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Hassani Azad M, Dehghani Sargazi L, Salari M, Jahangiri S, Hashemi SM, Asadi SS, Ghaedi Hengami G, Ghazalgoo A, Keivanlou MH, Amini-Salehi E, Asadi Yousefabad SH. Epidemiology of measles in southern Iran: trends, challenges, and vaccination insights. Ann Med Surg (Lond) 2024; 86:3273-3280. [PMID: 38846899 PMCID: PMC11152772 DOI: 10.1097/ms9.0000000000002004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/18/2024] [Indexed: 06/09/2024] Open
Abstract
Background Measles, a highly contagious and vaccine-preventable disease, continues to present global public health challenges. This retrospective study focused on measles outbreaks in Hormozgan province, southern Iran, spanning from 2014 to 2019. Methods Between 2014 and 2019, patients suspected of having measles, as reported by medical centers in Hormozgan, were subject to a comprehensive evaluation. The diagnosis of measles was conclusively established through the use of real-time polymerase chain reaction (RT-PCR) testing. A detailed collection of pertinent data was undertaken. SPSS software, version 21, was employed for statistical analysis. Results In the current study, out of 1291 clinically suspected measles cases, 151 were PCR-confirmed, with an average age of 16.77 years (±10.46), comprising 50.9% males and 49.1% females. The annual distribution showed varied incidence: 8.4% in 2014, peaking at 18.8% in 2015, then fluctuating to 11.4% in 2016, 0.8% in 2017, and 17.9% in 2018, with no cases in 2019. Among confirmed cases, 16.5% were vaccinated, while 68.2% were not, and 15.23% had unknown vaccination status. Conclusion This retrospective study highlights the ongoing challenge of measles in Hormozgan province, Iran, from 2014 to 2019. Despite measles being preventable by vaccination, a significant number of cases were confirmed among both vaccinated and unvaccinated individuals, indicating gaps in immunization coverage and effectiveness. The fluctuating annual incidence, with a peak in 2015 and no cases in 2019, suggests variable success in disease control efforts. This underscores the need for enhanced surveillance, improved vaccination strategies, and public health interventions to effectively combat measles outbreaks in this region.
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Affiliation(s)
- Mehdi Hassani Azad
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute
| | | | | | - Samaneh Jahangiri
- Internal Medicine Resident, Research Development Unit, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman
| | | | | | | | | | - Mohammad-Hossein Keivanlou
- Gastrointestinal and Liver Diseases Research Center
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Amini-Salehi
- Gastrointestinal and Liver Diseases Research Center
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Davila-Payan CS, Hill A, Kayembe L, Alexander JP, Lynch M, Pallas SW. Analysis of the yearly transition function in measles disease modeling. Stat Med 2024; 43:435-451. [PMID: 38100282 DOI: 10.1002/sim.9951] [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: 05/10/2022] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 12/17/2023]
Abstract
Globally, there were an estimated 9.8 million measles cases and 207 500 measles deaths in 2019. As the effort to eliminate measles around the world continues, modeling remains a valuable tool for public health decision-makers and program implementers. This study presents a novel approach to the use of a yearly transition function that formulates mathematically the vaccine schedules for different age groups while accounting for the effects of the age of vaccination, the timing of vaccination, and disease seasonality on the yearly number of measles cases in a country. The methodology presented adds to an existing modeling framework and expands its analysis, making its utilization more adjustable for the user and contributing to its conceptual clarity. This article also adjusts for the temporal interaction between vaccination and exposure to disease, applying adjustments to estimated yearly counts of cases and the number of vaccines administered that increase population immunity. These new model features provide the ability to forecast and compare the effects of different vaccination timing scenarios and seasonality of transmission on the expected disease incidence. Although the work presented is applied to the example of measles, it has potential relevance to modeling other vaccine-preventable diseases.
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Affiliation(s)
- C S Davila-Payan
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A Hill
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - L Kayembe
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J P Alexander
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M Lynch
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S W Pallas
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Sharma S, Dhamne C, Bhosale S, Parambil B, Divatia J, Chinnaswamy G, Patil V, Joshi R, Epari S, Mahadevan A, Vaidya S, Kulkarni S, Kulkarni A, Patil V, Srinivasan S, Gollamudi VRM, Roy Moulik N, Prasad M, Narula G, Banavali S. Epilepsia Partialis Continua as a Sequelae of Measles Infection in Children With Hematolymphoid Malignancies. JCO Glob Oncol 2024; 10:e2300399. [PMID: 38422460 PMCID: PMC10914244 DOI: 10.1200/go.23.00399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/27/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE To share our clinical experience with the diagnosis and management of children with hematolymphoid malignancies presenting with epilepsia partialis continua (EPC) as a sequelae of measles infection. MATERIALS AND METHODS In December 2022, a series of children in our hemato-oncology unit presented with focal status epilepticus with no conclusive evidence pointing toward any underlying etiology. One such child had a typical measles rash a few weeks before the onset of this focal status epilepticus. After a series of cases with a similar presentation, a clinical pattern suspicious for measles became evident. cerebrospinal fluid polymerase chain reaction was positive for measles virus with measles immunoglobin M detected in the serum. This led to the diagnosis of measles inclusion-body encephalitis in a series of children who presented with EPC over a period of 3 months. EPC is a rare manifestation of measles that is seen only in immunocompromised patients. RESULTS Among the 18 children reported in this series, only 10 had a history of rashes. The rash was mostly transient and elicited only on retrospective history taking. Five of the 18 children who did not lose consciousness during the prolonged seizure episode survived the disease but had residual neurologic sequelae. Among the 18 children, two were unimmunized and immunization status could not be confirmed in three other children. CONCLUSION This case series highlights the threats posed by measles infection in children with cancer who are immunosuppressed because of the underlying disease and ongoing chemotherapy. Loss of herd immunity because of declining measles immunization rates secondary to vaccine hesitancy and COVID-19 lockdown pose a greater risk of measles infection and its complications for patients with deficient immune systems.
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Affiliation(s)
- Sudivya Sharma
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Chetan Dhamne
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shilpushp Bhosale
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Badira Parambil
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jigeeshu Divatia
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vasundhara Patil
- Department of Radiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Sridhar Epari
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sunil Vaidya
- Virus Registry and Virus Repository, National Institute of Virology, Pune, India
| | - Shilpa Kulkarni
- Department of Neurology, Wadia Children's Hospital, Mumbai, India
| | - Atul Kulkarni
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vijaya Patil
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shyam Srinivasan
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Nirmalya Roy Moulik
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Roh T, Regan AK, Johnson NM, Hasan NT, Trisha NF, Aggarwal A, Han D. Association of arsenic exposure with measles antibody titers in US children: Influence of sex and serum folate levels. ENVIRONMENT INTERNATIONAL 2024; 183:108329. [PMID: 38071850 DOI: 10.1016/j.envint.2023.108329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/18/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024]
Abstract
Exposure to arsenic during childhood is associated with various adverse health conditions. However, little is known about the effect of arsenic exposure on vaccine-related humoral immunity in children. We analyzed data from the National Health and Nutrition Examination Survey (2003-2004 and 2009-2010) to study the relationship between urinary arsenic and measles antibody levels in 476 US children aged 6-11. Multivariable linear regression was used to evaluate the association, adjusting for cycle, age, race, body mass index (BMI), serum cotinine, poverty index ratio, and vitamin B12 and selenium intakes. Stratified analyses were conducted by sex and serum folate levels using the median as cutoff (18.7 ng/mL). The measles antibody concentrations in the 3rd and 4th quartiles were found to have significantly decreased by 28.5 % (95 % Confidence Interval (CI) -47.6, -2.28) and 36.8 % (95 % CI -50.2, -19.5), compared to the lowest quartile among boys with serum folate levels lower than 18.7 ng/ml. The serum measles antibody titers significantly decreased by 16.7 % (95 %CI -25.0, -7.61) for each doubling of creatinine-corrected urinary total inorganic arsenic concentrations in the same group. No associations were found in boys with high serum folate levels or in girls. Further prospective studies are needed to validate these findings and develop interventions to protect children from infectious diseases.
