MMR Vaccine Research Articles

Evaluation of the Efficacy of Intralesional Measles, Mumps, and Rubella Vaccine with Intralesional Vitamin D3 as Immunotherapies in the Treatment of Recalcitrant Cutaneous Warts in Adult- A Randomized Placebo-Controlled Study.

Introduction:Currently, various destructive and ablative treatment options are conventionally used for warts, but all of them are limited in some form by their adverse effects, high recurrences, suboptimal effectiveness, and the need to treat every wart. Lately, immunotherapy has emerged as a safe treatment relying on biological substances that modulate the immune system to achieve disease control.Aims and Objectives:We aimed at conducting a placebo-controlled study to compare the rate of efficacy of intralesional MMR vaccine with vitamin D3 in the management of recalcitrant extragenital warts in immune-competent adults. Follow-up was done at third and sixth month.Materials and Methods:Patients were divided into three groups, namely, group A, B, and C. Groups A, B, and C received intralesional MMR vaccine, vitamin D3 and normal saline, respectively, in the largest wart. The injections were repeated every 2 weeks, for a maximum of four injections.Results:Among injected warts, in group A, complete clearance was seen in 29 (87.8%) patients, partial clearance in two (6.1%) and no response in two (6.1%) patients. In group B, 24 (77.4%) patients, five (16.1%) patients, and two (6.5%) patients showed signs of complete, partial, and no clearance, respectively, in injected warts. Complete response in distant warts was seen in 25 (75.7%) patients in group A and 20 (64.5%) patients in group B. There was no statistically significant difference between responses of the two groups. In group C, only three (12.5%) patients had complete clearance in injected warts, and none in distant warts. Recurrence was seen in two (6.4%) patients, each in group B and C. However, for management of verruca plana MMR was found to be superior to vitamin D3.Limitations:Our study was limited by a small sample size, absence of immunological analysis, and limited follow-up period.Conclusion:MMR vaccine and vitamin D3 are equally effective and safe treatment option for multiple, recalcitrant warts, as well as warts on difficult to treat sites with minimal recurrence.

Attitudes and Knowledge Towards Immunization in Tuzla Canton Population

Introduction: Despite the proven safety and efficacy of vaccines, common diseases which can be prevented by regular vaccination, are still not controlled in all European countries. The most important barriers which parents encounter while making decisions about vaccination include unwanted vaccination effects, attitude towards the disease, and the effectiveness and safety of the vaccine. Methods: The sample consisted of 1850 participants who have registered place of residence in one of the five cities in the region of the Tuzla Canton. The questioner was created by the authors of this paper and it consisted of 22 items which were divided into 4 categories. Results: Statistical analysis showed that more than half of participants who have declared themselves as vaccine skeptics had completed secondary school as their last level of education, and base their attitude on the information provided through the mass media sources without performing additional verification. It has been found that there is a certain percentage of healthcare workers with whom the parents contacted, and who advised them against the immunization of their child, which further deepens the skepticism of parents. Discussion: We need better and more efficient ways of informing and engaging the vaccine sceptic parents. This whole process cannot be left to the parents themselves, and the role of a healthcare professional is based on the fact that he/she is a reference person who will inform, through adequate communication, provide basic knowledge and help the parents during this entire process. Key Words: vaccine, active immunization, MMR vaccine, anti-vaccination movement

Protective Heterologous T Cell Immunity in COVID-19 Induced by MMR and Tdap Vaccine Antigens

