Measles Immunization Status Research Articles

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.

FACTORS RELATED TO THE INCIDENCE OF MEASLES IN CHILDREN AGED 12 – 59 MONTHS IN THE WORKING AREA OF THE TIRTAYASA HEALTH CENTER, SERANG REGENCY IN 2023

This thesis aims to determine the factors related to the incidence of measles in the working area of the Tirtayasa Health Center, Serang Regency in 2023. The variables used consisted of independent variables consisting of: child factors (gender, measles immunization status, nutritional status, complete basic immunization status, status of high-dose vitamin A supplements), maternal factors (education level, level of knowledge, employment status, attitude), father factors (education level, employment status), environmental factors (occupancy density, house ventilation) and economic socialization factors (family income). The sample was mothers who had children aged 12 months to 59 months as many as 100 people and data was collected by distributing questionnaires. The results showed factors that were not associated with the incidence of measles: the sex of the child with a Pvalue of 0.427, the status of high-dose vitamin A supplementation with a Pvalue of 0.982, the employment status of the mother with a Pvalue of 0.950, and the employment status of the father with a Pvalue of 0.878. While the factors that are significantly related to the1 incidence of measles include: measles immunization status with Pvalue 0.000, nutritional status with Pvalue 0.026, maternal education level with Pvalue 0.000, maternal knowledge level with Pvalue 0.017, maternal attitude with Pvalue 0.006, father's education level towards with a Pvalue of 0.044, a density of a house with a Pvalue of 0.02, home ventilation with a Pvalue of 0.035 and family income against the incidence of measles Pvalue of 0.001. In accordance with the results of the study, the researchers' suggestions are: puskesmas officers to increase counseling, puskesmas to collaborate with other parties to improve the living environment and explore other variables for further researchers.

Measles vaccination coverage and immunization status of nurses: An interventional study in Türkiye

IntroductionHealthcare workers are more likely to contract measles than the general population. Our study aimed to assess measles vaccination and immunization levels among nurses, examine the influencing factors and implement an intervention program to increase immunization coverage. Materials and methodsOur study was conducted in a university hospital in Türkiye. The study included 1012 nurses. It was an intervention study, continued between 01/11/2021 and 30/10/2023. Measles IgG and vaccination status of the participants were evaluated. Participants with negative measles IgG results who had not been vaccinated against measles or received a single dose of the vaccine were invited to the outpatient clinic to receive two doses. Participants who had received two doses of the measles vaccine and had negative measles IgG results were invited to the outpatient clinic for one dose of the measles vaccine. Nine hundred seventy-eight people participated in our study. The access frequency was 96.6%. ResultsAmong the participants aged 21–30, 68.4 % were Measles IgG (+). Measles IgG (+) prevalence was higher in women than men (85.3 % vs. 61.0 %). The department with the lowest measles IgG positivity was intensive care (75.8 %). Measles IgG (+) prevalence became higher as the duration of employment increased. The measles seropositivity in total population rose from 83.1 % before the intervention to 94.3 % after, to 91.8 % in the 21–30 age group, and to 90.2 % in male. Sixteen people had never received measles vaccination. Of the 37 participants who had previously received two doses of measles vaccine, 22 received a single dose and after the intervention 16 (72.7 %) were positive. Only 1 person was found to have vaccine refusal during the intervention. ConclusionExpanding the immunization scope in hospitals by screening for measles antibodies among healthcare personnel and vaccinating those who are seronegative can be considered an effective public health strategy.

