Resurgence Of Measles Research Articles

Characterisation of measles after the introduction of the combined measles-mumps-rubella (MMR) vaccine in 2004 with focus on the laboratory data, 2016 to 2019 outbreak, Romania.

BackgroundSince January 2016, a resurgence of measles in Romania has led to the third measles epidemic in the past 12 years; 64 deaths have been confirmed so far–the highest number of measles-related deaths since the measles-mumps-rubella (MMR) vaccine was introduced in 2004.AimTo provide an overview on the characterisation on measles in Romania after the introduction of the MMR vaccine with focus on the current outbreak, laboratory and molecular analysis.MethodsWe performed an analysis of measles incidence and mortality after the introduction of MMR vaccination and a retrospective study using serological and molecular data in three consecutive outbreaks with focus on the current outbreak.ResultsIn the current outbreak, 17,533 measles cases were notified to the national surveillance system, 93% were unvaccinated. Measles virus was isolated from 429 samples and 283 were genotyped. Genotype B3 was predominant (n = 269) and sporadic measles cases associated with D8 genotype (n = 9) were also observed; genotype D4 and D8 were identified in the previous two measles outbreaks. The detection of several distinct measles virus B3 genotypes suggests multiple virus importations to Romania.ConclusionThe current outbreak is a consequence of insufficient vaccine coverage. Control measures were implemented to improve uptake of MMR vaccine, including administering the first MMR dose at a younger age (9–11 months) and offering catch-up vaccination to children that have not followed the recommended dosing schedule. More measures are needed to improve the surveillance performance and to achieve high routine MMR vaccination coverage.

Molecular characterization of measles viruses in China: Circulation dynamics of the endemic H1 genotype from 2011 to 2017.

Due to the Expanded Program on Immunization (EPI) and supplementary immunization activities (SIAs) in China, the incidence of measles in China has decreased extensively. The incidence reached its lowest levels in contemporary history in 2012 and 2017, with incidence rates of 4.6 and 4.3 per million population, respectively. However, more than 147,000 measles cases were reported from 2013 to 2016. Furthermore, the proportions of cases in infants < 8 months and adults have been increasing since 2013, representing a considerable challenge for measles elimination in China. A total of 14,868 measles viruses were isolated from confirmed measles cases from 2011 to 2017, of which 14,631 were identified as the predominant endemic genotype, H1; 87 were identified as genotype A viruses that were vaccine associated strains; and 150 were identified as non-H1 genotype viruses. The non-H1 genotype viruses included 62 D8 viruses, 70 D9 viruses, 3 D11 viruses, 14 B3 viruses, and 1 G3 virus, which were identified as imported or import-related viruses that caused sporadic cases or small outbreaks. Most of the transmission chains detected during the period 2011–2012 were interrupted and were followed by many new transmission chains of unknown origin that spread, causing a large measles resurgence in China during 2013–2016. After 4 years of measles resurgence and continuous implementation of the routine immunization program and SIAs, the population immunity reached a sufficiently high level to interrupt most of the transmission chains; only a few strains survived, which continued to be sporadically detected in China in 2017. In the present study, the results from the combined epidemiological and molecular virological data demonstrated the great progress towards measles elimination in China by the further analysis of circulation dynamics for the endemic H1 genotype measles virus from 2011 to 2017. And this study accumulated critical baseline data on circulating wild-type measles viruses in China and provides comprehensive information to the world. These comprehensive baseline data provide evidence to support measles elimination in the future, not only in China but also in other countries worldwide. In addition, the information will be very useful to other countries for tracing their sources of measles cases and for identifying transmission links, which can help prevent potential measles outbreaks.

The introduction of \u2018No jab, No school\u2019 policy and the refinement of measles immunisation strategies in high-income countries

