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Neurological Sciences : Official... Jul 2024Measles inclusion-body encephalitis (MIBE) is rare, with insights largely from case studies. We systematically analyzed subacute Sclerosing Panencephalitis (SSPE) cases... (Review)
Review
Clinical features, pathogenesis, pathology, neuroimaging, clinical course and outcome of measles inclusion-body encephalitis: a systematic review of published case reports and case series.
Measles inclusion-body encephalitis (MIBE) is rare, with insights largely from case studies. We systematically analyzed subacute Sclerosing Panencephalitis (SSPE) cases in immunocompromised patients, identifying distinctive clinical and neuroimaging features. These findings could facilitate MIBE diagnosis without the need for brain biopsies. Our systematic review on MIBE and HIV-related SSPE adhered to PRISMA guidelines and was registered with PROSPERO. We searched multiple databases and followed a detailed inclusion process with independent reviews and quality assessment. Data on patient demographics, clinical features, and outcomes were compiled. A review of 39 studies on 49 MIBE patients and 8 reports on HIV-positive SSPE patients was conducted. Acute lymphoblastic leukemia, HIV, organ transplants, and malignancies were common precursors to MIBE. Perinatal HIV was prevalent among SSPE cases. Seizures were the primary symptom in MIBE, often drug-resistant and progressing to status epilepticus or epilepsia partialis continua, whereas periodic myoclonus was universal in SSPE. Neuroimaging showed distinct patterns for each group, and histopathology confirmed measles virus presence in 39% of MIBE cases. MIBE patients typically progressed to coma and death. In conclusion, MIBE and SSPE in HIV-infected patients present with distinct clinical pictures but identical brain pathological abnormalities.
Topics: Humans; Subacute Sclerosing Panencephalitis; Neuroimaging; Measles; Brain
PubMed: 38512528
DOI: 10.1007/s10072-024-07480-1 -
PloS One 2024Nigeria has a high proportion of the world's underimmunised children. We estimated the inequities in childhood immunisation coverage associated with socioeconomic,...
Systematic review of social determinants of childhood immunisation in low- and middle-income countries and equity impact analysis of childhood vaccination coverage in Nigeria.
BACKGROUND
Nigeria has a high proportion of the world's underimmunised children. We estimated the inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and healthcare characteristics among children aged 12-23 months in Nigeria using a social determinants of health perspective.
METHODS
We conducted a systematic review to identify the social determinants of childhood immunisation associated with inequities in vaccination coverage among low- and middle-income countries. Using the 2018 Nigeria Demographic and Health Survey (DHS), we conducted multiple logistic regression to estimate the association between basic childhood vaccination coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, and 1-dose measles) and socioeconomic, geographic, maternal, child, and healthcare characteristics in Nigeria.
RESULTS
From the systematic review, we identified the key determinants of immunisation to be household wealth, religion, and ethnicity for socioeconomic characteristics; region and place of residence for geographic characteristics; maternal age at birth, maternal education, and household head status for maternal characteristics; sex of child and birth order for child characteristics; and antenatal care and birth setting for healthcare characteristics. Based of the 2018 Nigeria DHS analysis of 6,059 children aged 12-23 months, we estimated that basic vaccination coverage was 31% (95% CI: 29-33) among children aged 12-23 months, whilst 19% (95% CI:18-21) of them were zero-dose children who had received none of the basic vaccines. After controlling for background characteristics, there was a significant increase in the odds of basic vaccination by household wealth (AOR: 3.21 (2.06, 5.00), p < 0.001) for the wealthiest quintile compared to the poorest quintile, antenatal care of four or more antenatal care visits compared to no antenatal care (AOR: 2.87 (2.21, 3.72), p < 0.001), delivery in a health facility compared to home births (AOR 1.32 (1.08, 1.61), p = 0.006), relatively older maternal age of 35-49 years compared to 15-19 years (AOR: 2.25 (1.46, 3.49), p < 0.001), and maternal education of secondary or higher education compared to no formal education (AOR: 1.79 (1.39, 2.31), p < 0.001). Children of Fulani ethnicity in comparison to children of Igbo ethnicity had lower odds of receiving basic vaccinations (AOR: 0.51 (0.26, 0.97), p = 0.039).
