MMR Vaccine Research Articles

Securing long-term immunity: The possible necessity of supplementary measles vaccination.

The global initiative to eliminate measles, spearheaded by the World Health Organization, has yet to achieve its intended goals. In Turkey, despite robust vaccination strategies, recent increases in measles cases have been attributed to vaccine hesitancy and irregular migration. This study evaluates measles serology within a pediatric population to determine the impact of vaccination regimens on immunity. A retrospective study at Ankara Bilkent City Hospital analyzed serum measles IgG levels in children aged 1-18 years from January 2020 to August 2023. Exclusions were applied for individuals with positive IgM results, incomplete vaccinations, and immunocompromised conditions. Patients were categorized based on their M-M-R®II vaccine status into those having received either one or two doses. Seropositivity was assessed using the ELISA method. Of the 686 children, 30.2% received a single dose, and 69.8% received two doses of the MMR vaccine. Overall, 70.7% exhibited positive IgG levels. No significant differences were found in IgG levels between those who received one dose and those who received two doses. However, a decline in IgG levels was observed with age, particularly notable in adolescents aged 14-18 years. The study reveals seropositivity rates lower than expected, highlighting challenges in achieving WHO targets. This suggests a potential need for booster doses during adolescence to maintain protective antibody levels. The findings emphasize the importance of continued surveillance and research to adapt vaccination strategies effectively and prevent measles outbreaks, particularly considering the decline in antibody levels and diverse vaccination histories across populations.

Assessment of Antibody Levels and Vaccine-induced Serologic Responses After Completion of Cancer Treatment in Pediatric Patients: A 6-year Experience in Turkey on HAV, HBV, VZV, and MMR Vaccinations

Objective: Childhood cancer treatment disrupts vaccination schedules and weakens or eliminates vaccine-induced immunity. In addition, post-treatment vaccine responses vary. This study aimed to assess post-treatment serum antibody levels and vaccine responses in children. Methods: Pediatric patients treated at Hacettepe University between years 2015 and 2020, achieved remission after chemotherapy for lymphoma and solid tumors were included. Post-treatment vaccination status, serum antibody levels for hepatitis A (HAV), hepatitis B (HBV), varicella-zoster (VZV), measles-mumps-rubella (MMR), and changes in vaccine responses were retrospectively analyzed. Results: The study included 533 patients. Post-treatment seronegativity rates were: measles (83.5%), HAV (64%), rubella (60.1%), HBV (48.5%), VZV (43.3%), and mumps (28%). Post-treatment antibody loss was observed for measles (47.1%), HAV (31.9%), HBV (31.4%), mumps (28.6%), VZV (21.7%), and rubella (11.4%). Seropositivity after 1 vaccine dose was seen with HAV (83.6%), rubella (82.9%), HBV (81.4%), VZV (63.5%), mumps (45.4%), and measles (33.3%). Seropositivity after 2 vaccine doses was achieved with HAV (98.8%), VZV (84.6%), rubella (80%), HBV (80%), measles (32.2%), and mumps (36.2%). Conclusion: Post-treatment serological vaccine responses in children were lower than anticipated despite multiple doses. Given the potential need for periodic serological assessments and booster vaccinations, long-term follow-ups are planned.

Detection of live attenuated measles virus in the respiratory tract following subcutaneous MMR Vaccination

Abstract The live attenuated measles vaccine is extremely effective in preventing measles and induces mucosal immunity in the respiratory tract, however the mechanism is not known. We show that live attenuated measles virus (LAMV) RNA is frequently detected in the respiratory tract 7-21 days after subcutaneous measles-mumps-rubella (MMR) vaccination in healthy children (n = 5/20) and macaques (n = 6/8). Replicating LAMV was isolated from the lungs of 2 macaques, with no evidence of transmission to unvaccinated individuals. These observations suggest that LAMV in the respiratory tract may play a role in the development of robust mucosal immunity following MMR vaccination.