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Affiliation(s)
- Taehyun Roh
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX 77843, USA.
| | - Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA
| | - Natalie M Johnson
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Nishat Tasnim Hasan
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Nusrat Fahmida Trisha
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Anisha Aggarwal
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Daikwon Han
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX 77843, USA
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Xia S, Gullickson CC, Metcalf CJE, Grenfell BT, Mina MJ. Assessing the Effects of Measles Virus Infections on Childhood Infectious Disease Mortality in Brazil. J Infect Dis 2022; 227:133-140. [PMID: 35767276 PMCID: PMC10205611 DOI: 10.1093/infdis/jiac233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/29/2022] [Accepted: 06/26/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Measles virus infection induces acute immunosuppression for weeks following infection, and also impairs preexisting immunological memory, resulting in "immune amnesia" that can last for years. Both mechanisms predispose the host to severe outcomes of subsequent infections. Therefore, measles dynamics could potentially affect the epidemiology of other infectious diseases. METHODS To examine this hypothesis, we analyzed the annual mortality rates of children aged 1-9 years in Brazil from 1980 to 1995. We calculated the correlation between nonmeasles infectious disease mortality rates and measles mortality rates using linear and negative-binomial models, with 3 methods to control the confounding effects of time. We also estimated the duration of measles-induced immunomodulation. RESULTS The mortality rates of nonmeasles infectious diseases and measles virus infection were highly correlated. This positive correlation remained significant after removing the time trends. We found no evidence of long-term measles immunomodulation beyond 1 year. CONCLUSIONS These results support that measles virus infection could increase the mortality of other infectious diseases. The short lag identified for measles effects (<1 year) implies that acute immunosuppression was potentially driving this effect in Brazil. Overall, our study indicates disproportionate contributions of measles to childhood infectious disease mortality, highlighting the importance of measles vaccination.
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Affiliation(s)
- Siyang Xia
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Cricket C Gullickson
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
- Princeton School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA
| | - Bryan T Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
- Princeton School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA
| | - Michael J Mina
- Department of Pathology at Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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He Q, Fan S, Xue Z, Yuan J, Wang Y, Yang Z, Zhou Z, Zhang Z. Waning of maternal antibody against measles virus in Shufu, China. Hum Vaccin Immunother 2022; 18:2045854. [PMID: 36399713 DOI: 10.1080/21645515.2022.2045854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As measles vaccination coverage has increased, measles infection has shifted to the population of infants. We conducted a follow-up seroepidemiological study among mothers and their infants to evaluate measles seroprevalence and the persistence of maternal measles antibody in Shufu, Kashgar from 2018 to 2020. METHODS Maternal venous blood and cord blood was obtained among mothers and their infants at 0, 3, 5, 8, 9, and 12 months of age. An enzyme-linked immunosorbent assay was used for quantitative measurement of measles antibodies. We analyzed the correlation between maternal and neonatal measles antibodies, and antibodies persistence after infants were born. RESULTS The overall neonatal maternal ratio was 2.38 (95%CI: 2.05-2.71). The measles antibodies for mothers and newborns were 438.93 IU/mL (95%CI: 409.47-470.51 IU/mL) and 440.10 IU/mL (95%CI: 410.82-471.48 IU/mL), respectively. Neonatal measles antibodies were dropping after birth and then beginning to increase starting at 8 months of age. CONCLUSIONS Infant measles antibody levels progressively declined after birth regardless of maternal measles antibody levels. Efforts should be carried out to eliminate measles.
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Affiliation(s)
- Qing He
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Shujun Fan
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Zhenxiang Xue
- Emergency Management department, Shufu Center for Disease Control and Prevention, Kashgar, China
| | - Jun Yuan
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yuzhong Wang
- Emergency Management department, Shufu Center for Disease Control and Prevention, Kashgar, China
| | - Zhicong Yang
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Ziyan Zhou
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Zhoubin Zhang
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
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7
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Morales GB, Muñoz MA. Immune amnesia induced by measles and its effects on concurrent epidemics. J R Soc Interface 2021; 18:20210153. [PMID: 34129794 PMCID: PMC8205533 DOI: 10.1098/rsif.2021.0153] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
It has been recently discovered that the measles virus can damage pre-existing immunological memory, destroying B lymphocytes and reducing the diversity of non-specific B cells of the infected host. In particular, this implies that previously acquired immunization from vaccination or direct exposition to other pathogens could be partially erased in a phenomenon named ‘immune amnesia’, whose effects can become particularly worrisome given the actual rise of anti-vaccination movements. Here, we present the first attempt to incorporate immune amnesia into standard models of epidemic spreading by proposing a simple model for the spreading of two concurrent pathogens causing measles and another generic disease. Different analyses confirm that immune amnesia can have important consequences for epidemic spreading, significantly altering the vaccination coverage required to reach herd immunity. We also uncover the existence of novel propagating and endemic phases induced by immune amnesia. Finally, we discuss the meaning and consequences of our results and their relation with, e.g. immunization strategies, together with the possibility that explosive types of transitions may emerge, making immune-amnesia effects particularly dramatic. This work opens the door to further developments and analyses of immune-amnesia effects, contributing also to the theory of interacting epidemics on complex networks.
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Affiliation(s)
- Guillermo B Morales
- Departamento de Electromagnetismo y Física de la Materia, e Instituto Carlos I de Física Teórica y Computacional, Universidad de Granada, E-18071 Granada, Spain
| | - Miguel A Muñoz
- Departamento de Electromagnetismo y Física de la Materia, e Instituto Carlos I de Física Teórica y Computacional, Universidad de Granada, E-18071 Granada, Spain
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8
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Ashbaugh HR, Cherry JD, Hoff NA, Doshi RH, Alfonso VH, Gadoth A, Mukadi P, Higgins SG, Budd R, Randall C, Mwamba GN, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Gerber SK, Rimoin AW. Measles antibody levels among vaccinated and unvaccinated children 6-59 months of age in the Democratic Republic of the Congo, 2013-2014. Vaccine 2021; 38:2258-2265. [PMID: 32057333 PMCID: PMC7026690 DOI: 10.1016/j.vaccine.2019.09.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 09/02/2019] [Accepted: 09/11/2019] [Indexed: 01/13/2023]
Abstract
Background Measles is endemic in the Democratic Republic of the Congo (DRC), and 89–94% herd immunity is required to halt its transmission. Much of the World Health Organization African Region, including the DRC, has vaccination coverage below the 95% level required to eliminate measles, heightening concern of inadequate measles immunity. Methods We assessed 6706 children aged 6–59 months whose mothers were selected for interview in the 2013–2014 DRC Demographic and Health Survey. History of measles was obtained by maternal report, and classification of children who had measles was completed using maternal recall and measles immunoglobulin G serostatus obtained from a multiplex chemiluminescent automated immunoassay dried blood spot analysis. A logistic regression model was used to identify associations of covariates with measles and seroprotection, and vaccine effectiveness (VE) was calculated. Results Out of our sample, 64% of children were seroprotected. Measles vaccination was associated with protection against measles (OR: 0.15, 95% CI: 0.03, 0.81) when administered to children 12 months of age or older. Vaccination was predictive of seroprotection at all ages. VE was highest (88%) among children 12–24 months of age. Conclusion Our results demonstrated lower than expected seroprotection against measles among vaccinated children. Understanding the factors that affect host immunity to measles will aid in developing more efficient and effective immunization programs in DRC.
