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Pleșca VȘ, Streinu-Cercel A, Săndulescu O, Drăgănescu AC, Hainăroșie R, Pleșca AD. Incidence and Characteristics of Pediatric Patients with Acute Otitis Hospitalized in a Romanian Infectious Diseases Hospital. CHILDREN (BASEL, SWITZERLAND) 2024; 11:832. [PMID: 39062281 PMCID: PMC11274892 DOI: 10.3390/children11070832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/24/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Otic involvement is common in children during acute infectious diseases, and is an important cause of morbidity and health service utilization. METHODS We performed a retrospective analysis of pediatric cases hospitalized in the largest infectious disease hospital in Romania between 2018 and 2023, with the aim of quantifying the incidence and impact of acute otitis (AO) according to pediatric age subgroups. RESULTS A total of 1118 cases diagnosed with AO were eligible and included in the analysis. Acute congestive otitis media was the most common subtype, identified in 53.3% of cases, followed by acute purulent otitis media (APOM) in 26.7% of children. The majority of AO cases (69.9%) were diagnosed in the pre-pandemic period (2018-2019), and infants (10.6%), toddlers (49.4%), and preschoolers (29.2%) were the most affected age groups. A viral infection associated with the AO episode was documented in 49.6% of cases. Influenza viruses were most commonly reported (20.5%), followed by SARS-CoV-2 (5.8%), and adenovirus (4.9%). A total of 38 cases of AO were identified in children with measles. In 15.9% of APOM cases, Streptococcus pneumoniae was isolated by culture from otic secretions. The duration of hospitalization was longer in children with APOM and acute otitis externa compared to the other subtypes of AO (p < 0.001). CONCLUSIONS Our study highlights the importance of ENT (ear, nose, and throat) monitoring in children hospitalized for acute infectious diseases, as the majority of AO cases occur in the context of a viral infection. These findings emphasize the necessity for tailored assessment and intervention in suspected cases of AO, especially in young children under 5 years of age.
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Affiliation(s)
- Vlad Ștefan Pleșca
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute of Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
| | - Anca Streinu-Cercel
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute of Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
- Academy of Romanian Scientists (AOSR), 050045 Bucharest, Romania
| | - Oana Săndulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute of Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
- Academy of Romanian Scientists (AOSR), 050045 Bucharest, Romania
| | - Anca Cristina Drăgănescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute of Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
| | - Răzvan Hainăroșie
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Anca Doina Pleșca
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Asplin P, Mancy R, Finnie T, Cumming F, Keeling MJ, Hill EM. Symptom propagation in respiratory pathogens of public health concern: a review of the evidence. J R Soc Interface 2024; 21:20240009. [PMID: 39045688 PMCID: PMC11267474 DOI: 10.1098/rsif.2024.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/28/2024] [Indexed: 07/25/2024] Open
Abstract
Symptom propagation occurs when the symptom set an individual experiences is correlated with the symptom set of the individual who infected them. Symptom propagation may dramatically affect epidemiological outcomes, potentially causing clusters of severe disease. Conversely, it could result in chains of mild infection, generating widespread immunity with minimal cost to public health. Despite accumulating evidence that symptom propagation occurs for many respiratory pathogens, the underlying mechanisms are not well understood. Here, we conducted a scoping literature review for 14 respiratory pathogens to ascertain the extent of evidence for symptom propagation by two mechanisms: dose-severity relationships and route-severity relationships. We identify considerable heterogeneity between pathogens in the relative importance of the two mechanisms, highlighting the importance of pathogen-specific investigations. For almost all pathogens, including influenza and SARS-CoV-2, we found support for at least one of the two mechanisms. For some pathogens, including influenza, we found convincing evidence that both mechanisms contribute to symptom propagation. Furthermore, infectious disease models traditionally do not include symptom propagation. We summarize the present state of modelling advancements to address the methodological gap. We then investigate a simplified disease outbreak scenario, finding that under strong symptom propagation, isolating mildly infected individuals can have negative epidemiological implications.
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Affiliation(s)
- Phoebe Asplin
- EPSRC & MRC Centre for Doctoral Training in Mathematics for Real-World Systems, University of Warwick, Coventry, UK
- Mathematics Institute, University of Warwick, Coventry, UK
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
| | - Rebecca Mancy
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Thomas Finnie
- Data, Analytics and Surveillance, UK Health Security Agency, London, UK
| | - Fergus Cumming
- Foreign, Commonwealth and Development Office, London, UK
| | - Matt J. Keeling
- Mathematics Institute, University of Warwick, Coventry, UK
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
- School of Life Sciences, University of Glasgow, Glasgow, UK
| | - Edward M. Hill
- Mathematics Institute, University of Warwick, Coventry, UK
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
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Salimović-Bešić I, Musa S, Kotorić-Keser Š, Zahirović E, Mutevelić S, Dedeić-Ljubović A. Measles outbreak in 2019: a warning for the post-COVID-19 pandemic period. J Med Microbiol 2024; 73. [PMID: 38995847 DOI: 10.1099/jmm.0.001855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
Introduction. At the end of 2019 and the year before, there was a significant spread of measles in the World Health Organization (WHO) European Region.Gap statement. Among the countries that reported, a measles outbreak was Bosnia and Herzegovina (BiH).Aim. To describe the measles outbreak in BiH (an entity of the Federation of BiH, FBiH) in 2019.Methodology. Confirmatory IgM serology, measles nucleic acid detection by real-time RT-PCR and virus genotyping were done in the WHO-accredited laboratory for measles and rubella at the Clinical Center of the University of Sarajevo, Unit for Clinical Microbiology. Genotype was determined in all measles-RNA-positive cases by sequence analysis of the 450 nt fragment coding the C-terminal of measles virus nucleoprotein (N).Results. From 1 January to 31 December 2019, 1332 measles cases were reported, with the peak observed in April 2019 (413/1332, 31.01 %). Sarajevo Canton had the highest incidence, number of cases and percentage (206.4; 868/1332; 65.17 %) of measles cases. Around four-fifths of infected persons were unvaccinated (1086/1332, 81.53 %), while 4.58 % of the patients (61/1332) were immunized with one dose of measles-containing vaccine. The highest proportion of cases was found in children 0-6 years of age (738/1332, 55.41 %). Measles IgM positivity was determined in 75.88 % (346/456), while virus RNA was detected in 82.46 % (47/57) of the swab samples. All measles virus sequences belonged to genotype B3. SNP (position 216: C=>T) was detected in 1 of the 40 sequences obtained during this outbreak.Conclusion. Due to suboptimal immunization coverage, BiH belongs to countries at a high risk for measles outbreaks. Post-COVID-19 (coronavirus disease 2019) pandemic, targeted and tailored strategies are required to ensure routine vaccination demand and acceptance and broad partner and stakeholder group participation.
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Affiliation(s)
- Irma Salimović-Bešić
- Clinical Center of the University of Sarajevo, Unit for Clinical Microbiology, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina
- Faculty of Health Studies, University of Sarajevo, Stjepana Tomića 1, 71000 Sarajevo, Bosnia and Herzegovina
| | - Sanjin Musa
- Institute for Public Health of the Federation of Bosnia and Herzegovina, Ul. Maršala Tita br. 9, 71000 Sarajevo, Bosnia and Herzegovina
- Sarajevo Medical School, Sarajevo School of Science and Technology, Hrasnička cesta 3a, Sarajevo, 71000, Bosnia and Herzegovina
| | - Šejla Kotorić-Keser
- Clinical Center of the University of Sarajevo, Unit for Clinical Microbiology, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina
| | - Edina Zahirović
- Clinical Center of the University of Sarajevo, Unit for Clinical Microbiology, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina
- Faculty of Health Studies, University of Sarajevo, Stjepana Tomića 1, 71000 Sarajevo, Bosnia and Herzegovina
| | - Selma Mutevelić
- Clinical Center of the University of Sarajevo, Unit for Clinical Microbiology, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina
| | - Amela Dedeić-Ljubović
- Clinical Center of the University of Sarajevo, Unit for Clinical Microbiology, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina
- Faculty of Health Studies, University of Sarajevo, Stjepana Tomića 1, 71000 Sarajevo, Bosnia and Herzegovina
- Sarajevo Medical School, Sarajevo School of Science and Technology, Hrasnička cesta 3a, Sarajevo, 71000, Bosnia and Herzegovina
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Cant S, Shanks GD, Keeling MJ, Penman BS. Extreme mortality during a historical measles outbreak on Rotuma is consistent with measles immunosuppression. Epidemiol Infect 2024; 152:e85. [PMID: 38736255 PMCID: PMC11149033 DOI: 10.1017/s095026882400075x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/05/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024] Open
Abstract
Until the early twentieth century, populations on many Pacific Islands had never experienced measles. As travel to the Pacific Islands by Europeans became more common, the arrival of measles and other pathogens had devastating consequences. In 1911, Rotuma in Fiji was hit by a measles epidemic, which killed 13% of the island population. Detailed records show two mortality peaks, with individuals reported as dying solely from measles in the first and from measles and diarrhoea in the second. Measles is known to disrupt immune system function. Here, we investigate whether the pattern of mortality on Rotuma in 1911 was a consequence of the immunosuppressive effects of measles. We use a compartmental model to simulate measles infection and immunosuppression. Whilst immunosuppressed, we assume that individuals are vulnerable to dysfunctional reactions triggered by either (i) a newly introduced infectious agent arriving at the same time as measles or (ii) microbes already present in the population in a pre-existing equilibrium state. We show that both forms of the immunosuppression model provide a plausible fit to the data and that the inclusion of immunosuppression in the model leads to more realistic estimates of measles epidemiological parameters than when immunosuppression is not included.
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Affiliation(s)
- Susie Cant
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
- Mathematics Institute, University of Warwick, Coventry, UK
| | - G. Dennis Shanks
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Matt J. Keeling
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
- Mathematics Institute, University of Warwick, Coventry, UK
- School of Life Sciences, University of Warwick, Coventry, UK
| | - Bridget S. Penman
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
- School of Life Sciences, University of Warwick, Coventry, UK
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Wang D, Lang JC, Chen YH. Assessment of using Google Trends for real-time monitoring of infectious disease outbreaks: a measles case study. Sci Rep 2024; 14:9470. [PMID: 38658657 PMCID: PMC11043416 DOI: 10.1038/s41598-024-60120-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
Measles remains a significant threat to children worldwide despite the availability of effective vaccines. The COVID-19 pandemic exacerbated the situation by leading to the postponement of supplementary measles immunization activities. Along with this postponement, measles surveillance also deteriorated, with the lowest number of submitted specimens in over a decade. In this study, we focus on measles as a challenging case study due to its high vaccination coverage, which leads to smaller outbreaks and potentially weaker signals on Google Trends. Our research aimed to explore the feasibility of using Google Trends for real-time monitoring of infectious disease outbreaks. We evaluated the correlation between Google Trends searches and clinical case data using the Pearson correlation coefficient and Spearman's rank correlation coefficient across 30 European countries and Japan. The results revealed that Google Trends was most suitable for monitoring acute disease outbreaks at the regional level in high-income countries, even when there are only a few weekly cases. For example, from 2017 to 2019, the Pearson correlation coefficient was 0.86 (p-value< 0.05) at the prefecture level for Okinawa, Japan, versus 0.33 (p-value< 0.05) at the national level for Japan. Furthermore, we found that the Pearson correlation coefficient may be more suitable than Spearman's rank correlation coefficient for evaluating the correlations between Google Trends search data and clinical case data. This study highlighted the potential of utilizing Google Trends as a valuable tool for timely public health interventions to respond to infectious disease outbreaks, even in the context of diseases with high vaccine coverage.
