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1
Tahseen, Shahzadi Asma. "RELATIONSHIP OF MEASLES CASES IN MEASLES VACCINATED CHILDREN DURING OUTBREAK OF MEASLES IN BAHAWALPUR." Professional Medical Journal 26, no. 07 (July 10, 2019): 1125–30. http://dx.doi.org/10.29309/tpmj/2019.26.07.3780.
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Objectives: To evaluate the clinical profile and case fatality rate and their comparison in relation with vaccination status in admitted children. Study Design: Case series retrospective study. Setting: Pediatric units of the tertiary care Hospitals (Bahawal Victoria Hospital and the Civil Hospital) affiliated with Quaid-e-Azam medical College Bahawalpur situated in Southern Punjab, Pakistan). Period: 01/01/2013 to 06/9/2013. Methods and Material: A clinical diagnosis of measles (as made by consultants of said Pediatric units) and residing in Bahawalpur district for more than one month of period before admitting in the hospital was included and reviewed. The help of Statistical department of Executive District Officer Health Bahawalpur was taken for missing information as the measles is notifiable disease and all cases were notified to Executive District Officer Health. The children who were nonresident of Bahawalpur District or with incomplete data were excluded. The children were divided into three groups depending on number of measles vaccine doses given. Results: The data of 557 children admitting during the period 01/01/2013 to 06/9/2013 with a clinical diagnosis of measles and resident of Bahawalpur district was included. 52.97% were males. 26.57% were unvaccinated and 73.43% vaccinated (39.14% with one dose and 34.29% with two doses). The mean age ± SD in unvaccinated children was 24.68±27.04, with one dose vaccination 50.94 ±35.58 and with two doses vaccination was 45.05 ±23.67 months. The case fatality rate was 2.87%. The case fatality was significantly higher in males vaccinated with two doses of vaccine as compared to either ones vaccinated with one dose or unvaccinated ones but this difference was not found in females. Conclusion: This study shows that there is urgent need of proper surveillance of measles cases.
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Ластовка, И. Н., Т. А. Артемчик, and О. Н. Трубчик. "Measles in a Vaccinated Patient." Клиническая инфектология и паразитология, no. 1 (April 16, 2020): 123–28. http://dx.doi.org/10.34883/pi.2020.9.1.011.
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Корь высококонтагиозное, острое вирусное заболевание, которое может привести к та- ким осложнениям, как пневмония, энцефалит, вплоть до летального исхода. В результате вы- сокого охвата 2-дозной вакцинацией против кори в нашем регионе сохраняется относитель- но благоприятная эпидемиологическая ситуация. Регистрация кори в Республике Беларусь связана с завозными случаями из других стран, где корь остается эндемичной. Не исключены в данной ситуации и случаи возникновения кори у иммунизированных пациентов. В статье представлен клинический случай заболевания корью у вакцинированного пациента. Measles is a highly contagious, acute viral illness that can lead to complications such as pneumonia, encephalitis, and death. As a result of high 2-dose measles vaccination coverage in the Belarus and the high control of measles in our region, a relatively favorable measles situation remains. Nevertheless, the import of cases from other countries where measles remains endemic continues to occur, which leads to the emergence of groups of cases in Belarus. Cases of measles, even in vaccinated patients, are not excluded in this situation. The article presents a clinical case of measles in a vaccinated patient.
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De Serres, G., N. Boulianne, F. Meyer, and B. J. Ward. "Measles vaccine efficacy during an outbreak in a highly vaccinated population: Incremental increase in protection with age at vaccination up to 18 months." Epidemiology and Infection 115, no. 2 (October 1995): 315–23. http://dx.doi.org/10.1017/s0950268800058441.
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SummaryDuring a large measles outbreak in Quebec City in 1989, two investigations conducted in parallel evaluated the relative risk of measles and measles vaccine effectiveness with respect to age at vaccination. The study was a school-based case-control study including 563 cases and 1126 classmate controls. The second was a cohort study of the siblings of school cases including 493 siblings aged between 1 and 19 years. The relative risks (RR) of measles were similar in both settings and the trend towards increased vaccine efficacy with increasing age at vaccination was highly significant (P < 0·001). Vaccine efficacy rose from 85% in children vaccinated at 12 months of age to ≥ 94% in those vaccinated at 15 months and older. Even for children vaccinated at or after 18 months of age. the RR of measles was reduced when compared with children vaccinated between 15 and 17 months of age (RR 0·61. CI 95% 0·33–1·15). Small changes in the timing of initial measles vaccination can have a major impact on vaccine efficacy.
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Ammarah Jamal, Yousuf Yahya, and Agha Muhammad Ashfaq. "Impact of Measles Vaccination on the Acquisition and Frequency of Measles Infection in Province of Sindh." ANNALS OF ABBASI SHAHEED HOSPITAL AND KARACHI MEDICAL & DENTAL COLLEGE 22, no. 4 (December 31, 2017): 237–42. http://dx.doi.org/10.58397/ashkmdc.v22i4.138.
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Objective: To determine the status of vaccination among confirmed measles cases and to determine the association of vaccination status with the occurrence of measles infection.
Methods: A cross-sectional survey was carried out in the province of Sindh from January 2016 to April 2016. The study included patients of both gender, ³9 months of age, fulfilling the case definition of measles by World Health Organization (WHO), who were reported to and/or picked by the measles
surveillance officers. A sample of 3-5 ml of blood was collected from each registered patient between day 4 and day 28 of the rash to test for measles IgM antibodies. The samples were labelled and sent to National Measles Laboratory, National Institute of Health (NIH) Islamabad in reverse cold chain. Patients who tested positive for IgM antibodies were grouped as confirmed measles while patients negative for measles IgM antibodies were grouped as suspected measles. Data of both the groups was analysed using windows SPSS 21 for vaccination status, for frequency of measles infection against the number of doses of measles vaccine received. Frequencies of vaccination among confirmed measles cases were compared with suspected measles for statistical significance using Chi-square. P-value of <0.05 was taken as significant.
Results: A total of 572 out of 915 study subjects were confirmed measles cases, of which 258 (45%)were never vaccinated against the disease as compared to 72 (12.6%) who were completely vaccinated. Overall, 128 (37.3%) were fully vaccinated amongst suspected measles. Vaccination sta- tus was not known in a quarter of patients in both groups. A significant association was found be- tween the vaccination status and measles infection with higher frequency of measles in unvaccinated as compared to the vaccinated (p<0.001).
Conclusion: We conclude that the vaccination rate among measles patients was significantly lower than among non-measles patients. A sizable 12.6% got the disease in spite of completing measles vaccination.
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López-Perea, Noemí, Aurora Fernández-García, Juan Emilio Echevarría, Fernando de Ory, Mayte Pérez-Olmeda, and Josefa Masa-Calles. "Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020." Viruses 13, no. 10 (October 2, 2021): 1982. http://dx.doi.org/10.3390/v13101982.
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The MMR vaccination program was introduced in Spain in 1981. Consistently high vaccination coverage has led to Spain being declared free of endemic measles transmission since 2014. A few imported and import-related cases were reported during the post-elimination phase (2014 to 2020), with very low incidence: three cases per million of inhabitants a year, 70% in adults. In the post-elimination phase an increasing proportion of measles appeared in two-dose vaccinated individuals (up to 14%), posing a challenge to surveillance and laboratory investigations. Severity and clinical presentation were milder among the vaccinated. The IgM response varied and the viral load decreased, making the virus more difficult to detect. A valid set of samples (serum, urine and throat swab) is strongly recommended for accurate case classification. One third of measles in fully vaccinated people was contracted in healthcare settings, mainly in doctors and nurses, consistent with the important role of high intensity exposure in measles breakthrough cases. Surveillance protocols and laboratory algorithms should be adapted in advanced elimination settings. Reinforcing the immunity of people working in high exposure environments, such as healthcare settings, and implementing additional infection control measures, such as masking and social distancing, are becoming crucial for the global aim of measles eradication.
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St-Pierre, Annie, Anne-Marie Charron, Pamela Doyon-Plourde, and Caroline Quach. "Determinants of Protection Against Measles Infection in a Vaccinated Healthcare Worker." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s185. http://dx.doi.org/10.1017/ice.2020.722.
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Background: In 2019, a measles community outbreak resulted in a secondary case in a health care worker (HCW) working in a pediatric hospital in Montral, Canada. Following the event, HCWs were screened to identify individuals susceptible to measles infection based on serology results. Objective: Our aim was to assess measles seroprotection rates and to evaluate vaccine responses of susceptible HCWs using commercial enzyme immunoassay (EIA) or enzyme linked immunosorbent assay (ELISA). Methods: Emergency department (ED) employees, including doctors, were screened for measles susceptibility as part of a postoutbreak measure by the hospital occupational health service. Demographic information was collected. Measles history and vaccination information were collected using a personal vaccination booklet, employee vaccination profile, or the Qubec vaccination registry. According to the Quebec Immunization Protocol (PIQ), individuals born before 1970, or who have received 2 doses of a measles-containing vaccines are considered protected. Individuals with undetectable or equivocal antibody levels were considered at risk of measles infection. These individuals were offered vaccination and were tested for vaccine response 4 weeks after vaccination. Results: Anti-IgG measles antibody results, demographic information, and vaccination information were obtained for 257 employees. The results are currently available for 233 HCWs: 224 HCWs (96%) were seropositive, 7 (3%) were seronegative, and 2 were equivocal. Among seronegative individuals, 6 (85.7%) were born after 1980 and 3 (42.9%) had received 2 doses of a measles-containing vaccine. Of those with an equivocal result, 1 (50%) had received 2 doses and 1 (50%), born after 1970, did not confirm vaccination status. Finally, 9 (4%) of seropositive individuals were not vaccinated; of whom 8 (88.9%) were born before 1970. Conclusions: Our preliminary results suggest that the 95% immunity threshold that is usually required to prevent secondary transmission of measles has been reached in our ED HCW cohort. Even years after the second MMR dose, HCWs remain well protected. Relying on documented vaccination status is thus acceptable.Funding: NoneDisclosures: None
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Kaman, Ayşe, and Melahat Melek Oğuz. "Prevention of Health Care–Associated Measles Transmission in a Pediatric Clinic." Journal of Pediatric Infectious Diseases 17, no. 06 (November 2022): 303–7. http://dx.doi.org/10.1055/s-0042-1758054.
