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Seminars in Pediatric Neurology Oct 2023Sequelae Renee Buchanan, Daniel J. Bonthius Seminars in Pediatric Neurology Volume 19, Issue 3, September 2012, Pages 107-114 Worldwide, measles remains one of the most...
Sequelae Renee Buchanan, Daniel J. Bonthius Seminars in Pediatric Neurology Volume 19, Issue 3, September 2012, Pages 107-114 Worldwide, measles remains one of the most deadly vaccine-preventable diseases. In the United States, enrollment in the public schools requires that each child receives 2 doses of measles-containing vaccine before entry, essentially eliminating this once endemic disease. Recent outbreaks of measles in the United States have been associated with importation of measles virus from other countries and subsequent transmission to intentionally undervaccinated children. The central nervous system complications of measles can occur within days or years of acute infection and are often severe. These include primary measles encephalitis, acute postinfectious measles encephalomyelitis, measles inclusion body encephalitis, and subacute sclerosing panencephalitis. These measles associated central nervous system diseases differ in their pathogenesis and pathologic effects. However, all involve complex brain-virus-immune system interactions, and all can lead to severe and permanent brain injury. Despite better understanding of the clinical presentations and pathogenesis of these illnesses, effective treatments remain elusive.
Topics: Child; Humans; Measles virus; Central Nervous System; Measles; Subacute Sclerosing Panencephalitis; Brain; Encephalomyelitis, Acute Disseminated
PubMed: 37919033
DOI: 10.1016/j.spen.2023.101078 -
Vaccine Nov 2021All WHO regions have set measles elimination objective for 2020. To address the specific needs of achieving measles elimination, Nigeria is using a strategy focusing on... (Review)
Review
INTRODUCTION
All WHO regions have set measles elimination objective for 2020. To address the specific needs of achieving measles elimination, Nigeria is using a strategy focusing on improving vaccination coverage with the first routine dose of (monovalent) measles (MCV1) at 9 months, providing measles vaccine through supplemental immunization activities (children 9-59 months), and intensified measles case-based surveillance system.
METHODS
We reviewed measles immunization coverage from population-based surveys conducted in 2010, 2013 and 2017-18. Additionally, we analyzed measles case-based surveillance reports from 2008-2018 to determine annual, regional and age-specific incidence rates.
FINDINGS
Survey results indicated low MCV1 coverage (54.0% in 2018); with lower coverage in the North (mean 45.5%). Of the 153,097 confirmed cases reported over the studied period, 85.5% (130,871) were from the North. Moreover, 70.8% (108,310) of the confirmed cases were unvaccinated. Annual measles incidence varied from a high of 320.39 per 1,000,000 population in 2013 to a low of 9.80 per 1,000,000 in 2009. The incidence rate is higher among the 9-11 months (524.0 per million) and 12-59 months (376.0 per million). Between 2008 and 2018, the incidence rate had showed geographical variation, with higher incidence in the North (70.6 per million) compare to the South (17.8 per million).
CONCLUSION
The aim of this study was to provide a descriptive analysis of measles vaccine coverage and incidence in Nigeria from 2008 to 2018 to assess country progress towards measles elimination. Although the total numbers of confirmed measles cases had decreased over the time period, measles routine coverage remains sub-optimal, and the incidence rates are critically high. The high burden of measles in the North highlight the need for region-specific interventions. The measles program relies heavily on polio resources. As the polio program winds down, strong commitments will be required to achieve elimination goals.
Topics: Child; Disease Eradication; Humans; Immunization Programs; Incidence; Infant; Measles; Measles Vaccine; Nigeria; Population Surveillance; Vaccination; Vaccination Coverage
PubMed: 33875267
DOI: 10.1016/j.vaccine.2021.03.095 -
Current Opinion in Pediatrics Feb 2020In September 2019, the United States was at risk of losing measles elimination status due to several large-scale outbreaks resulting in more than 1200 confirmed cases... (Review)
Review
PURPOSE OF REVIEW
In September 2019, the United States was at risk of losing measles elimination status due to several large-scale outbreaks resulting in more than 1200 confirmed cases across 31 states. This resurgence caps approximately 10 years of increasing incidence, marked by a highly publicized outbreak in 2015 associated with Disneyland when an infected traveler from the Philippines unknowingly spread the virus to susceptible park visitors and the recently ended large outbreak in undervaccinated Orthodox Jewish communities in New York City and Rockland counties. This review highlights current literature elucidating factors associated with current trends in measles epidemiology in the United States, the public health implications of current measles outbreaks and a path forward for addressing challenges contributing to the resurgence of measles in the United States and globally.
RECENT FINDINGS AND SUMMARY
As the most highly transmissible vaccine preventable disease, measles is especially sensitive to changes in herd immunity, the impact of vaccine refusal and globalization. Results highlight the confluence of these factors in current outbreaks, provide tools to predict outbreak risk, demonstrate the growing impact of misinformation and evaluate the impact of policy approaches for outbreak control and prevention.
