Resurgence Of Measles Research Articles

The Scourge of measles

Abstract Once considered a disease of the past, the resurgence of measles in England has garnered significant attention in recent weeks and months. The uptake of routine childhood vaccines including the measles, mumps and rubella (MMR) vaccine is the lowest it has been in a decade and is well below the 95% uptake needed to protect the population and prevent outbreaks. This is giving this serious disease a chance to get a foothold in our communities. From having never seen a case of measles in their life time doctors in England are now notifying cases of measles based on clinical suspicion. Since October, we have seen a rapid increase in both measles cases and outbreaks of measles across England (the total number of cases confirmed since October 2023 to date is 1109) and it has been declared a national incident. The abstract highlights the consequences of vaccine hesitancy, illustrated by case studies of outbreaks of measles among susceptible populations such as schools and prisons and the steps being taken to control the spread. Social media misinformation, distrust in healthcare authorities, and concerns over vaccine safety are some of the factors shaping parental attitudes towards MMR vaccination. In response to these challenges, the abstract underscores the importance of targeted interventions aimed at addressing vaccine hesitancy, such as community engagement initiatives, tailored communication strategies, and healthcare provider training. By emphasizing the critical role of MMR vaccination in preventing measles resurgence, this abstract advocates for a collaborative approach involving healthcare stakeholders, policymakers, and the public to combat to combat this preventable yet persistent threat to public health.

Incomplete Immunity for Varicella and Measles in Pediatric Organ Transplant Candidates. Real World Experience From an Infectious Diseases Pre-Transplantation Clinic.

Vaccinating pediatric solid organ transplant candidates against measles and varicella is crucial due to the risk of severe disease in immunosuppressed recipients and general avoidance of live virus vaccines post-transplantation. The world saw a resurgence of measles starting 2012 prompting the American Society of Transplantation in 2015 to release guidelines on recognition, prevention, and post-exposure prophylaxis of this disease in solid transplant recipients. This study aims to assess the extent of incomplete immunity to these viruses in candidates and the approach to immunity optimization during a period of heightened awareness. A cross-sectional study from 2012 to 2016 at Cleveland Clinic Children's included pediatric solid organ transplant candidates. Data on vaccination history, serology, and demographics were collected. Incomplete immunity was defined by incomplete vaccination or seronegativity. Among 91 candidates, 54.9% had complete varicella vaccination. Serological varicella immunity among patients tested varied by age: < 7 years, 50.0% positive in patients with complete schedules, none in the incomplete; ≥ 7 years, 50.0% positive in patients with complete schedules, 65.5% in the incomplete. For measles, 69.2% had complete vaccination, with immunity varying by age among those tested: < 7 years, 84.6% positive in patients with complete schedules, 42.9% in the incomplete; ≥ 7 years, 81.0% with complete, 62.5% with incomplete. Only 31.1% of those who qualified for a varicella additional dose and 28% who qualified for an additional measles dose received it, respectively. Incomplete immunity to varicella and measles was prevalent in pediatric solid organ transplant candidates at our center during the study period. Despite an increase in global measles activity, our efforts to optimize immunity through additional vaccine doses were only partially successful. Future research should focus on addressing strategies and understanding barriers to ensure timely vaccination for this vulnerable population prior to transplant, especially during periods of increased viral activity.

Low Rates of Immunity among Medical Students and Residents in the Era of the Resurgence of Measles.

Measles is a highly contagious viral disease spread through respiratory droplets. The number of reported cases increased worldwide in 2023, particularly in the European Region. Italy reported 213 cases in the first quarter of 2024, with most of them in unvaccinated adults aged 15-64. Maintaining high vaccination coverage is essential to prevent outbreaks, especially in healthcare settings where measles transmission is a significant risk. In our study, we collected serological and demographic information from all Italian and foreign medical students and residents (850) who underwent a pre-training assessment at the Tor Vergata Occupational Medicine Service, Rome, between 3 April 2023 and 31 January 2024. Of the 850 students and residents analyzed, we found only 546 (64.2%) with a protective level of IgG antibodies against measles, with a median IgG level of 2.00 AI. A significant proportion of students and residents were serologically non-immune, raising concerns about the potential risk of hospital transmission. To manage this risk, it is important to assess serological levels, vaccinate those with inadequate levels, and promote vaccination in the general population.

