The decline of measles antibody titers in previously vaccinated adults: a cross-sectional analysis

ABSTRACT The global reemergence of measles in 2018-2019 reinforces the relevance of high-coverage immunization to maintain the disease elimination. During an outbreak in the Sao Paulo State in 2019, several measles cases were reported in individuals who were adequately vaccinated according to the current immunization schedule recommends. This study aimed to assess measles IgG antibody seropositivity and titers in previously vaccinated adults. A cross-sectional study was conducted at CRIE-HC-FMUSP (Sao Paulo, Brazil) in 2019. It included healthy adults who had received two or more Measles-Mumps-Rubella vaccines (MMR) and excluded individuals with immunocompromising conditions. Measles IgG antibodies were measured and compared by ELISA (Euroimmun®) and chemiluminescence (LIASON®). The association of seropositivity and titers with variables of interest (age, sex, profession, previous measles, number of measles-containing vaccine doses, interval between MMR doses, and time elapsed since the last MMR dose) was analyzed. A total of 162 participants were evaluated, predominantly young (median age 30 years), women (69.8%) and healthcare professionals (61.7%). The median interval between MMR doses was 13.2 years, and the median time since the last dose was 10.4 years. The seropositivity rate was 32.7% by ELISA and 75.3% by CLIA, and a strong positive correlation was found between the tests. Multivariate analyses revealed that age and time since the last dose were independently associated with positivity. Despite being a single-center evaluation, our results suggest that measles seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose.

Catarata congênita nas infecções intrauterinas mais comuns (STORCH): revisão de literatura / Congenital cataract in the most common intrauterine infections (STORCH): a review of the literature

RESUMO Objetivo: O objetivo deste estudo foi revisar os aspectos clínicos e patológicos da catarata congênita secundária às infecções por sífilis, toxoplasmose, rubéola, citomegalovírus e herpes simples. Métodos: Trata-se de uma revisão de literatura, na qual foram incluídos artigos de periódicos indexados às bases de dados PubMed®, Cochrane, Lilacs, Embase e SciELO de 2010 a 2023. Resultados: Foram encontrados 45 artigos, e, após seleção, restaram 9 artigos. Além disso, foram adicionados artigos para enriquecer a discussão. A infecção por sífilis está relacionada a alterações corneanas. O citomegalovírus e a toxoplasmose estão relacionados com a coriorretinite e/ou microftalmia. A rubéola é responsável por causar catarata, glaucoma, microftalmia e retinite em sal e pimenta. Conclusão: Foram abordadas as principais etiologias infecciosas e seu quadro clínico na CC. O melhor tratamento para CC é cirúrgico associado a acompanhamento clínico, mas a prevenção é a maneira mais eficaz de combater a CC de etiologia infecciosa. O diagnóstico precoce e o tratamento efetivo previnem alterações e sequelas visuais irreversíveis. Nesse contexto, mostram-se importantes as ações de políticas públicas para o melhor desfecho clínico e melhor qualidade de vida.

ABSTRACT Objective: To review the clinical and pathological aspects of CC secondary to infections by syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes simplex. Methods: This is a literature review. Articles from journals indexed to PubMed, COCHRANE, LILACS, EMBASE and SCIELO from 2010 to 2023 were included. Results: A total of 45 articles were found, which, after selection, remained in 9 articles. Some articles were included to enrich the discussion in this topic. The infection caused by syphilis is related to corneal changes. Cytomegalovirus and Toxoplasmosis due to chorioretinitis and/or microphthalmia. Rubella is responsible for causing cataracts, glaucoma, microphthalmia, and salt and pepper retinitis. Conclusion: The main infectious etiologies and their clinical status in CC were addressed. The best treatment for CC is surgery associated with clinical follow-up, but prevention is the most effective way to combat CC of infectious etiology. Early diagnosis and effective treatment prevent irreversible visual changes and sequelae. In this context, public policy actions are important for the best clinical outcome and better quality of life.

Immunogenicity of measles-rubella vaccine administered under India’s Universal Immunization Programme in the context of measles rubella elimination goal: A longitudinal study

Background & objectives: There is a paucity of data regarding immunogenicity of recently introduced measles–rubella (MR) vaccine in Indian children, in which the first dose is administered below one year of age. This study was undertaken to assess the immunogenicity against rubella and measles 4-6 wk after one and two doses of MR vaccine administered under India’s Universal Immunization Programme (UIP). Methods: In this longitudinal study, 100 consecutive healthy infants (9-12 months) of either gender attending the immunization clinic of a tertiary care government hospital affiliated to a medical college of Delhi for the first dose of routine MR vaccination were enrolled. MR vaccine (0.5 ml, subcutaneous) was administered to the enrolled participants (1st dose at 9-12 months and 2nd dose at 15-24 months). On each follow up (4-6 wk post-vaccination), 2 ml of venous blood sample was collected to estimate the antibody titres against measles and rubella using quantitative ELISA kits. Seroprotection (>10 IU/ml for measles and >10 WHO U/ml for rubella) and antibody titres were evaluated after each dose. Results: The seroprotection rate against rubella was 97.5 and 100 per cent and against measles was 88.7 per cent and 100 per cent 4-6 wk after the first and second doses, respectively. The mean (standard deviation) titres against rubella and measles increased significantly (P<0.001) after the second dose in comparison to the levels after the first dose by about 100 per cent and 20 per cent, respectively. Interpretation & conclusions: MR vaccine administered below one year of age under the UIP resulted in seroprotection against rubella and measles in a large majority of children. Furthermore, its second dose resulted in seroprotection of all children. The current MR vaccination strategy of two doses, out of which the first is to be given to infants below one year of age, appears robust and justifiable among Indian children.