Topics: Communication; Disease Outbreaks; Disease Susceptibility; Humans; Immunity, Herd; Internationality; Measles; Measles Vaccine; United States; Vaccination
PubMed: 31790030
DOI: 10.1097/MOP.0000000000000845 -
Travel Medicine and Infectious Disease 2021While measles vaccination is widely implemented in national immunisation programmes, measles incidence rates are increasing worldwide. Dutch inhabitants who were born...
BACKGROUND
While measles vaccination is widely implemented in national immunisation programmes, measles incidence rates are increasing worldwide. Dutch inhabitants who were born between 1965-1975 may have fallen between two stools, lacking protection from a natural infection, and having missed the introduction of the measles vaccination schedule. With this study we aim to find the measles seroprevalence in travellers born between 1965 and 1975, compared to those born before 1965 and after 1975.
METHODS
Families travelling to Eastern Europe or outside Europe during the preceding year were recruited via Dutch secondary schools between 2016 and 2018. Their vaccination status was assessed using questionnaires, vaccination records and measles serology in dried blood spot (DBS) eluates. Measles virus antibody concentrations were determined with an ELISA (EUROIMMUNE®) and a subset was retested with a focus reduction neutralization assay (FRNT).
RESULTS
In 188 (79%) of the 239 available DBS eluates, the ELISA could detect sufficient measles virus-specific IgG antibodies. Of the negative samples that were retested with FRNT, 85% remained negative, resulting in an overall seroprevalence of 82% [95% CI 76-86]. Children had a lower seroprevalence (72%) than adults (87%). Travellers born between 1965 and 1975 were protected in 89%.
CONCLUSIONS
In this study, we report a measles seroprevalence of 82% among Dutch travelling families. Remarkably, seroprevalence rates were lowest in children (12-18 years) instead of travellers born between 1965 and 1975. Although a fraction of people without detectable antibodies may be protected by other immune mechanisms, these data suggest that measles (re)vaccination should be considered for travellers to endemic regions.
Topics: Adult; Antibodies, Viral; Child; Humans; Immunization Schedule; Measles; Measles Vaccine; Seroepidemiologic Studies; Vaccination
PubMed: 34728385
DOI: 10.1016/j.tmaid.2021.102194 -
The Journal of Emergency Medicine Apr 2020It is vital for frontline emergency physicians to immediately recognize the signs and symptoms of measles to initiate appropriate therapy and prevent spread to the... (Review)
Review
BACKGROUND
It is vital for frontline emergency physicians to immediately recognize the signs and symptoms of measles to initiate appropriate therapy and prevent spread to the health care team and other patients.
OBJECTIVE
This review serves as a clinically practical updated reference for when the differential diagnosis includes measles.
DISCUSSION
Measles is a highly contagious illness that classically presents with a rash, fever, cough, coryza, and conjunctivitis. Cases in the United States since 2000 have been attributed mainly to travelers who are infected abroad and then spread the illness to small, susceptible populations within the United States. Complications from measles are relatively common and can be associated with significant morbidity and mortality. Clinical suspicion should be confirmed with laboratory testing, which is most commonly a serum immunoglobulin M. The management of measles is mainly supportive. Patients that require more aggressive management include those who are pregnant, immunocompromised, or unvaccinated. Treatment may consist of the measles vaccine, intravenous immunoglobulin, vitamin A, and even ribavirin. Additionally, special precautions are required by hospital workers to help prevent the spread of the virus, which include N-95 masks and patient isolation in an airborne infection isolation room.
CONCLUSION
Emergency physicians must be readily able to identify, contain patients with suspected measles, and determine who will need further medical management for this potentially life-threatening illness. As this public health crisis evolves, novel ways of screening for and reporting cases of measles is needed.
Topics: Disease Outbreaks; Female; Fever; Humans; Immunoglobulin M; Measles; Measles Vaccine; Physicians; Pregnancy
PubMed: 32241708
DOI: 10.1016/j.jemermed.2020.02.007 -
Nursing For Women's Health Feb 2020Measles (rubeola) was once nearly eradicated in the United States. Unfortunately, it has reappeared, with more than three times the number of confirmed cases in 2019...
Measles (rubeola) was once nearly eradicated in the United States. Unfortunately, it has reappeared, with more than three times the number of confirmed cases in 2019 than in 2018. The virus, which produces a distinct rash that appears within days of exposure, can spread quickly and can produce severe complications. There is no cure; treatment is supportive care. Measles was once a minimal concern in the United States due to high vaccination rates. The Centers for Disease Control and Prevention reports that, because of the increase in individuals traveling to countries with high rates of measles and the fact that fewer U.S. children are being immunized against measles, the incidence of measles will likely continue to rise in the United States. It is vital that nurses and other health care providers educate individuals about the importance of the prevention and treatment of measles.
