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Evans I, Jury S, Morrison A, Best E, King V, Reynolds E. Onward transmission of measles virus among vaccinated cases in a large community outbreak in Auckland, New Zealand, 2019. Vaccine 2024; 42:126257. [PMID: 39191179 DOI: 10.1016/j.vaccine.2024.126257] [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: 03/26/2024] [Revised: 08/09/2024] [Accepted: 08/20/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Isolation of cases and quarantining of non-immune contacts are the mainstay of measles outbreak management in elimination settings. Serology testing of exposed contacts may not be feasible in large outbreaks; therefore, vaccination history is used as a proxy for determining immunity to measles and thus prevention of onward virus transmission. This study sought to investigate the risk of measles virus transmission from individuals with a history of one or two doses of measles-containing vaccine (MCV). METHODS Retrospective analysis of data from measles cases reported to Auckland Regional Public Health Service during the 2019 Auckland region measles outbreak. Vaccination history was verified using patient records and the New Zealand National Immunisation Register. Onward transmission was determined through case interviews and assessment of exposed contacts. RESULTS 1451 measles cases were assessed as eligible for vaccination at the time of measles outbreak. Of these, 1015 (70.0%) were unvaccinated, 220 (15.2%) had unknown vaccination status, 139 (9.6%) had received only one dose of MCV and 77 (5.3%) had received two doses of the vaccine. Compared to unvaccinated cases, the odds of onward transmission were lower among those with one dose only (OR 0.41, 95% CI: 0.20-0.75) or two doses of MCV (OR 0.44, 95% CI: 0.17-0.95). Median time since vaccination was longer among those with onward transmission compared to those without onward transmission for one and two doses of the vaccine, suggesting a potential effect of waning immunity among this cohort. CONCLUSION These findings support the hypothesis that measles cases with a history of prior vaccination are less likely to transmit the virus to others compared to unvaccinated cases. Such information can be used to support decisions around quarantine requirements for vaccinated contacts in future measles outbreaks.
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Affiliation(s)
- Imogen Evans
- Auckland Regional Public Health Service, Health New Zealand - Te Whatu Ora Te Toka Tumai Auckland, New Zealand.
| | - Sheryl Jury
- Auckland Regional Public Health Service, Health New Zealand - Te Whatu Ora Te Toka Tumai Auckland, New Zealand
| | - Anne Morrison
- Auckland Regional Public Health Service, Health New Zealand - Te Whatu Ora Te Toka Tumai Auckland, New Zealand
| | - Emma Best
- Department of Paediatrics: Child and Youth Health, The University of Auckland, New Zealand
| | - Victoria King
- Department of Paediatrics: Child and Youth Health, The University of Auckland, New Zealand
| | - Edwin Reynolds
- Auckland Regional Public Health Service, Health New Zealand - Te Whatu Ora Te Toka Tumai Auckland, New Zealand
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Crowcroft NS, Minta AA, Bolotin S, Cernuschi T, Ariyarajah A, Antoni S, Mulders MN, Bose AS, O’Connor PM. The Problem with Delaying Measles Elimination. Vaccines (Basel) 2024; 12:813. [PMID: 39066457 PMCID: PMC11281398 DOI: 10.3390/vaccines12070813] [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: 04/30/2024] [Revised: 07/02/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Measles is a highly infectious disease leading to high morbidity and mortality impacting people's lives and economies across the globe. The measles vaccine saves more lives than any other vaccine in the Essential Programme of Immunization and is also the most cost-effective vaccine, with an extremely high return on investment. This makes achieving measles elimination through vaccination a key child health intervention, particularly in low-income countries, where the overwhelming majority of measles deaths continue to occur. All countries and regions of the world have committed to achieving measles elimination, yet many have faced challenges securing political commitment at national and global levels and predictable, timely, and flexible support from global donors, and experienced setbacks during the COVID-19 pandemic. This has happened against a backdrop of stagnant measles vaccination coverage and declining enthusiasm for vertical programmes, culminating in a World Health Organization Strategic Advisory Group of Experts (WHO SAGE) review of the feasibility of measles eradication in 2019. Sustaining the elimination of measles long term is extremely difficult, and some countries have lost or nearly lost their measles elimination status in the face of ongoing importation of cases from neighbouring or closely connected countries in which elimination had been delayed. Thus, a widening equity gap in measles immunisation coverage creates challenges for all countries, not just those facing the greatest burden of measles morbidity and mortality. Delaying elimination of measles in some countries makes it cumulatively harder for all countries to succeed for three principal reasons: increased inequity in measles immunisation coverage makes outbreaks more likely to happen and to be larger; political will is very difficult to sustain; and immunity may wane to a point that transmission is re-established. New strategies are needed to support countries and regions in their vision for a world without measles, including ways to galvanise domestic, regional and global resources and ignite the political will that is essential to make the vision a reality.
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Affiliation(s)
- Natasha S. Crowcroft
- Immunization, Vaccines and Biologicals, World Health Organization, 1211 Geneva, Switzerland (M.N.M.); (A.S.B.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 3H2, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON M5S 3H2, Canada
| | - Anna A. Minta
- Immunization, Vaccines and Biologicals, World Health Organization, 1211 Geneva, Switzerland (M.N.M.); (A.S.B.)
| | - Shelly Bolotin
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 3H2, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON M5S 3H2, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 3H2, Canada
- Public Health Ontario, Toronto, ON M5G 1V2, Canada
| | - Tania Cernuschi
- Immunization, Vaccines and Biologicals, World Health Organization, 1211 Geneva, Switzerland (M.N.M.); (A.S.B.)
| | - Archchun Ariyarajah
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 3H2, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON M5S 3H2, Canada
- ICES, Toronto, ON M4N 3M5, Canada
| | - Sébastien Antoni
- Immunization, Vaccines and Biologicals, World Health Organization, 1211 Geneva, Switzerland (M.N.M.); (A.S.B.)
| | - Mick N. Mulders
- Immunization, Vaccines and Biologicals, World Health Organization, 1211 Geneva, Switzerland (M.N.M.); (A.S.B.)
| | - Anindya S. Bose
- Immunization, Vaccines and Biologicals, World Health Organization, 1211 Geneva, Switzerland (M.N.M.); (A.S.B.)
| | - Patrick M. O’Connor
- Immunization, Vaccines and Biologicals, World Health Organization, 1211 Geneva, Switzerland (M.N.M.); (A.S.B.)
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Dyda A, Broome A, Rawlinson W, Mahimbo A, Saha A, Kefalas B, Seale H, Macintyre CR, Zwar N, Gidding HF, Heywood AE. Measles, mumps, rubella and varicella antibodies among international and domestic university students. J Travel Med 2024; 31:taae004. [PMID: 38195239 DOI: 10.1093/jtm/taae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
BACKGROUND Vaccine-preventable infections are generally well controlled in Australia. However, gaps in immunity can lead to outbreaks and are important to identify. Young adults are a highly mobile population and a potential source of imported infections. We aimed to evaluate anti- measles, mumps, rubella and varicella (MMR&V) IgG seroprevalence and explore factors relating to antibody seropositivity. METHODS A cross-sectional online survey was conducted among students from a large Australian university to collect demographic, vaccination, infection and travel characteristics. Blood samples were collected to measure MMR&V seroprevalence. Logistic regression was used to identify factors associated with seropositivity. RESULTS Among 804 university students, seroprevalence (positive or equivocal) for measles was 82.3% (95% CI 79.6-84.8%), mumps 79.5% (95% CI 76.7-82.3%), rubella 91.5% (95% CI 89.6-93.5%) and varicella 86.2% (95% CI 84.1-88.8%), with 452 (56.2%, 95% CI 52.8-59.6) seropositive to all four viruses. Varicella seropositivity was highest in the older birth cohort (born 1988-1991). Measles seropositivity was higher for international students compared to domestic students. Among international students, mumps seroprevalence was significantly lower than measles and rubella seroprevalence. International travel in the previous 12 months was reported by 63.1% of students, but only 18.2% of travellers reported seeking pre-travel health advice prior to most recent international travel. CONCLUSIONS Overall, this study suggests immunity to MMR&V is sub-optimal. We found the university student population to be highly mobile and unlikely to seek pre-travel advice; thus, they are a potential source of infection importation. The implementation of university immunization policies could address the gaps identified and our findings can inform the development of targeted vaccination campaigns.
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Affiliation(s)
- Amalie Dyda
- School of Public Health, University of Queensland, Brisbane, QLD 4072, Australia
| | - Audrey Broome
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - William Rawlinson
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, NSW 2031, Australia
| | - Abela Mahimbo
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Amit Saha
- The Kirby Institute, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Bill Kefalas
- UNSW Health Service, University of New South Wales, Sydney, NSW 2052, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - C Raina Macintyre
- The Kirby Institute, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Nicholas Zwar
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia
| | - Heather F Gidding
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Anita E Heywood
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
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Chen R, Guay M, Gilbert NL, Dubé E, Witteman HO, Hakim H. Determinants of parental vaccine hesitancy in Canada: results from the 2017 Childhood National Immunization Coverage Survey. BMC Public Health 2023; 23:2327. [PMID: 38001412 PMCID: PMC10668395 DOI: 10.1186/s12889-023-17079-4] [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] [Received: 05/15/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND In 2019, the World Health Organization (WHO) designated vaccine hesitancy as one of the ten leading threats to global health. Vaccine hesitancy exists when vaccination services are available and accessible, but vaccine uptake is lower than anticipated. It is often attributed to lack of trust in vaccine safety and effectiveness, or low level of concern about the risk of many vaccine-preventable diseases. This study aimed to examine the sociodemographic factors associated with parental vaccine hesitancy and vaccine refusal in Canada using data from the 2017 Childhood National Immunization Coverage Survey (CNICS). METHOD The 2017 CNICS was a cross-sectional and nationally representative survey to estimate national vaccine uptake and to collect information about parents' Knowledge, Attitudes and Beliefs (KAB) regarding vaccination. Using the KAB questions, parental vaccine hesitancy (i.e., parental hesitation, delay or refusal of at least one recommended vaccination) and refusal (i.e., unvaccinated children) by sociodemographic factors was estimated using weighted prevalence proportions. A multinomial logistic regression model was fitted to examine associations between parental vaccine hesitancy or refusal and sociodemographic factors among parents of two-year-old children in Canada. Adjusted odds ratios (aOR) of being vaccine-hesitant or vaccine-refusing versus being non-vaccine-hesitant were generated. RESULTS Both unadjusted and adjusted logistic regressions models showed that parents with lower household income (aOR 1.7, 95% CI 1.2-2.5), and those with a higher number of children in the household (aOR 2.2, 95% CI 1.4-3.5) had higher vaccine hesitancy. Conversely, lower vaccine hesitancy was observed among non-immigrant parents (aOR 0.4, 95% CI 0.3-0.6). In addition, lower household income (aOR 4.0, 95% CI 1.3-12.9), and higher number of children in the household (aOR 6.9, 95% CI 2.1-22.9) were significantly associated with parental vaccine refusal. Regional variations were also observed. CONCLUSION Several sociodemographic determinants are associated with parental vaccine hesitancy and refusal. The findings of the study could help public health officials and policymakers to develop and implement targeted interventions to improve childhood vaccination programs.
