Cobertura de vacinação e surtos de sarampo em uma região do Ceará / Vaccination coverage and measles outbreaks in a region of Ceará / Cobertura de vacunación y casos de sarampión en una región de Ceará

O objetivo desta pesquisa foi analisar a relação entre surtos de sarampo e as coberturas vacinais municipais na 11ª Região de Saúde de Sobral, noroeste do Ceará, ocorridos entre 2013 e 2015. Para isso, elaborou-se estudo misto por fonte de dados secundários, extraídos na referida região de saúde. Para análise quantitativa, foram investigadas 766 notificações de casos suspeitos de sarampo. Além disso, realizou-se pesquisa de campo pós-epidemia com profissionais envolvidos na imunização, por meio da aplicação de 31 questionários eletrônicos. A análise das informações permitiu identificar que 451 casos notificados da doença foram descartados; 65 foram considerados inconclusivos; e 217 foram confirmados. Os profissionais envolvidos sinalizaram como causa dos surtos: baixas coberturas vacinais, bolsões de suscetíveis, falta de capacitação dos profissionais e inexperiência na contenção de bloqueios. As estratégias de vacinação realizadas priorizaram a imunização da população de risco, a reorientação e sistematização das ações de bloqueio e a varredura.

This research aimed to analyze the relationship between measles outbreaks and municipal vaccination coverage in the 11th Health Region of Sobral, northwest of Ceará, which occurred between 2013 and 2015. To that end, a mixed study by source of secondary data, extracted in the health region was elaborated. For quantitative analysis, a total of 766 reports of suspected measles cases were investigated. Also, post-epidemic field research was carried out with professionals involved in immunization, by applying 31 electronic questionnaires. The analyzes of the information allowed us to identify that 451 notified cases of the disease were discarded; 65 were considered inconclusive; and 217 were confirmed. The professionals involved pointed out the following as the cause of the outbreaks: low vaccination coverage, pockets of susceptible people, lack of training of professionals and inexperience in containing blockages. The vaccination strategies prioritized the immunization of the population at risk, the reorientation and systematization of blocking and scanning actions.

El objetivo de este estudio fue analizar la relación entre los casos de sarampión y las coberturas municipales de vacunación en la 11.ª Región de Salud de Sobral, noreste de Ceará (Brasil), ocurridos en el periodo entre 2013 y 2015. Para ello, se utilizó un estudio mixto por fuente de datos secundarios, extraídos en la citada región. Para el análisis cuantitativo, se investigaron un total de 766 informes de casos sospechosos de sarampión. Se realizó investigación de campo postepidemia con los profesionales involucrados en inmunización, mediante la aplicación de 31 cuestionarios electrónicos. El análisis de la información permitió identificar que se descartaron 451 casos notificados de la enfermedad; 65 fueron no concluyentes y 217 confirmados. Los profesionales implicados señalaron las siguientes causas de los brotes: bajas coberturas de vacunación, bolsa de susceptibles, falta de formación profesional e inexperiencia en la contención de bloqueos. Las estrategias de vacunación priorizaron la inmunización de la población en riesgo, la reorientación y sistematización de las acciones de bloqueo y barrido.

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)

Estimación del número reproductivo efectivo del brote de sarampión 2018-2019 en Chile / Estimation of the effective reproduction number of measles 2018-2019 in Chile

Resumen Introducción: Los casos de sarampión están resurgiendo en muchos países del mundo. Hubo un brote de sarampión importado entre noviembre de 2018 y febrero de 2019 en Chile, lo que generó preocupación entre el público y las autoridades sanitarias. Muchos se preocuparon por la tasa de inmunización contra el sarampión de la población, un factor que se relaciona con la capacidad reproductiva del virus (medida de transmisibilidad de un patógeno). Objetivo: Aquí estimamos el número reproductivo efectivo (Re) de este brote de sarampión. Resultados: Aunque la estimación tiene mucha incertidumbre por el bajo número de casos y la ausencia de mezcla homogénea de la población, encontramos que Re fue aproximadamente 1,5. Discusión y Conclusiones: En consecuencia estimamos que aproximadamente 90,3% de la población tiene inmunidad al sarampión, lo que coincide con las estimaciones del Ministerio de Salud. Estos resultados sugieren que la población chilena ha establecido la inmunidad colectiva contra la introducción de casos importados de sarampión, lo que refleja un manejo preventivo adecuado de esta enfermedad.