BackgroundIn recent years, we witnessed a resurgence of measles even in countries where, according to WHO guidelines, elimination should have already been achieved. In high-income countries, the raise of anti-vaccination movements and parental vaccine hesitancy are posing major challenges for the achievement and maintenance of high coverage during routine programmes. Italy and France approved new regulations, respectively in 2017 and 2018, aimed at raising immunisation rates among children by introducing mandatory vaccination at school entry.MethodsWe simulated the evolution of measles immunity profiles in seven distinct countries for the period 2018–2050 and evaluated the effect of possible adjustments of immunisation strategies adopted in the past on the overall fraction and age distribution of susceptible individuals in different high-income demographic settings. The proposed model accounts for country-specific demographic components, current immunity gaps and immunisation activities in 2018. Vaccination strategies considered include the enhancement of coverage for routine programmes already in place and the introduction of a compulsory vaccination at primary school entry in countries where universal school enrolment is likely achieved.ResultsOur model shows that, under current vaccination policies, the susceptible fraction of the population would remain below measles elimination threshold only in Singapore and South Korea. In the UK, Ireland, the USA and Australia either the increase of coverage of routine programmes above 95% or the introduction of a compulsory vaccination at school entry with coverage above 40% are needed to maintain susceptible individuals below 7.5% up to 2050. Although the implementation of mandatory vaccination at school entry would be surely beneficial in Italy, strategies targeting adults would also be required to avoid future outbreaks in this country.ConclusionsCurrent vaccination policies are not sufficient to achieve and maintain measles elimination in most countries. Strategies targeting unvaccinated children before they enter primary school can remarkably enhance the fulfilment of WHO targets.

Measles resurgence in the USA: how international travel compounds vaccine resistance

Measles resurgence in the USA: how international travel compounds vaccine resistance

Is the global measles resurgence a “public health emergency of international concern”?

Is the global measles resurgence a “public health emergency of international concern”?

The MMR Vaccine and Autism.

Autism is a developmental disability that can cause significant social, communication, and behavioral challenges. A report published in 1998, but subsequently retracted by the journal, suggested that measles, mumps, and rubella (MMR) vaccine causes autism. However, autism is a neurodevelopmental condition that has a strong genetic component with genesis before one year of age, when MMR vaccine is typically administered. Several epidemiologic studies have not found an association between MMR vaccination and autism, including a study that found that MMR vaccine was not associated with an increased risk of autism even among high-risk children whose older siblings had autism. Despite strong evidence of its safety, some parents are still hesitant to accept MMR vaccination of their children. Decreasing acceptance of MMR vaccination has led to outbreaks or resurgence of measles. Health-care providers have a vital role in maintaining confidence in vaccination and preventing suffering, disability, and death from measles and other vaccine-preventable diseases.

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.

Anti-Vaccine Decision-Making and Measles Resurgence in the United States.

Measles outbreaks in 2019 reached emergency levels in the United States, in addition to other countries such as the Philippines, Ukraine, Venezuela, Brazil, Italy, France, and Japan.1 The aim of our article is to provide an overview of the major social, psychological, and technological factors that led to these outbreaks in the United States. We also explore the policy landscape and potential solutions for public health researchers. Specifically, we address the social and contextual factors can provide health professionals with tools to develop an effective pro-vaccine response campaign for this highly contagious, preventable disease.

Highlights in this issue

Measles is one of the most contagious infectious diseases. Before the introduction of an efficient vaccine, it is estimated that there were 30 million cases and two million deaths each year, mostly among children in low-income countries. During the 1980s, measles was almost eliminated in many European countries. An editorial by Leif Dotevall 1 discusses the paradoxical and painful resurgence of measles in Europe in the last few years and highlights the need to regain confidence in immunisation. In a double-blind randomised study, Wejryd et al. gave 134 extremely low-birthweight infant oil drops containing the probiotic Lactobacillus reuteri DSM 17938 or a placebo. They did this once a day until the infants reached 36 weeks of gestation 2. The authors found that the probiotic did not reduce the time it took the infants to reach full enteral feeds. However, the infants who received the probiotic supplements had a better head growth rate during the first month of life. Claris 3 comments on the findings. This issue includes three reviews on paediatric hypertension. Wühl 4 shows that hypertension in childhood obesity was associated with significantly increased cardiovascular morbidity and mortality and states that early diagnosis and treatment for blood pressure control and weight reduction are essential. Meanwhile, Krmar 5 reviewed the prevalence of white-coat hypertension from a paediatric perspective and reports that this condition was best diagnosed in children by using ambulatory blood pressure monitoring over a 24-hour period. Carlström 6 studied hydronephrosis, and the risk of later hypertension, and points out that today's nonoperative management of hydronephrosis should be reconsidered to reduce the risk of developing elevated blood pressure or hypertension later in life. In 2014, an outbreak of group B streptococcus caused severe late-onset septicaemia in five very preterm infants and colonisation in 10 more infants in a neonatal intensive care unit (NICU) in Sweden. Åberg et al. 7 analysed the course of the outbreak, to find tools that stopped it from happening again. Meanwhile, Rønning et al. 8 adopted a similar approach to investigate an outbreak caused by antibiotic-susceptible Klebsiella oxytoca in a Norwegian NICU. The authors concluded that appropriate microbiological molecular screening methods and strict infection control measures are important, in order to control an outbreak. Readers may also be interested in the paper by Özenci and Schubert 9, which evaluated the implementation of an earlier, and more targeted, treatment of neonatal sepsis. The number of child deaths fell in Sweden from 2000 to 2014, but as many as 25% were from badly defined external causes or unknown causes, according to a study by Otterman et al. 10. A sizeable number of deaths were registered without death certificates, especially for infants. The authors conclude that systematic death reviews could yield information that could prevent future deaths. Palusci 11 comments on the findings. Readers may also be interested in the paper by Lykke et al. 12 on child mortality rates in Denmark, which we published in 2018, and the accompanying editorial by Kreicbergs 13, who discussed why and where children die. Figures 1–5. Istockphoto.com.

