Parents' and Health Professionals' Attitudes to Advancing Primary MMR Vaccine Administration from Fifteen to Six Months of Age-A Qualitative Thematic Analysis Embedded in a Randomized Trial.

Declining levels and duration of passively acquired maternal antibodies prompted a Danish trial to test the feasibility of advancing administration of the first measles, mumps, and rubella vaccine (MMR1) from 15 to 6 months of age. A trial-embedded qualitative study aimed to understand parents' (N = 24) and health professionals' (N = 11) attitudes about the measles, mumps, and rubella vaccine (MMR) in general and about advancing MMR1 administration. Overly positive parent attitudes were contrasted by members of a vaccine-skeptical organization including parents considering that their child was seriously vaccine-injured long ago. Parents' attitudes to advancing MMR1 mirrored their attitudes about the MMR vaccine in general, with four positions along a continuum of trust in the healthcare system: unquestioning trust, acceptance after careful consideration, challenging indecisiveness, and defensive rejection. Low tolerance was identified between vaccine supporters and vaccine opponents. Parents of children with perceived serious vaccine-related injuries described lifelong unresolved feelings of guilt. Supporters of advanced MMR1 saw it as a timely and convenient administration of a well-known vaccine, whereas opponents feared it would disturb the children's immature immune systems and emphasized difficulties in recognizing side effects so early in life. Health professionals were supportive of advancing the MMR1 vaccine and they carefully challenged the parents. Current MMR vaccine supporters show readiness to advance MMR1 administration.

Does Measles, Mumps, and Rubella (MMR) Vaccination Protect against COVID-19 Outcomes: A Nationwide Cohort Study.

Cross-protection from previous live attenuated vaccines is proposed to explain the low impact of COVID-19 on children. This study aimed to evaluate the effect of live attenuated MMR vaccines on the risk of being hospitalized for COVID-19 in children. An exposed (MMR vaccine)-non-exposed cohort study was conducted using the nationwide French National Health Data System (SNDS). We included children born between 1 January 2009 and 31 December 2019. Exposure was defined as a claim of at least one dose of MMR vaccine since birth. Hospitalization for COVID-19 was defined using main diagnostic ICD10 codes. Non-conditional logistic regression was used to calculate the adjusted odds ratios (aORs) of the association between MMR exposure and hospitalization for COVID-19, controlling for socio-demographic and socio-economic factors, co-morbidities, and general health. In total, 6,800,542 (median age 6 IQR [3-8] years) children exposed to a MMR vaccine and 384,162 (6 [3-9] years) not exposed were followed up with for 18 months. Among them, 873 exposed to the MMR vaccine and 38 who were not exposed were hospitalized for COVID-19. In a multi-variate analysis, the exposure of children to MMR vaccination was not associated with a decreased risk of COVID-19 hospitalization versus non-exposure (aOR (95%CI) = 1.09 [0.81-1.48]). A stratified analysis by age showed an aOR = 1.03 [0.64-1.66] for children aged 1-4, an aOR = 1.38 [0.82-2.31] for those aged 5-9, and an aOR = 1.11 [0.54-2.29] for those aged 10-12. Our study suggests that the live attenuated MMR vaccine does not protect children against COVID-19 hospitalization.

Examples of Outcome Reporting Bias in Vaccine Studies: Illustrating How Perpetuating Medical Consensus Can Impede Progress in Public Health.