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

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

Perfil epidemiológico dos casos suspeitos de sarampo e rubéola notificados no SINAN, Brasil, 2007 a 2016 / Epidemiological profile of suspected cases of measles and rubella notified on SINAN, Brazil, 2007 to 2016

Descrever os casos suspeitos de sarampo e rubéola notificados no Sistema de Informação de Agravos de Notificação (Sinan), Brasil, 2007 a 2016. Métodos: Os dados foram extraídos do Sinan, referentes aos anos de 2007 a 2016. As variáveis utilizadas foram os números de notificações de casos de sarampo e rubéola por regiões e ano, idade, sexo, hospitalização, estado gestacional, histórico vacinal, realização de bloqueio vacinal, coletas sorológicas (S1 e S2), sinais e sintomas, investigação adequada, critério de confirmação ou descarte e classificação final do caso. Resultados: Entre 2007 e 2016 houve 127.802 casos suspeitos de sarampo e rubéola notificados. Aproximadamente 92% dos casos foram investigados, a maioria em menores de cinco anos. Os sintomas mais frequentes foram tosse (40%) e coriza (38%). Como instrumento de vigilância foi coletado sangue para confirmação laboratorial em 87% das notificações. A maioria dos casos de sarampo ocorreu entre os anos de 2011 e 2015, relacionados a casos importados, totalizando 1.443 casos; para rubéola, 10.125 casos foram confirmados. Foram descartados 1,3% (1.698/127.802) e 5,1% (6.555/127.802) das notificações de sarampo e rubéola, respectivamente. Foram ignorados 9% (11.523/127.802) para sarampo e 49% (62.978/127.802) para rubéola. Conclusão: A vigilância dos casos de doenças exantemáticas permitiu demonstrar a situação dos casos de doenças exantemáticas circulantes no país como importante ferramenta de saúde pública. O grande número de casos descartados classificados como ignorados merece atenção, no sentido de melhorar o encerramento dos casos suspeitos notificados

To describe the suspected cases of measles and rubella notified in the Notifiable Diseases Information System (Sinan), Brazil, from 2007 to 2016. Methods: Data were extracted from Sinan referring to the years 2007 to 2016. The variables used were the number of notifications of measles and rubella cases by region and year, age, gender, hospitalization, gestational status, vaccination history, vaccination blockade, serological collections (S1 and S2), signs and symptoms, adequate investigation, confirmation criteria or disposal and final case classification. Results: Between 2007 and 2016, there were 127,802 suspected cases of measles and rubella reported. Approximately 92% of cases were investigated, mostly in children under five years of age. The most frequent symptoms were cough (40%) and runny nose (38%). As a surveillance tool, blood was collected for laboratory confirmation in 87% of notifications. Most Measles cases occurred between 2011 and 2015, related to imported cases, totaling 1,443 cases; for Rubella 10,125 cases were confirmed. 1.3% (1,698/127,802) and 5.1% (6,555/127,802) of measles and rubella notifications, respectively, were discarded. 9% (11,523/127,802) for measles and 49% (62,978/127,802) for rubella were ignored. Conclusion: Surveillance of cases of exanthematous diseases allowed demonstrating the situation of cases of exanthematous diseases circulating in the country as an important public health tool. The large number of discarded cases classified as ignored deserves attention, in order to improve the closing of notified suspected cases

Safety analysis of children of different ages vaccinated with measles, mumps and rubella combined attenuated live vaccine/measles and rubella combined attenuated live vaccine in Jilin Province from 2015 to 2022 / 中国生物制品学杂志

