Measles Elimination Research Articles

Measles and Rubella Elimination in the Western Pacific Region in 2013-2022: Lessons Learned from Progress and Achievements Made during Regional and Global Measles Resurgences.

Measles is the most contagious communicable disease, causing an estimated 5.5 million cases and more than 30,000 deaths in the Western Pacific Region (WPR) during 2000. Rubella infection in a pregnant woman can be devastating for the foetus, resulting in congenital rubella syndrome (CRS) in 90% of rubella infections in early pregnancy. It was estimated that approximately 9000 CRS cases occurred in the WPR in 2010. World Health Organization (WHO) Member States in the WPR decided in 2003 to eliminate measles and in 2014 to eliminate rubella from the region. While the WPR successfully attained historically low measles incidence in 2012, it experienced a region-wide measles resurgence in 2013-2016. During the regional resurgence, WHO and Member States accumulated greater knowledge on the epidemiology of measles and rubella in the WPR and strategies to maintain gains. The implementation of the resulting new regional strategy and plan of action from 2018 has proven that measles and rubella elimination is achievable and sustainable under the pressure of multiple importations of measles virus during the world-wide measles resurgences in 2018-2019. This article discusses this progress and achievements towards achieving the global eradication of measles and rubella.

Vaccination Week in the Americas: An Ongoing Initiative to Strengthen and Sustain Measles and Rubella Elimination in the Region.

Vaccination Week in the Americas (VWA) is a yearly regional initiative that promotes the benefits of vaccination to all persons in the region. In its 22-year history, more than 1.15 billion people have been reached under the framework of VWA across more than 40 countries and territories. This review examines multiple PAHO and WHO data points, documents and reports related to measles/rubella vaccination coverage and VWA since its inception. Its goal is to document the impact that the VWA has had in maintaining and accelerating measles and rubella disease elimination, in the context of PAHO's Disease Elimination Initiative. The results suggest that VWA's contributions to measles and rubella elimination have been substantial. Every year, VWA promotes (a) renewed political commitment to the immunization program from the highest political authorities of Member States; (b) vaccination operations to close immunity gaps, recover under-vaccinated persons, and reach chronically underserved populations; and (c) the dissemination of messages on the benefits of vaccination through regional and national communications campaigns. VWA will continue to be an important contributor to disease elimination efforts in the Americas, even as new targets are set in response to the evolving epidemiological landscape.

Successful Elimination of Endemic Rubella in the WHO European Region. Is It Proper to Remove the Recommendation for Preconceptional Immunization?

Rubella is a contagious viral infection that has garnered significant attention in the field of public health due to its potential consequences, especially during pregnancy. In recent decades, it has been recommended that non-immune women receive immunization during the preconceptional and/or postpartum periods. The goal of this strategy is to prevent primary rubella infection in order to protect pregnant women against congenital rubella syndrome. In November 2022, the WHO's Regional Verification Commission declared the elimination of rubella infection in Italy. In recent years, the main migration flows to Italy have originated from regions where rubella has not yet been eliminated and where no program is in place to achieve this goal. The aim of this study was to retrospectively assess rubella immunity in pregnant women who have attended three delivery centers in Rome over the past three years, from January 2021 to May 2023. Data about the rubella serological status of 7937 non-consecutive pregnant women were collected. Univariate analysis was performed to verify any difference between the study groups in terms of age distribution. Anti-rubella IgG antibodies were found in 7224 (91%) women while 713 (9%) were susceptible to rubella (IgG negative), without differences in terms of immunity rate between Italian and non-Italian women. Age analysis showed a statistically significant older age of immune women than receptive women and of Italian immune women than non-Italian immune women. The National Plan for the Elimination of Measles and Congenital Rubella aimed to achieve a percentage of susceptible women of childbearing age below 5%. These data indicate the relevance of maintaining the recommendation for preconceptional rubella vaccination in Italy.

The Epidemiological Characteristics and Spatiotemporal Clustering of Measles - China, 2005-2022.

