First Dose Of Measles Vaccine Research Articles

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.

Evolution in key indicators of maternal and child health across the wealth gradient in 41 sub-Saharan African countries, 1986–2019

BackgroundAggregate trends can be useful for summarizing large amounts of information, but this can obscure important distributional aspects. Some population subgroups can be worse off even as averages climb, for example. Distributional information can identify health inequalities, which is essential to understanding their drivers and possible remedies.MethodsUsing publicly available Demographic and Health Survey (DHS) data from 41 sub-Saharan African countries from 1986 to 2019, we analyzed changes in coverage for eight key maternal and child health indicators: first dose of measles vaccine (MCV1); Diphtheria-Pertussis-Tetanus (DPT) first dose (DPT1); DPT third dose (DPT3); care-seeking for diarrhea, acute respiratory infections (ARI), or fever; skilled birth attendance (SBA); and having four antenatal care (ANC) visits. To evaluate whether coverage diverged or converged over time across the wealth gradient, we computed several dispersion metrics including the coefficient of variation across wealth quintiles. Slopes and 5-year moving averages were computed to identify overall long-term trends.ResultsAverage coverage increased for all quintiles and indicators, although the range and the speed at which they increased varied widely. There were small changes in the wealth-related gap for SBA, ANC, and fever. The wealth-related gap of vaccination-related indicators (DPT1, DPT3, MCV1) decreased over time. Compared to 2017, the wealth-gap between richest and poorest quintiles in 1995 was 7 percentage points larger for ANC and 17 percentage points larger for measles vaccination.ConclusionsMaternal and child health indicators show progress, but the distributional effects show differential evolutions in inequalities. Several reasons may explain why countries had smaller wealth-related gap trends in vaccination-related indicators compared to others. In addition to service delivery differences, we hypothesize that the allocation of development assistance for health, the prioritization of vaccine-preventable diseases on the global agenda, and indirect effects of structural adjustment programs on health system-related indicators might have played a role.

Association of Factors Affecting Measles Vaccine Coverage During Covid-19 Pandemic among the Children Aged 09-24 Months

Background: The COVID-19 pandemic has had a significant impact on public health measures, including routine childhood immunizations. Measles, a highly contagious viral infection, remains a significant public health threat, and routine vaccination against measles is critical in preventing outbreaks. Objective: To evaluate the immunization status and factors affecting measles vaccination for measles vaccine coverage during COVID-19 in children aged 09–24 month. Study Design: Descriptive cross-sectional study. Settings: This study was done at department of community medicine and samples were collected from Union Council -II, District Tando Muhammad khan Sindh Pakistan. Duration: March 2020 to December 2020. Methods: All the children those who were aged 09 to 24 months, living in Tando Muhammad khan. UC-II, District Tando Muhammad Khan, parents/guardians who consent to participate in the study and those children who were defaulter of first dose of measles vaccine were included. All parents and guardians were interviewed regarding vaccination status according to the study protocol. Data were collected using a pre-designed and pre-tested questionnaire. The principal investigator conducted the interviews and filled out the questionnaire. However, in some instances, Lady Health Workers (LHWs) were also visited to provide assistance. Additionally, the previous year's records of measles immunization in Union Council-2 Tando Muhammad Khan were obtained from the District Health Office (DHO) in District Tando Muhammad Khan. The collected information was entered into SPSS version 22.0 for analysis. Results: The study involved 422 cases with a mean age of 13.4 months. The study found that 98.1% of the children received routine vaccinations, but only 1.95% did not visited vaccination centers during the pandemic. The main reasons for not getting the measles vaccination were fear of COVID-19 (50.5%) and lockdown (31.85%). Socioeconomic factors, such as disease (92.2%), economic crises (80.6%), and domestic issues (37.9%), also affected vaccination coverage. Even though the most parents believed that vaccination can save their child from measles (82.7%). Conclusion: The outbreak of COVID-19 has significantly impacted the vaccination rates for measles. Factors such as lockdowns, transportation issues, unreachable programs, child health-related issues, and financial crises have all contributed to a decline in measles vaccination rates. Fear of COVID-19 has led to a reluctance among some parents to bring their children to healthcare facilities for routine vaccinations.

