First Dose Of MMR Research Articles

Accuracy and quality of immunization data in Iran: findings from data quality self-assessment survey in 2017

BackgroundThe aim of this study was to assess the accuracy and quality of immunization data on the pentavalent (diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B (Hib)) and MMR vaccines as the administrative data of the expanded program on immunization (EPI) in Iran.MethodsWe conducted a Data Quality Self-assessment (DQS) survey from October to December 2017. Standardized DQS tools were used to assess the accuracy of reported immunizations data and quality of the immunization monitoring system at the provincial level of the healthcare system including health houses, health posts, rural and urban health centers and district health centers. Multistage cluster random sampling with proportional to size (PPS) weights was used to select target provinces and related health units. Accuracy ratio, quality index (QI), completeness and relevant quality indices of first dose of MMR (MMR1) and third dose of pentavalent vaccines were reported. Corresponding period of the survey was limited to reported administrative immunization data during the first 6 months of 2016.ResultsIn relation to accuracy ratio, there was some evidence of under reporting of pentavalent (3rd dose) and MMR1 vaccines in health house units which were 100.94 and 101.1%, respectively. Completeness of reporting for both vaccines at different provincial levels was near 100%. However, the corresponding value for pentavalent (3rd dose) and MMR1 vaccines at the level of urban health centers was 96.67 and 94.17% respectively.Among the five components of a monitoring system data usage and core output had the lowest QI scores in either rural or urban as well as district healthcare centers.ConclusionsFindings from our DQS survey reveals that administrative reporting of the immunization data was adequate at provincial and district levels of the healthcare centers. Although, addressing the existing concerns regarding timelines of the reporting by health authorities and staffs of EPI is warranted.

Measles, mumps, and rubella antibody patterns of persistence and rate of decline following the second dose of the MMR vaccine

BackgroundAntibodies to measles, mumps, and rubella decline 3% per year on average, and have a high degree of individual variation. Yet, individual variations and differences across antigens are not well understood. To better understand potential implications on individual and population susceptibility, we reanalyzed longitudinal data to identify patterns of seropositivity and persistence. MethodsChildren vaccinated with the second dose of measles, mumps, rubella vaccine (MMR2) at 4–6 years of age were followed up to 12 years post-vaccination. The rates of antibody decline were assessed using regression models, accounting for differences between and within subjects. ResultsMost of the 302 participants were seropositive throughout follow-up (96% measles, 88% mumps, 79% rubella). The rate of antibody decline was associated with MMR2 response and baseline titer for measles and age at first dose of MMR (MMR1) for rubella. No demographic or clinical factors were associated with mumps rate of decline. One month post-MMR2, geometric mean titer (GMT) to measles was high (3892 mIU/mL), but declined on average 9.7% per year among those with the same baseline titer and <2-fold increase post-MMR2. Subjects with ≥2-fold experienced a slower decline (≤7.4%). GMT to rubella was 149 one month post-MMR2, declining 2.6% and 5.9% per year among those who received MMR1 at 12–15 months and >15 months, respectively. GMT to mumps one month post-MMR2 was 151, declining 9.2% per year. Only 14% of subjects had the same persistence trends for all antigens. ConclusionsThe rate of antibody decay varied substantially among individuals and the 3 antigen groups. A fast rate of decline coupled with high variation was observed for mumps, yet no predictors were identified. Future research should focus on better understanding waning titers to mumps and its impacts on community protection and individual susceptibility, in light of recent outbreaks in vaccinated populations.

Measles, Mumps, and Rubella Antibody: Patterns of Persistence and Rate of Decline Following the Second Dose of the MMR Vaccine

