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Rosenfeld KA, Frey K, McCarthy KA. Optimal Timing Regularly Outperforms Higher Coverage in Preventative Measles Supplementary Immunization Campaigns. Vaccines (Basel) 2024; 12:820. [PMID: 39066459 PMCID: PMC11281443 DOI: 10.3390/vaccines12070820] [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: 04/12/2024] [Revised: 05/03/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Measles threatens the lives and livelihoods of tens of millions of children and there are countries where routine immunization systems miss enough individuals to create the risk of large outbreaks. To help address this threat, measles supplementary immunization activities are time-limited, coordinated campaigns to immunize en masse a target population. Timing campaigns to be concurrent with building outbreak risk is an important consideration, but current programmatic standards focus on campaigns achieving a high coverage of at least 95%. We show that there is a dramatic trade-off between campaign timeliness and coverage. Optimal timing at coverages as low as 50% for areas with weak routine immunization systems is shown to outperform the current standard, which is delayed by as little as 6 months. Measured coverage alone is revealed as a potentially misleading performance metric.
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Affiliation(s)
- Katherine A. Rosenfeld
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA 98109, USA
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2
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Nasiri A, Farshidi H, Rezaei F, Dehdari T, Kazemi A, Rezapour H, Goshtaei M. Perceived barriers of migrants and refugees to vaccinate their children against Measles and polio: a study in Iran. Int J Equity Health 2023; 22:253. [PMID: 38057773 DOI: 10.1186/s12939-023-02075-2] [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: 09/11/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND This study examined the perceived barriers of migrants and refugees to vaccinating their children against measles and polio in Iran. METHODS First, an instrument was developed and validated through several steps. Next, 1,067 parents who had not vaccinated their children against polio and measles or had delayed receiving any dose of these two vaccines until the age of 15 were selected from 16 provinces and completed the instrument. Finally, the data were analyzed. RESULTS The results of the explanatory factor analysis showed that the perceived barriers affecting vaccination against polio and measles vaccines were categorized into five factors: low knowledge, negative attitude, communication challenges, lack of participation in vaccination programs, and problems related to migration and refugees. Additionally, the results indicated a significant difference in the mean score of perceived barriers based on participants' level of education, economic status, and nationality. CONCLUSION The identified barriers may provide a perspective for developing effective efforts in this area. Interventions should focus on parents with low education and poor economic status.
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Affiliation(s)
- Amir Nasiri
- Department of Health Education and Health Promotion, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Farshidi
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshid Rezaei
- Health Education and Promotion Department, Deputy of Public Health, MOHME, Tehran, Iran
| | - Tahereh Dehdari
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Afrouzeh Kazemi
- Health Education and Promotion Department, Deputy of Public Health, MOHME, Tehran, Iran
| | - Hamid Rezapour
- Health Education and Promotion Department, Deputy of Public Health, MOHME, Tehran, Iran
| | - Massomeh Goshtaei
- Health Education and Promotion Department, Deputy of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Hidano A, Holt H, Durrance-Bagale A, Tak M, Rudge JW. Exploring why animal health practices are (not) adopted among smallholders in low and middle-income countries: a realist framework and scoping review protocol. Front Vet Sci 2022; 9:915487. [PMID: 35968008 PMCID: PMC9372438 DOI: 10.3389/fvets.2022.915487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Improving livestock health is considered critical to address poverty, malnutrition and food insecurity in low- and middle-income countries (LMICs). Modifications of livestock management practices is also increasingly recognized as an important strategy to mitigate global threats such as climate change and novel disease emergence. Smallholders are, however, under various constraints which prohibit them from altering health practices for livestock and little is known about how the adoption of these practices may be promoted. The proposed scoping review aims to systematically map evidence around "what practices are (not) adopted by smallholders under what circumstances, how and why?." Method and analysis We conducted initial scoping searches to broadly define types of animal health practices relevant for smallholders in LMICs and formulated search terms. A scoping review protocol was designed and registered. A systematic literature search will be conducted using electronic databases including CAB Abstract, Scopus, MEDLINE, EMBASE, and Web of Science Core Collection. Gray literature will be searched from AGRIS and Standards for Supporting Agricultural Livelihoods in Emergencies. Articles in English, pertaining to the animal health practices considered highly relevant will be considered eligible for inclusion. Articles will be screened at two stages by two independent reviewers; screening of titles, abstracts, and keywords, followed by full-article screening. The first reviewer will review 100% of the articles at both stages. The second reviewer will review a random sample of 20% of the articles at both stages. Any disagreements will be resolved using inputs from the third reviewer. A thematic analysis will be conducted to catalog contexts and mechanisms for adoption and discussed under a realist framework. Discussion Understanding of the mechanisms underlying the adoption of animal health practices by livestock smallholders in LMICs is crucial for successful implementation of interventions including those which are based on a One Health approach. This review will identify the extent of this knowledge across disciplines and inform future research priorities for the design of effective and feasible interventions which can contribute toward Sustainable Development Goal 2. Registration This protocol is registered within the Open Science Framework (https://doi.org/10.17605/OSF.IO/FUQAX).
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Affiliation(s)
- Arata Hidano
- Communicable Disease Policy Research Group, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United kingdom
| | - Hannah Holt
- Communicable Disease Policy Research Group, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United kingdom
- Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, London, United Kingdom
| | - Anna Durrance-Bagale
- Communicable Disease Policy Research Group, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United kingdom
| | - Mehroosh Tak
- Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, London, United Kingdom
| | - James W. Rudge
- Communicable Disease Policy Research Group, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United kingdom
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
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4
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Rajaonarifara E, Bonds MH, Miller AC, Ihantamalala FA, Cordier L, Razafinjato B, Rafenoarimalala FH, Finnegan KE, Rakotonanahary RJL, Cowley G, Ratsimbazafy B, Razafimamonjy F, Randriamanambintsoa M, Raza-Fanomezanjanahary EM, Randrianambinina A, Metcalf CJ, Roche B, Garchitorena A. Impact of health system strengthening on delivery strategies to improve child immunisation coverage and inequalities in rural Madagascar. BMJ Glob Health 2022; 7:bmjgh-2021-006824. [PMID: 35012969 PMCID: PMC8753401 DOI: 10.1136/bmjgh-2021-006824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background To reach global immunisation goals, national programmes need to balance routine immunisation at health facilities with vaccination campaigns and other outreach activities (eg, vaccination weeks), which boost coverage at particular times and help reduce geographical inequalities. However, where routine immunisation is weak, an over-reliance on vaccination campaigns may lead to heterogeneous coverage. Here, we assessed the impact of a health system strengthening (HSS) intervention on the relative contribution of routine immunisation and outreach activities to reach immunisation goals in rural Madagascar. Methods We obtained data from health centres in Ifanadiana district on the monthly number of recommended vaccines (BCG, measles, diphtheria, tetanus and pertussis (DTP) and polio) delivered to children, during 2014–2018. We also analysed data from a district-representative cohort carried out every 2 years in over 1500 households in 2014–2018. We compared changes inside and outside the HSS catchment in the delivery of recommended vaccines, population-level vaccination coverage, geographical and economic inequalities in coverage, and timeliness of vaccination. The impact of HSS was quantified via mixed-effects logistic regressions. Results The HSS intervention was associated with a significant increase in immunisation rates (OR between 1.22 for measles and 1.49 for DTP), which diminished over time. Outreach activities were associated with a doubling in immunisation rates, but their effect was smaller in the HSS catchment. Analysis of cohort data revealed that HSS was associated with higher vaccination coverage (OR between 1.18 per year of HSS for measles and 1.43 for BCG), a reduction in economic inequality, and a higher proportion of timely vaccinations. Yet, the lower contribution of outreach activities in the HSS catchment was associated with persistent inequalities in geographical coverage, which prevented achieving international coverage targets. Conclusion Investment in stronger primary care systems can improve vaccination coverage, reduce inequalities and improve the timeliness of vaccination via increases in routine immunisations.
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Affiliation(s)
- Elinambinina Rajaonarifara
- Sciences & Ingénierie, Sorbonne Universite, Paris, France .,UMR 224 MIVEGEC, Univ. Montpellier-CNRS-IRD, Montpellier, France.,NGO PIVOT, Ranomafana, Madagascar
| | - Matthew H Bonds
- NGO PIVOT, Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Karen E Finnegan
- NGO PIVOT, Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | - C Jessica Metcalf
- Dept of Ecology and Evol. Biology, Princeton University, Princeton, New Jersey, USA
| | - Benjamin Roche
- UMR 224 MIVEGEC, Univ. Montpellier-CNRS-IRD, Montpellier, France.,Universidad Nacional Autónoma de México, Coyoacan, Distrito Federal, Mexico
| | - Andres Garchitorena
- UMR 224 MIVEGEC, Univ. Montpellier-CNRS-IRD, Montpellier, France.,NGO PIVOT, Ranomafana, Madagascar
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Viral Vaccines. ENCYCLOPEDIA OF INFECTION AND IMMUNITY 2022. [PMCID: PMC8830773 DOI: 10.1016/b978-0-12-818731-9.00225-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cutts FT, Ferrari MJ, Krause LK, Tatem AJ, Mosser JF. Vaccination strategies for measles control and elimination: time to strengthen local initiatives. BMC Med 2021; 19:2. [PMID: 33397366 PMCID: PMC7781821 DOI: 10.1186/s12916-020-01843-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Through a combination of strong routine immunization (RI), strategic supplemental immunization activities (SIA) and robust surveillance, numerous countries have been able to approach or achieve measles elimination. The fragility of these achievements has been shown, however, by the resurgence of measles since 2016. We describe trends in routine measles vaccine coverage at national and district level, SIA performance and demographic changes in the three regions with the highest measles burden. FINDINGS WHO-UNICEF estimates of immunization coverage show that global coverage of the first dose of measles vaccine has stabilized at 85% from 2015 to 19. In 2000, 17 countries in the WHO African and Eastern Mediterranean regions had measles vaccine coverage below 50%, and although all increased coverage by 2019, at a median of 60%, it remained far below levels needed for elimination. Geospatial estimates show many low coverage districts across Africa and much of the Eastern Mediterranean and southeast Asian regions. A large proportion of children unvaccinated for MCV live in conflict-affected areas with remote rural areas and some urban areas also at risk. Countries with low RI coverage use SIAs frequently, yet the ideal timing and target age range for SIAs vary within countries, and the impact of SIAs has often been mitigated by delays or disruptions. SIAs have not been sufficient to achieve or sustain measles elimination in the countries with weakest routine systems. Demographic changes also affect measles transmission, and their variation between and within countries should be incorporated into strategic planning. CONCLUSIONS Rebuilding services after the COVID-19 pandemic provides a need and an opportunity to increase community engagement in planning and monitoring services. A broader suite of interventions is needed beyond SIAs. Improved methods for tracking coverage at the individual and community level are needed together with enhanced surveillance. Decision-making needs to be decentralized to develop locally-driven, sustainable strategies for measles control and elimination.
