Measles: An Overview of a Re-Emerging Disease in Children and Immunocompromised Patients

Testing-isolation interventions will likely be insufficient to contain future novel disease outbreaks

Rapid identification and isolation of infected individuals with diagnostic testing plays a critical role in combating invasions of novel human pathogens. Unfortunately, unprepared health agencies may struggle to meet the massive testing capacity demands imposed by an outbreaking novel pathogen, potentially resulting in a failure of epidemic containment as occurred with COVID-19. Despite the critical importance of understanding the likelihood of such an outcome, it remains unclear how the particular characteristics of a novel disease will impact the magnitude of resource constraints on controllability. Specifically, is the failure of testing-isolation unique to COVID-19, or is this a likely outcome across the spectrum of disease traits that may constitute future epidemics? Here, using a generalized mathematical model parameterized for seven different human diseases and variants, we show that testing-isolation strategies will typically fail to contain epidemic outbreaks at practicably achievable testing capacities. From this analysis, we identify three key disease characteristics that govern controllability under resource constraints; the basic reproduction number, mean latent period, and non-symptomatic transmission index. Interactions among these characteristics play prominent roles in both explaining controllability differences among diseases and enhancing the efficacy of testing-isolation in combination with transmission-reduction measures. This study provides broad guidelines for managing controllability expectations during future novel disease invasions, describing which classes of diseases are most amenable to testing-isolation strategies alone and which will necessitate additional transmission-reduction measures like social distancing.

Elucidation of Postfusion Structures of the Measles Virus F Protein for the Structure-Based Design of Fusion Inhibitors

Measles is a highly infectious disease and remains a major cause of childhood mortality worldwide. In some cases, the measles virus (MV) induces subacute sclerosing panencephalitis within several years of the acute infection. The infection of the target cells by MV is mediated by the F protein, in which two heptad repeat regions, HR1 and HR2, form a six-helix bundle before membrane fusion. We previously reported anti-MV peptides, which were designed from the HR region of the MV F protein. Here, we characterized the essential interactions between the HR1 and HR2 regions on the postfusion six-helix bundles of synthetic HR1 and HR2 peptides by crystallographic studies. Based on the crystal structures, we identified the minimal α-helix sequence for antiviral activity. Additionally, optimizing HR2 peptides by introducing α-helix-inducible motifs and maintaining key hydrogen bond networks at the N- and C-terminal regions led to the identification of highly potent antiviral peptides.

Specialist nurse's health promotion work with the national childhood immunization programme: A qualitative study

PURPOSE

Childhood immunizations have proven to be one of the most beneficial interventions to promote public health and prevent childhood deaths due to disease. However, global coverage of childhood immunization has decreased throughout the world due to guardians' growing hesitancy towards immunizations. This study aims to describe how specialist nurses promote legal guardians to adhere to national childhood immunization programmes.

DESIGN AND METHODS

This study had a qualitative design. Semistructured interviews with 11 specialist nurses, who were paediatric primary care nurses or nurse practitioners, were conducted. Data were analysed using qualitative content analysis.

RESULTS

The findings, with four main categories including four subcategories, showed nurses using both local guidelines and national guidelines to promote guardians to adhere to the childhood immunization programme. The main intervention the nurses did to promote childhood immunization coverage was giving legal guardians general information about the programme. With hesitant guardians, adopting a person-centred approach towards the legal guardian improved adherence.

PRACTICE IMPLICATIONS

Further research should focus on how specialist nurses can respond to guardians who decline immunization for their children, as this study identified difficulties in this area. Furthermore, research on guardians' perspectives towards childhood immunization may also help generate further effective guidance on how to promote immunization coverage among children.

Study to Assess the Clinical and Sociodemographic Profile of Measles in Children Admitted to a Tertiary Care Center: A Retrospective Study

Background Measles remains a significant contributor to illness and death among young children, despite the presence of a safe and efficacious vaccine. One of the most highly transmissible viruses affecting humans is measles, which can be almost entirely prevented through vaccination. The recent surge in measles cases worldwide has been particularly notable in India. A total of 172 confirmed outbreaks of measles were recorded between October 2021 and September 2022, resulting in 12,589 cases. Measles, being highly contagious, is transmitted through the respiratory route. The disease affects 75 to 90% of susceptible household contacts, reaching peak infectivity three days before the rash emerges. The recent measles outbreak observed since January 2023 holds significance, as Bangalore district alone has reported around 500 cases. Therefore, the current study aims to evaluate the clinical and sociodemographic characteristics of measles in pediatric patients. Methods This was a retrospective study conducted over seven months. Data pertaining to demographics such as age, gender, parental occupation, parental educational background, and housing situation were gathered. Details regarding the child's immunization status, the onset of fever, and the onset of rash were also documented. Descriptive data was represented using mean, standard deviation, and percentage or proportion. Results Over the study period of seven months, 53 children were admitted due to measles. The majority of the individuals were female, accounting for 28 cases (52.8%). The typical clinical manifestations of measles such as cough, coryza, and conjunctivitis were documented in 45 (84.90%), 43 (81.13%), and 32 (60.37%) children, respectively. Specifically, two (3.77%), 14 (26.41%), 20 (37.73%), and 17 (32.07%) individuals were categorized as belonging to the upper middle, lower middle, upper lower, and lower socioeconomic strata. Six children in the nine- to 12-month age range had not received the measles-rubella (MR) vaccination. Thirteen (54.16%) out of 24 children aged one to five years had not received a single dose of the vaccine, while the children who had received at least one dose did not experience any complications. Among children aged less than nine months, nine to 12 months, and more than 12 months, three (100%), two (66.6%), and three (75%) respectively, experienced complications. All the patients recovered completely and were discharged from the hospital. Conclusion Measles is re-emerging as an infectious disease among children, as evidenced by the current outbreak. Study indicates that measles tends to impact infants and under five children more frequently. Through prompt and suitable medical intervention, all affected children experienced full recovery. It was observed that immunized children had fewer complications in comparison to their non-immunized counterparts. Acquiring a thorough understanding of the clinical profile of the illness is crucial for policymakers in developing essential guidelines for measles immunization coverage.

