Measles Outbreak Research Articles

Measles Back to the Future: Chicago's Current Measles Outbreak Demands the Creation of Federally Managed Isolation Housing Reminiscent of the Origin Story of the Vaccines for Children Program.

Measles Back to the Future: Chicago's Current Measles Outbreak Demands the Creation of Federally Managed Isolation Housing Reminiscent of the Origin Story of the Vaccines for Children Program.

Determinants of measles-rubella vaccine second dose uptake among 24 to 35 month-old children in Wajir Town, Kenya

Background: Two vaccine doses can prevent measles and rubella (MR2); achieving ≥95% coverage is crucial for effective population immunity. Low MR2 uptake is linked to increased measles outbreaks. With only 57.1% MR2 uptake, Kenya reported 1,775 measles cases in 2021. This study evaluates MR2 uptake and its determinants among 24-35-month-old children in Wajir town. Methods: A cross-sectional design was employed using cluster sampling in Wajir town, Wajir East sub-county, in December 2023. Parents of 399 children aged 24-35 months were interviewed using a pretested and predesigned questionnaire. Data was analyzed in SPSS V27. Socio-demographic characteristics were summarized in proportions. COR, aOR, and 95% Confidence Intervals measured association and significance. The analysis was two-tailed with a significance level set at p<0.05. Results: The study included 399 children with a median age of 25 months (interquartile range 24-29). MR2 uptake was 49.6%. Statistically significant predictors of MR2 uptake were parents' or guardians' occupation (aOR 2.85, 95% CI=1.18, 6.87, p=0.020), knowledge of the number of measles vaccines (aOR 16.05, 95% CI=4.16, 62.87, p<0.001), and the child’s gender (aOR 3.9, 95% CI=1.81, 7.86, p<0.001). Inadequate awareness about MR2 was the primary reason for not vaccinating children. Conclusions: MR2 uptake was low compared to the WHO-recommended target of ≥95%. The parents’ occupation, knowledge of the vaccine schedule, and the child’s gender determined MR2 uptake. The Wajir County Department of Health should carry out targeted knowledge-creation for parents/guardians and gender-aligned advocacy to improve MR2 uptake.

Modelling the Impact of Vaccination on the Control of Measles in Nepal

Measles is a highly contagious disease in human caused by virus. Despite the accessibility of successful vaccines, measles outbreaks still occur, presumably because of the lack of compliance with vaccination. We developed a mathematical model to evaluate the effects of vaccines in different age structures particularly focusing on two groups, to control and eradicate the disease, that may help the planner. Using our model, we formulate the basic reproduction number R 0 that determines, whether the disease persists or dies out. In addition, we carry out sensitivity analysis to identify important parameters that can play a significant role in the control and prevention of measles in different groups of individuals. Furthermore, we investigate the behavior of the disease and effect of vaccination on disease dynamics over a long period.

Measles outbreak in 2019: a warning for the post-COVID-19 pandemic period.

Introduction. At the end of 2019 and the year before, there was a significant spread of measles in the World Health Organization (WHO) European Region.Gap statement. Among the countries that reported, a measles outbreak was Bosnia and Herzegovina (BiH).Aim. To describe the measles outbreak in BiH (an entity of the Federation of BiH, FBiH) in 2019.Methodology. Confirmatory IgM serology, measles nucleic acid detection by real-time RT-PCR and virus genotyping were done in the WHO-accredited laboratory for measles and rubella at the Clinical Center of the University of Sarajevo, Unit for Clinical Microbiology. Genotype was determined in all measles-RNA-positive cases by sequence analysis of the 450 nt fragment coding the C-terminal of measles virus nucleoprotein (N).Results. From 1 January to 31 December 2019, 1332 measles cases were reported, with the peak observed in April 2019 (413/1332, 31.01 %). Sarajevo Canton had the highest incidence, number of cases and percentage (206.4; 868/1332; 65.17 %) of measles cases. Around four-fifths of infected persons were unvaccinated (1086/1332, 81.53 %), while 4.58 % of the patients (61/1332) were immunized with one dose of measles-containing vaccine. The highest proportion of cases was found in children 0-6 years of age (738/1332, 55.41 %). Measles IgM positivity was determined in 75.88 % (346/456), while virus RNA was detected in 82.46 % (47/57) of the swab samples. All measles virus sequences belonged to genotype B3. SNP (position 216: C=>T) was detected in 1 of the 40 sequences obtained during this outbreak.Conclusion. Due to suboptimal immunization coverage, BiH belongs to countries at a high risk for measles outbreaks. Post-COVID-19 (coronavirus disease 2019) pandemic, targeted and tailored strategies are required to ensure routine vaccination demand and acceptance and broad partner and stakeholder group participation.

Dr. Ratan Chandra Kar: The Journey of the Jarawa Doctor.