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Affiliation(s)
- Ruoke Chen
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada.
| | - Mireille Guay
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Nicolas L Gilbert
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada
- University of Montreal School of Public Health, Quebec, Canada
| | - Eve Dubé
- Institut National de Santé Publique du Québec, Quebec, Canada
- Department of Anthropology, Laval University, Quebec, Canada
| | | | - Hina Hakim
- Faculty of Medicine, Laval University, Quebec, Canada
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Brazilian Adults’ Attitudes and Practices Regarding the Mandatory COVID-19 Vaccination and Their Hesitancy towards Childhood Vaccination. Vaccines (Basel) 2022; 10:vaccines10111853. [DOI: 10.3390/vaccines10111853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background: This study investigated the attitudes and practices of Brazilian adults regarding the mandatory COVID-19 vaccination and their hesitancy towards the vaccination of children. Methods: Between March and May 2022, Brazilian adults answered an online questionnaire distributed through social media. The SAGE-WG questionnaire was adapted to measure hesitancy to the vaccination of children. Results: Of the 1007 participants, 67.4% believed that adult COVID-19 vaccination should be mandatory. Just over half of the participants (51.5%) believed that parents and/or guardians should decide if their children should be vaccinated against COVID-19 or not and 9.1% were unsure. Individuals who were younger, non-religious and had higher awareness of COVID-19 risks and critics of the federal government’s performance in combating the pandemic were more likely to agree with mandatory adult vaccination. However, less agreement among parents and/or guardians concerning children’s vaccination was observed, with lower scores for hesitancy to the vaccination of children. Conclusion: In Brazil, there is still far from a consensus on mandatory COVID-19 vaccination for adults and a significant proportion of the population believes that parents and/or guardians should be free to decide on their children’s vaccination. These views are associated with age, religion, knowledge of COVID-19 risks and political inclination.
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Makarenko C, San Pedro A, Paiva NS, Santos JPCD, Medronho RDA, Gibson G. Measles resurgence in Brazil: analysis of the 2019 epidemic in the state of São Paulo. Rev Saude Publica 2022; 56:50. [PMID: 35703604 PMCID: PMC9239333 DOI: 10.11606/s1518-8787.2022056003805] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/08/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the epidemiological profile of cases and the pattern of spatial diffusion of the largest measles epidemic in Brazil that occurred in the post-elimination period in the state of São Paulo. METHOD A cross-sectional study based on confirmed measles cases in 2019. Bivariate analysis was performed for socioeconomic, clinical, and epidemiological variables, according to prior vaccination and hospitalization, combined with an analysis of spatial diffusion of cases using the Inverse Distance Weighting (IDW) method. RESULTS Of the 15,598 confirmed cases, 2,039 were hospitalized and 17 progressed to death. The epidemic peak occurred in epidemiological week 33, after confirmation of the first case, in the epidemiological week 6. Most cases were male (52.1%), aged between 18 and 29 years (38.7%), identified as whites (70%). Young adults (39.7%) and children under five years (32.8%) were the most affected age groups. A higher proportion of previous vaccination was observed in whites as compared to Blacks, browns, yellows and indigenous people (p < 0.001), as well as in the most educated group compared to the other categories (p < 0.001). The risk of hospitalization was higher in children than in the older age group (RI = 2.19; 95%CI: 1.66-2.88), as well as in the unvaccinated than in the vaccinated (RI = 1.59; 95%CI: 1.45-1.75). The pattern of diffusion by contiguity combined with diffusion by relocation followed the urban hierarchy of the main cities' regions of influence. CONCLUSION In addition to routine vaccination in children, the findings indicate the need for immunization campaigns for young adults. In addition, studies that seek to investigate the occurrence of clusters of vulnerable populations, prone to lower vaccination coverage, are essential to broaden the understanding of the dynamics of transmission and, thus, reorienting control strategies that ensure disease elimination.
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Affiliation(s)
- Cristina Makarenko
- Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Alexandre San Pedro
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Centro de Estudos, Políticas e Informação sobre Determinantes Sociais da Saúde. Rio de Janeiro, RJ, Brasil
| | - Natalia Santana Paiva
- Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | | | | | - Gerusa Gibson
- Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
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Population immunity to measles in Canada using Canadian Health Measures survey data - A Canadian Immunization Research Network (CIRN) study. Vaccine 2022; 40:3228-3235. [PMID: 35491342 PMCID: PMC9246716 DOI: 10.1016/j.vaccine.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 01/13/2023]
Abstract
We aimed to determine population immunity to measles in Canada, and to assess the risk of future outbreaks. We tested 11,176 sera from Cycles 2 (2009-2011) and 3 (2011-2013) cohorts from the biobank of Statistics Canada's Canadian Health Measures Survey (CHMS) using the BioPlex 2220 MMRV IgG assay. We then tested all BioPlex negative and equivocal samples using a more sensitive Plaque Reduction Neutralization Test (PRNT). We determined the weighted proportion of positive, equivocal, and negative samples by age, sex, region and whether individuals were born in Canada. We found that 90.0% (95% confidence interval (CI): 88.2, 91.9) of samples were positive, 4.5% (95% CI: 3.4, 5.5) were equivocal and 5.5% (95% CI: 4.3, 6.7) were negative. Individuals in the 12-19 year age band had the lowest proportion positive at 78.7% (95% CI: 74.2, 83.2) and the highest proportion of positive samples was found in those 60-79 years (99.6%, 95% CI: 99.3, 99.9). Seropositivity was consistently <90% across a broad range of pediatric and adult age bands (6-39 years). We found that a slightly higher proportion of females were positive (91.9%, 95% CI: 90.1, 93.6) compared to males (88.3%, 95% CI: 85.8, 90.7). When taking into account interaction between age and born in Canada status, we found individuals born in Canada aged 19 and under were less susceptible (OR = 0.6 (95% CI: 0.4, 0.95)) compared to those born outside Canada whereas, those aged 20 and over were more susceptible (OR = 1.7 (95% CI: 1.1, 2.8)). Our findings indicate that measles immunity in Canada is below the 95% immunity threshold required to sustain measles elimination, underscoring the importance of maintaining high vaccine coverage to prevent future measles outbreaks and sustain Canada's elimination status.
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Vaccine Hesitancy in Saudi Arabia: A Cross-Sectional Study. Trop Med Infect Dis 2022; 7:tropicalmed7040060. [PMID: 35448835 PMCID: PMC9025486 DOI: 10.3390/tropicalmed7040060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/27/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: vaccine hesitancy can put the public’s health at risk from vaccine-preventable diseases. This study aimed to address vaccine hesitancy in Saudi Arabia and understand the problem’s magnitude and causes. (2) Methods: this was a descriptive observational study using quantitative and qualitative evaluation methods conducted in Saudi Arabia between December 2020 and February 2021. Public survey forms, exit interviews, and healthcare professional survey forms were used. (3) Results: our study involved 2030 public survey participants, 119 exit interviews of caregivers, and 500 healthcare professionals, demonstrating that vaccine hesitancy was relatively low. Ninety percent of the participants agreed that it was essential for everyone to receive the recommended vaccines with their children (p < 0.001), 92% believed that vaccines are safe for their children (p < 0.001), 91% of the participants agreed to give their new children all the recommended doses (p < 0.001), 86% welcomed mass/school vaccination campaigns (p < 0.001), and 81% were willing to pay for additional vaccines for themselves and their children (p < 0.001). (4) Conclusions: vaccine hesitancy is low in Saudi Arabia, and a positive attitude toward vaccination was detected among most of the participants. Vaccination decision-making is complex and includes emotional, cultural, social, spiritual, and political aspects.
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Wessendorf L, Richter E, Schulte B, Schmithausen RM, Exner M, Lehmann N, Coenen M, Fuhrmann C, Kellings A, Hüsing A, Jöckel KH, Streeck H. Dynamics, outcomes and prerequisites of the first SARS-CoV-2 superspreading event in Germany in February 2020: a cross-sectional epidemiological study. BMJ Open 2022; 12:e059809. [PMID: 35387836 PMCID: PMC8987213 DOI: 10.1136/bmjopen-2021-059809] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The first German SARS-CoV-2 outbreak was a superspreading event in Gangelt, North Rhine-Westphalia, during indoor carnival festivities called 'Kappensitzung' (15 February 2020). We determined SARS-CoV-2 RT-PCR positivity rate, SARS-CoV-2-specific antibodies, and analysed the conditions and dynamics of superspreading, including ventilation, setting dimensions, distance from infected persons and behavioural patterns. DESIGN In a cross-sectional epidemiological study (51 days postevent), participants were asked to give blood, pharyngeal swabs and complete self-administered questionnaires. SETTING The SARS-CoV-2 superspreading event took place during festivities in the small community of Gangelt in February 2020. This 5-hour event included 450 people (6-79 years of age) in a building of 27 m × 13.20 m × 4.20 m. PARTICIPANTS Out of 450 event participants, 411 volunteered to participate in this study. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome: infection status (determined by IgG ELISA). SECONDARY OUTCOME symptoms (determined by questionnaire). RESULTS Overall, 46% (n=186/404) of participants had been infected, and their spatial distribution was associated with proximity to the ventilation system (OR 1.39, 95% CI 0.86 to 2.25). Risk of infection was highly associated with age: children (OR 0.33, 95% CI 0.267 to 0.414) and young adults (age 18-25 years) had a lower risk of infection than older participants (average risk increase of 28% per 10 years). Behavioural differences were also risk associated including time spent outside (OR 0.55, (95% CI 0.33 to 0.91) or smoking (OR 0.32, 95% CI 0.124 to 0.81). CONCLUSIONS Our findings underline the importance of proper indoor ventilation for future events. Lower susceptibility of children/young adults indicates their limited involvement in superspreading.
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Affiliation(s)
| | - Enrico Richter
- Institute of Virology, University Hospital Bonn, Bonn, Germany
| | - Bianca Schulte
- Institute of Virology, University Hospital Bonn, Bonn, Germany
| | | | - Martin Exner
- Department of Hygiene, University Hospital Bonn, Bonn, Germany
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Duisburg, Germany
| | - Martin Coenen
- Clinical Study Core Unit, Study Center Bonn (SZB), Rheinische Friedrich Wilhelms Universitat Bonn, Bonn, Germany
| | - Christine Fuhrmann
- Clinical Study Core Unit, Study Center Bonn (SZB), Rheinische Friedrich Wilhelms Universitat Bonn, Bonn, Germany
| | - Angelika Kellings
- Clinical Study Core Unit, Study Center Bonn (SZB), Rheinische Friedrich Wilhelms Universitat Bonn, Bonn, Germany
| | - Anika Hüsing
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Duisburg, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Duisburg, Germany
| | - Hendrik Streeck
- Institute of Virology, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research, Braunschweig, Niedersachsen, Germany
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Galal B, Lazieh S, Al-Ali S, Khoshnood K. Assessing vaccine hesitancy in Arab countries in the Middle East and North Africa (MENA) region: a scoping review protocol. BMJ Open 2022; 12:e045348. [PMID: 35149559 PMCID: PMC8844954 DOI: 10.1136/bmjopen-2020-045348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Vaccine-preventable disease outbreaks have increased in past years, and there is great public health interest in monitoring attitudes towards vaccination as well as identifying factors contributing to vaccine hesitancy and refusal. Although the WHO declared vaccine hesitancy as one of the top threats to global health in 2019, studies focused on the determinants and extent of vaccine hesitancy in Arab countries in the Middle East and North Africa (MENA) region are lacking. This scoping review explores the various factors surrounding vaccine hesitancy, including but not limited to geographic, cultural and religious factors, and examines the extent and nature of the existing evidence on this topic. In light of current development of various COVID-19 vaccines, our work seeks to elucidate the barriers to vaccine uptake in specific populations. METHODS AND ANALYSIS This review will be conducted using the Joanna Briggs Institute Manual for Scoping Reviews. It will comply with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies published in English, Arabic and French between January 1998 and December 2020 will be drawn from PubMed, Embase, Cochrane and Scopus. The search strategy will include terms related to vaccination and vaccine hesitancy in Arab countries in the MENA region. We will also include grey literature on the topic by searching Google and Google Scholar. Studies will be selected according to the Participants-Intervention-Comparators-Outcome model, and all study titles and abstracts will be screened by two reviewers. Disagreements will be resolved with a third reviewer's input. ETHICS AND DISSEMINATION This review is exempted from ethical approval and will be published in a peer-reviewed open-access journal to ensure wide dissemination.
