Measles Immunization Research Articles

Unveiling immunity gaps and determining a suitable age for a third dose of the measles-containing vaccine: a strategic approach to accelerating measles elimination.

In highly measles immunized countries, immunity gaps in adolescents and young adults are a key issue posing an obstacle to measles elimination. This study aims to identify the gaps by estimating the age-stratified probability of seropositivity, and to ascertain a suitable age for the administration of a third dose of a measles-containing vaccine (MCV3) to effectively fill these gaps. We retrospectively obtained measles serological results from hospital setting among among individuals aged 13-39 years and developed a serocatalytic dynamic probability model, stratifying seropositivity due to vaccination or natural infection. We calibrated the model to age-stratified seropositivity data within a Bayesian setting using the Metropolis-Hastings algorithm. A scenario analysis to determine a suitable age for MCV3 administration was also performed. The overall prevalence of measles seropositivity was 65.6% (95% confidence interval [CI]: 61.5-69.6). Posterior predictive curves for the age-stratified seroprevalence exhibited a decreasing trend from ages 13-20 years but an upward trend from 26 to 30 years. The age at which a given individual's serostatus reached a 50% probability of seronegativity was found to be approximately 18-20 years depending on the annual measles force of infection. Our findings highlight a significant measles immunity gap in young adults aged 20-26 years, posing an increased risk of transmission. A MCV3 at the age of 18-20 years potentially closes the gap and aids measles elimination programmes. This work was supported by Faculty of Tropical Medicine (MCTM, ICTM grant), Mahidol University (to T.N.) and APC fee was supported by Mahidol University (to T.N.). S.M. and W.P. were funded in whole, or in part, by the Wellcome Trust [Grant number 220211]. For the purpose of open access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.

Seroprevalence of measles antibodies in women born between 1985 and 1999 in metropolitan city in India: a cross-sectional study

IntroductionThe Universal Immunisation Programme of India recommends first dose of measles vaccine in children at 9 months as the infant is protected by the maternal antibodies till then, and the...

Further analysis of determinants of Pentavalent and Measles immunizations dropouts among children under five years of age in Ethiopia from Mini-EDHS 2019

BackgroundGlobally, immunization prevents an estimated 2–3 million deaths from illnesses that can be prevented by vaccination. The predictors of Pentavalent and Measles immunization dropout were not investigated sufficiently. Therefore, this analysis was meant to determine the coverage, burden, and predictors of Pentavalent and Measles immunizations in Ethiopia.Materials and methodsThis study was a further analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019, conducted with a nationally representative sample. In this study, immunization data was collected from a total sample of 3208 children of which 2004 (34.8%) children who received pentavalent 1 were considered for this study. Univariable, bi-variable, and multilevel mixed effect analysis was done using STATA version 17 Software. The mixed-effect model with the lowest AIC and BIC (information criteria) was chosen. A factor was designated as a significant predictor of immunization dropout if its p-value was less than 0.05 at 95% CI. The best-fitting model among the fitted models was ultimately chosen using the Akaike and Bayesian Information Criteria (AIC and BIC).ResultThe mean age of the head of the household was 37.6. The majority (68.9%) of the residents were from rural areas and of the total population, 64.9% have no formal education. Being residents of Afar increased the odds of dropping out by 3.28 (AOR = 3.28; 95% CI: 1.12, 9.56), whereas being residents of Addis Ababa reduced their odds of dropping out from prentavalent 3 by 68.1% (AOR = 0.319; 95% CI: 0.122, 0.833) compared to their Tigray counterparts. The dropout rate of Pentavalent 1 to measles 1 vaccination was 4.33 times higher among residents of Afar (AOR = 4.33; 95% CI: 1.38, 13.56). As the level of wealth increases, the quintile increases from poorer to richer compared to those in the poorest wealth quantile category, and marital status also affects the immunization dropout rate of their children.ConclusionsImmunization coverage of Ethiopian children was low and the dropout from pentavalent 1 and measles vaccination was high compared to the national and international targets to improve immunization coverage and reduce dropout. So different cost-effective interventions like Education provision for the community, decision-making facilitation, behavioral change support, and multi-system participation were required to increase vaccination coverage and reduce the vaccine dropout among children in Ethiopia.