Antibody Persistence Following Administration of a Hexavalent DTwP-IPV-HB-PRP~T Vaccine Versus Separate DTwP-HB-PRP~T and IPV Vaccines and Safety and Immunogenicity of a Booster Dose of DTwP-IPV-HB-PRP~T Administered With an MMR Vaccine in Healthy Infants in India.

Antibody persistence of a whole-cell pertussis-containing hexavalent vaccine (DTwP-IPV-HB-PRP~T) and its co- or sequential administration with measles, mumps, rubella (MMR) vaccine were evaluated. Phase III, open-label, randomized, multicenter study in India. Healthy toddlers aged 12-24 months who had received DTwP-IPV-HB-PRP~T or separate DTwP-HB-PRP~T+IPV primary vaccination at 6-8, 10-12 and 14-16 weeks of age received a DTwP-IPV-HB-PRP~T booster concomitantly with MMR (N = 336) or 28 days before MMR (N = 340). Participants had received a first dose of measles vaccine. Immunogenicity assessment used validated assays and safety was by parental reports. All analyses were descriptive. All participants had prebooster anti-T ≥0.01 IU/mL and anti-polio 1 and 3 ≥8 1/dil, and ≥96.5% had anti-D ≥0.01 IU/mL, anti-HBs ≥10 mIU/mL, anti-polio 2 ≥8 1/dil and anti-PRP ≥0.15 µg/mL; for pertussis, antibody persistence was similar in each group. Postbooster immunogenicity for DTwP-IPV-HB-PRP~T was similar for each antigen in each group: ≥99.5% of participants had anti-D ≥0.01 IU/mL, anti-T ≥0.01 IU/mL, anti-polio 1, 2 and 3 >8 1/dil, anti-HBs ≥10 mIU/mL and anti-PRP ≥1 µg/mL; for pertussis, vaccine response was similar in each group [72.0%-75.9% (anti-PT), 80.8%-81.4% (anti-FIM), 77.6%-79.5% (anti-PRN), 78.2%-80.8% (anti-FHA)]. There was no difference in MMR immunogenicity between groups, and no difference in DTwP-IPV-HB-PRP~T booster immunogenicity based on the primary series. There were no safety concerns. DTwP-IPV-HB-PRP~T antibody persistence was similar to licensed comparators. Booster immunogenicity was robust after DTwP-IPV-HB-PRP~T with or without MMR, and MMR immunogenicity was not affected by coadministration with DTwP-IPV-HB-PRP~T. Clinical Trials Registry India Number: CTRI/2020/04/024843.

COVID-19 lockdown effect on healthcare utilization and in-hospital mortality in children under 5 years in Cape Town, South Africa: a cross-sectional study.

COVID-19 pandemic measures resulted in the de-escalation of non-COVID-19 healthcare provision. A retrospective cross-sectional study of routinely collected data was done to investigate the effect of COVID-19 policies on the healthcare utilization and mortality of children younger than 5 years in Eastern Cape Town, South Africa. We compared visits to primary and urgent care facilities, hospitalization, in-hospital deaths, and vaccine uptake from 1 January to 31 December 2020 to similar periods in 2018 and 2019. During April and May 2020, the most restricted period, visits to primary care facilities declined from 126 049 in 2019 to 77 000 (1.8-fold; p < 0.05). This corresponded with a 1.2-fold reduction in the provision of the first dose of measles vaccine at 6 months compared to 2019. Throughout 2020 there was a 4-fold decline in the number of fully immunized children at 1 year of age (p = 0.84). Emergency room visits fell by 35.7% in 2020 (16 368) compared to 2019 (25 446). Hospital admissions decreased significantly (p < 0.01) in 2020 (9810) compared to 2018 (11 698) and 2019 (10 247). The in-hospital mortality rate increased from 2.3% (96/4163) in 2019 to 3.8% (95/2498) (p < 0.01) in Tygerberg Hospital, where 80% (95/119) of deaths were recorded. Twelve of the 119 (10%) deaths occurred in HIV-positive children (p = <0.01). Measures instituted during the COVID-19 pandemic disrupted access to healthcare services for children. This resulted in an immediate, and potential future, indirect effect on child morbidity and mortality in Cape Town.