T cells are critical for control of viral infection and effective vaccination. We investigated whether prior Measles-Mumps-Rubella (MMR) or Tetanus-Diphtheria-pertussis (Tdap) vaccination elicit cross-reactive T cells that mitigate COVID-19. Using co-cultures of antigen presenting cells (APC) loaded with antigens and autologous T cells, we found a high correlation between T cell responses to SARS-CoV-2 (Spike-S1 and Nucleocapsid) and MMR and Tdap vaccine proteins in both SARS-CoV-2 infected individuals and individuals immunized with mRNA-based SARS-CoV-2 vaccines. The overlapping T cell population contained effector memory T cells (T EMRA ) previously implicated in anti-viral immunity. TCR- and scRNA-sequencing detected cross-reactive clones with T EMRA features among the cells recognizing SARS-CoV-2, MMR and Tdap epitopes. A propensity-weighted analysis of 73,582 COVID-19 patients revealed that severe disease outcomes (hospitalization and transfer to intensive care unit or death) were reduced in MMR or Tdap vaccinated individuals by 38-32% and 23-20% respectively. In summary, Tdap and MMR memory T cell reactivated by SARS-CoV-2 provides protection against developing severe COVID-19 disease.Funding: This work was supported by National Institutes of Health R01HL065095 (T.M.), R01AI152522 (T.M.), R01NS097719 (L.J.) and a generous donation from Barbara and Amos Hostetter and the Chleck Foundation (D.R.W.)Declaration of Interest: V.M., X.C., M.D., A.H.L., M.K., L.J. and T.M. declare that they have no competing interests to disclose. D.R.W has a financial interest in Quanterix Corporation, a company that develops an ultra-sensitive digital immunoassay platform. He is an inventor of the Simoa technology, founder of the company and serves on its Board of Directors. The anti-SARS-CoV-2 Simoa assays in this publication have been licensed by Brigham and Women’s Hospital to Quanterix Corporation. T.G. receives royalty payments from Brigham and Women’s Hospital for the antibodies assay technology.Ethical Approval: All procedures performed were in accordance with ethical standards. Blood samples were obtained from consented healthy, self-reporting SARS-CoV-2 uninfected volunteers under a Mass General Brigham Institutional Review Board (IRB)-approved protocol (1999P001694). Patients signed informed consent to participate in a Mass General Brigham IRB-approved COVID-19 observational sample collection protocol (2020P000849).

Recalcitrant giant genital wart treated with the combination of measles–mumps–rubella vaccine and human papillomavirus vaccine

Recalcitrant giant genital wart treated with the combination of measles–mumps–rubella vaccine and human papillomavirus vaccine

Mumps outbreak among fully vaccinated school-age children and young adults, Portugal 2019/2020.

On 16-17 January 2020, four suspected mumps cases were reported to the local Public Health Authorities with an epidemiological link to a local school and football club. Of 18 suspected cases identified, 14 were included in this study. Laboratory results confirmed mumps virus as the cause and further sequencing identified genotype G. Our findings highlight that even with a high MMR vaccine coverage, mumps outbreaks in children and young adults can occur. Since most of the cases had documented immunity for mumps, we hypothesise that waning immunity or discordant mumps virus strains are likely explanations for this outbreak.

Clinical form of asthma and vaccine immunity in preschoolers

IntroductionAsthma is the most common chronic disease in children. Its exacerbation results from allergic and infectious diseases.AimTo assess the influence of a clinical form of asthma on preschoolers’ vaccine immunity following 3 years after the completion of the mandatory vaccination programme.Material and methodsThe study encompassed 172 preschool children with asthma being newly diagnosed, including 140 patients with mild asthma and 32 with moderate asthma, whose vaccine immunity (level of IgG-specific antibodies) was assessed after the mandatory early vaccines had been administered in the early childhood. Monovalent vaccines (HBV + IPV + Hib) along with a three-component combined vaccine (DTwP) and MMR were given to 86 children while a six-component combined vaccine (DTaP + IPV + Hib + HBV) along with a three-component MMR vaccine were administered to the remaining 86 children. The immunity class for particular vaccinations was assessed according to the manufacturers’ instructions.ResultsChildren suffering from mild asthma had considerably more frequently vaccinations administered on time (p < 0.001) and the type of vaccines (monovalent or highly-combined) administered did not have a significant influence on the clinical form of asthma in the children examined (p = 0.6951). Apart from the vaccines against hepatitis B and rubella where considerably more frequently a high level of antibodies occurred in children with mild asthma, the antibody levels to other vaccines, namely diphtheria, tetanus, pertussis, Hib and mumps, were not associated with the severity of asthma.ConclusionsModerate asthma may have a negative impact on remote vaccine immunity to HBV and rubella.

