MMR Vaccine Research Articles

The Resurgence of Measles - A Tragic Residue of Covid Epoch

Measles is a highly contagious, serious viral disease mainly affecting children under the age of five with a case fatality rate ranging from 0.1% 1in developed world to as much as 30% among refugee communities. As of the beginning of November 2022, the most current monthly statistics submitted to the WHO indicated that India was one of the top 10 nations responsible for the highest number of cases (9500 cases) worldwide . The most significant factor was COVID pandemic that had detrimental impact on the main approach including nterruption of health services, supply-chain disruption and routine immunization-measles vaccination campaigns being paused or postponed in many countries to avert further spread of COVID-19 that lead to fall in consumption of MR vaccine in a span of few months after pandemic started. Other contributing factors might include burgeoning migrant community, missed doses of vaccination and malnutriton spike.There is a need to urgently address the basic needs of health care facilities and to fill the gaps in routine immunization and its surveillance system to curb the measles outbreak in this post pandemic era.

COVID-19 immune response in adults post Measles-Rubella vaccination

ObjectiveThis study aimed to see how measles, mumps, and rubella vaccination affected the increase in SARS-CoV-2 immunoglobulin levels in individuals who had received the second dose of the SARS-CoV-2 vaccine. Material and methodThis research is a quasi-experimental type with a pre-post test design. The population studied were adults who had received the second dose of the SARS-CoV-2 vaccine, consisting of 30 people. ResultsThe results of this study were that most (60%) research subjects experienced an increase in IgM and some subjects (46.6%) experienced an increase in anti-SARS-CoV-2 IgG levels. The administration of the MR vaccination had no effect on increasing anti-SARS-CoV-2 IgG and IgM levels. This happened because the increase in IgM and IgG levels in the pre and post-tests in most research subjects was relatively low. ConclusionThe administration of the MR vaccine to adults who had received a second dose of the SARS-CoV-2 vaccine elicited a response with low levels of IgG and IgM SARS-CoV-2.

Mumps resurgence in a highly vaccinated population: Insights gained from surveillance in Canada, 2002–2020

Although mumps vaccination has been routine in Canada for decades, mumps cases and outbreaks continue to occur periodically. Mumps surveillance, including monitoring of the mumps virus genotype associated with disease activity, is important to document baseline activity and to advance further research into vaccine effectiveness. Here we describe a detailed analysis of mumps cases that have been detected in Canada from 2002 to 2020, with a focus on the mumps molecular epidemiology. In total, 7395 cases of mumps were reported to the surveillance system, with outbreaks occurring in the years 2007, 2010 and 2016 to 2018. Adolescents and young adults aged 15 to 29 years had the highest risk of being a case (rate ratios ranging from 1.50 to 2.29), compared to adults aged 30 to 39. Genotypes of mumps viruses were determined in 3225 specimens. Genotype G was predominantly detected (96% of genotyped specimens) and was first reported in 2005. Other genotypes were more likely to be detected in cases that also reported travel (or were linked to imported cases) than the cases with genotype G detected (p < 0.0001). The genotype G viruses had little sequence diversity in the 316 nucleotide window used for genotyping (the small hydrophobic protein gene) and mainly belonged to a single phylogenetic lineage that included the MuVi/Sheffield.GBR/1.05 reference sequence. The analysis of over ten years of data has demonstrated that mumps genotype G, specifically belonging to a single lineage, the Sheffield lineage, is the endemically circulating virus in Canada. This lineage is seen also in other countries using the genotype A vaccine. Mumps remains endemic despite high MMR vaccination coverage which has been sufficient to eliminate circulation of measles and rubella in Canada, raising the hypothesis of the evolution towards a vaccine escape mumps virus.

Why Parents Say No to Having Their Children Vaccinated against Measles: A Systematic Review of the Social Determinants of Parental Perceptions on MMR Vaccine Hesitancy.