Determinants of Measles Vaccine Uptake among Mothers of Children between 9 and 24 Months in Narok North Subcounty

The low uptake of measles vaccines in Kenya is a noticeable public health problem. Therefore, the study assessed the determinants of low uptake and hesitancy of measles vaccination among mothers of children aged 9 – 24 months in Narok North Sub-County, Narok. Cross-sectional quantitative study was done. The study was conducted in four purposively selected health centers in Narok North Sub-County. A structured and pretested questionnaire was used to collect data from 100 mothers. The multistage sampling method was used in this study to select the mothers who participated in the current study. The data were analysed descriptively. Additionally, Pearson’s chi-square, Kruskal-Wallis H, and logistic regression tests were conducted to determine the significance of the relationships and associations between the determinants and MCV uptake. A total of 69(69%) of the children (N =100) who had qualified for the first dose of measles vaccines (MCV1) had received the vaccines, while 31(31%) had not. Thirteen (26.5%) of the children (n = 49) who had qualified for the second dose of measles vaccine (MCV2) had received the vaccine, while 36(73.5%) did not. The significant maternal determinants of MCV uptake included; maternal age (p = .019) and maternal level of education (p = .030). The significant child’s determinants were birth order (p = .032) and place of birth (p = .001). The significant socioeconomic factors included; low socioeconomic background (p = .004) and cultural and religious issues (p = .003). The significant healthcare determinants included distance from the health facility (p = .020) and availability of vaccines in the health center (p = .000). Measles vaccine uptake was very low compared to the World Health Organization (WHO) recommended coverage rate of &gt;95%. Thus, there is a need to provide health education and information to mothers or caregivers on measles vaccine uptake. Keywords: Vaccine, Vaccine Uptake, Measles

The impact of the COVID-19 pandemic on vaccine coverage in Kilifi, Kenya: A retrospective cohort study.

The COVID-19 pandemic caused unprecedented disruption in health service delivery, globally. This study sought to provide evidence on the impact of the pandemic on vaccine coverage in Kilifi County, Kenya. We conducted a vaccine coverage survey between April and June 2021 within the Kilifi Health and Demographic Surveillance System (KHDSS). Simple random sampling was used to identify 1500 children aged 6weeks-59months. Participants were grouped into three retrospective cohorts based on when they became age-eligible for vaccination: before the pandemic, during the first year, or during the second year of the pandemic. Survival analysis with Cox regression was used to evaluate the association between the time-period at which participants became age-eligible for vaccination and the rate of vaccination within a month of age-eligibility for the third dose of pentavalent vaccine (Pentavalent-3) and within three months of age-eligibility for the first dose of Measles vaccine (MCV-1). A total of 1,341 participants were included in the survey. Compared to the pre-COVID-19 baseline period, the rate of vaccination within a month of age-eligibility for Pentavalent-3 was not significantly different in the first year of the pandemic (adjusted hazard ratio [aHR] 1.03, 95% confidence interval [CI] 0.90-1.18) and was significantly higher during the second year of the pandemic (aHR 1.33, 95% CI 1.07-1.65). The rate of vaccination with MCV-1 within three months of age-eligibility was not significantly different among those age-eligible for vaccination during the first year of the pandemic (aHR 1.04, 95% CI 0.88-1.21) and was 35% higher during the second year of the pandemic (95% CI 1.11-1.64), compared to those age-eligible pre-COVID-19. After adjusting for known determinants of vaccination, the COVID-19 pandemic did not adversely affect the rate of vaccination within the KHDSS.

