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Cuerda ADL, González MIT, López Aparicio A, Monfort Vinuesa C, López Pedraza MJ, Isidoro B, Mayordomo-Cava J, Barberán LC, Collazos J, Pérez-Ortiz JM, Barberán J. Seroprevalence for measles among healthcare workers in Madrid, Spain. J Hosp Infect 2024; 147:63-67. [PMID: 38040037 DOI: 10.1016/j.jhin.2023.11.006] [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: 07/04/2023] [Revised: 10/31/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Immunity of healthcare workers (HCWs) against measles is a particular concern. They are more likely to contract it than the general population due to their occupational exposure which may cause a nosocomial outbreak. AIM To assess the measles immune status of HCWs at five Spanish university hospitals. PATIENTS AND METHODS Serologic testing (IgG) for measles by chemiluminescence indirect immunoassay (CLIA) was carried out prospectively and consecutively in HCWs from five university hospitals. All HCWs were classified into four epidemiological groups: vaccinated individuals, those with a history of measles disease, subjects with no history of measles or vaccination, and those who did not know whether they had measles or were vaccinated, and into five professional categories: physicians, nurses, nursing assistants, other clinical workers and non-clinical workers. A logistic regression model was constructed to identify the factors independently associated with immunity to measles. RESULTS The study group was composed of 2157 HCWs. 89% had protective antibodies against measles. Of the 238 non-immune HCWs, 199 (83.6%) had been vaccinated, compared with 1084 of the 1919 (56.5%) immune individuals (P<0.0001). The parameters significantly predictive of having protective antibodies against measles were: older age (P<0.0001), epidemiological status (P=0.0002, mainly past measles disease), and professional category (P=0.02, in particular nurses). CONCLUSION This study shows that HCWs, including those previously vaccinated, are currently at risk of measles and suggests that those with a natural history of infection are better protected. Therefore, knowledge and maintenance of immunity to measles are an essential part of infection control among HCWs.
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Affiliation(s)
- A de la Cuerda
- Occupational Risk Prevention Service, Hospital Universitario HM Montepríncipe, Universidad Camilo José Cela, Madrid, Spain
| | - M I Tejeda González
- Infectious Diseases Unit, Hospital Universitario HM Montepríncipe, Universidad Camilo José Cela, Madrid, Spain
| | - A López Aparicio
- Infectious Diseases Unit, Hospital Universitario HM Montepríncipe, Universidad Camilo José Cela, Madrid, Spain
| | - C Monfort Vinuesa
- Infectious Diseases Unit, Hospital Universitario HM Montepríncipe, Universidad Camilo José Cela, Madrid, Spain
| | - M J López Pedraza
- Preventive Medicine Department, Hospital Universitario HM Montepríncipe, Universidad Camilo José Cela, Madrid, Spain
| | - B Isidoro
- Preventive Medicine Department, Hospital Universitario HM Montepríncipe, Universidad Camilo José Cela, Madrid, Spain
| | - J Mayordomo-Cava
- School of Health Sciences - HM Hospitals, Universidad Camilo José Cela, Madrid, Spain
| | - L C Barberán
- Infectious Diseases Unit, Hospital Universitario HM Montepríncipe, Universidad Camilo José Cela, Madrid, Spain
| | - J Collazos
- Infectious Diseases Unit, Hospital de Galdácano, Vizcaya, Spain
| | - J M Pérez-Ortiz
- School of Health Sciences - HM Hospitals, Universidad Camilo José Cela, Madrid, Spain
| | - J Barberán
- Infectious Diseases Unit, Hospital Universitario HM Montepríncipe, Universidad Camilo José Cela, Madrid, Spain.
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Cassini A, Cobuccio L, Glampedakis E, Cherpillod P, Crisinel PA, Pérez-Rodríguez FJ, Attinger M, Bachelin D, Tessemo MN, Maeusezahl M, Gardiol C, Boubaker K. Adapting response to a measles outbreak in a context of high vaccination and breakthrough cases: an example from Vaud, Switzerland, January to March 2024. Euro Surveill 2024; 29:2400275. [PMID: 38818746 PMCID: PMC11141130 DOI: 10.2807/1560-7917.es.2024.29.22.2400275] [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: 05/08/2024] [Accepted: 05/30/2024] [Indexed: 06/01/2024] Open
Abstract
A measles outbreak with 51 cases occurred in the canton of Vaud, Switzerland, between January and March 2024. The outbreak was triggered by an imported case, and 37 (72.5%) subsequent cases were previously vaccinated individuals. Epidemiological investigations showed that vaccinated measles cases were symptomatic and infectious. In a highly vaccinated population, it is important to raise awareness among healthcare professionals to suspect and test for measles virus when an outbreak is declared, irrespective of the vaccination status of the patients.
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Affiliation(s)
- Alessandro Cassini
- These authors contributed equally to this work and share first authorship
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
- Cantonal Doctor Office, Public Health Department, Canton of Vaud, Lausanne, Switzerland
| | - Ludovico Cobuccio
- These authors contributed equally to this work and share first authorship
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
- Cantonal Doctor Office, Public Health Department, Canton of Vaud, Lausanne, Switzerland
| | - Emmanouil Glampedakis
- Cantonal Doctor Office, Public Health Department, Canton of Vaud, Lausanne, Switzerland
| | - Pascal Cherpillod
- Laboratory of Virology, Laboratory Medicine Division, Geneva University Hospitals, Geneva, Switzerland
- National Measles and Rubella Reference Laboratory, Geneva University Hospitals, Geneva, Switzerland
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Alex Crisinel
- Unit of paediatric infectious diseases and vaccinology, Service of Paediatrics, Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Francisco-Javier Pérez-Rodríguez
- Laboratory of Virology, Laboratory Medicine Division, Geneva University Hospitals, Geneva, Switzerland
- National Measles and Rubella Reference Laboratory, Geneva University Hospitals, Geneva, Switzerland
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Monica Attinger
- Cantonal Doctor Office, Public Health Department, Canton of Vaud, Lausanne, Switzerland
| | - Dominique Bachelin
- Cantonal Doctor Office, Public Health Department, Canton of Vaud, Lausanne, Switzerland
| | | | - Mirjam Maeusezahl
- Communicable Disease Division, Federal Office of Public Health, Bern, Switzerland
| | - Céline Gardiol
- Communicable Disease Division, Federal Office of Public Health, Bern, Switzerland
| | - Karim Boubaker
- Cantonal Doctor Office, Public Health Department, Canton of Vaud, Lausanne, Switzerland
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Smíšková D, Janovic S, Kadeřávková P, Nováková L, Blechová Z, Malý M, Limberková R. Measles in Czech population with varying vaccination rates in 2018-2019: clinical and laboratory differences between vaccinated and unvaccinated individuals and their relevance to clinical practice. Infect Dis (Lond) 2024:1-8. [PMID: 38613412 DOI: 10.1080/23744235.2024.2339870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/02/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES In a highly vaccinated population, an increasing number of previously vaccinated measles cases can be expected. The aim of this study was to assess the effect of vaccination on the clinical course and immune response in relation to the current measles case definition. METHODS The presence of fever, catarrhal symptoms, exanthema and complications, and specific IgM and IgG positivity were assessed in all 230 patients and compared in 193 patients with known vaccination status, divided into measles-containing vaccine (MCV) groups: MCV0 (85 patients), MCV1 (25 patients) and MCV2 (83 patients). RESULTS Statistically significant differences between groups were found for catarrhal symptoms.Conjunctivitis and rhinitis were significantly less frequent in the MCV2 group (47% and 54%) compared to MCV0 (80% and 80%), p < 0.001 and p = 0.002 respectively. Typical exanthema was present in 74 (87%) MCV0 and 56 (67%) MCV2 patients, p = 0.005. Complications were most common in the MCV0 group (29%). ECDC clinical case criteria were met in 81 (95%) MCV0, 18 (72%) MCV1 and 59 (71%) MCV2 patients, p < 0.001. IgM were positive in 64 (83%) MCV0, 14 (74%) MCV1 and 36 (67%) MCV2 patients, differences were not statistically significant. There were highly significant differences in IgG between MCV0 and both vaccinated groups (p < 0.001). CONCLUSIONS A redefinition of the clinical case classification is essential to better capture modified measles and to raise awareness among healthcare workers of the differences in measles in vaccinated patients.
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Affiliation(s)
- Dita Smíšková
- Department of Infectious Diseases, Second Faculty of Medicine, Charles University and Bulovka University Hospital, Prague, Czech Republic
| | - Simona Janovic
- Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Pavlína Kadeřávková
- Department of Infectious Diseases, University Hospital Bulovka, Prague, Czech Republic
| | - Ludmila Nováková
- Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Zuzana Blechová
- Department of Infectious Diseases, Second Faculty of Medicine, Charles University and Bulovka University Hospital, Prague, Czech Republic
| | - Marek Malý
- Department of Biostatistics, National Institute of Public Health, Prague, Czech Republic
| | - Radomíra Limberková
- Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
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Kurata T, Kaida Y, Kanbayashi D, Motomura K. Achieving measles elimination and emerging modified measles: Longitudinal measles epidemiology from 1982 to 2021 in Osaka Prefecture, Japan. Vaccine 2024; 42:271-286. [PMID: 38097458 DOI: 10.1016/j.vaccine.2023.12.004] [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: 08/08/2023] [Revised: 11/14/2023] [Accepted: 12/01/2023] [Indexed: 01/01/2024]
Abstract
BACKGROUND Measles is a contagious viral disease causing infant mortality in developing countries without vaccination programs. In Japan, measles vaccination was launched in 1978, surveillance commenced in 1981, and elimination was achieved in 2015. This was due to improved, legally required surveillance methods and vaccine programs. METHODS The data sets of sentinel (1982-2007) and notifiable (2008-2021) disease surveillance, as well as the vaccination coverage, detected genotypes, and seroepidemiology during the study period in Osaka Prefecture, were analyzed. Additionally, the trend under the current notifiable surveillance was compared before (2008-2014) and after (2015-2021) measles elimination. RESULTS Under sentinel surveillance, 51,107 cases were reported, predominantly infants aged 1-4 years (63.6 %). Under notifiable disease surveillance, the 781 patients were predominantly in their 20s-30s (43.7 %). From 2000, the age of the major susceptible group increased due to the rise in vaccination coverage, which exceeded 95% for the first dose in 1998 and 90% for the second dose in 2009. Consistent with these data, seroprevalence exceeded 95% in 2011. However, the geometric mean of the antibody titer showed a decreasing trend with a falling number of patients. Compared with before and after measles elimination, the number of modified measles cases increased from 10.1% to 48.2%. During the study period, 398 strains comprising eight genotypes were identified, and the dominant type changed over time. After measles elimination, genotypes B3 and D8, derived from imported cases, became predominant. CONCLUSIONS Improved vaccination coverage and surveillance reduced measles cases and increased herd immunity. However, the lack of a booster effect due to the low incidence of measles caused waning antibody titers despite high seroprevalence, which may contribute to the rising rate of vaccine failures causing modified measles. Careful monitoring of measles incidence and herd immunity are necessary for measles eradication.
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Affiliation(s)
- Takako Kurata
- Osaka Institute of Public Health, Division of Microbiology, Virology Section Nakamichi 1-3-3, Higashinari-ku, Osaka 537-0025, Japan.
| | - Yuko Kaida
- Fujiidera Public Health Center, Inspection Division, Fujiidera 1-8-36, Fujiidera-shi, Osaka 583-0024, Japan.
| | - Daiki Kanbayashi
- Osaka Institute of Public Health, Division of Microbiology, Virology Section Nakamichi 1-3-3, Higashinari-ku, Osaka 537-0025, Japan.
| | - Kazushi Motomura
- Osaka Institute of Public Health, Division of Public Health, Nakamichi 1-3-3, Higashinari-ku, Osaka 537-0025, Japan.
