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BMJ (Clinical Research Ed.) Oct 2016To evaluate the effects on non-specific and all cause mortality, in children under 5, of Bacillus Calmette-Guérin (BCG), diphtheria-tetanus-pertussis (DTP), and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To evaluate the effects on non-specific and all cause mortality, in children under 5, of Bacillus Calmette-Guérin (BCG), diphtheria-tetanus-pertussis (DTP), and standard titre measles containing vaccines (MCV); to examine internal validity of the studies; and to examine any modifying effects of sex, age, vaccine sequence, and co-administration of vitamin A.
DESIGN
Systematic review, including assessment of risk of bias, and meta-analyses of similar studies.
STUDY ELIGIBILITY CRITERIA
Clinical trials, cohort studies, and case-control studies of the effects on mortality of BCG, whole cell DTP, and standard titre MCV in children under 5.
DATA SOURCES
Searches of Medline, Embase, Global Index Medicus, and the WHO International Clinical Trials Registry Platform, supplemented by contact with experts in the field. To avoid overlap in children studied across the included articles, findings from non-overlapping birth cohorts were identified.
RESULTS
Results from 34 birth cohorts were identified. Most evidence was from observational studies, with some from short term clinical trials. Most studies reported on all cause (rather than non-specific) mortality. Receipt of BCG vaccine was associated with a reduction in all cause mortality: the average relative risks were 0.70 (95% confidence interval 0.49 to 1.01) from five clinical trials and 0.47 (0.32 to 0.69) from nine observational studies at high risk of bias. Receipt of DTP (almost always with oral polio vaccine) was associated with a possible increase in all cause mortality on average (relative risk 1.38, 0.92 to 2.08) from 10 studies at high risk of bias; this effect seemed stronger in girls than in boys. Receipt of standard titre MCV was associated with a reduction in all cause mortality (relative risks 0.74 (0.51 to 1.07) from four clinical trials and 0.51 (0.42 to 0.63) from 18 observational studies at high risk of bias); this effect seemed stronger in girls than in boys. Seven observational studies, assessed as being at high risk of bias, have compared sequences of vaccines; results of a subset of these suggest that administering DTP with or after MCV may be associated with higher mortality than administering it before MCV.
CONCLUSIONS
Evidence suggests that receipt of BCG and MCV reduce overall mortality by more than would be expected through their effects on the diseases they prevent, and receipt of DTP may be associated with an increase in all cause mortality. Although efforts should be made to ensure that all children are immunised on schedule with BCG, DTP, and MCV, randomised trials are needed to compare the effects of different sequences.
Topics: BCG Vaccine; Child; Child, Preschool; Diphtheria; Diphtheria-Tetanus-Pertussis Vaccine; Evidence-Based Medicine; Female; Humans; Immunization Schedule; Infant; Male; Measles; Measles Vaccine; Mortality; Tetanus; Tuberculosis; United Kingdom; Vaccination; Whooping Cough
PubMed: 27737834
DOI: 10.1136/bmj.i5170 -
Cureus Jul 2019Although measles was eradicated in the United States in 2000, there has been an increasing number of cases. As of April 4, 2019, the Centers for Disease Control and... (Review)
Review
Although measles was eradicated in the United States in 2000, there has been an increasing number of cases. As of April 4, 2019, the Centers for Disease Control and Prevention (CDC) reported 465 cases of measles as compared to 372 in 2018. Pockets of unvaccinated communities and travelers bringing measles from countries with large outbreaks are attributed to the rise in cases in the United States. With the increasing anti-vaccine sentiment, it's imperative to take preventative measures to avoid the proliferation of deadly diseases. The objective of this study was to determine effective techniques to decrease vaccine refusal and increase the childhood vaccination rate. To this effect, a systematic review of English peer-reviewed articles published in the years 2000 to 2019 using Arizona State University's online database was conducted. The titles, abstracts, and discussions for each journal article were screened for methods that promote vaccination. Any articles that included vaccine development, promoting vaccination coverage rate in developing countries, pregnant women, healthcare workers, and animals, and promoting the uptake of vaccines that aren't part of CDC's seven-vaccine series were excluded. A total of nine journal articles were identified, including five systematic reviews, one case study, a randomized controlled trial, a literature review, and a quasi-experimental study. The methods discovered pertained to three themes: technological, mass marketing or campaigning, and direct communication. The Guide to Tailored Immunization Programme (TIP) in conjunction with visually enhanced educational materials and storytelling articles were found to be effective tools in encouraging vaccination coverage. The basis of any strategy is determining the perspective and needs of the target population and tailoring the approaches to match them to alleviate barriers that hinder vaccination uptake. The use of technology perpetuates the efficacy of social marketing strategies, further promoting vaccines and their benefits.
