conclusion, our study identified genes/pathways linked to antigen-induced B cell proliferation, differentiation, apoptosis, and clonal selection, that are associated with, and impact measles virus-specific humoral immunity after MMR vaccination.

Long-term Neutralizing Antibody Levels Against Measles and Rubella Viruses Among Adults With 3 Doses of Measles-Mumps-Rubella Vaccine.

A third dose of measles-mumps-rubella vaccine (MMR) may be administered for various reasons, but data on long-term immunity are limited. We assessed neutralizing antibody levels against measles and rubella among adults up to 11 years after receipt of a third MMR dose. In this longitudinal study, healthy adults who received a third MMR dose as young adults (ages 18-28 years) were recalled around 5 years and 9-11 years after the third dose. Measles and rubella antibody levels were assessed by plaque-reduction and immunocolorimetric neutralization assays, respectively. Antibody concentrations <120 mIU/mL and <10 U/mL were considered potentially susceptible to measles and rubella, respectively. Geometric mean concentrations (GMCs) and 95% confidence intervals (CIs) over time were estimated from generalized estimating equation models. Approximately 5 and 9-11 years after receipt of the third dose, 405 and 304 adults were assessed, respectively. Measles GMC was 428 mIU/mL (95% CI, 392-468 mIU/mL) 5 years postvaccination, declining to 381 mIU/mL (95% CI, 339-428 mIU/mL) 11 years postvaccination. At the last follow-up visit (9-11 years postvaccination), 10% of participants were potentially susceptible to measles infection. Rubella GMCs were stable throughout the follow-up period (63 U/mL to 65 U/mL); none of the participants was susceptible to rubella at the last follow-up visit. Eleven years after receiving a third MMR dose, measles and rubella neutralizing antibody levels remained high in adults. However, on the basis of waning antibody levels, some adults may become susceptible to measles infection over time despite receipt of 3 vaccine doses.

The decline of measles antibody titers in previously vaccinated adults: a cross-sectional analysis.

The global reemergence of measles in 2018-2019 reinforces the relevance of high-coverage immunization to maintain the disease elimination. During an outbreak in the Sao Paulo State in 2019, several measles cases were reported in individuals who were adequately vaccinated according to the current immunization schedule recommends. This study aimed to assess measles IgG antibody seropositivity and titers in previously vaccinated adults. A cross-sectional study was conducted at CRIE-HC-FMUSP (Sao Paulo, Brazil) in 2019. It included healthy adults who had received two or more Measles-Mumps-Rubella vaccines (MMR) and excluded individuals with immunocompromising conditions. Measles IgG antibodies were measured and compared by ELISA (Euroimmun®) and chemiluminescence (LIASON®). The association of seropositivity and titers with variables of interest (age, sex, profession, previous measles, number of measles-containing vaccine doses, interval between MMR doses, and time elapsed since the last MMR dose) was analyzed. A total of 162 participants were evaluated, predominantly young (median age 30 years), women (69.8%) and healthcare professionals (61.7%). The median interval between MMR doses was 13.2 years, and the median time since the last dose was 10.4 years. The seropositivity rate was 32.7% by ELISA and 75.3% by CLIA, and a strong positive correlation was found between the tests. Multivariate analyses revealed that age and time since the last dose were independently associated with positivity. Despite being a single-center evaluation, our results suggest that measles seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose.

1148. Long-term Persistence of Measles and Rubella Virus Neutralizing Antibody Levels among Adults with Three Doses of Measles-Mumps-Rubella Vaccine