In recent years, the incidence of measles in China has consistently remained below 1 per 100,000 population, yet the disease has not been eliminated. This study aims to comprehensively analyze the epidemiological characteristics of measles from 2005 to 2022, identify high-risk populations and areas, and propose targeted interventions. We utilized data from the China Disease Prevention and Control Information System for our comprehensive analysis. Spatial autocorrelation was employed to examine the spatial clustering of measles, while spatiotemporal scanning analysis was used to detect spatiotemporal clustering to describe measles epidemiology during the study period. Between 2005 and 2022, 732,218 measles cases were reported in China. Overall, the incidence of measles exhibited a downward trend, particularly during the periods of 2008-2011 and 2015-2022. In 2022, the incidence rate reached its historical low at 0.039 per 100,000 population. Measles predominantly affects young children. Since 2017, global spatial clustering has diminished, although hotspot areas persist in the western provinces. Spatial-temporal scanning identified a high-incidence cluster from 2005 to 2008, comprising 15 provinces in the western, central, and northern regions of China. Conversely, from 2016 to 2022, a low-incidence cluster was detected in the southern and central provinces. China has made significant progress in measles prevention and control. The recent low incidence and absence of substantial spatiotemporal clustering indicate that China is nearing measles elimination. However, there is a continuing need to enhance prevention and control efforts among very young children and in historic incidence hotspots in western provinces. Additionally, improving the diagnosis of vaccine-associated rash illnesses is essential.

The implementation of a new measles vaccine mandate in Germany: A qualitative study in local health departments.

Measles is a highly contagious disease with the potential for severe complications. Despite the availability of effective vaccines, there have been recurrent measles outbreaks in Germany over the past decades. In response, a new measles vaccine mandate was introduced on March 1, 2020, aimed at closing vaccination gaps in high-risk populations. This study evaluates the mandate's implementation, identifies operational challenges, assesses the impact of the Coronavirus disease 2019 pandemic, and investigates expert attitudes towards the new policy. Semi-structured expert interviews were conducted with staff members of 16 different local health departments in Germany. The interviews, carried out in April and May 2021, were electronically recorded, transcribed verbatim, and analyzed using the Framework method. The implementation of the measles vaccine mandate in local health departments varied substantially. Challenges in implementing the mandate primarily arose from uncertainties regarding procedural specifics, such as handling fraudulent medical certificates and imposing sanctions, leading to a call from many interviewees for uniform guidelines to ensure coherent implementation. At the time the measles vaccine mandate came into force, managing the Coronavirus disease 2019 pandemic was a priority in most local health departments, often delaying the implementation of the mandate. Despite the difficulties encountered, most experts considered the mandate to be an effective step towards measles elimination. The measles vaccine mandate has imposed a new responsibility on staff in German local health departments, which is associated with implementation challenges such as procedural uncertainties and vaccine hesitancy, but also the Coronavirus disease 2019 pandemic as a contextual impediment. Significant differences in the implementation approach underscore the need for harmonization to enhance implementation efficiency and public acceptance of the mandate. Despite the mandate's potential to increase vaccination rates, our findings advocate for a comprehensive approach, incorporating public education, accessible vaccination, and measures to address social disparities.

Evolution and Contribution of a Global Partnership against Measles and Rubella, 2001-2023.

This article describes the arc of global measles and rubella elimination since 2000 from the perspective of the founding partners of the Measles Initiative. The Measles Initiative was formed in 2001 as a partnership among the American Red Cross, the Centers for Disease Control and Prevention, UNICEF, the United Nations Foundation, and the World Health Organization with the aim to reduce measles deaths in low-income countries. Recognizing rubella as the leading infectious disease cause of congenital abnormalities globally and achievement of measles and rubella elimination in the region of the Americas, the partnership was renamed the Measles and Rubella Initiative (MRI) in 2012. The goals of the MRI were at least a 95% reduction in global measles mortality and elimination of measles and rubella in at least five of the six WHO regions. In January 2023, the membership of the partnership was expanded to include the Bill and Melinda Gates Foundation (BMGF) and Gavi the Vaccine Alliance, and its name changed to the IA2030 Measles and Rubella Partnership. We describe the role the partnership has had in measles partner effectiveness and its impact on measles and rubella disease burden, including how the partnership has strategically adapted to the evolving immunization landscape. We conclude with lessons learned regarding the role global partnerships can play in furthering the impact of disease control programs within the current global immunization environment.