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Affiliation(s)
- Dawei Wang
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA.
| | - John Cameron Lang
- Health Economic and Decision Sciences, Merck Canada Inc., Kirkland, QC, Canada
| | - Yao-Hsuan Chen
- Health Economic and Decision Sciences, MSD (UK) Limited, London, UK
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Mamman Na'uzo A, Sanni UA, Lawal TO, Musa TL, Gabriel OO, Abdullahi K Z, Habib MI. Subcutaneous Emphysema Complicating the Convalescent Stage of Measles in a Malnourished Indigent Child: A Case Report From North-Western Nigeria. Cureus 2024; 16:e58668. [PMID: 38774182 PMCID: PMC11106638 DOI: 10.7759/cureus.58668] [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] [Accepted: 04/20/2024] [Indexed: 05/24/2024] Open
Abstract
Measles is a highly infectious, vaccine-preventable viral disease that runs a devastating course in developing countries due to its association with malnutrition and poor immunization coverage. Subcutaneous emphysema (SE) is a rare complication of measles that can be challenging to manage and may portend poor outcomes if untreated. We present a case of a two-year-old unimmunized rural dweller who presented with facial, neck, and chest swellings three days after being managed for measles exanthem from a referral hospital. Clinical findings were consistent with massive SE comorbid with malnutrition complicating the convalescent stage of measles. The child failed to improve with conservative management but responded to closed thoracostomy tube drainage (CTTD) through an underwater seal bottle with intermittent negative pressure wound therapy (NPWT). The child spent 47 days in the hospital during which the social welfare unit of the hospital supported the treatment. SE is a rare complication of measles infection that can be challenging to manage, especially when comorbid with malnutrition in an indigent child. The application of a multidisciplinary team approach and the use of CTTD with NPWT may shorten the duration of hospital stay for the patient.
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Affiliation(s)
| | - Usman A Sanni
- Paediatrics, Federal Medical Centre, Birnin Kebbi, NGA
| | | | | | | | - Zainab Abdullahi K
- Community Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, NGA
| | - Muhammad I Habib
- Plastic and Reconstructive Surgery, Federal Medical Centre, Birnin Kebbi, NGA
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7
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Ly H. Measles disease outbreaks and vaccination impacting global public health. J Med Virol 2024; 96:e29593. [PMID: 38572935 DOI: 10.1002/jmv.29593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Hinh Ly
- Department of Veterinary & Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, Twin Cities, Minnesota, USA
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Conceição PB, San Pedro A, Praça HLF, dos Santos YT, Reis LNM, Gibson G. [Stratification of risk areas for measles transmission: a systematic reviewEstratificación de las zonas de riesgo de transmisión del sarampión: revisión sistemática]. Rev Panam Salud Publica 2024; 48:e1. [PMID: 38226153 PMCID: PMC10787521 DOI: 10.26633/rpsp.2024.1] [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: 09/25/2023] [Accepted: 11/17/2023] [Indexed: 01/17/2024] Open
Abstract
Objective To perform a systematic review of scientific publications addressing the use of stratification methods to define risk areas for measles transmission. Method Articles published in English, Portuguese, and Spanish in journals indexed in the SciELO, PubMed, and LILACS databases were selected. The search terms risk assessment AND measles were used without date limits. Editorials, opinion articles, individual-level observational studies, and publications that did not focus on the application of methods to stratify measles transmission risk areas were excluded. Year of publication, authorship, country where the study was performed, objective, geographic level of analysis, method used, indicators, and limitations were recorded in a data form. Results Thirteen articles published between 2011 and 2022 in nine countries from the six World Health Organization (WHO) regions were selected. Of these, 10 referred to the Measles Risk Assessment Tool developed by the WHO/Centers for Disease Control and Prevention. Only one study adapted the tool to the local context. The risk stratification indicators used in the selected studies focused on a combination of the following dimensions: population immunity, quality of surveillance systems, and epidemiologic status. The systematic output of data with adequate quality and coverage was a noteworthy aspect hindering risk stratification. Conclusion There seems to be limited dissemination of measles risk stratification strategies, especially at local levels. The need to train human resources to process and interpret risk analyses as part of the routine of surveillance services is emphasized.
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Affiliation(s)
- Paula Barbosa Conceição
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - Alexandre San Pedro
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - Heitor Levy Ferreira Praça
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - Yasmin Toledo dos Santos
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - Larissa Nunes Moreira Reis
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - Gerusa Gibson
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
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Garrouste C, Juet A, Samson AL. Direct and crowding-out effects of a Hepatitis B vaccination campaign. ECONOMICS AND HUMAN BIOLOGY 2023; 51:101279. [PMID: 37567047 DOI: 10.1016/j.ehb.2023.101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023]
Abstract
We evaluate the direct and spillover causal effects of a Hepatitis B (HB) vaccination campaign in French schools on the vaccination adherence of the targeted pupils. Using a regression discontinuity design, we show that this campaign created an exogenous shock on vaccination behavior, increasing the HB vaccination rate for children aged 11 and above. At the same time, we show a drop in the measles, mumps, and rubella (MMR) vaccination rate of the targeted pupils and an increase in the parental belief that measles is a benign disease. We interpret these results as a salience effect: the focus on HB vaccination leads to a decrease in the belief that other vaccines are as important. The effect on MMR vaccination was relatively unexpected and may imply a negative externality. Measles is an extremely contagious disease. If the vaccination rate falls, the disease will spread further, raising the question of the net effect of the HB vaccination campaign on the well-being of the population.
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Affiliation(s)
- Clémentine Garrouste
- Université de Lille, CNRS, IESEG School of Management, UMR 9221 - LEM - Lille Économie Management, F-59000 Lille, France.
| | - Arthur Juet
- Université Paris-Dauphine, PSL Research University, CNRS, IRD, LEDa, LEGOS; Place du Maréchal de Lattre de Tassigny, 75016 Paris, France.
| | - Anne-Laure Samson
- Université Paris-Panthéon Assas, LEMMA, 4 rue Blaise Desgoffe, 75006 Paris, France.
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Alruqaie N, Al Qadrah B, Almansour S, Alghamdi E, Alharbi M. A Measles Outbreak in Riyadh in 2023: Clinical and Epidemiological Characteristics. Cureus 2023; 15:e48171. [PMID: 38046773 PMCID: PMC10693316 DOI: 10.7759/cureus.48171] [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] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Background Measles is a highly contagious viral disease that has recently made headlines due to outbreaks in several parts of the world. The disease can cause serious health complications, especially in young children, which has led to concerns about vaccination rates and public health policies. This study aims to investigate and describe the epidemiology, clinical characteristics, and outcomes of measles infection among children in Riyadh. Methodology We conducted a descriptive cross-sectional study among all pediatric patients with confirmed measles infection at a tertiary hospital from January 15, 2023, to March 15, 2023. We collected data including demographic characteristics, clinical presentations, and clinical outcomes. Results A total of 63 confirmed measles cases were reported. Most patients were under four years of age (82.7%), and 85.7% were unvaccinated. Adenovirus was the most common viral coinfection (12.7%). The most common complication was pneumonia (58.7%). Chest X-ray findings reported a localized right parenchymal infiltrate in 19% of patients and a patchy bilateral infiltrate in 15.9% of patients. In addition, 88.9% required hospital admission secondary to dehydration (47.6%) and hypoxia (41.3%). Among admitted patients, 17.5% were admitted to the pediatric intensive care unit (PICU), 9.5% were admitted due to respiratory failure, and 6.3% due to septic shock. Children under one year of age had a higher risk for PICU admission (p < 0.05). The mortality rate was 1.6%. Conclusions Measles is a serious disease that causes significant health effects and incurs high financial costs for public health systems. Vaccination remains the most effective way to prevent measles outbreaks and reduce their impact on individuals and communities.
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Affiliation(s)
- Nourah Alruqaie
- Pediatric Infectious Diseases, King Abdulaziz Medical City, Riyadh, SAU
| | | | | | - Eman Alghamdi
- Public Health, King Abdulaziz Medical City, Riyadh, SAU
| | - Musaed Alharbi
- Pediatric Infectious Diseases, King Abdulaziz Medical City, Riyadh, SAU
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Masters ET. Medicinal plants of the upper Aswa River catchment of northern Uganda - a cultural crossroads. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2023; 19:48. [PMID: 37884931 PMCID: PMC10605377 DOI: 10.1186/s13002-023-00620-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND This paper presents a comparative inventory of medicinal plant taxa and their uses by smallholder farming communities of four cultures in the Aswa River catchment of northern Uganda, situated in the eastern Sudanian savanna parkland ecotype of sub-Saharan Africa. The purpose of the study was to document the ethnobotanical use of medicinal plants by the Lango, Acholi, Teso (Atesot) and Ethur (jo Abwor), in an historical moment before civil conflict and mass displacement of the respondent communities disrupted the inter-generational transmission of traditional technical knowledge within the study area. METHODS Following community consultations in four districts of northern Uganda during 1999-2000, interviews were conducted with holders of specialist knowledge on plants used as medicine on basis of a plant specimen allocated a voucher number and identified by the national herbarium. Use reports reflecting specific medicinal applications were compiled in aggregate to obtain a Relative Importance Index ranking. The commonality of medicinal taxa cited between each cultural interface was assessed by the Jaccard Index of Similarity, and the similarity of specific medicinal usage by taxon using Rahman's Similarity Index. RESULTS The data collected from 112 respondents comprise 280 medicinal use reports describing 263 applications for 62 medical conditions, citing 108 taxa from 44 botanical families of which Fabaceae comprised 20% of all use reports. No earlier mention could be found to corroborate 72 use reports (27% of the total), representing medicinal indications as yet undocumented, and potentially worthy of investigation. The RI values ranged between 15 and 94%, with 13 taxa having RI values above 50%. The JI ratios indicate the highest degree of similarity in the plant taxa used as medicine (21%) between the Lango and Teso cultures who share a common origin; however, Rahman's Similarity Index indicates the highest similarity of specific medicinal usage by taxon between the Lango and Acholi, who share a common language group through cultural assimilation over time. CONCLUSIONS As a comparative study, the results imply that cultural exchange and assimilation may be a greater driver of inter-cultural similarity of ethnopharmacological use of a given taxon, as compared to shared historical origins.
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Affiliation(s)
- Eliot T Masters
- Nelson Marlborough Institute of Technology (Te Pūkenga), Nelson, New Zealand.
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12
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Blutinger E, Schmitz G, Kang C, Comp G, Wagner E, Finnell JT, Cozzi N, Haddock A. Measles: Contemporary considerations for the emergency physician. J Am Coll Emerg Physicians Open 2023; 4:e13032. [PMID: 37692196 PMCID: PMC10492449 DOI: 10.1002/emp2.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/02/2023] [Accepted: 07/06/2023] [Indexed: 09/12/2023] Open
Abstract
Measles, or rubeola, is a highly contagious acute febrile viral illness. Despite the availability of an effective vaccine since 1963, measles outbreaks continue worldwide. This article seeks to provide emergency physicians with the contemporary knowledge required to rapidly diagnose potential measles cases and bolster public health measures to reduce ongoing transmission.