Abstract Background: Measles cases are reemerging in many countries across the globe. There was an outbreak of imported measles between November 2018 and February 2019 in Chile, raising concern among the public and health authorities. Many were worried about the Chilean measles herd immunity, a factor that relates to the reproductive capacity of the virus (measure of transmissibility of a pathogen). Aim: Here we estimate the effective reproductive number (Re) of this measles outbreak. Results: Although the estimate is highly uncertain due to the low number of cases and the absence of homogeneous mixing of the population, we found Re was approximately 1.5. Discussion and Conclusions: Consequently we estimated about 90,3 % had measles immunity, consistent with administrative estimates from the Ministry of Health. These results suggest the Chilean population has established herd immunity against the introduction of imported measles cases, reflecting adequate preventive management of this disease.

Cobertura y factores asociados a la vacunación contra el sarampión en niños de 12 a 59 meses en Perú: estimación basada en la encuesta demográfica y de salud familiar 2017 / Coverage and factors associated with measles vaccination in children aged 12-59 months in Peru: estimate based on the 2017 demographic and family health survey

RESUMEN Objetivos . Estimar la cobertura y determinar los factores asociados a la vacunación contra el sarampión en Perú. Materiales y métodos . Realizamos un estudio de fuente secundaria utilizando la Encuesta Demográfica y de Salud Familiar (ENDES) del 2017, la unidad informante fue una mujer en edad fértil de 15 a 49 años; la unidad de análisis fue un niño de 12 a 59 meses (para la primera dosis) o niño de 18 a 59 meses (para la dosis de refuerzo) y que contaba con datos de vacunación. Los datos de cobertura fueron obtenidos de la tarjeta de vacunación. Resultados . Según la tarjeta de vacunación, la cobertura para la primera dosis fue del 70,2% (IC95%: 68,8-71,6), para la dosis de refuerzo del 52,0% (IC95%: 50,5-53,6). Los niños de 24-35 meses tuvieron más probabilidades de ser vacunados para la primera dosis (OR: 1,59; IC95%: 1,28-1,97) y dosis de refuerzo (OR:2,04; IC95%: 1,62-2,56) comparado con los niños de 12-23 meses y 18-23 meses respectivamente. Los niños cuyo control de crecimiento y desarrollo fue en el sector privado tuvieron menores probabilidades de ser vacunados para la primera dosis (OR: 0,30; IC95%: 0,21-0,43) y dosis de refuerzo (OR: 0,26; IC95%: 0,17-0,40) comparado con los que se controlaron en el sector público. Conclusiones . Según la ENDES 2017, Perú y ninguna de sus regiones alcanzó una cobertura del 95,0% para la primera dosis y su refuerzo. El control de crecimiento y desarrollo en establecimientos del sector público está asociado con la vacunación de sarampión en su primera dosis y refuerzo.

ABSTRACT Objectives . To estimate coverage and determine factors associated with measles vaccination in Peru. Materials and Methods . We conducted a secondary source study using the 2017 Demographic and Family Health Survey (ENDES). The reporting unit was a woman of childbearing age, 15 to 49 years; the unit of analysis was a child, 12 to 59 months (for the first dose), or a child, 18 to 59 months (for the booster dose) who had vaccination information. Coverage data were obtained from the vaccination card. Results . According to the vaccination card, coverage for the first dose was 70.2% (95% CI: 68.8-71.6); for the booster dose, 52% (95% CI: 50.5-53.6). Children aged 24-35 months were more likely to be vaccinated for the first dose (OR 1.59, 95% CI: 1.28-1.97) and booster dose (OR 2.04, 95% CI: 1.62-2.56), compared with children aged 12-23 months and 18-23 months respectively. Children with growth and development check-ups performed in the private sector were less likely to be vaccinated for the first dose (OR 0.30, 95% CI: 0.21-0.43) and booster dose (OR 0.26, 95% CI: 0.17-0.40), compared to those being monitored in the public sector. Conclusions . According to ENDES 2017, Peru and none of its regions achieved 95.0% coverage for the first and booster doses. Growth and development monitoring in public sector facilities is associated with measles vaccination in terms of first and booster doses.