State of immunization against measles among health professionals in at-risk units of the Caen University Hospital

France is facing a new resurgence of measles. Since November 2017, the number of cases has been increasing sharply. Immunization coverage in the general population, all ages combined, is below the threshold required for a rapid decline of the virus propagation. Regarding health professionals, the rate of immunization against this disease is insufficiently documented. In this context, the Occupational Health Service of the University Hospital of Caen has carried out an inventory of health personnel knowledge of immunization against measles in the units the most exposed to risk. Knowledge of immunization against measles was studied in pediatric, imaging, and pediatric and adult emergencies departments of the University Hospital of Caen, and the Hematology Institute of Lower Normandy (IHBN). The analysis included all health professionals present within these units during the study period: March and April 2018. Data collection was carried out by consulting the medical files of the occupational health unit and considering the set of responses to postal inquiries sent to staff. Measured immunization status data refer to 1017 health professionals. Based on the criteria specific to the recommendations, 234 (50.6%) of the 462 professionals born before 1980 and 437 (78.7%) of the 555 professionals born in or after 1980 could be considered as immune. Of the total sample, 115 (11.3%) had positive measles serology. Among these 1017 professionals, information on the state of immunization against measles was lacking for 174 (17.1%). The state of immunization of the nursing staff remains insufficient to prevent the occurrence of measles cases and the staff is also insufficiently informed. It is essential to have knowledge of the immunization status of this population, to organize the vaccination of non-immunized personnel within the occupational health unit, to prevent the emergence of new cases of measles and to reinforce the information regarding the importance of precautions related to airborne transmission in case of measles.

Progress Toward Regional Measles Elimination - Worldwide, 2000-2017.

In 2010, the World Health Assembly set three milestones for measles prevention to be achieved by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district; 2) reduce global annual measles incidence to less than five cases per million population; and 3) reduce global measles mortality by 95% from the 2000 estimate (1).* In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP),† with the objective of eliminating measles§ in four of the six World Health Organization (WHO) regions by 2015 and in five regions by 2020. Countries in all six WHO regions have adopted goals for measles elimination by 2020. This report describes progress toward global measles control milestones and regional measles elimination goals during 2000-2017 and updates a previous report (2). During 2000-2017, estimated MCV1 coverage increased globally from 72% to 85%; annual reported measles incidence decreased 83%, from 145 to 25 cases per million population; and annual estimated measles deaths decreased 80%, from 545,174 to 109,638. During this period, measles vaccination prevented an estimated 21.1 million deaths. However, measles elimination milestones have not been met, and three regions are experiencing a large measles resurgence. To make further progress, case-based surveillance needs to be strengthened, and coverage with MCV1 and the second dose of measles-containing vaccine (MCV2) needs to increase; in addition, it will be important to maintain political commitment and ensure substantial, sustained investments to achieve global and regional measles elimination goals.

Monitoring the age-specificity of measles transmissions during 2009-2016 in Southern China.