Abstract Background A third dose of measles-mumps-rubella vaccine (MMR) may be administered for various reasons, but there are limited data on long-term immunogenicity. We assessed persistence of measles and rubella neutralizing antibodies among adults after receipt of three MMR doses. Methods Adults who received two MMR doses in childhood and a third dose as young adults (aged 18-28 years) in 2009-2010 were recalled at around 5 (2014-2016) and 9-11 (2019-2021) years after receipt of the third MMR dose. Measles and rubella antibody levels were assessed by plaque-reduction and soluble immunocolorimetric neutralization assays, respectively. Participants with measles antibody concentrations &amp;lt; 120 mIU/ml or rubella antibody concentrations &amp;lt; 10 U/mL were considered potentially susceptible to infection. Generalized estimating equations models were used to estimate geometric mean concentrations (GMC) and 95% confidence intervals (CI) of antibody levels over time. Results Approximately 5 and 9-11 years after receipt of the third MMR dose, 408 (aged 22-33 years) and 304 (aged 26-37 years) adults were reassessed, respectively. For measles, GMC was 428 mIU/mL (95% CI, 392 – 468 mIU/mL) at 5 years after the third MMR dose, declining to 381 mIU/mL (95% CI, 339 – 428 mIU/mL) at 11 years after the third MMR dose (Fig 1). Measles antibody concentrations during both long-term follow-up periods declined to levels lower than before receipt of the third dose (Fig 2). At the last follow-up visit (2019-2021), 10% of participants were potentially susceptible to measles infection compared to 3% before receipt of the third MMR dose up to 11 years earlier. For rubella, GMCs were stable throughout the long-term follow-up period (63 U/mL to 65 U/mL) (Fig 3). Rubella antibody concentrations during the long-term follow-up periods remained higher than levels before receipt of the third MMR dose and were similar to levels at 1 year after receipt of the third MMR dose (Fig 2). None of the participants were susceptible to rubella at the last follow-up visit. The solid black line shows the trend in population GMC estimates from before vaccination (0 year) through 12 years after receipt of the third MMR dose. The gray lines show the measles virus antibody concentrations over time for each individual. The dotted horizontal line shows concentration &amp;lt;120 mIU/mL used as the cutoff for susceptibility. The vertical dotted lines represent the cutoff for susceptibility. The geometric mean concentrations (GMCs) were estimated using generalized estimating equations model. The solid black line shows the trend in population GMC estimates from before vaccination (0 year) through 12 years after receipt of the third MMR dose. The gray lines show the rubella virus antibody concentrations over time for each individual. The dotted horizontal line shows concentration &amp;lt;10 U/mL used as the cutoff for susceptibility. Conclusion Neutralizing antibody levels to measles and rubella remained high and persisted through 11 years after vaccination among adults who received three MMR doses. However, some adults may become susceptible to measles infection over time despite receipt of three MMR doses. Disclosures Stephen N. Crooke, PhD, Bionano Genomics: Stocks/Bonds|Caribou Biosciences: Stocks/Bonds|Pfizer: Stocks/Bonds|Vistagen Therapeutics: Stocks/Bonds Huong McLean, PhD, MPH, Seqirus: Grant/Research Support

Mumps vaccine effectiveness of a 3rd dose of measles, mumps, rubella vaccine in school settings during a mumps outbreak -- Arkansas, 2016-2017

ObjectivesThe largest mumps outbreak in the United States since 2006 occurred in Arkansas during the 2016-17 school year. An additional dose (third dose) of measles-mumps-rubella vaccine (MMR3) was offered to school children. We evaluated the vaccine effectiveness (VE) of MMR3 compared with two doses of MMR for preventing mumps among school-aged children during the outbreak. Study designA generalized linear mixed effects model was used to estimate the incremental vaccine effectiveness (VE) of a third dose of MMR compared with two doses of MMR for preventing mumps. MethodsWe obtained school enrollment, immunization status and mumps case status from school registries, Arkansas's immunization registry, and Arkansas's mumps surveillance system, respectively. We included students who previously received 2 doses of MMR in schools with ≥1 mumps case after the MMR3 clinic. We used a generalized linear mixed model to estimate VE of MMR3 compared with two doses of MMR. ResultsSixteen schools with 9272 students were included in the analysis. Incremental VE of MMR3 versus a two-dose MMR regimen was 52.7% (95% confidence interval [CI]: -3.6%‒78.4%) overall and in 8 schools with high mumps transmission it was 64.0% (95% CI: 1.2%‒86.9%). MMR3 VE was higher among middle compared with elementary school students (68.5% [95% CI: -30.2%‒92.4%] vs 37.6% [95% CI: -62.5%‒76.1%]); these differences were not statistically significant. ConclusionOur findings suggest MMR3 provided additional protection from mumps compared with two MMR doses in elementary and middle school settings during a mumps outbreak.

Unmet vaccination need among children under the age of five attending the paediatric emergency department: a cross-sectional study in a large UK district general hospital

ObjectiveTo estimate vaccination coverage among children under the age of five attending the paediatric emergency department (PED) using tetanus and MMR vaccination as a proxy.DesignA cross-sectional observational study with a...

