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Ravi SJ, Vecino-Ortiz AI, Potter CM, Merritt MW, Patenaude BN. Group-based trajectory models of integrated vaccine delivery and equity in low- and middle-income countries. Int J Equity Health 2024; 23:5. [PMID: 38195588 PMCID: PMC10775446 DOI: 10.1186/s12939-023-02088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Integrated vaccine delivery - the linkage of routine vaccination with provision of other essential health services - is a hallmark of robust primary care systems that has been linked to equitable improvements in population health outcomes. METHODS We gathered longitudinal data relating to routine immunization coverage and vaccination equity in 78 low- and middle-income countries that have ever received support from Gavi, the Vaccine Alliance, using multiple imputation to handle missing values. We then estimated several group-based trajectory models to describe the relationship between integrated vaccine delivery and vaccination equity in these countries. Finally, we used multinomial logistic regression to identify predictors of group membership. RESULTS We identified five distinct trajectories of geographic vaccination equity across both the imputed and non-imputed datasets, along with two and four trajectories of socioeconomic vaccination equity in the imputed and non-imputed datasets, respectively. Integration was associated with reductions in the slope index of inequality of measles vaccination in the countries analyzed. Integration was also associated with an increase in the percentage of districts reporting high measles vaccination coverage. CONCLUSIONS Integrated vaccine delivery is most strongly associated with improvements in vaccination equity in settings with high baseline levels of inequity. Continued scholarship is needed to further characterize the relationship between integration and health equity, as well as to improve measurement of vaccination coverage and integration.
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Affiliation(s)
- Sanjana J Ravi
- Center for Health Security, Johns Hopkins Bloomberg School of Public Health, 700 East Pratt Street, Suite 900, Baltimore, MD, 21202, USA.
| | - Andrés I Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8527, Baltimore, MD, 21205, USA
| | - Christina M Potter
- Center for Health Security, Johns Hopkins Bloomberg School of Public Health, 700 East Pratt Street, Suite 900, Baltimore, MD, 21202, USA
| | - Maria W Merritt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8527, Baltimore, MD, 21205, USA
- Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, 1809 Ashland Avenue, Baltimore, MD, 21205, USA
| | - Bryan N Patenaude
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8527, Baltimore, MD, 21205, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, 5th Floor, Baltimore, MD, 21231, USA
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Barakat M, Abdaljaleel M, Atawneh N, Alkhazaleh R, Aburumman D, Hamed E, Sallam M. Pervasive Parental Hesitancy and Resistance towards Measles Rubella Vaccination in Jordan. Vaccines (Basel) 2023; 11:1672. [PMID: 38006004 PMCID: PMC10674877 DOI: 10.3390/vaccines11111672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Measles remains a highly contagious and potentially severe infectious disease, necessitating high vaccine coverage. However, misinformation and measles vaccine hesitancy/resistance have posed significant challenges to achieving this goal. The COVID-19 pandemic further exacerbated these challenges, leading to a measles outbreak in Jordan in 2023. This study aimed to investigate the acceptance of the measles rubella (MR) vaccine among parents in Jordan and to identify its associated determinants. This cross-sectional questionnaire-based study was conducted using a previously Arabic-validated version of the Parental Attitudes towards Childhood Vaccines (PACV) survey instrument. Data collection took place in October 2023, and the final study sample comprised a total of 391 parents, with mothers representing 69.8% of the participants (n = 273). The majority of participating parents expressed either resistance (n = 169, 43.2%) or hesitancy (n = 168, 43.0%) towards MR vaccination, while only 54 participants (13.8%) expressed MR vaccine acceptance. Multivariate analysis revealed that trust in vaccine safety/efficacy, behavior, and having fewer offspring were significantly associated with MR vaccine acceptance. The current study revealed a concerning level of MR vaccine hesitancy/resistance among parents in Jordan, which could signal a public health alarm in the country. Urgent and targeted interventions are strongly recommended to address this issue, including mass campaigns aimed at building trust in the MR vaccine's safety/efficacy. Additionally, there is an urgent need for effective public health initiatives to ensure sufficient measles vaccine coverage to prevent future outbreaks of this serious disease.
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Affiliation(s)
- Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan;
- MEU Research Unit, Middle East University, Amman 11831, Jordan
| | - Maram Abdaljaleel
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Nada Atawneh
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Rawan Alkhazaleh
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Dana Aburumman
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Eman Hamed
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
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3
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Swanepoel J, van der Zalm MM, Preiser W, van Zyl G, Whittaker E, Hesseling AC, Moore DAJ, Seddon JA. SARS-CoV-2 infection and pulmonary tuberculosis in children and adolescents: a case-control study. BMC Infect Dis 2023; 23:442. [PMID: 37386354 DOI: 10.1186/s12879-023-08412-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND The Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic has had an impact on the global tuberculosis (TB) epidemic but evidence on the possible interaction between SARS-CoV-2 and TB, especially in children and adolescents, remains limited. We aimed to evaluate the relationship between previous infection with SARS-CoV-2 and the risk of TB in children and adolescents. METHODS An unmatched case-control study was conducted using SARS-CoV-2 unvaccinated children and adolescents recruited into two observational TB studies (Teen TB and Umoya), between November 2020 and November 2021, in Cape Town, South Africa. Sixty-four individuals with pulmonary TB (aged < 20 years) and 99 individuals without pulmonary TB (aged < 20 years) were included. Demographics and clinical data were obtained. Serum samples collected at enrolment underwent quantitative SARS-CoV-2 anti-spike immunoglobulin G (IgG) testing using the Abbott SARS-CoV-2 IgG II Quant assay. Odds ratios (ORs) for TB were estimated using unconditional logistic regression. RESULTS There was no statistically significant difference in the odds of having pulmonary TB between those who were SARS-CoV-2 IgG seropositive and those who were seronegative (adjusted OR 0.51; 95% CI: 0.23-1.11; n = 163; p = 0.09). Of those with positive SARS-CoV-2 serology indicating prior infection, baseline IgG titres were higher in individuals with TB compared to those without TB (p = 0.04) and individuals with IgG titres in the highest tertile were more likely to have pulmonary TB compared to those with IgG levels in the lowest tertile (OR: 4.00; 95%CI: 1.13- 14.21; p = 0.03). CONCLUSIONS Our study did not find convincing evidence that SARS-CoV-2 seropositivity was associated with subsequent pulmonary TB disease; however, the association between magnitude of SARS-CoV-2 IgG response and pulmonary TB warrants further investigation. Future prospective studies, evaluating the effects of sex, age and puberty on host immune responses to M. tuberculosis and SARS-CoV-2, will also provide more clarity on the interplay between these two infections.
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Affiliation(s)
- Jeremi Swanepoel
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
- TB Centre, London School of Hygiene and Tropical Medicine, London, UK.
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Wolfgang Preiser
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Gert van Zyl
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Academic Hospital, Cape Town, South Africa
| | | | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - David A J Moore
- TB Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Infectious Disease, Imperial College London, London, UK
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Jacqueline C, Gavilán AM, López-Perea N, Penedos AR, Masa-Calles J, Echevarría JE, Fernández-García A. Utility of MF-non coding region for measles molecular surveillance during post-elimination phase, Spain, 2017-2020. Front Microbiol 2023; 14:1143933. [PMID: 37283922 PMCID: PMC10240958 DOI: 10.3389/fmicb.2023.1143933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/03/2023] [Indexed: 06/08/2023] Open
Abstract
Background In countries entering the post-elimination phase for measles, the study of variants by sequencing of 450 nucleotides of the N gene (N450) does not always allow the tracing of chains of transmission. Indeed, between 2017 and 2020, most measles virus sequences belonged to either the MVs/Dublin.IRL/8.16 (B3-Dublin) or the MVs/Gir Somnath.IND/42.16 (D8-Gir Somnath) variants. We evaluated the additional use of a non-coding region (MF-NCR) as a tool to enhance resolution and infer case origin, chains of transmission and characterize outbreaks. Methods We obtained 115 high-quality MF-NCR sequences from strains collected from Spanish patients infected with either B3-Dublin or D8-Gir Somnath variants between 2017 and 2020, performed epidemiological, phylogenetic and phylodynamic analyses and applied a mathematical model to determine relatedness among identified clades. Results Applying this model allowed us to identify phylogenetic clades potentially derived from concomitant importations of the virus rather than single chain of transmission, inferred based on only N450 and epidemiology data. In a third outbreak, we found two related clades that corresponded to two chains of transmission. Discussion Our results show the ability of the proposed method to improve identification of simultaneous importations in the same region which could trigger enhanced contact tracing. Moreover, the identification of further transmission chains indicates that the size of import-related outbreaks was smaller than previously found, supporting the interpretation that endemic measles transmission was absent in Spain between 2017 and 2020. We suggest considering the use of the MF-NCR region in conjunction with the study of N450 variants in future WHO recommendations for measles surveillance.
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Affiliation(s)
- Camille Jacqueline
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Majadahonda, Spain
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Ana María Gavilán
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Majadahonda, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Noemí López-Perea
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Josefa Masa-Calles
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan E. Echevarría
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Majadahonda, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Aurora Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Majadahonda, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Mebrate M, Hailu C, Alemu S. Measles outbreak investigation in Kasoshekumer kebele, Sinana district, South-Eastern Oromia, Ethiopia: A case-control study. SAGE Open Med 2023; 11:20503121231169182. [PMID: 37152839 PMCID: PMC10161311 DOI: 10.1177/20503121231169182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/24/2023] [Indexed: 05/09/2023] Open
Abstract
Objective This study aimed at verifying the outbreak, preventing further transmission, and identifying the risk factors for the outbreak. Method A case-control study design was conducted from March 4, 2020 to April 30, 2020, in Kasoshekumer kebele of Sinana district. Thirty-seven carer-patient pairs and 74 controls were recruited in a 1:2 case-control ratio. Patients were selected using a national standard case definition of the Ministry of Health. Controls were selected from neighbors of patients and interviewed after the second incubation period from the last patient of the outbreak by a structured questionnaire similar to patients. All cases were included while controls were selected purposively for their exposure status. Vaccine efficacy, attack rate, and case fatality rate were conducted as a descriptive epidemiology. Multivariate analysis was used to identify associated factors. Result Out of 109 study participants, there were 37 cases and 72 controls. The mean age was 58.8 months with ±54 standard deviation. Thirty-one (83.8%) of the cases had a known contact history and 23 (62.2%) were unvaccinated. The age-specific attack rate was 36/1000 in <5 years and 53/100,000 in >15 years. The estimated vaccine efficacy was 73.7%. Having any type of socialization behavior (adjusted odds ratio = 6.8, confidence interval: 4.25, 11.4), maternal poor knowledge of measles prevention (adjusted odds ratio = 4.152, confidence interval: 1.226, 8.058), and being unvaccinated (adjusted odds ratio = 7.79, confidence interval: 2.281, 12.63) were associated factors for measles infection. Conclusion Poor knowledge of the parents on vaccination and the less effort taken to deliver good attitude toward vaccination are resulting in measles outbreak. However, herd immunity can prevent the outbreak; if not, the community will continue to suffer from mortality and morbidity. A resilient immunization program with sustainable and equitable supply, delivery, monitoring, and evaluation is a fundamental action in prevention of measles outbreak. Increased awareness of vaccination and other prevention measures are also crucial to end the outbreaks.