CONCLUSIONS
Basic vaccination coverage is below target levels for all groups. Children from the poorest households, of Fulani ethnicity, who were born in home settings, and with young mothers with no formal education nor antenatal care, were associated with lower odds of basic vaccination in Nigeria. We recommend a proportionate universalism approach for addressing the immunisation barriers in the National Programme on Immunization of Nigeria.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Developing Countries; Immunization; Nigeria; Social Determinants of Health; Vaccination Coverage; Infant
PubMed: 38446836
DOI: 10.1371/journal.pone.0297326 -
Journal of Travel Medicine Feb 2024Ensuring vaccination coverage reaches established herd immunity thresholds (HIT) is the cornerstone of any vaccination programme. Diverse migrant populations in European...
BACKGROUND
Ensuring vaccination coverage reaches established herd immunity thresholds (HIT) is the cornerstone of any vaccination programme. Diverse migrant populations in European countries have been associated with cases of vaccine-preventable diseases (VPD) and outbreaks, yet it is not clear to what extent they are an under-immunised group.
METHODS
We did a systematic review and meta-analysis to synthesise peer-reviewed published primary research reporting data on the immune status of migrants in EU/EEA countries, the UK and Switzerland, calculating their pooled immunity coverage for measles, mumps, rubella, and diphtheria using random-effects models. We searched on Web of Science, Embase, Global Health and MEDLINE (January 1st 2000 to June 10th 2022), with no language restrictions. The protocol is registered with PROSPERO (CRD42018103666).
FINDINGS
Of 1103 abstracts screened, 62 met eligibility criteria, of which 39 were included in the meta-analysis. The meta-analysis included 75 089 migrants, predominantly from outside Europe. Pooled immunity coverage among migrant populations was well below the recommended HIT for diphtheria (n = 7, 57.4% [95% CI: 43.1-71.7%] I2 = 99% vs HIT 83-86%), measles (n = 21, 83.7% [95% CI: 79.2-88.2] I2 = 99% vs HIT 93-95%), and mumps (n = 8, 67.1% [95% CI: 50.6-83.6] I2 = 99% vs HIT 88-93%), and midway for rubella (n = 29, 85.6% [95% CI: 83.1-88.1%] I2 = 99% vs HIT 83-94%), with high heterogeneity across studies.
INTERPRETATION
Migrants in Europe are an under-immunised group for a range of important VPDs, with this study reinforcing the importance of engaging children, adolescents, and adults in 'catch-up' vaccination initiatives on arrival for vaccines, doses, and boosters they may have missed in their home countries. Co-designing strategies to strengthen catch-up vaccination across the life-course in under-immunised groups is an important next step if we are to meet European and global targets for VPD elimination and control and ensure vaccine equity.
PubMed: 38423523
DOI: 10.1093/jtm/taae033 -
CNS Spectrums Apr 2024Data related to psychiatric manifestations in subacute sclerosing panencephalitis (SSPE) is currently available only in the form of isolated case reports. In this... (Review)
Review
Data related to psychiatric manifestations in subacute sclerosing panencephalitis (SSPE) is currently available only in the form of isolated case reports. In this systematic review, we evaluated the spectrum of psychiatric manifestations and their impact on the course and outcome of SSPE. Data were obtained from 4 databases (PubMed, Embase, Scopus, and Google Scholar), with the most recent search conducted on March 27, 2023. The PRISMA guidelines were followed, and the PROSPERO registration number for the protocol is CRD42023408227. SSPE was diagnosed using Dyken's criteria. Extracted data were recorded in an Excel spreadsheet. To evaluate the quality of the data, the Joanna Briggs Institute Critical Appraisal tool was employed. Our search resulted in 30 published reports of 32 patients. The mean age was 17.9 years. Schizophrenia, catatonia, and poorly characterized psychotic illnesses were the 3 most common psychiatric presentations that were seen in 63% (20/32) of cases. Catatonia was seen in 4 patients. Affective disorders, mania, and depression were reported among 22% (7/32) cases. In approximately 81% (26/32) cases, the course of SSPE was acute fulminant. Treatment with antipsychotic drugs had poor or no response. Out of 17 patients, who received antipsychotic drugs, 6 patients noted severe extrapyramidal adverse effects. SSPE often masquerades as a psychiatric disorder. Unresponsive psychiatric symptoms, early extrapyramidal signs, and progressive encephalopathy indicate SSPE.
