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Adigweme I, Yisa M, Ooko M, Akpalu E, Bruce A, Donkor S, Jarju LB, Danso B, Mendy A, Jeffries D, Segonds-Pichon A, Njie A, Crooke S, El-Badry E, Johnstone H, Royals M, Goodson JL, Prausnitz MR, McAllister DV, Rota PA, Henry S, Clarke E. A measles and rubella vaccine microneedle patch in The Gambia: a phase 1/2, double-blind, double-dummy, randomised, active-controlled, age de-escalation trial. Lancet 2024:S0140-6736(24)00532-4. [PMID: 38697170 DOI: 10.1016/s0140-6736(24)00532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Microneedle patches (MNPs) have been ranked as the highest global priority innovation for overcoming immunisation barriers in low-income and middle-income countries. This trial aimed to provide the first data on the tolerability, safety, and immunogenicity of a measles and rubella vaccine (MRV)-MNP in children. METHODS This single-centre, phase 1/2, double-blind, double-dummy, randomised, active-controlled, age de-escalation trial was conducted in The Gambia. To be eligible, all participants had to be healthy according to prespecified criteria, aged 18-40 years for the adult cohort, 15-18 months for toddlers, or 9-10 months for infants, and to be available for visits throughout the follow-up period. The three age cohorts were randomly assigned in a 2:1 ratio (adults) or 1:1 ratio (toddlers and infants) to receive either an MRV-MNP (Micron Biomedical, Atlanta, GA, USA) and a placebo (0·9% sodium chloride) subcutaneous injection, or a placebo-MNP and an MRV subcutaneous injection (MRV-SC; Serum Institute of India, Pune, India). Unmasked staff ransomly assigned the participants using an online application, and they prepared visually identical preparations of the MRV-MNP or placebo-MNP and MRV-SC or placebo-SC, but were not involved in collecting endpoint data. Staff administering the study interventions, participants, parents, and study staff assessing trial endpoints were masked to treatment allocation. The safety population consists of all vaccinated participants, and analysis was conducted according to route of MRV administration, irrespective of subsequent protocol deviations. The immunogenicity population consisted of all vaccinated participants who had a baseline and day 42 visit result available, and who had no protocol deviations considered to substantially affect the immunogenicity endpoints. Solicited local and systemic adverse events were collected for 14 days following vaccination. Unsolicited adverse events were collected to day 180. Age de-escalation between cohorts was based on the review of the safety data to day 14 by an independent data monitoring committee. Serum neutralising antibodies to measles and rubella were measured at baseline, day 42, and day 180. Analysis was descriptive and included safety events, seroprotection and seroconversion rates, and geometric mean antibody concentrations. The trial was registered with the Pan African Clinical Trials Registry PACTR202008836432905, and is complete. FINDINGS Recruitment took place between May 18, 2021, and May 27, 2022. 45 adults, 120 toddlers, and 120 infants were randomly allocated and vaccinated. There were no safety concerns in the first 14 days following vaccination in either adults or toddlers, and age de-escalation proceeded accordingly. In infants, 93% (52/56; 95% CI 83·0-97·2) seroconverted to measles and 100% (58/58; 93·8-100) seroconverted to rubella following MRV-MNP administration, while 90% (52/58; 79·2-95·2) and 100% (59/59; 93·9-100) seroconverted to measles and rubella respectively, following MRV-SC. Induration at the MRV-MNP application site was the most frequent local reaction occurring in 46 (77%) of 60 toddlers and 39 (65%) of 60 infants. Related unsolicited adverse events, most commonly discolouration at the application site, were reported in 35 (58%) of 60 toddlers and 57 (95%) of 60 infants that had received the MRV-MNP. All local reactions were mild. There were no related severe or serious adverse events. INTERPRETATION The safety and immunogenicity data support the accelerated development of the MRV-MNP. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ikechukwu Adigweme
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Mohammed Yisa
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Michael Ooko
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Edem Akpalu
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Andrew Bruce
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Simon Donkor
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Lamin B Jarju
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Baba Danso
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Anthony Mendy
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - David Jeffries
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Anne Segonds-Pichon
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Abdoulie Njie
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Stephen Crooke
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elina El-Badry
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - James L Goodson
- Global Immunization Division, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Ed Clarke
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia.
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Mathis AD, Raines K, Masters NB, Filardo TD, Kim G, Crooke SN, Bankamp B, Rota PA, Sugerman DE. Measles - United States, January 1, 2020-March 28, 2024. MMWR Morb Mortal Wkly Rep 2024; 73:295-300. [PMID: 38602886 PMCID: PMC11008791 DOI: 10.15585/mmwr.mm7314a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Measles is a highly infectious febrile rash illness and was declared eliminated in the United States in 2000. However, measles importations continue to occur, and U.S. measles elimination status was threatened in 2019 as the result of two prolonged outbreaks among undervaccinated communities in New York and New York City. To assess U.S. measles elimination status after the 2019 outbreaks and to provide context to understand more recent increases in measles cases, CDC analyzed epidemiologic and laboratory surveillance data and the performance of the U.S. measles surveillance system after these outbreaks. During January 1, 2020-March 28, 2024, CDC was notified of 338 confirmed measles cases; 97 (29%) of these cases occurred during the first quarter of 2024, representing a more than seventeenfold increase over the mean number of cases reported during the first quarter of 2020-2023. Among the 338 reported cases, the median patient age was 3 years (range = 0-64 years); 309 (91%) patients were unvaccinated or had unknown vaccination status, and 336 case investigations included information on ≥80% of critical surveillance indicators. During 2020-2023, the longest transmission chain lasted 63 days. As of the end of 2023, because of the absence of sustained measles virus transmission for 12 consecutive months in the presence of a well-performing surveillance system, U.S. measles elimination status was maintained. Risk for widespread U.S. measles transmission remains low because of high population immunity. However, because of the increase in cases during the first quarter of 2024, additional activities are needed to increase U.S. routine measles, mumps, and rubella vaccination coverage, especially among close-knit and undervaccinated communities. These activities include encouraging vaccination before international travel and rapidly investigating suspected measles cases.
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Affiliation(s)
- Adria D. Mathis
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Kelley Raines
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Nina B. Masters
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Thomas D. Filardo
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Gimin Kim
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Stephen N. Crooke
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Bettina Bankamp
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Paul A. Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - David E. Sugerman
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
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Senin A, Noordin NM, Sani JAM, Mahat D, Donadel M, Scobie HM, Omar A, Chem YK, Zahari MI, Ismail F, Rahman RA, Hussin HM, Selvanesan S, Aziz ZA, Arifin WNAWM, Bakar RSA, Rusli N, Zailani MH, Soo P, Lo YR, Grabovac V, Rota PA, Mulders MN, Featherstone D, Warrener L, Brown DW. A measles IgM rapid diagnostic test to address challenges with national measles surveillance and response in Malaysia. PLoS One 2024; 19:e0298730. [PMID: 38483868 PMCID: PMC10939268 DOI: 10.1371/journal.pone.0298730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION A lateral flow rapid diagnostic test (RDT) enables detection of measles specific immunoglobulin M (IgM) antibody in serum, capillary blood, and oral fluid with accuracy consistent with enzyme immunoassay (EIA). The objectives of the study were: 1) to assess measles RDT inter-reader agreement between two clinic staff; 2) to assess the sensitivity and specificity of the measles RDT relative to standard surveillance testing in a low transmission setting; 3) to evaluate the knowledge, attitudes, and practices of staff in clinics using the RDT; and 4) to assess the impact of RDT testing on the measles public health response in Malaysia. MATERIALS AND METHODS The clinic-based prospective evaluation included all suspected measles cases captured by routine measles surveillance at 34 purposely selected clinics in 15 health districts in Malaysia between September 2019 and June 2020, following day-long regional trainings on RDT use. Following informed consent, four specimens were collected from each suspected case, including those routinely collected for standard surveillance [serum for EIA and throat swabs for quantitative reverse transcriptase polymerase chain reaction (RT-qPCR)] together with capillary blood and oral fluid tested with RDTs during the study. RDT impact was evaluated by comparing the rapidity of measles public health response between the pre-RDT implementation (December 2018 to August 2019) and RDT implementation periods (September 2019 to June 2020). To assess knowledge, attitudes, and practices of RDT use, staff involved in the public health management of measles at the selected sites were surveyed. RESULTS Among the 436 suspect cases, agreement of direct visual readings of measles RDT devices between two health clinic staff was 99% for capillary blood (k = 0.94) and 97% for oral fluid (k = 0.90) specimens. Of the total, 45 (10%) were positive by measles IgM EIA (n = 44, including five also positive by RT-qPCR) or RT-qPCR only (n = 1), and 38 were positive by RDT (using either capillary blood or oral fluid). Using measles IgM EIA or RT-qPCR as reference, RDT sensitivity using capillary blood was 43% (95% CI: 30%-58%) and specificity was 98% (95% CI: 96%-99%); using oral fluid, sensitivity (26%, 95% CI: 15%-40%) and specificity (97%, 95% CI: 94%-98%) were lower. Nine months after training, RDT knowledge was high among staff involved with the public health management of measles (average quiz score of 80%) and was highest among those who received formal training (88%), followed by those trained during supervisory visits (83%). During the RDT implementation period, the number of days from case confirmation until initiation of public response decreased by about 5 days. CONCLUSION The measles IgM RDT shows >95% inter-reader agreement, high retention of RDT knowledge, and a more rapid public health response. However, despite ≥95% RDT specificity using capillary blood or oral fluid, RDT sensitivity was <45%. Higher-powered studies using highly specific IgM assays and systematic RT-qPCR for case confirmation are needed to establish the role of RDT in measles elimination settings.
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Affiliation(s)
- A’aisah Senin
- Disease Control Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Noorliza M. Noordin
- Disease Control Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Jamiatul A. M. Sani
- Disease Control Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Diana Mahat
- Disease Control Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Morgane Donadel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Heather M. Scobie
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Aziyati Omar
- National Public Health Laboratory, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Yu K. Chem
- National Public Health Laboratory, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Mohamad I. Zahari
- Disease Control Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Fatanah Ismail
- Family Health Development Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Rozita A. Rahman
- Family Health Development Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Hani M. Hussin
- Disease Control Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Sengol Selvanesan
- National Public Health Laboratory, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Zirwatul A. Aziz
- National Public Health Laboratory, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | | | - Rehan S. A. Bakar
- National Public Health Laboratory, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Rusli
- Disease Control Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - M. Hanif Zailani
- Disease Control Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Paul Soo
- Office of the World Health Organization Representative to Malaysia, Brunei Darussalam and Singapore, Cyberjaya, Malaysia
| | - Ying-Ru Lo
- Office of the World Health Organization Representative to Malaysia, Brunei Darussalam and Singapore, Cyberjaya, Malaysia
| | - Varja Grabovac
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Paul A. Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Mick N. Mulders
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Lenesha Warrener
- Public Health Microbiology Division, United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - David W. Brown
- Public Health Microbiology Division, United Kingdom Health Security Agency (UKHSA), London, United Kingdom
- Laboratório de Vírus Respiratórios e do Sarampo, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
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Yousaf I, Hannon WW, Donohue RC, Pfaller CK, Yadav K, Dikdan RJ, Tyagi S, Schroeder DC, Shieh WJ, Rota PA, Feder AF, Cattaneo R. Brain tropism acquisition: The spatial dynamics and evolution of a measles virus collective infectious unit that drove lethal subacute sclerosing panencephalitis. PLoS Pathog 2023; 19:e1011817. [PMID: 38127684 PMCID: PMC10735034 DOI: 10.1371/journal.ppat.1011817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023] Open
Abstract
It is increasingly appreciated that pathogens can spread as infectious units constituted by multiple, genetically diverse genomes, also called collective infectious units or genome collectives. However, genetic characterization of the spatial dynamics of collective infectious units in animal hosts is demanding, and it is rarely feasible in humans. Measles virus (MeV), whose spread in lymphatic tissues and airway epithelia relies on collective infectious units, can, in rare cases, cause subacute sclerosing panencephalitis (SSPE), a lethal human brain disease. In different SSPE cases, MeV acquisition of brain tropism has been attributed to mutations affecting either the fusion or the matrix protein, or both, but the overarching mechanism driving brain adaptation is not understood. Here we analyzed MeV RNA from several spatially distinct brain regions of an individual who succumbed to SSPE. Surprisingly, we identified two major MeV genome subpopulations present at variable frequencies in all 15 brain specimens examined. Both genome types accumulated mutations like those shown to favor receptor-independent cell-cell spread in other SSPE cases. Most infected cells carried both genome types, suggesting the possibility of genetic complementation. We cannot definitively chart the history of the spread of this virus in the brain, but several observations suggest that mutant genomes generated in the frontal cortex moved outwards as a collective and diversified. During diversification, mutations affecting the cytoplasmic tails of both viral envelope proteins emerged and fluctuated in frequency across genetic backgrounds, suggesting convergent and potentially frequency-dependent evolution for modulation of fusogenicity. We propose that a collective infectious unit drove MeV pathogenesis in this brain. Re-examination of published data suggests that similar processes may have occurred in other SSPE cases. Our studies provide a primer for analyses of the evolution of collective infectious units of other pathogens that cause lethal disease in humans.