Measles–Rubella Microarray Patches Phase III Clinical Trial Framework: Proposal and Considerations

Background: The Measles–Rubella Microarray Patch (MR-MAP) is an important technology that is expected to reduce coverage and equity gaps for measles-containing vaccines (MCVs), reach zero-dose children, and contribute to elimination of measles and rubella. MR-MAPs are anticipated to be easier to deploy programmatically and could be delivered by lesser-trained health workers, thereby increasing immunization coverage. The most advanced MR-MAP has reached clinical proof-of-concept through a Phase I/II trial in the target population of infants and young children. The World Health Organization (WHO) and partners have developed the Phase III clinical trial framework for MR-MAPs presented in this article. Objectives and Methods: The purpose of such framework is to inform the considerations, design and approach for the pivotal clinical trial design, while considering the anticipated data requirements to inform regulatory approval, WHO prequalification, and policy decision. Results: The proposed Phase III trial would compare the immunogenicity and safety of an MR-MAP with MR vaccine delivered subcutaneously in 9- to 10-month-old infants. An analysis of non-inferiority (NI) of immunogenicity would occur six weeks after the first dose. Should regulatory agencies or policy makers require, a proportion of infants could receive a second dose of either the same or alternate MR vaccine presentation six months after the first dose, with those children returning six weeks after the second dose for a descriptive assessment of immunogenicity, and then followed up six months after the second dose for evaluation of safety and immunogenicity. It is anticipated that this proposed pivotal Phase III trial framework would generate the required clinical data for regulatory licensure and WHO prequalification (PQ) of MR-MAPs. However, the trial design would need to be reviewed and confirmed by a national regulatory authority (NRA) that will assess the product for regulatory licensure and the WHO PQ team. Additional research will likely be required to generate data on concomitant vaccine delivery, the safety and immunogenicity of MR-MAPs in other age groups such as children 1–5 years and infants younger than 9 months of age, and the impact of MR-MAPs on coverage and equity. Such studies could be conducted during or after clinical MR-MAP development.

Measles surveillance data analysis and serological survey in Quzhou, China, 2014–2024: an assessment of progress toward measles elimination

BackgroundMeasles is a disease that can be eliminated through vaccination. In recent years, measles incidence and mortality have been greatly reduced.MethodsAnalyze measles surveillance data from 2014 to 2023 and measles seroepidemiological characteristics of healthy populations in 2024 to assess progress toward measles elimination.ResultsA total of 35 measles cases were reported in the surveillance system from 2014–2023 in Quzhou, with an average annual incidence of 1.6/1 million. Since 2019, the incidence of measles has been lower than 0.5/1 million. A serological survey of 257 healthy people showed that the positive rate of measles IgG antibody was 90.3%, and the immunity of all age groups except 0–5 years old was lower than 95%, which did not reach the threshold of 95% herd immunity required for eliminating measles.ConclusionAlthough the incidence of measles in Quzhou is low, the immunity of healthy people to measles infection is insufficient. Measles is still in the control phase, not in the elimination phase. Inadequate immunity in the population may be due to the failure to achieve ≥95% vaccination coverage and low immunogenicity of the vaccine. Recommends that the quality of routine immunization data be assessed and monitored to verify reported vaccination coverage; at the same time, improve vaccination services and optimize vaccination policies to increase actual vaccination coverage. In addition, it is recommended to adjust the MMR immunization strategy, changing the time of the first MMR vaccination from 8 months of age to 12–15 months of age, and the second dose at 4 to 6 years of age.

Anaphylactic Reaction With The Measles-Mumps-Rubella Vaccine In A Patient With Cow's Milk Allergy

The most common food allergy in children worldwide is cow's milk allergy. The most known allergens from cow's milk proteins are casein, alpha-lactalbumin, and beta-lactoglobulin. Lactalbumin hydrolysate is used as a stabilizer in the measles mumps rubella (MMR) vaccine originating in India. Different commercial forms of the MMR vaccine are available. While neomycin stabilizes, lactalbumin hydrolysate is used in the other form. We present a patient who was followed up for cow's milk allergy and developed anaphylaxis after the MMR vaccine originating from India. A 4-year-old girl with a history of anaphylaxis with cow's milk whose vaccinations were applied by the routine vaccination schedule in the family health center. Sneezing and urticaria started 1 minute after immunization. The patient presented to the emergency department (within 10 minutes after vaccination) with severe respiratory distress and intercostal retractions. The patient was administered three doses of intramuscular adrenaline, 5 minutes apart, intravenous pheniramine and methylprednisolone, and a nebulizer short-acting beta agonist. Symptoms regressed approximately 40 minutes after hospitalization. In our patient with a history of cow's milk anaphylaxis and lactalbumin-specific immunoglobulin E value of 61.3 kU/L, anaphylactic reaction with MMR vaccine seems to be related to the lactalbumin contained in the vaccine. Families and physicians should be meticulous about reading labels in the follow-up of patients with known food allergies.

