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Liu Y, Xu B, Wang Q, Xu J, Zhang Y. A study on relationship between the incidence of measles and nosocomial exposure at measles epidemic season in Chongqing. Medicine (Baltimore) 2022; 101:e31109. [PMID: 36281197 PMCID: PMC9592507 DOI: 10.1097/md.0000000000031109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
After measles vaccine supplementary immunization, the epidemiological characteristics of measles have changed in Chongqing, China. In addition, according to data from the National Measles Surveillance Information System, the proportion of measles cases with a history of hospital visit 7 to 21 days prior to onset of measles increased year by year to 32.1% in 2016. Further studies are necessary to eliminate the influence of nosocomial exposure on measles. We performed a case-control study in seven districts of Chongqing from June to August 2016 to identify risk factors for measles virus infection and susceptibility. Laboratory-confirmed measles who younger than 5 years old were matched with one control by age and residence. We interviewed case patients and controls regarding potential risk factors for measles virus infection and susceptibility. Unadjusted and adjusted matched odds ratios and 95% confidence intervals (CIs) were calculated using non-conditional logistic regression. After a cross-sectional analysis of the behavioral characteristics of visiting hospitals in the case and control groups, it was found that there was a difference between the two groups in the choice of hospitals visited for the first time (χ2 = 35.500, P = .000), and that nosocomial transmission risk tended to develop in outpatient services of respiratory medicine. After analysis using one-way ANOVA, the relationship between hospital visits prior to onset and the incidence risk of measles was that visiting hospitals five times within 1 to 3 weeks prior to onset affected the incidence (OR = 44.866, 95%CI = 5.938-338.981). The relationship between the number of types of hospitals visited prior to onset and the risk of nosocomial exposure to measles showed that visiting any community hospital, children's hospital, or general hospital had no risk, but visiting two or more of these hospitals affected the incidence (OR = 6.928, 95%CI = 3.849-13.754). Based on further analysis, the relationship between the number of hospital visits after onset and the risk of nosocomial exposure to measles was that the chances of visiting hospitals increased after onset. Risks of nosocomial exposure to measles and infections are high in pediatric hospitals. Nosocomial exposure risk factors should be considered when controlling measles.
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Affiliation(s)
- Yang Liu
- Expanded Program on Immunization, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Binyue Xu
- Expanded Program on Immunization, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Qing Wang
- Expanded Program on Immunization, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Jiawei Xu
- Expanded Program on Immunization, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Yuanyuan Zhang
- Expanded Program on Immunization, Chongqing Center for Disease Control and Prevention, Chongqing, China
- *Correspondence: Yuanyuan Zhang, Expanded Program on Immunization, Chongqing Center for Disease Control and Prevention, Chongqing 400042, China (e-mail: )
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Zhou Y, Tang J, Zhang J, Wu Q. Impact of the coronavirus disease 2019 epidemic and a free influenza vaccine strategy on the willingness of residents to receive influenza vaccines in Shanghai, China. Hum Vaccin Immunother 2021; 17:2289-2292. [PMID: 33577397 PMCID: PMC8189049 DOI: 10.1080/21645515.2020.1871571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/30/2020] [Indexed: 11/21/2022] Open
Abstract
The influenza vaccine is not included in China's national immunization program. Here, we assessed influenza vaccine coverage among Shanghai residents and estimated the impacts of the coronavirus disease 2019 (COVID-19) epidemic and a hypothetical free vaccine strategy on the willingness of participants to receive influenza vaccines. The coverage of influenza vaccines among Shanghai residents from 2015 to 2019 was 1.4% (range: 1%-2.4%). A total of 792 adult participants (aged 19-59 years) along with 821 children and 445 older individuals were included in the analysis. The willingness of participants to receive influenza vaccines reached 68.4% following the COVID-19 epidemic. Furthermore, if the vaccine was made available at no cost, 85.9% of participants were willing to be vaccinated. Our data indicated that influenza vaccine coverage is extremely low in Shanghai but that more than two-thirds of participants were willing to receive influenza vaccines following the COVID-19 epidemic. Making influenza vaccines available for free could further increase coverage.