Progress and Challenges in Measles and Rubella Elimination in the WHO European Region.

The elimination of both measles and rubella remains a priority for all 53 Member States of the World Health Organization (WHO) European Region. To provide an update on the epidemiological status of measles and rubella in the Region, we reviewed surveillance data on both diseases for 2023 submitted monthly by national surveillance institutions. We analyzed the cases of measles and rubella for 2023 by age group, case classification, vaccination, hospitalization, and importation status and report on measles-related deaths. In 2023, 60,860 measles cases, including 13 fatal cases, were reported in 41 countries. Most cases (95%; n = 57,584) were reported by six countries: Azerbaijan, Kazakhstan, Kyrgyzstan, Romania, the Russian Federation, and Türkiye. Of the 60,848 cases with data on age, 19,137 (31%) were 1-4 years old and 12,838 (21%) were 5-9 years old. A total of 10,412 (17%) were 20 years and older. The genotypes identified in the Region were largely dominated by D8 variants (n = 1357) and the remainder were B3 variants (n = 221). In 2023, 345 rubella cases were reported by 17 countries, mostly from Poland, Kyrgyzstan, Tajikistan, Türkiye, and Ukraine. A total of 262 cases (76%) were classified as clinically compatible and 79 (23%) were laboratory-confirmed. To achieve the elimination of measles and rubella in the Region, political commitment needs to be revived to enable urgent efforts to increase vaccination coverage, improve surveillance and outbreak preparedness, and respond immediately to outbreaks.

Breakthrough Measles among Vaccinated Adults Born during the Post-Soviet Transition Period in Mongolia.

Mongolia experienced a nationwide measles outbreak during 1 March 2015-31 December 2016, with 49,077 cases reported to the WHO; many were among vaccinated young adults, suggesting a possible role of vaccine failure. Advanced laboratory methods, coupled with detailed epidemiological investigations, can help classify cases as vaccine failure, failure to vaccinate, or both. In this report, we conducted a study of cases to identify risk factors for breakthrough infection for a subset of laboratory-confirmed measles cases. Of the 193 cases analyzed, only 19 (9.8%) reported measles vaccination history, and 170 (88%) were uncertain. Measles-specific IgG avidity testing classified 120 (62%) cases as low IgG avidity, indicating no prior exposure to measles. Ten of these cases with low IgG avidity had a history of measles vaccination, indicating primary vaccine failure. Overall, sixty cases (31%) had high IgG avidity, indicating breakthrough infection after prior exposure to measles antigen through vaccination or natural infection, but the IgG avidity results were highly age-dependent. This study found that among young children aged 9 months-5 years, breakthrough infection was rare (4/82, 5%); however, among young adults aged 15-25 years, breakthrough infection due to secondary vaccine failure (SVF) occurred on a large scale during this outbreak, accounting for the majority of cases (42/69 cases, 61%). The study found that large-scale secondary vaccine failure occurred in Mongolia, which highlights the potential for sustained outbreaks in post-elimination settings due to "hidden" cohorts of young adults who may have experienced waning immunity. This phenomenon may have implications for the sustainability of measles elimination in countries that remain vulnerable to the importation of the virus from areas where it is still endemic. Until global measles elimination is achieved, enhanced surveillance and preparedness for future outbreaks in post- or peri-elimination countries may be required.

Accelerating Global Measles and Rubella Eradication-Saving Millions of Lives, Preventing Disability, and Averting the Next Pandemic.