Mumps outbreak in Zimbabwe: The case for universal MMR vaccination in Africa

Mumps outbreak in Zimbabwe: The case for universal MMR vaccination in Africa

Interventions’ transferability assessment to strengthen Vaccination Uptake Among Migrants in Greece

Abstract Background Migrant children in Greece face significantly lower vaccination coverage rates for MMR and HPV compared to their counterparts. To address this disparity, our research focuses on selecting and adapting evidence-based interventions tailored to the specific needs of different migrant communities staying in Greece, guided by the PIET-T framework. Methods Using a stakeholder-engaged approach, we involved 26 key stakeholders to select evidence-based interventions relevant to the Greek context. These interventions underwent detailed analysis, considering their effectiveness, cultural appropriateness, and potential for transferability within the PIET-T framework. Key stakeholders provided input on intervention feasibility and country- and context-specific adaptation. Results Three interventions were identified as promising for MMR and HPV vaccination uptake: two health promoter interventions and a school-based vaccination one. The health promoter intervention was adapted so to involve health professionals and trusted community members delivering culturally sensitive education and navigation support, addressing barriers such as language and lack of information. The original school-based program implements education sessions and on-site vaccinations, leveraging the trusted environment of schools to reach parents and children. On-site vaccinations were omitted since they were not relevant to the Greek context due to legal barriers. Conclusions Our stakeholder-engaged approach, guided by the PIET-T framework, ensures interventions are tailored to the specific needs and contexts of different migrant communities in Greece. By prioritizing cultural sensitivity and community involvement, we aim to enhance MMR and HPV vaccination uptake and improve health outcomes among migrant populations.

Primary care utilization in Bulgaria: some effects of the COVID-19 pandemic

Abstract Background Disruptions to primary care provision during the pandemic set back prior advancements in screening and chronic disease management. Delays in routine vaccination added to preexisting hesitancy and sustained the downward trend in vaccination rates. The study examines the magnitude and duration of primary care disruptions in Bulgaria between 2020 and 2022. Methods The impact of the pandemic on primary care is assessed using administrative data from the National Health Insurance Fund covering the annual number of primary care services. To evaluate the effect on healthcare utilization, the average number of check-ups per person during the pandemic is compared to a pre-pandemic period (2017-2019). Results After the onset of the pandemic, all visits declined significantly on an annual basis. In 2020, overall prophylactic check-ups dropped by 6-13% and remained lower than the baseline until 2022. Initial figures for 2023 suggest some recovery, while specific services are likely to experience an ongoing decrease. During the pandemic, the average number of prophylactic examinations for children fell between 6.9 and 9.3%. In 2022, there was a modest resumption, although these services did not reach the preceding levels. Adult prophylactic visits declined by approximately 10-12% between 2020 and 2021, but following a U-shaped pattern, they rebounded in 2022. Visits associated with chronic diseases experienced a drop of 7.8% in 2020 and continued to decrease in the next two years. Child vaccination was affected for a shorter period. In 2022, the coverage for most vaccine-preventable diseases was close to the pre-pandemic levels. However, the uptake of MMR and pneumococcal vaccines failed to demonstrate a clear path to recovery. Conclusions During the pandemic, a considerable drop in primary care utilization has been recorded. Effective recovery requires sustained service delivery and a rapid post-lockdown rebound to mitigate the negative impact on health outcomes. Key messages • Primary care needs additional recovery measures to prevent long-term harmful impacts on health outcomes. • Investing in service delivery innovations can boost resilience during disruptive events.

