Measles Outbreak Research Articles

Assessment of humoral immunity to the measles virus in healthcare workers

BACKGROUND: measles is an anthroponotic viral disease characterized by high contagiousness. In the early 2000s in the Russian Federation, the infection was on the verge of elimination, but outbreaks in 2003, 2014, 2019 and the rise in incidence since 2022 refutes this situation. Cleanup vaccination of risk groups and revaccination of persons vaccinated once are ongoing. It is relevant to determine antibodies in blood serum in the vaccinated population and in persons with an unknown vaccination and post-infection history. AIM: of the study is to present the results of a study of humoral immunity to the measles virus in healthcare workers vaccinated against measles and with an unknown vaccination and post-infectious history. MATERIALS AND METHODS: the study was conducted in Kazan, Republic of Tatarstan. The study involved employees of a skin and venereal disease clinic, children's clinics, and a blood center in the amount of 133 people (including 2 men), who were vaccinated and revaccinated with live measles vaccine, after which a sufficient amount of time had passed for the formation of an immune response - 3-4 weeks, as well as 40 female employees with an unknown vaccination and post-infection history. Specific IgG to the measles virus was determined in the test blood sera using the enzyme immunoassay method using the Vector-Best kit (Novosibirsk, Russia). Statistical analysis was carried out using the StatTech v.4.1.9 program (developed by Stattech LLC, Russia). RESULTS. The study was conducted in Kazan, Republic of Tatarstan. The study involved employees of a skin and venereal disease clinic, children's clinics, and a blood center in the amount of 133 people (including 2 men), who were vaccinated and revaccinated with live measles vaccine, after which a sufficient amount of time had passed for the formation of an immune response - 3-4 weeks, as well as 40 female employees with an unknown vaccination and post-infection history. Specific IgG to the measles virus was determined in the test blood sera using the enzyme immunoassay method using the Vector-Best kit (Novosibirsk, Russia). Statistical analysis was carried out using the StatTech v.4.1.9 program (developed by Stattech LLC, Russia). CONCLUSIONS. The ongoing outbreaks of measles in 2003, 2014, 2019, 2022-2023 require constant monitoring of the epidemiological situation with the study of the post-vaccination immune response in vaccinated people and the post-infection response in people with an unknown history of measles

The Scourge of measles

Abstract Once considered a disease of the past, the resurgence of measles in England has garnered significant attention in recent weeks and months. The uptake of routine childhood vaccines including the measles, mumps and rubella (MMR) vaccine is the lowest it has been in a decade and is well below the 95% uptake needed to protect the population and prevent outbreaks. This is giving this serious disease a chance to get a foothold in our communities. From having never seen a case of measles in their life time doctors in England are now notifying cases of measles based on clinical suspicion. Since October, we have seen a rapid increase in both measles cases and outbreaks of measles across England (the total number of cases confirmed since October 2023 to date is 1109) and it has been declared a national incident. The abstract highlights the consequences of vaccine hesitancy, illustrated by case studies of outbreaks of measles among susceptible populations such as schools and prisons and the steps being taken to control the spread. Social media misinformation, distrust in healthcare authorities, and concerns over vaccine safety are some of the factors shaping parental attitudes towards MMR vaccination. In response to these challenges, the abstract underscores the importance of targeted interventions aimed at addressing vaccine hesitancy, such as community engagement initiatives, tailored communication strategies, and healthcare provider training. By emphasizing the critical role of MMR vaccination in preventing measles resurgence, this abstract advocates for a collaborative approach involving healthcare stakeholders, policymakers, and the public to combat to combat this preventable yet persistent threat to public health.