INTRODUCTION: Outcome reporting bias in vaccine studies is a widespread problem among all researchers who have a tendency to report selective results and conclusions that support their beliefs and values or those of sponsoring agencies. Especially during the COVID-19 pandemic, this bias surfaced through the unprecedented proliferation of conflicting vaccine studies. Many researchers strongly recommend and report on the safety and effectiveness of the COVID-19 vaccine. Those researchers who embrace the COVID-19 vaccine and vaccines, in general, are often dismissive of other researchers who present views that differ from medical orthodoxy and oppose medical consensus. METHODS: The aim of this analysis is to critically evaluate seven vaccine studies using qualitative and/or quantitative approaches to identify outcome reporting bias and assess its potential impact on the stated conclusions that align with medical consensus. Four studies claim to have found no association between autism and (a) blood levels of mercury, (b) measles, mumps, and rubella (MMR) vaccine, and (c) thimerosal-containing vaccines. Three other studies claim no association exists between infant mortality rate and the number of vaccine doses, universal varicella vaccination and herpes zoster, and pandemic influenza vaccines and fetal losses. RESULTS: The presence of outcome reporting bias and independent reanalysis demonstrated an impact on both the direction and magnitude of the observed effect - raising questions concerning the robustness of the original study design and conclusions and challenging the current medical consensus. Medical consensus has exonerated vaccines as having any causal relationship to autism spectrum disorders (ASDs), yet no other reasonable cause has been proposed. Medical consensus attributes significant ASD increases to better case ascertainment and broadened clinical diagnosis. According to 2018 data, an estimated 1 in 44 eight-year-olds has been identified with ASD. From 1990 to 2019, there have been an estimated two million new cases of ASD in the US, with lifetime social costs exceeding $7 trillion (in 2019 dollars). Can perpetuating medical consensus impede the advancement of public health? Or has it already done so? CONCLUSIONS:  Conflicts of interest (e.g., financial) that abound between health regulatory agencies and the pharmaceutical industry impact what is ultimately reckoned as medical consensus. Outcome reporting bias that is inherent to all researchers to some degree, obscures medical and scientific truth. Advancement of public health requires that researchers have integrity and an openness and willingness to collaborate to resolve contradictory findings. In fact, it is usually through meticulous, rigorous, scientific investigation of contradictory findings that medical science has advanced and contributed to improvements in public health - since medical consensus and orthodoxy can be incorrect.

Measles, mumps and rubella vaccine and heterologous immunity: a way out of the COVID-19 crisis?

Heterologous immunity is a well-known concept in immunology wherein prior exposure to an antigen confers cross-protection against an unrelated antigen. With the surge in global COVID-19 cases, there has been significant research into the application of vaccine-induced heterologous immunity associated with measles, mumps and rubella (MMR) vaccine, Bacillus Calmette-Guérin vaccine, oral polio vaccine, and hepatitis A vaccine in curbing the worst outcomes of COVID-19 infection. Despite having specific vaccines against COVID-19, it is worthwhile exploring the application of available vaccines in the prevention of severe disease until the vaccines reach all sections of the population across the globe. In this article, we aim to outline the concept of heterologous immunity and its relevance in context to MMR vaccine and COVID-19.

Comparative study of scientific articles on MMR vaccines published from India over the last few decades

The MMR vaccine as we know is a vital vaccine to protect against three disease-causing microbes- measles, mumps, and rubella. To commemorate 75 years of Indian independence, the present study delves into the achievement of Indian research and lists out articles retrieved from the Web of Science Core Collection database on the domain of MMR vaccine research. The data has been restricted to the publication from India, thereby, has throwing some understanding into the MRR vaccine research in India over the last 28 years- 1994 to 2021. The data have been compared based on scientometric analysis. Qualitative and quantitative analysis have also been taken into account in order to give a comparative insight into the research. The comparison was done based on citation data, usage count data, year of publication, journals, publication media, domains focussed on the papers, and type of document. Astonishingly, in 2021, the most number of papers were published, most of them have related MMR vaccine as a potential immunity developer against COVID-19 infection. A total of 43 articles were retrieved from the search, the numbers are quite big, and the highest citation among them being 99 which was published in 2014, which is quite impressive for such a short duration of time. The comparative study suggests a positive growth of MMR vaccine research in India.

Estimating the number of US children susceptible to measles resulting from COVID-19-related vaccination coverage declines.

Measles elimination hinges on vaccination coverage remaining above 95% to retain sufficient community protection. Recent declines in routine measles vaccinations due to the COVID-19 pandemic coupled with prior models indicating the country was close to the 92% herd immunity benchmark are a cause for concern. We evaluated population-level measles susceptibility in the US, including sensitivity analyses accounting for pandemic-related impacts on immunization. We estimated the number of children aged 0-18 currently susceptible to measles and modeled susceptibility proportions in decreased vaccination scenarios. Participants were respondents to the NIS-Teen survey between 2008 and 2017 that also had provider-verified vaccination documentation. The exposure of interest was vaccination with a measles-containing vaccine (MCV), and the age at which they were vaccinated for all doses given. Using age at vaccination, we estimated age-based probabilities of vaccination and modeled population levels of MCV immunization and immunity vs. susceptibility. Currently, 9,145,026 children (13.1%) are estimated to be susceptible to measles. With pandemic level vaccination rates, 15,165,221 children (21.7%) will be susceptible to measles if no attempt at catch-up is made, or 9,454,436 children (13.5%) if catch-up vaccinations mitigate the decline by 2-3%. Models based on increased vaccine hesitancy also show increased susceptibility at national levels, with a 10% increase in hesitancy nationally resulting in 14,925,481 children (21.37%) susceptible to measles, irrespective of pandemic vaccination levels. Current levels of measles immunity remain below herd immunity thresholds. If pandemic-era reductions in childhood immunization are not rectified, population-level immunity to measles is likely to decline further.