A distinguished physician Dr. Ratan Chandra Kar, born in 1954 in West Bengal, India, is known for his pivotal role in providing healthcare to the Jarawa tribe of the Andaman Islands. He began his service towardthe Jarawa tribes in 1998, notably combating a devastating measles outbreak in 1999 that threatened the tribe's existence. Overcoming initial distrust, Dr. Kar earned the tribe's confidence through cultural respect and medical expertise, treating over a hundred patients at the peak of the epidemic. He had established a dedicated Jarawa Ward at Kadamtala Hospital, integrating their traditional practices with modern medicine. For his dedication, Dr. Kar received the Padma Shri in 2023, for contributing significantly to the tribe's growth from 255 to 260 individuals in 1998 to over 560 today. His work stands as a testament to the importance of culturally sensitive healthcare in preserving vulnerable indigenous communities.

Statistical Models for Outbreak Detection of Measles in North Cotabato, Philippines

A measles outbreak occurs when the number of cases of measles in the population exceeds the typical level. Outbreaks that are not detected and managed early can increase mortality and morbidity and incur costs from activities responding to these events. The number of measles cases in the Province of North Cotabato, Philippines, was used in this study. Weekly reported cases of measles from January 2016 to December 2021 were provided by the Epidemiology and Surveillance Unit of the North Cotabato Provincial Health Office. Several integer-valued autoregressive (INAR) time series models were used to explore the possibility of detecting and identifying measles outbreaks in the province along with the classical ARIMA model. These models were evaluated based on goodness of fit, measles outbreak detection accuracy, and timeliness. The results of this study confirmed that INAR models have the conceptual advantage over ARIMA since the latter produces non-integer forecasts, which are not realistic for count data such as measles cases. Among the INAR models, the ZINGINAR (1) model was recommended for having a good model fit and timely and accurate detection of outbreaks. Furthermore, policymakers and decision-makers from relevant government agencies can use the ZINGINAR (1) model to improve disease surveillance and implement preventive measures against contagious diseases beforehand.

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

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

Qualitative Insights on Barriers to Receiving a Second Dose of Measles-Containing Vaccine (MCV2), Oromia Region of Ethiopia.

Introduction: Ethiopia introduced a second dose of measles-containing vaccine (MCV2) in 2019 to provide further protection against measles and further progress toward elimination. However, the sub-optimal coverage of both MCV1 and MCV2 suggest challenges with vaccine uptake. In this qualitative study, we explored barriers to the uptake of MCV2 among caregivers, community leaders, and healthcare workers (HCWs). Method: A qualitative study was conducted between mid-April and mid-May 2021. We selected ten woredas (districts) in the Oromia Region, Ethiopia, stratified by settlement type (urban/rural), MCV1 coverage (high ≥ 80%; low < 80%), and history of measles outbreaks between June 2019 and June 2020. Experiences surrounding barriers to MCV2 uptake were discussed via focus group discussions (FGDs) and in-depth interviews (IDIs) with caregivers of children 12-23 and 24-36 months and key informant interviews (KIIs) with HCWs who administer vaccines and with community leaders. Participants were recruited via snowball sampling. Recorded data were transcribed, translated to English, and analyzed using ATLAS.ti v.09. Results: Forty FGDs and 60 IDIs with caregivers, 60 IDIs with HCWs, and 30 KIIs with community leaders were conducted. Barriers among caregivers included lack of knowledge and awareness about MCV2 and the vaccination schedule, competing priorities, long wait times at health facilities, vaccine unavailability, negative interactions with HCWs, and transportation challenges. At the community level, trusted leaders felt they lacked adequate knowledge about MCV2 to address caretakers' questions and community misconceptions. HCWs felt additional training on MCV2 would prepare them to better respond to caretakers' concerns. Health system barriers identified included the lack of human, material, and financial resources to deliver vaccines and provide immunization outreach services, which caretakers reported as their preferred way of accessing immunization. Conclusions: Barriers to MCV2 uptake occur at multiple levels of immunization service delivery. Strategies to address these barriers include tools to help caretakers track appointments, enhanced community engagement, HCW training to improve provider-client interactions and MCV2 knowledge, and efforts to manage HCW workload.

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

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

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

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

Reply to the letter to the editor concerning reexamining the measles outbreak in the Philippines: Strengthening the vaccination program through women

Reply to the letter to the editor concerning reexamining the measles outbreak in the Philippines: Strengthening the vaccination program through women

Re-examining the measles outbreak in the Philippines: Strengthening the vaccination program through women

Re-examining the measles outbreak in the Philippines: Strengthening the vaccination program through women

Quantifying the risk of measles importation and spread in the United States in 2024.

Measles outbreaks have increased globally following the COVID-19 pandemic. We combine multiple data sets on global measles incidence, air travels, and vaccinations to assess the risk of travel-related importation and subsequent dissemination of measles in the United States in 2024, and identify months and states with higher measles outbreak risks.

Measles Outbreak in Socioeconomically Diverse Sections: A Review.