PubMed: 31516778
DOI: 10.7759/cureus.5067 -
Clinical Infectious Diseases : An... Aug 2019The World Health Organization (WHO) recommends an additional dose of measles-containing vaccine (MCV) for human immunodeficiency virus (HIV)-infected children receiving...
BACKGROUND
The World Health Organization (WHO) recommends an additional dose of measles-containing vaccine (MCV) for human immunodeficiency virus (HIV)-infected children receiving highly active antiretroviral therapy following immune reconstitution. We conducted a systematic review to synthesize available evidence regarding measles seroprevalence and measles vaccine immunogenicity, efficacy, and safety in HIV-infected adolescents and adults to provide the evidence base for recommendations on the need for measles vaccination.
METHODS
We conducted searches of 8 databases through 26 September 2017. Identified studies were screened independently by 2 reviewers.
RESULTS
The search identified 30 studies meeting inclusion criteria. Across studies, measles seroprevalence among HIV-infected adolescents and adults was high (median, 92%; 27 studies), with no significant difference compared to HIV-uninfected participants (10 studies). In 6 studies that evaluated the immunogenicity of MCVs among seronegative HIV-infected adults, measles seropositivity at end of follow-up ranged from 0% to 56% (median, 39%). No severe adverse events were reported following measles vaccination in HIV-infected patients.
CONCLUSIONS
Based on similar measles seroprevalence between HIV-infected and HIV-uninfected adolescents and adults, and the low response to vaccination, these studies do not support the need for an additional dose of MCV in HIV-infected adolescents and adults. These findings support WHO guidelines that measles vaccine be administered to potentially susceptible, asymptomatic HIV-infected adults, and may be considered for those with symptomatic HIV infection if not severely immunosuppressed. Measles-susceptible adolescents and adults, regardless of HIV status, may require targeted vaccination efforts to reach critical vaccination thresholds and achieve regional elimination goals.
Topics: Adolescent; Adult; Antibodies, Viral; Antiretroviral Therapy, Highly Active; HIV Infections; Humans; Immunogenicity, Vaccine; Measles; Measles Vaccine; Seroepidemiologic Studies
PubMed: 30452621
DOI: 10.1093/cid/ciy980 -
International Journal of Public Health Sep 2016Despite the availability of vaccines and the existence of public vaccination recommendations, outbreaks of vaccine-preventable childhood diseases still cause public... (Review)
Review
OBJECTIVES
Despite the availability of vaccines and the existence of public vaccination recommendations, outbreaks of vaccine-preventable childhood diseases still cause public health debate. The objective of this systematic review was to provide an overview of the current epidemiology and economic burden of measles, mumps, pertussis, and varicella in Germany.
METHODS
We systematically reviewed studies published since 2000. The literature search was conducted using PubMed and EMBASE. Also, we used German notification data to give an up-to-date overview of the epidemiology of the four diseases under consideration.
RESULTS
Thirty-six studies were included in our review. Results suggest that there is still considerable morbidity due to childhood diseases in Germany. Studies providing cost estimates are scarce. Comparative analyses of different data sources (notification data vs. claims data) revealed a potential underestimation of incidence estimates when using notification data. Furthermore, several studies showed regional differences in incidence of some of the diseases under consideration.
CONCLUSIONS
Our findings underline the need for improved vaccination and communication strategies targeting all susceptible age and risk groups on a national and local level.
Topics: Chickenpox; Chickenpox Vaccine; Germany; Humans; Incidence; Measles; Measles-Mumps-Rubella Vaccine; Mumps; Vaccines, Combined; Virus Diseases; Whooping Cough
PubMed: 27488917
DOI: 10.1007/s00038-016-0842-8 -
Dermatology Online Journal Mar 2020New treatment options for warts include intralesional wart injection with agents such as vitamin D, measles, mumps, and rubella (MMR) vaccine antigen, Bacillus...
BACKGROUND
New treatment options for warts include intralesional wart injection with agents such as vitamin D, measles, mumps, and rubella (MMR) vaccine antigen, Bacillus Calmette-Guerin (BCG) antigen, and candida antigen but there have been limited studies to compare their efficacies.
