Mumps Rubella Research Articles

A Study to Evaluate the Role of Intradermal and Intralesional Measles, Mumps, Rubella (MMR) Vaccine in Treatment of Common Warts.

Background:Warts are common cutaneous viral infection with a wide range of therapeutic modalities. Various agents have been tried for immunotherapy in warts.Objectives:Determine the role of intralesional and intradermal measles, mumps, rubella (MMR) vaccine in the treatment of common warts; to compare the efficacy of intralesional versus intradermal MMR vaccine.Methods and Materials:Patients diagnosed with verruca vulgaris were divided into two groups. In study group A, the individuals were injected with an intralesional MMR vaccine of 0.3 mL in the representative wart (largest) once in 3 weeks till there is complete clearance or maximum of four injections whichever is earlier, while in study group B, the individuals were injected with an intradermal MMR vaccine of 0.3 mL over the unilateral deltoid muscle area at similar intervals.Results:There were 33 patients in each group. In group A, 10 (30.3%) patients showed complete, 9 (27.3%) marked, 6 (18.2%) moderate, 3 (9.1%) mild, and 5 (15.2%) no response. In group B, seven (21.2%) patients showed complete, one (3.0%) marked, one (3.0%) moderate, four (12.1%) mild, and 20 (60.6%) no response. There were minimal side effects in the form of pain, erythema, itching at the injection site in a few patients, only one patient had syncope.Conclusion:We conclude that the MMR vaccine is an effective and safe modality of treatment for verruca vulgaris without any serious adverse effects. Also, the intralesional route showed better results in comparison to the intradermal route when we consider the treatment of a representative wart.

Comparison of Intralesional Measles, Mumps, Rubella Vaccine and Needling in the Treatment of Recurrent Warts.

Context:Warts constitute 21% of all the cases in a dermatology clinic. Their causative agent is the human papillomavirus (HPV). Most of the cutaneous warts are cosmetically disfiguring and their treatment requires patience by both the practitioner and the patients.Aim:This study aimed to compare the efficacy of intralesional measles, mumps, rubella (MMR) vaccine and needling in the treatment of recurrent warts.Settings and Design:This was a prospective, comparative, and interventional study.Subjects and Methods:This hospital-based study was conducted in a tertiary health-care center from September 2017 to August 2019. Overall 40 patients of recurrent warts were included in the study.Statistical Analysis:Fisher test, Student t test, and chi-square test were used for statistical analysis.Results:Improvement was noted in patients belonging to both the groups. However, after applying chi-square test, it was found that results were statistically significant in the needling group only. When both the groups were compared using chi-square test, needling showed statistically significant results after 4 and 6 weeks.Conclusion:Needling was observed to be a better treatment modality as compared to intralesional MMR vaccine at the end of 4 and 6 weeks. More number of sessions were required in the intralesional MMR vaccine group for complete clearance of the lesions as compared to needling. Hence, the response was better and faster in the needling group as compared to the intralesional MMR group.

Measles re-emerges and recommendation of vaccination.

Measles is a highly infectious viral illness and is one of the world's most contagious diseases that can affect all people if they have not been vaccinated or have not had it before. Before measles vaccine became available in 1963, major epidemic occurred approximately every 2 to 3 years and thus 99% of the people were thought to have been infected naturally with measles virus and got immune for life. In 2000, measles was declared eliminated from the United States, and yet 1215 cases have been reported from 30 states as of August 22, 2019. Currently, there are several large measles outbreaks universally, and some people who were not immune and they need to get their measles, mumps, rubella (MMR) vaccine to prevent measles outbreaks. As vaccination coverage increases, the average age of measles infection can change to adolescents and young adults. In addition, the protective antibodies derived from vaccination might decrease gradually, and the risk of measles infection in young adults is increasing regardless of international travelling.

Cross-sectional Retrospective Study on Paracetamol Post Infants' Vaccination in Malaysia.

