Is vaccination against measles, mumps, and rubella associated with reduced rates of antibiotic treatments among children below the age of 2 years? Nationwide register-based study from Denmark, Finland, Norway, and Sweden

OBJECTIVES

Previous studies have shown that vaccination against measles, mumps, and rubella (MMR) may have beneficial non-specific effects, reducing the risk of infections not targeted by the vaccine. We investigated if MMR vaccine given after the third dose of diphtheria-tetanus-acellular pertussis vaccine (DTaP3), was associated with reduced rates of antibiotic treatments.

METHODS

Register-based cohort study following children from the age of recommended MMR vaccination until age 2 years. We included 831,287 children born in Denmark, Finland, Norway, and Sweden who had received DTaP3 but not yet MMR vaccine. Cox proportional hazards regression with age as the underlying timescale and vaccination status as a time-varying exposure was used to estimate covariate-adjusted Hazard Ratios (aHRs) and inverse probability of treatment weighted (IPTW) HRs of antibiotic treatments. Summary estimates were calculated using random-effects meta-analysis.

RESULTS

Compared with only having received DTaP3, receipt of MMR vaccine after DTaP3 was associated with reduced rates of antibiotic treatments in all countries: the aHR was 0.92 (0.91-0.93) in Denmark, 0.92 (0.90-0.94) in Finland, 0.84 (0.82-0.85) in Norway, and 0.87 (0.85-0.90) in Sweden, yielding a summary estimate of 0.89 (0.85-0.93). A stronger beneficial association was seen in a negative control exposure analysis comparing children vaccinated with DTaP3 vs two doses of DTaP.

CONCLUSIONS

Across the Nordic countries, receipt of MMR vaccine after DTaP3 was associated with an 11% lower rate of antibiotic treatments. The negative control analysis suggests that the findings are affected by residual confounding. Findings suggest that potential non-specific effects of MMR vaccine are of limited clinical and public health importance for the milder infections treated out-of-hospital in the Nordic setting.

Recent Surge in Mumps Cases in India: Need for Urgent Remedial Measures

Mumps is a global public health problem caused by mumps virus, a member of paramyxoviridae family. MMR (Mumps, Measles, Rubella), an effective vaccine, has been incorporated into routine immunization schedules in over 100 countries. On the contrary, in India, vaccine against mumps has not been included in the routine immunization schedule as mumps is still not viewed as a significant public health problem by the government to warrant such an intervention. An increasing number of mumps outbreaks being reported from many parts of the country in the recent past, is matter of concern. The current paper reviews the situation of mumps in India including the recent surge, and discusses the remedial measures to contain these outbreaks. We conclude that inclusion of Mumps component as MMR vaccine in the Universal Immunization Programme of India along with strengthening surveillance is required to tackle the situation.

A national registry-based study on uptake of the first dose of MMR vaccine in 380 administrative regions in Poland, 2013-2016-2020

INTRODUCTION AND OBJECTIVE

Regular monitoring of the measles, mumps, and rubella (MMR) vaccine uptake quickly exposes immunity gaps in the population. In Poland, the first dose of the MMR vaccine is mandatory for children between 13 and 15 months of life. This study aimed to assess the uptake of the first dose of MMR vaccine in 380 administrative counties in Poland in 2020, as well as to analyze the MMR vaccine uptake trends in 2013-2016-2020.

MATERIAL AND METHODS

This study is an epidemiological retrospective national registry-based analysis. Data on mandatory childhood vaccinations in all 380 counties in Poland were collected from the epidemiological reports of the State Sanitary Inspectorate territorial representatives. MMR vaccine uptake was calculated as the percentage of children who received the first dose of MRR vaccine to all children subject to mandatory vaccination in the county.

RESULTS

The uptake of the first dose of MMR vaccine decreased from 99.4% in 2013, to 95.5% in 2016 and 91.9% in 2020. In 2013, 93.2% of countys MMR vaccine uptake level reached the herd immunity level, followed by 77.1% of counties in 2016 and only 38.3% of countys in 2020. In 2020, two counties reached complete (100%) MMR vaccine uptake, and the lowest MMR vaccine uptake was 63.88%. Of the 380 counties in Poland, in 226 (61.1%) the MMR vaccine uptake level was lower than the herd immunity level, and a downward trend was observed. MMR vaccine uptake decreased with an increased number of residents in a county (r= -0.35; p<0.001).

CONCLUSIONS

This study revealed that in 61% of administrative regions in Poland, the MMR vaccine uptake was below the herd immunity level. Regional differences in the MMR vaccine uptake were observed. A significant decrease in MMR vaccine uptake between 2013 - 2020 poses a risk of measles outbreaks.

Estimation of the infection attack rate of mumps in an outbreak among college students using paired serology

Mumps virus is a highly transmissible pathogen that is effectively controlled in countries with high vaccination coverage. Nevertheless, outbreaks have occurred worldwide over the past decades in vaccinated populations. Here we analyse an outbreak of mumps virus genotype G among college students in the Netherlands over the period 2009-2012 using paired serological data. To identify infections in the presence of preexisting antibodies we compared mumps specific serum IgG concentrations in two consecutive samples (n=746), whereby the first sample was taken when students started their study prior to the outbreaks, and the second sample was taken 2-5 years later. We fit a binary mixture model to the data. The two mixing distributions represent uninfected and infected classes. Throughout we assume that the infection probability increases with the ratio of antibody concentrations of the second to first sample. The estimated infection attack rate in this study is higher than reported earlier (0.095 versus 0.042). The analyses yield probabilistic classifications of participants, which are mostly quite precise owing to the high intraclass correlation of samples in uninfected participants (0.85, 95%CrI: 0.82-0.87). The estimated probability of infection increases with decreasing antibody concentration in the pre-outbreak sample, such that the probability of infection is 0.12 (95%CrI: 0.10-0.13) for the lowest quartile of the pre-outbreak samples and 0.056 (95%CrI: 0.044-0.068) for the highest quartile. We discuss the implications of these insights for the design of booster vaccination strategies.

Measles vaccination - An underestimated prevention measure: Analyzing a fatal case in Hildesheim, Germany

Measles and rubella are targeted for elimination in the WHO region Europe. To reach the elimination goal, vaccination coverage of 95% must be achieved and sustained, the genotype information has to be provided for 80% of all outbreaks and transmission chains of a certain variant must not be detected for >12 months. The latter information is collected at Germany's National Reference Center Measles, Mumps, Rubella (NRC MMR). We describe here an outbreak of measles occurring in Hildesheim. The outbreak comprised 43 cases and lasted 14 weeks. Surprisingly, a high number of vaccination failures was observed since 11 cases had received two doses of the MMR vaccine and 4 additional cases were vaccinated once. A 33-year-old woman passed away during the outbreak. She was the mother of 5 children between 4 and 16 years of age. Two schoolchildren contracted measles and passed it on to the rest of the family. Due to delivery bottlenecks, the vaccination of the mother was delayed. She developed measles-like symptoms 3 days after vaccination and was found dead on the morning of day 8 after vaccination. A post-mortem examination was done to identify the cause of death. Moreover, molecular characterization of the virus was performed to analyze whether she was infected by the wildtype virus circulating at that time in Hildesheim or whether the vaccine may have been a concomitant and aggravating feature of her death. The result showed that the samples taken from her at the time of death and during necropsy contained the wildtype measles virus variant corresponding to MVs/Gir Somnath.IND/42.16 (WHO Seq-ID D8-4683) that fueled the Hildesheim outbreak and circulated in Germany from March 2018 to March 2020. The vaccine virus was not detected. Moreover, two aspects uncovered by the post-mortem examination were remarkable; the woman died from giant cell pneumonia, which is a complication seen in immune-suppressed individuals and she was actively using cannabis. THC is known to influence the immune system, but literature reports describing the effects are limited.

What is the relevancy of a surveillance of mumps without a systematic laboratory confirmation in highly immunized populations? Epidemiology of suspected and biologically confirmed mumps cases seen in general practice in France between 2014 and 2020

BACKGROUND

In France, mumps surveillance is conducted in primary care by the Sentinelles network, the National Reference Centre for Measles, Mumps and Rubella and Santé publique France.

