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Pittet LF, Gualtieri R, Verolet CM, L'Huillier AG, Wildhaber BE, McLin VA, Posfay-Barbe KM. Long-term persistence of seroprotection against measles following measles-mumps-rubella vaccination administered before and after pediatric liver transplantation. Am J Transplant 2024:S1600-6135(24)00440-4. [PMID: 39029873 DOI: 10.1016/j.ajt.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/21/2024]
Abstract
Liver transplant (LT) recipients are susceptible to infections, including measles. Concerns about the safety and efficacy of live-attenuated vaccines, such as the measles-mumps-rubella (MMR) vaccine, have led to hesitancy among providers in administering them to immunocompromised patients. This 9-year interventional study assessed seroprotection against measles following MMR vaccination in pediatric LT recipients. Of 119 participants enrolled, 60 (50%) were seroprotected against measles after transplantation. Among the 59 non-seroprotected participants, 56 fulfilled safety criteria and received MMR vaccination with a seroprotection rate of 90% (95%CI 73-98%) after a first dose, 95% (95%CI 85-99%) after primary vaccination with 1 to 3 doses, comparable to non-immunocompromised populations. However, measles antibodies declined over time, suggesting the need for regular monitoring, and booster doses. Half of the vaccinees (26/53, 49%) subsequently lost seroprotection. Among them, 23 received additional doses of MMR, with high seroconversion rate. At their last follow up (median 6.1 years, IQR 3.0-8.1 after inclusion), 63% (95%CI 49-75%) of all vaccinees were seroprotected against measles. In conclusion, MMR vaccination in pediatric LT recipients offers seroprotection against measles, but long-term immunity should be monitored closely. CLINICAL TRIAL REGISTRATION: The trial is registered at the US National Institutes of Health (Clinicaltrials.gov) number NCT01770119.
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Affiliation(s)
- Laure F Pittet
- Swiss Pediatric Liver Center, Geneva University Hospitals, Geneva, Switzerland; Department of Pediatrics, Gynecology and Obstetrics Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Centre for Vaccinology, Departments of Pathology-Immunology, University of Geneva, Geneva, Switzerland
| | - Renato Gualtieri
- Swiss Pediatric Liver Center, Geneva University Hospitals, Geneva, Switzerland; Department of Pediatrics, Gynecology and Obstetrics Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Charlotte M Verolet
- Swiss Pediatric Liver Center, Geneva University Hospitals, Geneva, Switzerland; Department of Pediatrics, Gynecology and Obstetrics Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Arnaud G L'Huillier
- Swiss Pediatric Liver Center, Geneva University Hospitals, Geneva, Switzerland; Department of Pediatrics, Gynecology and Obstetrics Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Barbara E Wildhaber
- Swiss Pediatric Liver Center, Geneva University Hospitals, Geneva, Switzerland; University Center of Pediatric Surgery of Western Switzerland, Department of Pediatrics, Gynecology and Obstetrics, Swiss Pediatric Liver Center, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Valérie A McLin
- Swiss Pediatric Liver Center, Geneva University Hospitals, Geneva, Switzerland; Pediatric Gastroenterology, Hepatology and Nutrition Unit, Swiss Pediatric Liver Center, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Switzerland
| | - Klara M Posfay-Barbe
- Swiss Pediatric Liver Center, Geneva University Hospitals, Geneva, Switzerland; Department of Pediatrics, Gynecology and Obstetrics Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Krow-Lucal E, Marin M, Shepersky L, Bahta L, Loehr J, Dooling K. Measles, Mumps, Rubella Vaccine (PRIORIX): Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1465-1470. [PMID: 36395065 PMCID: PMC9707358 DOI: 10.15585/mmwr.mm7146a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Vaccination is the main means for preventing measles, mumps, and rubella virus infections and their related complications (1,2). Achieving and maintaining high 2-dose measles, mumps, and rubella vaccination coverage in the United States has led to elimination of endemic measles in 2000, rubella and congenital rubella syndrome in 2004, and a sharp decrease in mumps cases. However, measles and rubella remain endemic in many countries, leading to importations of cases and occasional local transmission within the United States (3). Reported U.S. mumps cases declined >99% from the prevaccine period (4); however, mumps is endemic worldwide, and since 2006, the number of mumps cases and mumps outbreaks has increased in the United States, with wider geographic spread since 2016 (4). Given the risk for importation of measles and rubella and the resurgence of mumps, maintaining high measles, mumps, and rubella (MMR) vaccination coverage is important. Since 1978, only one MMR vaccine, M-M-R II (Merck and Co., Inc.), has been available in the United States. On June 6, 2022, the Food and Drug Administration approved a second MMR vaccine, PRIORIX (GlaxoSmithKline Biologicals), for the prevention of measles, mumps, and rubella in persons aged ≥12 months. The three live attenuated viruses contained in PRIORIX are genetically similar or identical to the corresponding components in M-M-R II (Table) (5-7). On June 23, 2022, the Advisory Committee on Immunization Practices (ACIP) unanimously recommended PRIORIX as an option to prevent measles, mumps, and rubella according to the existing recommended schedules and for off-label uses (i.e., indications not included in the package insert)* (1,2). ACIP considered PRIORIX to be safe, immunogenic, and noninferior to M-M-R II. Both PRIORIX and M-M-R II are fully interchangeable for all indications for which MMR vaccination is recommended. This report contains ACIP recommendations specific to PRIORIX and supplements the existing ACIP recommendations for MMR use (1,2).