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Affiliation(s)
- Milkessa Mebrate
- Field Epidemiology Training Program, Department of Epidemiology, Jimma University, Jimma, Ethiopia
| | - Cherinet Hailu
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Soresa Alemu
- Mettu Health Science College, Mettu, Ethiopia
- Soresa Alemu, Mettu Health Science College, Mettu, Oromia, Ethiopia.
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6
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Sievers BL, Sievers RE, Sievers EL. Incentivized self-vaccination for global measles eradication. J Virus Erad 2022; 8:100310. [PMID: 36578361 PMCID: PMC9791812 DOI: 10.1016/j.jve.2022.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Measles-we've become inured to its cruel, insidious impact as it kills over 100,000 children yearly because of suboptimal vaccination coverage. It does not have to be this way. A familiar, safe, exceptionally effective measles vaccine saves lives and permanent, global measles eradication is within reach. But now we need to be clever and courageously explore new strategies to save lives. Firstly, let us enable people to vaccinate themselves, not with a needle and syringe, but with a quick inhaled puff of dry powder vaccine. Secondly, let us provide micro-payments using digital currency to incentivize those who vaccinate themselves. Thirdly, let us leverage learnings from how our social networks guide our behaviors to further encourage self-vaccination. Fourthly, let us inspire friendly regional competition among communities vying for the highest proportion of citizens who show measles neutralizing antibodies in spot saliva samples. With global cooperation and relentless determination, we eradicated smallpox. Next up? Measles.
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Affiliation(s)
| | - Robert E. Sievers
- Department of Chemistry and Biochemistry, University of Colorado Boulder, Boulder, CO, 80309, USA
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Yu CP, Chen BC, Chou YC, Hsieh CJ, Lin FH. Epidemiological features and risk factors for measles and rubella in Taiwan during 2011 to 2020. Medicine (Baltimore) 2022; 101:e31254. [PMID: 36316902 PMCID: PMC9622609 DOI: 10.1097/md.0000000000031254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The risk of geographic transmission of infectious diseases due to air travel varies greatly. Our aim is to survey empirical data that provide a retrospective historical perspective on measles and rubella. This study used the open data website provided by the Taiwan Centers for Disease Control (TCDC) to extract the reported numbers of measles and rubella case between 2011 and 2020. There were 306 cases of measles and 135 cases of rubella. The incidence of measles and rubella per million population were 0 to 6.0 and 0 to 2.6, respectively. There was a gradual increase in the numbers of cases in those aged 20-39 years, and distinct duration patterns. It indicated that the risk of contracting rubella has significantly decreased in the last 5 years. Measles cases aged 20 to 39 years accounted for 72.5% of all cases. Rubella cases aged 20 to 39 years accounted for 59.3% of all cases. The male and residency in the Taipei metropolitan area or northern area were identified as potential risk factors for measles and rubella. Coverage with the first dose of the measles, mumps and rubella (MMR) vaccine in Taiwan increased from 97.31% to 98.86%, and the uptake rate of the second dose of the MMR vaccine increased from 95.73% to 98.39% between 2010 and 2020. Furthermore, the numbers of imported cases of measles (n = 0) and rubella (n = 0) reported during the coronavirus disease 2019 (COVID-19) pandemic were lower than those from 2011 to 2019. Measles and rubella cases were imported most frequently from Cambodia and Vietnam. This study represents the first report of confirmed cases of acquired measles and rubella from surveillance data of the TCDC between 2011 and 2020, also demonstrates that the numbers of cases of measles and rubella significantly decreased in Taiwan during the COVID-19 pandemic.
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Affiliation(s)
- Chia-Peng Yu
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Bao-Chung Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Chi-Jeng Hsieh
- Department of Health Care Administration, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
- *Correspondence: Fu-Huang Lin, School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan (e-mail: )
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8
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Ahmad SN, Sameen D, Dar MA, Jallu R, Shora TN, Dhingra M. Do SARS-CoV-2-Infected Pregnant Women Have Adverse Pregnancy Outcomes as Compared to Non-Infected Pregnant Women? Int J Womens Health 2022; 14:1201-1210. [PMID: 36081450 PMCID: PMC9447998 DOI: 10.2147/ijwh.s375739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/25/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose To determine the feto-maternal outcome in pregnant women infected with SARS-CoV-2 in comparison to non-infected pregnant women and plan management strategies. Patients and Methods A retrospective review of case records in the Department of Obstetrics and Gynecology for 1 year was conducted. A total of 6468 case files fulfilling the inclusion criteria were enrolled in the study. Patients who tested positive for SARS CoV-2 and fulfilled inclusion criteria were labeled as cases, whereas patients who tested negative were labeled as controls. Outcome measures including lower segment cesarean section (LSCS) rate, maternal and neonatal intensive care admission and feto-maternal mortality were compared between the two groups. Results Our hospital was not an exclusive COVID-19 designated center, and 117 patients infected with SARS-CoV-2 fulfilling the inclusion criteria were enrolled in the study. Fever (67.52%), cough (56.41%), and altered smell (45.29%) were the frequently reported symptoms. Pneumonia affected 16.23% of the cases. LSCS rate was significantly higher in the COVID-19-infected patients (72.41%; OR 2.19; 95% CI 1.46–3.34; p<0.001). The rate of maternal ICU admission in COVID-19-infected pregnant women was 11.96% as compared to 0.8% in the non-infected women (OR 16.76; 95% CI 8.72–30.77; p<0.001). We observed a significantly higher maternal mortality in COVID-19-infected women (2.56%) [OR 41.61; 95% CI 7.65–203.5; p<0.001]. Viral RNA was detected in cord blood and nasopharyngeal swab of one neonate. The neonatal death ratio was high in infected mothers (2.6%) [OR 8.6; 95% CI 1.99–27.23; p<0.001]. Conclusion Significant maternal morbidity, mortality, and neonatal mortality were observed in COVID-19-positive patients.
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Affiliation(s)
- Syed Nawaz Ahmad
- Department of Obstetrics and Gynecology, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India
| | - Duri Sameen
- Department of Obstetrics and Gynecology, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India
| | - Mansoor Ahmad Dar
- Department of Psychiatry, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India
- Correspondence: Mansoor Ahmad Dar, Department of Psychiatry, Government Medical College, Anantnag, Jammu and Kashmir, Tel +919596010111, Email
| | - Romaan Jallu
- Department of Microbiology, Government Medical College Srinagar, Srinagar, Jammu and Kashmir, India
- Romaan Jallu, Department of Microbiology, Government Medical College, Srinagar, Jammu and Kashmir, 190010, India, Tel +916006888061, Email
| | - Tajali Nazir Shora
- Department of Community Medicine, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India
| | - Mansi Dhingra
- Department of Obstetrics and Gynecology, Vaga Hospital, Lucknow, India
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Rabaan AA, Mutair AA, Alhumaid S, Garout M, Alsubki RA, Alshahrani FS, Alfouzan WA, Alestad JH, Alsaleh AE, Al-Mozaini MA, Koritala T, Alotaibi S, Temsah MH, Akbar A, Ahmad R, Khalid Z, Muhammad J, Ahmed N. Updates on Measles Incidence and Eradication: Emphasis on the Immunological Aspects of Measles Infection. Medicina (B Aires) 2022; 58:medicina58050680. [PMID: 35630096 PMCID: PMC9147347 DOI: 10.3390/medicina58050680] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 12/31/2022] Open
Abstract
Measles is an RNA virus infectious disease mainly seen in children. Despite the availability of an effective vaccine against measles, it remains a health issue in children. Although it is a self-limiting disease, it becomes severe in undernourished and immune-compromised individuals. Measles infection is associated with secondary infections by opportunistic bacteria due to the immunosuppressive effects of the measles virus. Recent reports highlight that measles infection erases the already existing immune memory of various pathogens. This review covers the incidence, pathogenesis, measles variants, clinical presentations, secondary infections, elimination of measles virus on a global scale, and especially the immune responses related to measles infection.
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Affiliation(s)
- Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
- Correspondence: (A.A.R.); (N.A.)
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi Arabia;
- College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
- School of Nursing, Wollongong University, Wollongong, NSW 2522, Australia
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia;
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia;
| | - Roua A. Alsubki
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia;
| | - Fatimah S. Alshahrani
- Department of Internal Medicine, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia;
- Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, King Saud University Medical City, Riyadh 11451, Saudi Arabia
| | - Wadha A. Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait;
- Microbiology Unit, Department of Laboratories, Farwania Hospital, Farwania 85000, Kuwait
| | - Jeehan H. Alestad
- Immunology and Infectious Microbiology Department, University of Glasgow, Glasgow G1 1XQ, UK;
- Microbiology Department, College of Medicine, Jabriya 46300, Kuwait
| | - Abdullah E. Alsaleh
- Core Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia;
| | - Maha A. Al-Mozaini
- Immunocompromised Host Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11564, Saudi Arabia;
| | - Thoyaja Koritala
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Mankato, MN 56001, USA;
| | - Sultan Alotaibi
- Molecular Microbiology Department, King Fahad Medical City, Riyadh 11525, Saudi Arabia;
| | - Mohamad-Hani Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Ali Akbar
- Department of Microbiology, University of Balochistan, Quetta 87300, Pakistan;
| | - Rafiq Ahmad
- Department of Microbiology, The University of Haripur, Haripur 22610, Pakistan; (R.A.); (Z.K.); (J.M.)
| | - Zainab Khalid
- Department of Microbiology, The University of Haripur, Haripur 22610, Pakistan; (R.A.); (Z.K.); (J.M.)
| | - Javed Muhammad
- Department of Microbiology, The University of Haripur, Haripur 22610, Pakistan; (R.A.); (Z.K.); (J.M.)
| | - Naveed Ahmed
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, University Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia
- Correspondence: (A.A.R.); (N.A.)
