1
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Green MS, Schwartz N, Peer V. Gender differences in measles incidence rates in a multi-year, pooled analysis, based on national data from seven high income countries. BMC Infect Dis 2022; 22:358. [PMID: 35410143 PMCID: PMC8996552 DOI: 10.1186/s12879-022-07340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Gender differences in a number of infectious diseases have been reported. The evidence for gender differences in clinical measles incidence rates has been variable and poorly documented over age groups, countries and time periods. Methods We obtained data on cases of measles by sex and age group over a period of 11–27 years from seven countries. Male to female incidence rate ratios (IRR) were computed for each year, by country and age group. For each age group, we used meta-analytic methods to combine the IRRs. Meta-regression was conducted to the estimate the effects of age, country, and time period on the IRR. Results In the age groups < 1, 1–4, 5–9, 10–14, 15–44, and 45–64 the pooled IRRs (with 95% CI) were 1.07 (1.02–1.11), 1.10 (1.07–1.14), 1.03 (1.00–1.05), 1.05 (0.99–1.11), 1.08 (0.95–1.23), and 0.82 (0.74–0.92) respectively. The excess incidence rates (IR) from measles in males up to age 45 are remarkably consistent across countries and time-periods. In the age group 45–64, there is an excess incidence in women. Conclusions The consistency of the excess incidence rates in young males suggest that the sex differences are more likely due to physiological and biological differences and not behavioral factors. At older ages, differential exposure can play a part. These findings can provide further keys to the understanding of mechanisms of infection and tailoring vaccination schedules.
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Affiliation(s)
- Manfred S Green
- School of Public Health, University of Haifa, Abba Khoushy 199, Mount Carmel, 3498838, Haifa, Israel.
| | - Naama Schwartz
- School of Public Health, University of Haifa, Abba Khoushy 199, Mount Carmel, 3498838, Haifa, Israel
| | - Victoria Peer
- School of Public Health, University of Haifa, Abba Khoushy 199, Mount Carmel, 3498838, Haifa, Israel
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2
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Cascante-Vega J, Torres-Florez S, Cordovez J, Santos-Vega M. How disease risk awareness modulates transmission: coupling infectious disease models with behavioural dynamics. ROYAL SOCIETY OPEN SCIENCE 2022; 9:210803. [PMID: 35035985 PMCID: PMC8753147 DOI: 10.1098/rsos.210803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
Epidemiological models often assume that individuals do not change their behaviour or that those aspects are implicitly incorporated in parameters in the models. Typically, these assumptions are included in the contact rate between infectious and susceptible individuals. However, adaptive behaviours are expected to emerge and play an important role in the transmission dynamics across populations. Here, we propose a theoretical framework to couple transmission dynamics with behavioural dynamics due to infection awareness. We modelled the dynamics of social behaviour using a game theory framework, which is then coupled with an epidemiological model that captures the disease dynamics by assuming that individuals are aware of the actual epidemiological state to reduce their contacts. Results from the mechanistic model show that as individuals increase their awareness, the steady-state value of the final fraction of infected individuals in a susceptible-infected-susceptible (SIS) model decreases. We also incorporate theoretical contact networks, having the awareness parameter dependent on global or local contacts. Results show that even when individuals increase their awareness of the disease, the spatial structure itself defines the steady state.
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Affiliation(s)
- Jaime Cascante-Vega
- Departamento de Ingeniería Biomédica, Grupo de Investigación en Biología Matemática y Computacional, Universidad de los Andes, Bogotá D.C., Colombia
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Samuel Torres-Florez
- Departamento de Ingeniería Biomédica, Grupo de Investigación en Biología Matemática y Computacional, Universidad de los Andes, Bogotá D.C., Colombia
| | - Juan Cordovez
- Departamento de Ingeniería Biomédica, Grupo de Investigación en Biología Matemática y Computacional, Universidad de los Andes, Bogotá D.C., Colombia
| | - Mauricio Santos-Vega
- Departamento de Ingeniería Biomédica, Grupo de Investigación en Biología Matemática y Computacional, Universidad de los Andes, Bogotá D.C., Colombia
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3
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Brunelli L, Valent F, Romanese F, Tricarico P, Pellizzaro A, d'Angelo M, Benetollo PP, Iob A, Forgiarini M, Brusaferro S. Parental trust and beliefs after the discovery of a six-year-long failure to vaccinate. Hum Vaccin Immunother 2021; 17:583-587. [PMID: 32750274 PMCID: PMC7899632 DOI: 10.1080/21645515.2020.1777820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND In Italy vaccine hesitancy worsened after a failure to vaccinate episode that took place in Friuli Venezia-Giulia Region until early 2017 which undermined herd immunity by leaving unprotected more than 5,444 children. METHODS Between May and June 2017, 2,557 parents were surveyed at the local vaccination clinic where they were invited within the subsequent extraordinary vaccination campaign. The aim of the survey was to evaluate whether the multi-channel extraordinary vaccination campaign had reached the target population and to know parental beliefs and trusted sources of information after the failure to vaccinate event. RESULTS While 279 parents were non-hesitant (10.9%) and 1,491 hesitant acceptors (58.3%), just 38 (1.5%) refused to have their children revaccinated. Overall, the most consulted sources of information were print media (18.8%), physicians (16.0%), relatives and friends (12.1%). The majority of parents considered vaccination as a fundamental practice (73.9%), but many were worried about potential side effects (38.8%) or doubtful about the effectiveness of some vaccines (11.0%). According to parents, 19.7% of them (57) changed their opinion about vaccines after the Codroipo case. CONCLUSIONS After the Codroipo case, most parents chose to have their children re-vaccinated and just a little proportion refused the re-administration of vaccines. More studies are needed to confirm the importance of a coherent multi-channel communication strategy using both traditional and new media in order to counteract vaccine hesitancy.