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Zhao Z, Liao Y, Li Y, Jiang G, Huang Z, Yang H, Ou Z, Yin Q, Chen J, Deng Y, Jiang R, Che Y, Li Q, Zheng H, Zhang J. Immunogenicity and safety of the inactivated enterovirus 71 vaccine administered concomitantly with the measles-rubella vaccine in infants aged 8 months in China: A noninferiority randomized controlled trial. Vaccine 2022; 40:4709-4715. [PMID: 35753838 DOI: 10.1016/j.vaccine.2022.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate the immunogenicity and safety of simultaneous administration of the enterovirus 71 (EV71) vaccine with the measles and rubella (MR) combined vaccine. METHODS In this phase 4, randomized, open-label and noninferiority study, a total of 680 infants aged 8 months were enrolled and assigned to the simultaneous administration group (infants received the first dose of EV71 vaccine and MR vaccine on Day 0, and the second dose of EV71 vaccine on Day 28), or the separate administration groups (EV71 group: infants received two doses of EV71 vaccine on Day 0 and Day 28, respectively; MR group: infants received MR vaccine on Day 0). Blood sample was obtained on Day 0 and Day 56 to measure antibody responses to each of the antigens in terms of antibody titer or concentration, respectively. Local and systemic adverse reactions (ARs) and other adverse events (AEs) following each dose were monitored and compared among groups. RESULTS After vaccination, simultaneous administration group showed similar seroconversion rates of antibody against EV71(97.9%), measles (97.4%), and rubella (94.3%) compared to EV71 group (99.6% for anti-EV71) or MR group (98.4% for anti-measles and 98.9% for anti-rubella, respectively). Noninferiority was demonstrated for all antibodies as the lower limits of two-sided 97.5% confidence intervals (CIs) of the difference in seroconversion rates between simultaneous administration group and separate administration groups were above the predefined margin of -10%. Additionally, the adverse reaction rates were comparable among groups (54.4% in the simultaneous group versus 43.9% in the MR group versus 52.6% in the EV71 group). CONCLUSION Antibody responses induced by simultaneous administration of EV71 vaccine with MR vaccine were robust and noninferior to those by single administration alone. Like the previous findings by single administration alone, simultaneous administration demonstrated comparable reactogenicity and safety profiles.
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Affiliation(s)
- Zhimei Zhao
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan 650118, China
| | - Yuyi Liao
- Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong 510440, China
| | - Yuan Li
- Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong 510440, China; NMPA Key Laboratory for Technology Research and Evaluation of Pharmacovigilance, Guangzhou, Guangdong 510315, China
| | - Guorun Jiang
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan 650118, China
| | - Zhuhang Huang
- Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong 510440, China
| | - Huijuan Yang
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan 650118, China
| | - Zhiqiang Ou
- Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong 510440, China
| | - Qiongzhou Yin
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan 650118, China
| | - Junhu Chen
- Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong 510440, China
| | - Yan Deng
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan 650118, China
| | - Ruiju Jiang
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan 650118, China
| | - Yanchun Che
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan 650118, China.
| | - Qihan Li
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan 650118, China.
| | - Huizhen Zheng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China.
| | - Jikai Zhang
- Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong 510440, China; NMPA Key Laboratory for Technology Research and Evaluation of Pharmacovigilance, Guangzhou, Guangdong 510315, China.