ABSTRACTIntroduction:Practice of dispensing paracetamol (PCM) in post infants’ vaccination remains debatable in Malaysia as the administration of PCM postvaccination in infants was found to cause the vaccine to be less effective, thus requiring appropriate regulation measures.Objective:This research aimed to investigate the prevalence of adverse events following immunization (AEFI) with/without PCM to be prescribed post infants’ vaccination in Malaysia (possible associated factors: age, types and stages of vaccination, concomitant vaccines and drugs, and/vitamins).Materials and Methods:A retrospective cross-sectional study was conducted from 2011 to 2017. The AEFI was extracted from Quests 2, 3, and 3+ System of National Pharmaceutical Regulatory Agency (NPRA). The population of vaccinated infants was obtained from the Ministry of Health (MOH) Malaysia official website. The AEFI data were further categorized into (i) AEFI with possibility for PCM to be prescribed, and (ii) AEFI with no possibility for PCM to be prescribed. The data were analyzed using Microsoft Excel 2013, Portland, USA simple and multiple logistic regression tests, Statistical Package for the Social Sciences (SPSS) software programme, version 22.0 (IBM), New York, USA.Result:Various AEFI cases (359 infants) were reported. DTaP/Hib/IPV and measles–mumps–rubella (MMR) showed higher prevalence of AEFI with/without PCM to be prescribed post infants’ vaccination cases per 100,000 population (2.07 and 2.21, respectively) than other types of vaccinations. DTaP/Hib/IPV (2 months) vaccination showed the highest value (3.00) among other age groups. Backward elimination presented DTaP/Hib/IPV (3–4 months) (95%CI; 0.231, 0.899%; P = 0.023) was the possible associated factor. Hepatitis B (1–5 months), DTaP/Hib/IPV (3–4 months), DTaP/Hib/IPV (5–12 months), concomitant vaccines as well as concomitant drugs and/ vitamins were the identified potential cofounders.Conclusion:Prescribing and dispensing of PCM post infants’ vaccination may be confined to DTaP/Hib/IPV (2–4 months) and 12 months MMR groups.

Evaluation of Immunity to Measles in a Cohort of Medical Students in Rome, Italy.

Background: Measles is a highly contagious viral disease with serious complications. Currently, in Italy, measles vaccination is not mandatory for health care workers (HCWs) and medical students, and the free offer of the Measles Mumps Rubella (MMR) vaccine is the only national prevention measure to increase the coverage rate among these subjects. Aims: The aim of our study was to evaluate the impact on vaccination rate of the National Plan of Vaccine Prevention (NPVP) implemented in 2017. Material and Methods: This is a retrospective observational study that evaluated the measles-specific IgG immunity status of medical students at the University Tor Vergata of Rome, which underwent occupational health surveillance from 1 January to 31 December 2018. Results: In 2018, 84 of 319 students (26.30%) were serologically non-immune to measles; among these, 16 (19%) had previously been vaccinated, and 35 of the remaining 68 students accepted the MMR vaccine. Therefore, 33 out of 319 students did not undergo vaccination in 2018. These data are similar to those obtained in the previous year. In the 2017 screening, 84/314 (26.75%) students tested negative at the serological screening, whereas 15/85 (17.8%) among them documented a previous vaccination with two doses of the MMR vaccine; 69 students tested as unprotected. Vaccine compliance was 51.44%. Conclusions: No change in vaccination coverage occurred after the introduction of the last NPVP. Further efforts are needed to sensitize target populations about the relevance of vaccination; providing pre-employment screening for measles and free vaccine might be useful for this purpose.

Serologic screening and infectious disease consultation (IDC): Indicated in heart, lung, liver (HLL) solid organ transplants (SOT) for measles, mumps, rubella, and varicella.