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Affiliation(s)
- Hayley R Ashbaugh
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States.
| | - James D Cherry
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States.
| | - Nicole A Hoff
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Reena H Doshi
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | | | - Adva Gadoth
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Patrick Mukadi
- Kinshasa University, School of Medicine, Kinshasa, The Democratic Republic of the Congo
| | - Stephen G Higgins
- Lentigen Technology, Incorporated, Gaithersburg, MD 20878, United States
| | - Roger Budd
- DYNEX Technologies Incorporated, Chantilly, VA 20151, United States
| | | | - Guillaume Ngoie Mwamba
- Expanded Program on Immunization, Ministry of Public Health, Kinshasa, The Democratic Republic of the Congo
| | | | | | - Sue K Gerber
- Bill and Melinda Gates Foundation, Seattle, WA 98109, United States
| | - Anne W Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States.
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Bozzola E, Spina G, Tozzi AE, Villani A. Global Measles Epidemic Risk: Current Perspectives on the Growing Need for Implementing Digital Communication Strategies. Risk Manag Healthc Policy 2020; 13:2819-2826. [PMID: 33312006 PMCID: PMC7725071 DOI: 10.2147/rmhp.s201279] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
A safe vaccine against measles has been available and globally recommended since 1974. The World Health Organization established measles elimination as a goal for 2020 but, unfortunately, this objective has not been achieved yet and outbreaks still occur. Herd immunity, ie, a population immunity higher than 95%, is required to stop the measles virus transmission. Communication plays a crucial role in immunization strategy to obtain high coverage levels, as it helps to fight barriers against vaccination. Delay and refusal of measles vaccination have become widespread due to misinformation, fake news and barriers to effective communication. This phenomenon has been defined as “vaccine hesitancy” and is considered as one of the top ten risks for global health. The alleged association between measles vaccination and autism has caused a sharp decline in vaccination rates. In this current situation, mass communication integrated into public health policies is fundamental to sway people’s positive attitudes toward vaccination. Digital communication strategies based on social media and other internet platforms may represent useful tools to promote immunization and discourage skepticism and complement information provided by health-care professionals who have been considered as the most credible source on risk/benefits on vaccines for families. Digital communication strategies that may help supporting the measles elimination strategy include monitoring information needs online, integrating digital communication into immunization programs, involving a multidisciplinary group in communication, developing content that balances facts with positive messaging, using multiple communication channels. Further research activities should be promoted in the field of effective communication for immunization.
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Affiliation(s)
- Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Spina
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Eugenio Tozzi
- Multifactorial and Complex Diseases Research Area, Predictive and Preventive Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Denkel L, Espelage W, Matysiak-Klose D, Morwinsky T, Siedler A, Beermann S. [The global measles crisis-a diversity of causes from armed conflicts to vaccination skepticism]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:1445-1453. [PMID: 33185709 PMCID: PMC7686185 DOI: 10.1007/s00103-020-03241-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023]
Abstract
Hintergrund und Ziel Obwohl seit vielen Jahren ein sicherer und effektiver Impfstoff verfügbar ist, nehmen Fälle von Masern seit 2018 weltweit wieder zu. Ziel dieses Berichts ist die Identifizierung möglicher Gründe für diese Entwicklung. Methode Es erfolgte eine selektive Literaturrecherche sowie die Auswertung aktueller Berichte und Daten der Weltgesundheitsorganisation (WHO), des Kinderhilfswerkes der Vereinten Nationen (UNICEF) und der Weltbank. Ergebnisse Madagaskar, die Ukraine und Israel wiesen laut WHO im Zeitraum vom 01.07.2018 bis 30.06.2019 die weltweit höchsten Inzidenzen für Masern auf. Masernausbrüche sind ein Zeichen unzureichender Impfquoten, die durch vielfältige strukturelle und psychologische Barrieren verursacht werden. Strukturelle Barrieren für Masernimpfungen, wie mangelnde Routineimpfprogramme, bestehen vor allem in fragilen Ländern u. a. durch bewaffnete Konflikte. Sie wurden jedoch auch in Subpopulationen einkommensstärkerer Länder als Hauptursachen für geringe Masernimpfquoten u. a. durch fehlende Ressourcen für Impfdienste identifiziert. Psychologische Barrieren und nachfolgende Impfskepsis waren hauptsächlich in entwickelten Ländern mit gut funktionierenden Gesundheitssystemen und hohem Lebensstandard verbreitet. Diskussion Die Gründe für die globale Masernkrise sind vielfältig und existieren teilweise schon seit Jahrzehnten. Sie scheinen sich jedoch inzwischen zu akkumulieren und seit 2018 dramatisch auf die Fallzahlen auszuwirken. Das Ziel, die Masern zu eliminieren, und die Aufrechterhaltung der hierfür notwendigen Impfprogramme sind ständige Herausforderungen, welche die strikte und permanente Einhaltung der WHO-Empfehlungen erfordern. Auch in Deutschland liegt die Anzahl der übermittelten Masernfälle immer noch auf einem Niveau deutlich über dem im Nationalen Impfplan festgelegten Leitziel zur Eliminierung der Masern. Immer wieder kommt es zu zeitlich begrenzten regionalen bis bundesweiten Ausbrüchen. Da Infektionserreger grenzübergreifend übertragen werden können, ist die internationale Perspektive ein wesentlicher Bestandteil der nationalen Gesundheitspolitik in Deutschland.
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Affiliation(s)
- Luisa Denkel
- Abteilung für Infektionsepidemiologie, FG33 - Fachgebiet für Impfprävention, Robert Koch-Institut, Seestraße 10, 10315, Berlin, Deutschland.,Zentrum für internationalen Gesundheitsschutz, ZIG1 - Informationsstelle für Internationalen Gesundheitsschutz, Robert Koch-Institut, Berlin, Deutschland
| | - Werner Espelage
- Zentrum für internationalen Gesundheitsschutz, ZIG1 - Informationsstelle für Internationalen Gesundheitsschutz, Robert Koch-Institut, Berlin, Deutschland
| | - Dorothea Matysiak-Klose
- Abteilung für Infektionsepidemiologie, FG33 - Fachgebiet für Impfprävention, Robert Koch-Institut, Seestraße 10, 10315, Berlin, Deutschland
| | | | - Anette Siedler
- Abteilung für Infektionsepidemiologie, FG33 - Fachgebiet für Impfprävention, Robert Koch-Institut, Seestraße 10, 10315, Berlin, Deutschland
| | - Sandra Beermann
- Abteilung für Infektionsepidemiologie, FG33 - Fachgebiet für Impfprävention, Robert Koch-Institut, Seestraße 10, 10315, Berlin, Deutschland. .,Zentrum für internationalen Gesundheitsschutz, ZIG1 - Informationsstelle für Internationalen Gesundheitsschutz, Robert Koch-Institut, Berlin, Deutschland.
