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Hagan J, Dashpagma O, Vichit O, Chham S, Demberelsuren S, Grabovac V, Hossain S, Iijima M, Lee CW, Purevdagva A, Mariano K, Evans R, Zhang Y, Takashima Y. Challenges for Sustaining Measles Elimination: Post-Verification Large-Scale Import-Related Measles Outbreaks in Mongolia and Cambodia, Resulting in the Loss of Measles Elimination Status. Vaccines (Basel) 2024; 12:821. [PMID: 39066458 PMCID: PMC11281564 DOI: 10.3390/vaccines12070821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 07/28/2024] Open
Abstract
The Western Pacific Region's pursuit of measles elimination has seen significant progress and setbacks. Mongolia and Cambodia were the first two middle-income countries in the Western Pacific to be verified as having eliminated measles by the Western Pacific Regional Verification Commission for Measles and Rubella Elimination, in March 2014 and 2015, respectively. However, both countries experienced large-scale or prolonged importation-related measles outbreaks shortly afterwards, leading to the re-establishment of endemic transmission. We describe the path to initial elimination in both countries and explore these outbreaks' characteristics, factors contributing to the loss of elimination status, and implications for broader elimination efforts. Data sources include case-based epidemiological and laboratory surveillance reports, historical immunization coverage, genotype data, and published reports of in-depth outbreak investigations. In Mongolia, a single prolonged and large-scale outbreak revealed a hidden immunity gap among young adults and was driven in part by nosocomial transmission, leading to significant morbidity and mortality and loss of elimination status. Cambodia suffered multiple importations from neighboring endemic countries during the global measles resurgence in 2018-2019, complicated by cross-border mobility and significant nosocomial amplification, and the country was ultimately unable to sufficiently distinguish independent chains of transmission, leading to loss of elimination status. Our findings highlight the importance of broadening population immunity assessments beyond children to include adults and specific high-risk groups. Robust routine immunization programs, supplemented by tailored SIAs, are crucial for preventing and managing outbreaks. Additionally, strong outbreak preparedness plans, rapid response strategies, and cross-border collaboration and the global effort to prevent multiple resurgences and large-scale importation-induced outbreaks are vital for maintaining elimination status. The experiences of Mongolia and Cambodia underscore the challenges of sustaining measles elimination in the face of importation risks, shared borders with endemic countries, healthcare system gaps, and population movements. Strengthening the global coordination and synchronization of measles elimination activities is imperative to protect the gains achieved and prevent future setbacks.
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Affiliation(s)
- José Hagan
- World Health Organization, 1211 Geneva, Switzerland; (J.H.)
| | | | - Ork Vichit
- National Immunization Program, Ministry of Health, Phnom Penh 12151, Cambodia
| | - Samnang Chham
- World Health Organization, 1211 Geneva, Switzerland; (J.H.)
| | | | - Varja Grabovac
- World Health Organization, 1211 Geneva, Switzerland; (J.H.)
| | | | - Makiko Iijima
- World Health Organization, 1211 Geneva, Switzerland; (J.H.)
| | - Chung-won Lee
- World Health Organization, 1211 Geneva, Switzerland; (J.H.)
| | | | - Kayla Mariano
- World Health Organization, 1211 Geneva, Switzerland; (J.H.)
| | - Roger Evans
- World Health Organization, 1211 Geneva, Switzerland; (J.H.)
| | - Yan Zhang
- World Health Organization, 1211 Geneva, Switzerland; (J.H.)
