Mumps, And Rubella Immunization Research Articles

State Policy Removing the Personal Belief Exemption for Measles, Mumps, and Rubella (MMR) School Immunization Requirement, Washington State, 2014-2022.

Objectives. To assess the impact of Washington State's 2019 Engrossed House Bill (EHB) 1638-which removed measles, mumps, and rubella (MMR) personal belief exemptions-on MMR vaccine series completion and exemption rates in K-12 students. Methods. We used interrupted time-series analyses to examine changes in MMR vaccine series completion rates before and after EHB 1638 was passed and the χ2 test for differences in exemption rates. Results. EHB 1638 implementation was associated with a 5.4% relative increase in kindergarten MMR vaccine series completion rates (95% confidence interval = 3.8%, 7.1%; P ≤ .001), and results were similar with Oregon as a control state (no change observed in Oregon; P = .68). MMR exemptions overall decreased 41% (from 3.1% in 2018-2019 to 1.8% in 2019-2020; P ≤ .001), and religious exemptions increased 367% (from 0.3% to 1.4%; P ≤ .001). Conclusions. EHB 1638 was associated with an increase in MMR vaccine series completion rates and a decrease in any MMR exemption. However, effects were partially offset by an increase in religious exemption rates. Public Health Implications. Removal of personal belief exemptions for the MMR immunization requirement only may be an effective approach to increase MMR vaccine coverage rates statewide and among underimmunized communities. (Am J Public Health. 2023;113(7):795-804. https://doi.org/10.2105/AJPH.2023.307285).

Measles Vaccination and Outbreaks in Croatia from 2001 to 2019; A Comparative Study to Other European Countries.

Due to the current burden of COVID-19 on public health institutions, increased migration and seasonal touristic traveling, there is an increased risk of epidemic outbreaks of measles, mumps and rubella (MMR). The aim of the present study was to analyze the epidemiological data on MMR immunization coverage and the number of measles cases in 2001–2019 in Croatia and a number of European countries. Results revealed a decreasing trend in vaccination in 2001–2019 throughout Europe. However, Croatia and Hungary still have the highest primary and revaccination coverage, compared to other analyzed countries. The highest number of measles cases was in 2017 in Romania. There was no significant correlation between the percentage of primary vaccination and the number of measles cases (r = −0.0528, p = 0.672), but there was a significant negative correlation between the percentage of revaccination and the number of measles cases (r = −0.445, p < 0.0001). In conclusion, the results of the present study emphasize the necessity to perform a full protocol of vaccination to reach appropriate protection from potential epidemic outbreaks. Furthermore, in the light of present migrations, documenting the migrants’ flow and facilitating vaccination as needed is of utmost importance to prevent future epidemics.

Improving Immunization Rates During the 2019 Measles Outbreak.

In 2019, there were multiple outbreaks of measles in the United States. In the context of the public awareness of these outbreaks, we performed an intervention with the intent to improve the rate of measles immunization in our pediatric population. Pediatric patients that were lacking adequate measles immunization were identified by electronic medical record (EMR) survey. Charts were reviewed and updated if records were found to be incomplete. Parents of the remaining children were sent a letter, personally signed by the child’s primary care provider, encouraging measles immunization. A measles fact sheet, produced by the United States Center for Disease Control, was also included with the letter. There were 44 patients in the study group whose parents received a letter and measles fact sheet. As a result, 5 of these children were brought in for a measles, mumps, and rubella (MMR) immunization. The 44 patients whose parents received a letter included 20 patients whose parents had previously expressed intent to not vaccinate their children as documented in the EMR. None of these children received an MMR immunization. Although small in scope, this project provides a glimpse into the importance of personal provider guidance to parents who are inclined to immunize their children. Unfortunately, it also demonstrated that provider advice did not change the opinions of parents who had already taken a stance against vaccination, even in the context of an urgent public health situation that had garnered widespread coverage in the lay press and social media.