Non-COVID-19 vaccine hesitancy among migrant populations worldwide: a scoping review of the literature, 2000-2020.

INTRODUCTION: Migration can be linked to the transmission of vaccine-preventable diseases. Hence, monitoring migrants' vaccination-related concerns can inform needed interventions to support vaccine acceptance. AREAS COVERED: Along with Google and Google Scholar, we searched 13 bibliographic databases between 1 January 2000 and 10 October 2020, to identify published studies of vaccine hesitancy among migrant populations. From a total of 8,915 records, we screened 745 abstracts and included 112 eligible articles. We summarized extracted data using figures, tables, and narrations. Of the 112 articles, 109 were original quantitative (48%), qualitative (45%), and mixed-methods (7%) research, originating mainly from the United States (US) (68%), the United Kingdom (UK) (12%), and Scandinavia (6%). Most articles addressed human papillomavirus (63%), measles (13%), and influenzas (9%) vaccinations, and the leading sponsor of funded research was the US National Institutes of Health (50%). Discernable migrant groups with vaccine-specific concerns included Somali diasporas, UK-based Poles and Romanians, and US-based Haitians and Koreans. Among US-based Latina/Latino immigrants, lower vaccine uptake frequency was mostly associated with awareness levels, knowledge gaps, and uninsured status. EXPERT OPINION: Migrants' vaccine-related apprehensions may cascade well beyond their proximate social connections and influence vaccine attitudes and behaviors in their countries-of-origin.

Measles in Afghan refugees: Challenges, efforts and recommendations

Recently, measles outbreaks have been reported across Afghanistan, and in many refugees. Although, Afghanistan has a previous history of measles outbreaks, the presence of such epidemics during a humanitarian crisis is burdening a fragile healthcare system. In addition, it is creating new challenges for Afghan refugees who are endangered by political conditions of the country. Despite efforts such as vaccination to reduce the number of cases in Afghanistan, there are still multiple outbreaks. Various factors such as political conflict, insecurity, internal displacement, supply chain issues and, most recently, COVID-19 have hampered the eradication of measles. High mortality rate, faster transmission, and clinical similarities with COVID-19 are exacerbating challenges for refugees, who are now facing delays in resettlement, especially in the United States. To curb the spread of measles, refugees need immediate and effective vaccination measures, and access to healthcare information in their own languages.

Vaccine-Associated Measles in a Hematopoietic Cell Transplant Recipient: Case Report and Comprehensive Review of the Literature.

Measles is a worldwide viral disease that can cause fatal complications in immunocompromised hosts such as hematopoietic cell transplant (HCT) recipients. The live attenuated measles, mumps, and rubella (MMR) vaccine is generally contraindicated post-HCT due to the risk for vaccine-associated measles. This, combined with decreasing vaccination rates due to vaccine hesitancy and the coronavirus disease 2019 pandemic, raises significant concerns for a measles resurgence that could portend devastating consequences for immunocompromised hosts. Multiple guidelines have included criteria to determine which HCT recipients can safely receive the MMR vaccine. Here, we report a case of vaccine-associated measles in a HCT recipient who met guideline-recommended criteria for MMR vaccination. The objective of this article is to query these criteria, highlight the importance of MMR vaccination, and comprehensively review the literature.

Recent MMR vaccination in health care workers and Covid-19: A test negative case-control study.