BackgroundDespite several immunization efforts, China saw a resurgence of measles in 2012. Monitoring of transmissions of individuals from different age groups could offer information that would be valuable for planning adequate disease control strategies. We compared the age-specific effective reproductive numbers (R) of measles during 2009–2016 in Guangdong, China.MethodsWe estimated the age-specific R values for 7 age groups: 0–8 months, 9–18 months, 19 months to 6 years, 7–15 years, 16–25 years, 26–45 years, and ≥46 years adapting the contact matrix of China. The daily numbers of laboratory and clinically confirmed cases reported to the Center for Disease Control and Prevention of Guangdong were used.ResultsThe peak R values of the entire population were above unity from 2012 to 2016, indicating the persistence of measles in the population. In general, children aged 0–6 years and adults aged 26–45 years had larger values of R when comparing with other age groups after 2012. While the peaks of R values for children aged 0–6 years dropped steadily after 2013, the peaks of R values for adults aged 26–45 years kept at a high range every year.ConclusionsAlthough the provincial supplementary immunization activities (SIAs) conducted in 2009 and 2010 were able to reduce the transmissions from 2009 to 2011, larger values of R for children aged 0–6 years were observed after 2012, indicating that the benefits of the SIAs were short-lived. In addition, the transmissions from adults aged between 26 and 45 years increased over time. Disease control strategies should target children and adult groups that carry high potential for measles transmission.

L’affaire Wakefield et le mouvement anti-vaccination

The focus on the controversy on autism and MMR vaccine aims to show how an identified and revealed fraud may still influence people. To a large extent, this controversy relies on a 1998 Wakefield's publication with clear falsification of data. In 2009, after 7 years of investigation, Brian Deer provide evidence of a deliberate fraud and Wakefield's conflict of interest through his involvement with a lawsuit against manufacturers of the MMR Vaccine. The rise of the anti-vaccination movement, the influence of parents’ associations, and the declining trust in state institutions are analyzed to better understand the impact of this publication on the decrease of vaccination and the resurgence of measles, mumps, rubella, poliomyelitis, diphtheria, and pertussis.

Resurgence of measles and mumps: not just a childhood problem.

Resurgence of measles and mumps: not just a childhood problem.

Many Inflammatory Bowel Disease Patients Are Not Immune to Measles or Pertussis.

Current guidelines emphasize vaccination for influenza and pneumococcus for IBD patients and the avoidance of live virus vaccines for those who are on immunosuppressive (ISS) therapy. Given the recent resurgence of measles and pertussis infections, we assessed the immune status of our IBD population in order to advise about these risks. We prospectively collected measles and pertussis titers in our IBD patients from February 1-May 1, 2015. Immune status based on standard threshold values was determined: measles antibodies ≤0.8 antibody index (AI)=negative immunity, 0.9-1.1 AI=equivocal immunity and titers ≥1.2 AI=positive immunity. For pertussis immunity, anti-pertussis antibodies ≤5IU/mL were considered negative immunity. Univariate analysis was performed to examine predictive factors including age, disease duration, and current medical therapies. A total of 122 patients' titers were assessed (77 Crohn's disease, 1 indeterminate colitis, and 45 ulcerative colitis). Sixteen (13.1%) patients lacked detectable immunity to measles, and four (3%) had equivocal immunity. Twelve (75%) of the measles non-immune patients were on ISS therapy versus 65 (64%) of 102 immune patients (OR 1.7, 95% CI 0.5-5.9, p=0.34). Out of 96 patients, 58 (60%) were not immune to pertussis. Disease duration ≥10years and age ≥50 were associated with significant lower measles titers. A significant number of our IBD patients lack immunity to measles, and a majority of our IBD patients do not have detectable immunity to pertussis. Importantly, the majority of the measles non-immune patients are on ISS therapy and therefore unable to receive a booster.

Ebola Scare and Measles Resurgence: Mandatory Isolation/quarantine and Vaccination

Public outcry for radical isolation and quarantine policies followed the first Ebola diagnosis in the United States when Eric Duncan, upon his return home Oct 2014 from West Africa, then in the midst of a catastrophic Ebola epidemic, tested positive for Ebola. Likewise, the Dec 2014 Disneyland measles outbreak unleashed an angry backlash against parents who refused to have their children vaccinated; and there was public momentum to repeal all legal exemptions to mandatory vaccination of school children. This paper presents an ethical and legal analysis to adjudicate the issue which is at stake in both controversies; namely the inherent conflict between individual rights v. public health when the nation is threatened by serious communicable disease. It presents reasoned arguments, weighing duty-based v. consequence-maximizing ethical principles of right action through application of the felicity calculus (net utility). And the paper demonstrates how the metaethical theory of emotivism is operative in formation and expression of public sentiment which fueled the ethical and legal deliberations.

Measles vaccine: Past, present, and future.