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10
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Feutz K, Shirey D. Measles: Moving toward eradication. Nurse Pract 2022; 47:14-20. [PMID: 35470329 DOI: 10.1097/01.npr.0000827116.22104.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABSTRACT Measles is a vaccine-preventable, highly contagious virus once considered eradicated in the US. It is still a significant source of morbidity and mortality for children under 5 years of age worldwide. Advanced practice registered nurses are on the frontlines of reducing the spread of disease and educating the community on measles prevention.
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Malama K, Tichacek A, Kelly H, Parker R, Inambao M, Sharkey T, Wall KM, Kilembe W, Price MA, Fast P, Priddy F, Allen S. Measles immunity gap among reproductive-age women participating in a simulated HIV vaccine efficacy trial in Zambia. Hum Vaccin Immunother 2022; 18:2066426. [PMID: 35446726 PMCID: PMC9302517 DOI: 10.1080/21645515.2022.2066426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Measles is a vaccine-preventable viral disease whose vaccination coverage remains low in Zambia, where the target group for vaccination is children aged 9 to 18 months. In addition to inadequate measles vaccination coverage among children, few studies address potential resultant immunity gaps among adults. We analyzed data from a simulated HIV vaccine efficacy trial (SiVET) conducted from 2015–2017 among adult Zambian women of childbearing age to determine measles antibody seroprevalence before and after vaccination with the measles, mumps and rubella (MMR) vaccine. We used MMR vaccine as a substitute for an experimental HIV vaccine as part of a simulation exercise to prepare for an HIV vaccine efficacy trial. We found that 75% of women had measles antibodies prior to receiving MMR, which increased to 98% after vaccination. In contrast, mumps and rubella antibody prevalence was high before (93% and 97%, respectively) and after (99% and 100%, respectively) vaccination. The low baseline measles seropositivity suggests an immunity gap among women of childbearing age. We recommend that measles vaccination programs target women of childbearing age, who can pass antibodies on to neonates. Moreover, administering the MMR vaccine to clinical trial candidates could prevent measles, mumps or rubella-related adverse events during actual trials.
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Affiliation(s)
- Kalonde Malama
- Center for Family Health Research in Zambia, Rwanda Zambia HIV Research Group, Lusaka, Zambia
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Emory University, School of Medicine, Atlanta, GA, USA
| | - Hilary Kelly
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Emory University, School of Medicine, Atlanta, GA, USA
| | - Mubiana Inambao
- Center for Family Health Research in Zambia, Rwanda Zambia HIV Research Group, Ndola, Zambia
| | - Tyronza Sharkey
- Center for Family Health Research in Zambia, Rwanda Zambia HIV Research Group, Lusaka, Zambia
| | - Kristin M Wall
- Rwanda Zambia HIV Research Group, Emory University, School of Medicine, Atlanta, GA, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - William Kilembe
- Center for Family Health Research in Zambia, Rwanda Zambia HIV Research Group, Lusaka, Zambia
| | - Matt A Price
- IAVI, New York, NY, USA.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | | | | | - Susan Allen
- Rwanda Zambia HIV Research Group, Emory University, School of Medicine, Atlanta, GA, USA
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12
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Zhuzzhasarova A, Bayesheva D, Azimbaeva N, Smagul M, Nusupbaeva G, Turdalina B, Seidullayeva A, Abdullaev B, Kushugulova A. Epidemiological and Molecular-Genetic Characteristics of the Measles Outbreak in Kazakhstan. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/11549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Mehtar S, AlMhawish N, Shobak K, Reingold A, Guha-Sapir D, Haar RJ. Measles in conflict-affected northern Syria: results from an ongoing outbreak surveillance program. Confl Health 2021; 15:95. [PMID: 34933672 PMCID: PMC8689574 DOI: 10.1186/s13031-021-00430-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/29/2021] [Indexed: 01/02/2023] Open
Abstract
Background The Syrian conflict has dramatically changed the public health landscape of Syria since its onset in March of 2011. Depleted resources, fractured health systems, and increased security risks have disrupted many routine services, including vaccinations, across several regions in Syria. Improving our understanding of infectious disease transmission in conflict-affected communities is imperative, particularly in the Syrian conflict. We utilize surveillance data from the Early Warning Alert and Response Network (EWARN) database managed by the Assistance Coordination Unit (ACU) to explore trends in the incidence of measles in conflict-affected northern Syria and analyze two consecutive epidemics in 2017 and 2018. Methods We conducted a retrospective time-series analysis of the incidence of clinically suspected cases of measles using EWARN data between January 2015 and June 2019. We compared regional and temporal trends to assess differences between geographic areas and across time. Results Between January 2015 and June 2019, there were 30,241 clinically suspected cases of measles reported, compared to 3193 cases reported across the whole country in the decade leading up to the conflict. There were 960 regional events that met the measles outbreak threshold and significant differences in the medians of measles incidence across all years (p-value < 0.001) and in each pairwise comparison of years as well as across all geographic regions (p-value < 0.001). Although most governorates faced an elevated burden of cases in every year of the study, the measles epidemics of 2017 and 2018 in the governorates of Ar-Raqqa, Deir-Ez-Zor, and Idlib accounted for over 71% of the total suspected cases over the entire study period. Conclusions The 2017 and 2018 measles epidemics were the largest since Syria eliminated the disease in 1999. The regions most affected by these outbreaks were areas of intense conflict and displacement between 2014 and 2018, including districts in Ar-Raqqa, Deir-Ez-Zor, and Idlib. The spread of measles in northern Syria serves as an indicator of low immunization coverage and limited access to care and highlights the Syrian peoples’ vulnerability to infectious diseases and vaccine preventable diseases in the setting of the current conflict. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00430-0.
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Affiliation(s)
- Sammy Mehtar
- UC Berkeley - UCSF Joint Medical Program, Berkeley, USA
| | | | | | - Art Reingold
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94705, USA
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters, University of Louvain School of Public Health, Leuven, Belgium
| | - Rohini J Haar
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94705, USA.
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14
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Metcalf CJE, Andriamandimby SF, Baker RE, Glennon EE, Hampson K, Hollingsworth TD, Klepac P, Wesolowski A. Challenges in evaluating risks and policy options around endemic establishment or elimination of novel pathogens. Epidemics 2021; 37:100507. [PMID: 34823222 PMCID: PMC7612525 DOI: 10.1016/j.epidem.2021.100507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/20/2021] [Accepted: 10/06/2021] [Indexed: 11/12/2022] Open
Abstract
When a novel pathogen emerges there may be opportunities to eliminate transmission - locally or globally - whilst case numbers are low. However, the effort required to push a disease to elimination may come at a vast cost at a time when uncertainty is high. Models currently inform policy discussions on this question, but there are a number of open challenges, particularly given unknown aspects of the pathogen biology, the effectiveness and feasibility of interventions, and the intersecting political, economic, sociological and behavioural complexities for a novel pathogen. In this overview, we detail how models might identify directions for better leveraging or expanding the scope of data available on the pathogen trajectory, for bounding the theoretical context of emergence relative to prospects for elimination, and for framing the larger economic, behavioural and social context that will influence policy decisions and the pathogen’s outcome.
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Affiliation(s)
- C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Princeton School of Public and International Affairs, Princeton University, Princeton, USA.
| | | | - Rachel E Baker
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Princeton High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA
| | - Emma E Glennon
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
| | - Katie Hampson
- Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, UK
| | - T Deirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, UK
| | - Petra Klepac
- London School of Hygiene and Tropical Medicine, London, UK
| | - Amy Wesolowski
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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15
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Moss WJ, Shendale S, Lindstrand A, O'Brien KL, Turner N, Goodman T, Kretsinger K. Feasibility assessment of measles and rubella eradication. Vaccine 2021; 39:3544-3559. [PMID: 34045102 DOI: 10.1016/j.vaccine.2021.04.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 12/28/2022]
Abstract
This report addresses the epidemiological aspects and feasibility of measles and rubella eradication and the potential resource requirements in response to the request of the Director-General at the Seventieth World Health Assembly held on May 31, 2017. A guiding principle is that the path toward measles and rubella eradication should serve to strengthen primary health care, promote universal health coverage, and be a pathfinder for new vision and strategy for immunization over the next decade as laid out in the Immunization Agenda 2030. Specifically, this report: 1) highlights the importance of measles and rubella as global health priorities; 2) reviews the current global measles and rubella situation; 3) summarizes prior assessments of the feasibility of measles and rubella eradication; 4) assesses the progress and challenges in achieving regional measles and rubella elimination; 5) assesses additional considerations for measles and rubella eradication, including the results of modelling and economic analyses; 6) assesses the implications of establishing a measles and rubella eradication goal and the process for setting an eradication target date; 7) proposes a framework for determining preconditions for setting a target date for measles and rubella eradication and how these preconditions should be understood and used; and 8) concludes with recommendations endorsed by SAGE.
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Affiliation(s)
- William J Moss
- International Vaccine Access Center, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Ann Lindstrand
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Katherine L O'Brien
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Nikki Turner
- Division of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Tracey Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Katrina Kretsinger
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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16
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Goncu Ayhan S, Oluklu D, Atalay A, Menekse Beser D, Tanacan A, Moraloglu Tekin O, Sahin D. COVID-19 vaccine acceptance in pregnant women. Int J Gynaecol Obstet 2021; 154:291-296. [PMID: 33872386 PMCID: PMC9087778 DOI: 10.1002/ijgo.13713] [Citation(s) in RCA: 167] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022]
Abstract
Objective To determine vaccine acceptance and hesitancy attitudes toward coronavirus disease 2019 (COVID‐19) vaccines in pregnant women. Methods Three hundred pregnant women were surveyed face to face with 40 questions. Sociodemographic characteristics, vaccination history, perception of risk for the COVID‐19 pandemic, the impact of the COVID‐19 pandemic, and acceptance of and attitude toward future COVID‐19 vaccination were prospectively evaluated. Results Among all participants, 111 (37%) stated their intent to receive the vaccine if it were recommended for pregnant women. Most common refusal reasons were lack of data about COVID‐19 vaccine safety in pregnant populations and possibility of harm to the fetus. There was a weak positive correlation between COVID‐19 vaccine acceptancy and number of school‐age children. Pregnant women in the first trimester expressed higher acceptance of COVID‐19 vaccination than those in the second and third trimesters. Conclusion The present study reported low acceptance of COVID‐19 vaccination in a sample of pregnant women. Concern about vaccine safety was the major reason for hesitancy. Identifying attitudes among priority groups will be useful for creating vaccination strategies that increase uptake during the current pandemic. Identifying attitudes among priority groups like pregnant women will be useful to create vaccination strategies in the prevention and control of COVID‐19.