Solid organ transplant (SOT) recipients are a special group of patients who require comprehensive evaluation for preventable infectious diseases before transplantation. The main aim of our study was to investigate the number of heart, lung, and liver (HLL) transplant recipients who were evaluated for their immune status against measles, mumps, rubella (MMR), and varicella (VZV). As a secondary aim, we investigated whether pre-transplant infectious disease consultation (IDC) improves vaccination rates. This study was an institution-based retrospective analysis of HLL transplant recipients born in or after 1957 and evaluated at Mayo Clinic, FL Transplant Center between January 1st, 2016 and December 31st, 2017. Data collection was obtained from electronic medical records. The vaccination rates were compared by univariate analysis based on IDC and no ID consultation (NIDC). One hundred and eighty-seven (77%) of a total 242 patients received an IDC pre-transplantation. Varicella IgG levels were screened in all 187 IDC candidates. Among the 187 IDC patients, mumps, measles, and rubella IgG serologies were performed in 9 (5%), 21 (11%), and 51 (27%), respectively. Among all 242 patients,vaccines given included 2 (0.8%) MMR, 10 (4.1%) varicella and 85 (35.12%) Zostavax. Univariate analysis revealed that Zostavax was given to 76 (40.6%) pre-transplant IDC patients and only in 9 (16.7%) NIDC patients (P<.001). Despite the relatively high IDC rate, patients' screened numbers for MMR IgG levels were low. Results pointed out the need for MMR protocol-driven serologic screening as well as for VZV and IDC prior to transplantation to increase vaccination rates.

Comparison of cryotherapy versus intralesional measles, mumps, rubella vaccine versus their combination therapy in Indian patients with cutaneous wart: a single centre prospective observational study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Need for more effective and less time consuming therapeutic method is current necessity for treatment of cutaneous warts. The objective of the study was to evaluate and compare the efficacy, safety of cryotherapy versus intralesional measles, mumps, rubella (MMR) vaccine versus combination of cryotherapy and intralesional MMR vaccine in Indian patients with cutaneous wart.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective observational study was conducted in 60 patients of cutaneous warts. Patients were divided into three groups viz., group A, group B and group C. Group A was treated with cryotherapy alone, Group B received intralesional injection 0.1 to 0.3 ml of MMR vaccine alone and Group C received combination of group A and group B therapy. In each group treatment was repeated at 3 week interval for a maximum of 4 sittings. Percentage of improvement was evaluated using visual analogue scale (VAS) for local as well as distant (non-inoculated) warts. Follow-up was made every 2 months till 4 months to detect any recurrence.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; For local warts in second half of treatment (12&lt;sup&gt;th&lt;/sup&gt; week) patients of Group B and Group C showed significantly better response than patients in Group A. For distant warts in first half of treatment session patients showed significantly better response to Group C than as compared to Group B therapy (p&amp;lt;0.039).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Immunotherapy with MMR is superior treatment than cryotherapy for cutaneous warts with minimum side effects but the combination of cryotherapy with intralesional MMR has shown to have complementary effect in treatment response.&lt;/p&gt;

Study on epidemic dynamics model with time delay to eliminate measles in China

Measles is an infectious illness and especially harmful to children. Although the national immunization program is implemented, measles remains to be an important public health issue in China. This paper is devoted to modelling the combined effects of the first dose of Measles rubella combination vaccines (MR1) and the second dose of Measles mumps rubella combination vaccines (MMR2) coverage rates on the controlling of measles. To do that, we propose and study a robust time delayed compartment measles epidemic model where MMR2 is followed after an interval time τ by MR1. Via simulation method, we find ℜ0 is a decreasing function on the coverage rates of MR1 η1 and the coverage rates of MMR2 η2, but an increasing function on the interval time τ . We also find ℜ0 > 1 based on the Chinese current situation of η1 = 0.95, η2 = 0.95 and τ = 1.25. In order to completely eliminate measles in China, η1 should be more than 0.9643, or η2 should be more than 0.9586, or τ should be within 8 month. By comparison, it is easier to shorten the interval time τ by revising the Chinese national immunization program.

