Mumps, And Rubella Vaccine Research Articles

Determinants of students' willingness to accept a measles-mumps-rubella booster vaccination during a mumps outbreak: a cross-sectional study.

BackgroundDespite high vaccination coverage, a mumps outbreak that affected mainly vaccinated university students and their contacts took place in the Netherlands in the period 2009–2012. We presented university students with a hypothetical case in which we offered them a measles, mumps, and rubella (MMR) booster vaccination to control the mumps outbreak. The aim of this study was to get insight into the determinants of university students' willingness to accept this vaccination.MethodsA questionnaire containing 38 items was developed for the purpose of assessing students' willingness and the psychosocial and social demographic determinants influencing their willingness to accept an MMR booster vaccination. In addition, we explored how organisational characteristics influenced the willingness to be vaccinated. Data were collected at six Dutch universities; a total of 790 students from various faculties were invited to participate. This was a convenience sampling procedure.Results687 university students participated (response rate 87.0 %) and 60.4 % of the participants said they would be willing accept the hypothetical MMR booster vaccination. The perceived seriousness of mumps (OR 6.1) was the most important predictor of willingness to accept vaccination. Students who expected the MMR vaccination to be effective and to prevent individual illness and who believed their own vaccination would help stop the epidemic were more likely to be willing than others. The students were more willing to accept vaccination when they perceived that the social norms of significant others and the government favoured vaccination. Organisational characteristics, such as offering vaccination cost free and offering it at the university site, increased students’ willingness.ConclusionDuring a mumps outbreak, university students were generally willing to accept a hypothetical MMR booster vaccination. Risk perception, outcome expectations, perceived social norms, and organisational characteristics should be taken into account in the planning of any vaccination campaign for university students during an outbreak of an infectious disease.

Asthma and allergy in children with and without prior measles, mumps, and rubella vaccination.

The existing literature on the association between measles vaccination and subsequent risk of allergic disease is inconclusive. The aim of this study was, therefore, to determine whether measles, mumps, and rubella (MMR) vaccination administered in early childhood was associated with asthma and allergic diseases at ages 5, 7 and 13yrs in a birth cohort. In the Faroe Islands, 640 children were followed from birth. Follow-up examinations at ages 5, 7 and 13yrs included a physical examination and a maternal questionnaire about the child's health. At age 7, total and grass-specific IgE was quantified in the child's serum, and at age 13, the children underwent skin prick tests (SPT). The child's vaccination card was reviewed at examinations. At age 5, 533 of 555 children had been vaccinated for MMR. After confounder adjustment, we found early life MMR vaccination to be associated with a two-third reduction in the odds of asthma (OR: 0.33, 95% CI: 0.12; 0.90) and hypersensitivity/allergy (OR: 0.32, 95% CI: 0.11; 0.88) at age 5, and the substantially decreased odds of asthma were replicated at age 13 (OR: 0.22, 95% CI: 0.08; 0.56). At age 7, serum total IgE was reduced by 62.8% (CI 95%: -84.3%; -11.9%) in the vaccinated children. MMR vaccination was not significantly associated with allergic rhinoconjuctivitis symptoms, eczema, or SPT reactions at age 13. MMR vaccination early in life may have a protective effect against allergy at least up to age 7 and against asthma through age 13yrs.

MMR vs. Autism: A False Choice

Because of parents who think that giving their children an MMR (measles, mumps, and rubella) vaccination can lead to autism, parents with babies too young to be vaccinated now have to be afraid that putting their child in day care or going on a vacation to Disneyland will put them at risk for the disease. Every year, there are outbreaks of measles in this country — despite the fact that there is a vaccine that is safe and effective.

To promote vaccination, physicians need to provide booster shots of information.

To promote vaccination, physicians need to provide booster shots of information.