OBJECTIVE
The purpose of this systematic review is to compare the efficacy and safety of injectable agents used for the treatment of warts.
METHODS
A PubMed search included terms "intralesional wart therapy," "wart injection" and "verruca injection." Articles reviewed were published over 10 years.
RESULTS
A total of 43 articles were reviewed; 30 covered studies with more than 10 participants and 13 were case reports, case series, and reviews. In comparison studies intralesional agents have equal or superior efficacy (66%-94.9%) compared to first-line salicylic acid or cryotherapy (65.5-76.5%). One advantage of intralesional injections is the rate of complete resolution of distant warts.
LIMITATIONS
Each study varied in their agents, treatment interval, and treatment dose, making comparisons difficult.
CONCLUSIONS
Intralesional wart injections are safe, affordable, and efficacious treatments for warts. Physicians should consider intralesional injections for patients with refractory warts, multiple warts, or warts in sensitive areas.
Topics: Aminolevulinic Acid; Anti-Bacterial Agents; Antiviral Agents; BCG Vaccine; Bacterial Vaccines; Humans; Injections, Intralesional; Interferon-alpha; Mycobacterium; Tuberculin; Vitamin D; Warts
PubMed: 32609439
DOI: No ID Found -
Vaccine May 2021In North America, the first dose of a measles-containing vaccine (MCV1) is administered at ≥12 months of age. However, MCV1 may be given to infants <12 months living... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In North America, the first dose of a measles-containing vaccine (MCV1) is administered at ≥12 months of age. However, MCV1 may be given to infants <12 months living in highly endemic areas or traveling to these areas. Although an early dose of MCV1 leads to immediate protection, it remains unclear how this impacts long-term immunity.
METHODS
This systematic review and meta-analysis evaluates the impact of MCV1 given at <12 months vs. ≥12 months of age on long-term immunogenicity and vaccine effectiveness, with long-term defined as at least one-year post-vaccination. PubMed, EMBASE, Global Health, Web of Science and Scopus were searched on October 31st, 2019. Studies were included if they included a cohort of infants vaccinated <12 months of age and evaluated long-term immunogenicity, vaccine efficacy, or effectiveness.
RESULTS
A total of 51 texts were identified: 23 reported outcomes related to vaccine effectiveness and 30 to immunogenicity. Infants vaccinated with MCV1 < 12 months of age showed an overall higher risk of measles compared to ≥12 months of age (RR = 3.16, 95% CI: 2.00, 5.01; OR = 2.46, 95% CI: 1.40, 4.32). Risk of measles decreased with increasing age at first vaccination, with those vaccinated with one dose ≥15 months at a lesser risk compared to 12-14 months or <12 months. Measles seroconversion and seropositivity was not affected by age at first vaccination, but antibody levels were significantly lower in the MCV1 < 12-month group (MD = -0.40, 95% CI: -0.71, -0.09).
CONCLUSION
Long-term measles seroconversion and seropositivity did not appear to be affected by age at MCV1, while vaccine effectiveness decreased with younger age. There was not enough evidence to look at the effect of age at MCV1 on immune blunting.
Topics: Antibodies, Viral; Humans; Immunization Schedule; Infant; Measles; Measles Vaccine; Measles virus; North America; Vaccination
PubMed: 33926750
DOI: 10.1016/j.vaccine.2021.04.012 -
PharmacoEconomics May 2023Economic evaluations of vaccines should accurately represent all relevant economic and health consequences of vaccination, including losses due to adverse events...
Accounting for Adverse Events Following Immunization in Economic Evaluation: Systematic Review of Economic Evaluations of Pediatric Vaccines Against Pneumococcus, Rotavirus, Human Papillomavirus, Meningococcus and Measles-Mumps-Rubella-Varicella.
OBJECTIVES
Economic evaluations of vaccines should accurately represent all relevant economic and health consequences of vaccination, including losses due to adverse events following immunization (AEFI). We investigated to what extent economic evaluations of pediatric vaccines account for AEFI, which methods are used to do so and whether inclusion of AEFI is associated with study characteristics and the vaccine's safety profile.