Ongoing outbreaks of measles threaten its elimination status in the United States. Its resurgence points to lower parental vaccine confidence and local pockets of unvaccinated and undervaccinated individuals. The geographic clustering of hesitancy to MMR indicates the presence of social drivers that shape parental perceptions and decisions on immunization. Through a qualitative systematic review of published literature (n = 115 articles; 7 databases), we determined major themes regarding parental reasons for MMR vaccine hesitancy, social context of MMR vaccine hesitancy, and trustworthy vaccine information sources. Fear of autism was the most cited reason for MMR hesitancy. The social drivers of vaccine hesitancy included primary care/healthcare, education, economy, and government/policy factors. Social factors, such as income and education, exerted a bidirectional influence, which facilitated or hindered vaccine compliance depending on how the social determinant was experienced. Fear of autism was the most cited reason for MMR hesitancy. Vaccine hesitancy to MMR and other childhood vaccines clustered in middle- to high-income areas among mothers with a college-level education or higher who preferred internet/social media narratives over physician-based vaccine information. They had low parental trust, low perceived disease susceptibility, and were skeptical of vaccine safety and benefits. Combating MMR vaccine misinformation and hesitancy requires intersectoral and multifaceted approaches at various socioecological levels to address the social drivers of vaccine behavior.

Comparison of MMR Vaccine V/S 5-Fluorouracil in Treatment of Palmo-plantar Warts

Background: Human papilloma virus is a large group of DNA containing viruses that infect squamous epithelium of skin or uncornified mucous membrane. Aim: To compare the outcomes of MMR vaccine V/S 5 fluorouracil in treatment of palmo-plantar warts in patients among male and female patients. Study Design: Experimental study. Methodology: In order to collect the data, simple random sampling technique was used. Enrolled patients (n=102) were divided into two groups. Group-A received intra-lesional MMR vaccine (0.1-0.5mal) while other group received intra-lesional 5-Fluorouracil (0.1-0.5mal) injection. Both groups received intra-lesional injections in warts at 2 weekly interval for 3 months. SPSS v 23 evaluated data. Chi-square test was used to compare the gender distribution, results, responder and recurrence between both groups with p-value less than 0.05 as significant. Results: Mean age of the patients of group A was 30.5 ± 6.0 and the mean age of patients of group B was 28.2 ± 8.7 years. In Group A, 33 patients (58.9%) were responders, while in Group B, 43 patients (76.8%) were responders. P-value (0.043) suggested that the difference in response rate between the two groups was statistically significant. Practical Implication: This study compared the efficacy of two different treatment options that were commonly used in palmo-planter warts management. Secondly, it added to local literature regarding their efficacy in comparison to each-other. Conclusion: It was concluded that intra-lesional 5-FU was more safe and effective treatment in comparison to injection MMR for palmo-planter warts as it showed high response rate with low recurrence. Keywords: Efficacy, MMR Vaccine, Response Rate, 5-Flourouracil and Intra-lesional Injection.

Gaps in measles immunisation coverage for pre-school children in Aotearoa New Zealand: a cross-sectional study.

To evaluate gaps in measles immunisation coverage for children <5 years in Aotearoa New Zealand. In this cross-sectional study, we extracted coverage rates for the first measles, mumps and rubella (MMR1) vaccine and second MMR vaccine (MMR2) from the National Immunisation Register for birth cohorts 2017 to 2020. We described measles coverage rates per birth cohort, and stratified per district health board (DHB), ethnicity and deprivation quintile. Coverage for MMR1 declined from 95.1% for those born in 2017 to 88.9% for those born in 2020. The coverage for MMR2 was below 90% for all the birth cohorts, with the lowest MMR2 coverage in the birth cohort of 2018 (61.6%). MMR1 coverage was lowest for children of Māori ethnicity and coverage declined over time: 92.8% for those born in 2017 to 78.4% for those born in 2020. Six DHBs had average MMR1 coverage <90% including Bay of Plenty, Lakes, Northland, Tairāwhiti, West Coast and Whanganui. Immunisation coverage rates for measles are insufficient to prevent a potential measles outbreak in children <5 years. Concerningly, the coverage for MMR1 is declining, especially in Māori children. Catch-up immunisation programmes are urgently needed to improve immunisation coverage.