Rubella susceptibility in pregnant women and results of a postpartum immunization strategy in Catalonia, Spain

BackgroundElimination of congenital rubella syndrome depends not only on effective childhood immunization but also on the identification and immunization of rubella susceptible women. We assessed rubella susceptibility among pregnant women and evaluated the adherence and response to postpartum immunization with measles, mumps and rubella (MMR) vaccine. MethodsCross-sectional study of women who gave birth at the Hospital Clinic de Barcelona (Spain) between January 2008 and December 2013. Antenatal serological screening for rubella was performed in all women during pregnancy. In rubella-susceptible women, two doses of MMR vaccine were recommended following birth. We evaluated rubella serological response to MMR vaccination in mothers who complied with the recommendations. ResultsA total of 22,681 pregnant women were included in the study. The mean age was 32.3 years (SD 5.6), and 73.6% were primipara. The proportion of immigrants ranged from 43.4% in 2010 to 38.5% in 2012. The proportion of women susceptible to rubella was 5.9% (1328). Susceptibility to rubella declined with increasing maternal age. Immigrant pregnant women were more susceptible to rubella (7.6%) than women born in Spain (4.6%). Multivariate analyses showed that younger age (≤19 years) aOR 1.7 (95% CI 1.1–2.5), primiparas aOR 1.3 (95% CI 1.1–1.5) and immigrant women aOR 1.6 (95% CI 1.4–1.8) were more likely to be susceptible. The second dose of MMR vaccine was received by 57.2% (718/1256) of rubella-susceptible women, with the highest proportion being immigrant women compared with women born in Spain. After vaccination, all women showed rubella immunity. ConclusionsThe higher rubella susceptibility found in the three youngest age groups and in immigrant women highlights the relevance of antenatal screening, in order to ensure identification and postpartum immunization. The postpartum immunization strategy is an opportunity to protect women of childbearing age and consequently prevent occurrence of CRS, and to increase vaccination coverage against rubella and other vaccine-preventable diseases.

The Impact of 2-Dose Routine Measles, Mumps, Rubella, and Varicella Vaccination in France on the Epidemiology of Varicella and Zoster Using a Dynamic Model With an Empirical Contact Matrix

PurposeVaricella has a high incidence affecting the vast majority of the population in France and can lead to severe complications. Almost every individual infected by varicella becomes susceptible to herpes zoster later in life due to reactivation of the latent virus. Zoster is characterized by pain that can be long-lasting in some cases and has no satisfactory treatment. Routine varicella vaccination can prevent varicella. The vaccination strategy of replacing both doses of measles, mumps, and rubella (MMR) with a combined MMR and varicella (MMRV) vaccine is a means of reaching high vaccination coverage for varicella immunization. The objective of this analysis was to assess the impact of routine varicella vaccination, with MMRV in place of MMR, on the incidence of varicella and zoster diseases in France and to assess the impact of exogenous boosting of zoster incidence, age shift in varicella cases, and other possible indirect effects. MethodsA dynamic transmission population-based model was developed using epidemiological data for France to determine the force of infection, as well as an empirically derived contact matrix to reduce assumptions underlying these key drivers of dynamic models. Scenario analyses tested assumptions regarding exogenous boosting, vaccine waning, vaccination coverage, risk of complications, and contact matrices. FindingsThe model provides a good estimate of the incidence before varicella vaccination implementation in France. When routine varicella vaccination is introduced with French current coverage levels, varicella incidence is predicted to decrease by 57%, and related complications are expected to decrease by 76% over time. After vaccination, it is observed that exogenous boosting is the main driver of change in zoster incidence. When exogenous boosting is assumed, there is a temporary increase in zoster incidence before it gradually decreases, whereas without exogenous boosting, varicella vaccination leads to a gradual decrease in zoster incidence. Changing vaccine efficacy waning levels and coverage assumptions are still predicted to result in overall benefits with varicella vaccination. ImplicationsIn conclusion, the model predicted that MMRV vaccination can significantly reduce varicella incidence. With suboptimal coverage, a limited age shift of varicella cases is predicted to occur post-vaccination with MMRV. However, it does not result in an increase in the number of complications. GSK study identifier: HO-12-6924.