@#Objective To analyze the safety of children of different ages vaccinated with measles,mumps and rubella combined attenuated live vaccine(MMR in brief)/measles and rubella combined attenuated live vaccine(MR in brief)in Jilin Province from 2015 to 2022.Methods The actual vaccination data of MMR and MR from January 1,2015 to December 31,2022 were collected through the Jilin information management system for immunization programming,and all AEFI case information reported after vaccination with MMR and MR in this period was collected through the national adverse event following immunization(AEFI) monitoring and reporting system.The incidence rates of AEFI reports were compared among8-month-old children vaccinated with the first dose of MMR(MMR 8 group) and MR(MR8 group),18-month-old children vaccinated with the first dose of MMR(vaccinated with MR at 8 months old,MMR18-1 group) and the second dose of MMR(vaccinated with the first dose of MMR at 8 months old,MMR18-2 group) to preliminarily evaluate the safety of children vaccinated with MMR and MR at different ages.Results The reported incidence of AEFI in MMR8,MR8,MMR18-1 and MMR18-2 groups were 374.41/100 000,350.81/100 000,101.70/100 000 and 104.91/100 000,respectively,with significant difference among the four groups(χ~2=1 145.47,P=0.00);There was no significant difference between MMR8 and MR8,as well as MMR18-1 and MMR18-2 groups(χ~2=3.780 and 0.194,respectively,each P> 0.05);There were significant differences between MMR8 and MMR18-1,MMR8 and MMR18-2,as well as MR8 and MMR18-1groups(χ~2=920.440,412.110 and 1 021.120,respectively,each P=0.00).Most of the adverse reactions were general reactions,mainly fever,local redness and induration;A few were abnormal reactions,which were mainly allergic reactions(rash,papules,urticaria,etc.).Only one case of coincidence was reported in MMR8 group,and no psychogenic reaction,vaccine quality accident and vaccination accident occurred.All AEFI turned out to be improved or cured.Conclusion The differences of AEFI reported incidence of 8-month-old children vaccinated with MMR and MR were all small,and the difference of AEFI reported incidence of 18-month-old children vaccinated with the second dose of MMR was small regardless of the initial vaccination with MMR or MR.It is safe to use MMR instead of MR for the first vaccination in8-month-old children.

Epidemiological analysis of rubella and genetic characteristics of 1E-L2 subtype strains in Liaoning Province in 2019 / 中国生物制品学杂志

@#Objective To understand the epidemiological characteristics of rubella in Liaoning Province in 2019,and analyze the epidemiological characteristics of rubella virus genotypes and gene subtypes at molecular level.Methods By collecting the incidence data of rubella in Liaoning Province in 2019 from the national notifiable infectious diseases reporting system,the epidemiological characteristics of rubella were analyzed.At the same time,the measles/rubella laboratory network of Liaoning Province was used to collect throat swab samples from suspected rubella outbreaks and sporadic cases.After three generations of blind transmission of positive samples,rubella virus isolates were obtained.Viral nucleic acid was extracted,amplified and the 739 bp nucleotide fragment sequence of E1 gene of positive rubella virus isolates was determined.The phylogenetic tree was constructed with the genotype reference strain sequences recommended by WHO and the published gene subtype reference strain sequences.The genotypes and subtypes were compared and the amino acid variation sites were analyzed.Results The reported incidence of rubella in Liaoning Province in 2019 was 0.927/100 000,which showed an obvious trend of recovery after a significant decrease in the incidence of rubella from 2017 to 2018,and the age of rubella patients was mainly 15 to 19 years old.A total of 55 rubella virus strains were isolated from 7 cities in Liaoning Province in 2019.Sequence phylogenetic analysis showed that all rubella isolates belonged to 1E-L2 gene subtype,which was also the dominant gene subtype of rubella epidemic in China.The nucleotide and amino acid homology among the strains were 99.051%～99.864% and 98.780%～100% respectively.Compared with the BRD-Ⅱ vaccine strain,the rubella isolates mainly showed A333T mutation and showed highly conserved amino acid sequence.Conclusion The 2019 rubella isolates in Liaoning Province were all 1E-L2 gene subtypes,which led to the resurgence of rubella epidemic.Therefore,molecular epidemiological surveillance of rubella virus should be further strengthened to provide a basis for the formulation and elimination of rubella prevention and control measures in Liaoning Province.

Surveillance of adverse events following immunization with combined attenuated live measles, mumps and rubella vaccines in Huzhou City from 2015 to 2021 / 预防医学

Objective@#To monitor the adverse events following immunization (AEFI) with combined attenuated live measles, mumps and rubella vaccines (MMR) in Huzhou City from 2015 to 2021, so as to provide insights into the implementation of the MMR immunization strategy.@*Methods@#All AEFI caused by MMR immunization in Huzhou City from 2015 to 2021 were captured from the AEFI Monitoring Information Management System of the Immunization Planning System of Chinese Disease Control and Prevention Information System, and the incidence, clinical features and epidemiological features of AEFI were analyzed descriptively.@*Results@#The reported incidence of AEFI caused by MMR immunization appeared a tendency towards a rise in Huzhou City from 2015 to 2021 (χ2trend=124.126, P<0.001). Totally 324 386 doses of MMR vaccines were immunized, and 317 cases with AEFI were reported, with an reported incidence rate of 9.77/104 doses. Following two-dose immunization, the reported incidence of AEFI caused by two-dose MMR immunization was significantly lower than by one-dose immunization (6.01/104 doses vs. 25.43/104 doses; χ2=113.692, P<0.001). The incidence rates of general reactions, abnormal reactions and coincidental events were 6.20/104 doses, 3.42/104 dose and 0.15/104 doses, respectively. Fever and allergic rash were predominant clinical manifestations of AEFI, and no vaccine quality accident, inoculation accident or psychogenic reaction were reported. There were 246 (77.60%) cases with AEFI within 24 hours following vaccination, and among children with AEFI, there were 173 boys (54.57%), and 200 children (63.09%) age ages of less than one year (63.09%). AEFI was reported in each quarter, and 99 cases (31.23%) were reported in the fourth quarter. The largest number of children with AEFI was reported in Wuxing District (78 cases, 24.61%).@*Conclusions@#The safety of MMR vaccination is high in Huzhou City. General reaction is the predominant AEFI, which mainly occurs within 24 hours following vaccination. Two-dose MMR vaccination does not increase the risk of AEFI.

