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BMC Public Health Nov 2023Malaysia introduced the two dose measles-mumps-rubella (MMR) vaccine in 2004 as part of its measles elimination strategy. However, despite high historical coverage of...
BACKGROUND
Malaysia introduced the two dose measles-mumps-rubella (MMR) vaccine in 2004 as part of its measles elimination strategy. However, despite high historical coverage of MCV1 and MCV2, Malaysia continues to report high measles incidence. This study suggests a novel indicator for investigating population immunity against measles in the Malaysian population.
METHODS
We define effective vaccine coverage (EVC) of measles as the proportion of a population vaccinated with measles-containing vaccine (MCV) and effectively protected against measles infection. A quantitative evaluation of EVC throughout the life course of Malaysian birth cohorts was conducted accounting for both vaccine efficacy (VE) and between-dose correlation (BdC). Measles vaccination coverage was sourced from WHO-UNICEF estimates of Malaysia's routine immunisation coverage and supplementary immunisation activities (SIAs). United Nations World population estimates and projections (UNWPP) provided birth cohort sizes stratified by age and year. A step wise joint Bernoulli distribution was used to proportionate the Malaysian population born between 1982, the first year of Malaysia's measles vaccination programme, and 2021, into individuals who received zero dose, one dose and multiple doses of MCV. VE estimates by age and doses received are then adopted to derive EVC. A sensitivity analysis was conducted using 1000 random combinations of BdC and VE parameters.
RESULTS
This study suggests that no birth cohort in the Malaysian population has achieved > 95% population immunity (EVC) conferred through measles vaccination since the measles immunisation programme began in Malaysia.
CONCLUSION
The persistence of measles in Malaysia is due to pockets of insufficient vaccination coverage against measles in the population. Monitoring BdC through immunisation surveillance systems may allow for the identification of susceptible subpopulations (primarily zero-dose MCV individuals) and increase the coverage of individuals who are vaccinated with multiple doses of MCV. This study provides a tool for assessment of national-level population immunity of measles conferred through vaccination and does not consider subnational heterogeneity or vaccine waning. This tool can be readily applied to other regions and vaccine-preventable diseases.
Topics: Humans; Immunization Programs; Immunization Schedule; Measles; Measles Vaccine; Measles virus; Measles-Mumps-Rubella Vaccine; Vaccination; Vaccine Efficacy
PubMed: 38017415
DOI: 10.1186/s12889-023-17082-9 -
Journal of Pregnancy 2020Measles is a highly contagious airborne disease. Unvaccinated pregnant women are not only at risk of infection but also at risk of severe pregnancy complications. As...
Measles is a highly contagious airborne disease. Unvaccinated pregnant women are not only at risk of infection but also at risk of severe pregnancy complications. As measles causes a dysregulation of the entire immune system, we describe immunological variations and how immune response mechanisms can lead to adverse pregnancy outcomes. We evaluated data during the measles outbreak reported in the province of Catania, Italy, from May 2017 to June 2018. We controlled hospital discharge records for patients admitted to hospital obstetric wards searching the measles diagnostic code. We have indicated the case as "confirmed" when the IgM was found to be positive with the ELISA method. We registered 843 cases of measles and 51% were females (430 cases). 24 patients between the ages of 17 and 40 had measles while they were pregnant. Adverse pregnancy outcomes included 2 spontaneous abortions, 1 therapeutic abortion, 1 foetal death, and 6 preterm deliveries. Respiratory complications were more prevalent in pregnant women (21%) than in nonpregnant women with measles (9%). 14 health care workers (1.7%) were infected with measles, and none of these had been previously vaccinated. Immune response mechanisms were associated with adverse pregnancy outcomes in women with measles. To reduce the rate of measles complications, gynaecologists should investigate vaccination history and antibody test results in all women of childbearing age. During a measles outbreak, gynaecologists and midwives should be active proponents of vaccination administration and counteract any vaccine hesitancy not only in patients but also among health care workers.
Topics: Adolescent; Disease Outbreaks; Female; Humans; Italy; Measles; Measles Vaccine; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Young Adult
PubMed: 32802510
DOI: 10.1155/2020/6532868 -
Central European Journal of Public... Jun 2018Between February 2014 and September 2015 a large measles outbreak (5,084 cases) occurred in the Federation of Bosnia and Herzegovina (FB&H). The aim of this study is to...