How Australia's measles control activities have catalyzed rubella elimination

BackgroundBy 2017, rubella had been officially eliminated in Australia. This success was attributed to Australia's longstanding national immunization programme and two enhanced measles immunization activities using measles, mumps, and rubella (MMR) vaccines — the Measles Control Campaign (MCC) and the Young Adult MMR Campaign (YAC). Our study describes the impact of these activities on rubella incidence, and its elimination in Australia. MethodsAggregate national serological survey data were assigned to birth cohorts, and mean, median, and age-group estimates calculated and analyzed against MMR immunization coverage estimates (1998–2018) and rubella notifications (1993–2018). Three-year cumulative incidences were calculated by birth cohort. ResultsThe serological surveys revealed high and stable levels of rubella immunity among females, but estimates for three male cohorts were lower. Since 2007, MMR immunization coverage among children aged 24–27 months has remained above 90% for both doses. The 3-year cumulative incidence of rubella declined across all birth cohorts following the MCC and the YAC. DiscussionUsing MMR vaccines to address measles immunity gaps had the additional benefit of controlling rubella in Australia. Both the MCC and YAC shifted rubella epidemiology, accelerating the interruption of endemic transmission. Countries should consider combined measles and rubella vaccines for all catch-up activities.

Childhood MMR Vaccination and the Incidence Rate of Measles Infection

Objective: The efficacy of the measles, mumps, and rubella (MMR) immunization in children against subsequent measles diagnoses was the focus of this research. Method: After the ethical approval from institution review board, this crossectional study was conducted at Indus hospital lahore. In this study, MMR vaccination data was collected from all the government vaccination centers from 1st January 2019 till 1st January 2023. Individuals' month and year of enrollment, gender, date of birth, and county level domicile were all included in the comprehensive eligibility data. Each person's diagnostic status was recorded in great detail in their claims file. Those who received just one dose of the MMR vaccination were included as part of the vaccinated group, whereas those who did not get any kind of vaccine containing measles were excluded from the research. Participants who had previously received more than one dose of MMR or any other measles-containing vaccine were not included in this analysis. Results: There were a total of 2000 people in the MMR-vaccinated cohort, accounting for 1543 person-years of data, and a total of 5000 people in the unvaccinated cohort, accounting for 3423 person-years of data. The male-to-female ratio in the MMR-vaccinated group was 0.97, while it was 1.13 in the unvaccinated group. 7% children in the MMR vaccinated group were diagnosed with measles, while 25% children in the unvaccinated group was diagnosed with measles. Conclusion: The prevalence of measles infections in children has been drastically decreased due to widespread MMR immunization. Keywords: MMR, measles, childhood, immunization

Establishing best practices in measles, mumps, and rubella serologic screening for kidney transplant candidates.

Optimizing immunity against vaccine-preventable diseases improves outcomes in kidney transplant (KT) patients (Arora et al, World J Transplant, 2019, 9:1; Sester et al, Transplant Rev, 2008, 22:274; Fishman, N Engl J Med, 2007, 357:2601). The American Society for Transplantation (AST) Clinical Practice Guidelines advises that serologic screening for measles, mumps, and rubella (MMR) be conducted for all KT candidates, since live-attenuated vaccines are contraindicated post-transplantation (Malinis et al, Clin Transplant, 2019, 33:e13548). Our team at Mayo Clinic Florida (MCF) conducted a quality improvement (QI) initiative to establish a best MMR screening and immunizations clinical practice in KT candidates using a Plan-Do-Study-Act (PDSA) model. By retrospective chart review of all KT candidates evaluated at our institution from January 1, 2016 to December 31, 2017, baseline data determining the rate of MMR serologic screening was established. PDSA cycles were implemented to adopt protocol-driven testing for MMR serologies, immunization documentation, and vaccination in cases of seronegativity to any of the three MMR viruses in all pre-KT candidates. Two PDSA cycles were completed in 4months. The study population totaled 447 patients (baseline n=283, PDSA 1 n=61, PDSA 2 n=103). Baseline data showed that 83% (n=235) of pre-KT candidates received infectious disease consultation (IDC). Complete MMR (all three viruses) serological screening in KT candidates improved from baseline 3.9%-87.4% post-PDSA cycle 2 (P<.001). Necessary immunizations per AST guidelines were ordered in only 41.1% (n=23) of the control cohort vs 100% (n=12) and 96.9% (n=31) of PDSA cycles 1 and 2, respectively (P<.001). The data reflect significant practice improvements in MMR screening and immunization rates among KT candidates by using protocol-driven orders combined with our pre-existing IDCs.