Current Status Of Immunoglobulin M And Immunoglobulin G Seroprevalence Of Torch Infections In Pregnant Women With Bad Obstetric History At A Tertiary Care Hospital

Introduction: TORCH stands for Toxoplasma gondii, Rubella virus, Cytomegalo virus (CMV) and Herpes simplex virus- 2 (HSV-2). These infections are transmitted to the foetus through transplacental route at any time during gestation or sometimes at the time of delivery. The infection may be asymptomatic or mild in mother but associated with inadvertent outcomes for the foetus. One of the causes of BOH is maternal infection. TORCH infection is asymptomatic in pregnant women and on clinical basis it is difficult to diagnose. To study the TORCH infection (IgM and IgG antibodies)Aim: prevalence in pregnant women with Bad Obstetric History. A hospital based cross-sectionalMaterials And Methods: study conducted in Department of Microbiology in collaboration with Department of Obstetrics and Gynecology, SHKM GMC, Nalhar, Nuh, Haryana over a period of one year (February 2020 - January 2021). A total of 90 samples were included in the study including control group. The IgM seroprevalence of TORCH in participants with bad obstetricResults: history was found to be 11.11%. In cases with Bad obstetric history prevalence of IgM Toxoplasma, Rubella, Cytomegalovirus & Herpes Simplex Virus was found as 4.44%, 0%, 2.22% & 4.44% respectively and prevalence of IgG Toxoplasma, Rubella, Cytomegalovirus, & Herpes Simplex Virus was found as 53.33%, 91.11%, 88.89% & 66.67% respectively. This study concluded that a previous history of pregnancy wastage and the serologicalConclusion: screening for TORCH infections during current pregnancy must be considered while managing BOH cases to reduce the adverse fetal outcome

Does BCG Or MMR Or Routine Vaccination Coverage Protect Against COVID Infection And Mortality In India?

Background: The routine vaccinations and acquired immunity by other viral infections were believed to be acting as a protective factor against severe COVID-19 outbreaks in some countries. Objective: This study is overviewing the relationship of routine BCG, MMR vaccinations and reported MMR disease outbreak with reported COVID-19 infection across the Indian states. Methods: The data on vaccination coverage and respiratory disease infection was obtained from Univer-sal immunization program and Integrated disease surveillance project reports. Spearman rank correla-tion has been used to assess the relationship of routine vaccination and COVID-19 infection. Results: The result did not find any relationship of routine vaccination with BCG and MMR or exposure to MMR infection on COVID-19 infections in India. Conclusion: The exposure to BCG or MMR vaccination did not have a non-specific protection against COVID-19 infection. The results imply that a larger proportion of the Indian population is still vulnerable to COVID-19 infection.

Epidemiological study to assess the status of measles vaccination in under five children and factors associated, in a peri-urban area, Asudgaon village, in Raigad district, Maharashtra, India

Background: Measles continues to be a major cause of childhood morbidity and mortality in India. Measles is considered one of the leading vaccine-preventable causes of child mortality worldwide. Major reasons for low vaccine coverage exist within the health care system itself, which creates barriers to obtaining immunization. Materials and Methods: A cross-sectional, descriptive, epidemiological study that aimed to examine the coverage of measles vaccination among under-five children of Asudgaon village. All under-five children residing in every 5th household of the village were included(n = 445). After obtaining consent from the mother, data was collected from her using a pre-designed and pre-tested questionnaire. The data was entered and analyzed in SPSS 23. Results: There was a total of 100 children eligible for the study. Overall, 41% of children were fully immunized against measles, 37% were partially immunized, 5% were immunized to date and 17% were not immunized. The most reasons for partial or non-immunization for measles were inadequate knowledge about immunization (19%), unawareness of days of vaccination(n = 14%), the child being ill at the time of vaccination, husband or mother-in-law against vaccination, fear of effects, and others. The Chi-square test indicates a significant association between mothers’ education and measles vaccination. Conclusion: Immunization status needs to be improved through education, increasing awareness, and counseling of parents regarding immunization and associated misconceptions as observed in the study.