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Affiliation(s)
- F T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - M J Ferrari
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
| | - L K Krause
- Vaccine Delivery, Global Development, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - A J Tatem
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - J F Mosser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, 98121, USA
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TERRACCIANO E, AMADORI F, PETTINICCHIO V, ZARATTI L, FRANCO E. Strategies for elimination of rubella in pregnancy and of congenital rubella syndrome in high and upper-middle income countries. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E98-E108. [PMID: 32490275 PMCID: PMC7225652 DOI: 10.15167/2421-4248/jpmh2020.61.1.1310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 01/30/2020] [Indexed: 11/24/2022]
Abstract
Rubella infection generally leads to mild symptoms; otherwise, in pregnant women it can cause severe damages. The only way to prevent rubella is vaccine. Before the introduction of the vaccine, up to 4 babies in 1000 live births were born with CRS. This work aims to review the most important strategies for the elimination of CRS in upper and high-income countries. Papers were selected through a PubMed search up to January 2019, using keywords rubella, congenital rubella syndrome and epidemiology. Articles published in the last 12 years and referred to upper income and high-income countries in title or abstract were included. Sixty-five papers were selected dealing with one or more of the following strategies: increasing of rubella vaccination coverage in childbearing age women, males, immigrants; exploitation of all appropriate occasions; improving of rubella surveillance. Despite numerous suggestions and indications for valid strategies to eliminate rubella in pregnancy and congenital rubella syndrome, a practical application is often missing.
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Affiliation(s)
- E. TERRACCIANO
- Specialization School for Hygiene and Preventive Medicine, Tor Vergata University of Rome, Italy
| | - F. AMADORI
- Specialization School for Hygiene and Preventive Medicine, Tor Vergata University of Rome, Italy
| | | | - L. ZARATTI
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Italy
| | - E. FRANCO
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Italy
- Correspondence: Elisabetta Franco Department of Biomedicine and Prevention, Tor Vergata University of Rome, via Montpellier 1, 00133 Rome Italy - Tel. +39 06 72596122 - +39 06 2025285 - E-mail:
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8
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Rubella IgM epidemiology in the pre-rubella vaccination era in Uganda. BMC Infect Dis 2020; 20:219. [PMID: 32164592 PMCID: PMC7068886 DOI: 10.1186/s12879-020-4928-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Control of Rubella and Congenital Rubella Syndrome using vaccination has shown great success in the America’s. Uganda is due to introduce the Rubella vaccine however the magnitude of transmission is not well documented. Therefore this study was done to determine IgM sero-prevalance for Rubella in order to help monitor vaccine effectiveness post introduction of the vaccine in routine vaccination programme. Methods A retrospective review of suspected measles cases data for the reporting period January 2007 to December 2016 in Uganda was Done. rubella IgM testing was done on 15,296 of the cases and the data was analyzed using STATA version 13. Results In total 15,296 cases were tested and 4255 (27.8%) tested positive and among females aged 15-49 years 88 out of 322 (27%) tested positive. The age distribution range was 0–80 years, rubella IgM positivity was reported in all the 15 regions of Uganda and throughout the ten year period in every month. Age group 5–15 years had OR 2.5 p-value < 0.001 of being rubella IgM positive compared to age < 5 years and testing measles IgM negative OR 6.3 p-value < 0.001. Conclusion Rubella is endemic in Uganda and although rubella IgM positivity is highest in the age 5-15 years even the younger, older and women of reprodutive age are affected. This means the risk of Congenital Rubella Syndrome is high hence the need to introduce the rubella vaccine for infants and pregnant mothers and continued surveillance to enhance its control.
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Cutts FT, Dansereau E, Ferrari MJ, Hanson M, McCarthy KA, Metcalf CJE, Takahashi S, Tatem AJ, Thakkar N, Truelove S, Utazi E, Wesolowski A, Winter AK. Using models to shape measles control and elimination strategies in low- and middle-income countries: A review of recent applications. Vaccine 2020; 38:979-992. [PMID: 31787412 PMCID: PMC6996156 DOI: 10.1016/j.vaccine.2019.11.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 01/30/2023]
Abstract
After many decades of vaccination, measles epidemiology varies greatly between and within countries. National immunization programs are therefore encouraged to conduct regular situation analyses and to leverage models to adapt interventions to local needs. Here, we review applications of models to develop locally tailored interventions to support control and elimination efforts. In general, statistical and semi-mechanistic transmission models can be used to synthesize information from vaccination coverage, measles incidence, demographic, and/or serological data, offering a means to estimate the spatial and age-specific distribution of measles susceptibility. These estimates complete the picture provided by vaccination coverage alone, by accounting for natural immunity. Dynamic transmission models can then be used to evaluate the relative impact of candidate interventions for measles control and elimination and the expected future epidemiology. In most countries, models predict substantial numbers of susceptible individuals outside the age range of routine vaccination, which affects outbreak risk and necessitates additional intervention to achieve elimination. More effective use of models to inform both vaccination program planning and evaluation requires the development of training to enhance broader understanding of models and where feasible, building capacity for modelling in-country, pipelines for rapid evaluation of model predictions using surveillance data, and clear protocols for incorporating model results into decision-making.
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Affiliation(s)
- F T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - E Dansereau
- Vaccine Delivery, Global Development, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - M J Ferrari
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
| | - M Hanson
- Vaccine Delivery, Global Development, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - K A McCarthy
- Institute for Disease Modeling, 3150 139th Ave SE, Bellevue, WA 98005, USA
| | - C J E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - S Takahashi
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - A J Tatem
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - N Thakkar
- Institute for Disease Modeling, 3150 139th Ave SE, Bellevue, WA 98005, USA
| | - S Truelove
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - E Utazi
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - A Wesolowski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - A K Winter
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Ozawa S, Yemeke TT, Evans DR, Pallas SE, Wallace AS, Lee BY. Defining hard-to-reach populations for vaccination. Vaccine 2019; 37:5525-5534. [PMID: 31400910 PMCID: PMC10414189 DOI: 10.1016/j.vaccine.2019.06.081] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/29/2022]
Abstract
Extending the benefits of vaccination to everyone who is eligible requires an understanding of which populations current vaccination efforts have struggled to reach. A clear definition of "hard-to-reach" populations - also known as high-risk or marginalized populations, or reaching the last mile - is essential for estimating the size of target groups, sharing lessons learned based on consistent definitions, and allocating resources appropriately. A literature review was conducted to determine what formal definitions of hard-to-reach populations exist and how they are being used, and to propose definitions to consider for future use. Overall, we found that (1) there is a need to distinguish populations that are hard to reach versus hard to vaccinate, and (2) the existing literature poorly defined these populations and clear criteria or thresholds for classifying them were missing. Based on this review, we propose that hard-to-reach populations be defined as those facing supply-side barriers to vaccination due to geography by distance or terrain, transient or nomadic movement, healthcare provider discrimination, lack of healthcare provider recommendations, inadequate vaccination systems, war and conflict, home births or other home-bound mobility limitations, or legal restrictions. Although multiple mechanisms may apply to the same population, supply-side barriers should be distinguished from demand-side barriers. Hard-to-vaccinate populations are defined as those who are reachable but difficult to vaccinate due to distrust, religious beliefs, lack of awareness of vaccine benefits and recommendations, poverty or low socioeconomic status, lack of time to access available vaccination services, or gender-based discrimination. Further work is needed to better define hard-to-reach populations and delineate them from populations that may be hard to vaccinate due to complex refusal reasons, improve measurement of the size and importance of their impact, and examine interventions related to overcoming barriers for each mechanism. This will enable policy makers, governments, donors, and the vaccine community to better plan interventions and allocate necessary resources to remove existing barriers to vaccination.
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Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | | | - Sarah E Pallas
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Aaron S Wallace
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Bruce Y Lee
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, USA
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11
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Chotta NAS, Mgongo M, Uriyo JG, Msuya SE, Stray-Pedersen B, Stray-Pedersen A. Awareness and Factors Associated with Health Care Worker's Knowledge on Rubella Infection: A Study after the Introduction of Rubella Vaccine in Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101676. [PMID: 31091685 PMCID: PMC6571888 DOI: 10.3390/ijerph16101676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/11/2019] [Accepted: 05/12/2019] [Indexed: 11/16/2022]
Abstract
Background Congenital rubella syndrome is a global health problem. The incidence is much higher in Africa and Southeast Asia than the rest of the world, especially in countries where universal rubella vaccination has not been implemented. Healthcare worker's knowledge on rubella infection and the rubella vaccine is of utmost importance in achieving and maintaining vaccination coverage targets. This study aimed to assess health care workers knowledge on rubella infection in Kilimanjaro Tanzania, after the introduction of a rubella vaccination. Methods This was a health facility-based cross sectional study. It was conducted in three districts of the Kilimanjaro region between August and October 2016. The study involved eligible health care workers in selected health facilities. An interview guide was used for collecting information by face-to-face interviews. Multivariate analysis was used to assess factors associated with rubella knowledge among healthcare workers. Results A total of 126 health care workers were interviewed. An acceptable level of knowledge was considered if all five questions about rubella were correctly answered. Only 26.4% (n = 31) answered all questions correctly. In multivariate analysis education level and working department were predictors of rubella knowledge; health care workers with an advanced diploma had an adjusted odds ratio (AOR) of 7.7 (95% Confidence interval; CI: 1.4, 41.0), those with a university degree (AOR: 10; 95% CI: 2.4; 42.5) and health care workers in the outpatient department (AOR: 0.06; 95% CI: 0.04; 0.29). Conclusions Our study confirmed that health care worker's knowledge on rubella infection was low in the areas where rubella vaccination had been introduced. We recommend continuous education and supportive supervision post vaccine introduction in order to increase healthcare worker's knowledge on rubella infection, congenital rubella syndrome and prevention through sustained high vaccination coverage.