Factors Related To The Success Of Measles Immunization In Children Aged 2-3 Years

Providing immunizations to children can prevent and protect children from other dangerous and contagious infectious diseases, so that they will have the opportunity to take part in activities such as playing and studying. To determine the factors associated with the success of measles immunization in toddlers 2-3 years old in Loji Village. The location of this research was carried out in the working area of ​​the Pasir Mulya Community Health Center, precisely in Loji Village, West Bogor District, Bogor City, West Java 16118. This research was carried out from January 2023 to July 2023 with a time span of around 7 months. This type of research uses quantitative methods. This study used cross-sectional or cross-sectional. The sampling technique used was a total sampling technique with a sample size of 70 samples. The research instrument this time used by the researcher was a questionnaire. This bivariate analysis uses the Chi-square test. The educational level of parents, type of work, and the role of health workers and posyandu cadres can influence the success of measles immunization in toddlers 2-3 years old with respective p values ​​(0.004; 0.006; 0.014; 0.008). Therefore, it is important to increase public awareness and participation in immunization programs in order to achieve optimal targets. In conclusion, socio-economic factors and the role of health workers greatly influence the success of measles immunization in toddlers 2-3 years old, so there needs to be collaborative efforts between the government, community and health workers to increase immunization coverage.

Inequalities in measles immunization coverage among two-year-olds in Sierra Leone, 2008–2019

BackgroundMeasles, a highly contagious and potentially fatal disease, remains a significant public health concern, particularly in low- and middle-income countries. Vaccination is the most effective way to prevent measles and achieving high immunization coverage is crucial for protecting children and communities. This study investigated the trends and inequalities in measles immunization coverage among two-year-olds in Sierra Leone between 2008 and 2019.MethodsThe study utilized data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. The World Health Organisation Health Equity Assessment Toolkit was used to calculate various inequality measures, including Difference (D), Ratio (R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAF). An inequality assessment was conducted for six stratifiers: age, economic status, level of education, place of residence, sex of the child, and sub-national province.ResultsIn Sierra Leone, measles immunization coverage increased between 2008 and 2013 and decreased slightly in 2019. In 2008, 66.2% of two-year-olds were immunized, which increased to 86.2% in 2013 and then fell slightly to 82.2% in 2019. There was a decrease in inequality for age from 4.2 percentage points in 2008 to 3.0 percentage points in 2019 (D = 4.2 in 2008 and 3.0 in 2019). Economic-related inequality decreased from 8.1 percentage points in 2008 to 7.5 percentage points in 2019 (D = 8.1 in 2008 and 7.5 in 2019). Inequality in education decreased from 10.3 percentage points in 2008 to 7.4 percentage points in 2019 based on results from the inequality measure D. For place of residence, inequality decreased from 6.0 percentage points in 2008 to 4.0 percentage points in 2019. For the child’s sex, the inequality increased from 1.9 percentage points in 2008 to 4.5 percentage points in 2019. The PAF revealed that the setting average could have been 1.4% higher in 2008 and 2.7% higher in 2019 without the child’s sex inequality. Provincial inequality decreased from 19.4 percentage points in 2008 to 16.9 percentage points in 2019 (D = 19.4 in 2008 and 16.9 in 2019).ConclusionThe observed fluctuations in national measles immunization coverage for children under two underscore the need for sustained efforts in vaccination programs. While improvements in access based on age, socioeconomic status, education level, and place of residence suggest progress in reducing inequalities, the persistent provincial disparities, with a significant gap in 2019, highlight ongoing challenges that must be addressed to ensure equitable health outcomes. Additionally, the increase in inequalities based on the child’s sex during the study period raises concerns about targeted interventions that may inadvertently neglect specific groups. These findings imply that policymakers must prioritize strategies that maintain high vaccination rates and focus on closing the geographical and sex-based gaps, particularly in underserved provinces and among vulnerable populations.