AIM

The objective of this study was to estimate the incidence of suspected mumps in general practice, the proportion of laboratory confirmed cases and the factors associated with a virological confirmation.

METHODS

General practitioners (GPs) participating in the Sentinelles network should report all patients with suspected mumps according to a clinical definition in case of parotitis and a serological definition in case of clinical expression without parotitis. All suspected mumps cases reported between January 2014 and December 2020 were included. A sample of these cases were tested by real time reverse transcriptase polymerase chain reaction (RT-PCR) for mumps biological confirmation.

RESULTS

A total of 252 individuals with suspected mumps were included in the study. The average annual incidence rate of suspected mumps in general practice in France between 2014 and 2020 was estimated at 11 cases per 100,000 population [CI95%: 6-17]. A mumps confirmation RT-PCR test was performed on 146 cases amongst which 17 (11.5 %) were positive. Age (between 20 and 29 years old), the presence of a clinical complication and an exposure to a suspected mumps case within the 21 days prior the current episode were associated with a mumps biological confirmation.

CONCLUSION

If these results confirm the circulation of mumps virus in France, they highlight the limits of a surveillance without a systematic laboratory confirmation in highly immunized populations.

[Epidemiological characteristics of mumps among people aged 0-14 in Jiangxi Province, 2015-2022]

Objective: To analyze the epidemic characteristics of mumps in people aged 0-14 years in Jiangxi Province and the vaccination situation of mumps-containing vaccines (including mumps vaccines) from 2015 to 2022 to provide a scientific basis for the prevention and control of mumps epidemic in Jiangxi Province. Methods: The mumps epidemic situation and mumps vaccination data in Jiangxi Province from 2015 to 2022 were obtained from Chinese Disease Prevention and Control Information System and Jiangxi Immunization Program Information System and were analyzed using descriptive epidemiological methods. The chi-square test, cluster analysis, and Cochran-Armitage trend test were used for statistical analysis. Results: From 2015 to 2022, a total of 40 734 cases of mumps were reported in people aged 0-14 in Jiangxi Province, with an annual average reported incidence rate of 53.69/100 000, and the peak of incidence occurred in aged 6-7 years group, and the reported incidence rate was 86.43/100 000. The high incidence seasons in 2015-2019 were summer and winter, and there was no significant high incidence season in 2020-2022. Mumps outbreaks mainly occurred in Shangrao, Ganzhou, and Ji'an, and the outbreak sites were mainly reported primary schools. From 2015 to 2019, the 1-year group was the primary age group for vaccination against mumps, while from 2020 to 2021, it was 0 and 1-year groups. Conclusions: From 2015 to 2022, the incidence of mumps in the population aged 0-14 in Jiangxi Province showed a downward trend, and the peak of incidence occurred in age group 6-7 years. It is suggested to continue to strengthen the coverage rate of 2 doses of mumps vaccination for school-age children and, simultaneously, strengthen the monitoring and prevention of mumps in key places to avoid outbreaks.

Vaccine-preventable diseases: Immune response in a large population of healthcare students

BACKGROUND

Students in medicine and other health professions are exposed to numerous occupational hazards, primarily biological hazards, during their academic careers at university. The aim of the present study was to investigate the seroprevalence characteristics of anti-HBsAg, anti-Measles, anti-Mumps, anti-Rubella and anti-Varicella IgG antibodies in healthcare students of a large teaching hospital in Rome.

METHODS

To accomplish the study's aims, antibody serology data were gathered from students of Medicine and Surgery, Dentistry, and Health Professions at the Catholic University of the Sacred Heart (Rome Campus) during their first Health Surveillance visit, that took place from 2013 to 2023.

RESULTS

Our study sample included 2523 students, 44.4 % were protected against Hepatitis B, 87.3 % against measles, 85.5 % against mumps, 94.6 % rubella and 95.2 % against varicella. Differences in antibody coverage between age groups were statistically significant (p < 0.001), except for mumps. It found a lower probability of having seronegative anti-HBVs with an older date since the presumed primary vaccination.

CONCLUSION

In our sample, seropositivity rate against vaccine-preventable diseases, especially for Hepatitis B, was often inadequate to prevent possible biological risks connected with the activities carried out on the ward.

Mumps treatment by quacks in Pakistan: A neglected danger to public health

Dear Editor, In this letter, we aim to draw attention to mumps treatment through pseudo therapies by quacks in Pakistan. Our goal is to raise awareness and promote the prevention of mistreatment. Pakistan has seen an unprecedented rise in mumps outbreaks after the COVID-19 pandemic. From 1 January to 31 December 2022, a total of 19,444 mumps cases had been recorded from all provinces of the country. [1] Mumps is a common childhood respiratory infection caused by a paramyxovirus. It can be transmitted through direct contact and droplet spread. Symptoms include swelling of the parotid gland, which occurs in 60-70% of infections and 95% of patients with symptoms. [2] The swelling progresses over 2-3 days and persists for about a week. Sometimes mumps can lead to later complications such as epididymal-orchitis, oophoritis, meningitis, encephalitis, thyroiditis, unilateral deafness, spontaneous abortion, pancreatitis or infertility. Mumps is benign, resolving on its own, requiring only symptomatic relief by proven medical therapies. [3] Unfortunately, in Pakistan, especially in rural areas, people seek pseudo therapies for various diseases including Mumps from quacks which are found in a significant number of over 600,000 in the country. [4] The harmful effects of such malpractices include abandonment and delays in effective medical treatment, emergence of complications, psychological-physical traumas, and financial burden. [5] For treating Mumps, these mal practitioners offer the "massage" of the parotid gland, which involves rotating the index finger from the centre of the gland towards the outside while blowing on the patient's face. [6] These methods are not scientifically proven and may even be harmful. According to a study, non-medical interventions like acupuncture have also proved to be futile and of no advantage. [7] People often attribute the recovery to the quack's treatment, increasing their trust in these practitioners and propagation of false beliefs. These quacks often charge significant amounts of money, further exploiting their patients. We urge physicians, public health workers and the general public to prioritise the prevention and control of mumps outbreaks. This will require proactive education to address the misinformation surrounding mumps and quack treatments. Furthermore, research is needed to determine the frequency of mumps complications later in life, which may be associated with these ongoing practices for many years. Finally, the government should take stern action against quack practitioners, and the public needs to be better informed about the harms. ---Continue

Measles, mumps, rubella and varicella antibodies among international and domestic university students

BACKGROUND

Vaccine-preventable infections are generally well controlled in Australia. However, gaps in immunity can lead to outbreaks and are important to identify. Young adults are a highly mobile population and a potential source of imported infections. We aimed to evaluate anti- measles, mumps, rubella and varicella (MMR&V) IgG seroprevalence and explore factors relating to antibody seropositivity.

METHODS

A cross-sectional online survey was conducted among students from a large Australian university to collect demographic, vaccination, infection and travel characteristics. Blood samples were collected to measure MMR&V seroprevalence. Logistic regression was used to identify factors associated with seropositivity.

RESULTS

Among 804 university students, seroprevalence (positive or equivocal) for measles was 82.3% (95% CI 79.6-84.8%), mumps 79.5% (95% CI 76.7-82.3%), rubella 91.5% (95% CI 89.6-93.5%) and varicella 86.2% (95% CI 84.1-88.8%), with 452 (56.2%, 95% CI 52.8-59.6) seropositive to all four viruses. Varicella seropositivity was highest in the older birth cohort (born 1988-1991). Measles seropositivity was higher for international students compared to domestic students. Among international students, mumps seroprevalence was significantly lower than measles and rubella seroprevalence. International travel in the previous 12 months was reported by 63.1% of students, but only 18.2% of travellers reported seeking pre-travel health advice prior to most recent international travel.

CONCLUSIONS

Overall, this study suggests immunity to MMR&V is sub-optimal. We found the university student population to be highly mobile and unlikely to seek pre-travel advice; thus, they are a potential source of infection importation. The implementation of university immunization policies could address the gaps identified and our findings can inform the development of targeted vaccination campaigns.

Impact of pregnancy vaccine uptake and socio-demographic determinants on subsequent childhood Measles, Mumps and Rubella vaccine uptake: A UK birth cohort study

BACKGROUND

We examined the association between socio-demographic determinants and uptake of childhood Measles, Mumps & Rubella (MMR) vaccines and the association between pregnant women's pertussis vaccine uptake and their children's MMR vaccine uptake.