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Do LAH, Tsedenbal N, Khishigmunkh C, Tserendulam B, Altanbumba L, Luvsantseren D, Ulziibayar M, Suuri B, Narangerel D, Tsolmon B, Demberelsuren S, Nguyen C, Mungun T, von Mollendorf C, Badarch D, Mulholland K. Impact of pneumococcal conjugate vaccine 13 introduction on severe lower respiratory tract infections associated with respiratory syncytial virus or influenza virus in hospitalized children in Ulaanbaatar, Mongolia. IJID REGIONS 2024; 11:100357. [PMID: 38577554 PMCID: PMC10992709 DOI: 10.1016/j.ijregi.2024.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024]
Abstract
Objectives Limited data indicate a beneficial effect of pneumococcal conjugate vaccines (PCVs) on respiratory syncytial virus (RSV) and influenza infections in young children. We evaluated the impact of 13-valent PCV (PCV13) introduction on the incidence of severe lower respiratory tract infections (LRTIs) associated with RSV or influenza in hospitalized children. Methods Our study was restricted to children aged <2 years with arterial oxygen saturation <93% and children with radiologically confirmed pneumonia nested in a pneumonia surveillance project in four districts of Ulaanbaatar city, Mongolia. We tested nasopharyngeal swabs collected on admission for RSV and influenza using quantitative reverse transcription-polymerase chain reaction. The impact of PCV13 on the incidence of LRTI outcomes associated with RSV or with influenza for the period April 2015-March 2020 was estimated. Incidence rate ratios comparing pre- and post-vaccine periods were estimated for each outcome for each district using negative binomial models and for all districts combined with a mixed-effects negative binomial model. Adjusted models accounted for seasonality. Sensitivity analyses were conducted to assess the robustness of our findings. Results Among 5577 tested cases, the adjusted incidence rate ratios showed a trend toward a reduction in RSV-associated outcomes: all LRTIs (0.77, 95% confidence interval [CI] 0.44-1.36), severe LRTIs (0.88, 95% CI 0.48-1.62), very severe LRTIs (0.76, 95% CI 0.42-1.38), and radiologically confirmed pneumonia (0.66, 95% CI 0.32-1.38) but inconsistent trends in outcomes associated with influenza. Conclusions No significant reductions were observed in any outcomes associated with RSV and influenza after PCV introduction.
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Affiliation(s)
- Lien Anh Ha Do
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | | | | | - Dorj Narangerel
- Ministry of Health, National Center for Communicable Diseases, Ulaanbaatar, Mongolia
| | - Bilegtsaikhan Tsolmon
- National Center of Communicable Diseases, Ulaanbaatar, Mongolia
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Cattram Nguyen
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Tuya Mungun
- National Center of Communicable Diseases, Ulaanbaatar, Mongolia
| | - Claire von Mollendorf
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Darmaa Badarch
- National Center of Communicable Diseases, Ulaanbaatar, Mongolia
| | - Kim Mulholland
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Do L, Tsedenbal N, Khishigmunkh C, Tserendulam B, Altanbumba L, Luvsantseren D, Ulziibayar M, Suuri B, Narangerel D, Tsolmon B, Demberelsuren S, Pell C, Manna S, Satzke C, Nguyen C, Mungun T, von Mollendorf C, Badarch D, Mulholland K. Respiratory Syncytial Virus and Influenza Infections in Children in Ulaanbaatar, Mongolia, 2015-2021. Influenza Other Respir Viruses 2024; 18:e13303. [PMID: 38757258 PMCID: PMC11099724 DOI: 10.1111/irv.13303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Data available for RSV and influenza infections among children < 2 years in Mongolia are limited. We present data from four districts of Ulaanbaatar from April 2015 to June 2021. METHODS This study was nested in an enhanced surveillance project evaluating pneumococcal conjugate vaccine (PCV13) impact on the incidence of hospitalized lower respiratory tract infections (LRTIs). Our study was restricted to children aged < 2 years with arterial O2 saturation < 93% and children with radiological pneumonia. Nasopharyngeal (NP) swabs collected at admission were tested for RSV and influenza using qRT-PCR. NP swabs of all patients with radiological pneumonia and of a subset of randomly selected NP swabs were tested for S. pneumoniae (S.p.) by qPCR and for serotypes by culture and DNA microarray. RESULTS Among 5705 patients, 2113 (37.0%) and 386 (6.8%) had RSV and influenza infections, respectively. Children aged 2-6 months had a higher percentage of very severe RSV infection compared to those older than 6 months (42.2% versus 31.4%, p-value Fisher's exact = 0.001). S.p. carriage was detected in 1073/2281 (47.0%) patients. Among S.p. carriage cases, 363/1073 (33.8%) had S.p. and RSV codetection, and 82/1073 (7.6%) had S.p. and influenza codetection. S.p. codetection with RSV/influenza was not associated with more severe LRTIs, compared to only RSV/influenza cases. CONCLUSION In Mongolia, RSV is an important pathogen causing more severe LRTI in children under 6 months of age. Codetection of RSV or influenza virus and S.p. was not associated with increased severity.