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Affiliation(s)
- Iris Yousaf
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, United States of America
| | - William W. Hannon
- Basic Sciences and Computational Biology, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
- Molecular and Cellular Biology Graduate Program, University of Washington, Seattle, Washington, United States of America
| | - Ryan C. Donohue
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, United States of America
| | - Christian K. Pfaller
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, United States of America
| | - Kalpana Yadav
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ryan J. Dikdan
- Public Health Research Institute, Rutgers University, Newark, New Jersey, United States of America
| | - Sanjay Tyagi
- Public Health Research Institute, Rutgers University, Newark, New Jersey, United States of America
| | - Declan C. Schroeder
- Department of Veterinary Population Medicine, University of Minnesota, St Paul, Minnesota, United States of America
| | - Wun-Ju Shieh
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Center for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Paul A. Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Center for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alison F. Feder
- Genome Sciences, University of Washington, Seattle, Washington, United States of America
- Public Health Sciences and Computational Biology, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Roberto Cattaneo
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, United States of America
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Minta AA, Ferrari M, Antoni S, Portnoy A, Sbarra A, Lambert B, Hatcher C, Hsu CH, Ho LL, Steulet C, Gacic-Dobo M, Rota PA, Mulders MN, Bose AS, Caro WP, O’Connor P, Crowcroft NS. Progress Toward Measles Elimination - Worldwide, 2000-2022. MMWR Morb Mortal Wkly Rep 2023; 72:1262-1268. [PMID: 37971951 PMCID: PMC10684353 DOI: 10.15585/mmwr.mm7246a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Measles is a highly contagious, vaccine-preventable disease that requires high population immunity for transmission to be interrupted. All six World Health Organization regions have committed to eliminating measles; however, no region has achieved and sustained measles elimination. This report describes measles elimination progress during 2000-2022. During 2000-2019, estimated coverage worldwide with the first dose of measles-containing vaccine (MCV) increased from 72% to 86%, then declined to 81% in 2021 during the COVID-19 pandemic, representing the lowest coverage since 2008. In 2022, first-dose MCV coverage increased to 83%. Only one half (72) of 144 countries reporting measles cases achieved the measles surveillance indicator target of two or more discarded cases per 100,000 population in 2022. During 2021-2022, estimated measles cases increased 18%, from 7,802,000 to 9,232,300, and the number of countries experiencing large or disruptive outbreaks increased from 22 to 37. Estimated measles deaths increased 43% during 2021-2022, from 95,000 to 136,200. Nonetheless, an estimated 57 million measles deaths were averted by vaccination during 2000-2022. In 2022, measles vaccination coverage and global surveillance showed some recovery from the COVID-19 pandemic setbacks; however, coverage declined in low-income countries, and globally, years of suboptimal immunization coverage left millions of children unprotected. Urgent reversal of coverage setbacks experienced during the COVID-19 pandemic can be accomplished by renewing efforts to vaccinate all children with 2 MCV doses and strengthening surveillance, thereby preventing outbreaks and accelerating progress toward measles elimination.
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Melot L, Bankamp B, Rota PA, Coughlin MM. Characterizing infection of B cells with wild-type and vaccine strains of measles virus. iScience 2023; 26:107721. [PMID: 37736039 PMCID: PMC10510084 DOI: 10.1016/j.isci.2023.107721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/14/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023] Open
Abstract
Acute infection with measles virus (MeV) causes transient immunosuppression often leading to secondary infections. MeV infection of B lymphocytes results in changes in the antibody repertoire and memory B cell populations for which the mechanism is unknown. In this study, we characterize the infection of primary B cells with wild-type and vaccine strains of MeV. Vaccine-infected B cells were characterized by a higher percentage of cells positive for viral protein, a higher level of viral transcription and reduced cell death compared to wild-type infected cells, regardless of B cell subtype. Vaccine-infected cells showed more production of TNF-α and IL-10 but less production of IL-8 compared to wild-type infected cells. IL-4 and IL-6 levels detected were increased during both vaccine and wild-type infection. Despite evidence of replication, measles-infected B cells did not produce detectable viral progeny. This study furthers our understanding of the outcomes of MeV infection of human B cells.
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Affiliation(s)
- Logan Melot
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Emory University, Atlanta, GA 303333, USA
| | - Bettina Bankamp
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Paul A. Rota
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Emory University, Atlanta, GA 303333, USA
| | - Melissa M. Coughlin
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Masters NB, Beck AS, Mathis AD, Leung J, Raines K, Paul P, Stanley SE, Weg AL, Pieracci EG, Gearhart S, Jumabaeva M, Bankamp B, Rota PA, Sugerman DE, Gastañaduy PA. Measles virus transmission patterns and public health responses during Operation Allies Welcome: a descriptive epidemiological study. Lancet Public Health 2023; 8:e618-e628. [PMID: 37516478 PMCID: PMC10411127 DOI: 10.1016/s2468-2667(23)00130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND On Aug 29, 2021, Operation Allies Welcome (OAW) was established to support the resettlement of more than 80 000 Afghan evacuees in the USA. After identification of measles among evacuees, incoming evacuee flights were temporarily paused, and mass measles vaccination of evacuees aged 6 months or older was introduced domestically and overseas, with a 21-day quarantine period after vaccination. We aimed to evaluate patterns of measles virus transmission during this outbreak and the impact of control measures. METHODS We conducted a measles outbreak investigation among Afghan evacuees who were resettled in the USA as part of OAW. Patients with measles were defined as individuals with an acute febrile rash illness between Aug 29, 2021, and Nov 26, 2021, and either laboratory confirmation of infection or epidemiological link to a patient with measles with laboratory confirmation. We analysed the demographics and clinical characteristics of patients with measles and used epidemiological information and whole-genome sequencing to track transmission pathways. A transmission model was used to evaluate the effects of vaccination and other interventions. FINDINGS 47 people with measles (attack rate: 0·65 per 1000 evacuees) were reported in six US locations housing evacuees in four states. The median age of patients was 1 year (range 0-26); 33 (70%) were younger than 5 years. The age distribution shifted during the outbreak towards infants younger than 12 months. 20 (43%) patients with wild-type measles virus had rash onset after vaccination. No fatalities or community spread were identified, nor further importations after flight resumption. In a non-intervention scenario, transmission models estimated that a median of 5506 cases (IQR 10-5626) could have occurred. Infection clusters based on epidemiological criteria could be delineated into smaller clusters using phylogenetic analyses; however, sequences with few substitution count differences did not always indicate single lines of transmission. INTERPRETATION Implementation of control measures limited measles transmission during OAW. Our findings highlight the importance of integration between epidemiological and genetic information in discerning between individual lines of transmission in an elimination setting. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Nina B Masters
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Andrew S Beck
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adria D Mathis
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kelley Raines
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Prabasaj Paul
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Scott E Stanley
- Office of the Joint Staff Surgeon, The Joint Staff, Department of Defense, Washington, DC, USA
| | - Alden L Weg
- Office of the Joint Staff Surgeon, The Joint Staff, Department of Defense, Washington, DC, USA
| | - Emily G Pieracci
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon Gearhart
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Madina Jumabaeva
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Bettina Bankamp
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David E Sugerman
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul A Gastañaduy
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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8
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Minta AA, Ferrari M, Antoni S, Portnoy A, Sbarra A, Lambert B, Hauryski S, Hatcher C, Nedelec Y, Datta D, Ho LL, Steulet C, Gacic-Dobo M, Rota PA, Mulders MN, Bose AS, Perea WA, O’Connor P. Progress Toward Regional Measles Elimination - Worldwide, 2000-2021. MMWR Morb Mortal Wkly Rep 2022; 71:1489-1495. [PMID: 36417303 PMCID: PMC9707362 DOI: 10.15585/mmwr.mm7147a1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
All six World Health Organization (WHO) regions have committed to eliminating measles.* The Immunization Agenda 2021-2030 (IA2030)† aims to achieve the regional targets as a core indicator of impact and positions measles as the tracer of a health system's ability to deliver essential childhood vaccines. IA2030 highlights the importance of ensuring rigorous measles surveillance systems to document immunity gaps and achieve 95% coverage with 2 timely doses of measles-containing vaccine (MCV) among children. This report describes progress toward measles elimination during 2000-2021 and updates a previous report (1). During 2000-2021, estimated global coverage with a first MCV dose (MCV1) increased from 72% to a peak of 86% in 2019, but decreased during the COVID-19 pandemic to 83% in 2020 and to 81% in 2021, the lowest MCV1 coverage recorded since 2008. All countries conducted measles surveillance, but only 47 (35%) of 135 countries reporting discarded cases§ achieved the sensitivity indicator target of two or more discarded cases per 100,000 population in 2021, indicating surveillance system underperformance in certain countries. Annual reported measles incidence decreased 88% during 2000-2016, from 145 to 18 cases per 1 million population, then rebounded to 120 in 2019 during a global resurgence (2), before declining to 21 in 2020 and to 17 in 2021. Large and disruptive outbreaks were reported in 22 countries. During 2000-2021, the annual number of estimated measles deaths decreased 83%, from 761,000 to 128,000; an estimated 56 million measles deaths were averted by vaccination. To regain progress and achieve regional measles elimination targets during and after the COVID-19 pandemic, accelerating targeted efforts is necessary to reach all children with 2 MCV doses while implementing robust surveillance and identifying and closing immunity gaps to prevent cases and outbreaks.
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Dollard S, Chen MH, Lindstrom S, Marin M, Rota PA. Diagnostic and Immunologic Testing for Varicella in the Era of High-Impact Varicella Vaccination: An Evolving Problem. J Infect Dis 2022; 226:S450-S455. [PMID: 36265850 DOI: 10.1093/infdis/jiac363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The clinical presentation of varicella in unvaccinated persons, with skin vesicles and scabs, has facilitated the use of rapid diagnostic methods for confirming disease. Polymerase chain reaction (PCR) assays are the diagnostic method of choice. The sharp decline in unmodified cases of varicella due to the US varicella vaccination program has led to fewer healthcare providers being familiar with varicella presentation and an increased reliance on laboratory diagnosis to confirm suspected cases. The mild, atypical presentation of the disease in vaccinated persons (fewer skin lesions, mostly maculopapular) has made it more challenging for providers to recognize and also to collect samples to detect the virus. Nonetheless, PCR is highly sensitive and specific in confirming modified disease if adequate samples are provided. While a positive PCR result is confirmatory, interpreting a negative result can prove to be more challenging in determining whether suspected varicella is falsely negative or attributable to other causes. Enhanced education of healthcare providers is critical for adequate specimen collection from modified varicella cases. In addition, more sensitive commercial serologic assays are needed in the United States for varicella immunity testing in the vaccine era.