THE ROLE OF NUTRITIONAL STATUS IN THE PERSISTENCE OF MEASLES IMMUNITY AMONG CHILDREN: A MULTIVARIATE ANALYSIS

<p><strong>Background:</strong> The persistence of measles immunity in children is influenced by multiple factors, including nutritional status. This study aimed to assess the role of body mass index (BMI) as a proxy for nutritional status in the persistence of measles immunity, alongside other socio-demographic factors, in a pediatric population. <strong>Methods:</strong> A multivariate logistic regression analysis was conducted on 200 children (2-15 years) attending the University Teaching Children's Hospital in Lusaka, Zambia. Immunity retention was measured through IgG serology. BMI represented nutritional status, and the analysis adjusted for key variables such as HIV status, breastfeeding history, sex, and education level. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to determine the association between nutritional status and immunity persistence. <strong>Results:</strong> Children categorized as well-nourished had significantly lower odds of waning immunity (OR = 0.37, 95% CI = 0.16–0.83, p = 0.016). However, for children with over or under malnutrition, the association was not statistically significant (OR = 0.23, 95% CI = 0.03–1.62, p = 0.140). Additionally, HIV-positive status was associated with decreased immunity retention (OR = 0.28, 95% CI = 0.14–0.56, p < 0.001). Breastfeeding was positively associated with immunity persistence (OR = 3.34, 95% CI = 1.53–7.29, p = 0.003), while other socio-demographic factors such as sex and education level showed no significant effect. <strong>Conclusion:</strong> Nutritional status, as measured by BMI, plays a significant role in the persistence of measles immunity among children, with over- and under-nourished children being associated with lower immunity retention. These findings suggest that nutritional interventions may be necessary to improve vaccine efficacy, particularly in populations with high rates of malnutrition or obesity. The results also highlight the need for further investigation into the mechanisms linking nutritional status to immune response and the development of targeted public health strategies to optimize measles immunization outcomes in children.</p><p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/soc/0722/a.php" alt="Hit counter" /></p>

The Health and Economic Benefits of United States Investments in Measles and Rubella Control and Elimination.

Background: Prior to measles vaccine introduction in 1963, measles virus caused hundreds of thousands of annual reported cases, which led to substantial US morbidity, mortality, and costs. Similarly, congenital rubella syndrome (CRS) led to highly visible and tragic lifelong disability for thousands of Americans, before rubella vaccine introduction in 1969. The US certified national virus transmission elimination of indigenous measles in 2000 and rubella in 2004. Methods: Applying an existing integrated transmission and economic model, this analysis characterizes the net benefits of US investments in measles (1963-2030) and rubella (1969-2030) immunization assuming continued high routine immunization coverage. Due to importation risks, the US maintains two doses of both vaccines in its routine immunization schedule. Results: This analysis estimates total US costs of 8.1 billion (economics reported in 2023 US dollars) for measles immunization for 1963-2023 and 14.1 billion for rubella immunization for 1969-2023. The analysis estimates an additional approximately 1.2 billion for measles immunization and 1.5 billion for rubella immunization expected for 2024-2030. Historical and future US investments prevented an estimated approximately 237 million measles infections, 228,000 measles deaths, 193 million rubella infections, and 166,000 CRS cases. These investments imply net benefits (from avoided treatment costs minus immunization costs) of approximately 310 billion for measles and 430 billion for rubella and CRS, even without incorporating avoided productivity losses and intangible costs. Conclusions: US investments in measles and rubella immunization continue to provide enormous savings of human and financial costs and to prevent substantial mortality and morbidity.