METHODS
A systematic literature search (MEDLINE, EMBASE, Cochrane Systematic Reviews and Trials, Database of the Centre for Reviews and Dissemination of the University of York, EconPapers, Paediatric Economic Database Evaluation, Tufts New England Cost-Effectiveness Analysis Registry, Tufts New England Global Health CEA, International Network of Agencies for Health Technology Assessment Database) was performed for economic evaluations published between 2014 and 29 April 2021 (date of search) pertaining to the five groups of pediatric vaccines licensed in Europe and the United States since 1998: the human papillomavirus (HPV) vaccines, the meningococcal vaccines (MCV), the measles-mumps-rubella-varicella (MMRV) combination vaccines, the pneumococcal conjugate vaccines (PCV) and the rotavirus vaccines (RV). Rates of accounting for AEFI were calculated, stratified by study characteristics (e.g., region, publication year, journal impact factor, level of industry involvement) and triangulated with the vaccine's safety profile (Advisory Committee on Immunization Practices [ACIP] recommendations and information on safety-related product label changes). The studies accounting for AEFI were analyzed in terms of the methods used to account for both cost and effect implications of AEFI.
RESULTS
We identified 112 economic evaluations, of which 28 (25%) accounted for AEFI. This proportion was significantly higher for MMRV (80%, four out of five evaluations), MCV (61%, 11 out of 18 evaluations) and RV (60%, nine out of 15 evaluations) compared to HPV (6%, three out of 53 evaluations) and PCV (5%, one out of 21 evaluations). No other study characteristics were associated with a study's likelihood of accounting for AEFI. Vaccines for which AEFI were more frequently accounted for also had a higher frequency of label changes and a higher level of attention to AEFI in ACIP recommendations. Nine studies accounted for both the cost and health implications of AEFI, 18 studies considered only costs and one only health outcomes. While the cost impact was usually estimated based on routine billing data, the adverse health impact of AEFI was usually estimated based on assumptions.
DISCUSSION
Although (mild) AEFI were demonstrated for all five studied vaccines, only a quarter of reviewed studies accounted for these, mostly in an incomplete and inaccurate manner. We provide guidance on which methods to use to better quantify the impact of AEFI on both costs and health outcomes. Policymakers should be aware that the impact of AEFI on cost-effectiveness is likely to be underestimated in the majority of economic evaluations.
Topics: Child; Humans; Chickenpox; Cost-Benefit Analysis; Streptococcus pneumoniae; Human Papillomavirus Viruses; Rotavirus; Neisseria meningitidis; Mumps; Papillomavirus Infections; Vaccination; Immunization; Measles; Rotavirus Vaccines; Rubella
PubMed: 36809673
DOI: 10.1007/s40273-023-01252-z -
The Lancet. Infectious Diseases Feb 2021Despite the universal use of the two-dose trivalent measles-mumps-rubella (MMR) vaccine in the past two decades, outbreaks of these diseases still occur in countries... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite the universal use of the two-dose trivalent measles-mumps-rubella (MMR) vaccine in the past two decades, outbreaks of these diseases still occur in countries with high vaccine uptake, giving rise to concerns about primary and secondary failure of MMR vaccine components. We aimed to provide seroconversion and waning rate estimates for the measles, mumps, and rubella components of MMR vaccines.
METHODS
In this systematic review and meta-analysis we searched PubMed (including MEDLINE), Web of Science, and Embase for randomised controlled trials, cohort studies, or longitudinal studies reporting the immunogenicity and persistence of MMR vaccines, published in English from database inception to Dec 31, 2019. Studies were included if they investigated vaccine-induced immunity in healthy individuals who received a trivalent MMR vaccine, including different dosages and timepoints of vaccine administration. Studies featuring coadministration of MMR with other vaccines, maternal immunity to the MMR vaccine, or non-trivalent formulations of the vaccine were excluded. Pooled seroconversion and waning rates were estimated by random-effects meta-analyses. This study is registered with PROSPERO, CRD42019116705.
FINDINGS
We identified 3615 unique studies, 62 (1·7%) of which were eligible for analysis. Estimated overall seroconversion rates were 96·0% (95% CI 94·5-97·4; I=91·1%) for measles, 93·3% (91·1-95·2; I=94·9%) for mumps when excluding the Rubini strain, 91·1% (87·4-94·1; I=96·6%) for mumps when including the Rubini strain, and 98·3% (97·3-99·2; I=93·0%) for rubella. Estimated overall annual waning rates were 0·009 (95% CI 0·005-0·016; I=85·2%) for measles, 0·024 (0·016-0·039; I=94·7%) for mumps, and 0·012 (0·010-0·014; I=93·3%) for rubella.