Case Ascertainment of Measles during a Large Outbreak-Laboratory Compared to Epidemiological Confirmation

Measles is a highly contagious viral disease, and hence, sufficient herd immunity is obligatory to prevent infection transmission. Measles is still a cause of considerable disease burden globally, mainly in children. During a national measles outbreak in Israel in 2018-2019, the peak incidence rates occurred in the Jerusalem district. Most measles cases in the Jerusalem district (75.5%, 1702) were observed in children younger than 15 years of age, 49.2% (1109) were in children under 5 years of age, and 18.9% (425) were in infants under 1 year of age. The routine measles vaccination schedule includes two doses at 1 and 6 years of age. Most cases (1828, 81.1%) were unvaccinated (zero measles vaccine doses). These cases comprised the 425 affected infants under 1 year of age, who were ineligible for vaccination, along with the 1403 children over 1 year of age, who were otherwise unvaccinated. This study aimed to describe the epidemiologic and laboratory features of this measles outbreak, and to investigate case ascertainment (laboratory confirmed compared to epidemiologically confirmed cases). The study population included 2254 measles cases notified during the period spanning June 2018 to May 2019 in the Jerusalem district (incidence rate 176 per 10,000 population). Of the 2254 cases, 716 (31.8%) were laboratory confirmed, and 1538 (68.2%) were confirmed as epidemiologically linked. Most laboratory confirmed cases (420, 58.7%) underwent real-time PCR tests. Serological tests (measles IgM and IgG) were used in 189 (26.4%) cases, and a combination of RT-PCR and serology was used in 107 (14.9%) cases. In a multivariate model analysis, the variables significantly associated (after adjustment) with higher odds for laboratory confirmation included month of disease onset (late), additional measles cases in the household (single case), place of medical treatment (hospital; either emergency department, or hospitalization) and vaccination status (at least one prior vaccine dose). The measles outbreak described demonstrates the urgency of addressing vaccination gaps with appropriate outbreak prevention programs. The road to measles elimination needs to be paved with robust public health infrastructure, excellent field epidemiology for outbreak surveillance, investigation, and control, and laboratory proficiency.

Descriptive Analysis of Measles Outbreak in Liberia, 2022

Background

Liberia reported a large outbreak of measles involving all the counties in 2022. We conducted a descriptive analysis of the measles surveillance data to understand the trend of the outbreak and guide further policy action to prevent future outbreaks.

Methods

We analyzed the measles surveillance data from Epi week 1 to 51, 2022. All the laboratory-confirmed cases, clinically compatible and epidemiologically linked cases were included in the analysis, the variables of interest included the patient's age, sex, place of residence, measles classification, measles vaccination status, and outcome. We cleaned and analyzed the data using R version 4.2.0 and Arc GIS Pro. The demographic characteristics of the cases were presented, the progression of the cases was presented in Epicurve and the spatial distribution and the case fatality rate (CFR) of the case were presented at the district level using the Arc GIS Pro.

Results

The median age of the cases was 4 years (interquartile range: 2-8 years). Children under five years of age constituted 60% of the cases (4836/8127), and females accounted for 52% (4204/8127) of the cases. Only 1% (84/8127) of the cases had documentary evidence of receiving at least one dose of measles-containing vaccine (MCV). Only 3 out of 92 health districts in the country did not report a case of measles during the period under review. The overall cases fatality rate was 1% however CFR of up to 10% were reported in some districts.

Conclusion

The outbreak of measles involved almost all the districts of the country, exposing a possible nationwide suboptimal immunization coverage for MCV. The high CFR reported in some districts needs further investigation.

Assessment of Knowledge of Communicable Diseases Among Medical Students at Al-Balqa Applied University

INTRODUCTION

Medical education is the foundation of knowledge among medical students. This study aims to investigate the knowledge of medical students at Al-Balqa Applied University, exploring their awareness of five communicable diseases, namely, leishmaniasis, hepatitis B, tuberculosis, measles, and cholera.