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Akpo EIH, Cristeau O, Hunjan M, Casabona G. Epidemiological Impact and Cost-Effectiveness of Varicella Vaccination Strategies in the United Kingdom. Clin Infect Dis 2021; 73:e3617-e3626. [PMID: 33173938 PMCID: PMC8664478 DOI: 10.1093/cid/ciaa1708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Indexed: 12/14/2022] Open
Abstract
Background Despite the burden of varicella, there is no universal varicella vaccination (UVV) program in the United Kingdom (UK) due to concerns that it could increase herpes zoster (HZ) incidence. We assessed the cost-utility of a first-dose monovalent (varicella [V]) or quadrivalent (measles-mumps-rubella-varicella [MMRV]) followed by a second-dose MMRV UVV program. GSK and MSD varicella-containing vaccines (VCVs) were considered. Methods Dynamic transmission and cost-effectiveness models were adapted to the UK. Outcomes measured included varicella and HZ incidences and the incremental cost-utility ratio (ICURs) over a lifetime horizon. Payer and societal perspectives were evaluated. Results The impact of V-MMRV and MMRV-MMRV UVV programs on varicella incidence was comparable between both VCVs at equilibrium. HZ incidence increased by 1.6%–1.7% over 7 years after UVV start, regardless of the strategies, then decreased by >95% at equilibrium. ICURs ranged from £5665 (100 years) to £18 513 (20 years) per quality-adjusted life-year (QALY) gained with V-MMRV and from £9220 to £27 101 per QALY gained with MMRV-MMRV (payer perspective). MMRV-MMRV was cost-effective in the medium- and long-terms with GSK VCV and only cost-effective in the long term with MSD VCV at a £20 000 per QALY gained threshold. Without the exogenous boosting hypothesis, HZ incidence decreased through UVV implementation. ICURs were most sensitive to discount rates and MMRV price. Conclusions A 2-dose UVV was demonstrated to be a cost-effective alternative to no vaccination. With comparable effectiveness as MSD VCV at lower costs, GSK VCV may offer higher value for the money.
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Kuter BJ, Marshall GS, Fergie J, Schmidt E, Pawaskar M. Prevention of measles, mumps and rubella: 40 years of global experience with M-M-R II. Hum Vaccin Immunother 2021; 17:5372-5383. [PMID: 35130794 PMCID: PMC8903938 DOI: 10.1080/21645515.2021.2007710] [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: 09/03/2021] [Accepted: 11/14/2021] [Indexed: 02/09/2023] Open
Abstract
Measles, mumps, and rubella are highly contagious diseases that caused significant global mortality and morbidity in the pre-vaccine era. Since its first approval in the United States over 40 years ago, M-M-RII has been used in >75 countries for prevention of these diseases. The vaccine has been part of immunization programs that have achieved dramatic global reductions in case numbers and mortality rates, as well as the elimination of measles and rubella in several countries and regions. This report summarizes over four decades of global safety, immunogenicity, efficacy, and effectiveness data for the vaccine. We include studies on the use of M-M-RII in different age groups, concomitant use with other routine childhood vaccines, administration via different routes, persistence of immunity, and vaccine effectiveness during outbreaks of measles and mumps. We conclude that M-M-RII is well tolerated and has shown consistently high performance during routine use in multiple countries, in randomized controlled trials with diverse designs, and in outbreak settings, including use as measles postexposure prophylaxis. Physicians, parents, and the public can continue to have a high degree of confidence in the use of M-M-RII as a vital part of global public health programs.