Mumps in Poland in 2020.

Mumps is an acute, generalized viral disease whose source of infection is the infected person. In 2003, vaccination against mumps became compulsory in Poland, performed according to a twodose scheme. The combined MMR vaccine (against measles, mumps and rubella) was introduced as part of the Protective Vaccination Program (PVP), which influenced the number of cases in Poland. The aim of the study was to evaluate the epidemiological indicators of mumps in Poland in 2020 compared to previous years. The analysis of the epidemiological situation of mumps in Poland in 2020 was based on the interpretation of data from the bulletin "Infectious diseases and poisonings in Poland in 2020" and "Vaccinations in Poland in 2020". In 2020, 582 cases of mumps were registered in Poland. The total incidence was 1.5 per 100,000 inhabitants and was lower compared to 2019. The highest incidence was 2.0 per 100,000 inhabitants were registered in the Świętokrzyskie Voivodeship and the lowest - 0.7 in the Dolnośląskie Voivodeship. The highest incidence (24.6/100,000) was recorded in children aged 5-9 years. The incidence of men (1.8/100,000) was higher than that of women (1.2/100,000). In 2020, 6 patients were hospitalized in Poland due to mumps, which was less than in 2019 (22 patients). The level of vaccination against mumps in children aged 3 was lower by 0.7 percentage points compared to 2019 and amounted to 91.9% across Poland. In 2020, there was a decrease in the number of mumps cases compared to the previous year. The lower incidence may have been the result of a reduction in mumps virus transmission due to a change in population health behavior during the COVID-19 pandemic. Due to the epidemiological threat, the functioning of nurseries, kindergartens and schools was also temporarily suspended, which resulted in a reduction in the incidence of mumps in younger age groups, which are the main group of patients.

5 non-COVID vaccine recommendations from ACIP

Although COVID-19 vaccination remains at the forefront, ACIP has offered guidance on MMR, pneumococcal, influenza, and travel vaccines. Here's a round-up.

Are pediatricians responsible for maintaining high MMR vaccination coverage? Nationwide survey on parental knowledge and attitudes towards MMR vaccine in Serbia.

To assess parental knowledge and attitudes related to MMR vaccination and to determine factors associated with parental decision whether to vaccinate their child with MMR vaccine in Serbian population. The selection of participants was performed using multi-phase sampling. Seventeen out of the total 160 public health centers on the territory of Republic of Serbia were randomly selected. All parents of children up to the age of 7 who visited the pediatrician at the public health centers from June to August 2017 were recruited. Parents filled in an anonymous questionnaire regarding their knowledge, attitudes and practices in immunization with MMR vaccine. The relative contribution of different factors was explored by univariable and multivariable logistic regression analysis. The majority of parents were female (75.2%), with mean age of 34.3 ± 5.7 years, and the average age of children was 4.7 ± 2.4 years, 53.7% of them were girls. In the multivariable model, getting information on vaccination from a pediatrician was associated with 7.5 fold increased probability to vaccinate child with MMR vaccine (OR = 7.52; 95% CI 2.73-20.74; p<0.001), while previous vaccination of the child increased this chance two times (OR = 2.07; 95% CI 1.01-4.27; p = 0.048), and having two children was associated with 84% increase in chance of vaccinating child with MMR vaccine compared to having one child or three or more children (OR = 1.84; 95% CI 1.03-3.29; p = 0.040). Our study emphasized the key role of pediatricians in the formation of parental attitude on MMR vaccination of their child.

Prediction of Specific Antibody- and Cell-Mediated Responses Using Baseline Immune Status Parameters of Individuals Received Measles-Mumps-Rubella Vaccine.