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Affiliation(s)
- Nikolas A S Chotta
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0863 Oslo, Norway.
| | - Melina Mgongo
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0863 Oslo, Norway.
- Better Health for African Mother and Child, P.O. Box 8418, Moshi, Tanzania.
| | - Jacqueline G Uriyo
- Better Health for African Mother and Child, P.O. Box 8418, Moshi, Tanzania.
| | - Sia E Msuya
- Better Health for African Mother and Child, P.O. Box 8418, Moshi, Tanzania.
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Tanzania.
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Tanzania.
| | - Babill Stray-Pedersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0863 Oslo, Norway.
- Better Health for African Mother and Child, P.O. Box 8418, Moshi, Tanzania.
| | - Arne Stray-Pedersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0863 Oslo, Norway.
- Department of Forensic Sciences, Oslo University Hospital, 0863 Oslo, Norway.
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12
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Modelling a Supplementary Vaccination Program of Rubella Using the 2012⁻2013 Epidemic Data in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081473. [PMID: 31027277 PMCID: PMC6518427 DOI: 10.3390/ijerph16081473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/17/2019] [Accepted: 04/23/2019] [Indexed: 12/16/2022]
Abstract
From 2012-2013, Japan experienced a major epidemic of rubella, involving a total of 12,614 rubella cases and 45 confirmed cases of congenital rubella syndrome (CRS). One of the contributory factors in this outbreak may have been that the majority of adult males remained unvaccinated. To plan for a supplementary immunization program (SIP) to elevate the herd immunity level, it is critical to determine the required amount of vaccine and identify the target age groups among males for the SIP. The present study aimed to answer these policy questions, employing a mathematical model and analyzing epidemiological datasets from 2012-2013. Our model allowed us to reconstruct the age- and sex-dependent transmission patterns, and the effective reproduction number during the exponential growth phase in 2013 was estimated to be 1.5. The computed next-generation matrix indicated that vaccinating adult males aged from 20-49 years in 2013, using at least 17 million doses, was considered essential to prevent a major epidemic in the future. The proposed model also indicated that, even with smaller doses of vaccine, the SIP in adult males could lead to a substantial reduction in the incidence of rubella, as well as CRS. Importantly, the present study endorses a substantial background risk of observing another major epidemic from 2018-2019, in which cases may be dominated by adult males aged from 25-54 years, that is, our identified age groups plus a five-year time lag from 2013 to 2018.
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Hayford K, Mutembo S, Carcelen A, Matakala HK, Munachoonga P, Winter A, Wanyiri JW, Searle K, Mwansa FD, Mwiche A, Phiri C, Book C, Thuma PE, Moss WJ. Measles and rubella serosurvey identifies rubella immunity gap in young adults of childbearing age in Zambia: The added value of nesting a serological survey within a post-campaign coverage evaluation survey. Vaccine 2019; 37:2387-2393. [PMID: 30905529 PMCID: PMC6467544 DOI: 10.1016/j.vaccine.2019.02.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/13/2022]
Abstract
We nested a measles and rubella serological survey in a vaccination coverage survey. Measles and rubella immunity was significantly higher than expected by vaccination. Study revealed immunity gap in young adults and risk of congenital rubella syndrome. Adding serology to a survey leveraged resources and provided complementary information.
Background Serological surveys can potentially complement vaccine coverage surveys, such as post-vaccination campaign coverage evaluation surveys (PCES), by providing direct information on population immunity within and outside the target age range of the mass vaccination campaign. We estimate age-specific population immunity to measles and rubella viruses in Southern Province, Zambia, and assess the value of adding serological data to vaccination coverage estimates by nesting a serological survey within a PCES. Methods Dried blood spots (DBS) from fingerprick blood were collected from all individuals ages nine months or older in households participating in the PCES and tested for measles and rubella virus-specific immunoglobulin G (IgG) by enzyme immunoassay (Siemens Enzygnost, Marburg, Germany). Results Overall seroprevalence was 95.5% (95% CI: 92.8, 97.2) for measles virus-specific IgG and 97.7% (95% CI: 96.0, 98.7) for rubella virus-specific IgG. Rubella seroprevalence was 98.4% (95% CI: 95.9, 99.4) among children eligible for the MR vaccination campaign, significantly higher than the reported measles-rubella (MR) vaccination campaign coverage of 89.8% (p = 0.003), and higher than the 91.3% rubella seroprevalence for adolescents and adults 16–30 years of age (p = 0.049). Conclusion Seroprevalence to measles and rubella viruses in children younger than 16 years of age was significantly higher than expected from vaccination coverage estimates, likely reflecting exposure to wild-type viruses and underreporting of vaccination. The serosurvey revealed rubella immunity gaps among women 16–30 years of age, precisely the age group in which protection from rubella is most important to prevent congenital rubella syndrome. Nesting serological surveys within existing surveys can leverage resources and infrastructure while providing complementary information important to immunization programs.
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Affiliation(s)
- Kyla Hayford
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Simon Mutembo
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia; Department of Epidemiology and Biostatistics, University of Georgia, College of Public Health, Athens, GA, USA
| | - Andrea Carcelen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Amy Winter
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jane W Wanyiri
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kelly Searle
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Francis D Mwansa
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | - Angels Mwiche
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | - Caroline Phiri
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | | | | | - William J Moss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Predicting congenital rubella syndrome in Japan, 2018-2019. Int J Infect Dis 2019; 82:1-5. [PMID: 30807870 DOI: 10.1016/j.ijid.2019.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES A rubella epidemic has been ongoing in Japan since August 2018. In the present study, we aimed to predict the likely size of a congenital rubella syndrome (CRS) epidemic during 2018-19. METHODS The expected number of CRS cases was estimated using an integral equation based on age-specific incidence of rubella among adult women, the time delay from gestational age of infection to diagnosis of CRS, and distribution of the mothers' age at delivery. We used epidemic data during 2012-14 to parameterize the model and applied this in the prediction for 2018-19. RESULTS In analyzing the 2012-14 epidemic data, the mean delay from the mother's infection to diagnosis was estimated at 24.2weeks (95% confidence interval (CI): 20.7, 28.1). Applying the parameterized model, together with the more than 480 rubella cases in women in 2018 as well as delayed mother's age at delivery in 2017, we determined that the expected number of CRS cases would be 9.7 (95% CI: 6.5, 12.5) cases. As the epidemic is ongoing, the cumulative number of CRS cases could potentially reach 96.8 (95% CI: 65.3, 125.5) cases, if rubella cases in adult women rose to 10 times the number by week 49 in 2018. CONCLUSIONS CRS is expected to occur an average of 24weeks following the mother's infection with rubella virus. Accounting for an increase to 650 cases in women by week 5 in 2019, the expected number of CRS cases during 2018-19 has already exceeded 13 cases, as of week 5 in 2019.
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Truelove SA, Graham M, Moss WJ, Metcalf CJE, Ferrari MJ, Lessler J. Characterizing the impact of spatial clustering of susceptibility for measles elimination. Vaccine 2019; 37:732-741. [PMID: 30579756 PMCID: PMC6348711 DOI: 10.1016/j.vaccine.2018.12.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 01/16/2023]
Abstract
Measles elimination efforts are primarily focused on achieving and maintaining national vaccination coverage goals, based on estimates of the critical vaccination threshold (Vc): the proportion of the population that must be immune to prevent sustained epidemics. Traditionally, Vc estimates assume evenly mixing populations, an invalid assumption. If susceptible individuals preferentially contact one another, communities may remain vulnerable to epidemics even when vaccination coverage targets are met at the national level. Here we present a simple method to estimate Vc and the effective reproductive number, R, while accounting for spatial clustering of susceptibility. For measles, assuming R0 = 15 and 95% population immunity, adjustment for high clustering of susceptibility increases R from 0.75 to 1.29, Vc from 93% to 96%, and outbreak probability after a single introduction from <1% to 23%. The impact of clustering remains minimal until vaccination coverage nears elimination levels. We illustrate our approach using Demographic and Health Survey data from Tanzania and show how non-vaccination clustering potentially contributed to continued endemic transmission of measles virus during the last two decades. Our approach demonstrates why high national vaccination coverage sometimes fails to achieve measles elimination, and that a shift from national to subnational focus is needed as countries approach elimination.
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Affiliation(s)
- Shaun A Truelove
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Matthew Graham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; The Hospital for Tropical Diseases, Wellcome Trust Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Office of Population Research, Woodrow Wilson School, Princeton University, Princeton, NJ, USA
| | - Matthew J Ferrari
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA; Department of Biology, The Pennsylvania State University, University Park, PA, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Wesolowski A, Winter A, Tatem AJ, Qureshi T, Engø-Monsen K, Buckee CO, Cummings DAT, Metcalf CJE. Measles outbreak risk in Pakistan: exploring the potential of combining vaccination coverage and incidence data with novel data-streams to strengthen control. Epidemiol Infect 2018; 146:1575-1583. [PMID: 29860954 PMCID: PMC6090714 DOI: 10.1017/s0950268818001449] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/15/2018] [Accepted: 04/18/2018] [Indexed: 11/26/2022] Open
Abstract
Although measles incidence has reached historic lows in many parts of the world, the disease still causes substantial morbidity globally. Even where control programs have succeeded in driving measles locally extinct, unless vaccination coverage is maintained at extremely high levels, susceptible numbers may increase sufficiently to spark large outbreaks. Human mobility will drive potentially infectious contacts and interact with the landscape of susceptibility to determine the pattern of measles outbreaks. These interactions have proved difficult to characterise empirically. We explore the degree to which new sources of data combined with existing public health data can be used to evaluate the landscape of immunity and the role of spatial movement for measles introductions by retrospectively evaluating our ability to predict measles outbreaks in vaccinated populations. Using inferred spatial patterns of accumulation of susceptible individuals and travel data, we predicted the timing of epidemics in each district of Pakistan during a large measles outbreak in 2012-2013 with over 30 000 reported cases. We combined these data with mobility data extracted from over 40 million mobile phone subscribers during the same time frame in the country to quantify the role of connectivity in the spread of measles. We investigate how different approaches could contribute to targeting vaccination efforts to reach districts before outbreaks started. While some prediction was possible, accuracy was low and we discuss key uncertainties linked to existing data streams that impede such inference and detail what data might be necessary to robustly infer timing of epidemics.