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Affiliation(s)
- Bayan Galal
- Yale University, New Haven, Connecticut, USA
| | - Stefany Lazieh
- Rutgers University School of Arts and Sciences, New Brunswick, New Jersey, USA
| | | | - Kaveh Khoshnood
- Department of Epidemiology of Microbial Diseases, Yale University, New Haven, Connecticut, USA
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Saffar H, Mousavi SJ, Saffar H, Parsaei MR, Ghorbani GR, Saffar MJ. Seroconversion rates following 2 doses of measles- mumps- rubella vaccination given at the ages 12 and 18 months: data for possible additional dose at older age. BMC Immunol 2022; 23:2. [PMID: 35034609 PMCID: PMC8762940 DOI: 10.1186/s12865-021-00465-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background Despite high rate of vaccination coverage with 2-doses of measles containing vaccine among Iranian children, outbreaks of measles occurred among different age groups and fully vaccinated subjects. Although the main reason for these outbreaks is unknown, however, vaccine failure was supposed to be an important cause. This study was designed to determine the seroconversion rates to measles- mumps- rubella (MMR) vaccine currently in use among Iranian children. Methods This prospective study was conducted among healthy children older than 12 months who were candidates of scheduled MMR vaccination. Blood samples were obtained from each mother- infant pair just before vaccination, and from infants 4–6 weeks after MMR1 and MMR2 immunization. Collected sera were tested for specific lgG antibodies against MMR agents using ELISA method. The proportion of seroprotected subjects among mother- infant pairs before vaccination as well as the prevalence rates of seroconversion after MMR1 and MMR2 vaccination were calculated. Collected data were analyzed using descriptive statistical methods. Results During 22-months study period, 92 mother- infant pairs were participated. Seroimmunity rates against MMR viruses were 85.8%, 84.7% and 86.9% for mothers, and 3.2%, 2.1% and 1.0% for children, respectively. After MMR1 vaccination from 52 seronegative children, 80.7%, 78.8% and 75% were seroconverted. These rates increased to 94.8%, 89.7% and 94.8% after the MMR2 vaccination. Also, the specific immunity was enhanced among seropositive children. Conclusion Majority of the mothers and few infants were immune to MMR viruses prior to MMR1 vaccination. Immune responses detected after MMR1 injection, and overall seroconversion rates achieved after 2-doses of MMR vaccination were less than expected and inadequate to preserve long-term protection against MMR agents.
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Affiliation(s)
- Hana Saffar
- Department of Anatomical and Clinical Pathology, IKHC, Teheran University of Medical Sciences, Tehran, Iran
| | - Sayed Jaber Mousavi
- Department of Community Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hiva Saffar
- Department of Pathology, Shariati Hospital, Teheran University of Medical Sciences, Tehran, Iran
| | | | | | - Mohammad Jafar Saffar
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute and Department of Pediatric Infectious Diseases, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Pasdaran Bolv, Sari, Iran.
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12
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Cascini F, Pantovic A, Al-Ajlouni Y, Failla G, Ricciardi W. Attitudes, acceptance and hesitancy among the general population worldwide to receive the COVID-19 vaccines and their contributing factors: A systematic review. EClinicalMedicine 2021; 40:101113. [PMID: 34490416 PMCID: PMC8411034 DOI: 10.1016/j.eclinm.2021.101113] [Citation(s) in RCA: 206] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/06/2021] [Accepted: 08/13/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND High rates of vaccination worldwide are required to establish a herd immunity and stop the current COVID-19 pandemic evolution. Vaccine hesitancy is a major barrier in achieving herd immunity across different populations. This study sought to conduct a systematic review of the current literature regarding attitudes and hesitancy to receiving COVID-19 vaccination worldwide. METHODS A systematic literature search of PubMed and Web of Science was performed on July 5th, 2021, using developed keywords. Inclusion criteria required the study to (1) be conducted in English; (2) investigate attitudes, hesitancy, and/or barriers to COVID-19 vaccine acceptability among a given population; (3) utilize validated measurement techniques; (4) have the full text paper available and be peer-reviewed prior to final publication. FINDINGS Following PRISMA guidelines, 209 studies were included. The Newcastle Ottawa (NOS) scale for cross-sectional studies was used to assess the quality of the studies.Overall, vaccine acceptance rates ranged considerably between countries and between different time points, with Arabian countries showing the highest hesitancy rates compared with other parts of the world. INTERPRETATION A variety of different factors contributed to increased hesitancy, including having negative perception of vaccine efficacy, safety, convenience, and price. Some of the consistent socio-demographic groups that were identified to be associated with increased hesitancy included: women, younger participants, and people who were less educated, had lower income, had no insurance, living in a rural area, and self-identified as a racial/ethnic minority.
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Affiliation(s)
- Fidelia Cascini
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Ana Pantovic
- Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | - Yazan Al-Ajlouni
- New York Medical College School of Medicine, Valhalla, New York, United States
| | - Giovanna Failla
- Department of Public Health, University of Verona, Verona, Italy
| | - Walter Ricciardi
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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13
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Evaluation of Diagnostic Accuracy of Eight Commercial Assays for the Detection of Measles Virus-Specific IgM Antibodies. J Clin Microbiol 2021; 59:JCM.03161-20. [PMID: 33731415 PMCID: PMC8315954 DOI: 10.1128/jcm.03161-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Abstract
The World Health Organization (WHO) has targeted measles for global eradication through mass immunization. For effective monitoring of eradication targets, high-quality surveillance is needed. The detection of IgM antibodies, specific to the measles virus, with the use of commercial enzyme-linked immunosorbent assays (ELISA or EIA) is broadly used within the WHO global measles and rubella laboratory network for laboratory confirmation, and in particular, ELISA kits manufactured by Siemens (Enzygnost kits) have been primarily used. Spurred by the discontinuation of these kits, this study aims to report on the clinical sensitivity and specificity of comparable commercial ELISA kits and one automated chemiluminescent immunoassay (CLIA) method. A panel of 239 serum samples was assembled that included sera from confirmed measles cases (n = 50) and probable post-MMR vaccine response (n = 2). Measles-negative sera (n = 187) were collected from individuals presenting with other fever and rash illnesses. A total of 7 ELISA kits (Euroimmun native antigens and recombinant nucleoprotein, IBL, Clin-Tech Microimmune, NovaTec NovaLisa, Serion, and Siemens Enzygnost) and one CLIA method (DiaSorin LIAISON XL) were evaluated. The ELISA kits included two IgM capture methods and five indirect methods. Calculated sensitivities and specificities ranged from 75.0% to 98.1% and 86.6% to 99.5%, respectively. The parvovirus B19 IgM positive sera were noted to cause false-positive results, particularly for the ELISA kits from Serion and NovaLisa; specificities for this subset of samples ranged from 51.4% to 100.0%. The capture IgM ELISA methods provided the best combination of sensitivity and specificity.
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14
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Han K, Francis MR, Zhang R, Wang Q, Xia A, Lu L, Yang B, Hou Z. Confidence, Acceptance and Willingness to Pay for the COVID-19 Vaccine among Migrants in Shanghai, China: A Cross-Sectional Study. Vaccines (Basel) 2021; 9:vaccines9050443. [PMID: 34063182 PMCID: PMC8147504 DOI: 10.3390/vaccines9050443] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/21/2022] Open
Abstract
Understanding the public’s attitude towards COVID-19 vaccination and their acceptance could help facilitate the COVID-19 rollout. This study aimed to assess the acceptance and willingness to pay (WTP) for the COVID-19 vaccine among migrants in Shanghai, China. A cross-sectional study was conducted among 2126 migrants in Shanghai for the period 1–20 November 2020. Convenience sampling was used to recruit respondents in workplaces with large numbers of migrant workers. Multivariable (ordered) logistic regressions were used to examine factors associated with acceptance and WTP of the COVID-19 vaccine. Most (89.1%) migrants would accept COVID-19 vaccination. Over 90.0% perceived the COVID-19 vaccine as important, while only 75.0% and 77.7% perceived vaccines safe and effective. Socio-demographic factors were not significantly associated with vaccine acceptance, but confidence in the importance (OR 8.71, 95% CI 5.89–12.89), safety (OR 1.80, 95% CI 1.24–2.61) and effectiveness (OR 2.66, 95% CI 1.83–3.87) of COVID-19 vaccine was significantly positively associated with vaccine acceptance. The top reasons for vaccine hesitancy were lack of vaccine information and confidence. The proportion of those definitely willing to get the COVID-19 vaccine was 20% lower if paid by themselves than free vaccination. Migrants were willing to pay a median amount of USD 46 for the COVID-19 vaccine. Results show that a high acceptance of the COVID-19 vaccine was universal among migrants in Shanghai. Concerns about vaccine safety, effectiveness and high costs of the COVID-19 vaccine may hinder their uptake. Effective health communication to build confidence in the COVID-19 vaccine and subsidies toward the costs of these vaccines are needed to improve uptake.
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Affiliation(s)
- Kaiyi Han
- School of Public Health, Fudan University, Shanghai 200032, China; (K.H.); (R.Z.); (Q.W.); (A.X.); (L.L.)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Mark R. Francis
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland;
| | - Ruiyun Zhang
- School of Public Health, Fudan University, Shanghai 200032, China; (K.H.); (R.Z.); (Q.W.); (A.X.); (L.L.)
| | - Qian Wang
- School of Public Health, Fudan University, Shanghai 200032, China; (K.H.); (R.Z.); (Q.W.); (A.X.); (L.L.)
| | - Aichen Xia
- School of Public Health, Fudan University, Shanghai 200032, China; (K.H.); (R.Z.); (Q.W.); (A.X.); (L.L.)
| | - Linyao Lu
- School of Public Health, Fudan University, Shanghai 200032, China; (K.H.); (R.Z.); (Q.W.); (A.X.); (L.L.)
| | - Bingyi Yang
- Division of Epidemiology and Biostatistics, The University of Hong Kong, Hong Kong 999077, China;
| | - Zhiyuan Hou
- School of Public Health, Fudan University, Shanghai 200032, China; (K.H.); (R.Z.); (Q.W.); (A.X.); (L.L.)
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
- Correspondence:
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15
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Saffar H, Khalifeloo M, Saffar MJ, Abdollahi A, Parsaei MR, Ghorbani GR, Salarvand S, Aarabi M. Measles and rubella serosusceptibity among population vaccinated with different schedules: the potential impact on measles-rubella elimination in Iran. BMC Infect Dis 2021; 21:305. [PMID: 33765968 PMCID: PMC7995582 DOI: 10.1186/s12879-021-05970-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Iranian children were vaccinated with the scheduled two doses of monovalent measles vaccine (mMV) from 1984. In December 2003, a nationwide campaign of measles-rubella (MR) immunization was established to vaccinate 5-25 year- old individuals. In 2004, the mMV was replaced with measles- mumps- rubella (MMR) vaccine. Despite the high vaccination coverage, the outbreaks of measles still occur in the country. In this Study, the MR immunity status of various age groups, vaccinated with different schedules was investigated, and the immunologic response of seronegative subjects to revaccination was examined. METHODS This cross-sectional study was conducted among 7-33-year-old healthy individuals with a documented history of measles vaccination from November 2017 to June 2018. The subjects were categorized as follows: group A, including 20-33 year-old individuals; vaccinated with 1-2 doses of mMV at ages 9 and 15 months, and revaccinated with MR, group B, including 15-19-year-old individuals, vaccinated with two doses of mMV at 9 and 15 months of age, and received additional dose of MMR upon school entrance, group C, including 11-14 year-old individuals, vaccinated with two-doses of MMR at the ages of 15 months and 6 years, and group D, including 7-10 year-old individuals vaccinated with two-doses of MMR vaccine at the ages 12 and 18 months, respectively. Levels of antimeasles- antirubella IgG antibodies in the collected sera were measured. Also antimeasles- antirubella IgM and IgG of seronegative individuals were reexamined at 4-6 weeks after MMR revaccination. The collected data were analyzed using descriptive statistical methods. RESULTS A total of 635 individuals were investigated in this study. Group A, 98; group B, 295; group C, 139; and group D, 103 persons. Overall, 12.3 and 18.4% of the population were seronegative for measles and rubella antibodies. This rate varied greatly between the 4 groups: group A, 0/0-2%; group B,15.2-25.0%; group C,11.5-17.2%; and groupD,14.6-18.4%. After revaccination, 92 and 94.9% of seronegative individuals showed IgG response to measles and rubella vaccines, respectively. CONCLUSION Despite the high coverage rate of M-R containing vaccines, a significant number of vaccinated subjects were seronegative for measles and rubella, possibly because of secondary vaccine failure; this may negatively affect measles-rubella elimination targets in the country. If these findings are confirmed in similar future studies, a more robust regional/national supplementary immunization activity will be considered.