Measles outbreak under the Leaning Tower of Pisa in Italy

Abstract Background Measles cases in Italy (58,9 mln population) were 8 in 2021, 15 in 2022 and 43 in 2023. Between January and April 2024 there were 213 cases in Italy, with higher incidence in children. Pisa Local Public Health Department (201073 population) experienced a measles outbreak in the same period. Methods Cases were classified according to Decision (EU) 2018/945. A bidirectional tracing (backward and forward) was conducted to identify transmission chain and contacts of cases. Immunization status was checked on Regional Vaccination Registry. Results 33 suspected measles cases were notified in Pisa between 21st January and 17th April 2024: 16 by General Practitioners and 17 by Hospital Emergency Room. Additionally, 1 undiagnosed case was found during the epidemiological investigation. 2 notifications were withdrawn by General Practitioner because of lack of the diagnostic criteria. Laboratory analysis confirmed 24 cases. Last confirmed case occurred on 23rd February, while not confirmed cases occurred mostly in the last part of the period (6 in a row from 3rd March to 17th April), suggesting an infodemic effect. Women were more affected than men (17 vs. 7). Except for 2 babies (9 months and 1 year old age), the outbreak affected young adults with a mean age of 40 yo. Hospitalization rate was 37,5%. The first 5 unrelated cases occurred between 19th and 21st January. A second wave involved 13 people, 12 of them were related to a single case. Transmission occurred in Emergency Room (7), in a mall (1) and in the neighborhood (4). A third wave involved 4 cases (family contacts). 2 cases were imported from Sicily and Spain. All cases were unvaccinated, 2 were migrants. Around 950 contacts were traced. Conclusions In Pisa, high vaccination coverage of children < 2years of age (≥95%) protected school population and cases to spread, but there are pockets of unvaccinated adults which could allow measles circulation. Key messages • An effective public health response is required to contrast increasing measles cases in EU/EE countries. • As recommended by ECDC, public health services need to close immunity gaps, addressing catch-up actions towards adults and vulnerable groups as migrants.

Vaccine-preventable diseases in migrants to Europe: a systematic review

Abstract Migrant populations in Europe are at increased risk of under-immunisation and therefore likely to be at high risk of vaccine-preventable diseases (VPD), yet the relationship between migration and VPD incidence is not fully understood. This study aimed to explore the prevalence of VPDs in migrant populations in Europe and to define at-risk groups. Following PRISMA guidelines, Embase, MEDLINE and Global Health were searched for peer-reviewed papers published from 1st January 2010. Inclusion criteria comprised primary research on VPD cases (measles, mumps, rubella, diphtheria, pertussis, tetanus) among migrants to/within EU/EEA and Switzerland. We defined migrants as foreign-born nationals. Forty-seven eligible studies from 15 EU/EEA countries and Switzerland were included, with a total of 1357 migrant VPD cases reported. Analysis revealed 1357 migrant cases across measles (28 publications; 926 cases), pertussis (9; 267 cases), mumps (9; 107 cases), diphtheria (11; 67 cases), rubella (2; 6 cases imported from Romania and Pakistan), tetanus (2; 2 cases). Over-representation of measles cases was observed among migrant children and adolescents, predominantly from the WHO Europe region (particularly Bulgaria, Bosnia and Herzegovina and Serbia). Migrants of East African origin were over-represented among diphtheria cases. This study underscores the association between migration and VPD cases in EU/EEA and Switzerland, establishing a clear association between European migrant children and adolescents in measles outbreaks, and adult migrants from East Africa in diphtheria cases. This study suggests strengthening systems for targeted catch-up vaccination for migrants is imperative upon arrival in European countries to align them with national schedules, alongside the need to improve data collection and surveillance systems to inform effective public health interventions. Key messages • Migrant populations in Europe face heightened risk of vaccine-preventable diseases and need to be better incorporated into catch-up vaccination initiatives on arrival. • Improved data collection and surveillance systems are crucial for informing effective public health interventions targeting migrant populations.