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11
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Díaz-Ortega JL, Ferreira-Guerrero E, Cruz-Hervert LP, Delgado-Sánchez G, Ferreyra-Reyes L, Yanes-Lane M, Mongua-Rodríguez N, Montero-Campos R, Castañeda-Desales D, García-García L. Seroprevalence of measles antibodies and factors associated with susceptibility: a national survey in Mexico using a plaque reduction neutralization test. Sci Rep 2020; 10:17488. [PMID: 33060627 PMCID: PMC7562930 DOI: 10.1038/s41598-020-73618-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 09/16/2020] [Indexed: 11/19/2022] Open
Abstract
Measles continues to be one of the leading causes of child mortality worldwide, even though a highly effective vaccine has existed for more than 40 years. We aimed to describe the seroprevalence of measles antibodies in Mexico in 2012 and the risk factors associated with susceptibility. A total of 7,785 serum samples were analyzed from the National Health and Nutrition Survey in Mexico. This national survey is representative of the general population, including noninstitutionalized adult, adolescent, and child populations. Antibody titers were classified into protective (> 120 mIU/mL) or susceptible (≤ 120 mIU/mL) levels. The weighted seroprevalence and susceptibility of the overall population were 99.37% (95% CI 99.07–99.58) and 0.63% (95% CI 0.42–0.93), respectively. Among 1-to-4-year-old children, 2.18% (95% CI 1.36–3.48) were susceptible to measles. Among adolescents and young adults, the prevalence of susceptibility was as follows: those 15–19 years of age had a prevalence of 0.22% (95% CI 0.09–0.57), and those 30–39 years of age had a prevalence of 1.17% (95% CI 0.47–2.85). Susceptibility was associated with young age, living in Mexico City, living in crowded households and unknown or nonvaccinated status among 1- to 5-year-old children. Although the overall sample population seroprevalence for measles is above 95%, increased susceptibility among younger children signals the importance of the timely administration of the first vaccine dose at 12 months of age. Furthermore, increased susceptibility among specific subgroups indicates the need to reinforce current vaccination policies, including the immunization of unvaccinated or incompletely vaccinated individuals from 10 to 39 years of age.
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Affiliation(s)
- José Luis Díaz-Ortega
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Luis Pablo Cruz-Hervert
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Mercedes Yanes-Lane
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Norma Mongua-Rodríguez
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Rogelio Montero-Campos
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Deyanira Castañeda-Desales
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Lourdes García-García
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México.
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12
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Younsi FZ, Chakhar S, Ishizaka A, Hamdadou D, Boussaid O. A Dominance-Based Rough Set Approach for an Enhanced Assessment of Seasonal Influenza Risk. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2020; 40:1323-1341. [PMID: 32421864 DOI: 10.1111/risa.13478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 01/11/2020] [Accepted: 02/27/2020] [Indexed: 06/11/2023]
Abstract
Accounting for about 290,000-650,000 deaths across the globe, seasonal influenza is estimated by the World Health Organization to be a major cause of mortality. Hence, there is a need for a reliable and robust epidemiological surveillance decision-making system to understand and combat this epidemic disease. In a previous study, the authors proposed a decision support system to fight against seasonal influenza. This system is composed of three subsystems: (i) modeling and simulation, (ii) data warehousing, and (iii) analysis. The analysis subsystem relies on spatial online analytical processing (S-OLAP) technology. Although the S-OLAP technology is useful in analyzing multidimensional spatial data sets, it cannot take into account the inherent multicriteria nature of seasonal influenza risk assessment by itself. Therefore, the objective of this article is to extend the existing decision support system by adding advanced multicriteria analysis capabilities for enhanced seasonal influenza risk assessment and monitoring. Bearing in mind the characteristics of the decision problem considered in this article, a well-known multicriteria classification method, the dominance-based rough set approach (DRSA), was selected to boost the existing decision support system. Combining the S-OLAP technology and the multicriteria classification method DRSA in the same decision support system will largely improve and extend the scope of analysis capabilities. The extended decision support system has been validated by its application to assess seasonal influenza risk in the northwest region of Algeria.
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Affiliation(s)
| | - Salem Chakhar
- Portsmouth Business School, University of Portsmouth, Portsmouth, Hampshire, UK
- Centre for Operational Research & Logistics, University of Portsmouth, Portsmouth, Hampshire, UK
| | | | - Djamila Hamdadou
- LIO Laboratory, University of Oran 1 Ahmed Ben Bella, Oran, Algeria
| | - Omar Boussaid
- ERIC Laboratory, University of Lumière Lyon 2, Bron, France
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13
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Prausnitz MR, Goodson JL, Rota PA, Orenstein WA. A microneedle patch for measles and rubella vaccination: a game changer for achieving elimination. Curr Opin Virol 2020; 41:68-76. [PMID: 32622318 PMCID: PMC7497860 DOI: 10.1016/j.coviro.2020.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/10/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
While morbidity and mortality associated with measles and rubella (MR) have dramatically decreased, there are still >100000 estimated deaths due to measles and an estimated 100000 infants born with congenital rubella syndrome annually. Given highly effective MR vaccines, the primary barrier to global elimination of these diseases is low vaccination coverage, especially among the most underserved populations in resource-limited settings. In contrast to conventional MR vaccination by hypodermic injection, microneedle patches are being developed to enable MR vaccination by minimally trained personnel. Simplified supply chain, reduced need for cold chain storage, elimination of vaccine reconstitution, no sharps waste, reduced vaccine wastage, and reduced total system cost of vaccination are advantages of this approach. Preclinical work to develop a MR vaccine patch has proceeded through successful immunization studies in rodents and non-human primates. On-going programs seek to make MR vaccine patches available to support MR elimination efforts around the world.
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Affiliation(s)
- Mark R Prausnitz
- School of Chemical & Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, GA 30332, USA.
| | - James L Goodson
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Paul A Rota
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
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El Zarif T, Kassir MF, Bizri N, Kassir G, Musharrafieh U, Bizri AR. Measles and mumps outbreaks in Lebanon: trends and links. BMC Infect Dis 2020; 20:244. [PMID: 32216754 PMCID: PMC7098136 DOI: 10.1186/s12879-020-04956-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/10/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Lebanon has experienced several measles and mumps outbreaks in the past 20 years. In this article, a case-based surveillance of both measles and mumps outbreaks in Lebanon was carried out in an attempt to outline factors contributing to the failure of elimination plans and to provide potential solutions. The relationship between the outbreaks of both diseases was described and explored. METHODS A retrospective descriptive study of confirmed cases of measles and mumps in Lebanon between 2003 and 2018 collected from the Lebanese Ministry of Public Health Epidemiological Surveillance Unit public database was carried out. The information collected was graphically represented taking into consideration dates of reported cases, age groups affected, and vaccination status. RESULTS The mean number of measles cases was 150.25 cases/year in the 1-4 years age group, 87 cases/year in individuals aging between 5 and 14, and 63.68 cases/year in those > 14 years old. In the latter group, only 18.05% were unvaccinated. The mean number of mumps cases was 30.4 cases/year in the < 4 year age group and 53.8 cases/year in the 10-19 years age group. During the study period, every spike in measles cases was followed by a similar spike in mumps. 9.66% of measles cases occurred in individuals who received at least 2 doses of the vaccine, 52.26% in the unvaccinated, and 38% in those whose vaccination status was undetermined. CONCLUSIONS Measles in Lebanon is a disease of the pediatric population, but adults remain at risk. Outbreaks of mumps followed those of measles and were mainly among adolescents. Presence of a large number of Syrian refugees in the country may further complicate the situation. Vaccination activities need to be intensified.