Frequency and cost of live vaccines administered too soon after prior live vaccine in children aged 12 months through 6 years, 2014–2017

ObjectiveTo identify number of children who received live vaccines outside recommended intervals between doses and calculate corrective revaccination costs. MethodsWe analyzed >1.6 million vaccination records for children aged 12 months through 6 years from six immunization information system (IIS) Sentinel Sites from 2014–15 when live attenuated influenza vaccine (LAIV, FluMist® Quadrivalent) was recommended for use, and from 2016–17, when not recommended for use. Depending on the vaccine, insufficient intervals between live vaccine doses are less than 24 or 28 days from a preceding live vaccine dose. Private and public purchase costs of vaccines were used to determine revaccination costs of live vaccine doses administered during the live vaccine conflict interval. Measles, mumps, rubella (MMR), varicella, combined MMRV, and LAIV were live vaccines evaluated in this study. ResultsAmong 946,659 children who received at least one live vaccine dose from 2014–15, 4,873 (0.5%) received at least one dose too soon after a prior live vaccine (revaccination cost, $786,413) with a median conflict interval of 16 days. Among 704,591 children who received at least one live vaccine dose from 2016–17, 1,001 (0.1%) received at least one dose too soon after a prior live vaccine (revaccination cost, $181,565) with a median conflict interval of 14 days. The live vaccine most frequently administered outside of the recommended intervals was LAIV from 2014–15, and varicella from 2016–17. ConclusionsLive vaccine interval errors were rare (0.5%), indicating an adherence to recommendations. If all invalid doses were corrected by revaccination over the two time periods, the cost within the IIS Sentinel Sites would be nearly one million dollars. Provider awareness about live vaccine conflicts, especially with LAIV, could prevent errors, and utilization of clinical decision support functionality within IISs and Electronic Health Record Systems can facilitate better vaccination practices.

Early childhood vaccination and subsequent mortality or morbidity: are observational studies hampered by residual confounding? A Danish register-based cohort study

ObjectivesTo estimate the association between childhood vaccination and subsequent morbidity and mortality by adjusting for environmental and host factors. Further, to examine the degree of residual confounding in such observational...

The risk of non-specific hospitalised infections following MMR vaccination given with and without inactivated vaccines in the second year of life. Comparative self–controlled case-series study in England

Observational cohort studies in high-income settings have suggested that vaccination order may affect children’s subsequent risk of a heterologous infection, with live vaccines reducing and inactivated vaccines (given on their own or with a live vaccine), increasing the risk. We used the self-controlled case-series method, which automatically controls for the individual level confounding to which such cohort studies are prone, to test this hypothesis. We compared the relative incidence (RI) of infections post-vaccination in two calendar periods in England; in Period 1 (September 2002–August 2006) live measles, mumps, rubella (MMR) vaccine was given on its own and in Period 2 (September 2006–April 2010) inactivated vaccines (7-valent pneumococcal conjugate vaccine (PCV7) and sometimes the combined Haemophilus influenzae type b/meningococcal group C vaccine (Hib-MenC)) were given concomitantly with MMR. Admissions for an infection of the upper or lower respiratory tract, gastrointestinal system or other site in children aged 11–23 months were selected from the Hospital Episode Statistics database in England and linked to child health immunisation histories. The analysis included a total of 24,144 infections in 21,067 children in Period 1 and 36,880 in 31,616 children in Period 2. The RI of admission for any infection in Period 1 was 1.00 (95% confidence interval 0.95–1.06) compared with 0.95 (95% confidence interval 0.90–1.00) in Period 2. Comparing the two periods showed no evidence of a difference in the relative incidence estimates with a ratio of RI of 0.94 (95% confidence interval 0.87–1.02), RIs within 90 days of vaccination were 0.94 (0.91–0.97) in Period 1 and 0.94 (0.91–0.97) in Period 2, consistent with a temporary healthy vaccinee effect. In conclusion, we found no evidence to support the hypothesis that there is a reduction in heterologous infections after MMR on its own or an increase after MMR given concomitantly with an inactivated vaccine.

Reevaluating immunization delays after red blood cell transfusion.