Factors influencing the first dose of measles vaccination uptake in 42 low- and middle-income countries

ObjectivesVaccination against measles still stands as a highly impactful public health strategy for mitigating childhood morbidity and mortality. Relatively poor immunization coverage among children has been observed in low and middle-income countries (LMICs). Our study intended to determine socio-demographic factors associated with the 1st dose of measles vaccination among South Asian (SA) and SubSaharan African (SSA) countries children. Study designThis was a cross-sectional study. MethodsThis study utilized demographic and health survey data from 42 low-and middle-income countries (LMICs) in SA and SSA. The children's dataset yielded 255,775 children between the ages of 12 and 59 months. The independent predictors were determined by using crude and adjusted odds ratios with 95% confidence intervals (CI). ResultsThe prevalence of first-dose measles-immunized children was 55.5% for the selected LMICs. The multivariable analysis for combined regions (SA and SSA) showed that parents with a higher level of education, rich wealth quintile, mothers with media access, mothers with more than four antenatal care (ANC) visits and baby postnatal check-up (PNC) within two months were significantly associated with the first dose of measles vaccination among children. ConclusionThe first dose measles immunization coverage in the selected LMICs was considerably low. To boost the uptake of childhood measles vaccination, public health interventions particularly need to focus on children born to uneducated parents, poor families, and those who have not used health services (ANC and PNC). Financial funding is crucial for establishing mobile vaccination clinics to improve immunization rates among the impoverished.

Measles Population Immunity Profiles: Updated Methods and Tools.

Measles is a highly contagious disease and remains a major cause of child mortality worldwide. While measles vaccine is highly effective, high levels of population immunity are needed to prevent outbreaks. Simple but accurate tools are needed to estimate the profile of population measles immunity by age to identify and fill immunity gaps caused by low levels of vaccination coverage. The measles immunity profile estimates and visualizes the percentage of each birth cohort immune or susceptible to measles based on measles vaccination coverage. Several tools that employed this approach have been developed in the past, including informal unpublished versions. However, these tools used varying assumptions and produced inconsistent results. We updated the measles population immunity profile methodology to standardize and better document the assumptions and methods; provide timely estimates of measles population immunity; and facilitate prompt actions to close immunity gaps and prevent outbreaks. We recommend assuming that the second dose of the measles-containing vaccine (MCV2) and doses given during supplementary immunization activities (SIAs) first reach children who have been previously vaccinated against measles, so that previously unvaccinated children are reached only when the coverage of MCV2 or SIA is higher than the coverage achieved by all previous measles vaccination opportunities. This updated method provides a conservative estimate of immunization program impact to assess measles outbreak risk and to facilitate early planning of timely preventive SIAs to close population immunity gaps.

Using Regular High-Quality Serosurveys to Identify and Close National Immunity Gaps-Measles and Rubella Elimination in Japan.

In Japan, periodic measles outbreaks occurred mainly among young children under the routine immunization program with one dose of the measles-containing vaccine (MCV). A second dose of MCV was introduced in 2006. During a nationwide measles resurgence in 2007-2008, the most affected age group was teenagers. The national serological surveillance for vaccine-preventable diseases made it clear that there was a measles immunity gap among teenagers who had not received a second dose of MCV. To fill this immunity gap, nationwide non-selective supplementary immunization activities (SIAs) were carried out as a five-year program from April 2008 to March 2013 by providing an opportunity to be vaccinated with the measles and rubella vaccine during the first year of junior high school (12-13 years old) and the last year of high school (17-18 years old). The SIA was conducted with the strong involvement of local governments in charge of vaccination delivery and collaboration between the health and education sectors. Japan was verified as achieving measles elimination in 2015 and this has been sustained to date. The challenge of rubella elimination following a similar strategy of a serological diagnosis of an immunity gap and targeted vaccination is also discussed.

Measles immunity status in Iranian infants and children and outbreak concerns: Time for reconsidering the vaccination schedule?