“Stick without a Carrot”: An Anthropological Analysis of the Daily Press on Mandatory MMR Immunization in Serbia

The vaccine is considered in academic, foremost medical, but also in political and public discourse as one of the greatest human achievements. Immunization has saved and is saving millions of lives around the world. However, from a historical perspective, immunization was always followed by more or less public resistance due to its alleged negative side-effects, such as outbursts of severe illnesses. A mandatory childhood vaccine against measles, mumps, and rubella (MMR) is part of the current controversy over the harmfulness of vaccines in Serbia. In view of the fact that the media is an important source for transmitting health messages and understanding health issues, the subject of this paper is the media presentation of MMR immunization in Serbia. How was the state health care narrative on MMR immunization presented in the Serbian daily press during the last two measles outbreaks in 2014-2015 and 2017-2018? By using the theoretical “text-context-hypertext” approcah to media content by Ljiljana Gavrilović, Serbian broadsheets and daily papers, such as Blic, Kurir, Politika, Večernje Novosti, from the period 2014-2020, are analyzed. The preliminary results show that the news that concurs with the 2014-15 measles epidemic differs greatly from the news during the 2017-18 epidemic. During the first period, the papers carried medical experts’ advice on the benefits and importance of the MMR vaccine, criticizing (irrational and emotional) parents (mostly mothers) who do not vaccinate their children, in parallel with parental lay evidence on its harmfulness. From approximately 2017 anti-vaccination attitudes disappeared from the newspapers, even from the yellow press. This is concomitant with the new Law on the Protection of the Population against Communicable Diseases (2016), which penalizes anti-vaccination lobbying. In other words, instead of gaining public trust in the health sector and the state by presenting facts, offering dialogue with opponents and systematic education, the state leaders discredited and excluded opposing opinions as “uncivilized”, “irrational” and part of “anti-vaccination lobbying”. Studies explained that citizens of post-socialist countries trust more individuals (friends and family) and distrust the state authorities (as enemies). By introducing compulsory penalties for non-vaccination, the state only deepened this historical and cultural distrust between the state and its citizen. To conclude, insults to parents of non-immunized children, threats of penalties and actual penalties, and the exaggeration of the outcomes of the 2014-15 measles epidemic did not lead to mass immunization. On the contrary, all this acted only counterproductively, as the latest epidemic broke out precisely among non-vaccinated and semi-vaccinated populations. Therefore, it is suggested in the paper that this vaccine should be optional, parallel with the introduction of organized promotion of MMR vaccination, its benefits and side-effects, detailed information on vaccine content, greater freedom of media content on the MMR vaccine, and open public dialogue of parents with medical experts.

Sustained Immune Response to Measles, Mumps and Rubella in Immunosuppressed Inflammatory Bowel Disease Patients