BackgroundAntibodies to measles, mumps, and rubella decline an estimated average of 3% per year, and have a high degree of variation among individuals. Yet, this variation and differences in individual-level response to the 3 antigens are not well understood. To better understand potential implications on individual and population-level susceptibility, we reanalyzed existing longitudinal data to identify patterns of seropositivity and antibody persistence.MethodsWisconsin children given the second dose of measles, mumps, and rubella vaccine (MMR2) at age 4–6 years were followed up to 12 years postvaccination. The rate of antibody decline and factors associated with the rate of decline were assessed using regression models that accounted for differences between and among subjects.ResultsMost of the 302 participants were seropositive throughout follow-up (96% measles, 88% mumps, 79% rubella). The rate of antibody decline was associated with MMR2 response and baseline titer for measles and age at first dose of MMR (MMR1) for rubella. None of the demographic or clinical factors examined were associated with rate of decline for mumps. One month after MMR2, geometric mean titer (GMT) to measles was high (3892 mIU/mL), but declined on average 9.7% per year among subjects with the same baseline titer and <2-fold increase in antibody titer after MMR2. Subjects with ≥2-fold increase experienced a slower decline (≤7.4%). GMT to rubella was 149 IU/mL one month after MMR2 and declined 2.6% and 5.9% per year among those who received MMR1 at 12–15 months and >15 months, respectively. GMT to mumps one month after MMR2 was 151 and declined 9.2% per year. Only 14% of participants had the same trends in antibody persistence for all 3 antigens.ConclusionThe rate of antibody decay varied substantially among individuals and among the 3 antigens. Despite waning titers, measles and rubella antibody levels remained high 12 years post MMR2. However, a fast rate of decline and high degree of variation was observed for mumps, yet no predictors of the decline were identified. Future research should focus on better understanding waning antibody titers to mumps and its impact on community protection and individual susceptibility, in light of recent mumps outbreaks in vaccinated populations.Figure 1.MeaslesFigure 2.MumpsFigure 3.RubellaDisclosures All authors: No reported disclosures.

Immunisation schedule of the Spanish Association of Paediatrics: 2015 Recommendations

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of current vaccines, including levels of recommendation. In our opinion, this is the optimal vaccination calendar for all children resident in Spain. Regarding the vaccines included in the official unified immunization schedule, the Committee emphasizes the administration of the first dose of hepatitis B either at birth or at 2 months of life; the recommendation of the first dose of MMR and varicella vaccine at the age of 12 months, with the second dose at the age of 2-3 years; DTaP or Tdap vaccine at the age of 6 years, followed by another Tdap booster dose at 11-12 years old; Tdap strategies for pregnant women and household contacts of the newborn, and immunization against human papillomavirus in girls aged 11-12 years old with a 2 dose scheme (0, 6 months). The Committee reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule, the same as it is being conducted in Western European countries. The recently authorised meningococcal B vaccine, currently blocked in Spain, exhibits the profile of a universal vaccine. The Committe insists on the need of having the vaccine available in communitary pharmacies. It has also proposed the free availability of varicella vaccines. Their efectiveness and safety have been confirmed when they are administred from the second year of life. Vaccination against rotavirus is recommended in all infants. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A.

Mumps resurgence in Denmark

BackgroundThe past decade has witnessed a resurgence of parotitisvirus (mumps) in several countries where seemingly good mumps control otherwise had been achieved through vaccination. Recently detection of mumps has increased in Denmark. ObjectivesTo describe the age-specific changes and time trends of parotitisvirus detection in Denmark over a 10 year period. Study design: Retrospective cohort study based on national laboratory data for parotitisvirus typing surveillance and national epidemiology data for mumps reporting. ResultsThe parotitisvirus detection rate has increased almost 10 times during the past 10 years from an incidence <0.1 per 100,000 in 2003 to 0.96 per 100,000 in 2013. The age distribution has shifted from children to young adults, and most cases are unvaccinated (54%) or vaccinated once (41%). The increase is due mainly to the existence of cohorts with low MMR vaccine coverage. ConclusionAnalysis of mumps surveillance data from Denmark documents that the incidence of mumps is increasing, and that the resurgence of parotitisvirus is primarily occurring among young Danish adults. Almost half of the infected clinical mumps cases had received the first dose of MMR.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2014

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (ACV-SAP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on safety, effectiveness and efficiency of vaccines.The present schedule includes levels of recommendation. We have graded as routine vaccinations those that the ACV-SAP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in special situations.Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Based on the latest epidemiological trends, ACV-SAP recommends the administration of the first dose of MMR and varicella vaccines at age 12 months and the second dose at age 2-3 years; the administration of DTaP or Tdap vaccine at age 4-6 years, always followed by another Tdap dose at 11-12 years; and the 3 or 4 meningococcal C scheme (1 or 2+1+1) at 2 and 4 months, or just 4 months, 12 months and 12 years of age.It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. The ACV-SAP believes that the coverage of vaccination against human papillomavirus in girls aged 11-12 years must be increased. Universal vaccination against varicella in the second year of life is an effective strategy, and the immediate public availability of the vaccine is requested in order to guarantee the right of healthy children to be vaccinated. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. The recently authorized meningococcal B vaccine has opened a chapter of hope in the prevention of this disease. In anticipation of upcoming national and international studies, the Committee recommends the vaccine for the control of disease outbreaks and insists on the need to be available in pharmacies.Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2014