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Affiliation(s)
- Yehong Zhou
- Department of Immunization, The Changqiao Community Health Service Centre in Xuhui District, Shanghai, China
| | - Jing Tang
- Department of Immunization, The Changqiao Community Health Service Centre in Xuhui District, Shanghai, China
| | - Junjie Zhang
- Department of Immunization and Epidemiology, Xuhui District Centre for Disease Control and Prevention, Shanghai, China
| | - Qiangsong Wu
- Department of Immunization and Epidemiology, Xuhui District Centre for Disease Control and Prevention, Shanghai, China
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Ma C, Hao L, Rodewald L, An Q, Wannemuehler KA, Su Q, An Z, Quick L, Liu Y, Yan R, Liu X, Zhang Y, Yu W, Zhang X, Wang H, Cairns L, Luo H, Gregory CJ. Risk factors for measles virus infection and susceptibility in persons aged 15 years and older in China: A multi-site case-control study, 2012–2013. Vaccine 2020; 38:3210-3217. [PMID: 32173094 PMCID: PMC10375840 DOI: 10.1016/j.vaccine.2020.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/28/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Endemic measles persists in China, despite >95% reported coverage of two measles-containing vaccine doses and nationwide campaign that vaccinated >100 million children in 2010. An increasing proportion of infections now occur among adults and there is concern that persistent susceptibility in adults is an obstacle to measles elimination in China. We performed a case-control study in six Chinese provinces between January 2012 to June 2013 to identify risk factors for measles virus infection and susceptibility among adults. METHODS Persons ≥15 years old with laboratory-confirmed measles were age and neighborhood matched with three controls. Controls had blood specimens collected to determine their measles IgG serostatus. We interviewed case-patients and controls about potential risk factors for measles virus infection and susceptibility. Unadjusted and adjusted matched odds ratios and 95% confidence intervals (CIs) were calculated via conditional logistic regression. We calculated attributable fractions for infection for risk factors that could be interpreted as causal. RESULTS 899 cases and 2498 controls were enrolled. Among controls, 165 (6.6%) were seronegative for measles IgG indicating persistent susceptibility to infection. In multivariable analysis, hospital visit and travel outside the prefecture in the prior 1-3 weeks were significant risk factors for measles virus infection. Occupation and reluctance to accept measles vaccination were significant risk factors for measles susceptibility. The calculated attributable fraction of measles cases from hospital visitation was 28.6% (95% CI: 20.6-38.8%). CONCLUSIONS Exposure to a healthcare facility was the largest risk factor for measles virus infection in adults in China. Improved adherence to hospital infection control practices could reduce risk of ongoing measles virus transmission and increase the likelihood of achieving and sustaining measles elimination in China. The use of control groups stratified by serological status identified distinct risk factors for measles virus infection and susceptibility among adults.
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Mao Y, He R, Zhu B, Liu J, Zhang N. Notifiable Respiratory Infectious Diseases in China: A Spatial-Temporal Epidemiology Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2301. [PMID: 32235375 PMCID: PMC7177391 DOI: 10.3390/ijerph17072301] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/21/2022]
Abstract
Nowadays, tuberculosis, scarlet fever, measles, influenza, and mumps are five major notifiable respiratory infectious diseases (RIDs) in China. The objective of this study was to describe, visualize, and compare the spatial-temporal distributions of these five RIDs from 2006 to 2016. In addition to descriptive epidemiology analysis, seasonality and spatial autocorrelation analysis were also applied to explore the epidemiologic trends and spatial changing patterns of the five RIDs, respectively. The results indicated that the incidence of tuberculosis, measles, and mumps presented a downtrend trend, while those of scarlet fever and influenza was in a strong uptrend across the research period. The incidences of the five diseases all peaked in spring. There were significant spatial disparities in the distribution of tuberculosis, scarlet fever, and measles cases, with the hotspots mainly located in the western plateau region, northern plain region, and southern mountainous region. To conclude, notable epidemiological differences were observed across regions, indicating that some provincial units should pay more attention to prevent and control respiratory infectious diseases.