Epidemiological characteristics of the 2019 Measles outbreak in central Tunisia

Abstract Background Measles is still an important public health problem worldwide causing significant morbidity and mortality. Measles represents a vaccine-preventable disease. In Tunisia, vaccination against measles was launched in 1983. In spite of the progress made towards measles elimination, Tunisia experienced an outbreak in 2019. We aimed to describe the measles outbreak in the central region of Tunisia in 2019. Methods We carried out a descriptive study using surveillance data from January to December 2019 in four governorates in Tunisia (Monastir, Mahdia, Kairouan, and Kasserine). All suspected measles cases and declared to regional directorate of primary health care were included. A suspected measles case was defined as any person with fever and generalized maculo-papular rash plus one of the following symptoms: cough or coryza or conjunctivitis. A laboratory confirmed measles case is a suspected case of measles that has been confirmed positive by testing (IgM+). Results A total of 2,688 suspected cases were recorded, of which 369 cases were (14.7%) were confirmed measles through serological testing. The sex ratio was 1.06 for suspected cases and 1.12 for measles cases. Infants under one year old accounted 42.2% of suspected cases. The majority of suspected cases (67.3%) were not vaccinated. Among confirmed measles cases, positivity rates were 81.8% for unvaccinated, 70.0% for those with one dose and 27.2% for those with two doses. The hospitalization rate was 61.5 %; highest rates were observed in infants under one year of age (65.7%) and in the age group over 38 years (69.0%). In total, 27 deaths were reported. The highest lethality rate was observed in the age group under 12 months (2%). Conclusions The 2019 measles outbreak in Tunisia highlighted that this disease remains a serious viral infection. Unvaccinated populations could be a potential source for new outbreaks, imposing substantial public health burdens. Key messages • The country needs to establish a national review committee to monitor measles elimination status. • To address future challenges, immunity gaps in the population should be closed.

Preparing for outbreaks of vaccine preventable diseases: why are prisons invisible?

Abstract From 1 March 2023 to 29 February 2024, 30 EU/EEA Member States reported a total of 5 770 cases of measles, 4 864 (84.3%) of which were laboratory-confirmed. Th7e highest number of cases were reported by Romania- at the time of writing, 11,397 confirmed cases, including 12 deaths from 1 January 2023 to 7 April 2024. Measles is a highly infectious disease. The best mitigation is vaccination which is highly effective. Outbreaks in many countries have been driven by decreases in vaccine coverage with a two-dose measles-containing vaccine (MCV), especially evident since the COVID-19 pandemic. In many countries, vulnerable migrant populations, ethnic groups and communities experiencing social deprivation have been over-represented in cases and under-covered by vaccine programmes. We know that prisons contain such populations. Historic seroprevalence studies of prison populations, which themselves are scant, show that prison populations are under-vaccinated. Prisons are a setting that can cause disease amplification. Given these facts, it is perhaps surprising that many countries in Europe cannot provide specific surveillance data on either cases in prisons or vaccine coverage specifically in prison populations. Further, that prisons are not often cited as specific settings for vaccine catch-up programmes in national or regional programmes. This is despite evidence of measles cases and outbreaks historically and currently in several European countries. In the presentation we will ask why this ‘blind spot’ in national and international disease surveillance continues and what Member States could and should do to prevent the risk of mass outbreaks of measles in prisons, causing pressures on justice and health systems and risking wider community outbreaks. Finally, we will reflect on how this experience should alert us to the risk of other infectious diseases going undetected, unprevented, and under-studies in prisons, threatening our collective health security.

Health status, healthcare use and prevention in Travellers in Nouvelle Aquitaine, France, 2019-2022

Abstract Background The poor health status of underserved populations is compounded by low vaccination uptake, leading to a greater risk of epidemics. On October 2017, a measles outbreak started in the southwest of France among under-vaccinated social groups, including Travellers. We aimed to describe the health status, healthcare use and child measles-mumps-rubella (MMR) vaccination coverage in Travellers according to their environmental and living conditions. Methods A cross-sectional study with a three-stage random sample design was conducted between October 2019 and March 2022 in the Nouvelle-Aquitaine region in France. Trained social workers administered face-to-face questionnaires to collect data on adults and children. Anthropometric measurements, vaccination records, and data using an environmental exposure questionnaire were also collected. Results The participation rate was high (73.6%), with 1030 adults and 337 children included. Concerning the adults, 36.6% had obesity, 14.4% reported diabetes, 24.7% hypertension, and 14.4% major depression. The prevalence of major depression was significantly higher in adults living in precarious and unauthorized housing than in those with adequate housing (19.8 vs. 14.7%, p = 0.03). The unmet health care needs in the last 12 months was 48.4%. With regard to children, 45.3% had full (i.e., 2-dose) MMR vaccination coverage at 24 months and 17.9% had obesity. Finally, 74.5% of the households experienced housing insecurity, and 22.2% did not have a supply of drinking water. Conclusions Traveller children and adults faced deleterious environmental and living conditions potentially affecting their health, healthcare use, and vaccination coverage. These results demonstrate the need for urgent interventions for underserved populations which take into account their difficult living conditions. Key messages • Travellers have a greater burden of chronic diseases than the general French population and measles-mumps-rubella vaccination coverage among Traveller children is lower than in the general population. • The more precarious the housing, the more likely Travellers are to report having a chronic disease (social exclusion gradient).