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Affiliation(s)
- Erik Blutinger
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Gillian Schmitz
- Department of Military and Emergency MedicineUniformed Services UniversityBethesdaMarylandUSA
| | - Christopher Kang
- Department of Emergency MedicineMadigan Army Medical CenterTacomaWashingtonUSA
| | - Geoffrey Comp
- Department of Emergency MedicineCreighton University School of Medicine/Valleywise Health Medical CenterPhoenixArizonaUSA
| | - Emily Wagner
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - John T Finnell
- Department of Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Nicolas Cozzi
- Department of Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Alison Haddock
- Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
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13
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Franconeri L, Antona D, Cauchemez S, Lévy-Bruhl D, Paireau J. Two-dose measles vaccine effectiveness remains high over time: A French observational study, 2017-2019. Vaccine 2023; 41:5797-5804. [PMID: 37586955 DOI: 10.1016/j.vaccine.2023.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND From 2008 to 2019, France has experienced a resurgence of measles epidemics. Surveillance data have shown that the proportion of cases vaccinated with two doses of measles-containing vaccine (MCV) increased with age, raising concerns about the duration of vaccine protection. Our objectives were to investigate age-stratified vaccine effectiveness (VE) for the second dose of MCV (MCV2) and to quantify protection levels over time. METHODS We analyzed data on measles cases aged 2-31 years, reported via mandatory notification to the French measles surveillance system from October 2017 to September 2019. We estimated an age-stratified VE for MCV2 using the screening method, which compares the vaccination status of cases with that of the general population. We improved this method by accounting for natural immunity, exploring four scenarios with four possible levels of natural immunity in the population. In addition, we quantified the decay rate of protection over time, by fitting an exponential decay model among individuals vaccinated in early life. RESULTS In the baseline analysis (absence of natural immunity), VE estimates were high in all age groups and decreased with age, from 99.6 % (95 % confidence interval: 99.3-99.8) in 2-5 years old to 91.4 % (85.1-95.0) in 26-31 years old. Accounting for natural immunity increased VE in the older age group to 93.2-99.2 % depending on the scenario. We estimated that VE was slowly decreasing over time, with an exponential decay rate of 0.0022/year (0.0017-0.0028), leading to VE of 96.7 % (96.0-97.4) 16 years after MCV2 vaccination. This decline was most compatible with scenario 2, a scenario of 4.4 % naturally immunized, non-vaccinated individuals in the 26-31 years old. CONCLUSION Our study confirms the continued high effectiveness of two doses of MCV with only slight degradation, decades after immunization. These findings support the importance of achieving a very high vaccination coverage with 2 doses of MCV.
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Affiliation(s)
- Léa Franconeri
- Direction des Maladies Infectieuses, Santé publique France, 94415 Saint Maurice, France.
| | - Denise Antona
- Direction des Maladies Infectieuses, Santé publique France, 94415 Saint Maurice, France
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 2000, 75015 Paris, France
| | - Daniel Lévy-Bruhl
- Direction des Maladies Infectieuses, Santé publique France, 94415 Saint Maurice, France
| | - Juliette Paireau
- Direction des Maladies Infectieuses, Santé publique France, 94415 Saint Maurice, France; Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 2000, 75015 Paris, France
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14
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Viret C, Lavedrine A, Lamiral G, Rozières A, Faure M. Contextual influence of mammalian macro-autophagy in virus-bacteria coinfected cell phenotypes. PLoS Pathog 2023; 19:e1011625. [PMID: 37733691 PMCID: PMC10513301 DOI: 10.1371/journal.ppat.1011625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Affiliation(s)
- Christophe Viret
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Aude Lavedrine
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Guénaëlle Lamiral
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Aurore Rozières
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Mathias Faure
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
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Sbarra AN, Jit M, Mosser JF, Ferrari M, Cutts F, Papania M, Kretsinger K, McCarthy KA, Thakkar N, Gaythorpe KAM, Gamage D, Krause LK, Dansereau E, Crowcroft N, Portnoy A. Population-Level Risk Factors Related to Measles Case Fatality: A Conceptual Framework Based on Expert Consultation and Literature Review. Vaccines (Basel) 2023; 11:1389. [PMID: 37631957 PMCID: PMC10458804 DOI: 10.3390/vaccines11081389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023] Open
Abstract
A better understanding of population-level factors related to measles case fatality is needed to estimate measles mortality burden and impact of interventions such as vaccination. This study aimed to develop a conceptual framework of mechanisms associated with measles case fatality ratios (CFRs) and assess the scope of evidence available for related indicators. Using expert consultation, we developed a conceptual framework of mechanisms associated with measles CFR and identified population-level indicators potentially associated with each mechanism. We conducted a literature review by searching PubMed on 31 October 2021 to determine the scope of evidence for the expert-identified indicators. Studies were included if they contained evidence of an association between an indicator and CFR and were excluded if they were from non-human studies or reported non-original data. Included studies were assessed for study quality. Expert consultation identified five mechanisms in a conceptual framework of factors related to measles CFR. We identified 3772 studies for review and found 49 studies showing at least one significant association with CFR for 15 indicators (average household size, educational attainment, first- and second-dose coverage of measles-containing vaccine, human immunodeficiency virus prevalence, level of health care available, stunting prevalence, surrounding conflict, travel time to major city or settlement, travel time to nearest health care facility, under-five mortality rate, underweight prevalence, vitamin A deficiency prevalence, vitamin A treatment, and general malnutrition) and only non-significant associations for five indicators (antibiotic use for measles-related pneumonia, malaria prevalence, percent living in urban settings, pneumococcal conjugate vaccination coverage, vitamin A supplementation). Our study used expert consultation and a literature review to provide additional insights and a summary of the available evidence of these underlying mechanisms and indicators that could inform future measles CFR estimations.
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Affiliation(s)
- Alyssa N. Sbarra
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Jonathan F. Mosser
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA 98195, USA
| | - Matthew Ferrari
- Department of Biology, Pennsylvania State University, State College, PA 16801, USA
| | - Felicity Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Mark Papania
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Katrina Kretsinger
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Kevin A. McCarthy
- Institute for Disease Modeling, Global Health Division, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Niket Thakkar
- Institute for Disease Modeling, Global Health Division, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Katy A. M. Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Deepa Gamage
- Epidemiology Unit, Ministry of Health, Colombo 01000, Sri Lanka
| | - L. Kendall Krause
- Global Development Division, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Emily Dansereau
- Global Development Division, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Natasha Crowcroft
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 1202 Geneva, Switzerland
| | - Allison Portnoy
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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16
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Kuddus MA, Rahman A, Alam F, Mohiuddin M. Analysis of the different interventions scenario for programmatic measles control in Bangladesh: A modelling study. PLoS One 2023; 18:e0283082. [PMID: 37384663 PMCID: PMC10310053 DOI: 10.1371/journal.pone.0283082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/02/2023] [Indexed: 07/01/2023] Open
Abstract
In recent years measles has been one of the most critical public health problem in Bangladesh. Although the Ministry of Health in Bangladesh employs a broad extension of measles control policies, logistical challenges exist, and there is significant doubt regarding the disease burden. Mathematical modelling of measles is considered one of the most effective ways to understand infection transmission and estimate parameters in different countries, such as Bangladesh. In this study, a mathematical modelling framework is presented to explore the dynamics of measles in Bangladesh. We calibrated the model using cumulative measles incidence data from 2000 to 2019. Also, we performed a sensitivity analysis of the model parameters and found that the contact rate had the most significant influence on the basic reproduction number R0. Four hypothetical intervention scenarios were developed and simulated for the period from 2020 to 2035. The results show that the scenario which combines enhanced treatment for exposed and infected population, first and second doses of vaccine is the most effective at rapidly reducing the total number of measles incidence and mortality in Bangladesh. Our findings also suggest that strategies that focus on a single interventions do not dramatically affect the decline in measles incidence cases; instead, those that combine two or more interventions simultaneously are the most effective in decreasing the burden of measles incidence and mortality. In addition, we also evaluated the cost-effectiveness of varying combinations of three basic control strategies including distancing, vaccination and treatment, all within the optimal control framework. Our finding suggested that combines distancing, vaccination and treatment control strategy is the most cost-effective for reducing the burden of measles in Bangladesh. Other strategies can be comprised to measles depending on the availability of funds and policymakers' choices.
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Affiliation(s)
- Md Abdul Kuddus
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- Department of Mathematics, University of Rajshahi, Rajshahi, Bangladesh
| | - Azizur Rahman
- School of Computing and Mathematics, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Farzana Alam
- Department of Electrical and Electronic Engineering, Rajshahi University of Engineering & Technology, Rajshahi, Bangladesh
| | - M. Mohiuddin
- Department of Mathematics, Comilla University, Cumilla, Bangladesh
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17
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Shi X, Liu X, Sun Y. The Pathogenesis of Cytomegalovirus and Other Viruses Associated with Hearing Loss: Recent Updates. Viruses 2023; 15:1385. [PMID: 37376684 DOI: 10.3390/v15061385] [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: 05/08/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Virus infection is one of the most common etiologies of hearing loss. Hearing loss associated with viral infection can be unilateral or bilateral, mild or severe, sudden or progressive, and permanent or recoverable. Many viruses cause hearing loss in adults and children; however, the pathogenesis of hearing loss caused by viral infection is not fully understood. This review describes cytomegalovirus, the most common virus causing hearing loss, and other reported hearing loss-related viruses. We hope to provide a detailed description of pathogenic characteristics and research progress on pathology, hearing phenotypes, possible associated mechanisms, treatment, and prevention measures. This review aims to provide diagnostic and treatment assistance to clinical workers.
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Affiliation(s)
- Xinyu Shi
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiaozhou Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yu Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan 430022, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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18
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Liu P, Ikram R, Khan A, Din A. The measles epidemic model assessment under real statistics: an application of stochastic optimal control theory. Comput Methods Biomech Biomed Engin 2023; 26:138-159. [PMID: 35297714 DOI: 10.1080/10255842.2022.2050222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A stochastic epidemic model with random noise transmission is taken into account, describing the dynamics of the measles viral infection. The basic reproductive number is calculated corresponding to the stochastic model. It is determined that, given initial positive data, the model has bounded, unique, and positive solution. Additionally, utilizing stochastic Lyapunov functional theory, we study the extinction of the disease. Stationary distribution and extinction of the infection are examined by providing sufficient conditions. We employed optimal control principles and examined stochastic control systems to regulate the transmission of the virus using environmental factors. Graphical representations have been offered for simplicity of comprehending in order to further verify the acquired analytical findings.
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Affiliation(s)
- Peijiang Liu
- School of Statistics and Mathematics, Guangdong University of Finance and Economics, Big data and Educational Statistics Application Laboratory, Guangzhou, PR China.,School of Statistics and Mathematics, Guangdong University of Finance and Economics, Guangzhou, PR China
| | - Rukhsar Ikram
- Department of Mathematics and Statistics, University of Swat, Khyber Pakhtunkhwa, Pakistan
| | - Amir Khan
- Department of Mathematics, Faculty of Science, King Mongkut's University of Technology, Thonburi (KMUTT), Bangkok, Thailand
| | - Anwarud Din
- Department of Mathematics, Sun Yat-sen University, Guangzhou, PR China
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19
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Casabona G, Berton O, Singh T, Knuf M, Bonanni P. Combined measles-mumps-rubella-varicella vaccine and febrile convulsions: the risk considered in the broad context. Expert Rev Vaccines 2023; 22:764-776. [PMID: 37642012 DOI: 10.1080/14760584.2023.2252065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/01/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Studies on quadrivalent measles, mumps, rubella, and varicella (MMRV) vaccines have indicated a twofold increased relative risk of febrile convulsion (FC) after the first dose compared to MMR and V administered at the same medical visit (MMR+V). AREAS COVERED This narrative review contextualizes FC occurrence after the first MMRV vaccine dose from a clinical perspective and outlines approaches to attenuate FC occurrence post-vaccination. EXPERT OPINION While the relative FC risk increases after the first dose of MMRV compared to MMR+V vaccine in measles-naïve infants, the attributable risk is low versus the overall FC risk in the pediatric population triggered by other causes, like natural exposure to pathogens or routine vaccination. No increased risk of FC has been reported after MMRV co-administration with other routine vaccines compared to MMRV alone. Based on our findings and considering the MMRV vaccination benefits (fewer injections, higher coverage, better vaccination compliance), the overall benefit-risk profile of MMRV vaccine is considered to remain positive. Potential occurrence of FC in predisposed children (e.g. with personal/family history of FC) may be attenuated if they receive MMR+V instead of MMRV as the first dose. It is also important to monitor vaccinees for fever during the first 2 weeks post-vaccination.