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Abstract Objective Preventive measures in the setting of a suspected measles case in a hospital setting are important to stop the secondary spread. In this report, we evaluated the prevention attempts after two suspected cases of measles were reported in a pediatric clinic. Methods We evaluated prevention interventions including isolation, intravenous immunoglobulin, or measles–mumps–rubella (MMR) vaccine after two patients were diagnosed with maculopapular rash compatible with measles in the pediatric clinic. Results There were 50 patients (29 were outpatients, 21 were inpatients), 19 health care personnel (HCP), and 50 caregivers who were in contact with index cases. All of the HCP and 40 of the caregivers were immune to measles. Additional dose of MMR vaccine was recommended to five of the outpatients by phone. A total of 12 patients who were being followed up as inpatients (8 patients aged 6–12 months, 4 patients aged ≥ 12 months) were vaccinated with one dose of MMR vaccine. Only a 12-year-old male patient was admitted due to complaints suggesting measles after 14 days from discharge. It was learned that he had received a single dose of vaccine before so he was recommended an additional dose of MMR vaccine by the phone, but he did not go to the health institution on the day of the call. Conclusion Postexposure prophylaxis is effective to prevent measles transmission. Although young infants have the highest risk for transmission of measles in a health care–associated outbreak, adolescents and older children who are single vaccinated also have high risk for clinical measles.
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Sowers, Sun B., Jennifer S. Rota, Carole J. Hickman, Sara Mercader, Susan Redd, Rebecca J. McNall, Nobia Williams, et al. "High Concentrations of Measles Neutralizing Antibodies and High-Avidity Measles IgG Accurately Identify Measles Reinfection Cases." Clinical and Vaccine Immunology 23, no. 8 (June 22, 2016): 707–16. http://dx.doi.org/10.1128/cvi.00268-16.
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ABSTRACTIn the United States, approximately 9% of the measles cases reported from 2012 to 2014 occurred in vaccinated individuals. Laboratory confirmation of measles in vaccinated individuals is challenging since IgM assays can give inconclusive results. Although a positive reverse transcription (RT)-PCR assay result from an appropriately timed specimen can provide confirmation, negative results may not rule out a highly suspicious case. Detection of high-avidity measles IgG in serum samples provides laboratory evidence of a past immunologic response to measles from natural infection or immunization. High concentrations of measles neutralizing antibody have been observed by plaque reduction neutralization (PRN) assays among confirmed measles cases with high-avidity IgG, referred to here as reinfection cases (RICs). In this study, we evaluated the utility of measuring levels of measles neutralizing antibody to distinguish RICs from noncases by receiver operating characteristic curve analysis. Single and paired serum samples with high-avidity measles IgG from suspected measles cases submitted to the CDC for routine surveillance were used for the analysis. The RICs were confirmed by a 4-fold rise in PRN titer or by RT-quantitative PCR (RT-qPCR) assay, while the noncases were negative by both assays. Discrimination accuracy was high with serum samples collected ≥3 days after rash onset (area under the curve, 0.953; 95% confidence interval [CI], 0.854 to 0.993). Measles neutralizing antibody concentrations of ≥40,000 mIU/ml identified RICs with 90% sensitivity (95% CI, 74 to 98%) and 100% specificity (95% CI, 82 to 100%). Therefore, when serological or RT-qPCR results are unavailable or inconclusive, suspected measles cases with high-avidity measles IgG can be confirmed as RICs by measles neutralizing antibody concentrations of ≥40,000 mIU/ml.
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Hull, Harry F., Jean M. Montes, Patricia C. Hays, and Robert L. Lucero. "Risk Factors for Measles Vaccine Failure Among Immunized Students." Pediatrics 76, no. 4 (October 1, 1985): 518–23. http://dx.doi.org/10.1542/peds.76.4.518.
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An outbreak of measles occurred in a municipal school system which had reported 98% of students immunized against measles. A case-control study was conducted to determine reasons for vaccine failure Vaccine failure was associated with immunizations that could not be documented in the provider's records. Among children with provider-documented immunization, vaccine failure was associated with vaccination at 12 to 14 months of age with an odds ratio of 4.73. Among children vaccinated at 15 months or older, vaccine failure was not associated with time elapsed since vaccination. Studies should be conducted to determine whether unreliable immunization records are a more widespread problem. Further consideration should be given to routine revaccination of children previously vaccinated at 12 to 14 months of age.
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Hyle, Emily P., Audrey C. Bangs, Amy P. Fiebelkorn, Alison T. Walker, Paul Gastanaduy, Anne M. Neilan, Sowmya R. Rao, Edward T. Ryan, Regina C. LaRocque, and Rochelle P. Walensky. "2769. The Clinical and Economic Impact of MMR Vaccinations to Prevent Measles Importations from US Pediatric Travelers Returning from Abroad." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S976—S977. http://dx.doi.org/10.1093/ofid/ofz360.2446.
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Abstract Background Although pediatric travelers comprise < 10% of US international travelers, they account for almost half of all measles importations among returning travelers. For travelers 1–18 years with no other evidence of measles immunity, the Advisory Committee on Immunization Practices (ACIP) recommends 2 MMR vaccine doses before departure; 1 dose is recommended for infant travelers (6 to <12 months) and does not count toward their primary immunization series. All US travelers (6 months to < 6 years) are at risk for being undervaccinated for measles because MMR is routinely given at 1 years and 4–6 years. Methods We developed a decision tree model to evaluate the clinical impact and cost per case averted of pretravel health encounters (PHE) that vaccinate MMR-eligible pediatric international travelers. We compared 2 strategies for infant (6 to < 12 months) and preschool-aged (1 to <6 years) travelers: (1) no PHE: travelers departed with baseline MMR vaccination status vs. (2) PHE: MMR-eligible travelers were offered vaccination. All simulated travelers experienced a destination-specific risk of measles exposure during travel (mean, 237exposures/10M travelers; range, 19–6,750 exposures/10M travelers); if exposed to measles, travelers were at risk of illness stratified by age and MMR vaccination status (range, 0.03–0.90). Costs include direct medical costs and lost work wages for guardians. Model outcomes included measles cases, costs, and cost per case averted. We varied inputs in sensitivity analyses. Results Compared with no PHE, PHE averted 451 measles cases at $985,000/case averted for infant travelers and 54 measles cases at $1.5 million/case averted for preschool-aged travelers (table, bottom). PHE can be cost-saving for travelers to regions with higher risk of measles exposure and if more MMR-eligible travelers are vaccinated at PHE (Figure 1). At a risk of exposure associated with European travel, PHE had better value when a measles importation led to a higher number of contacts or more US-acquired cases per importation (Figure 2). Conclusion PHE for pediatric travelers (6 months to <6 years) decreased the number of imported measles cases and saved costs, especially if targeted to travelers with higher-risk destinations, if more MMR-eligible travelers are vaccinated at PHE, or if outbreaks are larger. Disclosures All authors: No reported disclosures.
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Bianchi, Silvia, Maria Gori, Clara Fappani, Giulia Ciceri, Marta Canuti, Daniela Colzani, Marco Dura, et al. "Characterization of Vaccine Breakthrough Cases during Measles Outbreaks in Milan and Surrounding Areas, Italy, 2017–2021." Viruses 14, no. 5 (May 17, 2022): 1068. http://dx.doi.org/10.3390/v14051068.
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Despite the existence of an effective live-attenuated vaccine, measles can appear in vaccinated individuals. We investigated breakthrough measles cases identified during our surveillance activities within the measles/rubella surveillance network (MoRoNet) in Milan and surrounding areas (Northern Italy). Between 2017 and 2021, we confirmed measles virus (genotypes B3 or D8) infections in 653 patients and 51 of these (7.8%) were vaccinees. Among vaccinated individuals whose serum was available, a secondary failure was evidenced in 69.4% (25/36) of cases while 11 patients (30.6%) were non-responders. Non-responders were more frequently hospitalized and had significantly lower Ct values in both respiratory and urine samples. Median age and time since the last immunization were similar in the two groups. Importantly, we identified onward transmissions from vaccine failure cases. Vaccinees were involved in 20 outbreaks, in 10 of them they were able to transmit the virus, and in 8 of them, they were the index case. Comparing viral hemagglutinin sequences from vaccinated and non-vaccinated subjects did not show a specific mutation pattern. These results suggest that vaccination failure was likely due to the poor immune response of single individuals and highlights the importance of identifying breakthrough cases and characterizing their clinical and virologic profiles.
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Barbosa, Joana Rodrigues, Ana Silva Martins, Jorge Ruivo, and Leonor Carvalho. "Fever and Rash: Revisiting Measles." Acta Médica Portuguesa 31, no. 6 (June 29, 2018): 341. http://dx.doi.org/10.20344/amp.9776.
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Fever and rash are a common combination of symptoms in the young adult patient. The etiologic investigation is usually oriented towards the most common diseases, but atypical presentations of less frequent conditions should also be recalled. We describe the case of a 44 year-old Portuguese woman who presented with fever, conjunctivitis, cough and rash, rapidly evolving to hepatitis and extensive pneumonia with respiratory failure. Although she claimed to be vaccinated according to the national immunisation schedule, a final diagnosis of primary measles pneumonia was clinically made and confirmed by serology. However, some less typical features mislead us initially. Although the rare form of primary measles pneumonia is more prevalent among immunosuppressed patients, our patient was immunocompetent. Moreover, absence of contagiousness, as was the case, occurs more frequently in atypical measles. This case highlights the need to always confirm the alleged vaccination status in adults and raises attention to some unusual features of typical measles.
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Edmonson, M. Bruce, Jeffrey P. Davis, Daniel J. Hopfensperger, Jeffrey L. Berg, and Leonard A. Payton. "Measles Vaccination During the Respiratory Virus Season and Risk of Vaccine Failure." Pediatrics 98, no. 5 (November 1, 1996): 905–10. http://dx.doi.org/10.1542/peds.98.5.905.