Safety of measles, mumps, and rubella vaccine in adolescents and adults in the vaccine safety Datalink

Measles, mumps, and rubella vaccine (MMR) is routinely administered to children; however, adolescents and adults may receive MMR for various reasons. Safety studies in adolescents and adults are limited. We report on safety of MMR in this age group in the Vaccine Safety Datalink. We included adolescents (aged 9-17years) and adults (aged≥18years) who received≥1 dose of MMR from January 1, 2010-December 31, 2018. Pre-specified outcomes were identified by diagnosis codes. Clinically serious outcomes included anaphylaxis, encephalitis/myelitis, Guillain-Barré syndrome, immune thrombocytopenia, meningitis, and seizure. Non-serious outcomes were allergic reaction, arthropathy, fever, injection site reaction, lymphadenopathy, non-specific reaction, parotitis, rash, and syncope. All serious outcomes underwent medical record review. Outcome-specific incidence was calculated in pre-defined post-vaccination windows. A self-controlled risk interval design was used to determine the relative risk of each outcome in a risk window after vaccination compared to a more distal control window. During the study period, 276,327 MMR doses were administered to adolescents and adults. Mean age of vaccinees was 34.8years; 65.8% were female; 53.2% of doses were administered simultaneously with≥1 other vaccine. Serious outcomes were rare, with incidence≤6 per 100,000 doses for each outcome assessed, and none had a significant elevation in incidence during the risk window compared to the control window. Incidence of non-serious outcomes per 100,000 doses ranged from 3.4 for parotitis to 263.0 for arthropathy. Other common outcomes included injection site reaction and rash (157.0 and 112.9 per 100,000 doses, respectively). Significantly more outcomes were observed during the risk window compared to the control window for all non-serious outcomes except parotitis. Some variability was observed by sex and age group. Serious outcomes after MMR are rare in adolescents and adults, but vaccinees should be counseled regarding anticipated local and systemic non-serious adverse events.

435. Investigation of the cause of low measles seroprevalence among young healthcare workers in South Korea

Abstract Background After a large measles outbreak in 2000∼2001, national measles vaccination program was implemented in Korea, and more than 95% of people born after 1985 have been vaccinated with 2-dose MMR. But sporadic outbreaks have continued to occur mainly in adults in their 20’s and 30’s in 2014 and 2019. Although low prevalence in young adults have been reported, there are limited data regarding the cause of low seropositivity (positive vaccine failure vs. secondary vaccine failure). We aimed to evaluate the cause of low seroprevalence of measles. Methods This study was performed in a 2743-bed tertiary-care hospital in South Korea. At 1-month after MMR vaccination in healthcare workers (HCWs) who were seronegative for measles, we performed measles antibody test(enzyme immunoassay), IgM/IgG index ratio, and avidity test. Results Of the 1,698 new HCWs in 2020 and, 1,686 in 2021, 54 HCWs with negative measles IgG at their entering at our hospital were enrolled in this study. Of these, 36(67%) were female, and the median age was 25 (IQR, 24-27) years. Of 43 HCWs who measured IgM/IgG index 1 month after MMR vaccination, 38 HCWs had IgM/IgG index of less than 1 and remaining 5 had negative IgG results (seroconversion rate of 88%). All 54 healthcare workers who performed avidity test showed high avidity index Measles vaccination record in KCDA showed that 45 had documented vaccination record during their childhood (of these, 11 received MMR vaccine again during their adult age) and remaining 9 had no documented vaccination record during their childhood. Of these 9 healthcare workers without record in their childhood, 3 had a history of vaccination at adult. Analyzing 48 healthcare workers with vaccination record, they received MMR vaccination median 18 years (IQR, 7-20) before. Therefore, at least 48 received at least 2 dose MMR vaccination, and 11 received at least 3 dose MMR vaccination. Conclusion Secondary vaccine failure may be the reason for vaccine failure in young adults in Korea. Therefore, HCWs with negative measles antibody who were born after 1985 may receive 1 dose booster vaccination rather than 2 dose vaccination. Disclosures All Authors: No reported disclosures.

Biological Profile and Clinical Features as Determinants for Prolonged Hospitalization in Adult Patients with Measles: A Monocentric Study in Western Romania.