Differential diagnosis on measles and rubella discarded cases highlights a sharp increase in parvovirus B19 infections in Milan, Northern Italy, in the first months of 2024.

In line with European trends, since 2023 Lombardy (Northern Italy) is experiencing a resurgence of measles and an increased number of reported cases of fever and rash. Measles discarded cases observed in our region within the context of measles and rubella surveillance from the first few months of 2024 (N = 30) were investigated for parvovirus B19 (B19V) and other rash-associated viruses. Thirteen cases tested positive for B19V DNA, representing a significant increase from previous years (on average 3 cases per year, p < 0.001) and ~40% of all B19V DNA-positive patients we detected since 2017. In 2024, B19V DNA-positive subjects spanned all ages, and the virus was predominant among adolescents and adults (84.6%). Two B19V infected patients were hospitalised, and likely cross-reacting anti-measles virus IgM were found in both. Our data align with the recent reports from the ECDC and various European countries, which are experiencing a surge in B19V infections, and underline the importance of comprehensive measles and rubella surveillance systems that can adapt to changing epidemiological trends.

Using Regular High-Quality Serosurveys to Identify and Close National Immunity Gaps-Measles and Rubella Elimination in Japan.

In Japan, periodic measles outbreaks occurred mainly among young children under the routine immunization program with one dose of the measles-containing vaccine (MCV). A second dose of MCV was introduced in 2006. During a nationwide measles resurgence in 2007-2008, the most affected age group was teenagers. The national serological surveillance for vaccine-preventable diseases made it clear that there was a measles immunity gap among teenagers who had not received a second dose of MCV. To fill this immunity gap, nationwide non-selective supplementary immunization activities (SIAs) were carried out as a five-year program from April 2008 to March 2013 by providing an opportunity to be vaccinated with the measles and rubella vaccine during the first year of junior high school (12-13 years old) and the last year of high school (17-18 years old). The SIA was conducted with the strong involvement of local governments in charge of vaccination delivery and collaboration between the health and education sectors. Japan was verified as achieving measles elimination in 2015 and this has been sustained to date. The challenge of rubella elimination following a similar strategy of a serological diagnosis of an immunity gap and targeted vaccination is also discussed.

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.

Global resurgence of measles in the vaccination era and influencing factors

ObjectivesRecent years have seen increased cases of measles despite widespread vaccination. We examined the potential drivers behind the resurgence of measles. MethodsWe analyzed the trends in measles incidence and vaccine coverage from 2010 to 2019 across World Health Organization member countries using country-level linear regression models. We computed the Spearman rank correlation coefficient (ρ) between measles incidence and socioeconomic and vaccination-related variables using published data from the World Health Organization member countries to identify the key factors influencing measles incidence. ResultsBetween 2010 and 2019, global measles cases fluctuated, with a notable rise in 2019 (measles cases per million in 2019 was about 140% higher than in 2010), alongside a declining vaccination coverage in many countries (59 of 194 countries). Among 10 socioeconomic factors examined, per-capita national gross income, population literacy, urban residences, and political stability were significantly associated with measles incidence (ρ <0, and P <0.05 for all these variables). These factors likely reflect the quality of public health infrastructure (e.g. access to vaccines), particularly, in low- and middle-income countries. In addition, a stratified analysis suggests vaccine hesitancy likely contributed to measles case increases in high- and upper middle–income countries. ConclusionsThe socioeconomic determinants of measles transmission are interconnected and region-specific. The availability of public health resources and political stability significantly influence measles burdens in low- and middle-income countries, whereas vaccine hesitancy presents a unique challenge to measles elimination in high- and upper middle–income countries.

Measles and Rubella Elimination in the Western Pacific Region in 2013-2022: Lessons Learned from Progress and Achievements Made during Regional and Global Measles Resurgences.