A Cross-sectional Serological Study for Measles among Italian Medical Students in 2020

Background: Measles is an infectious disease and a major health concern worldwide. Among individuals with a higher risk of exposure to measles, there are the Health Care Workers (HCWs), who may transmit the virus to other people. According to the Italian National Plan for Immunization and Prevention, all HCWs should have presumptive evidence of immunity to measles (documented two doses of MMR vaccination) or serological evidence of protective antibodies. Aim: The study aims to evaluate the immunological status, the vaccine coverage, and the protective IgG antibody titre for measles in medical students of the teaching hospital PoliclinicoTor Vergata (PTV). Methods: IgG measles antibodies titre was evaluated in a sample of 461 medical students undergoing annual health surveillance visits from January 1st to May 31th, 2020. Results: 73.7% of medical students showed protective measles IgG antibody levels. The immunization rate was higher among subjects aged less than 25 years with respect to students aged over 25 years (77.4% vs. 66.4%; P &lt;0,001). Furthermore, average antibody titre showed a statistically significant association with the age group (124,2 AU/ml for the age group 18-25 and 133,2 AU/ml among subjects aged 25 or more; P&lt;0.001). Conclusion: Our study shows a non-protective measles IgG antibody titre, especially among the older students. Therefore, it is essential to evaluate the serological levels, to vaccinate those subjects whose antibody level is not adequate, and promote the vaccination even in the general population.

Influence of measles-mumps-rubella vaccine series initiation and completion on influenza vaccination among adolescents.

BackgroundInfluenza vaccine participation in adolescents is low. Barriers to the influenza vaccine may be shared with the measles-mumps-rubella (MMR) vaccine.MethodsWe studied adolescents aged 13–17 years who participated in the National Immunization Survey-Teen between 2011 and 2017 (N = 129,200). Data were analyzed to determine whether MMR vaccination status was associated with being up-to-date on the influenza vaccination.ResultsA total of 49% adolescents received at least one dose of the influenza vaccine within the past 3 years, and 92% completed the MMR series. In multivariable analysis, not initiating or not completing the MMR series was associated with lower odds of being up-to-date on influenza vaccination.ConclusionsAdolescents who do not initiate or complete the MMR vaccine series have lower odds of being up-to-date on their influenza vaccination. Lower influenzavaccine participation is associated with lower socioeconomic status, lack of insurance, increased time since last child visit, and higher maternal education.

Measles-mumps-rubella vaccine at 6\u2009months of age, immunology, and childhood morbidity in a high-income setting: study protocol for a randomized controlled trial

BackgroundMeasles is a highly contagious and serious infection. Before the introduction of vaccination, measles caused yearly epidemics putting vulnerable children at risk of brain damage and death. Despite safe and cost-effective vaccines, measles remains a leading cause of death in children globally. Due to insufficient vaccine coverage and low levels of in utero transferred antibodies from vaccinated mothers, outbreaks of measles in Denmark and other high-income countries are observed at increasing frequency.The current vaccine was introduced in Denmark in 1987 as a one-shot measles-mumps-rubella vaccine at 15 months, a timing chosen to avoid inhibition of the infant’s immune response by maternal antibodies. One generation later, the MMR vaccinated mothers have lower antibody levels compared to the naturally infected, and their infants are already susceptible at 6 months of age or earlier, thus increasing the risk of epidemics.MethodsThe Danish MMR trial is a double-blind randomized clinical trial recruiting between March 2019 and December 2021 with last patient last visit in February 2022. Altogether N = 6500 infants aged 6 months will be randomly assigned to intramuscular vaccination with routine MMR (M-M-R VaxPro) or placebo (solvent only). According to the Danish Childhood vaccination program, all infants will receive a routine MMR vaccination at 15 months of age. At randomization, 1 month later, and 1 month after routine MMR vaccination at 15 months of age, a blood sample is drawn from app. 10% (N = 600) of the population. Additionally, hair, saliva, and urine are sampled at randomization. The co-primary study outcomes are immunogenicity 1 month after MMR vaccination at 6 months of age assessed as plaque-reduction neutralization test, and incidence of infectious disease hospitalizations from randomization to 12 months of age. Six weeks post randomization, all participants are interviewed regarding adverse events.Trial registrationThe trial is registered in the EU Clinical Trials Registry. EudraCT registration number: 2016-001901-18. Registered on 14 February 2017.