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Affiliation(s)
- Ying Mao
- School of Public Policy and Administration, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an 710049, China; (R.H.); (B.Z.); (J.L.); (N.Z.)
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an 710049, China
| | - Rongxin He
- School of Public Policy and Administration, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an 710049, China; (R.H.); (B.Z.); (J.L.); (N.Z.)
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an 710049, China
| | - Bin Zhu
- School of Public Policy and Administration, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an 710049, China; (R.H.); (B.Z.); (J.L.); (N.Z.)
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an 710049, China
- Department of Public Policy, City University of Hong Kong, Hong Kong 999077, China
| | - Jinlin Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an 710049, China; (R.H.); (B.Z.); (J.L.); (N.Z.)
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an 710049, China
- Walter H. Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, CA 94305, USA
| | - Ning Zhang
- School of Public Policy and Administration, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an 710049, China; (R.H.); (B.Z.); (J.L.); (N.Z.)
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an 710049, China
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Zheng H, Jia KM, Sun R, Hu P, Wang MH, Zee BCY, Liang W, Chong KC. Epidemiological changes in measles infections in southern China between 2009 and 2016: a retrospective database analysis. BMC Infect Dis 2020; 20:197. [PMID: 32138688 PMCID: PMC7059666 DOI: 10.1186/s12879-020-4919-x] [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: 02/23/2019] [Accepted: 02/26/2020] [Indexed: 11/15/2022] Open
Abstract
Background The incidence rate of measles in China reached a nadir in 2012 after 2 supplementary immunization activities (SIAs) were undertaken in 2009 and 2010. However, the disease began re-emerging in 2013, with a high prevalence rate observed in 2013–2014 in the southern province of Guangdong. In this study, we assessed the changes that occurred in measles epidemiology during 2009–2016, particularly between 2009 and 2011 (when the influence of the SIAs were in full effect) and between 2012 and 2016 (when this influence subsided). Methods Data from 22,362 patients with measles diagnosed between 2009 and 2016, and whose diagnoses were confirmed clinically and/or with laboratory testing, were extracted from the National Infectious Disease Monitoring Information System. Descriptive analyses were performed, and changes in epidemiological characteristics between 2009 and 2011 and 2012–2016 were compared. Results There was a substantial surge in 0–8-month-old patients after 2012; the incidence rate increased from 4.0 per 100,000 population in 2011 (10.3% of the total) to 280 per 100,000 population in 2013 (32.8% of the total). Patients aged 0–6 years represented 73.4% of the total increase between 2011 and 2013. Compared with 2009–2011, adults aged ≥25 years accounted for a higher proportion of patients in 2013 and after (p < 0.01), and were highest in 2016 (31% of the patient total). Conclusion Despite the remarkable results achieved by SIAs in terms of providing herd immunity, the 2013 resurgence of measles revealed insufficient immunization coverage among children. Therefore routine immunization programs should be strengthened, and supplementary vaccinations targeting adults should also be contemplated.
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Affiliation(s)
- Huizhen Zheng
- Center for Disease Control and Prevention of Guangdong Province, Guangzhou, China
| | - Katherine Min Jia
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Riyang Sun
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Pui Hu
- Center for Disease Control and Prevention of Guangdong Province, Guangzhou, China
| | - Maggie Haitian Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Benny Chung-Ying Zee
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Wenjia Liang
- Center for Disease Control and Prevention of Guangdong Province, Guangzhou, China.