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Affiliation(s)
- Hana Saffar
- Department of Pathology, School of medicine, IKHC, Teheran University of Medical Sciences, Tehran, Iran
| | - Maryam Khalifeloo
- Department of Pathology, School of medicine, IKHC, Teheran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Jafar Saffar
- Pediatric Infectious Diseases Research Center, communicable Diseases Institute, and Department of Pediatric Infectious Diseases, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Pasdaran Bolv, Sari, Iran
| | - Alireza Abdollahi
- Department of Pathology, School of medicine, IKHC, Teheran University of Medical Sciences, Tehran, Iran
| | | | | | - Samaneh Salarvand
- Department of Pathology, School of medicine, IKHC, Teheran University of Medical Sciences, Tehran, Iran
| | - Mohsen Aarabi
- Deputy of Health, Mazandaran University of Medical Sciences, Sari, Iran
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16
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Thunström L, Ashworth M, Finnoff D, Newbold SC. Hesitancy Toward a COVID-19 Vaccine. ECOHEALTH 2021; 18:44-60. [PMID: 34086129 PMCID: PMC8175934 DOI: 10.1007/s10393-021-01524-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 05/08/2023]
Abstract
The scientific community has come together in a mass mobilization to combat the public health risks of COVID-19, including efforts to develop a vaccine. However, the success of any vaccine depends on the share of the population that gets vaccinated. We designed a survey experiment in which a nationally representative sample of 3,133 adults in the USA stated their intentions to vaccinate themselves and their children for COVID-19. The factors that we varied across treatments were: the stated severity and infectiousness of COVID-19 and the stated source of the risk information (White House or the Centers for Disease Control). We find that 20% of people in the USA intend to decline the vaccine. We find no statistically significant effect on vaccine intentions from the severity of COVID-19. In contrast, we find that the degree of infectiousness of the coronavirus influences vaccine intentions and that inconsistent risk messages from public health experts and elected officials may reduce vaccine uptake. However, the most important determinants of COVID-19 vaccine hesitancy seem to be distrust of the vaccine safety (including uncertainty due to vaccine novelty), as well as general vaccine avoidance, as implied by not having had a flu shot in the last two years.
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Affiliation(s)
- Linda Thunström
- Department of Economics, University of Wyoming, Laramie, WY, 82071, USA.
| | - Madison Ashworth
- Department of Economics, University of Wyoming, Laramie, WY, 82071, USA
| | - David Finnoff
- Department of Economics, University of Wyoming, Laramie, WY, 82071, USA
| | - Stephen C Newbold
- Department of Economics, University of Wyoming, Laramie, WY, 82071, USA
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17
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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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18
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Rearigh L, O'Neill J, Kubat M, Sayles H, Swindells S, Bares SH. Surprisingly Low Levels of Measles Immunity in Persons With HIV: A Seroprevalence Survey in a United States HIV Clinic. Open Forum Infect Dis 2020; 7:ofaa428. [PMID: 33072815 PMCID: PMC7553243 DOI: 10.1093/ofid/ofaa428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/10/2020] [Indexed: 11/14/2022] Open
Abstract
Background Measles outbreaks have become increasingly common due to deteriorating vaccination rates, fluctuating herd immunity, and varying antibody decline. Limited knowledge exists regarding prevalence and risk factors associated with measles seronegativity among persons with HIV (PWH). Methods This was a cross-sectional study conducted at an academic HIV clinic in Omaha, Nebraska. Participants were screened for the presence of measles IgG antibody. Demographic and clinical information was obtained through electronic medical record review. Simple and multivariable logistic regressions were performed to identify risk factors for measles seronegativity. Results Three hundred fifty-one participants were enrolled, with a measles seroprevalence rate of 70.3%. The mean age (range) was 48 (20-74) years, 77% were male, and 53% were Caucasian. The mean CD4 nadir (range) was 334 (1-1675) cells/mm3. At the time of testing, 86% and 87% of the seronegative and seropositive participants had an HIV RNA <50 copies/mL, respectively. Younger age was significantly associated with measles seronegativity (P = .003), as was birth year after 1957 (P = .021). Prior history of measles infection was associated with seropositivity (P = .011). All other risk factors evaluated, including written documentation of adequate vaccination, were not associated with seronegativity. Conclusions Our study demonstrates a measles seroprevalence rate that is remarkably lower than previously reported in PWH (92%), and, more importantly, is considerably lower than the rate needed to maintain herd immunity (95%). With higher than expected seronegativity and absence of notable risk factors aside from age, our findings support expanded measles immunity screening for PWH who are at risk of measles exposure.
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Affiliation(s)
- Lindsey Rearigh
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jennifer O'Neill
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Maureen Kubat
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Harlan Sayles
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Susan Swindells
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sara H Bares
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
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19
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Ramsay LC, Crowcroft NS, Thomas S, Aruffo E, Teslya A, Heffernan JM, Gournis E, Hiebert J, Jaeger V, Jiaravuthisan M, Sharron J, Severini A, Deeks SL, Gubbay J, Mazzulli T, Sander B. Cost-effectiveness of measles control during elimination in Ontario, Canada, 2015. ACTA ACUST UNITED AC 2020; 24. [PMID: 30892178 PMCID: PMC6425553 DOI: 10.2807/1560-7917.es.2019.24.11.1800370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundGiven that measles is eliminated in Canada and measles immunisation coverage in Ontario is high, it has been questioned whether Ontario's measles outbreak response is worthwhile.AimOur objective was to determine cost-effectiveness of measles containment protocols in Ontario from the healthcare payer perspective.MethodsWe developed a decision-analysis model comparing Ontario's measles containment strategy (based on actual 2015 outbreak data) with a hypothetical 'modified response'. The modified scenario assumed 10% response costs with reduced case and contact tracing and no outbreak-associated vaccinations; it was based on local and provincial administrative and laboratory data and parameters from peer-reviewed literature. Short- and long-term health outcomes, quality-adjusted life years (QALYs) and costs discounted at 1.5%, were estimated. We conducted one- and two-way sensitivity analyses.ResultsThe 2015 outbreak in Ontario comprised 16 measles cases and an estimated 3,369 contacts. Predictive modelling suggested that the outbreak response prevented 16 outbreak-associated cases at a cost of CAD 1,213,491 (EUR 861,579). The incremental cost-effectiveness ratio was CAD 739,063 (EUR 524,735) per QALY gained for the outbreak response vs modified response. To meet the commonly accepted cost-effectiveness threshold of CAD 50,000 (EUR 35,500) per QALY gained, the outbreak response would have to prevent 94 measles cases. In sensitivity analyses, the findings were robust.ConclusionsOntario's measles outbreak response exceeds generally accepted cost-effectiveness thresholds and may not be the most efficient use of public health resources from a healthcare payer perspective. These findings should be balanced against benefits of increased vaccine coverage and maintaining elimination status.
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Affiliation(s)
- Lauren C Ramsay
- University Health Network, Eaton Building, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | | | | | | | | | - Effie Gournis
- Toronto Public Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Joanne Hiebert
- Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | | | | | | | - Alberto Severini
- University of Manitoba, Winnipeg, Manitoba, Canada.,Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Shelley L Deeks
- University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | | | - Tony Mazzulli
- University Health Network, Eaton Building, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Beate Sander
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,University Health Network, Eaton Building, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
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20
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Sundell N, Dotevall L, Lindh M, Westin J, Liljeqvist JÅ, Bergström T, Studahl M, Andersson LM. Authors' response: Measles outbreak in Gothenburg urban area, Sweden, 2017/18: lower viral load in breakthrough infections. ACTA ACUST UNITED AC 2020; 24. [PMID: 31362806 PMCID: PMC6668285 DOI: 10.2807/1560-7917.es.2019.24.30.1900478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Nicklas Sundell
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Leif Dotevall
- Department of Communicable Disease Control, Region Västra Götaland, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Westin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan-Åke Liljeqvist
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tomas Bergström
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Studahl
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars-Magnus Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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21
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Bonneton M, Antona D, Danis K, Aït-Belghiti F, Levy-Bruhl D. Are vaccinated measles cases protected against severe disease? Vaccine 2020; 38:4516-4519. [PMID: 32418790 DOI: 10.1016/j.vaccine.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/17/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We aimed to estimate vaccine effectiveness against severe measles based on the number of vaccine doses administered and the time since last vaccination. PATIENTS AND METHODS We included measles cases aged at least 2 years and born since 1980 who were notified in France between 2006 and mid-2019. We considered two severity levels (moderate, severe) and calculated adjusted relative risks (aRR) using multinomial logistic regression. RESULTS We included 10,399 cases. The risk of severe measles in two-dose vaccine recipients was 71% (aRR = 0.29 [95%CI 0.12-0.72]) and 83% (aRR = 0.17 [95%CI 0.04-0.70]) lower than in unvaccinated cases, if the time since last dose was less or more than 15 years, respectively. The risk of moderate disease followed a similar pattern. CONCLUSIONS Two-dose measles vaccination provided long-term protection against severe cases, even after vaccine failures. These findings underscore the need for compliance to the recommended measles vaccination schedule to prevent severe cases.
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Affiliation(s)
- M Bonneton
- Direction des Maladies Infectieuses, Santé Publique France, 12 rue du Val-d'Osne, 94415 Saint Maurice Cedex, France.
| | - D Antona
- Direction des Maladies Infectieuses, Santé Publique France, 12 rue du Val-d'Osne, 94415 Saint Maurice Cedex, France.
| | - K Danis
- Direction des Maladies Infectieuses, Santé Publique France, 12 rue du Val-d'Osne, 94415 Saint Maurice Cedex, France.
| | - F Aït-Belghiti
- Direction des Maladies Infectieuses, Santé Publique France, 12 rue du Val-d'Osne, 94415 Saint Maurice Cedex, France.
| | - D Levy-Bruhl
- Direction des Maladies Infectieuses, Santé Publique France, 12 rue du Val-d'Osne, 94415 Saint Maurice Cedex, France.
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22
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Carazo S, Billard MN, Boutin A, De Serres G. Effect of age at vaccination on the measles vaccine effectiveness and immunogenicity: systematic review and meta-analysis. BMC Infect Dis 2020; 20:251. [PMID: 32223757 PMCID: PMC7104533 DOI: 10.1186/s12879-020-4870-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 02/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background The objectives of this review were to evaluate the effect of age at administration of the first dose of a measles-containing vaccine (MCV1) on protection against measles and on antibody response after one- and two-dose measles vaccinations. Methods We conducted a systematic review of the PubMed/MEDLINE, Embase, Web of Science and Cochrane databases (1964–2017) to identify observational studies estimating vaccine effectiveness and/or measles attack rates by age at first vaccination as well as experimental studies comparing seroconversion by age at first vaccination. Random effect models were used to pool measles risk ratios (RR), measles odds ratios (OR) and seroconversion RR of MCV1 administered at < 9, 9–11 or ≥ 15 months compared with 12 or 12–14 months of age. Results We included 41 and 67 studies in the measles protection and immunogenicity analyses. Older age at MCV1, from 6 to ≥15 months, improved antibody response and measles protection among one-dose recipients. Pooled measles RR ranged from 3.56 (95%CI: 1.28, 9.88) for MCV1 at < 9 months to 0.48 (95%CI: 0.36, 0.63) for MCV1 at ≥15 months, both compared to 12–14 months. Pooled seroconversion RR ranged from 0.93 (95%CI: 0.90, 0.96) for MCV1 at 9–11 months to 1.03 (95%CI: 1.00, 1.06) for MCV1 at ≥15 months, both compared to 12 months. After a second dose, serological studies reported high seropositivity regardless of age at administration of MCV1 while epidemiological data based on few studies suggested lower protection with earlier age at MCV1. Conclusions Earlier age at MCV1 decreases measles protection and immunogenicity after one dose and might still have an impact on vaccine failures after two doses of measles vaccine. While two-dose vaccination coverage is most critical to interrupt measles transmission, older age at first vaccination may be necessary to keep the high level of population immunity needed to maintain it.