Determinants of pentavalent and measles vaccination dropouts among children aged 12\u201323 months in The Gambia

BackgroundEvery year, vaccination averts about 3 million deaths from vaccine-preventable diseases (VPDs). However, despite that immunization coverage is increasing globally, many children in developing countries are still dropping out of vaccination. Thus, the present study aimed to identify determinants of vaccination dropouts among children aged 12–23 months in The Gambia.MethodsThe study utilized cross-sectional data obtained from the Gambia Demographic and Health Survey 2019–20 (GDHS). The percentage of children aged 12–23 months who dropped out from pentavalent and measles vaccination were calculated by (1) subtracting the third dose of pentavalent vaccine from the first dose of Pentavalent vaccine, and (2) subtracting the first dose of measles vaccine from the first dose Pentavalent vaccine. Generalized Estimating Equation models (GEE) were constructed to examine the risk factors of pentavalent and measles vaccinations dropout.ResultsApproximately 7.0% and 4.0% of the 1,302 children aged 12–23 months had dropped out of measles and pentavalent vaccination respectively. The multivariate analyses showed that when caregivers attended fewer than four antenatal care sessions, when children had no health card or whose card was lost, and resided in urban areas increased the odds of pentavalent dropout. On the other hand, when women gave birth in home and other places, when children had no health card, and being an urban areas dweller increased the odds of measles dropout.ConclusionTailored public health interventions towards urban residence and health education for all women during ANC are hereby recommended.

Impact on the Utilization of Reproductive, Maternal, Newborn and Child Health Care Services at Primary Health Care Level During First Wave of COVID-19 Outbreak in Pakistan.

Introduction: Very little is known and predictable on how long the COVID-19 pandemic will last, even though dramatic preventive measures to flatten the curve and stop its transmission have been taken worldwide periodically since its start. These preventive measures coupled with people’s fear of COVID-19, significantly altered people’s health-seeking behavior and healthcare accessibility. This study aims to measure the impact of the COVID-19 pandemic on the utilization of reproductive, maternal, newborn, and child health (RMNCH) care services at primary health care (PHC) facilities in Pakistan. Methods: A retrospective study was conducted in 22 districts using data from 1169 primary health care facilities. The District Health Information System (DHIS) was used to retrieve district-wise services utilization data from January to April 2020 i.e. January to February 2020 (pre-COVID-19) and March to April 2020 (during COVID-19). The monthly difference (in percentage change) for selected RMNCH services indicators was calculated using the expected number of clients (January to February average) versus the actual number of clients for March and April 2020.Results: We observed a decrease of 12.5% for March and 33% for April 2020 in the total number of clients who availed of primary health care services in Sindh as compared to the pre-COVID-19 monthly average. A decrease in first antenatal care visits (15.6% and 16.3%), delivery coverage (12.8% and 17.9%) and family planning client visits (31.6% and 36.3%) were observed for March and April 2020 respectively. The pentavalent vaccine results revealed a decrease of 19.3% and 63.1%, while a decrease of 17.3% and 54.3% were observed for children receiving the first dose of measles vaccine in March and April, respectively. Conclusions: Our findings show that the number of clients who avail of routine care or RMNCH services at the primary health care level considerably declined during the initial phase of the first wave of the COVID-19 outbreak in Sindh, Pakistan. These results highlight a rising threat to poor RMNCH and outcomes.

An International Spatial Analysis of Welfare Spending’s Influence on Measles

BACKGROUND: National welfare policies have the potential to influence population health. Yet, no research has investigated the influence that welfare spending levels have on primary prevention interventions.&#x0D; &#x0D; METHODS: This study uses generalized linear mixed model Bayesian analysis to explore how welfare spending influences the relationship between measles counts and measles vaccination rates at a national level. Furthermore, models include random effects to account for the nested structure of countries within regions. A conditional autoregressive model was also developed to test for the influence of spatial relationships among the variables of interest.&#x0D; &#x0D; RESULTS: Analysis of the Bayesian Information Criterion (BIC) indicated that the non-spatial model (BIC=19743.090) was preferred over the spatial model (BIC = 24225.730). The final model found that both the first dose of measles vaccine (B = -0.835, 95% Cr. I. = -0.975, -0.699), public social protection (B = -0.936, 95% Cr. I. = -1.132, -0.744), and their interaction (B = -0.239, 95% Cr. I. -0.319, -0.156) had a negative influence on national measles counts.&#x0D; &#x0D; CONCLUSIONS: This finding indicates that welfare spending may enhance primary prevention interventions, like measles vaccination.