Topics: Humans; Adolescent; Subacute Sclerosing Panencephalitis; Measles virus; Catatonia; Antipsychotic Agents
PubMed: 38282559
DOI: 10.1017/S1092852924000038 -
Journal of Clinical Microbiology Feb 2024Measles and rubella serological diagnoses are done by IgM detection. The World Health Organization Global Measles and Rubella Laboratory Network previously endorsed... (Meta-Analysis)
Meta-Analysis
Measles and rubella serological diagnoses are done by IgM detection. The World Health Organization Global Measles and Rubella Laboratory Network previously endorsed Siemens Enzygnost enzyme-linked immunosorbant assay kits, which have been discontinued. A recommended replacement has not been determined. We aimed to search for suitable replacements by conducting a systematic review and meta-analysis of IgM detection methods that are currently available for measles and rubella. A systematic literature search was performed in Medline, Embase, Global Health, Cochrane Central, and Scopus on March 22 and on 27 September 2023. Studies reporting measles and/or rubella IgM detection with terms around diagnostic accuracy were included. Risk of bias was assessed using QUADAS tools. Meta-DiSc and R were used for statistical analysis. Clinical samples totalling 5,579 from 28 index tests were included in the measles meta-analysis. Sensitivity and specificity of the individual measles studies ranged from 0.50 to 1.00 and 0.53 to 1.00, respectively. Pooled sensitivity and specificity of all measles IgM detection methods were 0.94 (CI: 0.90-0.97) and 0.94 (CI: 0.91-0.97), respectively. Clinical samples totalling 4,983 from 15 index tests were included in the rubella meta-analysis. Sensitivity and specificity of the individual rubella studies ranged from 0.78 to 1.00 and 0.52 to 1.00, respectively. Pooled sensitivity and specificity of all rubella IgM detection methods were 0.97 (CI: 0.93-0.98) and 0.96 (CI: 0.93-0.98), respectively. Although more studies would be ideal, our results may provide valuable information when selecting IgM detection methods for measles and/or rubella.
Topics: Humans; Rubella virus; Antibodies, Viral; Immunoglobulin M; Measles; Rubella; Serologic Tests
PubMed: 38275299
DOI: 10.1128/jcm.01339-23 -
Journal of Pharmaceutical Policy and... 2024Measles became a public health important disease in sub-Saharan Africa. World Health Organization recommended measles-containing vaccine dose 2 (MCV2) through routine... (Review)
Review
BACKGROUND
Measles became a public health important disease in sub-Saharan Africa. World Health Organization recommended measles-containing vaccine dose 2 (MCV2) through routine service delivery. This study aims to determine coverage of second-dose measles vaccination uptake and its predictors among children aged 24-35 months in sub-Saharan Africa.
METHODS AND MATERIALS
We conducted an extensive search of literature as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). The databases used were PubMed, Google Scholar, and HINARI literature.
RESULTS
The overall uptake of the second dose of measles vaccine uptake was 41% (95% CI: 28.90-53.47). Caregiver's awareness of the importance of the second dose of measles (2.51, 95% CI 1.77, 3.25), educational status of mothers (1.30, 95% CI 1.16, 1.45), distance from vaccination site (1.22, 95% CI 1.12, 1.32), and attending four and above ANC visit (2.72, 95% CI 2.29, 3.15) were determinants for second dose measles vaccine uptake.
CONCLUSION
Coverage of the second dose of measles uptake in Sub-Saharan Africa was low (41%) which is lower than the recommendation from WHO. Therefore policymakers and stakeholders should increase mother's awareness. Also, special strategies should be developed for those who are far from the vaccination site.
ABBREVIATION AND ACRONYMS
ANC: Ante Natal Care; JBI: Joanna Briggs Institute; MCV1: Measles containing vaccine dose 1; MCV2: Measles containing vaccine dose 2; WHO: World Health Organization.
PubMed: 38205190
DOI: 10.1080/20523211.2023.2285507 -
European Journal of Public Health Apr 2024Child vaccinations are among the most effective public health interventions. However, wide gaps in child vaccination remain among different groups with uptake in most...
Understanding the health system barriers and enablers to childhood MMR and HPV vaccination among disadvantaged, minority or underserved populations in middle- and high-income countries: a systematic review.