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Affiliation(s)
- Sara Carazo
- Department of Social and Preventive Medicine, Laval University, 1050, Avenue de la Médecine, Quebec, QC, G1V 0A6, Canada
| | - Marie-Noëlle Billard
- CHU de Québec - Université Laval Research Center, 2400, Avenue d'Estimauville, Quebec, QC, G1E 7G9, Canada
| | - Amélie Boutin
- CHU de Québec - Université Laval Research Center, 2400, Avenue d'Estimauville, Quebec, QC, G1E 7G9, Canada
| | - Gaston De Serres
- Department of Social and Preventive Medicine, Laval University, 1050, Avenue de la Médecine, Quebec, QC, G1V 0A6, Canada. .,CHU de Québec - Université Laval Research Center, 2400, Avenue d'Estimauville, Quebec, QC, G1E 7G9, Canada. .,Institut National de Santé Publique du Québec, 2400, Avenue d'Estimauville, Quebec, QC, G1E 7G9, Canada.
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van Dam A, Woudenberg T, de Melker H, Wallinga J, Hahné S. Effect of vaccination on severity and infectiousness of measles during an outbreak in the Netherlands, 2013-2014. Epidemiol Infect 2020; 148:e81. [PMID: 32200773 PMCID: PMC7189345 DOI: 10.1017/s0950268820000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/28/2020] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
An outbreak of measles in the Netherlands in 2013-2014 provided an opportunity to assess the effect of MMR vaccination on severity and infectiousness of measles.Measles is notifiable in the Netherlands. We used information on vaccination, hospitalisation, complications, and most likely source(s) of infection from cases notified during the outbreak. When a case was indicated as a likely source for at least one other notified case, we defined it as infectious. We estimated the age-adjusted effect of vaccination on severity and infectiousness with logistic regression.Of 2676 notified cases, 2539 (94.9%) were unvaccinated, 121 (4.5%) were once-vaccinated and 16 (0.6%) were at least twice-vaccinated; 328 (12.3%) cases were reported to have complications and 172 (6.4%) cases were hospitalised. Measles in twice-vaccinated cases led less often to complications and/or hospitalisation than measles in unvaccinated cases (0% and 14.5%, respectively, aOR 0.1 (95% CI 0-0.89), P = 0.03). Of unvaccinated, once-vaccinated and twice-vaccinated cases, respectively, 194 (7.6%), seven (5.1%) and 0 (0%) were infectious. These differences were not statistically significant (P > 0.05).Our findings suggest a protective effect of vaccination on the occurrence of complications and/or hospitalisation as a result of measles and support the WHO recommendation of a two-dose MMR vaccination schedule.
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Affiliation(s)
- A.S.G. van Dam
- Department of infectious diseases, GGD Hart voor Brabant, ‘s-Hertogenbosch, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - T. Woudenberg
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - H.E. de Melker
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - J. Wallinga
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - S.J.M. Hahné
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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24
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Savage RD, Rosella LC, Crowcroft NS, Horn M, Khan K, Holder L, Varia M. Direct Medical Costs of 3 Reportable Travel-Related Infections in Ontario, Canada, 2012-2014. Emerg Infect Dis 2019; 25:1501-1510. [PMID: 31310226 PMCID: PMC6649327 DOI: 10.3201/eid2508.190222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Immigrants traveling to their birth countries to visit friends or relatives are disproportionately affected by travel-related infections, in part because most preventive travel health services are not publicly funded. To help identify cost-effective policies to reduce this disparity, we measured the medical costs (in 2015 Canadian dollars) of 3 reportable travel-related infectious diseases (hepatitis A, malaria, and enteric fever) that accrued during a 3-year period (2012-2014) in an ethnoculturally diverse region of Canada (Peel, Ontario) by linking reportable disease surveillance and health administrative data. In total, 318 case-patients were included, each matched with 2 controls. Most spending accrued in inpatient settings. Direct healthcare spending totaled $2,058,196; the mean attributable cost per case was $6,098 (95% CI $5,328-$6,868) but varied by disease (range $4,558-$7,852). Costs were greatest for enteric fever. Policies that address financial barriers to preventive health services for high-risk groups should be evaluated.
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25
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Bolotin S, Crowcroft NS, Hughes SL, De Serres G. Letter to the editor: Measles outbreak in Gothenburg urban area, Sweden, 2017 to 2018: low viral load in breakthrough infections. Euro Surveill 2019; 24. [PMID: 31362810 PMCID: PMC6668287 DOI: 10.2807/1560-7917.es.2019.24.30.1900465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shelly Bolotin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King’s College Circle, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Canada
| | - Natasha S Crowcroft
- ICES, 2075 Bayview Ave, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King’s College Circle, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Canada
| | - Stephanie L Hughes
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Canada
| | - Gaston De Serres
- Laval University, Quebec, Canada
- Institut National de Santé Publique du Québec, Québec, Canada
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26
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Bhattacharyya S, Vutha A, Bauch CT. The impact of rare but severe vaccine adverse events on behaviour-disease dynamics: a network model. Sci Rep 2019; 9:7164. [PMID: 31073195 PMCID: PMC6509123 DOI: 10.1038/s41598-019-43596-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/25/2019] [Indexed: 12/02/2022] Open
Abstract
The propagation of rumours about rare but severe adverse vaccination or infection events through social networks can strongly impact vaccination uptake. Here we model a coupled behaviour-disease system where individual risk perception regarding vaccines and infection are shaped by their personal experiences and the experiences of others. Information about vaccines and infection either propagates through the network or becomes available through globally available sources. Dynamics are studied on a range of network types. Individuals choose to vaccinate according to their personal perception of risk and information about infection prevalence. We study events ranging from common and mild, to severe and rare. We find that vaccine and infection adverse events have asymmetric impacts. Vaccine (but not infection) adverse events may significantly prolong the tail of an outbreak. Similarly, introducing a small risk of a vaccine adverse event may cause a steep decline in vaccine coverage, especially on scale-free networks. Global dissemination of information about infection prevalence boosts vaccine coverage more than local dissemination. Taken together, these findings highlight the dangers associated with vaccine rumour propagation through scale-free networks such as those exhibited by online social media, as well as the benefits of disseminating public health information through mass media.
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Affiliation(s)
- Samit Bhattacharyya
- Department of Mathematics, School of Natural Sciences, Shiv Nadar University, Greater Noida, India.
| | - Amit Vutha
- ICTS, Tata Institute for Fundamental Research, Bangalore, India.
| | - Chris T Bauch
- Department of Applied Mathematics, University of Waterloo, Waterloo, Canada.
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Carroll MW, Kuenzig ME, Mack DR, Otley AR, Griffiths AM, Kaplan GG, Bernstein CN, Bitton A, Murthy SK, Nguyen GC, Lee K, Cooke-Lauder J, Benchimol EI. The Impact of Inflammatory Bowel Disease in Canada 2018: Children and Adolescents with IBD. J Can Assoc Gastroenterol 2018; 2:S49-S67. [PMID: 31294385 PMCID: PMC6512244 DOI: 10.1093/jcag/gwy056] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/30/2018] [Indexed: 12/15/2022] Open
Abstract
Canada has among the highest rates of childhood-onset IBD in the world. Over 7000 children and youth under 18 years old are living with IBD in Canada, and 600 to 650 children under 16 years old are diagnosed annually. While the peak age of onset of IBD is highest in the second and third decades of life, over the past two decades incidence has risen most rapidly in children under 5 years old. The treatment of children with IBD presents important challenges including therapeutic choices, risk of adverse events to medications, psychosocial impact on the child and family, increased cost of health care and the implications of the transition from pediatric to adult care. Despite the unique circumstances faced by children and their families, there is a lack of research to help understand the causes of the rising incidence and the best therapies for children with IBD. Scientific evidence—and specifically clinical trials of pharmaceuticals—are too often extrapolated from adult research. Health care providers must strive to understand the unique impact of childhood-onset IBD on patients and families, while researchers must expand work to address the important needs of this growing patient population. Highlights Key Summary Points Gaps in Knowledge and Future Research Directions
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Affiliation(s)
- Matthew W Carroll
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - M Ellen Kuenzig
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Children's Hospital of Eastern Ontario IBD Centre, Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - David R Mack
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Children's Hospital of Eastern Ontario IBD Centre, Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Anthony R Otley
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Division of Gastroenterology and Nutrition, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne M Griffiths
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,SickKids IBD Centre, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Gilaad G Kaplan
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta Canada
| | - Charles N Bernstein
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alain Bitton
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,McGill IBD Centre of Excellence, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sanjay K Murthy
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Ottawa Hospital Research Institute, Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Geoffrey C Nguyen
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Mount Sinai Hospital Centre for IBD, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kate Lee
- Crohn's and Colitis Canada, Toronto, Ontario, Canada
| | | | - Eric I Benchimol
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Children's Hospital of Eastern Ontario IBD Centre, Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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28
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Loeb M, Russell ML, Neupane B, Thanabalan V, Singh P, Newton J, Pullenayegum E. A randomized, blinded, placebo-controlled trial comparing antibody responses to homeopathic and conventional vaccines in university students. Vaccine 2018; 36:7423-7429. [PMID: 30352746 DOI: 10.1016/j.vaccine.2018.08.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Homeopathic vaccines are licensed in many countries but scientific data to support their use are sparse. The goal of this study was to compare the antibody response of homeopathic and conventional vaccines and placebo in young adults. We hypothesized that there would be no significant difference between homeopathic vaccines and placebo, while there would be a significant increase in antibodies in those received conventional vaccines. METHODS A randomized blinded placebo-controlled trial was conducted where 150 university students who had received childhood vaccinations were assigned to diphtheria, pertussis, tetanus, mumps, measles homeopathic vaccine, placebo, or conventional diphtheria, pertussis, tetanus (Tdap) and mumps, measles, rubella (MMR) vaccines. The primary outcome was a ≥ two-fold increase in antibodies from baseline following vaccination as measured by ELISA. Participants, investigators, study coordinator, data blood drawers, laboratory technician, and data analyst were blinded. RESULTS None of the participants in either the homeopathic vaccine or the placebo group showed a ≥ two-fold response to any of the antigens. In contrast, of those vaccinated with Tdap, 68% (33/48) had a ≥ two-fold response to diphtheria, 83% (40/48) to pertussis toxoid, 88% (42/48) to tetanus, and 35% (17/48) of those vaccinated with MMR had a response to measles or mumps antigens (p < 0.001 for each comparison of conventional vaccine to homeopathic vaccine or to placebo). There was a significant increase in geometric mean titres of antibody from baseline for conventional vaccine antigens (p < 0.001 for each), but none for the response to homeopathic antigens or placebo. CONCLUSIONS Homeopathic vaccines do not evoke antibody responses and produce a response that is similar to placebo. In contrast, conventional vaccines provide a robust antibody response in the majority of those vaccinated. TRIAL REGISTRY NCT 02825368.