METHODS

We used nationally-representative linked mother-baby electronic records from the United Kingdom's Clinical-Practice-Research-Datalink. We created a birth cohort of children born between 01.01.2000 and 12.12.2020. We estimated the proportion vaccinated with first MMR vaccine by age 2 years and first and second MMR vaccines by age 5 years. We used survival-analysis and Cox proportional hazard models to examine the association between deprivation, ethnicity and maternal age and pertussis vaccination in pregnancy and children's MMR uptake.

RESULTS

Overall, 89.4 % (710,797/795,497) of children had first MMR by age 2 years and 92.6 % (736,495/795,497) by age 5 years. Among children still in the cohort when second MMR was due, 85.9 % (478,480/557,050) had two MMRs by age 5 years. Children from the most-deprived areas, children of Black ethnicity and children of mothers aged < 20 years had increased risk of being unvaccinated compared with children from the least-deprived areas, White children and children of mothers aged 31-40 years: first MMR by 5 years, adjusted Hazard Ratios (HR):0.86 (CI:0.85-0.87), HR:0.87 (CI:0.85-0.88) & HR:0.89 (CI:0.88-0.90) respectively. Deprivation was the determinant associated with the greatest risk of missed second MMR: adjusted HR:0.82 (CI:0.81-0.83). Children of mothers vaccinated in pregnancy were more likely than children of unvaccinated mothers to have MMR vaccines after adjusting for ethnicity, deprivation, and maternal age (First and Second MMRs adjusted HRs:1.43 (CI:1.41-1.45), 1.49 (CI:1.45-1.53).

CONCLUSION

Children from most-deprived areas are less likely to have MMR vaccines compared with children from least-deprived areas. Mothers who take up pregnancy vaccines are more likely to have their children vaccinated with MMR. Healthcare services should promote and facilitate access to both maternal and childhood vaccines during pregnancy.

Investigating Local Patterns of Mumps Virus Circulation, Using a Combination of Molecular Tools

Mumps is a vaccine-preventable disease caused by the mumps virus (MuV). However, MuV has re-emerged in many countries with high vaccine coverage. The World Health Organization (WHO) recommends molecular surveillance based on sequencing of the small hydrophobic (SH) gene. Additionally, the combined use of SH and non-coding regions (NCR) has been described in different studies, proving to be a useful complement marker to discriminate general patterns of circulation at national and international levels. The aim of this work is to test local-level usefulness of the combination of SH and MF-NCR sequencing in tracing hidden transmission clusters and chains during the last epidemic wave (2015-2020) in Spain. A database with 903 cases from the Autonomous Community of Madrid was generated by the integration of microbiological and epidemiological data. Of these, 453 representative cases were genotyped. Eight different SH variants and thirty-four SH haplotypes were detected. Local MuV circulation showed the same temporal pattern previously described at a national level. Only two of the thirteen previously identified outbreaks were caused by more than one variant/haplotype. Geographical representation of SH variants allowed the identification of several previously undetected clusters, which were analysed phylogenetically by the combination of SH and MF-NCR, in a total of 90 cases. MF-NCR was not able to improve the discrimination of geographical clusters based on SH sequencing, showing limited resolution for outbreak investigations.

[Application of autoregressive integrated moving average model to predict and analyze the incidence trend of mumps in Jiangxi Province]

Objective: To predict and analyze the incidence trend of mumps using the Autoregressive integrated moving average model (ARIMA) in Jiangxi Province. Methods: The ARIMA was used to model the number of mumps cases per month from 2015 to 2019 in Jiangxi Province. The number of mumps cases in 12 months was predicted and was compared with the actual reported cases in 2020, 2021, and 2022, respectively. Results: The optimal model was ARIMA (0,2,1)(1,2,0)12. The predicted number of cases was significantly higher than that reported in 2020, 2021 and 2022. The number of reported cases of mumps in 2020, 2021, and 2022 decreased by 54.02%, 63.40%, and 66.09% compared with the forecast. Conclusions: From 2020 to 2022, the reported incidence of mumps in Jiangxi Province was significantly lower than the predicted incidence. Considering that it was related to non-drug intervention measures and changes in immunization strategies, it was suggested to strengthen mumps surveillance further to better cope with the epidemic situation of mumps.

Estimated number of reported vaccine-preventable disease cases averted following the introduction of routine vaccination programs in Sweden, 1910-2019

BACKGROUND

Routine childhood vaccination programs have had enormous positive public health impacts worldwide. However, in some areas, these benefits may be impeded by vaccine hesitancy and undervaccination. We estimated the number of reported cases of measles, pertussis, mumps and poliomyelitis averted in Sweden after the introduction of routine childhood vaccination programs.

METHODS

We used annual national data on population size and the number of reported cases of measles (1911-2019), pertussis (1911-2019), mumps (1914-2019) and poliomyelitis (1910-2019) for Sweden. For each disease, we calculated the median and 95% confidence interval of the annual pre-vaccination incidence to estimate the number of counterfactual cases; that is, the estimated number of cases that would have been observed in the post-vaccination period had no vaccine been introduced (median incidence × average annual population). For the post-vaccination periods, we calculated reported cases averted and assumed all decreases were due to vaccines.

RESULTS

In total, for all four diseases combined, over 2.1 million cases were reported over the respective surveillance periods. Since the introduction of vaccinations, we estimate that over 1.5 million reported cases of these four diseases combined have been averted: measles (633 091), pertussis (608 670), mumps (262 951) and poliomyelitis (58 240). However, due to underreporting, especially during pre-vaccination years, these are likely underestimates.

CONCLUSIONS

Since the introduction of these routine childhood vaccination programs in Sweden, a substantial number of reported cases of vaccine-preventable diseases have been averted. Vigilance against both failure to vaccinate and undervaccination is necessary to prevent future increases of these vaccine-preventable diseases.

Prenatal Exposure to Poly- and Perfluoroalkyl Substances (2009-2014) and Vaccine Antibody Titers of Measles, Mumps, Rubella, and Varicella in Children Four to Eight Years Old from the Healthy Start Cohort

BACKGROUND

Prenatal exposures to certain poly- and perfluoroalkyl substances (PFAS) are associated with reduced humoral responses to some childhood immunizations.

OBJECTIVE

We estimated associations between prenatal PFAS exposure and child antibody titers for measles, mumps, rubella (MMR), and varicella after immunization.

METHODS

We measured serum antibody titers of 145 children (4-8 y old) enrolled in the Healthy Start cohort in Colorado, whose mothers had PFAS quantified mid-pregnancy (2009-2014). We used linear and logistic regression models to assess the relationship between five PFAS detected in > 65 % of mothers and continuous or non-high-censored ("low") antibody titers and quantile g-computation to evaluate the overall effect of the PFAS mixture.

RESULTS

Median concentrations of individual PFAS were at or below the median reported among females in the United States. After receiving two vaccine doses, seropositive levels of antibodies were detected among most (93%-100%) children. Each log-unit increase in perfluorononanoate was associated with 2.09 [95% confidence interval (CI): 1.13, 3.87] times higher odds of a low measles titer, and each log-unit increase in perfluorooctanoate was associated with 2.46 (95% CI: 1.28, 4.75) times higher odds of a low mumps titer. Odds ratios for all other PFAS were elevated, but CIs included the null. Each quartile increase in the PFAS mixture was associated with 1.35 (95% CI: 0.80, 2.26) times higher odds of a low measles titer and 1.44 (95% CI: 0.78, 2.64) times higher odds of a low mumps titer. No significant associations were observed between PFAS and varicella or rubella antibodies. In stratified analyses, associations were negative among female children, except for perfluorohexane sulfonate and varicella, whereas they were positive among males.

DISCUSSION

Some prenatal PFAS were associated with lower antibody titers among fully immunized children. The potential for immunotoxic effects of PFAS requires further investigation in a larger study, because exposure is ubiquitous globally. https://doi.org/10.1289/EHP12863.