METHODS

This cross-sectional survey included 271 participants who answered a structured validated questionnaire with varying questions on causes, symptoms, complications, transmission routes, and preventive measures for each disease.

RESULTS

Knowledge of all five communicable diseases was low. Leishmaniasis knowledge was notably low (mean=6.07, SD=1.43), with participants grappling with misconceptions about transmission modes, symptoms, and preventability. Hepatitis B knowledge was also low (mean=10.46, SD=1.67), especially regarding transmission modes, revealing that 76% of students were unaware of how the virus spreads. Tuberculosis knowledge unveiled gaps (mean=7.007, SD=1.90), particularly in recognizing the causes, symptoms, and transmission routes. Measles knowledge (mean=9.56, SD=1.92) indicated a robust understanding of symptoms but unveiled misconceptions about complications and transmission routes. For cholera (mean=14.50, SD=1.98), a knowledge of symptoms was demonstrated, but confusion about causative agents, transmission routes, and preventive measures was highlighted.

CONCLUSION

The findings of the study emphasize the critical need for enhanced educational strategies including curriculum revisions, increased practical exposure, engaging awareness campaigns, and the integration of interactive learning methods to increase knowledge about communicable diseases.

Pervasive Parental Hesitancy and Resistance towards Measles Rubella Vaccination in Jordan

Measles remains a highly contagious and potentially severe infectious disease, necessitating high vaccine coverage. However, misinformation and measles vaccine hesitancy/resistance have posed significant challenges to achieving this goal. The COVID-19 pandemic further exacerbated these challenges, leading to a measles outbreak in Jordan in 2023. This study aimed to investigate the acceptance of the measles rubella (MR) vaccine among parents in Jordan and to identify its associated determinants. This cross-sectional questionnaire-based study was conducted using a previously Arabic-validated version of the Parental Attitudes towards Childhood Vaccines (PACV) survey instrument. Data collection took place in October 2023, and the final study sample comprised a total of 391 parents, with mothers representing 69.8% of the participants (n = 273). The majority of participating parents expressed either resistance (n = 169, 43.2%) or hesitancy (n = 168, 43.0%) towards MR vaccination, while only 54 participants (13.8%) expressed MR vaccine acceptance. Multivariate analysis revealed that trust in vaccine safety/efficacy, behavior, and having fewer offspring were significantly associated with MR vaccine acceptance. The current study revealed a concerning level of MR vaccine hesitancy/resistance among parents in Jordan, which could signal a public health alarm in the country. Urgent and targeted interventions are strongly recommended to address this issue, including mass campaigns aimed at building trust in the MR vaccine's safety/efficacy. Additionally, there is an urgent need for effective public health initiatives to ensure sufficient measles vaccine coverage to prevent future outbreaks of this serious disease.

Pre-Pandemic Distribution of Bacterial Species in Nasopharyngeal Swab Specimens from Pediatric and Adult Patients Detected via RT-PCR Using the Allplex Respiratory Panel

Background: Recently, panel-based molecular diagnostics for the simultaneous detection of respiratory viruses and bacteria in nasopharyngeal swab (NPS) specimens have been highlighted. We identified the distribution of bacterial species in NPS specimens collected from pediatric and adult patients by employing RT-PCR (Allplex respiratory panel 4, RP4, Seegene) to estimate its applicability in a panel-based assay for detecting respiratory viruses. Methods: We used 271 and 173 NPS specimens from pediatric and adult patients, respectively. The results of the Allplex RP4 panel using NPS (NPS-RP4) from adult patients were compared with those of the Seeplex PneumoBacter ACE Detection assay (Seegene), which used sputum for testing (sputum-Seeplex). Results: A total of 147 specimens (54.2%) were positive for the NPS-RP4 panel in pediatric patients. There were 94, 77, 10, 3, 3, and 2 specimens that were positive for Haemophilus influenzae (HI), Streptococcus pneumoniae (SP), Mycoplasma pneumoniae (MP), Chlamydia pneumoniae (CP), Bordetella pertussis (BP), and B. parapertussis (BPP), respectively. Among 173 adult patients, 39 specimens (22.5%) were positive in the NPS-RP4. Thirty specimens were positive for HI, and 13 were positive for SP. One specimen tested positive for both MP and Legionella pneumophila (LP). CP, BP, and BPP results were all negative. However, 126 specimens (72.8%) had positive results with sputum-Seeplex (99 SP, 59 HI, three LP, and two MP), and the overall percentage of agreement between the two assays was 39.3% in the adult patients. Conclusions: Bacterial species in NPS from more than half of pediatric patients were detected. Performing the Allplex RP4 assay with NPS revealed additional respiratory bacteria that are not detected in current clinical practices, which do not include bacterial testing, demanding the use of sputum specimens. However, the use of NPS showed low agreement with standard assays using sputum in adult patients. Thus, more research is needed to develop a reliable RT-PCR method using NPS specimens in adult patients.

Oncolytic virotherapies for pediatric tumors

INTRODUCTION

Many pediatric patients with malignant tumors continue to suffer poor outcomes. The current standard of care includes maximum safe surgical resection followed by chemotherapy and radiation which may be associated with considerable long-term morbidity. The emergence of oncolytic virotherapy (OVT) may provide an alternative or adjuvant treatment for pediatric oncology patients.