The evolution of vaccine mandates: from historical perspectives to contemporary applications

Abstract Luigi Sacco pioneered efforts in 19th-century Italian vaccination campaigns when mandatory vaccination practices began as a public health strategy. We bridge past and present through a systematic review of both historical and contemporary vaccine mandate policies. While Sacco’s early initiatives, characterised by compulsory vaccination and effective communication strategies, set foundational principles for vaccine mandates, the modern era, especially during the COVID-19 pandemic, has seen a significant shift in the nature and application of vaccine mandates. Recent legislative changes across various countries have introduced stricter mandates aimed at managing public health crises. For instance, Italy and France, deeply impacted by reduced vaccine uptake and subsequent measles outbreaks, responded by reinforcing vaccine mandates. These countries aimed to mitigate the dual challenges of achieving high vaccination coverage and combating growing vaccine hesitancy. Comparative analysis of recent legislative changes reveals a trend towards increasing coerciveness in vaccine mandates, reflecting a blend of functional and political pressures driving government decisions. This trend is evident in the legislative adjustments made in California, Australia, France, and Italy, where heightened penalties and reduced exemptions were introduced to counteract declining public compliance. The synthesis of these experiences highlights the critical role of robust, credible communication and the nuanced application of mandates that consider societal and cultural contexts. Contemporary strategies are characterised by targeted interventions aimed at specific populations, reflecting the complex interplay of social, political, and health dynamics in vaccine policy. The enduring relevance of vaccine mandates underscores the necessity of flexible, responsive public health strategies that effectively address both long-standing and emergent vaccine hesitancy and coverage challenges. Speakers/Panelists Carlo Signorelli HSR, Milan, Italy Maria Gańczak Department of Infectious Diseases, University of Zielona Góra, Zielona Góra, Poland

Crisis-Related Measles Outbreaks in Low-Income Countries and the Need for Increased Health Systems Resilience.

The measles is a highly contagious disease that can be prevented by vaccination. During and after crises, vaccination against measles decreases in low-income countries, leading to outbreaks. It is possible for developed countries to be at risk from these outbreaks through travel. Low-income countries' health systems are not resilient to crises. Lack of capacity among these countries causes a decrease in vaccinations. As a result, we provide some recommendations for increasing the resilience of the health system in low-income countries in this letter.

Social listening applied to tailor communication on immunization in the Republic of Moldova.

Although the Republic of Moldova had good vaccination rates, anti-vax messages have recently begun to spread, eroding the population's confidence. Vaccination coverage against measles, mumps, and rubella at the target age of 12 months decreased from 95% in 2008 to 83% in 2021. The recent measles outbreak in Romania and three confirmed cases in Moldova, combined with the refugee crisis, have highlighted the importance of vaccination and sparked online conversations on this subject. A mixed-methods study was conducted, involving social listening activities on immunization using the Talkwalker software and qualitative analysis of the identified narratives. Out of 450 identified comments, 30 were selected for further analysis. Over 5 months, a total of 865 results were obtained, with an engagement rate of 6300. The peak in results occurred between 11 and 18 December, driven by the recent measles outbreak in Romania, which saw several confirmed cases and one death, as well as the first cases of measles in Moldova after 3 years. However, no significant increase in the engagement rate was recorded. Comments on immunization tended to reflect distrust in authorities and doctors, political and ideological views, and a lack of knowledge about the risks of vaccine-preventable diseases. The analysed conversations are assessed as having a low risk of spreading, though some employ techniques to influence or manipulate behaviours. The topic of vaccination is used to promote political ideologies through messages issued by the mass media. The information vacuum must be filled with messages designed to produce attitude change regarding vaccination.