No vaccine has been more effective in reducing disease burden, especially in preventing child deaths, than measles-containing vaccine. The return on investment makes measles-containing vaccine one of the most cost-effective public health measures available. Exhaustive reviews of biological, technical, economic and programmatic evidence have concluded that measles can and should be eradicated, and by including rubella antigen in measles-containing vaccine, congenital rubella syndrome will also be eradicated. All World Health Organisation Regions have pledged to achieve measles elimination. Unfortunately, not all countries and global partners have demonstrated an appropriate commitment to these laudable public health goals, and the negative impact of the COVID-19 pandemic on coverage rates has been profound. Unsurprisingly, large disruptive outbreaks are already occurring in many countries with a global epidemic curve ominously similar to that of 2018/2019 emerging. The Immunization Agenda 2030 will fail dismally unless measles and rubella eradication efforts are accelerated. Over half of all member states have been verified to have eliminated rubella and endemic rubella transmission has not been re-established in any country to date. In 2023, 84 countries and areas were verified to have sustained elimination of measles. However, without a global target, this success will be difficult to sustain. Now is the time for a global eradication goal and commitment by the World Health Assembly. Having a galvanising goal, with a shared call for action, will demand adequate resourcing from every country government and global partners. Greater coordination across countries and regions will be necessary. Measles, rubella and congenital rubella syndrome eradication should not remain just a technically feasible possibility but rather be completed to ensure that future generations of children do not live under the shadow of preventable childhood death and lifelong disability.

A World without Measles and Rubella: Addressing the Challenge of Vaccine Hesitancy.

The worldwide elimination of measles and rubella is feasible, but not without overcoming the substantial challenge of vaccine hesitancy. This challenge is complicated by the spread of misinformation and disinformation fueled by rapidly progressing technologies and evolving forms of online communication. The recent COVID-19 pandemic has only added further complexity to this challenge. However, considerable progress has been made in understanding the scope of the problem and the complex factors that influence vaccine hesitancy. Our understanding of evidence-based strategies for addressing vaccine hesitancy has grown significantly, including evidence for effective communication and behavioral interventions. In this article, we review measles and rubella vaccines and vaccine hesitancy. We then provide an overview of evidence-based strategies for addressing vaccine hesitancy, including communication strategies and behavioral interventions. This article is relevant to healthcare professionals, health system leaders, public health professionals, policymakers, community leaders, and any individuals who have a role in addressing vaccine hesitancy in their communities. Finally, we review future directions and major areas of research need.

Sustaining the Elimination of Measles, Rubella and Congenital Rubella Syndrome in the Americas, 2019-2023: From Challenges to Opportunities.

This report reviews national data from all Member States on measles, rubella, and congenital rubella syndrome (CRS) elimination in the Region of the Americas during 2019-2023. It includes an analysis of compliance with vaccination coverage, surveillance indicators, and measles outbreaks, as well as an analysis of the response capacity of the laboratory network and a country case study that meets all indicators. The sources of information were the integrated epidemiological surveillance system for measles and rubella of the Pan American Health Organization (PAHO)/World Health Organization (WHO) and the Joint Reporting Form (eJRF), among others. From 2020 to 2022, regional coverage with first (MMR-1) and second doses (MMR-2) decreased to rates below 90%. The regional suspected case notification rate was maintained above the minimum expected 2.0 suspect cases per 100,000 population, except in 2021. During 2019 to 2023, 18 countries experienced outbreaks, with two of the outbreaks resulting in re-established endemic transmission. In conclusion, two countries in the Americas have not maintained measles elimination, but by the end of 2023 no country showed endemic measles transmission. One of the countries that lost its certification of elimination in 2018 managed to be reverified in 2023; the other is pending reverification. All countries maintained rubella elimination. Despite these challenges, the sustainability of the elimination of these diseases remains a health priority in the Region.