Topics: Humans; Measles; Measles-Mumps-Rubella Vaccine; United States; Vaccination
PubMed: 31917147
DOI: 10.1016/j.nwh.2019.11.005 -
Pediatrics Apr 2021Between December 31, 2018, and April 26, 2019, 72 confirmed cases of measles were identified in Clark County. Our objective was to estimate the economic burden of the...
BACKGROUND AND OBJECTIVES
Between December 31, 2018, and April 26, 2019, 72 confirmed cases of measles were identified in Clark County. Our objective was to estimate the economic burden of the measles outbreak from a societal perspective, including public health response costs as well as direct medical costs and productivity losses of affected individuals.
METHODS
To estimate costs related to this outbreak from the societal perspective, 3 types of costs were collected or estimated: public health response (labor, material, and contractor costs used to contain the outbreak), direct medical (third party or patient out-of-pocket treatment costs of infected individuals), and productivity losses (costs of lost productivity due to illness, home isolation, quarantine, or informal caregiving).
RESULTS
The overall societal cost of the 2019 Clark County measles outbreak was ∼$3.4 million ($47 479 per case or $814 per contact). The majority of the costs (∼$2.3 million) were incurred by the public health response to the outbreak, followed by productivity losses (∼$1.0 million) and direct medical costs (∼$76 000).
CONCLUSIONS
Recent increases in incident measles cases in the United States and across the globe underscore the need to more fully understand the societal cost of measles cases and outbreaks and economic consequences of undervaccination. Our estimates can provide valuable inputs for policy makers and public health stakeholders as they consider budget determinations and the substantial value associated with increasing vaccine coverage and outbreak preparedness as well as the protection of society against vaccine-preventable diseases, such as measles, which are readily preventable with high vaccination coverage.
Topics: Child; Costs and Cost Analysis; Disease Outbreaks; Humans; Measles; Measles Vaccine; Public Health; Quarantine; Washington
PubMed: 33712549
DOI: 10.1542/peds.2020-027037 -
PloS One 2022The World Health Organization has identified vaccine hesitancy as one of its top ten global health threats for 2019. Efforts are underway to define the factors...
The World Health Organization has identified vaccine hesitancy as one of its top ten global health threats for 2019. Efforts are underway to define the factors responsible for reductions in vaccine confidence. However, as global measles cases accelerated beginning in 2018, it became evident that additional factors were promoting measles re-emergence, including war, political and socio-economic collapse, shifting poverty, and vulnerability to weather events and climate change. Accordingly, we propose a Global Vaccine Risk Index (VRI) to consider these variables as a more comprehensive means to identify vulnerable nations where we might expect measles and other vaccine-preventable diseases to emerge or re-emerge. In Sub-Saharan African and Middle Eastern nations, conflict and political instability predominated as the basis for high vaccine risk scores, whereas in Southeast Asian countries, the major reasons included climate variability, current levels of measles vaccination coverage, and economic and educational disparities. In Europe, low vaccine confidence and refugee movements predominated, while in the Americas, economic disparities and vaccine confidence were important. The VRI may serve as a useful indicator and predictor for international agencies committed to childhood immunizations and might find relevance for accelerating future COVID19 vaccination programs.
Topics: COVID-19; COVID-19 Vaccines; Child; Global Health; Humans; Measles; Measles Vaccine; Vaccination; Vaccination Coverage; Vaccines
PubMed: 36001622
DOI: 10.1371/journal.pone.0272784 -
Journal of Clinical Virology : the... Jul 2020Measles is a highly contagious viral illness that continues to cause significant mortality among young children worldwide despite the availability of a safe and... (Review)
Review
Measles is a highly contagious viral illness that continues to cause significant mortality among young children worldwide despite the availability of a safe and effective vaccine. During the first half of 2019, over 182 countries reported more than 300,000 measles cases; greater than double the number from the same period in 2018. Timely recognition and laboratory confirmation of infected individuals as well as appropriate infection prevention measures are crucial to avert further transmission. This review highlights the importance of early recognition of the signs and symptoms of measles and provides details on the laboratory methods commonly employed to confirm cases, investigate outbreaks and characterize the virus. It's critical that clinicians, laboratorians and public health administrations work together to rapidly identify, confirm and contain the spread of measles globally.
Topics: Child; Clinical Laboratory Techniques; Disease Outbreaks; Humans; Measles; Measles Vaccine; Measles virus; Vaccination
PubMed: 32454430
DOI: 10.1016/j.jcv.2020.104430 -
The Lancet. Public Health May 2024
Topics: Humans; Measles; Prisons; Jails; Measles Vaccine; Prisoners
PubMed: 38614107
DOI: 10.1016/S2468-2667(24)00074-4