Current American and Canadian guidelines recommend delaying live vaccine immunization by 5 to 6 months after transfusion of red blood cells (RBCs) due to potential interference by serum antibodies. Due to lack of data, the recommendations may be unfounded and prevent valuable vaccination opportunities for children with frequent blood transfusions. The primary aim of this study was to determine measles, mumps, rubella (MMR) vaccine immunogenicity in patients chronically transfused with RBCs. A secondary aim was to quantify vaccine antibodies in RBC donations. MMR-specific antibodies were quantified in 25 pediatric patients who received both doses of MMR vaccine while on a chronic RBC transfusion program (median, 6.6 years after vaccination). MMR antibodies were also quantified in 30 samples of supernatants from RBC donations. Immunity to each of the MMR components was 68% to 76%. In blood donors born before 1976 (pre-MMR vaccine), 67% of MMR serologies in the supernatants of RBC donations were at the immune level versus 7% in blood donors born after 1976. This is the first study of the impact of RBC transfusions on MMR vaccine immunogenicity. Although lower than in the literature (immunity rates, ≥90%), the results show a high rate of immunogenicity of the MMR vaccine in chronically transfused patients. Additionally, results suggest that MMR antibody content in transfusions will continue to decrease with time. Weighing the risks and benefits of disease prevention in a vulnerable population, a reevaluation of immunization delays after RBC transfusions is called for.

Increase in measles cases — United States, January 1–April 26, 2019

As of April 26, 2019, CDC had reported 704 cases of measles in the United States since the beginning of 2019, representing the largest number of cases reported in the country in a single year since 1994, when 963 cases occurred, and since measles was declared eliminated* in 2000 (1,2). Measles is a highly contagious, acute viral illness characterized by fever and a maculopapular rash; complications include pneumonia, encephalitis, and death. Among the 704 cases, 503 (71%) were in unvaccinated persons and 689 (98%) occurred in U.S. residents. Overall, 66 (9%) patients were hospitalized. Thirteen outbreaks have been reported in 2019, accounting for 663 cases, 94% of all reported cases. Six of the 13 outbreaks were associated with underimmunized close-knit communities and accounted for 88% of all cases. High 2-dose measles vaccination coverage in the United States has been critical to limiting transmission (3). However, increased global measles activity poses a risk to U.S. elimination, particularly when unvaccinated travelers acquire measles abroad and return to communities with low vaccination rates (4). Health care providers should ensure persons are up to date with measles, mumps, rubella (MMR) vaccine, including before international travel, and rapidly report all suspected cases of measles to public health authorities.

Qualitative Assessment of Vaccine Hesitancy in Romania.

Background and objectives: Health systems all over the world are confronted with an alarming rise of cases in which individuals hesitate, delay, and even refuse vaccination, despite availability of quality vaccine services. In order to mitigate and combat this phenomenon, which are now defined by the World Health Organization (WHO) as vaccine hesitancy (VH), we must first understand the factors that lead to its occurrence in an era characterized by wide access to safe and effective vaccines. To achieve this, we conducted field testing of the Vaccine Hesitancy Scale (VHS), as it was developed by the Strategic Advisory Group of Experts Working Group (SAGE WG), in Cluj-Napoca city, Cluj County, Romania. The scale is designed to quantify VH prevalence in a population, establish which vaccines generate the highest percentage of hesitancy, and allow a qualitative assessment of the individual’s reasons for hesitance. Materials and Methods: We conducted an observational cross-sectional survey, which was comprised of descriptive, analytical, and qualitative elements regarding VH. The necessary sample size was 452 individuals. The VHS and Matrix of Determinants (recommended by SAGE WG) for reasons people gave to justify their hesitance, was interpreted by qualitative thematic analysis (QTA) to ensure the validity and reliability in detecting hesitancy across various cultural settings and permit global comparisons. Results: We found a VH of 30.3% and 11.7% of parents reported refusing to vaccinate their child. Among the VH responders, the varicella vaccine generated 35% hesitancy, measles vaccine 27.7%, Human Papillomavirus (HPV) 24.1%, and mumps vaccine 23.4%, respectively. The QTA values for percent agreement ranged from 91% to 100%. Cohen’s Kappa values ranged from 0.45 to 0.95. Contextual influences identified for VH were “media,” “leaders and lobbies,” and “perception of the pharmaceutical industry.” Individual and group influences for VH were “beliefs,” “knowledge,” and “risk/benefits (perceived).” Vaccine and vaccination specific issues for VH were “risk/benefit (rational)” and “health care practitioners (trustworthiness, competence).” Conclusions: One-third of the investigated population had expressed VH, and a further one-third of these had refused a vaccine for their child. Chicken Pox, Measles, Mumps, Rubella (MMR), and HPV vaccines generated the most hesitation. Negative information from the media was the most frequently evoked reason for VH.