Effectiveness of Measles Mass Vaccination in the Reduction of Childhood Morbidity and Mortality in Yobe State, Northeast Nigeria

Measles is an issue of public health concern responsible for outbreaks and death of children especially in Sub-Saharan Africa. This study sought to determine the effectiveness of mass vaccination against measles in Yobe State, Northeast Nigeria. An ecological epidemiological study design involving the collection of secondary data from the same population was carried out over a period of two years. These data were collected from Epidemiology Unit of Yobe State Primary Healthcare Development Board from the Integrated Disease Surveillance Response database which collects records of notifiable diseases in Nigeria. All cases of measles within the period under review (2016-2017) were included and a comparison of the number of cases and deaths from measles reported in two different periods before supplementary immunization activity or mass vaccination against measles (2016) and after supplementary immunization activity against measles in the state (2017) was done. The mass vaccination intervention was conducted within first week of January 2017 as a measure to address outbreaks of measles in the state. Data were analyzed using the Statistical Package for Social Sciences (SPSS) windows version 22. A total of 4242 cases were reported during the study period. 3780(89.1%) in 2016 (before mass vaccination) and 462(10.9%) were reported in 2017 (after mass vaccination). A total of 556 deaths with case fatality rate of 13.1% was recorded during the study period. Majority of the deaths 525(94.4%) occurred in 2016 when there was no mass vaccination while few 31(5.6%) occurred in 2017 after the mass vaccination. Mass vaccination resulted in a 78.2% decline in number of cases and 88.8% decline in the number of deaths from measles. There was a statistical significant difference in the number of cases and mortality from measles pre and post mass vaccination against the disease in Yobe state. Paired sample t-test done revealed a monthly case distribution mean of 276.6 (95% CI 89.8 to 463.3) with alpha set at 0.05, P = 0.008 while monthly mortality mean was 41.1 (95% CI 15.5 to 66.7) with alpha set at 0.05, P = 0.005. Mass vaccination against measles therefore confers immunity and herd immunity to populations with a subsequent significant decline in morbidity and mortality associated with the measles infection. It is therefore recommended that this initiative be sustained for every two years or possibly yearly to ensure elimination of measles in the Sub-Saharan Africa region and the World at large.

Measles in Poland in 2021.

Measles is one of the most contagious childhood diseases, and the behavior also occurs in adults. This is a multi-year vaccination covered by an elimination program coordinated by the World Health Organization (WHO). Elimination of measles in the country is conditional on a 95% incidence of infection with two victims, monitoring the epidemiological situation, registering all suspected cases of measles, and monitoring by the WHO Reference Laboratory. In our country, the Department of Virology of the NIZP PZH-PIB in Warsaw serves as the head of the Department of Virology. The aim of this study was to evaluate epidemiological indicators of measles in Poland in 2021 compared to previous years, taking into account the impact of the COVID-19 pandemic. The assessment of the epidemiological situation was based on a review of data from the bulletin, "Infectious Diseases and Poisons in Poland in 2021" (5), and the assessment of the immunization status of the population was based on data from the bulletin, "Immunization in Poland in 2021" (6). Classification of cases was made based on the definition used in the 2021 surveillance (7). Data from the epidemiological surveillance system "EpiBase" were also used. In 2021, 13 measles cases were registered in Poland (incidence 0.03 per 100,000), 44.8% less than in 2020 and 80% less than the median in 2014-2018. In 2021, the highest incidence was recorded at 0.32 per 100,000 children aged 0-4 years. 6 patients (46.2%) were hospitalized; no deaths due to measles were reported. 32 suspected measles cases were recorded, with over a hundred cases expected. Vaccination status of children aged 3 with the first dose was 90.8%, and the second dose was given to children at the age of 9. - 84.6%. Epidemiological indicators of measles in 2021 in Poland compared to 2020 have decreased. A similar trend observed throughout Europe. This is related to the extinguishment of outbreaks that occurred before the pandemic, mainly in 2019.