Viral Vampires

Viral Vampires

Measles outbreak investigation in Al-Jowf – Saudi Arabia: An analytical cross-sectional study for cases reported from (January 1st to March 18th) 2019

Background: Measles vaccine made the global efforts for measles elimination possible. Even with the vaccine coverage of 98%, an outbreak of measles was detected in Al-Jowf region in the north of Saudi Arabia between January 1st and March 18th 2019. This investigation is to describe the characteristics and epidemiology of the outbreak. And to identify the risk factors. Methods and materials: Using the surveillance data, an analytical cross-sectional study done on cases reported to the regional infection control unit from (01/01/2019) to (18/03/2019). Cases were investigated using the Saudi MOH measles standard protocols based on the WHO definitions including patients demographic and Vaccination information, the clinical criteria for measles during the prodromal period followed by the maculopapular rash and the laboratory case confirmation by measles IgM antibody detection. Epi-info7 and excel-360 were used for statistical analysis. Results: A total of 780 cases. The average age 7 years (±11 m). Geographically, 97% of the cases were from five cities are Tubarjal (89% of cases), Sakaka, Dumah Al Jandal, Maiqoa, And Al-Qurayyat. All cases were presented with rash and fever only. 64.8% of serum results came positive for measles IgM. 41% of cases under age of 5 were not due the age of vaccination (9 months). Unvaccinated cases 32% OR = 0.96 and p-value = 0.83. Cases received the mono measles vaccine before 40% OR = 1.03 and p-value = 0.87. Cases received MMR vaccine 1 dose only 11% OR = 1.63 and p-value = 0.10. Cases received MMR vaccine 2 doses 23% OR = 0.49 and p-value = 0.027. None of the cases had contact with measles patients or history of traveling. All the cases were recovered with no complications. Conclusion: The goal of this investigation is to describe the characteristics and epidemiology of the measles outbreak in Al-Jowf region (Janaury–18 March) 2019 and to identify the contributing factors. This study emphasized that vaccination is protective (OR = 0.49) specially after the second MMR dose, and the incidence is more among the unvaccinated individuals. But it may cause mild symptoms similar to the wildtype infection. The mean age was (7 years ± 11 m) this requires more investigation regarding the exposure among school-aged children. Further study needed regarding perception and attitude regarding vaccination.

How Australia's commitment and activities for measles control achieved rubella elimination

Background: The global measles and rubella strategic plan 2012–20 has a target for measles and rubella elimination in five WHO regions by the end of 2020. Only one region has eliminated rubella. The WHO Strategic Advisory Group of Experts on Immunization advised rubella control was lagging and recommended rubella vaccination be introduced into all country immunisation programmes as soon as possible. We describe the impact enhanced measles control activities, using measles-mumps-rubella (MMR) vaccines, had on rubella incidence in Australia and how these activities lead to the successful elimination of both viruses. Methods and materials: We reviewed rubella notifications from Australia's National Notifiable Disease Surveillance System (1991–2018) and stratified by age, sex and vaccination status. Three-year cumulative incidences were calculated by birth-cohort to assess the impact of two major measles immunisation activities in Australia; the 1998 Measles Control Campaign (MCC), targeted children 5–12 years; and the 2001 Young Adult MMR immunisation program (YA-MMR), targeted adults 18–30 years. MMR immunisation coverage estimates were extracted and compared with notification data. Aggregate national serological survey data (1999, 2002, 2007 and 2012) was assigned to birth-cohorts and the mean, median and ranges of age-group estimates were calculated. Results: The MCC attained 96% coverage, the three-year cumulative incidence of rubella declined by 90% compared with the three years preceding. This effect was also seen following the YA-MMR with a 73% decline in pre-and-post three-year periods, however vaccine coverage during this campaign was considerably lower. Serological surveys displayed a high and constant level of immune protection among females, but males were estimated to have 4–13% lower immunity. Rubella immunity significantly benefited by a direct 17% boost in serological immunity in those 6–11 years of age in the 1999 pre-and-post serological survey. Conclusion: The use of combined MMR vaccines to address measles immunity concerns in Australia demonstrated a symbiotic benefit in not only controlling and eliminating measles transmission but rubella as well. Although the coverage of the YA-MMR was considered to be “sub-optimal”, it effectively closed the rubella immunity gap in Australia, and demonstrates that utilising combination MR-containing vaccines in routine and mass vaccination programs is effective in eliminating the transmission of both viruses.