Sarampión: antecedentes históricos y situación actual / Measles: historical background and current situation

Resumen: El sarampión sigue siendo una causa importante de morbilidad y mortalidad en el niño. Durante estos últimos años, se ha convertido en un problema de salud pública mundial, que se atribuye a bajas coberturas de vacunación observadas en diferentes países. Para su control se dispone de una vacuna a virus vivo, altamente eficaz, que fue empleada por primera vez en Chile en 1964, logrando cobertura en prácticamente todo el país en un breve plazo. Esta fue la primera experiencia mundial, imitada lue go por otros países que resulto en una importante caída de las tasas de morbilidad y de mortalidad. Su eficacia ha sido ampliamente demostrada, pero requiere de la mantención de coberturas superiores a 95%. En Chile persistió una situación de endemia de menor magnitud hasta el año 1993. En años recientes, ha habido algunos brotes reducidos y casos esporádicos vinculados a contactos con casos importados, sin embargo, según datos recientes, el sarampión está circulando ahora en más de 160 países en un nivel de propagación sin precedentes, siendo los viajeros infectados el principal vehículo de transmisión. En Chile, el Ministerio de Salud ha decidido reforzar y poner al día la vacunación de grupos susceptibles, en especial viajeros. En esta actualización se revisan aspectos históricos y la información actual de esta enfermedad que ha resurgido mostrando su alto impacto epidemiológico en la población pediátrica y adulta a nivel global.

Abstract: Measles is still a major cause of child morbidity and mortality. In recent years, it has become a global public health problem, attributed to low vaccination coverage observed in different countries. In order to control it, a highly effective live virus vaccine is available, which was used for the first time in Chile in 1964, covering practically the whole country in a short period of time. This was the first world experience, which was later imitated by other countries leading to a significant drop in mor bidity and mortality rates. Its effectiveness has been amply demonstrated, but it requires coverage maintenance higher than 95%. In Chile, minor endemic situation persisted until 1993. In recent years, there have been some reduced outbreaks and sporadic cases linked to contacts with imported cases, however, according to recent data, measles is now circulating in more than 160 countries at an unprecedented spread level, where infected travelers are the main vehicle of transmission. In Chile, the Ministry of Health has decided to strengthen and update the vaccination of susceptible groups, especially travelers. This update reviews historical aspects and current information on this re-emer ging disease, showing its high epidemiological impact on the pediatric and adult population globally.

Editorial: Sarampión: Una epidemia prevenible / Editorial Measles: A preventable epidemic

El sarampión una enfermedad que en el siglo IX (860-932)fue descrita por el médico persa Muhammad ibn Zacariya al-Razi quien la diferenció de la viruela por sus síntomas y signos clínicos .

Current and Prospect on Measles Outbreak / 대한내과학회지

Measles is a highly contagious infectious disease characterized by fever, rash, cough, coryza, and conjunctivitis. The causative organism is the measles virus transmitted via the respiratory route. Before the introduction of an effective vaccine, measles was one of most prevalent diseases worldwide. Mortality may occur in patients with complications, including pneumonia, which is the most common cause of measles-associated death. The diagnosis of measles is based on clinical symptoms and laboratory tests, including the detection of measles virus-specific antibodies or measles virus ribonucleic acid and cultured viruses. The treatment for measles is primarily supportive care. In Korea, availability of the measles vaccine has substantially reduced the incidence and mortality of the disease. The World Health Organization verified the elimination of measles in March 2014; however, small outbreaks continue to be reported. Although a large proportion of measles cases occur in infants less than 1 year old, the disease has been reported in young adults with a history of measles vaccination. Here, we review the current literature on measles and discuss the importance of measles prevention in Korean adults.