M-F noncoding region sequences of H1 genotype measles virus provide higher resolution for virus transmission tracing

As countries and regions move toward measles elimination, extended sequence window including noncoding region located between the matrix and fusion protein genes (M − F NCR) was considered to be used in molecular surveillance. The molecular resolution of M − F NCR was evaluated with 192 genotype H1 strains circulating during 2011–2018 in China. Phylogenetic analyses of the N450 and M − F NCR targets indicated that both two targets could confirm epi-linked outbreak, while M − F NCR target could further improve resolution of the molecular characterization: (1) it could differentiate the strains with identical N450 circulated in one county within one month of disease onset; (2) different transmission chains could be distinguished for strains with identical N450; (3) better spatial-temporal consistency with topology could be provided among sporadic cases with inconsistent N450. Accordingly, M − F NCR could be used to complement the information from N450 to address the specific questions in tracking the virus transmission chains.

Exploring landscape of measles vaccination coverage: A step towards measles elimination goal in India

IntroductionMeasles remains a critical public health concern causing significant morbidity and mortality globally. Despite the success of measles vaccination programs, challenges persist, particularly in India. This study investigates dose-wise measles vaccination coverage and explores gaps in immunization focusing on zero-dose, one-dose, and two-dose coverage among children aged 24–35 months. Data sources and methodologyThe National Family Health Survey 2019–21 (NFHS-5) served as the data source and the study analyzed information from 43,864 children aged 24–35 months. Sociodemographic variables such as birth order, wealth quintile, gender, social group, religion, residence, mother education, delivery-related factors, and media exposure were considered. Statistical analysis involved weighted estimates, chi-square tests, and multivariate multinomial logistic regression. ResultsThe study revealed that challenges persist in achieving optimal measles vaccination coverage. Analysis by sociodemographic factors highlighted disparities in coverage, with variations in zero dose prevalence across states and districts. The percentage of zero-dose children was significantly higher, with 11.5% of children in India remaining to receive any measles vaccination. Factors influencing vaccine coverage include birth order, age, wealth quintile, social group, religion, residence, maternal education, place of delivery, media exposure, and mode of delivery. The findings from the spatial analysis show the clustering of zero-dose children is high in the northeastern states of India. DiscussionMeasles zero-dose children pose a significant obstacle to achieving elimination goals. Spatial analysis identifies clusters of unvaccinated populations guiding targeted interventions. The study aligns with global initiatives such as the Immunization Agenda 2030 emphasizing equitable vaccine access and discusses how India can tailor its strategies to achieve the goal. Lessons from polio eradication efforts inform strategies for measles elimination, stressing the importance of high-quality data and surveillance. The study underscores the urgency of addressing last-mile measles vaccination gaps in India. Spatially targeted interventions informed by sociodemographic factors can enhance immunization coverage. Achieving measles elimination requires sustained efforts and leveraging lessons from successful vaccination campaigns. The study findings have the potential to contribute to informed decision-making, supporting India's roadmap for the measles and rubella elimination goal.

Determinants of second-dose measles vaccination dropout in Ethiopia: A community-based matched case-control study