BACKGROUND
Child vaccinations are among the most effective public health interventions. However, wide gaps in child vaccination remain among different groups with uptake in most minorities or ethnic communities in Europe substantially lower compared to the general population. A systematic review was conducted to understand health system barriers and enablers to measles, mumps and rubella (MMR) and human papilloma virus (HPV) child vaccination among disadvantaged, minority populations in middle- and high-income countries.
METHODS
We searched Medline, Cochrane, CINAHL, ProQuest and EMBASE for articles published from 2010 to 2021. Following title and abstract screening, full texts were assessed for relevance. Study quality was appraised using Critical Appraisal Skills Program checklists. Data extraction and analysis were performed. Health system barriers and enablers to vaccination were mapped to the World Health Organization health system building blocks.
RESULTS
A total of 1658 search results were identified from five databases and 24 from reference lists. After removing duplicates, 1556 titles were screened and 496 were eligible. Eighty-six full texts were assessed for eligibility, 28 articles met all inclusion criteria. Factors that affected MMR and HPV vaccination among disadvantaged populations included service delivery (limited time, geographic distance, lack of culturally appropriate translated materials, difficulties navigating healthcare system), healthcare workforce (language and poor communication skills), financial costs and feelings of discrimination.
CONCLUSION
Policymakers must consider health system barriers to vaccination faced by disadvantaged, minority populations while recognizing specific cultural contexts of each population. To ensure maximum policy impact, approaches to encourage vaccinations should be tailored to the unique population's needs. A one-size-fits-all approach is not effective.
Topics: Child; Humans; Vulnerable Populations; Developed Countries; Papillomavirus Infections; Vaccination; Delivery of Health Care
PubMed: 38183166
DOI: 10.1093/eurpub/ckad232 -
Scandinavian Journal of Immunology Jun 2023Measles, mumps and rubella (MMR) are contagious infectious diseases that can be prevented by immunization. However, MMR infections can occur in previously immunized... (Review)
Review
Measles, mumps and rubella (MMR) are contagious infectious diseases that can be prevented by immunization. However, MMR infections can occur in previously immunized individuals. The vaccine response is, among other factors, influenced by the combined effects of many genes. This systematic review investigates the genetic influence on measles, mumps and rubella antibody responses after childhood vaccination. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), systematic literature searches were conducted in the medical databases PubMed, EMBASE and PsycINFO. Search strings were adjusted for each database. Citations were included if they measured and compared the immune response with immunogenetics after vaccination with a vaccine containing one or more of the following components: measles, mumps and/or rubella, MMR. The measure of vaccine response studied was antibodies after vaccination. Forty-eight articles were included in the final analysis. The results suggest that genetic determinants, including host genes, and single nucleotide polymorphisms in immune-related genes influence the MMR antibody responses after vaccination. Specifically, replicated associations were found between HLA, CD46, RARB, IRF9, EIF2AK2, cytokine genes and MMR vaccine-induced humoral immune responses. This knowledge can be useful in understanding and predicting immune responses and may have implications for future vaccine strategies.
Topics: Humans; Adolescent; Infant; Mumps; Measles-Mumps-Rubella Vaccine; Rubella; Measles; Antibodies, Viral
PubMed: 38157324
DOI: 10.1111/sji.13266 -
Journal of Medical Internet Research Dec 2023Vaccination programs are instrumental in prolonging and improving people's lives by preventing diseases such as measles, diphtheria, tetanus, pertussis, and influenza... (Review)
Review
BACKGROUND
Vaccination programs are instrumental in prolonging and improving people's lives by preventing diseases such as measles, diphtheria, tetanus, pertussis, and influenza from escalating into fatal epidemics. Despite the significant impact of these programs, a substantial number of individuals, including 20 million infants annually, lack sufficient access to vaccines. Therefore, it is imperative to raise awareness about vaccination programs.
OBJECTIVE
This study aims to investigate the potential utilization of social media, assessing its scalability and robustness in delivering accurate and reliable information to individuals who are contemplating vaccination decisions for themselves or on behalf of their children.