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Objective. To determine whether measles vaccine failure is more common in persons who were vaccinated during the respiratory virus season, when they were more likely to have had concurrent minor illnesses. Design. Population-based case series and case-control study. Setting. Wisconsin and Ohio. Subjects. The case series included all 545 of the states' residents who had confirmed measles reported during 1985 through 1990 and a history of receiving a single dose of measles vaccine during 1975 through 1988 at 15 to 59 months of age. In a case-control study restricted to 1984 through 1988 vaccinees, season of vaccination was compared in 170 case children and 6070 control students. Main Outcome Measure. Risk of clinical vaccine failure after measles vaccination during the respiratory virus season (September through May) or the peak season (November through March) compared with summertime (June through August), after adjustment for age at vaccination and place of residence. Results. In the case series of persons with vaccine failure, the proportion who had been vaccinated during the respiratory virus season (74.7%) was no greater than expected (September through May = 74.8% of the year). In the case-control study, vaccination during the respiratory virus season (odds ratio, 0.92; 95% confidence interval, 0.66 to 1.30) or the peak season (odds ratio, 0.93) did not increase the risk of vaccine failure. Conclusion. Despite the high and strongly seasonal prevalence of viral respiratory illness in young children, routine childhood measles vaccination during the respiratory virus season does not increase their risk of vaccine failure. Findings provide epidemiologic support for recently strengthened recommendations that measles vaccination not be deferred in children with minor respiratory illnesses.
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Malik, Muhammad Wasif, Mumtaz Ali Khan, Muhammad Salman, Muazam Abbas Ranjha, Tayyab Razi Rathore, Urooj Aqeel, Syed Ijaz Ali Shah, Mirza Amir Baig, and Aamer Ikram. "A ASSESSMENT OF RISK FACTORS AND DETERMINATION OF VACCINE EFFICACY FOR MEASLES OUTBREAK DURING APRIL 2017 IN DHOK KAZIN, ISLAMABAD." Pakistan Journal of Public Health 8, no. 4 (January 3, 2019): 190–96. http://dx.doi.org/10.32413/pjph.v8i4.124.
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Background: On 13th April 2017, 3 measles cases were reported in Dhok Kazin, Islamabad to National Institute of Health, Islamabad. Federal Disease Surveillance & Response Unit on request of Islamabad Capital Territory (ICT) health administration started disease outbreak investigation and active case finding. The study was aimed to identify risk factors associated with disease outbreak, to assess vaccine coverage and vaccine efficacy in the outbreak area, and to suggest control measures. Methods: To determine possible risk factors age and sex matched case-control study was conducted in April, 2017. A case was defined as "Any resident of Dhok Kazin, presented with fever and maculopapular rash with any of signs/symptoms like coryza, conjunctivitis, cough, otitis media or pneumonia after March 20 to April 30, 2017". For each case 04 matched controls were selected. A structured questionnaire prepared to collect data. Vaccine coverage survey was conducted. Uni and multivariate analyses and vaccine efficacy were calculated. Results: A total of 14 cases identified including 11 cases found on active search. Cases were compared with 57 matched controls. Mean age was 39 months (range 08- 132 months). Among cases male to female ratio observed was 1:2.5. Overall attack rate was 1.2%, while most severely affected age-group was <12 months (AR=10.3%). The most common complications were diarrhea n=8 (57.1%) and pneumonia n=1 (7.1%). On vaccine coverage survey in 230 households, 31(70.5%) out of 44 children checked were vaccinated. The un-vaccinated children had attack rate of 14.3% while vaccinated had attack rate of 6.7%. The vaccine efficacy calculated was 53%. Significant association found in risk factors were; contact with positive case [OR 19.5, 95% CI; 4.5-84, P=0.00], unvaccinated children [OR=10.0, 95%, CI;1.2.0-49.3, P= 0.003], Mother illiteracy [OR 10.2, 95% CI; 2.5-41, P=0.00], Misconception about vaccination [OR 13.2, 95%, CI;3.1-57.1, P=0.00), vaccinator not visited home as a part of outreach activity [OR=6.4, 95%CI;1.7-23.4, P=0.00]. Reasons for non-vaccination were found to be misconception about vaccination (OR=34.8, 95%CI=5.5-219.7) and mother's illiteracy (OR=6.4, 95%CI=1.2-34.8). Conclusion: Most severely affected age group was 12 months and below. Low immunization rates were the most probable cause of outbreak. Case contacts, partial vaccination, misconception of vaccination, no visit of vaccinator to home, and mother's education were risk factors significantly associated with Measles outbreak. Findings were shared with the district health authorities for implementation of control measures.
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Shoukat, Hina, Fahad Pervaiz, Sobia Noreen, Ayesha Khadim, and Maira Latif. "Evaluation of Prevalence of Complications of Measles." Global Pharmaceutical Sciences Review II, no. I (December 30, 2017): 34–41. http://dx.doi.org/10.31703/gpsr.2017(ii-i).04.
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Study and evaluation of the prevalence of measles and its complication in vaccinated and non- vaccinated patients. To evaluate the prevalence of complications of measles among different age groups of children in the pedriatric ward. Clinical description of a case series. Children of different age groups suffering from measles. We have observed 315 measles patients in the pediatric ward of Bahawal Victoria Hospital in Bahawalpur. They were evaluated on the basis of complications. Different complications were observed in children of different age group and gender, and the main complications were encephalitis, conjunctivitis, pneumonia, diarrhoea and ear infections. Children of age less than 1 year to 7 years were observed, and it was observed that conjunctivitis, pneumonia and diarrhoea were among the most common complications, while encephalitis and ear infections were rare. Patients admitted to the pedriatric ward having long term complications have a high risk of death when treated. These patients were due to malnutrition and improper vaccination coverage, and improper vaccine storage. Respiratory distress, i.e., pneumonia, diarrhoea, conjunctivitis, ear infection and encephalitis, were the most common complications. To reduce the severity of these complications, mechanical ventilation, antibiotics treatment, electrolyte balance should be instituted early in patients with measles.
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Golubkova, A. A., T. A. Platonova, A. N. Kharitonov, E. A. Rybinskova, E. V. Lelenkova, and T. S. Yuzhanina. "Measles. Characteristics of the Epidemic Process and its Determinant in Real-Time Conditions (on the Example of a Measles outbreak in Yekaterinburg in 2016)." Epidemiology and Vaccine Prevention 16, no. 6 (December 20, 2017): 54–58. http://dx.doi.org/10.31631/2073-3046-2017-16-6-54-58.
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Introduction. Measles still poses a threat to the inhabitants of the planet. In different regions of the world and the Russian Federation are recorded instances of contamination and subsequent infection with formation of foci with a significant number of victims. Measles has a high reproduction rate of the infection. The purpose of this study was to determine the main characteristics of the epidemic process of measles and its determinants in realtime for direct and indirect control of epidemic process. Materials and methods. The authors analyzed the data of official registration of the incidence of measles the population of Ekaterinburg from 1988 to 2016, and medical records of cases of measles in 2016. We used epidemiological, clinical and statistical research methods. Results. The authors found that the epidemic process of measles has undergone significant changes. Measles was not registered in the city from 2001 to 2015, the unit drifts measles-endemic territories didn't leak. However, the situation changed at the end of 2016. It was 72 clinically and laboratory confirmed case of measles in a period of 11 weeks. The largest proportion of cases were in children who are not vaccinated against measles. The average age of infection in children was 3.8 years. 59 measles epidemic foci were formed during the flash. Foci were registered in families, educational institutions and health care organizations. The most active spread of the infection was in medical organizations. The spread was associated with the presence of susceptible children and adults, serious shortcomings in terms of timely diagnostics of measles in the first and subsequent cases, violations in the organization of antiepidemic measures. Conclusion. 1. Despite positive shifts in the direction of measles elimination, it remains an actual infection, reserving opportunities for distribution among unvaccinated adults and children. 2. A special feature of the outbreak of measles in the territory of Yekaterinburg was the spread in medical organizations with the formation of secondary foci along the routes of following sick children and adults. The share of foci in medical organizations was 15.2% of the number of all foci, and the number of cases in any - 70.8% of registered cases.3. The significance of previously vaccinated cases as potential sources of infection in the foci is not high, the incidence rate when in contact with them is 0.53 ± 0.15, whereas in contact with previously not vaccinated - 7.94 ± 0.56.
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Nozdrachevа, Аnna Valer'evna, Marina N. Asatryan, Larisa Alexandrovna Rybak, Artem Alexandrovich Voloshkin, and Anatoly Victorovich Semenenko. "Improvement of epidemiological diagnosis in the system of epidemiological surveillance of current infections by creating a database of the results of foci investigation." Sanitarnyj vrač (Sanitary Doctor), no. 5 (May 16, 2022): 316–25. http://dx.doi.org/10.33920/med-08-2205-01.
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Measles is one of the preventable infections that does not lose its relevance to this day. In Russia, as well as throughout the world, waves of an increase in the incidence of measles are still being recorded, so in 2019 the maximum incidence rate over the past 20 years (3.05 %ооо) was noted. According to the current Measles Elimination Program of the Russian Federation, each case of this infection is subject to investigation, based on the results of which the epidemiologist organizes measures to prevent its spread in the outbreak. The main anti-epidemic measures in this case are isolation of the patient (at home or in a hospital according to clinical indications) and vaccination of persons in contact with him who need it. Thus, in order to prevent the occurrence of secondary cases, it is necessary to determine the vaccination and infectious history of all persons in contact with the sick person and vaccinate them no later than the seventh day from the moment the outbreak was registered. To date, it is difficult to generalize data from investigations of measles cases, despite their value for epidemiological diagnosis and the development of epidemiological surveillance (ES) tactics. The aim of the work was to improve the information support for the investigation of measles cases by creating and analyzing a database. The authors proposed a method for summarizing and analyzing the results of the investigation of measles cases using the formation of a database. For this purpose, about 1000 acts and reports on the results of the investigation of measles foci (on paper) registered in Moscow in the period from 2013 to 2015 were analyzed. The data contained in these documents is entered into the database, systematized in separate blocks and processed by the appropriate software for the purpose of their subsequent accumulation, storage and analysis. Based on the results of the work, the age composition of measles patients was analyzed. It was found that children under 18 years of age were more likely to have this infection, while the largest share among them was in persons aged 3–6 (32.4 %) and 7–14 years (25.0 %). The use of the database made it possible to confirm the high epidemiological effectiveness of the measles vaccine — the protection factor (E) was 86 %. Using the database, it was found that adults aged 20–35 years old were most actively vaccinated in measles foci (vaccination coverage was 57.7 %). With the threat of this infection, only 25.9 % of children (under 17 years old) who needed vaccination agreed to be vaccinated, and the percentage of refusals varied from 69.8 % in the age group up to two years old to 42.3 % in the group 20–35 years old.