A successful vaccination implies the induction of effective specific immune responses. We intend to find biomarkers among various immune cell subpopulations, cytokines and antibodies that could be used to predict the levels of specific antibody- and cell-mediated responses after measles-mumps-rubella vaccination. We measured 59 baseline immune status parameters (frequencies of 42 immune cell subsets, levels of 13 cytokines, immunoglobulins) before vaccination and 13 response variables (specific IgA and IgG, antigen-induced IFN-γ production, CD107a expression on CD8+ T lymphocytes, and cellular proliferation levels by CFSE dilution) 6 weeks after vaccination for 19 individuals. Statistically significant Spearman correlations between some baseline parameters and response variables were found for each response variable (p < 0.05). Because of the low number of observations relative to the number of baseline parameters and missing data for some observations, we used three feature selection strategies to select potential predictors of the post-vaccination responses among baseline variables: (a) screening of the variables based on correlation analysis; (b) supervised screening based on the information of changes of baseline variables at day 7; and (c) implicit feature selection using regularization-based sparse regression. We identified optimal multivariate linear regression models for predicting the effectiveness of vaccination against measles-mumps-rubella using the baseline immune status parameters. It turned out that the sufficient number of predictor variables ranges from one to five, depending on the response variable of interest.

A prospective randomized controlled study of Mycobacterium Indicus Pranii vaccine, Measles Mumps Rubella vaccine and Vitamin D3 in extragenital cutaneous warts.

Interventional, prospective, four arm randomized control. Outpatient department, Department of Dermatology, Venereology and Leprology, AIIMS Jodhpur (Rajasthan), India. Two hundred patients. The intervention administered in the groups were normal saline (A), vitamin D3 (B), MIP (C), and MMR (D). The injections were given into the largest wart at 2-weekly intervals until complete clearance or for a maximum of seven sittings. Post-treatment clearance of the injected wart and the distant wart was compared on the basis of change in wart number, percentage clearance, and mean time to complete clearance. Side effects were recorded. A total of 197 patients were recruited. The mean percentage improvement in the injected and non-injected warts was 68.4% and 66.8%, respectively. Intention to treat analysis (ITT) showed that complete clearance of lesions in injected wart occurred in placebo, vit D3 , MMR, and MIP arms in 64%, 66%, 58%, and 55% patients, respectively (p > 0.05), while in the non-injected warts in 62%, 64%, 52%, and 53%, respectively (p > 0.05). The mean time to achieve complete clearance of wart was fastest in MIP at 7.1 weeks followed by MMR at 7.2 weeks, VIT D3 at 7.4 weeks and in placebo group 7.8 weeks (p > 0.05). Side effects noted were fever, pain, erythema, and swelling which was highest in VIT D3 group (p < 0.05). The efficacy of immunotherapies was comparable to placebo with minimal side effects.

Parental acceptance of and preferences for administration of routine varicella vaccination in the UK: A study to inform policy.

To explore acceptability of and preferences for the introduction of varicella vaccination to the UK childhood immunisation schedule. We conducted an online cross-sectional survey exploring parental attitudes towards vaccines in general, and varicella vaccine specifically, and their preferences for how the vaccine should be administered. 596 parents (76.3% female, 23.3% male, 0.4% other; mean age 33.4years) whose youngest child was aged 0-5years. Willingness to accept the vaccine for their child and preferences for how the vaccine should be administered (in combination with the MMR vaccine [MMRV], on the same day as the MMR vaccine but as a separate injection [MMR+V], on a separate additional visit). 74.0% of parents (95% CI 70.2% to 77.5%) were extremely/somewhat likely to accept a varicella vaccine for their child if one became available, 18.3% (95% CI 15.3% to 21.8%) were extremely/somewhat unlikely to accept it and 7.7% (95% CI 5.7% to 10.2%) were neither likely nor unlikely. Reasons provided by parents likely to accept the vaccine included protection from complications of chickenpox, trust in the vaccine/healthcare professionals, and wanting their child to avoid their personal experience of chickenpox. Reasons provided by parents who were unlikely included chickenpox not being a serious illness, concern about side effects, and believing it is preferable to catch chickenpox as a child rather than as an adult. A combined MMRV vaccination or additional visit to the surgery were preferred over an additional injection at the same visit. Most parents would accept a varicella vaccination. These findings highlight parents' preferences for varicella vaccine administration, information needed to inform vaccine policy and practice and development of a communication strategy.