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Affiliation(s)
- Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada; Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada; Institute for Infectious Diseases Research, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada.
| | - Margaret L Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive W Calgary, Alberta T2N4Z6, Canada
| | - Binod Neupane
- Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada
| | - Vitheya Thanabalan
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada
| | - Pardeep Singh
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada
| | - Jennifer Newton
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St West, MDCL 3208 Hamilton, Ontario L8S 4K1, Canada
| | - Eleanor Pullenayegum
- Hospital for Sick Childrene, 555 University Avenue Toronto, Ontario M5G 1X8, Canada
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The tip of the iceberg: incompleteness of measles reporting during a large outbreak in The Netherlands in 2013-2014. Epidemiol Infect 2018; 147:e23. [PMID: 30298798 DOI: 10.1017/s0950268818002698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Measles is a notifiable disease, but not everyone infected seeks care, nor is every consultation reported. We estimated the completeness of reporting during a measles outbreak in The Netherlands in 2013-2014. Children below 15 years of age in a low vaccination coverage community (n = 3422) received a questionnaire to identify measles cases. Cases found in the survey were matched with the register of notifiable diseases to estimate the completeness of reporting. Second, completeness of reporting was assessed by comparing the number of susceptible individuals prior to the outbreak with the number of reported cases in the surveyed community and on a national level.We found 307 (15%) self-identified measles cases among 2077 returned questionnaires (61%), of which 27 could be matched to a case reported to the national register; completeness of reporting was 8.8%. Based on the number of susceptible individuals and number of reported cases in the surveyed community and on national level, the completeness of reporting was estimated to be 9.1% and 8.6%, respectively. Estimating the completeness of reporting gave almost identical estimates, which lends support to the credibility and validity of both approaches. The size of the 2013-2014 outbreak approximated 31 400 measles infections.
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30
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Gastañaduy PA, Funk S, Paul P, Tatham L, Fisher N, Budd J, Fowler B, de Fijter S, DiOrio M, Wallace GS, Grenfell B. Impact of Public Health Responses During a Measles Outbreak in an Amish Community in Ohio: Modeling the Dynamics of Transmission. Am J Epidemiol 2018; 187:2002-2010. [PMID: 29635277 PMCID: PMC6118071 DOI: 10.1093/aje/kwy082] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 11/14/2022] Open
Abstract
We quantified measles transmissibility during a measles outbreak in Ohio in 2014 to evaluate the impact of public health responses. Case incidence and the serial interval (time between symptom onset in primary cases and secondary cases) were used to assess trends in the effective reproduction number R (the average number of secondary cases generated per case). A mathematical model was parameterized using early R values to determine the size and duration of the outbreak that would have occurred if containment measures had not been initiated, as well as the impact of vaccination. As containment started, we found a 4-fold decline in R (from approximately 4 to 1) over the course of 2 weeks and maintenance of R < 1 as control measures continued. Under a conservative scenario, the model estimated 8,472 cases (90% confidence interval (CI): 8,447, 8,489) over 195 days (90% CI: 179, 223) without control efforts and 715 cases (90% CI: 103, 1,338) over 128 days (90% CI: 117, 139) when vaccination was included; 7,757 fewer cases (90% CI: 7,130, 8,365) and 67 fewer outbreak days (90% CI: 48, 98) were attributed to vaccination. Vaccination may not account entirely for transmission reductions, suggesting that changes in community behavior (social distancing) and other control efforts (isolation, quarantining) are important. Our findings highlight the benefits of measles outbreak response and of understanding behavior change dynamics.
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Affiliation(s)
- Paul A Gastañaduy
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Prabasaj Paul
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | - Gregory S Wallace
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bryan Grenfell
- Department of Ecology and Evolutionary Biology, Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey
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Komabayashi K, Seto J, Tanaka S, Suzuki Y, Ikeda T, Onuki N, Yamada K, Ahiko T, Ishikawa H, Mizuta K. The Largest Measles Outbreak, Including 38 Modified Measles and 22 Typical Measles Cases in Its Elimination Era in Yamagata, Japan, 2017. Jpn J Infect Dis 2018; 71:413-418. [PMID: 29962488 DOI: 10.7883/yoken.jjid.2018.083] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The incidence of modified measles (M-Me), characterized by milder symptoms than those of typical measles (T-Me), has been increasing in Japan. However, the outbreak dominated by M-Me cases has not been thoroughly investigated worldwide. The largest importation-related outbreak of measles with genotype D8 occurred in Yamagata Prefecture, Japan, from March to April 2017. This phenomenon was observed after Japan had achieved measles elimination in 2015. We confirmed 60 cases by detecting the genome of the measles virus (MeV). Among the cases, 38 were M-Me and 22 were T-Me. Thirty-nine (65.0%) patients were 20-39 years of age. Three out of 7 primary cases produced 50 transmissions, of which each patient caused 9-25 transmissions. These patients were 22-31 years old and were not vaccinated. Moreover, they developed T-Me and kept contact with the public during their symptomatic periods. Considering that M-Me is generally caused by vaccine failure, some individuals in Japan may have insufficient immunity for MeV. Accordingly, additional doses of measles vaccine may be necessary in preventing measles importation and endemicity among individuals aged 20-39 years. Furthermore, to accurately and promptly diagnose individuals with measles, particularly those who can be considered as primary cases, efforts must be exerted to detect all measles cases using epidemiological and genetic approaches in countries where measles elimination had been achieved.
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Affiliation(s)
| | - Junji Seto
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
| | - Shizuka Tanaka
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
| | - Yu Suzuki
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
| | - Tatsuya Ikeda
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
| | - Noriko Onuki
- Yamagata Prefecture Division of Health and Welfare Planning
| | | | - Tadayuki Ahiko
- Department of Microbiology, Yamagata Prefectural Institute of Public Health.,Murayama Public Health Center
| | | | - Katsumi Mizuta
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
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Rivadeneira MF, Bassanesi SL, Fuchs SC. Role of health determinants in a measles outbreak in Ecuador: a case-control study with aggregated data. BMC Public Health 2018; 18:269. [PMID: 29458349 PMCID: PMC5819223 DOI: 10.1186/s12889-018-5163-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/07/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In 2011-2012, an outbreak of measles occurred in Ecuador. This study sought to ascertain which population characteristics were associated. METHODS Case-control study of aggregate data. The unit of analysis was the parish (smallest geographic division). The national communicable disease surveillance database was used to identify 52 case parishes (with at least one confirmed case of measles) and 972 control parishes (no cases of measles). A hierarchical model was used to determine the association of measles with population characteristics and access to health care. RESULTS Case parishes were mostly urban and had a higher proportion of children under 1 year of age, heads of household with higher educational attainment, larger indigenous population, lower rates of measles immunization, and lower rates of antenatal care visit attendance. On multivariate analysis, associations were found with educational attainment of head of household ≥8 years (OR: 0.29; 95%CI 0.15-0.57) and ≥1.4% indigenous population (OR: 3.29; 95%CI 1.63-6.68). Antenatal care visit attendance had a protective effect against measles (OR: 0.98; 95%CI 0.97-0.99). Measles vaccination was protective of the outbreak (OR: 0.97; 95%CI 0.95-0.98). The magnitude of these associations was modest, but represents the effect of single protective factors, capable of acting at the population level regardless of socioeconomic, biological, and environmental confounding factors. CONCLUSION In Ecuador, the parishes with the highest percentage of indigenous populations and those with the lowest vaccination coverage were the most vulnerable during the measles outbreak.
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Affiliation(s)
- María F. Rivadeneira
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Av. 12 de octubre 1076 y Roca, Quito, Ecuador
| | - Sérgio L. Bassanesi
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sandra C. Fuchs
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Public health response to a measles outbreak on a university campus in Australia, 2015. Epidemiol Infect 2018; 146:314-318. [PMID: 29338804 DOI: 10.1017/s0950268817003089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This report describes the effective public health response to a measles outbreak involving a university campus in Brisbane, Australia. Eleven cases in total were notified, mostly university students. The public health response included targeted measles vaccination clinics which were established on campus and focused on student groups most likely to have been exposed. The size of the university population, social interaction between students on and off campus, as well as limited vaccination records for the university community presented challenges for the control of this extremely infectious illness. We recommend domestic students ensure vaccinations are current prior to matriculation. Immunisation information should be included in university student enrolment packs. Incoming international students should ensure routine vaccinations are up-to-date prior to arrival in Australia, thereby reducing the risk of importation of measles and other infectious diseases.
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Ferreira CSM, Perin MCAA, Moraes-Pinto MID, Simão-Gurge RM, Goulart AL, Weckx LY, dos Santos AMN. Humoral immune response to measles and varicella vaccination in former very low birth weight preterm infants. Braz J Infect Dis 2018; 22:41-46. [PMID: 29306654 PMCID: PMC9425665 DOI: 10.1016/j.bjid.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 12/19/2017] [Indexed: 11/01/2022] Open
Abstract
Introduction Objectives Methods Results Conclusions
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Bichon A, Aubry C, Benarous L, Drouet H, Zandotti C, Parola P, Lagier JC. Case report: Ribavirin and vitamin A in a severe case of measles. Medicine (Baltimore) 2017; 96:e9154. [PMID: 29390321 PMCID: PMC5815733 DOI: 10.1097/md.0000000000009154] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Despite a vaccine being widely available, measles continues to occur frequently, with sometimes lethal consequences. PATIENTS CONCERNS The mortality rate reaches 35% and measles represents 44% of the 1.4 million deaths which are due to preventable diseases. Severe forms of measles are reported, mainly in young, unvaccinated adults, and in specific populations. The risk factors for severe measles include no or incomplete vaccination and vitamin A deficiency. Apart from secondary measles-related infections, severe measles is mainly represented by neurological, respiratory, and digestive symptoms. DIAGNOSES Strengthening the hypothesis that there is a link between vitamin A deficiency and severe measles in this paper we report the case of a 25-year-old unvaccinated man hospitalized for severe and complicated measles. OUTCOMES The evolution was good after administration of intramuscular vitamin A as well as intravenous ribavirin. LESSONS Measles remains a fatal and serious disease. The early use of ribavirin and vitamin A shows significant improvements regarding morbimortality and should be systematic in severe cases.
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Affiliation(s)
- Amandine Bichon
- Aix Marseille Univ, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, Marseille Cedex 5
| | - Camille Aubry
- Aix Marseille Univ, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, Marseille Cedex 5
| | - Lucas Benarous
- Assistance Publique Hôpitaux de Marseille, CHU Timone, Service de réanimation médicale, Marseille, France
| | - Hortense Drouet
- Aix Marseille Univ, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, Marseille Cedex 5
| | - Christine Zandotti
- Aix Marseille Univ, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, Marseille Cedex 5
| | - Philippe Parola
- Aix Marseille Univ, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, Marseille Cedex 5
| | - Jean-Christophe Lagier
- Aix Marseille Univ, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, Marseille Cedex 5
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Billard MN, De Serres G, Gariépy MC, Boulianne N, Toth E, Landry M, Skowronski DM. Prevalence of risk factors for acquiring measles during the 2011 outbreak in Quebec and impact of the province-wide school-based vaccination campaign on population immunity. PLoS One 2017; 12:e0186070. [PMID: 29020069 PMCID: PMC5636119 DOI: 10.1371/journal.pone.0186070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/25/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A large measles outbreak occurred in Quebec, Canada, in 2011. Although nearly two-thirds of the cases occurred in only two health districts, a mass vaccination campaign targeting all Quebec elementary and high school students without valid two-dose history was undertaken to prevent future outbreaks. We compared rates of non-vaccination and age at first measles vaccine dose among students in the two most-affected districts and the rest of the province and estimated the improvement in overall student measles immunity due to the mass school-based vaccination campaign. METHODS Data were extracted from the provincial vaccination registry for students in kindergarten to grade 11 during the 2011/2012 school year. A telephone survey was conducted in three sub-groups: students whose first measles vaccine dose recorded in the vaccination registry was received during the 2011 school vaccination campaign; students with no dose recorded in the registry whose parents refused receipt during the school campaign; and students with no dose recorded in the registry and no information about parental consent/refusal during the school campaign. RESULTS Neither the prevalence of being non-vaccinated nor a younger age at first pediatric dose were higher in the two most-affected districts versus the rest of the province. The school campaign vaccinated nearly 8% of all students including 7% who previously received at least one dose. Before the outbreak, 3% of students were not vaccinated and one-third of these (1%/3%) were vaccinated during the campaign. The campaign likely increased the absolute school population immunity by just 1.7%. CONCLUSION The concentration of measles cases in the two most-affected health districts during the large Quebec outbreak is not explained by more students who were unvaccinated or who had received their first vaccine dose at a younger age. The vaccination campaign reached one-third of unvaccinated students and only marginally improved population immunity.