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Fonseca, Silvia, Ivana Lucca, Franceliana Sgobi, Andre Fioravante, Alexandre Celia, Rafael Diniz, Maysa Souza, et al. "Hospital Preparedness for a Community Measles Outbreak in Ribeirao Preto, Brazil." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s253. http://dx.doi.org/10.1017/ice.2020.814.
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Background: Measles was considered eradicated in Brazil in 2016, but the virus reemerged in the country in 2018, causing large outbreaks. Ribeirao Preto has been measles free since 1997, but the outbreak in Sao Paulo City, 180 miles away in June 2019, alerted us to the possibility of measles patients coming to our emergency room (ER). The preparedness challenge was considerable: most healthcare workers (HCWs) had never seen a measles case before, and confirmatory measles laboratory tests were not readily available to us. Objective: To describe the hospital preparedness for the coming community measles outbreak. Methods: Hospital So Francisco is a 170-bed, general, tertiary-care hospital with 10,000 ER visits monthly. Measles preparedness consisted of measles training classes for HCWs, and flow charts with pictures and measles information in every ER office, also sent to HCW cell phones. We also designated areas for suspected measles patients for prompt medical evaluation; and we implemented mass measles vaccination for all hospital HCWs regardless of vaccination status, excluding pregnant or immunosuppressed HCWs. We considered a measles suspected case any person with fever, 1 of 3 symptoms (cough, coryza or conjunctivitis), and a generalized maculopapular rash with head-to-toe distribution. All contacts for suspected cases were recommended to obtain a measles vaccination. Detection of viral RNA in a biological sample and or a positive IgM result in serum was used to confirm a clinically suspected case. The study period spanned July 2019 to September 2019. Results: Measles training occurred for 3 weeks in July–August and reached 200 HCWs. The measles vaccination was offered July 23 to August 15; 1,362 HCWs were already vaccinated (93% of target population). In total, 35 clinical suspected measles cases were seen in the ER, and 3 of these were HCWs who had received the measles vaccine in their incubation period. Also, 3 patients were admitted to the hospital and 1 to the intensive care unit; there were no deaths. Overall, 8 patients had laboratory-confirmed measles, and 1,343 community contacts of these patients were vaccinated. We did not detect measles transmission to inpatients or to other HCWs after mass vaccination began. In the same period, Sao Paulo state had >7,000 laboratory-confirmed measles cases and 12 deaths. Conclusions: Community measles outbreaks are a challenge for the hospital infection control team, and they can potentially disrupt the daily activities in the hospital. We were able to adequately prepare for the largest state outbreak in 20 years without secondary cases or deaths.Funding: NoneDisclosures: None
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McMickle, Robert, Lauren Fryling, and Ross Fleischman. "Acute Demyelinating Encephalomyelitis Following Measles Infection Due to Vaccine Failure: A Case Report." Clinical Practice and Cases in Emergency Medicine 2, no. 5 (March 24, 2021): 171–73. http://dx.doi.org/10.5811/cpcem.2021.2.49481.
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Introduction: Local outbreaks of measles infection are primarily mediated by international travel of persons from endemic areas, with subsequent spread of the virus via undervaccinated populations. Recent resurgences of measles in communities where vaccination rates are non-ideal secondary to philosophical objections require the emergency physician to more routinely consider the diagnosis. In cases of measles complicated by acute encephalitis or encephalopathy, the diagnosis can be especially difficult to make due to lack of a reliable primary historian. Case report: Here we present a case of altered mental status and new-onset bilateral lower extremity weakness in a fully vaccinated young woman diagnosed with measles infection caused by acute disseminated encephalomyelitis in the setting of vaccine failure. Conclusion: Despite a documented history of immunization, acute measles infection and its uncommon sequelae are possible. Recognizing vaccine failure and appropriately isolating patients are of paramount importance.
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Mohd Rahim, S., N. Ezrin Ilham, S. Norbaya Masri, and Z. Sekawi. "Severe measles infection due to primary vaccine failure in vaccinated children – A case report." International Journal of Infectious Diseases 101 (December 2020): 476. http://dx.doi.org/10.1016/j.ijid.2020.09.1247.
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Mohiuddin, Syed Adnan, Muna AlMaslamani, Samar Hashim, Hanfa Karim Panthalayinitharayil, Saad Rashid Alkaabi, Abdulwahab Abdulwahab, and Moutaz Derbala. "Measles hepatitis in a vaccinated liver transplant recipient: case report and review of literature." Clinical Case Reports 5, no. 6 (April 20, 2017): 867–70. http://dx.doi.org/10.1002/ccr3.783.
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Molochkova, O. V., O. B. Kovalev, M. A. Kosyreva, N. O. Ilyina, O. V. Shamsheva, E. N. Getmanova, A. A. Korsunsky, E. V. Galeeva, and A. A. Guzhavina. "Characteristics of measles in children during the rise in incidence in 2019." CHILDREN INFECTIONS 21, no. 4 (November 23, 2022): 27–31. http://dx.doi.org/10.22627/2072-8107-2022-21-4-27-31.
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In Moscow, as in Russia, in 2019 there was an increase in the incidence of measles in recent years.Purpose: to analyze the course of measles in children hospitalized in 2019 during the period of rising incidence.Materials and methods: a retrospective analysis and statistical processing of 30 case histories of children hospitalized with measles in the infectious diseases department of the Children's City Clinical Hospital № 9 named after G.N. Speransky in 2019.Results: More than half of the patients were under the age of 3 years (53%). In 90% of cases, the sick were not vaccinated, in 73% – due to the refusal of their parents. Only 23% of patients had measles contact, mostly familial. Measles in hospitalized children proceeds typically, in 83.3% of cases in a moderate form, with characteristic pathognomonic symptoms: in 83.3% of patients, Belsky-Filatov-Koplik spots are detected, on average, on the 4.4 ± 0.8 day of illness, spotted – papular rash on the face with staged distribution and subsequent staged pigmentation in all patients. Complications develop in 66.7% of cases, more often pneumonia (36.7%) and obstructive bronchitis (20%), which in 16.7% of cases cause the severity of the course and lead to the development of emergency syndromes and conditions (respiratory failure, obstructive syndrome).Conclusions. Failure to vaccinate against measles contributes to morbidity with possible complications.
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Muscat, M., A. H. Christiansen, B. E. Böttiger, A. Plesner, and S. Glismann. "A cluster of measles cases in Denmark following importation, January and February 2008." Eurosurveillance 13, no. 9 (February 28, 2008): 1–2. http://dx.doi.org/10.2807/ese.13.09.08050-en.
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Five cases of measles were reported to the Department of Epidemiology in Denmark between mid-January and early February, 2008. The cluster involved four adults aged between 23 and 39 years and an infant. All cases resided in the greater Copenhagen area. Three cases were unvaccinated, one was vaccinated with two doses, and in one case the vaccination status is not yet known.
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Islam, Ariful, Yamin Shahriar Chowdhury, Sheikh Azimul Haq, Narayan Chandra Saha, and Nazmul Haque. "An Unusual Findings of Elevated Urinary Copper Excretion in a Patient with Subacute Sclerosing Panencephalitis (SSPE): A Case Report." Journal of National Institute of Neurosciences Bangladesh 3, no. 2 (May 26, 2018): 113–15. http://dx.doi.org/10.3329/jninb.v3i2.36777.
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Subacute sclerosing panencephalitis is a progressive neurological disorder of childhood and early adolescence. It is caused by persistent defective measles virus1.We report a ten years old normally developed female patient who came with a history of drop attacks while walking, declining scholastic performance, progressively increasing myoclonic jerks. She had history of measles at five years of age though she was vaccinated as per EPI schedule. Physical examination and cerebrospinal fluid findings along with EEG changes in addition supported its diagnosis as a case of SSPE. The presence of increased urinary excretion of copper in SSPE is so far not yet reported in any published literature.Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 113-115
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Roy, Dr Dilip Kumar, Dr Mohammad Enamul Haque, and Dr Kaushik Roy. "Clinical Profiles and Outcome of Children Admitted with Measles in District Level Hospital, Nilphamari, Bangladesh." SAS Journal of Medicine 7, no. 7 (July 28, 2021): 324–29. http://dx.doi.org/10.36347/sasjm.2021.v07i07.006.
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Introduction: Measles is a highly contagious acute viral infection. It is a common cause of morbidity and mortality constituting half of vaccine preventable diseases. Aim of the study: The study was designed to describe the demographic, vaccination status, clinical profiles, and outcome of children admitted with measles during study time. Method: This was a retrospective observational study conducted in the department of Pediatrics at Adhunik Sadar Hospital, Nilphamari, Bangladesh. The diagnosis of measles based on clinical features. Demographic characteristics of patients and occurrence of measles from the time of vaccination was recorded. Patients below the age of 2 years who were clinically diagnosed as cases of measles were treated and followed. Data were analyzed by using SPSS version 22. Results: The most frequent age group of children admitted with measles during the study time 10-14 months was which constitute 35(54.69%) of cases. The youngest age group was 4-9 months constitute 24(37.50%) and the oldest was 15-18 months constitute 5(7.81%).This study showed that 36(56.25%) patients were males and 28(43.75%) were females with a male/female ratio of 1.14:1.21(32.81%) cases where from urban areas and 43(67.19%) were from rural area.39 (60.94%) cases were malnourished in 10-14 months age group, in 4-9months age group 20(30.25%) and in 15-18months age group was 5(7.81%).39(60.94%) children had history of contact with a case of measles in the preceding 3 weeks.20(31.25%) children had no history of contact and 5(7.81%) children had unknown history of contact. The total death ratio of the participants was 4(6.25%) where vaccinated patients was 1(1.56%), not vaccinated was 2(3.13%) which was significant and unknown cases was 1(1.56%). Conclusion: One third of measles infections occurred before the age of 9 months. Half of measles cases were not vaccinated. The majority of the complicated cases had occurred in the unvaccinated children. Pneumonia was found to .....