Cost-Effectiveness of Routine Varicella Vaccination Using the Measles, Mumps, Rubella and Varicella Vaccine in France: An Economic Analysis Based on a Dynamic Transmission Model for Varicella and Herpes Zoster

PurposeEach year in France, varicella and zoster affect large numbers of children and adults, resulting in medical visits, hospitalizations for varicella- and zoster-related complications, and societal costs. Disease prevention by varicella vaccination is feasible, wherein a plausible option involves replacing the combined measles, mumps, and rubella (MMR) vaccine with the combined MMR and varicella (MMRV) vaccine. This study aimed to: (1) assess the cost-effectiveness of adding routine varicella vaccination through MMRV, using different vaccination strategies in France; and (2) address key uncertainties, such as the economic consequences of breakthrough varicella cases, the waning of vaccine-conferred protection, vaccination coverage, and indirect costs. MethodsBased on the outputs of a dynamic transmission model that used data on epidemiology and costs from France, a cost-effectiveness model was built. A conservative approach was taken regarding the impact of varicella vaccination on zoster incidence by assuming the validity of the hypothesis of an age-specific boosting of immunity against varicella. FindingsThe model determined that routine MMRV vaccination is expected to be a cost-effective option, considering a cost-effectiveness threshold of €20,000 per quality-adjusted life-year saved; routine vaccination was cost-saving from the societal perspective. Results were driven by a large decrease in varicella incidence despite a temporary initial increase in the number of zoster cases due to the assumption of exogenous boosting. In the scenario analyses, despite moderate changes in assumptions about incidence and costs, varicella vaccination remained a cost-effective option for France. ImplicationsRoutine vaccination with MMRV was associated with high gains in quality-adjusted life-years, substantial reduction in the occurrences of varicella- and zoster-related complications, and few deaths due to varicella. Routine MMRV vaccination is also expected to provide reductions in costs related to hospitalizations, medication use, and general-practitioner visits, as well as indirect costs, and it is expected to be a cost-effective intervention in France (GSK study identifier: HO-12-6924).

Prevalence of anti-rubella, anti-measles and anti-mumps IgG antibodies in neonates and pregnant women in Catalonia (Spain) in 2013: susceptibility to measles increased from 2003 to 2013.

Non-immune neonates and non-immune pregnant women are at risk of developing rubella, measles and mumps infections, including congenital rubella syndrome. We describe the seroepidemiology of measles, mumps and rubella (MMR) in neonates and pregnant women in Catalonia (Spain). Anti-rubella, anti-measles and anti-mumps serum IgG titres were assessed using enzyme-linked immunosorbent assay (ELISA) tests in 353 cord blood samples from neonates of a representative sample of pregnant women obtained in 2013. The prevalence of protective antibody titres in neonates was 96 % for rubella IgG (≥8 IU/ml), 90 % for measles IgG (>300 IU/ml) and 84 % for mumps IgG (>460 EU/ml). Slightly lower prevalences of protective IgG titres, as estimated from the cord blood titres, were found in pregnant women: 95 % for rubella IgG, 89 % for measles IgG and 81 % for mumps IgG. The anti-measles and anti-mumps IgG titres and the prevalences of protective IgG titres against measles and mumps increased significantly (p < 0.001) with maternal age. The prevalence of protective anti-measles IgG titres decreased by 7 % [odds ratio (OR) = 0.15, p < 0.001), the prevalence of protective anti-rubella IgG titres increased by 3 % (OR = 1.80, p < 0.05) and the MMR vaccination coverage (during childhood) in pregnant women increased by 54 % (OR = 2.09, p < 0.001) from 2003 to 2013. We recommend to develop an MMR prevention programme in women of childbearing age based on mass MMR vaccination or MMR screening and vaccination of susceptible women to increase immunity levels against MMR.

Adverse Events Following Measles, Mumps, and Rubella Vaccine in Adults Reported to the Vaccine Adverse Event Reporting System (VAERS), 2003-2013.