Seroprevalence for measles among healthcare workers in Madrid, Spain

Immunity of healthcare workers (HCWs) against measles is a particular concern. They are more likely to contract it than the general population due to their occupational exposure which may cause a nosocomial outbreak. To assess the measles immune status of HCWs at five Spanish university hospitals. Serologic testing (IgG) for measles by chemiluminescence indirect immunoassay (CLIA) was carried out prospectively and consecutively in HCWs from five university hospitals. All HCWs were classified into four epidemiological groups: vaccinated individuals, those with a history of measles disease, subjects with no history of measles or vaccination, and those who did not know whether they had measles or were vaccinated, and into five professional categories: physicians, nurses, nursing assistants, other clinical workers and non-clinical workers. A logistic regression model was constructed to identify the factors independently associated with immunity to measles. The study group was composed of 2157 HCWs. 89% had protective antibodies against measles. Of the 238 non-immune HCWs, 199 (83.6%) had been vaccinated, compared with 1084 of the 1919 (56.5%) immune individuals (P<0.0001). The parameters significantly predictive of having protective antibodies against measles were: older age (P<0.0001), epidemiological status (P=0.0002, mainly past measles disease), and professional category (P=0.02, in particular nurses). This study shows that HCWs, including those previously vaccinated, are currently at risk of measles and suggests that those with a natural history of infection are better protected. Therefore, knowledge and maintenance of immunity to measles are an essential part of infection control among HCWs.

Correlation between basic measles immunization historical and nutritional status on toddler: factorial stunting prevalence

Introduction: The problem of nutritional status on toddlers is still one of the world’s problems that must continue to be resolved, such as stunting. Stunting, or being too short for one’s age, is defined as below -2 standard deviations from the median height-for-age z-score. Stunting can directly be affected by infectious disease and incomplete immunization such as basic measles immunization. Objectives: This research aims to determine and analyze the correlation between giving basic measles immunization and nutritional status, especially the incidence of stunting on toddlers. Methods: This research was an observational analytic study using a cross-sectional approach with non-probability sampling. The samples were 134 toddlers who were 12-36 months, were not sick, and have the KIA/KMS book. Basic measles immunization and nutritional status were dependent variables whereas stunting prevalence was an independent variable. Data analysis used the Spearman’s Rho correlation test with α = 0.05. Results: The results showed the majority of toddlers experienced nutritional status problems especially stunting (51.5%) and the majority of toddlers had received basic measles immunization (67.9%). Based on the Spearman’s Rho statistical test, obtained p-value = 0.003 (p-value &lt; 0.05) with correlation coefficient (r) = -0.251. Conclusions: There is a significant correlation between basic measles immunization and nutritional status, especially in the incidence of stunting. This finding suggests that the local government should initiate an innovative program of health education focusing on knowledge and prevent the increasing stunting such as by collaborating with the nursing profession which can act as a good educator and caregiver.

Measles Immunity Status of Greek Population after the Outbreak in 2017-2018: Results from a Seroprevalence National Survey.

Accurate data on susceptibility rates against measles in the general population of Greece are scarce. Many studies have estimated the vaccination coverage, but none have calculated the nationwide immunity rate, including all age groups, against the measles virus. The purpose of our study was to determine the measles immunity status, especially after the latest outbreak in 2017-2018. In total, 3972 leftover blood samples were obtained during 2020-2021. They were collected from a nationwide laboratory network using a geographically stratified sampling strategy and were tested for the presence of measles-specific IgG antibodies. The overall crude seroprevalence was calculated to be 89.6% and the adjusted was 89.8% (95% CI: 88.8-90.8%). There was no statistically significant difference in seropositivity between sexes (p = 0.783). Higher immunity rates and antibody concentrations were found in older age groups ≥41 years old (94.9%, 95% CI: 93.7-95.9%, and 730.0 mIU/mL) in comparison with younger individuals aged 1-40 years old (83.4%, 95% CI: 81.6-85.7%, and 616.5 mIU/mL). Comparing the seroprevalence among the Nomenclature of Territorial Units for Statistics (NUTS 2), a statistically significant difference was estimated among them (<0.001). The two regions where higher measles incidence was observed during the 2017-2018 outbreak, Eastern Macedonia and Thrace, and Western Greece, were among the four regions with lower seropositivity (84.6%, 95% CI: 79.9-89.4%, and 85.9%, 95% CI: 81.4-90.4%, respectively). Our study showed a measles immunity gap that affects the younger age groups and makes a new measles outbreak likely. The enforcement of vaccination campaigns and addressing vaccine hesitancy could bridge it and achieve the required target of herd immunity.