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Affiliation(s)
- Laura Brunelli
- Dipartimento di Area Medica, Università Degli Studi di Udine , Udine, Italy
| | - Francesca Valent
- Istituto di Igiene Ed Epidemiologia Clinica, Azienda Sanitaria Universitaria Integrata di Udine , Udine, Italy
| | - Federico Romanese
- Dipartimento di Area Medica, Università Degli Studi di Udine , Udine, Italy
| | | | - Alice Pellizzaro
- Dipartimento di Area Medica, Università Degli Studi di Udine , Udine, Italy
| | - Matteo d'Angelo
- Dipartimento di Area Medica, Università Degli Studi di Udine , Udine, Italy
| | - Pier Paolo Benetollo
- Azienda per l'Assistenza Sanitaria No.3 Del Friuli Venezia Giulia , Gemona, Italy
| | - Andrea Iob
- Azienda per l'Assistenza Sanitaria No.3 Del Friuli Venezia Giulia , Gemona, Italy
| | - Mariarita Forgiarini
- Azienda per l'Assistenza Sanitaria No.3 Del Friuli Venezia Giulia , Gemona, Italy
| | - Silvio Brusaferro
- Dipartimento di Area Medica, Università Degli Studi di Udine , Udine, Italy
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4
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Biribawa C, Atuhairwe JA, Bulage L, Okethwangu DO, Kwesiga B, Ario AR, Zhu BP. Measles outbreak amplified in a pediatric ward: Lyantonde District, Uganda, August 2017. BMC Infect Dis 2020; 20:398. [PMID: 32503450 PMCID: PMC7274507 DOI: 10.1186/s12879-020-05120-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
Background Measles is a highly infectious viral disease. In August 2017, Lyantonde District, Uganda reported a measles outbreak to Uganda Ministry of Health. We investigated the outbreak to assess the scope, factors facilitating transmission, and recommend control measures. Methods We defined a probable case as sudden onset of fever and generalized rash in a resident of Lyantonde, Lwengo, or Rakai Districts from 1 June-30 September 2017, plus ≥1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with serum positivity of measles-specific IgM. We conducted a neighborhood- and age-matched case-control study to identified exposure factors, and used conditional logistic regression to analyze the data. We estimated vaccine effectiveness and vaccination coverage. Results We identified 81 cases (75 probable, 6 confirmed); 4 patients (4.9%) died. In the case-control study, 47% of case-patients and 2.3% of controls were hospitalized at Lyantonde Hospital pediatric department for non-measles conditions 7–21 days before case-patient’s onset (ORadj = 34, 95%CI: 5.1–225). Estimated vaccine effectiveness was 95% (95%CI: 75–99%) and vaccination coverage was 76% (95%CI: 68–82%). During the outbreak, an “isolation” ward was established inside the general pediatric ward where there was mixing of both measles and non-measles patients. Conclusions This outbreak was amplified by nosocomial transmission and facilitated by low vaccination coverage. We recommended moving the isolation ward outside of the building, supplemental vaccination, and vaccinating pediatric patients during measles outbreaks.
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Affiliation(s)
| | | | - Lilian Bulage
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | | | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, Kampala, Uganda.,Ministry of Health, Kampala, Uganda
| | - Bao-Ping Zhu
- US Centers for Disease Control and Prevention, Kampala, Uganda.,Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, USA
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5
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Carazo S, Billard MN, Boutin A, De Serres G. Effect of age at vaccination on the measles vaccine effectiveness and immunogenicity: systematic review and meta-analysis. BMC Infect Dis 2020; 20:251. [PMID: 32223757 PMCID: PMC7104533 DOI: 10.1186/s12879-020-4870-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 02/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background The objectives of this review were to evaluate the effect of age at administration of the first dose of a measles-containing vaccine (MCV1) on protection against measles and on antibody response after one- and two-dose measles vaccinations. Methods We conducted a systematic review of the PubMed/MEDLINE, Embase, Web of Science and Cochrane databases (1964–2017) to identify observational studies estimating vaccine effectiveness and/or measles attack rates by age at first vaccination as well as experimental studies comparing seroconversion by age at first vaccination. Random effect models were used to pool measles risk ratios (RR), measles odds ratios (OR) and seroconversion RR of MCV1 administered at < 9, 9–11 or ≥ 15 months compared with 12 or 12–14 months of age. Results We included 41 and 67 studies in the measles protection and immunogenicity analyses. Older age at MCV1, from 6 to ≥15 months, improved antibody response and measles protection among one-dose recipients. Pooled measles RR ranged from 3.56 (95%CI: 1.28, 9.88) for MCV1 at < 9 months to 0.48 (95%CI: 0.36, 0.63) for MCV1 at ≥15 months, both compared to 12–14 months. Pooled seroconversion RR ranged from 0.93 (95%CI: 0.90, 0.96) for MCV1 at 9–11 months to 1.03 (95%CI: 1.00, 1.06) for MCV1 at ≥15 months, both compared to 12 months. After a second dose, serological studies reported high seropositivity regardless of age at administration of MCV1 while epidemiological data based on few studies suggested lower protection with earlier age at MCV1. Conclusions Earlier age at MCV1 decreases measles protection and immunogenicity after one dose and might still have an impact on vaccine failures after two doses of measles vaccine. While two-dose vaccination coverage is most critical to interrupt measles transmission, older age at first vaccination may be necessary to keep the high level of population immunity needed to maintain it.