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Affiliation(s)
- Lien Anh Ha Do
- New Vaccines GroupMurdoch Children's Research InstituteMelbourneAustralia
- Department of PaediatricsThe University of MelbourneParkvilleAustralia
| | - Naranzul Tsedenbal
- Virology DepartmentNational Center of Communicable DiseasesUlaanbaatarMongolia
| | | | | | | | | | | | - Bujinlkham Suuri
- Virology DepartmentNational Center of Communicable DiseasesUlaanbaatarMongolia
| | - Dorj Narangerel
- National Center for Communicable DiseasesMinistry of HealthUlaanbaatarMongolia
| | - Bilegtsaikhan Tsolmon
- Virology DepartmentNational Center of Communicable DiseasesUlaanbaatarMongolia
- Medical DepartmentMongolian National University of Medical SciencesUlaanbaatarMongolia
| | | | - Casey L Pell
- Translational Microbiology GroupMurdoch Children's Research InstituteMelbourneAustralia
| | - Sam Manna
- Translational Microbiology GroupMurdoch Children's Research InstituteMelbourneAustralia
| | - Catherine Satzke
- Department of PaediatricsThe University of MelbourneParkvilleAustralia
- Translational Microbiology GroupMurdoch Children's Research InstituteMelbourneAustralia
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and ImmunityThe University of MelbourneMelbourneVictoriaAustralia
| | - Cattram Nguyen
- New Vaccines GroupMurdoch Children's Research InstituteMelbourneAustralia
- Department of PaediatricsThe University of MelbourneParkvilleAustralia
| | - Tuya Mungun
- Virology DepartmentNational Center of Communicable DiseasesUlaanbaatarMongolia
| | - Claire von Mollendorf
- New Vaccines GroupMurdoch Children's Research InstituteMelbourneAustralia
- Department of PaediatricsThe University of MelbourneParkvilleAustralia
| | - Darmaa Badarch
- Virology DepartmentNational Center of Communicable DiseasesUlaanbaatarMongolia
| | - Kim Mulholland
- New Vaccines GroupMurdoch Children's Research InstituteMelbourneAustralia
- Department of PaediatricsThe University of MelbourneParkvilleAustralia
- Infectious Disease Epidemiology & International HealthLondon School of Hygiene and Tropical MedicineLondonUK
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Prieto Alvarado FE, Salas Suspes HP, Cortés Molano NP, Tavera PA. [Maintaining measles elimination status in Colombia during outbreak control, 2019Manutenção do status de eliminação do sarampo na Colômbia durante o controle de surtos, 2019]. Rev Panam Salud Publica 2023; 47:e165. [PMID: 38089106 PMCID: PMC10712572 DOI: 10.26633/rpsp.2023.165] [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: 05/24/2023] [Accepted: 10/10/2023] [Indexed: 03/08/2024] Open
Abstract
Objective Describe measles outbreaks caused by importation of multiple cases, and the corresponding control interventions. Methods Descriptive study of measles outbreaks caused by the importation of multiple cases to Colombia in 2018-2019. Case definitions, classification of source of infection, collection of biological specimens, searches for suspected cases, case identification, and contact tracing were employed. Vaccination records were obtained from vaccination cards or from the Colombian information system. Nationality was determined from records found in the public health surveillance system. The incident command system was used, and response teams and action plans were activated to control outbreaks. Results In March 2018, the first case of measles imported from Venezuela was confirmed. Measles incidence in 2018 was 0.2 cases per 100 000 population, and it was 0.3 per 100 000 in 2019. The case fatality rate in 2019 was 0.4%. A total of 214 cases were confirmed in the Venezuelan population (91% with no vaccination history); and 69 outbreaks with no epidemiological link were studied. The MVi/Hulu Langat.MYS/26.11[D8] lineage was identified. Endemic circulation was prevented through innovative interventions such as infection surveillance and control, immediate notification, prioritization of field visits, and transmission risk level criteria. Conclusions Colombia controlled measles outbreaks that resulted from imported cases, and it prevented endemic circulation, thereby maintaining certification of measles elimination in the country.