| | - Ka Chun Chong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China. .,Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
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Kornbluh R, Davis R. Global trends in measles publications. Pan Afr Med J 2020; 35:14. [PMID: 32373265 PMCID: PMC7195917 DOI: 10.11604/pamj.supp.2020.35.1.18508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 01/20/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Beginning with the 1960s, this review analyzes trends in publications on measles indexed by the National Library of Medicine from January 1960 to mid-2018. It notes both the growth in numbers of published papers, and the increasing number and proportion of publications, in the current century, of articles on such items as costing, measles elimination, and determinants of coverage. METHODS A two-person team extracted from the National Library of Medicine (NLM) homepage all citations on measles beginning in 1960 and continuing through mid-2018. These were then classified both by overall number and by subject matter, with tabular summaries of both by decade and by subject matter. The tabular presentation forms the basis for a discussion of the ten most frequently cited subjects, and publication trends, with a special emphasis on the current century. RESULTS As in the past, the most often currently published items have been on coverage and its determinants, measles elimination, outbreak reports, SSPE, and SIAs. The putative relationship between vaccination and autism saw a spurt of articles in the 1990s, rapidly declining after the IOM report rejecting the causative hypothesis. CONCLUSION There is a discussion on the sequencing of polio and measles eradication, the former unlikely before 2022, and an examination of likely research priorities as the world moves from measles control to measles eradication. There is a key role for social science in combatting vaccination reticence. The role of technical innovations, such as micropatch vaccination, is discussed.
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Qin S, Ding Y, Yan R, He H. Measles in Zhejiang, China, 2004-2017: Population Density and Proportion of Floating Populations Effects on Measles Epidemic. Health Secur 2019; 17:193-199. [PMID: 31206323 DOI: 10.1089/hs.2019.0011] [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] [Indexed: 11/13/2022] Open
Abstract
The target of eliminating measles has not been achieved, and measles has resurged in Zhejiang, China, since 2013. In this study, we hypothesized that population density and the proportion of the floating population were the potential causes of measles persistence in Zhejiang. Measles cases in Zhejiang from 2004 through 2017 were analyzed using data from the National Notifiable Diseases Reporting System (NNDRS). Reported measles incidence and annual incidence by age were described. Spearman correlation coefficients were used to assess correlations between measles incidence and population density and the proportion of floating population. A total of 48,648 measles cases were reported during the 14-year period. Two large measles epidemics occurred in 2005 (14,317 cases, incidence of 29.38/100,000) and 2008 (12,782 cases, incidence of 25.26/100,000). A higher proportion of cases occurred in young adults aged 20 to 34 years and infants under 1 year of age. A positive correlation was observed between measles incidence and either population density or proportion of inter-provincial floating populations. In general, Zhejiang suffers from a high incidence of measles partly because of its high population density and the low vaccination rates among inter-provincial floating populations. To meet the target of measles elimination, convincing susceptible young adults and migrant children to get vaccinated remains a critical issue.
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Affiliation(s)
- Shangren Qin
- Shangren Qin, PhD, is a Lecturer, School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China. Ye Ding, MS, is an Experimentalist, Department of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, China. Rui Yan, MS, is an Attending Physician, and Hanqing He, MS, is Associate Chief Physician, both at Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Ye Ding
- Shangren Qin, PhD, is a Lecturer, School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China. Ye Ding, MS, is an Experimentalist, Department of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, China. Rui Yan, MS, is an Attending Physician, and Hanqing He, MS, is Associate Chief Physician, both at Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Rui Yan
- Shangren Qin, PhD, is a Lecturer, School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China. Ye Ding, MS, is an Experimentalist, Department of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, China. Rui Yan, MS, is an Attending Physician, and Hanqing He, MS, is Associate Chief Physician, both at Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Hanqing He
- Shangren Qin, PhD, is a Lecturer, School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China. Ye Ding, MS, is an Experimentalist, Department of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, China. Rui Yan, MS, is an Attending Physician, and Hanqing He, MS, is Associate Chief Physician, both at Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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Chong KC, Rui Y, Liu Y, Zhou T, Jia K, Wang MH, Mohammad KN, He H. Early Waning of Maternal Measles Antibodies in Infants in Zhejiang Province, China: A Comparison of Two Cross-Sectional Serosurveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234680. [PMID: 31771262 PMCID: PMC6926550 DOI: 10.3390/ijerph16234680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/14/2019] [Accepted: 11/21/2019] [Indexed: 01/28/2023]
Abstract
In China, children aged <8 months, who were expected to be protected by maternal antibodies before receiving the first dose of measles vaccine, were the age group with the greatest risk of infection in recent years. In this study, we evaluated whether infants yet to be age-eligible for measles vaccine had a sufficient seropositive level of maternal measles antibodies in 2009 and 2013. Blood samples were collected from infants aged <8 months through population-based serological surveys conducted in Zhejiang, China. Serum levels of immunoglobulin G measles antibodies were quantified using enzyme-linked immunosorbent assay. In 2013, the mean geometric mean titres (GMTs) of infants aged 4 to 8 months were below the seropositivity threshold (<200 mIU/mL), decreasing from 118.6 mIU/mL (95% confidence interval [CI] 83.0, 169.3 mIU/mL) at 4 months to 28.6 mIU/mL (95% CI 15.6, 52.3 mIU/mL) at 7 months. Antibody levels were significantly lower in 2013 than in 2009 starting from 5 months of age. In conclusion, infants aged 4 to 8 months are susceptible to measles due to low levels of maternal measles antibodies. It is thus suggested to provide infants with a supplementary dose on top of the routine schedule, and/or launch catch-up vaccination campaigns among young women.