Abstract Measles a highly contagious viral disease continues to cause childhood mortality worldwide. Measles outbreaks are increasingly reported in the US and Europe. This resurgence of measles makes it opportune to review the biology of the measles virus, clinical manifestations of infection and the pharmacology of the measles vaccine. Though measles vaccine is highly immunogenic and safe, sustaining high vaccination rates is essential to maintain measles eradication in the US. This article is protected by copyright. All rights reserved.

Resurgence of measles in Serbia 2010-2011 highlights the need for supplementary immunization activities.

Between December 2010 and August 2011 an outbreak of measles occurred in Serbia with 363 reported cases. Sera and/or nose/throat swabs were collected from 193 patients and tested for measles-specific IgM antibodies by ELISA and viral RNA by RT-PCR, respectively. Epidemiological data were obtained from the surveillance database of the Institute of Public Health of Serbia. Of the 363 cases involved in the outbreak, 113 were laboratory confirmed. More than one third of the patients were hospitalized (n = 130, 35·8%) and for 15 (4·1% of the reported outbreak cases) the infection was complicated by pneumonia. Mostly pre-school children aged ⩽4 years (37·8%) and adults aged ⩾30 years (27·3%) were affected. The majority of patients belonged to the Roma population with a preponderance of female cases (57·0%). Nearly 94% of the patients were either unvaccinated or of unknown vaccination status. The main outbreak virus was the D4-Hamburg strain. The outbreak in Serbia occurred after several years of very low measles incidence despite a high routine immunization coverage in the general population, suggesting that special efforts to identify and vaccinate susceptible population groups are required even in countries with apparently good disease control.

Measles Vaccine Administered to a Crohnʼs Disease Patient Receiving Vedolizumab

Introduction: Patients with IBD on immunosuppressive therapy (ISS) with thiopurines, methotrexate or anti-TNF biologics are advised against receiving live virus vaccines due to concern about infections. In addition, it is known that there is an attenuated immune response to vaccines in patients receiving immune suppression. Vedolizumab is a gut-selective α4β7 anti- integrin monoclonal antibody approved by the FDA for the treatment of moderately to severely active Crohn's disease and ulcerative colitis. We report a case of a patient successfully vaccinated against measles virus while on vedolizumab therapy. Case Description: A 26 year old female with Crohn's ileocolitis was receiving vedolizumab and methotrexate 15 mg PO/week. She reported having received prior measles, mumps, rubella (MMR) vaccination in childhood. Due to a nation-wide measles resurgence, we assessed her measles titers to advise her of her risk of infection. Her measles antibody index (AI) was 0.7 (negative). We instructed her to stop the methotrexate and to continue the vedolizumab. Two weeks after stopping the methotrexate, she received the MMR vaccine. The methotrexate was restarted 4 weeks later. Measles AI 8 weeks after the MMR vaccine was 2.06 (positive). In 2 months follow up after she received the vaccine, there have been no adverse sequelae. Discussion: This case describes a novel approach to the MMR vaccination process in an IBD patient on vedolizumab with methotrexate. Although current guidelines state that MMR vaccine is contraindicated among immunocompromised IBD patients and should not be given to patients expected to start immunosuppressive agents within 6 weeks (1), these guidelines do not address organ-selective anti-integrin therapies. We believe that the gut-selective activity of vedolizumab allows for safe and effective administration of live virus vaccinations.Table 1: Summary of Measles IgG Antibody Index Before and After MMR Booster Administration

Vaccines are Good - Disease is Bad: Current Exemptions Laws and Trends in Arizona and the Effect it Has on Public Health

State laws require children to be vaccinated in order to attend private, public and charter school. However, some states allow the parent to exempt their child from immunization requirements for personal or religious beliefs. These exemptions are referred to as, exemptionsOver the last decade communities locally in Arizona and Nationally have experienced an increase in non-medical exemptions from state required immunizations. As exemptions increase there is a corresponding decrease in coverage. The decreasing coverage slowly chips away at the fragile herd immunity that the community relies upon. For highly infectious diseases such as measles, 95% coverage is ideal to create herd immunity. Communities across the country are falling below this threshold and as a result the nation is experiencing a resurgence of measles, a disease that for the last 20 years was rarely heard of. This manuscript reviews current exemption laws in Arizona and nationally and the effect it has on the community. Ultimately, the manuscript proposes changes to the Arizona Revised Statutes and Arizona Administrative Code, to address the rising exemption rates. These proposed changes could be applied in other states as well.