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Affiliation(s)
| | | | | | - Pilar Andrea Tavera
- Instituto Nacional de SaludBogotáColombiaInstituto Nacional de Salud, Bogotá, Colombia.
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Ramírez MA, Fernádez Santisteban MT, Galange MM, Carralero RR, Júlio G, Samutondo C, Gaston C, Manuel E, Pedro AM, Paixão J, Freitas H, Morais J, Francisco NM. Epidemiology of measles in Angola: Results from routine surveillance from 2015 to 2021. IJID REGIONS 2023; 7:256-261. [PMID: 37223088 PMCID: PMC10200832 DOI: 10.1016/j.ijregi.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/25/2023]
Abstract
Background Measles, an acute infectious disease of extremely contagious viral aetiology, has been eliminated in some parts of the world. To the best of the authors' knowledge, this is the first study on the epidemiological pattern of the measles virus in Angola, and it was carried out through a review of 7 years of observational retrospective data from the national measles laboratory surveillance programme. Methods A retrospective study using national databases on the laboratory surveillance of measles was performed. Patients of all ages with suspected measles from all provinces of Angola were included. Serum samples were used to detect IgM-type measles-virus-specific antibodies by enzyme-linked immunosorbent assay. Findings In total, 3690 suspected measles samples were sent to the Instituto Nacional de Investigação em Saúde. There were 962 (26.1%) laboratory-confirmed cases, and the most affected age group was children aged 1-4 years. The highest incidence rate per 100,000 population was found in Benguela (17.9%), followed by Huambo (16.7%) and Cuanza Sul (13.6%). Of the study years, the incidence rate per 1,000,000 population was highest in 2020 (11.9%). The most common complication was diarrhoea (n=406, 42.2%). Of the confirmed cases, 209 (21.7%) were vaccinated, 633 (65.8%) were unvaccinated, and 120 (12.5%) had unknown vaccination status. For all study years, vaccination coverage was <70%. Interpretation Measles continues to be a serious problem in Angola, and more efforts are needed to increase measles surveillance and achieve a high percentage of vaccination coverage.
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Affiliation(s)
- Mabel A. Ramírez
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | | | - Maria M. Galange
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | - Raisa R. Carralero
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | - Graciete Júlio
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | | | - Celestina Gaston
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | - Eusebio Manuel
- Direcção Nacional de Saúde Pública, Ministério da Saúde, Luanda, Angola
| | - Alda M. Pedro
- Direcção Nacional de Saúde Pública, Ministério da Saúde, Luanda, Angola
| | - Joana Paixão
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | - Helga Freitas
- Direcção Nacional de Saúde Pública, Ministério da Saúde, Luanda, Angola
| | - Joana Morais
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
- Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola
| | - Ngiambudulu M. Francisco
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
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Batbayar B, Kariya T, Boldoo T, Purevdorj E, Dambaa N, Saw YM, Yamamoto E, Hamajima N. Patient delay and health system delay of patients with newly diagnosed pulmonary tuberculosis in Mongolia, 2016-2017. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:339-351. [PMID: 35967952 PMCID: PMC9350575 DOI: 10.18999/nagjms.84.2.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
Although diagnosis and treatment of tuberculosis (TB) have been improved in many countries, delays in the diagnosis and treatment remain problematic in resource-limited countries. This study aimed to identify factors affecting delays in TB care in Mongolia. Data on TB cases registered from January 2016 to December 2017 were obtained from the national registry of TB at the Department of TB Surveillance and Research in National Center for Communicable Disease. The total number of TB cases registered in these two years was 8,166, including 3,267 cases of newly diagnosed pulmonary TB. Pulmonary TB cases (1,836 males and 1,431 females) were analyzed to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Patient delays longer than the median (28 days) were significantly associated with patient age >32 years (aOR=1.31, 95%CI: 1.14-1.51), residence in areas other than Ulaanbaatar (aimags) (aOR=1.38, 95%CI: 1.20-1.59), and smear-negative (aOR=0.57, 95%CI: 0.47-0.69). Health system delays longer than the median (7 days) were significantly associated with patient age >32 years (aOR=1.16, 95%CI: 1.00-1.33), residence in aimags (aOR=0.82, 95%CI: 0.71-0.95), special facilities including a prison hospital (aOR=4.40, 95%CI: 2.42-7.83), registration in 2017 relative to 2016 (aOR=0.83, 95%CI: 0.71-0.95), and smear-negative (aOR=1.72, 95%CI: 1.42-2.07). Total delays longer than the median (45 days) were significantly associated with patient age >32 years (aOR=1.39, 95%CI: 1.21-1.60), residence in aimags (aOR=1.27, 95%CI: 1.11-1.47), and smear-negative (aOR=0.74, 95%CI: 0.62-0.90). To shorten the total delay, improvement of the access to medical facilities in aimags is necessary.