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Affiliation(s)
- Ka Chun Chong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (K.C.C.); (Y.L.); (T.Z.); (K.J.); (M.H.W.)
- Clinical Trials and Biostatistics Laboratory Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518172, China
| | - Yan Rui
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310058, China;
| | - Yan Liu
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (K.C.C.); (Y.L.); (T.Z.); (K.J.); (M.H.W.)
| | - Tianyuan Zhou
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (K.C.C.); (Y.L.); (T.Z.); (K.J.); (M.H.W.)
| | - Katherine Jia
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (K.C.C.); (Y.L.); (T.Z.); (K.J.); (M.H.W.)
| | - Maggie Haitian Wang
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (K.C.C.); (Y.L.); (T.Z.); (K.J.); (M.H.W.)
- Clinical Trials and Biostatistics Laboratory Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518172, China
| | - Kirran N. Mohammad
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (K.C.C.); (Y.L.); (T.Z.); (K.J.); (M.H.W.)
- Correspondence: (K.N.M.); (H.H.)
| | - Hanqing He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310058, China;
- Correspondence: (K.N.M.); (H.H.)
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Yang W, Li J, Shaman J. Characteristics of measles epidemics in China (1951-2004) and implications for elimination: A case study of three key locations. PLoS Comput Biol 2019; 15:e1006806. [PMID: 30716080 PMCID: PMC6375639 DOI: 10.1371/journal.pcbi.1006806] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/14/2019] [Accepted: 01/19/2019] [Indexed: 11/19/2022] Open
Abstract
Measles is a highly infectious, severe viral disease. The disease is targeted for global eradication; however, this result has proven challenging. In China, where countrywide vaccination coverage for the last decade has been above 95% (the threshold for measles elimination), measles continues to cause large epidemics. To diagnose factors contributing to the persistency of measles, here we develop a model-inference system to infer measles transmission dynamics in China. The model-inference system uses demographic and vaccination data for each year as model inputs to directly account for changing population dynamics (including births, deaths, migrations, and vaccination). In addition, it simultaneously estimates unobserved model variables and parameters based on incidence data. When fitted to yearly incidence data for the entire population, it is able to accurately estimate independent, out-of-sample age-specific incidence. Using this validated model-inference system, we are thus able to estimate epidemiological and demographical characteristics key to measles transmission during 1951-2004 for three key locations in China, including its capital Beijing. These characteristics include age-specific population susceptibility and incidence rates, the basic reproductive number (R0), reporting rate, population mixing intensity, and amplitude of seasonality. Key differences among the three sites reveal population and epidemiological characteristics crucial for understanding the current persistence of measles epidemics in China. We also discuss the implications our findings have for future elimination strategies.