BackgroundMeasles vaccination is the most important public health intervention and a cost-effective strategy to reduce morbidity and mortality in under-five children. Although Ethiopia's government developed a measles elimination strategic plan by 2020, the full coverage of immunization was 43 %. Therefore, this study aimed to identify determinants of second-dose measles vaccination (MCV2) dropout among children aged 24–35 months in East Bale Zone, Ethiopia. MethodA community-based matched case-control study was conducted among 351 children (117 cases and 234 controls). Children who received the first dose of measles vaccine but did not receive the second dose were cases, and children who received both doses of measles vaccine were control. The matches were based on age and residence. The data were collected using a structured questionnaire, entered into Epi Data 3.1, cleaned, exported, and analyzed using Stata version 16.1. A multivariable conditional logistic regression analysis was performed. Variables with a P value of <0.05 were considered significant determinants of the dependent variable at the 95 % confidence level. ResultsMothers who were unable to read and write (mAOR: 4.0; 95 % CI: 1.59–10.2), did not receive counseling (mAOR: 3.19; 95 % CI: 1.62–6.27), spent ≥30 min to reach health facilities (mAOR; 2.76, 95 % CI: 1.25–6.1), and did not attend postnatal care (mAOR; 3.46, 95 % CI: 1.58–7.57) were significantly and positively associated with second-dose measles vaccination dropout. In addition, mothers who had poor knowledge of second-dose measles vaccination (mAOR; 3.20, 95 % CI: 1.50–6.70) and waited more than an hour for measles vaccination at health facilities (mAOR; 2.61, 95 % CI: 1.0–6.20) were significantly more likely to experience second-dose measles vaccine dropout. ConclusionsThe key factors associated with second-dose measles vaccination dropout are maternal illiteracy, lack of PNC, inadequate maternal knowledge and poor counseling about MCV2 vaccination, long distances travel to healthcare facilities and extended waiting times at vaccination providing sites. Health extension workers emphasize strengthening home visit programs in catchment households to improve mothers' awareness of measles vaccination.

Measles - United States, January 1, 2020-March 28, 2024.

Measles is a highly infectious febrile rash illness and was declared eliminated in the United States in 2000. However, measles importations continue to occur, and U.S. measles elimination status was threatened in 2019 as the result of two prolonged outbreaks among undervaccinated communities in New York and New York City. To assess U.S. measles elimination status after the 2019 outbreaks and to provide context to understand more recent increases in measles cases, CDC analyzed epidemiologic and laboratory surveillance data and the performance of the U.S. measles surveillance system after these outbreaks. During January 1, 2020-March 28, 2024, CDC was notified of 338 confirmed measles cases; 97 (29%) of these cases occurred during the first quarter of 2024, representing a more than seventeenfold increase over the mean number of cases reported during the first quarter of 2020-2023. Among the 338 reported cases, the median patient age was 3 years (range=0-64 years); 309 (91%) patients were unvaccinated or had unknown vaccination status, and 336 case investigations included information on ≥80% of critical surveillance indicators. During 2020-2023, the longest transmission chain lasted 63 days. As of the end of 2023, because of the absence of sustained measles virus transmission for 12 consecutive months in the presence of a well-performing surveillance system, U.S. measles elimination status was maintained. Risk for widespread U.S. measles transmission remains low because of high population immunity. However, because of the increase in cases during the first quarter of 2024, additional activities are needed to increase U.S. routine measles, mumps, and rubella vaccination coverage, especially among close-knit and undervaccinated communities. These activities include encouraging vaccination before international travel and rapidly investigating suspected measles cases.

IJCM_225A: Assessment of factors influencing measles vaccine uptake in a metropolitan city: A cross-sectional study

Background: Globally, measles deaths were estimated to be over 1,28,000 in the year 2021, despite the easy availability of safe and effective vaccines to prevent the infection. Routine childhood immunization coverage rates dropped during the COVID-19 pandemic and India has been one of the worst affected countries. The most recent measles outbreak was reported last year in Mumbai, Maharashtra. Objectives: 1. To estimate the level of uptake of measles vaccine in children aged 12 months to 5 years 2. To determine the factors associated with the uptake of measles vaccine. Methodology: This cross-sectional study was conducted over 2 months in a municipal ward of Mumbai during Oct-Nov 2023 in mothers with children aged 12 to 60 months, living in the area for at least past 6 months. Five out of fifteen clusters of Municipal Health Post areas were selected randomly &amp; from each, 82 eligible households were chosen randomly for door-to-door interviews with the participants. Results: Among the sample of 428 children, measles vaccine coverage was 96.7%, but only 263 (61.45%) children were vaccinated in timely manner. The facilitator for mothers in vaccine uptake was receiving information from healthcare workers during and after pregnancy (77.57%). The barriers were lack of information about vaccination schedule (18.69%), and child being unwell during vaccination (10.74%). Conclusion: Huge efforts have been taken by the Public Health Department for achieving this level of vaccine coverage, however, measles elimination is still a challenge due to delayed vaccination.