Efficacy of Intralesional Measles Mumps Rubella Vaccine in the Treatment of Verruca Vulgaris: An Interventional Study.

Background A wart is a mucocutaneous illness caused by the growth of HPV-infected skin or mucosal cells. Intralesional immunotherapy makes use of the immune system's ability to identify injected antigens, which might cause a delayed-type hypersensitivity reaction not just to the antigen but also to the wart virus. This, in turn, improves the immune system's ability to identify and eliminate HPV not just at the treated wart but also at distant places, as well as prevent recurrences. Aims and objectives To study the efficacy of the intralesional measles, mumps, and rubella (MMR) vaccine in verruca vulgaris and its side effects. Materials and methods Interventional research with a 94-case sample size was conducted over a period of seven months. A volume of 0.3 ml of the MMRvaccination was reconstituted with sterile water and injected into the largest wart at three-week intervals until complete clearance or for a maximum of three treatments.Following a six-month observation period, patients were evaluated to look for recurrence, and the degree of response was categorized as total, partial, or none at all. Results The youngest case included in the study was of age 10 years and the eldest case was of 45 years. The mean age was 28.22± 10.98. Of 94 patients, 83 (88.3%) were men and 11 (11.7%) were women. Complete remission was reported in 38 (40.42%) cases, a partial response in 46 (48.94%) cases, and no response in 10 (10.63%) cases. All 38 patients who showed complete clearance had a duration of warts in six months or less. The pain was a universal complaint (100%) after each visit followed by bleeding at 25.53%. Flu-like symptoms were noted in three cases after the first dose and two cases after the second dose, while urticaria was seen in one case during all visits. Cervical lymphadenopathy was observed in two cases after the first dose. Erythema multiforme minor was seen only in one patient after the first dose. Conclusion Intra-lesional MMR vaccine therapy proved to be a simple and safe treatment option in cases having multiple warts. The response rate may increase if a higher concentration of vaccine (0.5ml) and additional doses (maximum of five doses) are given.

Intralesional measles-mumps-rubella vaccine in recurrent common warts: A placebo-controlled study

Background: Cutaneous warts cause immense an burden to patients as well as physicians. Although most resolve spontaneously within two years, treatment is sought for pain alleviating and cosmetic reasons. Various modalities of treatment are known. The destructive methods are unsuitable for multiple warts and are associated with chances of recurrence, scarring, and pain. In contrast, immunotherapy boosts the host immune response against the virus and helps in clearance, even in distant warts, without scars or physical change. This study was undertaken to assess the efficacy of intralesional MMR vaccine in multiple recurrent common warts. Materials and Methods: Sixty-six patients with recurrent common warts were divided equally into two groups. In group one, 0.5 mL of the MMR vaccine and, in group two, 0.5 mL of normal saline were injected intralesionally into the base of the largest wart. The sessions were repeated once in two weeks for a maximum of four sessions. The patients were followed up for twelve months to detect recurrences. Results: Complete clearance of warts was noted in 75.76% (n = 25) of the patients in the study group, whereas, in the control group, 78.79% (n = 26) patients showed no response. The result was statistically significant (p &lt; 0.01). Conclusion: Intralesional MMR is a safe and effective treatment option for recurrent common warts with minimal side effects. Key words: viral warts; intralesional MMR vaccine; immunotherapy

Are Boosters Necessary If Adult Patients Do Not Achieve Seroconversion After 2 Doses of the MMR Vaccine?