Análise das Doenças Exantemáticas de Notificação Compulsória no Estado de Santa Catarina Entre 2009 e 2019 / Analysis of Exanthematous Diseases of Compulsory Notification in the State of Santa Catarina from 2009 to 2019

Introdução: Doenças exantemáticas (DE) são patologias infecciosas agudas, que têm como característica principal a manifestação dermatológica. Entre elas, sarampo e rubéola são de notificação compulsória. A permanência da circulação destes vírus no mundo tem causado surtos em diversas regiões, como em SC, embora sejam doenças evitáveis por meio da imunização. Métodos: Trata-se de um estudo de delineamento ecológico, constituído de casos notificados por DE em SC no período de 2009 a 2019. Os dados foram coletados no Sistema Nacional de Agravos e Notificações (SINAN/DATASUS). Resultados: Foram notificados 190 casos de DE, 41,57% na faixa etária de 20 a 29 anos, 55,91% masculinos, 88,70% brancos e 2,15% gestantes. Houve confirmação laboratorial em 85,16%, e 72,72% foram causados pelo vírus sarampo selvagem. Exantema predominou em novembro em 46,77%, e febre em outubro, em 41,93%. Tosse esteve presente em 89,24%, coriza em 67,20% e conjuntivite em 50,53%. A macrorregião com maior média de cobertura vacinal foi a Grande Oeste, com 86,85%, e a menor, a Grande Florianópolis, com 72,07%. A maior incidência de sarampo ocorreu em 2019 no Nordeste e Planalto Norte com 11,34, e a de rubéola 0,13 no Grande Oeste no mesmo ano. Foi realizado bloqueio vacinal em 95,34% dos casos, e 64,28% foram autóctones. Conclusão: Observou-se que as DE acometem indistintamente ambos os sexos, etnias e idades, sendo a vacinação a forma mais eficaz de prevenir surtos. A reemergência ocorrida no estado foi consequência das baixas taxas de cobertura vacinal, apontando para a necessidade de melhorias nas ações de imunização.

Introduction: Exanthematous diseases (ED) are acute infectious pathologies that present mainly dermatological manifestations. Among them, measles and rubella demand compulsory notification. The continued circulation of these viruses has caused outbreaks in several regions, such as Santa Catarina, although they are preventable diseases through immunization. Methods: This is a study of ecological design consisting of cases notified of ED in SC from 2009 to 2019. Data collection from the National System of Diseases and Notifications (SINAN/DATASUS). Results: 190 cases of ED were notified, 41.57% in the age group 20 to 29 years, 55.91% male, 88.70% white, and 2.15% pregnant women. Laboratory confirmation occurred in 85.16%, and the wild measles virus was the cause in 72.72%. Exanthema predominated in November with 46.77% and fever in October with 41.93%. Cough was present in 89.24%, coryza in 67.20%, and conjunctivitis in 50.53%. The macro-region with the highest average vaccination coverage was the great west, 86.85%, and the lowest was greater Florianópolis, 72.07%. The highest incidence of measles occurred in 2019. Northeast and North Plateau scored 11.34, and rubella at 0.13 in the Great West in the same year. Vaccine block occurred in 95.34% of cases, and 64.28% were autochthonous. Conclusions: The study observed that EDs affect both sexes, ethnicities, and ages indistinctly, and vaccination is the most effective way to prevent outbreaks. The re-emergence that occurred in the state was a consequence of low rates of vaccination coverage, pointing to the need for improvements in immunization activities

Situação vacinatória da tríplice e da tetra viral em crianças matriculadas na Educação Infantil / The vaccination situation of triple and tetra viral in children enrolled in Early Childhood Education

Objetivo Descrever a situação vacinal de crianças matriculadas nos Centros Municipais de Educação Infantil da Zona Sul do município de Natal, Rio Grande do Norte com relação às vacinas de tríplice e tetra viral. Método Trata-se de um estudo epidemiológico, descritivo e retrospectivo, realizado a partir da análise de cartões de vacina de crianças matriculadas em 15 instituições, nas quais foi possível reunir 773 cartões que foram analisados a partir do calendário básico de vacinação do ano 2015. Os cartões foram classificados em: esquema vacinal completo, incompleto e/ou não vacinado. Resultados Observou-se que 576 (75,51%) crianças estavam com o esquema vacinal completo, sendo o esquema considerado finalizado com a segunda dose da tríplice ou com a tetra viral. A melhor situação vacinal foi atingida nas crianças de dois a quatro anos, com uma cobertura de 84,31%, sendo que 83,3% das crianças dessa faixa etária estavam com o esquema completo e 12,79% das crianças estavam com o esquema vacinal incompleto. Um total de 67 crianças (8,66%) não apresentaram registros de vacina. Com relação à tetra viral, 226 crianças (29,73%) apresentaram esquema vacinal completo. Conclusão Os resultados obtidos no presente estudo revelam uma situação vacinal abaixo da meta estabelecida pelo Programa Nacional de Imunização.

Objective To describe a vaccination situation of children up to 8 years old from the Municipal Centers of Early Childhood Education in the South Zone of the city of Natal, Rio Grande do Norte for vaccines of triple and tetra viral. Method This is an epidemiological, descriptive and retrospective study, carried out based on the analysis of vaccination cards for children from 15 institutions, where it was possible to gather 773 cards, a course based on the basic calendar of the year 2015. They were classified in: complete, incomplete and/or unvaccinated vaccination schedule. Results It is observed that 576 (75.51%) of the children have a complete vaccination schedule, the schedule being completed with a second dose of triple or tetra viral. The best vaccination status was achieved in children aged 2 to 4 years with a coverage of 84.31% and 83.3% children with the complete regimen. We have 12.79% of children with an incomplete vaccination schedule. A total of 67 children (8.66%) who did not have any vaccine records. Regarding Tetra Viral, 226 children (29.73%) had a complete vaccination schedule. Conclusion The results obtained in this study reveal a vaccination situation below the target established by the National Immunization Program.