Introduction: Measles vaccination has greatly reduced the disease burden worldwide, but challenges remain due to variations in vaccine effectiveness across age groups. This study aimed to assess the serological profile of measles antibodies across different age groups, evaluate the impact of maternal immunity on antibody levels in infants under 12 months, and assess measles immunity in vaccinated individuals. Material and methods: This cross-sectional study was conducted from June 2022 to January 2023 at the Children’s Medical Center, a referral hospital in Iran. Serum samples were tested for measles-specific IgG and IgM antibodies using a commercial enzyme-linked immunosorbent assay (ELSA). An avidity assay was performed to assess measles virus-specific IgG antibodies on the samples that were positive and borderline for the measles IgG ELISA. Results: The study included 969 participants across various age groups. Among them, 23% (221 out of 953) tested positive for measles IgM ELISA, and 52% (504 out of 969) for measles IgG ELISA. Regarding the avidity assay for measles virus-specific IgG, the majority (418 out of 573, 73%) showed high-avidity antibodies. Measles-specific IgG levels varied significantly across different age groups, with infants below 6 months old showing a mean IgG level of 477 mIU/mL, declining to 230 mIU/mL between 6 and 12 months, and increasing significantly to 683 mIU/mL in the 12 to 18 month age group, reaching a peak at 938 mIU/mL among children aged 18–72 months. Conclusion: The increasing IgM positivity among young Iranians suggests a rising risk of measles outbreaks, possibly due to vaccination gaps. Inadequate antibody levels in infants raise concerns about vaccination effectiveness. Considering declining maternal antibodies, vaccinating infants at 6–9 months could be beneficial. Boosters for adolescents and women may further mitigate outbreak risks.

Mapping the Implementation Determinants of Second Dose Measles Vaccination in the World Health Organization African Region: A Rapid Review.

The second dose of measles-containing vaccines (MCV2) has significant programmatic relevance in the current immunisation landscape because it serves as both an opportunity to reduce measles immunity gaps and strengthen second year of life vaccination platforms. However, MCV2 coverage remains suboptimal across countries in the World Health Organization (WHO) African Region and this puts a significant number of children at risk of morbidity and mortality from measles despite the availability of an effective vaccine. There is an urgent need to strengthen the implementation of MCV2 but this requires a thorough and systematic understanding of contextual factors that influence it. The literature that describes the determinants of implementation of MCV2 in a manner that adequately accounts for the complexity of the implementation context is scarce. Therefore, the purpose of this rapid review was to explore the implementation determinants of MCV2 in the WHO African Region using systems thinking. Literature search in two databases (PubMed and Google Scholar) were conducted. After screening, a total of 17 eligible articles were included in the study. Thematic analysis of extracted data was performed to identify the implementation determinants, after which they were mapped using the Consolidated Framework for Implementation Research (CFIR). A causal loop diagram (CLD) was used to illustrate the linkages between identified determinants. We found 44 implementation determinants across the five CFIR domains, i.e., innovation, outer setting, inner setting, individual, and implementation process. The majority of identified determinants are within the individual domain followed by the inner setting domain. The CLD showed that multiple contingent connections and feedback relationships exist between the identified implementation determinants within and across CFIR domains. The linkages between the implementation determinants revealed three balancing and reinforcing loops each. The findings suggest that implementation determinants of second-dose measles vaccination in the WHO African Region are complex, with multiple interconnections and interdependencies, and this insight should guide subsequent policies. There is an urgent need for further implementation research with embedded CLD in specific settings to inform the design of tailored systemic strategies to improve the implementation effectiveness of MCV2.

Measles resurgence in Armenia: unmasking health system vulnerabilities and crafting comprehensive eradication strategies - a review.