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Affiliation(s)
- Sheila Dollard
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min-Hsin Chen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen Lindstrom
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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Adigweme I, Akpalu E, Yisa M, Donkor S, Jarju LB, Danso B, Mendy A, Jeffries D, Njie A, Bruce A, Royals M, Goodson JL, Prausnitz MR, McAllister D, Rota PA, Henry S, Clarke E. Study protocol for a phase 1/2, single-centre, double-blind, double-dummy, randomized, active-controlled, age de-escalation trial to assess the safety, tolerability and immunogenicity of a measles and rubella vaccine delivered by a microneedle patch in healthy adults (18 to 40 years), measles and rubella vaccine-primed toddlers (15 to 18 months) and measles and rubella vaccine-naïve infants (9 to 10 months) in The Gambia [Measles and Rubella Vaccine Microneedle Patch Phase 1/2 Age De-escalation Trial]. Trials 2022; 23:775. [PMID: 36104719 PMCID: PMC9472726 DOI: 10.1186/s13063-022-06493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New strategies to increase measles and rubella vaccine coverage, particularly in low- and middle-income countries, are needed if elimination goals are to be achieved. With this regard, measles and rubella vaccine microneedle patches (MRV-MNP), in which the vaccine is embedded in dissolving microneedles, offer several potential advantages over subcutaneous delivery. These include ease of administration, increased thermostability, an absence of sharps waste, reduced overall costs and pain-free administration. This trial will provide the first clinical trial data on MRV-MNP use and the first clinical vaccine trial of MNP technology in children and infants. METHODS This is a phase 1/2, randomized, active-controlled, double-blind, double-dummy, age de-escalation trial. Based on the defined eligibility criteria for the trial, including screening laboratory investigations, 45 adults [18-40 years] followed by 120 toddlers [15-18 months] and 120 infants [9-10 months] will be enrolled in series. To allow double-blinding, participants will receive either the MRV-MNP and a placebo (0.9% sodium chloride) subcutaneous (SC) injection or a placebo MNP and the MRV by SC injection (MRV-SC). Local and systemic adverse event data will be collected for 14 days following study product administration. Safety laboratories will be repeated on day 7 and, in the adult cohort alone, on day 14. Unsolicited adverse events including serious adverse events will be collected until the final study visit for each participant on day 180. Measles and rubella serum neutralizing antibodies will be measured at baseline, on day 42 and on day 180. Cohort progression will be dependent on review of the unblinded safety data by an independent data monitoring committee. DISCUSSION This trial will provide the first clinical data on the use of a MNP to deliver the MRV and the first data on the use of MNPs in a paediatric population. It will guide future product development decisions for what may be a key technology for future measles and rubella elimination. TRIAL REGISTRATION Pan-African Clinical Trials Registry 202008836432905 . CLINICALTRIALS gov NCT04394689.
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Affiliation(s)
- Ikechukwu Adigweme
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Edem Akpalu
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Mohammed Yisa
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Simon Donkor
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Lamin B Jarju
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Baba Danso
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Anthony Mendy
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - David Jeffries
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Abdoulie Njie
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Andrew Bruce
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia
| | - Michael Royals
- Micron Biomedical, Inc, 311 Ferst Dr, NW, Suite L1309, Atlanta, GA, 30332, USA
| | - James L Goodson
- Accelerated Disease Control Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark R Prausnitz
- Micron Biomedical, Inc, 311 Ferst Dr, NW, Suite L1309, Atlanta, GA, 30332, USA
| | - Devin McAllister
- Micron Biomedical, Inc, 311 Ferst Dr, NW, Suite L1309, Atlanta, GA, 30332, USA
| | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sebastien Henry
- Micron Biomedical, Inc, 311 Ferst Dr, NW, Suite L1309, Atlanta, GA, 30332, USA
| | - Ed Clarke
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia.
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11
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Durrheim DN, Baker MG, Capeding MR, Goh KT, Lee D, Papania M, Rota PA, Soo TL, Tsang TH, Xu A. Accelerating measles elimination in the Western Pacific Region during the calm between the storms. Lancet Reg Health West Pac 2022; 23:100495. [PMID: 35663430 PMCID: PMC9153286 DOI: 10.1016/j.lanwpc.2022.100495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- David N. Durrheim
- Chairperson: Western Pacific Measles and Rubella Elimination Regional Verification Commission, Professor of Public Health Medicine, University of Newcastle, Wallsend, New South Wales, Australia
- Corresponding author.
| | - Michael G. Baker
- Professor of Public Health, University of Otago, Wellington, New Zealand
| | - Maria Rosario Capeding
- Head Department of Pediatric Infectious Diseases, Asian Hospital and Medical Centre, Muntinlupa City, Philippines
| | - Kee Tai Goh
- Adjunct Professor of Public Health, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Dukhyoung Lee
- Invited Professor, International Tuberculosis Research Centre, Gyeongsangnam-do, Republic of Korea
| | - Mark Papania
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Paul A. Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Thian Lian Soo
- Clinical Associate Professor, International Medical University, Malaysia
| | - Thomas H. Tsang
- President, Hong Kong College of Community Medicine, Hong Kong Special Administrative Region, China
| | - Aiqiang Xu
- Chief Expert in Epidemiology, Shangdong Center for Disease Prevention and Control, Jinan, Shandong Province, People's Republic of China
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12
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Masters NB, Mathis AD, Leung J, Raines K, Clemmons NS, Miele K, Balajee SA, Lanzieri TM, Marin M, Christensen DL, Clarke KR, Cruz MA, Gallagher K, Gearhart S, Gertz AM, Grady-Erickson O, Habrun CA, Kim G, Kinzer MH, Miko S, Oberste MS, Petras JK, Pieracci EG, Pray IW, Rosenblum HG, Ross JM, Rothney EE, Segaloff HE, Shepersky LV, Skrobarcek KA, Stadelman AM, Sumner KM, Waltenburg MA, Weinberg M, Worrell MC, Bessette NE, Peake LR, Vogt MP, Robinson M, Westergaard RP, Griesser RH, Icenogle JP, Crooke SN, Bankamp B, Stanley SE, Friedrichs PA, Fletcher LD, Zapata IA, Wolfe HO, Gandhi PH, Charles JY, Brown CM, Cetron MS, Pesik N, Knight NW, Alvarado-Ramy F, Bell M, Talley LE, Rotz LD, Rota PA, Sugerman DE, Gastañaduy PA, Ahluwalia IB, Akinkugbe OA, Aranas A, Arons M, Atherstone C, Bampoe V, Bessler P, Bligh L, Bonner K, Bowen VB, Broadwater K, Brunette GW, Brunkard JM, Burns DA, Cantrell M, Christensen BE, Cope JR, Cory J, Crawford NE, Daigle D, Daly SM, Dejonge P, Dualeh M, Dunn KH, Eidex RB, Elgethun K, Fajardo G, Fonseca-Ford M, Franc K, Gaines J, George N, Goodson J, Green C, Grober AJ, Hailu K, Hammond DR, Harcourt BH, Hess A, Hesse E, Hirst DV, Hornsby-Myers J, Humrighouse B, Ishaq M, Ishii K, James A, Jayapaul-Philip B, Jentes ES, Johnson L, Johnston M, Jolley CD, Kacha-Ochana A, Kaur H, Keaveney M, Kelly HC, Krishnasamy V, Kumar GS, Larkin M, Layde M, LeBouf RF, Lee D, Lira RC, Lopez R, Lozier MJ, Macler A, Mainzer H, Malden D, Malenfant J, Marano N, Marsh Z, Mayer O, McDonald R, Mehta N, Menon AN, Meyer E, Miles ST, Minhaj F, Mirza S, Moller KM, Morris SB, Neu DT, Oakley LP, Ocasio DV, Osborne T, Ou AC, Peck M, Person M, Posey D, Pullia A, Qi C, Raziano AJ, Richmond-Crum M, Roohi S, Saindon JM, Sami S, Sanchez-Gonzalez L, Schweitzer R, Schwitters AM, Shamout M, Shockey CE, Shragai T, Singler KB, Sison EJ, Smith D, Smith M, Sood NJ, Sunshine BJ, Trujillo A, Vallabhaneni S, Wickson A, Yoder JS, Zambuto LR, Cozzarelli T, Rice M, Ricks M, Birchfield JS, Nambiar A, Avrakatos A, Ballard TP, Dennis E, Gambino-Shirley K, Huston AE, Jennings MG, Oldham DM, Rabener MJ, Fandre MN, Jablonka RJ, Love A, Peduzzi OL, Snow K, Greer JA, Hughes CA, Humphreys MA, Korduba AB, Neamand-Cheney KA, Pritchard NL, Smith AM, Whelpley JL, Adekoya S, Alexander V, Davis M, Falk J, Kurkjian K, McCarty E, Moss J, Myrick-West A, Patel C, Pruitt R, Saady D, Sockwell D, Touma A, Wheawill S, Woolard D, Young A, Griffin-Thomas L, Kelly S, McLeod J, Lambert MC, Danz TL, Davis T, Guenther K, Hanson E. Public Health Actions to Control Measles Among Afghan Evacuees During Operation Allies Welcome - United States, September-November 2021. MMWR Morb Mortal Wkly Rep 2022; 71:592-596. [PMID: 35482557 PMCID: PMC9098237 DOI: 10.15585/mmwr.mm7117a2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
On August 29, 2021, the United States government oversaw the emergent establishment of Operation Allies Welcome (OAW), led by the U.S. Department of Homeland Security (DHS) and implemented by the U.S. Department of Defense (DoD) and U.S. Department of State (DoS), to safely resettle U.S. citizens and Afghan nationals from Afghanistan to the United States. Evacuees were temporarily housed at several overseas locations in Europe and Asia* before being transported via military and charter flights through two U.S. international airports, and onward to eight U.S. military bases,† with hotel A used for isolation and quarantine of persons with or exposed to certain infectious diseases.§ On August 30, CDC issued an Epi-X notice encouraging public health officials to maintain vigilance for measles among Afghan evacuees because of an ongoing measles outbreak in Afghanistan (25,988 clinical cases reported nationwide during January-November 2021) (1) and low routine measles vaccination coverage (66% and 43% for the first and second doses, respectively, in 2020) (2).
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13
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Joyce JC, Collins ML, Rota PA, Prausnitz MR. Thermostability of Measles and Rubella Vaccines in a Microneedle Patch. Adv Ther (Weinh) 2021; 4. [PMID: 34926791 DOI: 10.1002/adtp.202100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Measles and rubella vaccinations are highly effective at reducing disease prevalence; however, logistic issues related to subcutaneous administration and vaccine wastage limit the extent of vaccination coverage. Microneedle (MN) patches can increase coverage by easing logistics through simplified administration and improved stability. This study demonstrates the thermostability of a bivalent measles and rubella vaccine MN patch. Rubella vaccine stability required pH buffering during drying; potassium phosphate buffer at neutral pH was optimal for both vaccines. Screening 43 excipients for their ability to retain potency during drying and storage yielded sucrose-threonine-potassium phosphate buffer formulation at pH 7.5 as an optimal formulation. MN patches made with this formulation had no significant loss of vaccine titer after one month and remained within a one log10 titer loss cutoff after 3 - 4 months at 5°C, 25°C and 40°C. Finally, these patches were shown to be immunogenic in juvenile rhesus macaques. This work demonstrates the potential for MN patches for measles and rubella vaccination to be removed from the cold chain, which is expected to decrease vaccine cost and wastage, and increase vaccination coverage.