AREAS COVERED

We reviewed seven virus types that have been investigated in past or ongoing pediatric tumor clinical trials: adenovirus (AdV-tk, Celyvir, DNX-2401, VCN-01, Ad-TD-nsIL-12), herpes simplex virus (G207, HSV-1716), vaccinia (JX-594), reovirus (pelareorep), poliovirus (PVSRIPO), measles virus (MV-NIS), and Senecavirus A (SVV-001). For each virus, we discuss the mechanism of tumor-specific replication and cytotoxicity as well as key findings of preclinical and clinical studies.

EXPERT OPINION

Substantial progress has been made in the past 10 years regarding the clinical use of OVT. From our review, OVT has favorable safety profiles compared to chemotherapy and radiation treatment. However, the antitumor effects of OVT remain variable depending on tumor type and viral agent used. Although the widespread adoption of OVT faces many challenges, we are optimistic that OVT will play an important role alongside standard chemotherapy and radiotherapy for the treatment of malignant pediatric solid tumors in the future.

Measles, mumps and rubella vaccine 12 months after hematopoietic stem cell transplantation

The measles, mumps and rubella (MMR) vaccine is usually recommended from 24 months after a hematopoietic stem cell transplant (HSCT). Some authors have demonstrated that the MMR vaccination can be safe from 12 months post-HSCT in non-immunosuppressed patients, as recommended by the Brazilian National Immunization Program/Ministry of Health, since 2006. The objectives of this study were to evaluate when patients received MMR vaccine after an HSCT in our care service and if there were reports of any side effects. We retrospectively reviewed the records of HSCT recipients who received at least one MMR dose in our care service, a quaternary teaching hospital in Sao Paulo city, Brazil, from 2017 to 2021. We identified 82 patients: 75.6% (90.1% in the autologous group and 45.1% in the allogeneic group) were vaccinated before 23 months post-transplantation. None reported side effects following the vaccination. Our data support that the MMR vaccination is safe from 12 to 23 months after HSCT.

Opportunistic etiological agents causing lung infections: emerging need to transform lung-targeted delivery

Lung diseases continue to draw considerable attention from biomedical and public health care agencies. The lung with the largest epithelial surface area is continuously exposed to the external environment during exchanging gas. Therefore, the chances of respiratory disorders and lung infections are overgrowing. This review has covered promising and opportunistic etiologic agents responsible for lung infections. These pathogens infect the lungs either directly or indirectly. However, it is difficult to intervene in lung diseases using available oral or parenteral antimicrobial formulations. Many pieces of research have been done in the last two decades to improve inhalable antimicrobial formulations. However, very few have been approved for human use. This review article discusses the approved inhalable antimicrobial agents (AMAs) and identifies why pulmonary delivery is explored. Additionally, the basic anatomy of the respiratory system linked with barriers to AMA delivery has been discussed here. This review opens several new scopes for researchers to work on pulmonary medicines for specific diseases and bring more respiratory medication to market.

Characteristics of measles in children during the rise in incidence in 2019

In Moscow, as in Russia, in 2019 there was an increase in the incidence of measles in recent years.

Purpose: to analyze the course of measles in children hospitalized in 2019 during the period of rising incidence.

Materials and methods: a retrospective analysis and statistical processing of 30 case histories of children hospitalized with measles in the infectious diseases department of the Children's City Clinical Hospital № 9 named after G.N. Speransky in 2019.

Results: More than half of the patients were under the age of 3 years (53%). In 90% of cases, the sick were not vaccinated, in 73% – due to the refusal of their parents. Only 23% of patients had measles contact, mostly familial. Measles in hospitalized children proceeds typically, in 83.3% of cases in a moderate form, with characteristic pathognomonic symptoms: in 83.3% of patients, Belsky-Filatov-Koplik spots are detected, on average, on the 4.4 ± 0.8 day of illness, spotted – papular rash on the face with staged distribution and subsequent staged pigmentation in all patients. Complications develop in 66.7% of cases, more often pneumonia (36.7%) and obstructive bronchitis (20%), which in 16.7% of cases cause the severity of the course and lead to the development of emergency syndromes and conditions (respiratory failure, obstructive syndrome).

Conclusions. Failure to vaccinate against measles contributes to morbidity with possible complications.