Actualización situacion sarampion y acciones intensificadas de vigilancia y control / Update to measles situation and intensified actions on surveillance and control

El 28 de marzo de 2018 se confirmó un caso de sarampión en un bebe de 8 meses, residente de la Ciudad de Buenos Aires. En función de ello, y teniendo como escenario posible lo que está ocurriendo en la actualidad, desde el Ministerio de Salud de la CABA, se comenzaron a diseñar estrategias de abordaje de carácter preventivo, para promover el control de este evento en la población en general y, en particular, en los niños susceptibles: por un lado, todos los menores de 6 años que cuentan -o deberían contar- con al menos una dosis de triple viral (entre el año de vida y el inicio escolar) y, principalmente, aquellos que por calendario, no les corresponde vacunación (los menores de un año). El 19 de julio de 2018, a poco menos de 3 meses del caso confirmado previo (categorizado como "relacionado con la importación", luego de haber hallado la fuente de infección proveniente de Asia), se notificaron dos casos confirmados que se atendieron en efectores públicos de la Ciudad de Buenos Aires, un residente de CABA y otro de Provincia de Buenos Aires. En este apartado se actualiza la situación epidemiológica a la fecha y se detallan las acciones realizadas y por realizar para la prevención y control de este evento.(AU)

Influencing factors for high level measles antibodies among 6-15 year-old children in Zhejiang province / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To determine measles antibody levels and influencing factors among children aged 6 to 15 years in Zhejiang province.</p><p><b>METHODS</b>Blood samples were collected from 2069 children aged 6 to 15 years in Changxing county (Huzhou) and Liandu district (Lishui) of Zhejiang province. Serum level of measles IgG antibody was measured using ELISA, and 800 mIU/mL was applied as the cut-off point of high antibody level. Chi-square or trend Chi-square test was used to analyze difference in positive rates of high antibody level among children with different characters, and the factors related to high antibody level in the vaccinated children were analyzed using multivariate logistic regression.</p><p><b>RESULTS</b>Among 2069 subjects, positive rate of high measles antibody level was 36.06% (746/2069). Multivariate logistic regression showed that the high measles antibody level was significantly associated with age of children and the age of first measles vaccine inoculation. The positive rate of high measles antibody level decreased with age(=0.866, 95%:0.830-0.904, <0.01), and the positive rate in children whose first vaccination at ≥ 12 months of age was higher than those whose first vaccination at 8 months of age(=0.633, 95%:0.498-0.805, <0.01).</p><p><b>CONCLUSIONS</b>In order to obtain high measles antibody level and to maintain high levels of population immune barrier, it is suggested that first dose of vaccination can be appropriately delayed in low epidemic areas, and elder children should have timely catch-up vaccination.</p>

What is the importance of vaccine hesitancy in the drop of vaccination coverage in Brazil? / Qual a importância da hesitação vacinal na queda das coberturas vacinais no Brasil?

ABSTRACT The successful Programa Nacional de Imunizações do Brasil (Brazilian National Immunization Program) has been experiencing a major challenge with regard to vaccination coverage for children, which has been dropping. Several aspects are related, but certainly vaccine hesitancy has been strengthening itself as one of the main concerns of Brazilian public administrators and researchers. Vaccine hesitancy is the delay in acceptance or refusal despite having the recommended vaccines available in health services, being a phenomenon that varies over time, over location and over types of vaccines. Hesitant individuals are between the two poles of total acceptance and refusal of vaccination. Vaccine hesitancy is nothing new in European and North-American countries, and even in Brazil, it has been studied even if under another name. The drop of vaccination coverage observed from 2016 on reiterates the relevance of the theme, which must be better understood through scientific research.

RESUMO O exitoso Programa Nacional de Imunizações do Brasil tem vivenciado grande desafio com relação às coberturas vacinais infantis, que têm apresentado queda. Diversos aspectos estão relacionados, mas certamente a hesitação vacinal vem se fortalecendo como uma das principais preocupações dos gestores e pesquisadores brasileiros. Hesitação vacinal é o atraso em aceitar ou a recusa das vacinas recomendadas quando elas estão disponíveis nos serviços de saúde, sendo um fenômeno que varia ao longo do tempo, do local e dos tipos de vacinas. Indivíduos hesitantes situam-se entre os dois polos de aceitação e recusa total da vacinação. A hesitação vacinal não é novidade em países europeus e norte-americanos e, mesmo no Brasil, ela já vem sendo estudada ainda que sob outra denominação. A queda das coberturas vacinais observadas a partir de 2016 reitera a relevância do tema, que deve ser mais bem compreendido por meio de investigações científicas.