Measles is an acute febrile illness associated with rashes, fever and life-threatening complications. It is a vaccine-preventable disease with the Measles Mumps Rubella(MMR) vaccine but a recent global trend unveils a resurgence of measles in various parts of the world including Armenia. Measles was declared eliminated from Armenia in 2021 before reports of local outbreaks surfaced in 2023. The WHO identified discrepancies in the vaccination coverage during COVID-19. Measles also poses a great financial burden as a public health issue worldwide. Sociocultural factors impacting measles transmission are maternal education, healthcare access, migration, vaccine hesitancy, and socioeconomic status (Table 3). Efforts to control and eradicate measles from Armenia are run by a collaborative approach of national and international health bodies such as United Nations Children's Fund (UNICEF), WHO, Global Vaccine Alliance (GAVI), and the Ministry of Health. Thus, the resurgence of measles can be managed through widespread patient education, innovative approaches, strengthening the healthcare system and addressing vaccine hesitancy, sociocultural barriers, and humanitarian emergencies. This review investigates the complicated dynamics of measles inside Armenia's health system in depth. A thorough examination of measles incidence and immunization patterns highlights the shift from few cases and high vaccination rates to a comeback caused by imported viruses. The causes of its recurrence have been thoroughly investigated, including reduced immunization programs and vaccine hesitancy. The research delves further into the 'One Health' idea, assessing the possibility of interspecies transmission among nonhuman primates and examining the environmental factors that influence measles transmission. Among the challenges are weaknesses within Armenia's health system as well as the possibility of interruptions from the COVID-19 outbreak. In measles vaccination status, the combination of maternal education, postnatal care, and socioeconomic variables exposes the larger drivers at work. The study concludes with a comprehensive set of public health policy recommendations covering vaccination promotion, surveillance, healthcare provider education, public awareness, international collaboration, data analysis, law enforcement, emergency preparedness, research, and coordination. The research sheds light on the tangled web of measles dynamics, health system resilience, and contextual subtleties via this multifaceted approach, inviting readers to investigate the multiple strategies required for eliminating measles in Armenia.

Study to Assess the Clinical and Sociodemographic Profile of Measles in Children Admitted to a Tertiary Care Center: A Retrospective Study.

Background Measles remains a significant contributor to illness and death among young children, despite the presence of a safe and efficacious vaccine. One of the most highly transmissible viruses affecting humans is measles, which can be almost entirely prevented through vaccination. The recent surge in measles cases worldwide has been particularly notable in India. A total of 172 confirmed outbreaks of measles were recorded between October 2021 and September 2022, resulting in 12,589 cases. Measles, being highly contagious, is transmitted through the respiratory route. The disease affects 75 to 90% of susceptible household contacts, reaching peak infectivity three days before the rash emerges. The recent measles outbreak observed since January 2023 holds significance, as Bangalore district alone has reported around 500 cases. Therefore, the current study aims to evaluate the clinical and sociodemographic characteristics of measles in pediatric patients. Methods This was a retrospective study conducted over seven months. Data pertaining to demographics such as age, gender, parental occupation, parental educational background, and housing situation were gathered. Details regarding the child's immunization status, the onset of fever, and the onset of rash were also documented. Descriptive data was represented using mean, standard deviation, and percentage or proportion. Results Over the study period of seven months, 53 children were admitted due to measles. The majority of the individuals were female, accounting for 28 cases (52.8%). The typical clinical manifestations of measles such as cough, coryza, and conjunctivitis were documented in 45 (84.90%), 43 (81.13%), and 32 (60.37%) children, respectively.Specifically, two (3.77%), 14 (26.41%), 20 (37.73%), and 17 (32.07%) individuals were categorized as belonging to the upper middle, lower middle, upper lower, and lower socioeconomic strata. Six children in the nine- to 12-month age range had not received the measles-rubella (MR) vaccination. Thirteen (54.16%) out of 24 children aged one to five years had not received a single dose of thevaccine, while the children who had received at least one dose did not experience any complications. Among children aged less than nine months, nine to 12 months, and more than 12 months, three (100%), two (66.6%), and three (75%) respectively,experienced complications. All the patients recovered completely and were discharged from the hospital. Conclusion Measles is re-emerging as an infectious disease among children, as evidenced by the current outbreak. Study indicates that measles tends to impact infants and under five children more frequently. Through prompt and suitable medical intervention, all affected children experienced full recovery. It was observed that immunized children had fewer complications in comparison to their non-immunized counterparts. Acquiring a thorough understanding of the clinical profile of the illness is crucial for policymakers in developing essential guidelines for measles immunization coverage.

A Cross-Sectional Study of Measles-Specific Antibody Levels in Australian Blood Donors-Implications for Measles Post-Elimination Countries.