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Affiliation(s)
| | | | | | - Markus Knuf
- Department for Pediatric and Adolescent Medicine, General Hospital Worms, General Hospital Worms, Worms, Germany
- Pediatric Infectious Diseases, University Medicine, Mainz, Germany
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
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20
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Xia S, Gullickson CC, Metcalf CJE, Grenfell BT, Mina MJ. Assessing the Effects of Measles Virus Infections on Childhood Infectious Disease Mortality in Brazil. J Infect Dis 2022; 227:133-140. [PMID: 35767276 PMCID: PMC10205611 DOI: 10.1093/infdis/jiac233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/29/2022] [Accepted: 06/26/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Measles virus infection induces acute immunosuppression for weeks following infection, and also impairs preexisting immunological memory, resulting in "immune amnesia" that can last for years. Both mechanisms predispose the host to severe outcomes of subsequent infections. Therefore, measles dynamics could potentially affect the epidemiology of other infectious diseases. METHODS To examine this hypothesis, we analyzed the annual mortality rates of children aged 1-9 years in Brazil from 1980 to 1995. We calculated the correlation between nonmeasles infectious disease mortality rates and measles mortality rates using linear and negative-binomial models, with 3 methods to control the confounding effects of time. We also estimated the duration of measles-induced immunomodulation. RESULTS The mortality rates of nonmeasles infectious diseases and measles virus infection were highly correlated. This positive correlation remained significant after removing the time trends. We found no evidence of long-term measles immunomodulation beyond 1 year. CONCLUSIONS These results support that measles virus infection could increase the mortality of other infectious diseases. The short lag identified for measles effects (<1 year) implies that acute immunosuppression was potentially driving this effect in Brazil. Overall, our study indicates disproportionate contributions of measles to childhood infectious disease mortality, highlighting the importance of measles vaccination.
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Affiliation(s)
- Siyang Xia
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Cricket C Gullickson
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
- Princeton School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA
| | - Bryan T Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
- Princeton School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA
| | - Michael J Mina
- Department of Pathology at Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Popović Dragonjić L, Jovanović M, Vrbić M, Nastić A, Djordjević M, Veljković M. The Occurrence of Acute Pancreatitis in Adult Patients during a Measles Outbreak from November 2017 to May 2018 in Southeastern Serbia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111650. [PMID: 36422189 PMCID: PMC9692428 DOI: 10.3390/medicina58111650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/26/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Although it is believed that measles infections are under control, there is a global reappearance, and their treatment has become more complex as the disease is followed by a relatively high incidence of complications. This study, conducted on patients during a measles outbreak from November 2017 to May 2018, aims to evaluate a rarely reported complication of measles, acute morbilous pancreatitis (AMP), which has been reported in several cases to date. Materials and Methods: A total of 207 patients admitted and treated at the Clinic for Infectious Diseases, Clinical Center Nis, for measles infection were included in the analysis. The data collected from the patient's medical records included the demographic characteristics, disease duration, full blood, serum, and urine biochemical analysis, general measles-associated symptoms, and disease outcome. Results: According to the serum and urine amylase activity, and some clinical symptoms AMP were diagnosed in 14% (29/207) of the studied patients. These patients had significantly higher levels of ALT and vomited more frequently than the patients without AMP. Only slight differences in measles duration, changes in RBC count, and CRP levels were found between the males and females with AMP. Conclusions: Acute morbillous pancreatitis should not be underestimated as a complication, even though according to the results of our survey, it was not associated with a fatal outcome or disease severity as the course of it can be frequently rapid and fatal.
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Affiliation(s)
- Lidija Popović Dragonjić
- Department of Infectious Diseases and Epidemiology, Faculty of Medicine, University of Niš, 18000 Nis, Serbia
- Clinic for Infectology, University Clinical Center Niš, 18000 Nis, Serbia
- Correspondence:
| | - Maja Jovanović
- Department of Infectious Diseases and Epidemiology, Faculty of Medicine, University of Niš, 18000 Nis, Serbia
- Clinic for Infectology, University Clinical Center Niš, 18000 Nis, Serbia
| | - Miodrag Vrbić
- Department of Infectious Diseases and Epidemiology, Faculty of Medicine, University of Niš, 18000 Nis, Serbia
- Clinic for Infectology, University Clinical Center Niš, 18000 Nis, Serbia
| | - Aleksandar Nastić
- Department of Mathematics, Faculty of Sciences and Mathematics, University of Niš, 18000 Nis, Serbia
| | - Miodrag Djordjević
- Department of Mathematics, Faculty of Sciences and Mathematics, University of Niš, 18000 Nis, Serbia
| | - Milica Veljković
- Department Physiology, Faculty of Medicine, University of Niš, 18000 Nis, Serbia
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Chilot D, Belay DG, Shitu K, Gela YY, Getnet M, Mulat B, Muluneh AG, Merid MW, Bitew DA, Alem AZ. Measles second dose vaccine utilization and associated factors among children aged 24–35 months in Sub-Saharan Africa, a multi-level analysis from recent DHS surveys. BMC Public Health 2022; 22:2070. [PMID: 36371164 PMCID: PMC9655865 DOI: 10.1186/s12889-022-14478-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although a safe and effective vaccine is available, measles remains an important cause of mortality and morbidity among young children in Sub-Saharan Africa (SSA). The WHO and UNICEF recommended measles-containing vaccine dose 2 (MCV2) in addition to measles-containing vaccine dose 1 (MCV1) through routine services strategies. Many factors could contribute to the routine dose of MCV2 coverage remaining far below targets in many countries of this region. This study aimed to assess the prevalence of MCV2 utilization among children aged 24–35 months and analyze factors associated with it by using recent nationally representative surveys of SSA countries. Methods Secondary data analysis was done based on recent Demographic and Health Surveys (DHS) data from eight Sub-Saharan African countries. In this region, only eight countries have a record of routine doses of measles-containing vaccine dose 2 in their DHS dataset. The multilevel binary logistic regression model was fitted to identify significantly associated factors. Variables were extracted from each of the eight country’s KR files. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤ 0.05 in the multivariable model were used to declare significant factors associated with measles-containing vaccine dose 2 utilization. Result The pooled prevalence of MCV2 utilization in SSA was 44.77% (95% CI: 27.10–62.43%). In the multilevel analysis, mothers aged 25–34 years [AOR = 1.15,95% CI (1.05–1.26), mothers aged 35 years and above [AOR = 1.26, 95% CI (1.14–1.41)], maternal secondary education and above [AOR = 1.27, 95% CI (1.13–1.43)], not big problem to access health facilities [AOR = 1.21, 95% CI (1.12–1.31)], four and above ANC visit [AOR = 2.75, 95% CI (2.35–3.24)], PNC visit [AOR = 1.13, 95% CI (1.04–1.23)], health facility delivery [AOR = 2.24, 95% CI (2.04–2.46)], were positively associated with MCV2 utilization. In contrast, multiple twin [AOR = 0.70, 95% CI (0.53–0.95)], rural residence [AOR = 0.69, 95% CI (0.57–0.82)] and high community poverty [AOR = 0.66, 95% CI (0.54–0.80)] were found to be negatively associated with MCV2 utilization. Conclusions and recommendations Measles-containing vaccine doses 2 utilization in Sub-Saharan Africa was relatively low. Individual-level factors and community-level factors were significantly associated with low measles-containing vaccine dose 2 utilization. The MCV2 utilization could be improved through public health intervention by targeting rural residents, children of uneducated mothers, economically poor women, and other significant factors this study revealed.
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Krumova S, Santibanez S, Andonova I, Stefanova R, Mankertz A, Kantardjiev T. Detection of measles virus in Bulgaria from 2012 to 2018. Croat Med J 2022; 63. [PMID: 36325672 PMCID: PMC9648082 DOI: 10.3325/cmj.2022.63.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the circulation patterns of measles virus in Bulgaria from 2012 to 2018 after a large measles outbreak in the country (2009-2011). METHODS Three types of clinical material were collected: serum samples, urine samples, and nasal swabs. Enzyme-linked immunosorbent assay (ELISA) was used to detect specific viral immunoglobulin (Ig) M/IgG antibodies. Viral RNA was extracted from all urine and nasal swabs. RESULTS In the investigated period, 102 patients were confirmed to have measles (age range: two months to 55 years). A total of 101 samples (99%) were measles-IgM positive. Most of them were detected in 2017 (73%, 74/101), when a measles outbreak in the country was reported. The majority of patients were unvaccinated children aged under 13 months. Out of 101 measles serum samples confirmed by ELISA, 18 (20.45%) were measles-IgG positive and 15 (17.05%) were borderline. Thirty-three positive PCR products were sequenced and genotyped. In 2013, 2016, 2017, and 2018, three different measles viral genotypes were detected: D8, H1, and B3. Most patients were unvaccinated or insufficiently vaccinated. CONCLUSION Preventive measures are indispensable to limit the infection in different regions of Bulgaria and its spread to other countries. As vaccination coverage against measles and other vaccine-preventable infections, including SARS-Co2, is low, it is necessary to perform molecular identification of viruses to monitor their circulation and pathogenicity.
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Affiliation(s)
- Stefka Krumova
- Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Sabine Santibanez
- National Reference Center for Measles, Mumps, Rubella, Robert Koch Institute, Berlin, Germany
| | - Ivona Andonova
- Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Radostina Stefanova
- Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Annette Mankertz
- National Reference Center for Measles, Mumps, Rubella, Robert Koch Institute, Berlin, Germany
| | - Todor Kantardjiev
- National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
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Chechetova S, Kadyrova R, Dzholbunova Z, Khalupko E, Radchenko E, Yethindra V, Tagaev T, Kanteti KP. Measles in children: a re-emergence of the vaccine-preventable disease. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i4.1835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Despite the availability of a safe and effective vaccine, measles remains an endemic in many countries and is the main cause of morbidity and mortality among young children. Therefore, the main objective of this study was to describe the most important aspects of measles that allow clinicians to identify suspected cases for timely diagnosis and treatment, which are essential to avoid inappropriate interventions and prevent complications. The measles virus is highly contagious, is transmitted through fomites and respiratory secretions, and remains active in the environment or on surfaces for several hours. Diagnosing measles can be difficult because most clinicians are unfamiliar as there have been few confirmed cases in recent years. Taking a complete medical history, while considering the clinical phases of measles, and a thorough physical examination can help guide the diagnosis, as the main characteristics of measles (fever and rash) can be seen in both infectious and non-infectious diseases. Treatment consists of three fundamental aspects: supportive care (management of fever and hydration), identification and treatment of associated complications, and prevention of disease spread through patient and family group education. It is important to ensure compliance with immunization policies and strategies globally to control the re-emergence of measles and increase in the burden of disease caused by the measles virus.
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A Case Report of Secondary Syphilis Co-Infected with Measles: A Diagnostic Dilemma with Fever and Rash. Trop Med Infect Dis 2022; 7:tropicalmed7050070. [PMID: 35622697 PMCID: PMC9144679 DOI: 10.3390/tropicalmed7050070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022] Open
Abstract
Fever and rash as manifestations of infection by microorganisms are collectively known as febrile exanthem. Since viruses are more frequently associated with fever and rash, these symptoms are thus impetuously termed viral exanthem. However, bacteria represent a frequently overlooked infectious etiology causing rash in humans. In addition, certain microbes may exhibit pathognomonic features that erupt during illness and facilitate clinical diagnosis. Conversely, coinfections often obscure the clinical characteristics of the primary disease and further challenge clinicians attempting to reach a diagnosis. We retrospectively looked at de-identified clinical data of a patient who presented to the Hospital for Tropical Diseases in Bangkok in July 2019 with complaints of fever and rash. The case involved a 35-year-old who presented with a 3-day history of fever, respiratory symptoms, myalgia, conjunctivitis, diarrhea, and a generalized maculopapular rash. On examination, the patient was febrile, tachycardic, and tachypneic, with a mean arterial pressure of 95 mmHg. A differential white blood cell count showed: leukocytes, 5800/µL; neutrophils, 4408/µL; lymphocytes, 406/µL; and platelets, 155,000/µL. Striking findings involving the integumentary system included Koplik’s spots and generalized maculopapular rash. Further serology revealed positive immunoglobulin (Ig)M and IgG for both measles and rubella virus, including reactive serology for Treponema pallidum. Here we describe the clinical course and management of this patient.