Determinants of maternal adherence to child vaccination in jordan: A cross-sectional study

In the past few years, a significant decline in vaccination coverage has been noted, leading to measles outbreaks. Mothers’ adherence or reluctance to undergo childhood immunization is a major contributing factor to a substantial population of children who remain unvaccinated or inadequately vaccinated. This study aimed to investigate adherence to children’s vaccination by investigating mothers’ personal and contextual factors in addition to knowledge and attitudes scores. A cross-sectional analytical design was employed, and data were collected from a sample of 533 mothers in Jordan between May and July 2023. The statistical analysis included descriptive analysis, t-test, ANOVA, and Pearson r correlation. The results demonstrated that adherence to vaccination was associated with several factors, including knowledge score (r = 0.33, p < 0.01), the ability to access and understand health information (r = 0.16, p < 0.01), income level (F = 11.88, p < 0.01), education level (F = 5.71, p < 0.01), employment (t = 2.41, p < 0.05), and working in a medical field (t = 4.5, p < 0.01). Scheffe post hoc analysis was performed to evaluate adherence outcomes according to the different categories of education and income levels. Mothers’ adherence to vaccination needs improvement, with special attention given to contributing factors. Strategies should be developed to target mothers with low incomes and educational levels and limited ability to access and understand health information to enhance maternal knowledge and eventually adherence to children’s vaccination.

Estimating the risk and spatial spread of measles in populations with high MMR uptake: Using school-household networks to understand the 2013 to 2014 outbreak in the Netherlands.

Measles outbreaks are still routine, even in countries where vaccination coverage exceeds the guideline of 95%. Therefore, achieving ambitions for measles eradication will require understanding of how unvaccinated children interact with others who are unvaccinated. It is well established that schools and homes are key settings for both clustering of unvaccinated children and for transmission of infection. In this study, we evaluate the potential for contacts between unvaccinated children in these contexts to facilitate measles outbreaks with a focus on the Netherlands, where large outbreaks have been observed periodically since the introduction of mumps, measles and rubella (MMR). We created a network of all primary and secondary schools in the Netherlands based on the total number of household pairs between each school. A household pair are siblings from the same household who attend a different school. We parameterised the network with individual level administrative school and household data provided by the Dutch Ministry for Education and estimates of school level uptake of the MMR vaccine. We analysed the network to establish the relative strength of contact between schools and found that schools associated with low vaccine uptake are highly connected, aided by a differentiated school system in the Netherlands (Coleman homophily index (CHI) = 0.63). We simulated measles outbreaks on the network and evaluated the model against empirical measles data per postcode area from a large outbreak in 2013 (2,766 cases). We found that the network-based model could reproduce the observed size and spatial distribution of the historic outbreak much more clearly than the alternative models, with a case weighted receiver operating characteristic (ROC) sensitivity of 0.94, compared to 0.17 and 0.26 for models that do not account for specific network structure or school-level vaccine uptake, respectively. The key limitation of our framework is that it neglects transmission routes outside of school and household contexts. Our framework indicates that clustering of unvaccinated children in primary schools connected by unvaccinated children in related secondary schools lead to large, connected clusters of unvaccinated children. Using our approach, we could explain historical outbreaks on a spatial level. Our framework could be further developed to aid future outbreak response.

Measles and Pertussis outbreaks in England and Wales: a time-series analysis

Background Vaccine coverage for common infectious diseases such as Measles and Pertussis (also known as whooping cough) have been declining in England and Wales since 2014. Consequently, significant increases in Measles and Pertussis cases are observed in the community. Aim To explore whether Google Trends offers a predictive utility as a health surveillance tool for Meases and Pertussis in England and Wales. Design and Setting Google search data related to Measles and Pertussis, including common associated symptoms, were downloaded for 52 weeks from 07/01/2023 – 07/01/2024. Measles and Pertussis case data were retrieved from the weekly Notification of Infectious Disease (NOID) reports. Methods The associations between searching and case data were explored using a time-series analyses, including cross-correlations, Prais-Winsten regression and joinpoint analysis. Results Significant cross-correlations were found for Measles cases and “measles” searching (r=.41) at a lag of -1 week. For Pertussis cases, searching for “whooping cough” (r=.31), “cough” (r=.39), “100 day cough” (r.41) and “vomiting” (r=.42) were significantly correlated at a lag of -3 to -2 weeks. In multivariable regression, “measles” remained significantly associated with Measles cases (β=.24, SE=.33, p=.02) as did “whooping cough” (β=.71, SE=.27, p=.01) and “cough” (β=1.99, SE=.54, p=.001) for pertussis. Conclusion Increases in Measles and Pertussis cases follow increases in online searches for both diseases and selected respective symptoms. Further work is required to explore how GT can be used in conjunction with other health surveillance systems to monitor or even predict disease outbreaks, to better target public health interventions.