Passive immunisation with normal human immunoglobulin (NHIG) is recommended as post-exposure prophylaxis (PEP) for higher-risk measles contacts where vaccination is contraindicated. However, the concentration of measles-specific antibodies in NHIG depends on antibody levels within pooled donor plasma. There are concerns that measles immunity in the Australian population may be declining over time and that blood donors' levels will progressively decrease, impacting levels required to produce effective NHIG for measles PEP. A cross-sectional study of Australian plasmapheresis donors was performed using an age-stratified, random sample of recovered serum specimens, collected between October and November 2019 (n = 1199). Measles-specific IgG antibodies were quantified by ELISA (Enzygnost anti-measles virus IgG, Siemens), and negative and equivocal specimens (n = 149) also underwent plaque reduction neutralisation testing (PRNT). Mean antibody levels (optical density values) progressively decreased from older to younger birth cohorts, from 2.09 [±0.09, 95% CI] to 0.58 [±0.04, 95% CI] in donors born in 1940-1959 and 1990-2001, respectively (p < 0.0001). This study shows that mean measles-specific IgG levels are significantly lower in younger Australian donors. While current NHIG selection policies target older donors, as younger birth cohorts become an increasingly larger proportion of contributing donors, measles-specific antibody concentrations of NHIG will progressively reduce. We therefore recommend monitoring measles-specific antibody levels in future donors and NHIG products in Australia and other countries that eliminated measles before the birth of their youngest blood donors.

The Problem with Delaying Measles Elimination.

Measles is a highly infectious disease leading to high morbidity and mortality impacting people's lives and economies across the globe. The measles vaccine saves more lives than any other vaccine in the Essential Programme of Immunization and is also the most cost-effective vaccine, with an extremely high return on investment. This makes achieving measles elimination through vaccination a key child health intervention, particularly in low-income countries, where the overwhelming majority of measles deaths continue to occur. All countries and regions of the world have committed to achieving measles elimination, yet many have faced challenges securing political commitment at national and global levels and predictable, timely, and flexible support from global donors, and experienced setbacks during the COVID-19 pandemic. This has happened against a backdrop of stagnant measles vaccination coverage and declining enthusiasm for vertical programmes, culminating in a World Health Organization Strategic Advisory Group of Experts (WHO SAGE) review of the feasibility of measles eradication in 2019. Sustaining the elimination of measles long term is extremely difficult, and some countries have lost or nearly lost their measles elimination status in the face of ongoing importation of cases from neighbouring or closely connected countries in which elimination had been delayed. Thus, a widening equity gap in measles immunisation coverage creates challenges for all countries, not just those facing the greatest burden of measles morbidity and mortality. Delaying elimination of measles in some countries makes it cumulatively harder for all countries to succeed for three principal reasons: increased inequity in measles immunisation coverage makes outbreaks more likely to happen and to be larger; political will is very difficult to sustain; and immunity may wane to a point that transmission is re-established. New strategies are needed to support countries and regions in their vision for a world without measles, including ways to galvanise domestic, regional and global resources and ignite the political will that is essential to make the vision a reality.

Analysis of Age Appropriate Measles Immunisation among the Eligible Children in India: A Cross-Sectional Analysis of National Family Health Survey–5

Abstract Background: Measles continues to pose a significant health threat to children in India, contributing significantly to the global burden of measles-related fatalities. Moreover, a considerable number of children did not even receive their first dose of the measles vaccine, and those who did generally did not receive it at the recommended age. Additionally, there is limited information available in India about age-appropriate measles immunization coverage. Hence, a modest attempt was made to evaluate the extent of timeliness of measles immunization and identify factors associated with the administration of the same among children aged 12 to 23 months in India. Materials and Methods: Data from the most recent National Family Health Survey (NFHS 5, 2019–2021) were used in the present study. The sample comprised 48,928 children aged 12 to 23 months. Cox Proportional Hazard regression analysis was used to determine the significant influencing factors on age-appropriate measles immunization in India. Results: Despite fairly up-to-date measles immunization coverage in India, more than 55% of immunized children received their immunization after the recommended age. Significant percentages of untimely immunization were observed for a substantial number of States and Union Territories across India. From the regression analysis, maternal age and education, religious affiliation, access to media, and healthcare-seeking behaviors such as institutional delivery and utilization of antenatal checkup were identified as the prominent factors related to age-appropriate immunization in India. Conclusion: Untimely immunization is a crucial issue in India. Addressing the timeliness of measles immunization requires a comprehensive strategy that includes healthcare delivery, family planning, immunization perception, and general education. Efforts should be prioritized to improve awareness and accessibility for ensuring timely immunization, thereby safeguarding the health of children across India.