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Ranjan, Alok, Purushottam Kumar, Manisha Verma, Chandramani Singh, Sanjay Pandey, Bijaya Nanda Naik, Santosh Kumar Nirala, and Rajath Rao. "Role of BCG and Measles vaccination in protection against COVID-19 infection and severity of the disease: A pilot case-control study." National Journal of Community Medicine 13, no. 2 (February 28, 2022): 108–13. http://dx.doi.org/10.55489/njcm1322022160.
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Background: The role of BCG and MMR/Measles vaccination in reducing the burden of COVID-19 has been based on ecological data mostly. We planned this explorative pilot case-control study to understand the role of vaccination with Bacillus Calmette–Guerin (BCG) and measles administered as part of MMR vaccine on COVID 19.
Methodology: A case-control study was conducted in AIIMS Patna during December 2020 and January 2021. A total of 100 COVID-19 patients confirmed by RT-PCR test were taken as cases, and for each case, age and gender-matched SARS-COV-2 negative individual was taken as control. A study tool containing a pre-tested semi-structured questionnaire was used.
Results: The unadjusted odds of COVID-19 were found to be significantly higher among BCG vaccinated [1.88(1.03-4.4)] and MMR vaccinated individuals [5.06(2.34-10.90]. BCG vaccine was not found to have an independent effect on COVID-19 after adjusting for tobacco use, MMR vaccination status, unprotected contact with SARS-COV-2 positive patients, and co-morbidities. But Measles vaccine was found to independently increase the risk of COVID-19 [AOR: 4.505(1.8-11.3)].
Conclusion: BCG vaccination status was not found to be an independent predictor of COVID-19. Further studies with large sample size and better study design (cohort, randomized trials) need to be conducted.
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Bloch, Alan B., Walter A. Orenstein, William M. Ewing, William H. Spain, George F. Mallison, Kenneth L. Herrmann, and Alan R. Hinman. "Measles Outbreak in a Pediatric Practice: Airborne Transmission in an Office Setting." Pediatrics 75, no. 4 (April 1, 1985): 676–83. http://dx.doi.org/10.1542/peds.75.4.676.
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In February 1981, a measles outbreak occurred in a pediatric practice in DeKalb County, GA. The source case, a 12-year-old boy vaccinated against measles at 111/2 months of age, was in the office for one hour on the second day of rash, primarily in a single examining room. On examination, he was noted to be coughing vigorously. Seven secondary cases of measles occurred due to exposure in the office. Four children had transient contact with the source patient as he entered or exited through the waiting room; only one of the four had face-to-face contact within 1 m of the source patient. The three other children who contracted measles were never in the same room with the source patient; one of the three arrived at the office one hour after the source patient had left. The risk of measles for unvaccinated infants (attack rate 80%, 4/5) was 10.8 times the risk for vaccinated children (attack rate 7%, 2/27) (P = .022, Fisher exact test, two-tailed). Airflow studies demonstrated that droplet nuclei generated in the examining room used by the source patient were dispersed throughout the entire office suite. Airborne spread of measles from a vigorously coughing child was the most likely mode of transmission. The outbreak supports the fact that measles virus when it becomes airborne can survive at least one hour. The rarity of reports of similar outbreaks suggests that airborne spread is unusual. Modern office design with tight insulation and a substantial proportion of recirculated ventilation may predispose to airborne transmission.
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Ndikuyeze, A., A. Cook, F. T. Cutts, and S. Bennett. "Priorities in global measles control: report of an outbreak in N'Djamena, Chad." Epidemiology and Infection 115, no. 2 (October 1995): 309–14. http://dx.doi.org/10.1017/s095026880005843x.
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SummaryIn N'Djamena, capital of Chad, measles vaccination coverage of 12–23-month-old children fell from 61% in 1990 to 15% in 1993. A community survey of measles after an outbreak in 1993 showed that among children < 5 years of age, the mean monthly attack rate was 37 per 1000 (95% CI, 32–43) and the mean case fatality rate was 7·4%. Measles incidence was highest (77/1000/month) in children aged 9–11 months and fell among children > 3 years of age. Incidence rates were high (56/1000/month) among 6–8-month-old children, but only 3 deaths occurred in this age group. Measles vaccine efficacy, estimated by comparing attack rates in unvaccinated and vaccinated children, was 71 % (95% CI, 59–80%). Extrapolation of the results to the city population indicated that an estimated 19000 cases and > 1000 measles-associated deaths occurred in 1993. This preventable morbidity and mortality, in a city where coverage was formerly among the highest in Africa, shows the need for sustained global commitment to preventive health care.
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Al-Marbouai, Hanan. "An Imported Measles Outbreak in Al Buraimi Governorate, Oman, in April 2020." Iproceedings 8, no. 1 (February 10, 2022): e36683. http://dx.doi.org/10.2196/36683.
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Background On April 16, 2020, the communicable disease department of Al Buraimi Governorate, Oman, was notified about 3 cases of measles. On laboratory confirmation of measles on April 19, 2020, further field investigation was conducted. Oman has had few cases of measles since 1995; however, Al Buraimi Governorate has had imported cases of measles in recent years. Objective We conducted this study to investigate the epidemiology of imported cases of measles in Al Buraimi, Oman, in April 2020. Methods This case series retrospectively reported measles cases. Epidemiological investigation began by meeting the families of the affected children. The data obtained included clinical symptoms, exposure information, travel history, immunization, and history of contact with others. Results Among the positive cases of measles, 75% were in girls and 25% were in boys. In addition, 6 patients were Afghani nationals and 2 were Pakistani nationals. A detailed investigation that included virus isolation and genotyping identified the B3 genotype in all measles cases and traced the virus to Pakistan as the country of origin. Despite Pakistan being the place of origin of the virus, most cases of measles (75%) were reported in Afghani nationals because of low vaccination coverage. We also found that most of the children affected were 10 to 19 years old (75%). All children who did not have vaccination records or were unvaccinated, regardless of whether they had contracted the virus, were given the measles-mumps-rubella vaccine. This was done to prevent future outbreaks and to increase measles vaccination coverage. Conclusions This study demonstrated that the greatest challenge in eliminating measles in Oman is imported cases among non-Omani expatriates and unvaccinated children. It should therefore be a priority to vaccinate all expatriate children. Only when everyone is vaccinated in Oman can the goal of creating a measles-free country be realized.
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Costa, Vivian Barros Curvo, Rodrigo Guimarães Cunha, and Giovanna Ferraiouli. "Sarampo em profissional de saúde vacinado: relato de caso / Measles in vaccinated health professional: case report." Brazilian Journal of Health Review 3, no. 5 (2020): 13049–51. http://dx.doi.org/10.34119/bjhrv3n5-134.
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GHEBREHEWET, S., G. HAYHURST, A. KEENAN, and H. MOORE. "Outbreak of measles in Central and Eastern Cheshire, UK, October 2008–February 2009." Epidemiology and Infection 141, no. 9 (November 9, 2012): 1849–56. http://dx.doi.org/10.1017/s0950268812002300.
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SUMMARYWe describe the largest outbreak of measles in Central and Eastern Cheshire (North West England) since the MMR vaccine was introduced in 1988, the majority of cases were not vaccinated and more than 20% of the cases belonged to the travelling community. Over 4 months, 147 clinical cases of measles were notified locally to the Cheshire & Merseyside Health Protection Unit (CMHPU). Of these, 67 (45·6%) were laboratory confirmed, 42 (28·6%) were negative, and one was equivocal, leaving 23 probable and 14 possible cases. The primary case was probably an 8-year-old unvaccinated travelling child, symptomatic on 1 October 2008. Measles spread locally and within school-aged children until early February 2009. Most of Central and Eastern Cheshire, including 23 educational institutions (playgroups, nurseries, primary schools, secondary schools, colleges), were affected, showing that there were enough susceptible/unvaccinated children to sustain an outbreak. Nearly a quarter of the confirmed cases (15/67, 22·4%) were aged <13 months and too young to be vaccinated under the UK immunization schedule. This outbreak is a reminder of the importance of achieving herd immunity to prevent spread and protect those at risk of severe illness or complications. There were no fatalities in this outbreak and no significant complications were reported.
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Helfand, Rita F., Howard E. Gary, William L. Atkinson, James D. Nordin, Harry L. Keyserling, and William J. Bellini. "Decline of Measles-Specific Immunoglobulin M Antibodies after Primary Measles, Mumps, and Rubella Vaccination." Clinical Diagnostic Laboratory Immunology 5, no. 2 (March 1, 1998): 135–38. http://dx.doi.org/10.1128/cdli.5.2.135-138.1998.
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ABSTRACT Detection of measles-specific immunoglobulin M (IgM) has become the standard diagnostic method for laboratory confirmation of measles. In outbreaks, the interpretation of an IgM-positive result can be complicated when persons with suspected measles receive a dose of measles vaccine as part of outbreak control measures. This investigation evaluated the decay of measles-specific IgM antibodies 1 to 4 months after primary vaccination with measles, mumps, and rubella vaccine (MMRII). Serum samples were obtained from 536 infants vaccinated when they were 15 months old as part of a study to assess primary and secondary measles vaccine failure. Sixty serum specimens per week were selected from specimens collected between 4 and 9 weeks after MMRII vaccination; all 176 available serum specimens collected between 10 and ≥16 weeks were included. Specimens were tested for the presence of measles-specific IgM by an antibody-capture enzyme immunoassay. The proportion of IgM-positive specimens dropped from 73% at 4 weeks after vaccination to 52% at 5 weeks after vaccination and then declined to 7% by 8 weeks after vaccination. Less than 10% of children remained IgM positive between 9 and 11 weeks. An IgM-negative result helps rule out the diagnosis of measles in a person with suspected infection and a history of recent vaccination. The interpretation of a positive IgM result from a person with a clinically suspected case of measles and a recent history of measles vaccination (especially within 8 weeks) is problematic, and the diagnosis of measles should be based on epidemiologic linkage to a confirmed case or on detection of wild-type measles virus.