Disease Progression, Clinical Features, and Risk Factors for Pneumonia in Unvaccinated Children and Adolescents with Measles: A Re-Emerging Disease in Romania

Measles causes in vaccinated children, with some exceptions, a mild disease, while the unvaccinated can suffer complications that result in serious consequences and even death. Although the introduction of the measles vaccine has reduced the number of cases and the viral spread, the current downward vaccination trend has resulted in the resurgence of the disease. Currently, Romania has a measles vaccination coverage below the 95% safety threshold. Thus, an outbreak started in 2016 and still ongoing in Romania, many cases being identified in the Western region in the pediatric population. Our objective was to conduct a thorough examination of clinical characteristics, evolution, and risk factors in vaccinated and unvaccinated children in this region. To reach our objectives we used a retrospective cohort analysis. The authors reviewed clinical and laboratory data from patients hospitalized at "Victor Babes" Hospital for Infectious Diseases and Pulmonology in Timisoara. We found a total of 136 qualifying cases of measles among the children admitted to this facility. The two comparison groups consisted of 104 children under 10 years and 32 patients between 10 and 18 years. An important characteristic of both study groups was the high prevalence of patients from the Roma ethnicity, which, although represents a minority in Romania, the prevalence was over 40% in the current study. The infection source was in 40.4% of children under 10 years inside the family, while 71.9% of infections in the group of adolescents were isolated (p-value = 0.047). The multivariate risk factor analysis identified as independent risk factors for the development of pneumonia the older age of patients (OR = 1.62), poor nutritional status (OR = 1.25), Roma ethnicity (OR = 2.44), presence of anemia (OR = 1.58), and procalcitonin (OR = 3.09). It is essential to handle these risk factors in a patient with measles, especially in conjunction with an unknown vaccination status. To achieve a vaccination rate greater than 95 percent for Romanian children, measles vaccination awareness must be promoted, moreover in the Roma population. More comprehensive preventative methods must be developed promptly with the objective of eradicating measles in Romania via a vigorous vaccination campaign.

Biological Profile and Clinical Features as Determinants for Prolonged Hospitalization in Adult Patients with Measles: A Monocentric Study in Western Romania

Measles is a highly infectious and sometimes deadly illness that is preventable with vaccination. The present research aims to analyze the most recent measles epidemic from Romania that occurred in a population with a falling desire to receive immunizations, by detailing the clinical picture and biological profile of hospitalized patients. A secondary goal of the present research is to identify characteristics that increase the likelihood of a longer hospitalization and the development of measles-related pneumonia. A retrospective cohort study was conducted to follow the course and effects of measles virus infection in adult hospitalized patients who were divided into two groups based on whether they had been in the hospital for more than 6 days or fewer than 6 days. A total of 114 adult patients with measles were eligible to participate in the trial if they had a positive measles-specific IgM antibody test resulting from the study. The average age in the short hospital stay group was 28.1 years, while the average age in the long hospital stay group was 31.9 years. There was a statistically significant difference in the number of Roma persons in the research groups, with 17.4 percent of them having a lengthy hospital stay compared to 5.9 percent in the group with a short hospital stay, according to the findings. It was observed that many patients had a long hospitalization associated with chronic lung disease (OR = 1.07), liver damage (OR = 1.66), Roma ethnicity (OR = 1.79), a long duration elapsed from the last MMR dose (OR = 2.02), elevated c-reactive protein (OR = 2.17), the presence of bilateral pulmonary condensations on X-ray (OR = 3.13), and elevated procalcitonin (OR = 3.49). The same significant independent risk factors were also associated with the development of pneumonia. It is of imperative need to address these risk factors in a patient with measles, moreover in association with an unknown status of vaccination. Vaccination awareness against measles must be pushed in Romania to determine a higher than 95% coverage. Significant efforts are still needed to ensure improved protection against measles epidemics within a specific region or population and, more importantly, in patients with significant risk factors for complications, as described in this study.

Five-Year Trend of Measles and Its Associated Factors in Pahang, Malaysia: A Population-Based Study

Measles is a disease that has resurfaced as a public health concern in Malaysia. Malaysia has had a Measles Elimination Program in place since 2004, but the incidence of measles in Pahang has not improved significantly. The purpose of this study was to describe the incidence and trend of measles in Pahang, as well as to identify the risk factors. The five-year population-based surveillance data of the entire Pahang state was extracted and analyzed for the trend and incidence of measles from January 2016 to December 2020. Multiple logistic regression was used to examine the relationship between measles and available sociodemographic data. A total of 2844 reported measles cases were investigated. Out of the measles cases reported, 7.41 percent were confirmed. According to the five-year fluctuating trend, the incidence rate ranges from 13.51 to 50.97 per 1,000,000 population. Confirmed measles was significantly associated with an indigenous background (AdjOR = 4.90, 95% CI: 1.74, 13.78), history of contact with measles cases (AdjOR = 14.03, 95% CI: 8.23, 23.90), and incomplete vaccination (AdjOR = 3.38, 95% CI: 2.28, 5.01). In conclusion, the incidence of measles in Pahang remains sporadic, owing to sporadic outbreaks. Vaccination is an important preventive measure that must reach out to the isolated populations such as indigenous people.