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Affiliation(s)
| | - Gary S. Marshall
- Norton Children’s and University of Louisville School of Medicine, Louisville, KY, USA
| | - Jaime Fergie
- Infectious Diseases, Driscoll Children’s Hospital, Corpus Christi, TX, USA
| | - Elvira Schmidt
- Certara Germany GmbH, Evidence and Access, Loerrach, Germany
| | - Manjiri Pawaskar
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Nyaku M, Richardson E, Martinon-Torres F, Kuter BJ. Evaluation of the Safety and Immunogenicity of M-M-RII (Combination Measles-mumps-rubella Vaccine): Clinical Trials of Healthy Children and Adults Published Between 2010 and 2019. Pediatr Infect Dis J 2021; 40:1046-1054. [PMID: 34310506 DOI: 10.1097/inf.0000000000003273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The safety and immunogenicity of M-M-RII (measles, mumps and rubella virus vaccine live, Merck & Co., Inc., West Point, PA)-the only combined measles, mumps and rubella vaccine licensed for use in the United States-were previously reported in pre- and postlicensure clinical trials conducted from 1988 to 2009. M-M-RII continues to be evaluated as a comparator in clinical trials of other vaccines. Here, we review safety and efficacy data from more recent clinical trials of M-M-RII. METHODS We performed a systematic literature review of trials using M-M-RII published from 2010 to 2019. RESULTS In the 15 studies that met the inclusion criteria, a total of 12,032 subjects were vaccinated: 7667 persons received a first dose only, 2137 participated in 2-dose studies (128 received 1 dose and 2009 received both) and 2063 received a single dose of M-M-RII as their second dose. Dose number was not specified for 165 participants, ≥6 years old, in 2 studies in which a single dose of M-M-RII was administered. Similar to previous reports, M-M-RII was well tolerated and immunogenic when administered alone or concomitantly with other routinely recommended vaccinations. The most common adverse events included transient injection site pain and fever. Serious adverse events were extremely rare, with only 4 probable or potential vaccine-related events reported among the 12,032 participating subjects. CONCLUSIONS In trials published from 2010 to 2019, M-M-RII continued to be safe and immunogenic in all age groups studied. These data, along with the results of earlier trials, indicate that the performance of the vaccine has been consistent across more than 30 years of postlicensure studies.
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Affiliation(s)
- Mawuli Nyaku
- From the Merck & Co., Inc., Kenilworth, New Jersey
| | | | - Federico Martinon-Torres
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
- Genetics, Vaccines, and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago and Universidad de Santiago de Compostela (USC), Galicia, Spain
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Namazova-Baranova L, Habib MA, Povey M, Efendieva K, Fedorova O, Fedoseenko M, Ivleva T, Kovshirina Y, Levina J, Lyamin A, Ogorodova L, Reshetko O, Romanenko V, Ryzhenkova I, Sidorenko I, Yakovlev Y, Zhestkov A, Tatochenko V, Scherbakov M, Shpeer EL, Casabona G. A randomized trial assessing the efficacy, immunogenicity, and safety of vaccination with live attenuated varicella zoster virus-containing vaccines: ten-year follow-up in Russian children. Hum Vaccin Immunother 2021; 18:1959148. [PMID: 34435933 PMCID: PMC9067519 DOI: 10.1080/21645515.2021.1959148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In Russia, a universal varicella vaccination (UVV) program has not been implemented, and varicella vaccination coverage is low. We assessed the efficacy, antibody persistence, and safety of one- and two-dose varicella vaccination schedules in Russian children with a ten-year follow-up period, as part of an international phase IIIB, observer-blind, randomized, controlled trial (NCT00226499). Children aged 12-22 months were randomized (3:3:1) to receive two doses of tetravalent measles-mumps-rubella-varicella vaccine (V2 group), one dose trivalent measles-mumps-rubella (MMR) vaccine and one dose of varicella vaccine (V1 group), or two doses of MMR vaccine (V0 [control] group), 42 days apart. Main study outcomes were: vaccine efficacy (VE) against confirmed varicella cases, anti-varicella zoster virus (VZV) seropositivity rates and geometric mean concentrations, and reporting of (serious) adverse events ([S]AEs). The total vaccinated cohort in Russia comprised 1000 children; 900 were followed up until study end (year [Y] 10). VE estimates against confirmed varicella (Y10) were 92.4% in the V2 group and 74.7% in the V1 group. Anti-VZV seropositivity rates remained ≥99.4% in the V2 group and ≥89.7% in the V1 group from day 42 post-vaccination 2 until Y10. Occurrence of (un)solicited AEs and SAEs was similar across groups and confirmed the safety profile of the vaccines. No vaccination-related SAEs or deaths were reported. These results are consistent with the global trial results, i.e., the highest VE estimates observed following the two-dose schedule compared to the one-dose schedule. These data may inform decision-making related to potential implementation of a UVV program.