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Affiliation(s)
- Sara Carazo
- Department of Social and Preventive Medicine, Laval University, 1050, Avenue de la Médecine, Quebec, QC, G1V 0A6, Canada
| | - Marie-Noëlle Billard
- CHU de Québec - Université Laval Research Center, 2400, Avenue d'Estimauville, Quebec, QC, G1E 7G9, Canada
| | - Amélie Boutin
- CHU de Québec - Université Laval Research Center, 2400, Avenue d'Estimauville, Quebec, QC, G1E 7G9, Canada
| | - Gaston De Serres
- Department of Social and Preventive Medicine, Laval University, 1050, Avenue de la Médecine, Quebec, QC, G1V 0A6, Canada. .,CHU de Québec - Université Laval Research Center, 2400, Avenue d'Estimauville, Quebec, QC, G1E 7G9, Canada. .,Institut National de Santé Publique du Québec, 2400, Avenue d'Estimauville, Quebec, QC, G1E 7G9, Canada.
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6
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van Dam A, Woudenberg T, de Melker H, Wallinga J, Hahné S. Effect of vaccination on severity and infectiousness of measles during an outbreak in the Netherlands, 2013-2014. Epidemiol Infect 2020; 148:e81. [PMID: 32200773 PMCID: PMC7189345 DOI: 10.1017/s0950268820000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/28/2020] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
An outbreak of measles in the Netherlands in 2013-2014 provided an opportunity to assess the effect of MMR vaccination on severity and infectiousness of measles.Measles is notifiable in the Netherlands. We used information on vaccination, hospitalisation, complications, and most likely source(s) of infection from cases notified during the outbreak. When a case was indicated as a likely source for at least one other notified case, we defined it as infectious. We estimated the age-adjusted effect of vaccination on severity and infectiousness with logistic regression.Of 2676 notified cases, 2539 (94.9%) were unvaccinated, 121 (4.5%) were once-vaccinated and 16 (0.6%) were at least twice-vaccinated; 328 (12.3%) cases were reported to have complications and 172 (6.4%) cases were hospitalised. Measles in twice-vaccinated cases led less often to complications and/or hospitalisation than measles in unvaccinated cases (0% and 14.5%, respectively, aOR 0.1 (95% CI 0-0.89), P = 0.03). Of unvaccinated, once-vaccinated and twice-vaccinated cases, respectively, 194 (7.6%), seven (5.1%) and 0 (0%) were infectious. These differences were not statistically significant (P > 0.05).Our findings suggest a protective effect of vaccination on the occurrence of complications and/or hospitalisation as a result of measles and support the WHO recommendation of a two-dose MMR vaccination schedule.
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Affiliation(s)
- A.S.G. van Dam
- Department of infectious diseases, GGD Hart voor Brabant, ‘s-Hertogenbosch, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - T. Woudenberg
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - H.E. de Melker
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - J. Wallinga
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - S.J.M. Hahné
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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7
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Geretti AM, Brook G, Cameron C, Chadwick D, French N, Heyderman R, Ho A, Hunter M, Ladhani S, Lawton M, MacMahon E, McSorley J, Pozniak A, Rodger A. British HIV Association Guidelines on the Use of Vaccines in HIV-Positive Adults 2015. HIV Med 2018; 17 Suppl 3:s2-s81. [PMID: 27568789 DOI: 10.1111/hiv.12424] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | | | | | | | | | | | | | | | - Mark Lawton
- Royal Liverpool University Hospital, Liverpool, UK
| | - Eithne MacMahon
- Guy's & St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | | | - Anton Pozniak
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
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8
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Albarnaz JD, Torres AA, Smith GL. Modulating Vaccinia Virus Immunomodulators to Improve Immunological Memory. Viruses 2018; 10:E101. [PMID: 29495547 PMCID: PMC5869494 DOI: 10.3390/v10030101] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 12/14/2022] Open
Abstract
The increasing frequency of monkeypox virus infections, new outbreaks of other zoonotic orthopoxviruses and concern about the re-emergence of smallpox have prompted research into developing antiviral drugs and better vaccines against these viruses. This article considers the genetic engineering of vaccinia virus (VACV) to enhance vaccine immunogenicity and safety. The virulence, immunogenicity and protective efficacy of VACV strains engineered to lack specific immunomodulatory or host range proteins are described. The ultimate goal is to develop safer and more immunogenic VACV vaccines that induce long-lasting immunological memory.
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Affiliation(s)
- Jonas D Albarnaz
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK.
| | - Alice A Torres
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK.
| | - Geoffrey L Smith
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK.
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9
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Ceccarelli G, Vita S, Riva E, Cella E, Lopalco M, Antonelli F, De Cesaris M, Fogolari M, Dicuonzo G, Ciccozzi M, Angeletti S. Susceptibility to measles in migrant population: implication for policy makers. J Travel Med 2018; 25:4711101. [PMID: 29232456 DOI: 10.1093/jtm/tax080] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/13/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite a large measles outbreak is taking place in WHO European region, currently no data are available on measles immunization coverage in the asylum seeker and migrants hosted in this area. METHODS Two hundred and fifty-six migrants upon their arrival in Italy on March, April and May 2016 were screened for measles virus IgG antibodies by chemiluminescence immunoassay (Liaison XL analyzer, Diasorin, Italy). The virus susceptibility in this cohort, the differences between the official country reported and the observed measles immunization coverage and the impact of current measles outbreak on the asylum seekers hosted in the largest Asylum Seeker centres of Italy, were evaluated. RESULTS The prevalence of subjects with positive result for measles IgG antibodies ranged between 79.9% and 100%. In Senegal, Mali, Nigeria, Pakistan and Bangladesh, the measles IgG seroprevalence observed was greater than the vaccinal coverage reported by WHO after I dose of vaccine. Based on data regarding the II dose coverage, the ASs population presented a seroprevalence greater to that expected. CONCLUSION On the basis of the results obtained, extraordinary screening and vaccination campaigns in the migrant population, especially in the course of large outbreaks, could represent a resource to reach an adequate measles immunization coverage and to control this infectious disease.
