Measles Mumps Rubella Research Articles

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

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

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

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

Measles resurgence in Armenia: unmasking health system vulnerabilities and crafting comprehensive eradication strategies - a review.

Measles is an acute febrile illness associated with rashes, fever and life-threatening complications. It is a vaccine-preventable disease with the Measles Mumps Rubella(MMR) vaccine but a recent global trend unveils a resurgence of measles in various parts of the world including Armenia. Measles was declared eliminated from Armenia in 2021 before reports of local outbreaks surfaced in 2023. The WHO identified discrepancies in the vaccination coverage during COVID-19. Measles also poses a great financial burden as a public health issue worldwide. Sociocultural factors impacting measles transmission are maternal education, healthcare access, migration, vaccine hesitancy, and socioeconomic status (Table 3). Efforts to control and eradicate measles from Armenia are run by a collaborative approach of national and international health bodies such as United Nations Children's Fund (UNICEF), WHO, Global Vaccine Alliance (GAVI), and the Ministry of Health. Thus, the resurgence of measles can be managed through widespread patient education, innovative approaches, strengthening the healthcare system and addressing vaccine hesitancy, sociocultural barriers, and humanitarian emergencies. This review investigates the complicated dynamics of measles inside Armenia's health system in depth. A thorough examination of measles incidence and immunization patterns highlights the shift from few cases and high vaccination rates to a comeback caused by imported viruses. The causes of its recurrence have been thoroughly investigated, including reduced immunization programs and vaccine hesitancy. The research delves further into the 'One Health' idea, assessing the possibility of interspecies transmission among nonhuman primates and examining the environmental factors that influence measles transmission. Among the challenges are weaknesses within Armenia's health system as well as the possibility of interruptions from the COVID-19 outbreak. In measles vaccination status, the combination of maternal education, postnatal care, and socioeconomic variables exposes the larger drivers at work. The study concludes with a comprehensive set of public health policy recommendations covering vaccination promotion, surveillance, healthcare provider education, public awareness, international collaboration, data analysis, law enforcement, emergency preparedness, research, and coordination. The research sheds light on the tangled web of measles dynamics, health system resilience, and contextual subtleties via this multifaceted approach, inviting readers to investigate the multiple strategies required for eliminating measles in Armenia.

Vaccination in children living with HIV – review of Polish recommendations

Vaccines are an extremely effective primary prevention tool recommended for routine use in children worldwide. Vaccination is crucial for patients with underlying diseases, including children living with HIV, because of their increased risk of morbidity and mortality from various vaccine-preventable diseases. Complex care for patients living with HIV includes antiretroviral therapy (which has dramatically improved survival), prophylaxis and treatment of common infections, prophylaxis and treatment of opportunistic infections, and vaccination. Immunisation is generally safe and beneficial for children living with HIV, although HIV-induced immune suppression reduces the benefits. All inactivated vaccines, whether killed whole organism or subunit, recombinant, toxoid, polysaccharide or conjugate (which includes diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, hepatitis B, hepatitis A, Streptococcus pneumoniae vaccines, Neisseria meningitidis, influenza, HPV), can be administered safely. Live attenuated measles–mumps–rubella and varicella vaccines are indicated in children without severe immunodeficiency. The Bacillus Calmette–Guérin vaccine is contraindicated due to the risk of disseminated BCG infection. Although a live attenuated influenza vaccine is available, it is contraindicated for people living with HIV because of the paucity of safety data and the availability of alternative vaccines. The study reviews the current paediatric immunisation recommendations in HIV infection in Poland. Additionally, we focus on vaccine effectiveness, especially HBV protection based on anti-Hbs antibodies.

Intralesional Mumps, Measles, Rubella (MMR) Vaccine as Therapy for Recurrent Condyloma Acuminata: A Case Report

Background: Condyloma acuminata (CA), a prevalent sexually transmitted infection caused by the human papillomavirus (HPV), presents challenges in treatment due to its high recurrence rate. While various treatment modalities exist, intralesional immunotherapy with the mumps, measles, rubella (MMR) vaccine has shown promise in managing HPV-related conditions. This case report investigates intralesional MMR vaccine in treating recurrent CA. Case presentation: A 24-year-old female presented with recurrent CA lesions on the labia majora and perianal region. Despite prior treatment with trichloroacetic acid (TCA), the lesions had reappeared. Intralesional MMR vaccine injections were administered twice, one month apart, resulting in complete lesion resolution within six weeks of the second injection. No recurrence was observed during a six-month follow-up period, and the patient reported only mild, transient pain at the injection sites. Conclusion: This case report highlights the potential of intralesional MMR vaccine as an effective and well-tolerated treatment option for recurrent CA. Further research is warranted to validate these findings and establish optimal treatment protocols.