Practice nurses' perceptions of their immunization role and strategies used to promote measles, mumps, and rubella vaccine uptake in 2014 - 2018: A qualitative study.

The aim of this study was to explore which aspects of their role practice nurses perceive to be most influential and the strategies they employ to promote the MMR vaccine. Qualitative study employing in depth interviews. Fifteen London based practice nurses, nine in 2014 and six in 2018, took part in semi-structured interviews that were audio recorded and transcribed verbatim. Qualitative content analysis was used to systematically manage, analyse, and identify themes. Analysis of data identified aspects of their role practice nurses perceived to be most influential (the themes) including: promoting vaccination, assisting parents' to make informed decisions, and provided insight into how they used specific strategies to achieve these in practice. These themes were consistent over both phases of the study. The findings provide an understanding of: (i) the practice nurses perceptions of the most important aspects of their role when promoting the measles, mumps, and rubella vaccine; and (ii) the strategies they implemented in practice to achieve these. The latter included assisting parents in their immunization decisions and was facilitated by practice nurses engaging with parents to provide relevant evidence to address parent queries, dispel misconceptions and tailor strategies to promote the measles, mumps, and rubella vaccine. This study addresses the paucity of literature available that specifically explores practice nurses' perceptions of their role concerning the measles, mumps, and rubella vaccine. The findings reveal how practice nurses promote the measles, mumps, and rubella vaccine by identifying strategies to enable parents to make informed decisions. At a time of an increasing incidence of measles, practice nurses have an important public health role in achieving herd immunity levels for measles, mumps, and rubella.

Analysis of Measles-Mumps-Rubella (MMR) Titers of Recovered COVID-19 Patients.

The measles-mumps-rubella (MMR) vaccine has been theorized to provide protection against coronavirus disease 2019 (COVID-19). Our aim was to determine whether any MMR IgG titers are inversely correlated with severity in recovered COVID-19 patients previously vaccinated with MMR II. We divided 80 subjects into two groups, comparing MMR titers to recent COVID-19 severity levels. The MMR II group consisted of 50 subjects who would primarily have MMR antibodies from the MMR II vaccine, and a comparison group of 30 subjects consisted of those who would primarily have MMR antibodies from sources other than MMR II, including prior measles, mumps, and/or rubella illnesses. There was a significant inverse correlation (rs = -0.71, P < 0.001) between mumps virus titers (mumps titers) and COVID-19 severity within the MMR II group. There were no significant correlations between mumps titers and severity in the comparison group, between mumps titers and age in the MMR II group, or between severity and measles or rubella titers in either group. Within the MMR II group, mumps titers of 134 to 300 arbitrary units (AU)/ml (n = 8) were found only in those who were functionally immune or asymptomatic; all with mild symptoms had mumps titers below 134 AU/ml (n = 17); all with moderate symptoms had mumps titers below 75 AU/ml (n = 11); all who had been hospitalized and had required oxygen had mumps titers below 32 AU/ml (n = 5). Our results demonstrate that there is a significant inverse correlation between mumps titers from MMR II and COVID-19 severity.IMPORTANCE COVID-19 has presented various paradoxes that, if understood better, may provide clues to controlling the pandemic, even before a COVID-19 vaccine is widely available. First, young children are largely spared from severe disease. Second, numerous countries have COVID-19 death rates that are as low as 1% of the death rates of other countries. Third, many people, despite prolonged close contact with someone who is COVID-19 positive, never test positive themselves. Fourth, nearly half of people who test positive for COVID-19 are asymptomatic. Some researchers have theorized that the measles-mumps-rubella (MMR) vaccine may be responsible for these disparities. The significance of our study is that it showed that mumps titers related to the MMR II vaccine are significantly and inversely correlated with the severity of COVID-19-related symptoms, supporting the theorized association between the MMR vaccine and COVID-19 severity.