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Santibanez S, Mankertz A. Measles Foci Reduction Neutralization Test (FRNT). Methods Mol Biol 2024; 2808:209-224. [PMID: 38743373 DOI: 10.1007/978-1-0716-3870-5_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
The plaque reduction neutralization test (PRNT) and the enzyme-linked immunosorbent assay (ELISA) are both widely used to assess immunity to infectious diseases such as measles, but they use two different measurement principles: ELISA measures the ability of antibodies to bind to virus components, while the PRNT detects the aptitude of antibodies to prevent the infection of a susceptible cell. As a result, detection of measles virus (MV) neutralizing antibodies is the gold standard for assessing immunity to measles. However, the assay is laborious and requires experience and excellent technical skills. In addition, the result is only available after several days. Therefore, the classical PRNT is not suitable for high-throughput testing. By using an immunocolorimetric assay (ICA) to detect MV-infected cells, the standard PRNT has been developed into a focus reduction neutralization test (FRNT). This assay is faster and has improved specificity. The FRNT described here is extremely useful when immunity to measles virus needs to be assessed in patients with a specific medical condition, such as immunocompromised individuals in whom presumed residual immunity needs to be assessed. The FRNT is not generally recommended for use with large numbers of specimens, such as in a seroprevalence study.
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Affiliation(s)
- Sabine Santibanez
- National Reference Center Measles, Mumps, Rubella, Robert Koch-Institute, Berlin, Germany
| | - Annette Mankertz
- National Reference Center Measles, Mumps, Rubella, Robert Koch-Institute, Berlin, Germany.
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Choi S, Chung JW, Chang YJ, Lim EJ, Moon SH, Do HH, Lee JH, Cho SM, Kwon BS, Chung YS, Park SY. A Lesson from a Measles Outbreak among Healthcare Workers in a Single Hospital in South Korea: The Importance of Knowing the Prevalence of Susceptibility. Vaccines (Basel) 2023; 11:1505. [PMID: 37766181 PMCID: PMC10535736 DOI: 10.3390/vaccines11091505] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Despite the high vaccination coverage rate, in-hospital transmission of measles continues to occur in South Korea. We present a measles outbreak in which two healthcare workers (HCWs) with presumptive evidence of measles immunity were infected by a patient with typical measles at a single hospital in South Korea. This facilitated the evaluation of measles seroprevalence in all HCWs. METHODS In 2018, suspected patients and contacts exposed during a measles outbreak were investigated based on their medical histories and vaccination status. Cases were confirmed by the detection of measles-specific immunoglobulin M or RNA. After the measles outbreak in 2018, measles IgG testing was conducted on a total of 972 HCWs for point-prevalence, including those exposed to the measles. In addition, we have routinely performed measles IgG tests on newly employed HCWs within one week of their hire date since 2019. The measles vaccine was administered to HCWs who tested negative or equivocally negative for IgG antibodies. RESULTS An index patient who returned from China with fever and rash was diagnosed with measles at a hospital in Korea. Two additional HCWs were revealed as measles cases: one was vaccinated with the two-dose measles-mumps-rubella (MMR) vaccine, and the other, who was born in 1967, was presumed to have immunity from natural infection in South Korea. All three patients harbored the same D8 genotype. No additional measles cases were identified among the 964 contacts of secondary patients. A total of 2310 HCWs, including those tested during the 2018 outbreak, underwent measles IgG tests. The average age at the time of the test was 32.6 years, and 74.3% were female. The overall seropositivity of measles was 88.9% (95% confidence interval, 87.5-90.1). Although the birth cohorts between 1985 and 1994 were presumed to have received the measles-rubella (MR) catch-up vaccination in 2001, 175 (89.3%) HCWs were born after 1985 among the 195 seronegative cases. CONCLUSION Despite high population immunity, imported measles transmission occurred among HCWs with presumed immunity. This report underscores the importance of understanding the prevalence of measles susceptibility among newly employed HCWs. This is important for policymaking regarding hospital-wide vaccinations to prevent the spread of vaccine-preventable diseases.
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Affiliation(s)
- Sungim Choi
- Department of Infectious Diseases, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea;
- Department of Infection Control, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea
| | - Jae-Woo Chung
- Department of Infection Control, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea
- Department of Laboratory Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea
| | - Yun Jung Chang
- Department of Infection Control, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea
| | - Eun Jung Lim
- Department of Infection Control, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea
| | - Sun Hee Moon
- Department of Infection Control, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea
| | - Han Ho Do
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea
| | - Jeong Hun Lee
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea
| | - Sung-Min Cho
- Department of Pediatrics, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea
| | - Yoon-Seok Chung
- Division of Infectious Disease Diagnosis Control, Honam Regional Center for Disease Control and Prevention, Korea Disease Control and Prevention Agency, Gwangju 61947, Gyeonggi-do, Republic of Korea
| | - Seong Yeon Park
- Department of Infectious Diseases, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea;
- Department of Infection Control, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang-si 10326, Gyeonggi-do, Republic of Korea
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Shin L, Choi JR, Huh K, Chung DR, Cho SY, Jeong J, Ko JH, Kang CI, Peck KR. Trend of immunity against measles and varicella zoster virus in healthcare workers in Korea. Vaccine 2023:S0264-410X(23)00664-3. [PMID: 37349224 DOI: 10.1016/j.vaccine.2023.06.018] [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: 03/09/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To examine the seroprevalence of measles and varicella zoster virus (VZV) among healthcare workers (HCW) and evaluate the concordance between self-reported history of previous disease or vaccination and seropositivity. DESIGN A seroprevalence study and survey. SETTING A university-affiliated tertiary care hospital. PARTICIPANTS All HCWs working in high-risk services in 2017 underwent serologic tests and survey; all new HCWs employed in the subsequent years, serologic tests only. METHODS A serologic study was conducted using chemiluminescence immunoassay (2017) or enzyme immunoassays (2018 and later). HCWs who underwent serological testing in 2017 completed a self-administered questionnaire on their history of infection and vaccination. RESULTS A total of 10,278 and 9607 HCWs underwent serologic tests for measles and VZV IgG, respectively, from 2017 to 2022. The overall seropositivity rates for measles and VZV were 78.1 % and 92.8 %, respectively. Measles seropositivity declined gradually from >90 % in the HCWs born in the 1960s to <80 % in those born in the 1990s. There was a significant difference in measles seropositivity between the birth cohorts (BCs) 1967-1984 and 1985-1999 (P < 0.001; odds ratio, 1.16; 95 % confidence interval, 1.14-1.18). The seropositivity for VZV was stable, at >90 % in all BCs. The self-reported vaccination history was not independently associated with seropositivity, and the negative predictive value of the survey was very low (9.6 % and 13.1 %, respectively). CONCLUSIONS Measles seropositivity showed a substantial decline among HCWs born in 1985 or later, while varicella seropositivity remained high. The self-reported vaccination history was not sufficiently reliable for screening HCWs.
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Affiliation(s)
- Linda Shin
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea
| | - Jong Rim Choi
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Doo Ryeon Chung
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Sun Young Cho
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jongsuk Jeong
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae-Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Charlton CL, Bailey ANM, Thompson LA, Kanji JN, Marshall NC. What's in a number? The value of titers as routine proof of immunity for medical students. Vaccine 2023; 41:2734-2738. [PMID: 36948982 DOI: 10.1016/j.vaccine.2023.03.009] [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: 10/19/2022] [Revised: 02/24/2023] [Accepted: 03/05/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVES To assess the guideline concordance of medical school requirements for students' proof-of-immunity in the United States (US) and Canada. METHODS National guidelines for healthcare worker proof-of-immunity to measles, mumps, rubella, and varicella were compared to admission requirements for 62 US and 17 Canadian medical schools. RESULTS All surveyed schools accepted at least one recommended form of proof-of-immunity, however, contrary to national guidelines, 16% of surveyed US schools asked for a serologic titer, and only 73-79% US schools accepted vaccination as the sole proof-of-immunity. CONCLUSIONS The requirement of numerical, non-standardized serologic testing highlights an oversight in medical school admissions documentation. The requirement for quantitative values to demonstrate immunity is not practical from a laboratory standpoint, and is not needed to show individual immunity to these vaccine-preventable diseases. Until a more standardized process is adopted, laboratories will need to provide clear documentation and direction for quantitative titer requests.
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Affiliation(s)
- Carmen L Charlton
- Division of Diagnostic & Applied Medicine, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada; Alberta Precision Laboratories - Public Health, AB, Canada; Li Ka Shing Institute of Virology, Edmonton, AB, Canada; Women and Children's Health Research Institute, Edmonton, AB, Canada.
| | - Ashley-Nicole M Bailey
- Division of Diagnostic & Applied Medicine, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada
| | - L Alexa Thompson
- Division of Diagnostic & Applied Medicine, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada; Women and Children's Health Research Institute, Edmonton, AB, Canada
| | - Jamil N Kanji
- Division of Diagnostic & Applied Medicine, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada; Alberta Precision Laboratories - Public Health, AB, Canada; Division of Infectious Diseases, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Section of Medical Microbiology, Department of Pathology & Laboratory Medicine, Cumming School of Medicine, Calgary, AB, Canada
| | - Natalie C Marshall
- Division of Diagnostic & Applied Medicine, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada; Alberta Precision Laboratories - Public Health, AB, Canada
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Torner N, Mercader S, Dominguez A, Martinez A, Costa J, Sowers SB, Abernathy ES, Bellini WJ, Hickman CJ. Etiological analysis of discarded measles in the context of a measles outbreak among a highly immunized population. Pediatr Int 2023; 65:e15430. [PMID: 36461709 PMCID: PMC10107150 DOI: 10.1111/ped.15430] [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: 07/19/2022] [Revised: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Measles can lead to serious complications and remains an important cause of morbidity and mortality worldwide. In this study we aimed to assess the etiological diagnosis of discarded measles cases in the context of an outbreak among a highly immunized population. METHODS We conducted a retrospective observational study of discarded measles cases from an outbreak that occurred from October 2006 to July 2007 in Catalonia. A confirmed case was defined as having a positive measles serum IgM result and/or a positive result by RT-PCR in urine and/or nasopharyngeal swab; or an epidemiological link to a confirmed case. Serum specimens were tested by a commercially available indirect-format and by an in-house capture-format measles IgM enzyme immunoassays. RESULTS Testing of 89 samples discarded for measles determined the etiologies for 10 (11.2%), including one rubella, three human herpes virus 6, and six measles infections. Of 381 confirmed cases in the outbreak, 10% had received at least one dose of the measles-mumps-rubella vaccine versus 54% of the discarded for measles (OR: 0.09; 95% CI: 0.06, 0.14; p < 0.001). CONCLUSIONS Highly sensitive surveillance systems are critical to identifying cases, responding to outbreaks and verifying progress towards measles elimination. Molecular tools for measles detection and differential diagnosis, and collection of appropriate specimens for molecular and serological testing are essential to correctly diagnose suspected measles infection.
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Affiliation(s)
- Nuria Torner
- CIBER Epidemiology and Public Health CIBERESPInstitute Carlos IIIMadridSpain
- Department of MedicineUniversity of BarcelonaBarcelonaSpain
| | - Sara Mercader
- Division of Viral Diseases, Centers for Disease Control and PreventionNational Center for Immunization and Respiratory DiseasesAtlantaGeorgiaUSA
| | - Angela Dominguez
- CIBER Epidemiology and Public Health CIBERESPInstitute Carlos IIIMadridSpain
- Department of MedicineUniversity of BarcelonaBarcelonaSpain
| | - Ana Martinez
- CIBER Epidemiology and Public Health CIBERESPInstitute Carlos IIIMadridSpain
- Public Health Agency of CataloniaBarcelonaSpain
| | - Josep Costa
- Virology Unit, Centre de Diagnòstic BiomèdicHospital ClínicBarcelonaSpain
| | - Sun B. Sowers
- Division of Viral Diseases, Centers for Disease Control and PreventionNational Center for Immunization and Respiratory DiseasesAtlantaGeorgiaUSA
| | - Emily S. Abernathy
- Division of Viral Diseases, Centers for Disease Control and PreventionNational Center for Immunization and Respiratory DiseasesAtlantaGeorgiaUSA
| | - William J. Bellini
- Division of Viral Diseases, Centers for Disease Control and PreventionNational Center for Immunization and Respiratory DiseasesAtlantaGeorgiaUSA
| | - Carol J. Hickman
- Division of Viral Diseases, Centers for Disease Control and PreventionNational Center for Immunization and Respiratory DiseasesAtlantaGeorgiaUSA
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Quach HQ, Chen J, Monroe JM, Ratishvili T, Warner ND, Grill DE, Haralambieva IH, Ovsyannikova IG, Poland GA, Kennedy RB. The Influence of Sex, Body Mass Index, and Age on Cellular and Humoral Immune Responses Against Measles After a Third Dose of Measles-Mumps-Rubella Vaccine. J Infect Dis 2022; 227:141-150. [PMID: 35994504 DOI: 10.1093/infdis/jiac351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A third dose of measles-mumps-rubella vaccine (MMR3) is recommended in mumps outbreak scenarios, but the immune response and the need for widespread use of MMR3 remain uncertain. Herein, we characterized measles-specific immune responses to MMR3 in a cohort of 232 healthy subjects. METHODS Serum and peripheral blood mononuclear cells (PBMCs) were sampled at day 0 and day 28 after MMR3. Measles-specific binding and neutralizing antibodies were quantified in sera by enzyme-linked immunosorbent assay and a microneutralization assay, respectively. PBMCs were stimulated with inactivated measles virus, and the release of cytokines/chemokines was assessed by a multiplex assay. Demographic variables of subjects were examined for potential correlations with immune outcomes. RESULTS Of the study participants, 95.69% and 100% were seropositive at day 0 and day 28, respectively. Antibody avidity significantly increased from 38.08% at day 0 to 42.8% at day 28 (P = .00026). Neutralizing antibodies were significantly enhanced, from 928.7 at day 0 to 1289.64 mIU/mL at day 28 (P = .0001). Meanwhile, cytokine/chemokine responses remained largely unchanged. Body mass index was significantly correlated with the levels of inflammatory cytokines/chemokines. CONCLUSIONS Measles-specific humoral immune responses, but not cellular responses, were enhanced after MMR3 receipt, extending current understanding of immune responses to MMR3 and supporting MMR3 administration to seronegative or high-risk individuals.