Measles is the most contagious communicable disease, causing an estimated 5.5 million cases and more than 30,000 deaths in the Western Pacific Region (WPR) during 2000. Rubella infection in a pregnant woman can be devastating for the foetus, resulting in congenital rubella syndrome (CRS) in 90% of rubella infections in early pregnancy. It was estimated that approximately 9000 CRS cases occurred in the WPR in 2010. World Health Organization (WHO) Member States in the WPR decided in 2003 to eliminate measles and in 2014 to eliminate rubella from the region. While the WPR successfully attained historically low measles incidence in 2012, it experienced a region-wide measles resurgence in 2013-2016. During the regional resurgence, WHO and Member States accumulated greater knowledge on the epidemiology of measles and rubella in the WPR and strategies to maintain gains. The implementation of the resulting new regional strategy and plan of action from 2018 has proven that measles and rubella elimination is achievable and sustainable under the pressure of multiple importations of measles virus during the world-wide measles resurgences in 2018-2019. This article discusses this progress and achievements towards achieving the global eradication of measles and rubella.

Challenges for Sustaining Measles Elimination: Post-Verification Large-Scale Import-Related Measles Outbreaks in Mongolia and Cambodia, Resulting in the Loss of Measles Elimination Status.

The Western Pacific Region's pursuit of measles elimination has seen significant progress and setbacks. Mongolia and Cambodia were the first two middle-income countries in the Western Pacific to be verified as having eliminated measles by the Western Pacific Regional Verification Commission for Measles and Rubella Elimination, in March 2014 and 2015, respectively. However, both countries experienced large-scale or prolonged importation-related measles outbreaks shortly afterwards, leading to the re-establishment of endemic transmission. We describe the path to initial elimination in both countries and explore these outbreaks' characteristics, factors contributing to the loss of elimination status, and implications for broader elimination efforts. Data sources include case-based epidemiological and laboratory surveillance reports, historical immunization coverage, genotype data, and published reports of in-depth outbreak investigations. In Mongolia, a single prolonged and large-scale outbreak revealed a hidden immunity gap among young adults and was driven in part by nosocomial transmission, leading to significant morbidity and mortality and loss of elimination status. Cambodia suffered multiple importations from neighboring endemic countries during the global measles resurgence in 2018-2019, complicated by cross-border mobility and significant nosocomial amplification, and the country was ultimately unable to sufficiently distinguish independent chains of transmission, leading to loss of elimination status. Our findings highlight the importance of broadening population immunity assessments beyond children to include adults and specific high-risk groups. Robust routine immunization programs, supplemented by tailored SIAs, are crucial for preventing and managing outbreaks. Additionally, strong outbreak preparedness plans, rapid response strategies, and cross-border collaboration and the global effort to prevent multiple resurgences and large-scale importation-induced outbreaks are vital for maintaining elimination status. The experiences of Mongolia and Cambodia underscore the challenges of sustaining measles elimination in the face of importation risks, shared borders with endemic countries, healthcare system gaps, and population movements. Strengthening the global coordination and synchronization of measles elimination activities is imperative to protect the gains achieved and prevent future setbacks.

Space-time heterogeneity of measles, mumps, and rubella vaccination indicators in children from BrazilHeterogeneidad espaciotemporal de los indicadores de inmunización con la vacuna triple viral en la población infantil de Brasil

To evaluate immunization coverage and dropout rates of the measles, mumps, and rubella vaccine across Brazilian regions. This ecological study employing a space-time approach used data from the National Immunization Program (PNI) and the Live Births Information System (SINASC). We estimated the annual variation (2014 to 2021) in immunization coverage and dropout rate of the measles, mumps, and rubella vaccine in children aged 12 and 15 months in the 5 570 Brazilian municipalities. Statistical analysis was conducted for the municipalities contained in each Brazilian region using the space-time scan technique, considering the Poisson probabilistic model and the hypothesis that municipalities with lower immunization coverage or high dropout rates would form space-time clusters. From 2014 to 2021, 38.3% and 12.9% of municipalities achieved a coverage ≥ 95.0% in the first and second doses respectively; 53.6% of municipalities had a high dropout rate (20.0% to 49.9%) and 37.2% had a very high dropout rate. The Northeast region had primary clusters for low coverage of the first (2018 to 2021) and second vaccine doses (2020 to 2021) with higher relative risks (RR) compared to other primary clusters. The RR for high dropout rate was elevated in all Brazilian regions (1.57 to 26.23). In some Brazilian regions, the dropout rate has been high since 2014, signaling a risk of measles resurgence. In turn, space-time analysis indicated lower vaccination coverage in 2020, suggesting the influence of the COVID-19 pandemic.