Introduction: Patients with inflammatory bowel disease (IBD) are routinely immunosuppressed, and those on anti-TNF therapy can have a lower sustained antibody response to vaccines. Recent measles and mumps outbreaks have occurred in those not receiving measles, mumps and rubella (MMR) vaccine. There is a paucity of data regarding response to the MMR vaccine in IBD patients. Methods: We performed a cross sectional study measuring antibody concentrations to MMR vaccine among IBD patients compared to healthy controls. Our study consisted of three IBD groups: adults with IBD stratified based on maintenance medication regimen for at least three months 1) azathioprine/6-mercaptopurine (AZA/6MP); 2) biologic (TNF alpha inhibitor); and 3) combination therapy (biologic and immunomodulator (AZA/6MP or methotrexate). The healthy control group consisted of patient without chronic health conditions. All subjects received the two doses of MMR vaccine. Measles,mumps, and rubella antibody concentrations were measured using ELISA methods (Alpha Diagnostic International; San Antonio, TX) and the results adjusted to WHO standards. The primary objective of this study is to compare MMR antibody concentrations in three IBD treatment groups: azathioprine/6-mercaptopurine, anti-TNF agents, and combination therapy. Results: Sixty-six individuals with documented MMR immunization (n=46 IBD patients; n=20 healthy) were used. The patients with IBD and the healthy controls were comparable in age, sex distribution, and time since MMR administration. (Table 1). The antibody concentrations in subjects with IBD were not significantly different from that of the healthy subjects (Table 2). Among the three treatment groups, statistically significant difference was found in the mumps antibody concentration between the azathioprine and the combination treatment groups. MMR antibody concentrations were not significantly different among all other comparison groups.Table. DemographicsTable: Table. Measels, Mumps and Rubella Antibody ConcentrationsConclusion: This is the first study evaluating sustained antibody concentrations in immunosuppressed IBD patients with confirmed history of MMR vaccine series. No significant difference in MMR antibody concentrations were found between IBD and healthy patients, as well as among three common IBD treatment groups. IBD patients immunized with the MMR series have sustained protection comparable to healthy controls regardless of immunosuppressive regimen. Immunization history is a reliable surrogate for determining seroprotection to measles and rubella.

Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK

ObjectivesThere was a large outbreak of measles in Liverpool, UK, in 2012–2013, despite measles, mumps and rubella (MMR) immunisation uptake rates that were higher than the national average. We estimated...

Measles, misinformation, and risk: personal belief exemptions and the MMR vaccine.

Across the United States, children entering schools are required to get a series of vaccinations that includes the measles, mumps, and rubella (MMR) vaccine.1 Designed to prevent those three devastating childhood illnesses, the MMR vaccine has proven highly effective and low risk. By the year 2000, decades of the vaccine's use in the US led to the official elimination of measles in this country;2 during those decades, children had severe, vaccine-associated adverse reactions so infrequently that the Centers for Disease Control and Prevention (CDC) does not report them as causally linked.3 Nonetheless, a now-retracted 1998 paper linked the MMR vaccine with the development of autism. This paper set off the most-recent anti-vaccination movement—a wave of fear and mistrust of vaccines (and particularly of MMR) that persists in some communities to this day.4 Because of a clustering of such communities in affluent regions of California,5 epidemiological conditions in the state became favorable for a new, widespread outbreak of measles.6 Such an outbreak began at Southern California's Disneyland in early 2015.7 As the outbreak spread to 23 other states and the District of Columbia, it reignited debates about states' exemptions from their MMR mandates. Those exemptions fall into two categories: medical and non-medical. Generally, the latter category further divides into religious exemptions and philosophical exemptions; the latter of these often becomes the tool that anti-vaccine parents use to avoid MMR. Though only two states (California and Vermont) have entirely eliminated their philosophical exemptions in response to the Disneyland outbreak, several other states have at least considered either restriction or complete elimination of philosophical exemptions as a means to improve vaccination rates. In doing so, those states have sparked debates about the ethics of MMR immunization mandates and their exemptions. This paper first outlines some of the basic science around measles and the MMR vaccine. This science is essential to understanding the debates around the vaccine exemption laws. This paper then discusses the different types of exemption laws with a focus on who uses them. After summarizing the specific circumstances of the 2015 Disneyland outbreak, this paper considers the two main sides of the ethical debate around vaccine exemption. This consideration leads to the conclusion that states considering changes to their vaccine exemption laws should balance the concerns of both those who support and those who oppose vaccines. Striking that balance will be crucial to developing the right changes to the laws around the MMR vaccine—which will promote higher vaccination rates and prevent future harm to children from measles outbreaks.