Associative Patterns Between Iron Deficiency Anemia and Febrile Seizures in the Five to 60 Months Age Group: A Comprehensive Systematic Review.

Febrile seizures (FS) are commonly seen in younger age groups. The cause of seizures is multifactorial, including viral illnesses, certain vaccines such as MMR (measles, mumps, rubella), family history of FS, and certain mineral deficiencies like zinc. Iron deficiency anemia (IDA) is the most common cause of anemia in children of the same age group. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. This review aimed to investigate the correlation between IDA and fever convulsions. A systematic literature search was conducted using PubMed and Google Scholar databases for studies published between January 2013 and September 2023. The following keywords were used to search the articles: "children", "febrile seizures", and "iron deficiency anemia", using all possible combinations and using the word "and" between them. Following the inclusion and exclusion criteria application, we included 23 case-control studies written in the English language in this study. Quality assessment of studies was done using the Newcastle Ottawa Scale.

Measles-specific antibodies loss after a single dose of MMR vaccine in children with oligo-articular JIA on methotrexate treatment: a single-center case-controlled study.

Novel treatments have revolutionized the care and outcome of patients with juvenile idiopathic arthritis (JIA). Patients with rheumatic diseases are susceptible to infections, including vaccine preventable ones, due to waning immunity, failing immune system and immunosuppressive treatment received. However, data regarding long-term immunological memory and response to specific vaccines are limited. Assessment of the impact of methotrexate (MTX) treatment on measles-specific-IgG titers, in children with oligo-JIA previously vaccinated with Measles Mumps Rubella (MMR) vaccine (1 dose); by evaluating the persistence of antibodies produced after measles vaccination while on immunomodulating treatment at 0, 12 and 24months. Single-center controlled study including 54 oligo-JIA patients and 26 healthy controls. Seroprotection rates and measles-specific-IgG titers were measured by ELISA and were expressed as GMCs (Geometric Mean Concentrations).The two groups had similar demographic characteristics, vaccination history and immunization status. Seroprotection rates were adequate for both groups. Nonetheless, measles GMCs were significantly lower in the oligo-JIA compared to the control group at one (p = 0.039) and two years' follow-up (p = 0.021). Children with oligo-JIA on MTX treatment appeared to have lower measles-specific-IgG titers. Further studies are required to assess the long-term immunity conveyed by immunizations given at an early stage in children with rheumatic diseases on synthetic Disease Modifying Antirheumatic Drugs (sDMARDs) and to assess the need for booster doses to subjects at risk.

A review of clinical trials registered in India from 2008 to 2022 to describe the first-in-human trials.

This analysis was conducted to review the number, and describe the characteristics of first-in-human (FIH) Phase 1 clinical trials registered in India from 2008 to 2022. The data were extracted from the Clinical Trials Registry - India database for all FIH Phase 1 clinical trials registered between 2008 and 2022. Early-phase trials that were not FIH trials (e.g., pharmacokinetic studies and drug-drug interaction studies) were excluded from the study. A total of 1891 trials were retrieved and 220 were included in the analysis. Most of the investigational products were drugs (55%) followed by vaccines (38.2%). The most common therapeutic class of drugs was cancer chemotherapy (19.8%), followed by antimicrobial chemotherapy and endocrinology (18.2% each). The most common vaccine was the influenza vaccine (21.4%), followed by the measles-mumps-rubella vaccine (15.5%). The pharmaceutical industry was the predominant sponsor for most (91%) of the Phase 1 trials. Of the top five sites where most of the Phase 1 trials were conducted, three were private nonacademic centers (cumulatively 31%) and two were tertiary care medical colleges (cumulatively 9%). Phase 1 clinical trials seem to be conducted in India predominantly with industry sponsorship. There is a need to have an alternate ecosystem to take forward molecules that do not receive adequate attention from the industry and molecules that are of national health priority other than areas such as chemotherapy, antimicrobials, and endocrinology. The Indian Council of Medical Research is setting up Phase 1 clinical trial capacity for molecules that predominantly may arise from nonindustry channels.

Effect of COVID-19 on immunization coverage of children aged 0-11 months in the center region of Cameroon.