Clinical Characteristics of Measles in Infancy: A Hospital Based Study

Background: There is a global resurgence of measles among children in recent years and a number of infants are being affected.&#x0D; Objectives: The aim of the study was to determine the frequency of measles in infancy and to describe their clinical characteristics in a tertiary care children hospital.&#x0D; Methods: A prospective observational study was conducted in Dr. MR Khan Shishu Hospital and Institute of Child Health from March, 2019 to February, 2020. The children who came with signs and symptoms of measles, like fever with maculopapular rash associated with cough, runny nose and conjunctivitis were recorded and frequency of measles in infants among hospitalized measles patients was noted. Infants with measles were enrolled for the study and their clinical characteristics, complications and outcome were determined. Data were analyzed by SPSS version 23.&#x0D; Results: A total of 64 infants were studied. The frequency of measles in infants among hospitalized measles patients was 43%. Forty seven percent infants were between 9 to 10 months. Clinical features were typical and all had fever and maculopapular rash. Pneumonia was the main complication and occurred in 50(78%) cases which was followed by oral ulcer 42(66%), diarrhea 26(41%), febrile seizure 9(14%) and croup 5(8%). Thirty four (53%) infant had normal nutritional status. Only 19.51% infant received first dose of measles vaccine. The mortality rate was 2(3%).&#x0D; Conclusion: A number of children are being affected by measles before completing first year of life and they develop complications which are related to morbidity and mortality. So, control and prevention of measles in infancy should give more importance.&#x0D; DS (Child) H J 2020; 36(1) : 20-24

Application of the Parent Attitudes about Childhood Vaccines (PACV) survey in three national languages in Switzerland: Exploratory factor analysis and Mokken scale analysis

ABSTRACT Vaccine hesitancy (VH) is a complex and context-specific phenomenon that is linked to under-immunization and poses challenges to immunization programs. The Parent Attitudes about Childhood Vaccines (PACV) is an instrument developed to measure VH. We translated the PACV into three languages (German, French and Italian) and administered it to 1388 Swiss parents. We used exploratory factor analysis (EFA) to confirm the scale sub-domains, Cronbach’s alpha to assess internal consistency reliability, and Mokken scale analysis (MSA), to explore unidimensionality of each language version. We determined to construct validity by linking parental PACV score to children’s immunization status for the first dose of measles vaccine. For the 15-item PACV, EFA extracted three sub-domains in German and French and four sub-domains in Italian. Cronbach’s alpha was >0.8 across the three languages, and MSA produced a 13-item German, 14-item French, and 11-item Italian PACV. EFA and MSA of the short version PACV extracted a single factor and scale with Cronbach’s alpha >0.7 in all three language versions. VH was significantly associated with non-timely receipt of the first dose of measles in all languages (odds ratio of 20.7, 21.3, and 8.3 for German, French, and Italian languages, respectively). The translated and revised PACV-15 versions are valid and reliable instruments for VH measurement. The structure and reliability of the short version of the PACV was as good as the long version. Our results suggest that the PACV can be used to measure parental VH outside the US in the validated languages.

Vaccine Delay and Its Association With Undervaccination in Children in Sub-Saharan Africa