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Oliveira, Solange A., Marilda M. Siqueira, Antonio J. L. Costa, Maria T. C. Almeida, and Jussara P. Nascimento. "Serological findings during a measles outbreak occurring in a population with vaccine coverage." Revista do Instituto de Medicina Tropical de São Paulo 37, no. 5 (October 1995): 421–25. http://dx.doi.org/10.1590/s0036-46651995000500007.
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From March 1991 to April 1992, serum samples for IgM detection were collected from 112 clinical measles cases reported to the Health Department of Niterói, State of Rio de Janeiro. The positivity exceeded 90% for specimens collected from the 5th to the 29th day after the onset of the disease. After day 30 a decline in IgM detection was observed, although positivity has been detected up to 90 days after the onset of the symptoms. Forty-four patients (48.9%) with an IgM response had a history of prior measles vaccination. In 5 of the 22 measles-IgM negative cases the infection was due to other agents (rubella: 4 cases, dengue: 1 case). These results show that sensitivity of the test employed for confirming suspected measles cases is high, even in vaccinated patients.
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Sowe, Alieu, Mbye Njie, Dawda Sowe, Sidat Fofana, Lamin Ceesay, Yaya Camara, Brook Tesfaye, et al. "Epidemiology of measles cases, vaccine effectiveness, and performance towards measles elimination in The Gambia." PLOS ONE 16, no. 10 (October 21, 2021): e0258961. http://dx.doi.org/10.1371/journal.pone.0258961.
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Introduction In 2011, member states of the World Health Organization (WHO) Africa Regional Office (AFRO) resolved to eliminate Measles by 2020. Our study aims to assess The Gambia’s progress towards the set AFRO measles elimination target and highlight surveillance and immunisation gaps to better inform future measles prevention strategies. Material and methods A retrospective review of measles surveillance data for the period 2011–2019, was extracted from The Gambia case-based measles surveillance database. WHO—UNICEF national coverage estimates were used for estimating national level MCV coverage. Measles post campaign coverage survey coverage estimates were used to estimate national measles campaign coverage. Results One hundred and twenty-five of the 863 reported suspected cases were laboratory confirmed as measles cases. More than half (53.6%) of the confirmed cases have unknown vaccination status, 24% of cases were vaccinated, 52.8% of cases occurred among males, and 72.8% cases were among urban residents. The incidence of measles cases per million population was lowest (0) in 2011–2012 and highest in 2015 and 2016 (31 and 23 respectively). The indicator for surveillance sensitivity was met in all years except in 2016 and 2019. Children aged 5–9 years (Incidence Rate Ratio—IRR = 0.6) and residents of Central River region (IRR = 0.21) had lower measles risk whilst unvaccinated (Adjusted IRR = 5.95) and those with unknown vaccination status (IRR 2.21) had higher measles risk. Vaccine effectiveness was 89.5%. Conclusion The Gambia’s quest to attain measles elimination status by 2020 has registered significant success but it is unlikely that all target indicators will be met. Vaccination has been very effective in preventing cases. There is variation in measles risk by health region, and it will be important to take it into account when designing prevention and control strategies. The quality of case investigations should be improved to enhance the quality of surveillance for decision making.
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Ragusa, Rosalia, Armando Platania, Mario Cuccia, Gaetano Zappalà, Gabriele Giorgianni, Placido D’Agati, Maria Alessandra Bellia, and Marina Marranzano. "Measles and Pregnancy: Immunity and Immunization—What Can Be Learned from Observing Complications during an Epidemic Year." Journal of Pregnancy 2020 (August 1, 2020): 1–8. http://dx.doi.org/10.1155/2020/6532868.
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Measles is a highly contagious airborne disease. Unvaccinated pregnant women are not only at risk of infection but also at risk of severe pregnancy complications. As measles causes a dysregulation of the entire immune system, we describe immunological variations and how immune response mechanisms can lead to adverse pregnancy outcomes. We evaluated data during the measles outbreak reported in the province of Catania, Italy, from May 2017 to June 2018. We controlled hospital discharge records for patients admitted to hospital obstetric wards searching the measles diagnostic code. We have indicated the case as “confirmed” when the IgM was found to be positive with the ELISA method. We registered 843 cases of measles and 51% were females (430 cases). 24 patients between the ages of 17 and 40 had measles while they were pregnant. Adverse pregnancy outcomes included 2 spontaneous abortions, 1 therapeutic abortion, 1 foetal death, and 6 preterm deliveries. Respiratory complications were more prevalent in pregnant women (21%) than in nonpregnant women with measles (9%). 14 health care workers (1.7%) were infected with measles, and none of these had been previously vaccinated. Immune response mechanisms were associated with adverse pregnancy outcomes in women with measles. To reduce the rate of measles complications, gynaecologists should investigate vaccination history and antibody test results in all women of childbearing age. During a measles outbreak, gynaecologists and midwives should be active proponents of vaccination administration and counteract any vaccine hesitancy not only in patients but also among health care workers.
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Al-Abdullah, Nabeela Abdullah. "Measles outbreak amongst Manymar population of Jeddah City, Saudi Arabia." International Journal Of Community Medicine And Public Health 5, no. 7 (June 22, 2018): 2657. http://dx.doi.org/10.18203/2394-6040.ijcmph20182420.
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Background: Worldwide efforts for measles elimination are made possible due to the availability of a highly effective measles vaccine. In spite of a highly vaccinated population, an outbreak of measles has occurred in Jeddah province of Saudi Arabia, from January to February 2018.Methods: An outbreak investigation was conducted to describe the epidemiology of the outbreak. A performance audit of the control measures taken by the primary healthcare team was carried out in accordance with the World Health Organization (WHO) standards.Results: Of the 31 cases reported, the patient’s ages range from 1–9 years with an average age of 6 (±2) years. The index case was a 9 year old male. The performance indicator target for outbreak control measures was achieved. Ninety percent of the cases were investigated within 48 hours. Specimens such as serum blood and nasopharyngeal swabs were collected within the optimal period to test for measles IgG and IgM antibody.Conclusions: This outbreak demonstrates the increased susceptibility of unvaccinated children aged 6–11 months. To prevent possible future outbreaks, community awareness through educational campaigns, a review of children’s vaccination records, enhanced community surveillance and a measles ‘catch-up’ mass immunization campaign to interrupt chains of transmission are necessary.
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Savin, T. V., R. N. Kuznetsova, A. A. Kuznetsova, and Areg A. Totolian. "Primary immunodeficiency masks: A clinical case of vaccine-associated paralytic poliomyelitis." Russian Journal of Immunology 23, no. 4 (October 15, 2020): 499–504. http://dx.doi.org/10.46235/1028-7221-398-pmi.
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Human inborn immune-related errors comprise a heterogeneous group of rare genetically determined diseases of the immune system caused by loss or gain of function mutations altering relevant protein functions. The 2019 International Union of Immunological Societies recently proposed the classification for such pathologies now comprising 406 distinct disorders with 430 different gene defects. Predominantly antibody deficiencies represent most common group of human inborn immune-related errors, which diagnostics poses uneasy challenge for general practitioner due to a broad range of their clinical manifestations, such as infection, allergy, autoimmunity and malignancy. In addition, patients with human immune-related inborn errors may develop a vaccine-associated disease after administering live vaccines in accordance with the Russia-wide National Vaccine Schedule. Most common among vaccine-associated diseases are vaccine-associated paralytic poliomyelitis, vaccine-associated encephalitis (1 case per 1 000 000 doses of measles, rubella, varicella vaccine), vaccine-associated meningitis (1 case per 250 000 – 500 000 doses of mumps vaccine) as well as adverse effects related to BCG immunization: local (infiltration, cold abscess – 8.6 case per 100,000 vaccinated patients) and disseminated complications (BCG lymphadenitis – 15.5 case per 100 000 vaccinated patients, BCG osteitis – 3.5 case per 100 000 vaccinated patients). Vaccine-associated paralytic poliomyelitis in vaccinated patients occurs after the first, second and rarely third oral polio vaccine dose inoculation. Incidence rate for vaccineassociated paralytic polio after 1 and 3 oral vaccine inoculation ranges from 1 case per 700 000 vaccine doses to 1 case per 3 500 000, respectively. Vaccine-associated paralytic poliomyelitis mainly emerges due to inborn mutations related to humoral immunity after primary vaccination with oral polio vaccine or close contact of unvaccinated patients with subjects vaccinated with oral polio vaccine. Here, we describe a clinical case of vaccine-associated paralytic poliomyelitis in patient with primary immunodeficiency. Our is aimed at emphasizing importance of immunological alertness with regard to detecting primary immunodeficiencies and timely apply a replacement therapy prior to verifying type of immunodeficiency.
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Rota, Jennifer S., Carole J. Hickman, Sun Bae Sowers, Paul A. Rota, Sara Mercader, and William J. Bellini. "Two Case Studies of Modified Measles in Vaccinated Physicians Exposed to Primary Measles Cases: High Risk of Infection But Low Risk of Transmission." Journal of Infectious Diseases 204, suppl_1 (July 2011): S559—S563. http://dx.doi.org/10.1093/infdis/jir098.
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Gibney, Katherine B., Lucy O. Attwood, Suellen Nicholson, Thomas Tran, Julian Druce, Julia Healy, Janet Strachan, Lucinda Franklin, Robert Hall, and Gail B. Cross. "Emergence of Attenuated Measles Illness Among IgG-positive/IgM-negative Measles Cases: Victoria, Australia, 2008–2017." Clinical Infectious Diseases 70, no. 6 (May 16, 2019): 1060–67. http://dx.doi.org/10.1093/cid/ciz363.