Transferability of vaccination interventions from a community perspective: One size does not fit all

Abstract Background Removing health system barriers to childhood vaccination is an urgent matter in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian minority in Poland, and the marginalized Roma community in Slovakia. The objective of this study was to select and adapt potentially transferable evidence-based interventions for HPV and MMR vaccine uptake in partnership with the underserved communities. Methods Using a participatory approach, we assessed transferability of six pre-selected interventions with the Population, Intervention, Environment and Transfer (PIET-T) models: All countries investigated two interventions with trained community members to support vaccination as health promoters. Greece and the Netherlands included a school-based vaccination program. The Netherlands added two interventions addressing providers’ HPV vaccine communication, and Slovakia a multilevel intervention. Results We identified barriers and facilitators for successful intervention transfer in each of the target contexts. The transferability analysis showed that an intervention with health promoters is potentially transferable with adaptations in all countries. Principles of trust in the educator, tailored and trustworthy information, help in navigating the health system for vaccination and easy access at no cost are transferable key elements in all contexts. Adaptations refer to the intervention elements that need to be tailored to specific contextual needs. School-based vaccination was nowhere transferable. Health provider training needs to be culturally sensitive and adapted to the Dutch system. The multilevel intervention in Slovakia is not fully transferable. Conclusions Participatory transferability analysis was essential for decision-making and intervention adaptation. All countries independently selected a health promoter intervention as having potential to remove the identified health system barriers in the respective context.

Determinants of Acute Watery Diarrhea in Children Under Five Years: A Comprehensive Analysis

Background: Acute watery diarrhea (AWD), which has a sudden onset and is associated with a risk of severe dehydration, is primarily spread through unsafe water, poor sanitation, and inadequate hygiene. Socioeconomic factors, like low parental education and poverty, further increase risks. WHO-recommended interventions, including oral rehydration therapy, zinc supplementation, and rotavirus vaccinations, have reduced diarrhea-related deaths globally. Aim of the study: This study aims to explore the socio-demographic, environmental, and behavioral factors associated with childhood watery diarrhea, particularly in high-risk regions. Methods: This prospective observational study was conducted at the Department of Pediatric, 250 Bedded General Hospital, Khulna, Bangladesh, with 210 children aged 0–60 months presenting acute watery diarrhea, enrolled over one year July 2023 to June 2024. Eligible children met specific inclusion criteria, while exclusion was applied to cases of chronic diarrhea or unrelated pre-existing conditions. Data confidentiality was maintained, with ethical approval granted. The analysis involved descriptive statistics in SPSS (version 26) for comprehensive result interpretation. Result: The study included 210 children under five, with a mean age of 14.51±5.34 months; most were aged 7-12 months (38.10%), and 54.29% were male. Caregivers were predominantly aged 28.39±4.11 years, with 73.81% having completed primary education. Key findings included high MMR vaccination rates (62.38%), significant exclusive breastfeeding for six months (58.57%), and recent diarrhea reports among 20.95% of caregivers. In terms of WASH practices, 60.48% used piped water, 57.62% stored drinking water separately, and 95.71% had toilet facilities. Notably, 67.14% used water only for handwashing, and 45.24% washed hands with soap post-toilet use. Conclusion: Safe water, sanitation, and handwashing practices are essential to reducing acute watery diarrhea in children under five. Children in households with untreated water and inconsistent caregiver handwashing face higher risks. Targeted public health initiatives to improve water treatment and hygiene could greatly reduce diarrhea incidence and improve child health outcomes.

8.N. Scientific session: Transferability and adaptation of vaccination interventions: Learning from underserved communities

