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Drees M, Weber DJ. Prevention and Control of Nosocomial Varicella During the United States Varicella Vaccination Program Era. J Infect Dis 2022; 226:S456-S462. [PMID: 36265849 DOI: 10.1093/infdis/jiac254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
The United States varicella vaccination program has successfully reduced varicella incidence and hospitalizations by ≥90%, consequently reducing the risk of nosocomial exposures. However, patients and healthcare personnel (HCP) continue to introduce varicella zoster virus (VZV) into healthcare settings. Herpes zoster (HZ) is less contagious than varicella, but it can also result in exposures. Unrecognized varicella and HZ may lead to extensive contact investigations, control efforts, and HCP furloughs that result in significant disruption of healthcare activities as well as substantial costs. Robust occupational health and infection prevention programs that ensure healthcare personnel immunity and prompt recognition and isolation of patients with varicella or HZ will lower the risk of VZV transmission and reduce or eliminate the need to furlough exposed HCP and associated costs.
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Affiliation(s)
- Marci Drees
- Department of Medicine, ChristianaCare, Wilmington, Delaware, USA.,Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David J Weber
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Population immunity to measles in Canada using Canadian Health Measures survey data - A Canadian Immunization Research Network (CIRN) study. Vaccine 2022; 40:3228-3235. [PMID: 35491342 PMCID: PMC9246716 DOI: 10.1016/j.vaccine.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 01/13/2023]
Abstract
We aimed to determine population immunity to measles in Canada, and to assess the risk of future outbreaks. We tested 11,176 sera from Cycles 2 (2009-2011) and 3 (2011-2013) cohorts from the biobank of Statistics Canada's Canadian Health Measures Survey (CHMS) using the BioPlex 2220 MMRV IgG assay. We then tested all BioPlex negative and equivocal samples using a more sensitive Plaque Reduction Neutralization Test (PRNT). We determined the weighted proportion of positive, equivocal, and negative samples by age, sex, region and whether individuals were born in Canada. We found that 90.0% (95% confidence interval (CI): 88.2, 91.9) of samples were positive, 4.5% (95% CI: 3.4, 5.5) were equivocal and 5.5% (95% CI: 4.3, 6.7) were negative. Individuals in the 12-19 year age band had the lowest proportion positive at 78.7% (95% CI: 74.2, 83.2) and the highest proportion of positive samples was found in those 60-79 years (99.6%, 95% CI: 99.3, 99.9). Seropositivity was consistently <90% across a broad range of pediatric and adult age bands (6-39 years). We found that a slightly higher proportion of females were positive (91.9%, 95% CI: 90.1, 93.6) compared to males (88.3%, 95% CI: 85.8, 90.7). When taking into account interaction between age and born in Canada status, we found individuals born in Canada aged 19 and under were less susceptible (OR = 0.6 (95% CI: 0.4, 0.95)) compared to those born outside Canada whereas, those aged 20 and over were more susceptible (OR = 1.7 (95% CI: 1.1, 2.8)). Our findings indicate that measles immunity in Canada is below the 95% immunity threshold required to sustain measles elimination, underscoring the importance of maintaining high vaccine coverage to prevent future measles outbreaks and sustain Canada's elimination status.