Direct and crowding-out effects of a Hepatitis B vaccination campaign

We evaluate the direct and spillover causal effects of a Hepatitis B (HB) vaccination campaign in French schools on the vaccination adherence of the targeted pupils. Using a regression discontinuity design, we show that this campaign created an exogenous shock on vaccination behavior, increasing the HB vaccination rate for children aged 11 and above. At the same time, we show a drop in the measles, mumps, and rubella (MMR) vaccination rate of the targeted pupils and an increase in the parental belief that measles is a benign disease. We interpret these results as a salience effect: the focus on HB vaccination leads to a decrease in the belief that other vaccines are as important. The effect on MMR vaccination was relatively unexpected and may imply a negative externality. Measles is an extremely contagious disease. If the vaccination rate falls, the disease will spread further, raising the question of the net effect of the HB vaccination campaign on the well-being of the population.

Measles in vulnerable populations: An outbreak in Roma settlements of Loire-Atlantique, France, 2019

In May 2019, a measles outbreak occurred in the French subregion of Loire-Atlantique, particularly affecting Roma settlements. Various obstacles hindered the implementation of postexposure measures among Roma population, resulting in the spread of the cases to other settlements. Suspected cases of measles were immediately investigated and concerned settlements were visited for measles-mumps-rubella (MMR) vaccination. From July 1 to September 3, 2019, a first and then a second Health Reserve team helped for vaccination on the affected and then also the measles-free settlements. Vaccination uptake was monitored with the use of the department's vaccination center immunization registry. Genotyping of selected samples was performed for comparison with viruses circulating at the same time in France and Romania. As of September 16 2019, 109 cases of measles were confirmed among Roma population, including 99 (91%) children under 15 years. Of the 85 people eligible for vaccination, 60 (71%) had not been vaccinated and 23 (27%) had an unknown vaccination status. Sequence comparison revealed that 28/29 sequenced D8 strains were 100% identical to the strain responsible for a large number of cases throughout France in 2019, and to two sequences reported in Romania among sporadic cases. The vaccination campaign resulted in 1136 people on 35 settlements receiving at least one dose of MMR vaccine and in the increase of one-dose MMR vaccine coverage at 24 months from 43% (23/53) to 91% (48/53). With measles transmission continuing in Europe, efforts must be made to meet immunization coverage targets, particularly in hard-to-reach communities where outbreaks may be difficult to control.

Epidemiological characteristics of seven notifiable respiratory infectious diseases in the mainland of China: an analysis of national surveillance data from 2017 to 2021

BACKGROUND

Respiratory infectious diseases (RIDs) remain a pressing public health concern, posing a significant threat to the well-being and lives of individuals. This study delves into the incidence of seven primary RIDs during the period 2017-2021, aiming to gain deeper insights into their epidemiological characteristics for the purpose of enhancing control and prevention strategies.

METHODS

Data pertaining to seven notifiable RIDs, namely, seasonal influenza, pulmonary tuberculosis (PTB), mumps, scarlet fever, pertussis, rubella and measles, in the mainland of China between 2017 and 2021 were obtained from the National Notifiable Disease Reporting System (NNDRS). Joinpoint regression software was utilized to analyze temporal trends, while SaTScan software with a Poisson probability model was used to assess seasonal and spatial patterns.

RESULTS

A total of 11,963,886 cases of the seven RIDs were reported during 2017-2021, and yielding a five-year average incidence rate of 170.73 per 100,000 individuals. Among these RIDs, seasonal influenza exhibited the highest average incidence rate (94.14 per 100,000), followed by PTB (55.52 per 100,000), mumps (15.16 per 100,000), scarlet fever (4.02 per 100,000), pertussis (1.10 per 100,000), rubella (0.59 per 100,000), and measles (0.21 per 100,000). Males experienced higher incidence rates across all seven RIDs. PTB incidence was notably elevated among farmers and individuals aged over 65, whereas the other RIDs primarily affected children and students under 15 years of age. The incidences of PTB and measles exhibited a declining trend from 2017 to 2021 (APC = -7.53%, P = 0.009; APC = -40.87%, P = 0.02), while the other five RIDs peaked in 2019. Concerning seasonal and spatial distribution, the seven RIDs displayed distinct characteristics, with variations observed for the same RIDs across different regions. The proportion of laboratory-confirmed cases fluctuated among the seven RIDs from 2017 to 2021, with measles and rubella exhibiting higher proportions and mumps and scarlet fever showing lower proportions.

CONCLUSIONS

The incidence of PTB and measles demonstrated a decrease in the mainland of China between 2017 and 2021, while the remaining five RIDs reached a peak in 2019. Overall, RIDs continue to pose a significant public health challenge. Urgent action is required to bolster capacity-building efforts and enhance control and prevention strategies for RIDs, taking into account regional disparities and epidemiological nuances. With the rapid advancement of high-tech solutions, the development and effective implementation of a digital/intelligent RIDs control and prevention system are imperative to facilitate precise surveillance, early warnings, and swift responses.

Susceptibility of nursery teachers to measles, rubella, varicella and mumps in Japan

BACKGROUND

A guideline published in 2018 by the Ministry of Health, Labour and Welfare stipulated confirmation of the vaccine history of nursery staff members.

OBJECT

This study was conducted to elucidate nursery teachers' vaccine and infection histories for measles, mumps, rubella, and varicella through survey responses.

METHOD

After sending questionnaires through the mail to 5000 nursery teachers in November 2022, we received responses through December 2022. We measured the proportion of susceptibility in three ways. Additionally, we compared the proportions of susceptibility by disease by age class.

RESULTS

After receiving 1620 responses in all, the data of 1229 respondents under 50 years old were analyzed. Under the broad definition by which "no answer" was also regarded as unvaccinated or uinfected as well as "unknown," the proportions of susceptibility for measles, rubella, and varicella were higher: 22-23%. For mumps, the proportion was 42%. For varicella, they were 31% for respondents in their 30 s, and 14% for respondents in their 40 s. For mumps, the respective values were 58% and 26%.

DISCUSSION

Respondents assessed for this study were less susceptible and unknown in comparison with earlier studies investigating health care workers, school teachers, university students, and pregnant women.

CONCLUSION

The survey revealed that measles and rubella susceptibility was higher among respondents in their 30 s. However, it was higher for varicella and mumps among respondents in their 20 s.

Seroprevalence of Measles, Mumps, Rubella, and Varicella-Zoster Virus and Seroresponse to the Vaccinations in Adult Solid Organ Transplant Candidates

BACKGROUND

Updating live vaccines such as measles, mumps, rubella, and varicella (MMRV) is an important step in preparing patients for solid organ transplant (SOT) to prevent morbidity from these preventable diseases. However, data for this approach are scarce. Thus, we aimed to describe the seroprevalence of MMRV and the efficacy of the vaccines in our transplant center.

METHODS

Pre-SOT candidates >18 y of age were retrospectively retrieved from SOT database in Memorial Hermann Hospital Texas Medical Center. MMRV serologies are routinely screened at the time of pretransplant evaluation. We divided patients into 2 groups: MMRV-positive group versus MMRV-negative group, patients with positive all MMRV serologies and with negative immunity to at least 1 dose of MMRV, respectively.

RESULTS

A total of 1213 patients were identified. Three hundred ninety-four patients (32.4%) did not have immunity to at least 1 dose of MMRV. Multivariate analysis was conducted. Older age (odds ratio [OR]: 1.04) and liver transplant candidates (OR: 1.71) were associated with seropositivity. Previous history of SOT (OR: 0.54) and pancreas/kidney transplant candidates (OR: 0.24) were associated with seronegativity. Among 394 MMRV seronegative patients, 60 patients received 1 dose of MMR vaccine and 14 patients received 1 dose of varicella-zoster virus vaccine without severe adverse events. A total of 35% (13/37) of patients who had follow-up serologies did not have a serological response.

CONCLUSIONS

A significant number of pre-SOT candidates were not immune to at least 1 dose of MMRV. This highlights the importance of MMRV screening and vaccinations pre-SOT. Postvaccination serological confirmation should be performed to evaluate the necessity for a second dose.