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Affiliation(s)
- Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Roma, Italy.,Migrant and Global Health Research Organisation, Centro di ricerca sulla salute globale e delle popolazioni mobili (Mi-Hero), Via del Pigneto 3, 00176 Roma, Italy.,Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Via della Circonvallazione della Protezione Civile 1, 00100 Rome, Italy.,Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - Serena Vita
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Roma, Italy.,Migrant and Global Health Research Organisation, Centro di ricerca sulla salute globale e delle popolazioni mobili (Mi-Hero), Via del Pigneto 3, 00176 Roma, Italy.,Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Via della Circonvallazione della Protezione Civile 1, 00100 Rome, Italy.,Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - Elisabetta Riva
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Eleonora Cella
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Roma, Italy.,Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Via della Circonvallazione della Protezione Civile 1, 00100 Rome, Italy.,Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - Maurizio Lopalco
- Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Via della Circonvallazione della Protezione Civile 1, 00100 Rome, Italy.,Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - Francesca Antonelli
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Marina De Cesaris
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Marta Fogolari
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Giordano Dicuonzo
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Massimo Ciccozzi
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Silvia Angeletti
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
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10
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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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11
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Measles immunity gaps and the progress towards elimination: a multi-country modelling analysis. THE LANCET. INFECTIOUS DISEASES 2017; 17:1089-1097. [PMID: 28807627 DOI: 10.1016/s1473-3099(17)30421-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/26/2017] [Accepted: 06/16/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND The persistent circulation of measles in both low-income and high-income countries requires a better characterisation of present epidemiological trends and existing immunity gaps across different sociodemographic settings. Serological surveys, which provide direct measures of population protection against the infection, are underexploited and often supply fragmentary estimates of population immunity. This study aims to investigate how measles immunity has changed over time across different socioeconomic settings, as a result of demographic changes and past immunisation policies. METHODS For this multi-country modelling analysis, we developed a transmission model to simulate measles circulation during the past 65 years in nine countries with distinct demographic and vaccination histories. The model was calibrated on historical serological data and used to estimate the reduction of disease burden as a result of vaccination and present age-specific residual susceptibility. FINDINGS Our model shows that estimated residual susceptibility to measles ranges from 3% in the UK to more than 10% in Kenya and Ethiopia. In high-income countries, such as Italy, Singapore, and South Korea, where routine first-dose administration produced more than 90% of immunised individuals, only about 20% of susceptible individuals are younger than 5 years. We also observed that the reduction in fertility that has occurred during the past decades in high-income countries has contributed to almost half of the reduction in measles incidence. In low-income countries, where fertility is high, the population is younger and routine vaccination has been suboptimum. Susceptible individuals are concentrated in early childhood, with about 60% of susceptible individuals in Ethiopia younger than 10 years. In these countries, Supplementary Immunization Activities (SIAs) were responsible for more than 25% of immunised individuals (up to 45% in Ethiopia), mitigating the consequences of suboptimum routine vaccination coverage. INTERPRETATION Future vaccination strategies in high-fertility countries should focus on increasing childhood immunisation rates, either by raising first-dose coverage or by making erratic SIAs more frequent and regular. Immunisation campaigns targeting adolescents and adults are required in low-fertility countries, where the susceptibility in these age groups will otherwise sustain measles circulation. FUNDING European Research Council.
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12
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Keenan A, Ghebrehewet S, Vivancos R, Seddon D, MacPherson P, Hungerford D. Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK. BMJ Open 2017; 7:e014106. [PMID: 28363926 PMCID: PMC5387959 DOI: 10.1136/bmjopen-2016-014106] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES There was a large outbreak of measles in Liverpool, UK, in 2012-2013, despite measles, mumps and rubella (MMR) immunisation uptake rates that were higher than the national average. We estimated measles susceptibility of a cohort of children born in Liverpool between 1995 and 2012 to understand whether there was a change in susceptibility before and after the outbreak and to inform vaccination strategy. DESIGN Retrospective cohort study. SETTING The city of Liverpool, North West UK. PARTICIPANTS All children born in Liverpool (72 101) between 1995 and 2012 inclusive who were identified using the Child Health Information System (CHIS) and were still resident within Liverpool in 2014. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated cohort age-disaggregated and neighbourhood-disaggregated measles susceptibility according to WHO thresholds before and after the outbreak for children aged 1-17 years. RESULTS Susceptibility to measles was above WHO elimination thresholds before and after the measles outbreak in the 10+ age group. The proportion of children susceptible before and after outbreak, respectively: age 1-4 years 15.0% before and 14.9% after; age 5-9 years 9.9% before and 7.7% after; age 10+ years 8.6% before and 8.5% after. Despite an intensive MMR immunisation catch-up campaign after the 2012-2013 measles outbreak, the overall proportion of children with no MMR remains high at 6.1% (4390/72 351). Across all age groups and before and after the outbreak, measles susceptibility was clustered by neighbourhood, with deprived areas having the greatest proportion of susceptible children. CONCLUSIONS The risk of sustained measles outbreaks remains, especially as large pools of susceptible older children will start leaving secondary education and continue to aggregate in higher education, employment and other community settings and institutions resulting in the potential for a propagated measles outbreak.