Applications of geographic information systems in public health: A geospatial approach to analyzing MMR immunization uptake in Alberta.

This study evaluates the temporal, spatial, and spatio-temporal variation of immunization rates for measles, mumps and rubella (MMR) immunization in the province of Alberta. The study uses yearly immunization rate data for Health Zones and Local Geographic Areas (2004-2012), which were obtained from Alberta Health's Interactive Health Data Application (IHDA). Spatial analyses include a global spatial analysis, Moran's I, and local indicators of spatial association (LISA) analysis - Getis and Ord's G* - to identify clusters of high or low immunization rates. Spatial methods are then applied to a time series analysis to examine how the immunization rates change over time in conjunction with space. Mapped results indicate decreasing immunization rates over time for the majority of the province where most local geographic areas (LGAs) fall short of the 95% herd immunity threshold. Clusters of high immunization rates in the metropolitan centres, and clusters of low immunization rates in the southern and northern region of the province exist spatially and spatio-temporally. Over time, the high rate clusters are decreasing in size and the low rate clusters are increasing. This research provides a localized geographic approach to assessing MMR immunization rates in Alberta. Findings from this research can be used to target public health interventions to specific areas that exhibit the lowest immunization rates. These results can also be used for hypothesis generation in future research on barriers to immunization uptake.

Is there an association between the coverage of immunisation boosters by the age of 5 and deprivation? An ecological study

ObjectiveTo determine whether there was an association between the coverage of booster immunisation of Diphtheria, Tetanus, acellular Pertussis and Polio (DTaP/IPV) and second Measles, Mumps and Rubella (MMR) dose by age 5 in accordance with the English national immunisation schedule by area-level socioeconomic deprivation and whether this changed between 2007/08 and 2010/11. DesignEcological study. DataRoutinely collected national Cover of Vaccination Evaluated Rapidly data on immunisation coverage for DTaP/IPV booster and second MMR dose by age 5 and the Index of Multiple Deprivation (IMD). SettingPrimary Care Trust (PCT) areas in England between 2007/08 and 2010/11. Outcome MeasuresPopulation coverage (%) of DTaP/IPV booster and second MMR immunisation by age 5. ResultsOver the 4 years among the 9,457,600 children there was an increase in the mean proportion of children being immunised for DTaP/IPV booster and second MMR across England, increasing from 79% (standard deviation (SD12%)) to 86% (SD8%) for DTaP/IPV and 75% (SD10%) to 84% (SD6%) for second MMR between 2007/08 and 2010/11. In 2007/08 the area with lowest DTaP/IPV booster coverage was 31% compared to 54.4% in 2010/11 and for the second MMR in 2007/08 was 39% compared to 64.8% in 2010/11. A weak negative correlation was observed between average IMD score and immunisation coverage for the DTaP/IPV booster which reduced but remained statistically significant over the study period (r=−0.298, p<0.001 in 2007/08 and r=−0.179, p=0.028 in 2010/11). This was similar for the second MMR in 2007/08 (r=−0.225, p=0.008) and 2008/09 (r=−0.216, p=0.008) but there was no statistically significant correlation in 2009/10 (r=−0.108, p=0.186) or 2010/11 (r=−0.078, p=0.343). ConclusionLower immunisation coverage of DTaP/IPV booster and second MMR dose was associated with higher area-level socioeconomic deprivation, although this inequality reduced between 2007/08 and 2010/11 as proportions of children being immunised increased at PCT level, particularly for the most deprived areas. However, coverage is still below the World Health Organisation recommended 95% threshold for Europe.