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Affiliation(s)
- Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Amy Winter
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, USA
| | - Andrew J. Tatem
- Department of Geography and Environment, University of Southampton, Southampton, UK
- Fogarty International Center, National Institutes of Health, Bethesda, USA
- Flowminder Foundation, Stockholm, Sweden
| | | | | | - Caroline O. Buckee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
- Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Derek A. T. Cummings
- Department of Biology, University of Florida, Gainesville, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, USA
| | - C. Jessica E. Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, USA
- Woodrow Wilson School, Princeton University, Princeton, USA
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Frade J, Nunes C, Mesquita JR, São José Nascimento M, Gonçalves G. Rubella antibodies in cord blood sera in Portugal: association with maternal age and vaccination status. Epidemiol Infect 2018; 146:600-605. [PMID: 29458448 PMCID: PMC9134545 DOI: 10.1017/s0950268818000237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 01/04/2018] [Accepted: 01/21/2018] [Indexed: 11/06/2022] Open
Abstract
This study evaluated the impact of maternal vaccination against rubella on the levels of specific rubella IgG (rIgG) in 198 newborn cord sera samples. Detailed maternal vaccination data were available. Specific rIgG was measured using a commercial enzyme immunoassay. Most mothers (78.8%) had been vaccinated against rubella at least once in their lives. In 15 (7.6%) cord sera samples, the concentration of specific rIgG was below 11 IU/ml, which was classified as seronegative. Statistical analysis using multiple logistic regression (n = 198) showed that newborns of mothers born between 1986 and 1995, and those born to unvaccinated mothers, were more likely to be seronegative (odds ratio (ORs) 5.2 and 4.9, respectively, adjusted for sex and gestational age). For vaccinated mothers (n = 156), those born between 1986 and 1995 were more likely to have seronegative newborns (OR 11.5 adjusting for sex, gestational age and time since last vaccination). Mothers of the 15 (7.6%) seronegative newborns might have been susceptible to rubella during pregnancy. Checking the vaccination status therefore recommended.
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Affiliation(s)
- J. Frade
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
- Health Research Unit of School of Health Sciences, Polytechnic Institute of Leiria, Campus 2 – Morro do Lena – Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - C. Nunes
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal
| | - J. R. Mesquita
- Agrarian Superior School, Polytechnic Institute of Viseu, Quinta da Alagoa – Estrada de Nelas, Ranhados, 3500 – 606 Viseu, Portugal
| | - M. São José Nascimento
- Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy of University of Porto, Rua de Jorge Viterbo Ferreira n. 228, 4050-313 Porto, Portugal
| | - G. Gonçalves
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
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Hachiya M, Miyano S, Mori Y, Vynnycky E, Keungsaneth P, Vongphrachanh P, Xeuatvongsa A, Sisouk T, Som-Oulay V, Khamphaphongphane B, Sengkeopaseuth B, Pathammavong C, Phounphenghak K, Kitamura T, Takeda M, Komase K. Evaluation of nationwide supplementary immunization in Lao People's Democratic Republic: Population-based seroprevalence survey of anti-measles and anti-rubella IgG in children and adults, mathematical modelling and a stability testing of the vaccine. PLoS One 2018; 13:e0194931. [PMID: 29596472 PMCID: PMC5875789 DOI: 10.1371/journal.pone.0194931] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background Measles outbreaks have occurred in some countries despite supplementary immunization activities (SIA) using measles-containing vaccine with high vaccination coverage. We conducted a cross-sectional seroprevalence survey to estimate population immunity in Lao People's Democratic Republic where repeated mass immunization has failed to eliminate measles. Methods and findings In this nationwide multistage cluster sampling survey conducted in 2014 based on probability proportionate to size sampling, blood samples were collected from 2,135 children and adults living in 52 randomly selected villages. Anti-measles and anti-rubella IgG were measured, and IgG prevalence was calculated. We applied mathematical modelling to estimate the number of cases of congenital rubella syndrome (CRS) in 2013 that were averted by the 2011 SIA. A stability testing was applied to the MR vaccine at 4°C, 25°C, and 35°C to examine stability differences between measles and rubella vaccine components. Measles IgG prevalence was significantly lower in the target age groups (5–21 years) of the 2011 SIA using a combination vaccine for measles and rubella vaccine (MR vaccine) than in young adults (22–39 years) (86.8% [95% CI: 83.0–90.6] vs. 99.0% [98.3–99.8]; p<0.001), whereas rubella IgG prevalence was significantly higher (88.2% [84.5–91.8] vs. 74.6% [70.7–78.5]; p<0.001). In the SIA target age groups, prevalence of measles IgG, but not rubella IgG, increased with age. CRS cases prevented in 2013 ranged from 16 [0–50] to 92 [32–180] if the force of infection had remained unchanged or had been reduced by 75%, respectively. In freeze-dried conditions, the measles vaccine component was more heat sensitive than the rubella component. Conclusions Inconsistent IgG prevalence between measles and rubella in Lao PDR can be partly explained by different stability of the measles and rubella vaccine components under heat exposure. Suboptimal vaccine handling may cause insufficient immunogenicity for measles, which subsequently leads to an outbreak despite high SIA coverage, while direct evidence is lacking. Temperature monitoring of the vaccine should be conducted.
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Affiliation(s)
- Masahiko Hachiya
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
- * E-mail:
| | - Shinsuke Miyano
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Yoshio Mori
- Department of Virology 3, National Institute of Infectious Diseases, Musashimurayama, Tokyo, Japan
| | - Emilia Vynnycky
- Modelling and Economics Unit, Public Health England, London, United Kingdom
- TB Modelling Group and TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Phath Keungsaneth
- Department of Hygiene and Health Promotion, Ministry of Health, Vientiane Capital, Lao PDR
| | - Phengta Vongphrachanh
- National Center for Laboratory and Epidemiology, Ministry of Health, Vientiane Capital, Lao PDR
| | - Anonh Xeuatvongsa
- National Immunization Program, Ministry of Health, Vientiane Capital, Lao PDR
| | - Thongchanh Sisouk
- National Center for Laboratory and Epidemiology, Ministry of Health, Vientiane Capital, Lao PDR
| | - Vilasak Som-Oulay
- National Center for Laboratory and Epidemiology, Ministry of Health, Vientiane Capital, Lao PDR
| | | | | | | | | | - Tomomi Kitamura
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Makoto Takeda
- Department of Virology 3, National Institute of Infectious Diseases, Musashimurayama, Tokyo, Japan
| | - Katsuhiro Komase
- Department of Virology 3, National Institute of Infectious Diseases, Musashimurayama, Tokyo, Japan
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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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Nóbrega YKM, de Carvalho BC, Nitz N, Vital TE, Leite FB, Sequeira IJ, Moreira EE, de Andrade JKB, Gandolfi L, Pratesi R, Hecht MM. Rubella Seropositivity in Pregnant Women After Vaccination Campaign in Brazil's Federal District. Viral Immunol 2017; 30:675-677. [PMID: 28972455 DOI: 10.1089/vim.2017.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rubella is an acute viral disease that usually does not generate sequels; however, in pregnant women the infection can cause serious abnormalities to fetuses, which are collectively called congenital rubella syndrome. In Brazil, population immunization was started in 1992, but few epidemiological studies have been conducted to assess vaccination coverage and seroconversion since then. The aim of this work is to evaluate the seropositivity of pregnant women to rubella virus after vaccination campaign was carried out in 2008. Serological tests for rubella diagnosis were performed in 87 pregnant women who attended the University of Brasilia Hospital, Federal District, Brazil. Antirubella IgG antibodies were detected in 83 out of 87 pregnant women (95.4%), with an age-independent seroprevalence. Only one woman was positive in IgM serological tests. Our data suggest high levels of vaccination coverage and antirubella immunization in the Brazil Federal District population.