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Affiliation(s)
- Batmunkh Batbayar
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Ministry of Health of Mongolia, Ulaanbaatar, Mongolia
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Tsolmon Boldoo
- National Center for Communicable Diseases, Ministry of Health of Mongolia, Ulaanbaatar, Mongolia
| | - Enkhtamir Purevdorj
- National Center for Communicable Diseases, Ministry of Health of Mongolia, Ulaanbaatar, Mongolia
| | - Naranzul Dambaa
- National Center for Communicable Diseases, Ministry of Health of Mongolia, Ulaanbaatar, Mongolia
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Sereenen E, Saw YM, Erkhembayar R, Volodya B, Dashpagma O, Orsoo O, Kariya T, Ochir C, Yamamoto E, Hamajima N. Estimation of the unvaccinated among those aged less than 25 years according to aimag and its association with incidence of measles outbreak 2015-2016 in Mongolia. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:437-447. [PMID: 33132428 PMCID: PMC7548245 DOI: 10.18999/nagjms.82.3.437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/14/2020] [Indexed: 12/03/2022]
Abstract
Mongolia had an epidemic of measles in 2015-2016, even though more than 90% of the population have been vaccinated since 1997. This study aimed to examine the associations between unvaccinated proportion and measles incidence according to aimag. Mongolia has 21 provinces (aimag) with Ulaanbaatar as the capital city. Vaccination coverage between 1991 and 2014 and measles incidence according to aimag were obtained from the National Center for Communicable Diseases of Mongolia database. Accumulated unvaccinated proportion (AUP) among those aged 1 to 24 years in 2015 was estimated from the unvaccinated at the 1st dose of 1991 to 2014. From 1991 to 2014, unvaccinated proportion among those aged 1 to 24 years in the whole country has been reducing from 28.0% in 1991 to 1.8% in 2014. The AUP in 2015 varied from 2.7% (Selenge) to 21.8% (Govisumber). The incidence was remarkably higher in only two aimags with a large density of the unvaccinated aged 1 to 24 years (Ulaanbaatar and Darkhan-Uul) than in the other aimags. The incidence had no significant correlation with the AUP, although the correlation between the incidence and the density of unvaccinated aged 1 to 24 years was significant when the two aimags were included. In conclusion, the AUP between 2.7% and 21.8% had no correlation with the incidence according to aimags in Mongolia measles epidemic 2015-2016.