Limited data exist on the safety of the measles, mumps, and rubella (MMR) vaccine in adults. We reviewed reports of adverse events (AEs) to the Vaccine Adverse Event Reporting System (VAERS) to assess safety in this previously understudied group. VAERS is the national spontaneous vaccine safety surveillance system coadministered by the Centers for Disease Control and Prevention and the US Food and Drug Administration. We searched the VAERS database for US reports of adults aged ≥19 years who received the MMR vaccine from 1 January 2003 to 31 July 2013. We clinically reviewed reports and available medical records for serious AEs, pregnancy reports, and reports for selected prespecified outcomes. During this period, VAERS received 3175 US reports after MMR vaccine in adults. Of these, 168 (5%) were classified as serious, including 7 reports of death. Females accounted for 77% of reports. The most common signs and symptoms for all reports were pyrexia (19%), rash (17%), pain (13%), and arthralgia (13%). We did not detect any new safety findings in empirical Bayesian data mining. We identified 131 reports of MMR vaccine administered to a pregnant woman; the majority of these vaccinations were in the first trimester and in 83 (62%), no AE was reported. In our review of VAERS data, we did not detect any new or unexpected safety concerns for MMR vaccination in adults. We identified reports of pregnant women exposed to MMR, which is a group in whom the vaccine is contraindicated, suggesting the need for continued provider education on vaccine recommendations and screening.

Immunotherapy of viral warts: myth and reality

Immunotherapy has become one of the most important therapeutic tools for the treatment of warts. At present, immunotherapy for warts is usually limited to recalcitrant lesions that are not responding to conventional therapy. Although there are a lot of immunotherapeutic regimens, a minority seem to be really effective. Moreover, there is a lack of evidence-based data on their effectiveness. Common immunotherapeutic modalities used for the treatment of warts include contact sensitizers, imiquimod, intralesional interferon, and oral drugs such as levamisole, cimetidine, and zinc sulfate. Intralesional antigens such as MMR (measles, mumps, and rubella) vaccine, skin test antigens (mumps, Candida, and Trichophyton), BCG (bacillus Calmette-Guιrin) vaccine, and Candida antigen were reported as successful treatment modalities in various forms of warts. Moreover, intradermal injection of some vaccines such as purified protein derivatives was also reported as a successful regimen for the treatment of genital warts. Among the available options for treatment of warts, none is uniformly effective or viricidal. Moreover, in most cases their safety and efficacy has not been assessed in double-blind, controlled clinical trials, and thus the reproducibility of many of the listed treatments is difficult to evaluate and a possible placebo effect cannot be ruled out. In this report, the various forms of immunotherapy for warts are discussed and each regimen is evaluated in order to assess the efficacy of each form of treatment.

Book review / Buchbesprechung Ghazanfar S. A. & Edmondson J. R. (ed.): Flora of Iraq, Volume 5 Part 2:Lythraceae to Campanulaceae. — Kew: Royal Botanic Gardens, 2013. — ISBN 978-1-84246-493-9. — xi + 349 p., 120 line drawings; paper-back. — Price: EUR 100. DOI: http://dx.doi.org/10.3372/wi.44.44316