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on safety, effectiveness and efficiency of vaccines.The present schedule includes levels of recommendation. We have graded, as routine vaccinations, those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in special situations.Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Based on the latest epidemiological trends, CAV-AEP recommends the administration of the first dose of MMR and varicella vaccines at age 12 months, with the second dose at age 2-3 years; the administration of DTaP or Tdap vaccine at age 4-6 years, always followed by another Tdap dose at 11-12 years; and the three meningococcal C scheme at 2 months, 12 months and 12 years of age.It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-12 years must be increased. Universal vaccination against varicella in the second year of life is an effective strategy, and the immediate public availability of the vaccine is requested in order to guarantee the right of healthy children to be vaccinated. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. The recently authorised meningococcal B vaccine has opened a chapter of hope in the prevention of this disease. In anticipation of upcoming national and international studies, the Committee recommends the vaccine for the control of disease outbreaks, and insists on the need to be available in pharmacies.Finally, it emphasises the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule.

Timeliness of infant vaccination and factors related with delay in Flanders, Belgium

Achieving high vaccination coverage is a necessary, but not a sufficient indicator of the quality of a vaccination programme, in terms of control and prevention of childhood infectious diseases. For optimal protection of infants, timeliness of vaccination is increasingly recognized as another important target.The aim of this study was to assess the timeliness of measles-mumps-rubella (MMR) and diphtheria-tetanus-pertussis (DTP) vaccination in infants in Flanders (Belgium), and to identify predictors of vaccination delay. The timeliness was assessed using the Kaplan–Meier estimator in three consecutive vaccination coverage surveys among children aged 18–24 months, conducted in 2005, 2008 and 2012, respectively. Factors associated with delayed administration of the vaccines were identified using Cox regression analysis.Over the time period, vaccination coverage for the first dose of MMR ranged from 94.0 to 96.6% and for the third dose of DTP from 97.9 to 98.7%. However, up to 32% (for MMR1) and 95% (for DTP3) of infants received vaccine doses delayed according to the recommended schedule. Although some improvement was achieved over the last decade, further efforts are needed to reach risk groups with delays, more specifically children vaccinated outside the baby well clinics, born from a mother originating from outside the European Union, children with a higher ranking or in families with a lower income.

Seroprevalence of measles among children affected by national measles elimination program in Korea, 2010

BackgroundFollowing the implementation of national measles elimination plan in Korea, the elimination was declared in 2006. In order to sustain the elimination, high population immunity should be continuously monitored. To evaluate the current age-related susceptibility within the Korean population, we conducted the seroprevalence in children and adolescents who were affected by the national measles elimination plan. MethodsWe used residual serum specimens to measure measles specific IgG and geometric mean titer (GMT) in birth cohorts 2007–2008 and 1997–2003. Among birth cohorts, 2007–2008 cohorts were grouped to evaluate the timeliness of first dose of MMR, 1994–2003 cohorts were grouped to evaluate the effect of keep-up MMR2 campaign, and 1992–1993 cohorts were grouped to evaluate the effect of catch-up campaign in 2001. ResultsOverall, measles seropositivity rate was 86%. The highest seroprevalence of measles IgG was in birth cohorts 2007–2008. Measles seropositivity declined continuously in age groups. The birth cohorts 1994–1996 showed significantly lower levels of seropositivity and GMT than did the other birth cohorts. ConclusionDespite efforts to eliminate measles for the past 10 years in Korea, our study revealed specific birth cohorts remaining at risk for transmission. The adolescents born during 1994–1996 had the lowest measles seropositivity levels, and might represent a ‘pocket’ that has potential at increased risk for measles transmission. Further discussion for follow-up immunization should be placed for consideration in the near future.

MMR vaccine effectiveness in an outbreak that involved day-care and primary schools

In 2006, a large measles outbreak occurred in Catalonia (Spain), where the immunization schedule included two doses of MMR vaccine at 15 months and 4 years. The aim of this study was to investigate the vaccine effectiveness (VE) of MMR in children attending day-care and pre-school centres and to estimate the number of cases that would have been avoided by administering the first dose of MMR at 12 months. A retrospective cohort study was carried out between October 2006 and January 2007 in day-care and pre-school centres with confirmed measles cases. VE was calculated in children aged ≥15 months without previous measles infection. Cases avoided by advancing the first dose of MMR to 12 months were estimated by calculating the basic and effective reproduction number in centres where transmission outside the class was observed. Fifteen centres and 1394 children were included. There were 77 confirmed cases (attack rate=5.5%). Vaccination coverage of the 1121 children aged ≥15 months was 91.6% and VE was 96% (95%CI 89-98%). There were 33 (41%) cases in the 81 children aged 12-14 months. Advancing the first dose to 12 months would have prevented 74 cases (91.5%) and lowered the attack rate from 41% to 8.6%. Over 90% of cases in children aged 12-14 months would have been avoided by MMR administration at 12 rather than 15 months. We strongly recommend advancing the first dose of MMR to 12 months in order to reduce the risk of measles outbreaks.