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Affiliation(s)
- Huy Quang Quach
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jun Chen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathon M Monroe
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tamar Ratishvili
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathaniel D Warner
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Diane E Grill
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Iana H Haralambieva
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Inna G Ovsyannikova
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory A Poland
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard B Kennedy
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Bianchi FP, Stefanizzi P, Diella G, Martinelli A, Di Lorenzo A, Gallone MS, Tafuri S. Prevalence and management of rubella susceptibility in healthcare workers in Italy: A systematic review and meta-analysis. Vaccine X 2022; 12:100195. [PMID: 36032697 PMCID: PMC9399279 DOI: 10.1016/j.jvacx.2022.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/18/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction In the pre-vaccination era, all adults acquired immunity status due to natural infections during childhood and adolescence, whereas universal mass vaccination has changed the seroepidemiology of rubella among adults, showing lack of immunity in some subgroups. National and international guidelines recommend evaluating all healthcare workers (HCWs) for their immune status to rubella and possibly vaccinating those who are seronegative. We conducted a systematic review and meta-analysis to estimate the susceptibility rate to rubella among HCWs in Italy and to explore possible options for the management of those found to be susceptible. Methods Eight studies were included in the meta-analysis, selected from scientific papers available in the MEDLINE/PubMed and Google Scholar (till page 10) databases between January 1, 2015 and November 30, 2021. The following terms were used for the search strategy: (sero* OR seroprevalence OR prevalence OR susceptibilit* OR immunit* OR immunogenict*) AND (healthcare worker* OR health personnel OR physician* OR nurse OR student*) AND (rubella OR german measles OR TORCH) AND (Italy) Results The prevalence of rubella-susceptible HCWs was 9.0 % (95 %CI: 6.4–12.1 %). In a comparison of female vs. male serosusceptible HCWs, the RR was 0.67 (95 %CI = 0.51–0.88). Occupational medicine examinations for rubella screening with possible subsequent vaccination of seronegatives and exclusion of susceptible HCWs from high-risk settings were common management strategies. Conclusions HCWs susceptible to rubella are an important epidemiological concern in Italy, and efforts to identify and actively offer the vaccine to this population should be increased.
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Thakur M, Zhou R, Mohan M, Marathe A, Chen J, Hoops S, Machi D, Lewis B, Vullikanti A. COVID's collateral damage: likelihood of measles resurgence in the United States. BMC Infect Dis 2022; 22:743. [PMID: 36127637 PMCID: PMC9487857 DOI: 10.1186/s12879-022-07703-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Lockdowns imposed throughout the US to control the COVID-19 pandemic led to a decline in all routine immunizations rates, including the MMR (measles, mumps, rubella) vaccine. It is feared that post-lockdown, these reduced MMR rates will lead to a resurgence of measles. METHODS To measure the potential impact of reduced MMR vaccination rates on measles outbreak, this research examines several counterfactual scenarios in pre-COVID-19 and post-COVID-19 era. An agent-based modeling framework is used to simulate the spread of measles on a synthetic yet realistic social network of Virginia. The change in vulnerability of various communities to measles due to reduced MMR rate is analyzed. RESULTS Results show that a decrease in vaccination rate [Formula: see text] has a highly non-linear effect on the number of measles cases and this effect grows exponentially beyond a threshold [Formula: see text]. At low vaccination rates, faster isolation of cases and higher compliance to home-isolation are not enough to control the outbreak. The overall impact on urban and rural counties is proportional to their population size but the younger children, African Americans and American Indians are disproportionately infected and hence are more vulnerable to the reduction in the vaccination rate. CONCLUSIONS At low vaccination rates, broader interventions are needed to control the outbreak. Identifying the cause of the decline in vaccination rates (e.g., low income) can help design targeted interventions which can dampen the disproportional impact on more vulnerable populations and reduce disparities in health. Per capita burden of the potential measles resurgence is equivalent in the rural and the urban communities and hence proportionally equitable public health resources should be allocated to rural regions.
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Affiliation(s)
- Mugdha Thakur
- Biocomplexity Institute, Town Center Four, 994 Research Park Boulevard, Charlottesville, VA, 22904, USA.
| | - Richard Zhou
- Biocomplexity Institute, Town Center Four, 994 Research Park Boulevard, Charlottesville, VA 22904 USA
| | - Mukundan Mohan
- Biocomplexity Institute, Town Center Four, 994 Research Park Boulevard, Charlottesville, VA 22904 USA
| | - Achla Marathe
- Biocomplexity Institute, Town Center Four, 994 Research Park Boulevard, Charlottesville, VA 22904 USA
| | - Jiangzhuo Chen
- Biocomplexity Institute, Town Center Four, 994 Research Park Boulevard, Charlottesville, VA 22904 USA
| | - Stefan Hoops
- Biocomplexity Institute, Town Center Four, 994 Research Park Boulevard, Charlottesville, VA 22904 USA
| | - Dustin Machi
- Biocomplexity Institute, Town Center Four, 994 Research Park Boulevard, Charlottesville, VA 22904 USA
| | - Bryan Lewis
- Biocomplexity Institute, Town Center Four, 994 Research Park Boulevard, Charlottesville, VA 22904 USA
| | - Anil Vullikanti
- Biocomplexity Institute, Town Center Four, 994 Research Park Boulevard, Charlottesville, VA 22904 USA
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Hu S, Logan N, Coleman S, Evans C, Willett BJ, Hosie MJ. Correlating IgG Levels with Neutralising Antibody Levels to Indicate Clinical Protection in Healthcare Workers at Risk during a Measles Outbreak. Viruses 2022; 14:v14081716. [PMID: 36016338 PMCID: PMC9415042 DOI: 10.3390/v14081716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 02/01/2023] Open
Abstract
The rapid transmission of measles poses a great challenge for measles elimination. Thus, rapid testing is required to screen the health status in the population during measles outbreaks. A pseudotype-based virus neutralisation assay was used to measure neutralising antibody titres in serum samples collected from healthcare workers in Sheffield during the measles outbreak in 2016. Vesicular stomatitis virus (VSV) pseudotypes bearing the haemagglutinin and fusion glycoproteins of measles virus (MeV) and carrying a luciferase marker gene were prepared; the neutralising antibody titre was defined as the dilution resulting in 90% reduction in luciferase activity. Spearman’s correlation coefficients between IgG titres and neutralising antibody levels ranged from 0.40 to 0.55 (p < 0.05) or from 0.71 to 0.79 (p < 0.0001) when the IgG titres were obtained using different testing kits. In addition, the currently used vaccine was observed to cross-neutralise most circulating MeV genotypes. However, the percentage of individuals being “well-protected” was lower than 95%, the target rate of vaccination coverage to eliminate measles. These results demonstrate that the level of clinical protection against measles in individuals could be inferred by IgG titre, as long as a precise correlation has been established between IgG testing and neutralisation assay; moreover, maintaining a high vaccination coverage rate is still necessary for measles elimination.
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Affiliation(s)
- Siyuan Hu
- MRC-University of Glasgow Centre for Virus Research, Bearsden Road, Glasgow G61 1QH, UK
- Correspondence: (S.H.); (M.J.H.)
| | - Nicola Logan
- MRC-University of Glasgow Centre for Virus Research, Bearsden Road, Glasgow G61 1QH, UK
| | - Sarah Coleman
- Virology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
| | - Cariad Evans
- Virology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
| | - Brian J. Willett
- MRC-University of Glasgow Centre for Virus Research, Bearsden Road, Glasgow G61 1QH, UK
| | - Margaret J. Hosie
- MRC-University of Glasgow Centre for Virus Research, Bearsden Road, Glasgow G61 1QH, UK
- Correspondence: (S.H.); (M.J.H.)
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Fappani C, Gori M, Canuti M, Terraneo M, Colzani D, Tanzi E, Amendola A, Bianchi S. Breakthrough Infections: A Challenge towards Measles Elimination? Microorganisms 2022; 10:microorganisms10081567. [PMID: 36013985 PMCID: PMC9413104 DOI: 10.3390/microorganisms10081567] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 12/04/2022] Open
Abstract
Measles is one of the most contagious diseases known to man. Despite the existence of a safe and effective live attenuated vaccine, measles can appear in vaccinated individuals. Paradoxically, breakthrough cases increase as vaccination coverage in the general population rises. In measles endemic areas, breakthrough cases represent less than 10% of total infections, while in areas with high vaccination coverage these are over 10% of the total. Two different vaccination failures have been described: primary vaccination failure, which consists in the complete absence of humoral response and occurs in around 5% of vaccinated individuals; and secondary vaccination failure is due to waning immunity or incomplete immunity and occurs in 2–10% of vaccinees. Vaccination failures are generally associated with lower viral loads and milder disease (modified measles) since vaccination limits the risk of complicated disease. Vaccination failure seems to occur between six and twenty-six years after the last vaccine dose administration. This review summarizes the literature about clinical, serological, epidemiological, and molecular characteristics of measles breakthrough cases and their contribution to virus transmission. In view of the measles elimination goal, the assessment of the potential decline in antibody protection and the targeted implementation of catch-up vaccination are essential.
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Affiliation(s)
- Clara Fappani
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Maria Gori
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
| | - Marta Canuti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Mara Terraneo
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
| | - Daniela Colzani
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
| | - Elisabetta Tanzi
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
- Coordinated Research Center “EpiSoMI”, Università degli Studi di Milano, 20133 Milan, Italy
| | - Antonella Amendola
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
- Coordinated Research Center “EpiSoMI”, Università degli Studi di Milano, 20133 Milan, Italy
- Correspondence: (A.A.); (S.B.)
| | - Silvia Bianchi
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
- Correspondence: (A.A.); (S.B.)