Measles in the elimination period: the epidemic situation in Voronezh region

Vaccine-preventable diseases, one of which is measles, do not lose their importance and still remain a threat to public health. There is a deterioration in the epidemic situation regarding measles, both in the world and in the Russian Federation. The purpose of the study was to characterize the manifestations of the measles epidemic process in the Voronezh region for the period 1940–2023. The study of morbidity was carried out on the basis of data from Rosstat Form 2, 146 maps of the epidemiological investigation of a case of measles in the Voronezh region for the period 2011–2023 with the calculation of basic statistical indicators. The general availability of effective measles vaccination led to a decrease in the incidence, which by the beginning of the 21st century had become sporadic. However, from 2011 to 2023, there is an upward trend in incidence: rates increased from 0.27 cases (95 % CI 0.06–0.48) to 2.14 per 100 thousand population (95 % CI: 1.54–2,74); the risk group were children (average age 5.70 ± 0.24 years). From 2011 to 2015 imported cases predominated; since 2016 local cases predominated. For 2011–2023 146 cases (81 outbreaks) of measles were registered; among those who fell ill, the majority were not vaccinated against this infection or did not know about their vaccination status. Seroprotection level for the period 2011–2023 averaged 94.09±0.41 %; in certain years, there was an insufficient level of the immune layer in indicator groups of the population 16–17 years old and older. Thus, the pronounced activation of the measles epidemic process in the Voronezh region in recent years is due to a decrease in the immune layer.

Predictors of measles-rubella vaccination status in the Savannah Region, Ghana: A cross-sectional study among caregivers of children aged 18–59 months

IntroductionSavannah Region witnessed a decline in measles-rubella (MR) vaccination coverage prior to the measles outbreak in 2022. This study aimed to assess contributory factors of the low routine MR vaccination coverage and proffer recommendations to improve vaccination uptake. MethodsA cross-sectional study was conducted in two districts (Bole and Central Gonja) of Savannah Region from December 2022 to June 2023. Caregivers of children 18–59 months were randomly selected and interviewed using a structured questionnaire. Bivariate and multivariate logistic regression were performed to assess predictors of MR vaccination status. ResultsChildren of caregivers with inadequate knowledge of MR vaccination (AOR = 0.58, 95 %CI: 0.47–0.72), travelled more than five km to access health services (AOR = 0.48, 95 %CI: 0.39–0.59), described health workers attitude as poor (AOR = 0.44, 95 %CI: 0.26–0.74), and those who sought treatment for adverse events following immunization (AEFI) from the pharmacy (AOR = 0.65, 95 %CI: 0.51–0.84) were less likely to complete MR vaccination. On the contrary, children of female sex (AOR = 1.27, 95 %CI: 1.05–1.53), aged 24–59 month (AOR = 2.56, 95 %CI: 1.05–1.53), caregivers with primary or secondary education (AOR = 1.43, 95 %CI: 1.11–1.84; and AOR = 2.23, 95 %CI: 1.64–3.03 respectively), and those who did not experience rescheduling of vaccination sessions (AOR = 1.61, 95 % CI: 1.25–2.01) were more likely to complete routine MR vaccination schedule. ConclusionInadequate caregiver knowledge, poor geographical access to health services, poor healthcare worker attitude, and non-institutional management of AEFI significantly contributed to the low MR vaccination uptake in the Savannah Region. Adopting tailored approaches to addressing these factors could improve vaccination coverage.