Worth a Shot: Experience and Lessons From an Unsuccessful Pediatric Immunization Quality Improvement Effort in a Large Health System During the COVID-19 Pandemic.

During the coronavirus disease of 2019 (COVID-19) pandemic, routine childhood immunization rates dropped dramatically across the world, and the Military Health System (MHS) was no exception. In the MHS, which is a large, universally covered, low-to-no-cost health system, the immunization rates with the measles, mumps, and rubella (MMR) vaccine remain below the rate necessary to prevent community transmission of measles. We aimed to improve childhood immunization rates in the MHS with an expansive quality improvement project. Measles, mumps, and rubella immunization rates served as proxy outcome measures for routine immunization rates tracked by the Center for Disease Control multi-immunization combination measures. The tracked measure was the percentage of 16- to 18-month olds and 6-year olds who had received MMR #1 and MMR #2, respectively. Various countermeasures were implemented throughout the study period, and standard quality improvement analyses informed the effect of countermeasures. By January 2023, the percentage of 16- to 18-month olds and 6-year olds who had received MMR #1 and MMR #2 was 85% and 91%, respectively, with no positive shift in immunization rates despite various countermeasures introduced during the study period. For reference, the MMR immunization rates of commercial health maintenance organization and commercial preferred provider organization for 24-month-old populations were 92% and 90.3%, respectively. On chart review, the most common cause for under-immunization (55%) was vaccine abandonment. MMR #1 rates rose to 92% in 24-month olds. Measles, mumps, and rubella immunization rates within the MHS remained below commercial health system rates and below public health standards required for herd immunity despite various countermeasures throughout the COVID-19 pandemic. Immunization rates increased with age, suggesting that children within the MHS eventually catch up despite potential barriers.

Maternal antibody level, sex and birth route drive individual measles immunity differences.

Maternal antibody level, sex and birth route drive individual measles immunity differences.

Active surveillance of immunization adverse effects: a multicentre, open-label, three-arm randomized uncontrolled trial in Ethiopia.

Participant-centred active adverse event following immunization (AEFI) surveillance can offer real-time vaccine safety data and help in signal detection. This study aimed to evaluate the effectiveness of participant-centred active adverse events (AEs) surveillance following measles immunization in Gedeo Zone health facilities in Ethiopia. An open-label, multicentred, three-arm randomized uncontrolled trial was conducted from 1 June to 21 October 2023. After assessing enrolment eligibility, the study participants were randomized into three groups (short message service [SMS], telephone interview, and diary card). They were expected to report AEs in children 1week after receiving immunization. Binary and multivariable logistic regression and χ2 tests were used to analyse the data. Among the 396 participants randomized into the three groups, 80.8% (320 participants) reported back about their children's AE status. Participants in the telephone interview group exhibited a substantially superior response rate (93.2% of 132 participants; p<0.00001) compared with the SMS (71.2%) and diary card (78%) groups. The likelihood of reporting the status of AEs experienced by children was lower by 77% (adjusted odds ratio 0.23 [95% confidence interval 0.1 to 0.52], p-value <0.00001) in the diary card group compared with the telephone interview group. In this study, a telephone interview was found to be the best method for AEFI reporting. Participant-centred active AE surveillance could potentially permit more rapid identification of emerging safety signals. Trial registration: https://clinicaltrials.gov/ct2/show/NCT05803538.