The Centers for Disease Control (CDC) recommend 2 documented doses of the MMR (measles-mumps-rubella) vaccine for adequate measles, mumps, and rubella immunity for all children and most adults. Sometimes, individuals are asked to provide serologic proof of immunity to measles, mumps, and/or rubella for educational or employment purposes. In other instances, serologic testing may be used to help clarify whether an individual has immunity to measles, mumps, and/or rubella. These serologic tests may sometimes show negative or equivocal antibody titers to measles, mumps and/or rubella, raising the question of adequate immunity. This report provides practical guidance for clinicians on when to use serologic testing to determine measles, mumps, and rubella immunity.

A retrospective nationwide register-based study to evaluate the non-specific effects of first MMR vaccination among children in Finland.

According to earlier studies, live vaccines like measles-mumps-rubella (MMR) vaccine could reduce also other infections than only the infections they are targeted against. This non-specific effect has been seen especially in studies in low-income countries and results from high-income countries have not been unambiguous. In 2011 Finland changed the recommended schedule for the first MMR vaccination from 18months to 12months of age. This change created a natural experiment for evaluating the potential non-specific effects. This is a retrospective nationwide register-based cohort study of Finnish children born between 2008 and 2012. Children were divided into two cohorts by age at MMR vaccination: children administered early MMR vaccination (11 through 12months of age) and late MMR vaccination (18 through 19months of age). Morbidity was evaluated during the main follow-up period (from 13 to 17months of age) and before any MMR vaccination (3 to 10months) and after all were vaccinated with MMR (20 to 35months) as control follow-up periods. We analyzed all infections and did additional analyzes for urinary tract infections (UTI) and bronchitis. Injuries were analyzed as a control outcome. Early MMR vaccinated children (N=79949) had fewer infections compared to late MMR vaccinated (N=60965) during the main follow-up period. The incidence rate ratio (IRR) was 0.84 (95% confidence interval (95% CI) 0.81-0.87). However, similar differences were also observed during the control follow-up periods. MMR vaccinated children had less UTI in the main follow-up period (IRR 0.73, 0.60-0.89) but not in the control follow-up periods. When stratified by sex, the difference was observed among girls but not in boys. No clear evidence was found for non-specific effects in infectious diseases morbidity. However, there could be a nonspecific effect on UTI. Confirmation is needed from other studies, especially from high-income countries.

Retrospective analysis of treatment of cutaneous warts with measles, mumps, and rubella immunotherapy over 8 years

Introduction: Warts are benign lesions caused by human papilloma virus. Various types of cutaneous warts include verruca vulgaris, genital warts, and palmoplantar warts. Various therapeutic modalities are available for warts with varying response. These include destructive therapies, cytotoxic agents (Bleomycin), and immunotherapy (measles, mumps, and rubella [MMR], candida antigen, etc.). We have analyzed the efficacy of intralesional MMR immunotherapy in patients with different kinds of cutaneous warts. Aim: The purpose of this study was to retrospectively analyze the effectiveness and safety of MMR immunotherapy in the treatment of different kinds of cutaneous warts. Materials and Methods: We included all the patients with cutaneous warts receiving MMR vaccine between March 2014 and March 2022. Demographic data were recorded. MMR vaccine was given for four doses at 3 weeks interval or till there was complete clearance, whichever was earlier. Clearance and reduction of wart sizes and potential side effects were recorded. Results: A total of 184 patients were enrolled, and 45% patients were women. Predominant age group of patients was 21–40 years. Most common types of warts observed was palmoplantar warts. Complete resolution was seen in 66% patients and partial response in 22% patients. Palmo-plantar and warts on extremities responded completely to immunotherapy, whereas 43% of genital warts had no improvement. Pain at injection site was observed in all patients, and 32% patients had flu-like symptoms. Conclusions: Immunotherapy with MMR vaccine shows a promising response in the treatment of palmo-plantar warts and warts on extremities, without any serious adverse effect, whereas the genital warts and verruca plana respond variably to immunotherapy.