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Affiliation(s)
- Wan Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States
| | - Juan Li
- Beijing Center for Disease Control and Prevention, Beijing, China
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States
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10
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Sindhu TG, Geeta MG, Krishnakumar P, Sabitha S, Ajina KK. Clinical profile of measles in children with special reference to infants. Trop Doct 2018; 49:20-23. [PMID: 30319076 DOI: 10.1177/0049475518804695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was conducted to analyse the clinical characteristics of measles in infants and to compare them with those in older children. Clinical and sociodemographic details of all hospitalised children with suspected measles were recorded and confirmed cases were analysed further. Twenty-four infants and 34 children aged >1 year were included. Most infants were boys and 15 (62.5%) of them were aged <9 months. Early onset of rash (within three days of fever in 62.5% of cases) occurred in infants. The complications of measles in infants included bronchopneumonia (n = 17, 71%), acute diarrhoea (n = 8, 33%), meningitis (n = 1, 4%) and staphylococcal sepsis (n = 2, 8%). The number of infants with complications was significantly high (88% and 65%; P = 0.05). Measles in infants can have atypical presentations, a greater risk for complications and may occur before they are due to receive the conventional first dose of measles vaccine.
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Affiliation(s)
- T G Sindhu
- 1 Associate Professor, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
| | - M G Geeta
- 2 Additional Professor, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
| | - P Krishnakumar
- 3 Additional Professor of Paediatrics and Director, Institute of Mental Health and Neurosciences (IMHANS), Kozhikode, Kerala, India
| | - S Sabitha
- 1 Associate Professor, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
| | - K K Ajina
- 4 Junior Resident, Department of Paediatrics, Government Medical College, Kozhikode, Kerala, India
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11
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Ge YL, Zhai XW, Zhu YF, Wang XS, Xia AM, Li YF, Zeng M. Measles Outbreak in Pediatric Hematology and Oncology Patients in Shanghai, 2015. Chin Med J (Engl) 2018; 130:1320-1326. [PMID: 28524832 PMCID: PMC5455042 DOI: 10.4103/0366-6999.206358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Despite substantial progress toward measles control are making in China, measles outbreaks in immunocompromised population still pose a challenge to interrupt endemic transmission. This study aimed to investigate the features of measles in pediatric hematology and oncology patients and explore the reasons behind the outbreak. Methods: We collected demographic, epidemiological, and clinical data of immunocompromised measles children. All suspected measles cases were laboratory-confirmed based on the presence of measles IgM and/or identification of measles RNA. The clinical data were statistically analyzed by t-test for continuous variables and Fisher's exact test for categorical variables. Results: From March 9 to July 25 in 2015, a total of 23 children with malignancies and post hematopoietic stem cell transplantation (post-HSCT) were notified to develop measles in Shanghai. Of these 23 patients with the median age of 5.5 years (range: 11 months–14 years), 20 (87.0%) had received 1–3 doses of measles vaccine previously; all patients had fever with the median fever duration of 8 days; 21 (91.3%) had cough; 18 (78.3%) had rash; 13 (56.5%) had Koplik's spot; 13 (56.5%) had complications including pneumonia and acute liver failure; and five (21.7%) vaccinated patients died from severe pneumonia or acute liver failure. Except the first patient, all patients had hospital visits within 7–21 days before measles onset and 20 patients were likely to be exposed to each other. Conclusions: The outcome of measles outbreak in previously vaccinated oncology and post-HSCT pediatric patients during chemotherapy and immunosuppressant medication was severe. Complete loss of protective immunity induced by measles vaccine during chemotherapy was the potential reason. Improved infection control practice was critical for the prevention of measles in malignancy patients and transplant recipients.