Vaccine sentiments and under-vaccination: Attitudes and behaviour around Measles, Mumps, and Rubella vaccine (MMR) in an Australian cohort

ObjectiveThe study aimed to examine the consistency in factors associated with attitudes towards vaccination and MMR vaccination status. MethodsUsing the nationally representative Longitudinal Study of Australian Children matched with the Australian Childhood Immunisation Register, 4,779 children were included from 2004–2005 to 2010–11. Different MMR vaccine dosages and general attitude towards vaccination were modelled individually with multinomial logit regressions, controlling for demographic, socioeconomic, and health related factors of the children and their primary carers. ResultsThe group with non-vaccination and negative attitudes was characterised by more siblings and older parents; the group with under-vaccination but positive attitudes was characterised by younger parental age; and the group with under-vaccination and neutral attitudes was characterised by less socioeconomically advantaged areas. The presence of parental medical condition(s), being private or public renters, and higher parental education were associated with under-vaccination but not with attitudes towards vaccination, whilst parental religion was associated with attitudes towards vaccination but not reflected in the vaccine uptake. ConclusionsVaccine attitudes were largely consistent with MRR vaccine outcomes. However, there was variation in the associations of factors with vaccine attitudes and uptake. The results have implications for different policy designs that target subgroups with consistent or inconsistent vaccination attitudes and behaviour. Parents with intentional and unintentional under-vaccination are of policy concern and require different policy solutions.

Survey of Attitudes on Personal Protection Interventions against COVID-19 Including MMR Vaccination and Future Anti-COVID Vaccines

An electronic survey was conducted in October, 2020 among individuals primarily age 60 and older regarding their degree of confidence of deriving personal protection from 8 different anti-COVID interventions - social isolation, lockdowns, avoiding restaurants, taking MMR vaccine, wearing masks when indoors with others, avoiding hotels, avoiding commercial air travel, and using the first future specific anti-COVID vaccine. Responses were received from 135 persons from many different U.S. regions and 5 foreign countries. Respondents were generally individuals with very high levels of education and personal achievement. Results demonstrated wide diversity of responses regarding each of these interventions. None were strongly supported by a majority of respondents, but those receiving the largest proportions of strong support were social isolation (41%), wearing masks indoors (41%), and using the first anti-COVID vaccine (41%). MMR (Measles-Mumps-Rubella) vaccination was viewed much more positively than negatively but had the highest proportion of individuals who felt they had insufficient data to formulate an opinion. The largest number of strong negative assessments were toward lockdowns (37%). We speculate that the wide variation in perception of possible benefits from the surveyed interventions, most of which have been widely practiced by or imposed upon millions of individuals, in this highly accomplished older population at increased personal risk from COVID-19 reflects the current absence of rigorous scientific proof of the efficacy of any these interventions, and the continuation of the epidemic despite the widespread utilization of most of them.

Durability of humoral immune responses to rubella following MMR vaccination

BackgroundWhile administration of the measles-mumps-rubella (MMR-II®) vaccine has been effective at preventing rubella infection in the United States, the durability of humoral immunity to the rubella component of MMR vaccine has not been widely studied among older adolescents and adults. MethodsIn this longitudinal study, we sought to assess the durability of rubella virus (RV)-specific humoral immunity in a healthy population (n = 98) of adolescents and young adults at two timepoints: ~7 and ~17 years after two doses of MMR-II® vaccination. Levels of circulating antibodies specific to RV were measured by ELISA and an immune-colorimetric neutralization assay. RV-specific memory B cell responses were also measured by ELISpot. ResultsRubella-specific IgG antibody titers, neutralizing antibody titers, and memory B cell responses declined with increasing time since vaccination; however, these decreases were relatively moderate. Memory B cell responses exhibited a greater decline in men compared to women. ConclusionsCollectively, rubella-specific humoral immunity declines following vaccination, although subjects’ antibody titers remain well above the currently recognized threshold for protective immunity. Clinical correlates of protection based on neutralizing antibody titer and memory B cell ELISpot response should be defined.