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Affiliation(s)
- Sule Goncu Ayhan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Aysegul Atalay
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Coinfection of tuberculosis and COVID-19 limits the ability to in vitro respond to SARS-CoV-2. Int J Infect Dis 2021; 113 Suppl 1:S82-S87. [PMID: 33713816 PMCID: PMC7944764 DOI: 10.1016/j.ijid.2021.02.090] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 12/11/2022] Open
Abstract
Objectives The interaction of COVID-19 and tuberculosis (TB) are still poor characterized. Here we evaluated the immune response specific for Micobacterium tuberculosis (Mtb) and SARS-CoV-2 using a whole-blood-based assay-platform in COVID-19 patients either with TB or latent TB infection (LTBI). Methods We evaluated IFN-γ level in plasma from whole-blood stimulated with Mtb antigens in the Quantiferon-Plus format or with peptides derived from SARS-CoV-2 spike protein, Wuhan-Hu-1 isolate (CD4-S). Results We consecutively enrolled 63 COVID-19, 10 TB-COVID-19 and 11 LTBI-COVID-19 patients. IFN-γ response to Mtb-antigens was significantly associated to TB status and therefore it was higher in TB-COVID-19 and LTBI-COVID-19 patients compared to COVID-19 patients (p ≤ 0.0007). Positive responses against CD4-S were found in 35/63 COVID-19 patients, 7/11 LTBI-COVID-19 and only 2/10 TB-COVID-19 patients. Interestingly, the responders in the TB-COVID-19 group were less compared to COVID-19 and LTBI-COVID-19 groups (p = 0.037 and 0.044, respectively). Moreover, TB-COVID-19 patients showed the lowest quantitative IFN-γ response to CD4-S compared to COVID-19-patients (p = 0.0336) and LTBI-COVID-19 patients (p = 0.0178). Conclusions Our data demonstrate that COVID-19 patients either TB or LTBI have a low ability to build an immune response to SARS-CoV-2 while retaining the ability to respond to Mtb-specific antigens.
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18
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Lu P, Deng X, Hu Y, Guo H. The genotype distribution and phylodynamic of measles viruses circulating in the east of China in postvaccine era, 2005-2017. J Med Virol 2021; 93:5141-5145. [PMID: 33527448 DOI: 10.1002/jmv.26842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/03/2020] [Accepted: 01/29/2021] [Indexed: 02/02/2023]
Abstract
The increase of the evolutionary pressure will cause phylodynamics changes of viruses. In post-vaccine coverage era, measles viruses face more immune pressure than ever before. Vice versa, the phylodynamic changes may reflect herd immunity level provided by vaccination. In this study, we analyzed phylodynamic characteristics of measles viruses isolated from 2005 to 2017 in Jiangsu province of China using nucleoprotein gene sequences of measles viruses. The phylogenetic tree was constructed with Markov chain Monte Carlo algorithm. The mean gene distance within each group was computed with MEGA7.0 software. Our results showed that a decline trend is observed in the gene distance of nucleoprotein gene with time as well as incidence of measles from epidemic surveillance system. Two clusters of H1a genotype show cocirculation of multiple variants in early years and the disappearance of most variants with time. We explore the phylodynamic of measles virus under high immune pressure. Our findings highlight that phylodynamic of measles viruses is a helpful tool to assess the effectiveness of epidemic control.
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Affiliation(s)
- Peishan Lu
- Department of Expand Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiuying Deng
- Department of Expand Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ying Hu
- Department of Expand Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hongxiong Guo
- Department of Expand Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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19
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Lee Y, Maes RK, Kruger JM, Kiupel M, Giessler KS, Soboll Hussey G. Safety and Efficacy of Felid Herpesvirus-1 Deletion Mutants in Cats. Viruses 2021; 13:v13020163. [PMID: 33499363 PMCID: PMC7911815 DOI: 10.3390/v13020163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/10/2021] [Accepted: 01/18/2021] [Indexed: 02/05/2023] Open
Abstract
Felid herpesvirus-1 (FeHV-1) is an important respiratory and ocular pathogen of cats and current vaccines are limited in duration and efficacy because they do not prevent infection, viral nasal shedding and latency. To address these shortcomings, we have constructed FeHV-1 gE-TK- and FeHV-1 PK- deletion mutants (gE-TK- and PK-) using bacterial artificial chromosome (BAC) mutagenesis and shown safety and immunogenicity in vitro. Here, we compare the safety and efficacy of a prime boost FeHV-1 gE-TK- and FeHV-1 PK- vaccination regimen with commercial vaccination in cats. Cats in the vaccination groups were vaccinated at 3-week intervals and all cats were challenge infected 3 weeks after the last vaccination. Evaluations included clinical signs, nasal shedding, virus neutralizing antibodies (VN), cytokine mRNA gene expression, post-mortem histology and detection of latency establishment. Vaccination with gE-TK- and PK- mutants was safe and resulted in significantly reduced clinical disease scores, pathological changes, viral nasal shedding, and viral DNA in the trigeminal ganglia (the site of latency) following infection. Both mutants induced VN antibodies and interferons after immunization. In addition, after challenge infection, we observed a reduction of IL-1β expression, and modulation of TNFα, TGFβ and IL10 expression. In conclusion, this study shows the merits of using FeHV-1 deletion mutants for prevention of FeHV-1 infection in cats.
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Affiliation(s)
- Yao Lee
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, 784 Wilson Road, East Lansing, MI 48824, USA; (Y.L.); (R.K.M.); (M.K.); (K.S.G.)
| | - Roger K. Maes
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, 784 Wilson Road, East Lansing, MI 48824, USA; (Y.L.); (R.K.M.); (M.K.); (K.S.G.)
- Veterinary Diagnostic Laboratory, Michigan State University, 4125 Beaumont Road, Lansing, MI 48910, USA
| | - John M. Kruger
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, 784 Wilson Road, East Lansing, MI 48824, USA;
| | - Matti Kiupel
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, 784 Wilson Road, East Lansing, MI 48824, USA; (Y.L.); (R.K.M.); (M.K.); (K.S.G.)
- Veterinary Diagnostic Laboratory, Michigan State University, 4125 Beaumont Road, Lansing, MI 48910, USA
| | - Kim S. Giessler
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, 784 Wilson Road, East Lansing, MI 48824, USA; (Y.L.); (R.K.M.); (M.K.); (K.S.G.)
| | - Gisela Soboll Hussey
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, 784 Wilson Road, East Lansing, MI 48824, USA; (Y.L.); (R.K.M.); (M.K.); (K.S.G.)
- Correspondence: ; Tel.: +1-517-432-3273
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Kobayashi T, Nishiura H. Transmission Network of Measles During the Yamagata Outbreak in Japan, 2017. J Epidemiol 2020; 32:96-104. [PMID: 33281152 PMCID: PMC8761560 DOI: 10.2188/jea.je20200455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background A measles outbreak involving 60 cases occurred in Yamagata, Japan in 2017. Using two different mathematical models for different datasets, we aimed to estimate measles transmissibility over time and explore any heterogeneous transmission patterns. Methods The first model relied on the temporal distribution for date of illness onset for cases, and a generation-dependent model was applied to the data. Another model focused on the transmission network. Using the illness-onset date along with the serial interval and geographical location of exposure, we reconstructed a transmission network with 19 unknown links. We then compared the number of secondary transmissions with and without clinical symptoms or laboratory findings. Results Using a generation-dependent model (assuming three generations other than the index case), the reproduction number (R) over generations 0, 1, and 2 were 25.3, 1.3, and <0.1, respectively, explicitly yielding the transmissibility over each generation. The network data enabled us to demonstrate that both the mean and the variance for the number of secondary transmissions per primary case declined over time. Comparing primary cases with and without secondary transmission, high viral shedding was the only significant determinant (P < 0.01). Conclusions The R declined abruptly over subsequent generations. Use of network data revealed the distribution of the number of secondary transmissions per primary case and also allowed us to identify possible secondary transmission risk factors. High viral shedding from the throat mucosa was identified as a potential predictor of secondary transmission.
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Affiliation(s)
- Tetsuro Kobayashi
- Kyoto University School of Public Health.,CREST, Japan Science and Technology Agency.,Graduate School of Medicine, Hokkaido University
| | - Hiroshi Nishiura
- Kyoto University School of Public Health.,CREST, Japan Science and Technology Agency.,Graduate School of Medicine, Hokkaido University
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21
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Sodjinou VD, Douba A, Nimpa MM, Masembe YV, Randria M, Ndiaye CF. Madagascar 2018-2019 measles outbreak response: main strategic areas. Pan Afr Med J 2020; 37:20. [PMID: 33062122 PMCID: PMC7532848 DOI: 10.11604/pamj.2020.37.20.24530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/15/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction on October 4th, 2018, a measles outbreak was declared in Madagascar. This study describes the outbreak response in terms of coordination, case management, vaccination response and epidemiological surveillance. Methods data were collected using a line list and vaccination tally sheet. Serum samples were collected within 30 days of rash onset for laboratory testing; confirmation was made by detection of measles immunoglobulin M antibody. Results from September 2018 to May 2019, a total of 146,277 measles cases were reported which included 1394 (1%) laboratory-confirmed cases and 144,883 (99%) epidemiological link-confirmed cases. The outbreak affected equally males (72,917 cases; 49.85%) and females (73,233 cases; 50.06%). The sex was not specified for 127 (0.09%) cases. Case fatality rate and attack rate were high among children less than 5 years. Responses interventions include effective coordination, free of charge case management, reactive vaccination, strengthened real-time surveillance, communication and community engagement and the revitalization of the routine immunization. Reactive vaccination was implemented in different phases. A total of 7,265,990 children aged from 6 months to 9 years were vaccinated. Post campaign survey coverage was 95%, 96% and 97% for phase 1, 2, 3 respectively. Conclusion elimination of measles will be challenging in Madagascar because of low routine immunization coverage and the absence of a second dose of measles vaccine in the routine immunization schedule.
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Affiliation(s)
| | - Alfred Douba
- World Health Organization Country Office, Madagascar.,Felix Houphouet Boigny University, Abidjan, Côte d´Ivoire
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22
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Clarke KEN, MacNeil A, Hadler S, Scott C, Tiwari TSP, Cherian T. Global Epidemiology of Diphtheria, 2000-2017 1. Emerg Infect Dis 2020; 25:1834-1842. [PMID: 31538559 PMCID: PMC6759252 DOI: 10.3201/eid2510.190271] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2017, a total of 8,819 cases of diphtheria were reported worldwide, the most since 2004. However, recent diphtheria epidemiology has not been well described. We analyzed incidence data and data from the literature to describe diphtheria epidemiology. World Health Organization surveillance data were 81% complete; completeness varied by region, indicating underreporting. As national diphtheria–tetanus–pertussis (DTP) 3 coverage increased, the proportion of case-patients <15 years of age decreased, indicating increased protection of young children. In countries with higher case counts, 66% of case-patients were unvaccinated and 63% were <15 years of age. In countries with sporadic cases, 32% of case-patients were unvaccinated and 66% were >15 years of age, consistent with waning vaccine immunity. Global DTP3 coverage is suboptimal. Attaining high DTP3 coverage and implementing recommended booster doses are necessary to decrease diphtheria incidence. Collection and use of data on subnational and booster dose coverage, enhanced laboratory capacity, and case-based surveillance would improve data quality.