Measles is a highly infectious and sometimes deadly illness that is preventable with vaccination. The present research aims to analyze the most recent measles epidemic from Romania that occurred in a population with a falling desire to receive immunizations, by detailing the clinical picture and biological profile of hospitalized patients. A secondary goal of the present research is to identify characteristics that increase the likelihood of a longer hospitalization and the development of measles-related pneumonia. A retrospective cohort study was conducted to follow the course and effects of measles virus infection in adult hospitalized patients who were divided into two groups based on whether they had been in the hospital for more than 6 days or fewer than 6 days. A total of 114 adult patients with measles were eligible to participate in the trial if they had a positive measles-specific IgM antibody test resulting from the study. The average age in the short hospital stay group was 28.1 years, while the average age in the long hospital stay group was 31.9 years. There was a statistically significant difference in the number of Roma persons in the research groups, with 17.4 percent of them having a lengthy hospital stay compared to 5.9 percent in the group with a short hospital stay, according to the findings. It was observed that many patients had a long hospitalization associated with chronic lung disease (OR = 1.07), liver damage (OR = 1.66), Roma ethnicity (OR = 1.79), a long duration elapsed from the last MMR dose (OR = 2.02), elevated c-reactive protein (OR = 2.17), the presence of bilateral pulmonary condensations on X-ray (OR = 3.13), and elevated procalcitonin (OR = 3.49). The same significant independent risk factors were also associated with the development of pneumonia. It is of imperative need to address these risk factors in a patient with measles, moreover in association with an unknown status of vaccination. Vaccination awareness against measles must be pushed in Romania to determine a higher than 95% coverage. Significant efforts are still needed to ensure improved protection against measles epidemics within a specific region or population and, more importantly, in patients with significant risk factors for complications, as described in this study.

Vaccination Against Measles, Mumps, Rubella and Incident Inflammatory Bowel Disease in a National Cohort of Privately Insured Children.

Infection is believed to be a potential trigger for inflammatory bowel disease (IBD). Whether vaccination against childhood infections including measles, mumps, and rubella may reduce risk of IBD is uncertain. We conducted a retrospective cohort study using de-identified claims data from a national private payer (Optum Clinformatics Data Mart). Eligible infants were born between 2001 and 2018 and were continuously enrolled with medical and pharmacy coverage from birth for at least 2 years (n = 1 365 447). Measles, mumps, and rubella vaccination or MMR is administered beginning at 12 months of age. Cox proportional hazard regression models were used to compare time with incident disease in children by category of vaccination, after adjustment for sex, birth year, region of country, history of allergy to vaccines, and seizure history. The incidence of early pediatric IBD increased between 2001 and 2018. Ten percent (n = 141 230) of infants did not receive MMR, and 90% (n = 1 224 125) received at least 1 dose of MMR. There were 334 cases of IBD, 219 cases of Crohn's disease, and 164 cases of ulcerative colitis. Children who had received at least 1 dose of MMR had lower risk for IBD than children who did not (hazard ratio, 0.71; 95% confidence interval, 0.59-0.85). These associations did not change after further adjustment for childhood comorbid conditions, preterm birth, or older siblings affected with IBD. Similar associations were observed for MMR with Crohn's disease and ulcerative colitis, although these did not reach statistical significance. MMR is associated with decreased risk for childhood IBD.

Rubella antibodies in vertically and horizontally HIV-infected young adults vaccinated early in life and response to a booster dose in those with seronegative results

BackgroundVery limited data are available on the persistence of rubella antibodies in vertically HIV-infected individuals who were vaccinated early in life. MethodsProspective, cohort study on 4 groups of patients: 96 vertically HIV-1-infected individuals (v-HIV), 69 horizontally HIV-1-infected individuals (h-HIV), 93 healthy controls previously vaccinated for rubella (vac-CON) and 20 healthy controls with history of rubella disease (dis-CON). A blood sample was collected and rubella antibodies were analyzed by ELISA. Rubella antibodies above 10 IU/mL were considered protective. Individuals with seronegative results were offered an extra MMR vaccine dose and were tested at least 30 days afterwards. ResultsTime since previous rubella vaccination was similar in v-HIV, h-HIV and vac-CON (16, 11 and 11 years; p = 0.428). v-HIV and h-HIV were also comparable regarding median CD4 T cells (613 and 614 cells/mm3; p = 0.599) and percentage on ART (93.8% and 98.6%; p = 0.135) at study entry. v-HIV had less individuals on virological suppression (63.5%) compared to 85.5% in h-HIV (p < 0.001). Rubella seropositivity and antibodies were significantly lower in v-HIV compared to h-HIV (32.3% vs 65.5%, 4.3 IU/mL vs 21.1 IU/mL; p < 0.001). Time interval between the last rubella vaccine dose and study entry was associated with an increase of rubella seronegativity, with a 7% higher chance of seronegativity for each one-year increase. After an extra MMR dose, 40 out of 48 (83.3%) seronegative individuals responded, with no significant difference among groups considering rubella seropositivity and antibody levels. ConclusionAs vertically HIV-infected individuals reach adolescence and adulthood, assessment of vaccine antibodies can identify those who might benefit from an extra vaccine dose.