‘Dirty Medicine. The Handbook’, the latest book from the British investigative writer Martin J. Walker, does a good job of summing itself up in its long subtitle: ‘Dirty Medicine. The Handbook. Of Doctors, Epidemiologists, Researchers, Advisers, Insurance Scammers, Quackbusters, Bad Journalists, Corporate Scientists, Industry Shills, and Other Agents Who Do Now, or Have in The Past Worked For, Sided With, Supported or Simply Been a Part of Corporate Interests, Manufacturing, Pushing, or Promoting, Products or Ideologies Antagonistic to The Private and Public Health of Workers, Consumers, Citizens, Patients, Alternative Practitioners and Science in The Public Interest; Who They Are, How to Recognise Them and Their Organisations, and What to Do About Them.’ The handbook, an extension and reworking of his previous book ‘Dirty Medicine. Science, Big Business and the Assault on Natural Health Care’, provides a who’s who of individuals, groups and websites with a history of attacking complementary and alternative medicine (CAM), particularly in Britain. Starting with an overview, he links the rise of the ‘health fraud’ movement, ‘quackbusters’ and ‘skeptics’ with the rise of corporate science, noting that science is no longer the domain only of scientists, but of public relation companies who provide ‘trained mercenaries to fight the sciences battles’. Continuing with the language of war, he describes the battle tactics of the pharmaceutical industry as akin to those initiated and perfected by the tobacco and asbestos industries. Writing of an organised plan against natural medicine, he states that, as there is no major profit in natural medicine, it has to be ‘controlled and destabilised’ to protect pharmaceutical profits, which increased when medical science became more focused on problems to be fixed rather than the patient as a person. In alphabetical order he gives background information ranging from a line to a page on what he calls ‘health corporatists’: individuals, organisations, ad hoc groups and websites. Pharmaceutical company, personal, and committee links, and their history in relation to attacks against individuals or groups involved in CAM, are outlined. Following these chapters he provides a counterbalance: the antidote groups and individuals historically and currently battling for freedom of treatment and exposing the tactics behind CAM censorship. Some have had their careers damaged or destroyed in the process. In the closing chapter, entitled ‘Organising and Fighting Back’ he pulls no punches in relation to how serious he considers the war against CAM, warning against underestimating the dangers and the lengths to which pharmaceutical companies are willing to go to protect their profits, stating ‘we can define our enemy very simply as those who consistently use lies and manipulation to put profits before people and corporations before communities’. I suspect there are those who will consider much of Walker’s writing as the ravings of a conspiracy theorist who sees apparent links everywhere and who demonises the pharmaceutical industry. In the current climate, however, his work is not so easy to dismiss. Welcoming genuine and honest scientific debate within the scientific community, his major objections are to the often undisclosed conflicts of interest which exist in the media, industry, academia and government, and the way in which the damage caused by allopathic medicine is swept under the carpet. A recent example of this was the failure of BMJ editor Fiona Godlee to disclose the journal’s financial relationship with Merck and GlaxoSmithKline (both measles, mumps and rubella (MMR) vaccine manufacturers) in relation to her editorial and commissioning of 3 articles by a journalist about the Andrew Wakefield case. Wakefield, an English research doctor, lost his licence to practice following a suggestion (in a co-authored paper) that further investigations were needed to see if there was a link between the MMR vaccine and gastrointestinal disease/developmental regression [1]. In her response to criticism, Godlee stated ‘We didn’t declare these competing interests because it didn’t occur to us to do so’ [2]. Her subsequent declaration of advertising and sponsorship income from Merck and GlaxoSmithKline still failed to disclose the partnership agreement between the BMJ and Merck providing online education. While it is within the realms of possibility that the failure of the BMJ to disclose their links to companies that benefitted from Wakefield being considered guilty was an innocent (albeit sloppy) mistake by a journal editor, it is this lack of transparency that, unfortunately, creates a need for research such as that found in the handbook. Anyone who has been confused by the constant rejection of a good research paper, who has been refused the opportunity to rebut criticism in the letters page, or whose comments in a public forum were deleted might better understand the reasons by following the money or political links, some of which are outlined there. Although every link to pharmaceutical companies cannot be automatically considered manipulative and some critics of CAM are driven by an