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Affiliation(s)
- Yanna K M Nóbrega
- 1 Immunogenetic and Chronic-Degenerative Diseases Laboratory, School of Medicine, University of Brasilia , Brasilia, Brazil
| | - Bruna C de Carvalho
- 2 Methodologies Applied to Infectious Diseases Laboratory, School of Medicine, University of Brasilia , Brasilia, Brazil
| | - Nadjar Nitz
- 2 Methodologies Applied to Infectious Diseases Laboratory, School of Medicine, University of Brasilia , Brasilia, Brazil
| | - Tamires E Vital
- 2 Methodologies Applied to Infectious Diseases Laboratory, School of Medicine, University of Brasilia , Brasilia, Brazil
| | - Franco B Leite
- 3 Clinical Analysis Laboratory, Immunology Sector, University of Brasilia Hospital, University of Brasilia , Brasilia, Brazil
| | - Inês J Sequeira
- 4 Department of Mathematics, School Science and Technology, Mathematics and Applications Center, New University of Lisbon , Lisbon, Portugal
| | - Elsa E Moreira
- 4 Department of Mathematics, School Science and Technology, Mathematics and Applications Center, New University of Lisbon , Lisbon, Portugal
| | - Juliana K B de Andrade
- 1 Immunogenetic and Chronic-Degenerative Diseases Laboratory, School of Medicine, University of Brasilia , Brasilia, Brazil
| | - Lenora Gandolfi
- 1 Immunogenetic and Chronic-Degenerative Diseases Laboratory, School of Medicine, University of Brasilia , Brasilia, Brazil
| | - Riccardo Pratesi
- 1 Immunogenetic and Chronic-Degenerative Diseases Laboratory, School of Medicine, University of Brasilia , Brasilia, Brazil
| | - Mariana M Hecht
- 2 Methodologies Applied to Infectious Diseases Laboratory, School of Medicine, University of Brasilia , Brasilia, Brazil
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Assessing age-dependent susceptibility to measles in Japan. Vaccine 2017; 35:3309-3317. [PMID: 28501456 DOI: 10.1016/j.vaccine.2017.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/10/2017] [Accepted: 05/03/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Routine vaccination against measles in Japan started in 1978. Whereas measles elimination was verified in 2015, multiple chains of measles transmission were observed in 2016. We aimed to reconstruct the age-dependent susceptibility to measles in Japan so that future vaccination strategies can be elucidated. METHODS An epidemiological model was used to quantify the age-dependent immune fraction using datasets of vaccination coverage and seroepidemiological survey. The second dose was interpreted in two different scenarios, i.e., booster and random shots. The effective reproduction number, the average number of secondary cases generated by a single infected individual, and the age at infection were explored using the age-dependent transmission model and the next generation matrix. RESULTS While the herd immunity threshold of measles likely ranges from 90% to 95%, assuming that the basic reproductive number ranges from 10 to 20, the estimated immune fraction in Japan was below those thresholds in 2016, despite the fact that the estimates were above 80% for all ages. If the second dose completely acted as the booster shot, a proportion immune above 90% was achieved only among those aged 5years or below in 2016. Alternatively, if the second dose was randomly distributed regardless of primary vaccination status, a proportion immune over 90% was achieved among those aged below 25years. The effective reproduction number was estimated to range from 1.50 to 3.01 and from 1.50 to 3.00, respectively, for scenarios 1 and 2 in 2016; if the current vaccination schedule were continued, the reproduction number is projected to range from 1.50 to 3.01 and 1.39 to 2.78, respectively, in 2025. CONCLUSION Japan continues to be prone to imported cases of measles. Supplementary vaccination among adults aged 20-49years would be effective if the chains of transmission continue to be observed in that age group.
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Choe YJ, Eom HE, Cho SI. Trend of measles, mumps, and rubella incidence following the measles-rubella catch up vaccination in the Republic of Korea, 2001. J Med Virol 2017; 89:1528-1531. [PMID: 28303592 DOI: 10.1002/jmv.24808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/01/2017] [Indexed: 11/09/2022]
Abstract
Following the introduction of measles-rubella (MR) catch-up vaccination in 2001 and two dose measles-mumps-rubella (MMR2) keep-up program in 2002, the incidence of measles, mumps, and rubella was not evaluated systematically. To describe the recent changes in epidemiology, a population-based incidence study from 2001 to 2015 using national notifiable disease surveillance data was conducted. Between 2001 and 2015, there was decrease in the incidence of measles and rubella, whereas a steady increase in mump incidence was noted. The age distribution of mumps cases has shifted to the older age group, whereas rubella became more frequent in younger age group. The incidence of mumps showed an increase in every birth cohorts, except for the decrease in incidence for catch-up vaccination cohort from 131 cases in 2007-2011 to 64 cases per 100 000 in 2012-2015. Continuing in monitoring of mumps and strengthening of the high two-dose MMR vaccination coverage should be taken place in Korea.
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Affiliation(s)
- Young June Choe
- Department of Epidemiology, Seoul National University School of Public Health, Seoul, Republic of Korea.,Division of National Immunization Program and Vaccine-Preventable Disease Control, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Hye-Eun Eom
- Division of National Immunization Program and Vaccine-Preventable Disease Control, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Sung-Il Cho
- Department of Epidemiology, Seoul National University School of Public Health, Seoul, Republic of Korea
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Furuse Y, Oshitani H. Global Transmission Dynamics of Measles in the Measles Elimination Era. Viruses 2017; 9:v9040082. [PMID: 28420160 PMCID: PMC5408688 DOI: 10.3390/v9040082] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/26/2017] [Accepted: 04/11/2017] [Indexed: 11/30/2022] Open
Abstract
Although there have been many epidemiological reports of the inter-country transmission of measles, systematic analysis of the global transmission dynamics of the measles virus (MV) is limited. In this study, we applied phylogeographic analysis to characterize the global transmission dynamics of the MV using large-scale genetic sequence data (obtained for 7456 sequences) from 115 countries between 1954 and 2015. These analyses reveal the spatial and temporal characteristics of global transmission of the virus, especially in Australia, China, India, Japan, the UK, and the USA in the period since 1990. The transmission is frequently observed, not only within the same region but also among distant and frequently visited areas. Frequencies of export from measles-endemic countries, such as China, India, and Japan are high but decreasing, while the frequencies from countries where measles is no longer endemic, such as Australia, the UK, and the USA, are low but slightly increasing. The world is heading toward measles eradication, but the disease is still transmitted regionally and globally. Our analysis reveals that countries wherein measles is endemic and those having eliminated the disease (apart from occasional outbreaks) both remain a source of global transmission in this measles elimination era. It is therefore crucial to maintain vigilance in efforts to monitor and eradicate measles globally.
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Affiliation(s)
- Yuki Furuse
- Tohoku University Graduate School of Medicine, 980-8575 Sendai, Japan.
| | - Hitoshi Oshitani
- Tohoku University Graduate School of Medicine, 980-8575 Sendai, Japan.
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Tang X, Geater A, McNeil E, Deng Q, Dong A, Zhong G. Spatial, temporal and spatio-temporal clusters of measles incidence at the county level in Guangxi, China during 2004-2014: flexibly shaped scan statistics. BMC Infect Dis 2017; 17:243. [PMID: 28376738 PMCID: PMC5379653 DOI: 10.1186/s12879-017-2357-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/28/2017] [Indexed: 01/17/2023] Open
Abstract
Background Outbreaks of measles re-emerged in Guangxi province during 2013–2014, where measles again became a major public health concern. A better understanding of the patterns of measles cases would help in identifying high-risk areas and periods for optimizing preventive strategies, yet these patterns remain largely unknown. Thus, this study aimed to determine the patterns of measles clusters in space, time and space-time at the county level over the period 2004–2014 in Guangxi. Methods Annual data on measles cases and population sizes for each county were obtained from Guangxi CDC and Guangxi Bureau of Statistics, respectively. Epidemic curves and Kulldorff’s temporal scan statistics were used to identify seasonal peaks and high-risk periods. Tango’s flexible scan statistics were implemented to determine irregular spatial clusters. Spatio-temporal clusters in elliptical cylinder shapes were detected by Kulldorff’s scan statistics. Population attributable risk percent (PAR%) of children aged ≤24 months was used to identify regions with a heavy burden of measles. Results Seasonal peaks occurred between April and June, and a temporal measles cluster was detected in 2014. Spatial clusters were identified in West, Southwest and North Central Guangxi. Three phases of spatio-temporal clusters with high relative risk were detected: Central Guangxi during 2004–2005, Midwest Guangxi in 2007, and West and Southwest Guangxi during 2013–2014. Regions with high PAR% were mainly clustered in West, Southwest, North and Central Guangxi. Conclusions A temporal uptrend of measles incidence existed in Guangxi between 2010 and 2014, while downtrend during 2004–2009. The hotspots shifted from Central to West and Southwest Guangxi, regions overburdened with measles. Thus, intensifying surveillance of timeliness and completeness of routine vaccination and implementing supplementary immunization activities for measles should prioritized in these regions.
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Affiliation(s)
- Xianyan Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, Guangxi Zhuang Autonomous Region, China. .,Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Qiuyun Deng
- Guangxi Center for Disease Control and Prevention, Institute of Vaccination, Guangxi Zhuang Autonomous Region, China
| | - Aihu Dong
- Guangxi Center for Disease Control and Prevention, Institute of Vaccination, Guangxi Zhuang Autonomous Region, China
| | - Ge Zhong
- Guangxi Center for Disease Control and Prevention, Institute of Vaccination, Guangxi Zhuang Autonomous Region, China.
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Bavdekar SB, Karande S. Elimination of measles from India: Challenges ahead and the way forward. J Postgrad Med 2017; 63:75-78. [PMID: 28397737 PMCID: PMC5414430 DOI: 10.4103/jpgm.jpgm_166_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- SB Bavdekar
- Department of Pediatrics, T. N. Medical College and B.Y.L. Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Li S, Ma C, Hao L, Su Q, An Z, Ma F, Xie S, Xu A, Zhang Y, Ding Z, Li H, Cairns L, Wang H, Luo H, Wang N, Li L, Ferrari MJ. Demographic transition and the dynamics of measles in six provinces in China: A modeling study. PLoS Med 2017; 14:e1002255. [PMID: 28376084 PMCID: PMC5380361 DOI: 10.1371/journal.pmed.1002255] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 02/08/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Industrialization and demographic transition generate nonstationary dynamics in human populations that can affect the transmission and persistence of infectious diseases. Decades of increasing vaccination and development have led to dramatic declines in the global burden of measles, but the virus remains persistent in much of the world. Here we show that a combination of demographic transition, as a result of declining birth rates, and reduced measles prevalence, due to improved vaccination, has shifted the age distribution of susceptibility to measles throughout China. METHODS AND FINDINGS We fit a novel time-varying catalytic model to three decades of age-specific measles case reporting in six provinces in China to quantify the change in the age-specific force of infection for measles virus over time. We further quantified the impact of supplemental vaccination campaigns on the reduction of susceptible individuals. The force of infection of measles has declined dramatically (90%-97% reduction in transmission rate) in three industrialized eastern provinces during the last decade, driving a concomitant increase in both the relative proportion and absolute number of adult cases, while three central and western provinces exhibited dynamics consistent with endemic persistence (24%-73% reduction in transmission rate). The reduction in susceptible individuals due to supplemental vaccination campaigns is frequently below the nominal campaign coverage, likely because campaigns necessarily vaccinate those who may already be immune. The impact of these campaigns has significantly improved over time: campaigns prior to 2005 were estimated to have achieved less than 50% reductions in the proportion susceptible in the target age classes, but campaigns from 2005 onwards reduced the susceptible proportion by 32%-87%. A limitation of this study is that it relies on case surveillance, and thus inference may be biased by age-specific variation in measles reporting. CONCLUSIONS The age distribution of measles cases changes in response to both demographic and vaccination processes. Combining both processes in a novel catalytic model, we illustrate that age-specific incidence patterns reveal regional differences in the progress to measles elimination and the impact of vaccination controls in China. The shift in the age distribution of measles susceptibility in response to demographic and vaccination processes emphasizes the importance of progressive control strategies and measures to evaluate program success that anticipate and react to this transition in observed incidence.