Abstract Removing barriers in the health system that make it difficult for cultural, religious or ethnic minorities to access vaccinations is an urgent concern in order to prevent infectious diseases in the future. Childhood vaccine uptake for MMR and HPV in most underserved communities is lower than in the general population. The project RIVER-EU (Reducing Inequalities in Vaccine uptake in the European region - Engaging Underserved communities) engages the migrant community in Greece, females with a Turkish or Moroccan migration background in the Netherlands, the Ukrainian minority in Poland and marginalized Roma communities in Slovakia to remove health system barriers to vaccination. Barriers include, e.g., lack of culturally and linguistically appropriate information, financial barriers, insufficient capacities, coordination and delivery of health care. Based on a Participatory Action Research (PAR) approach we selected and adapted potentially transferable evidence-based interventions in partnership with the communities. First, we pre-selected 6 useful interventions from a realist review on 36 effective vaccine uptake interventions. Second, we assessed them in depth for their transferability. Building a bridge between evidence on interventions and community needs is not an easy task: We involved various stakeholders in a longitudinal process under consideration of contextual conditions in the primary intervention context and the context of the respective underserved community. We co-created knowledge through 25 workshops and 39 interviews or focus groups for decision-making and determining need for adaptation of selected interventions. The aim of this workshop is to present the results of this co-creative process in each country. Special attention is payed to facilitators and barriers for transferability of evidence-based interventions from the perspective of underserved communities, and contextual commonalities and differences that lead to a specific intervention tailoring. This workshop will contribute to an improved understanding of how to consider contextual needs underserved communities have to remove health system barriers to vaccination on the one hand and suitable evidence on interventions to improve their situation on the other hand. The workshop will include five presentations of eight minutes and a questions and answers session to involve the audience. First, an introductory presentation on transferability of interventions for HPV and MMR vaccine uptake to underserved communities in specific contexts will be given. Then each country will present the intervention(s) to address health system barriers adapted to their context. Thereby, we will underline common key elements that have potential for transferability in all countries. After all presentations, we will discuss the need for context-based decision-making on evidence-based interventions and intervention tailoring to improve vaccine uptake for cultural, religious or ethnic minorities. Key messages • Improving vaccine uptake in underserved communities requires local solutions with tailored interventions. Trusted partnerships with various stakeholders are key to reducing health system barriers. • Participatory approaches to evidence-informed decision-making build bridges between evidence on interventions and needs of underserved communities to understand the transferability of interventions.

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).

An Application of an Initial Full Value of Vaccine Assessment Methodology to Measles-Rubella MAPs for Use in Low- and Middle-Income Countries.

Measles and rubella micro-array patches (MR-MAPs) are a promising innovation to address limitations of the current needle and syringe (N&S) presentation due to their single-dose presentation, ease of use, and improved thermostability. To direct and accelerate further research and interventions, an initial full value vaccine assessment (iFVVA) was initiated prior to MR-MAPs entering phase I trials to quantify their value and identify key data gaps and challenges. The iFVVA utilized a mixed-methods approach with rapid assessment of literature, stakeholder interviews and surveys, and quantitative data analyses to (i) assess global need for improved MR vaccines and how MR-MAPs could address MR problem statements; (ii) estimate costs and benefits of MR-MAPs; (iii) identify the best pathway from development to delivery; and (iv) identify outstanding areas of need where stakeholder intervention can be helpful. These analyses found that if MR-MAPs are broadly deployed, they can potentially reach an additional 80 million children compared to the N&S presentation between 2030-2040. MR-MAPs can avert up to 37 million measles cases, 400,000 measles deaths, and 26 million disability-adjusted life years (DALYs). MR-MAPs with the most optimal product characteristics of low price, controlled temperature chain (CTC) properties, and small cold chain volumes were shown to be cost saving for routine immunization (RI) in low- and middle-income countries (LMICs) compared to N&S. Uncertainties about price and future vaccine coverage impact the potential cost-effectiveness of introducing MR-MAPs in LMICs, indicating that it could be cost-effective in 16-81% of LMICs. Furthermore, this iFVVA highlighted the importance of upfront donor investment in manufacturing set-up and clinical studies and the critical influence of an appropriate price to ensure country and manufacturer financial sustainability. To ensure that MR-MAPs achieve the greatest public health benefit, MAP developers, vaccine manufacturers, donors, financiers, and policy- and decision-makers will need close collaboration and open communications.

The Effects of Vaccination Status and Age on Clinical Characteristics and Severity of Measles Cases in the United States in the Post-Elimination Era, 2001-2022.