Demographical, clinical, and complication differences between vaccinated and unvaccinated hospitalized children with measles in mogadishu somalia: a hospital-based retrospective cohort study.

A hospital-based retrospective cohort study was implemented between 10 October and 10 November 2022 by reviewing case record files following a well-structured checklist of admitted clinical features, demographic characteristics, history of measles immunization, and measles complication status. Descriptive statistics were used by presenting frequency and percentage for categorical and the mean score for continuous variables. χ2 and Fisher's exact test at P =0.05 were used to identify the proportions differences between vaccinated and unvaccinated cases. A total of 93 hospitalized measles children participated in the study. Over half were boys, the mean age in months was 20.9 (SD±7.28), and over two-thirds of the mothers/caregivers did not have formal education. Almost 9.7% of hospitalized measles children had one dose of the measles-containing vaccine, while none had two doses. The vaccinated cases had fewer ill with fewer complications than the unvaccinated cases. Fever, cough, rash, and Koplik's spots were clinical features associated with measles immunization status. Around one in ten hospitalized children had one dose of the measles vaccine. Vaccinated cases had fewer illnesses with few complications than unvaccinated cases. The paper highly emphasizes providing booster doses, improving vaccine logistics and storage, and following immunization schedules. In addition, conducting further multicentral high sample-size studies is highly required to identify whether vaccine inadequacy was due to host-related or vaccine-related factors.

Measles Immunization Status of Health Care Workers: A Cross-Sectional Study Exploring Factors Associated with Lack of Immunization According to the Health Belief Model.

Suboptimal levels of measles vaccination coverage make Italy a country where the circulation of the virus is still endemic. In the past decade, several nosocomial outbreaks of measles occurred in Italy that rapidly spread the infection among large numbers of hospitalized patients and susceptible healthcare workers (HCWs). A cross-sectional study was conducted at the University Hospital of Palermo (Italy) to estimate the rate of HCWs immunization and to investigate the factors associated with lack of immunization. The attitude to the immunization practice was evaluated by exploring the Health Belief Model. Overall, 118 HCWs were enrolled, with a mean age of 31 years and 59.3% male. About half of the sample (45.8%, n = 54) was found not to be immunized against measles. Multivariable analysis showed that the factors directly associated with the non-immunization status against measles were female sex (OR = 3.70, p = 0.056), being an HCW different from a physician (OR = 10.27, p = 0.015), having a high perception of barriers to vaccination (OR = 5.13, p = 0.047), not being immunized for other exanthematous diseases such as chickenpox (OR = 9.93, p = 0.003), mumps (OR = 33.64, p < 0.001) and rubella (OR = 10.12, p= 0.002). There is a need to contrast the low adherence of HCWs to measles vaccination by identifying effective strategies to increase immunization coverage and limiting the risk of further nosocomial measles outbreaks.

Evaluation of measles vaccination coverage in Lincang City, Yunnan Province, China

ABSTRACT Background: Lincang City in Yunnan Province on the China-Myanmar border, has reached the World Health Organization recommended coverage (95%) for measles-containing vaccine (MCV), but measles outbreaks still occur. We conducted a survey in Lincang City to determine the measles vaccination status of children on the China–Myanmar border. Methods: We used multistage sampling among children aged 8–83 months. Information on measles vaccination status was obtained from the child’s vaccination certificate, and serum samples were tested using commercially available ELISA kits. Results: A total of 938 children were surveyed. The vaccination coverage rate was 98.9% (95% CI: 98.2–99.6%) for measles–containing vaccine dose 1 (MCV1), and 95.8% (95% CI:94.9–96.7%) for measles–containing vaccine dose 2 (MCV2). The timely vaccination coverage rate was 52.0% (95% CI:48.8–55.2%) for MCV1, and 74.1% (95% CI: 82.9–89.0%) for MCV2. The timely-and–complete vaccination coverage rate was 41.0% (95% CI: 36.7–45.3%). The median delay period was 33 (95% CI: 27–39) days for MCV1, and 196 (95% CI: 146–246) days for MCV2. The seropositivity rate in children aged less than 7 years was 94.0% (95% CI: 92.5–95.5%) with a geometric mean titer of 1210.1 mIU/mL. Conclusions: The MCV coverage was high, but timely and timely-and-complete vaccination coverage were low and insufficient to prevent measles outbreaks. It is necessary to add the timely and timely-and-complete vaccination coverage as indicators of vaccination to provide a more complete picture of measles immunization status.