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Bangs AC, Gastañaduy P, Neilan AM, Fiebelkorn AP, Walker AT, Rao SR, Ryan ET, LaRocque RC, Walensky RP, Hyle EP. The Clinical and Economic Impact of Measles-Mumps-Rubella Vaccinations to Prevent Measles Importations From US Pediatric Travelers Returning From Abroad. J Pediatric Infect Dis Soc 2022; 11:257-266. [PMID: 35333347 PMCID: PMC9214784 DOI: 10.1093/jpids/piac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/01/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pediatric international travelers account for nearly half of measles importations in the United States. Over one third of pediatric international travelers depart the United States without the recommended measles-mumps-rubella (MMR) vaccinations: 2 doses for travelers ≥12 months and 1 dose for travelers 6 to <12 months. METHODS We developed a model to compare 2 strategies among a simulated cohort of international travelers (6 months to <6 years): (1) No pretravel health encounter (PHE): travelers depart with baseline MMR vaccination status; (2) PHE: MMR-eligible travelers are offered vaccination. All pediatric travelers experience a destination-specific risk of measles exposure (mean, 30 exposures/million travelers). If exposed to measles, travelers' age and MMR vaccination status determine the risk of infection (range, 3%-90%). We included costs of medical care, contact tracing, and lost wages from the societal perspective. We varied inputs in sensitivity analyses. Model outcomes included projected measles cases, costs, and incremental cost-effectiveness ratios ($/quality-adjusted life year [QALY], cost-effectiveness threshold ≤$100 000/QALY). RESULTS Compared with no PHE, PHE would avert 57 measles cases at $9.2 million/QALY among infant travelers and 7 measles cases at $15.0 million/QALY among preschool-aged travelers. Clinical benefits of PHE would be greatest for infants but cost-effective only for travelers to destinations with higher risk for measles exposure (ie, ≥160 exposures/million travelers) or if more US-acquired cases resulted from an infected traveler, such as in communities with limited MMR coverage. CONCLUSIONS Pretravel MMR vaccination provides the greatest clinical benefit for infant travelers and can be cost-effective before travel to destinations with high risk for measles exposure or from communities with low MMR vaccination coverage.
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Affiliation(s)
- Audrey C Bangs
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Gastañaduy
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anne M Neilan
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA,Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Parker Fiebelkorn
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison Taylor Walker
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sowmya R Rao
- MGH Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,Travelers' Advice and Immunization Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA,Travelers' Advice and Immunization Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rochelle P Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily P Hyle
- Corresponding Author: Emily P. Hyle, MD, MSc, Division of Infectious Diseases, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114, USA. E-mail:
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Kostinov MP, Zhuravlev PI, Loktionova MN, Shmitko AD, Polishchuk VB, Tatarinchik AA, Smirnova OA, Fursov IS. [Comparison of measles incidence in different age groups with the intensity of specific humoral immunity in healthcare workers in Moscow]. Vopr Virusol 2022; 67:27-36. [PMID: 35293186 DOI: 10.36233/0507-4088-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The study of the intensity of humoral immunity to the measles virus (Paramyxoviridae: Morbillivirus) (MV) remains relevant due to the ongoing registration of the cluster cases of measles (including nosocomial cases).The aim of the study was to analyze correlation between the intensity of the humoral immunity to measles virus and the measles incidence in different age groups of the Moscow residents. MATERIAL AND METHODS A simple analytic study was carried out under the framework of measles prevention improvement program conducted in the subjects of the Russian Federation. The study included the analysis of the reasons for the increase in the proportion of seronegative individuals and the comparison of the results of seromonitoring with the data of age-related measles incidence. Throughout 2018, total 1,855 blood serum samples obtained from employees of a large hospital center in Moscow who were previously vaccinated against measles were tested for IgG antibodies (ABs) to MV. The subjects were divided into 11 groups according to their age. Statistical analysis of the obtained data was performed using nonparametric criteria. RESULTS AND DISCUSSION The proportion of seronegative individuals among the staff of the medical facility decreased with age, from 38.5% in persons aged 19-23 to 0% among employees aged 64 and over. Persons aged 19-43 years were the most susceptible to measles infection, which was confirmed also by the highest incidence rate at these age groups (from 6.93 to 14.03 per 100,000 population). The age group most protected against measles was those over 64 years of age, who were all seropositive and had the lowest rates of incidence. This is probably due to the fact that by this age most of them have had a measles infection and have formed a sufficient immune response. At the same time, younger individuals living in the post-elimination era have only vaccine-induced ABs to MV, the level of which declines rapidly to non-protective values in the absence of boosterization due to the exposure to the wild-type strain of the pathogen. CONCLUSION The monitoring of the MV-specific IgG- AB levels is required for employees in the medical institutions under the age of 35. Administration of the single dose of the appropriate vaccine is recommended for seronegative individuals.
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Affiliation(s)
- M P Kostinov
- FSBRI «I.I. Mechnikov Research Institute of Vaccines and Sera»; FSAEI HE I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of the Health of Russia
| | - P I Zhuravlev
- FBIH «The Center of Hygiene and Epidemiology in Moscow» of the Federal Service for Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
| | - M N Loktionova
- FSAEI HE I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of the Health of Russia
| | - A D Shmitko
- FSBRI «I.I. Mechnikov Research Institute of Vaccines and Sera»
| | - V B Polishchuk
- FSBRI «I.I. Mechnikov Research Institute of Vaccines and Sera»
| | - A A Tatarinchik
- FBIH «The Center of Hygiene and Epidemiology in Moscow» of the Federal Service for Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
| | - O A Smirnova
- FBIH «The Center of Hygiene and Epidemiology in Moscow» of the Federal Service for Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
| | - I S Fursov
- FBIH «The Center of Hygiene and Epidemiology in Moscow» of the Federal Service for Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
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Makarenko C, Pedro AS, Paiva NS, Souza-Santos R, Medronho RDA, Gibson G. Identificação de áreas de risco e fatores associados à epidemia de sarampo de 2019 no Estado de São Paulo, Brasil. CAD SAUDE PUBLICA 2022; 38:e00039222. [DOI: 10.1590/0102-311xpt039222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/04/2022] [Indexed: 11/27/2022] Open
Abstract
O objetivo foi analisar a ocorrência de clusters e fatores associados ao ressurgimento de casos de sarampo da maior epidemia do período pós-eliminação, ocorrida no Estado de São Paulo, Brasil, em 2019. Fatores sociossanitários e assistenciais foram analisados por modelos de Poisson inflacionado de zero (ZIP) e ZIP com efeito espacial estruturado e não estruturado. A estatística de varredura SCAN foi usada para analisar a ocorrência de clusters de casos. Foram identificados clusters de casos de alto risco em municípios que compõem a região intermediária de São Paulo. No modelo ZIP, foram observadas como fatores de risco no nível municipal as variáveis chefes de domicílio menores de 18 anos (RR ajustado = 1,39; ICr95%: 1,27-1,53), desigualdade na distribuição de renda (RR ajustado = 36,67; ICr95%: 26,36-51,15), desocupação em maiores de 18 anos (RR ajustado = 1,10; ICr95%: 1,08-1,12) e iluminação pública inexistente (RR ajustado = 1,05; ICr95%: 1,04-1,05). Nos modelos ZIP com efeito espacial estruturado e não estruturado, foram identificados como fatores de risco os indicadores chefes de domicílio menores de 18 anos (RR ajustado = 1,36; ICr95%: 1,04-1,90) e desigualdade na distribuição dos rendimentos do trabalho (RR ajustado = 3,12; ICr95%: 1,02-9,48). Em ambos os modelos, a cobertura de agentes de saúde se apresentou como fator de proteção. Os achados reforçam a importância de intensificar as ações de vigilância de sarampo articuladas à Estratégia Saúde da Família, especialmente em áreas de maior vulnerabilidade social, para garantir coberturas vacinais equânimes e satisfatórias e reduzir o risco de reemergência da doença.
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Affiliation(s)
| | | | | | | | | | - Gerusa Gibson
- Universidade Federal do Rio de Janeiro, Brazil; Fundação Oswaldo Cruz, Brazil
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Jain R, Aulakh R. Measles-Associated CNS Complications: A Review. JOURNAL OF CHILD SCIENCE 2022. [DOI: 10.1055/s-0042-1757914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AbstractMeasles virus infection is a common infectious disease of childhood, incidence of which is still high in developing countries. Other than the morbidity associated with the acute systemic infection, the measles virus can cause serious fatal neural complications. It can either enter the brain leading to acute encephalitis like primary measles encephalitis and acute post infectious measles encephalomyelitis or it may persist in brain cells (as mutated virus) leading to long-term neurodegenerative diseases like measles inclusion body encephalitis and subacute sclerosing pan encephalitis. The patho-clinical features, treatment, and the outcomes of these complications are different and should be identified in time for early diagnosis and management.
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Affiliation(s)
- Reena Jain
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
| | - Roosy Aulakh
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
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Thompson KM, Badizadegan K. Health economic analyses of secondary vaccine effects: a systematic review and policy insights. Expert Rev Vaccines 2021; 21:297-312. [PMID: 34927511 DOI: 10.1080/14760584.2022.2017287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION : Numerous analyses demonstrate substantial health economic impacts of primary vaccine effects (preventing or mitigating clinical manifestations of the diseases they target), but vaccines may also be associated with secondary effects, previously known as non-specific, heterologous, or off-target effects. AREAS COVERED : We define key concepts to distinguish primary and secondary vaccine effects for health economic analyses, summarized terminology used in different fields, and perform a systematic review of health economic analyses focused on secondary vaccine effects (SVEs). EXPERT OPINION : Health economists integrate evidence from multiple fields, which often use incomplete or inconsistent definitions. Like regulators and policy makers, health economists require high-quality evidence of specific effects. Consistent with the limited evidence on mechanisms of action for SVEs, the associated health economic literature remains highly limited, with 4 studies identified by our systematic review. The lack of specific and well-controlled evidence that supports quantification of specific SVEs limits the consideration of these effects in vaccine research, development, regulatory, and recommendation decisions and health economic analyses.
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Laya BF, Concepcion NDP, Garcia-Peña P, Naidoo J, Kritsaneepaiboon S, Lee EY. Pediatric Lower Respiratory Tract Infections: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:15-40. [PMID: 34836562 DOI: 10.1016/j.rcl.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lower respiratory tract infection (LRTI) remains a major cause of morbidity and mortality in children. Various organisms cause LRTI, including viruses, bacteria, fungi, and parasites, among others. Infections caused by 2 or more organisms also occur, sometimes enhancing the severity of the infection. Medical imaging helps confirm a diagnosis but also plays a role in the evaluation of acute and chronic sequelae. Medical imaging tests help evaluate underlying pathology in pediatric patients with recurrent or long-standing symptoms as well as the immunocompromised.