Progress towards measles elimination in Singapore

ObjectiveWe describe the epidemiological trends of measles in Singapore in relation to its progress towards measles elimination and identify gaps in fulfilling the World Health Organization Western Pacific Regional Office regional measles elimination criteria. MethodsEpidemiological data on measles maintained by the Communicable Diseases Division, Ministry of Health from 1981 to 2012 were collated and analysed. Data on measles vaccination coverage were obtained from the National Immunization Registry and School Health Services, Health Promotion Board. To assess the seroprevalence of the population, the findings of periodic seroepidemiological surveys on measles were traced and reviewed. FindingsWith the successful implementation of the National Childhood Immunization Programme using the monovalent measles vaccine, measles incidence declined from 88.5 cases per 100,000 in 1984 to 6.9 per 100,000 in 1991. Resurgences were observed in 1992, 1993 and 1997. A ‘catch-up’ vaccination programme using the trivalent measles, mumps and rubella (MMR) vaccine was conducted in 1997, followed by introduction of the two-dose vaccination schedule in January 1998. Measles incidence subsequently declined sharply to 2.9 per 100,000 in 1998. Vaccination coverage was maintained at 95% for the first dose and 92–94% for the second dose. Seroprevalence surveys showed seropositivity for measles IgG antibodies in over 95% of adults in 2004, and in 83.1% of children aged 1–17 years in 2008–2010. Sporadic cases with occasional clusters of two or more cases continued to occur among the unvaccinated population, especially children aged below 4 years. The predominant measles virus genotype has shifted from D9 to the B3 and G3 genotypes, which are endemic in neighbouring countries. ConclusionSingapore has made good progress towards the elimination of endemic measles. To further eliminate sporadic cases of measles, the national immunisation schedule has recently been amended to vaccinate children with 2 doses of MMR vaccine before 2 years of age.

Measles–mumps–rubella vaccination and respiratory syncytial virus-associated hospital contact

BackgroundThe live measles vaccine has been associated with lower non-measles mortality and admissions in low-income countries. The live measles–mumps–rubella vaccine has also been associated with lower rate of admissions with any type of infection in Danish children; the association was strongest for admissions with lower respiratory infections. ObjectiveTo examine whether measles, mumps, and rubella (MMR) vaccination was associated with reduced rate of hospital contact related to respiratory syncytial virus (RSV) in a high-income country. MethodsNationwide cohort study of laboratory-confirmed RSV hospital contacts at age 14–23 months in all children born in Denmark 1997–2002 who had already received the vaccine against diphtheria, tetanus, pertussis (acellular), polio, and Haemophilus influenzae type b (DTaP-IPV-Hib) at the recommended ages of 3, 5, and 12 months. ResultsThe study included 888 RSV hospital contacts in 128,588 person years of follow up (rate 6.8/1000 person years). Having MMR as the most recent vaccine was associated with a reduced rate of RSV hospital contacts compared with having DTaP-IPV-Hib as the most recent vaccine (Incidence rate ratio (IRR), 0.75; 95% confidence interval (CI), 0.63–0.89). After adjustment for potential confounders including exact age in days the IRR was 0.78 (95% CI, 0.66–0.93). The adjusted IRR was 0.74 (95% CI, 0.60–0.92) in males and 0.84 (95% CI, 0.66–1.06) in females (P Interaction, 0.42). There was no association in the first month after MMR vaccination (adjusted IRR, 0.97; 95% CI, 0.76–1.24) but the adjusted IRR was 0.70 (95% CI, 0.58–0.85) from one month after MMR vaccination. ConclusionsMMR vaccination was associated with reduced rate of hospital contacts related to laboratory-confirmed RSV infection. Further research on the association between MMR vaccination and other unrelated pathogens are warranted.

Vaccination perceptions of school employees in a rural school district

BackgroundThere continues to be a need for increases in adult vaccination rates, especially among those working in environments which may easily become communicable disease outbreak centers, such as school employees in the school environment. The purpose of this study was to evaluate why rural Utah school employees were non-compliant with the influenza and measles, mumps, and rubella (MMR) vaccines, as well as to identify their views on mandatory vaccination policies. MethodsA questionnaire was distributed to all school employees in a rural Utah school district. Data analysis included frequencies and measures of central tendency and dispersion for quantitative items and theme identification for qualitative items. ResultsOnly 51% of school employees were adequately vaccinated for influenza. Reasons for noncompliance with the influenza vaccine included inconvenience, lack of perceived need, and questionable vaccine efficacy. There were 39.3% school employees who had not received an MMR during adulthood, which was commonly attributed to lack of knowledge regarding the need for this vaccine. Almost half (45.7%) of school employees believed a mandatory vaccination policy should be instituted, although 24.2% of school employees were opposed to mandatory adult vaccination policies. Reasons for opposing vaccination mandates included violation of personal choice, lack of perceived vaccination safety and efficacy, lack of perceived need for adult vaccines, and vaccine cost. ConclusionsSuboptimal vaccination rates of school employees may negatively affect the health and well-being of individuals in the school environment. School employees report a variety of beliefs regarding the influenza and MMR vaccines. While over half of school employees support mandatory vaccination policies for adults working in the school environment, those opposing such a policy report concerns regarding violation of personal choice. Public health officials and school administrators should coordinate efforts to increase vaccination rates among adults in the school environment.