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Affiliation(s)
- Sheng Li
- School of Public Health, City University of New York, New York, New York, United States of America
| | - Chao Ma
- National Immunization Program, China Centers for Disease Control and Prevention, Beijing, China
| | - Lixin Hao
- National Immunization Program, China Centers for Disease Control and Prevention, Beijing, China
| | - Qiru Su
- National Immunization Program, China Centers for Disease Control and Prevention, Beijing, China
| | - Zhijie An
- National Immunization Program, China Centers for Disease Control and Prevention, Beijing, China
| | - Fubao Ma
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Shuyun Xie
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Aiqiang Xu
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Yanyang Zhang
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China
| | - Zhengrong Ding
- Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Hui Li
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Lisa Cairns
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Huaqing Wang
- National Immunization Program, China Centers for Disease Control and Prevention, Beijing, China
| | - Huiming Luo
- National Immunization Program, China Centers for Disease Control and Prevention, Beijing, China
| | - Ning Wang
- Nation Center for AIDS, China Centers for Disease Control and Prevention, Beijing, China
| | - Li Li
- National Immunization Program, China Centers for Disease Control and Prevention, Beijing, China
| | - Matthew J. Ferrari
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, Pennsylvania, United States of America
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Charlton Hume HK, Lua LHL. Platform technologies for modern vaccine manufacturing. Vaccine 2017; 35:4480-4485. [PMID: 28347504 PMCID: PMC7115529 DOI: 10.1016/j.vaccine.2017.02.069] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/21/2017] [Accepted: 02/23/2017] [Indexed: 10/29/2022]
Abstract
Improved understanding of antigenic components and their interaction with the immune system, as supported by computational tools, permits a sophisticated approach to modern vaccine design. Vaccine platforms provide an effective tool by which strategically designed peptide and protein antigens are modularized to enhance their immunogenicity. These modular vaccine platforms can overcome issues faced by traditional vaccine manufacturing and have the potential to generate safe vaccines, rapidly and at a low cost. This review introduces two promising platforms based on virus-like particle and liposome, and discusses the methodologies and challenges.
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Affiliation(s)
- Hayley K Charlton Hume
- The University of Queensland, Protein Expression Facility, St Lucia, QLD 4072, Australia
| | - Linda H L Lua
- The University of Queensland, Protein Expression Facility, St Lucia, QLD 4072, Australia.
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Tang X, Geater A, McNeil E, Zhou H, Deng Q, Dong A. Timeliness and completeness of measles vaccination among children in rural areas of Guangxi, China: A stratified three-stage cluster survey. J Epidemiol 2017; 27:317-324. [PMID: 28187960 PMCID: PMC5498417 DOI: 10.1016/j.je.2016.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 08/07/2016] [Indexed: 12/01/2022] Open
Abstract
Background Large-scale outbreaks of measles occurred in 2013 and 2014 in rural Guangxi, a region in Southwest China with high coverage for measles-containing vaccine (MCV). This study aimed to estimate the timely vaccination coverage, the timely-and-complete vaccination coverage, and the median delay period for MCV among children aged 18–54 months in rural Guangxi. Methods Based on quartiles of measles incidence during 2011–2013, a stratified three-stage cluster survey was conducted from June through August 2015. Using weighted estimation and finite population correction, vaccination coverage and 95% confidence intervals (CIs) were calculated. Weighted Kaplan–Meier analyses were used to estimate the median delay periods for the first (MCV1) and second (MCV2) doses of the vaccine. Results A total of 1216 children were surveyed. The timely vaccination coverage rate was 58.4% (95% CI, 54.9%–62.0%) for MCV1, and 76.9% (95% CI, 73.6%–80.0%) for MCV2. The timely-and-complete vaccination coverage rate was 47.4% (95% CI, 44.0%–51.0%). The median delay period was 32 (95% CI, 27–38) days for MCV1, and 159 (95% CI, 118–195) days for MCV2. Conclusions The timeliness and completeness of measles vaccination was low, and the median delay period was long among children in rural Guangxi. Incorporating the timeliness and completeness into official routine vaccination coverage statistics may help appraise the coverage of vaccination in China. The timeliness and completeness of measles vaccination was low. The median delay period of measles vaccination was long among Guangxi children. Regions with higher measles incidence had higher rates of untimely coverage.
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Affiliation(s)
- Xianyan Tang
- Department of Epidemiology & Biostatistics, School of Public Health, Guangxi Medical University, Guangxi Zhuang Autonomous Region, China; Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Hongxia Zhou
- Department of Epidemiology & Biostatistics, School of Public Health, Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
| | - Qiuyun Deng
- Institute of Vaccination, Guangxi Center for Disease Control and Prevention, Guangxi Zhuang Autonomous Region, China
| | - Aihu Dong
- Institute of Vaccination, Guangxi Center for Disease Control and Prevention, Guangxi Zhuang Autonomous Region, China
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29
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Buckee CO, Tatem AJ, Metcalf CJE. Seasonal Population Movements and the Surveillance and Control of Infectious Diseases. Trends Parasitol 2016; 33:10-20. [PMID: 27865741 DOI: 10.1016/j.pt.2016.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/08/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
National policies designed to control infectious diseases should allocate resources for interventions based on regional estimates of disease burden from surveillance systems. For many infectious diseases, however, there is pronounced seasonal variation in incidence. Policy-makers must routinely manage a public health response to these seasonal fluctuations with limited understanding of their underlying causes. Two complementary and poorly described drivers of seasonal disease incidence are the mobility and aggregation of human populations, which spark outbreaks and sustain transmission, respectively, and may both exhibit distinct seasonal variations. Here we highlight the key challenges that seasonal migration creates when monitoring and controlling infectious diseases. We discuss the potential of new data sources in accounting for seasonal population movements in dynamic risk mapping strategies.
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Affiliation(s)
- Caroline O Buckee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Andrew J Tatem
- Flowminder Foundation, Stockholm, Sweden; WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, USA; Office of Population Research, Woodrow Wilson School, Princeton University, Princeton, USA
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Morbillivirus Experimental Animal Models: Measles Virus Pathogenesis Insights from Canine Distemper Virus. Viruses 2016; 8:v8100274. [PMID: 27727184 PMCID: PMC5086610 DOI: 10.3390/v8100274] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 12/19/2022] Open
Abstract
Morbilliviruses share considerable structural and functional similarities. Even though disease severity varies among the respective host species, the underlying pathogenesis and the clinical signs are comparable. Thus, insights gained with one morbillivirus often apply to the other members of the genus. Since the Canine distemper virus (CDV) causes severe and often lethal disease in dogs and ferrets, it is an attractive model to characterize morbillivirus pathogenesis mechanisms and to evaluate the efficacy of new prophylactic and therapeutic approaches. This review compares the cellular tropism, pathogenesis, mechanisms of persistence and immunosuppression of the Measles virus (MeV) and CDV. It then summarizes the contributions made by studies on the CDV in dogs and ferrets to our understanding of MeV pathogenesis and to vaccine and drugs development.
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Clements CJ, Soakai TS, Sadr-Azodi N. A review of measles supplementary immunization activities and the implications for Pacific Island countries and territories. Expert Rev Vaccines 2016; 16:161-174. [PMID: 27690704 DOI: 10.1080/14760584.2017.1237290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Standard measles control strategies include achieving high levels of measles vaccine coverage using routine delivery systems, supplemented by mass immunization campaigns as needed to close population immunity gaps. Areas covered: This review looks at how supplementary immunization activities (SIAs) have contributed to measles control globally, and asks whether such a strategy has a place in Pacific Islands today. Expert commentary: Very high coverage with two doses of measles vaccine seems to be the optimal strategy for controlling measles. By 2015, all but two Pacific Islands had introduced a second dose in the routine schedule; however, a number of countries have not yet reached high coverage with their second dose. The literature and the country reviews reported here suggest that a high coverage SIA combined with one dose of measles vaccine given in the routine system will also do the job. The arguments for and against the use of SIAs are complex, but it is clear that to be effective, SIAs need to be well designed to meet specific needs, must be carried out effectively and safely with very high coverage, and should, when possible, carry with them other public health interventions to make them even more cost-effective.
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Affiliation(s)
- C John Clements
- a School of Population Health, The University of Melbourne , Melbourne , Australia
| | - Taniela Sunia Soakai
- b Maternal and Child Health Unit, Public Health Division , Secretariat of the Pacific Community , Suva , Fiji
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Lessler J, Metcalf CJE, Cutts FT, Grenfell BT. Impact on Epidemic Measles of Vaccination Campaigns Triggered by Disease Outbreaks or Serosurveys: A Modeling Study. PLoS Med 2016; 13:e1002144. [PMID: 27727285 PMCID: PMC5058560 DOI: 10.1371/journal.pmed.1002144] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 09/02/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Routine vaccination supplemented by planned campaigns occurring at 2-5 y intervals is the core of current measles control and elimination efforts. Yet, large, unexpected outbreaks still occur, even when control measures appear effective. Supplementing these activities with mass vaccination campaigns triggered when low levels of measles immunity are observed in a sample of the population (i.e., serosurveys) or incident measles cases occur may provide a way to limit the size of outbreaks. METHODS AND FINDINGS Measles incidence was simulated using stochastic age-structured epidemic models in settings conducive to high or low measles incidence, roughly reflecting demographic contexts and measles vaccination coverage of four heterogeneous countries: Nepal, Niger, Yemen, and Zambia. Uncertainty in underlying vaccination rates was modeled. Scenarios with case- or serosurvey-triggered campaigns reaching 20% of the susceptible population were compared to scenarios without triggered campaigns. The best performing of the tested case-triggered campaigns prevent an average of 28,613 (95% CI 25,722-31,505) cases over 15 y in our highest incidence setting and 599 (95% CI 464-735) cases in the lowest incidence setting. Serosurvey-triggered campaigns can prevent 89,173 (95% CI, 86,768-91,577) and 744 (612-876) cases, respectively, but are triggered yearly in high-incidence settings. Triggered campaigns reduce the highest cumulative incidence seen in simulations by up to 80%. While the scenarios considered in this strategic modeling exercise are reflective of real populations, the exact quantitative interpretation of the results is limited by the simplifications in country structure, vaccination policy, and surveillance system performance. Careful investigation into the cost-effectiveness in different contexts would be essential before moving forward with implementation. CONCLUSIONS Serologically triggered campaigns could help prevent severe epidemics in the face of epidemiological and vaccination uncertainty. Hence, small-scale serology may serve as the basis for effective adaptive public health strategies, although, in high-incidence settings, case-triggered approaches are likely more efficient.