INTERPRETATION
Our meta-analysis provides estimates of primary and secondary vaccine failure, which are essential to improve the accuracy of mathematical and statistical modelling to understand and predict the occurrence of future measles, mumps, and rubella outbreaks in countries with high vaccine uptake.
FUNDING
European Research Council.
Topics: Antibodies, Viral; Humans; Immunogenicity, Vaccine; Measles; Measles-Mumps-Rubella Vaccine; Mumps; Rubella
PubMed: 32888410
DOI: 10.1016/S1473-3099(20)30442-4 -
Vaccine Feb 2018Most infants are born with immunity to measles through maternal antibodies transferred in pregnancy, which decay over time. However, in measles elimination settings,... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Most infants are born with immunity to measles through maternal antibodies transferred in pregnancy, which decay over time. However, in measles elimination settings, where measles does not circulate endemically and most immunity is from immunization rather than infection, maternal antibody levels are lower. This results in infant immunity that wanes earlier, and a wider susceptibility gap between maternal antibody decay and infant immunization than in non-eliminated settings. We aimed to systematically quantify the extent and duration of protection from measles in infants in settings that have sustained measles elimination.
METHODS
We conducted a systematic review of studies of measles maternal antibody waning in infants in measles elimination settings. We searched MEDLINE, Embase, CINAHL, Scopus, BIOSIS Previews, and Global Health databases for relevant studies. Studies were included if they were set in countries that had eliminated measles for ≥3 years, and if the study cohort included healthy, full-term, unvaccinated infants ≤12 months, born to healthy mothers, and reported a relevant measure of measles maternal antibody in infants. We assessed study quality using the MetaQAT tool.
RESULTS
We identified 4692 unique citations, eight of which met inclusion criteria. One study reported anti-measles antibody in cord blood, six reported antibody in infant sera, and one reported both. Two studies reported that 80 and 100% of infants were protected from measles at birth. One study reported no protection amongst 3-7 month old infants, and another reported limited protection in infants >4 months. The remaining studies reported the proportion of infants with detected antibody, but not the proportion immune.
CONCLUSION
Although limited, these data suggest that in settings that have sustained measles elimination, some infants are susceptible to measles well before the age of routine measles immunization. Setting-specific seroprevalence and vaccine effectiveness studies are required to evaluate this in different jurisdictions.
Topics: Antibodies, Neutralizing; Antibodies, Viral; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunity, Maternally-Acquired; Immunization; Infant; Infant, Newborn; Male; Measles; Measles Vaccine; Measles virus; Milk, Human; Pregnancy
PubMed: 29398276
DOI: 10.1016/j.vaccine.2018.01.002 -
Vaccine Oct 2017The risk of post-vaccination adverse events (AEs) is a primary public health concern. Among the AEs, pain is a significant source of anxiety for both children and their... (Review)
Review
PURPOSE
The risk of post-vaccination adverse events (AEs) is a primary public health concern. Among the AEs, pain is a significant source of anxiety for both children and their parents. This review describes and assesses the intensity of pain experienced by children post-vaccination with widely used Measles-Mumps-Rubella (MMR) vaccines.
METHODS
A systematic literature search was conducted in Pubmed, Embase and Cochrane to identify publications describing immediate pain at injection site (primary objective) or pain within days (secondary objective) after 2 specific MMR vaccines. Immediate pain ('acute pain' according to the Brighton Collaboration case definition) was defined as pain occurring at the time or within 5min of injection.
RESULTS
Four studies, which compared the intensity of immediate injection site pain experienced by children after MMR vaccination, were identified. Various pain assessment tools and methods were used to quantify the intensity of pain, including the median difference in Visual Analog Scale scores between vaccine groups. All four studies showed significantly less immediate pain caused by Priorix (GSK Vaccines) compared with M-M-R II (Merck & Co., Inc.).
CONCLUSIONS
To our knowledge, this review summarizes for the first time the available scientific evidence on the intensity of pain following different MMR vaccines. It highlights that MMR vaccines can differ in terms of immediate pain. Further research may be needed to better understand the underlying reason for this observation. In this context, it is very important to understand which physicochemical properties are most relevant for the immediate pain profile of a vaccine to thereby support the development of vaccines with the best possible immediate pain profile.
Topics: Humans; Measles-Mumps-Rubella Vaccine; Pain; Vaccination; Vaccines, Combined
PubMed: 28893478
DOI: 10.1016/j.vaccine.2017.08.068