Mumps epidemic dynamics in the United States before vaccination (1923-1932)

Mumps is a vaccine-preventable, reemerging, and highly transmissible infectious disease. Widespread vaccination dramatically reduced cases; however, case counts have been increasing over the past 20 years. To provide a quantitative overview of historical mumps dynamics that can act as baseline information to help identify causes of mumps reemergence, we analyzed timeseries of cases reported from 1923 to 1932 in the United States. During that time, 239,230 mumps cases were reported in 70 cities. Larger cities reported annual epidemics and smaller cities reported intermittent, sporadic outbreaks. The critical community size above which transmission continuously occurred was likely between 365,583 and 781,188 individuals but could range as high as 3,376,438 individuals. Mumps cases increased as city size increased, suggesting density-dependent transmission. Using a density-dependent SEIR model, we calculated a mean effective reproductive number (Re) of 1.2. Re varied by city and over time, with periodic high values that could characterize short periods of very high transmission known as superspreading events. Case counts most often peaked in March, with higher-than-average transmission from December through April and showed a correlation with weekly births. While certain city pairs in Midwestern states had synchronous outbreaks, most outbreaks were less synchronous and not driven by distance between cities. This work demonstrates the importance of long-term infectious disease surveillance data and will inform future studies on mumps reemergence and control.

Quantification of Waning Immunity After Measles Vaccination-Evidence From a Seroprevalence Study

We aimed to quantify rates of waning immunity after measles vaccination from seroprevalence data collected in a study of a population with high vaccination coverage and a fixed vaccination schedule. Data were collected during a national survey (the Immunological Survey) carried out in the Slovak Republic in 2018. The average rate of waning immunity against measles after the first dose of measles, mumps, and rubella (MMR) vaccine (ages 1.5-10 years) was 9.7% per year from the geometric mean titer value of 2,634 mUI/mL. The average waning rate after the second dose of MMR vaccine (ages 10-33 years) was significantly lower: 4.8% per year from the lower geometric mean titer of 1,331 mUI/mL. This decline in antibody levels suggests that vaccine-induced protection may be compromised and results in an increase in the proportion of seronegative/borderline individuals. These outcomes may provide a valuable source for critical assessment of direct and indirect effects of MMR vaccination.

Measles and Rubella Seroprevalence Among Children and Adolescents of Córdoba, Argentina: A Cross-Section Study in the Context of the Elimination Program

We determined anti-rubella and anti-measles immunoglobulin G (IgG) in 7- to 19-year-old children and adolescents with vaccine only-induced immunity of Córdoba, Argentina, during a 6-month period over 2021-2022. Of the 180 individuals studied, 92.2% and 88.3% were positive for anti-measles and anti-rubella IgG, respectively. No significant differences were found comparing anti-rubella IgG concentrations (p = 0.144) and anti-measles IgG concentrations (p = 0.105) of individuals classified by age, but anti-measles IgG and anti-rubella IgG levels were significantly higher among female individuals compared with males (p = 0.031 and p = 0.036, respectively). Female subjects in the younger age group had higher concentrations of anti-rubella IgG as well (p = 0.020), even when anti-measles IgG concentrations did not differ among female age-subgroups (p = 0.187). In contrast, age subgroups of male individuals did not have significantly different IgG concentrations for rubella (p = 0.745) or measles (p = 0.124). Among samples with discordant results (22/180, 12.6%), 9.1% were negative for rubella but positive for measles; 13.6% were equivocal for rubella and positive for measles; 22.7% were equivocal for rubella and negative for measles, while 54.5% were positive for rubella but negative for measles. The findings indicate a seroprevalence below recommended for preventing measles in the population studied, while they evidence the need for standardization of serological tests for rubella IgG.

Investigation of the Seroprevalence of Antimeasles Immunoglobulin G Antibody in Students at Shiraz University of Medical Sciences

Measles is an acute, highly contagious disease with a high mortality rate in children. Although vaccination has reduced measles incidence, outbreaks still occur. Therefore, in this study, we aimed to investigate the frequency of antimeasles immunoglobulin G (IgG) antibody (Ab) among students at Shiraz University of Medical Sciences (SUMS). Four hundred fifty SUMS students were enrolled in this cross-sectional study. Information on demographics and measles vaccination history was collected using a questionnaire. Participants were divided into two groups, including A and B, according to routine doses of measles vaccine and the national measles/rubella immunization program. The antimeasles IgG Abs were tested using a commercial Enzyme-Linked Immunosorbent Assay Kit. Participants ranged in age from 18 to 48 years, with a mean age of 22.2 (±4.3). Fifty percent of the subjects were male. Our results showed that 63.6% of the cases were positive for antimeasles IgG Abs. The seroprevalence of IgG Abs between groups A and B did not differ significantly (p = 0.612). There was also no significant correlation between the seroprevalence of antimeasles IgG Abs and the age (p = 0.43) or sex (p = 0.24) of the subjects. The results showed that the frequency of antimeasles IgG Abs is lower than required to prevent the measles virus from circulating. Therefore, a booster vaccination may be necessary.

Epidemiological Characteristics of Notifiable Respiratory Infectious Diseases in Mainland China from 2010 to 2018

Respiratory infectious diseases (RIDs) pose threats to people's health, some of which are serious public health problems. The aim of our study was to explore epidemic situations regarding notifiable RIDs and the epidemiological characteristics of the six most common RIDs in mainland China. We first collected the surveillance data of all 12 statutory notifiable RIDs for 31 provinces in mainland China that reported between 2010 and 2018, and then the six most prevalent RIDs were selected to analyze their temporal, seasonal, spatiotemporal and population distribution characteristics. From 2010 to 2018, there were 13,985,040 notifiable cases and 25,548 deaths from RIDs in mainland China. The incidence rate of RIDs increased from 109.85/100,000 in 2010 to 140.85/100,000 in 2018. The mortality from RIDs ranged from 0.18/100,000 to 0.24/100,000. The most common RIDs in class B were pulmonary tuberculosis (PTB), pertussis, and measles, while those in class C were seasonal influenza, mumps and rubella. From 2010 to 2018, the incidence rate of PTB and rubella decreased; however, pertussis and seasonal influenza increased, with irregular changes in measles and mumps. The mortality from PTB increased from 2015 to 2018, and the mortality from seasonal influenza changed irregularly. PTB was mainly prevalent among people over 15 years old, while the other five common RIDs mostly occurred among people younger than 15 years old. The incidence of the six common RIDs mostly occurred in winter and spring, and they were spatiotemporally clustered in different areas and periods. In conclusion, PTB, seasonal influenza and mumps remain as public health problems in China, suggesting that continuous government input, more precise interventions, and a high-tech digital/intelligent surveillance and warning system are required to rapidly identify emerging events and timely response.

A Measles Outbreak in a Local Children's Hospital in Korea, 2019

A measles outbreak with 20 confirmed cases occurred at a local children's hospital in Daejeon from March 28 to April 21, 2019. The index patient was a 7-month-old girl with a recent history of travel to Vietnam. Contact tracing, active surveillance, and post-exposure prophylaxis were conducted by health authorities. Among the 20 patients, 11 (55%) were infants (0-11 months of age), three (15%) were aged 1-3 years, one (5%) was aged 4 years, and five (25%) were adults. Fifteen (75%) patients did not have a history of measles vaccination, and five (25%) had received only one vaccine dose. This study described the importance of prompt application of infection control measures in susceptible environments, including hospitals. Age-appropriate vaccination and providing information on infectious diseases to international travelers and multicultural families in Korea is vital.

Impact of the COVID-19 pandemic on timeliness and equity of measles, mumps and rubella vaccinations in North East London: a longitudinal study using electronic health records

OBJECTIVES

To quantify the effect of the COVID-19 pandemic on the timeliness of, and geographical and sociodemographic inequalities in, receipt of first measles, mumps and rubella (MMR) vaccination.

DESIGN

Longitudinal study using primary care electronic health records.

SETTING

285 general practices in North East London.

PARTICIPANTS

Children born between 23 August 2017 and 22 September 2018 (pre-pandemic cohort) or between 23 March 2019 and 1 May 2020 (pandemic cohort).

MAIN OUTCOME MEASURE

Receipt of timely MMR vaccination between 12 and 18 months of age.

METHODS

We used logistic regression to estimate the ORs (95% CIs) of receipt of a timely vaccination adjusting for sex, deprivation, ethnic background and Clinical Commissioning Group. We plotted choropleth maps of the proportion receiving timely vaccinations.