#1: The Clinico-Epidemiologic Profile and the Correlation of Nutrition and Immunization Status With Outcome of Measles Patients During an Outbreak

Abstract Background Measles is a highly contagious disease that leads to substantial morbidity among pediatric patients. Vaccination has already been implemented in the Philippines, but still measles outbreak is resurgent. This study will be of importance because it can be utilized to establish the factors that lead to the recent measles outbreak. Objectives To describe the demographic and clinical profile of pediatric patients diagnosed with measles during the recent measles outbreak in a tertiary hospital in Central Luzon, Philippines; and to investigate the relationship of nutrition and measles immunization status with the outcomes of measles. Methods Cross-sectional analytic study, conducted in Tertiary training government hospital. Included in the study were less than 19 years old, admitted between January and April 2019, and manifested the following criteria for suspected measles:fever, generalized maculopapular rash, cough, coryza, conjunctivitis. Descriptive statistics was used to present data for the clinico-demographic profile of patients. A correlation study was done by determining the statistical significance of the relationship of nutrition and vaccination status with measles complications and outcomes; and the relationship of complications with outcomes of patients. Results In total, 373 patients were included in this study, 60% (224) were males; 40% (149) were females. The majority was under 0–6 months, 40% (149). Most cases came from Pampanga, 333 (89.2%). A total of 355 (95%) patients were classified as clinically compatible measles, seven (2%) were laboratory confirmed, and all seven had measles IgM antibodies, four (1%) were epidemiologically linked cases. Most of the cases manifested the classic symptoms of measles: fever 100%, rashes 99%, cough 96%, colds 84%, conjunctivitis 55%, and Koplik’s spots was seen in only 13%. As to exposure, those with exposure (49%) and without exposure (51%) are almost the same. The majority of the patients (285, 76%) had no measles vaccine and the top reason for non-immunization is the issue of the patients being too young for vaccination. The majority had normal nutritional status (72.4%). Three hundred and twelve patients reported the occurrence of clinical complications in patients with measles. Pneumonia was seen in 75% of cases and 9.3% had diarrhea. The occurrence of diarrhea is not directly correlated (P = 0.823) with the outcome of measles while Pneumonia shows a significant correlation (P &amp;lt; 0.001) with the outcome of measles. Death among patients was seen in cases with pneumonia. The occurrence of pneumonia is not significantly correlated with nutritional status (P = 0.083) while diarrhea is significantly correlated with nutritional status(P = 0.027). Two hundred and forty-eight patients with normal nutritional status did not develop diarrhea. Vaccination status shows a significant correlation with the occurrence of pneumonia(P =0.001). Out of the 285 non-vaccinated cases, 223 developed pneumonia. Vaccination status did not show a significant correlation with the occurrence of diarrhea (P = 0.946). Nutritional status and vaccination status was not significantly correlated with measles outcome(P = 0.605 and 0.120).In terms of outcome, 90% of the patients were discharged while 10% died. Conclusion Most were males, aged 0 to 6 months. There was a clustering of cases in Pampanga. The majority was classified as clinically compatible measles. The most common complication was pneumonia. Half had exposure to measles. The majority had no vaccine. The presence of diarrhea is significantly related to nutritional status. Pneumonia is significantly correlated with vaccination status and the outcome of measles. Most of the patients were discharged.