Measles-Rubella Positivity Rate and Associated Factors in Pre-Mass and Post-Mass Vaccination Periods: Analysis of Uganda Routine Surveillance Laboratory Data

Toward 2019, Uganda experienced an extensive outbreak of measles and rubella. The Uganda National Expanded Programme on Immunization implemented a mass measles-rubella vaccination campaign aimed at halting the ongoing transmission. This study determined the changes in the disease burden thereafter. We conducted a retrospective cross-sectional study on measles-rubella positivity and its associated factors in Uganda using 1697 case-based surveillance data for 2019 and 2020 stratified into two dispensations: prevaccination and postvaccination campaigns. Statistical tests employed in STATA 15 included chi-square, Fisher’s exact, and binomial tests. Measles positivity rates in the period before and after the mass immunization campaign were 41.88% (95% CI: 39.30–44.51) and 37.96% (95% CI: 32.81–43.40), respectively. For rubella, the positivity rate in the precampaign season was 21.73% (95% CI: 19.61–23.99) and in the postvaccination season was 6.65% (95% CI: 4.36–10.00). Binomial tests indicated that postcampaign positivity rates were significantly lower than the precampaign rate for measles ( $p=0.003$ ) and rubella ( $p<0.001$ ). Generally, age (χ2 = 58.94, $p=0.001$ /χ2 = 51.91, $p<0.001$ ) and vaccination status (χ2 = 60.48, $p=0.001$ /χ2 = 16.90, $p=0.001$ ) were associated with the measles positivity rate in both pre/postcampaign periods. Rubella positivity rate was associated with vaccination status (χ2 = 32.97, $p<0.001$ / $p=0.001$ ) in both periods and age in the precampaign season ( $p<0.001$ ). The measles-rubella mass campaign lessened rubella burden remarkably, but barely adequate change was observed in the extent of spread of measles. Children aged less than 9 months are at higher chances of testing positive amidst low vaccination levels among the eligible. The immunization programme must attain and maintain routine immunization coverage at 95% or more and roll out a second-dose measles-rubella vaccination to sustain the reduced disease burden.

The AEROsolization of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Phase I

Introduction

The degree to which Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is aerosolized has yet to be determined. The aim of this study is to prove methods of detection of aerosolization of SARS-CoV-2 in hospitalized patients in anticipation of testing for aerosolization in procedural and operative settings.

Methods

In this prospective study, inpatients with SARS-CoV-2 were identified. Demographic information was obtained, and a symptom questionnaire was completed. Polytetrafluoroethylene (PTFE) filters, which were attached to an air pump, were used to detect viral aerosolization and placed in four locations in each patient’s room. The filters were left in the rooms for a three-hour period.

Results

There were 10 patients who enrolled in the study, none of whom were vaccinated. Only two patients were more than a week from the onset of symptoms, and half of the patients received treatment for COVID with antivirals and steroids. Among ten RT-PCR positive and hospitalized patients, and four filters per patient, there was only one positive SARS-CoV-2 aerosol sample, and it was directly attached to one of the patients. Overall, there was no correlation between symptoms or symptom onset and aerosolized test result.

Conclusions

The results of this suggest that there is limited aerosolization of SARS-CoV-2 and provided proof of concept for this filter sampling technique. Further studies with increased sample size should be performed in a procedural and operative setting to provide more information about SARS-CoV-2 aerosolization.

Blood Transcriptomes of Anti-SARS-CoV-2 Antibody-Positive Healthy Individuals Who Experienced Asymptomatic Versus Clinical Infection

The reasons behind the clinical variability of SARS-CoV-2 infection, ranging from asymptomatic infection to lethal disease, are still unclear. We performed genome-wide transcriptional whole-blood RNA sequencing, bioinformatics analysis and PCR validation to test the hypothesis that immune response-related gene signatures reflecting baseline may differ between healthy individuals, with an equally robust antibody response, who experienced an entirely asymptomatic (n=17) versus clinical SARS-CoV-2 infection (n=15) in the past months (mean of 14 weeks). Among 12.789 protein-coding genes analysed, we identified six and nine genes with significantly decreased or increased expression, respectively, in those with prior asymptomatic infection relatively to those with clinical infection. All six genes with decreased expression (IFIT3, IFI44L, RSAD2, FOLR3, PI3, ALOX15), are involved in innate immune response while the first two are interferon-induced proteins. Among genes with increased expression six are involved in immune response (GZMH, CLEC1B, CLEC12A), viral mRNA translation (GCAT), energy metabolism (CACNA2D2) and oxidative stress response (ENC1). Notably, 8/15 differentially expressed genes are regulated by interferons. Our results suggest that subtle differences at baseline expression of innate immunity-related genes may be associated with an asymptomatic disease course in SARS-CoV-2 infection. Whether a certain gene signature predicts, or not, those who will develop a more efficient immune response upon exposure to SARS-CoV-2, with implications for prioritization for vaccination, warrant further study.

Between virus correlations in the outcome of infection across host species: Evidence of virus by host species interactions

Virus host shifts are a major source of outbreaks and emerging infectious diseases, and predicting the outcome of novel host and virus interactions remains a key challenge for virus research. The evolutionary relationships between host species can explain variation in transmission rates, virulence, and virus community composition between hosts, but it is unclear if correlations exist between related viruses in infection traits across novel hosts. Here, we measure correlations in viral load of four Cripavirus isolates across experimental infections of 45 Drosophilidae host species. We find positive correlations between every pair of viruses tested, suggesting that some host clades show broad susceptibility and could act as reservoirs and donors for certain types of viruses. Additionally, we find evidence of virus by host species interactions, highlighting the importance of both host and virus traits in determining the outcome of virus host shifts. Of the four viruses tested here, those that were more closely related tended to be more strongly correlated, providing tentative evidence that virus evolutionary relatedness may be a useful proxy for determining the likelihood of novel virus emergence, which warrants further research.