The occurrence of epidemics is known to contribute in reducing the capacity of health facilities to deliver care and the predisposition of populations to seek care through several mechanisms. The objective was to assess the effect of the COVID-19 on vaccination coverage of the expanded program of immunization (EPI) vaccines in children aged 0-11 months. The study involved a descriptive and case control designs exhaustively targeting health facilities in health areas from selected health districts. The descriptive part explored the distribution of immunization coverage 12 months before and during COVID-19. Data were extracted from monthly EPI reports of health areas. Cases were months with immunization coverages of Bacille Calmette-Guerin (BCG), Measles Mumps-Rubella 1 (MMR1) or Diphtheria-Pertussis-Tetanus Hepatitis B + Hemophilus influenzae type b dose 3 (DPT-Hi+Hb3) less than 80%. The exposure were months belonging to the pandemic period. Of the 78 targeted health areas, 74 (94.87%) were reached. The monthly immunization coverage of BCG, RR1, DPT-Hi+Hb 1 and 3 decreased during the pandemic period by minimum 30%. Being a health-area month belonging to the COVID-19 pandemic period was found to be significantly associated to lower BCG [OR=2.00 (1.61; 2.50); P#x003C;0.001], MMR1 [OR=2.45 (1.76; 3.41); P#x003C;0.001] and DPT-Hi+Hb3 [OR=2.11 (1.68; 2.640); P#x003C;0.001] immunisation coverage. COVID-19 had a significant effect on the decrease of immunization coverages of antigens offered in the EPI program. This raises the need to develop interventions during health emergencies to prevent disruption of health services access.

Comparative Study of Intralesional Measles–Mumps–Rubella Vaccine versus Needling-Induced Autoinoculation in the Management of Genital Warts

Abstract Background Genital warts caused by human papillomavirus (HPV) are one of the most common sexually transmitted infections, especially among women. Genital HPV infection has a relatively long incubation period up to 8 months. It is known to have a high recurrence rate, and the infection by certain high-risk HPV strains is known to be associated with malignancies of cervix, penis, vulva, vagina, and anus. Thus, factors such as long latency, lesions’ multiplicity, high recurrence rate, and the tendency to malignant transformation, are essential challenges during management of genital HPV infections. The clinical outcome of traditional treatment modalities; such as podophyllotoxin, imiquimod, cryotherapy, electrocautery, trichloroacetic acid, photodynamic therapy, and laser, is limited to individual lesions. Therefore, they are usually inconvenient for patients with multiple and/or recurrent lesions. Aim of the Work to evaluate the safety and efficacy of intralesional injection of MMR vaccine in comparison with needling-induced autoinoculation in the treatment of genital warts. Patients and Methods Our study included 50 patients with multiple and recurrent genital warts (more than 4 genital warts) divided into two equal matched groups. One group was subjected to MMR injection and the other subjected to needling-induced autoinoculation every two weeks for maximum three sessions. Follow-up was done for 8 weeks after last session. Results This study reports that both treatment options showed statistically significant value in treatment of genital warts, and here was no statistically significant difference between both study groups as regard response to treatment. Conclusion both MMR and needling are simple and effective modalities of immunotherapy for treatment of multiple genital warts with excellent safety profile. The only disadvantage is the long time taken for immune response to occur. Combination treatment plan can overcome this disadvantage. Needling-induced autoinoculation; being more safe and inexpensive, may be considered as a competing immunotherapeutic treatment modality for multiple and recurrent genital warts.

A comparison of health policies, public opinion and vaccination rates in France and Germany

Abstract Objectives France and Germany have different approaches towards childhood immunisation. The aim of this study was to determine the similarities and differences between France and Germany in terms of heath policies, vaccination rates and public opinion as far as infant vaccinations were concerned. Study design Literature review. Subject and methods We used the databases of the Robert Koch Institute (RKI) and of Santé publique France (SpF) to compare the vaccination rates of children in the year 2017. The state of public opinion was principally assessed by comparing data from SpF and the German Federal Center for Health Education (BZgA). Results Vaccination rates were higher in French pre-school children in 2017 for the hexavalent and anti-pneumococcal vaccines, whereas Measles–Mumps–Rubella and anti-meningococcal vaccination rates were higher in Germany. Public opinion was more favourable towards vaccines in Germany than in France. Some vaccines, especially against seasonal influenza and hepatitis B, were viewed with criticism in France, whereas German parents considered hepatitis B immunisation to be important for their children. Moreover, both countries showed higher immunisation rates in northern regions. This correlated with the state of vaccine confidence in France. In Germany, eastern regions were more favourable towards vaccines, which correlated with higher immunisation rates in these regions. Conclusions The state of vaccine confidence seemed to correlate with immunisation rates in both countries. The need for information about vaccines is still high in both countries and trust in the medical community as well as in the immunisation policymakers should be reinforced as a priority.