Progress towards elimination of measles in Kenya, 2003-2016

Introduction: measles is targeted for elimination in the World Health Organization African Region by the year 2020. In 2011, Kenya was off track in attaining the 2012 pre-elimination goal. We describe the epidemiology of measles in Kenya and assess progress made towards elimination.Methods: we reviewed national case-based measles surveillance and immunization data from January 2003 to December 2016. A case was confirmed if serum was positive for anti-measles IgM antibody, was epidemiologically linked to a laboratory-confirmed case or clinically compatible. Data on case-patient demographics, vaccination status, and clinical outcome and measles containing vaccine (MCV) coverage were analyzed. We calculated measles surveillance indicators and incidence, using population estimates for the respective years.Results: the coverage of first dose MCV (MCV1) increased from 65% to 86% from 2003-2012, then declined to 75% in 2016. Coverage of second dose MCV (MCV2) remained < 50% since introduction in 2013. During 2003-2016, there were 26,188 suspected measles cases were reported, with 9043(35%) confirmed cases, and 165 deaths (case fatality rate, 1.8%). The non-measles febrile rash illness rate was consistently > 2/100,000 population, and "80% of the sub-national level investigated a case in 11 of the 14 years. National incidence ranged from 4 to 62/million in 2003-2006 and decreased to 3/million in 2016. The age specific incidence ranged from 1 to 364/million population and was highest among children aged < 1 year.Conclusion: Kenya has made progress towards measles elimination. However, this progress remains at risk and the recent declines in MCV1 coverage and the low uptake in MCV2 could reverse these gains

An Outbreak of Measles in a University in Korea, 2014

Measles has been declared eliminated from the Korea since 2006. In April 2014, a measles outbreak occurred at a University in Seoul. A total of 85 measles cases were identified. In order to estimate vaccine effectiveness of measles vaccine, we reviewed the vaccination records of the university students. The vaccine effectiveness of two doses of measles containing vaccine was 60.0% (95% CI, 38.2–74.1; P < 0.05). Transmission was interrupted after the introduction of outbreak-response immunization. The outbreak shows that pockets of under-immunity among college students may have facilitated the disease transmission despite the high 2-dose vaccination coverage in the community.

Visiting health centers as a risk factor for measles transmission: Kamwenge District, Uganda, April ­ July 2015

Introduction: Uganda has been implementing a one-dose measles vaccination at age 9 months in its national EPI schedule. On 27 April 2015, a measles outbreak, which was confirmed by serum positivity in several patients, occurred in Kamwenge District. Since then, the number of reported measles patients has increased despite the implementation of measures to control the outbreak by the local government. We investigated this outbreak to identify the risk factors for measles transmission, estimate vaccination coverage, determine vaccine effectiveness, and recommend control measures.Methods: we defined a probable case as onset in a Kamwenge District resident of fever and generalized rash from 16 April 2015 onward with ≥ 1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with positive measles-specific IgM in patient serum. For case-finding we reviewed medical records and found patients in the community with the help of the village health team. We determined vaccination histories by vaccination cards or interviews. In a case-control study, we compared the exposure histories of 50 probable case-persons with 200 asymptomatic control-persons during case-persons' exposure period (i.e., between minimum and maximum incubation). We matched case- and control-persons by age and residence village. We estimated vaccination coverage for children aged ≤ 2 years based on the percent of control-children vaccinated. Results: we identified 213 probable/ confirmed cases from 3 affected sub-counties (attack rate = 5.1/10,000). The epidemic curve showed sustained community transmission. The case-control study showed that 42% (21/50) of case-persons and 12% (23/200) of control-persons visited health centers during case-persons' exposure period (AORM-H = 6.1; 95% CI = 2.7-14). Vaccination coverage among children aged ≤ 2 years was 58% (95% CI = 47-68%). The vaccine effectiveness was 80% (95% CI = 35-94%). We found that all health centers were crowded, with no triaging system to separate suspect measles patients from patients with other illnesses.Conclusion: exposures to measles patients at crowded health centers, low vaccination coverage, and suboptimal vaccine effectiveness facilitated measles transmission in this outbreak. We recommended an emergency immunization campaign targeting young children, triaging and isolating suspect measles patients at health centers, and introducing a second dose of measles vaccine in the immunization schedule