Case Study: Contribution of Extended Sequencing and Phylogeographic Analysis in the Investigation of Measles Outbreaks in Tunisia in 2019.

Despite the availability of an effective vaccine for several decades, the measles virus continues to spread worldwide. From 2018 to 2019, several countries experienced large measles outbreaks with genotype B3, including Tunisia. We analyzed 66 samples collected from serologically confirmed measles cases during this outbreak. Fifty-five percent were aged less than 12 months and had not received a measles vaccine. Phylogenetic analysis using the 450 nucleoprotein (N450) window revealed that all strains belonged to genotype B3, with five different variants identified. The N450 sequence of the predominant one, which circulated all through the epidemic period, was identical to the named strain MVs/Kabul.AFG/20.14/3. For better molecular discrimination, the amplification and sequencing of 1018 nucleotides in the non-coding region between the M and F genes (MF-NCRs) revealed higher variability with at least nine clusters. A phylogeographic study using Bayesian methods suggested the Governorate of Kasserine (on the borders of Algeria) as the introduction point with a TMRCA (Time to Most Recent Common Ancestor) for the 2019 sequences estimated around October 2018. These findings emphasize the crucial role of advanced molecular investigations in tracing measles transmission pathways which, together with good vaccine coverage, will help the final success of the global measles elimination program.

Determinants of measles second dose vaccination dropout among children aged 18-24 months in Ejere woreda, central Ethiopia; unmatched case-control study.

Measles continues to pose a significant public health challenge, especially in low- and middle-income countries. Despite the implementation of national vaccination programs, measles outbreaks persist in some parts of Ethiopia, and the determinants of dropout from the second measles vaccine dose are not well understood. Hence, this study aimed to assess determinants of measles second dose vaccination dropout among children aged 18-24 months in Ejere woreda, central Ethiopia. A community-based unmatched case-control design was conducted in the Ejere Woreda of the Oromia regional state in Ethiopia between February 14 and April 6, 2023. Data were collected using a pre-tested structured questionnaire. The collected data were coded and entered into Epi-data version 3.1 and then transported to SPSS version 27 for statistical analysis. Descriptive analysis like frequency, mean, and percentage was calculated. Binary and multivariable logistic regression analysis was done. Finally, variables with a p-value <0.05 were considered statistically significant. A total of 446 mothers/caregivers, comprising 110 cases and 336 controls, participated in this study, making the response rate 97.8%. Lack of a reminder for the measles vaccine during postnatal care (PNC) (AOR = 5.19; 95% CI: 2.34, 7.83), having ≤2 antenatal care (ANC) contacts (AOR = 4.95; 95% CI: 2.86, 9.24), long waiting times during previous vaccination (AOR = 2.78; 95% CI: 1.19, 4.38), children of mothers/caregivers without formal education (AOR = 6.46; 95% CI: 2.81, 11.71), mothers/caregivers of children who were unaware of the importance of the second dose of measles (AOR = 8.37; 95% CI: 4.22, 15.08), and mothers/caregivers whose children did not receive at least two doses of vitamin A (AOR = 4.05; 95% CI: 2.15, 8.11) were significant determinants of measles second dose vaccination dropout. Implementing targeted interventions during antenatal care and when mothers visit health facilities for other vaccines can significantly improve the uptake of the second dose of the measles vaccine. These strategies not only enhance overall vaccination coverage but also mitigate the risk of measles outbreaks in the community.

Impact of the COVID-19 Pandemic on Measles Vaccination Coverage and Estimated Catch-up Efforts for Serbia.