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Affiliation(s)
- Bernard F Laya
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center-Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112 Philippines.
| | - Nathan David P Concepcion
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center-Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112 Philippines
| | - Pilar Garcia-Peña
- Autonomous University of Barcelona (AUB), University Hospital Materno-Infantil Vall d'Hebron, Pso. Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jaishree Naidoo
- Paeds Diagnostic Imaging and Envisionit Deep AI, 2nd Floor, One-on Jameson Building, 1 Jameson Avenue, Melrose Estate, Johannesburg, 2196, South Africa
| | - Supika Kritsaneepaiboon
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Kanjanavanich Road, Hat Yai, 90110, Thailand
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Di Pietrantonj C, Rivetti A, Marchione P, Debalini MG, Demicheli V. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev 2021; 11:CD004407. [PMID: 34806766 PMCID: PMC8607336 DOI: 10.1002/14651858.cd004407.pub5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Measles, mumps, rubella, and varicella (chickenpox) are serious diseases that can lead to serious complications, disability, and death. However, public debate over the safety of the trivalent MMR vaccine and the resultant drop in vaccination coverage in several countries persists, despite its almost universal use and accepted effectiveness. This is an update of a review published in 2005 and updated in 2012. OBJECTIVES To assess the effectiveness, safety, and long- and short-term adverse effects associated with the trivalent vaccine, containing measles, rubella, mumps strains (MMR), or concurrent administration of MMR vaccine and varicella vaccine (MMR+V), or tetravalent vaccine containing measles, rubella, mumps, and varicella strains (MMRV), given to children aged up to 15 years. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2019, Issue 5), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 2 May 2019), Embase (1974 to 2 May 2019), the WHO International Clinical Trials Registry Platform (2 May 2019), and ClinicalTrials.gov (2 May 2019). SELECTION CRITERIA We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), prospective and retrospective cohort studies (PCS/RCS), case-control studies (CCS), interrupted time-series (ITS) studies, case cross-over (CCO) studies, case-only ecological method (COEM) studies, self-controlled case series (SCCS) studies, person-time cohort (PTC) studies, and case-coverage design/screening methods (CCD/SM) studies, assessing any combined MMR or MMRV / MMR+V vaccine given in any dose, preparation or time schedule compared with no intervention or placebo, on healthy children up to 15 years of age. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the methodological quality of the included studies. We grouped studies for quantitative analysis according to study design, vaccine type (MMR, MMRV, MMR+V), virus strain, and study settings. Outcomes of interest were cases of measles, mumps, rubella, and varicella, and harms. Certainty of evidence of was rated using GRADE. MAIN RESULTS We included 138 studies (23,480,668 participants). Fifty-one studies (10,248,159 children) assessed vaccine effectiveness and 87 studies (13,232,509 children) assessed the association between vaccines and a variety of harms. We included 74 new studies to this 2019 version of the review. Effectiveness Vaccine effectiveness in preventing measles was 95% after one dose (relative risk (RR) 0.05, 95% CI 0.02 to 0.13; 7 cohort studies; 12,039 children; moderate certainty evidence) and 96% after two doses (RR 0.04, 95% CI 0.01 to 0.28; 5 cohort studies; 21,604 children; moderate certainty evidence). The effectiveness in preventing cases among household contacts or preventing transmission to others the children were in contact with after one dose was 81% (RR 0.19, 95% CI 0.04 to 0.89; 3 cohort studies; 151 children; low certainty evidence), after two doses 85% (RR 0.15, 95% CI 0.03 to 0.75; 3 cohort studies; 378 children; low certainty evidence), and after three doses was 96% (RR 0.04, 95% CI 0.01 to 0.23; 2 cohort studies; 151 children; low certainty evidence). The effectiveness (at least one dose) in preventing measles after exposure (post-exposure prophylaxis) was 74% (RR 0.26, 95% CI 0.14 to 0.50; 2 cohort studies; 283 children; low certainty evidence). The effectiveness of Jeryl Lynn containing MMR vaccine in preventing mumps was 72% after one dose (RR 0.24, 95% CI 0.08 to 0.76; 6 cohort studies; 9915 children; moderate certainty evidence), 86% after two doses (RR 0.12, 95% CI 0.04 to 0.35; 5 cohort studies; 7792 children; moderate certainty evidence). Effectiveness in preventing cases among household contacts was 74% (RR 0.26, 95% CI 0.13 to 0.49; 3 cohort studies; 1036 children; moderate certainty evidence). Vaccine effectiveness against rubella, using a vaccine with the BRD2 strain which is only used in China, is 89% (RR 0.11, 95% CI 0.03 to 0.42; 1 cohort study; 1621 children; moderate certainty evidence). Vaccine effectiveness against varicella (any severity) after two doses in children aged 11 to 22 months is 95% in a 10 years follow-up (rate ratio (rr) 0.05, 95% CI 0.03 to 0.08; 1 RCT; 2279 children; high certainty evidence). Safety There is evidence supporting an association between aseptic meningitis and MMR vaccines containing Urabe and Leningrad-Zagreb mumps strains, but no evidence supporting this association for MMR vaccines containing Jeryl Lynn mumps strains (rr 1.30, 95% CI 0.66 to 2.56; low certainty evidence). The analyses provide evidence supporting an association between MMR/MMR+V/MMRV vaccines (Jeryl Lynn strain) and febrile seizures. Febrile seizures normally occur in 2% to 4% of healthy children at least once before the age of 5. The attributable risk febrile seizures vaccine-induced is estimated to be from 1 per 1700 to 1 per 1150 administered doses. The analyses provide evidence supporting an association between MMR vaccination and idiopathic thrombocytopaenic purpura (ITP). However, the risk of ITP after vaccination is smaller than after natural infection with these viruses. Natural infection of ITP occur in 5 cases per 100,000 (1 case per 20,000) per year. The attributable risk is estimated about 1 case of ITP per 40,000 administered MMR doses. There is no evidence of an association between MMR immunisation and encephalitis or encephalopathy (rate ratio 0.90, 95% CI 0.50 to 1.61; 2 observational studies; 1,071,088 children; low certainty evidence), and autistic spectrum disorders (rate ratio 0.93, 95% CI 0.85 to 1.01; 2 observational studies; 1,194,764 children; moderate certainty). There is insufficient evidence to determine the association between MMR immunisation and inflammatory bowel disease (odds ratio 1.42, 95% CI 0.93 to 2.16; 3 observational studies; 409 cases and 1416 controls; moderate certainty evidence). Additionally, there is no evidence supporting an association between MMR immunisation and cognitive delay, type 1 diabetes, asthma, dermatitis/eczema, hay fever, leukaemia, multiple sclerosis, gait disturbance, and bacterial or viral infections. AUTHORS' CONCLUSIONS: Existing evidence on the safety and effectiveness of MMR/MMRV vaccines support their use for mass immunisation. Campaigns aimed at global eradication should assess epidemiological and socioeconomic situations of the countries as well as the capacity to achieve high vaccination coverage. More evidence is needed to assess whether the protective effect of MMR/MMRV could wane with time since immunisation.
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Affiliation(s)
- Carlo Di Pietrantonj
- Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Azienda Sanitaria Locale ASL AL, Alessandria, Italy
| | - Alessandro Rivetti
- Dipartimento di Prevenzione - S.Pre.S.A.L, ASL CN2 Alba Bra, Alba, Italy
| | - Pasquale Marchione
- Signal Management Unit, Post-Marketing Surveillance Department, Italian Medicine Agency - AIFA, Rome, Italy
| | | | - Vittorio Demicheli
- Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Azienda Sanitaria Locale ASL AL, Alessandria, Italy
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Kuddus MA, Mohiuddin M, Rahman A. Mathematical analysis of a measles transmission dynamics model in Bangladesh with double dose vaccination. Sci Rep 2021; 11:16571. [PMID: 34400667 PMCID: PMC8368032 DOI: 10.1038/s41598-021-95913-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/31/2021] [Indexed: 11/25/2022] Open
Abstract
Although the availability of the measles vaccine, it is still epidemic in many countries globally, including Bangladesh. Eradication of measles needs to keep the basic reproduction number less than one \documentclass[12pt]{minimal}
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\begin{document}$$(\mathrm{i}.\mathrm{e}. \, \, {\mathrm{R}}_{0}<1)$$\end{document}(i.e.R0<1). This paper investigates a modified (SVEIR) measles compartmental model with double dose vaccination in Bangladesh to simulate the measles prevalence. We perform a dynamical analysis of the resulting system and find that the model contains two equilibrium points: a disease-free equilibrium and an endemic equilibrium. The disease will be died out if the basic reproduction number is less than one \documentclass[12pt]{minimal}
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\begin{document}$$(\mathrm{i}.\mathrm{e}. \, \, {\mathrm{ R}}_{0}<1)$$\end{document}(i.e.R0<1), and if greater than one \documentclass[12pt]{minimal}
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\begin{document}$$(\mathrm{i}.\mathrm{e}. \, \, {\mathrm{R}}_{0}>1)$$\end{document}(i.e.R0>1) epidemic occurs. While using the Routh-Hurwitz criteria, the equilibria are found to be locally asymptotically stable under the former condition on \documentclass[12pt]{minimal}
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\begin{document}$${\mathrm{R}}_{0}$$\end{document}R0. The partial rank correlation coefficients (PRCCs), a global sensitivity analysis method is used to compute \documentclass[12pt]{minimal}
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\begin{document}$${\mathrm{R}}_{0}$$\end{document}R0 and measles prevalence \documentclass[12pt]{minimal}
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\begin{document}$$\left({\mathrm{I}}^{*}\right)$$\end{document}I∗ with respect to the estimated and fitted model parameters. We found that the transmission rate \documentclass[12pt]{minimal}
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\begin{document}$$(\upbeta )$$\end{document}(β) had the most significant influence on measles prevalence. Numerical simulations were carried out to commissions our analytical outcomes. These findings show that how progression rate, transmission rate and double dose vaccination rate affect the dynamics of measles prevalence. The information that we generate from this study may help government and public health professionals in making strategies to deal with the omissions of a measles outbreak and thus control and prevent an epidemic in Bangladesh.
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Affiliation(s)
- Md Abdul Kuddus
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia. .,Department of Mathematics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
| | - M Mohiuddin
- Department of Mathematics, Comilla University, Cumilla, 3506, Bangladesh
| | - Azizur Rahman
- School of Computing and Mathematics, Charles Sturt University, Wagga Wagga, NSW, 2678, Australia
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Ali S, Kumar H, Ullah S, Haq MAU, Gul NG, Kumar J. Electroencephalography Patterns of Subacute Sclerosing Panencephalitis. Cureus 2021; 13:e15728. [PMID: 34285840 PMCID: PMC8286205 DOI: 10.7759/cureus.15728] [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] [Accepted: 06/17/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and background: This article explores the electroencephalography (EEG) pattern in patients of suspected subacute sclerosing panencephalitis (SSPE) visiting Lady Reading Hospital, Peshawar. Pakistan has a huge deficit of research culture, and limited studies are done on this topic. This study concluded that a typical pattern is the most common EEG pattern, although atypical and normal EEG patterns were also observed. It is worth inclusion into the existing literature and may be used for future literature review of similar studies done elsewhere in Pakistan to give a wider perspective comprised of a larger sample size - integrating all studies. Objective: To determine the frequency of different patterns of EEG (typical, atypical, and normal) in SSPE patients. Methodology: Seventy-seven patients of both male and female genders between ages one to 20 years, who were diagnosed with SSPE, were included in the study. Dyken’s criteria were used to diagnose the patients. A prior history of previous measles infection with signs and symptoms suggestive of SSPE and positive anti-measles IgG antibodies in the cerebrospinal fluid (CSF) was found in all the patients included in the study. Besides this, typical EEG patterns and raised CSF globulin levels were also used for confirmation of the diagnosis. All the patients fulfilling the above criteria and presenting to the neurology department of Lady Reading Hospital, Peshawar, from February 1, 2019, to November 30, 2019, were included in the study. All the patients underwent the EEG monitoring in the same EEG laboratory and were reported by the same consultant with careful exclusion of any artifacts during the study. Result: There were 59 (76.62%) males and 18 (23.37%) females. The mean age was 15 ± 8.6 years, and the mean duration of symptoms was 4.79 ± 1.68 months. EEG was normal in 14 (18.18%) patients, while 63 (81.81%) patients had an abnormal EEG pattern, with a majority of 53 (84.12%) patients showing periodic delta wave complexes. Only 10 (15.87%) patients showed atypical patterns. Conclusion: Almost all the patients of SSPE showed periodic high-amplitude delta waves complexes, which usually occurs in patients with a disease duration of more than four months. However, further studies with a large sample size are needed for the confirmation of this observation.