Vaccination coverage of triple viral and poliomyelitis in Brazil, 2011-2021: temporal trend and spatial dependency.

To analyze the coverage of MMR and polio vaccines, the temporal trend and spatial dependence, in children up to one year of age in Brazil, between 2011 and 2021. Ecological study with secondary data on vaccination coverage rates, made available by the National Immunization Program Information System. Trend analysis was carried out using the joinpoint method, according to geographic regions, estimating the annual percentage change (APC) and its respective confidence interval (95%CI). Choropleth maps of distribution by health region were constructed and, subsequently, the spatial dependence was verified using Moran's statistics. Between 2011 and 2021, vaccination coverage declined in Brazil, both for MMR (APC: -6.4%; 95%CI -9.0; -3.8) and for poliomyelitis (APC: -4. 5%; 95%CI -5.5; -3.6). There was a decline in coverage of both vaccines in all geographic regions over the years of the study, except in the South and Midwest for the MMR vaccine. Since 2015, few health regions in the country have achieved adequate vaccination coverage (≥95.0% to <120.0%). The North and Northeast health regions showed low-low clusters in the univariate analysis for both immunobiological. It is urgent to consider studies like this one for the planning of more effective strategies for immunizing children, especially in areas with higher falls. In this way, barriers to access to immunization can be broken, given Brazil's heterogeneity, and access to reliable information that increases confidence in vaccine efficacy can be expanded.

Disseminated life-threatening viral skin rash in a child with atopic dermatitis.

We report the case of a toddler, with a history of mild atopic dermatitis (AD) since early infancy, presented to the Giannina Gaslini, a pediatric polyclinic hospital, 14 days after measles-mumps-rubella (MMR) vaccination, for the occurrence of a disseminated vesico-pustular rash, accompanied by general malaise, fever, restlessness, and anorexia. Eczema herpeticum (EH) was diagnosed clinically and confirmed by laboratory examinations. The exact pathogenesis of EH in AD is still debated and possibly involves an inter-play between altered cell-mediated and humoral immunity, failure to up-regulate antiviral proteins, and exposure of viral binding sites through the dermatitis and an epidermal barrier failure. We hypothesize that in this particular case, MMR vaccination might have played an additional important role in the alteration of innate immune response, facilitating the manifestation of herpes simplex virus type 1 in the form of EH.

Barriers to measles mumps rubella vaccine acceptance in the three southern border provinces of Thailand.

This qualitative study utilizing phenomenological methodology aimed to depict parental measles mumps rubella (MMR) vaccine acceptance through the work experiences of health personnel. Twenty-two public health workers working as vaccination providers in the three southern border provinces of Thailand were recruited. In-depth, face-to-face, semi-structured interviews were conducted. Data were analyzed using thematic analysis. Four main themes emerged: (1) religious beliefs, (2) personal disagreements, (3) fear and mistrust regarding potential vaccine side effects, and (4) misperceptions about the potential severity of measles. Four subthemes were identified: (1) haram (prohibited), (2) the will of Allah, (3) spousal disagreement, and (4) disagreement from a religious leader. The results of this study indicated that perceived religious prohibition was the most important reason for refusing to vaccinate among Muslim parents. Vaccine-hesitant parents were concerned that the vaccine might contain gelatin derived from pig products. Also, halal certification of the vaccine was required from Muslim parents to ensure that vaccine has been approved for Muslims. Meanwhile, a lack of knowledge and positive attitudes concerning immunizations of vaccine-hesitant parents were also found as predominant reasons for incomplete childhood immunizations in the deep south of Thailand. Health education and engagement by religious leaders to endorse the vaccination and bridge the gap between religious beliefs and vaccine acceptance is needed to overcome this issue. This study findings could be effectively applied to improve vaccination uptake in a Muslim majority context.