Successful Response to a Measles Exposure in a Pediatric Clinic Utilizing Measles, Mumps, and Rubella (MMR) Vaccine Prophylaxis

Background: To be effective, postexposure prophylaxis (PEP) must be administered promptly after measles exposure. MMR vaccine is recommended within 72 hours of exposure. Immunoglobulin (IG) is recommended for infants aged &lt;6–12 months, susceptible individuals, and severely immunocompromised people within 6 days of exposure. MMR vaccine is readily available, less expensive, and more easily administered than IG, and it provides long-term immunity. However, due to delays in diagnosis of measles cases, it is often not possible to administer MMR PEP to contacts within 72 hours. We describe an unvaccinated infant with fever and rash after recent international travel who presented to a pediatric outpatient clinic. Measles was promptly suspected, and specimens were collected for measles polymerase chain reaction (PCR) testing at the California Department of Public Health (CDPH) laboratory. PCR results confirming measles were obtained within 24 hours of the patient visit. Methods: A multidisciplinary team of medical, employee health, nursing, pharmacy and infection prevention staff was assembled. Electronic health records (EHRs) were used to identify exposed patients based on registration times, as well as to determine their MMR vaccination status and to identify any immunocompromising conditions. Exposed patients were notified either by e-mail or phone. Adult caretakers were interviewed to determine who accompanied the child to the clinic. Caretakers were questioned regarding their MMR vaccination status and the high risk to accompanying persons. The use of EHRs with data integration from other healthcare system helped validate and supplement vaccine statuses and medical histories of exposed family members. Results: In total, 128 persons were exposed; 31 staff (24%), 46 patients (36%) and 51 family members (40$). All 128 patients (100%) and family members were notified within 24 hours of case confirmation, and 44 of 128 (34%) required PEP. All staff had documentation of measles immune status. However, 1 of 31 staff (3%) needed PEP due to immunosuppression. MMR vaccine was given to 35 of 36 eligible persons (97%), except for 1 sibling who received IG due to delay in exposure identification. An additional 8 of 44 persons (18%) required IG due to age or immunosuppression. There were no secondary cases. Conclusions: MMR vaccine was used as primary PEP due to prompt suspicion for measles, early laboratory confirmation, and swift coordinated response using a multidisciplinary team. Leveraging EHRs helped rapidly identify exposed persons, validate measles immunity status and risk factors, order prophylaxis, and track outcomes.Funding: NoneDisclosures: None

Measles immunisation status of healthcare workers in smaller Victorian hospitals: can we do better?

ObjectiveTo determine the proportion of healthcare workers (HCWs) in smaller Victorian public healthcare facilities with documented evidence of measles immunity. MethodsA cross‐sectional survey, developed by the Victorian Healthcare Associated Surveillance System Coordinating Centre, was completed by all eligible facilities. HCWs were reported as having evidence or no evidence of measles immunity. Those without evidence of immunity were sub‐classified as incomplete, declined or unknown status. ResultsSeventy‐five facilities reported measles immunity status of 17,522 employed HCWs. Of these, 11,751 (67.1%) had documented evidence of immunity. The proportion with evidence of immunity was lowest (45.6%) in facilities with ≤50 HCWs. The majority of HCWs without evidence of immunity (88.2%) had ‘unknown’ status. Declination or incomplete status comprised very low overall proportions (0.3% and 3.6%, respectively). ConclusionsReported evidence of HCW measles immunity was moderate in surveyed facilities, with a large proportion having unknown status. HCW immunisation programs in some facilities require refinement to appropriately support public health responses to measles cases and prevention of occupational acquisition of measles. Implications for public healthNon‐immune HCWs are at increased risk for acquiring and transmitting measles. Timely access to accurate HCW immunisation records is required to ensure that public health responses are effective.