RESULTS

Timely MMR receipt fell by 4.0% (95% CI: 3.4% to 4.6%) from 79.2% (78.8% to 79.6%) to 75.2% (74.7% to 75.7%) in the pre-pandemic (n=33 226; 51.3% boys) and pandemic (n=32 446; 51.4%) cohorts, respectively. After adjustment, timely vaccination was less likely in the pandemic cohort (0.79; 0.76 to 0.82), children from black (0.70; 0.65 to 0.76), mixed/other (0.77; 0.72 to 0.82) or with missing (0.77; 0.74 to 0.81) ethnic background, and more likely in girls (1.07; 1.03 to 1.11) and those from South Asian backgrounds (1.39; 1.30 to 1.48). Children living in the least deprived areas were more likely to receive a timely MMR (2.09; 1.78 to 2.46) but there was no interaction between cohorts and deprivation (Wald statistic: 3.44; p=0.49). The proportion of neighbourhoods where less than 60% of children received timely vaccination increased from 7.5% to 12.7% during the pandemic.

CONCLUSIONS

The COVID-19 pandemic was associated with a significant fall in timely MMR receipt and increased geographical clustering of measles susceptibility in an area of historically low and inequitable MMR coverage. Immediate action is needed to avert measles outbreaks and support primary care to deliver timely and equitable vaccinations.

Spatial Effect of Ecological Environmental Factors on Mumps in China during 2014-2018

(1) Background: although mumps vaccines have been introduced in most countries around the world in recent years, mumps outbreaks have occurred in countries with high vaccination rates. At present, China remains the focus of the global fight against mumps. This study aims to observe the epidemic characteristics and spatial clustering patterns of mumps and to investigate the potential factors affecting the disease incidence, which could provide novel ideas and avenues for future research as well as the prevention and control of mumps. (2) Methods: we used ArcGIS software to visualize the spatial distribution and variation of mumps. Spatial autocorrelation analysis was applied to detect the spatial dependence and clustering patterns of the incidence. We applied the Spatial Durbin Panel Model (SDPM) to explore the spatial associations of ecological environmental factors with mumps. (3) Results: overall, the incidence rate showed a significant upward trend from 2014 to 2018, with the highest number of cases in the 10-15-year age group and from May to June. Geographically, the high incidence clusters were concentrated in southern regions, including Hunan, Hubei, Chongqing, Guizhou, Guangdong, and Guangxi. This study also found that mumps has a positive spatial spillover effect in the study area. The average temperature and GDP of the local and adjacent areas have a significant impact on mumps. The increase in PM2.5 contributes to the rise in the incidence of mumps in this region. (4) Conclusions: these results can offer some novel ideas for policymakers and researchers. Local meteorological conditions and economic levels can extend to surrounding areas to affect the occurrence of mumps, so regional cooperation becomes particularly important. We recommend investment of public health funds in areas with a high incidence of mumps and developing economies to reduce and control the incidence of mumps.

Measles, Mumps, Rubella Vaccine (PRIORIX): Recommendations of the Advisory Committee on Immunization Practices - United States, 2022

Vaccination is the main means for preventing measles, mumps, and rubella virus infections and their related complications (1,2). Achieving and maintaining high 2-dose measles, mumps, and rubella vaccination coverage in the United States has led to elimination of endemic measles in 2000, rubella and congenital rubella syndrome in 2004, and a sharp decrease in mumps cases. However, measles and rubella remain endemic in many countries, leading to importations of cases and occasional local transmission within the United States (3). Reported U.S. mumps cases declined >99% from the prevaccine period (4); however, mumps is endemic worldwide, and since 2006, the number of mumps cases and mumps outbreaks has increased in the United States, with wider geographic spread since 2016 (4). Given the risk for importation of measles and rubella and the resurgence of mumps, maintaining high measles, mumps, and rubella (MMR) vaccination coverage is important. Since 1978, only one MMR vaccine, M-M-R II (Merck and Co., Inc.), has been available in the United States. On June 6, 2022, the Food and Drug Administration approved a second MMR vaccine, PRIORIX (GlaxoSmithKline Biologicals), for the prevention of measles, mumps, and rubella in persons aged ≥12 months. The three live attenuated viruses contained in PRIORIX are genetically similar or identical to the corresponding components in M-M-R II (Table) (5-7). On June 23, 2022, the Advisory Committee on Immunization Practices (ACIP) unanimously recommended PRIORIX as an option to prevent measles, mumps, and rubella according to the existing recommended schedules and for off-label uses (i.e., indications not included in the package insert)* (1,2). ACIP considered PRIORIX to be safe, immunogenic, and noninferior to M-M-R II. Both PRIORIX and M-M-R II are fully interchangeable for all indications for which MMR vaccination is recommended. This report contains ACIP recommendations specific to PRIORIX and supplements the existing ACIP recommendations for MMR use (1,2).

Epidemiological features and risk factors for measles and rubella in Taiwan during 2011 to 2020

The risk of geographic transmission of infectious diseases due to air travel varies greatly. Our aim is to survey empirical data that provide a retrospective historical perspective on measles and rubella. This study used the open data website provided by the Taiwan Centers for Disease Control (TCDC) to extract the reported numbers of measles and rubella case between 2011 and 2020. There were 306 cases of measles and 135 cases of rubella. The incidence of measles and rubella per million population were 0 to 6.0 and 0 to 2.6, respectively. There was a gradual increase in the numbers of cases in those aged 20-39 years, and distinct duration patterns. It indicated that the risk of contracting rubella has significantly decreased in the last 5 years. Measles cases aged 20 to 39 years accounted for 72.5% of all cases. Rubella cases aged 20 to 39 years accounted for 59.3% of all cases. The male and residency in the Taipei metropolitan area or northern area were identified as potential risk factors for measles and rubella. Coverage with the first dose of the measles, mumps and rubella (MMR) vaccine in Taiwan increased from 97.31% to 98.86%, and the uptake rate of the second dose of the MMR vaccine increased from 95.73% to 98.39% between 2010 and 2020. Furthermore, the numbers of imported cases of measles (n = 0) and rubella (n = 0) reported during the coronavirus disease 2019 (COVID-19) pandemic were lower than those from 2011 to 2019. Measles and rubella cases were imported most frequently from Cambodia and Vietnam. This study represents the first report of confirmed cases of acquired measles and rubella from surveillance data of the TCDC between 2011 and 2020, also demonstrates that the numbers of cases of measles and rubella significantly decreased in Taiwan during the COVID-19 pandemic.

[Antibody levels of measles, rubella and mumps viruses in healthy population in Shanghai from 2010 to 2020]

Objective: To determine IgG antibody levels of measles, rubella, mumps in healthy population in Shanghai from 2010 to 2020 and analyze the trend of antibody changes in different age groups. Methods: 10 828 healthy people without measles, rubella and mumps in Shanghai were included in the study from 2010 to 2020. Serum samples were collected from 12 age groups, and the serum IgG antibody of measles, rubella and mumps were detected by ELISA. The difference of antibody positive rates and antibody levels were analyzed. Results: The median age M (Q₁, Q₃) of 10 828 objects were 8 years old (9 months old, 20 years old). Males accounted for 48.34% (5 234/10 828) and females accounted for 50.92% (5 514/10 828). Unknown gender information accounted for 0.74% (80/10 828), and 27.03% (2 927/10 828) of participants had unknown MMR immunization history. The total positive rates of measles, rubella and mumps IgG antibody were 76.78%, 64.46% and 64.29% and their GMCs were 541.45 mIU/ml, 31.76 IU/ml and 133.73 U/ml respectively. There were significant differences in serum IgG antibody GMC of measles, rubella and mumps in each year (F_measles=180.74, P<0.001; F_rubella=189.95, P<0.001; F_mumps=122.40, P<0.001). The positive rate of measles antibody was higher than that of rubella and mumps, and the difference was statistically significant (χ²=518.09, P<0.001). Conclusion: The level of measles IgG antibody in healthy people in Shanghai is higher, while the level of rubella and mumps IgG antibody is slightly lower.