OBJECTIVE
Between February 2014 and September 2015 a large measles outbreak (5,084 cases) occurred in the Federation of Bosnia and Herzegovina (FB&H). The aim of this study is to assess the effectiveness of routine measles vaccination in the FB&H.
METHODS
We conducted an analysis of the resurgence period surveillance data and a retrospective cohort study involving primary school aged children in randomly selected schools.
RESULTS
Measles cases occurred among all age groups, mostly among the unvaccinated. Among fully immunized, 2.1% contracted measles. Measles vaccine effectiveness was high. The study indicates that one dose reduced the risk for measles by 91.9% (95% CI: 81.4-96.4%), two doses reduced the risk by 97.3% (95% CI: 95.5-98.4%). No evidence of waning immunity was found. Our survey reveals that a significant number of children had no immunization status registered.
CONCLUSIONS
The results of this study suggest that the resurgence was likely caused by an accumulation of measles-susceptible children not being vaccinated. This vaccine effectiveness study does not support possible vaccination failure as a contributing factor.
Topics: Adolescent; Bosnia and Herzegovina; Child; Child, Preschool; Disease Outbreaks; Female; Humans; Immunization Schedule; Male; Measles; Measles Vaccine; Retrospective Studies
PubMed: 30102493
DOI: 10.21101/cejph.a4754 -
Pediatric Allergy and Immunology :... Jan 2022Some live vaccines, particularly Bacillus Calmette-Guérin (BCG), oral polio vaccine (OPV), and measles vaccine, can reduce the incidence of all-cause mortality by...
Some live vaccines, particularly Bacillus Calmette-Guérin (BCG), oral polio vaccine (OPV), and measles vaccine, can reduce the incidence of all-cause mortality by outreaching the mere control of specific infections and exerting off-target effects. Asides from the prevention of viral infection, some other vaccines, such as those against flu or rotavirus, could reduce the risk of developing autoimmunity. The nonspecific effects of vaccines are mediated by the innate immune system, mainly through the so-called trained innate immunity. These observations paved the way for developing tolerogenic and trained immunity-based vaccines with substantial implications for more effective use of vaccines and combat vaccine hesitancy.
Topics: BCG Vaccine; Humans; Immunity, Innate; Measles Vaccine; Virus Diseases
PubMed: 35080298
DOI: 10.1111/pai.13638 -
The Journal of Infectious Diseases Sep 2021The global measles vaccination program has been extraordinarily successful in reducing measles-related disease and deaths worldwide. Eradication of measles is feasible...
The global measles vaccination program has been extraordinarily successful in reducing measles-related disease and deaths worldwide. Eradication of measles is feasible because of several key attributes, including humans as the only reservoir for the virus, broad access to diagnostic tools that can rapidly detect measles-infectious persons, and availability of highly safe and effective measles-containing vaccines (MCVs). All 6 World Health Organization (WHO) regions have established measles elimination goals. Globally, during 2000-2018, measles incidence decreased by 66% (from 145 to 49 cases per million population) and deaths decreased by 73% (from 535 600 to 142 300), drastically reducing global disease burden. Routine immunization with MCV has been the cornerstone for the control and prevention of measles. Two doses of MCV are 97% effective in preventing measles, qualifying MCV as one of the most effective vaccines ever developed. Mild adverse events occur in <20% of recipients and serious adverse events are extremely rare. The economic benefits of measles vaccination are highlighted by an overall return on investment of 58 times the cost of the vaccine, supply chains, and vaccination. Because measles is one of the most contagious human diseases, maintenance of high (≥95%) 2-dose MCV coverage is crucial for controlling the spread of measles and successfully reaching measles elimination; however, the plateauing of global MCV coverage for nearly a decade and the global measles resurgence during 2018-2019 demonstrate that much work remains. Global commitments to increase community access to and demand for immunizations, strengthen national and regional partnerships for building public health infrastructure, and implement innovations that can overcome access barriers and enhance vaccine confidence, are essential to achieve a world free of measles.