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

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

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

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

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

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

Защитное действие вакцинации против кори, краснухи и паротита в отношении COVID-19

Based on the results of studies, it has been shown that vaccination against measles, mumps rubella (MMR) can prevent mortality and severe forms of COVID-19 in vulnerable groups of the population. It was found that the high level of vaccination coverage against MMR was inversely correlated with the mortality rate from COVID-19 – the higher the vaccination rate against MMR, the lower the number of mortality from COVID-19 and severe forms. The effect of MMR immunization on the incidence of COVID-19 is explained by correspondence between COVID-19 virus proteins and MMR viruses. The results of studies conducted in various countries and have shown that the effect of protection against COVID-19 is based on the homology of individual sequences of SARS-CoV-2 coronavirus proteins with MMR viruses. The similarity of the SARS-COV-2 virus with the MMR viruses allows the MMR vaccine to be used for mass use for non-specific protection against COVID-19. In order to increase the effectiveness of vaccination against MMR in people with impaired health, the use of immunomodulatory drugs is recommended. This approach not only increases specific immunity against vaccinated infections, but also enhances nonspecific protection against COVID-19. Key words: SARS-CoV-2 virus, live vaccines, COVID-19 disease, immunization, measles, rubella, mumps

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

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

Prevention of Health Care–Associated Measles Transmission in a Pediatric Clinic

Abstract Objective Preventive measures in the setting of a suspected measles case in a hospital setting are important to stop the secondary spread. In this report, we evaluated the prevention attempts after two suspected cases of measles were reported in a pediatric clinic. Methods We evaluated prevention interventions including isolation, intravenous immunoglobulin, or measles–mumps–rubella (MMR) vaccine after two patients were diagnosed with maculopapular rash compatible with measles in the pediatric clinic. Results There were 50 patients (29 were outpatients, 21 were inpatients), 19 health care personnel (HCP), and 50 caregivers who were in contact with index cases. All of the HCP and 40 of the caregivers were immune to measles. Additional dose of MMR vaccine was recommended to five of the outpatients by phone. A total of 12 patients who were being followed up as inpatients (8 patients aged 6–12 months, 4 patients aged ≥ 12 months) were vaccinated with one dose of MMR vaccine. Only a 12-year-old male patient was admitted due to complaints suggesting measles after 14 days from discharge. It was learned that he had received a single dose of vaccine before so he was recommended an additional dose of MMR vaccine by the phone, but he did not go to the health institution on the day of the call. Conclusion Postexposure prophylaxis is effective to prevent measles transmission. Although young infants have the highest risk for transmission of measles in a health care–associated outbreak, adolescents and older children who are single vaccinated also have high risk for clinical measles.

3.M. Workshop: Health system barriers to vaccination in underserved communities: a tale of four countries

Abstract The literature highlights low vaccination coverage among most minority or ethnic pediatric communities in EU, including migrants. In addition to being less likely to get a vaccine, such communities may be vulnerable to developing certain infectious diseases. It is particularly important in the context of the current humanitarian crisis connected with Russia's aggression towards Ukraine. Identification of potential barriers to vaccination and system gaps is crucial to further ensure that underserved pediatric communities benefit from the same level of protection as the general population in terms of disease prevention and control, including those diseases which can be prevented by routine vaccinations. The proposed workshop moderated by well-known experts of the subject (Bernardette Kumar and Maria Ganczak) will be based on the results from qualitative data collected as a part of the 5-year RIVER-EU (Reducing Inequalities in Vaccine uptake in the European region - Engaging Underserved communities) project which tackles health system barriers among selected underserved communities living in four countries: Ukrainian migrants in Poland, females with a Turkish and Moroccan migration background in the Netherlands, marginalized Roma communities in Slovakia and migrants/refugees in Greece. This interactive workshop will provide short (5 minutes per country) comparisons of the health system barriers to vaccination against MMR (measles, mumps, rubella) and Human Papillomavirus (HPV) in children living in different underserved communities, and contrast barriers to vaccination experienced by the community members with barriers perceived by the health care professionals. International comparisons of in-depth information collected during qualitative studies (interviews and focus groups) will help to provide an increased understanding of the health system determinants of low vaccine uptake in their specific multi-factorial contexts that will vary in terms of geography, size, wealth, health sector structures, culture and vaccination law. Such qualitative research is particularly valuable regarding its potential for producing comprehensive and refinement analyses adjusted for understanding the voices of underserved communities. The session will go beyond describing those. Based on the presentations the participants will be divided into 4 groups to discuss (15 minutes) the Key Barriers; Key Facilitators to vaccination; Main lessons Learnt; Ways forward for the future to increase vaccine uptake among underserved pediatric communities to reduce the burden of vaccine preventable diseases. These 4 groups of workshop participants will be led by experts from the MEMH and IDC sections. Then, concluding remarks will be presented by each group (5 minutes per group). The final resume delivered by session chairs will end the workshop. Key messages • The health system barriers to child vaccination among underserved communities vary among European countries, and the optimal way to adequately address them is likely to be context specific. • The RIVER-EU project gives an opportunity to discuss lessons already learnt around the different components of the vaccination process and to pinpoint ways forward for the future to reduce the VPD.