[Meta analysis on mumps virus seroprevalence and evaluation of immunization effect in Chinese healthy population]

Objective: To systematically analyze the IgG seroprevalence of mumps virus (MuV) in Chinese healthy population, and evaluate the immune effect based on the immunization strategy and the incidence of mumps in China. Methods: The databases of Wanfang data knowledge service platform, China National Knowledge Infrastructure, SinoMed, PubMed, and Web of Science were searched to retrieve literature about the level of MuV IgG antibody in Chinese healthy population from January 1, 2000, to March 31, 2022. The quality of eligible papers was appraised by using the cross-sectional study evaluation tool from Joanna Briggs Institute. Data analysis, including the stratified analysis of the IgG seroprevalence in different generations, regions, gender, immunization status, and age groups, was performed using R 4.1.2 and Stata 16.0. Results: A total of 69 papers (66 in Chinese and 3 in English) were included, involving 97 034 people in 26 administrative regions across China. The results showed that the MuV IgG seroprevalence in Chinese healthy population was 74.87% (95%CI: 71.41%-78.17%) and increased over time according to the cumulative Meta-analysis. The geometric mean concentration of antibody was 177.83 U/ml. The subgroup analysis showed that the positive rate of MuV IgG antibody increased with the age and vaccination doses. The positive rate of antibody in children aged from 0 to 17 months was only 32.42% (95%CI: 25.96%-38.88%). The highest positive rate was reported in North China, about 81.45% (95%CI: 75.76%-87.14%). In addition, the positive rate of MuV IgG antibody in urban population was higher than that in rural population (P<0.01) and the positive rate of MuV IgG antibody in women was higher than that in men (P<0.01). Conclusion: Since the vaccine was included in the expanded immunization program, the positive rate of mumps antibody in China has increased, and the antibody level varies in different regions and populations. It is still necessary to improve the MuV antibody level in Chinese healthy population, so as to better prevent and control the mumps epidemic in the future.

Exploring the Mumps Virus Glycoproteins: A Review

The resurgence of mumps in vaccinated adult populations has raised concerns about possible waning vaccine immunity or a potential lack of protection to the circulating strain. A number of individual studies have investigated if there are amino acid variations between the circulating wild-type strains and vaccine strains. In these studies, the HN and F mumps surface glycoproteins have been of interest, because of their role in viral infection, and because the HN protein is the target of neutralizing antibodies. Here, we summarize the single nucleotide variants and their potential effect that have been identified between mumps genotypes in the HN and F proteins.

Association between Meteorological Factors and Mumps and Models for Prediction in Chongqing, China

(1) Background: To explore whether meteorological factors have an impact on the prevalence of mumps, and to make a short−term prediction of the case number of mumps in Chongqing. (2) Methods: K−means clustering algorithm was used to divide the monthly mumps cases of each year into the high and low case number clusters, and Student t−test was applied for difference analysis. The cross−correlation function (CCF) was used to evaluate the correlation between the meteorological factors and mumps, and an ARIMAX model was constructed by additionally incorporating meteorological factors as exogenous variables in the ARIMA model, and a short−term prediction was conducted for mumps in Chongqing, evaluated by MAE, RMSE. (3) Results: All the meteorological factors were significantly different (p < 0.05), except for the relative humidity between the high and low case number clusters. The CCF and ARIMAX model showed that monthly precipitation, temperature, relative humidity and wind velocity were associated with mumps, and there were significant lag effects. The ARIMAX model could accurately predict mumps in the short term, and the prediction errors (MAE, RMSE) were lower than those of the ARIMA model. (4) Conclusions: Meteorological factors can affect the occurrence of mumps, and the ARIMAX model can effectively predict the incidence trend of mumps in Chongqing, which can provide an early warning for relevant departments.

Revisiting the potential role of BCG and MMR vaccines in COVID-19

Despite the development and deployment of effective COVID-19 vaccines, many regions remain poorly covered. Seeking alternative tools for achieving immunity against COVID-19 remains to be of high importance. "Trained immunity" is the nonspecific immune response usually established through administering live attenuated vaccines and is a potential preventive tool against unrelated infections. Evidence regarding a possible protective role for certain live attenuated vaccines against COVID-19 has emerged mainly for those administered as part of childhood vaccination protocols. This review summarizes the relevant literature about the potential impact of Bacille Calmette-Guérin (BCG) and measles, mumps and rubella (MMR) vaccines on COVID-19. Existing available data suggest a potential role for BCG and MMR in reducing COVID-19 casualties and burden. However, more investigation and comparative studies are required for a better understanding of their impact on COVID-19 outcomes.

Seroprevalence of mumps among children and adolescents in Thailand, 2020

Thailand has implemented single-dose mumps-containing vaccines since 1997 and two doses since 2010. This study aimed to describe the seroprevalence of mumps among children who received one- or two-dose mumps vaccines. A cross-sectional study of 145 children (aged 3-9 years) and 422 adolescents (10-18 years) was conducted. Mumps IgG seropositivity was defined as ≥ 22 RU/mL by EUROIMMUN ELISA method. The mumps seroprevalence was higher in children (82.1%, 95% CI 74.8-87.9) compared to adolescents (41.7%, 95% CI 37.0-46.6) who had received at least one dose of the mumps vaccine. Among those receiving 2 doses of mumps vaccine at ≥ 5 years after their last mumps vaccination, only 51.3% had maintained IgG ≥ 22 RU/ml. There was a reverse correlation between mumps IgG titer and the time interval from the second dose of mumps vaccine (R = -0.44, p < 0.001). A booster dose of MMR vaccine in young adults may be needed.

Annual trends in adverse events following mumps vaccination in Japan: A retrospective study

BACKGROUND

In Japan, a monovalent mumps vaccine is provided on a voluntary basis. Due to public concerns over post-vaccination aseptic meningitis, the vaccination coverage is not high enough. The present study investigated the incidence of adverse events, including aseptic meningitis, after Torii strain-derived mumps vaccination.

METHODS

This retrospective, observational study used data collected by a vaccine manufacturer regarding adverse events following mumps vaccinations at medical institutions between 1992 and 2018. In addition, the number of Torii strain-derived mumps vaccines shipped each year was obtained. The incidence (per 100,000 doses) and 95% confidence intervals (CIs) were calculated for all adverse events and each adverse event, categorized as aseptic meningitis, encephalitis, mumps, mumps complications, and others.

RESULTS

During the study period, 8,262,121 mumps vaccine doses were shipped, and 688 subjects reported adverse events. The incidence for all adverse events (per 100,000 doses) was 8.33, and the incidence was 4.19 for aseptic meningitis, 0.33 for encephalitis, 0.80 for mumps, 0.25 for mumps complications, and 3.78 for others. The incidence of aseptic meningitis (per 100,000 doses) was 7.90 (95% CI: 5.61-10.18) between 1998 and 2000 but declined by half, to 3.91 (2.46-5.36), between 2001 and 2003. The most recent incidence (per 100,000 doses) of aseptic meningitis, for the period 2016 to 2018, was 2.78 (1.94-3.62).

CONCLUSION

The incidence of post-vaccination aseptic meningitis has declined significantly since 2001, and the incidence has remained stable at fewer than 3 cases per 100,000 doses since 2010. Multiple factors might have contributed to the decline in aseptic meningitis incidence, including (i) lowered misclassification of aseptic meningitis resulting from echovirus infection; (ii) changes in the vaccine manufacturing process in 2000; and (iii) publication in 2008 of the recommendation for vaccination of children at 1 year of age.

Association Between Subnational Vaccine Coverage, Migration, and Incident Cases of Measles, Mumps, and Rubella in Iraq, 2001–2016

Objective

This analysis examines governorate-level disease incidence as well as the relationship between incidence and the number of persons of concern for three vaccine-preventable diseases—measles, mumps, and rubella—between 2001 and 2016.

Methods

Using Iraqi Ministry of Health and United Nations High Commissioner for Refugees (UNHCR) data, we performed descriptive analyses of disease incidence and conducted a pooled statistical analysis with a linear mixed effects regression model to examine the role of vaccine coverage and migration of persons of concern on subnational disease incidence.