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Affiliation(s)
- Saad Ali
- Neurology, Lady Reading Hospital Medical Teaching Institute Peshawar, Peshawar, PAK
| | - Harwindar Kumar
- Neurology, Lady Reading Hospital Medical Teaching Institute Peshawar, Peshawar, PAK
| | - Shakir Ullah
- Pharmacology, Khyber Medical University, Peshawar, PAK
| | - Mian Ayaz U Haq
- Neurology, Lady Reading Hospital Medical Teaching Institute Peshawar, Peshawar, PAK
| | - Nusrat G Gul
- Neurophysiology, Lady Reading Hospital Medical Teaching Institute Peshawar, Peshawar, PAK
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35
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Mutoh Y, Kano Y, Oguri T, Kato H, Umemura T, Norizuki C, Ichihara T, Yuasa H. Severe Measles Encephalitis and Acute Disseminated Encephalomyelitis in an Immunocompetent Japanese Young Male. Intern Med 2021; 60:1971-1976. [PMID: 33456033 PMCID: PMC8263189 DOI: 10.2169/internalmedicine.5362-20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Measles encephalitis rarely affects young adults and has no established treatment strategy. This brief report described the rare case of an immunocompetent 30-year-old man with severe measles pneumonia and encephalitis, following the autoimmune disease acute disseminated encephalomyelitis, during a large measles outbreak in 2018 in Japan. With multidisciplinary treatments, including corticosteroids, intravenous immunoglobulins, vitamin A, and therapeutic plasma exchange, the patient was successfully treated. This case provides a new strategy for treating measles encephalitis and its complications during measles outbreak.
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Affiliation(s)
- Yoshikazu Mutoh
- Department of Infectious Diseases, Tosei General Hospital, Japan
| | - Yuya Kano
- Department of Neurology, Tosei General Hospital, Japan
| | - Takuya Oguri
- Department of Neurology, Tosei General Hospital, Japan
| | - Hideki Kato
- Department of Neurology, Tosei General Hospital, Japan
| | - Takumi Umemura
- Department of Infection Control Team, Tosei General Hospital, Japan
| | - Chihiro Norizuki
- Department of Infection Control Team, Tosei General Hospital, Japan
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36
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Transdermal drug delivery systems for fighting common viral infectious diseases. Drug Deliv Transl Res 2021; 11:1498-1508. [PMID: 34024014 PMCID: PMC8140753 DOI: 10.1007/s13346-021-01004-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 02/08/2023]
Abstract
Transdermal drug delivery systems (TDDS) have many advantages and represent an excellent alternative to oral delivery and hypodermic injections. TDDS are more convenient and less invasive tools for disease and viral infection treatment, prevention, detection, and surveillance. The emerging development of microneedles for TDDS has facilitated improved skin barrier penetration for the delivery of macromolecules or hydrophilic drugs. Microneedle TDDS patches can be fabricated to deliver virus vaccines and potentially provide a viable alternative vaccine modality that offers improved immunogenicity, thermostability, simplicity, safety, and compliance as well as sharp-waste reduction, increased cost-effectiveness, and the capacity for self-administration, which could improve vaccine distribution. These advantages make TDDS-based vaccine delivery an especially well-suited option for treatment of widespread viral infectious diseases including pandemics. Because microneedle-based bioassays employ transdermal extraction of interstitial fluid or blood, they can be used as a minimally invasive approach for surveying disease markers and providing point-of-care (POC) diagnostics. For cutaneous viral infections, TDDS can provide localized treatment with high specificity and less systemic toxicity. In summary, TDDS, especially those that employ microneedles, possess special attributes that can be leveraged to reduce morbidity and mortality from viral infectious diseases. In this regard, they may have considerable positive impact as a modality for improving global health. In this article, we introduce the possible role and summarize the current literature regarding TDDS applications for fighting common cutaneous or systemic viral infectious diseases, including herpes simplex, varicella or herpes zoster, warts, influenza, measles, and COVID-19.
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Toptan T, Ciesek S, Hoehl S. Pediatrics and COVID-19. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:197-208. [PMID: 33973180 DOI: 10.1007/978-3-030-63761-3_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Viral respiratory tract infections are prevalent in children. They have substantial effects on childhood morbidity throughout the world, especially in developing countries. In this chapter, we describe the preliminary characteristics of pediatric COVID-19 and discover that severe and critical disease in children is rare. Many children remain asymptomatic. The reason why severity increases with progressing age and largely spares children is not yet known. In the search for possible explanations, we explore key differences between the pediatric and adult immune responses to new pathogens, and in host factors, such as ACE2 abundance.
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Affiliation(s)
- Tuna Toptan
- Institute of Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Sandra Ciesek
- Institute of Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Sebastian Hoehl
- Institute of Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
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Will SARS-CoV-2 Become Just Another Seasonal Coronavirus? Viruses 2021; 13:v13050854. [PMID: 34067128 PMCID: PMC8150750 DOI: 10.3390/v13050854] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022] Open
Abstract
The future prevalence and virulence of SARS-CoV-2 is uncertain. Some emerging pathogens become avirulent as populations approach herd immunity. Although not all viruses follow this path, the fact that the seasonal coronaviruses are benign gives some hope. We develop a general mathematical model to predict when the interplay among three factors, correlation of severity in consecutive infections, population heterogeneity in susceptibility due to age, and reduced severity due to partial immunity, will promote avirulence as SARS-CoV-2 becomes endemic. Each of these components has the potential to limit severe, high-shedding cases over time under the right circumstances, but in combination they can rapidly reduce the frequency of more severe and infectious manifestation of disease over a wide range of conditions. As more reinfections are captured in data over the next several years, these models will help to test if COVID-19 severity is beginning to attenuate in the ways our model predicts, and to predict the disease.
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Baldo A, Leunda A, Willemarck N, Pauwels K. Environmental Risk Assessment of Recombinant Viral Vector Vaccines against SARS-Cov-2. Vaccines (Basel) 2021; 9:453. [PMID: 34063733 PMCID: PMC8147846 DOI: 10.3390/vaccines9050453] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 12/19/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease 2019 (COVID-19) pandemic. Over the past months, considerable efforts have been put into developing effective and safe drugs and vaccines against SARS-CoV-2. Various platforms are being used for the development of COVID-19 vaccine candidates: recombinant viral vectors, protein-based vaccines, nucleic acid-based vaccines, and inactivated/attenuated virus. Recombinant viral vector vaccine candidates represent a significant part of those vaccine candidates in clinical development, with two already authorised for use in the European Union and one currently under rolling review by the European Medicines Agency (EMA). Since recombinant viral vector vaccine candidates are considered as genetically modified organisms (GMOs), their regulatory oversight includes besides an assessment of their quality, safety and efficacy, also an environmental risk assessment (ERA). The present article highlights the main characteristics of recombinant viral vector vaccine (candidates) against SARS-CoV-2 in the pipeline and discusses their features from an environmental risk point of view.
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Affiliation(s)
- Aline Baldo
- Sciensano, Service Biosafety and Biotechnology, Rue Juliette Wytsmanstraat 14, B-1050 Brussels, Belgium; (A.L.); (N.W.); (K.P.)
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40
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Ketola T, Briga M, Honkola T, Lummaa V. Town population size and structuring into villages and households drive infectious disease risks in pre-healthcare Finland. Proc Biol Sci 2021; 288:20210356. [PMID: 33878921 DOI: 10.1098/rspb.2021.0356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Social life is often considered to cost in terms of increased parasite or pathogen risk. However, evidence for this in the wild remains equivocal, possibly because populations and social groups are often structured, which affects the local transmission and extinction of diseases. We test how the structuring of towns into villages and households influenced the risk of dying from three easily diagnosable infectious diseases-smallpox, pertussis and measles-using a novel dataset covering almost all of Finland in the pre-healthcare era (1800-1850). Consistent with previous results, the risk of dying from all three diseases increased with the local population size. However, the division of towns into a larger number of villages decreased the risk of dying from smallpox and to some extent of pertussis but it slightly increased the risk for measles. Dividing towns into a larger number of households increased the length of the epidemic for all three diseases and led to the expected slower spread of the infection. However, this could be seen only when local population sizes were small. Our results indicate that the effect of population structure on epidemics, disease or parasite risk varies between pathogens and population sizes, hence lowering the ability to generalize the consequences of epidemics in spatially structured populations, and mapping the costs of social life, via parasites and diseases.
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Affiliation(s)
- Tarmo Ketola
- Department of Biological and Environmental Science, University of Jyväskylä, PO Box 35, 40014 Jyväskylä, Finland
| | - Michael Briga
- Department of Biology, University of Turku, Turku 20014, Finland
| | - Terhi Honkola
- Department of Biology, University of Turku, Turku 20014, Finland.,Department of Anthropology and Archaeology, University of Bristol, Bristol BS8 1UU, UK
| | - Virpi Lummaa
- Department of Biology, University of Turku, Turku 20014, Finland
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Saygili E, Yildiz-Ozturk E, Green MJ, Ghaemmaghami AM, Yesil-Celiktas O. Human lung-on-chips: Advanced systems for respiratory virus models and assessment of immune response. BIOMICROFLUIDICS 2021; 15:021501. [PMID: 33791050 PMCID: PMC7990507 DOI: 10.1063/5.0038924] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/15/2021] [Indexed: 05/06/2023]
Abstract
Respiratory viral infections are leading causes of death worldwide. A number of human respiratory viruses circulate in all age groups and adapt to person-to-person transmission. It is vital to understand how these viruses infect the host and how the host responds to prevent infection and onset of disease. Although animal models have been widely used to study disease states, incisive arguments related to poor prediction of patient responses have led to the development of microfluidic organ-on-chip models, which aim to recapitulate organ-level physiology. Over the past decade, human lung chips have been shown to mimic many aspects of the lung function and its complex microenvironment. In this review, we address immunological responses to viral infections and elaborate on human lung airway and alveolus chips reported to model respiratory viral infections and therapeutic interventions. Advances in the field will expedite the development of therapeutics and vaccines for human welfare.
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Affiliation(s)
- Ecem Saygili
- Department of Bioengineering, Faculty of Engineering, Ege University, 35100 Izmir, Turkey
| | - Ece Yildiz-Ozturk
- Translational Pulmonary Research Center, Ege University, 35100 Izmir, Turkey
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42
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Steuwer B, Jamrozik E, Eyal N. Prioritizing second-generation SARS-CoV-2 vaccines through low-dosage challenge studies. Int J Infect Dis 2021; 105:307-311. [PMID: 33592338 PMCID: PMC7881292 DOI: 10.1016/j.ijid.2021.02.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 12/25/2022] Open
Abstract
The design of human challenge studies balances scientific validity, efficiency and study safety. This Perspective explores some advantages and disadvantages of ‘low-dosage’ challenge studies, in the setting of testing second-generation vaccines against COVID-19. Compared with a conventional vaccine challenge, a low-dosage vaccine challenge would be more likely to start, and start earlier. A low-dosage challenge would also be less likely to rule out a vaccine candidate that would have potentially been effective, particularly in certain target uses. A key ethical advantage of a low-dosage challenge over a conventional challenge is that both it and its dose escalation process are safer for each participant. Low-dosage studies would require larger numbers of participants than conventional challenges, but this and other potential disadvantages are less serious than they may initially appear. Overall, low-dosage challenges should be considered for certain roles such as prioritizing between second-generation vaccines against COVID-19.
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Affiliation(s)
- Bastian Steuwer
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, NJ, USA; Rutgers Biomedical and Health Sciences, Newark, NJ, USA.
| | - Euzebiusz Jamrozik
- Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK; Monash Bioethics Centre, Monash University, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
| | - Nir Eyal
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, NJ, USA; Department of Philosophy, Rutgers University, New Brunswick, NJ, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA.