Epidemiological changes in mumps infections between 1990 and 2017 in urban area of Shanghai, China

ABSTRACT 2-dose measles-mumps-rubella (MMR) vaccine was recommended for children in Shanghai in November 1996 and incorporated into Shanghai immunization program in December 2008. We described the mumps epidemiology and assessed impact of the 2-dose MMR vaccination in Changning district, Shanghai, 1990–2017. We obtained the MMR vaccination coverage for children born during 1995–2015 and examined the incidence and disease characteristics of mumps during 1990–2017. The 1st dose MMR coverage had maintained above 95% since 1999 birth cohort. The 2nd dose MMR coverage reached above 90% since 2006 birth cohort. A total of 13,388 cases were reported during 1990–2017. The incidence decreased from 315.2 per 100,000 population in 1990 to 8.8 per 100,000 population in 2017. Of the 13,388 cases, 7585 (56.7%) were male and 91.7% were 1–14 years of age and 86.8% were children in kindergartens and students in schools. Compared with 1990–1996, the incidence had a significant decrease in 0–4 and ≥15 years in 1997–2008 and in all age groups in 2009–2017. A later birth cohort was associated with a lower incidence in children covered by MMR vaccination. In Conclusions, the incidence of mumps has dramatically declined with high coverage of 2-dose MMR in Changning district, Shanghai. Children in kindergartens and schools are still the most affected populations. An increase in incidence in adults has not occurred after 20 years of MMR vaccination. Long-term surveillance is needed to fully evaluate the impact of MMR vaccination policy.

COVID-19, seasonal influenza and measles: potential triple burden and the role of flu and MMR vaccines.

While we wait for an effective vaccine against SARS-CoV-2, the influenza and Measles-Mumps-Rubella vaccine with proven safety and efficacy profile can a play critical role in reducing the healthcare burden. First, an increase in the coverage of influenza and Measles-Mumps-Rubella vaccines will decrease the number of cases and the need for hospitalisations for severe illnesses due to these diseases. It will, thereby, reduce the burden on healthcare providers and facilities, which will be particularly crucial in resource-poor settings in making the scarce resources (e.g. hospital beds) allocated to those who need them the most. Second, live attenuated vaccines such as Measles-Mumps-Rubella and Bacillus Calmette-Guerin have been reported to provide non-specific protection against lethal infections including pneumonia and sepsis, especially in low-income settings. Third, infection with measles has been shown to increase children's susceptibility to other infections by reducing the immune system's memory against other pathogens including the influenza virus. Therefore, infection with measles may also increase the susceptibility to SARS-CoV-2 even though it is yet to be empirically tested. Therefore, as we wait for a successful vaccine for COVID-19, we can minimise winter pressures on health systems and societies by maximising the uptake of influenza and Measles-Mumps-Rubella vaccines (and potentially Bacillus Calmette-Guerin vaccines, especially in tuberculosis-endemic areas).

Vaccinomics and Adversomics in the Era of Precision Medicine: A Review Based on HBV, MMR, HPV, and COVID-19 Vaccines.

Precision medicine approaches based on pharmacogenomics are now being successfully implemented to enable physicians to predict more efficient treatments and prevention strategies for a given disease based on the genetic background of the patient. This approach has already been proposed for vaccines, but research is lagging behind the needs of society, and precision medicine is far from being implemented here. While vaccinomics concerns the effectiveness of vaccines, adversomics concerns their side effects. This area has great potential to address public concerns about vaccine safety and to promote increased public confidence, higher vaccination rates, and fewer serious adverse events in genetically predisposed individuals. The aim here is to explore the contemporary scientific literature related to the vaccinomic and adversomic aspects of the three most-controversial vaccines: those against hepatitis B, against measles, mumps, and rubella, and against human Papilloma virus. We provide detailed information on the genes that encode human leukocyte antigen, cytokines and their receptors, and transcription factors and regulators associated with the efficacy and safety of the Hepatitis B and Measles, Mumps and Rubella virus vaccines. We also investigate the future prospects of vaccinomics and adversomics of a COVID-19 vaccine, which might represent the fastest development of a vaccine ever.