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Measles eradication—retreating is not an option. THE LANCET. INFECTIOUS DISEASES 2020; 20:e138-e141. [DOI: 10.1016/s1473-3099(20)30052-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 12/21/2022]
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24
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Durrheim DN, Andrus JK, Pfaff G, Tabassum S, Bashour H, Githanga D. Eradicating Measles: A Call for an Exceptional Coordinated Global Effort. J Infect Dis 2020; 220:1870-1872. [PMID: 30615164 DOI: 10.1093/infdis/jiz011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/04/2019] [Indexed: 11/13/2022] Open
Abstract
There are compelling epidemiological, economic, and ethical arguments for setting a global measles eradication goal. The 6 chairpersons of Regional Verification Commissions for Measles and Rubella elimination advocate that the time for courageously accelerating efforts to ensure a world where no child dies of measles, is NOW!
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Affiliation(s)
| | | | - Günter Pfaff
- State Department for Public Health of Baden-Wurttemberg, Germany
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Nimpa MM, Andrianirinarison JC, Sodjinou VD, Douba A, Masembe YV, Randriatsarafara F, Ramamonjisoa CB, Rafalimanantsoa AS, Razafindratsimandresy R, Ndiaye CF, Rakotonirina J. Measles outbreak in 2018-2019, Madagascar: epidemiology and public health implications. Pan Afr Med J 2020; 35:84. [PMID: 32537087 PMCID: PMC7250232 DOI: 10.11604/pamj.2020.35.84.19630] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/16/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction In October 4th, 2018, a measles outbreak was declared in Madagascar. This study describes the epidemiology of the outbreak and determines public health implications for measles elimination in Madagascar. Methods Data have been collected using line list developed for the outbreak. Serum samples were collected within 30 days of rash onset for laboratory testing; confirmation was made by detection of measles immunoglobulin M (IgM) antibody. Results A total of 2,930 samples were analysed in the laboratory among which 1,086 (37%) were laboratory confirmed. Measles cases age ranged from a minimum of 1 month to a maximum of 88 years. The median and the mean were 7 years and 9 years respectively. Children between 1 to 9 years accounted for 50.6% of measles cases. Attack rate (39,014 per 1,000,000 inhabitants) and case fatality rate (1.2%) were highest among children aged 9-11 months. A total of 67.2% cases were unvaccinated. As of March 14th, 2019, all the 22 regions and 105 (92%) health districts out of 114 were affected by the measles outbreak in Madagascar. Conclusion Measles outbreak in Madagascar showed that the country is not on the track to achieve the goal of measles elimination by 2020.
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Affiliation(s)
| | | | | | - Alfred Douba
- World Health Organization Country Office for Madagascar, Antananarivo, Madagascar.,Felix Houphouet Boigny University, Abidjan-Cocody, Cote d'Ivoire
| | - Yolande Vuo Masembe
- World Health Organization Country Office for Madagascar, Antananarivo, Madagascar
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Lee AD, Clemmons NS, Patel M, Gastañaduy PA. International Importations of Measles Virus into the United States During the Postelimination Era, 2001-2016. J Infect Dis 2020; 219:1616-1623. [PMID: 30535027 DOI: 10.1093/infdis/jiy701] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/04/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although measles was declared eliminated from the United States in 2000, measles cases and outbreaks continue to occur, resulting from importations of the disease from countries where it remains endemic. METHODS We describe the epidemiology of international importations of measles virus into the United States during the postelimination era. RESULTS From 2001 to 2016, 553 imported measles cases were reported to the Centers for Disease Control and Prevention. A median of 28 importations occurred each year (range: 18-80). The median age of imported case-patients was 18 years (range: 3 months-75 years); 87% were unvaccinated or had an unknown vaccination status. US residents (as opposed to foreign visitors) accounted for 62% of imported measles cases. Overall, 62% of all imported case-patients reported travel to countries in the Western Pacific and European Regions of the World Health Organization during their exposure periods. The number of measles importations from specific countries was related to the incidence of measles in and the volume of travel to and from the source country. CONCLUSIONS Our findings emphasize the importance of measles vaccination of US residents aged ≥6 months before international travel according to the Advisory Committee on Immunization Practices recommendations and supporting global measles elimination efforts.
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Affiliation(s)
- Adria D Lee
- IHRC Inc., contracting agency to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nakia S Clemmons
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manisha Patel
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul A Gastañaduy
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Measles in pregnant women: A systematic review of clinical outcomes and a meta-analysis of antibodies seroprevalence. J Infect 2019; 80:152-160. [PMID: 31891729 DOI: 10.1016/j.jinf.2019.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Pregnant women represent a category at high risk of severe measles infection, that negatively affects the fetus as well. A systematic review of clinical outcomes of measles infection in gravid subjects and a meta-analysis of antibodies prevalence among pregnant women was conducted. METHODS MEDLINE and EMBASE databases were searched up to 18 June 2018. The screening focused on: (i) articles describing the outcome of measles in pregnancy, synthesized in a descriptive fashion; (ii) articles addressing the measles seroprevalence in cohorts of gravid women, analysed quantitatively. RESULTS Twenty-nine articles met inclusion criteria. A total of 420 cases of measles in gravid subjects were described, from 1941 to 2012. Among women, 18 deaths (4.3%) occurred, and the most frequent complication was pneumonia (75/420, 17.9%). Prematurity was the most important complication concerning fetal outcomes (55 out of 410 cases with available data, 13.4%). The random-effects pooled seroprevalence of measles in 20,546 gravid women worldwide was 89.3% (95% CI: 87.3-91.1%), that decreased, although not in a statistically significant way, over time (p = 0.54). CONCLUSIONS Measles infection in pregnancy is dangerous both for the mother and the foetus. Antibody seroprevalence among gravid women on a global scale is lower than the herd immunity threshold.
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Samaraweera B, Mahanama A, Ahamad AZ, Wimalaratne GI, Abeynayake J. The laboratory investigation of a measles outbreak in the eve of its elimination in Sri Lanka. J Clin Virol 2019; 122:104230. [PMID: 31821951 DOI: 10.1016/j.jcv.2019.104230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Measles is highly contagious and cause significant morbidity and mortality. Sri-Lanka has the goal to eliminate endogenous measles by 2020 in par with WHO. OBJECTIVE To describe laboratory confirmation and genotype distribution of measles cases during the outbreak occurred from mid-March to May 2019, Sri-Lanka STUDY DESIGN: This retrospective study was conducted at National Measles Reference Laboratory (NMRL), Sri-Lanka. All samples received were tested according to the testing flow chart at NMRL with WHO recommended kits. Blood samples were tested for anti-measles IgM and IgG with IgG avidity for IgG positives. Samples within 5days post-onset rash were tested with measles real-time RT-PCR. Products of genotyping PCR were sent to Regional Reference Laboratory, Thailand for sequencing. Subsequent phylogenetic analysis was done at NMRL. Data were analyzed by descriptive statistics. RESULTS A total of 182 blood and 46 throat/nasopharyngeal swabs were received from 195 suspected cases and 37(19 %) were positive for measles by anti-measles IgM, rRT-PCR or both. Majority was females, with mean age of 20 years. Cases represented three main geographical areas; Western-35 %, Central-32 % and Southern-27 %. High avidity IgG was detected in 27/37(73 %). Sequencing data of six cases (4 from Western and 2 from Central province) revealed genotype D8. CONCLUSION Nineteen percent of the suspected patients were measles positive with 73 % having re-infections. Majority were 22 years or over. Measles genotype was D8 in two provinces, suggesting the spread of virus within the country. Laboratory confirmation with measles PCR; IgG avidity and sequencing/genetic analysis is critical in the verge of measles elimination.
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Kowal DR. Integer-valued functional data analysis for measles forecasting. Biometrics 2019; 75:1321-1333. [PMID: 31254384 DOI: 10.1111/biom.13110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/22/2019] [Indexed: 11/29/2022]
Abstract
Measles presents a unique and imminent challenge for epidemiologists and public health officials: the disease is highly contagious, yet vaccination rates are declining precipitously in many localities. Consequently, the risk of a measles outbreak continues to rise. To improve preparedness, we study historical measles data both prevaccine and postvaccine, and design new methodology to forecast measles counts with uncertainty quantification. We propose to model the disease counts as an integer-valued functional time series: measles counts are a function of time-of-year and time-ordered by year. The counts are modeled using a negative-binomial distribution conditional on a real-valued latent process, which accounts for the overdispersion observed in the data. The latent process is decomposed using an unknown basis expansion, which is learned from the data, with dynamic basis coefficients. The resulting framework provides enhanced capability to model complex seasonality, which varies dynamically from year-to-year, and offers improved multimonth-ahead point forecasts and substantially tighter forecast intervals (with correct coverage) compared to existing forecasting models. Importantly, the fully Bayesian approach provides well-calibrated and precise uncertainty quantification for epi-relevant features, such as the future value and time of the peak measles count in a given year. An R package is available online.
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Affiliation(s)
- Daniel R Kowal
- Department of Statistics, Rice University, Houston, Texas
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30
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Virucidal Activity of Gold Nanoparticles Synthesized by Green Chemistry Using Garlic Extract. Viruses 2019; 11:v11121111. [PMID: 31801280 PMCID: PMC6950311 DOI: 10.3390/v11121111] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 01/17/2023] Open
Abstract
Measles virus (MeV) is a paramyxovirus that infects humans, principally children. Despite the existence of an effective and safe vaccine, the number of cases of measles has increased due to lack of vaccination coverage. The World Health Organization (WHO) reports that the number of cases worldwide multiplied fourfold between January and March 2019, to 112,000. Today, there is no treatment available for MeV. In recent years, it has been demonstrated that natural extracts (herbal or algal) with antiviral activity can also work as reducing agents that, in combination with nanotechnology, offer an innovative option to counteract viral infections. Here, we synthetized and evaluated the antiviral activity of gold nanoparticles using garlic extract (Allium sativa) as a reducing agent (AuNPs-As). These nanoparticles actively inhibited MeV replication in Vero cells at a 50% effective concentration (EC50) of 8.829 µg/mL, and the selectivity index (SI) obtained was 16.05. AuNPs-As likely inhibit viral infection by blocking viral particles directly, showing a potent virucidal effect. Gold nanoparticles may be useful as a promising strategy for treating and controlling the infection of MeV and other related enveloped viruses.