Using a Harm Reduction Model to Reduce Barriers to Vaccine Administration

Vaccination is a strategic public health measure designed to reduce the adverse effects of many infectious diseases. Although national recommendations exist for vaccine administration across the life span, immunization rates are affected by barriers to vaccine access and hesitancy in vaccine acceptance. Midwives and women's health clinicians are optimally poised to assess their client's vaccination status and provide vaccinations during clinical encounters. In order to address client concerns about vaccine safety and administration, each clinician is expected to be knowledgeable about vaccine benefits, recommendations, side effects, and potential adverse reactions. Socioeconomic factors, social policies, and historic and continued experiences related to racism have been identified as barriers to ready access to vaccinations and vaccine acceptance. Midwives can act as leaders within their practice sites and communities through participation in projects that reduce barriers to vaccine access and uptake. Community vaccine outreach programs and relationship-based care can increase vaccine uptake through improved health literacy and associated behavioral changes including greater vaccine acceptance. This article focuses on identifying barriers to vaccine uptake and describing harm reduction measures designed to improve uptake of vaccines. A variety of leadership activities are discussed that can improve clinicians' understanding of their role in optimizing vaccination.

Gastrointestinal cytomegalovirus disease secondary to measles in an immunocompetent infant

Yang et al reported an immunocompetent infant with gastrointestinal cytomegalovirus disease secondary to measles infection. We express our opinion about the diagnosis and treatment of this rare disease.

Post-partum Hospital Stay and Mothers' Choices on Breastfeeding and Vaccines: A Chance We Should Not Miss

Parents' education and knowledge regarding major topics of children's health, such as nutrition and vaccines, have a paramount role. However, breastfeeding rates in first year of life are lower than recommended, and vaccine hesitancy is progressively spreading. To reverse this harmful trend, healthcare professionals are challenged to promote correct health information. This study aimed to assess newly mothers' knowledge of breastfeeding and vaccinations, and education received on both topics during hospital stay. We performed a cross-sectional survey in the Postnatal Unit of our Center. Mothers of full-term babies with a birthweight >2,500 g were enrolled. Two different questionnaires, one about breastfeeding and one about vaccines, were proposed to the 140 enrolled mothers. Ninety-nine percent of mothers enrolled were aware of breastfeeding benefits, and 92% felt adequately supported by maternity staff. Less than 25% stated to have received sufficient information regarding breastfeeding. Only 20% of mothers received information about vaccines during hospital stay. Healthcare providers were identified as primary, secondary, and tertiary source of information on vaccines by 55, 15, and 30% of mothers, respectively. Healthcare professionals are crucial in informing and educating mothers on breastfeeding and vaccinations. Post-partum hospital stay could be the right time for this critical responsibility.

Trough Concentrations of Specific Antibodies in Primary Immunodeficiency Patients Receiving Intravenous Immunoglobulin Replacement Therapy

Immunoglobulin replacement therapy is a mainstay therapy for patients with primary immunodeficiency (PID). The content of these preparations was studied extensively. Nevertheless, data regarding the effective specific antibodies content (especially in the nadir period), and, in different groups of PID patients is limited. We studied trough IgG concentrations as well as anti-Pneumococcus, anti-Haemophilus influenzae b, anti-Tetanus, and anti-Measles antibody concentrations in 17 PID patients receiving intravenous immunoglobulin (IVIg) compared with healthy controls matched for age and ethnicity. We also analyzed these results according to the specific PID diagnosis: X-linked agammaglobulinemia (XLA), combined immunodeficiency (CID), and ataxia telangiectasia (AT). We recorded a higher concentration of anti-pneumococcal polysaccharide antibodies in healthy controls compared to the entire group of PID patients. We also found significantly higher anti-tetanus toxoid antibody concentrations in the XLA patients, compared to CID patients. Anti-Haemophilus Influenzae b antibody titers were overall similar between all the groups. Interestingly, there were overall low titers of anti-Measles antibodies below protective cutoff antibody concentrations in most patients as well as in healthy controls. We conclude that relying on total IgG trough levels is not necessarily a reflection of effective specific antibodies in the patient’s serum. This is especially relevant to CID patients who may have production of nonspecific antibodies. In such patients, a higher target trough IgG concentration should be considered. Another aspect worth considering is that the use of plasma from adult donors with a waning immunity for certain pathogens probably affects the concentrations of specific antibodies in IVIg preparations.