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Affiliation(s)
- Alex Keenan
- Cheshire and Merseyside Health Protection Team, Public Health England North West, Liverpool, UK
| | - Sam Ghebrehewet
- Cheshire and Merseyside Health Protection Team, Public Health England North West, Liverpool, UK
| | - Roberto Vivancos
- Field Epidemiology Services, Public Health England, Liverpool, UK
| | | | - Peter MacPherson
- Cheshire and Merseyside Health Protection Team, Public Health England North West, Liverpool, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Daniel Hungerford
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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The changing epidemiology of measles in an era of elimination: lessons from health-care-setting transmissions of measles during an outbreak in New South Wales, Australia, 2012. Western Pac Surveill Response J 2017; 7:12-20. [PMID: 28246577 PMCID: PMC5330218 DOI: 10.5365/wpsar.2016.7.1.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction In countries where measles is rare, health-care-setting transmissions remain problematic. Australia experienced its largest measles outbreak in 15 years in 2012 with 199 cases reported nationally; 170 cases occurred in the state of New South Wales (NSW) with symptom onset between 7 April and 29 November 2012. Methods A descriptive study was conducted using measles case data obtained from metropolitan Sydney local health districts in NSW in 2012. Characteristics of measles source and secondary cases were described. Details of health-care presentations resulting and not resulting in measles transmission were also analysed. Results There were 168 confirmed and two probable cases resulting in 405 documented health-care presentations. Thirty-four secondary cases acquired in health-care settings were identified, including 29 cases resulting from 14 source cases and 5 cases whose source could not be identified. Health-care-acquired cases accounted for 20% of all cases in this outbreak. Source cases were more likely to be of Pacific Islander descent (P = 0.009) and to have had more presentations before diagnosis (P = 0.012) compared to other cases. The percentage of presentations to emergency departments was higher for presentations that resulted in transmission compared to those that did not (71.4% and 37.6%, respectively, P = 0.028). There were no significant differences between transmission and non-transmission presentations with respect to presence of rash and infection control measures (P = 0.762 and P = 0.221, respectively), although the power to detect these differences was limited. Rash was reported at 66% of the presentations. Conclusion Development of and adherence to protocols for the management of patients presenting to hospitals with fever and rash will minimize secondary transmission of measles.
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Effect of socioeconomic deprivation on uptake of measles, mumps and rubella vaccination in Liverpool, UK over 16 years: a longitudinal ecological study. Epidemiol Infect 2015; 144:1201-11. [PMID: 26542197 DOI: 10.1017/s0950268815002599] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Suboptimal uptake of the measles, mumps and rubella (MMR) vaccine by certain socioeconomic groups may have contributed to recent large measles outbreaks in the UK. We investigated whether socioeconomic deprivation was associated with MMR vaccine uptake over 16 years. Using immunization data for 72,351 children born between 1995 and 2012 in Liverpool, UK, we examined trends in vaccination uptake. Generalized linear models were constructed to examine the relative effect of socioeconomic deprivation and year of birth on MMR uptake. Uptake of MMR1 by age 24 months ranged between 82·5% in 2003 [95% confidence interval (CI) 81·2-83·7] and 93·4% in 2012 (95% CI 92·7-94·2). Uptake of MMR2 by age 60 months ranged between 65·3% (95% CI 64·4-67·4) in 2006 and 90·3% (95% CI 89·4-91·2) in 2012. In analysis adjusted for year of birth and sex, children in the most deprived communities were at significantly greater risk of not receiving MMR1 [risk ratio (RR) 1·70, 95% CI 1·45-1·99] and MMR2 (RR 1·36, 95% CI 1·22-1·52). Higher unemployment and lower household income were significantly associated with low uptake. Contrary to concerns about lower MMR uptake in affluent families, over 16 years, children from the most socioeconomically deprived communities have consistently had the lowest MMR uptake. Targeted catch-up campaigns and strategies to improve routine immunization uptake in deprived areas are needed to minimize the risk of future measles outbreaks.
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Cost effectiveness of a web-based decision aid for parents deciding about MMR vaccination: a three-arm cluster randomised controlled trial in primary care. Br J Gen Pract 2015; 64:e493-9. [PMID: 25071062 DOI: 10.3399/bjgp14x680977] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Levels of measles in England and Wales are at their highest for 18 years, and strategies targeting the different groups of parents who do not vaccinate their children continue to be needed. Decision aids for decisions regarding childhood immunisation appear to be effective in achieving an increase in vaccine uptake but their cost effectiveness is unknown. AIM To assess the cost effectiveness of a web-based decision aid to increase uptake of the MMR vaccine. DESIGN AND SETTING Economic evaluation conducted alongside a cluster randomised controlled trial using urban GP practices in the north of England. METHOD Fifty GP practices in the north of England were randomised to one of three trial arms: decision aid, leaflet, usual practice. A total of 220 first-time parents (child aged 3-12 months) were recruited. Parents self-reported their contacts with the NHS and other previous/expected resource utilisation; associated costs were calculated. Vaccine-uptake data were collected from GP practices. A cost-effectiveness analysis was undertaken and provided the incremental cost per first-vaccine uptake. Multiple imputation was used to account for missing data and findings were adjusted for baseline differences in parents' levels of decisional conflict regarding MMR vaccination. RESULTS Of the 220 first-time parents recruited to the study, 179 completed the baseline and post-intervention questionnaires. MMR uptake was highest for those receiving the decision aid (42 out of 42, 100%) versus usual practice (61 out of 62, 98%) and leaflet arm (69 out of 75, 92%), and was associated with lower cost (-£9.20 versus usual practice and -£7.17 versus leaflet). CONCLUSION The decision aid has a high chance of being cost effective, regardless of the value placed on obtaining additional vaccinations. It also appears to offer an efficient means of decision support for parents.
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Reasons for measles cases not being vaccinated with MMR: investigation into parents' and carers' views following a large measles outbreak. Epidemiol Infect 2015; 144:870-5. [PMID: 26265115 DOI: 10.1017/s0950268815001909] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Uptake rates for the combined measles, mumps and rubella (MMR) vaccine have been below the required 95% in the UK since a retracted and discredited article linking the MMR vaccine with autism and inflammatory bowel disease was released in 1998. This study undertook semi-structured telephone interviews among parents or carers of 47 unvaccinated measles cases who were aged between 13 months and 9 years, during a large measles outbreak in Merseyside. Results showed that concerns over the specific links with autism remain an important cause of refusal to vaccinate, with over half of respondents stating this as a reason. A quarter stated child illness during scheduled vaccination time, while other reasons included general safety concerns and access issues. Over half of respondents felt that more information or a discussion with a health professional would help the decision-making process, while a third stated improved access. There was clear support for vaccination among respondents when asked about current opinions regarding MMR vaccine. The findings support the hypothesis that safety concerns remain a major barrier to MMR vaccination, and also support previous evidence that experience of measles is an important determinant in the decision to vaccinate.