Improving the timeliness and completion of vaccination is the key to reducing under-5 childhood mortality. This study examines the prevalence of delayed vaccination for doses administered at birth and age 6 weeks, 10 weeks, 14 weeks, and 9 months and its association with undervaccination among infants in Sub-Saharan Africa. Pooling data across 33 Sub-Saharan Africa countries, vaccination timing and series completion were assessed for children aged 12-35 months who were included in the immunization module of the Demographic and Health Surveys conducted between 2010 and 2019. Survey design-adjusted logistic regression modeled the likelihood of not fully completing the basic immunization schedule associated with dose-specific delays in vaccination. Data were obtained and analyzed in May 2020. Among children with complete date records (n=70,006), the proportion of children vaccinated with delays by ≥1 month was high: 25.9% for Bacille Calmette-Guerin (at birth); 49.1% for the third dose of pentavalent combination vaccine (at 14 weeks); and 63.9% for the first dose of measles vaccines (at 9 months). Late vaccination was more common for children born to mothers with lower levels of educational attainment (p<0.001) and wealth (p<0.001). Controlling for place, time, and sociodemographics, vaccination delays at any dose were significantly associated with not completing the immunization schedule by 12 months (Bacille Calmette-Guerin: AOR=1.93, [95% CI=1.83, 2.02]; pentavalent 3: AOR=1.50 [95% CI=1.35, 1.64]; measles: AOR=3.76 [95% CI=3.37, 4.15]). Timely initiation of vaccination could contribute to higher rates of immunization schedule completion, improving the reach and impact of vaccination programs on child health outcomes in Sub-Saharan Africa. This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.

Socio-demographic correlates of first dose of measles (MCV1) vaccination coverage in India

BackgroundBetween 2010 and 2018, measles-related mortality had halved in India mainly with effective measles vaccination campaigns and widespread coverage across the states and population subgroups. Despite the commendable vaccination coverage, 2.9 million children in India missed the first dose of measles vaccine (MCV1) in 2017, and many of those vaccinated were not vaccinated at the recommended age (i.e. between 9 and 12 months). This study analyzed pattern and correlates of MCV1 coverage and MCV1 administration at recommended age among children aged 12–23 months in India.MethodsWe used the official data from the recent round of National Family Health Survey (NFHS-4), a nationally representative cross-sectional household survey in India conducted in 2015–16. Descriptive statistics and logistic regression analysis were applied to ascertain the influence of specified socio-demographic variables affecting measles vaccination coverage in India.ResultsThe study revealed the distinct variations in coverage of MCV1 between the districts of India. There were also major challenges with age recommended vaccination, with about 15% of eligible children not vaccinated within the recommended age range, attributable to several socio-demographic factors. Significantly, antenatal care utilization of mothers strongly influenced MCV1 coverage and age recommended MCV1 coverage in India. The study also identified that children who missed MCV1 had one or more adverse health risks such as malnutrition, anemia and diarrhea disease.ConclusionsA socio-economic gradient exists in India’s MCV1 coverage, mediated by antenatal visits, education of mothers, and highlighted socio-demographic factors. Infection with measles was significantly correlated with greater anthropometric deficits among the study cohort, indicating a wider range of benefits from preventing measles infection. Eliminating morbidity and mortality from measles in India is feasible, although it will require efficient expanded program on immunization management, enhanced health literacy among mothers, continuing commitment from central state and district political authorities.

Pediatric measles cases by residence status in Tel Aviv, Israel

BackgroundMeasles is a vaccine-preventable infectious disease whose outbreaks generally originate from exposure to populations with low vaccination coverage. MethodsThis study compared the rates and morbidity of measles cases in the district of Tel-Aviv during two outbreaks (2012 and 2018–2019) by citizenship and geographic location. ResultsThere were 67 pediatric cases reported in 2012 and 222 in 2018–2019. Cases were more likely to have pneumonia in 2012 as compared to in 2018–2019 (58.2% versus 6.3%) and less likely to report a single vaccination dose (9.5% versus 22.8%, respectively). In 2012, the majority of cases were among children without legal residence (CWLR), while in 2018–2019, they were the minority of cases (N = 54, 80.6% versus N = 51, 23.0%, respectively). In both outbreaks, CWLR were more likely to be less than one year old (the recommended age for the first dose of measles vaccination), unvaccinated or with unknown vaccine status, to be treated in a tertiary care center, and to have pneumonia than children with Israeli citizenship (CC). In both outbreaks, CWLR lived in a concentrated neighborhood in Southern Tel Aviv. ConclusionWhile the two measles outbreaks differed in overall morbidity, in both outbreaks CWLR presented with a more severe clinical presentation and were less likely to be vaccinated (in part due to their younger age) than CC. The geographically concentration of CWLR was distinct from that of the CC in both outbreaks. Healthcare professionals should promote vaccination uptake and increase parents' awareness to early signs of the disease.