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OUP accepted manuscript. J Infect Dis 2022; 226:1127-1139. [DOI: 10.1093/infdis/jiac039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 03/16/2022] [Indexed: 11/15/2022] Open
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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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Lee YC, Lee YH, Lu CW, Cheng SY, Yang KC, Huang KC. Measles immunity gaps in an era of high vaccination coverage: A serology study from Taiwan. Travel Med Infect Dis 2020; 36:101804. [PMID: 32569810 DOI: 10.1016/j.tmaid.2020.101804] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/19/2020] [Accepted: 06/17/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Routine vaccination for children drastically reduces measles cases. Nonetheless, the global resurgence of measles since 2018 highlights the need for evaluating vaccine-induced immunity in an era of high vaccination coverage, especially in international travelers. This study aims to identify high-risk persons via analyzing the impact of age and different vaccination schedules on seroprevalence of measles in a country with high vaccination coverage, attempting to provide suggestions regarding pre-travel measles vaccination in highly immunized countries. METHOD We retrospectively collected serological results of measles from Taiwanese travelers during 2008-2017 and middle-aged subjects from community during 2007-2009. Participants were classified by age groups and cohort based on the national immunization program: cohort I (pre-mass vaccination), cohort II (suboptimal measles vaccination), and cohort III (2-dose MMR in childhood). The effects of age group on seropositivity was shown by odds ratio (OR) with 95% confidence interval (CI) in a logistic regression model. RESULTS The overall measles seroprevalence was 74.5% (N = 1096, mean age = 31.7 ± 12.3 years), with adolescents having the lowest seropositivity (65.9%) and participants ≥50 years having the highest (89.4%). Seropositivity was significantly higher in cohort I (pre-mass vaccination) compared with the other 2 cohorts (P < 0.0001). The effect of aging on seropositivity was only significant in cohort II (OR = 1.84, 95% CI = 1.13-2.99, P = 0.014 for 30-39 years vs. 20-29 years). CONCLUSIONS Waning immunity to measles in adolescents and young adults is a dominant issue in highly vaccinated cohorts. Enhancing pre-travel vaccination against measles can effectively fill the immunity gaps in highly immunized countries.
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Affiliation(s)
- Yi-Chen Lee
- Department of Family Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Training Center for Travel Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Family Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Training Center for Travel Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Wen Lu
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan; Training Center for Travel Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan; Training Center for Travel Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuen-Cheh Yang
- Department of Family Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
| | - Kuo-Chin Huang
- Department of Family Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan; Training Center for Travel Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Fujita DM, Salvador FS, Nali LHDS, Luna EJDA. Decreasing vaccine coverage rates lead to increased vulnerability to the importation of vaccine-preventable diseases in Brazil. J Travel Med 2018; 25:5127106. [PMID: 30312442 DOI: 10.1093/jtm/tay100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/10/2018] [Indexed: 11/14/2022]
Affiliation(s)
- Dennis Minoru Fujita
- Federal Institute of Education, Science and Technology of São Paulo, São Paulo, Brazil
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Hyle EP, Rao SR, Jentes ES, Parker Fiebelkorn A, Hagmann SHF, Taylor Walker A, Walensky RP, Ryan ET, LaRocque RC. Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations. Ann Intern Med 2017; 167:77-84. [PMID: 28505632 PMCID: PMC5513758 DOI: 10.7326/m16-2249] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Measles outbreaks continue to occur in the United States and are mostly due to infections in returning travelers. Objective To describe how providers assessed the measles immunity status of departing U.S. adult travelers seeking pretravel consultation and to assess reasons given for nonvaccination among those considered eligible to receive the measles, mumps, rubella (MMR) vaccine. Design Observational study in U.S. pretravel clinics. Setting 24 sites associated with Global TravEpiNet (GTEN), a Centers for Disease Control and Prevention-funded consortium. Patients Adults (born in or after 1957) attending pretravel consultations at GTEN sites (2009 to 2014). Measurements Structured questionnaire completed by traveler and provider during pretravel consultation. Results 40 810 adult travelers were included; providers considered 6612 (16%) to be eligible for MMR vaccine at the time of pretravel consultation. Of the MMR-eligible, 3477 (53%) were not vaccinated at the visit; of these, 1689 (48%) were not vaccinated because of traveler refusal, 966 (28%) because of provider decision, and 822 (24%) because of health systems barriers. Most MMR-eligible travelers who were not vaccinated were evaluated in the South (2262 travelers [65%]) or at nonacademic centers (1777 travelers [51%]). Nonvaccination due to traveler refusal was most frequent in the South (1432 travelers [63%]) and in nonacademic centers (1178 travelers [66%]). Limitation These estimates could underrepresent the opportunities for MMR vaccination because providers accepted verbal histories of disease and vaccination as evidence of immunity. Conclusion Of U.S. adult travelers who presented for pretravel consultation at GTEN sites, 16% met criteria for MMR vaccination according to the provider's assessment, but fewer than half of these travelers were vaccinated. An increase in MMR vaccination of eligible U.S. adult travelers could reduce the likelihood of importation and transmission of measles virus. Primary Funding Source Centers for Disease Control and Prevention, National Institutes of Health, and the Steve and Deborah Gorlin MGH Research Scholars Award.