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Affiliation(s)
- Talal El Zarif
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | | | - Nazih Bizri
- Faculty of Medicine, University of Balamand, Koura, Lebanon
| | - Ghida Kassir
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Umayya Musharrafieh
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Rahman Bizri
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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15
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Coulborn RM, Nackers F, Bachy C, Porten K, Vochten H, Ndele E, Van Herp M, Bibala-Faray E, Cohuet S, Panunzi I. Field challenges to measles elimination in the Democratic Republic of the Congo. Vaccine 2020; 38:2800-2807. [PMID: 32111528 DOI: 10.1016/j.vaccine.2020.02.029] [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: 10/16/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND During a measles epidemic, the Ministry of Public Health (MOH) of the Democratic Republic of the Congo conducted supplementary immunization activities (2016-SIA) from August 28-September 3, 2016 throughout Maniema Province. From October 29-November 4, 2016, Médecins Sans Frontières and the MOH conducted a reactive measles vaccination campaign (2016-RVC) targeting children six months to 14 years old in seven health areas with heavy ongoing transmission despite inclusion in the 2016-SIA, and a post-vaccination survey. We report the measles vaccine coverage (VC) and effectiveness (VE) of the 2016-SIA and VC of the 2016-RVC. METHODS A cross-sectional VC cluster survey stratified by semi-urban/rural health area and age was conducted. A retrospective cohort analysis of measles reported by the parent/guardian allowed calculation of the cumulative measles incidence according to vaccination status after the 2016-SIA for an estimation of crude and adjusted VE. RESULTS In November 2016, 1145 children (6-59 months old) in the semi-urban and 1158 in the rural areas were surveyed. Post-2016-SIA VC (documentation/declaration) was 81.6% (95%CI: 76.5-85.7) in the semi-urban and 91.0% (95%CI: 84.9-94.7) in the rural areas. The reported measles incidence in October among children less than 5 years old was 5.0% for 2016-SIA-vaccinated and 11.2% for 2016-SIA-non-vaccinated in the semi-urban area, and 0.7% for 2016-SIA-vaccinated and 4.0% for 2016-SIA-non-vaccinated in the rural area. Post-2016-SIA VE (adjusted for age, sex) was 53.9% (95%CI: 2.9-78.8) in the semi-urban and 78.7% (95%CI: 0-97.1) in the rural areas. Post 2016-RVC VC (documentation/declaration) was 99.1% (95%CI: 98.2-99.6) in the semi-urban and 98.8% (95%CI: 96.5-99.6) in the rural areas. CONCLUSIONS Although our VE estimates could be underestimated due to misclassification of measles status, the VC and VE point estimates of the 2016-SIA in the semi-urban area appear suboptimal, and in combination, could not limit the epidemic. Further research is needed on vaccination strategies adapted to urban contexts.
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Affiliation(s)
| | | | - C Bachy
- Médecins Sans Frontières, Brussels, Belgium
| | | | - H Vochten
- Médecins Sans Frontières, Kinshasa, Democratic Republic of the Congo
| | - E Ndele
- Médecins Sans Frontières, Kinshasa, Democratic Republic of the Congo
| | - M Van Herp
- Médecins Sans Frontières, Brussels, Belgium
| | - E Bibala-Faray
- Ministry of Public Health, Maniema, Democratic Republic of the Congo
| | | | - I Panunzi
- Médecins Sans Frontières, Brussels, Belgium
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16
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Vassantachart JM, Yeo AH, Vassantachart AY, Jacob SE, Golkar L. Art of prevention: The importance of measles recognition and vaccination. Int J Womens Dermatol 2020; 6:89-93. [PMID: 32258338 PMCID: PMC7105691 DOI: 10.1016/j.ijwd.2019.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 11/20/2022] Open
Abstract
Measles is a viral infection that has a characteristic pattern of prodromal symptoms followed by a rash. Previously considered an inevitable childhood condition, measles is known as the "first" classic childhood exanthem. For most children, measles was a one-time, short-term illness; however, some children developed complications that led to severe sequelae and death. The introduction of the measles vaccine dramatically decreased the number of cases, but the current trend against vaccination has caused outbreaks of the condition. We propose the implementation of the AAA approach (assume, advise, and answer) as a way for providers to directly encourage the administration of the vaccine and prevent future cases of measles.
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Affiliation(s)
| | - Anthony H. Yeo
- Department of Psychiatry, Loma Linda University, Loma Linda, California
| | | | - Sharon E. Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California
| | - Linda Golkar
- Department of Dermatology, Loma Linda University, Loma Linda, California
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17
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Zahraei SM, Mokhtari-Azad T, Izadi S, Mohammadi M, Sabouri A. Seroprevalence of anti-rubella and anti-measles antibodies in women at the verge of marriage in Iran. Vaccine 2019; 38:235-241. [PMID: 31668816 DOI: 10.1016/j.vaccine.2019.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 10/09/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Measles and rubella as two highly contagious eruptive diseases are on the agenda to be eliminated in Iran by 2020. To evaluate the seroimmunity of the future mothers against rubella and measles, a nationwide serosurvey was implemented in 10 provinces, selected at random from 31 provinces in the country. METHODS using a multistage sampling method, 1600 participants were interviewed and blood sampled in 40 'Pre-marriage Consultation Centers' across 40 districts. Using ELISA method, the sera were tested for anti-rubella and anti-measles IgG antibodies in the National Reference Laboratory for Measles and Rubella, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. RESULTS Of the 1600 initial participants, the sera of 1573 participants were tested for rubella and 1569 for measles. The total seroprevalence of anti-rubella and anti-measles antibodies were 90.6% (95%CI: 89.1 to 92.0%) and 80.7% (95%CI: 78.7 to 82.6%) respectively. After 14 years, the effect of the immunization campaign of 2003 against rubella and measles on the age group of 5 to 25 years, was still apparent, i.e., there was a sharp difference between the seroprevalence of antibody (against both measles and rubella) of those who at the time of the present study were above 18 years with the younger age cohorts. For both diseases, higher seroprevalence of antibodies was detected in women above 18 years old. CONCLUSION Implementation of a Supplemental Immunization activity or revision of the national immunization schedule to add a third dose of measles and rubella containing vaccine during adolescence are/might be considered as possible options for bridging the gap in the seroimmunity of the younger age groups.