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15
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Immunogenicity after outbreak response immunization activities among young healthcare workers with secondary vaccine failure during the measles epidemic in Korea, 2019. BMC Infect Dis 2022; 22:530. [PMID: 35676650 PMCID: PMC9175155 DOI: 10.1186/s12879-022-07511-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite high vaccination coverage, measles outbreaks have been reported in measles elimination countries, especially among healthcare workers in their 20 and 30 s. This study was designed to identify measles-susceptible individuals and to evaluate whether primary or secondary vaccine failure occurred during measles outbreak response immunization (ORI) activities. METHODS The study population was divided into three groups as follows: natural immunity group (Group 1), vaccine-induced immunity group (Group 2), and vaccine failure group (Group 3). We evaluated the immunogenicity of measles among healthcare workers using three methods-enzyme-linked immunoassays, plaque reduction neutralization tests, and avidity assays. The results were assessed at baseline, 4 weeks after, and 6 months after the completion of measles-mumps-rubella (MMR) vaccination. RESULTS In total, 120 subjects were enrolled, with 40 subjects in each group. The median age of Group 3 was 29 years, which was significantly lower than that of the other groups. The baseline negative measles virus (MeV) IgG in Group 3 increased to a median value of 165 AU/mL at 4 weeks after ORI and was lower than that in Groups 1 and 2. The median neutralizing antibody titer was highest in Group 1, and this was significantly different from that in Group 2 or Group 3 at 4 weeks (944 vs. 405 vs. 482 mIU/mL, P = 0.001) and 6 months (826 vs. 401 vs. 470, P = 0.011) after ORI. The rates of high MeV avidity IgG were highest in Group 2, and these were significantly different from those in Groups 1 or 3 at 4 weeks (77.5 vs. 90% vs. 88.6%, P = 0.03) and 6 months (81 vs. 94.8 vs. 82.1%, P = 0.01) after ORI. CONCLUSIONS Considering the MeV-neutralizing antibodies and IgG avidity after MMR vaccination in measles-susceptible group, vaccine failure is inferred as secondary vaccine failure, and further data regarding the maintenance of immunogenicity are needed based on long-term data. The MeV-neutralizing antibody levels were highest in the natural immunity group, and the primary vaccine-induced immunity group showed the highest rates of high MeV IgG avidity.
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16
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Sanz JC, Ramos B, Pérez-Olmeda M, Fernández-García A. Reply to "Modified measles outbreak in vaccinated healthcare workers exposed to primary measles case". ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:344-345. [PMID: 35491354 DOI: 10.1016/j.eimce.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Juan Carlos Sanz
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, Spain; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Belén Ramos
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, Spain
| | - Mayte Pérez-Olmeda
- Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Aurora Fernández-García
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Spain; Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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17
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Sanz JC, Ramos B, Pérez-Olmeda M, Fernández-García A. Réplica a «Brote de sarampión-modificado en personal sanitario tras exposición a un caso de sarampión clásico». Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Bianchi FP, Stefanizzi P, Trerotoli P, Tafuri S. Sex and age as determinants of the seroprevalence of anti-measles IgG among European healthcare workers: A systematic review and meta-analysis. Vaccine 2022; 40:3127-3141. [PMID: 35491343 DOI: 10.1016/j.vaccine.2022.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The international literature shows good evidence of a significant rate of measles susceptibility among healthcare workers (HCWs). As such, they are an important public health issue. METHODS We conducted a systematic review and meta-analysis to estimate the prevalence of susceptible HCWs in EU/EEA countries and in the UK and to explore the characteristics (sex and age differences) and management of those found to be susceptible. RESULTS Nineteen studies were included in the meta-analysis. The prevalence of measles-susceptible HCWs was 13.3% (95 %CI: 10.0-17.0%). In a comparison of serosusceptible female vs. male HCWs, the RR was 0.92 (95 %CI = 0.83-1.03), and in a comparison of age classes (born after vs. before 1980) the RR was 2.78 (95 %CI = 2.20-3.50). The most recent studies proposed the mandatory vaccination of HCWs. DISCUSSION According to our meta-analysis, the prevalence of serosusceptible European HCWs is 13%; HCWs born in the post-vaccination era seem to be at higher risk. Healthcare professionals susceptible to measles are a serious epidemiological concern. Greater efforts should therefore be made to identify those who have yet to be vaccinated and actively encourage their vaccination.
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Affiliation(s)
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy
| | - Paolo Trerotoli
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy.
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Streifel AC, Varley CD, Ham Y, Sikka MK, Lewis JS. The challenge of antibiotic selection in prosthetic joint infections due to Corynebacterium striatum: a case report. BMC Infect Dis 2022; 22:290. [PMID: 35346085 PMCID: PMC8962155 DOI: 10.1186/s12879-022-07270-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/13/2022] [Indexed: 12/18/2022] Open
Abstract
Background Corynebacterium striatum is a gram-positive facultative anaerobe found in the environment and human flora that has historically been considered a contaminant. More recently, Corynebacterium striatum has been implicated in human infections, including respiratory infections, endocarditis, and bone and joint infections, particularly those involving hardware or implanted devices. Case presentation A 65-year-old man presented for washout of his left total knee arthroplasty following a revision 20 days prior. The patient underwent debridement of his left total knee and revision of the left total femur arthroplasty. Daptomycin was initiated empirically due to a previous rash from vancomycin. Operative tissue cultures grew Staphylococcus haemolyticus, Staphylococcus epidermidis and Corynebacterium striatum. Given concern for daptomycin resistance and the reliability of vancomycin susceptibility, daptomycin was discontinued and vancomycin initiated following a graded challenge. Within a few days, the patient developed a diffuse, blanching, erythematous, maculopapular rash and daptomycin was restarted. Over the next 72 h, his rash progressed and he met criteria for drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Daptomycin was stopped and oral linezolid initiated; rash improved. C. striatum returned with susceptibility to gentamicin, linezolid, vancomycin and daptomycin. Due to concern for adverse effects on long-term linezolid, daptomycin was restarted and was tolerated for 20 days, at which point purulent drainage from incision increased. The patient underwent another arthroplasty revision and washout. Operative cultures from this surgery were again positive for C. striatum. Repeat C. striatum susceptibilities revealed resistance to daptomycin but retained susceptibility to linezolid. Daptomycin was again changed to linezolid. He completed six weeks of linezolid followed by linezolid 600 mg daily for suppression and ultimately opted for disarticulation. Conclusions C. striatum has historically been regarded as a contaminant, particularly when grown in tissue culture in the setting of prosthetic joint infection. Based on the available literature and susceptibility patterns, the most appropriate first-line therapy is vancomycin or linezolid. Treatment with daptomycin should be avoided, even when isolates appear susceptible, due to the risk of development of high-level resistance (MIC > 256 µg/mL) and clinical failure.
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Affiliation(s)
- Amber C Streifel
- Department of Pharmacy, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
| | - Cara D Varley
- Department of Medicine, Division of Infectious Diseases, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.,School of Public Health, Oregon Health and Science University-Portland State University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - YoungYoon Ham
- Department of Pharmacy, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Monica K Sikka
- Department of Pharmacy, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - James S Lewis
- Department of Pharmacy, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.,Department of Medicine, Division of Infectious Diseases, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
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SR V, NS K, SS K, AM W, M A. Usefulness of diverse serological tests in the laboratory diagnosis of fever with skin-rash cases in children. JOURNAL OF CLINICAL VIROLOGY PLUS 2022. [DOI: 10.1016/j.jcvp.2022.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Antibody Levels at 3-Years Follow-Up of a Third Dose of Measles-Mumps-Rubella Vaccine in Young Adults. Vaccines (Basel) 2022; 10:vaccines10010132. [PMID: 35062794 PMCID: PMC8781586 DOI: 10.3390/vaccines10010132] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 02/01/2023] Open
Abstract
Mumps outbreaks and breakthrough infections of measles and rubella have raised concerns about waning of vaccine-induced immunity after two doses of measles-mumps-rubella (MMR) vaccination. In the present follow-up study, serum IgG antibodies against mumps, measles and rubella, as well as the functional neutralizing antibodies against both the mumps vaccine strain and mumps outbreak strains were measured longitudinally in young adults that received a third MMR (MMR3) dose. The mumps-specific IgG and virus neutralizing antibody levels at 3 years after vaccination were still elevated compared to pre-vaccination antibody levels, although the differences were smaller than at earlier timepoints. Interestingly, subjects with low antibody levels to mumps before vaccination benefited the most as they showed the strongest antibody increase after an MMR3 dose. Three years after an MMR3 dose, all subjects had antibody levels to measles and rubella above the internationally agreed antibody cutoff levels for clinical protection. Our data support the recommendation that an MMR3 dose may provide additional protection for those that have become susceptible to mumps virus infection during outbreaks. MMR3 also resulted in an increase in anti-measles and rubella antibody levels that lasted longer than might have been expected.
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22
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Song K, Lee JM, Lee EJ, Lee BR, Choi JY, Yun J, Lee SN, Jang MY, Kim HW, Kim HS, Moon SM, Kim YK. Control of a nosocomial measles outbreak among previously vaccinated adults in a population with high vaccine coverage: Korea, 2019. Eur J Clin Microbiol Infect Dis 2022; 41:455-466. [PMID: 34999974 DOI: 10.1007/s10096-021-04390-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/30/2021] [Indexed: 01/26/2023]
Abstract
We describe a measles outbreak among previously vaccinated healthcare workers (HCWs) and inpatients and the control measures implemented at a tertiary care hospital in 2019. Case-patients were laboratory-confirmed measles with throat swabs tested by quantitative polymerase chain reactions (PCR), during April-May 2019. Medical histories and documented immunization records were obtained. We compared attack rates (ARs) among HCWs by occupational subgroup and age and examined the outbreak-associated costs. The index case was not ascertained. Among 26 measles case-patients (22 HCWs, four inpatients) aged 18-28 years, 25 had previously received measles-mumps-rubella (MMR) vaccine (12/26, 46% (two doses); 13/26, 50% (one dose)), and 16 (62%) had positive results of measles IgG prior to measles diagnosis. ARs were higher among HCWs aged < 30 years (1.88%), especially in the subgroup under 25 years of age (2.22%). Control measures included work restrictions for seronegative HCWs (218/2320, 9.4%) in immunity verification, administration of the MMR vaccine (207 HCWs) or intravenous immunoglobulin (2 HCWs and 11 inpatients), enhanced health surveillance of HCWs, and mandatory assessment of patients with measles-like symptoms at the infectious diseases screening units. The hospital spent 90,417,132 Korean won (US $79,733) in response to the outbreak. Measles outbreaks can occur in healthcare settings despite high population immunity, highlighting the importance of stronger vaccination policies, particularly among young HCWs. Moreover, an effective outbreak response comprising immunization activities and enhanced surveillance of HCWs and patients to rapidly detect measles-like symptoms at a prodromal phase is essential to control nosocomial measles outbreaks.
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Affiliation(s)
- Kyunghyun Song
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ju Mi Lee
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Ju Lee
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Bo Ram Lee
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji Young Choi
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jihee Yun
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Se Na Lee
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Mi Young Jang
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Han Wool Kim
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea.,Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Han-Sung Kim
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea.,Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Song Mi Moon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.,Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Yong Kyun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea. .,Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea. .,Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
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23
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Kanduc D. From Genetics to Epigenetics: Top 4 Aspects for Improved SARS-CoV-2 Vaccine Designs as Paradigmatic Examples. Glob Med Genet 2021; 9:14-17. [PMID: 35169778 PMCID: PMC8837413 DOI: 10.1055/s-0041-1739495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/29/2021] [Indexed: 11/03/2022] Open
Abstract
AbstractThis literature review described the genetic and biochemical factors that may have been overlooked in the formulation of vaccines and that most likely underlie possible issues with mass vaccination.
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Affiliation(s)
- Darja Kanduc
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Bari, Italy
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24
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Doornekamp L, Comvalius AD, GeurtsvanKessel CH, Slobbe L, Scherbeijn SMJ, van Genderen PJJ, van Binnendijk RS, van Gorp ECM, de Swart RL, Goeijenbier M. Measles seroprevalence among Dutch travelling families. Travel Med Infect Dis 2021; 44:102194. [PMID: 34728385 DOI: 10.1016/j.tmaid.2021.102194] [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: 08/04/2020] [Revised: 10/05/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND While measles vaccination is widely implemented in national immunisation programmes, measles incidence rates are increasing worldwide. Dutch inhabitants who were born between 1965-1975 may have fallen between two stools, lacking protection from a natural infection, and having missed the introduction of the measles vaccination schedule. With this study we aim to find the measles seroprevalence in travellers born between 1965 and 1975, compared to those born before 1965 and after 1975. METHODS Families travelling to Eastern Europe or outside Europe during the preceding year were recruited via Dutch secondary schools between 2016 and 2018. Their vaccination status was assessed using questionnaires, vaccination records and measles serology in dried blood spot (DBS) eluates. Measles virus antibody concentrations were determined with an ELISA (EUROIMMUNE®) and a subset was retested with a focus reduction neutralization assay (FRNT). RESULTS In 188 (79%) of the 239 available DBS eluates, the ELISA could detect sufficient measles virus-specific IgG antibodies. Of the negative samples that were retested with FRNT, 85% remained negative, resulting in an overall seroprevalence of 82% [95% CI 76-86]. Children had a lower seroprevalence (72%) than adults (87%). Travellers born between 1965 and 1975 were protected in 89%. CONCLUSIONS In this study, we report a measles seroprevalence of 82% among Dutch travelling families. Remarkably, seroprevalence rates were lowest in children (12-18 years) instead of travellers born between 1965 and 1975. Although a fraction of people without detectable antibodies may be protected by other immune mechanisms, these data suggest that measles (re)vaccination should be considered for travellers to endemic regions.