METHODS
The protocol for this review is registered in PROSPERO (identifier CRD42022304229) and is being carried out in compliance with the Cochrane Handbook for Systematic Reviews of Interventions. Comprehensive searches have been conducted in databases including MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar. Only randomized controlled trials (RCTs) were deemed eligible for inclusion in this study. The target population encompasses the general public, including adults, children, and adolescents. The defined interventions comprise platforms facilitating 2-way communication for sharing information. These interventions were compared against traditional interventions and teaching methods, referred to as the control group. The outcomes assessed in the included studies encompassed days unvaccinated, vaccine acceptance, and the uptake of vaccines compared with baseline. The studies underwent a risk-of-bias assessment utilizing the Cochrane Risk-of-Bias tool for RCTs, and the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment.
RESULTS
This review included 10 studies, detailed in 12 articles published between 2012 and 2022, conducted in the United States, China, Jordan, Australia, and Israel. The studies involved platforms such as Facebook, Twitter, WhatsApp, and non-general-purpose social media. The outcomes examined in these studies focused on the uptake of vaccines compared with baseline, vaccine acceptance, and the number of days individuals remained unvaccinated. The overall sample size for this review was 26,286, with individual studies ranging from 58 to 21,592 participants. The effect direction plot derived from articles of good and fair quality indicated a nonsignificant outcome (P=.12).
CONCLUSIONS
The findings suggest that, in a real-world scenario, an equal number of positive and negative results may be expected due to the interventions' impact on the acceptance and uptake of vaccines. Nevertheless, there is a rationale for accumulating experience to optimize the use of social media with the aim of enhancing vaccination rates. Social media can serve as a tool with the potential to disseminate information and boost vaccination rates within a population. However, relying solely on social media is not sufficient, given the complex structures at play in vaccine acceptance. Effectiveness hinges on various factors working in tandem. It is crucial that authorized personnel closely monitor and moderate discussions on social media to ensure responsible and accurate information dissemination.
Topics: Adolescent; Adult; Child; Humans; Infant; Australia; Influenza Vaccines; Randomized Controlled Trials as Topic; Social Media; Systematic Reviews as Topic; Vaccination
PubMed: 38147375
DOI: 10.2196/50276 -
BMC Public Health Nov 2023Due to low vaccination uptake and measles outbreaks across Europe, public health authorities have paid increasing attention to anthroposophic communities. Public media...
BACKGROUND
Due to low vaccination uptake and measles outbreaks across Europe, public health authorities have paid increasing attention to anthroposophic communities. Public media outlets have further described these communities as vaccine refusers or "anti-vaxxers". The aim of this review was to understand the scope of the problem and explore assumptions about vaccination beliefs in anthroposophic communities. For the purpose of this review, we define anthroposophic communities as people following some/certain views more or less loosely connected to the philosophies of anthroposophy. The systematic review addresses three research questions and (1) collates evidence documenting outbreaks linked to anthroposophic communities, (2) literature on vaccination coverage in anthroposophic communities, and (3) lastly describes literature that summarizes theories and factors influencing vaccine decision-making in anthroposophic communities.
METHODS
This is a systematic review using the following databases: Medline, Web of Science, Psycinfo, and CINAHL. Double-blinded article screening was conducted by two researchers. Data was summarized to address the research questions. For the qualitative research question the data was analysed using thematic analysis with the assistance of Nvivo12.0.
RESULTS
There were 12 articles documenting 18 measles outbreaks linked to anthroposophic communities between the years 2000 and 2012. Seven articles describe lower vaccination uptake in anthroposophic communities than in other communities, although one article describes that vaccination coverage in low-income communities with a migrant background was lower than in the anthroposophic community they studied. We found eight articles examining factors and theories influencing vaccine decision making in anthroposophic communities. The qualitative analysis revealed four common themes. Firstly, there was a very broad spectrum of vaccine beliefs among the anthroposophic communities. Secondly, there was a consistent narrative about problems or concerns with vaccines, including toxicity and lack of trust in the system. Thirdly, there was a strong notion of the importance of making individual and well-informed choices as opposed to simply following the masses. Lastly, making vaccine choices different from public health guidelines was highly stigmatized by those outside of the anthroposophic community but also those within the community.
CONCLUSION
Continuing to further knowledge of vaccine beliefs in anthroposophic communities is particularly important in view of increasing measles rates and potential sudden reliance on vaccines for emerging diseases. However, popular assumptions about vaccine beliefs in anthroposophic communities are challenged by the data presented in this systematic review.
Topics: Humans; Anthroposophy; Vaccination Hesitancy; Vaccines; Vaccination; Measles
PubMed: 37957574
DOI: 10.1186/s12889-023-17081-w