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Affiliation(s)
| | - Gaston De Serres
- Centre de recherche du CHU de Québec—Université Laval, Quebec City, QC, Canada
- Institut national de santé publique du Québec, Quebec City, QC, Canada
| | | | - Nicole Boulianne
- Centre de recherche du CHU de Québec—Université Laval, Quebec City, QC, Canada
- Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Eveline Toth
- Ministère de la santé et des services sociaux du Québec, Montreal, QC, Canada
| | - Monique Landry
- Ministère de la santé et des services sociaux du Québec, Montreal, QC, Canada
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Carazo Perez S, De Serres G, Bureau A, Skowronski DM. Reduced Antibody Response to Infant Measles Vaccination: Effects Based on Type and Timing of the First Vaccine Dose Persist After the Second Dose. Clin Infect Dis 2017; 65:1094-1102. [PMID: 28595358 DOI: 10.1093/cid/cix510] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 06/07/2017] [Indexed: 04/06/2024] Open
Abstract
Background The effect of age at first dose on the immunogenicity of a 2-dose pediatric schedule of measles-mumps-rubella (MMR) or measles-mumps-rubella-varicella (MMRV) vaccine was assessed in children born to mostly vaccinated mothers. Methods Immunogenicity data among children given their first measles vaccine dose between 11 and 22 months of age were pooled from 5 randomized controlled trials conducted in Europe and the United States between 2004 and 2010. Measles antibody titers were measured by enzyme-linked immunosorbent assay before and after each dose; geometric mean concentrations (GMCs) and the proportion seronegative (GMC <150 mIU/mL) were derived by age at first dose. Results Among 5542 children given a first measles vaccine dose at 11, 12, 13-14, and 15-22 months of age, the proportion seronegative decreased from 8.5% to 3.2%, 2.4%, and 1.5%, respectively (P < .001), whereas GMCs increased with older age measles vaccine initiation (P < .001). MMRV induced higher GMCs than MMR (P < .001). First and second dose GMCs were highly correlated (Spearman coefficient = 0.8). Conclusions As previously noted among infants born to mothers with history of wild-type measles, antibody responses among children born to vaccinated mothers were reduced based on earlier administration of their first measles vaccine dose at ≤12 vs ≥15 months of age. Negative effects of earlier age at first measles vaccine dose persisted after the second dose. The measles elimination goal may require a careful balance between earlier infant protection and the risk of reduced antibody responses and secondary vaccine failure among successive birth cohorts systematically initiated to measles vaccination <15 months of age.
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Affiliation(s)
| | - Gaston De Serres
- Department of Social and Preventive Medicine, Laval University
- Institut National de Santé Publique du Québec
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Bocquier A, Ward J, Raude J, Peretti-Watel P, Verger P. Socioeconomic differences in childhood vaccination in developed countries: a systematic review of quantitative studies. Expert Rev Vaccines 2017; 16:1107-1118. [PMID: 28914112 DOI: 10.1080/14760584.2017.1381020] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The reasons for vaccine hesitancy and its relation to individual socioeconomic status (SES) must be better understood. Areas covered: This review focused on developed countries with programs addressing major financial barriers to vaccination access. We systematically reviewed differences by SES in uptake of publicly funded childhood vaccines and in cognitive determinants (beliefs, attitudes) of parental decisions about vaccinating their children. Using the PRISMA statement to guide this review, we searched three electronic databases from January 2000 through April 2016. We retained 43 articles; 34 analyzed SES differences in childhood vaccine uptake, 7 examined differences in its cognitive determinants, and 2 both outcomes. Expert commentary: Results suggest that barriers to vaccination access persist among low-SES children in several settings. Vaccination programs could be improved to provide all mandatory and recommended vaccines 100% free of charge, in both public organizations and private practices, and to reimburse vaccine administration. Multicomponent interventions adapted to the context could also be effective in reducing these inequalities. For specific vaccines (notably for measles, mumps, and rubella), in UK and Germany, uptake was lowest among the most affluent. Interventions carefully tailored to respond to specific concerns of vaccine-hesitant parents, without reinforcing hesitancy, are needed.
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Affiliation(s)
- Aurélie Bocquier
- a Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information , Marseille , France.,b ORS PACA, Southeastern Health Regional Observatory , Marseille , France
| | - Jeremy Ward
- a Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information , Marseille , France.,c UMR 8236 (LIED) , Université Paris Diderot , Paris , France
| | - Jocelyn Raude
- d UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille University - IRD 190 - Inserm 1207 - EHESP) , Marseille , France.,e UMR PIMIT, INSERM 1187, CNRS 9192, IRD 249. Plateforme Technologique CYROI , Université de La Réunion , Réunion , France
| | - Patrick Peretti-Watel
- a Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information , Marseille , France.,b ORS PACA, Southeastern Health Regional Observatory , Marseille , France
| | - Pierre Verger
- a Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information , Marseille , France.,b ORS PACA, Southeastern Health Regional Observatory , Marseille , France
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Determinants of under-immunization and cumulative time spent under-immunized in a Quebec cohort. Vaccine 2017; 35:5924-5931. [PMID: 28882440 DOI: 10.1016/j.vaccine.2017.08.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Under-immunization refers to a state of sub-optimal protection against vaccine preventable diseases. Vaccine coverage for age may not capture intentional or non-intentional spacing of vaccines in the recommended provincial immunization guidelines. We aimed to identify factors associated with coverage and under-immunization and to determine the number of days during which children were under-immunized during their first 24months of life. METHODS Secondary analysis of children ≤3years recruited through active surveillance for gastroenteritis from three Quebec pediatric emergency departments from 2012 to 2014. Vaccination status for children at least 24months of age was determined using provincial immunization guidelines. Cumulative days under-immunized were calculated for DTaP-VPI-Hib, PCV, MMR, and Men-C-C. Factors associated with up-to-date (UTD) status at 24months of life and for under-immunization ≥6months were analyzed using logistic regression. RESULTS Of 246 eligible children, 180 (73%) were UTD by 24months of life. The mean cumulative days under-immunized for MMR was 107days, for PCV 209days, for Men-C-C 145days, and for DTaP-VPI-Hib 227days. Overall, 149 children (60%) experienced delay for at least 1 vaccine. Factors associated with both an UTD status at 24months and concurrently associated with being under-immunization ≥6months, included timely initiation of immunization (OR=5.85; 95% CI: 2.80-12.22) and (OR=0.13; 95% CI: 0.07-0.24), failure to co-administer 18-month vaccines (OR=0.15; 95% CI: 0.10-0.21) and (OR=3.29; 95% CI: 2.47-4.39), and having a household with ≥3 children under 18years ((OR=0.50; 0.28-0.86) and (OR=2.99; 1.45-6.22), respectively. CONCLUSION Paired with an unexpected low level of coverage at 24months of life, the majority of our cohort also experienced a state of under-immunization for a least one vaccine. Estimates of coverage do not capture intentional or non-intentional gaps in protection from vaccine preventable illnesses. Timely preventive care should be prioritized.
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Le système d’innocuité vaccinale canadien en huit étapes : des notions pour les travailleurs de la santé. Paediatr Child Health 2017; 22:e17-e20. [PMCID: PMC5804923 DOI: 10.1093/pch/pxx074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Parce qu’ils s’inquiètent de l’innocuité vaccinale, certains parents hésitent à faire vacciner leurs enfants. Les professionnels de la santé jouent un rôle déterminant auprès des parents pour leur faire comprendre que le Canada est un chef de file en matière d’innocuité vaccinale. Le présent point de pratique fournit une mise à jour des huit étapes du système d’innocuité vaccinale canadien : 1) une analyse pré-homologation et un processus d’approbation fondés sur des données probantes; 2) une réglementation rigoureuse pour les fabricants; 3) des recommandations indépendantes et fondées sur des données probantes à l’égard de l’utilisation des vaccins; 4) la formation et les normes sur les compétences en matière d’immunisation pour les travailleurs de la santé; 5) des programmes de pharmacovigilance pour déceler et 6) déterminer la causalité des effets secondaires suivant l'immunisation (ESSI); 7) un programme pour la détection des signaux relatifs à l’innocuité et à l’efficacité vaccinales; et 8) les cliniques de vaccination spéciales du Réseau de recherche canadien sur l’immunisation pour les enfants qui ont été victimes de graves ESSI.
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MacDonald NE, Law BJ. Canada's eight-component vaccine safety system: A primer for health care workers. Paediatr Child Health 2017; 22:e13-e16. [PMID: 29507505 DOI: 10.1093/pch/pxx073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Concerns about vaccine safety make some parents hesitant about immunization. Health care providers are pivotal in helping parents understand that Canada is a leader in vaccine safety. The present practice point provides an update on the eight components of Canada's vaccine safety system: (1) an evidence-based pre-license review and approval process; (2) strong regulations for manufacturers; (3) independent evidence-based vaccine use recommendations; (4) immunization competency training and standards for health care providers; (5) pharmacovigilance programs to detect and (6) determine causality of adverse events following immunization (AEFIs); (7) a program for vaccine safety and efficacy signal detection; and (8) the Canadian Immunization Research Network's special immunization clinics for children who have experienced serious AEFIs.
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Affiliation(s)
- Noni E MacDonald
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario
| | - Barbara J Law
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario
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Davoodian P, Atashabparvar A, Dadvand H, Hosseinpour M, Daryanavard A, Safari R, Rastegar A, Khajeh E, Mahboobi H. A report of outbreaks of measles on the southern coast of Iran from 2009 to 2015. Electron Physician 2017; 9:3997-4002. [PMID: 28461876 PMCID: PMC5407234 DOI: 10.19082/3997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022] Open
Abstract
Introduction Immunogenicity assessment figures of the measles vaccine is approximately 90%, and decreases over time. Therefore, the immunity level of measles vaccine is variable which can result in outbreaks of measles in a population. The aim of current study was to report the outbreaks of measles in Hormozgan province from 2009 to 2015. Methods This cross-sectional study was carried out in Hormozgan Province on the southern coast of Iran. The documented data of all cases suspected of measles are included in this study. We used a checklist including gender, age, area, place of residence, contact history, and vaccination status to extract required data. Data was analyzed using IBM SPSS statistics software version 21.0. Results Eight hundred fifty-one suspicious cases of measles were determined from 2006 to 2015. Of those, 135 infected cases were reported. Among patients, 49% were male, 79% were Iranian, 18% were Afghans, and 3 % were Indians or Pakistanis. Also, 31% of cases were reported from Bandar Abbas, 25% were reported from Minab, 18% from Qeshm, 17 % from Jask and other cases were reported from other areas of the Hormozgan Province. Thirty percent of the cases were reported from urban areas. Conclusion A high percentage of cases with measles in rural areas were reported in the areas which were covered by complete vaccination. This shows interruption of cold continuum. Also, increasing the number of under one-years-old cases reported, could be due to poor nutritional status of the children and insufficient immunization of mothers. Further studies are required for identifying the causes of cold continuum interruption. Further studies are required for the assessment of immunization in children and mothers and various vaccination protocols.