Increase in Measles Cases - United States, January 1-April 26, 2019.

As of April 26, 2019, CDC had reported 704 cases of measles in the United States since the beginning of 2019, representing the largest number of cases reported in the country in a single year since 1994, when 963 cases occurred, and since measles was declared eliminated* in 2000 (1,2). Measles is a highly contagious, acute viral illness characterized by fever and a maculopapular rash; complications include pneumonia, encephalitis, and death. Among the 704 cases, 503 (71%) were in unvaccinated persons and 689 (98%) occurred in U.S. residents. Overall, 66 (9%) patients were hospitalized. Thirteen outbreaks have been reported in 2019, accounting for 663 cases, 94% of all reported cases. Six of the 13 outbreaks were associated with underimmunized close-knit communities and accounted for 88% of all cases. High 2-dose measles vaccination coverage in the United States has been critical to limiting transmission (3). However, increased global measles activity poses a risk to U.S. elimination, particularly when unvaccinated travelers acquire measles abroad and return to communities with low vaccination rates (4). Health care providers should ensure persons are up to date with measles, mumps, rubella (MMR) vaccine, including before international travel, and rapidly report all suspected cases of measles to public health authorities.

Annals for Educators - 16 April 2019.

Annals for Educators - 16 April 2019.

Assessing safety of Ontario's publicly funded MMR and MMRV immunization programs, 2012 to 2016.

The combined measles, mumps, rubella (MMR) and measles, mumps, rubella, and varicella (MMRV) vaccines are part of Ontario's routine immunization schedule. To assess adverse events following immunization (AEFIs) reported in Ontario following administration of MMR and MMRV vaccines between 2012 and 2016. Reports of AEFIs were extracted from the provincial surveillance database on May 9, 2017. Events were grouped by provincial surveillance definitions. Reporting rates were calculated using provincial population estimates or net doses distributed as the denominator. A serious AEFI is defined as an AEFI that resulted in an in-patient hospitalization or death. Overall, 289 AEFIs were reported following administration of MMR (n=246) or MMRV (n=43) vaccines, for annualized reporting rates of 16.6 and 8.8 reports per 100,000 distributed doses, respectively. The highest age-specific reporting rate was in children aged 1 to 3 years for MMR (7.7 per 100,000 population) and children aged 4 to 9 years for MMRV (0.8 per 100,000 population). Systemic reactions were the most frequently reported event category, while rash was the most frequently reported event for both vaccines. There were 22 serious AEFIs, 19 following MMR and 3 following MMRV (1.3 and 0.6 per 100,000 doses distributed, respectively). Our assessment found a low reporting rate of adverse events following MMR and MMRV vaccines in Ontario. No safety concerns were identified. Our findings are consistent with the safety profiles of these vaccines. Continued monitoring of vaccine safety is necessary to maintain timely detection of unusual postvaccine events and public confidence in vaccine safety.

Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study.