Eliminating congenital rubella: a seroepidemiological study on women of childbearing age and MMR vaccine coverage in newborns.

Rubella can have particularly serious effects on the product of conception if contracted during pregnancy. Thus, the main aim of rubella vaccination programmes is to prevent infection during pregnancy. A seroepidemiological study was conducted from July 2006 to December 2007 on 1000 women of childbearing age, 15 to 45 years old, using specific rubivirus antibody assays, IgG and IgM. A questionnaire administered at the same time allowed us to survey how much women knew about this disease. In addition, MMR vaccine coverage rates were analysed for cohorts born in the local health districts of Messina for the period 1993-2006. An analysis of the replies given to the questionnaire showed an estimated 42.8% of the women to have immunity from rubella, while the serological study showed an immunity coverage rate of80.6%. Vaccination coverage in the local health districts regarding the first dose of MMR was 81% (cohorts 1993-2005), while the rate was only 24% for the second dose (cohorts 1993-2002). Both immunity coverage in women of childbearing age and that for newborns (for the cohort considered)fall below the 95% target set by the National Elimination Plan for Measles and Congenital Rubella (PNEM). It is therefore necessary to provide women with adequate information about the risks of rubella during pregnancy and about the benefits of vaccination, as well as to recoup subjects at risk or those whose immune status is unknown. Public health authorities also need to make continued efforts to increase the number of MMR vaccinations throughout the region.

Coverage of recommended vaccines in children at 7–8 years of age in Flanders, Belgium

Evaluation of the coverage of primary diphtheria-tetanus-pertussis (DTP), poliomyelitis, hepatitis B (HBV) and measles-mumps-rubella (MMR) vaccine doses recommended before the age of 18 months in 7-year-old school children in Flanders, Belgium. Meningococcal serogroup C and DT-polio vaccines offered respectively as catch-up and booster vaccinations were also evaluated. Parents of 792 children born in Flanders in 1997 and selected by cluster sampling were interviewed at home in 2005. Vaccination data since infancy were collected retrospectively from vaccination documents and school health records. Coverage rates were 88.0% for the first dose of MMR, and 72.0%, 84.2% and 91.4% for the recommended HBV, DTP and poliomyelitis primary vaccine doses, respectively. These rates included catch-up of missed infant MMR (4.9%) and HBV (6.4%) vaccinations. In addition, 88.3% of the target group received the DT-polio booster dose recommended at 6 years of age and 83.1% a meningococcal C vaccine dose. Preventive public health services as well as private physicians were involved to a varying extent. A lower socioeconomic status of the family was associated with a higher risk of nonvaccination. Vaccinators in Flanders reach children relatively well during infancy and at school age, but catch-up of missed infant vaccine doses, especially MMR, should be optimized.

A high rate of seropositivity was demonstrated 20 years after the first dose of MMR* vaccine,

A high rate of seropositivity was demonstrated 20 years after the first dose of MMR* vaccine,

Dynamics and control of measles in Portugal: Accessing the impact of anticipating the age for the first dose of MMR from 15 to 12 months of age

The all-time low incidence of measles in Portugal in the recent years, raises questions regarding whether the disease has been eliminated, the role of recent control measures, and the epidemiological consequences of the rise in the proportion of newborns to vaccinated mothers, as opposed to those born to mothers who acquired immunity by natural infection. We estimate the vaccination coverage against measles in Portugal on a cohort-by-cohort basis, and incorporate this information into an age-structured seasonally-driven mathematical model aimed at reproducing measles dynamics in the past decades. The model reproduces documented trends in disease notifications and the serological profile of the Portuguese population, as estimated by a recent National Serological Survey. We provide evidence that the effective reproduction number (R(e)) of measles has been driven below 1 in Portugal, and that sustained measles elimination is crucially dependent upon the maintenance of a high (>95%) coverage with the MMR I vaccine in the future. If the vaccination coverage decreases to levels around 90% the anticipation of the first dose of the MMR I from 15 to 12 months of age, will ensure that R(e) remains below 1.