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Affiliation(s)
- Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - C. Jessica E. Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, United States of America
- Office of Population Research, Princeton University, Princeton, New Jersey, United States of America
- Fogarty International Center, Bethesda, Maryland, United States of America
| | - Felicity T. Cutts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bryan T. Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, United States of America
- Fogarty International Center, Bethesda, Maryland, United States of America
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Persistence of rubella and mumps antibodies, following changes in the recommended age for the second dose of MMR vaccine in Portugal. Epidemiol Infect 2016; 144:3139-3147. [DOI: 10.1017/s0950268816001655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
SUMMARYIn Portugal, the recommended age for the second dose of MMR (MMR2) was changed from 10–13 years to 5–6 years for those born in 1994 and afterwards. This study aimed to assess if MMR schedule and time elapsed from the last dose are associated with the concentration of rubella and mumps IgG antibodies. Three Portuguese birth cohorts (convenience samples) were selected for this study (66, 59 and 41 participants born respectively in 1990–1993, 1994–1995 and 2001–2003). Geometric mean concentrations (GMC) for mumps IgG were respectively 36, 30 and 38 RU/ml (P = 0·236) and for rubella IgG were 18, 20 and 17 IU/ml (P = 0·641). For both specific antibodies, no differences were observed with time since MMR2. Receiving MMR2 at 5–6 or 10–13 years was not associated with concentration of both antibodies. The GMC of rubella IgG was lower in males (P = 0·029). Taking into account previous evidence and the logistics needed to change vaccination schedules, it seems reasonable that sustaining very high coverage with two doses of MMR is currently the most pragmatic way to control mumps and rubella rather than any changes to the schedule.
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Cutts FT, Hanson M. Seroepidemiology: an underused tool for designing and monitoring vaccination programmes in low- and middle-income countries. Trop Med Int Health 2016; 21:1086-98. [PMID: 27300255 DOI: 10.1111/tmi.12737] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Seroepidemiology, the use of data on the prevalence of bio-markers of infection or vaccination, is a potentially powerful tool to understand the epidemiology of infection before vaccination and to monitor the effectiveness of vaccination programmes. Global and national burden of disease estimates for hepatitis B and rubella are based almost exclusively on serological data. Seroepidemiology has helped in the design of measles, poliomyelitis and rubella elimination programmes, by informing estimates of the required population immunity thresholds for elimination. It contributes to monitoring of these programmes by identifying population immunity gaps and evaluating the effectiveness of vaccination campaigns. Seroepidemiological data have also helped to identify contributing factors to resurgences of diphtheria, Haemophilus Influenzae type B and pertussis. When there is no confounding by antibodies induced by natural infection (as is the case for tetanus and hepatitis B vaccines), seroprevalence data provide a composite picture of vaccination coverage and effectiveness, although they cannot reliably indicate the number of doses of vaccine received. Despite these potential uses, technological, time and cost constraints have limited the widespread application of this tool in low-income countries. The use of venous blood samples makes it difficult to obtain high participation rates in surveys, but the performance of assays based on less invasive samples such as dried blood spots or oral fluid has varied greatly. Waning antibody levels after vaccination may mean that seroprevalence underestimates immunity. This, together with variation in assay sensitivity and specificity and the common need to take account of antibody induced by natural infection, means that relatively sophisticated statistical analysis of data is required. Nonetheless, advances in assays on minimally invasive samples may enhance the feasibility of including serology in large survey programmes in low-income countries. In this paper, we review the potential uses of seroepidemiology to improve vaccination policymaking and programme monitoring and discuss what is needed to broaden the use of this tool in low- and middle-income countries.
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Affiliation(s)
- Felicity T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Matt Hanson
- Vaccine Delivery, Global Development, The Bill & Melinda Gates Foundation, Seattle, WA, USA
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Cutts FT, Claquin P, Danovaro-Holliday MC, Rhoda DA. Monitoring vaccination coverage: Defining the role of surveys. Vaccine 2016; 34:4103-4109. [PMID: 27349841 PMCID: PMC4967442 DOI: 10.1016/j.vaccine.2016.06.053] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 11/24/2022]
Abstract
High quality community-based vaccination coverage surveys are resource-intensive. Other monitoring methods provide useful data for programme managers. Health facility-based assessments evaluate multiple aspects of service provision. Purposeful community samples give local health workers programmatic insights. To be useful, monitoring should lead to action to improve performance.
Vaccination coverage is a widely used indicator of programme performance, measured by registries, routine administrative reports or household surveys. Because the population denominator and the reported number of vaccinations used in administrative estimates are often inaccurate, survey data are often considered to be more reliable. Many countries obtain survey data on vaccination coverage every 3–5 years from large-scale multi-purpose survey programs. Additional surveys may be needed to evaluate coverage in Supplemental Immunization Activities such as measles or polio campaigns, or after major changes have occurred in the vaccination programme or its context. When a coverage survey is undertaken, rigorous statistical principles and field protocols should be followed to avoid selection bias and information bias. This requires substantial time, expertise and resources hence the role of vaccination coverage surveys in programme monitoring needs to be carefully defined. At times, programmatic monitoring may be more appropriate and provides data to guide program improvement. Practical field methods such as health facility-based assessments can evaluate multiple aspects of service provision, costs, coverage (among clinic attendees) and data quality. Similarly, purposeful sampling or censuses of specific populations can help local health workers evaluate their own performance and understand community attitudes, without trying to claim that the results are representative of the entire population. Administrative reports enable programme managers to do real-time monitoring, investigate potential problems and take timely remedial action, thus improvement of administrative estimates is of high priority. Most importantly, investment in collecting data needs to be complemented by investment in acting on results to improve performance.
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Gonçalves G, Nunes C, Mesquita JR, Nascimento MSJ, Frade J. Measles antibodies in cord blood in Portugal: Possible consequences for the recommended age of vaccination. Vaccine 2016; 34:2750-7. [PMID: 27109563 DOI: 10.1016/j.vaccine.2016.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/24/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Abstract
The optimum age to give the first dose of measles vaccine must balance the risks of disease and vaccine failure. Both are influenced by the levels of transplacentally acquired maternal antibodies. This study was conducted in the Obstetric service of Portuguese hospital, in 2012-2013. Mothers were recruited after informed consent. Measles IgG was measured in 206 cord sera, using a commercial immunoassay. Geometric mean concentrations (and 95% CI) were 1849mIU/ml (1196-2857) and 790mIU/ml (618-1008) in cord sera of newborns from unvaccinated and vaccinated mothers respectively. Maternal age and vaccination status were both associated with the concentration in cord sera, but maternal age was the major predictor. The likely explanation is the same already mentioned in other studies: as a vaccination program progresses, vaccination coverage increases as measles incidence decreases. That results newborns from younger vaccinated mothers having less measles antibodies while the older mothers are more likely to have been infected with the wild virus. As the proportion of vaccinated mothers increase, developed countries tend to anticipate the recommended age of the first dose to 12 months of age. Models using hypothetical measles antibody decay rates in infancy were explored. Anticipating the first dose of MMR1 in Portugal to the age of 12 months might have not been the best decision but results were not conclusive, and arguments supporting or not the anticipation were discussed.
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Affiliation(s)
- Guilherme Gonçalves
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.
| | - Carla Nunes
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal.
| | - João Rodrigo Mesquita
- Agrarian Superior School, Polytechnic Institute of Viseu, Quinta da Alagoa - Estrada de Nelas, Ranhados, 3500-606 Viseu, Portugal.
| | - Maria São José Nascimento
- Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy of University of Porto, Rua de Jorge Viterbo Ferreira n.°228, 4050-313 Porto, Portugal.
| | - João Frade
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; Health Research Unit of School of Health Sciences, Polytechnic Institute of Leiria, Campus 2 - Morro do Lena - Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal.
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Wesolowski A, Mensah K, Brook CE, Andrianjafimasy M, Winter A, Buckee CO, Razafindratsimandresy R, Tatem AJ, Heraud JM, Metcalf CJE. Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination. J R Soc Interface 2016; 13:20151101. [PMID: 27122178 PMCID: PMC4874430 DOI: 10.1098/rsif.2015.1101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/07/2016] [Indexed: 12/01/2022] Open
Abstract
Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require.