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Wangchuk S, Nogareda F, Tshering N, Khandu L, Pelden S, Wannemuehler K, Wangdi S, Wangchuk U, Mulders M, Tamang T, Patel MK. Measles and rubella immunity in the population of Bhutan, 2017. Vaccine 2019; 37:6463-6469. [PMID: 31500970 PMCID: PMC7034396 DOI: 10.1016/j.vaccine.2019.08.085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/17/2019] [Accepted: 08/30/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2017, measles elimination was verified in Bhutan, and the country appears to have sufficiently high vaccination coverage to achieve rubella elimination. However, a measles and rubella serosurvey was conducted to find if any hidden immunity gaps existed that could threaten Bhutan's elimination status. METHODS A nationwide, three-stage, cluster seroprevalence survey was conducted among individuals aged 1-4, 5-17, and >20 years in 2017. Demographic information and children's vaccination history were collected, and a blood specimen was drawn. Serum was tested for measles and rubella immunoglobulin G (IgG). Frequencies, weighted proportions, and prevalence ratios for measles and rubella seropositivity were calculated by demographic and vaccination history, taking into account the study design. RESULTS Of the 1325 individuals tested, 1045 (81%, 95% CI 78%-85%) were measles IgG seropositive, and 1290 (97%, 95% CI 95%-99%) were rubella IgG seropositive. Rubella IgG seropositivity was high in all three age strata, but only 47% of those aged 5-17 years were measles IgG seropositive. Additionally, only 41% of those aged 5-17 years who had documented receipt of two doses of measles- or measles-rubella-containing vaccine were seropositive for measles IgG, but almost all these children were rubella IgG seropositive. CONCLUSIONS An unexpected measles immunity gap was identified among children 5-17 years of age. It is unclear why this immunity gap exists; however, it could have led to a large outbreak and threatened sustaining of measles elimination in Bhutan. Based on this finding, a mass vaccination campaign was conducted to close the immunity gap.
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Affiliation(s)
- Sonam Wangchuk
- Royal Centre for Disease Control, Ministry of Health, Royal Government of Bhutan, Wangchutaba, Serbithang, Thimphu, Bhutan.
| | - Francisco Nogareda
- World Health Organization Consultant, C/Juan de Austria, 13, 28010 Madrid, Spain.
| | - Namgay Tshering
- Ministry of Health, Royal Government of Bhutan, P.O. Box: 726, Kawajangsa, Thimphu, Bhutan.
| | - Lekey Khandu
- Ministry of Health, Royal Government of Bhutan, P.O. Box: 726, Kawajangsa, Thimphu, Bhutan.
| | - Sonam Pelden
- Royal Centre for Disease Control, Ministry of Health, Royal Government of Bhutan, Wangchutaba, Serbithang, Thimphu, Bhutan.
| | - Kathleen Wannemuehler
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States.
| | - Sonam Wangdi
- Ministry of Health, Royal Government of Bhutan, P.O. Box: 726, Kawajangsa, Thimphu, Bhutan.
| | - Ugyen Wangchuk
- Ministry of Health, Royal Government of Bhutan, P.O. Box: 726, Kawajangsa, Thimphu, Bhutan.
| | - Mick Mulders
- Expanded Programme on Immunization, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland.
| | - Tshewang Tamang
- Ministry of Health, Royal Government of Bhutan, P.O. Box: 726, Kawajangsa, Thimphu, Bhutan.
| | - Minal K Patel
- Expanded Programme on Immunization, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland.
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Durrheim D. Measles Elimination, Immunity, Serosurveys, and Other Immunity Gap Diagnostic Tools. J Infect Dis 2019; 218:341-343. [PMID: 29562366 DOI: 10.1093/infdis/jiy138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- David Durrheim
- School of Public Health and Medicine, University of Newcastle, Wallsend, New South Wales, Australia
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Fonnesbeck CJ, Shea K, Carran S, Cassio de Moraes J, Gregory C, Goodson JL, Ferrari MJ. Measles outbreak response decision-making under uncertainty: a retrospective analysis. J R Soc Interface 2019; 15:rsif.2017.0575. [PMID: 29563241 DOI: 10.1098/rsif.2017.0575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/26/2018] [Indexed: 10/17/2022] Open
Abstract
Resurgent outbreaks of vaccine-preventable diseases that have previously been controlled or eliminated have been observed in many settings. Reactive vaccination campaigns may successfully control outbreaks but must necessarily be implemented in the face of considerable uncertainty. Real-time surveillance may provide critical information about at-risk population and optimal vaccination targets, but may itself be limited by the specificity of disease confirmation. We propose an integrated modelling approach that synthesizes historical demographic and vaccination data with real-time outbreak surveillance via a dynamic transmission model and an age-specific disease confirmation model. We apply this framework to data from the 1996-1997 measles outbreak in São Paulo, Brazil. To simulate the information available to decision-makers, we truncated the surveillance data to what would have been available at 1 or 2 months prior to the realized interventions. We use the model, fitted to real-time observations, to evaluate the likelihood that candidate age-targeted interventions could control the outbreak. Using only data available prior to the interventions, we estimate that a significant excess of susceptible adults would prevent child-targeted campaigns from controlling the outbreak and that failing to account for age-specific confirmation rates would underestimate the importance of adult-targeted vaccination.
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Affiliation(s)
- Christopher J Fonnesbeck
- Department of Biostatistics, Vanderbilt University Medical Center, Eleventh Floor, Suite 11000, 2525 West End Avenue, Nashville, TN, USA
| | - Katriona Shea
- Department of Biology and Intercollege Graduate Degree Program in Ecology, 208 Mueller Laboratory, The Pennsylvania State University, University Park, PA, USA.,Center for Infectious Disease Dynamics, Department of Biology, Eberly College of Science, The Pennsylvania State University, University Park, PA, USA
| | - Spencer Carran
- Center for Infectious Disease Dynamics, Department of Biology, Eberly College of Science, The Pennsylvania State University, University Park, PA, USA
| | | | - Christopher Gregory
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - James L Goodson
- Accelerated Disease Control and Vaccine Preventable Disease Surveillance Branch, Global Immunization Division, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew J Ferrari
- Department of Biology and Intercollege Graduate Degree Program in Ecology, 208 Mueller Laboratory, The Pennsylvania State University, University Park, PA, USA.,Center for Infectious Disease Dynamics, Department of Biology, Eberly College of Science, The Pennsylvania State University, University Park, PA, USA
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Whittaker E, López-Varela E, Broderick C, Seddon JA. Examining the Complex Relationship Between Tuberculosis and Other Infectious Diseases in Children. Front Pediatr 2019; 7:233. [PMID: 31294001 PMCID: PMC6603259 DOI: 10.3389/fped.2019.00233] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 05/22/2019] [Indexed: 12/21/2022] Open
Abstract
Millions of children are exposed to tuberculosis (TB) each year, many of which become infected with Mycobacterium tuberculosis. Most children can immunologically contain or eradicate the organism without pathology developing. However, in a minority, the organism overcomes the immunological constraints, proliferates and causes TB disease. Each year a million children develop TB disease, with a quarter dying. While it is known that young children and those with immunodeficiencies are at increased risk of progression from TB infection to TB disease, our understanding of risk factors for this transition is limited. The most immunologically disruptive process that can happen during childhood is infection with another pathogen and yet the impact of co-infections on TB risk is poorly investigated. Many diseases have overlapping geographical distributions to TB and affect similar patient populations. It is therefore likely that infection with viruses, bacteria, fungi and protozoa may impact on the risk of developing TB disease following exposure and infection, although disentangling correlation and causation is challenging. As vaccinations also disrupt immunological pathways, these may also impact on TB risk. In this article we describe the pediatric immune response to M. tuberculosis and then review the existing evidence of the impact of co-infection with other pathogens, as well as vaccination, on the host response to M. tuberculosis. We focus on the impact of other organisms on the risk of TB disease in children, in particularly evaluating if co-infections drive host immune responses in an age-dependent way. We finally propose priorities for future research in this field. An improved understanding of the impact of co-infections on TB could assist in TB control strategies, vaccine development (for TB vaccines or vaccines for other organisms), TB treatment approaches and TB diagnostics.
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Affiliation(s)
- Elizabeth Whittaker
- Department of Paediatrics, Imperial College London, London, United Kingdom
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St. Mary's Campus, London, United Kingdom
| | - Elisa López-Varela
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Claire Broderick
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - James A. Seddon
- Department of Paediatrics, Imperial College London, London, United Kingdom
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St. Mary's Campus, London, United Kingdom
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Masters NB, Wagner AL, Ding Y, Zhang Y, Boulton ML. Assessing measles vaccine failure in Tianjin, China. Vaccine 2019; 37:3251-3254. [PMID: 31078327 DOI: 10.1016/j.vaccine.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022]
Abstract
Despite increasing global measles vaccination coverage, progress toward measles elimination has slowed in recent years. In China, children receive a measles-containing vaccine (MCV) at 8 months, 18-24 months, and some urban areas offer a third dose at age 4-6 years. However, substantial measles cases in Tianjin, China, occur among individuals who have received multiple MCV doses. This study describes the vaccination history of measles cases 8 months - 19 years old. Data came from measles cases in Tianjin's reportable disease surveillance system (2009-2013), and from a case control study (2011-2015). Twenty-nine percent of those in the surveillance dataset and 54.4% of those in the case series received at least one dose of MCV. The minimum and median time-to-diagnosis since vaccination revealed an increase in time since vaccination for incremental doses. Considerable measles cases in Tianjin occur in vaccinated children, and further research is needed to understand the reasons for vaccine failure.
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Affiliation(s)
- Nina B Masters
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Yaxing Ding
- Division of Expanded Programs On Immunization, Tianjin Centers for Disease Control and Prevention, Tianjin 300011, China
| | - Ying Zhang
- Division of Expanded Programs On Immunization, Tianjin Centers for Disease Control and Prevention, Tianjin 300011, China
| | - Matthew L Boulton
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
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Masa-Calles J. ¿Vuelve el sarampión? Med Clin (Barc) 2019; 152:350-352. [PMID: 30678886 DOI: 10.1016/j.medcli.2018.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/22/2018] [Accepted: 11/25/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Josefa Masa-Calles
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III. CIBERESP, Madrid, España.