Topics: Disease Eradication; Global Health; Humans; Immunization Programs; Incidence; Infant; Measles; Measles Vaccine; Measles virus; Population Surveillance; World Health Organization
PubMed: 34590128
DOI: 10.1093/infdis/jiaa793 -
Epidemiology and Infection Mar 2020An outbreak of measles in the Netherlands in 2013-2014 provided an opportunity to assess the effect of MMR vaccination on severity and infectiousness of measles.Measles...
An outbreak of measles in the Netherlands in 2013-2014 provided an opportunity to assess the effect of MMR vaccination on severity and infectiousness of measles.Measles is notifiable in the Netherlands. We used information on vaccination, hospitalisation, complications, and most likely source(s) of infection from cases notified during the outbreak. When a case was indicated as a likely source for at least one other notified case, we defined it as infectious. We estimated the age-adjusted effect of vaccination on severity and infectiousness with logistic regression.Of 2676 notified cases, 2539 (94.9%) were unvaccinated, 121 (4.5%) were once-vaccinated and 16 (0.6%) were at least twice-vaccinated; 328 (12.3%) cases were reported to have complications and 172 (6.4%) cases were hospitalised. Measles in twice-vaccinated cases led less often to complications and/or hospitalisation than measles in unvaccinated cases (0% and 14.5%, respectively, aOR 0.1 (95% CI 0-0.89), P = 0.03). Of unvaccinated, once-vaccinated and twice-vaccinated cases, respectively, 194 (7.6%), seven (5.1%) and 0 (0%) were infectious. These differences were not statistically significant (P > 0.05).Our findings suggest a protective effect of vaccination on the occurrence of complications and/or hospitalisation as a result of measles and support the WHO recommendation of a two-dose MMR vaccination schedule.
Topics: Adolescent; Child; Child, Preschool; Disease Outbreaks; Female; Humans; Immunization Schedule; Infant; Male; Measles; Measles Vaccine; Measles-Mumps-Rubella Vaccine; Netherlands; Vaccination; Young Adult
PubMed: 32200773
DOI: 10.1017/S0950268820000692 -
PloS One 2022Malaria has been strongly linked to the transmission and pathophysiology of some viral diseases. Malaria and vaccine-preventable diseases often co-exist in endemic...
BACKGROUND
Malaria has been strongly linked to the transmission and pathophysiology of some viral diseases. Malaria and vaccine-preventable diseases often co-exist in endemic countries but the implication of their co-existence on their transmission dynamics and control is poorly understood. The study aims to evaluate the relationships between the incidence of malaria and cases of measles and yellow fever in Africa.
METHODS
The malaria incidence, death due to malaria, measles and yellow fever data were sourced from the WHO database. Poisson and zero-inflated time-trend regression were used to model the relationships between malaria and the two vaccine-preventable diseases. P-values <0.05 were considered statistically significant.
RESULTS
A significant negative relationship existed between malaria incidence and measles cases (P<0.05), however, malaria showed a positive relationship with yellow fever (P<0.05). The relationships between death due to malaria and measles/yellow fever cases followed similar trends but with a higher level of statistical significance (P<0.001).
CONCLUSIONS
Malaria varied negatively with measles cases but positively with yellow fever. The relationships observed in this study could be important for the management of malaria and the studied vaccine-preventable diseases. Increase vaccination coverage and/or malaria treatment could modulate the direction of these relationships.
Topics: Africa; Humans; Malaria; Measles; Measles Vaccine; Vaccination; Vaccine-Preventable Diseases; Yellow Fever; Yellow Fever Vaccine
PubMed: 35507574
DOI: 10.1371/journal.pone.0268080 -
Eastern Mediterranean Health Journal =... Sep 2023Every year, WHO and UNICEF estimate the immunization coverage for 195 Member States, based on reported data and independent coverage surveys (1,2). These estimates...
Every year, WHO and UNICEF estimate the immunization coverage for 195 Member States, based on reported data and independent coverage surveys (1,2). These estimates indicate progress in reaching children with life-saving vaccines while identifying coverage gaps (3). The 2022 estimates were much awaited, given that the COVID-19 pandemic caused a setback in coverage (1). Overall, there are encouraging signs of recovery in the WHO Eastern Mediterranean Region (EMR). For example, coverage of the third dose diphtheria-pertussis-tetanus containing vaccine (DTPcv3) and the second dose measles containing vaccine (MCV2), both almost restored or exceeded their 85% and 76% pre-pandemic 2019 levels, respectively (1). However, there are disparities across countries. Low-income countries with fragile, weak health systems and those in conflict situation are lagging. The number of children who missed their routine first dose of measles immunization increased from 3 million in 2019 to 3.16 million in 2022 (1). This underperformance, along with the accumulated immunity gap in 2020-2021, exposes us to the risk of preventable deadly outbreaks.