Vaccines for measles, mumps and rubella in children

Vaccines for measles, mumps and rubella in children

Die Varizellenimpfung in Deutschland

In 2004, a general varicella immunization was introduced in Germany for infants from the age of 11 months, followed by the subsequent recommendation in 2009 of a second vaccine dose. The vaccination is carried out at the same time as the immunization against measles, mumps, and rubella (MMR). Results of the nationwide sentinel surveillance of varicella and herpes zoster implemented by the Varicella Working Group (Arbeitsgemeinschaft Varizellen, AGV) show that the defined goals for varicella immunization (reduction of varicella-related morbidity, complications and hospitalizations) have been reached within a few years owing to the advances in vaccine coverage. Although coverage rates for varicella have not yet reached the same levels as for MMR, varicella immunization seems to have benefited from the established MMR immunization schedule. Moreover, there is no evidence for an adverse effect on the use and acceptance of the MMR vaccine. Lessons learnt in measles epidemiology (such as trends in the incidence of the disease in adolescents and infants), as well as in the history of MMR recommendations, may be useful for the evaluation of future epidemiological changes with respect to varicella and herpes zoster. In view of a rapidly waning immunity against the varicella zoster virus after vaccination with one dose and the lifelong persistence of the virus, achieving a robust and sustainable immunity in the general population seems to be an ambitious goal. However, this accomplishment will be indispensable in preventing breakthrough infections and a shift of varicella to older ages and in avoiding an increase in herpes zoster incidence.

Influencing factors in MMR immunisation decision making

Immunisation decision making is not a straightforward process for parents. Many factors influence parental decision making on whether they immunise their child with the measles, mumps and rubella (MMR) vaccine. The feasibility study described in this article provides insight into influencing factors associated with decisions regarding the immunisation of children by parents. The study findings suggest that the practice nurse is a credible source of information for parents seeking informed decision making. At a time when the incidence of measles and mumps is rising in the UK, the provision of appropriate information by the practice nurse has the potential to increase uptake of the MMR vaccine.

Cost-effectiveness analysis of MMR immunization in health care workers

Assessment of measles, mumps and rubella (MMR) status is an essential part of occupational health clearance for new health care workers (HCWs). At the time of this study the policy at Sheffield Occupational Health Service (SOHS) was to perform serological testing of HCWs without evidence of previous immunization prior to MMR vaccination. To identify the cost implications of changing policy to offer vaccination without prior serological testing to HCWs without evidence of previous immunization. A retrospective cohort analysis of all MMR serological results from individuals attending SOHS for pre-placement assessment between 1 April 2010 and 31 March 2012. Seven thousand five hundred and sixty-nine individuals attended SOHS for pre-placement screening. Of these, 52% (3921) had no evidence of prior vaccination to at least one MMR disease and underwent serological testing. Thirty-three per cent (1204) of these HCWs were sero-negative to at least one condition requiring vaccination. With the suggested change in policy, our data indicate a cost-saving of over £105 000 per year may currently be achieved at SOHS. Our findings highlight significant savings through offering vaccination without prior serology for HCWs with no evidence of prior immunization to MMR. An awareness of costs associated with serology, vaccination and staff clinics, as well as the wider impact of population vaccination campaigns, are important factors determining the most cost-effective strategy in this area.

Kinetics of antibody and memory B cell responses after MMR immunization in children and young adults

The persistence of antigen-specific memory B-cells (MBCs) in children and young adults long time after vaccination against measles, mumps and rubella (MMR) is not known. Here we have looked at the Swedish immunization program and examined children 1–10 years after the first MMR dose in early childhood, as well as young adults 7–18 years after the second dose of MMR. We show that Ab titers and MBCs against measles and rubella have different kinetics, indicating that the MBC pool and the corresponding Ab titers are regulated independently. These data fit well with other findings that continuous IgG secretion comes from long-lived plasma cells and not MBCs. We also demonstrate that individuals with low post-vaccination Ab titers might have an adequate MBC response. It remains to be shown if memory B-cells provide the same protection as specific antibodies, but our data is a valuable complement to the incomplete knowledge about correlates of protection after vaccination.