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Use of FTA Cards To Transport Throat Swabs and Oral Fluid Samples for Molecular Detection and Genotyping of Measles and Rubella Viruses. J Clin Microbiol 2019; 57:JCM.00048-19. [PMID: 30814262 DOI: 10.1128/jcm.00048-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/16/2019] [Indexed: 01/27/2023] Open
Abstract
The genetic characterization of measles viruses is an important tool for measles surveillance. Reverse cold chain requirements for the transportation of samples to reference laboratories are challenging in resource-limited settings. FTA cards facilitate the transport of virologic samples at ambient temperature as noninfectious material; however, the utility of FTA cards for the detection and genotyping of measles virus from clinical samples has not been evaluated. Throat swabs (TS) and oral fluid (OF) samples were collected from suspected measles cases in the Democratic Republic of the Congo. Virus detection (reverse transcription-quantitative real-time PCR [RT-qPCR]) and genotyping (endpoint RT-PCR) were compared for samples from 238 suspected cases; these samples were either transported using the reverse cold chain or at ambient temperature on FTA cards. Virus detection showed excellent positive agreement for OF samples compared to TS (95.3%; confidence interval [CI], 91.6 to 97.4), in contrast to 79.4% (CI, 73.5 to 84.3) for TS on FTA, and 85.5% (CI, 80.2 to 89.6) for OF on FTA compared to OF samples. Genotyping results obtained for a subset of samples indicated that 77.3% of all TS and 71.0% of OF samples would produce genotype information compared to 41.6% of TS and 41.3% of OF on FTA cards. Similar results were found for 16 measles-negative samples that were confirmed as rubella cases. Measles genotype B3 and rubella genotype 2B were detected. FTA cards have limited utility for virologic surveillance of sporadic cases of measles; however, they can be a useful tool for the expansion of virologic surveillance in countries where the reverse cold chain is not available.
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Computational Comparison and Visualization of Viruses in the Perspective of Clinical Information. Interdiscip Sci 2019; 11:86-94. [PMID: 28391493 PMCID: PMC7090701 DOI: 10.1007/s12539-017-0229-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/17/2017] [Accepted: 03/25/2017] [Indexed: 01/13/2023]
Abstract
This paper addresses the visualization of complex information using multidimensional scaling (MDS). MDS is a technique adopted for processing data with multiple features scattered in high-dimensional spaces. For illustrating the proposed techniques, the case of viral diseases is considered. The study evaluates the characteristics of 21 viruses in the perspective of clinical information. Several new schemes are proposed for improving the visualization of the MDS charts. The results follow standard clinical practice, proving that the method represents a valuable tool to study a large number of viruses.
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Ortega B, Sanjuán J, Casquero A. Social costs of illicit financial flows in low- and middle-income countries: the case of infant vaccination coverage. Health Policy Plan 2018; 33:224-236. [PMID: 29237018 DOI: 10.1093/heapol/czx170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 11/14/2022] Open
Abstract
The liberalization of capital flows is generally associated with prospects of higher growth. However, in developing countries, opening the capital account may also facilitate the flow of capital out of the country through illicit financial flows (IFFs). Given that IFFs drain the scarce public resources available to finance the provision of public goods and services, the extent of illicit capital flows from developing countries is serious cause for concern. In this context, as a first step in analysing the social costs of IFFs in developing countries, this article studied the relationship between IFFs and infant immunization coverage rates. Data for 56 low- and middle-income countries for the period 2002-13 were used in the empirical analysis. The main result was that the relative level of IFFs to total trade negatively impacted vaccination coverage but only in the case of countries with very high levels of perceived corruption. In this case, the total effect of an annual 1 p.p. increase in the ratio of IFFs to total trade was to reduce the level of vaccination coverage rates over the coming years by 0.19 p.p. Given that there was an annual average of 18 million infants in this cluster of 25 countries, this result suggests that at least 34 000 children may not receive this basic health care intervention in the future as a consequence of this increase in IFFs in any particular year.
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Affiliation(s)
- Bienvenido Ortega
- Departamento de Economía Aplicada (Estructura Económica), Universidad de Málaga, Campus El Ejido, Málaga 29071, Spain
| | - Jesús Sanjuán
- Departamento de Economía Aplicada (Estructura Económica), Universidad de Málaga, Campus El Ejido, Málaga 29071, Spain
| | - Antonio Casquero
- Departamento de Economía Aplicada (Estructura Económica), Universidad de Málaga, Campus El Ejido, Málaga 29071, Spain
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An investigation of a measles outbreak in Japan and China, Taiwan, China, March-May 2018. Western Pac Surveill Response J 2018; 9:25-31. [PMID: 30377547 PMCID: PMC6194226 DOI: 10.5365/wpsar.2018.9.2.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate a measles outbreak that spread to Japan and China, Taiwan, China during March–May 2018, exploring the characteristics of the super-spreading event. Methods A contact investigation of the index case and reconstruction of the epidemiological dynamics of measles transmission were conducted. Employing a mathematical model, the effective reproduction number was estimated for each generation of cases. Results and discussion A single index case gave rise to a total of 38 secondary cases, 33 in Japan and five in China, Taiwan, China. Subsequent chains of transmission were observed in highly vaccinated populations in both Japan and China, Taiwan, China. The effective reproduction number of the second generation was > 1 for both Japan and China, Taiwan, China. In Japan, the reproduction number was estimated to be < 1 during the third generation. Vaccination of susceptible individuals is essential to prevent secondary and tertiary transmission events.
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Gastañaduy PA, Banerjee E, DeBolt C, Bravo-Alcántara P, Samad SA, Pastor D, Rota PA, Patel M, Crowcroft NS, Durrheim DN. Public health responses during measles outbreaks in elimination settings: Strategies and challenges. Hum Vaccin Immunother 2018; 14:2222-2238. [PMID: 29932850 PMCID: PMC6207419 DOI: 10.1080/21645515.2018.1474310] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 04/19/2018] [Accepted: 05/03/2018] [Indexed: 02/08/2023] Open
Abstract
In late September 2016, the Americas became the first region in the world to have eliminated endemic transmission of measles virus. Several other countries have also verified measles elimination, and countries in all six World Health Organization regions have adopted measles elimination goals. The public health strategies used to respond to measles outbreaks in elimination settings are thus becoming relevant to more countries. This review highlights the strategies used to limit measles spread in elimination settings: (1) assembly of an outbreak control committee; (2) isolation of measles cases while infectious; (3) exclusion and quarantining of individuals without evidence of immunity; (4) vaccination of susceptible individuals; (5) use of immunoglobulin to prevent measles in exposed susceptible high-risk persons; (6) and maintaining laboratory proficiency for confirmation of measles. Deciding on the extent of containment efforts should be based on the expected benefit of reactive interventions, balanced against the logistical challenges in implementing them.
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Affiliation(s)
- Paul A. Gastañaduy
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Banerjee
- Vaccine Preventable Disease Surveillance Unit, Minnesota Department of Health, St. Paul, MN, USA
| | - Chas DeBolt
- Vaccine-Preventable Diseases, Washington State Department of Health, Shoreline, WA, USA
| | - Pamela Bravo-Alcántara
- Comprehensive Family Immunization Unit, Pan American Health Organization, Washington, DC, USA
| | | | - Desiree Pastor
- Comprehensive Family Immunization Unit, Pan American Health Organization, Washington, DC, USA
| | - Paul A. Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Manisha Patel
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natasha S. Crowcroft
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David N. Durrheim
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Evaluation of measles and rubella integrated surveillance system in Apulia region, Italy, 3 years after its introduction. Epidemiol Infect 2018. [PMID: 29532766 PMCID: PMC9134572 DOI: 10.1017/s0950268818000407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study aimed at evaluating the integrated measles and rubella surveillance system (IMRSS) in Apulia region, Italy, from its introduction in 2013 to 30 June 2016. Measles and rubella case reports were extracted from IMRSS. We estimated system sensitivity at the level of case reporting, using the capture–recapture method for three data sources. Data quality was described as the completeness of variables and timeliness of notification as the median-time interval from symptoms onset to initial alert. The proportion of suspected cases with laboratory investigation, the rate of discarded cases and the origin of infection were also computed. A total of 127 measles and four rubella suspected cases were reported to IMRSS and 82 were laboratory confirmed. Focusing our analysis on measles, IMRSS sensitivity was 82% (95% CI: 75–87). Completeness was >98% for mandatory variables and 57% for ‘genotyping’. The median-time interval from symptoms onset to initial alert was 4.5 days, with a timeliness of notification of 33% (41 cases reported ⩽48 h). The proportion of laboratory investigation was 87%. The rate of discarded cases was 0.1 per 100 000 inhabitants per year. The origin of infection was identified for 85% of cases. It is concluded that IMRSS provides good quality data and has good sensitivity; still efforts should be made to improve the completeness of laboratory-related variables, timeliness and to increase the rate of discarded cases.
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Abstract
Measles is an acute systemic viral disease with initial amplification of infection in lymphoid tissue and subsequent spread over 10–14 days to multiple organs. Failure of the innate response to control initial measles virus (MeV) replication is associated with the ability of MeV to inhibit the induction of type I interferon and interferon-stimulated antiviral genes. Rather, the innate response is characterized by the expression of proteins regulated by nuclear factor kappa B and the inflammasome. With eventual development of the adaptive response, the rash appears with immune cell infiltration into sites of virus replication to initiate the clearance of infectious virus. However, MeV RNA is cleared much more slowly than recoverable infectious virus and remains present in lymphoid tissue for at least 6 months after infection. Persistence of viral RNA and protein suggests persistent low-level replication in lymphoid tissue that may facilitate maturation of the immune response, resulting in lifelong protection from reinfection, while persistence in other tissues (for example, the nervous system) may predispose to development of late disease such as subacute sclerosing panencephalitis. Further studies are needed to identify mechanisms of viral clearance and to understand the relationship between persistence and development of lifelong immunity.
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Affiliation(s)
- Diane E Griffin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Wen-Hsuan W Lin
- Department of Pathology, Columbia University School of Medicine, New York, NY, 10032, USA
| | - Ashley N Nelson
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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de Jong W, Rusli M, Bhoelan S, Rohde S, Rantam FA, Noeryoto PA, Hadi U, Gorp ECMV, Goeijenbier M. Endemic and emerging acute virus infections in Indonesia: an overview of the past decade and implications for the future. Crit Rev Microbiol 2018; 44:487-503. [PMID: 29451044 DOI: 10.1080/1040841x.2018.1438986] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Being the largest archipelago country in the world, with a tropical climate and a unique flora and fauna, Indonesia habitats one of the most diverse biome in the world. These characteristics make Indonesia a popular travel destination, with tourism numbers increasing yearly. These characteristics also facilitate the transmission of zoonosis and provide ideal living and breading circumstances for arthropods, known vectors for viral diseases. A review of the past 10 years of literature, reports of the Ministry of Health, Republic of Indonesia and ProMED-mail shows a significant increase in dengue infection incidence. Furthermore, chikungunya, Japanese encephalitis and rabies are proven to be endemic in Indonesia. The combination of cohort studies, governmental data and ProMED-mail reveals an integrated overview for those working in travel medicine and public health, focusing on both endemic and emerging acute virus infections. This review summarizes the epidemiology of acute virus infections in Indonesia, including outbreak reports, as well as public health response measurements and their potential or efficacy. Knowledge about human behaviour, animal reservoirs, climate factors, environment and their role in emerging virus infection are discussed. We aim to support public health authorities and health care policy makers in a One Health approach.