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Affiliation(s)
- Enkhbold Sereenen
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
- E-Health Project, Ministry of Health, Ulaanbaatar, Mongolia
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Ryenchindorj Erkhembayar
- Department of International Cyber Education, Graduate School, Mongolian National University of Medical Science, Ulaanbaatar, Mongolia
| | - Baigal Volodya
- Immunization Department, National Center for Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia
| | - Otgonbayar Dashpagma
- Immunization Department, National Center for Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia
| | - Oyunchimeg Orsoo
- Department of Public Administration, Ministry of Health, Ulaanbaatar, Mongolia
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Chimedsuren Ochir
- Department of International Cyber Education, Graduate School, Mongolian National University of Medical Science, Ulaanbaatar, Mongolia
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Measles and rubella IgG seroprevalence in persons 6 month-35 years of age, Mongolia, 2016. Vaccine 2020; 38:4200-4208. [PMID: 32381479 DOI: 10.1016/j.vaccine.2020.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/17/2020] [Accepted: 04/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND In 2015-2016, Mongolia experienced an unexpected large measles outbreak affecting mostly young children and adults. After two nationwide vaccination campaigns, measles transmission declined. To determine if there were any remaining immunity gaps to measles or rubella in the population, a nationally representative serosurvey for measles and rubella antibodies was conducted after the outbreak was over. METHODS A nationwide, cross-sectional, stratified, three-stage cluster serosurvey was conducted in November-December 2016. A priori, four regional strata (Ulaanbaatar, Western, Central, and Gobi-Eastern) and five age strata (6 months-23 months, 2-7 years, 8-17 years, 18-30 years, and 31-35 years) were created. Households were visited, members interviewed, and blood specimens were collected from age-appropriate members. Blood specimens were tested for measles immunoglobulin G (IgG) and rubella IgG (Enzygnost® Anti-measles Virus/IgG and Anti-rubella Virus/IgG, Siemens, Healthcare Diagnostics Products, GmbH Marburg, Germany). Factors associated with seropositivity were evaluated. RESULTS Among 4598 persons aged 6 months to 35 years participating in the serosurvey, 94% were measles IgG positive and 95% were rubella IgG positive. Measles IgG seropositivity was associated with increasing age and higher education. Rubella IgG seropositivity was associated with increasing age, higher education, smaller household size, receipt of MMR in routine immunization, residence outside the Western Region, non-Muslim religious affiliation, and non-Kazakh ethnicity. Muslim Kazakhs living in Western Region had the lowest rubella seroprevalence of all survey participants. CONCLUSIONS Nationally, high immunity to both measles and rubella has been achieved among persons 1-35 years of age, which should be sufficient to eliminate both measles and rubella if future birth cohorts have ≥ 95% two dose vaccination coverage. Catch-up vaccination is needed to close immunity gaps found among some subpopulations, particularly Muslim Kazakhs living in Western Region.
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Do LAH, Tsedenbal N, von Mollendorf C, Mungun T, Bardach D, Mulholland K. What was the real cause of the dramatic increase in measles mortality during the 2015/2016 Mongolian Outbreak? J Infect Dis 2020; 224:1266-1268. [PMID: 32103234 PMCID: PMC8514190 DOI: 10.1093/infdis/jiaa084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/26/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Lien Anh Ha Do
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Australia
| | | | - Claire von Mollendorf
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Australia
| | - Tuya Mungun
- National Center of Communicable Diseases, Mongolia
| | | | - Kim Mulholland
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Australia.,London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lei M, Wang K, Li J, Zhang Y, Wei X, Qi L, Zhou G, Wu Y. Phylogenetic and Epidemiological Analysis of Measles Viruses in Shenzhen, China from January 2015 to July 2019. Med Sci Monit 2019; 25:9245-9254. [PMID: 31800568 PMCID: PMC6911309 DOI: 10.12659/msm.920614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Measles morbidity and mortality were significantly reduced after the measles vaccine was introduced in China in 1965. However, measles outbreaks easily occur in densely populated areas, especially where there is no universal vaccination. The outbreak that occurred in Shenzhen, the Chinese city with the largest internal immigration, provides a lesson in measles virus mutation and measles prevention. The present study is a phylogenetic analysis of measles viruses and comparison of clinical signs between individuals with and without vaccination. Material/Methods We performed phylogenetic analysis of the nucleoprotein (N) genes of measles virus from 129 measles patients in Shenzhen from January 2015 to July 2019. Phylogenetic trees were constructed using the neighbor-joining method. Results The phylogenetic analysis showed all viruses were classified into genotype H1. In addition, there is often a seasonal measles outbreak in July each year. The clinical data showed that patients who were unvaccinated were more likely to have coughing, chronic bronchitis, conjunctivitis, catarrh, Koplik spots, and diarrhea. Children of migrant workers and those living in mountainous and rural districts accounted for most measles cases. Conclusions Our results showed there was a seasonal measles outbreak in Shenzhen Children’s Hospital. All the measles virus from 129 measles patients were H1 viruses. The clinical signs also showed a difference between unvaccinated and vaccinated patients. Moreover, most of the unvaccinated patients came from migrant worker families. We suggest there is a need for increased health promotion and vaccination programs for migrant workers and people living in remote villages.