Despite high vaccine-effectiveness, wild-type measles can occur in previously vaccinated persons. We compared the clinical presentation and disease severity of measles by vaccination status and age in the post-elimination era in the United States. We included U.S. measles cases reported from 2001-2022. Breakthrough measles was defined as cases with ≥1 documented dose of measles-containing vaccine, classic measles as the presence of rash, fever, and ≥1 symptoms (cough, coryza, or conjunctivitis), and severe disease as the presence of pneumonia, encephalitis, hospitalization, or death. Vaccinated cases with low and high avidity IgG were classified as primary (PVF) and secondary (SVF) vaccine failures, respectively. Among 4,056 confirmed measles cases, 2,799 (69%) were unvaccinated, 475 (12%) were breakthrough infections, and 782 (19%) had unknown vaccination; 1,526 (38%), 1,174 (29%), and 1,355 (33%) were aged <5, 5-19, and ≥20 years, respectively. We observed a general decline in classic presentation and severe disease with an increase in the number of doses, and less complications among children aged 5-19 years compared to other age-groups. Among 93 breakthrough cases with avidity results, 11 (12%) and 76 (82%) were classified as PVF and SVF, respectively, with a higher proportion of PVFs having a classic measles presentation and severe disease than SVFs. Breakthrough measles cases tended to have milder disease with less complications. A small proportion of breakthrough infections were due to PVF than SVF. It is critical to maintain high MMR vaccination coverage in the United States to prevent serious measles illnesses.

The efficacy of 20% salicylic acid solution versus intralesional MMR vaccine combination with 20% salicylic acid solution in treatment of plane wart

Background and objectives: Plane wart treatment is challenging; modalities such as cauterization and cryotherapy having a great probability to recur, as well as the risk of scarring, discomfort, and expensive costs. The goal of this study is to compare the efficacy of salicylic acid 20% superficial chemical peel alone to topical salicylic acid solution 20% combined with intralesional measles mumps rubella vaccine. Methods: A therapeutic clinical trial conducted in outpatient department of “Shahid Nabaz Dermatology Teaching Center” a period from March to September of 2022.Fifty participants with plane wart were enrolled in this study, 27 female and 23 male. The participants were randomly divided into two groups, group­- A 25 patients, received topical 20% salicylic acid solution with intralesional measles-mumps- rubella vaccine. Group B, received topical 20% salicylic acid solution alone. The total number of therapeutic sessions was six, and the solution was applied every two weeks and the measles-mumps-rubella vaccine was injected every fortnightly. Every two weeks, the effectiveness of the treatment was assessed by counting the number of lesions. Result: Group A patients who were treated with intralesional measles mumps-rubella-vaccine combined with topical 20% salicylic acid solution showed complete clearance (24/25) with six sessions .group B patients treated with topical 20% salicylic acid solutions showed clearance (14/25) with six sessions. Lesions were significantly fewer in Group-A, which was statistically significant. Conclusion: The intralesional measles mumps-rubella-vaccine combination with 20% topical salicylic acid solution and the 20% salicylic acid solution alone were both effective in clearing plane warts, however, intralesional measles mumps-rubella-vaccine combination with 20% topical salicylic acid solution can achieve higher response with fewer sessions .

Data on recent measles cases at the Jalal-Abad city of Kyrgyzstan.

Measles caused by the virus is highly infectious and sometimes fatal, but it is prevented through vaccination. In Kyrgyzstan, measles cases were initially documented in September 2023, with a notable escalation observed between November and December of the same year. Children aged 3-5 years and 1-2 years exhibited the highest prevalence rates, followed by infants under one year old. Unvaccinated children constituted the majority of cases, with schoolchildren and kindergarten attendees also affected. Surprisingly, a significant proportion of measles cases occurred in vaccinated children, primarily those who received the MMR or Rubella-measles vaccine. Doctors identified 22 recent measles outbreaks and none of the 75 contacts recorded in these outbreaks acquired the disease. Therefore, it is of interest to report an analysis of measles outbreak spike at Jalal-Abad city of Kyrgyzstan in 2023.