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Affiliation(s)
- Jessica C Joyce
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, 314 Ferst Drive NW, Atlanta, GA 30332
| | - Marcus L Collins
- Centers for Disease Control and Prevention, Viral Vaccine Preventable Diseases Branch, 1600 Clifton Rd. M/S C22, Atlanta, GA 30333
| | - Paul A Rota
- Centers for Disease Control and Prevention, Viral Vaccine Preventable Diseases Branch, 1600 Clifton Rd. M/S C22, Atlanta, GA 30333
| | - Mark R Prausnitz
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, 314 Ferst Drive NW, Atlanta, GA 30332
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14
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Mathis AD, Clemmons NS, Redd SB, Pham H, Leung J, Wharton AK, Anderson R, McNall RJ, Rausch-Phung E, Rosen JB, Blog D, Zucker JR, Bankamp B, Rota PA, Patel M, Gastañaduy PA. Maintenance of measles elimination status in the United States for 20 years despite increasing challenges. Clin Infect Dis 2021; 75:416-424. [PMID: 34849648 DOI: 10.1093/cid/ciab979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Measles elimination (interruption of endemic measles virus transmission) in the United States was declared in 2000; however, the number of cases and outbreaks have increased in recent years. We characterized the epidemiology of measles outbreaks and measles transmission patterns post-elimination to identify potential gaps in the U.S. measles control program. METHODS We analyzed national measles notification data from January 1, 2001-December 31, 2019. We defined measles infection clusters as single cases (isolated cases not linked to additional cases), 2-case clusters, or outbreaks with 3 or more linked cases. We calculated the effective reproduction number (R) to assess changes in transmissibility and reviewed molecular epidemiology data. RESULTS During 2001-2019, 3,873 measles cases, including 747 international importations, were reported in the United States; 29% of importations were associated with outbreaks. Among 871 clusters, 69% were single cases and 72% had no spread. Larger and longer clusters were reported since 2013, including seven outbreaks with >50 cases lasting >2 months, 5 of which occurred in known underimmunized, close-knit communities. No measles lineage circulated in a single transmission chain for >12 months. Higher estimates of R were noted in recent years, although R remained below the epidemic threshold of 1. CONCLUSIONS Current epidemiology continues to support the interruption of endemic measles virus transmission in the United States. However, larger and longer outbreaks in recent post-elimination years and emerging trends of increased transmission in underimmunized communities emphasize the need for targeted approaches to close existing immunity gaps and maintain measles elimination.
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Affiliation(s)
- Adria D Mathis
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Nakia S Clemmons
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Susan B Redd
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Huong Pham
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Adam K Wharton
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Raydel Anderson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Rebecca J McNall
- Division of Laboratory Systems, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Elizabeth Rausch-Phung
- New York State Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237, USA
| | - Jennifer B Rosen
- New York City Department of Health and Mental Hygiene, 42-09 28 th St, Long Island City, NY 11101, USA
| | - Debra Blog
- New York State Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237, USA
| | - Jane R Zucker
- New York City Department of Health and Mental Hygiene, 42-09 28 th St, Long Island City, NY 11101, USA.,Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Bettina Bankamp
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Manisha Patel
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Paul A Gastañaduy
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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15
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Dixon MG, Ferrari M, Antoni S, Li X, Portnoy A, Lambert B, Hauryski S, Hatcher C, Nedelec Y, Patel M, Alexander JP, Steulet C, Gacic-Dobo M, Rota PA, Mulders MN, Bose AS, Rosewell A, Kretsinger K, Crowcroft NS. Progress Toward Regional Measles Elimination - Worldwide, 2000-2020. MMWR Morb Mortal Wkly Rep 2021; 70:1563-1569. [PMID: 34758014 PMCID: PMC8580203 DOI: 10.15585/mmwr.mm7045a1] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Gastañaduy PA, Goodson JL, Panagiotakopoulos L, Rota PA, Orenstein WA, Patel M. Measles in the 21st Century: Progress Toward Achieving and Sustaining Elimination. J Infect Dis 2021; 224:S420-S428. [PMID: 34590128 PMCID: PMC8482021 DOI: 10.1093/infdis/jiaa793] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The global measles vaccination program has been extraordinarily successful in reducing measles-related disease and deaths worldwide. Eradication of measles is feasible because of several key attributes, including humans as the only reservoir for the virus, broad access to diagnostic tools that can rapidly detect measles-infectious persons, and availability of highly safe and effective measles-containing vaccines (MCVs). All 6 World Health Organization (WHO) regions have established measles elimination goals. Globally, during 2000–2018, measles incidence decreased by 66% (from 145 to 49 cases per million population) and deaths decreased by 73% (from 535 600 to 142 300), drastically reducing global disease burden. Routine immunization with MCV has been the cornerstone for the control and prevention of measles. Two doses of MCV are 97% effective in preventing measles, qualifying MCV as one of the most effective vaccines ever developed. Mild adverse events occur in <20% of recipients and serious adverse events are extremely rare. The economic benefits of measles vaccination are highlighted by an overall return on investment of 58 times the cost of the vaccine, supply chains, and vaccination. Because measles is one of the most contagious human diseases, maintenance of high (≥95%) 2-dose MCV coverage is crucial for controlling the spread of measles and successfully reaching measles elimination; however, the plateauing of global MCV coverage for nearly a decade and the global measles resurgence during 2018–2019 demonstrate that much work remains. Global commitments to increase community access to and demand for immunizations, strengthen national and regional partnerships for building public health infrastructure, and implement innovations that can overcome access barriers and enhance vaccine confidence, are essential to achieve a world free of measles.
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Affiliation(s)
- Paul A Gastañaduy
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James L Goodson
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lakshmi Panagiotakopoulos
- Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Walt A Orenstein
- Emory University and the Emory Vaccine Center, Atlanta, Georgia, USA
| | - Manisha Patel
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Tinker SC, Szablewski CM, Litvintseva AP, Drenzek C, Voccio GE, Hunter MA, Briggs S, Heida DE, Folster J, Shewmaker PL, Medrzycki M, Bowen MD, Bohannon C, Bagarozzi D, Petway M, Rota PA, Kuhnert-Tallman W, Thornburg N, Prince-Guerra JL, Barrios LC, Tamin A, Harcourt JL, Honein MA. Point-of-Care Antigen Test for SARS-CoV-2 in Asymptomatic College Students. Emerg Infect Dis 2021; 27:2662-2665. [PMID: 34399086 PMCID: PMC8462309 DOI: 10.3201/eid2710.210080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We used the BinaxNOW COVID-19 Ag Card to screen 1,540 asymptomatic college students for severe acute respiratory syndrome coronavirus 2 in a low-prevalence setting. Compared with reverse transcription PCR, BinaxNOW showed 20% overall sensitivity; among participants with culturable virus, sensitivity was 60%. BinaxNOW provides point-of-care screening but misses many infections.
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18
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Melot L, Coughlin M, Rota PA, Bankamp B. Characterizing infection of B lymphocytes with vaccine and wild-type strains of measles virus. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.114.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
Wild-type (w.t.) measles virus (MeV) infection can result in immunosuppression that does not occur following vaccination. A rhesus macaque model indicated that B cells are a target of infection. The role of B cell infection in MeV-induced immune suppression is not fully understood. We characterize the differences in viral replication in human B cells infected with vaccine (Edmonston Zagreb [EZ]) or w.t. virus.
B cells from healthy donor blood were infected (MOI 1.0) with a GFP-expressing EZ virus or a w.t. virus to evaluate viral replication after 24 and 48 hours. The number of GFP+ cells (EZ infected) or hemagglutinin (H)+ cells (w.t. infected) was measured via flow cytometry. Transcription of the viral nucleoprotein (N) gene was measured by mRNA-specific cDNA generation and N gene specific qPCR. Production of infectious viral particles was measured via endpoint dilution.
In B cells infected with EZ, 30% of cells expressed GFP at 24 hours and 45% of cells expressed GFP at 48 hours. There was a 4.4-fold increase in N gene transcription from 0 to 48 hours. There was no detectable increase in viral titer over input after 48 hours. In B cells infected with w.t. virus, 10% of cells expressed viral H at 24 hours with no increase in H expression at 48 hours. The w.t. virus had a 2.4-fold increase in viral transcription from 0 to 48 hours. There was no detectable increase in viral titer over input after 48 hours.
MeV-infected B cells show viral protein production and N gene transcription at 24 and 48 hours. However, w.t. virus replication may be less efficient as shown by lower percentages of H+ cells at 24 and 48 hours and lower levels of N gene transcription at 48 hours. There is no evidence of infectious virus production by either strain of MeV despite evidence of replication.
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19
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Martin KG, Banerjee E, McMahon M, Kenyon C, Strain A, Halstead Muscoplat M, Gastañaduy PA, Rota PA, Mody RK, Ehresmann K. Identifying Vaccine-associated Rash Illness Amidst a Large Measles Outbreak: Minnesota, 2017. Clin Infect Dis 2021; 71:e517-e519. [PMID: 32067029 DOI: 10.1093/cid/ciaa168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/14/2020] [Indexed: 11/13/2022] Open
Abstract
Characteristics of vaccine-associated rash illness (VARI) and confirmed measles cases were compared during a measles outbreak. Although some clinical differences were noted, measles exposure and identification of the vaccine strain were helpful for public health decision-making. Rapid, vaccine strain-specific diagnostic assays will more efficiently distinguish VARI from measles.
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Affiliation(s)
- Karen G Martin
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Emily Banerjee
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | | | - Cynthia Kenyon
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Anna Strain
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | | | - Paul A Gastañaduy
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rajal K Mody
- Minnesota Department of Health, St. Paul, Minnesota, USA.,Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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20
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Bolotin S, Hughes SL, Gul N, Khan S, Rota PA, Severini A, Hahné S, Tricco A, Moss WJ, Orenstein W, Turner N, Durrheim D, Heffernan JM, Crowcroft N. What Is the Evidence to Support a Correlate of Protection for Measles? A Systematic Review. J Infect Dis 2021; 221:1576-1583. [PMID: 31674648 DOI: 10.1093/infdis/jiz380] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/22/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many studies assume that the serologic correlate of protection from measles disease is 120 mIU/mL. We systematically reviewed the literature to examine the evidence supporting this correlate of protection. METHODS We searched peer-reviewed and gray literature for articles reporting a measles correlate of protection. We excluded studies focusing on special populations, infants aged <9 months, and those using animal models or nonstandard vaccines or administration routes. We extracted and synthesized data from full-text articles that met inclusion criteria. RESULTS We screened 14 778 articles and included 5 studies in our review. The studies reported either preexposure antibody concentrations of individuals along with a description of symptoms postexposure, or the proportion of measles cases that had preexposure antibody concentrations above a threshold of immunity specified by the authors. Some studies also described secondary antibody responses upon exposure. The variation in laboratory methods between studies made comparisons difficult. Some of the studies that assumed 120 mIU/mL as a correlate of protection identified symptomatic individuals with preexposure titers exceeding this threshold. CONCLUSIONS Our findings underscore the scant data upon which the commonly used 120 mIU/mL measles threshold of protection is based, suggesting that further work is required to characterize the measles immunity threshold.