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Affiliation(s)
- Leyla Namazova-Baranova
- Scientific Center of Children Health, Moscow, Russia.,Pediatrics and Child Health Research Institute, CCH RAS, Ministry of Science and Higher Education of the Russian Federation, Moscow, Russia.,Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | | | | | - Kamilla Efendieva
- Scientific Center of Children Health, Moscow, Russia.,Pediatrics and Child Health Research Institute, CCH RAS, Ministry of Science and Higher Education of the Russian Federation, Moscow, Russia.,Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Olga Fedorova
- Regional Children Hospital, Tomsk, Russia.,Siberian State Medical University, Ministry of Health of the Russian Federation, Tomsk, Russia
| | - Marina Fedoseenko
- Scientific Center of Children Health, Moscow, Russia.,Pediatrics and Child Health Research Institute, CCH RAS, Ministry of Science and Higher Education of the Russian Federation, Moscow, Russia.,Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Tatyana Ivleva
- Medical Clinicodiagnostic Center Reafan, Novosibirsk, Russia
| | - Yulia Kovshirina
- Regional Children Hospital, Tomsk, Russia.,Siberian State Medical University, Ministry of Health of the Russian Federation, Tomsk, Russia
| | - Julia Levina
- Scientific Center of Children Health, Moscow, Russia.,Pediatrics and Child Health Research Institute, CCH RAS, Ministry of Science and Higher Education of the Russian Federation, Moscow, Russia
| | | | | | - Olga Reshetko
- City outpatient clinic #11, Saratov, Russia.,Saratov State Medical University, Ministry of Health of the Russian Federation, Saratov, Russia
| | - Viktor Romanenko
- Ural State Medical University, Ministry of Health of the Russian Federation, Ekaterinburg, Russia
| | - Inna Ryzhenkova
- City outpatient clinic #11, Saratov, Russia.,Saratov State Medical University, Ministry of Health of the Russian Federation, Saratov, Russia
| | | | - Yakov Yakovlev
- Novokuznetsk Municipal Children Hospital, Novokuznetsk, Russia.,Novokuznetsk State Institute of Postgraduate Medicine, Novokuznetsk, Russia
| | | | - Vladimir Tatochenko
- City Children Hospital Named after T.G.Petrova, Ivanteevka Moscow Region, Russia
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Connell AR, Connell J, Leahy TR, Hassan J. Mumps Outbreaks in Vaccinated Populations-Is It Time to Re-assess the Clinical Efficacy of Vaccines? Front Immunol 2020; 11:2089. [PMID: 33072071 PMCID: PMC7531022 DOI: 10.3389/fimmu.2020.02089] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/31/2020] [Indexed: 01/05/2023] Open
Abstract
History illustrates the remarkable public health impact of mass vaccination, by dramatically improving life expectancy and reducing the burden of infectious diseases and co-morbidities worldwide. It has been perceived that if an individual adhered to the MMR vaccine schedule that immunity to mumps virus (MuV) would be lifelong. Recent mumps outbreaks in individuals who had received two doses of the Measles Mumps Rubella (MMR) vaccine has challenged the efficacy of the MMR vaccine. However, clinical symptoms, complications, viral shedding and transmission associated with mumps infection has been shown to be reduced in vaccinated individuals, demonstrating a benefit of this vaccine. Therefore, the question of what constitutes a good mumps vaccine and how its impact is assessed in this modern era remains to be addressed. Epidemiology of the individuals most affected by the outbreaks (predominantly young adults) and variance in the circulating MuV genotype have been well-described alluding to a collection of influences such as vaccine hesitancy, heterogeneous vaccine uptake, primary, and/or secondary vaccine failures. This review aims to discuss in detail the interplay of factors thought to be contributing to the current mumps outbreaks seen in highly vaccinated populations. In addition, how mumps diagnoses has progressed and impacted the understanding of mumps infection since a mumps vaccine was first developed, the limitations of current laboratory tests in confirming protection in vaccinated individuals and how vaccine effectiveness is quantified are also considered. By highlighting knowledge gaps within this area, this state-of-the-art review proposes a change of perspective regarding the impact of a vaccine in a highly vaccinated population from a clinical, diagnostic and public perspective, highlighting a need for a paradigm shift on what is considered vaccine immunity.
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Affiliation(s)
- Anna R. Connell
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland
| | - Jeff Connell
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - T. Ronan Leahy
- Children's Health Ireland, Dublin, Ireland
- Department of Pediatrics, University of Dublin, Trinity College, Dublin, Ireland
| | - Jaythoon Hassan
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
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Javelle E, Colson P, Parola P, Raoult D. Measles, the need for a paradigm shift. Eur J Epidemiol 2019; 34:897-915. [DOI: 10.1007/s10654-019-00569-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/03/2019] [Indexed: 01/24/2023]
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