Infection Prevention and Control Practices Implemented for Congenital Measles in an Extremely Low Birth Weight Infant

Background: Measles can cause miscarriages and preterm birth in nonimmune pregnant women. During the 2018–2019 measles outbreak in New York, a woman with measles delivered an extremely low birth weight preterm infant at our Women and Children’s Hospital. We describe our measles preparedness strategies and infection prevention and control (IPC) management relevant to congenital measles. Methods: Because of the measles outbreak, in Q4 2018, IPC verified measles immunity in all obstetric and pediatric staff, per state regulations, and recommended determining the measles immune status of all pregnant women. To prevent measles exposure, visitor restrictions for the neonatal intensive care unit (NICU) were implemented (May 2019); only 3 visitors were permitted for each infant, including parents. All visitors had to provide written documentation of immunity to measles, regardless of epidemiologic risk factors or receive an MMR vaccine prior to visiting. New York state and New York City health departments performed measles diagnostic testing for maternal and infant specimens. Results: Our hospital was informed of the imminent transfer of a woman in preterm labor with suspected measles. To avoid any exposure, the mother was masked in the ambulance bay and taken by commandeered elevator to the obstetrical operating room suite, which was cleared of other patients. She delivered by C-section and was transferred to an airborne infection isolation (AII) room. The 25-week-gestation infant was transported by isolette to the NICU and was placed on AII. Testing confirmed measles in the mother (measles PCR- and IgM-positive) and congenital measles in the infant (Table 1). The mother was allowed to visit the NICU when her respiratory symptoms and rash resolved, as confirmed by her provider, ~10 days after discharge. The infant never developed a rash, pneumonia, or neurologic findings. AII was discontinued on day of life 61 in consultation with the health departments. The infant was discharged at ~36 weeks gestation. No secondary cases of measles occurred among patients, visitors, or staff. Conclusions: We safely cared for an extremely preterm infant with congenital measles. Laboratory testing suggested prolonged presence of measles virus, but it is unknown how long an infant in the NICU should remain on AII. The current Council of State and Territorial Epidemiologists case definition for measles requires the presence of rash. This case provides support to revise this case definition if laboratory findings are consistent with congenital measles.Funding: NoneDisclosures: None

Immunity to measles virus in diverse population groups

The aim of the study was to assess the measles immunity level among employees of medical organizations of various specialties, young subjects, and neonates. Materials and Methods. The measles immunity status was assessed for all the employees of St. Petersburg State Budgetary Healthcare Institution Maternity Hospital No. 10 (386 subjects), civilian medical staff of the clinics of the Military Medical Academy named after S.M. Kirov (Military Medical Academy) (1399 subjects), cadets of the Military Medical Academy (304 subjects) and 34 neonates. Laboratory testing was performed by using ELISA with test kits “VektoKor-IgG” (RF). Results. Medical workers displayed high total level of protection against measles virus serologically confirmed in 87.5% of the maternity hospital staff and 81.6% of the employees at the Military Medical Academy clinics. No differences in the immune status between the varying categories of medical personnel from the departments of various specialties were revealed. Lower population immunity was observed in the 20-40-year age group. Among the employees of the maternity hospital, the proportion of measles virus seropositive subjects aged 20—40 years was 75.9% (95%, CI 67.2—82.9%), 40—59 years — 91.5% (95%, CI 86.7—94.7%), 60 year and older subjects were all seropositive (95%, CI 94.6—100%). Dual vaccination did not guarantee emergence of effective measles immunity. The majority of seronegative subjects were dually vaccinated, hence, even in case of previous dual measles vaccination, it is necessary to perform a serological examination prior to recruitment to medical facilities. Females comprised more than 90% of medical workers. Therefore, women of fertile age previously dually vaccinated, but immunologically seronegative, are at risk of measles and intrauterine fetal infection, as well as the risk of its development is increased in vaccination age children. It was confirmed by demonstrating that as few as 70.6±15.3% of neonates were immune to the measles virus. The proportion of seronegative infants (29.4±15.3%) was comparable to that one in seronegative subjects aged 20—40 years (24.1±8.1%) working at the maternity hospital. Among the younger age group (aged 18—23 years) such as cadets of the Military Medical Academy, a significantly higher proportion of seronegative individuals was found — 48.3±5.6%, thereby increasing probability for measles outbreak therein. Conclusions. In order to eradicate measles, it is necessary to develop a screening program for detecting antibodies against measles among young and middle-aged subjects.