Safety and immunogenicity of combined immunization with live rotavirus vaccine (oral) and measles, mumps and rubella vaccine / 中华微生物学和免疫学杂志

Objective:To evaluate the difference in safety and immunogenicity of live rotavirus vaccine (oral) and measles, mumps and rubella (MMR) vaccine immunized alone or in combination.Methods:This study recruited 1 752 children aged 8-9 months who had not been vaccinated with live rotavirus vaccine (oral) or MMR vaccine after birth. The subjects were divided into three groups: study group (652 subjects, immunized with live rotavirus vaccine and MMR vaccine), control group 1 (723 subjects, immunized with live rotavirus vaccine) and control group 2 (377 subjects, immunized with MMR vaccine). Local and systemic adverse reactions within 30 d after vaccination were recorded. Serum samples were collected before and 35-42 d after immunization for analyzing the changes in antibodies.Results:Immunization alone or in combination with live rotavirus vaccine (oral) and MMR vaccine achieved similar results in the positive rates and concentrations of antibodies against rotavirus, measles and rubella viruses ( P>0.05). Moreover, the positive rates and the concentrations of the three antibodies were increased after vaccination. Compared with the control group 2, the concentration of antibody against mumps virus in the study group was increased ( P<0.05), but no significant difference in the positive rate of antibody against mumps virus was found between the two groups ( P>0.05). The positive rate and the concentration of antibody against mumps virus were increased after combined immunization or immunization with MMR vaccine alone. The overall incidence of fever and diarrhea was 1.54% (27/1 752) and 0.63% (11/1 752). No other abnormal reactions, incidental reactions or adverse reactions of any clinical significance were observed. Conclusions:Live rotavirus vaccine (oral) and MMR vaccine immunized alone or in combination showed good immunogenicity and safety.

Two cases of measles after vaccination with measles mumps and rubella combined live attenuated vaccine / 上海预防医学

Measles is an acute respiratory infectious disease caused by the measles virus. It is highly infectious and easy to occur in children. It causes many serious complications such as tracheitis， otitis media and pneumonia. Since the promotion of the measles vaccine in China， the measles epidemic has been effectively controlled. From June 1， 2020， the immunization procedure of measles-containing vaccine for children in Shanghai has been adjusted to one dose of measles， mumps and rubella combined live attenuated vaccine （MMR） at the age of 8 months， 18 months and 6 years. There is generally no local reaction after the injection of the MMR vaccine. A few individuals may have transient fever and scattered rash， which generally fade away by themselves. However， because it is a live vaccine， it may cause vaccine related diseases in extremely rare cases. This paper reports two cases of measles after vaccination with the MMR vaccine.

Congenital Rubella Syndrome as a possible cause for persistent thrombocytopenia in early infancy: The Forgotten Culprit

Abstract We present a case of a late preterm intrauterine growth-restricted neonate with isolated and persistent severe thrombocytopenia. At birth, the neonate did not have a complete clinical spectrum of congenital rubella syndrome (CRS) but later developed peculiar findings that helped clinch the diagnosis. The neonate also had interstitial pneumonia and died secondary to superimposed acute viral infection leading to acute respiratory distress syndrome. The serology was positive for IgM antibodies against the rubella virus. The constellation of clinical manifestations of congenital rubella in the presence of positive IgM antibody against rubella and consistent histopathology confirmed the diagnosis of CRS.

Evaluación neuroepidemiológica a partir de anticuerpos antivirales de memoria generados por la vacuna triple viral / Neuro-Epidemiological Evaluation From Memory Antiviral Antibodies Generated By The MMR Vaccine

Introducción: La vacuna contra sarampión-parotiditis-rubéola es administrada en Cuba con un 99 por ciento de cobertura vacunal. Actualmente se plantea la baja inmunogenicidad de la cepa de parotiditis con que se fabrica por lo que resulta importante velar por la eficacia de las vacunas y su respuesta inmune protectora. Objetivos: Evaluar el comportamiento de los índices de anticuerpo antirubéola, antiparotiditis y antisarampión de acuerdo con la edad, y analizar la variación de la respuesta de anticuerpos antiparotiditis con respecto a estudios anteriores. Materiales y métodos: Se estudiaron muestras de suero y líquido cefalorraquídeo de 42 pacientes pediátricos con procesos neuroinflamatorios y se les cuantificó IgG total y albúmina y anticuerpos específicos contra los tres virus a partir de ensayos innmunoenzimáticos tipo ELISA. Se realizaron los reibergramas correspondientes e índices de anticuerpos específicos. Resultados: Se observó un incremento sostenido de anticuerpos contra los tres inmunógenos de forma general, sin diferencias significativas por razones de edad ni cambios notables posrevacunación. Existió un decrecimiento del índice de anticuerpos a medida que se alejaba de la fecha de revacunación por lo que se debe mantener una vigilancia en esos grupos de edades. La velocidad de producción de anticuerpos antiparotiditis fue mayor que frente a los otros virus, aunque no de forma significativa. Conclusiones: Esta vacuna garantiza protección por la uniformidad de la respuesta inmune de memoria inducida en todos los grupos de edades. Se demostró un aumento de protección de la población estudiada frente a la parotiditis con respecto a estudios previos(AU)