Catch-up vaccination campaign in children between 6 and 8 years old during COVID-19 pandemic: The experience in a COVID hub in Milan, Italy

BackgroundCOVID-19 has led to disruption in routine immunization programs around the world. Effective strategies need to be developed to address the decline in vaccine coverage to avoid preventable disease outbreaks. Our study reports a 4-days campaign for the catching-up of missed vaccinations in children aged between 6 and 8 years, in Milan, Italy. MethodsThe catch-up vaccination campaign (21st-24th of September 2021) involved children born in 2013, 2014 and 2015. These cohorts, if not already immunized, received the fourth dose of the Diphtheria-Tetanus-acellular Pertussis and Poliomyelitis vaccination (DTaPP4), the second dose of the Measles-Mumps and Rubella vaccination (MMR2) and Chickenpox, according to the Italian vaccine schedule. Results3,943 letters were sent to children with a missing vaccination. 1,315 children, 33% of expected, were vaccinated during the campaign. The 2015 cohort was the one that benefited most from the initiative, 955 children were vaccinated for a total of 1,864 doses administered. This has led to a significant increase of 20.0 percentage points (p.p.) in vaccination coverages for the fourth dose of DTaPP and the second dose of MMR. 214 children for the 2014 cohort and 146 for the 2013 cohort were vaccinated during the following days, these cohorts have been already called previously therefore the participation in the campaign and consequently the increase in vaccination coverages were less substantial. ConclusionsThis experience has demonstrated that a mass vaccination campaign could be a useful tool in catch-up strategies, even during the pandemic. It should be part of a bigger immunization program strategy that also includes efforts to simultaneously strengthen routine immunization services. With the appropriate organizational improvements, this initiative could pave the way for future successful campaigns involving different age groups and vaccinations.

Titerphilia - The Irresistible Urge to Measure Postimmunization Antibody Values.

Some physicians and parents request to measure antimeasles serum IgG antibodies after measles-mumps-rubella (MMR) vaccination. Often, vaccine skeptical parents want to know if their child is "immune" after the first dose to avoid the second dose. In the usual healthy child, this should be discouraged for the following reasons. Commercially available antibody assays do not measure functional (neutralizing) antibodies. They cannot reliably measure immunity against measles and were designed to measure naturally acquired antibodies rather than those induced by vaccination. Furthermore, MMR also includes mumps and rubella vaccine viruses, which also require 2 doses for optimal protection; there is no reliable serologic correlate of protection for mumps. Therefore, the 2-dose MMR immunization concept is by far more effective, efficient and reliable than a single dose strategy based on a post-dose 1 positive anti-measles-IgG test. Consequently, physicians should resist the desire to measure antimeasles IgG antibodies unless there is a clear indication (e.g., immunodeficiency) or official recommendation as part of the national immunization program.

Second dose of measles-mumps-rubella-varicella vaccine (MMRV) and the risk of febrile convulsions

IntroductionStudies have shown an increased risk of febrile convulsions (FC) after first immunization with the quadrivalent measles-mumps-rubella-varicella vaccine (MMRV) compared to a first dose of measles-mumps-rubella vaccine (MMR) only or in combination with separately administered varicella vaccine (MMR + V). Therefore, it is recommended to give MMR + V at first dose and MMRV or MMR + V at second dose. Little is known on the risk of FC after MMRV at second dose, especially whether the risk depends on age, sex, history of FC or type of first dose vaccine. MethodsA retrospective cohort study using claims data from the German Pharmacoepidemiological Research database (GePaRD) was performed in children born between January 1st, 2004 and October 31st, 2015 who received two doses of MMRV, MMR + V or MMR. Cases were defined as hospitalization with a diagnosis of FC without neurological conditions coded as main discharge diagnosis. Unadjusted and adjusted odds ratios (OR) with 95% confidence intevals (CIs) were calculated to compare the risk of FC. Stratified analyses were performed to examine potential effect modification by age, sex, history of FC or type of first dose vaccine. ResultsIn the first 30 days after second dose vaccination, 464 FCs were observed in a cohort of 528,639 children with a median age of 17 months. After adjustment for potential confounders, the adjusted OR for FC in the 30 days after vaccination was 1.25 (95% CI 0.67–2.30) for MMRV compared to MMR + V and 1.04 (0.82–1.32) for MMRV compared to MMR. History of FC was the most important risk factor with an OR of 36.26 (29.30–44.89). We found no effect modification by age, sex, history of FC, or type of first dose vaccine. ConclusionUse of MMRV at second dose is not associated with an increased risk of FC compared to MMR + V or MMR, irrespective of age, sex, history of FC, or type of first dose vaccine.