Measles immunity in healthcare workers of an Italian hospital

BackgroundIn Italy, 4991 cases of measles were reported in 2017 and 322 involved healthcare workers (HCWs). These professionals are at high risk of infection and transmission of virus both to other hospital staff and importantly, to patients, some of whom may be at risk of severe illness and complications. According to the Italian National Immunization and Prevention Plan, all HCWs should have demonstrable evidence of immunity to measles and specific hospital surveillance is recommended. Given a recent measles outbreak recorded in Italy, which also involved HCWs, the aim of this study has been to assess the measles immunization status of the Perugia General Hospital's HCWs. MethodsA survey on all hospital staff was carried out, using a questionnaire to obtain information on demographic characteristics, personal history of measles and self-reported vaccination status, and offering the serological testing to HCWs who did not know their immune status. ResultsAmong the 1714 HCWs included in the study, 1207 (70%) were protected against measles (due to vaccination or natural infection), and 507 (30%) did not know their immune status. Of these, 461 subjects accepted a serological control, while 46 refused. Protective measles-specific IgG antibody titres were documented in 410/461 (89%) HCWs, and the percentage of immune subjects decreased with the age. ConclusionsOur study shows that in Perugia General Hospital, 26% of HCWs under the age of 30 were not protected against measles. In Italy, campaigns promoting vaccination of HCWs are needed to prevent transmission of this infection in hospital setting.

Measles Immunity among New Health Personnel at a Faculty of Medicine in Khon Kaen Province, Thailand, 2019

Measles continues to be an important global health problem despite the implementation of vaccination. Health personnel, a high-risk group, are considered to have immunity to measles. We aimed to investigate the measles immunity status among health personnel during pre-placement at the Faculty of Medicine, Khon Kaen University, northeastern Thailand. The sample included health personnel who were examined in the pre-placement program from October 2018 to September 2019. Data collected included sex, age, department, job characteristic (direct or indirect contact with patients), position, measles immunity status, based on serology tests, history of previous infection, and history of immunization. A total of 652 health personnel were included, of which 53.8% tested positive to measles IgG class antibodies, indicating prior exposure to the virus. Among them, the percentage testing positive to measles immunity was 59.5%. Two-thirds of personnel who could not recall their infection or vaccination history had a positive measles immunity status. A consensus for the definition of acceptable presumptive evidence of measles immunity in Thailand according to context must be stipulated, leading to improved management of measles immunization.

Healthcare Workers' Preparedness: An Exploratory Study for Measles Control in a Middle-Income Country.

BackgroundHealthcare workers (HCWs) should have an active role in measles control.ObjectiveThis study aimed to assess the HCWs’ measles immune status and its influencing factors; to measure their knowledge, attitude, and practice toward measles infection/vaccination; and to identify factors predicting their vaccination status.MethodsData were collected using a semi-tailored questionnaire. Immunoglobulin G against measles was measured. Regression analysis for measles vaccination was performed.ResultsApproximately 97 HCWs (93.3%) were seropositive, 79 (76.0%) were vaccinated, 18 (17.3%) were previously infected, and 9 (8.7%) were both vaccinated and previously infected. One previously vaccinated participant was seronegative. The immune status was associated with marital status, residence, work duration, infection control training, and wearing personal protective equipment. Positive attitudes and practices were reported. Marital status and infection control training were predictors for measles vaccination.ConclusionHCWs showed readiness to control the spread of measles. National policies for compulsory HCWs’ vaccination and immune status check before training and employment are required.