Introduction: The measles-mumps-rubella vaccine is administered in Cuba with 99 percent vaccination coverage. Currently, the low immunogenicity of the strain of mumps with which it is manufactured is raised, so it is important to ensure the effectiveness of vaccines and their protective immune response. Objectives: Evaluate the behavior of the anti-rubella, anti-mumps and anti-measles antibody indices according to age, and to analyze the variation of the anti-mumps antibody response with respect to previous studies. Materials and methods: Serum and cerebro-spinal fluid samples from 42 pediatric patients with neuro-inflammatory processes were studied and total IgG and albumin and specific antibodies against the three viruses were quantified from immunoenzymatic assays ELISA type. Corresponding reibergrams and specific antibody indices were performed. Results: A sustained increase in antibodies against the ethree immunogens was observed in general, without significant differences due to age or notable post-vaccination changes. There was a decrease in the antibody index as it moved away from the date of revaccination, so surveillance should be maintained in these age groups. The rate of production of anti-mumps antibodies was higher than against the other viruses, although not significantly. Conclusions: This vaccine guarantees protection by the uniformity of the memory induced immune response in all age groups. An increase in the protection of the studied population against mumps was demonstrated with respect to previous studies(AU)

Identificación de desórdenes autoinmunes e inmunodeficiencias a través de la evaluación neuroepidemiológica del índice de anticuerpos antiparotiditis, antirubéola y antisarampión / Identification of autoimmune disorders and immunodeficiencies by neuroepidemiological evaluation of the measles, mumps and rubella antibody index

Introducción: El esquema nacional de vacunación cubano presenta coberturas superiores al 99 por ciento que incluye la vacuna contra parotiditis, rubéola y sarampión. Así, cuando existe un proceso neuroinflamatorio se produce una amplia síntesis intratecal de anticuerpos antiparotiditis, antirubéola y antisarampión, que permite realizar evaluaciones neuroepidemiológicas de las campañas de vacunación y el sesgo de casos extremos, desde el punto de vista inmunológico. Objetivos: Correlacionar el índice de anticuerpos antirubéola, antiparotiditis y antisarampión con procesos autoinmunes asociados y en la identificación de posibles pacientes con inmunodeficiencias en la muestra estudiada. Métodos: Se realizó un estudio aplicado y descriptivo de corte transversal en 42 niños evaluados en los servicios de cuerpo de guardia de los hospitales pediátricos de La Habana del 2015 al 2018. La muestra fue dividida según los tres intervalos del índice de anticuerpos (menor o igual a 0,6; de 0,6 a 1,5 y mayor o igual a 1,5). Se procedió a detectar en los segmentos extremos pacientes con posible autoinmunidad (mayor o igual a 1,5) e inmunodeficiencia (se tomó el intervalo inferior a una desviación estándar). Resultados: En el grupo con índice de anticuerpos mayor o igual a 1,5, el 75 por ciento fue positivo a la reacción MRZ, indicativo de una enfermedad autoinmune activa. En el grupo con índice de anticuerpos menor o igual a 0,6 preponderó una clínica con prevalencia de enfermedades tumorales e infecciosas asociadas a un alto índice de hospitalización, test de inmunodeficiencia positivo y bajos niveles de IgG en suero. Conclusiones: Es posible identificar pacientes pediátricos con desórdenes autoinmunes y sospecha de inmunodeficiencias, a partir de la estrategia de la evaluación neuroepidemiológica de los índices de anticuerpos antiparotiditis, antirubéola y antisarampión(AU)

Introduction: The Cuban national vaccination scheme has a coverage of more than 99 percent of the population, and includes the measles-mumps-rubella vaccine. Therefore, in the presence of a neuroinflammatory process, a broad intrathecal synthesis of measles, mumps and rubella antibodies takes place which makes it possible to conduct neuroepidemiological evaluations of the vaccination campaigns and the bias of extreme cases, from an immunological perspective. Objectives: Correlate the measles, mumps and rubella antibody index with associated autoimmune processes and in the identification of patients with possible immunodeficiencies in the study sample. Methods: An applied cross-sectional descriptive study was conducted of 42 children attending the emergency services of Havana children's hospitals in the period 2015-2018. The sample was divided according to the three antibody index intervals: smaller than or equal to 0.6, from 0.6 to 1.5, and greater than or equal to 1.5. Extreme segments were examined to detect patients with possible autoimmunity (greater than or equal to 1.5) and immunodeficiency (the interval below a standard deviation was taken as reference). Results: 75 percent of the group with an antibody index greater than or equal to 1.5 was positive to the MRZ reaction, indicative of an active autoimmune disease. In the group with an antibody index lower than or equal to 0.6, the prevailing clinical status showed a prevalence of tumoral and infectious diseases associated to a high hospitalization index, a positive immunodeficiency test and low serum IgG levels. Conclusions: It is possible to identify pediatric patients with autoimmune disorders and suspicion of immunodeficiencies applying the strategy of neuroepidemiological evaluation of the measles, mumps and rubella antibody indices(AU)