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Schultz F, Osuji OF, Wack B, Anywar G, Garbe LA. Antiinflammatory Medicinal Plants from the Ugandan Greater Mpigi Region Act as Potent Inhibitors in the COX-2/PGH 2 Pathway. PLANTS 2021; 10:plants10020351. [PMID: 33673238 PMCID: PMC7918315 DOI: 10.3390/plants10020351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 12/11/2022]
Abstract
Our study investigates 16 medicinal plants via assessment of inhibition of proinflammatory enzymes such as cyclooxygenases (COX). The plants are used by traditional healers in the Greater Mpigi region in Uganda to treat inflammation and related disorders. We present results of diverse in vitro experiments performed with 76 different plant extracts, namely, (1) selective COX-2 and COX-1 inhibitor screening; (2) 15-LOX inhibition screening; (3) antibacterial resazurin assay against multidrug-resistant Staphylococcus aureus, Listeria innocua, Listeria monocytogenes, and Escherichia coli K12; (4) DPPH assay for antioxidant activity; and (5) determination of the total phenolic content (TPC). Results showed a high correlation between traditional use and pharmacological activity, e.g., extracts of 15 out of the 16 plant species displayed significant selective COX-2 inhibition activity in the PGH2 pathway. The most active COX-2 inhibitors (IC50 < 20 µg/mL) were nine extracts from Leucas calostachys, Solanum aculeastrum, Sesamum calycinum subsp. angustifolium, Plectranthus hadiensis, Morella kandtiana, Zanthoxylum chalybeum, and Warburgia ugandensis. There was no counteractivity between COX-2 and 15-LOX inhibition in these nine extracts. The ethyl acetate extract of Leucas calostachys showed the lowest IC50 value with 0.66 µg/mL (COX-2), as well as the most promising selectivity ratio with 0.1 (COX-2/COX-1). The TPCs and the EC50 values for DPPH radical scavenging activity showed no correlation with COX-2 inhibitory activity. This led to the assumption that the mechanisms of action are most likely not based on scavenging of reactive oxygen species and antioxidant activities. The diethyl ether extract of Harungana madagascariensis stem bark displayed the highest growth inhibition activity against S. aureus (MIC value: 13 µg/mL), L. innocua (MIC value: 40 µg/mL), and L. monocytogenes (MIC value: 150 µg/mL). This study provides further evidence for the therapeutic use of the previously identified plants used medicinally in the Greater Mpigi region.
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Affiliation(s)
- Fabien Schultz
- Institute of Biotechnology, Faculty III—Process Sciences, Technical University of Berlin, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
- Department of Agriculture and Food Sciences, Neubrandenburg University of Applied Sciences, Brodaer Str. 2, 17033 Neubrandenburg, Germany; (O.F.O.); (B.W.); (L.-A.G.)
- Correspondence: ; Tel.: +49-395-5693-2704
| | - Ogechi Favour Osuji
- Department of Agriculture and Food Sciences, Neubrandenburg University of Applied Sciences, Brodaer Str. 2, 17033 Neubrandenburg, Germany; (O.F.O.); (B.W.); (L.-A.G.)
| | - Barbara Wack
- Department of Agriculture and Food Sciences, Neubrandenburg University of Applied Sciences, Brodaer Str. 2, 17033 Neubrandenburg, Germany; (O.F.O.); (B.W.); (L.-A.G.)
| | - Godwin Anywar
- Department of Plant Sciences, Microbiology and Biotechnology, Makerere University, P.O. Box 7062 Kampala, Uganda;
| | - Leif-Alexander Garbe
- Department of Agriculture and Food Sciences, Neubrandenburg University of Applied Sciences, Brodaer Str. 2, 17033 Neubrandenburg, Germany; (O.F.O.); (B.W.); (L.-A.G.)
- ZELT—Neubrandenburg Center for Nutrition and Food Technology gGmbH, Seestraße 7A, 17033 Neubrandenburg, Germany
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Bağcı Z, Daki YY. Positive Effect of Single-Dose Measles Vaccination in Reducing the Incidence of Pneumonia in Children with Measles. J Trop Pediatr 2021; 67:5980412. [PMID: 33185246 DOI: 10.1093/tropej/fmaa085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM Measles is a worldwide common, highly infectious and vaccine-preventable contagious disease with high morbidity and mortality rates. We investigated the effects of administering single-dose measles vaccination in children with measles on the incidence of pneumonia and hospitalization. MATERIALS AND METHODS We retrospectively analysed the hospital records of children aged 0-18 years who were diagnosed with measles within a year before the study in a training and research hospital in Mogadishu, Somalia. We compared the measles vaccine ratios, hospitalization rates, hospitalization duration and pneumonia development rates. RESULTS We found that 34 (15.6%) patients had received measles vaccination, while 184 (84.4%) did not receive the vaccination. All the vaccinated patients received only a single dose of the vaccine. The proportion of those who had received pneumonia vaccine (14/34, 41.2%) was significantly lower than that of those who had never received a dose of measles containing vaccine (179/184, 97.3%) (p = 0.001). Moreover, patients who were immunized [n = 3 (3.1%)] had a significantly lower hospitalization rate than those who were not immunized [n = 94 (96.9%)] (p = 0.001). CONCLUSION The risk of pneumonia in children with measles vaccination, rate of hospitalization and length of hospital stay was significantly lower in children who had received even a single dose of the vaccine when compared with that in those who had not vaccinated. The results of this study reiterate the need for more effective global measles vaccination.
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Affiliation(s)
- Zafer Bağcı
- Department of Pediatrics, Konya Education and Research Hospital, University of Health Sciences, Konya, Turkey
| | - Yunis Yusuf Daki
- Department of Pediatrics, Konya Education and Research Hospital, University of Health Sciences, Konya, Turkey.,Department of Pediatrics, Somalia Mogadishu Recep Tayyip Erdoğan Education and Research Hospital, University of Health Sciences Turkey, Mogadishu, Somalia
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45
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Affiliation(s)
- Andrew R DiNardo
- From the Global Tuberculosis Program, William T. Shearer Center for Human Immunobiology, Texas Children's Hospital (A.R.D.), the Immigrant and Global Health Program, Department of Pediatrics (A.R.D.), and the Departments of Medicine and Molecular Virology and Microbiology (D.M.M.), Baylor College of Medicine, and the Medical Care Line, Infectious Disease Section, Michael E. DeBakey Veterans Affairs Medical Center (D.M.M.) - all in Houston; the Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands (M.G.N.); and the Department of Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany (M.G.N.)
| | - Mihai G Netea
- From the Global Tuberculosis Program, William T. Shearer Center for Human Immunobiology, Texas Children's Hospital (A.R.D.), the Immigrant and Global Health Program, Department of Pediatrics (A.R.D.), and the Departments of Medicine and Molecular Virology and Microbiology (D.M.M.), Baylor College of Medicine, and the Medical Care Line, Infectious Disease Section, Michael E. DeBakey Veterans Affairs Medical Center (D.M.M.) - all in Houston; the Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands (M.G.N.); and the Department of Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany (M.G.N.)
| | - Daniel M Musher
- From the Global Tuberculosis Program, William T. Shearer Center for Human Immunobiology, Texas Children's Hospital (A.R.D.), the Immigrant and Global Health Program, Department of Pediatrics (A.R.D.), and the Departments of Medicine and Molecular Virology and Microbiology (D.M.M.), Baylor College of Medicine, and the Medical Care Line, Infectious Disease Section, Michael E. DeBakey Veterans Affairs Medical Center (D.M.M.) - all in Houston; the Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands (M.G.N.); and the Department of Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany (M.G.N.)
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46
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Haeryfar SMM. On invariant T cells and measles: A theory of "innate immune amnesia". PLoS Pathog 2020; 16:e1009071. [PMID: 33332470 PMCID: PMC7745983 DOI: 10.1371/journal.ppat.1009071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- S. M. Mansour Haeryfar
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Department of Medicine, Division of Clinical Immunology & Allergy, Western University, London, Ontario, Canada
- Department of Surgery, Division of General Surgery, Western University, London, Ontario, Canada
- Centre for Human Immunology, Western University, London, Ontario, Canada
- * E-mail:
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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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Bozzola E, Spina G, Tozzi AE, Villani A. Global Measles Epidemic Risk: Current Perspectives on the Growing Need for Implementing Digital Communication Strategies. Risk Manag Healthc Policy 2020; 13:2819-2826. [PMID: 33312006 PMCID: PMC7725071 DOI: 10.2147/rmhp.s201279] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
A safe vaccine against measles has been available and globally recommended since 1974. The World Health Organization established measles elimination as a goal for 2020 but, unfortunately, this objective has not been achieved yet and outbreaks still occur. Herd immunity, ie, a population immunity higher than 95%, is required to stop the measles virus transmission. Communication plays a crucial role in immunization strategy to obtain high coverage levels, as it helps to fight barriers against vaccination. Delay and refusal of measles vaccination have become widespread due to misinformation, fake news and barriers to effective communication. This phenomenon has been defined as “vaccine hesitancy” and is considered as one of the top ten risks for global health. The alleged association between measles vaccination and autism has caused a sharp decline in vaccination rates. In this current situation, mass communication integrated into public health policies is fundamental to sway people’s positive attitudes toward vaccination. Digital communication strategies based on social media and other internet platforms may represent useful tools to promote immunization and discourage skepticism and complement information provided by health-care professionals who have been considered as the most credible source on risk/benefits on vaccines for families. Digital communication strategies that may help supporting the measles elimination strategy include monitoring information needs online, integrating digital communication into immunization programs, involving a multidisciplinary group in communication, developing content that balances facts with positive messaging, using multiple communication channels. Further research activities should be promoted in the field of effective communication for immunization.
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Affiliation(s)
- Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Spina
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Eugenio Tozzi
- Multifactorial and Complex Diseases Research Area, Predictive and Preventive Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Di Giamberardino P, Iacoviello D. Evaluation of the effect of different policies in the containment of epidemic spreads for the COVID-19 case. Biomed Signal Process Control 2020; 65:102325. [PMID: 33262807 PMCID: PMC7689349 DOI: 10.1016/j.bspc.2020.102325] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 10/19/2020] [Accepted: 11/01/2020] [Indexed: 12/23/2022]
Abstract
The paper presents a new mathematical model for the SARS-CoV-2 virus propagation, designed to include all the possible actions to prevent the spread and to help in the healing of infected people. After a discussion on the equilibrium and stability properties of the model, the effects of each different control actions on the evolution of the epidemic spread are analysed, through numerical evaluations for a more intuitive and immediate presentation, showing the consequences on the classes of the population. A new mathematical model for the spread of the SARS-CoV-2 is proposed and analysed. Available control actions are considered including social and political decisions. The effects on populations of containment policies and medical efforts are described. The model can support choices for large scale strategies of diseases contrast. Control actions can be defined according to economic, healthy and social issues.
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Affiliation(s)
- Paolo Di Giamberardino
- Department of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
| | - Daniela Iacoviello
- Department of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
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Kuylen E, Willem L, Broeckhove J, Beutels P, Hens N. Clustering of susceptible individuals within households can drive measles outbreaks: an individual-based model exploration. Sci Rep 2020; 10:19645. [PMID: 33184409 PMCID: PMC7665185 DOI: 10.1038/s41598-020-76746-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 10/19/2020] [Indexed: 01/18/2023] Open
Abstract
When estimating important measures such as the herd immunity threshold, and the corresponding efforts required to eliminate measles, it is often assumed that susceptible individuals are uniformly distributed throughout populations. However, unvaccinated individuals may be clustered in a variety of ways, including by geographic location, by age, in schools, or in households. Here, we investigate to which extent different levels of within-household clustering of susceptible individuals may impact the risk and persistence of measles outbreaks. To this end, we apply an individual-based model, Stride, to a population of 600,000 individuals, using data from Flanders, Belgium. We construct a metric to estimate the level of within-household susceptibility clustering in the population. Furthermore, we compare realistic scenarios regarding the distribution of susceptible individuals within households in terms of their impact on epidemiological measures for outbreak risk and persistence. We find that higher levels of within-household clustering of susceptible individuals increase the risk, size and persistence of measles outbreaks. Ignoring within-household clustering thus leads to underestimations of required measles elimination and outbreak mitigation efforts.
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Affiliation(s)
- Elise Kuylen
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
- Data Science Institute (DSI), Hasselt University, Hasselt, Belgium.
| | - Lander Willem
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Jan Broeckhove
- IDLab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- Data Science Institute (DSI), Hasselt University, Hasselt, Belgium
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