Post-campaign coverage evaluation of a measles and rubella supplementary immunization activity in five districts in India, 2019-2020.

In alignment with the Measles and Rubella (MR) Strategic Elimination plan, India conducted a mass measles and rubella vaccination campaign across the country between 2017 and 2020 to provide a dose of MR containing vaccine to all children aged 9 months to 15 years. We estimated campaign vaccination coverage in five districts in India and assessed campaign awareness and factors associated with vaccination during the campaign to better understand reasons for not receiving the dose. Community-based cross-sectional serosurveys were conducted in five districts of India among children aged 9 months to 15 years after the vaccination campaign. Campaign coverage was estimated based on home-based immunization record or caregiver recall. Campaign coverage was stratified by child- and household-level risk factors and descriptive analyses were performed to assess reasons for not receiving the campaign dose. Three thousand three hundred and fifty-seven children aged 9 months to 15 years at the time of the campaign were enrolled. Campaign coverage among children aged 9 months to 5 years documented or by recall ranged from 74.2% in Kanpur Nagar District to 90.4% in Dibrugarh District, Assam. Similar coverage was observed for older children. Caregiver awareness of the campaign varied from 88.3% in Hoshiarpur District, Punjab to 97.6% in Dibrugarh District, Assam, although 8% of children whose caregivers were aware of the campaign were not vaccinated during the campaign. Failure to receive the campaign dose was associated with urban settings, low maternal education, and lack of school attendance although the associations varied by district. Awareness of the MR vaccination campaign was high; however, campaign coverage varied by district and did not reach the elimination target of 95% coverage in any of the districts studied. Areas with lower coverage among younger children must be prioritized by strengthening the routine immunization programme and implementing strategies to identify and reach under-vaccinated children.

Аналіз захворюваності на кір в Україні та стану популяційного імунітету

Since 2001, due to the effectiveness of vaccines, the Measles Elimination Initiative was introduced. However, there are periodic increases in its incidence. In terms of intensity, the measles epidemic process in Ukraine in 2017-2019 can be considered as an epidemic. In 2022, 205,153 cases of measles were reported worldwide (67% more than in 2021). In 2023, this indicator in the European Region of the World Health Organization increased 30 times compared to 2022. Thus, measles remains a pressing problem. Aim - to analyze the incidence of measles, particularly among vaccinated individuals, the state of specific population immunity, as well as to assess of the current epidemic situation. Materials and methods. An analysis was carried out: the incidence of measles in Ukraine (2017-11/30/2023), its level among vaccinated people (2017-2022), the rates of vaccination against measles, mumps and rubella (MMR) (2016-2023), the state of specific population immunity of the population (2019-2022). Descriptive-evaluative and analytical approaches of the epidemiological method, as well as methods of mathematical statistics were used. Results and conclusions. The previous rise in the incidence of measles in Ukraine (2017-2019) and the beginning of the current one (2023) occurred against the background of unsatisfactory coverage of the first and second doses of the MMR vaccinations (2016 - 45.5% and 30.2%; 2022 - 74.1% and 69.1%, respectively). The population of all age groups is involved in the intensification of the measles epidemic process (with the exception of patients who were ill in the pre-vaccination period). The high effectiveness of MMR-1 for children aged 1 to 4 years has been shown, with its decrease with increasing age and gaps in the coverage of MMR-2 for children aged 6 years. Unvaccinated adults remain at risk. In 2019-2021, the proportion of individuals with a protective level of specific antibodies was 89-91%, and by age groups - 83-91%. A significant decrease of this indicator was observed in 2022 compared to 2021 in all age groups, with the exception of children aged 1-4 years. Ensuring proper vaccine prevention in Ukraine is one of the primary tasks for reducing the cyclical outbreaks of measles and achieving its elimination. No conflict of interests was declared by the authors.