Antibody Levels at 3-Years Follow-Up of a Third Dose of Measles-Mumps-Rubella Vaccine in Young Adults.

Mumps outbreaks and breakthrough infections of measles and rubella have raised concerns about waning of vaccine-induced immunity after two doses of measles-mumps-rubella (MMR) vaccination. In the present follow-up study, serum IgG antibodies against mumps, measles and rubella, as well as the functional neutralizing antibodies against both the mumps vaccine strain and mumps outbreak strains were measured longitudinally in young adults that received a third MMR (MMR3) dose. The mumps-specific IgG and virus neutralizing antibody levels at 3 years after vaccination were still elevated compared to pre-vaccination antibody levels, although the differences were smaller than at earlier timepoints. Interestingly, subjects with low antibody levels to mumps before vaccination benefited the most as they showed the strongest antibody increase after an MMR3 dose. Three years after an MMR3 dose, all subjects had antibody levels to measles and rubella above the internationally agreed antibody cutoff levels for clinical protection. Our data support the recommendation that an MMR3 dose may provide additional protection for those that have become susceptible to mumps virus infection during outbreaks. MMR3 also resulted in an increase in anti-measles and rubella antibody levels that lasted longer than might have been expected.

Introduction of Two-Dose Mumps-Containing Vaccine into Routine Immunization Schedule in Quzhou, China, Using Cox-Proportional Hazard Model.

Mumps is a vaccine-preventable disease caused by the mumps virus, but the incidence of mumps has increased among the children who were vaccinated with one-dose measles-mumps-rubella (MMR) in recent years. In this study, we analyzed the influence of different doses of mumps-containing vaccine (MuCV) against mumps using Cox-proportional hazard model. We collected 909 mumps cases of children who were born from 2006 to 2010 and vaccinated with different doses of MuCV in Quzhou during 2006-2018, which were all clinically diagnosed. Kaplan-Meier survival methods and Cox-proportional hazard model were used to estimate the hazard probabilities. Kaplan–Meier curves showed that the cumulative hazard of male and female has no difference; lower hazards were detected among those who were vaccinated with two-dose MuCV, born in 2006, and infected after supplementary immunization activities (SIA). Cox-proportional hazard regression suggested that onset after SIA, born in 2006, and vaccinated with two-dose MuCV were protective factors against infection even after adjusting for potential confounding effects. Our study showed that it was necessary to revise the diagnostic criteria of mumps and identify RT-PCR as the standard for mumps diagnosis in China. We suggested that routine immunization schedule should introduce two doses of MMR and prevaccination screening should be performed before booster immunization in vaccinated populations.

High seroprevalence of rubella in Thai children with a 2-dose MMR national immunization policy

Rubella is generally a mild disease, but infection during pregnancy can cause congenital rubella syndrome. Thailand has implemented a two-dose MMR vaccination policy since 2010. This study aimed to describe the seroprevalence rate of rubella among children and adolescents in Thailand. We conducted a cross-sectional study of 132 healthy children (aged 3–9 years) who had received 2 doses of rubella vaccine and 424 adolescents (aged 10–18 years) who were expected to receive at least 1 dose of rubella vaccine. Stored serum samples from healthy children and recently drawn serum samples from adolescents were tested for rubella IgG antibody using a commercial enzyme-linked immunosorbent assay (ELISA) kit (EUROIMMUN). Seroprotection was defined as a rubella IgG level ≥ 10 IU/mL. The rubella seroprevalence rate among children and adolescents who had 2 documented doses of MMR was 97.0% (95 %CI 92.5–99.2%) and 85.4% (95% CI 78.8–90.6%, p < 0.01) respectively. The geometric mean titer of rubella was higher in children, 38.3 (95% CI 33.5–43.9) compared to adolescents, 22.5 (19.4–25.9) IU/mL. We observed an inverse correlation between the rubella titer and time interval from the second rubella containing vaccine dose (R = -0.30, p < 0.01). A 2-dose MMR vaccination course produces a high seroprevalence of rubella immunity in children, which decreases with time, suggesting waning of immunity.Thai clinical trials registry number TCTR20191120001.