Topics: Child; Humans; Infant; Pandemics; Immunization Programs; COVID-19; Immunization; Vaccination; Measles Vaccine; Diphtheria-Tetanus-Pertussis Vaccine; Mediterranean Region; Measles; Immunization Schedule
PubMed: 37776128
DOI: 10.26719/2023.29.9.681 -
MMWR. Morbidity and Mortality Weekly... Nov 2020In 2010, the World Health Assembly (WHA) set the following three milestones for measles control to be achieved by 2015: 1) increase routine coverage with the first dose...
In 2010, the World Health Assembly (WHA) set the following three milestones for measles control 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 <5 cases per 1 million population, and 3) reduce global measles mortality by 95% from the 2000 estimate* (1). In 2012, WHA endorsed the Global Vaccine Action Plan, with the objective of eliminating measles in five of the six World Health Organization (WHO) regions by 2020. This report describes progress toward WHA milestones and regional measles elimination during 2000-2019 and updates a previous report (2). During 2000-2010, estimated MCV1 coverage increased globally from 72% to 84% but has since plateaued at 84%-85%. All countries conducted measles surveillance; however, approximately half did not achieve the sensitivity indicator target of two or more discarded measles and rubella cases per 100,000 population. Annual reported measles incidence decreased 88%, from 145 to 18 cases per 1 million population during 2000-2016; the lowest incidence occurred in 2016, but by 2019 incidence had risen to 120 cases per 1 million population. During 2000-2019, the annual number of estimated measles deaths decreased 62%, from 539,000 to 207,500; an estimated 25.5 million measles deaths were averted. To drive progress toward the regional measles elimination targets, additional strategies are needed to help countries reach all children with 2 doses of measles-containing vaccine, identify and close immunity gaps, and improve surveillance.
Topics: Disease Eradication; Global Health; Goals; Humans; Immunization Programs; Incidence; Infant; Measles; Measles Vaccine; World Health Organization
PubMed: 33180759
DOI: 10.15585/mmwr.mm6945a6 -
Deutsches Arzteblatt International Oct 2018The World Health Organization (WHO) set the year 2020 as a target date for the eradication of measles in Europe, yet Germany is still far away from this goal. In this... (Review)
Review
BACKGROUND
The World Health Organization (WHO) set the year 2020 as a target date for the eradication of measles in Europe, yet Germany is still far away from this goal. In this article, we provide an overview of current vaccination gaps and barriers to vaccination among children and adults in Germany, as well as potential strategies for overcoming them.
METHODS
This review is based on pertinent publications identified by a selective literature search in PubMed (Medline).
RESULTS
Measles vaccinations are not carried out in the appropriate timely fashion in Germany. Moreover, current vaccination rates among both children and adults are too low to achieve the goal of measles eradication. For example, among children born in 2014, the recommended vaccination rate of more than 95% was only reached when these children were 24 months old. Primary care physicians bear the responsibility for this situation, as they have the greatest influence on the decision to vaccinate. The main causes of vaccination gaps are safety worries and complacen- cy on the patients' part, and partial skepticism regarding vaccination on the part of the caregivers. We identified promising strategies for overcoming these problems: an instructive talk to provide evidence-based information to patients in an atmos- phere of mutual trust, reminder systems, multifactorial interventions, and facilitated access to vaccination, or, as a last resort, the reintroduction of compulsory vacci- nation.
CONCLUSION
Primary care physicians play a key role in vaccination. The focus of further strategies should lie above all in improved patient education and in targeted reminders for patients who neglect to vaccinate themselves and/or their children.
Topics: Child; Disease Outbreaks; Europe; Germany; Humans; Immunization Programs; Mass Vaccination; Measles; Measles Vaccine; World Health Organization
PubMed: 30518471
DOI: 10.3238/arztebl.2018.0723