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Affiliation(s)
- Parivash Davoodian
- M.D., Assistant Professor of Infectious Diseases, Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ali Atashabparvar
- M.D., Anatomical and Clinical Pathology, Fellowship of Molecular Pathology and Cytogenetic, Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Habib Dadvand
- M.D., General Physician, Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mahmoud Hosseinpour
- M.D., General Physician, Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ali Daryanavard
- M.D., Cardiology Resident, Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Reza Safari
- M.D., General Physician, Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abdolsalam Rastegar
- B.Sc., in Health Sciences, Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ebrahim Khajeh
- M.D., General Physician, Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hamidreza Mahboobi
- M.D., Internal Medicine Resident, Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Binkhamis K, Gillis H, Lafreniere JD, Hiebert J, Mendoza L, Pettipas J, Severini A, Hatchette TF, LeBlanc JJ. Comparison of monoplex and duplex RT-PCR assays for the detection of measles virus. J Virol Methods 2016; 239:58-60. [PMID: 27838260 DOI: 10.1016/j.jviromet.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/04/2016] [Accepted: 11/05/2016] [Indexed: 11/25/2022]
Abstract
Rapid and accurate detection of measles virus is important for case diagnosis and public health management. This study compared the performance of two monoplex RT-PCR reactions targeting the H and N genes to a duplex RT-PCR targeting both genes simultaneously. The duplex simplified processing without compromising assay performance characteristic.
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Affiliation(s)
- Khalifa Binkhamis
- Nova Scotia Health Authority (NSHA) and Dalhousie University, Halifax, NS, Canada
| | - Hayley Gillis
- Nova Scotia Health Authority (NSHA) and Dalhousie University, Halifax, NS, Canada
| | | | - Joanne Hiebert
- Viral Exanthemata and STDs, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, MB, Canada
| | - Lillian Mendoza
- Viral Exanthemata and STDs, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, MB, Canada
| | - Janice Pettipas
- Nova Scotia Provincial Public Health Laboratory Network (PPHLN), Halifax, NS, Canada
| | - Alberto Severini
- Viral Exanthemata and STDs, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, MB, Canada
| | - Todd F Hatchette
- Nova Scotia Health Authority (NSHA) and Dalhousie University, Halifax, NS, Canada
| | - Jason J LeBlanc
- Nova Scotia Health Authority (NSHA) and Dalhousie University, Halifax, NS, Canada.
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Chun BC. Understanding and Modeling the Super-spreading Events of the Middle East Respiratory Syndrome Outbreak in Korea. Infect Chemother 2016; 48:147-9. [PMID: 27433389 PMCID: PMC4945728 DOI: 10.3947/ic.2016.48.2.147] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Byung Chul Chun
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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Holzmann H, Hengel H, Tenbusch M, Doerr HW. Eradication of measles: remaining challenges. Med Microbiol Immunol 2016; 205:201-8. [PMID: 26935826 PMCID: PMC4866980 DOI: 10.1007/s00430-016-0451-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/11/2016] [Indexed: 12/11/2022]
Abstract
Measles virus (MeV) is an aerosol-borne and one of the most contagious pathogenic viruses known. Almost every MeV infection becomes clinically manifest and can lead to serious and even fatal complications, especially under conditions of malnutrition in developing countries, where still 115,000 to 160,000 patients die from measles every year. There is no specific antiviral treatment. In addition, MeV infections cause long-lasting memory B and T cell impairment, predisposing people susceptible to opportunistic infections for years. A rare, but fatal long-term consequence of measles is subacute sclerosing panencephalitis. Fifteen years ago (2001), WHO has launched a programme to eliminate measles by a worldwide vaccination strategy. This is promising, because MeV is a human-specific morbillivirus (i.e. without relevant animal reservoir), safe and potent vaccine viruses are sufficiently produced since decades for common application, and millions of vaccine doses have been used globally without any indications of safety and efficacy issues. Though the prevalence of wild-type MeV infection has decreased by >90 % in Europe, measles is still not eliminated and has even re-emerged with recurrent outbreaks in developed countries, in which effective vaccination programmes had been installed for decades. Here, we discuss the crucial factors for a worldwide elimination of MeV: (1) efficacy of current vaccines, (2) the extremely high contagiosity of MeV demanding a >95 % vaccination rate based on two doses to avoid primary vaccine failure as well as the installation of catch-up vaccination programmes to fill immunity gaps and to achieve herd immunity, (3) the implications of sporadic cases of secondary vaccine failure, (4) organisation, acceptance and drawbacks of modern vaccination campaigns, (5) waning public attention to measles, but increasing concerns from vaccine-associated adverse reactions in societies with high socio-economic standards and (6) clinical, epidemiological and virological surveillance by the use of modern laboratory diagnostics and reporting systems. By consequent implementation of carefully designed epidemiologic and prophylactic measures, it should be possible to eradicate MeV globally out of mankind, as the closely related morbillivirus of rinderpest could be successfully eliminated out of the cattle on a global scale.
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Affiliation(s)
| | - Hartmut Hengel
- />Institute of Virology, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Matthias Tenbusch
- />Department of Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - H. W. Doerr
- />Institute for Medical Virology, Goethe-University Hospital Frankfurt, Frankfurt/M., Germany
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Slater N, Mitchell RM, Whitlock RH, Fyock T, Pradhan AK, Knupfer E, Schukken YH, Louzoun Y. Impact of the shedding level on transmission of persistent infections in Mycobacterium avium subspecies paratuberculosis (MAP). Vet Res 2016; 47:38. [PMID: 26925966 PMCID: PMC4772324 DOI: 10.1186/s13567-016-0323-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 02/01/2016] [Indexed: 11/21/2022] Open
Abstract
Super-shedders are infectious individuals that contribute a disproportionate amount of infectious pathogen load to the environment. A super-shedder host may produce up to 10,000 times more pathogens than other infectious hosts. Super-shedders have been reported for multiple human and animal diseases. If their contribution to infection dynamics was linear to the pathogen load, they would dominate infection dynamics. We here focus on quantifying the effect of super-shedders on the spread of infection in natural environments to test if such an effect actually occurs in Mycobacterium avium subspecies paratuberculosis (MAP). We study a case where the infection dynamics and the bacterial load shed by each host at every point in time are known. Using a maximum likelihood approach, we estimate the parameters of a model with multiple transmission routes, including direct contact, indirect contact and a background infection risk. We use longitudinal data from persistent infections (MAP), where infectious individuals have a wide distribution of infectious loads, ranging upward of three orders of magnitude. We show based on these parameters that the effect of super-shedders for MAP is limited and that the effect of the individual bacterial load is limited and the relationship between bacterial load and the infectiousness is highly concave. A 1000-fold increase in the bacterial contribution is equivalent to up to a 2-3 fold increase in infectiousness.
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Affiliation(s)
- Noa Slater
- Gonda Brain Research Center, Bar-Ilan University, Ramat Gan, Israel.
| | - Rebecca Mans Mitchell
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA.
- Department of Mathematics and Computer Science, Emory University, Atlanta, GA, USA.
| | - Robert H Whitlock
- New Bolton Center, University of Pennsylvania, Kennett Square, Philadelphia, PA, USA.
| | - Terry Fyock
- New Bolton Center, University of Pennsylvania, Kennett Square, Philadelphia, PA, USA.
| | - Abani Kumar Pradhan
- Department of Nutrition and Food Science, Center for Food Safety and Security Systems, University of Maryland, College Park, College Park, MD, USA.
| | | | - Ynte Hein Schukken
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA.
- GD Animal Health, Deventer, The Netherlands.
- Department of Animal Sciences, Wageningen University, Wageningen, The Netherlands.
| | - Yoram Louzoun
- Gonda Brain Research Center, Bar-Ilan University, Ramat Gan, Israel.
- Department of Mathematics, Bar-Ilan University, Ramat Gan, Israel.
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Dias Leite R, Naaman Berezin E. Measles in Latin America: Current Situation. J Pediatric Infect Dis Soc 2015; 4:179-81. [PMID: 26407427 DOI: 10.1093/jpids/piv047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 07/07/2015] [Indexed: 11/14/2022]
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Wilson SE, Khan K, Gilca V, Miniota J, Deeks SL, Lim G, Eckhardt R, Bolotin S, Crowcroft NS. Global travel patterns and risk of measles in Ontario and Quebec, Canada: 2007-2011. BMC Infect Dis 2015; 15:341. [PMID: 26282392 PMCID: PMC4539886 DOI: 10.1186/s12879-015-1039-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 07/17/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In 2011 the largest measles outbreak in North America in a decade occurred in Quebec, Canada with over 700 cases. In contrast, measles activity in neighbouring province Ontario remained low (8 cases). Our objective was to determine the extent to which the difference could be explained by differing travel patterns. METHODS We explored the relationship between measles cases over 2007-2011, by importation classification, in Quebec and Ontario in relation to global travel patterns to each province using an ecological approach. Global measles exposure was estimated by multiplying the monthly traveler volume for each country of origin into Quebec or Ontario by the yearly measles incidence rate for the corresponding country. Visual inspection of temporal figures and calculation of Pearson correlation coefficients were performed. RESULTS Global measles exposure was similar in Ontario and Quebec. In Quebec, there was a nearly perfectly linear relationship between annual measles cases and its global measles exposure index over 2007-2011 (r = 0.99, p = 0.001). In contrast, there was a non-significant association in Ontario. The 2011 rise in Quebec's index was largely driven by a dramatic increase in measles activity in France the same year. CONCLUSIONS Global measles activity was associated with measles epidemiology in Quebec. Global measles exposure risk is higher in Ontario than Quebec. Differences in measles epidemiology between Ontario and Quebec from 2007-2011 are not explained by greater exposure in Quebec. A combination of alternative factors may be responsible, including differences in population susceptibility.
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Affiliation(s)
- Sarah E Wilson
- Public Health Ontario, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Kamran Khan
- St Michael's Hospital, Department of Medicine, Division of Infectious Diseases, Toronto, ON, Canada.
- Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
- Faculty of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada.
| | - Vladimir Gilca
- Institut national de santé publique du Québec, Québec, QC, Canada.
- Université Laval, Laval, QC, Canada.
| | - Jennifer Miniota
- Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
| | - Shelley L Deeks
- Public Health Ontario, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | | | - Rose Eckhardt
- Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
| | | | - Natasha S Crowcroft
- Public Health Ontario, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
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Fefferman NH, Naumova EN. Dangers of vaccine refusal near the herd immunity threshold: a modelling study. THE LANCET. INFECTIOUS DISEASES 2015; 15:922-6. [PMID: 25981883 DOI: 10.1016/s1473-3099(15)00053-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Childhood vaccination remains the focus of heated public debate. Parents struggle to understand the potential risks associated with vaccination but both parents and physicians assume that they understand the risks associated with infection. This study was done to characterise how modern vaccination practices have altered patient risks from infection. METHODS In this modelling study, we use mathematical analysis to explore how modern-era vaccination practices have changed the risks of severe outcomes for some infections by changing the landscape for disease transmission. We show these effects using published data from outbreaks in the USA for measles, chickenpox, and rubella. Calculation of risk estimation was the main outcome of this study. FINDINGS Our calculations show that negative outcomes are 4·5 times worse for measles, 2·2 times worse for chickenpox, and 5·8 times worse for rubella than would be expected in a pre-vaccine era in which the average age at infection would have been lower. INTERPRETATION As vaccination makes preventable illness rarer, for some diseases, it also increases the expected severity of each case. Because estimates of case risks rely on data for severity generated during a pre-vaccine era they underestimate negative outcomes in the modern post-vaccine epidemiological landscape. Physicians and parents should understand when making decisions about their children's health and safety that remaining unvaccinated in a predominantly vaccine-protected community exposes their children to the most severe possible outcomes for many preventable diseases. FUNDING None.
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Affiliation(s)
- Nina H Fefferman
- Department of Ecology, Evolution, and Natural Resources, Rutgers University, New Brunswick, NJ, USA; Center for Discrete Mathematics and Theoretical Computer Science (DIMACS), Rutgers University, Piscataway, NJ, USA; Tufts University Initiative for the Forecasting and Modeling of Infectious Diseases, Tufts University, Medford, MA, USA.
| | - Elena N Naumova
- Center for Discrete Mathematics and Theoretical Computer Science (DIMACS), Rutgers University, Piscataway, NJ, USA; Tufts University Initiative for the Forecasting and Modeling of Infectious Diseases, Tufts University, Medford, MA, USA; Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
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