Increased reports of measles in the Metropolitan City of Milan, northern Italy, September 2023 to March 2024.

Since late 2023, the Metropolitan City of Milan and surrounding areas (northern Italy) have been experiencing a resurgence of measles, with most cases detected starting from January 2024. During this brief period, we observed measles in travellers from endemic areas, participants in international events, vaccinees and healthcare workers. Indigenous cases have also been identified. Even though we have not yet identified large and disruptive outbreaks, strengthening surveillance and vaccination activities is pivotal to help limit the impact of measles spread.

The Resurgence of Measles: A Rash From the Past.

Measles, or rubeola, remains a highly contagious infectious disease with a concerning resurgence in the United States. Despite previous control efforts, the number of reported cases continues to rise, surpassing the total for the previous year in just the first quarter of 2024 (CDC, 2024a). Emergency nurse practitioners and other emergency clinicians are likely to encounter patients presenting with concerns of or exposure to measles. However, given the low frequency of cases in the past, many emergency clinicians have likely not previously encountered measles, making identification more challenging. Early recognition and isolation are paramount in containing the spread of this virus and mitigating potential complications. This article aims to provide a review of measles, covering its pathophysiology, clinical presentations, and recommended management strategies for suspected or confirmed cases in emergency care settings.

The Global Resurgence of Measles, Estimating the Risks of International Importations of Measles Among 181 Countries and Territories: a Modelling Study

The Global Resurgence of Measles, Estimating the Risks of International Importations of Measles Among 181 Countries and Territories: a Modelling Study

Dimeric immunoglobulin A as a novel diagnostic marker of measles infection.

The world is facing a measles resurgence, and improved diagnostic tests for measles infection are an urgent World Health Organization research priority. Detection of measles-specific immunoglobulin M (IgM) as a standard diagnostic test has low positive predictive value in elimination settings, and there is a need for new biomarkers of measles infection to enable enhanced surveillance and response to outbreaks. We demonstrate the detection of measles-specific dimeric immunoglobulin A (dIgA) in patients with confirmed measles infections using a new indirect enzyme-linked immunosorbent assay protocol that selects for the dIgA fraction from total IgA in the blood. The magnitude of measles-specific dIgA responses showed a low correlation with IgM responses, and our results highlight the potential of dIgA for further development as an alternative and/or complementary biomarker to IgM for serological diagnosis of measles infection.

Resurgence of measles infection among children: findings from a surveillance-based population study

Background There has been a resurgence of measles infection in countries with high vaccination rates, including Malaysia. Understanding the geographical variation in measles resurgence and associated factors is important for measles prevention and control programs, especially where local information is scarce.&#x0D; Objective To determine the incidence of laboratory-confirmed measles infection and associated factors in the state of Melaka, in the southern region of Malaysia.&#x0D; Methods We obtained measles surveillance data for 4 years (January 2015 to December 2018) from the e-Measles national database. A comparative cross-sectional study was carried out on these data involving children who had been selected through convenience sampling.&#x0D; Results A total of 130 laboratory-confirmed measles cases and 213 non-measles cases were included in the study. Among the laboratory-confirmed cases, 56 (43.1%) had not been vaccinated against measles virus. Thirty-eight cases (51.4%) had received at least one dose of measles vaccine, while 36 cases (48.6%) had completed two doses of measles vaccination. There was a higher risk of contracting laboratory-confirmed measles among unvaccinated children (OR 19.39, 95%CI 8.82 to 42.6, P&lt;0.001) and children aged 8–18 years (OR 0.40, 95% CI 0.21 to 0.76, P=0.005)&#x0D; Conclusion Unvaccinated children and children aged 8–18 years have a higher risk of contracting laboratory-confirmed measles. The policy on routine immunization should be strengthened, the vaccine should be accessible to all children, and all children and adolescents should be given booster vaccinations.