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Affiliation(s)
- Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Nazish Gul
- Public Health Ontario, Toronto, Ontario, Canada
| | | | - Paul A Rota
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alberto Severini
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Susan Hahné
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Andrea Tricco
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Walter Orenstein
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nikki Turner
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Science, University of Auckland, Tamaki Campus, Auckland, New Zealand
| | | | - Jane M Heffernan
- Centre for Disease Modelling, Mathematics and Statistics, York University,, Toronto, Ontario, Canada
| | - Natasha Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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21
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Prince-Guerra JL, Almendares O, Nolen LD, Gunn JKL, Dale AP, Buono SA, Deutsch-Feldman M, Suppiah S, Hao L, Zeng Y, Stevens VA, Knipe K, Pompey J, Atherstone C, Bui DP, Powell T, Tamin A, Harcourt JL, Shewmaker PL, Medrzycki M, Wong P, Jain S, Tejada-Strop A, Rogers S, Emery B, Wang H, Petway M, Bohannon C, Folster JM, MacNeil A, Salerno R, Kuhnert-Tallman W, Tate JE, Thornburg NJ, Kirking HL, Sheiban K, Kudrna J, Cullen T, Komatsu KK, Villanueva JM, Rose DA, Neatherlin JC, Anderson M, Rota PA, Honein MA, Bower WA. Evaluation of Abbott BinaxNOW Rapid Antigen Test for SARS-CoV-2 Infection at Two Community-Based Testing Sites - Pima County, Arizona, November 3-17, 2020. MMWR Morb Mortal Wkly Rep 2021; 70:100-105. [PMID: 33476316 PMCID: PMC7821766 DOI: 10.15585/mmwr.mm7003e3] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Patel MK, Goodson JL, Alexander JP, Kretsinger K, Sodha SV, Steulet C, Gacic-Dobo M, Rota PA, McFarland J, Menning L, Mulders MN, Crowcroft NS. Progress Toward Regional Measles Elimination - Worldwide, 2000-2019. MMWR Morb Mortal Wkly Rep 2020; 69:1700-1705. [PMID: 33180759 PMCID: PMC7660667 DOI: 10.15585/mmwr.mm6945a6] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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23
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Venkat H, Briggs G, Brady S, Komatsu K, Hill C, Leung J, Patel M, Livar E, Su CP, Kassem A, Sowers SB, Mercader S, Rota PA, Elson D, Timme E, Robinson S, Fitzpatrick K, Franco J, Hickman C, Gastañaduy PA. Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016. Clin Infect Dis 2020; 68:2018-2025. [PMID: 30256908 DOI: 10.1093/cid/ciy819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/20/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We describe a measles outbreak and control measures implemented at a privately operated detention facility housing US Immigration and Customs Enforcement detainees in 2016. METHODS Case-patients reported fever and rash and were either laboratory-confirmed or had an epidemiological link to a laboratory-confirmed case-patient. Immunoglobulin G (IgG) avidity and plaque reduction neutralization tests distinguished between primary acute and reinfection case-patients. Measles-specific IgG was measured to assess detainee immunity levels. We compared attack rates (ARs) among detainees and staff, between IgG-negative and IgG-positive detainees, and by detainee housing units and sexes. RESULTS We identified 32 measles case-patients (23 detainees, 9 staff); rash onsets were during 6 May-26 June 2016. High IgG avidity and neutralizing-antibody titers >40000 to measles (indicating reinfection) were identified in 18 (95%) and 15 (84%) of 19 tested case-patients, respectively. Among 205 unit A detainees tested for presumptive immunity, 186 (91%) had detectable IgG. Overall, the AR was 1.65%. ARs were significantly higher among detainees in unit A (7.05%) compared with units B-F (0.59%), and among male (2.33%) compared with female detainees (0.38%); however, ARs were not significantly different between detainees and staff or between IgG-negative and IgG-positive detainees. Control measures included the vaccination of 1424 of 1425 detainees and 190 of 510 staff, immunity verification for 445 staff, case-patient isolation, and quarantine of affected units. CONCLUSIONS Although ARs were low, measles outbreaks can occur in intense-exposure settings, despite a high population immunity, underscoring the importance of high vaccination coverage and containment in limiting measles transmission.
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Affiliation(s)
- Heather Venkat
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia.,Arizona Department of Health Services.,Maricopa County Department of Public Health, Phoenix
| | - Graham Briggs
- Pinal County Public Health Services District, Florence, Arizona
| | | | | | - Clancey Hill
- Pinal County Public Health Services District, Florence, Arizona
| | - Jessica Leung
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manisha Patel
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Chia-Ping Su
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia.,National Institutes of Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
| | - Ahmed Kassem
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia.,Idaho Department of Health and Welfare, Boise
| | - Sun B Sowers
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sara Mercader
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diana Elson
- United States Immigration and Customs Enforcement, Washington, D.C
| | - Evan Timme
- Pinal County Public Health Services District, Florence, Arizona
| | | | | | - Jabette Franco
- Pinal County Public Health Services District, Florence, Arizona
| | - Carole Hickman
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul A Gastañaduy
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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24
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Lawson B, Suppiah S, Rota PA, Hickman CJ, Latner DR. In vitro inhibition of mumps virus replication by favipiravir (T-705). Antiviral Res 2020; 180:104849. [PMID: 32553844 DOI: 10.1016/j.antiviral.2020.104849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/21/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022]
Abstract
During the last decade multiple mumps outbreaks have occurred in the U.S. despite high two dose MMR coverage with most cases detected among two dose MMR vaccine recipients. Waning immunity, the evolution of wild-type virus strains, and settings with intense exposure have contributed to the resurgence of mumps. Typically, mumps virus infections resolve without serious clinical sequelae; however, serious complications may occur among unvaccinated or severely immunocompromised individuals. Favipiravir (T-705) has been shown to have in vitro anti-viral activity against a broad range of positive and negative strand RNA viruses. Here, we demonstrate that T-705 inhibits the growth of wildtype and vaccine strains of mumps virus in vitro at low micro-molar concentrations (EC50 8-10μM). We did not observe the development of resistance after five subsequent passages at low concentrations of drug. Both viral RNA and protein synthesis were selectively reduced compared to host mRNA and protein synthesis. Antiviral treatment options for mumps virus infection may be valuable, especially for areas with a high disease burden or for cases with severe complications. These results presented here suggest that further studies are warranted.
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Affiliation(s)
- Benton Lawson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suganthi Suppiah
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carole J Hickman
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Donald R Latner
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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25
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Marine RL, Magaña LC, Castro CJ, Zhao K, Montmayeur AM, Schmidt A, Diez-Valcarce M, Ng TFF, Vinjé J, Burns CC, Nix WA, Rota PA, Oberste MS. Comparison of Illumina MiSeq and the Ion Torrent PGM and S5 platforms for whole-genome sequencing of picornaviruses and caliciviruses. J Virol Methods 2020; 280:113865. [PMID: 32302601 PMCID: PMC9119587 DOI: 10.1016/j.jviromet.2020.113865] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/04/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
Next-generation sequencing is a powerful tool for virological surveillance. While Illumina® and Ion Torrent® sequencing platforms are used extensively for generating viral RNA genome sequences, there is limited data comparing different platforms. The Illumina MiSeq, Ion Torrent PGM and Ion Torrent S5 platforms were evaluated using a panel of sixteen specimens containing picornaviruses and human caliciviruses (noroviruses and sapoviruses). The specimens were processed, using combinations of three library preparation and five sequencing kits, to assess the quality and completeness of assembled viral genomes, and an estimation of cost per sample to generate the data was calculated. The choice of library preparation kit and sequencing platform was found to impact the breadth of genome coverage and accuracy of consensus viral genomes. The Ion Torrent S5 510 chip runs produced more reads at a lower cost per sample than the highest output Ion Torrent PGM 318 chip run, and generated the highest proportion of reads for enterovirus D68 samples. However, indels at homopolymer regions impacted the accuracy of consensus genome sequences. For lower throughput sequencing runs (i.e., Ion Torrent 510 and Illumina MiSeq Nano V2), the cost per sample was lower on the MiSeq platform, whereas with higher throughput runs (Ion Torrent 530 and Illumina MiSeq V2) there is less of a difference in the cost per sample between the two sequencing platforms ($5.47-$10.25 more per sample for an Ion Torrent 530 chip run when multiplexing 24 samples). These findings suggest that the Ion Torrent S5 and Illumina MiSeq platforms are both viable options for genomic sequencing of RNA viruses, each with specific advantages and tradeoffs.
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Affiliation(s)
- Rachel L Marine
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Laura C Magaña
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Christina J Castro
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Kun Zhao
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Marta Diez-Valcarce
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Terry Fei Fan Ng
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cara C Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Allan Nix
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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26
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Brown DW, Warrener L, Scobie HM, Donadel M, Waku-Kouomou D, Mulders MN, Rota PA. Rapid diagnostic tests to address challenges for global measles surveillance. Curr Opin Virol 2020; 41:77-84. [PMID: 32615510 PMCID: PMC7492366 DOI: 10.1016/j.coviro.2020.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 12/13/2022]
Abstract
Recently, a lateral flow rapid diagnostic test (RDT) with good accuracy has been described. This test enables measles specific IgM antibody detection in serum, capillary blood and oral fluid. RDTs have the potential to transform measles surveillance by allowing real-time case confirmation outside of central/regional laboratories and by facilitating a timely public health response. Measles virus genes can also be amplified and sequenced consistently from dried IgM-positive RDTs stored outside of cold chain, which will enable more complete virologic surveillance. Critical questions remain regarding operational use of RDTs as part of global measles surveillance. Projects to evaluate RDT use as part of national surveillance programs and to commercialize the RDT are underway.
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Affiliation(s)
- David W Brown
- Virus Reference Department, National Infection Service, Public Health England, London, UK; Laboratório de Vírus Respiratórios e do Sarampo, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Lenesha Warrener
- Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - Heather M Scobie
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Morgane Donadel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mick N Mulders
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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27
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Prausnitz MR, Goodson JL, Rota PA, Orenstein WA. A microneedle patch for measles and rubella vaccination: a game changer for achieving elimination. Curr Opin Virol 2020; 41:68-76. [PMID: 32622318 PMCID: PMC7497860 DOI: 10.1016/j.coviro.2020.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/10/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
While morbidity and mortality associated with measles and rubella (MR) have dramatically decreased, there are still >100000 estimated deaths due to measles and an estimated 100000 infants born with congenital rubella syndrome annually. Given highly effective MR vaccines, the primary barrier to global elimination of these diseases is low vaccination coverage, especially among the most underserved populations in resource-limited settings. In contrast to conventional MR vaccination by hypodermic injection, microneedle patches are being developed to enable MR vaccination by minimally trained personnel. Simplified supply chain, reduced need for cold chain storage, elimination of vaccine reconstitution, no sharps waste, reduced vaccine wastage, and reduced total system cost of vaccination are advantages of this approach. Preclinical work to develop a MR vaccine patch has proceeded through successful immunization studies in rodents and non-human primates. On-going programs seek to make MR vaccine patches available to support MR elimination efforts around the world.
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Affiliation(s)
- Mark R Prausnitz
- School of Chemical & Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, GA 30332, USA.
| | - James L Goodson
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Paul A Rota
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
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28
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McNall RJ, Wharton AK, Anderson R, Clemmons N, Lopareva EN, Gonzalez C, Espinosa A, Probert WS, Hacker JK, Liu G, Garfin J, Strain AK, Boxrud D, Bryant PW, George KS, Davis T, Griesser RH, Shult P, Bankamp B, Hickman CJ, Wroblewski K, Rota PA. Genetic characterization of mumps viruses associated with the resurgence of mumps in the United States: 2015-2017. Virus Res 2020; 281:197935. [PMID: 32194138 DOI: 10.1016/j.virusres.2020.197935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/07/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
Despite high coverage with measles, mumps, and rubella vaccine in the United States, outbreaks of mumps occur in close contact settings such as schools, colleges, and camps. Starting in late 2015, outbreaks were reported from several universities, and by the end of 2017, greater than 13,800 cases had been reported nation-wide. In 2013, the CDC and the Association of Public Health Laboratories contracted four Vaccine Preventable Diseases Reference Centers (VPD-RCs) to perform real-time reverse transcription PCR (RT-qPCR) to detect mumps RNA in clinical samples and to determine the genotype. Twelve genotypes of mumps virus are currently recognized by the World Health Organization, and the standard protocol for genotyping requires sequencing the entire gene coding for the small hydrophobic (SH) protein. Phylogenetic analysis of the 1862 mumps samples genotyped from 2015 through 2017 showed that the overall diversity of genotypes detected was low. Only 0.8 % of the sequences were identified as genotypes C, H, J, or K, and 0.5 % were identified as vaccine strains in genotypes A or N, while most sequences (98.7 %) were genotype G. The majority of the genotype G sequences could be included into one of two large groups with identical SH sequences. Within genotype G, a small number of phylogenetically significant outlier sequences were associated with epidemiologically distinct chains of transmission. These results demonstrate that molecular and epidemiologic data can be used to track transmission pathways of mumps virus; however, the limited diversity of the SH sequences may be insufficient for resolving transmission in all outbreaks.