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Affiliation(s)
- Amy Wesolowski
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Keitly Mensah
- Virology Unit and Measles and Rubella WHO National Reference Laboratory, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Cara E Brook
- Department of Geography and Environment, University of Southampton, Southampton, UK
| | - Miora Andrianjafimasy
- Virology Unit and Measles and Rubella WHO National Reference Laboratory, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Amy Winter
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Caroline O Buckee
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA, USA Office of Population Research, Woodrow Wilson School, Princeton University, Princeton, NJ, USA
| | - Richter Razafindratsimandresy
- Virology Unit and Measles and Rubella WHO National Reference Laboratory, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Andrew J Tatem
- Department of Geography and Environment, University of Southampton, Southampton, UK Fogarty International Center, National Institutes of Health, Bethesda, MD, USA Flowminder Foundation, Stockholm, Sweden
| | - Jean-Michel Heraud
- Virology Unit and Measles and Rubella WHO National Reference Laboratory, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA Office of Population Research, Woodrow Wilson School, Princeton University, Princeton, NJ, USA
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Adewumi OM, Olayinka OA, Olusola BA, Faleye TOC, Sule WF, Adesina O. Epidemiological Evaluation of Rubella Virus Infection among Pregnant Women in Ibadan, Nigeria. J Immunoassay Immunochem 2016; 36:613-21. [PMID: 25774539 DOI: 10.1080/15321819.2015.1027404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Rubella is a vaccine-preventable, mild rash-inducing viral disease with complications that include a spectrum of birth defects in the developing fetus, especially if the infection is acquired in the early months of pregnancy. Consequently, the primary objective of global rubella control programs is prevention of congenital rubella infection and associated birth defects. Despite the availability of safe and effective vaccines, and the elimination of the rubella virus in many developed countries, substantial commitment to rubella control has not been demonstrated in developing countries. This study appraises immunity to rubella, and consequently makes appropriate recommendations aimed at facilitating effective control. A cross-sectional sero-surveillance study was carried out among defined 272 consenting ante-natal clinic attendees in south-western, Nigeria. Prevalence rates of 91.54% and 1.84% were recorded for the anti-rubella virus (anti-RV) IgG and IgM, respectively. Also, 90.7% and 92.3% of the women aged ≤30 years and >30 years, respectively, had detectable anti-RV IgG. No significant association (p = 0.94) was recorded between anti-RV IgG detection and age of the women. Previous exposure and susceptibility of significant fraction of the population to rubella infection were confirmed. Considerable political commitment and promotion of free rubella immunization specifically for women with childbearing potential were recommended.
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Affiliation(s)
- Olubusuyi M Adewumi
- a Department of Virology , College of Medicine, University College Hospital, University of Ibadan , Ibadan , Nigeria
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Gonçalves G, Frade J, Nunes C, Mesquita JR, Nascimento MSJ. Persistence of measles antibodies, following changes in the recommended age for the second dose of MMR-vaccine in Portugal. Vaccine 2015; 33:5057-63. [PMID: 26319061 DOI: 10.1016/j.vaccine.2015.08.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/10/2015] [Accepted: 08/17/2015] [Indexed: 11/27/2022]
Abstract
In populations vaccinated with two doses of combined measles-mumps-rubella vaccine (MMR), the serum levels of antibodies against measles depend on the vaccination schedule, time elapsed from the last dose and the area-specific epidemiological situation. Variables measuring "schedule" are age at first and second doses of MMR and intervals derived from that. Changes in vaccination schedules have been made in Portugal. The specific objectives of this study were to measure the association between those potential determinants and the concentration of measles-specific IgG antibodies, after the second dose of MMR. Convenience samples of three Portuguese birth cohorts were selected for this study (41, 66 and 60 born, respectively, in 2001-2003, 1990-1993 and 1994-1995). Geometric mean concentrations (GMC) for measles IgG were, respectively, 934, 251 and 144mIU/ml; p<0.001). Anti-measles-IgG serum concentration decreased with time since last vaccination (waning immunity) and was not influenced by any other component of vaccination schedule, namely age at vaccination with the second dose of MMR. Waning levels of measles antibodies have been observed elsewhere but not as fast as it was observed in Portuguese birth cohorts in this study. Changes in the vaccination schedules might have to be considered in the future.
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Affiliation(s)
- Guilherme Gonçalves
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto Rua de Jorge Viterbo Ferreira, no. 228, Porto 4050-313, Portugal; Unit for Multidisciplinary Biomedical Research (UMIB) Rua de Jorge Viterbo Ferreira, no 228, Porto 4050-313, Portugal.
| | - João Frade
- School of Health Sciences, Polytechnic Institute of Leiria Campus 2 - Morro do Lena - Alto do Vieiro, Apartado 4137, Leiria 2411-901, Portugal; National School of Public Health, Universidade Nova de Lisboa Avenida Padre Cruz, Lisboa 1600-560, Portugal.
| | - Carla Nunes
- National School of Public Health, Universidade Nova de Lisboa Avenida Padre Cruz, Lisboa 1600-560, Portugal; Centro de Investigação em Saúde Pública (CISP) Avenida Padre Cruz, Lisboa 1600-560, Portugal.
| | - João Rodrigo Mesquita
- Agrarian Superior School, Polytechnic Institute of Viseu Quinta da Alagoa - Estrada de Nelas, Ranhados, Viseu 3500-606, Portugal.
| | - Maria São José Nascimento
- Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy of University of Porto Rua de Jorge Viterbo Ferreira, no. 228, Porto 4050-313, Portugal.
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METCALF CJE, TATEM A, BJORNSTAD ON, LESSLER J, O'REILLY K, TAKAHASHI S, CUTTS F, GRENFELL B. Transport networks and inequities in vaccination: remoteness shapes measles vaccine coverage and prospects for elimination across Africa. Epidemiol Infect 2015; 143:1457-66. [PMID: 25119237 PMCID: PMC4411642 DOI: 10.1017/s0950268814001988] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/16/2014] [Accepted: 07/16/2014] [Indexed: 12/04/2022] Open
Abstract
Measles vaccination is estimated to have averted 13·8 million deaths between 2000 and 2012. Persisting heterogeneity in coverage is a major contributor to continued measles mortality, and a barrier to measles elimination and introduction of rubella-containing vaccine. Our objective is to identify determinants of inequities in coverage, and how vaccine delivery must change to achieve elimination goals, which is a focus of the WHO Decade of Vaccines. We combined estimates of travel time to the nearest urban centre (⩾50 000 people) with vaccination data from Demographic Health Surveys to assess how remoteness affects coverage in 26 African countries. Building on a statistical mapping of coverage against age and geographical isolation, we quantified how modifying the rate and age range of vaccine delivery affects national coverage. Our scenario analysis considers increasing the rate of delivery of routine vaccination, increasing the target age range of routine vaccination, and enhanced delivery to remote areas. Geographical isolation plays a key role in defining vaccine inequity, with greater inequity in countries with lower measles vaccine coverage. Eliminating geographical inequities alone will not achieve thresholds for herd immunity, indicating that changes in delivery rate or age range of routine vaccination will be required. Measles vaccine coverage remains far below targets for herd immunity in many countries on the African continent and is likely to be inadequate for achieving rubella elimination. The impact of strategies such as increasing the upper age range eligible for routine vaccination should be considered.
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Affiliation(s)
- C. J. E. METCALF
- Department of Zoology, Oxford University, Oxford, UK
- Fogarty International Center, National Institute of Health, Bethesda, MD, USA
- Department of Ecology and Evolutionary Biology, Eno Hall, Princeton University, Princeton, NJ, USA
| | - A. TATEM
- Fogarty International Center, National Institute of Health, Bethesda, MD, USA
- Department of Geography and Environment University of Southampton, Southampton, UK
- Flowminder Foundation, Stockholm, Sweden
| | - O. N. BJORNSTAD
- Centre for Infectious Disease Dynamics, The Pennsylvania State University, University Park, PA, USA
| | - J. LESSLER
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K. O'REILLY
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - S. TAKAHASHI
- Department of Ecology and Evolutionary Biology, Eno Hall, Princeton University, Princeton, NJ, USA
| | - F. CUTTS
- London School of Hygiene and Tropical Medicine, London, UK
| | - B.T. GRENFELL
- Fogarty International Center, National Institute of Health, Bethesda, MD, USA
- Department of Ecology and Evolutionary Biology, Eno Hall, Princeton University, Princeton, NJ, USA
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Boyers LN, Karimkhani C, Naghavi M, Sherwood D, Margolis DJ, Hay RJ, Williams HC, Naldi L, Coffeng LE, Weinstock MA, Dunnick CA, Pederson H, Vos T, Dellavalle RP. Global mortality from conditions with skin manifestations. J Am Acad Dermatol 2014; 71:1137-1143.e17. [PMID: 25282129 DOI: 10.1016/j.jaad.2014.08.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 08/11/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Global Burden of Disease Study is a research database containing systematically compiled information from vital statistics and epidemiologic literature to inform research, public policy, and resource allocation. OBJECTIVE We sought to compare mortality among conditions with skin manifestations in 50 developed and 137 developing countries from 1990 to 2010. METHODS This was a cross-sectional study to calculate mean age-standardized mortality (per 100,000 persons) across countries for 10 disease categories with skin manifestations. We compared differences in mortality from these disorders by time period (year 1990 vs year 2010) and by developing versus developed country status. RESULTS Melanoma death rates were 5.6 and 4.7 times greater in developed compared with developing countries in 1990 and 2010, respectively. Measles death rates in 1990 and 2010 were 345 and 197 times greater in developing countries, and corresponding syphilis death rates were 33 and 45 times greater. LIMITATIONS Inability to adjust for patient-, provider-, and geographic-level confounders may limit the accuracy and generalizability of these results. CONCLUSION The mortality burden from skin-related conditions differs between developing and developed countries, with the greatest differences observed for melanoma, measles, and syphilis. These results may help prioritize and optimize efforts to prevent and treat these disorders.
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Affiliation(s)
- Lindsay N Boyers
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Chante Karimkhani
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - David Sherwood
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado
| | - David J Margolis
- Department of Biostatistics and Epidemiology and Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Roderick J Hay
- Department of Dermatology, Kings College Hospital National Health Service Trust, London, United Kingdom
| | - Hywel C Williams
- Center of Evidence-based Dermatology, University of Nottingham, Nottingham, United Kingdom
| | - Luigi Naldi
- Department of Dermatology, Azienda Ospedaliera papa Giovanni XXIII, Bergamo, Italy
| | - Luc E Coffeng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Martin A Weinstock
- Dermatoepidemiology Unit, US Department of Veterans Affairs Medical Center Providence, Providence, Rhode Island; Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island; Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado
| | | | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Wicker S, Maltezou HC. Vaccine-preventable diseases in Europe: where do we stand? Expert Rev Vaccines 2014; 13:979-87. [DOI: 10.1586/14760584.2014.933077] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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