Toward Better Vaccine Safety Data and Safer Vaccination

In 1994 the Institute of Medicine's Vaccine Safety Committee concluded that “the evidence establishes a causal relation between measles-mumps-rubella vaccine (MMR) and thrombocytopenia. On the basis of data from Finland and Sweden, the incidence seems to be on the order of 1 per 30 000 to 40 000 vaccinated children.1” Although data available at that time were not optimal, the Committee's conclusions have stood the test of time and are supported by the accretion of evidence in subsequent studies, including the study by France et al published in this issue of Pediatrics2 that found an attributable risk of 1 case of immune thrombocytopenic purpura (ITP) per 40 000 doses of MMR administered in the second year of life. Given that the annual US birth cohort is >4 million and that the first dose of MMR is routinely recommended by the Centers for Disease Control and Prevention (CDC) early in the second year of life, then ∼100 cases of ITP per year would be attributable to MMR vaccination in the United States' setting of nearly universal immunization with this vaccine. Current evidence does not suggest substantial clinical differences between ITP after MMR vaccination and ITP due to other causes. ITP is frequently treated with corticosteroids and/or intravenous immunoglobulin, and then the condition usually resolves. Chronic ITP occurs in a small percentage of cases, 2 of 20 ITP cases post-MMR among children 12 to 23 months of age in the study by France et al.2 Hemorrhages requiring blood transfusion occur rarely, and reports of intracranial hemorrhage or death are very … Address correspondence to M. Miles Braun, MD, MPH, Division of Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, HFM-220, 1401 Rockville Pike, Rockville, MD 20852. E-mail: miles.braun{at}fda.hhs.gov

Immunogenicity and Safety of a Second Dose of Measles???Mumps???Rubella???Varicella Vaccine in Healthy Children Aged 5 to 6 Years

Two doses of measles-mumps-rubella (MMR) vaccine are recommended for elimination of these diseases in countries with universal mass vaccination; a 2-dose program is also likely to be required for elimination of childhood varicella and has recently been provisionally recommended in the United States. Given the overlap in MMR and varicella vaccination schedules, development of a combined vaccine appears logical and would facilitate the introduction of 2 doses of varicella vaccination in healthy children with no additional injections. The immunogenicity and safety of a second dose of an experimental MMR-varicella (MMRV) vaccine was assessed in an open-label phase III study (208136/017) in healthy children aged 5 to 6 years who had previously received a first dose of either MMRV (N = 48) or a licensed MMR vaccine (N = 45) in the second year of life. After administration of MMRV at 5 to 6 years of age, all subjects were seropositive for measles, rubella and varicella antibodies and only one subject in the MMRV group remained seronegative for mumps antibodies. Ratios of postover prevaccination geometric mean titers for antibodies against measles, mumps and rubella did not differ between the 2 study groups. A 5.2-fold increase (95% confidence interval: 3.5-7.8) in antivaricella antibody geometric mean titers was seen in initially seropositive subjects in the MMRV group after administration of the second vaccine dose. Local symptoms after the second dose of MMRV were more common in the MMRV group than in the MMR group. The incidence of fever was low in both groups compared with that usually seen after a first dose of MMR or MMRV vaccine. This experimental tetravalent MMRV vaccine appears well suited for use in national immunization programs in place of a second dose of MMR or MMR plus varicella in children who have already received a first dose of MMR.

Using Registry Data to Evaluate the 2004 Pneumococcal Conjugate Vaccine Shortage

The most recent pneumococcal conjugate vaccine (PCV7) shortage occurred between December 2003 and September 2004. To ensure vaccination of the highest-risk children, the Centers for Disease Control and Prevention recommended that providers delay administration of the third and fourth doses of vaccine to healthy children. We used Michigan Child Immunization Registry (MCIR) data collected from September 1, 2001 to November 30, 2004 to evaluate changes in PCV7 coverage. Vaccination and demographic data from MCIR were reviewed for 420,733 children born between September 2001 and August 2004. Main outcome measures were the proportion of children who received the third dose of PCV7 by 7 months of age and the fourth dose of PCV7 by 16 months of age. Vaccine coverage for measles, mumps, and rubella vaccine (MMR) and diphtheria, tetanus, and acellular pertussis vaccine (DTaP) was used for comparison, as these vaccines were abundant during this time period and their administration schedule is the same as the third and fourth doses of PCV7, respectively. Data analysis was conducted in spring 2005. Coverage for the third dose of DTaP and the first dose of MMR remained steady, while PCV7 coverage for the third dose dropped from 29% to 11%, and the fourth dose dropped from 27% to 22% in the month following the recommendations to defer doses. Coverage returned close to pre-shortage levels shortly after the recommendations to resume the normal schedule. PCV7 coverage trends were similar for children seen in the private or public sector. Registry data can be useful for evaluating vaccination coverage trends during a shortage. Our findings suggest that providers were compliant with recommendations to alter vaccine administration during the shortage.