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Affiliation(s)
- Rebecca J McNall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam K Wharton
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Raydel Anderson
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nakia Clemmons
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elena N Lopareva
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Alex Espinosa
- California Department of Public Health, Richmond, CA, USA
| | | | - Jill K Hacker
- California Department of Public Health, Richmond, CA, USA
| | - Gongping Liu
- Minnesota Department of Health, St Paul, MN, USA
| | - Jacob Garfin
- Minnesota Department of Health, St Paul, MN, USA
| | | | - David Boxrud
- Minnesota Department of Health, St Paul, MN, USA
| | - Patrick W Bryant
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Kirsten St George
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Timothy Davis
- Wisconsin State Laboratory of Hygiene, Madison, University of Wisconsin, WI, USA
| | - Richard H Griesser
- Wisconsin State Laboratory of Hygiene, Madison, University of Wisconsin, WI, USA
| | - Peter Shult
- Wisconsin State Laboratory of Hygiene, Madison, University of Wisconsin, WI, USA
| | - Bettina Bankamp
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carole J Hickman
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kelly Wroblewski
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Wohl S, Metsky HC, Schaffner SF, Piantadosi A, Burns M, Lewnard JA, Chak B, Krasilnikova LA, Siddle KJ, Matranga CB, Bankamp B, Hennigan S, Sabina B, Byrne EH, McNall RJ, Shah RR, Qu J, Park DJ, Gharib S, Fitzgerald S, Barreira P, Fleming S, Lett S, Rota PA, Madoff LC, Yozwiak NL, MacInnis BL, Smole S, Grad YH, Sabeti PC. Combining genomics and epidemiology to track mumps virus transmission in the United States. PLoS Biol 2020; 18:e3000611. [PMID: 32045407 PMCID: PMC7012397 DOI: 10.1371/journal.pbio.3000611] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/03/2020] [Indexed: 01/24/2023] Open
Abstract
Unusually large outbreaks of mumps across the United States in 2016 and 2017 raised questions about the extent of mumps circulation and the relationship between these and prior outbreaks. We paired epidemiological data from public health investigations with analysis of mumps virus whole genome sequences from 201 infected individuals, focusing on Massachusetts university communities. Our analysis suggests continuous, undetected circulation of mumps locally and nationally, including multiple independent introductions into Massachusetts and into individual communities. Despite the presence of these multiple mumps virus lineages, the genomic data show that one lineage has dominated in the US since at least 2006. Widespread transmission was surprising given high vaccination rates, but we found no genetic evidence that variants arising during this outbreak contributed to vaccine escape. Viral genomic data allowed us to reconstruct mumps transmission links not evident from epidemiological data or standard single-gene surveillance efforts and also revealed connections between apparently unrelated mumps outbreaks.
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Affiliation(s)
- Shirlee Wohl
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Hayden C. Metsky
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Stephen F. Schaffner
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Anne Piantadosi
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Meagan Burns
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, United States of America
| | - Joseph A. Lewnard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Bridget Chak
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Lydia A. Krasilnikova
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Katherine J. Siddle
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Christian B. Matranga
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Bettina Bankamp
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Scott Hennigan
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, United States of America
| | - Brandon Sabina
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, United States of America
| | - Elizabeth H. Byrne
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Rebecca J. McNall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rickey R. Shah
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - James Qu
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Daniel J. Park
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Soheyla Gharib
- Harvard University Health Services, Harvard University, Cambridge, Massachusetts, United States of America
| | - Susan Fitzgerald
- Harvard University Health Services, Harvard University, Cambridge, Massachusetts, United States of America
| | - Paul Barreira
- Harvard University Health Services, Harvard University, Cambridge, Massachusetts, United States of America
| | - Stephen Fleming
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, United States of America
| | - Susan Lett
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, United States of America
| | - Paul A. Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lawrence C. Madoff
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, United States of America
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Nathan L. Yozwiak
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Bronwyn L. MacInnis
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sandra Smole
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, United States of America
| | - Yonatan H. Grad
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- Center for Communicable Disease Dynamics, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Pardis C. Sabeti
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- Howard Hughes Medical Institute, Chevy Chase, Maryland, United States of America
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Badizadegan K, Goodson JL, Rota PA, Thompson KM. The potential role of using vaccine patches to induce immunity: platform and pathways to innovation and commercialization. Expert Rev Vaccines 2020; 19:175-194. [PMID: 32182145 PMCID: PMC7814398 DOI: 10.1080/14760584.2020.1732215] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/12/2020] [Indexed: 01/14/2023]
Abstract
Introduction: In the last two decades, the evidence related to using vaccine patches with multiple short projections (≤1 mm) to deliver vaccines through the skin increased significantly and demonstrated their potential as an innovative delivery platform.Areas covered: We review the vaccine patch literature published in English as of 1 March 2019, as well as available information from key stakeholders related to vaccine patches as a platform. We identify key research topics related to basic and translational science on skin physical properties and immunobiology, patch development, and vaccine manufacturing.Expert opinion: Currently, vaccine patch developers continue to address some basic science and other platform issues in the context of developing a potential vaccine patch presentation for an existing or new vaccine. Additional clinical data and manufacturing experience could shift the balance toward incentivizing existing vaccine manufactures to further explore the use of vaccine patches to deliver their products. Incentives for innovation of vaccine patches differ for developed and developing countries, which will necessitate different strategies (e.g. public-private partnerships, push, or pull mechanisms) to support the basic and applied research needed to ensure a strong evidence base and to overcome translational barriers for vaccine patches as a delivery platform.
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Affiliation(s)
| | - James L Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Patel M, Lee AD, Clemmons NS, Redd SB, Poser S, Blog D, Zucker JR, Leung J, Link‐Gelles R, Pham H, Arciuolo RJ, Rausch‐Phung E, Bankamp B, Rota PA, Weinbaum CM, Gastañaduy PA. National update on measles cases and outbreaks — United States, January 1 – October 1, 2019. Am J Transplant 2020. [DOI: 10.1111/ajt.15728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Manisha Patel
- Division of Viral Diseases National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Adria D. Lee
- Division of Viral Diseases National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Nakia S. Clemmons
- Division of Viral Diseases National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Susan B. Redd
- Division of Viral Diseases National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Sarah Poser
- Division of Viral Diseases National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Debra Blog
- New York State Department of Health Albany New York
| | - Jane R. Zucker
- New York City Department of Health and Mental Hygiene Long Island City New York
- Immunization Services Division National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Jessica Leung
- Division of Viral Diseases National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Ruth Link‐Gelles
- Division of Viral Diseases National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Huong Pham
- Division of Viral Diseases National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Robert J. Arciuolo
- New York City Department of Health and Mental Hygiene Long Island City New York
| | | | - Bettina Bankamp
- Division of Viral Diseases National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Paul A. Rota
- Division of Viral Diseases National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Cindy M. Weinbaum
- Immunization Services Division National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Paul A. Gastañaduy
- Division of Viral Diseases National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
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Gastañaduy PA, Funk S, Lopman BA, Rota PA, Gambhir M, Grenfell B, Paul P. Factors Associated With Measles Transmission in the United States During the Postelimination Era. JAMA Pediatr 2020; 174:56-62. [PMID: 31738391 PMCID: PMC6865326 DOI: 10.1001/jamapediatrics.2019.4357] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Measles cases and outbreaks continue to occur in the United States after the introduction of measles from endemic settings. OBJECTIVE To discern the factors associated with measles transmission in the United States after measles had been eliminated. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from January 1, 2001, to December 31, 2017, in the United States among US residents and international visitors with confirmed measles. A maximum likelihood algorithm that uses the observed dates of rash onset and the known distribution of the serial interval (time between symptom onset in related consecutive cases) was applied to outbreak notification data to estimate the effective reproduction number (R), or the mean number of new infections generated per case. Transmissibility was assessed by comparing R based on the characteristics of primary and secondary cases of measles. EXPOSURES Measles virus. MAIN OUTCOMES AND MEASURES Effective reproduction number (R), or the mean number of successful transmission events per case of measles (ie, the mean number of persons to whom each patient with measles spreads measles). RESULTS A total of 2218 individuals with confirmed measles cases (1025 female, 1176 male, and 17 sex not reported; median age, 15 years [range, 0-89 years]) reported from 2001 to 2017 were evaluated. Among patients who received no doses of measles vaccine, R was 0.76 (95% CI, 0.71-0.81); among patients who received 1 dose of measles vaccine, R was 0.17 (95% CI, 0.11-0.26); among patients who received 2 doses or more of measles vaccine, R was 0.27 (95% CI, 0.17-0.39); and among patients with unknown vaccination status, R was 0.52 (95% CI, 0.44-0.60). Among patients born before 1957, R was 0.35 (95% CI, 0.20-0.58), and among those born on or after 1957, R was 0.64 (95% CI, 0.61-0.68). R was higher when primary and secondary cases of measles were patients aged 5 to 17 years (0.36 [95% CI, 0.31-0.42]) compared with assortative transmission in other age groups (<1 year, 0.14 [95% CI, 0.10-0.20]; 1-4 years, 0.25 [95% CI, 0.20-0.30]; 18-29 years, 0.19 [95% CI, 0.15-0.24]; 30-49 years, 0.15 [95% CI, 0.11-0.20]; ≥50 years, 0.04 [95% CI, 0.01-0.10]). CONCLUSIONS AND RELEVANCE The findings of this study support having high targets for 2-dose measles vaccine coverage, particularly among school-aged children in the United States.
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Affiliation(s)
- Paul A. Gastañaduy
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Paul A. Rota
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manoj Gambhir
- Epidemiological Modelling Unit, Monash University, Melbourne, Victoria, Australia,Health Modelling and Analytics Team, IBM Research Australia, Melbourne, Victoria, Australia
| | - Bryan Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey
| | - Prabasaj Paul
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Patel MK, Dumolard L, Nedelec Y, Sodha SV, Steulet C, Gacic-Dobo M, Kretsinger K, McFarland J, Rota PA, Goodson JL. Progress Toward Regional Measles Elimination - Worldwide, 2000-2018. MMWR Morb Mortal Wkly Rep 2019; 68:1105-1111. [PMID: 31805033 PMCID: PMC6897527 DOI: 10.15585/mmwr.mm6848a1] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Patel M, Lee AD, Clemmons NS, Redd SB, Poser S, Blog D, Zucker JR, Leung J, Link-Gelles R, Pham H, Arciuolo RJ, Rausch-Phung E, Bankamp B, Rota PA, Weinbaum CM, Gastañaduy PA. National Update on Measles Cases and Outbreaks - United States, January 1-October 1, 2019. MMWR Morb Mortal Wkly Rep 2019; 68:893-896. [PMID: 31600181 PMCID: PMC6788396 DOI: 10.15585/mmwr.mm6840e2] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
During January 1-October 1, 2019, a total of 1,249 measles cases and 22 measles outbreaks were reported in the United States. This represents the most U.S. cases reported in a single year since 1992 (1), and the second highest number of reported outbreaks annually since measles was declared eliminated* in the United States in 2000 (2). Measles is an acute febrile rash illness with an attack rate of approximately 90% in susceptible household contacts (3). Domestic outbreaks can occur when travelers contract measles outside the United States and subsequently transmit infection to unvaccinated persons they expose in the United States. Among the 1,249 measles cases reported in 2019, 1,163 (93%) were associated with the 22 outbreaks, 1,107 (89%) were in patients who were unvaccinated or had an unknown vaccination status, and 119 (10%) measles patients were hospitalized. Closely related outbreaks in New York City (NYC) and New York State (NYS; excluding NYC), with ongoing transmission for nearly 1 year in large and close-knit Orthodox Jewish communities, accounted for 934 (75%) cases during 2019 and threatened the elimination status of measles in the United States. Robust responses in NYC and NYS were effective in controlling transmission before the 1-year mark; however, continued vigilance for additional cases within these communities is essential to determine whether elimination has been sustained. Collaboration between public health authorities and undervaccinated communities is important for preventing outbreaks and limiting transmission. The combination of maintenance of high national vaccination coverage with measles, mumps, and rubella vaccine (MMR) and rapid implementation of measles control measures remains the cornerstone for preventing widespread measles transmission (4).