The hypothesized link between the measles, mumps, rubella (MMR) vaccine and autism continues to cause concern and challenge vaccine uptake. To evaluate whether the MMR vaccine increases the risk for autism in children, subgroups of children, or time periods after vaccination. Nationwide cohort study. Denmark. 657461 children born in Denmark from 1999 through 31 December 2010, with follow-up from 1 year of age and through 31 August 2013. Danish population registries were used to link information on MMR vaccination, autism diagnoses, other childhood vaccines, sibling history of autism, and autism risk factors to children in the cohort. Survival analysis of the time to autism diagnosis with Cox proportional hazards regression was used to estimate hazard ratios of autism according to MMR vaccination status, with adjustment for age, birth year, sex, other childhood vaccines, sibling history of autism, and autism risk factors (based on a disease risk score). During 5025754 person-years of follow-up, 6517 children were diagnosed with autism (incidence rate, 129.7 per 100000 person-years). Comparing MMR-vaccinated with MMR-unvaccinated children yielded a fully adjusted autism hazard ratio of 0.93 (95% CI, 0.85 to 1.02). Similarly, no increased risk for autism after MMR vaccination was consistently observed in subgroups of children defined according to sibling history of autism, autism risk factors (based on a disease risk score) or other childhood vaccinations, or during specified time periods after vaccination. No individual medical charts were reviewed. The study strongly supports that MMR vaccination does not increase the risk for autism, does not trigger autism in susceptible children, and is not associated with clustering of autism cases after vaccination. It adds to previous studies through significant additional statistical power and by addressing hypotheses of susceptible subgroups and clustering of cases. Novo Nordisk Foundation and Danish Ministry of Health.

The Resurgence of Measles, Mumps, and Pertussis

Although vaccines are one of the greatest scientific innovations to prevent disease and promote well-being, 1 in 10 children is not being vaccinated. This has directly contributed to the rise in vaccine-preventable diseases. Because of the high contagiousness of measles, mumps, and pertussis, innovative efforts are paramount to prevent disease outbreaks in the United States and worldwide. This article reviews measles, mumps, and pertussis; explains the resurgence of these vaccine-preventable diseases; and offers evidence-based solutions for increasing vaccination rates.

Today's vaccination policies in Italy: The National Plan for Vaccine Prevention 2017-2019 and the Law 119/2017 on the mandatory vaccinations.

The National Plan for Vaccine Prevention 2017-2019 has expanded the vaccination offer including new vaccines, enlarging the target population and introducing for the first time in Italy a life-course approach to vaccination. A "lifetime immunization schedule" is aimed to reduce the burden and the related costs of vaccine-preventable diseases through effective vaccination programs. However, to counteract the national steady downward trend in the uptake of vaccinations that caused a drop of the vaccination coverage below the 95% threshold to allow herd immunity, it was decided to make 10 vaccinations mandatory by the law 119/2017. In particular, in addition to already mandatory vaccinations against diphtheria, tetanus, hepatitis B and poliomyelitis, those against measles, mumps, rubella (MMR), varicella, pertussis and Haemophilus influenzae type b (Hib) were added to the list. According to the law, all unvaccinated children cannot attend preschool services until the age of 6 years and fines (from 100 to 500 Euros) are provided for parents. Moreover, this law provided, in its first application, a catch-up campaign for children up to the age of 16 years and the free-of-charge offer of all mandatory and recommended vaccines to each child not yet vaccinated according to the previous NPVP. The NPVP includes also several at risk categories, such as pregnant women, healthcare workers and subjects suffering from chronic diseases, to whom specific vaccinations, free of charge, are offered. The vaccinations of pregnant women have different purposes. In order to decrease the pertussis risk in newborns in the first months of life, a booster immunization of DTPa is recommended, at every pregnancy, between week 27th and 36th. Instead, the influenza vaccine administration to pregnant women during the second or third quarter is mainly aimed to avoid the risk of serious disease complications for both the mother and the fetus. Another group of at risk subjects included in the NPVP is that made up by healthcare workers. According to the plan, "an adequate immunization of the healthcare workers is essential for the prevention and control of infections (anti-hepatitis B, anti-influenza, anti-measles-mumps-rubella, anti-varicella, anti-pertussis)". Finally, almost all the vaccinations foreseen by the NPVP are offered free of charge to subjects suffering from specific diseases. These include cardiovascular, respiratory, hepatic, neoplastic, renal and metabolic disorders, in addition to immunosuppression that exposes them to an increased risk of contracting invasive infectious diseases.