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Affiliation(s)
- Laura Doornekamp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Travel Clinic, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anouskha D Comvalius
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Corine H GeurtsvanKessel
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lennert Slobbe
- Travel Clinic, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Tropical Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sandra M J Scherbeijn
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Perry J J van Genderen
- Travel Clinic, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Tropical Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rob S van Binnendijk
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Eric C M van Gorp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Travel Clinic, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rik L de Swart
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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25
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López-Perea N, Fernández-García A, Echevarría JE, de Ory F, Pérez-Olmeda M, Masa-Calles J. Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014-2020. Viruses 2021; 13:v13101982. [PMID: 34696412 PMCID: PMC8537497 DOI: 10.3390/v13101982] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
The MMR vaccination program was introduced in Spain in 1981. Consistently high vaccination coverage has led to Spain being declared free of endemic measles transmission since 2014. A few imported and import-related cases were reported during the post-elimination phase (2014 to 2020), with very low incidence: three cases per million of inhabitants a year, 70% in adults. In the post-elimination phase an increasing proportion of measles appeared in two-dose vaccinated individuals (up to 14%), posing a challenge to surveillance and laboratory investigations. Severity and clinical presentation were milder among the vaccinated. The IgM response varied and the viral load decreased, making the virus more difficult to detect. A valid set of samples (serum, urine and throat swab) is strongly recommended for accurate case classification. One third of measles in fully vaccinated people was contracted in healthcare settings, mainly in doctors and nurses, consistent with the important role of high intensity exposure in measles breakthrough cases. Surveillance protocols and laboratory algorithms should be adapted in advanced elimination settings. Reinforcing the immunity of people working in high exposure environments, such as healthcare settings, and implementing additional infection control measures, such as masking and social distancing, are becoming crucial for the global aim of measles eradication.
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Affiliation(s)
- Noemí López-Perea
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (N.L.-P.); (J.M.-C.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
| | - Aurora Fernández-García
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
- Correspondence:
| | - Juan Emilio Echevarría
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
| | - Fernando de Ory
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
| | - Mayte Pérez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain
| | - Josefa Masa-Calles
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (N.L.-P.); (J.M.-C.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
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Abstract
Cardiopulmonary resuscitation (CPR) is an emergency lifesaving endeavor, performed in either the hospital or outpatient settings, that significantly improves outcomes and survival rates when performed in a timely fashion. As with any other medical procedure, CPR can bear potential risks not only for the patient but also for the rescuer. Among those risks, transmission of an infectious agent has been one of the most compelling triggers of reluctance to perform CPR among providers. The concern for transmission of an infection from the resuscitated subject may impede prompt initiation and implementation of CPR, compromising survival rates and neurological outcomes of the patients. Infections during CPR can be potentially acquired through airborne, droplet, contact, or hematogenous transmission. However, only a few cases of infection transmission have been actually reported globally. In this review, we present the available epidemiological findings on transmission of different pathogens during CPR and data on reluctance of health care workers to perform CPR. We also outline the levels of personal protective equipment and other protective measures according to potential infectious hazards that providers are potentially exposed to during CPR and summarize current guidelines on protection of CPR providers from international societies and stakeholders.
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27
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Bianchi FP, Mascipinto S, Stefanizzi P, De Nitto S, Germinario C, Tafuri S. Long-term immunogenicity after measles vaccine vs. wild infection: an Italian retrospective cohort study. Hum Vaccin Immunother 2021; 17:2078-2084. [PMID: 33502929 PMCID: PMC8189124 DOI: 10.1080/21645515.2020.1871296] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/17/2020] [Accepted: 12/29/2020] [Indexed: 11/08/2022] Open
Abstract
The persistence of specific IgG after measles infection and after measles vaccination has not been sufficiently investigated. Current evidence suggests that immunity after the disease is life-long, whereas the response after two doses of measles-containing vaccine declines within 10-15 years. This study evaluated the proportion of individuals with detectable anti-measles IgG in two groups, those vaccinated with two doses of anti-MMR vaccine and those with a self-reported history of measles infection. Among the 611 students and residents who were tested, 94 (15%) had no detectable protective anti-measles IgG. This proportion was higher among vaccinated individuals (20%; GMT = 92.2) than among those with a self-reported history of measles (6%; GMT = 213.3; p < .0001). After one or two MMR vaccine booster doses, the overall seroconversion rate was 92%. An important proportion of people immunized for measles did not have a protective IgG titer in the years after vaccination, but among those who had a natural infection the rate was three-fold lower. This finding should be considered in the pre-elimination phase, given the resurgence of measles cases among individuals who after being vaccinated lost their circulating IgG after several years, especially if they failed to receive a natural booster.
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Affiliation(s)
- Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Simona Mascipinto
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Sara De Nitto
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Cinzia Germinario
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
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28
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Kauffmann F, Heffernan C, Meurice F, Ota MOC, Vetter V, Casabona G. Measles, mumps, rubella prevention: how can we do better? Expert Rev Vaccines 2021; 20:811-826. [PMID: 34096442 DOI: 10.1080/14760584.2021.1927722] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Measles, mumps, and rubella incidence decreased drastically following vaccination programs' implementation. However, measles and mumps' resurgence was recently reported, outbreaks still occur, and challenges remain to control these diseases. AREAS COVERED This qualitative narrative review provides an objective appraisal of the literature regarding current challenges in controlling measles, mumps, rubella infections, and interventions to address them. EXPERT OPINION While vaccines against measles, mumps, and rubella (including trivalent vaccines) are widely used and effective, challenges to control these diseases are mainly related to insufficient immunization coverage and changing vaccination needs owing to new global environment (e.g. traveling, migration, population density). By understanding disease transmission peculiarities by setting, initiatives are needed to optimize vaccination policies and increase vaccination coverage, which was further negatively impacted by COVID-19 pandemic. Also, awareness of the potential severity of infections and the role of vaccines should increase. Reminder systems, vaccination of disadvantaged, high-risk and difficult-to-reach populations, accessibility of vaccination, healthcare infrastructure, and vaccination services management should improve. Outbreak preparedness should be strengthened, including implementation of high-quality surveillance systems to monitor epidemiology. While the main focus should be on these public health initiatives to increase vaccination coverage, slightly more benefits could come from evolution of current vaccines.
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Affiliation(s)
| | - Catherine Heffernan
- NHS England (London Region), 1st Floor, Wellington House, 133-155 Waterloo Road, London, SE16UG, UK
| | - François Meurice
- GSK, Avenue Fleming 20, 1300 Wavre, Belgium.,Biomedical Sciences Department, Faculty of Medicine, University of Namur (UNamur), Rue de Bruxelles 61, 5000 Namur, Belgium
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29
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Kurata T, Yamamoto SP, Nishimura H, Yumisashi T, Motomura K, Kinoshita M. A measles outbreak in Kansai International Airport, Japan, 2016: Analysis of the quantitative difference and infectivity of measles virus between patients who are immunologically naive versus those with secondary vaccine failure. J Med Virol 2021; 93:3446-3454. [PMID: 33325052 DOI: 10.1002/jmv.26733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/01/2020] [Accepted: 12/12/2020] [Indexed: 12/13/2022]
Abstract
Since the elimination of the measles virus, patients with vaccination records for the measles-containing vaccine have increased in Japan. According to several studies, the transmission risk from previously immunized patients, especially those with secondary vaccine failure (SVF), is lower than that from those with primary measles infections. Immunological features of SVF were identified per specific immunoglobulin G (IgG) induction with high avidity and high plaque reduction neutralization antibody concentration. However, the virological features of SVF have not been well investigated. To examine not only immunological but also virological differences between SVF and immunologically naive patients, throat swabs and blood and urine specimens of 25 patients with confirmed measles infection after an outbreak at the Kansai International Airport in 2016 were analyzed. Patients were categorized as naive (n = 3) or with SVF (n = 22) based on measles-specific IgG antibody concentrations and their avidity. Virus isolation and quantitative real-time polymerase chain reaction were performed to quantify the viral load in clinical specimens and estimate the infectivity in each specimen. The number of viral genome copies in the blood specimens of those with SVF was significantly different and approximately 1 out of 100 of that in immunologically naive patients. However, genome copy numbers in throat swabs and urine specimens were not significantly different between the groups. The virus was isolated only from those in the naive group. Our study indicated low transmission risk of the virus in patients with SVF.
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Affiliation(s)
- Takako Kurata
- Osaka Institute of Public Health, Morinomiya Center, Osaka, Japan
| | | | | | | | - Kazushi Motomura
- Osaka Institute of Public Health, Morinomiya Center, Osaka, Japan
| | - Masaru Kinoshita
- Department of Health and Medical Care, Osaka Prefectural Government, Osaka, Japan
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30
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von Linstow ML, Yde Nielsen A, Kirkby N, Eltvedt A, Nordmann Winther T, Bybeck Nielsen A, Bang D, Poulsen A. Immunity to vaccine-preventable diseases among paediatric healthcare workers in Denmark, 2019. ACTA ACUST UNITED AC 2021; 26. [PMID: 33928900 PMCID: PMC8086246 DOI: 10.2807/1560-7917.es.2021.26.17.2001167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Healthcare workers (HCW) have been identified as index cases in disease outbreaks of vaccine-preventable diseases (VPD) in hospitals. Aim We investigated whether Danish paediatric HCW were protected against selected serious VPD. Methods We included 90% of staff members from two paediatric departments. All 555 HCW (496 women) supplied a blood sample for serology and filled in a questionnaire. Antibodies were measured with enzyme immunoassay against measles, mumps, rubella (MMR), varicella zoster, pertussis toxin and diphtheria toxin. Results Protective levels of IgG were found for measles (90.3%), mumps (86.5%), rubella (92.3%), varicella (98.6%) and diphtheria (80.5%). We found seropositivity for all three MMR components in 421 (75.9%) HCW, lowest in those younger than 36 years (63.3%). Only 28 (5%) HCW had measurable IgG to pertussis. HCW with self-reported immunity defined as previous infection or vaccination, had protective levels of IgG against measles, mumps, rubella and varicella in 87.4–98.8% of cases, not significantly higher than in those not reporting immunity. Previous history of disease had a high positive predictive value (PPV) of 96.8–98.8%. The PPV for previous vaccination ranged from 82.5% to 90.3%. In contrast, negative predictive values of self-reported history of disease and vaccination were remarkably low for all diseases. Conclusion The immunity gaps found primarily in young HCW indicate a need for a screening and vaccination strategy for this group. Considering the poor correlation between self-reported immunity and seropositivity, efforts should be made to check HCW’s immune status in order to identify those who would benefit from vaccination.
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Affiliation(s)
- Marie-Louise von Linstow
- Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alex Yde Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Nikolai Kirkby
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anna Eltvedt
- Department of Paediatrics and Adolescent Medicine, Nordsjællands Hospital, Hillerød, Denmark
| | - Thilde Nordmann Winther
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Allan Bybeck Nielsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Didi Bang
- Department of Paediatrics and Adolescent Medicine, Nordsjællands Hospital, Hillerød, Denmark
| | - Anja Poulsen
- Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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31
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Lin WHW, Moran E, Adams RJ, Sievers RE, Hauer D, Godin S, Griffin DE. A durable protective immune response to wild-type measles virus infection of macaques is due to viral replication and spread in lymphoid tissues. Sci Transl Med 2021; 12:12/537/eaax7799. [PMID: 32238577 DOI: 10.1126/scitranslmed.aax7799] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/15/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022]
Abstract
Infection with wild-type (WT) measles virus (MeV) is an important cause of childhood mortality that leads to lifelong protective immunity in survivors. WT MeV and the live-attenuated MeV used in the measles vaccine (LAMV) are antigenically similar, but the determinants of attenuation are unknown, and protective immunity induced by LAMV is less robust than that induced by WT MeV. To identify factors that contribute to these differences, we compared virologic and immunologic responses after respiratory infection of rhesus macaques with WT MeV or LAMV. In infected macaques, WT MeV replicated efficiently in B and T lymphocytes with spreading throughout lymphoid tissues resulting in prolonged persistence of viral RNA. In contrast, LAMV replicated efficiently in the respiratory tract but displayed limited spread to lymphoid tissue or peripheral blood mononuclear cells. In vitro, WT MeV and LAMV replicated similarly in macaque primary respiratory epithelial cells and human lymphocytes, but LAMV-infected lymphocytes produced little virus. Plasma concentrations of interleukin-1β (IL-1β), IL-12, interferon-γ (IFN-γ), CCL2, CCL11, CXCL9, and CXCL11 increased in macaques after WT MeV but not LAMV infection. WT MeV infection induced more protective neutralizing, hemagglutinin-specific antibodies and bone marrow plasma cells than did LAMV infection, although numbers of MeV-specific IFN-γ- and IL-4-producing T cells were comparable. Therefore, MeV attenuation may involve altered viral replication in lymphoid tissue that limited spread and decreased the host antibody response, suggesting a link between lifelong protective immunity and the ability of WT MeV, but not LAMV, to spread in lymphocytes.