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Shah M, Quinlisk P, Weigel A, Riley J, James L, Patterson J, Hickman C, Rota PA, Stewart R, Clemmons N, Kalas N, Cardemil C. Mumps Outbreak in a Highly Vaccinated University-Affiliated Setting Before and After a Measles-Mumps-Rubella Vaccination Campaign-Iowa, July 2015-May 2016. Clin Infect Dis 2019; 66:81-88. [PMID: 29020324 DOI: 10.1093/cid/cix718] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/11/2017] [Indexed: 11/15/2022] Open
Abstract
Background In response to a mumps outbreak at the University of Iowa and surrounding community, university, state, and local health officials implemented a vaccination campaign targeting students <25 years of age with an additional dose of measles-mumps-rubella (MMR) vaccine. More than 4700 vaccine campaign doses were administered; 97% were documented third doses. We describe the epidemiology of the outbreak before and after the campaign, focusing on cases in university students. Methods Mumps cases were identified from reportable disease databases and university health system records. Detailed information on student cases was obtained from interviews, medical chart abstractions, university and state vaccination records, and state public health laboratory results. Pre- and postcampaign incidence among students, university faculty/staff, and community members <25 vs ≥25 years old were compared using Fisher exact test. Multivariable regression modeling was performed to identify variables associated with a positive mumps polymerase chain reaction test. Results Of 453 cases in the county, 301 (66%) occurred in university students. Student cases were primarily undergraduates (90%) and highly vaccinated (86% had 2 MMR doses, and 12% had 3 MMR doses). Fewer cases occurred in students after the campaign (75 [25%]) than before (226 [75%]). Cases in the target group (students <25 years of age) declined 9% postcampaign (P=.01). A positive mumps polymerase chain reaction test was associated with the presence of parotitis and early sample collection, and inversely associated with recent receipt of MMR vaccine. Conclusions Following a large additional dose MMR vaccination campaign, fewer mumps cases occurred overall and in the target population.
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Affiliation(s)
- Minesh Shah
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | - Carole Hickman
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul A Rota
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebekah Stewart
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nakia Clemmons
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Grant GB, Masresha BG, Moss WJ, Mulders MN, Rota PA, Omer SB, Shefer A, Kriss JL, Hanson M, Durrheim DN, Linkins R, Goodson JL. Accelerating measles and rubella elimination through research and innovation - Findings from the Measles & Rubella Initiative research prioritization process, 2016. Vaccine 2019; 37:5754-5761. [PMID: 30904317 PMCID: PMC7412823 DOI: 10.1016/j.vaccine.2019.01.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/22/2018] [Accepted: 01/23/2019] [Indexed: 12/26/2022]
Abstract
The Measles & Rubella Initiative (M&RI) identified five key strategies to achieve measles and rubella elimination, including research and innovation to support cost-effective operations and improve vaccination and diagnostic tools. In 2016, the M&RI Research and Innovation Working Group (R&IWG) completed a research prioritization process to identify key research questions and update the global research agenda. The R&IWG reviewed meeting reports and strategic planning documents and solicited programmatic inputs from vaccination experts at the program operational level through a web survey, to identify previous research priorities and new research questions. The R&IWG then convened a meeting of experts to prioritize the identified research questions in four strategic areas: (1) epidemiology and economics, (2) surveillance and laboratory, (3) immunization strategies, and (4) demand creation and communications. The experts identified 19 priority research questions in the four strategic areas to address key areas of work necessary to further progress toward elimination. Future commitments from partners will be needed to develop a platform for improved coordination with adequate and predictable resources for research implementation and innovation to address these identified priorities.
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Affiliation(s)
- Gavin B Grant
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Balcha G Masresha
- Immunisation and Vaccine Development Program, Regional Office for Africa, World Health Organization, Brazzaville, People's Republic of Congo
| | - William J Moss
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Mick N Mulders
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Paul A Rota
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Saad B Omer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, United States
| | - Abigail Shefer
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jennifer L Kriss
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Matt Hanson
- Bill and Melinda Gates Foundation, Seattle, Washington, United States
| | - David N Durrheim
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Robert Linkins
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - James L Goodson
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Kriss JL, Grant GB, Moss WJ, Durrheim DN, Shefer A, Rota PA, Omer SB, Masresha BG, Mulders MN, Hanson M, Linkins RW, Goodson JL. Research priorities for accelerating progress toward measles and rubella elimination identified by a cross-sectional web-based survey. Vaccine 2019; 37:5745-5753. [PMID: 30898393 PMCID: PMC7026910 DOI: 10.1016/j.vaccine.2019.02.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/08/2019] [Accepted: 02/22/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP) that set a target to eliminate measles and rubella in five of the six World Health Organization (WHO) regions by 2020. Significant progress has been made toward achieving this goal through intensive efforts by countries and Measles & Rubella Initiative (M&RI) partners. Accelerating progress will require evidence-based approaches to improve implementation of the core strategies in the Global Measles and Rubella Strategic Plan. The M&RI Research and Innovation Working Group (R&IWG) conducted a web-based survey as part of a process to identify measles and rubella research priorities. Survey findings were used to inform discussions during a meeting of experts convened by the M&RI at the Pan American Health Organization in November 2016. METHODS The cross-sectional web-based survey of scientific and programmatic experts included questions in four main topic areas: (1) epidemiology and economics (epidemiology); (2) new tools for surveillance, vaccine delivery, and laboratory testing (new tools); (3) immunization strategies and outbreak response (strategies); and (4) vaccine demand and communications (demand). Analyses were stratified by the six WHO regions and by global, regional, or national/sub-national level of respondents. RESULTS The six highest priority research questions selected by survey respondents from the four topic areas were the following: (1) What are the causes of outbreaks in settings with high reported vaccination coverage? (epidemiology); (2) Can affordable diagnostic tests be developed to confirm measles and rubella cases rapidly and accurately at the point of care? (new tools); (3) What are effective strategies for increasing coverage of the routine first dose of measles vaccine administered at 9 or 12 months? (strategies); (4) What are effective strategies for increasing coverage of the second dose given after the first year of life? (strategies); (5) How can communities best be engaged in planning, implementing and monitoring health services including vaccinations? (demand); (6) What capacity building is needed for health workers to be able to identify and work more effectively with community leaders? (demand). Research priorities varied by region and by global/regional/national levels for all topic areas. CONCLUSIONS Research and innovation will be critical to make further progress toward achieving the GVAP measles and rubella elimination goals. The results of this survey can be used to inform decision-making for investments in research activities at the global, regional, and national levels.
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Affiliation(s)
- Jennifer L Kriss
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Gavin B Grant
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William J Moss
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - David N Durrheim
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Abigail Shefer
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul A Rota
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Saad B Omer
- Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Balcha G Masresha
- Immunisation and Vaccine Development Program, Regional Office for Africa, World Health Organization, Brazzaville, Republic of the Congo
| | - Mick N Mulders
- Expanded Programme on Immunization, Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Matt Hanson
- Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Robert W Linkins
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James L Goodson
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Brown KE, Rota PA, Goodson JL, Williams D, Abernathy E, Takeda M, Mulders MN. Genetic Characterization of Measles and Rubella Viruses Detected Through Global Measles and Rubella Elimination Surveillance, 2016-2018. MMWR Morb Mortal Wkly Rep 2019; 68:587-591. [PMID: 31269012 PMCID: PMC6613570 DOI: 10.15585/mmwr.mm6826a3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Joyce JC, Sella HE, Jost H, Mistilis MJ, Esser ES, Pradhan P, Toy R, Collins ML, Rota PA, Roy K, Skountzou I, Compans RW, Oberste MS, Weldon WC, Norman JJ, Prausnitz MR. Extended delivery of vaccines to the skin improves immune responses. J Control Release 2019; 304:135-145. [PMID: 31071375 DOI: 10.1016/j.jconrel.2019.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/26/2019] [Accepted: 05/03/2019] [Indexed: 12/20/2022]
Abstract
Vaccines prevent 2-3 million childhood deaths annually; however, low vaccine efficacy and the resulting need for booster doses create gaps in immunization coverage. In this translational study, we explore the benefits of extended release of licensed vaccine antigens into skin to increase immune responses after a single dose in order to design improved vaccine delivery systems. By administering daily intradermal injections of inactivated polio vaccine according to six different delivery profiles, zeroth-order release over 28 days resulted in neutralizing antibody titers equivalent to two bolus vaccinations administered one month apart. Vaccinations following this profile also improved immune responses to tetanus toxoid and subunit influenza vaccine but not a live-attenuated viral vaccine, measles vaccine. Finally, using subunit influenza vaccine, we demonstrated that daily vaccination by microneedle patch induced a potent, balanced humoral immunity with an increased memory response compared to bolus vaccination. We conclude that extended presentation of antigen in skin via intradermal injection or microneedle patch can enhance immune responses and reduce the number of vaccine doses, thereby enabling increased vaccination efficacy.
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Affiliation(s)
- Jessica C Joyce
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA 30332, USA
| | - Hila E Sella
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. M/S C22, Atlanta, GA 30333, USA
| | - Heather Jost
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. M/S C22, Atlanta, GA 30333, USA
| | - Matthew J Mistilis
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, GA 30332, USA
| | - E Stein Esser
- Department of Microbiology and Immunology, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA
| | - Pallab Pradhan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA 30332, USA
| | - Randall Toy
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA 30332, USA
| | - Marcus L Collins
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. M/S C22, Atlanta, GA 30333, USA
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. M/S C22, Atlanta, GA 30333, USA
| | - Krishnendu Roy
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA 30332, USA
| | - Ioanna Skountzou
- Department of Microbiology and Immunology, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA
| | - Richard W Compans
- Department of Microbiology and Immunology, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA
| | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. M/S C22, Atlanta, GA 30333, USA
| | - William C Weldon
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. M/S C22, Atlanta, GA 30333, USA
| | - James J Norman
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, GA 30332, USA
| | - Mark R Prausnitz
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA 30332, USA; School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, GA 30332, USA.
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Bankamp B, Hickman C, Icenogle JP, Rota PA. Successes and challenges for preventing measles, mumps and rubella by vaccination. Curr Opin Virol 2019; 34:110-116. [PMID: 30852425 DOI: 10.1016/j.coviro.2019.01.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/21/2018] [Accepted: 01/16/2019] [Indexed: 01/13/2023]
Abstract
The measles, mumps and rubella (MMR) vaccine has an outstanding safety record and is highly efficacious. High coverage with MMR has led to the elimination of endemic measles, rubella, and congenital rubella syndrome in the US. The biggest challenges to global measles and rubella control and elimination are insufficient vaccination coverage globally and increasing hesitancy. Despite high two dose coverage rates, mumps has made a resurgence in the US and other countries. Mumps outbreaks have occurred primarily in close contact, high-density settings and most cases had received a second dose 10 or more years previously. Waning humoral immunity and antigenic variation of circulating wild-type mumps strains may play a role in the mumps resurgence.
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Affiliation(s)
- Bettina Bankamp
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Carole Hickman
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Joseph P Icenogle
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Paul A Rota
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
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Affiliation(s)
- Paul A Rota
- Centers for Disease Control and Prevention, Atlanta
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Dabbagh A, Laws RL, Steulet C, Dumolard L, Mulders MN, Kretsinger K, Alexander JP, Rota PA, Goodson JL. Progress Toward Regional Measles Elimination - Worldwide, 2000-2017. MMWR Morb Mortal Wkly Rep 2018; 67:1323-1329. [PMID: 30496160 PMCID: PMC6276384 DOI: 10.15585/mmwr.mm6747a6] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In 2010, the World Health Assembly set three milestones for measles prevention to be achieved by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district; 2) reduce global annual measles incidence to less than five cases per million population; and 3) reduce global measles mortality by 95% from the 2000 estimate (1).* In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP),† with the objective of eliminating measles§ in four of the six World Health Organization (WHO) regions by 2015 and in five regions by 2020. Countries in all six WHO regions have adopted goals for measles elimination by 2020. This report describes progress toward global measles control milestones and regional measles elimination goals during 2000-2017 and updates a previous report (2). During 2000-2017, estimated MCV1 coverage increased globally from 72% to 85%; annual reported measles incidence decreased 83%, from 145 to 25 cases per million population; and annual estimated measles deaths decreased 80%, from 545,174 to 109,638. During this period, measles vaccination prevented an estimated 21.1 million deaths. However, measles elimination milestones have not been met, and three regions are experiencing a large measles resurgence. To make further progress, case-based surveillance needs to be strengthened, and coverage with MCV1 and the second dose of measles-containing vaccine (MCV2) needs to increase; in addition, it will be important to maintain political commitment and ensure substantial, sustained investments to achieve global and regional measles elimination goals.