The Resurgence of Measles - A Tragic Residue of Covid Epoch

Measles is a highly contagious, serious viral disease mainly affecting children under the age of five with a case fatality rate ranging from 0.1% 1in developed world to as much as 30% among refugee communities. As of the beginning of November 2022, the most current monthly statistics submitted to the WHO indicated that India was one of the top 10 nations responsible for the highest number of cases (9500 cases) worldwide . The most significant factor was COVID pandemic that had detrimental impact on the main approach including nterruption of health services, supply-chain disruption and routine immunization-measles vaccination campaigns being paused or postponed in many countries to avert further spread of COVID-19 that lead to fall in consumption of MR vaccine in a span of few months after pandemic started. Other contributing factors might include burgeoning migrant community, missed doses of vaccination and malnutriton spike.There is a need to urgently address the basic needs of health care facilities and to fill the gaps in routine immunization and its surveillance system to curb the measles outbreak in this post pandemic era.

Post-COVID-19 Resurgence of Measles in Ahmedabad: A Study of 657 Cases in a Tertiary Care Center

Post-COVID-19 Resurgence of Measles in Ahmedabad: A Study of 657 Cases in a Tertiary Care Center

Hematological and Biochemical Assessment of Children Infected with Measles Virus: 2022 Outbreak in Pakistan

Measles is a contagious disease caused by an RNA virus. Resurgence of measles after Covid-19 and its severity among children has led to many speculations about the Measles vaccination coverage and its efficacy. In this study, the clinical data of children &lt;9 years (n=19) admitted at the Pakistan Institute of Medical Sciences (PIMS) in the measles ward was analyzed. The blood samples were processed for hematology and routine biochemistry tests. The results obtained were statistically analyzed on SPSS-21 software by using One-Way ANOVA for Complete Parameters (CP), Kruskal Wallis, and Mann-Whitney test for Differential leucocyte count (DLC) and Biochemical parameters. A p&lt;0.05 was considered significant. The results suggest no significant difference in Complete blood parameters (CP) among non-vaccinated, partially vaccinated and fully vaccinated patients. Among DLC Basophils level was significantly different (p=0.024), being lower in partially vaccinated than non-vaccinated patients. Biochemical parameters showed that serum urea level was significantly different (p=0.013), showing a decline in fully vaccinated patients as compared to non-vaccinated patients. Moreover, a significantly higher level of Alkaline phosphatase as compared to the normal range was observed in fully vaccinated patients. However, lower levels of MCH, MCV, MCHC, RBC, Hb, eosinophils, and a higher level of RDW-CV were observed overall as compared to the normal range (healthy individuals). The results suggest improvements are needed in vaccination strategies for effectively controlling the disease. Anemic conditions in overall measles patients indicate poor health conditions. This study contains a limited sample size, further research on measles virus (MeV) mutations, and vaccine optimization could be helpful for the complete eradication of measles from Pakistan.

Consciousness of evidence-based medicine in public health emergencies.

Consciousness of evidence-based medicine in public health emergencies.

Epidemija morbila na teritoriji Smedereva

The Republic of Serbia is a country with endemic measles transmission. Decline of MMR immunization coverage resulted in measles resurgence in Serbia at the beginning of 2023. Aim of this study is a description of measles outbreak at the territory of the City of Smederevo between January and April 2023 and identification of interventions for prevention of future measles outbreaks in the Republic of Serbia. The national active measles surveillance data were analysed. The outbreak involved 43 measles cases, of whom 42 were classified as laboratory confirmed and one as epidemiologically linked. Most of cases were aged 1 to 4 years (44.2%) and 20 to 49 years (32.6%) while the highest age-specific incidence rates were registered in children younger than 12 months (80.6/10,000) and children aged 1 to 4 years (50.5/10,000). Most of cases with known vaccination status (92.9%) were unvaccinated including 8 children younger than 12 months not yet eligible for vaccination according to the national immunization schedule. Number of hospitalized cases were 20 (46.5%) including two cases with pneumonia. Among 14 cases who contracted measles in healthcare settings 5 were employees of General Hospital Smederevo. Genom sequencing was performed in 10 cases and B3 genotype of morbilli virus was detected in all cases. In order to prevent future measles outbreaks in the Republic of Serbia it is necessary to achieve and maintain target values of coverage and timeliness of MMR vaccination. Timely notification of suspected cases and diagnosis of measles as well as immunization of susceptible employees of healthcare institutions are key strategies for prevention of measles transmission in healthcare settings.