Sí­ndrome da rubéola congênita: análise dos casos notificados no Brasil entre 1990 a 2016 / Congenital rubella syndrome: analysis of cases notified in Brazil from 1990 to 2016

Objetivo: analisar os casos de Síndrome da Rubéola Congênita notificados no Brasil durante o período de 1990 a 2016. Método: estudo transversal realizado no Brasil, cuja amostra foi de 122 casos notificados com Síndrome da Rubéola Congênita. Os dados foram disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. A coleta de dados foi realizada durante os meses de fevereiro e março de 2021. O tratamento dos dados se deu por análise estatística uni-variada. Resultados: observa-se prevalência no Estado de São Paulo cuja capital apresentou o maior número destas notificações. O ano em que houve prevalência do diagnóstico foi em 2008 e o mês de maior notificação foi dezembro. Todos os pacientes apresentavam idade menor que um ano, sexo feminino, com confirmação final para a doença por meio de critérios laboratoriais, e evolução para a cura. Conclusão: a idade apresentou significância no estudo. A terapêutica mostrou-se eficiente para um melhor prognóstico de cura, bem como a vacinação como medida preventiva.(AU)

Objective: to analyze the cases of Congenital Rubella Syndrome notified in Brazil from 1990 to 2016. Method: cross-sectional study conducted in Brazil, whose sample consisted of 122 cases notified with Congenital Rubella Syndrome. Data were made available by the Departamento de Informática do Sistema Único de Saúde. Data collection was conducted during February and March 2021. The data were processed using univariate statistical analysis. Results: prevalence was observed in the state of São Paulo, whose capital city had the highest number of these notifications. The year in which there was prevalence of the diagnosis was 2008, and the month of greatest notification was December. All patients were less than one year old, female, with final confirmation of the disease through laboratory criteria, and progression to cure. Conclusion: Age was significant in this study. Therapy proved to be efficient for a better prognosis of cure, as well as vaccination as a preventive measure.(AU)

Objetivo: analizar los casos de Síndrome de Rubéola Congénita notificados en Brasil entre 1990 a 2016. Método: estudio transversal realizado en Brasil, cuya muestra fue 122 casos notificados con Síndrome de Rubéola Congénita. Los datos fueron facilitados por el Departamento de Informática del Sistema Único de Salud. La recogida de datos se realizó durante los meses de febrero y marzo de 2021. El tratamiento de los datos se realiza mediante un análisis estadístico univariante. Resultados: se observa una prevalencia en el Estado de São Paulo, cuya capital presenta el mayor número de notificaciones. El año y mes en que se produjo la prevalencia del diagnóstico fue 2008 y diciembre. Todos los pacientes presentaban una edad inferior a un año, sexo femenino, con confirmación final de la enfermedad mediante criterios de laboratorio y evolución para la cura. Conclusión: la edad presentó un significado en el estudio. El tratamiento es eficiente para un mejor pronóstico de curación, así como la vacunación como medida preventiva.(AU)

Síndrome coronario agudo e insuficiencia mitral-aórtica grave en un paciente con rubeola congénita / Acute coronary syndrome and mitral-aortic insufficiency in a patient with congenital rubella

Resumen La rubeola es una enfermedad exantemática que se produce en la infancia. En caso de que se presente durante la gestación y hubiera afectación del producto, este puede desarrollar el síndrome de rubeola congénita, el cual incluye malformaciones cardiacas que se presentan en el 67% de los pacientes, de las cuales la más común es la persistencia del conducto arterioso, seguida de la estenosis valvular pulmonar y la comunicación interauricular. Se presenta el caso de un hombre de 20 años con diagnóstico de síndrome de rubeola congénita, quien desarrolló glaucoma congénito, insuficiencia aórtica grave, insuficiencia mitral grave y enfermedad miocárdica isquémica. Se realizó procedimiento quirúrgico de revascularización coronaria y recambio valvular mitral y aórtico. Los estudios encontrados durante el proceso de investigación mencionan el daño de los vasos sanguíneos y del miocardio producido por el virus. Con los datos obtenidos se corrobora la baja incidencia de presentación con compromiso coronario y valvular, por lo cual se hace énfasis en la importancia de este caso.

Abstract Rubella is an exanthematous disease that occurs in childhood. If it occurs during pregnancy and there is an effect on the product, it can develop congenital rubella syndrome. The congenital rubella syndrome includes cardiac malformations, which occur in 67% of patients, of which the most common is patent ductus arteriosus, followed by pulmonary valvular stenosis and atrial septal defect. We present the case of a 20-year-old man with a diagnosis of congenital rubella syndrome, presenting with congenital glaucoma, severe aortic insufficiency, severe mitral regurgitation and ischemic myocardial disease. In which a surgical procedure is performed by a coronary revascularization and mitral and aortic valve replacement. Studies found during the research process mention the damage to the blood vessels and myocardium produced by the virus. With the required data, the low incidence of presentation with coronary and valvular involvement is corroborated, which is why the importance of the present case is emphasized.