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Abstract Background Waning measles immunity among vaccinated individuals may result in an attenuated illness. This study compares the epidemiological, clinical, and laboratory profile of measles cases with waning immunity with other measles cases. Methods Polymerase chain reaction–positive (+) measles cases notified to Victoria’s Department of Health and Human Services from 2008 to 2017 with immunoglobulin (Ig) M and IgG tested at diagnosis were classified according to serology at diagnosis: IgG negative (−) (nonimmune), IgM+/IgG+ (indeterminate), or IgM−/IgG+ (waning immunity). Results Between 2008 and 2017, 297 measles cases were notified, of whom 190 (64%) were included; 151 of 190 (79%) were nonimmune at diagnosis, 26 (14%) were indeterminate, and 13 (7%) had waning immunity. Between 2008–2013 and 2014–2017, the proportion of cases with waning immunity increased from 0 of 87 (0%) to 13 of 103 (13%) (P < .001) and the diagnostic sensitivity of initial IgM fell from 93% to 81% (P = .012), respectively. Seven (54%) waning immunity cases reported receiving measles-containing vaccines; 1 case had 2 documented doses. Compared with nonimmune and indeterminate cases, waning immunity cases were more likely to be male; less likely to report fever, coryza, and cough; and had lower burden of virus (higher cycle threshold values). Waning immunity cases had higher IgG titers than indeterminate cases (mean optical density values, 1.96 vs 0.71; P = .004). Onward transmission from 1 waning immunity case was documented. Conclusions Waning immunity among measles cases, associated with secondary vaccine failure and modified clinical illness, is emerging in Victoria with transmission potential.
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Maritsi, Despoina N., George Vartzelis, John Kopsidas, Nikos Spyridis, and Maria N. Tsolia. "Antibody status against measles in previously vaccinated childhood systemic lupus erythematosus patients: a prospective case-control study." Rheumatology 57, no. 8 (June 1, 2018): 1491–93. http://dx.doi.org/10.1093/rheumatology/key142.
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D'AGARO, P., G. DAL MOLIN, T. GALLO, T. ROSSI, D. SANTON, M. BUSETTI, M. COMAR, and C. CAMPELLO. "Epidemiological and molecular assessment of a measles outbreak in a highly vaccinated population of northeast Italy." Epidemiology and Infection 139, no. 11 (March 14, 2011): 1727–33. http://dx.doi.org/10.1017/s095026881100032x.
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SUMMARYTwo distinct measles outbreaks, unrelated from the epidemiological point of view but caused by genetically related strains, occurred in the Friuli Venezia Giulia region of northeastern Italy. Forty-two cases were reported during the period April–May 2008. In the first outbreak the index case was a teacher who introduced the virus into the Pordenone area, involving eight adolescents and young adults. The other concomitant outbreak occurred in the city of Trieste with 33 cases. The containment of the epidemics can be explained by the high MMR vaccine coverage in an area where the first dose was delivered to 93·4% and the second dose to 88·3% of the target children. Phylogenetic analysis of 14 measles virus strains showed that they belonged to a unique D4 genotype indistinguishable from the MVs/Enfield.GBR/14.07 strain, probably introduced from areas (i.e. Piedmont and Germany) where this genotype was present or had recently caused a large epidemic.
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Georgakopoulou, Theano, Elina Horefti, Helena Maltezou, Kassiani Gkolfinopoulou, Alexandra Vernardaki, Eleni Triantafyllou, Pantelis Mavraganis, et al. "1724. Characteristics of the Ongoing Measles Outbreak in Greece in the Context of the Recent European-wide Epidemic and Public Health Measures." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S54. http://dx.doi.org/10.1093/ofid/ofy209.130.
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Abstract Background Measles is a highly contagious disease which still remains a cause of severe complications, including deaths worldwide, despite the existence of safe and effective vaccines. In the last 3 decades, the incidence of measles in Greece has constantly declined with only sporadic clusters or outbreaks (last outbreak in 2010–2011). We describe the characteristics of the ongoing measles outbreak and the Public Health response. Methods All measles cases are reported through the mandatory notification system (EU case definition 2012) to the Department of Surveillance and Intervention of the Hellenic Centre for Disease Control and Prevention. For laboratory confirmation patient sera were tested for IgM antibodies and pharyngeal swabs for the presence of measles virus RNA with RT-PCR. Sequencing of the measles nucleoprotein gene was applied in positively tested serological samples. Results From 9 May 2017 to 26 April 2018, 2,659 cases were reported in all 13 regions in Greece; 1,605 (60.4%) were laboratory confirmed. Most cases (n = 1,595; 60%) were Roma (73% children <10 years) followed by nonminority Greek nationals (n = 781; 29.4%, of whom 57% young adults 25–44 years), highlighting the immunity gap in Roma population. The vast majority of cases (80.5%) were unvaccinated. Ninety-four (3.5%) cases were healthcare workers (HCW); all were partially or not vaccinated. Genotype B3 was identified by molecular testing in all 88 cases tested. Severe complications were reported in 429 (16.1%) patients, most frequently pneumonia (43.8%) and hepatitis (21.2%). Three deaths were recorded in an 11-month-old immunocompromised Roma infant, a 17-year-old unvaccinated Roma, and a 35 year olds partially vaccinated individual from the general population. Extensive vaccination in refugee/migrant hosting sites prevented the emergence of a large number of cases. Mitigation efforts focused on closing the immunization gap in Roma population through emergency vaccination and raising awareness among HCWs to prevent further spread. Conclusion The current outbreak highlights the need to achieve high vaccination coverage with 2 doses of MMR vaccine in the general population (children, adolescents, and young adults) and in hard-to-reach vulnerable populations like Roma and refugees. Disclosures All authors: No reported disclosures.
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Skryabina, S. V., S. A. Kovyazina, S. V. Kuzmin, A. I. Yurovskikh, O. V. Tsvirkun, A. G. Gerasimova, N. T. Tikhonova, et al. "Measles Outbreak in Sverdlovsk Region." Epidemiology and Vaccine Prevention 17, no. 2 (April 20, 2018): 50–56. http://dx.doi.org/10.31631/2073-3046-2018-17-2-50-56.
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Objective.In the Russian Federation on the background of the sporadic incidence of measles, the trend is not highly uniform distribution of morbidity on territories of the country with the formation of local outbreaks, including the result of nosocomial infection. Find out the causes of the outbreak, for example the territory, for 15 years keeping and epidemic well-being in relation to measles, high vaccination coverage in children and adults, to assess the capacity of health care organizations and epidemiology to prevent the spread of measles and the elimination of flash was the goal of this research.Material and methods. A retrospective epidemiological analysis was held: the incidence of measles for the period 2001–2016 in the Sverdlovskiy region ; 76 «Cards epidemiological case investigation suspected measles», was from October to December 2016; the analysis of the extraordinary and final reports of the measles outbreak, reports on the activities carried out in the outbreak of measles. Laboratory verification of cases suspected were examined the ELISA method in the Perm regional centre, on the basis of detection of specific IgM and/or IgG increase. Molecular genetic research of 15 clinical specimens were performed at the Scientific- methodical centre on supervision of measles and rubella (Gabrichevsky Research Institute by Epidemiology & Microbiology», Moscow).Results.During the period c from 40 to 51 week of 2016 measles ill 76 people, mostly (66 persons) residents of the city of Yekaterinburg. Prevailed among the infected children was 67% (51 persons), usually not vaccinated against this infection – 90% (46) of children had a measles vaccination. All cases were laboratory confirmed. Expected sources or place of infection was established in 90.8% of cases. Among cases and 72.4% (55 persons) amounted to unvaccinated against measles, 11.8 per cent(9 people) were vaccinated once, of 15.8% (12) had a two-fold vaccination. In 8 hospitals was 8 foci of measles, 6 of which had spread. Among the cases of measles identified in health facilities, 35 children and 19 adults, including 5 health workers and 3 medical students. The formation of foci of nosocomial infection contributed to missed cases of measles, late diagnosis, significantly reduce the effectiveness of anti-epidemic measures. The results of molecular genetic studies of 15 clinical samples of patients selected at 42–44, and 47–49 weeks possible to establish the circulating strains of measles virus genotype D8. Epidemiological investigations and the common genetic variant circulating genotypes, selected at different stages of measles spread from different foci made it possible to combine all cases in one outbreak. Analysis of clinical manifestations of measles have testified to the fact that measles is proceeded typically in 92.2% of cases. Eleven drifts infection in educational institutions of Ekaterinburg was not accompanied by the secondary spread, indicating good collective immunity.Conclusion.Thus, a retrospective epidemiological analysis of outbreaks of measles showed that in conditions of sporadic measles in doctors reduced vigilance against measles. Late diagnosis of measles and as a consequence of its failure to carry out anti- epidemic measures led to the spread of infection, as well as skid measles in other medicine organization, which consisted of nosocomial foci. The present outbreak showed that measles requires constant attention, especially during her long absence in the region. It is only possible to prevent sustained secondary transmission if measles vaccination coverage is high for the entire population.
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Yagci Sokat, Kezban, and Benjamin Armbruster. "Modeling and Controlling Epidemic Outbreaks: The Role of Population Size, Model Heterogeneity and Fast Response in the Case of Measles." Mathematics 8, no. 11 (October 31, 2020): 1892. http://dx.doi.org/10.3390/math8111892.
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Modelers typically use detailed simulation models and vary the fraction vaccinated to study outbreak control. However, there is currently no guidance for modelers on how much detail (i.e., heterogeneity) is necessary and how large a population to simulate. We provide theoretical and numerical guidance for those decisions and also analyze the benefit of a faster public health response through a stochastic simulation model in the case of measles in the United States. Theoretically, we prove that the outbreak size converges as the simulation population increases and that the outbreaks are slightly larger with a heterogeneous community structure. We find that the simulated outbreak size is not sensitive to the size of the simulated population beyond a certain size. We also observe that in case of an outbreak, a faster public health response provides benefits similar to increased vaccination. Insights from this study can inform the control and elimination measures of the ongoing coronavirus disease (COVID-19) as measles has shown to have a similar structure to COVID-19.
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Kalugina, Vera G., Marina V. Fedoseenko, Anna A. Alekseeva, Kamilla E. Efendieva, Julia G. Levina, Tatiana A. Kaliuzhnaia, Svetlana V. Tolstova, Elena A. Vishneva, and Leyla S. Namazova-Baranova. "Multidisciplinary Approach in Vaccination of a Child with Food Allergy: Clinical Case." Pediatric pharmacology 19, no. 1 (March 3, 2022): 33–38. http://dx.doi.org/10.15690/pf.v19i1.2350.