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Affiliation(s)
- Wen-Hsuan W Lin
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Eileen Moran
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Robert J Adams
- Department of Molecular and Comparative Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
| | - Robert E Sievers
- Department of Chemistry, University of Colorado, Boulder, CO 80309, USA
| | - Debra Hauer
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - Diane E Griffin
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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32
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Yoshioka N, Deguchi M, Hagiya H, Kagita M, Tsukamoto H, Takao M, Yoshida H, Hamaguchi S, Maeda I, Hidaka Y, Tomono K. 10-Year survey on serum antibody positivity rates and titers for measles and rubella in healthcare workers; an observational study at a Japanese university hospital. J Infect Chemother 2021; 27:1295-1299. [PMID: 33910777 DOI: 10.1016/j.jiac.2021.04.006] [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: 02/02/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We evaluated the effect of the two-dose vaccination strategy, which has been a widely adopted as childhood routine schedule worldwide to acquire herd immunity, on healthcare workers (HCWs) in Japan. METHODS Between 2010 and 2019, antibody titers for measles and rubella were measured annually among newly employed HCWs at Osaka University Hospital, Japan, using Enzygnost® assays (Siemens Healthcare Diagnostics Co. Ltd., Marburg, Germany). The data were categorized by age to compare the antibody positivity rates and antibody titers among no-vaccine, single-dose, and two-dose groups. RESULTS Over the 10-year period, the annual antibody positivity rates for measles and rubella were 84.0%-95.3% and 90.0%-94.5%, respectively, without any particular trend. The antibody titers for measles (median [interquartile range]: 8.4 [3.9, 20] vs. 6.1 [3.5, 12]) and rubella (11 [5.5, 20] vs. 6 [3.7, 11]) were statistically lower (p < 0.001) in the two-dose generation than in the single-dose generation. DISCUSSION A shift from single-dose to two-dose vaccination did not yield an increase in antibody positivity rates for both measles and rubella among HCWs. Notably, antibody titers were significantly lower in the two-dose generation. CONCLUSION Despite several limitations, our data suggests a paradoxical vulnerability in young HCWs who received the two-dose vaccination in a view of sero-positivity rates.
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Affiliation(s)
- Nori Yoshioka
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan; Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Matsuo Deguchi
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan; Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
| | - Masanori Kagita
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan; Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hiroko Tsukamoto
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan; Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Miyuki Takao
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan; Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hisao Yoshida
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Shigeto Hamaguchi
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Ikuhiro Maeda
- Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yoh Hidaka
- Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Woods S, Power L, O'Connell NH, Dunne CP. A 2018 hospital-mediated outbreak of 42 measles cases in Ireland: observations regarding emergency department waiting times and staff vaccination levels. J Hosp Infect 2021; 112:114-115. [PMID: 33862155 DOI: 10.1016/j.jhin.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/18/2022]
Affiliation(s)
- S Woods
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - L Power
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - N H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation and Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland
| | - C P Dunne
- Centre for Interventions in Infection, Inflammation and Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland.
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Zmerli O, Chamieh A, Maasri E, Azar E, Afif C. A challenging modified measles outbreak in vaccinated healthcare providers. Infect Prev Pract 2021; 3:100105. [PMID: 34368732 PMCID: PMC8336165 DOI: 10.1016/j.infpip.2020.100105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Modified measles is rarely reported and thought to be an attenuated, less transmissible form of measles. The occupational safety and management of previously immunized healthcare providers (HCP) facing the global reemergence of measles is controversial and unclear.Aim: We report a measles outbreak with an unusual presentation among our vaccinated HCP at Saint George Hospital University Medical Center (SGHUMC) in Lebanon that occurred during a nationwide measles epidemic. METHODS We recorded cases at SGHUMC, a 333-bed tertiary-care center, from April 2018 to June 2018. We established a measles clinic for investigating all febrile patients. HCP exposure was linked to influx of index cases through our Emergency Department. Modified measles was defined as any variation in the classic presentation with a pinpoint/vesicular rash, documented exposure and evidence of prior immunity. We performed serology testing to diagnose and/or document immunity and implemented outbreak controls measures including PPE, airborne isolation, and mass notification. FINDINGS We diagnosed 8 inpatients with classic measles, and 9 affected HCP. We diagnosed 8 HCP with modified measles. One previously immunized HCP developed classic measles despite being immunized and having a positive IgG titer. Our contact tracing revealed a total of 96 exposed HCP with 27 HCP showing non-specific signs of viral illness. We required all the 9 affected HCP to undergo home isolation. CONCLUSION We believe it is a top priority to achieve adequate measles immunity, especially among HCP that are at the frontline of healthcare systems. This necessitates revisiting vaccination schedules and achieving seroprotective titers to reclaim proper herd immunity.
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Affiliation(s)
- Omar Zmerli
- Division of Infectious Diseases, Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - Amanda Chamieh
- Division of Infectious Diseases, Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
- Mediterranean University Hospital Institute for Infectious Diseases, Marseille, 13915, France
| | - Eliane Maasri
- Infection Control Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Eid Azar
- Division of Infectious Diseases, Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - Claude Afif
- Division of Infectious Diseases, Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
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Bolotin S, Hughes SL, Gul N, Khan S, Rota PA, Severini A, Hahné S, Tricco A, Moss WJ, Orenstein W, Turner N, Durrheim D, Heffernan JM, Crowcroft N. What Is the Evidence to Support a Correlate of Protection for Measles? A Systematic Review. J Infect Dis 2021; 221:1576-1583. [PMID: 31674648 DOI: 10.1093/infdis/jiz380] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/22/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many studies assume that the serologic correlate of protection from measles disease is 120 mIU/mL. We systematically reviewed the literature to examine the evidence supporting this correlate of protection. METHODS We searched peer-reviewed and gray literature for articles reporting a measles correlate of protection. We excluded studies focusing on special populations, infants aged <9 months, and those using animal models or nonstandard vaccines or administration routes. We extracted and synthesized data from full-text articles that met inclusion criteria. RESULTS We screened 14 778 articles and included 5 studies in our review. The studies reported either preexposure antibody concentrations of individuals along with a description of symptoms postexposure, or the proportion of measles cases that had preexposure antibody concentrations above a threshold of immunity specified by the authors. Some studies also described secondary antibody responses upon exposure. The variation in laboratory methods between studies made comparisons difficult. Some of the studies that assumed 120 mIU/mL as a correlate of protection identified symptomatic individuals with preexposure titers exceeding this threshold. CONCLUSIONS Our findings underscore the scant data upon which the commonly used 120 mIU/mL measles threshold of protection is based, suggesting that further work is required to characterize the measles immunity threshold.
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Affiliation(s)
- Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Nazish Gul
- Public Health Ontario, Toronto, Ontario, Canada
| | | | - Paul A Rota
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alberto Severini
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Susan Hahné
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Andrea Tricco
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Walter Orenstein
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nikki Turner
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Science, University of Auckland, Tamaki Campus, Auckland, New Zealand
| | | | - Jane M Heffernan
- Centre for Disease Modelling, Mathematics and Statistics, York University,, Toronto, Ontario, Canada
| | - Natasha Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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Gianniki M, Siahanidou T, Botsa E, Michos A. Measles epidemic in pediatric population in Greece during 2017-2018: Epidemiological, clinical characteristics and outcomes. PLoS One 2021; 16:e0245512. [PMID: 33471833 PMCID: PMC7817010 DOI: 10.1371/journal.pone.0245512] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background and aim A measles outbreak occurred in Greece during 2017–2018 affecting mainly pediatric population. The aim of the study was to describe the epidemiological and clinical characteristics of the cases diagnosed in the major pediatric tertiary hospital of Athens, where 26.5% of national pediatric measles cases were diagnosed and treated. Methods This is a retrospective study of children 0–16 years old, who presented at the emergency department and/or were hospitalized with clinical presentation compatible with measles and diagnosis was confirmed with molecular detection of the measles RNA in pharyngeal swabs. Epidemiological, clinical and laboratory characteristics were retrieved from medical records and analyzed. Results A total of 578 children with measles were identified during the study period. 322 (55.7%) were male with median age 36 months (range:1–193), while the largest number of documented cases (251; 43.4%) were children aged 1–5 years. Most children (429/578; 74.2%) belonged to the Roma minority and only 64 (11.1%) had Greek origin. 497 (91.5%) children were unvaccinated and 37 (6.8%) were partially vaccinated with measles vaccine. Hospitalization was required for 342 (59.2%) children, whereas one or more complications were reported in 230 (67.2%) of them. Most frequent complications were elevated transaminases (139; 40.6%), acute otitis media (72; 21%), dehydration (67; 19.6%) and pneumonia (58; 16.9%). 11 children (3.2%) required intensive care admission for altered mental status/status epilepticus (3), sepsis (2) and ARDS (6). 119/342 (34.8%) children were treated with antibiotics because of possible or confirmed bacterial coinfection. One death was reported, concerning an 11-month-old unvaccinated infant, with underlying dystrophy, who died of sepsis. Conclusion Measles is not an innocent viral infection, as it is still characterized by high morbidity and complications rates. Unvaccinated or partially vaccinated populations could trigger new outbreaks, resulting in significant cost in public health. To avoid future measles outbreaks, high vaccination coverage should be achieved, as well as closing immunity gaps in the population and ensuring high-quality measles surveillance.
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Affiliation(s)
- Maria Gianniki
- First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Tania Siahanidou
- First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Evanthia Botsa
- First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Athanasios Michos
- First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
- * E-mail:
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Gibney KB, Attwood LO, Nicholson S, Tran T, Druce J, Healy J, Strachan J, Franklin L, Hall R, Cross GB. Emergence of Attenuated Measles Illness Among IgG-positive/IgM-negative Measles Cases: Victoria, Australia, 2008-2017. Clin Infect Dis 2021; 70:1060-1067. [PMID: 31056637 DOI: 10.1093/cid/ciz363] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Waning measles immunity among vaccinated individuals may result in an attenuated illness. This study compares the epidemiological, clinical, and laboratory profile of measles cases with waning immunity with other measles cases. METHODS Polymerase chain reaction-positive (+) measles cases notified to Victoria's Department of Health and Human Services from 2008 to 2017 with immunoglobulin (Ig) M and IgG tested at diagnosis were classified according to serology at diagnosis: IgG negative (-) (nonimmune), IgM+/IgG+ (indeterminate), or IgM-/IgG+ (waning immunity). RESULTS Between 2008 and 2017, 297 measles cases were notified, of whom 190 (64%) were included; 151 of 190 (79%) were nonimmune at diagnosis, 26 (14%) were indeterminate, and 13 (7%) had waning immunity. Between 2008-2013 and 2014-2017, the proportion of cases with waning immunity increased from 0 of 87 (0%) to 13 of 103 (13%) (P < .001) and the diagnostic sensitivity of initial IgM fell from 93% to 81% (P = .012), respectively. Seven (54%) waning immunity cases reported receiving measles-containing vaccines; 1 case had 2 documented doses. Compared with nonimmune and indeterminate cases, waning immunity cases were more likely to be male; less likely to report fever, coryza, and cough; and had lower burden of virus (higher cycle threshold values). Waning immunity cases had higher IgG titers than indeterminate cases (mean optical density values, 1.96 vs 0.71; P = .004). Onward transmission from 1 waning immunity case was documented. CONCLUSIONS Waning immunity among measles cases, associated with secondary vaccine failure and modified clinical illness, is emerging in Victoria with transmission potential.