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Affiliation(s)
- Emily P Hyle
- From Massachusetts General Hospital, Harvard Medical School, and Boston University, Boston, Massachusetts; Centers for Disease Control and Prevention, Atlanta, Georgia; Bronx Lebanon Hospital Center, Bronx, New York; and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sowmya R Rao
- From Massachusetts General Hospital, Harvard Medical School, and Boston University, Boston, Massachusetts; Centers for Disease Control and Prevention, Atlanta, Georgia; Bronx Lebanon Hospital Center, Bronx, New York; and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emily S Jentes
- From Massachusetts General Hospital, Harvard Medical School, and Boston University, Boston, Massachusetts; Centers for Disease Control and Prevention, Atlanta, Georgia; Bronx Lebanon Hospital Center, Bronx, New York; and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amy Parker Fiebelkorn
- From Massachusetts General Hospital, Harvard Medical School, and Boston University, Boston, Massachusetts; Centers for Disease Control and Prevention, Atlanta, Georgia; Bronx Lebanon Hospital Center, Bronx, New York; and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stefan H F Hagmann
- From Massachusetts General Hospital, Harvard Medical School, and Boston University, Boston, Massachusetts; Centers for Disease Control and Prevention, Atlanta, Georgia; Bronx Lebanon Hospital Center, Bronx, New York; and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Allison Taylor Walker
- From Massachusetts General Hospital, Harvard Medical School, and Boston University, Boston, Massachusetts; Centers for Disease Control and Prevention, Atlanta, Georgia; Bronx Lebanon Hospital Center, Bronx, New York; and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rochelle P Walensky
- From Massachusetts General Hospital, Harvard Medical School, and Boston University, Boston, Massachusetts; Centers for Disease Control and Prevention, Atlanta, Georgia; Bronx Lebanon Hospital Center, Bronx, New York; and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edward T Ryan
- From Massachusetts General Hospital, Harvard Medical School, and Boston University, Boston, Massachusetts; Centers for Disease Control and Prevention, Atlanta, Georgia; Bronx Lebanon Hospital Center, Bronx, New York; and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Regina C LaRocque
- From Massachusetts General Hospital, Harvard Medical School, and Boston University, Boston, Massachusetts; Centers for Disease Control and Prevention, Atlanta, Georgia; Bronx Lebanon Hospital Center, Bronx, New York; and Icahn School of Medicine at Mount Sinai, New York, New York
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Nicoli F, Appay V. Immunological considerations regarding parental concerns on pediatric immunizations. Vaccine 2017; 35:3012-3019. [PMID: 28465096 DOI: 10.1016/j.vaccine.2017.04.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 01/10/2023]
Abstract
Despite the fundamental role of vaccines in the decline of infant mortality, parents may decide to decline vaccination for their own children. Many factors may influence this decision, such as the belief that the infant immune system is weakened by vaccines, and concerns have been raised about the number of vaccines and the early age at which they are administered. Studies focused on the infant immune system and its reaction to immunizations, summarized in this review, show that vaccines can overcome those suboptimal features of infant immune system that render them more at risk of infections and of their severe manifestations. In addition, many vaccines have been shown to improve heterologous innate and adaptive immunity resulting in lower mortality rates for fully vaccinated children. Thus, multiple vaccinations are necessary and not dangerous, as infants can respond to several antigens as well as when responding to single stimuli. Current immunization schedules have been developed and tested to avoid vaccine interference, improve benefits and reduce side effects compared to single administrations. The infant immune system is therefore capable, early after birth, of managing several antigenic challenges and exploits them to prompt its development.
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Affiliation(s)
- Francesco Nicoli
- Sorbonne Universités, UPMC Univ Paris 06, DHU FAST, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France; INSERM, U1135, CIMI-Paris, F-75013 Paris, France.
| | - Victor Appay
- Sorbonne Universités, UPMC Univ Paris 06, DHU FAST, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France; INSERM, U1135, CIMI-Paris, F-75013 Paris, France; International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan
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