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Affiliation(s)
- Yan-Ling Ge
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Xiao-Wen Zhai
- Department of Hematology, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Yan-Feng Zhu
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Xiang-Shi Wang
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Ai-Mei Xia
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Yue-Fang Li
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
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Zhang Y, Wagner AL, Wang X, Carlson BF, Ding Y, Montgomery JP, Gillespie BW, Boulton ML. Risk factors for measles among infants in Tianjin, China. Public Health 2017; 151:114-117. [PMID: 28780066 DOI: 10.1016/j.puhe.2017.07.001] [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: 04/05/2017] [Revised: 06/21/2017] [Accepted: 07/07/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Infants aged <8 months are ineligible for measles vaccination in China but represent a disproportionate number of cases. We examined the risk factors for measles among infants in Tianjin, China. STUDY DESIGN Case-control study. METHODS Cases were enrolled from a surveillance system, and IgG-negative controls were sampled from registries at immunization clinics. A logistic regression model assessed for risk factors. RESULTS Among 82 cases and 485 controls, exposure to a municipal hospital (OR [odds ratio]: 5.21; 95% confidence interval [CI]: 1.19-22.82) or a specialty hospital (OR: 13.22; 95% CI: 6.13-28.51) was associated with the disease, whereas visiting a township or district hospitals was not associated with increased odds of measles. CONCLUSIONS Hospitals were an important focal point of measles transmission for infants. Hospitals, particularly higher-level municipal and specialty hospitals, should enforce infection control programs to separate infants with highly communicable diseases to prevent transmission.
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Affiliation(s)
- Y Zhang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - A L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - X Wang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - B F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Y Ding
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - J P Montgomery
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - B W Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - M L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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13
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Hao L, Ma C, Wannemuehler KA, Su Q, An Z, Cairns L, Quick L, Rodewald L, Liu Y, He H, Xu Q, Ma Y, Yu W, Zhang N, Li L, Wang N, Luo H, Wang H, Gregory CJ. Risk factors for measles in children aged 8 months-14 years in China after nationwide measles campaign: A multi-site case-control study, 2012-2013. Vaccine 2016; 34:6545-6552. [PMID: 26876440 PMCID: PMC6293465 DOI: 10.1016/j.vaccine.2016.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Endemic measles persists in China, despite >95% reported coverage of two measles-containing vaccine doses and nationwide campaign that vaccinated more than 100 million children in 2010. In 2011, almost half of the 9943 measles cases in China occurred in children eligible for measles vaccination. We conducted a case-control study during 2012-2013 to identify risk factors for measles infection in children aged 8 months-14 years. METHODS Children with laboratory-confirmed measles were age- and neighborhood-matched with three controls. We interviewed parents of case and control infants on potential risk factors for measles. We calculated adjusted matched odds ratios and 95% confidence intervals of risk factors. We calculated attributable fractions for risk factors that could be interpreted as causal and vaccine efficacy (VE) for the measles containing vaccine (MCV) used in the Chinese immunization program. RESULTS In all, 969 case-patients and 2845 controls were enrolled. In multivariable analysis, lack of measles vaccination both overall (mOR 22.7 [16.6, 31.1] and when stratified by region (east region, mOR 74.2 [27.3, 202]; central/western regions mOR 17.4 [12.5, 24.3]), hospital exposure (mOR 63.0, 95% CI [32.8, 121]), and migration among counties (overall mOR 3.0 [2.3, 3.9]) were significant risk factors. The calculated VE was 91.9-96.1% for a single dose of MCV and 96.6-99.5% for 2 doses. CONCLUSIONS Lack of vaccination was the leading risk factor for measles infection, especially in children born since the 2010 supplementary immunization activity. Reducing missed vaccination opportunities, improving immunization access for migrant children, and strengthening school/kindergarten vaccine checks are needed to strengthen the routine immunization program and maintain progress toward measles elimination in China.
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Affiliation(s)
- Lixin Hao
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Chao Ma
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Kathleen A Wannemuehler
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Qiru Su
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Zhijie An
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Lisa Cairns
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Linda Quick
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Lance Rodewald
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Yuanbao Liu
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Hanqing He
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Qing Xu
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Yating Ma
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Wen Yu
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Ningjing Zhang
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Li Li
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Ning Wang
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Huiming Luo
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
| | - Huaqing Wang
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China.
| | - Christopher J Gregory
- Chinese center for Disease control and prevention, center of national immunization program, No 27, Nanwei Road, Xicheng District, Beijing 100050, China
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