Two-year experience of using the measles, mumps and rubella vaccine as intralesional immunotherapy for warts.

The currently available treatments for warts, including cryosurgery, laser surgery, electrosurgery, and topical keratolytic applications, are often very painful and can induce disfiguring scars. Recently, intralesional immunotherapy with skin test antigens and vaccines has been shown to be effective in the management of warts. To evaluate the efficacy of a new intralesional immunotherapy for warts, using the measles, mumps and rubella (MMR) vaccine. A retrospective study was performed, and we enrolled 136 patients with various types of warts into the study, which was for a duration of 2 years. Patients were treated for a total of six times at 2-week intervals. The treatment response was classified as one of three levels, based on reduction in the size and number of warts, and patients with complete response (CR) were checked for recurrence. Clinical evaluations were carried out using photographs and medical records. Over half (51.5%) of patients experienced > 50% reduction in the size and number of warts, and 46.7% who had distant warts (in different locations) showed good response. Common warts showed significantly higher treatment response than other types of warts (P < 0.05). However, other clinical variables did not have any effect on efficacy. Almost all the patients reported mild pain during the injection, but other side effects were rarely observed. Only 5.6% of patients who experienced CR had recurrence of warts after 6 months. We suggest that intralesional immunotherapy with MMR vaccine is a tolerable and effective method for patients who are sensitive to pain, concerned about side effects, or have common warts. Treatment response is improved by increasing the number of injections.

Introducing combined measles, mumps and rubella vaccine in Chandigarh, India: issues and concerns.

Cyclical outbreaks of mumps have been noticed across Chandigarh city during winter months. Chandigarh does not provide measles, mumps and rubella (MMR) vaccination in the State immunization schedule. Epidemiological shift in age at diagnosis of mumps was noticed with higher incidence in older children and adults. Increased occurrence of complications can be predicted with this age shift. Silent burden of rubella with serious outcomes in newborns further strengthen the case for MMR vaccine inclusion in routine immunization program of Chandigarh.

A short clinical review of vaccination against measles.

Major epidemics of measles are again in the news across the UK because of our failure to maintain population herd immunity. This situation has occurred primarily because of a loss of public confidence in the measles, mumps and rubella (MMR) vaccine, which was never restored following the Wakefield debacle, and a lack of awareness of the potential morbidity and mortality associated with measles. This article provides healthcare professionals with a succinct overview of important clinical aspects of measles and also describes the history of measles vaccination in the UK. Restoration of herd immunity will require higher public acceptance of the MMR vaccine in the context of recognition that measles remains an important infection. While achievement of this appears to be challenging, recent UK-based research suggests that it can be ascertained.

‘That’s just what’s expected of you … so you do it’: Mothers discussions around choice and the MMR vaccination

One of the major shifts in the form and experience of contemporary family life has been the increasing insertion of the ‘expert’ voice into the relationship between parents and children. This paper focuses on an exploration of mothers’ engagement with advice around the combined measles, mumps and rubella (MMR) vaccine. Much of the previous literature utilises a ‘decision-making’ framework, based on ‘risk assessment’ whereby mothers’ decisions are conceptualised as rooted in complex belief systems, and supposes that that by gaining an understanding of these systems, beliefs and behaviour can be modified and uptake improved. However, less attention has been paid to the ways in which mothers negotiate such advice or the ways in which advice is mediated by positionings, practices and relationships. Analysis of data from a focus group with five mothers identified three themes: (i) Sourcing advice and information, (ii) Constructing ‘Mother knows best’ and (iii) Negotiating agency. Despite the trustworthiness of advice and information being questioned, an awareness of concerns about the MMR, and health professionals being constructed as remote, ultimate conformity to, and compliance with, the ‘system’ and ‘society’ were described as determining MMR ‘decisions’.