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Affiliation(s)
- Wesley de Jong
- a Department of Viroscience , Erasmus MC , Rotterdam , the Netherlands
| | - Musofa Rusli
- b Department of Internal Medicine, Division of Tropical & Infectious Disease, Faculty of Medicine , Airlangga University , Surabaya , Indonesia
| | - Soerajja Bhoelan
- c Department of Internal medicine , Havenziekenhuis Institute for Tropical Medicine , Rotterdam , the Netherlands
| | - Sofie Rohde
- a Department of Viroscience , Erasmus MC , Rotterdam , the Netherlands
| | - Fedik A Rantam
- d Institute of Tropical Disease, Airlangga University , Surabaya , Indonesia
| | - Purwati A Noeryoto
- b Department of Internal Medicine, Division of Tropical & Infectious Disease, Faculty of Medicine , Airlangga University , Surabaya , Indonesia
| | - Usman Hadi
- b Department of Internal Medicine, Division of Tropical & Infectious Disease, Faculty of Medicine , Airlangga University , Surabaya , Indonesia
| | - Eric C M van Gorp
- a Department of Viroscience , Erasmus MC , Rotterdam , the Netherlands
| | - Marco Goeijenbier
- a Department of Viroscience , Erasmus MC , Rotterdam , the Netherlands.,c Department of Internal medicine , Havenziekenhuis Institute for Tropical Medicine , Rotterdam , the Netherlands
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45
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The Internet and the Anti-Vaccine Movement: Tracking the 2017 EU Measles Outbreak. BIG DATA AND COGNITIVE COMPUTING 2018. [DOI: 10.3390/bdcc2010002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pfeffermann K, Dörr M, Zirkel F, von Messling V. Morbillivirus Pathogenesis and Virus-Host Interactions. Adv Virus Res 2018; 100:75-98. [PMID: 29551144 DOI: 10.1016/bs.aivir.2017.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite the availability of safe and effective vaccines against measles and several animal morbilliviruses, they continue to cause regular outbreaks and epidemics in susceptible populations. Morbilliviruses are highly contagious and share a similar pathogenesis in their respective hosts. This review provides an overview of morbillivirus history and the general replication cycle and recapitulates Morbillivirus pathogenesis focusing on common and unique aspects seen in different hosts. It also summarizes the state of knowledge regarding virus-host interactions on the cellular level with an emphasis on viral interference with innate immune response activation, and highlights remaining knowledge gaps.
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Abstract
Measles is a highly contagious disease that results from infection with measles virus and is still responsible for more than 100 000 deaths every year, down from more than 2 million deaths annually before the introduction and widespread use of measles vaccine. Measles virus is transmitted by the respiratory route and illness begins with fever, cough, coryza, and conjunctivitis followed by a characteristic rash. Complications of measles affect most organ systems, with pneumonia accounting for most measles-associated morbidity and mortality. The management of patients with measles includes provision of vitamin A. Measles is best prevented through vaccination, and the major reductions in measles incidence and mortality have renewed interest in regional elimination and global eradication. However, urgent efforts are needed to increase stagnating global coverage with two doses of measles vaccine through advocacy, education, and the strengthening of routine immunisation systems. Use of combined measles-rubella vaccines provides an opportunity to eliminate rubella and congenital rubella syndrome. Ongoing research efforts, including the development of point-of-care diagnostics and microneedle patches, will facilitate progress towards measles elimination and eradication.
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Affiliation(s)
- William J Moss
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; W Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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Pei L, Yang Y, Zhao X, Zhang S, Yuan L, Liu Y, Yu Y. Identify the susceptibility profile to measles in the general population: Serological survey of measles antibodies in Shaanxi province, China, in 2016. Vaccine 2017; 35:7250-7255. [PMID: 29153585 DOI: 10.1016/j.vaccine.2017.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/17/2017] [Accepted: 11/07/2017] [Indexed: 12/12/2022]
Abstract
The reported coverage with two doses of the measles vaccine (MCV) in Shaanxi Province, China, is greater than 95%, but the measles incidence over the whole province remains high. Cross-sectional serological surveys of measles antibodies in Shaanxi Province were conducted in 2016 to assess the population's immunity. The measles IgG levels were measured in serum samples using ELISA. The geometric means concentration (GMC) levels and seroprevalence rates with 95% CIs were calculated by region, gender, and age. A total of 3574 serum samples were collected from participants aged from 2 months to 49 years. The GMC of measles antibodies was 471.3 mIU/ml (95% CI: 445.9-498.2 mIU/ml), and the seroprevalence was only 85.9% (95% CI: 84.8-87.1%). A significant difference in the GMC (P < .05) but not the seroprevalence (P > .05) was observed among the 3 regions. The report measles incidences were high in individuals aged 0-7 months (33.2/100 000) and 8-17 months (26.8/100 000). Although both measles immunity (90.7%) and MCV coverage (89.7%) were low in children aged 8-17 months, the measles seroprevalence in adults was high at greater than 90%. These results revealed that further actions may be taken to increase vaccination coverage in children aged 8 months to 5 years over the whole province and teenagers in the south region. In particular, timely administration of the first MCV dose should be emphasized to prevent measles epidemics in children aged 8-17 months. Vaccination strategies may be varied by age and region.
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Affiliation(s)
- Lin Pei
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China; Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710003, China
| | - Yuxuan Yang
- Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China
| | - Xiaodan Zhao
- Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China
| | - Shaobai Zhang
- Shaanxi Province Center for Disease Control and Prevention, Xi'an, Shaanxi 710054, China
| | - Lingyun Yuan
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China; Ankang Center for Disease Control and Prevention, An Kang, Shaanxi 725000, China
| | - Yamei Liu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China; Yulin Center for Disease Control and Prevention, Yu Lin, Shaanxi 719000, China
| | - Yan Yu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China.
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Pike J, Tippins A, Nyaku M, Eckert M, Helgenberger L, Underwood JM. Cost of a measles outbreak in a remote island economy: 2014 Federated States of Micronesia measles outbreak. Vaccine 2017; 35:5905-5911. [PMID: 28886945 PMCID: PMC5831405 DOI: 10.1016/j.vaccine.2017.08.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
After 20years with no reported measles cases, on May 15, 2014 the Centers for Disease Control and Prevention (CDC) was notified of two cases testing positive for measles-specific immunoglobulin M (IgM) antibodies in the Federated States of Micronesia (FSM). Under the Compact of Free Association, FSM receives immunization funding and technical support from the United States (US) domestic vaccination program managed by the Centers for Disease Control and Prevention (CDC). In a collaborative effort, public health officials and volunteers from FSM and the US government worked to respond and contain the measles outbreak through an emergency mass vaccination campaign, contact tracing, and other outbreak investigation activities. Contributions were also made by United Nations Children's Emergency Fund (UNICEF) and World Health Organization (WHO). Total costs incurred as a result of the outbreak were nearly $4,000,000; approximately $10,000 per case. Direct medical costs (≈$141,000) were incurred in the treatment of those individuals infected, as well as lost productivity of the infected and informal caregivers (≈$250,000) and costs to contain the outbreak (≈$3.5 million). We assessed the economic burden of the 2014 measles outbreak to FSM, as well as the economic responsibilities of the US. Although the US paid the majority of total costs of the outbreak (≈67%), examining each country's costs relative to their respective economy illustrates a far greater burden to FSM. We demonstrate that while FSM was heavily assisted by the US in responding to the 2014 Measles Outbreak, the outbreak significantly impacted their economy. FSM's economic burden from the outbreak is approximately equivalent to their entire 2016 Fiscal Year budget dedicated to education.
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Affiliation(s)
- Jamison Pike
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease, Immunization Services Division, Atlanta, GA, United States.
| | - Ashley Tippins
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease, Immunization Services Division, Atlanta, GA, United States
| | - Mawuli Nyaku
- Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States
| | - Maribeth Eckert
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease, Immunization Services Division, Atlanta, GA, United States
| | - Louisa Helgenberger
- Department of Health and Social Affairs, Government of the Federated States of Micronesia, Federated States of Micronesia
| | - J Michael Underwood
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease, Immunization Services Division, Atlanta, GA, United States
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Positive predictive value and effectiveness of measles case-based surveillance in Uganda, 2012-2015. PLoS One 2017; 12:e0184549. [PMID: 28886171 PMCID: PMC5590970 DOI: 10.1371/journal.pone.0184549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/26/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Disease surveillance is a critical component in the control and elimination of vaccine preventable diseases. The Uganda National Expanded Program on Immunization strives to have a sensitive surveillance system within the Integrated Disease Surveillance and Response (IDSR) framework. We analyzed measles surveillance data to determine the effectiveness of the measles case-based surveillance system and estimate its positive predictive value in order to inform policy and practice. METHODS An IDSR alert was defined as ≥1 suspected measles case reported by a district in a week, through the electronic Health Management Information System. We defined an alert in the measles case-based surveillance system (CBS) as ≥1 suspected measles case with a blood sample collected for confirmation during the corresponding week in a particular district. Effectiveness of CBS was defined as having ≥80% of IDSR alerts with a blood sample collected for laboratory confirmation. Positive predictive value was defined as the proportion of measles case-patients who also had a positive measles serological result (IgM +). We reviewed case-based surveillance data with laboratory confirmation and measles surveillance data from the electronic Health Management Information System from 2012-2015. RESULTS A total of 6,974 suspected measles case-persons were investigated by the measles case-based surveillance between 2012 and 2015. Of these, 943 (14%) were measles specific IgM positive. The median age of measles case-persons between 2013 and 2015 was 4.0 years. Between 2013 and 2015, 72% of the IDSR alerts reported in the electronic Health Management Information System, had blood samples collected for laboratory confirmation. This was however less than the WHO recommended standard of ≥80%. The PPV of CBS between 2013 and 2015 was 8.6%. CONCLUSION In conclusion, the effectiveness of measles case-based surveillance was sub-optimal, while the PPV showed that true measles cases have significantly reduced in Uganda. We recommended strengthening of case-based surveillance to ensure that all suspected measles cases have blood samples collected for laboratory confirmation to improve detection and ensure elimination by 2020.
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