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Affiliation(s)
- Katherine B Gibney
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia.,The Peter Doherty Institute for Infection and Immunity, the University of Melbourne and the Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Lucy O Attwood
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Thomas Tran
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Julia Healy
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Janet Strachan
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Lucinda Franklin
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Robert Hall
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gail B Cross
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.,Department of Infectious Diseases, National University Hospital, Singapore
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Bartelme RR. Anthroposophic Medicine: A Short Monograph and Narrative Review-Foundations, Essential Characteristics, Scientific Basis, Safety, Effectiveness and Misconceptions. Glob Adv Health Med 2020; 9:2164956120973634. [PMID: 33457106 PMCID: PMC7783888 DOI: 10.1177/2164956120973634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Anthroposophic medicine is a form of integrative medicine that originated in Europe but is not well known in the US. It is comprehensive and heterogenous in scope and remains provocative and controversial in many academic circles. Assessment of the nature and potential contribution of anthroposophic medicine to whole person care and global health seems appropriate. METHODS Because of the heterogenous and multifaceted character of anthroposophic medicine, a narrative review format was chosen. A Health Technology Assessment of anthroposophic medicine in 2006 was reviewed and used as a starting point. A Medline search from 2006 to July 2020 was performed using various search terms and restricted to English. Books, articles, reviews and websites were assessed for clinical relevance and interest to the general reader. Abstracts of German language articles were reviewed when available. Reference lists of articles and the author's personal references were also consulted. RESULTS The literature on anthroposophic medicine is vast, providing new ways of thinking, a holistic view of the world, and many integrating concepts useful in medicine. In the last ∼20 years there has been a growing research base and implementation of many anthroposophical concepts in the integrated care of patients. Books and articles relevant to describing the foundations, scientific status, safety, effectiveness and criticisms of anthroposophic medicine are discussed. DISCUSSION An objective and comprehensive analysis of anthroposophic medicine finds it provocative, stimulating and potentially fruitful as an integrative system for whole person care, including under-recognized life processes and psychospiritual aspects of human beings. It has a legitimate, new type of scientific status as well as documented safety and effectiveness in some areas of its multimodal approach. Criticisms and controversies of anthroposophic medicine are often a result of lack of familiarity with its methods and approach and/or come from historically fixed ideas of what constitutes legitimate science.
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Affiliation(s)
- Ricardo R Bartelme
- Department of Family Medicine, University of Michigan Medical
School, Ann Arbor, Michigan
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39
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Lucca A, Bayoumi N, Ramanathan LV, Sepkowitz K, Kamboj M. Lower Rate of Seropositivity to Measles Among Young Healthcare Personnel in New York City. Clin Infect Dis 2020; 71:3241-3243. [PMID: 32478832 DOI: 10.1093/cid/ciaa660] [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: 12/30/2019] [Accepted: 05/26/2020] [Indexed: 11/12/2022] Open
Abstract
We examined the prevalence of measles antibody among 12 349 newly hired HCP between 2009 and 2019. Younger HCP were significantly more likely to have no immunity. Compared with a 92.2% seropositive rate among 1057 persons hired at age >50 years, only 84.4% of approximately 10 000 HCP aged <40 years had protective antibody.
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Affiliation(s)
- Anabella Lucca
- Employee Health and Wellness Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nagla Bayoumi
- Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lakshmi V Ramanathan
- Clinical Chemistry Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kent Sepkowitz
- Division of Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mini Kamboj
- Infection Control and Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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40
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Bianchi FP, Stefanizzi P, De Nitto S, Larocca AMV, Germinario C, Tafuri S. Long-term Immunogenicity of Measles Vaccine: An Italian Retrospective Cohort Study. J Infect Dis 2020; 221:721-728. [PMID: 31580436 PMCID: PMC7026886 DOI: 10.1093/infdis/jiz508] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/30/2019] [Indexed: 02/07/2023] Open
Abstract
Background Levels of antibodies induced by the measles virus–containing vaccine have been shown to decline over time, but there is no formal recommendation about testing immunized subjects (in particular, healthcare workers [HCWs]) to investigate the persistence of measles immunoglobulin G (IgG). Methods This study aims to evaluate the long-term immunogenicity of measles vaccine in a sample of medical students and residents of the University of Bari who attended the Hygiene Department for a biological risk assessment (April 2014–June 2018). Results Two thousand immunized (2 doses of measles-mumps-rubella [MMR] vaccine) students and residents were tested; 305 of these (15%) did not show protective anti-measles IgG. This proportion was higher among subjects who received vaccination at ≤15 months (20%) than in those who received vaccination at 16–23 months (17%) and at ≥24 months (10%) (P < .0001). After an MMR vaccine booster dose, we noted a seroconversion of 74% of seronegative HCWs. The overall seroconversion rate after a second dose (booster) was 93%. No serious adverse events were noted after the booster doses. Conclusions An important proportion of subjects immunized for measles do not show a protective IgG titer in the 10 years after vaccination. Our management strategy seems consistent with the purpose of evidencing immunological memory.
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Affiliation(s)
- Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Sara De Nitto
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | | | - Cinzia Germinario
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
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Abstract
Introduction: Controlling the preventable infectious diseases is the main goal of vaccination. Among the vaccines, combined vaccines are of great importance for their social, public health, and economic values. It is stated that the combined vaccines are as efficient and safe as the monovalent vaccines. However, a concern has raised about the efficacy and safety of the combined vaccines due to the outbreaks of vaccine-preventable diseases and occurrence of serious adverse events. Areas covered: A retrospective literature search was conducted in the Google Scholar and PubMed databases to evaluate the efficacy and safety of the combined vaccines from 1980 to 2020 using appropriate keywords. Expert opinion: Several studies have shown efficacy and safety issues related to the combined vaccines. Different factors contribute to the inefficacy and lack of safety in the vaccines including formulation problems, limited data in the pre-licensure studies and challenges related to imperfection of the post-licensure surveillance systems. For surmounting the mentioned obstacles, there is a need to provide new formulations of the vaccines, revise the vaccines҆ safety and efficacy acceptance standards in the pre-licensure studies, improvement of post-licensure surveillance systems, and education of healthcare staff.
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Petraglia TCDMB, Farias PMCDM, Sá GRSE, Santos EMD, Conceição DAD, Maia MDLDS. Vaccine failures: assessing yellow fever, measles, varicella, and mumps vaccines. CAD SAUDE PUBLICA 2020; 36Suppl 2:e00008520. [PMID: 33146313 DOI: 10.1590/0102-311x00008520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/06/2020] [Indexed: 11/22/2022] Open
Abstract
Vaccination is one of the greatest public health interventions, based on its safety and effectiveness, but vaccination does not always mean immunization. Numerous aspects related both to the individual that receives the vaccine and the specificity of each vaccine administered are part of the process of obtaining adequate immunization, and it is essential to observe the aspects in order to avoid vaccine failures. The analysis of immunogenicity and effectiveness studies for the measles, varicella, and mumps vaccines point to the need to incorporate two doses into the basic vaccination calendars in order to control these diseases. Epidemiological studies that analyzed outbreaks of these diseases identified cases in individuals that received two doses of the vaccine, which may indicate likely secondary failure. For the yellow fever vaccine, the current discussion lies in the ideal number of doses for individual protection. The World Health Organization recommends a single dose for life. Despite the few reports in the literature concerning vaccine failures, immunogenicity studies demonstrate waning protection over the years, mainly in the pediatric age bracket. In the current scenario of elimination and control of diseases, associated with the decrease in the circulation of the wild-type viruses, the role of epidemiological surveillance is crucial for expanding knowledge on the multiple factors involved, culminating in vaccine failures and the emergence of outbreaks. Outbreaks of vaccine-preventable diseases negatively impact the credibility of immunization programs, leading to low vaccination coverage rates and interfering in vaccination's success.
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Affiliation(s)
| | | | - Glória Regina Silva E Sá
- Instituto de Saúde Coletiva, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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Bassal R, Indenbaum V, Pando R, Levin T, Shinar E, Amichay D, Barak M, Ben-Dor A, Haim AB, Mendelson E, Cohen D, Shohat T. Seropositivity of measles antibodies in the Israeli population prior to the nationwide 2018 - 2019 outbreak. Hum Vaccin Immunother 2020; 17:1353-1357. [PMID: 33121333 DOI: 10.1080/21645515.2020.1824968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Measles vaccine is administered in Israel as part of the routine childhood immunization program, at ages 1 and 6 years. In this study, we assessed seropositivity of the Israeli population against measles before the onset and propagation of the 2018-2019 measles outbreak. From the Israel Center for Disease Control National Serum Bank, 3,164 samples collected during 2015 were tested for measles antibodies. All the tests were performed using Enzyme-Linked Immunosorbent Assay (ELISA) commercial kit (Enzygnost, Anti-Measles Virus/IgG: Behring, Marburg, Germany). The overall seropositivity rate for measles was 90.7%. The seropositivity rate at 6 months and younger was 48.9%, and decreased to 3.8% among infants aged 6-11 months. Seropositivity increased to 90.7% in the 1-4-year age group, and reached 96.1% for 5-9 year-old children. Our results suggest high immunity in the Israeli population against measles virus, but not high enough to prevent outbreaks because of pockets of specific population groups with low immunization coverage. Infants between ages 6 and 11 months and children younger than 2 years had the lowest seropositivity rates being the age groups with the highest attack rates of measles during the epidemic of 2018. Efforts should be aimed at avoiding any delay in vaccination once a child reaches the age of 1 year and improving immunity levels in children aged 1-4 years.
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Affiliation(s)
- Ravit Bassal
- Ministry of Health, Gertner Institute, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Victoria Indenbaum
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Rakefet Pando
- Ministry of Health, Gertner Institute, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Tal Levin
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Eilat Shinar
- Blood Services, Magen David Adom, Ramat-Gan, Israel
| | - Doron Amichay
- Soroka University Medical Center, Clalit Health Services, Beer Sheva, Israel
| | - Mira Barak
- Haifa and Western Galilee Laboratories, Clalit Health Services, Nesher, Israel
| | - Anat Ben-Dor
- Schneider Children Medical Center, Clalit Health Services, Petah-Tiqwa, Israel
| | - Adina Bar Haim
- Blood Services, Mayanei Hayeshua Medical Center, Bnei-Brak, Israel
| | - Ella Mendelson
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamy Shohat
- Ministry of Health, Gertner Institute, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kaaijk P, Nicolaie MA, van Rooijen D, van Houten MA, van der Klis FR, Buisman AM, van Binnendijk RS. Dynamics of the Antibody Response After a Third Dose of Measles-Mumps-Rubella Vaccine Indicate a Slower Decline Compared With a Second Dose. Open Forum Infect Dis 2020; 7:ofaa505. [PMID: 33269296 PMCID: PMC7686655 DOI: 10.1093/ofid/ofaa505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/15/2020] [Indexed: 11/13/2022] Open
Abstract
Background Breakthrough infections of measles and mumps have raised concerns about the duration of vaccine-induced immunity, which might be improved by a third dose of measles-mumps-rubella vaccine (MMR3). Methods Here we compared (IgG) antibody levels against measles, mumps, and rubella in blood samples of 9-year-old children and young adults (18–25 years) following MMR2 and MMR3, respectively. Results We found that, in addition to antibody boosting for all 3 vaccine components, MMR3 resulted in lower antibody decay rates than MMR2; the declines were most prominent for mumps and rubella. Conclusions This study suggests that MMR3 provides long-lasting seroprotection against measles, mumps, and rubella.