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Affiliation(s)
- Seyed Mohsen Zahraei
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Talat Mokhtari-Azad
- National Reference Laboratory for Measles and Rubella, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Izadi
- Health Promotion Research Centre, School of Public Health, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Mahdi Mohammadi
- Health Promotion Research Centre, School of Public Health, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Azam Sabouri
- Focal Point for Measles and Rubella Surveillance, Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
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Siani A. Measles outbreaks in Italy: A paradigm of the re-emergence of vaccine-preventable diseases in developed countries. Prev Med 2019; 121:99-104. [PMID: 30763627 DOI: 10.1016/j.ypmed.2019.02.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/10/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
Over the last decade, outbreaks of vaccine-preventable diseases have been reported in developed countries around the world. In particular, measles outbreaks have been ongoing in the European Union since 2017, with the majority of cases concentrated in Romania and Italy. Measles has been identified as a powerful indicator of the status of vaccination programs in a region, as outbreaks have been reported to quickly emerge as a result of underlying problems in the immunisation routine. This paper aims to report and critically comment on the factors underpinning the recent measles outbreaks in Italy, considering the psychological, cultural, social and political causes of vaccine hesitancy and refusal amongst the population. Data from government agencies including the Italian National Institute of Statistics (ISTAT) and the Italian National Institute of Health (ISS) are analysed to describe incidence and mortality trends from 1887 to the present day, including regional variations and the impact of measles vaccination coverage. The topic of compulsory vaccination is currently the object of heated debate in the Italian social and political panorama; this paper discusses the current state of the vaccination controversy in the Italian political discourse and its potential impact on immunisation policies and measles vaccine coverage amongst the population. A burgeoning body of evidence indicates that every effort should be made to bolster the existing legislation on mandatory vaccination through widespread health education campaigns aimed at improving scientific literacy amongst the Italian population with regards to the topic of immunisation.
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Affiliation(s)
- Alessandro Siani
- School of Biological Sciences, University of Portsmouth, Portsmouth, UK.
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Robertson DA. Spatial Transmission Models: A Taxonomy and Framework. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2019; 39:225-243. [PMID: 30144107 DOI: 10.1111/risa.13142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 04/20/2018] [Accepted: 05/09/2018] [Indexed: 06/08/2023]
Abstract
Within risk analysis and, more broadly, the decision behind the choice of which modeling technique to use to study the spread of disease, epidemics, fires, technology, rumors, or, more generally, spatial dynamics, is not well documented. While individual models are well defined and the modeling techniques are well understood by practitioners, there is little deliberate choice made as to the type of model to be used, with modelers using techniques that are well accepted in the field, sometimes with little thought as to whether alternative modeling techniques could or should be used. In this article, we divide modeling techniques for spatial transmission into four main categories: population-level models, where a macro-level estimate of the infected population is required; cellular models, where the transmission takes place between connected domains, but is restricted to a fixed topology of neighboring cells; network models, where host-to-host transmission routes are modeled, either as planar spatial graphs or where shortcuts can take place as in social networks; and, finally, agent-based models that model the local transmission between agents, either as host-to-host geographical contacts, or by modeling the movement of the disease vector, with dynamic movement of hosts and vectors possible, on a Euclidian space or a more complex space deformed by the existence of information about the topology of the landscape. We summarize these techniques by introducing a taxonomy classifying these modeling approaches. Finally, we present a framework for choosing the most appropriate spatial modeling method, highlighting the links between seemingly disparate methodologies, bearing in mind that the choice of technique rests with the subject expert.
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Izadi S, Arabsalmani M, Mohammadi M, Tabatabaei SM, Haghdoost AA. Reiteration of the elimination status of measles in the southeast of Iran, 2015. Hum Vaccin Immunother 2018; 14:2957-2963. [PMID: 30085906 DOI: 10.1080/21645515.2018.1504537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
During 2015, the number of measles cases reported from Iran increased about three times the previous year; and Sistan-va-Baluchestan Province, located in the southeast of Iran, was the hottest point at the center of the dilemma. The main objective of the present study was to evaluate the situation of the population with regard to the elimination goals. The files of all measles cases were reviewed and categorized again based on surveillance system definitions; and the effective reproduction numbers, attack rates, and epidemic curves were calculated and graphed. In total, 152 laboratory-confirmed cases occurred in 2015 in the study population. The highest attack rate belonged to infants being in their first year of life and the lowest to the age groups 16 to 40. The estimated 'Effective Reproduction Number' for the eight districts ranged from 0.70 to 0.93; and considering the subsidence of all outbreaks by themselves, it might be speculated that elimination state is still in effect and accountable. Considering the large number of the susceptible islands among the sea of herd immune population, implicated by the large number of outbreaks, implementation of a supplementary immunization intervention is highly recommended.
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Affiliation(s)
- Shahrokh Izadi
- a Health Promotion Research Centre, School of Public Health , Zahedan University of Medical Sciences , Zahedan , Iran
| | - Masoome Arabsalmani
- b School of Public Health , Zahedan University of Medical Sciences , Zahedan , Iran
| | - Mahdi Mohammadi
- c Health Promotion Research Centre, School of Public Health , Zahedan University of Medical Sciences , Zahedan , Iran
| | - Seyed Mehdi Tabatabaei
- a Health Promotion Research Centre, School of Public Health , Zahedan University of Medical Sciences , Zahedan , Iran
| | - Ali-Akbar Haghdoost
- d School of Public Health , Kerman University of Medical Sciences , Kerman , Iran
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Izadi S, Zahraei SM, Mokhtari-Azad T. Seroprevalence of antibodies to measles and rubella eight months after a vaccination campaign in the southeast of Iran. Hum Vaccin Immunother 2018; 14:1412-1416. [PMID: 29420120 PMCID: PMC6037465 DOI: 10.1080/21645515.2018.1436920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/14/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022] Open
Abstract
Eight months after the mass immunization campaign of November 2015 against measles and rubella in the southeast of Iran, in order to evaluate the sero-immunity level of the people living in the mentioned region, a serosurvey study was performed. Using a multi-stage probability proportional to size cluster sampling, the sera of 1,056 participants, ranging from 15 months to 20 years old, were tested for measles and rubella IgG antibodies in the National Reference Laboratory at Tehran University of Medical Sciences, Tehran, Iran. The seroprevalence rates of antibodies against measles and rubella in the age groups below 16 years were respectively 98.4 and 93.2%. In the age group of 16 to 20 years, who was not the target of the mass immunization campaign, the said rates were respectively 91.7% and 87.4%. The herd immunity of the age groups below 16 years, who were the target of the campaign, is favourably high and reassuring both for measles and for rubella. Campaigns of supplementary vaccination play a substantial role for filling the gaps in the herd immunity.