Results

We found large variability in governorate-level incidence, particularly for measles (on the order of 100x). We identified decreases in incident measles cases per 100,000 persons for each additional percent vaccinated (0.82, 95% CI: [0.64, 1.00], p-value < 0.001) and for every additional 10,000 persons of concern when incorporating displacement into our model (0.26, 95% CI: [0.22, 0.30], p-value < 0.001). These relationships were insignificant for mumps and rubella.

Conclusions

National level summary statistics do not adequately capture the high geospatial disparity in disease incidence between 2001 and 2016. This variability is complicated by MMR vaccine coverage and the migration of “persons of concern” (refugees) during conflict. We found that even when vaccine coverage was constant, measles incidence was higher in locations with more displaced persons, suggesting conflict fueled the epidemic in ways that vaccine coverage could not control.

How Australia's measles control activities have catalyzed rubella elimination

BACKGROUND

By 2017, rubella had been officially eliminated in Australia. This success was attributed to Australia's longstanding national immunization programme and two enhanced measles immunization activities using measles, mumps, and rubella (MMR) vaccines - the Measles Control Campaign (MCC) and the Young Adult MMR Campaign (YAC). Our study describes the impact of these activities on rubella incidence, and its elimination in Australia.

METHODS

Aggregate national serological survey data were assigned to birth cohorts, and mean, median, and age-group estimates calculated and analyzed against MMR immunization coverage estimates (1998-2018) and rubella notifications (1993-2018). Three-year cumulative incidences were calculated by birth cohort.

RESULTS

The serological surveys revealed high and stable levels of rubella immunity among females, but estimates for three male cohorts were lower. Since 2007, MMR immunization coverage among children aged 24-27 months has remained above 90% for both doses. The 3-year cumulative incidence of rubella declined across all birth cohorts following the MCC and the YAC.

DISCUSSION

Using MMR vaccines to address measles immunity gaps had the additional benefit of controlling rubella in Australia. Both the MCC and YAC shifted rubella epidemiology, accelerating the interruption of endemic transmission. Countries should consider combined measles and rubella vaccines for all catch-up activities.

Seroprevalence of viral infectious diseases and associated factors in Korean patients with inflammatory bowel diseases

BACKGROUND/AIMS

Data on the immunoprotective status against measles, mumps, rubella, varicella zoster virus (VZV), hepatitis A virus (HAV), and Epstein-Barr virus (EBV) infection in patients with inflammatory bowel disease (IBD) are still lacking. Therefore, we investigated the seropositivity rates for viral infectious diseases and the associated factors in Korean patients with IBD.

METHODS

In this retrospective cohort study, serum immunoglobulin G antibody positivity rates against measles virus, mumps virus, rubella virus, VZV, HAV, and EBV viral capsid antigen (VCA) were measured in patients with Crohn's disease or ulcerative colitis (UC) who first visited the IBD clinic. Seropositivity rates and their associated factors were analyzed.

RESULTS

Between January 2016 and December 2018, 263 patients were enrolled (male, 167 [67.3%]; UC, 134 [50.9%]). The median age at serological test was 30 years (interquartile range, 22 to 46). The seropositivity rates were 84.0%, 85.2%, 66.5%, 87.4%, 50.0%, and 93.7% for measles, mumps, rubella, VZV, HAV, and EBV, respectively. Younger age at serological test was associated with seronegative status for measles (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.88 to 0.96), VZV (aOR, 0.83; 95% CI, 0.74 to 0.93), and HAV (aOR, 0.93; 95% CI, 0.91 to 0.95). Furthermore, IBD type-UC was associated with seronegative status against VZV (aOR, 0.33; 95% CI, 0.11 to 0.99).

CONCLUSION

Seropositivity rates for common viral infectious diseases in Korean patients with IBD were similar to those of the general population. In the younger age group, protective immunity against measles, VZV, and HAV is required, with proper vaccination, as necessary.

Epidemiological peculiarities and analysis of the incidence time series of viral airborne infections in Ukraine in 2010-2020

Illnesses with aerosol mode of transmission dominate in the structure of infectious diseases. Influenced by natural, social and biological factors, epidemiological characteristics of the infectious diseases change, that's why the objective of this research was to determine modern peculiar features of the epidemiological situation regarding viral infections with aerosol transmission in Ukraine. Influenza incidence ranged from 31.14‒184.45 per 100 thousand people, other acute respiratory viral infections from 13685.24‒ 18382.5. Epidemic process of measles was characterized by increasing incidence in 2018 and 2019. In Ukraine, there is a tendency to reduce the incidence of rubella and mumps (р <0.05). The positive effect of immunization on the incidence of mumps and rubella has been established. Vaccination against measles cannot be considered as evidence of immunity against measles. The demographic situation in Ukraine may indirectly influence the intensity of the epidemic situation of viral infections with aerosol transmission.

Association between ozone exposure and prevalence of mumps: a time-series study in a Megacity of Southwest China

In the present study, we aim to evaluate the delayed and cumulative effect of ozone (O₃) exposure on mumps in a megacity with high population density and high humidity. We took Chongqing, a megacity in Southwest China, as the research area and 2013-2017 as the research period. A total of 49,258 confirmed mumps cases were collected from 122 hospitals of Chongqing. We employed the distributed lag nonlinear models with quasi-Poisson link to investigate the relationship between prevalence of mumps and O₃ exposure after adjusting for the effects of meteorological conditions. The results show that the effect of O₃ exposure on mumps was mainly manifested in the lag of 0-7 days. The single-day ;lag effect was the most obvious on the 4th day, with the relative risk (RR) of mumps occurs of 1.006 (95% CI: 1.003-1.007) per 10 μg/m³ in the O₃ exposure. The cumulative RR within 7 days was 1.025 (95% CI: 1.013-1.038). Our results suggest that O₃ exposure can increase the risk of mumps infection, which fills the gap of relevant research in mountainous areas with high population density and high humidity.

Association between particulate matter pollution and the incidence of mumps in 31 provinces from China

Previous studies have found that particulate matter (PM) pollution is a risk factor for respiratory disease by affecting body's immunity and carrying microorganisms. This study aimed to explore the association between PM and the incidence of mumps in 31 provinces from China. Monthly mumps cases, air pollution concentration, and meteorological factors in each province were obtained between January 2014 to December 2017. We used a generalized additive model (GAM) to investigate the associations of PM2.5 and PM10 with monthly mumps cases. We also tested the statistical significance of the differences between effect estimates in the warm season (April to September) and cold season (October to March) to explore potential effect modification. We found that a 10-μg/m3 increase (lag0) in PM2.5, and PM10 was associated with a 2.34% (95% CI: 1.32 to 3.36) and 1.90% (95% CI: 1.19 to 2.62) increase in the monthly counts of mumps cases, respectively. We also observed significant positive associations of PM2.5 and PM10 with mumps cases at lag0-1. These results were robust in our sensitivity analyses. No significant differences were found between the season-specific effects. Our results indicate that there is a positive relationship between PM and the incidence of mumps, which provides important implications for the prevention and control of mumps.

Exploring the Relationship between Mumps and Meteorological Factors in Shandong Province, China Based on a Two-Stage Model

Background: Small-scale studies have identified temperature and other meteorological factors as risk factors for human health. However, only a few have quantified the specific impact of meteorological factors on mumps. A quantitative examination of the exposure–response relationship between meteorological factors and mumps is needed to provide new insights for multi-city analysis. Methods: The daily recorded number of mumps cases and meteorological data in 17 cities of Shandong Province from 2009 to 2017 were collected. A two-stage model was built to explore the relationship between meteorological factors and mumps. Results: A total of 104,685 cases of mumps were recorded from 2009 to 2017. After controlling for seasonality and long-term trends, the effect of low temperature on mumps was significant at the provincial level, with a cumulative RR of 1.035 (95%CI: 1.002–1.069) with a 1-day lagged effect. The proportion of primary and middle school students was determined as an effect modifier, which had a significant impact on mumps (Stat = 8.374, p = 0.039). There was heterogeneity in the combined effect of temperature on mumps (Q = 95.447, p = 0.000), and its size was I² = 49.7%. Conclusions: We have identified a non-linear relationship between mumps and temperature in Shandong Province. In particular, low temperatures could bring more cases of mumps, with certain lagged effects. More public health measures should be taken to reduce the risks when temperatures are low, especially for cities with a high proportion of primary and secondary school students.