COVID’s collateral damage: likelihood of measles resurgence in the United States

BackgroundLockdowns imposed throughout the US to control the COVID-19 pandemic led to a decline in all routine immunizations rates, including the MMR (measles, mumps, rubella) vaccine. It is feared that post-lockdown, these reduced MMR rates will lead to a resurgence of measles.MethodsTo measure the potential impact of reduced MMR vaccination rates on measles outbreak, this research examines several counterfactual scenarios in pre-COVID-19 and post-COVID-19 era. An agent-based modeling framework is used to simulate the spread of measles on a synthetic yet realistic social network of Virginia. The change in vulnerability of various communities to measles due to reduced MMR rate is analyzed.ResultsResults show that a decrease in vaccination rate (mathrm{alpha }) has a highly non-linear effect on the number of measles cases and this effect grows exponentially beyond a threshold (mathrm{alpha }). At low vaccination rates, faster isolation of cases and higher compliance to home-isolation are not enough to control the outbreak. The overall impact on urban and rural counties is proportional to their population size but the younger children, African Americans and American Indians are disproportionately infected and hence are more vulnerable to the reduction in the vaccination rate.ConclusionsAt low vaccination rates, broader interventions are needed to control the outbreak. Identifying the cause of the decline in vaccination rates (e.g., low income) can help design targeted interventions which can dampen the disproportional impact on more vulnerable populations and reduce disparities in health. Per capita burden of the potential measles resurgence is equivalent in the rural and the urban communities and hence proportionally equitable public health resources should be allocated to rural regions.

‘From cover-up to catastrophe:’ how the anti-vaccine propaganda documentary ‘Vaxxed’ impacted student perceptions and intentions about MMR vaccination

ABSTRACT Background: Although measles was declared eliminated in the U.S. in 2000, outbreaks have been reoccurring, due in part to misinformation about vaccines spread via social media. Through the lens of the Health Belief Model (HBM), this study sought to understand how viewing the anti-vaccine propaganda documentary, Vaxxed: From Cover-Up to Catastrophe, impacted individuals’ perceptions of the measles mumps rubella (MMR) vaccine and their subsequent expressed intentions to vaccinate prospective children. Methods: Qualitative pre/post video, one-on-one, in-depth interviews were conducted using think aloud protocol to understand 30 college students’ views about vaccines – specifically the MMR vaccine– before, during, and after viewing a segment of Vaxxed. Results: Analysis revealed two overarching themes: underlying distrust, and skepticism or shaken beliefs. Conclusions: The current study demonstrates how attitudes and expressed behavioral intentions are impacted by anti-vaccine messaging, specifically a documentary. In accordance with HBM, when individuals perceive themselves to not be susceptible, minimize the severity of diseases, perceive a lack of information to make an informed decision, and do not have any positive messaging reinforcing or triggering pro-vaccine behavior, it becomes evident why critically thinking young adults could be persuaded by propaganda to second guess vaccination. Stakeholders in the healthcare industry and those involved in any aspect of vaccine education and/or communication campaign efforts must reconsider their core assumptions about vaccines and the idea that parents will automatically acquiesce to vaccinating their children against infectious diseases, particularly when parents’ own lack of vaccine knowledge is revealed, and cognitive dissonance is induced via anti-vaccine propaganda.