Measles outbreaks among socioeconomically weaker sections constitute a significant public health challenge.The objective is to highlight the specific vulnerabilities and contributing factors that make these communities more susceptible to measles outbreaks. Socioeconomically weaker sections, often characterized by poverty, inadequate healthcare access, overcrowding, and suboptimal immunization rates, face heightened risks of measles outbreaks. These outbreaks occur due to various interrelated factors, including limited healthcare infrastructure, low vaccine coverage, a lack of awareness about vaccination benefits, and difficulties in accessing healthcare services. The effects of measles outbreaks in socioeconomically disadvantaged areas are critical. Particularly among vulnerable groups, including newborns, expectant mothers, and malnourished people, measles increases morbidity and mortality. There is also a considerable financial impact on the healthcare system and the afflicted families. Measles outbreaks in these populations must be addressed using a diversified strategy. In order to improve vaccine coverage through targeted immunization programs, raise community vaccination awareness, and address social determinants of health, efforts should concentrate on bolstering the healthcare infrastructure. Effective epidemic control and prevention depend on coordinated efforts by healthcare practitioners, legislators, local leaders, and public health groups. Healthcare systems can lessen the impact of measles in socioeconomically disadvantaged areas and strive toward attaining equitable health outcomes for all populations by addressing the socioeconomic variables that lead to the vulnerability of measles.

PHHP 111 - Lessons Learned from a Measles Outbreak in a Pediatric Population in Ohio

PHHP 111 - Lessons Learned from a Measles Outbreak in a Pediatric Population in Ohio

Vaccine Hesitancy and Resistance Following COVID-19 Vaccinations: Measles and Rubella Outbreak in Jordan

Vaccine Hesitancy and Resistance Following COVID-19 Vaccinations: Measles and Rubella Outbreak in Jordan

Clinicoepidemiological profile of measles in adults: A study from semi-urban area in South India

BackgroundMeasles is a highly contagious, airborne disease caused by rubeola virus of paramyxoviridae family. It presents with fever, rash, and other associated symptoms like headache, cough, coryza, and conjunctivitis. It is common in children, and when occurs in adults, it is usually morbid. The clinical data on adults’ measles in Indian scenario are sparse. We report here an outbreak of measles affecting 52 adults. The primary objective of the study was to describe the clinical and laboratory findings obtained in an outbreak of adult measles cases from semi-urban area in India. MethodsThe study was an observational study conducted in a secondary care health center over a period of 2 months. ResultsFifty-two males with median age of 22.02 ± 3.5yr were diagnosed and treated for measles. All presented with fever and rash. The characteristic Koplik's spots appeared in 21 cases. On the day of their admission, 48% had lymphopenia and only one had thrombocytopenia. Liver enzyme dearrangements were seen in 18 patients. Sixteen patients had complications which included eight pneumonitis, three corneal ulcerations, three otitis media, and one case of acute encephalitis and polyserositis each. No deaths were reported in our study. We followed 34 cases and observed that their rashes healed with scars and laboratory parameters got normalized after six weeks. ConclusionClinician should be vigilant of measles as a differential in adults presenting as fever with rash. In doubt, the serological sampling should be carried out. Mass immunization is necessary to prevent the outbreaks.

A Clinical Analysis of Measles Outbreak and Immunization Gaps

A Clinical Analysis of Measles Outbreak and Immunization Gaps

Digitalizing disease surveillance: experience from Sierra Leone.

The Integrated Disease Surveillance and Response (IDSR) system was adopted by the Sierra Leone Ministry of Health (MOH) in 2008, which was based on paper-based tools for health data recording and reporting from health facilities to the national level. The Sierra Leone MoH introduced the implementation of electronic case-based disease surveillance reporting of immediately notifiable diseases. This study aimed to document and describe the experience of Sierra Leone in transforming her paper-based disease surveillance system into an electronic disease surveillance system. Retrospective mixed methods of qualitative and quantitative data were reviewed. Qualitative data was collected by reviewing surveillance technical reports, epidemiological bulletins, COVID-19, IDSR technical guidelines, Digital Health strategy, and DHIS2 documentation. Content and thematic data analysis were performed for the qualitative data, while Microsoft Excel and DHIS2 platform were used for the quantitative data analysis to document the experience of Sierra Leone in digitalizing its disease surveillance system. In early 2017, a web-based electronic Case-Based Disease Surveillance (eCBDS) for real-time reporting of immediately notifiable diseases and health threats was piloted using the District Health Information System 2 (DHIS2) software. The eCBDS, integrates case profile, laboratory, and final outcome data. All captured data and information are immediately accessible to users with the required credentials. The system can be accessed via a browser or an Android DHIS2 application. By 2021, there was a significant increase in the proportion of immediately notifiable cases reported through the facility-level electronic platform, and more than 80% of the cases reported through the weekly surveillance platform had case-based data in eCBDS. Case-based data from the platform is analyzed and disseminated to stakeholders for public health decision-making. Several outbreaks of Lassa fever, Measles, vaccine-derived Polio, and Anthrax have been tracked in real-time through the eCBDS.

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

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