Prevalence of antibodies against measles, mumps and rubella in the childhood population in Singapore, 2008–2010

We undertook a national paediatric seroprevalence survey of measles, mumps and rubella (MMR) in Singapore to assess the impact of the national childhood immunization programme against these three diseases after introduction of the trivalent MMR vaccine in 1990. The survey involved 1200 residual sera of Singapore residents aged 1-17 years collected from two hospitals between 2008 and 2010. The overall prevalence of antibodies against measles, mumps and rubella was 83∙1% [95% confidence interval (CI) 80∙9-85∙1], 71.8% (95% CI 69∙1-74∙2) and 88∙5% (95% CI 86∙6-90∙2), respectively. For all three diseases, the lowest prevalence was in children aged 1 year (47∙8-62∙3%). The seroprevalence of the vaccinated children declined over time. The national MMR immunization programme is effective in raising the herd immunity of the childhood population, although certain age groups are more susceptible to infection, in particular, those who are not eligible for vaccination at age <15 months.

The effectiveness of telephone reminders and home visits to improve measles, mumps and rubella immunization coverage rates in children

In the Saskatoon Health Region (Saskatchewan), only 67.4% of children overall are fully immunized for measles, mumps and rubella (MMR) at 24 months of age, with only 43.7% of low-income children fully immunized. Parents of children who were behind in MMR immunizations were contacted to determine knowledge about, beliefs toward and barriers to immunization. The effectiveness of a telephone reminder system in improving immunization rates in a health region compared with a control health region was determined. Finally, the effectiveness of telephone reminders versus telephone reminders combined with home visits in improving child immunization coverage rates in low-income neighbourhoods was compared. The survey was completed by 629 parents (69% response rate). Of those, 81.8% were not aware that their child was behind in immunizations. In the Saskatoon Health Region, the MMR immunization coverage increased from 67.4% to 74.0% in the first year of intervention (rate ratio = 1.10; 95% CI 1.08 to 1.12). All four neighbourhood groupings (three urban by income and one rural) had relative increases ranging from 9% to 11%. The control health region observed an immunization coverage increase from 66.5% to 69.2% in the first year (rate ratio = 1.04; 95% CI 1.01 to 1.07). The three low-income neighbourhoods with only telephone reminders had an immunization coverage rate of 48.7% (95% CI 39.5% to 57.8%). The three low-income neighbourhoods that received a telephone reminder and home visit had an immunization coverage rate of 60.5% (95% CI 52.5% to 68.6%). Telephone reminder systems have some benefit in increasing child immunization coverage rates.

Temporal Data Mining for Adverse Events Following Immunization in Nationwide Danish Healthcare Databases

A rarely used opportunity in pharmacovigilance is data mining for adverse drug reactions (ADRs) in population-based healthcare databases. To evaluate the potential of data mining for ADRs in the nationwide Danish healthcare databases. We specifically considered hospital contacts following measles, mumps and rubella (MMR) immunization. We constructed a cohort consisting of all children born in Denmark from 1995 to 2007 (n = 918,831) with individual-level linked data on childhood vaccinations and hospital contacts from the nationwide Danish healthcare databases. We applied a cohort-based data mining methodology to compare the observed versus the expected incidence of adverse event in different time periods relative to immunization. With this approach we evaluated temporal associations between MMR immunization and 5915 different diagnoses occurring in the cohort. In order to evaluate the ability of our approach to detect signals, we singled out a set of four adverse events previously recognized as being associated with the MMR vaccine. We were able to link a total of 3,162,251 hospital contacts and 5915 different diagnoses to the children in the cohort. Previously recognized temporal associations between adverse events (febrile convulsions, idiopathic thrombocytopenic purpura, lymphadenopathy and rash) and MMR immunization were identified in the Danish databases by our method. Data mining in the Danish population-based healthcare databases provides adequate ability to detect adverse events. Pharmacovigilance using electronic healthcare databases holds potential as an important supplement to traditional pharmacovigilance.