Measles Seroprevalence in Yozgat City Hospital Employees

Objective: We aimed to determine the relationship between the measles immunity status of the employees of Yozgat City Hospital and their age, gender, occupation, and work unit. Methods: The results of the measles serology of the 623 health care workers together with information on their age, gender, occupation and work unit were recorded retrospectively […]

360: Measles IgG titers in a cohort of pregnant women in New York City

As of 7/29/2019, there have been 642 confirmed cases of measles in NYC this year. Pregnant women and their fetuses represent a susceptible population to measles infection. Ideally, proof of vaccination against measles should be documented prenatally. In the absence of such data, measles immunoglobulin G (IgG) titers can be used. Prior studies conducted before the present measles outbreak showed maternal measles IgG titers (MIT) to be in the non-immune range between 3.1-16.5% of the time. The percentage of pregnant women with MIT in the immune range during the current measles outbreak is unknown. The measles immunity status of pregnant women admitted to Labor and Delivery (L&D) in our hospital between 5/1/2019 and 7/13/2019 was assessed by MIT drawn during pregnancy or upon admission to L&D. Results were described as immune, equivocal or non-immune. All pregnant women with titers deemed to be non-immune or equivocal were offered an MMR vaccine prior to discharge. In the study period, a total of 558 women delivered at our hospital and of those 523 (94%) had available MIT. 386 (74%) were in the immune range, 131 (25%) were in the non-immune range, and 6 (1%) had equivocal immunity. Only 89 (65%) non-immune mothers received the MMR vaccine prior to discharge. Of the 48 (35%) mothers who did not receive the vaccine, 54% was due to maternal refusal. The percentage of mothers with negative MIT in our sample was higher than expected. Negative titers to measles do not necessarily suggest non-immunity as some vaccinated individuals have negative titers but produce an immune response when exposed to measles. Given that proof of immunization may not be available, administering a booster dose of MMR vaccine to patients with a negative MIT is reasonable, especially during an outbreak.

P58 A re-audit on the adherence to blood monitoring guidelines in paediatric rheumatology patients on methotrexate, etanercept and adalimumab after the introduction of a blood clerk in the team

Abstract Background A previous audit carried out in 2017 showed that the blood monitoring of patients on methotrexate was substandard with over 60% of patients not being monitored according to guidelines. A positive correlation was found between postcode distance to the tertiary centre and substandard monitoring (those patients living further away showing worse monitoring records). As a result of this audit, a blood clerk was introduced in the team who would be responsible for chasing patients for blood results. This is a re-audit to ascertain the impact of the changes introduced to our service. Methods All rheumatology patients being prescribed methotrexate, etanercept and adalimumab were captured using dispensing records. The electronic prescribing software MEDITECHv6 was used to gather data for each patient including demographic data, frequency of blood tests and varicella and measles immune status. Patients were divided into two groups: methotrexate and biologics. These were further divided into treatment starters and maintenance patients. Treatment starters needed to meet the following 6 criteria in order to achieve appropriate monitoring: correct frequency of tests, full blood count (FBC) checked, liver function tests (LFTs) checked, renal function checked and varicella and measles immunity checked. Maintenance patients needed to meet 4 criteria to achieve appropriate monitoring: correct frequency of monitoring, FBC, LFTs and renal function. Potential correlations between substandard monitoring and postcode distance to the centre were explored. Blood clerk intervention rates and their effects were analysed. Results 216 patients were included in the audit. Overall 76 of them (35%) were appropriately monitored. For all patients on methotrexate and those on maintenance biologics, the main reason for substandard monitoring was a delayed timing of blood taking (50% and 65% of patients respectively). For patients starting on biologics the main factor affecting standard of monitoring was the lack of documentation of varicella and measles immune status (42% of patients). 72% of the patients with inappropriate frequency of blood tests received an intervention from the blood clerk. No correlation was found between distance to the centre and appropriateness of monitoring. Conclusion Adherence to monitoring guidelines has not significantly changed after the introduction of the blood clerk, with figures of adequate monitoring very similar to the previous audit (35%). The blood clerk contacts starting patients at 4 weekly intervals if needed, and maintenance patients every 3 months. Bearing in mind the time needed to set up a blood monitoring appointment after a blood clerk intervention, the number of patients with appropriate monitoring raises to 64% in the methotrexate group and 67% in the maintenance biologics group. This shows efficacy of the blood clerk intervention once it happens. Improved guideline adherence may be achieved by bringing forward the blood clerk interventions by 2 to 4 weeks in each patient group. Conflicts of Interest The authors declare no conflicts of interest.