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Children with chicken egg protein allergy are denied performing vaccination against measles, mumps, influenza in Russian Federation thus far, thus it is unreasonable. This article presents a clinical case of 2 years 6 months old boy with cow’s milk protein allergy symptoms and high levels of specific IgE antibodies (sIgE) to chicken egg protein. He was unreasonably denied performing vaccination against measles, rubella, and mumps at the place of residence according to false interpretation of the clinical situation as the absolute contraindication for vaccination. Lately, the child was successfully vaccinated against these infections at Research Institute of Pediatrics and Children’s Health in “Central Clinical Hospital of the Russian Academy of Sciences”. The examination dynamics is presented, as well as the data on the extended allergy diagnostics of separate components via the ISAC allergochip. Finally, the prognosis on food allergy resolution and recommendations on nutrition and further vaccination were given for this patient.
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Bozzola, Elena, Mauro Bozzola, Valeria Calcaterra, Salvatore Barberi, and Alberto Villani. "Infectious Diseases and Vaccination Strategies: How to Protect the “Unprotectable”?" ISRN Preventive Medicine 2013 (April 3, 2013): 1–5. http://dx.doi.org/10.5402/2013/765354.
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Introduction. The circulation of infectious diseases puts small infants too young to be vaccinated at risk of morbidity and mortality, often requiring prolonged hospitalization. Material and Methods. We have reviewed the medical records of children not eligible for vaccination because of age, admitted to hospital for pertussis, measles, or varicella from February 1, 2010, till February 1, 2012. Results. Of the case records scrutinized, 21 were hospitalized for pertussis, 18 for measles, and 32 for varicella. Out of them, 42%, 66%, and 78% diagnosed with, respectively, pertussis, measles, and varicella had a complicated course of the disease. Discussion. To avoid infectious disease circulation, childhood immunization strategies should be adopted, such as vaccination of healthcare givers, adult household contacts, and parents planning to have, or who have had, a newborn baby.
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Hussain, Zakir, and Abdul Wali Khan. "FACTORS ASSOCIATED WITH A MEASLES OUTBREAK IN DISTRICT SKARDU, GILGIT BALTISTAN, PAKISTAN." Pakistan Journal of Public Health 9, no. 1 (July 15, 2019): 30–33. http://dx.doi.org/10.32413/pjph.v9i1.220.
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Background: In Pakistan, annually 20,000 children deaths reported due to measles. This outbreak was investigated with the objectives to identify the associated risk factors and recommend appropriate control measures to prevent future outbreaks. Methods: A case was defined as any child presented with fever, generalized maculopapular rash with one of the following symptoms; cough, coryza or conjunctivitis during March-April 2011 in Skardu district. Two healthy age and sex matched controls were selected for each case from the same neighborhood. Information was collected on demographics, date of onset of illness and possible risk factors. Results: A total of 29 suspected measles cases were identified. The overall attack rate was 19% and the most affected age group was 9-19 months (attack rates 16%). Measles vaccination was lower among children with measles (OR. 4, C.I 1.8-12.5, p<0.05). The proportion of parents who consider measles as dangerous was significantly higher among the parents of cases (OR 3.6, CI 1.4-9.3, P 0.006). Better educated mothers were more likely to get their child vaccinated (OR 4, CI, 2.1-7.9, p<0.05) and history of contact was found associated with the disease (OR 7.2, CI 3.5-12.7, p 0.002). Multivariate analysis yielded significant association of following risk factors; vaccination status (OR 3.8, CI 1.8-12.5, p 0.005) and history of contact (OR 3.2, CI 1.0-10.7, p<0.05) with the disease. Conclusion: Lower vaccination coverage and lack of awareness about measles among parents was the most probable cause of this outbreak. Improvement in routine vaccination coverage and health education on the safety of immunization was recommended.
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Lavrentieva, I. N., M. Hoang, A. Y. Antipova, M. A. Bichurina, and A. A. Totolyan. "Revealing measles cases in Vietnam during the spread of a new coronavirus infection." Russian Journal of Infection and Immunity 12, no. 1 (January 25, 2022): 105–12. http://dx.doi.org/10.15789/2220-7619-rmc-1806.
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Introduction. According to the WHO Strategic Plan, five out of six geographical regions were expected to achieve measles elimination by 2020, among which is the Western Pacific Region (WPR), which includes the Socialist Republic of Vietnam (VNM). In 2019, 14 156 measles cases were detected in Vietnam, which significantly exceeds the level required to achieve its elimination (less than 1 case per 1 million population). Analyzing the causes of the ongoing measles virus circulation in diverse global regions is very important. It is also important to assess a potential impact on the measles incidence due to anti-epidemic measures aimed at combating the COVID-19 pandemic. This research is devoted to revealation measles cases in South Vietnam within the period covering January 2020 to March 2021. Materials and methods. 799 samples of blood sera obtained from different territories of South Vietnam in 2020–2021 were examined for IgM antibodies against measles virus using the Anti-Measles Virus ELISA (IgM) test system (Euroimmun, Germany). The presence of IgM measles virus antibodies in the blood serum was assessed as an acute measles infection. Results. The measles virus was actively circulating in South Vietnam in the first months of 2020. Residents of large cities and industrial centers were mainly involved in the epidemic process. Measles spread mainly among unvaccinated (71.58%) subjects, or who was unaware of vaccinations (25.48%), but also among those who were vaccinated (2.12%) and revaccinated (0.64%). The absolute majority of cases (71%) affected children under the age of three, with a predominance of those at the first year of life. Among the latter, 48% were children aged 7-9 months old. In March- April 2020, there was a sharp decrease in the number of measles cases in South Vietnam, down to a sporadic level (from May 2020 to March 2021). This is probably due to the anti-epidemic measures that were carried out in the VNM in order to limit the spread of COVID-19. Consequently, after the restrictions are lifted, we can expect an increase in the measles incidence in VNM.
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Hoefer, Dina, Patricia S. Ruppert, Elizabeth Rausch-Phung, Elizabeth Dufort, Manisha Patel, Manisha Patel, Dylan Johns, et al. "LB15. Measles Outbreak in New York State (NYS) Outside of New York City, 2018–2019." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S999—S1000. http://dx.doi.org/10.1093/ofid/ofz415.2498.
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Abstract Background The United States is experiencing one of the largest and longest measles outbreaks since elimination was declared in 2000 and is at risk of losing this status. Most cases occurring in NYS were reported in undervaccinated communities. Methods We included all confirmed NYS measles cases (excluding NYC) from outbreak counties from October 1, 2018 to July 25, 2019. We used the CSTE measles case definition requiring an acute febrile rash illness and either laboratory confirmation or direct epidemiologic linkage to a lab-confirmed case. For each case, demographic and clinical characteristics were obtained. A medical record review was completed for those reported to have an encounter at a hospital, emergency department, or urgent care center. Results There were 371 cases of measles reported, including 11 internationally imported cases. Most occurred in Rockland county (n = 283); followed by Orange (n = 55), Westchester (n = 18), Sullivan (n = 14) and Greene (n = 1) (Figures 1 and 2). The median age was 5.5 years; 79% of all cases occurred among children younger than 18 years of age (Figure 3). Most cases (79%) had not received any doses of measles vaccine. Of the 371 cases, 263 (71%) were children who had received 0 doses of measles, mumps, rubella vaccine (MMR), 218 (83%) of whom were over 1 year of age (Table 1). There have been no deaths or documented cases of encephalitis. Twenty-eight (8%) patients were diagnosed with pneumonia and 25 (7%) patients were hospitalized. Among 17 hospitalized children, 5 (29%) were admitted to the intensive care unit (ICU) (ages 1 day to 7 years). There were two preterm births at 34 and 25 weeks gestation to women with measles while pregnant. During October 1, 2018–July 31, 2019, providers in outbreak counties vaccinated 72,465 individuals with MMR, a 46% increase from the same period the year prior. Conclusion Unvaccinated children were identified as the largest group affected and experienced severe complications; nearly 30% of hospitalized children were admitted to an ICU. These data support the critical need for continued education and outreach on the risks of measles and the value of vaccination to prevent continued circulation in undervaccinated communities and potential further cases of severe disease. Disclosures Kirsten St. George, MAppSc, PhD, Akonni Biosystems (Other Financial or Material Support), ThermoFisher (Grant/Research Support), Zeptometrix (Other Financial or Material Support, royalty generating collaborative agreement); others, no disclosures reported..
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Knipes, Alaine K., Aimee Summers, Alexandros A. Sklavounos, Julian Lamanna, Richard P. S. de Campos, Tanya Narahari, Christopher Dixon, et al. "Use of a rapid digital microfluidics-powered immunoassay for assessing measles and rubella infection and immunity in outbreak settings in the Democratic Republic of the Congo." PLOS ONE 17, no. 12 (December 21, 2022): e0278749. http://dx.doi.org/10.1371/journal.pone.0278749.
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The Democratic Republic of the Congo (DRC) has a high measles incidence despite elimination efforts and has yet to introduce rubella vaccine. We evaluated the performance of a prototype rapid digital microfluidics powered (DMF) enzyme-linked immunoassay (ELISA) assessing measles and rubella infection, by testing for immunoglobulin M (IgM), and immunity from natural infection or vaccine, by testing immunoglobulin G (IgG), in outbreak settings. Field evaluations were conducted during September 2017, in Kinshasa province, DRC. Blood specimens were collected during an outbreak investigation of suspected measles cases and tested for measles and rubella IgM and IgG using the DMF-ELISA in the field. Simultaneously, a household serosurvey for measles and rubella IgG was conducted in a recently confirmed measles outbreak area. DMF-ELISA results were compared with reference ELISA results tested at DRC’s National Public Health Laboratory and the US Centers for Disease Control and Prevention. Of 157 suspected measles cases, rubella IgM was detected in 54% while measles IgM was detected in 13%. Measles IgG-positive cases were higher among vaccinated persons (87%) than unvaccinated persons (72%). In the recent measles outbreak area, measles IgG seroprevalence was 93% overall, while rubella seroprevalence was lower for children (77%) than women (98%). Compared with reference ELISA, DMF-ELISA sensitivity and specificity were 82% and 78% for measles IgG; 88% and 89% for measles IgM; 85% and 85% for rubella IgG; and 81% and 83% for rubella IgM, respectively. Rubella infection was detected in more than half of persons meeting the suspected measles case definition during a presumed measles outbreak, suggesting substantial unrecognized rubella incidence, and highlighting the need for rubella vaccine introduction into the national schedule. The performance of the DMF-ELISA suggested that this technology can be used to develop rapid diagnostic tests for measles and rubella.