Seroprevalence of Antibodies to Measles, Mumps and Rubella (MMR) Vaccines in Previously Vaccinated Human Immunodeficiency Virus-Infected Children and their Control Counterparts

Background: Concerns remain regarding immunity to measles, mumps and rubella in HIV-infected children and need for booster doses during later adolescent-hood or young adulthood. Methods: We evaluated measles, mumps and rubella antibodies in 13 HIV- infected and 13 age-matched control children. All children had received 2 doses of the measles, mumps and rubella (MMR) vaccine. Anti-measles, mumps, and rubella antibody levels were assessed by ELISA at a mean of 30 months in the HIV-infected group and 27 months in the control children, following a second dose of the MMR vaccine. MMR antibodies considered to be protective levels were >1.1 ODR (Optical Density Ratio) for measles and mumps and >9.9 IU/ml for rubella. Results and Conclusions: Of the thirteen HIV-infected children, only four (31%) (p=0.01) had protective level (>1.11 ODR) of antibodies to measles and five (38%) (p=0.04) had protective level of antibodies to mumps compared to eleven (85%) of the thirteen controls. Although the prevalence of protective immunity (>9.9 IU/ml) for rubella was comparable in HIV-infected and control children, antibody levels were significantly lower (p=0.01) in HIVinfected children compared to their control counterparts. Our study results show that approximately seventy percent of HIV-infected children and adolescents compared to their control counterparts, remain susceptible to measles and mumps, despite two doses of the MMR vaccine. We therefore, recommend that booster doses of MMR vaccine be considered in HIV- infected children and adolescents when exposed to outbreaks of these infectious diseases in the US. Further prospective and larger studies may need to be conducted in HIV-infected children to determine if lower immunities in this group are due to primary vaccine failure or waning immunity.

Epidemiology of a Mumps Outbreak and Effect of Measles, Mumps and Rubella Vaccination in Nan Province, Thailand, June to December 2010

In early September 2010, a nurse in Pua District Hospital observed an unusual increase in number of mumps cases and an outbreak investigation was conducted on 5 Oct 2010. This study described epidemiological characteristics of the outbreak as well as secondary attack rates and outcome of MMR vaccination campaign conducted during the outbreak. We reviewed medical records at Pua District Hospital and interviewed the cases’ family members, classmates and teachers. A clinical case was a person with acute parotitis or acute lymphadenitis at preauricular, submandibular or submental area with onset of illness from 1 Jun to 31 Dec 2010. A confirmed case was a clinical case who tested positive for mumps viral IgM by enzyme-linked immunosorbent assay (ELISA), mumps virus by polymerase chain reaction (PCR) or virus isolation. During the investigation period, we also conducted a single mass measles, mumps and rubella (MMR) vaccination campaign, targeting children aged 1-6 years in 10 sub-districts. From 1 Jun to 13 Oct 2010, 129 clinical cases (attack rate = 0.2%) were found in 11 out of 12 sub-districts. Of which, 70.4% were less than six years old children. Among 10 laboratory confirmed cases, six were positive for mumps IgM by ELISA and four positive for mumps virus by PCR, with one case revealed as genotype J. Secondary attack rate among 1-6 years old children was 31.4%. Attack rate among children aged 1-6 years during the pre-vaccination campaign period was 289.4 per 10,000 populations and decreased to 54.3 per 10,000 after the campaign. This investigation supported the Ministry of Public Health to change from using monovalent measles vaccine to MMR vaccine for 9-month old children in June 2010.