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17
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An assessment of measles vaccine effectiveness, Australia, 2006-2012. Western Pac Surveill Response J 2015; 6:43-50. [PMID: 26668766 DOI: 10.5365/wpsar.2015.6.2.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Vaccine effectiveness analysis serves as a critical evaluation for immunization programmes and vaccination coverage. It also contributes to maintaining public confidence with the vaccine providers. This study estimated measles vaccine effectiveness at the population level using Australian national notifications data between 2006 and 2012. METHODS Notification data were obtained from the National Notifiable Diseases Surveillance System. Vaccination status was classified according to whether a case had received zero, one or two doses of measles-containing vaccine. Cases aged less than 1 year and those with unknown vaccination status were excluded. All children with disease onset between 1 January 2006 and 31 December 2012 who were born after 1996 were included. Cases were matched to controls extracted from the Australian Childhood Immunization Register according to date of birth and jurisdiction of residence. Vaccine effectiveness was estimated by conditional logistic regression. Sensitivity analyses were conducted to test data robustness. RESULTS Vaccine effectiveness was estimated at 96.7% (95% confidence interval [CI]: 94.5-98.0%) for one dose and 99.7% (95% CI: 99.2-99.9%) for two doses of measles vaccine. For at least one dose, effectiveness was estimated at 98.7% (95% CI: 97.9-99.2%). Sensitivity analyses did not significantly alter the base estimates. DISCUSSION Vaccine effectiveness estimates suggested that the measles vaccine was protective at the population level between 2006 and 2012. However, vaccination coverage gaps may have contributed to recent measles outbreaks and may represent a serious barrier for Australia to maintain measles elimination status.
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Sustained outbreak of measles in New South Wales, 2012: risks for measles elimination in Australia. Western Pac Surveill Response J 2015; 5:14-20. [PMID: 25635228 DOI: 10.5365/wpsar.2013.4.4.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE On 7 April 2012, a recently returned traveller from Thailand to Australia was confirmed to have measles. An outbreak of measles subsequently occurred in the state of New South Wales, prompting a sustained and coordinated response by public health authorities. The last confirmed case presented on 29 November 2012. This report describes the outbreak and its characteristics. METHODS Cases were investigated following Australian protocols, including case interviews and assessment of contacts for post-exposure prophylaxis. RESULTS Of the 168 cases identified, most occurred in south-western and western Sydney (92.9%, n = 156). Notable features of this outbreak were the disproportionately high number of cases in the 10-19-year-old age group (29.2%, n = 49), the overrepresentation among people of Pacific Islander descent (21.4%, n = 36) and acquisition in health-care facilities (21.4%, n = 36). There were no reported cases of encephalitis and no deaths. DISCUSSION This was the largest outbreak of measles in Australia since 1997. Its occurrence highlights the need to maintain vigilant surveillance systems for early detection and containment of measles cases and to maintain high population immunity to measles through routine childhood immunization. Vaccination campaigns targeting susceptible groups may also be necessary to sustain Australia's measles elimination status.
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Hens N, Abrams S, Santermans E, Theeten H, Goeyvaerts N, Lernout T, Leuridan E, Van Kerckhove K, Goossens H, Van Damme P, Beutels P. Assessing the risk of measles resurgence in a highly vaccinated population: Belgium anno 2013. Euro Surveill 2015; 20. [DOI: 10.2807/1560-7917.es2015.20.1.20998] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- N Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - S Abrams
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - E Santermans
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - H Theeten
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - N Goeyvaerts
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - T Lernout
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - E Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - K Van Kerckhove
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - H Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - P Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - P Beutels
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
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Hashim A, Dang V, Bolotin S, Crowcroft NS. How and why researchers use the number needed to vaccinate to inform decision making--a systematic review. Vaccine 2014; 33:753-8. [PMID: 25543164 DOI: 10.1016/j.vaccine.2014.12.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 12/12/2014] [Accepted: 12/16/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The number needed to vaccinate (NNV) is a measure that has been widely used in the scientific literature to draw conclusions about the usefulness and cost-effectiveness of various immunization programmes. The main objective of this review is to examine how and why the NNV has been used and reported in the published literature. METHODS Electronic databases were searched and records were screened against the eligibility criteria by two independent authors. We included papers that reported and interpreted NNV. RESULTS We identified 27 studies, the designs including observational studies, economic analyses, systematic reviews, and commentaries. The NNV has been used in the literature to describe three main themes: potential benefits of vaccination programmes, cost-effectiveness, and economic analyses, and modelling studies to compare different vaccination strategies. CONCLUSIONS NNV has been used in a wide variety of ways in the literature, yet there are no defined thresholds for what is a favourable NNV. Furthermore, the generalizability of the NNV is usually limited. Further work is required to determine the most appropriate use of this measure.
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Affiliation(s)
- Ahmed Hashim
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, Canada M5G 1V2.
| | - Vica Dang
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, Canada M5G 1V2.
| | - Shelly Bolotin
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, Canada M5G 1V2; Dalla Lana School of Public Health, University of Toronto , 155 College St, Toronto, ON, Canada M5T 3M7.
| | - Natasha S Crowcroft
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, Canada M5G 1V2; Dalla Lana School of Public Health, University of Toronto , 155 College St, Toronto, ON, Canada M5T 3M7; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto , Medical Sciences Building, 1 King's College Circle, Toronto, ON, Canada M5S 1A8.