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Affiliation(s)
- Patricia Kaaijk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - M Alina Nicolaie
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Debbie van Rooijen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Fiona R van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Anne-Marie Buisman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Rob S van Binnendijk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Immunogenicity and persistence of trivalent measles, mumps, and rubella vaccines: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2020; 21:286-295. [PMID: 32888410 DOI: 10.1016/s1473-3099(20)30442-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite the universal use of the two-dose trivalent measles-mumps-rubella (MMR) vaccine in the past two decades, outbreaks of these diseases still occur in countries with high vaccine uptake, giving rise to concerns about primary and secondary failure of MMR vaccine components. We aimed to provide seroconversion and waning rate estimates for the measles, mumps, and rubella components of MMR vaccines. METHODS In this systematic review and meta-analysis we searched PubMed (including MEDLINE), Web of Science, and Embase for randomised controlled trials, cohort studies, or longitudinal studies reporting the immunogenicity and persistence of MMR vaccines, published in English from database inception to Dec 31, 2019. Studies were included if they investigated vaccine-induced immunity in healthy individuals who received a trivalent MMR vaccine, including different dosages and timepoints of vaccine administration. Studies featuring coadministration of MMR with other vaccines, maternal immunity to the MMR vaccine, or non-trivalent formulations of the vaccine were excluded. Pooled seroconversion and waning rates were estimated by random-effects meta-analyses. This study is registered with PROSPERO, CRD42019116705. FINDINGS We identified 3615 unique studies, 62 (1·7%) of which were eligible for analysis. Estimated overall seroconversion rates were 96·0% (95% CI 94·5-97·4; I2=91·1%) for measles, 93·3% (91·1-95·2; I2=94·9%) for mumps when excluding the Rubini strain, 91·1% (87·4-94·1; I2=96·6%) for mumps when including the Rubini strain, and 98·3% (97·3-99·2; I2=93·0%) for rubella. Estimated overall annual waning rates were 0·009 (95% CI 0·005-0·016; I2=85·2%) for measles, 0·024 (0·016-0·039; I2=94·7%) for mumps, and 0·012 (0·010-0·014; I2=93·3%) for rubella. INTERPRETATION Our meta-analysis provides estimates of primary and secondary vaccine failure, which are essential to improve the accuracy of mathematical and statistical modelling to understand and predict the occurrence of future measles, mumps, and rubella outbreaks in countries with high vaccine uptake. FUNDING European Research Council.
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Venkat H, Briggs G, Brady S, Komatsu K, Hill C, Leung J, Patel M, Livar E, Su CP, Kassem A, Sowers SB, Mercader S, Rota PA, Elson D, Timme E, Robinson S, Fitzpatrick K, Franco J, Hickman C, Gastañaduy PA. Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016. Clin Infect Dis 2020; 68:2018-2025. [PMID: 30256908 DOI: 10.1093/cid/ciy819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/20/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We describe a measles outbreak and control measures implemented at a privately operated detention facility housing US Immigration and Customs Enforcement detainees in 2016. METHODS Case-patients reported fever and rash and were either laboratory-confirmed or had an epidemiological link to a laboratory-confirmed case-patient. Immunoglobulin G (IgG) avidity and plaque reduction neutralization tests distinguished between primary acute and reinfection case-patients. Measles-specific IgG was measured to assess detainee immunity levels. We compared attack rates (ARs) among detainees and staff, between IgG-negative and IgG-positive detainees, and by detainee housing units and sexes. RESULTS We identified 32 measles case-patients (23 detainees, 9 staff); rash onsets were during 6 May-26 June 2016. High IgG avidity and neutralizing-antibody titers >40000 to measles (indicating reinfection) were identified in 18 (95%) and 15 (84%) of 19 tested case-patients, respectively. Among 205 unit A detainees tested for presumptive immunity, 186 (91%) had detectable IgG. Overall, the AR was 1.65%. ARs were significantly higher among detainees in unit A (7.05%) compared with units B-F (0.59%), and among male (2.33%) compared with female detainees (0.38%); however, ARs were not significantly different between detainees and staff or between IgG-negative and IgG-positive detainees. Control measures included the vaccination of 1424 of 1425 detainees and 190 of 510 staff, immunity verification for 445 staff, case-patient isolation, and quarantine of affected units. CONCLUSIONS Although ARs were low, measles outbreaks can occur in intense-exposure settings, despite a high population immunity, underscoring the importance of high vaccination coverage and containment in limiting measles transmission.
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Affiliation(s)
- Heather Venkat
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia.,Arizona Department of Health Services.,Maricopa County Department of Public Health, Phoenix
| | - Graham Briggs
- Pinal County Public Health Services District, Florence, Arizona
| | | | | | - Clancey Hill
- Pinal County Public Health Services District, Florence, Arizona
| | - Jessica Leung
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manisha Patel
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Chia-Ping Su
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia.,National Institutes of Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
| | - Ahmed Kassem
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia.,Idaho Department of Health and Welfare, Boise
| | - Sun B Sowers
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sara Mercader
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diana Elson
- United States Immigration and Customs Enforcement, Washington, D.C
| | - Evan Timme
- Pinal County Public Health Services District, Florence, Arizona
| | | | | | - Jabette Franco
- Pinal County Public Health Services District, Florence, Arizona
| | - Carole Hickman
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul A Gastañaduy
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Waning immunity and re-emergence of measles and mumps in the vaccine era. Curr Opin Virol 2020; 40:48-54. [PMID: 32634672 DOI: 10.1016/j.coviro.2020.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
Vaccine-preventable diseases (VPD) including measles and mumps have been re-emerging in countries with sustained high vaccine coverage. For mumps, waning immunity has been recognized as a major contributor to recent outbreaks. Although unvaccinated individuals account for most cases in recent measles outbreaks, the role of immune waning remains unclear. Accumulating serological and epidemiological evidence suggests that natural immunity induced by infection may be more durable compared to vaccine-induced immunity. As the proportion of population immunity via vaccination gradually increases and boosting through natural exposures becomes rare, risk of outbreaks may increase. Mechanistic insights into the coupled immuno-epidemiological dynamics of waning and boosting will be important to understand optimal vaccination strategies to combat VPD re-emergence and achieve eradication.
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Sundell N, Dotevall L, Sansone M, Andersson M, Lindh M, Wahlberg T, Tyrberg T, Westin J, Liljeqvist JÅ, Bergström T, Studahl M, Andersson LM. Measles outbreak in Gothenburg urban area, Sweden, 2017 to 2018: low viral load in breakthrough infections. ACTA ACUST UNITED AC 2020; 24. [PMID: 31039835 PMCID: PMC6628760 DOI: 10.2807/1560-7917.es.2019.24.17.1900114] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In an outbreak of measles in Gothenburg, Sweden, breakthrough infections (i.e. infections in individuals with a history of vaccination) were common. The objective of this study was to compare measles RNA levels between naïve (i.e. primary) and breakthrough infections. We also propose a fast provisional classification of breakthrough infections. Medical records were reviewed and real-time PCR-positive samples genotyped. Cases were classified as naïve, breakthrough or vaccine infections. We compared clinical symptoms and measles RNA cycle threshold (Ct) values between breakthrough and naïve infections. Sixteen of 28 confirmed cases of measles in this outbreak were breakthrough infections. A fast provisional classification, based on previous history of measles vaccination and detectable levels of measles IgG in acute serum, correctly identified 14 of the 16 breakthrough infections, confirmed by IgG avidity testing. Measles viral load was significantly lower in nasopharyngeal samples from individuals with breakthrough compared with naïve infections (median Ct-values: 32 and 19, respectively, p < 0.0001). No onward transmission from breakthrough infections was identified. Our results indicate that a high risk of onward transmission is limited to naïve infections. We propose a fast provisional classification of breakthrough measles that can guide contact tracing in outbreak settings.
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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, Gothenburg, Sweden
| | - Martina Sansone
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Wahlberg
- Department of Communicable Disease Control, Region Västra Götaland, Gothenburg, Sweden
| | - Tobias Tyrberg
- 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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Kobayashi A, Shimada T, Tanaka-Taya K, Kanai M, Okuno H, Kinoshita M, Matsui T, Oishi K. Epidemiology of a workplace measles outbreak dominated by modified measles cases at Kansai international airport, Japan, during august-september 2016. Vaccine 2020; 38:4996-5001. [PMID: 32535017 DOI: 10.1016/j.vaccine.2020.05.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES In August 2016, a measles outbreak at Kansai International Airport was the first workplace measles outbreak since Japan was verified as having achieved measles-elimination status in March 2015. We investigated this outbreak with a focus on evaluating the ability of vaccinated individuals to transmit measles virus (MV). METHODS We considered a case of laboratory-confirmed measles with onset between August 9 and September 29, 2016, among workers of Kansai International Airport. History of vaccination status with measles-containing vaccine (MCV) was confirmed by reviewing records. The potential sources of each MV infection were assessed by interviewing each infected worker about the clinical course of their infection and their behavioral history. RESULTS Of 30 affected ground crews identified, 16 (53%) were vaccinated with ≥ 1 dose of MCV, 2 (7%) were unvaccinated, and 12 (40%) had an unknown vaccination status. The index case, a patient with classical measles with unknown vaccination status, presumably transmitted MV to all the subsequent 29 cases. The majority of patients (23, 77%; 15 vaccinated, 8 in unknown vaccination status) were diagnosed with modified measles due to mild illness. Modified measles were characterized clinically by signs of catarrh (4/23, 17%) in a few cases, with a median incubation period of 16 (range, 11-21) days. No onward transmission from vaccinated cases was suggested. An overseas traveler who visited the airport with measles symptoms was identified as the possible primary source of this outbreak. CONCLUSIONS The low MV transmission ability of vaccinated individuals was reaffirmed. Contact tracing of vaccinated modified measles cases can be limited to a person at high risk of infection (e.g., households, person with immunosuppression). To maintain measles-elimination status, completing two doses of MCV should be ensured, especially for international travelers and for those who are frequently exposed to these travelers, such as airport workers.
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Affiliation(s)
- Ayako Kobayashi
- Field Epidemiology Training Program, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjyuku, Tokyo 162-8640, Japan
| | - Tomoe Shimada
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjyuku, Tokyo 162-8640, Japan
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjyuku, Tokyo 162-8640, Japan
| | - Mizue Kanai
- Field Epidemiology Training Program, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjyuku, Tokyo 162-8640, Japan
| | - Hideo Okuno
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjyuku, Tokyo 162-8640, Japan
| | - Masaru Kinoshita
- Medical Administration Division, Public Health and Medical Administration Office, Department of Public Health and Medical Affairs, Osaka Prefectural Government, Otemae, Chuo, Osaka 540-8570, Japan
| | - Tamano Matsui
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjyuku, Tokyo 162-8640, Japan
| | - Kazunori Oishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjyuku, Tokyo 162-8640, Japan; Toyama Institute of Health, Imizu, Toyama 939-0363, Japan.
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50
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Brinkman ID, de Wit J, Smits GP, Ten Hulscher HI, Jongerius MC, Abreu TC, van der Klis FRM, Hahné SJM, Koopmans MPG, Rots NY, van Baarle D, van Binnendijk RS. Early Measles Vaccination During an Outbreak in the Netherlands: Short-Term and Long-Term Decreases in Antibody Responses Among Children Vaccinated Before 12 Months of Age. J Infect Dis 2020; 220:594-602. [PMID: 30972418 PMCID: PMC6639599 DOI: 10.1093/infdis/jiz159] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/03/2019] [Indexed: 11/14/2022] Open
Abstract
Background The majority of infants will not be protected by maternal antibodies until their first measles vaccination, between 12 and 15 months of age. This provides incentive to reduce the age at measles vaccination, but immunological consequences are insufficiently understood, and long-term effects are largely unknown. Methods A total of 79 infants who received early measles vaccination between 6 and 12 months age and a second dose at 14 months of age were compared to 44 children in a control group who received 1 dose at 14 months of age. Measles virus–specific neutralizing antibody concentrations and avidity were determined up to 4 years of age. Results Infants who first received measles vaccination before 12 months of age had a long-term decrease in the concentration and avidity of measles virus–specific neutralizing antibodies, compared with infants in the control group. For 11.1% of children with a first dose before 9 months of age, antibody levels at 4 years of age had dropped below the cutoff for clinical protection. Conclusions Early measles vaccination provides immediate protection in the majority of infants but yields a long-term decrease in neutralizing antibody responses, compared to vaccination at a later age. Additional vaccination at 14 months of age does not improve this. Over the long term, this may result in an increasing number of children susceptible to measles.
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Affiliation(s)
- Iris D Brinkman
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven.,Department of Viroscience, Erasmus Medical Center, Rotterdam
| | - Jelle de Wit
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | - Gaby P Smits
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | - Hinke I Ten Hulscher
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | - Maria C Jongerius
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | - Taymara C Abreu
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | - Fiona R M van der Klis
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | - Susan J M Hahné
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | | | - Nynke Y Rots
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | - Debbie van Baarle
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven.,Laboratory of Translational Immunology, Department of Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Robert S van Binnendijk
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
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