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Affiliation(s)
- Shahrokh Izadi
- Health Promotion Research Centre, School of Public Health, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Seyed Mohsen Zahraei
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Talat Mokhtari-Azad
- National Reference Laboratory for Measles and Rubella, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Ashbaugh HR, Hoff NA, Doshi RH, Alfonso VH, Gadoth A, Mukadi P, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Gerber SK, Cherry JD, Rimoin AW. Predictors of measles vaccination coverage among children 6-59 months of age in the Democratic Republic of the Congo. Vaccine 2018; 36:587-593. [PMID: 29248265 PMCID: PMC5780300 DOI: 10.1016/j.vaccine.2017.11.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/15/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Measles is a significant contributor to child mortality in the Democratic Republic of the Congo (DRC), despite routine immunization programs and supplementary immunization activities (SIA). Further, national immunization coverage levels may hide disparities among certain groups of children, making effective measles control even more challenging. This study describes measles vaccination coverage and reporting methods and identifies predictors of vaccination among children participating in the 2013-2014 DRC Demographic and Health Survey (DHS). METHODS We examined vaccination coverage of 6947 children aged 6-59 months. A multivariate logistic regression model was used to identify predictors of vaccination among children reporting vaccination via dated card in order to identify least reached children. We also assessed spatial distribution of vaccination report type by rural versus urban residence. RESULTS Urban children with educated mothers were more likely to be vaccinated (OR = 4.1, 95% CI: 1.6, 10.7) versus children of mothers with no education, as were children in wealthier rural families (OR = 2.9, 95% CI: 1.9, 4.4). At the provincial level, urban areas more frequently reported vaccination via dated card than rural areas. CONCLUSIONS Results indicate that, while the overall coverage level of 70% is too low, socioeconomic and geographic disparities also exist which could make some children even less likely to be vaccinated. Dated records of measles vaccination must be increased, and groups of children with the greatest need should be targeted. As access to routine vaccination services is limited in DRC, identifying and targeting under-reached children should be a strategic means of increasing country-wide effective measles control.
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Affiliation(s)
- Hayley R Ashbaugh
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States.
| | - Nicole A Hoff
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States
| | - Reena H Doshi
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States
| | - Vivian H Alfonso
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States
| | - Adva Gadoth
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States
| | - Patrick Mukadi
- Kinshasa University, School of Medicine, Kinshasa, The Democratic Republic of the Congo
| | | | | | - Sue K Gerber
- Bill and Melinda Gates Foundation, Seattle, WA 98109, United States
| | - James D Cherry
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Anne W Rimoin
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States.
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Guerra FM, Bolotin S, Lim G, Heffernan J, Deeks SL, Li Y, Crowcroft NS. The basic reproduction number (R 0 ) of measles: a systematic review. THE LANCET. INFECTIOUS DISEASES 2017; 17:e420-e428. [DOI: 10.1016/s1473-3099(17)30307-9] [Citation(s) in RCA: 270] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 03/10/2017] [Accepted: 03/23/2017] [Indexed: 01/07/2023]
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24
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Human Papillomavirus Vaccine. Obstet Gynecol 2017; 130:691-692. [DOI: 10.1097/aog.0000000000002271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Fojo AT, Kendall EA, Kasaie P, Shrestha S, Louis TA, Dowdy DW. Mathematical Modeling of "Chronic" Infectious Diseases: Unpacking the Black Box. Open Forum Infect Dis 2017; 4:ofx172. [PMID: 29226167 PMCID: PMC5716064 DOI: 10.1093/ofid/ofx172] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
Background Mathematical models are increasingly used to understand the dynamics of infectious diseases, including “chronic” infections with long generation times. Such models include features that are obscure to most clinicians and decision-makers. Methods Using a model of a hypothetical active case-finding intervention for tuberculosis in India as an example, we illustrate the effects on model results of different choices for model structure, input parameters, and calibration process. Results Using the same underlying data, different transmission models produced different estimates of the projected intervention impact on tuberculosis incidence by 2030 with different corresponding uncertainty ranges. We illustrate the reasons for these differences and present a simple guide for clinicians and decision-makers to evaluate models of infectious diseases. Conclusions Mathematical models of chronic infectious diseases must be understood to properly inform policy decisions. Improved communication between modelers and consumers is critical if model results are to improve the health of populations.
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Affiliation(s)
| | - Emily A Kendall
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Thomas A Louis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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26
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Zahoor MA. Global eradication of measles virus: current status. Future Virol 2017. [DOI: 10.2217/fvl-2017-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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27
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Thompson KM, Badizadegan ND. Modeling the Transmission of Measles and Rubella to Support Global Management Policy Analyses and Eradication Investment Cases. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2017; 37:1109-1131. [PMID: 28561947 DOI: 10.1111/risa.12831] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 06/07/2023]
Abstract
Policy makers responsible for managing measles and rubella immunization programs currently use a wide range of different vaccines formulations and immunization schedules. With endemic measles and rubella transmission interrupted in the region of the Americas, all five other regions of the World Health Organization (WHO) targeting the elimination of measles transmission by 2020, and increasing adoption of rubella vaccine globally, integrated dynamic disease, risk, decision, and economic models can help national, regional, and global health leaders manage measles and rubella population immunity. Despite hundreds of publications describing models for measles or rubella and decades of use of vaccines that contain both antigens (e.g., measles, mumps, and rubella vaccine or MMR), no transmission models for measles and rubella exist to support global policy analyses. We describe the development of a dynamic disease model for measles and rubella transmission, which we apply to 180 WHO member states and three other areas (Puerto Rico, Hong Kong, and Macao) representing >99.5% of the global population in 2013. The model accounts for seasonality, age-heterogeneous mixing, and the potential existence of preferentially mixing undervaccinated subpopulations, which create heterogeneity in immunization coverage that impacts transmission. Using our transmission model with the best available information about routine, supplemental, and outbreak response immunization, we characterize the complex transmission dynamics for measles and rubella historically to compare the results with available incidence and serological data. We show the results from several countries that represent diverse epidemiological situations to demonstrate the performance of the model. The model suggests relatively high measles and rubella control costs of approximately $3 billion annually for vaccination based on 2013 estimates, but still leads to approximately 17 million disability-adjusted life years lost with associated costs for treatment, home care, and productivity loss costs of approximately $4, $3, and $47 billion annually, respectively. Combined with vaccination and other financial cost estimates, our estimates imply that the eradication of measles and rubella could save at least $10 billion per year, even without considering the benefits of preventing lost productivity and potential savings from reductions in vaccination. The model should provide a useful tool for exploring the health and economic outcomes of prospective opportunities to manage measles and rubella. Improving the quality of data available to support decision making and modeling should represent a priority as countries work toward measles and rubella goals.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc., Orlando, FL, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
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Thompson KM. Modeling and Managing the Risks of Measles and Rubella: A Global Perspective Part II. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2017; 37:1041-1051. [PMID: 28471528 DOI: 10.1111/risa.12823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 06/07/2023]
Abstract
Measles and rubella continue to circulate globally. Complementing Part I of the special issue, this introduction provides a contrast between other global eradication initiatives and the experience with measles and rubella eradication to date. This introduction builds on the syntheses of the literature provided in Part I and it describes the creation and application of a national risk assessment tool and the development of a dynamic disease transmission model to support global efforts to optimally manage measles and rubella globally using vaccines. Currently, efforts to eradicate measles and rubella suffer from the lack of a commitment to global eradication by key stakeholders, despite strong evidence that their eradication represents a better health and financial option than continued control.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc., Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