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Pegorie M, Shankar K, Welfare WS, Wilson RW, Khiroya C, Munslow G, Fiefield D, Bothra V, McCann R. Measles outbreak in Greater Manchester, England, October 2012 to September 2013: epidemiology and control. ACTA ACUST UNITED AC 2014; 19. [PMID: 25523970 DOI: 10.2807/1560-7917.es2014.19.49.20982] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper describes the epidemiology and management of a prolonged outbreak of measles across the 2.7 million conurbation of Greater Manchester in the United Kingdom. Over a period of one year (from October 2012 to September 2013), over a thousand suspected measles cases (n = 1,073) were notified across Greater Manchester; of these, 395 (37%) were laboratory-confirmed, 91 (8%) were classed as probable, 312 (29%) were classed as possible and 275 (26%) excluded. Most confirmed and probable cases occurred in children within two age groups—infants (too young to be eligible for measles-mumps-rubella (MMR) vaccination according to the national immunisation programme) and children aged 10-19 years (low vaccine uptake in this cohort because of unfounded alleged links between the MMR vaccine and autism). During this one year period, there were a series of local outbreaks and many of these occurred within the secondary school setting. A series of public health measures were taken to control this prolonged outbreak: setting up incident management teams to control local outbreaks, a concerted immunisation catch-up campaign (initially local then national) to reduce the pool of children partially or totally unprotected against measles, and the exclusion of close contacts from nurseries and school settings for a period of 10 days following the last exposure to a case of measles.
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Affiliation(s)
- M Pegorie
- Health Protection Team, Greater Manchester Public Health England Centre, Public Health England, Manchester, United Kingdom
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22
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The effect of measles on health-related quality of life: a patient-based survey. PLoS One 2014; 9:e105153. [PMID: 25202905 PMCID: PMC4159135 DOI: 10.1371/journal.pone.0105153] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 06/13/2014] [Indexed: 12/03/2022] Open
Abstract
Background Measles is a highly contagious and potentially fatal illness preventable through vaccination. Outbreaks in the UK and many other European countries have been increasing over recent years, with over 3,207 laboratory-confirmed cases reported by Public Health England from January 2012 to the end of June 2013. To aid rational decision making regarding measles control versus other use of healthcare resources, it is important to measure the severity of measles in units that are comparable to other diseases. The standard metric for this in the UK is the quality-adjust life year (QALY). To our knowledge, the impact of measles on health-related quality of life (HRQoL) in terms of QALYs has not been quantified. Methods and Findings Individuals with confirmed measles were sent questionnaires requesting information on the short-term impact of the illness on their HRQoL using the EuroQol EQ-5D-3L questionnaire. HRQoL was reported for the day the questionnaire was received, the worst day of infection and at follow-up three weeks later. 507 questionnaires were sent to individuals with confirmed measles with 203 returned (40%). The majority of respondents were not vaccinated. The mean time off work or school was 9.6 days. The mean duration of perceived illness was 13.8 days. The mean number of QALYs lost was 0.019 (equivalent to 6.9 days). The overall burden of disease in terms of QALYs lost in England based on the total number of confirmed cases in the twelve month period from 1st June 2012 was estimated to be 44.2 QALYs. Conclusion The short-term impact of measles infection on HRQoL is substantial, both at the level of the individual patient and in terms of the overall disease burden. This is the first attempt to quantify QALY-loss due to measles at a population level, and provides important parameters to guide future intervention and control measures.
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LASSEN SGILLESBERG, SCHUSTER M, STEMMLER M, STEINMÜLLER A, MATYSIAK-KLOSE D, MANKERTZ A, SANTIBANEZ S, WICHMANN O, FALKENHORST G. Measles outbreak spreading from the community to an anthroposophic school, Berlin, 2011. Epidemiol Infect 2014; 142:789-96. [PMID: 23823129 PMCID: PMC9151084 DOI: 10.1017/s0950268813001398] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 04/26/2013] [Accepted: 05/17/2013] [Indexed: 11/06/2022] Open
Abstract
Between April and July 2011 there was an outbreak of measles virus, genotype D4, in Berlin, Germany. We identified 73 case-patients from the community and among students of an anthroposophic school, who participated in a 4-day school trip, as well as their family and friends. Overall, 27% were aged ≥ 20 years, 57% were female and 15% were hospitalized. Of 39 community case-patients, 38% were aged ≥ 20 years, 67% were female and 63% required hospitalization. Unvaccinated students returning from the school trip were excluded from school, limiting transmission. Within the group of 55 school-trip participants, including 20 measles case-patients, a measles vaccine effectiveness of 97.1% (95% confidence interval 83.4-100) for two doses was estimated using exact Poisson regression. Our findings support school exclusions and the recommendation of one-dose catch-up vaccination for everyone born after 1970 with incomplete or unknown vaccination status, in addition to the two-dose routine childhood immunization recommendation.
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Affiliation(s)
- S. GILLESBERG LASSEN
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - M. SCHUSTER
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - M. STEMMLER
- District Public Health Authority, Berlin, Germany
| | | | - D. MATYSIAK-KLOSE
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - A. MANKERTZ
- Robert Koch Institute, National Reference Centre Measles, Mumps, Rubella, Berlin, Germany
| | - S. SANTIBANEZ
- Robert Koch Institute, National Reference Centre Measles, Mumps, Rubella, Berlin, Germany
| | - O. WICHMANN
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - G. FALKENHORST
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
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Tumour immunogenicity, antigen presentation and immunological barriers in cancer immunotherapy. ACTA ACUST UNITED AC 2014; 2014. [PMID: 24634791 DOI: 10.1155/2014/734515] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the beginning of the 20th century, scientists have tried to stimulate the anti-tumour activities of the immune system to fight against cancer. However, the scientific effort devoted on the development of cancer immunotherapy has not been translated into the expected clinical success. On the contrary, classical anti-neoplastic treatments such as surgery, radiotherapy and chemotherapy are the first line of treatment. Nevertheless, there is compelling evidence on the immunogenicity of cancer cells, and the capacity of the immune system to expand cancer-specific effector cytotoxic T cells. However, the effective activation of anti-cancer T cell responses strongly depends on efficient tumour antigen presentation from professional antigen presenting cells such as dendritic cells (DCs). Several strategies have been used to boost DC antigen presenting functions, but at the end cancer immunotherapy is not as effective as would be expected according to preclinical models. In this review we comment on these discrepancies, focusing our attention on the contribution of regulatory T cells and myeloid-derived suppressor cells to the lack of therapeutic success of DC-based cancer immunotherapy.