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.

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.

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...

Being unvaccinated and having a contact history increased the risk of measles infection during an outbreak: a finding from measles outbreak investigation in rural district of Ethiopia

BackgroundMeasles is one of the most contagious diseases caused by an acute viral illness called Morbillivirus that usually occurs as an outbreak in low-income countries. As of May 2016 measles suspected outbreak was reported from Sekota Zuria district. We investigated the outbreak to identify its possible sources and risk factors of acquiring the infection in the district.MethodWe conducted a 1:2 unmatched case-control study in May 2016 in Sekota Zuria district, Northern Ethiopia. Cases involved in the study were lab confirmed and epidemiologically linked. Controls were those who had no clinical signs of measles and residing in the same communities where the cases were identified. An interviewer-administered questionnaire was used to collect the data. Data were cleaned and entered to Epi-info7 and analyzed using SPSS-20. A logistic regression analysis was conducted to identify risk factors associated with measles infection at a p-value ≤0.05.Results29 cases were identified during the outbreak investigation. The probable source of an outbreak was an index case who had a travel history to a district with a measles epidemic. Five samples were collected for confirmation of the diagnosis. No measles-related deaths were reported. The median age of cases and controls was 15 years (SD ± 7.8) and 11 years (SD ± 9.8), respectively. More than 55% of the cases were in age ≥ 15 years. In the multivariable analysis, being previously vaccinated for measles reduced the risk of measles infection by 83% (AOR, 95%CI = 0.17, 0.05–0.53) and having a contact history increased the risk of measles infection by 3.44 times (AOR, 95%CI = 3.44, 1.26–9.38).ConclusionWe confirmed a measles outbreak in Sekota Zuria district. The majority of the cases were in age ≥ 15 years. Being un-vaccinated and having a contact history with confirmed or suspected cases were increased the risk of measles infection. To catch up with missed children at the time of the first dose of measles vaccine and reduce their susceptibility, supplementary immunization activities (SIAs) or immunization campaigns shall be strengthened.

Research priorities for accelerating progress toward measles and rubella elimination identified by a cross-sectional web-based survey

BackgroundIn 2012, the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP) that set a target to eliminate measles and rubella in five of the six World Health Organization (WHO) regions by 2020. Significant progress has been made toward achieving this goal through intensive efforts by countries and Measles & Rubella Initiative (M&RI) partners. Accelerating progress will require evidence-based approaches to improve implementation of the core strategies in the Global Measles and Rubella Strategic Plan. The M&RI Research and Innovation Working Group (R&IWG) conducted a web-based survey as part of a process to identify measles and rubella research priorities. Survey findings were used to inform discussions during a meeting of experts convened by the M&RI at the Pan American Health Organization in November 2016. MethodsThe cross-sectional web-based survey of scientific and programmatic experts included questions in four main topic areas: (1) epidemiology and economics (epidemiology); (2) new tools for surveillance, vaccine delivery, and laboratory testing (new tools); (3) immunization strategies and outbreak response (strategies); and (4) vaccine demand and communications (demand). Analyses were stratified by the six WHO regions and by global, regional, or national/sub-national level of respondents. ResultsThe six highest priority research questions selected by survey respondents from the four topic areas were the following: (1) What are the causes of outbreaks in settings with high reported vaccination coverage? (epidemiology); (2) Can affordable diagnostic tests be developed to confirm measles and rubella cases rapidly and accurately at the point of care? (new tools); (3) What are effective strategies for increasing coverage of the routine first dose of measles vaccine administered at 9 or 12 months? (strategies); (4) What are effective strategies for increasing coverage of the second dose given after the first year of life? (strategies); (5) How can communities best be engaged in planning, implementing and monitoring health services including vaccinations? (demand); (6) What capacity building is needed for health workers to be able to identify and work more effectively with community leaders? (demand). Research priorities varied by region and by global/regional/national levels for all topic areas. ConclusionsResearch and innovation will be critical to make further progress toward achieving the GVAP measles and rubella elimination goals. The results of this survey can be used to inform decision-making for investments in research activities at the global, regional, and national levels.