Measles is highly infectious, requiring ≥95% vaccine coverage rate (VCR) to prevent outbreaks. This study aimed to understand the impact of the COVID-19 pandemic on routine measles-containing vaccine (MCV) VCRs in Serbia and estimate national and regional catch-up vaccination required to prevent outbreaks. A multiplier model was used to calculate annual MCV dose 1 (MCV1) and MCV dose 2 (MCV2) VCRs for children 1-6 and 6-12 years of age, respectively, for 2011-2022. Postpandemic (2023-2024) VCRs were modeled. The numbers of administered doses were compared to prepandemic and postpandemic, and monthly catch-up rates were calculated for 12-, 18- and 24-month campaigns. Between prepandemic and pandemic periods, national MCV1 VCR decreased from 88% to 81%, while MCV2 VCR decreased from 92% to 89%, corresponding to 20,856 missed MCV1 and 8760 missed MCV2 doses. Assuming national VCRs returned to prepandemic levels post-2022, 18% of children 1-6 years of age and 11% of children 6-12 years of age would have missed their MCV1 and MCV2 doses, respectively, by 2024. To catch up missed doses under this scenario, most regions would require monthly catch-up rates of 25%, 16% or 12% for MCV1 and 14%, 9% or 7% for MCV2, considering 12-, 18- or 24-month campaigns, respectively. The pandemic negatively impacted MCV VCRs in Serbia, leaving a sizeable proportion of children with missed doses. Significant catch-up efforts are required to recover VCRs to prepandemic levels and avoid future measles outbreaks, with increased monthly administration rates versus those in prepandemic periods.

Hospital-acquired infections and unvaccinated children due to chronic diseases: an investigation of the 2017–2019 measles outbreak in the northern region of Vietnam

BackgroundMeasles remains a major public health burden worldwide. Parents often hesitate to vaccinate children with chronic diseases. We investigated the association between the percentage of vaccination and chronic diseases and explore hospital infections’ role in the 2017–2019 measles outbreak across northern Vietnam provinces.MethodsA total of 2,064 children aged 0–15 years old admitted for measles to the National Children’s Hospital during the outbreak were included in the study. Demographic information, clinical characteristics, vaccination statuses and laboratory examination were extracted from electronic medical records, vaccination records, or interviews with parents when other sources were unavailable.ResultsThe incidence rate that provincial hospitals sent to the National Children’s Hospital was proportional to the population density of their provinces of residence. Early nosocomial transmission of measles was observed before community-acquired cases emerged in many provinces. Among patients aged over 18 months, those with chronic diseases had a proportion of vaccination of 9.4%, lower than patients without chronic diseases at 32.4%. Unvaccinated patients had a higher proportion of hospital-acquired infections with aOR = 2.42 (1.65–3.65), p < 0.001 relative to vaccinated patients. The proportion of hospital-acquired infections was higher among children with chronic diseases compared to those without, with aOR = 3.81 (2.90–5.02), p < 0.001.ConclusionMeasles spread in healthcare settings prior to community cases that occurred in several provinces. We recommend enhancing hospital infection control by increasing staff training and improving early detection and isolation during non-outbreak periods. Measles patients with chronic diseases exhibited lower proportions of vaccination and faced a higher risk of hospital-acquired infections. It is crucial to establish comprehensive vaccination guidelines and enhance parental awareness regarding the significance and safety of measles vaccination to protect these vulnerable individuals.

Challenges and Solutions to the Recurrent Measles Outbreak in Somalia

This study aims to address the persistent challenge of recurrent measles outbreaks inSomalia by providing an analysis of underlying issues and proposing evidence-basedsolutions. Measles, a highly contagious viral infection, continues to pose significantthreat to public health worldwide, with Somalia facing unique challenges due to itscomplex geographical and sociopolitical landscape. The country’s history of conflict,fragile healthcare infrastructure, and limited access to basic healthcare services havehindered efforts to control preventable diseases like measles.These recurrent outbreaks do not only have immediate consequences on public healthbut also exacerbate an already precarious situation in Somalia, leading to substantialsocioeconomic impacts as families grapple with the dual burden of disease and strainon livelihoods. The primary objective of this communication is to analyze the challengescontributing to the persistence of measles outbreaks in Somalia and propose evidencebasedsolutions.To achieve this goal, the subsequent sections of this brief delve into the specificchallenges facing Somalia in its battle against recurrent measles outbreaks. Thesechallenges encompass issues such as vaccine access, vaccine hesitancy, coveragedisparities, fragility of healthcare infrastructure, obstacles in community engagement,and limitations in disease surveillance and response.Understanding these intricate factors is crucial for designing targeted interventionsthat not only mitigate the immediate impact of measles outbreaks but also establish afoundation for long-term prevention.