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Hungerford D, Cleary P, Ghebrehewet S, Keenan A, Vivancos R. Risk factors for transmission of measles during an outbreak: matched case-control study. J Hosp Infect 2013; 86:138-43. [PMID: 24428975 DOI: 10.1016/j.jhin.2013.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND In 2012, an outbreak of measles occurred in Merseyside, UK with 359 confirmed cases by 30 June. Numerous cases reported visits to healthcare and social settings. AIM To identify risk factors associated with measles transmission during the outbreak. METHODS In April 2012, a retrospective matched case-control study was conducted. Fifty-five confirmed cases and 55 community controls, matched 1:1 for age and geography, were selected at random. Data on exposures in the two weeks before illness, including attendance at a healthcare setting, were collected via telephone interview. Univariate and multi-variate analyses were conducted and odds ratios were calculated. FINDINGS Forty-two cases and 42 matched controls were contacted successfully. Univariate exact conditional logistic regression analysis identified that cases were more likely to have attended an emergency department, been admitted to hospital and be incompletely vaccinated (for age). Multi-variate analysis found three factors to be independently associated with measles infection: incomplete/partial vaccination for age [adjusted odds ratio (aOR) 22.1, 95% confidence interval (CI) 3.8-∞, P < 0.001], under age for routine vaccination (aOR 20.4, 95% CI 2.0-∞, P = 0.009) and hospital admission (aOR 20.2, 95% CI 1.4-∞, P = 0.025). CONCLUSIONS Incomplete/partial vaccination, under age for routine vaccination and hospital admission were associated with measles infection. These findings highlight the importance of timely vaccination of eligible individuals, early diagnosis, timely isolation of cases, and implementation of strict infection control measures.
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Affiliation(s)
- D Hungerford
- Field Epidemiology Services North West, Public Health England, Liverpool, UK.
| | - P Cleary
- Field Epidemiology Services North West, Public Health England, Liverpool, UK
| | - S Ghebrehewet
- Health Protection Team, Cheshire & Merseyside Public Health England Centre, Public Health England, Liverpool, UK
| | - A Keenan
- Health Protection Team, Cheshire & Merseyside Public Health England Centre, Public Health England, Liverpool, UK
| | - R Vivancos
- Field Epidemiology Services North West, Public Health England, Liverpool, UK
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Torner N, Anton A, Barrabeig I, Lafuente S, Parron I, Arias C, Camps N, Costa J, Martínez A, Torra R, Godoy P, Minguell S, Ferrús G, Cabezas C, Domínguez Á, Spain. Epidemiology of two large measles virus outbreaks in Catalonia: what a difference the month of administration of the first dose of vaccine makes. Hum Vaccin Immunother 2013; 9:675-80. [PMID: 23303107 DOI: 10.4161/hv.23265] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Measles cases in the European Region have been increasing in the last decade; this illustrates the challenge of what we are now encountering in the form of pediatric preventable diseases. In Catalonia, autochthonous measles was declared eliminated in the year 2000 as the result of high measles-mumps-rubella vaccine (MMR) coverage for first and second dose (15 mo and 4 y) since the mid-1990s. From then on, sporadic imported cases and small outbreaks appeared, until in 2006-2007 a large measles outbreak affecting mostly unvaccinated toddlers hit the Barcelona Health Region. Consequently, in January 2008, first dose administration of MMR was lowered from 15 to 12 mo of age. A new honeymoon period went by until the end of 2010, when several importations of cases triggered new sustained transmission of different wild measles virus genotypes, but this time striking young adults. The aim of this study is to show the effect of a change in MMR vaccination schedule policy, and the difference in age incidence and hospitalization rates of affected individuals between both outbreaks. Epidemiologic data were obtained by case interviews and review of medical records. Samples for virological confirmation and genotyping of cases were collected as established in the Measles Elimination plan guidelines. Incidence rate (IR), rate ratio (RR) and their 95% CI and hospitalization rate (HR) by age group were determined. Statistic z was used for comparing proportions. Total number of confirmed cases was 305 in the 2010 outbreak and 381 in the 2006-2007 outbreak; mean age 20 y (SD 14.8 y; 3 mo to 51 y) vs. 15 mo (SD 13.1 y; 1 mo to 50 y). Highest proportion of cases was set in ≥ 25 y (47%) vs. 24.2% in 2006 (p < 0.001). Differences in IR for ≤ 15 mo (49/100,000 vs. 278.2/100,000; RR: 3,9; 95%CI 2,9-5.4) and in overall HR 29.8% vs. 15.7% were all statistically significant (p < 0.001). The change of the month of age for the administration of the first MMR dose proved successful to protect infants. Yet, given the current epidemiological situation, continued awareness and efforts to reach young adult population, especially those at high risk of infection and transmission such as healthcare workers and travelers, are needed to stop the spread of the virus when importations occur.
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Affiliation(s)
- Núria Torner
- Public Health Agency of Catalonia; Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP); Carlos III Institute; Madrid, Spain; Department of Public Health; University of Barcelona; Barcelona, Spain
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De Serres G, Markowski F, Toth E, Landry M, Auger D, Mercier M, Bélanger P, Turmel B, Arruda H, Boulianne N, Ward BJ, Skowronski DM. Largest Measles Epidemic in North America in a Decade—Quebec, Canada, 2011: Contribution of Susceptibility, Serendipity, and Superspreading Events. J Infect Dis 2012; 207:990-8. [DOI: 10.1093/infdis/jis923] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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