Emergent Pneumonia in Children

In recent decades there have been multiple pathogens, viruses and bacteria, which have emerged as causal agents of pneumonia affecting adults, albeit less frequently, to children. For the purposes of this article we have classified emerging pathogens as follows: True emerging, to pathogens identified for the very first time affecting human population (SARS-CoV-1, SARS-CoV-2, MERS-CoV, avian influenza, and hantavirus); Re-emerging, to known pathogens which circulation was controlled once, but they have reappeared (measles, tuberculosis, antimicrobial resistant bacteria such as CA-MRSA, Mycoplasma pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and new serotypes of post-vaccine pneumococcal); and finally, those that we have called old known with new presentations, including common pathogens that, in particular condition, have changed their form of presentation (rhinovirus, and non-SARS coronavirus). We will review for each of them their epidemiology, forms of presentation, therapy, and prognosis in children compared to the adult with the aim of being able to recognize them to establish appropriate therapy, prognostics, and effective control measures.

Host Cell Restriction Factors of Paramyxoviruses and Pneumoviruses

The paramyxo- and pneumovirus family includes a wide range of viruses that can cause respiratory and/or systemic infections in humans and animals. The significant disease burden of these viruses is further exacerbated by the limited therapeutics that are currently available. Host cellular proteins that can antagonize or limit virus replication are therefore a promising area of research to identify candidate molecules with the potential for host-targeted therapies. Host proteins known as host cell restriction factors are constitutively expressed and/or induced in response to virus infection and include proteins from interferon-stimulated genes (ISGs). Many ISG proteins have been identified but relatively few have been characterized in detail and most studies have focused on studying their antiviral activities against particular viruses, such as influenza A viruses and human immunodeficiency virus (HIV)-1. This review summarizes current literature regarding host cell restriction factors against paramyxo- and pneumoviruses, on which there is more limited data. Alongside discussion of known restriction factors, this review also considers viral countermeasures in overcoming host restriction, the strengths and limitations in different experimental approaches in studies reported to date, and the challenges in reconciling differences between in vitro and in vivo data. Furthermore, this review provides an outlook regarding the landscape of emerging technologies and tools available to study host cell restriction factors, as well as the suitability of these proteins as targets for broad-spectrum antiviral therapeutics.

Increasing Measles Seroprevalence in a Sample of Pediatric and Adolescent Population of Tuscany (Italy): A Vaccination Campaign Success

Background: Despite the National Plan for the Elimination of Measles and congenital Rubella (NPEMcR), in 2017, a measles outbreak occurred in Italy, due to sub-optimal vaccination coverage (<95%) for many years. Since that year, the anti-measles vaccination became compulsory in minors (0–16 years) for school attendance. The aim of our study was to assess the immunity/susceptibility against measles in a representative sample of pediatric and adolescent (1–18 years) residents of the province of Florence (Tuscany, Italy), and to compare these results with two previous surveys (2003 and 2005–2006). Methods: The enzyme-linked immunosorbent assay (ELISA) was applied for a qualitative measurement of anti-measles antibodies on 165 sera. The anamnestic and vaccination status was also collected. Results: No measles notification was reported. The overall seropositivity was 88.5%; mostly in the 5–9 years old subjects (97.9%). Among the 152 vaccinated, 92.1% were positive. The seropositivity persisted after many years since the last dose of vaccine and tended to be more long-lasting in those who had received two or three doses. The susceptibility towards measles decreased over time, reaching a lower value in the current survey (8.5%) than in 2003 (30.8%) and in 2005–2006 (25.5%). Conclusions: This study confirmed the anti-measles vaccination campaign success, which allowed for the increase in vaccination coverage and immunity levels against measles in the Florentine pediatric and adolescent population following the NPEMcR implementation.

Evaluating the population measles susceptibility in Tianjin, China

BACKGROUND

Measles is a highly infectious illness requiring herd immunity of 95% to interrupt transmission. China has not reached elimination goals despite high vaccination coverage. We estimated the population susceptibility against measles in Tianjin, China and to tailor awareness raising activities in the measles elimination plan.

METHODS

Age-specific measles seroprevalence was evaluated by Enzyme-Linked Immunosorbent Assay (ELISA) on 12,164 individual aged 0-44 years in 2009-2018. Measles IgG avidity testing was performed to confirm the relationship of the waning immunity after vaccination and secondary vaccination failures (SVF) on 324 confirmed measles cases in 2013-2018.

RESULTS

11,108 samples (91.32%) tested positive for measles IgG, 239 (1.96%) tested as equivocal and 817 (6.72%) were negative. The age distribution of measles cases in Tianjin followed a U-shaped curve and was highest for those at <8 months and again at 20-39 years which correlated closely with the age distribution of measles susceptibility based on measles IgG antibody status (r = 0.72, P < 0.001). The seropositivity rate and antibody geometric mean concentration (GMC) for the 2018 study population were significantly lower (χ² = 7.45, P = 0.006 and t = 12.01, P < 0.001) compared to 2009. The multivariate stepwise logistic regression analysis showed that age and region were the risk factors for both measles seropositivity rate and GMC after vaccination. The proportion of high avidity cases increased with age, being significantly higher in 75.31% of cases in patients aged 30-34 years (χ² = 18.04, P = 0.003).

CONCLUSIONS

High immunization coverage in children alone will not be adequate to realizing sufficient levels of population herd immunity, particularly given that the potential susceptibility window in adult. Implementation of supplemental immunization activity (SIA) targeted to appropriate group aged 30-34 years is recommended.