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Affiliation(s)
- Min Lei
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, Guangdong, China (mainland)
| | - Kai Wang
- Department of Nephrology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China (mainland)
| | - Jing Li
- Department of Respiration, Shenzhen Children's Hospital, Shenzhen, Guangdong, China (mainland)
| | - Yan Zhang
- Department of Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, Guangdong, China (mainland)
| | - Xuemei Wei
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, Guangdong, China (mainland)
| | - Lifeng Qi
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, Guangdong, China (mainland)
| | - Gaofeng Zhou
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, Guangdong, China (mainland)
| | - Yue Wu
- Department of Pharmacy, Shenzhen Children's Hospital, Shenzhen, Guangdong, China (mainland)
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Lee CT, Hagan JE, Jantsansengee B, Tumurbaatar OE, Altanchimeg S, Yadamsuren B, Demberelsuren S, Tserendorj C, Munkhtogoo O, Badarch D, Gunregjav N, Baatarkhuu B, Ochir C, Berman L, Anderson R, Patel MK, Gregory CJ, Goodson JL. Increase in Infant Measles Deaths During a Nationwide Measles Outbreak-Mongolia, 2015-2016. J Infect Dis 2019; 220:1771-1779. [PMID: 30923799 PMCID: PMC7034305 DOI: 10.1093/infdis/jiz140] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/23/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Surveillance data from a large measles outbreak in Mongolia suggested increased case fatality ratio (CFR) in the second of 2 waves. To confirm the increase in CFR and identify risk factors for measles death, we enhanced mortality ascertainment and conducted a case-control study among infants hospitalized for measles. METHODS We linked national vital records with surveillance data of clinically or laboratory-confirmed infant (aged <12 months) measles cases with rash onset during March-September 2015 (wave 1) and October 2015-June 2016 (wave 2). We abstracted medical charts of 95 fatal cases and 273 nonfatal cases hospitalized for measles, matched by age and sex. We calculated adjusted matched odds ratios (amORs) and 95% confidence intervals (CIs) for risk factors. RESULTS Infant measles deaths increased from 3 among 2224 cases (CFR: 0.13%) in wave 1 to 113 among 4884 cases (CFR: 2.31%) in wave 2 (P < .001). Inpatient admission, 7-21 days before measles rash onset, for pneumonia or influenza (amOR: 4.5; CI, 2.6-8.0), but not other diagnoses, was significantly associated with death. DISCUSSION Measles infection among children hospitalized with respiratory infections likely increased deaths due to measles during wave 2. Preventing measles virus nosocomial transmission likely decreases measles mortality.
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Affiliation(s)
- Christopher T Lee
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jose E Hagan
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Samdan Altanchimeg
- Mongolia National Center for Communicable Disease, Ulaanbaatar, Mongolia
| | | | | | | | | | - Darmaa Badarch
- Mongolia National Center for Communicable Disease, Ulaanbaatar, Mongolia
| | - Nyamaa Gunregjav
- Mongolia National Center for Communicable Disease, Ulaanbaatar, Mongolia
| | | | - Chimedsuren Ochir
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - LaShondra Berman
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Raydel Anderson
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Minal K Patel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christopher J Gregory
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA
| | - James L Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA
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12
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Javelle E, Colson P, Parola P, Raoult D. Measles, the need for a paradigm shift. Eur J Epidemiol 2019; 34:897-915. [DOI: 10.1007/s10654-019-00569-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/03/2019] [Indexed: 01/24/2023]
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