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Gastañaduy PA, Banerjee E, DeBolt C, Bravo-Alcántara P, Samad SA, Pastor D, Rota PA, Patel M, Crowcroft NS, Durrheim DN. Public health responses during measles outbreaks in elimination settings: Strategies and challenges. Hum Vaccin Immunother 2018; 14:2222-2238. [PMID: 29932850 PMCID: PMC6207419 DOI: 10.1080/21645515.2018.1474310] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 04/19/2018] [Accepted: 05/03/2018] [Indexed: 02/08/2023] Open
Abstract
In late September 2016, the Americas became the first region in the world to have eliminated endemic transmission of measles virus. Several other countries have also verified measles elimination, and countries in all six World Health Organization regions have adopted measles elimination goals. The public health strategies used to respond to measles outbreaks in elimination settings are thus becoming relevant to more countries. This review highlights the strategies used to limit measles spread in elimination settings: (1) assembly of an outbreak control committee; (2) isolation of measles cases while infectious; (3) exclusion and quarantining of individuals without evidence of immunity; (4) vaccination of susceptible individuals; (5) use of immunoglobulin to prevent measles in exposed susceptible high-risk persons; (6) and maintaining laboratory proficiency for confirmation of measles. Deciding on the extent of containment efforts should be based on the expected benefit of reactive interventions, balanced against the logistical challenges in implementing them.
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Affiliation(s)
- Paul A. Gastañaduy
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Banerjee
- Vaccine Preventable Disease Surveillance Unit, Minnesota Department of Health, St. Paul, MN, USA
| | - Chas DeBolt
- Vaccine-Preventable Diseases, Washington State Department of Health, Shoreline, WA, USA
| | - Pamela Bravo-Alcántara
- Comprehensive Family Immunization Unit, Pan American Health Organization, Washington, DC, USA
| | | | - Desiree Pastor
- Comprehensive Family Immunization Unit, Pan American Health Organization, Washington, DC, USA
| | - Paul A. Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Manisha Patel
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natasha S. Crowcroft
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David N. Durrheim
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Ogee-Nwankwo A, Opare D, Boateng G, Nyaku M, Haynes LM, Balajee SA, Conklin L, Icenogle JP, Rota PA, Waku-Kouomou D. Assessment of National Public Health and Reference Laboratory, Accra, Ghana, within Framework of Global Health Security. Emerg Infect Dis 2018; 23. [PMID: 29155650 PMCID: PMC5711297 DOI: 10.3201/eid2313.170372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Second Year of Life project of the Global Health Security Agenda aims to improve immunization systems and strengthen measles and rubella surveillance, including building laboratory capacity. A new laboratory assessment tool was developed by the Centers for Disease Control and Prevention to assess the national laboratory in Ghana to improve molecular surveillance for measles and rubella. Results for the tool showed that the laboratory is well organized, has a good capacity for handling specimens, has a good biosafety system, and is proficient for diagnosis of measles and rubella by serologic analysis. However, there was little knowledge about molecular biology and virology activities (i.e., virus isolation on tissue culture was not available). Recommendations included training of technical personnel for molecular techniques and advocacy for funding for laboratory equipment, reagents, and supplies.
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Joyce JC, Carroll TD, Collins ML, Chen MH, Fritts L, Dutra JC, Rourke TL, Goodson JL, McChesney MB, Prausnitz MR, Rota PA. A Microneedle Patch for Measles and Rubella Vaccination Is Immunogenic and Protective in Infant Rhesus Macaques. J Infect Dis 2018; 218:124-132. [PMID: 29701813 PMCID: PMC5989599 DOI: 10.1093/infdis/jiy139] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/13/2018] [Indexed: 01/16/2023] Open
Abstract
Background New methods to increase measles and rubella (MR) vaccination coverage are needed to achieve global and regional MR elimination goals. Methods Here, we developed microneedle (MN) patches designed to administer MR vaccine by minimally trained personnel, leave no biohazardous sharps waste, remove the need for vaccine reconstitution, and provide thermostability outside the cold chain. This study evaluated the immunogenicity of MN patches delivering MR vaccine to infant rhesus macaques. Results Protective titers of measles neutralizing antibodies (>120 mIU/mL) were detected in 100% of macaques in the MN group and 75% of macaques in the subcutaneous (SC) injection group. Rubella neutralizing antibody titers were >10 IU/mL for all groups. All macaques in the MN group were protected from challenge with wild-type measles virus, whereas 75% were protected in the SC group. However, vaccination by the MN or SC route was unable to generate protective immune responses to measles in infant macaques pretreated with measles immunoglobulin to simulate maternal antibody. Conclusions These results show, for the first time, that MR vaccine delivered by MN patch generated protective titers of neutralizing antibodies to both measles and rubella in infant rhesus macaques and afforded complete protection from measles virus challenge.
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Affiliation(s)
- Jessica C Joyce
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta
| | - Timothy D Carroll
- Center for Comparative Medicine, and California National Primate Research Center, University of California, Davis, CA
| | | | - Min-hsin Chen
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Linda Fritts
- Center for Comparative Medicine, and California National Primate Research Center, University of California, Davis, CA
| | - Joseph C Dutra
- Center for Comparative Medicine, and California National Primate Research Center, University of California, Davis, CA
| | - Tracy L Rourke
- Center for Comparative Medicine, and California National Primate Research Center, University of California, Davis, CA
| | | | - Michael B McChesney
- Center for Comparative Medicine, and California National Primate Research Center, University of California, Davis, CA
| | - Mark R Prausnitz
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Paul A Rota
- Centers for Disease Control and Prevention, Atlanta, GA
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Ng AHC, Fobel R, Fobel C, Lamanna J, Rackus DG, Summers A, Dixon C, Dryden MDM, Lam C, Ho M, Mufti NS, Lee V, Asri MAM, Sykes EA, Chamberlain MD, Joseph R, Ope M, Scobie HM, Knipes A, Rota PA, Marano N, Chege PM, Njuguna M, Nzunza R, Kisangau N, Kiogora J, Karuingi M, Burton JW, Borus P, Lam E, Wheeler AR. A digital microfluidic system for serological immunoassays in remote settings. Sci Transl Med 2018; 10:10/438/eaar6076. [DOI: 10.1126/scitranslmed.aar6076] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/06/2018] [Indexed: 12/29/2022]
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47
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Cui A, Rivailler P, Zhu Z, Deng X, Hu Y, Wang Y, Li F, Sun Z, He J, Si Y, Tian X, Zhou S, Lei Y, Zheng H, Rota PA, Xu W. Evolutionary analysis of mumps viruses of genotype F collected in mainland China in 2001-2015. Sci Rep 2017; 7:17144. [PMID: 29215070 PMCID: PMC5719434 DOI: 10.1038/s41598-017-17474-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/26/2017] [Indexed: 01/29/2023] Open
Abstract
Mumps incidence in mainland China remains at a high level. Genotype F has been the predominant genotype of mumps virus (MuV) in the last 20 years in mainland China. To better understand the genetic characteristics of MuV in China, the sequences of the Small Hydrophobic (SH), Hemagglutinin-Neuraminidase (HN) and Fusion (F) genes of MuVs of genotype F collected during 2001-2015 were determined. The evolutionary rates of the HN and F genes were similar (0.5 × 10-3 substitutions/site/year) whereas the SH gene evolutionary rate was three times faster. The most recent common ancestor of genotype F was traced back to 1980. Four lineages were identified within HN and F MuV sequences. A phylogeographic analysis indicated that the genotype F viruses originally spread from the Liaoning and Shandong provinces followed by a spread to the South and East of China. This study provides important genetic baseline data for the development of prevention and control measures of mumps.
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Affiliation(s)
- Aili Cui
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Pierre Rivailler
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, People's Republic of China
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road Atlanta, Atlanta, GA, 30329-4027, United States
| | - Zhen Zhu
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Xiuying Deng
- Jiangsu Provincial Centers for Disease Control and Prevention, No. 172, Jiangsu Road, Nanjing, 210009, The People's Republic of China
| | - Ying Hu
- Jiangsu Provincial Centers for Disease Control and Prevention, No. 172, Jiangsu Road, Nanjing, 210009, The People's Republic of China
| | - Yan Wang
- Liaoning Provincial Centers for Disease Control and Prevention, No. 242, Shayang Road, Heping District, Shenyang, 110005, The People's Republic of China
| | - Fangcai Li
- Hunan Provincial Centers for Disease Control and Prevention, No. 450, Furongzhongluyiduan Road, Changsha, 410005, The People's Republic of China
| | - Zhaodan Sun
- Heilongjiang Provincial Centers for Disease Control and Prevention, No. 40, Youfang Road, Xiangfang District, Ha'erbin, 150030, The People's Republic of China
| | - Jilan He
- Sichuan Provincial Centers for Disease Control and Prevention, No. 6, Zhongxue Road, Chengdu, 610041, The People's Republic of China
| | - Yuan Si
- Shannxi Provincial Centers for Disease Control and Prevention, No. 3, Hepingwenwaijiandong Road, Xi'an, 710054, The People's Republic of China
| | - Xiaoling Tian
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, No. 50, E'erduosida Road, Huhehaote, 010031, The People's Republic of China
| | - Shujie Zhou
- Anhui Provincial Centers for Disease Control and Prevention, No. 12560, Fanhuadadao Road, Hefei, 230601, The People's Republic of China
| | - Yake Lei
- Hubei Provincial Centers for Disease Control and Prevention, No.6, Zhuodaoquanbeilu Road, Hongshan District, Wuhan, 430079, The People's Republic of China
| | - Huanying Zheng
- Guangdong Provincial Centers for Disease Control and Prevention, No. 176, Xingangxi Road, Guangzhou, 510300, The People's Republic of China
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road Atlanta, Atlanta, GA, 30329-4027, United States.
| | - Wenbo Xu
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, People's Republic of China.
- Medical school, Anhui University of Science and Technology, Huainan, 232001, People's Republic of China.
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Bonwitt J, Kawakami V, Wharton A, Burke RM, Murthy N, Lee A, Dell B, Kay M, Duchin J, Hickman C, McNall RJ, Rota PA, Patel M, Lindquist S, DeBolt C, Routh J. Notes from the Field: Absence of Asymptomatic Mumps Virus Shedding Among Vaccinated College Students During a Mumps Outbreak - Washington, February-June 2017. MMWR Morb Mortal Wkly Rep 2017; 66:1307-1308. [PMID: 29190262 PMCID: PMC5708686 DOI: 10.15585/mmwr.mm6647a5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Xu W, Zhang Y, Wang H, Zhu Z, Mao N, Mulders MN, Rota PA. Global and national laboratory networks support high quality surveillance for measles and rubella. Int Health 2017; 9:184-189. [PMID: 28582561 DOI: 10.1093/inthealth/ihx017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/08/2017] [Indexed: 11/12/2022] Open
Abstract
Laboratory networks are an essential component of disease surveillance systems because they provide accurate and timely confirmation of infection. WHO coordinates global laboratory surveillance of vaccine preventable diseases, including measles and rubella. The more than 700 laboratories within the WHO Global Measles and Rubella Laboratory Network (GMRLN) supports surveillance for measles, rubella and congenial rubella syndrome in 191 counties. This paper describes the overall structure and function of the GMRLN and highlights the largest of the national laboratory networks, the China Measles and Rubella Laboratory Network.
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Affiliation(s)
- Wenbo Xu
- WHO WPRO Regional Reference Measles/Rubella Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Zhang
- WHO WPRO Regional Reference Measles/Rubella Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huiling Wang
- WHO WPRO Regional Reference Measles/Rubella Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhen Zhu
- WHO WPRO Regional Reference Measles/Rubella Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Naiying Mao
- WHO WPRO Regional Reference Measles/Rubella Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mick N Mulders
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
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Dabbagh A, Patel MK, Dumolard L, Gacic-Dobo M, Mulders MN, Okwo-Bele JM, Kretsinger K, Papania MJ, Rota PA, Goodson JL. Progress Toward Regional Measles Elimination - Worldwide, 2000-2016. MMWR Morb Mortal Wkly Rep 2017; 66:1148-1153. [PMID: 29073125 PMCID: PMC5689104 DOI: 10.15585/mmwr.mm6642a6] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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