The Pandemic's Shadow: Measles Vaccination Challenges and Trends

Measles is a highly contagious, serious disease caused by a virus. Before the introduction of measles vaccine in 1963, major epidemics occurred approximately every 2-3 years and caused an estimated 2.6 million deaths each year (1). Government of India launched Universal Immunization Program in 1985, which provides vaccination against 8 life threatening disease including measles and 65% vaccine coverage was achieved. In order to increase the vaccination coverage, Mission Indradhanush was launched in phased manner which aimed to fully immunize more than 90% of newborn by 2020. India has adopted the National strategic Plan for achieving and sustaining measles and Rubella elimination in India and has vaccinated over 324 million children between 2017 and 2020 through MR vaccination campaign (2). Due to the lag, India had shifted its self-imposed deadline to eliminate measles to 2023 and launched another vaccination campaign in 2021 called the Intensified Mission Indradhanush 3.0, targeting unvaccinated children.

Tracking Measles and Rubella Elimination Progress-World Health Organization African Region, 2022-2023.

Measles or rubella elimination is verified when endemic transmission of the corresponding virus has been absent for over 36 months in a defined area, in the presence of a well-performing surveillance system. This report updates the progress by 47 countries in the WHO African Region towards the goal of attaining verification of measles and rubella elimination in at least 80% of the countries of the region by 2030. We reviewed the WHO-UNICEF vaccination coverage estimates for the first and second doses of measles- and measles-rubella-containing vaccines, as well as the available coverage data for measles supplementary immunization activities, during 2022-2023. We also reviewed the measles-surveillance performance and analyzed the epidemiological trends of measles and rubella as reported in the case-based surveillance database. The WHO-UNICEF estimates of first measles vaccine dose (MCV1) and second measles vaccine dose (MCV2) coverage for the African Region for 2022 were 69% and 45%, respectively. Rubella-containing vaccines have been introduced in the routine immunization program in 32 of 47 (68%) countries as of the end of 2022, with no introductions during 2023. In 2022 and 2023, a total of 144,767,764 children were vaccinated in the region with measles or MR vaccines in 24 countries through 32 mass vaccination campaigns. The administrative coverage target of 95% was reached in only 15 (49%) of the 32 vaccination campaigns. In 2023, a total of 125,957 suspected cases of measles were reported through the case-based surveillance system, and 73,625 cases (58%) were confirmed to be measles, either by laboratory testing, by epidemiological linkage, or based on clinical compatibility. A total of 4805 confirmed rubella cases were reported, though this total represents substantial under-ascertainment. The regional incidence of measles was 60.3 cases per million population. Twenty-six countries (55%) met the targets for the two principal surveillance system performance-monitoring indicators. No country in the region has attained the verification of measles or rubella elimination as of the end of 2023. Addressing systemic problems with routine immunization and using tailored approaches to reach unvaccinated children can contribute to progress towards measles and rubella elimination. In addition, periodic and timely high-quality preventive SIAs remain a critical programmatic strategy to reach unvaccinated children.

A Comparative Study of the Efficacy of Intralesional Measles Mumps Rubella (MMR) Vaccine and Auto Implantation for the Treatment of Periungual and Palmoplantar Warts: A Randomized Controlled Trial.

Warts are benign epidermal proliferations, caused by infection of keratinocytes with human papillomavirus (HPV). Auto implantation and intralesional mumps, measles, and rubella (MMR) vaccine are novel methods of immunotherapy for treating periungual and palmoplantar warts. They act by stimulating the patient's immune system; this clears not only the local warts but also distant warts with lesser side effects. We conducted this study to compare the efficacy and safety of both methods in treating periungual and palmoplantar warts. A total of 160 patients were randomly allocated into two groups of 80 patients. Group A was treated with 0.3 mL of intralesional MMR vaccine at an interval of 3 weeks or for a maximum of three sittings, and Group B was treated with auto implantation. At the end of therapy, the result was better in group A (MMR vaccine) as 86% of cases yielded an excellent response as compared to 71% in group B (auto implantation). The recurrence rate was 5% in group A and 4% in group B. There were no serious side effects in both groups with pain during injection (70%) in group A and swelling at the recipient site (8%) in group B being the most common side effect. Both MMR and auto implantation had significant response rates. But MMR was faster and better.