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29
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Delineating morbillivirus entry, dissemination and airborne transmission by studying in vivo competition of multicolor canine distemper viruses in ferrets. PLoS Pathog 2017; 13:e1006371. [PMID: 28481926 PMCID: PMC5436898 DOI: 10.1371/journal.ppat.1006371] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/18/2017] [Accepted: 04/23/2017] [Indexed: 12/19/2022] Open
Abstract
Identification of cellular receptors and characterization of viral tropism in animal models have vastly improved our understanding of morbillivirus pathogenesis. However, specific aspects of viral entry, dissemination and transmission remain difficult to recapitulate in animal models. Here, we used three virologically identical but phenotypically distinct recombinant (r) canine distemper viruses (CDV) expressing different fluorescent reporter proteins for in vivo competition and airborne transmission studies in ferrets (Mustela putorius furo). Six donor ferrets simultaneously received three rCDVs expressing green, red or blue fluorescent proteins via conjunctival (ocular, Oc), intra-nasal (IN) or intra-tracheal (IT) inoculation. Two days post-inoculation sentinel ferrets were placed in physically separated adjacent cages to assess airborne transmission. All donor ferrets developed lymphopenia, fever and lethargy, showed progressively increasing systemic viral loads and were euthanized 14 to 16 days post-inoculation. Systemic replication of virus inoculated via the Oc, IN and IT routes was detected in 2/6, 5/6 and 6/6 ferrets, respectively. In five donor ferrets the IT delivered virus dominated, although replication of two or three different viruses was detected in 5/6 animals. Single lymphocytes expressing multiple fluorescent proteins were abundant in peripheral blood and lymphoid tissues, demonstrating the occurrence of double and triple virus infections. Transmission occurred efficiently and all recipient ferrets showed evidence of infection between 18 and 22 days post-inoculation of the donor ferrets. In all cases, airborne transmission resulted in replication of a single-colored virus, which was the dominant virus in the donor ferret. This study demonstrates that morbilliviruses can use multiple entry routes in parallel, and co-infection of cells during viral dissemination in the host is common. Airborne transmission was efficient, although transmission of viruses expressing a single color suggested a bottleneck event. The identity of the transmitted virus was not determined by the site of inoculation but by the viral dominance during dissemination. Canine distemper virus (CDV) infection of ferrets is a tractable animal model for measles. Ferrets are highly susceptible to CDV, and inoculation with a low dose leads to lethal disease. We performed in vivo competition experiments to study virus entry, dissemination and transmission. Ferrets were simultaneously inoculated with CDV via the conjunctival, intra-nasal and intra-tracheal routes. The viruses were identical except for the fluorescent reporter protein encoded by the viral genome. By detecting cells expressing the different fluorescent reporter proteins at various sites in the host, we determined that CDV can enter the host in parallel at multiple sites. Virus spread in the ferret occurred via infected lymphocytes, which often turned out to be double- or triple-infected. Sentinel ferrets, placed in physically separated adjacent cages, became infected by airborne transmission. Transmission of the dominant single color despite replication of multicolor viruses in the upper respiratory tract suggested a bottleneck event.
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Chaotic dynamics in the seasonally forced SIR epidemic model. J Math Biol 2017; 75:1655-1668. [PMID: 28434024 DOI: 10.1007/s00285-017-1130-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/08/2017] [Indexed: 10/19/2022]
Abstract
We prove analytically the existence of chaotic dynamics in the forced SIR model. Although numerical experiments have already suggested that this model can exhibit chaotic dynamics, a rigorous proof (without computer-aided) was not given before. Under seasonality in the transmission rate, the coexistence of low birth and mortality rates with high recovery and transmission rates produces infinitely many periodic and aperiodic patterns together with sensitive dependence on the initial conditions.
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Perspective on Global Measles Epidemiology and Control and the Role of Novel Vaccination Strategies. Viruses 2017; 9:v9010011. [PMID: 28106841 PMCID: PMC5294980 DOI: 10.3390/v9010011] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 12/21/2022] Open
Abstract
Measles is a highly contagious, vaccine preventable disease. Measles results in a systemic illness which causes profound immunosuppression often leading to severe complications. In 2010, the World Health Assembly declared that measles can and should be eradicated. Measles has been eliminated in the Region of the Americas, and the remaining five regions of the World Health Organization (WHO) have adopted measles elimination goals. Significant progress has been made through increased global coverage of first and second doses of measles-containing vaccine, leading to a decrease in global incidence of measles, and through improved case based surveillance supported by the WHO Global Measles and Rubella Laboratory Network. Improved vaccine delivery methods will likely play an important role in achieving measles elimination goals as these delivery methods circumvent many of the logistic issues associated with subcutaneous injection. This review highlights the status of global measles epidemiology, novel measles vaccination strategies, and describes the pathway toward measles elimination.
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Abstract
In a Perspective, Julie Garon and Walter Orenstein discuss Lessler and colleagues' modeling study on measles vaccination and the implications for triggered and routine immunization programs.
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Affiliation(s)
- Julie Garon
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Walter Orenstein
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
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Abstract
Measles is an infectious disease in humans caused by the measles virus (MeV). Before the introduction of an effective measles vaccine, virtually everyone experienced measles during childhood. Symptoms of measles include fever and maculopapular skin rash accompanied by cough, coryza and/or conjunctivitis. MeV causes immunosuppression, and severe sequelae of measles include pneumonia, gastroenteritis, blindness, measles inclusion body encephalitis and subacute sclerosing panencephalitis. Case confirmation depends on clinical presentation and results of laboratory tests, including the detection of anti-MeV IgM antibodies and/or viral RNA. All current measles vaccines contain a live attenuated strain of MeV, and great progress has been made to increase global vaccination coverage to drive down the incidence of measles. However, endemic transmission continues in many parts of the world. Measles remains a considerable cause of childhood mortality worldwide, with estimates that >100,000 fatal cases occur each year. Case fatality ratio estimates vary from <0.01% in industrialized countries to >5% in developing countries. All six WHO regions have set goals to eliminate endemic transmission of MeV by achieving and maintaining high levels of vaccination coverage accompanied by a sensitive surveillance system. Because of the availability of a highly effective and relatively inexpensive vaccine, the monotypic nature of the virus and the lack of an animal reservoir, measles is considered a candidate for eradication.
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Thompson KM, Cochi SL. Modeling and Managing the Risks of Measles and Rubella: A Global Perspective, Part I. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1288-96. [PMID: 27424287 PMCID: PMC10951992 DOI: 10.1111/risa.12655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 05/26/2015] [Accepted: 06/09/2015] [Indexed: 06/06/2023]
Abstract
Over the past 50 years, the use of vaccines led to significant decreases in the global burdens of measles and rubella, motivated at least in part by the successive development of global control and elimination targets. The Global Vaccine Action Plan (GVAP) includes specific targets for regional elimination of measles and rubella in five of six regions of the World Health Organization by 2020. Achieving the GVAP measles and rubella goals will require significant immunization efforts and associated financial investments and political commitments. Planning and budgeting for these efforts can benefit from learning some important lessons from the Global Polio Eradication Initiative (GPEI). Following an overview of the global context of measles and rubella risks and discussion of lessons learned from the GPEI, we introduce the contents of the special issue on modeling and managing the risks of measles and rubella. This introduction describes the synthesis of the literature available to support evidence-based model inputs to support the development of an integrated economic and dynamic disease transmission model to support global efforts to optimally manage these diseases globally using vaccines.
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Affiliation(s)
- Kimberly M. Thompson
- Kid Risk, Inc., Orlando, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Stephen L. Cochi
- Center for Global Health, Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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