BACKGROUND: It has been hypothesised that the measles-mumps-rubella (MMR) vaccine may afford cross-protection against SARS-CoV-2 which may contribute to the wide variability in disease severity of Covid-19. METHODS: We employed a test negative case-control study, utilising a recent measles outbreak during which many healthcare workers received the MMR vaccine, to investigate the potential protective effect of MMR against SARS-CoV-2 in 5905 subjects (n = 805 males, n = 5100 females). RESULTS: The odds ratio for testing positive for SARS-CoV-2, in recently MMR-vaccinated compared to not recently MMR-vaccinated individuals was 0.91 (95% CI 0.76, 1.09). An interaction analysis showed a significant interaction for sex. After sex-stratification, the odds ratio for testing positive for males was 0.43 (95% CI 0.24, 0.79, P = 0.006), and 1.01 (95% CI 0.83, 1.22, P = 0.92) for females. CONCLUSION: Our results indicate that there may be a protective effect of the MMR vaccine against SARS-CoV-2 in males but not females.

Measles, mumps, rubella prevention: how can we do better?

INTRODUCTION: Measles, mumps, and rubella incidence decreased drastically following vaccination programs' implementation. However, measles and mumps' resurgence was recently reported, outbreaks still occur, and challenges remain to control these diseases. AREAS COVERED: This qualitative narrative review provides an objective appraisal of the literature regarding current challenges in controlling measles, mumps, rubella infections, and interventions to address them. EXPERT OPINION: While vaccines against measles, mumps, and rubella (including trivalent vaccines) are widely used and effective, challenges to control these diseases are mainly related to insufficient immunization coverage and changing vaccination needs owing to new global environment (e.g. traveling, migration, population density). By understanding disease transmission peculiarities by setting, initiatives are needed to optimize vaccination policies and increase vaccination coverage, which was further negatively impacted by COVID-19 pandemic. Also, awareness of the potential severity of infections and the role of vaccines should increase. Reminder systems, vaccination of disadvantaged, high-risk and difficult-to-reach populations, accessibility of vaccination, healthcare infrastructure, and vaccination services management should improve. Outbreak preparedness should be strengthened, including implementation of high-quality surveillance systems to monitor epidemiology. While the main focus should be on these public health initiatives to increase vaccination coverage, slightly more benefits could come from evolution of current vaccines.

PLAIN LANGUAGE SUMMARYWhat is the context?Measles, mumps, and rubella are highly contagious diseases associated with significant medical and societal burden. Effective vaccines against these diseases are available, and the implementation of vaccination programs drastically reduced disease incidence globally. However, reports of measles and mumps outbreaks in the last few years highlight remaining challenges to eliminate these diseases.What does the review highlight?We conducted a literature review to identify challenges associated with controlling measles, mumps, and rubella infections, and interventions needed to address them. We identified 11 challenges mainly related to low immunization coverage and vaccine characteristics. Societal challenges could be addressed by increasing awareness of disease severity and vaccines impact, targeting high-risk, unvaccinated, and under-vaccinated populations, improving vaccination access, setting up clear outbreak preparedness plans, and implementing country-specific vaccination policies. System weaknesses could be addressed through improving vaccination services and health infrastructure, implementing high-quality surveillance, patient invite, and reminder systems, ensuring vaccine implementation and long-term supply. Interventions related to vaccine characteristic challenges could include adaptation of vaccination schedules (shorter interval between doses, administration of a third dose) and development of vaccines against emerging strains.What is the take-home message?Policymakers should support the following strategies to increase vaccination coverage and reach elimination of measles, mumps, and rubella: strengthening health systems and vaccination access; raising awareness of disease severity and vaccination impact; limiting disease propagation owing to global changing environment and population dynamics (traveling, migration); improving surveillance systems to rapidly address the immunity gaps against disease resurgence.

Significantly Improved COVID-19 Outcomes in Countries with Higher BCG Vaccination Coverage: A Multivariable Analysis.

The COVID-19 pandemic that started in China has spread within 3 months to the entire globe. We tested the hypothesis that the vaccination against tuberculosis by Bacille Calmette-Guérin vaccine (BCG) correlates with a better outcome for COVID-19 patients. Our analysis covers 55 countries complying with predetermined thresholds on the population size and number of deaths per million (DPM). We found a strong negative correlation between the years of BCG administration and the DPM along with the progress of the pandemic, corroborated by permutation tests. The results from multivariable regression tests with 23 economic, demographic, health-related, and pandemic restriction-related quantitative properties, substantiate the dominant contribution of BCG years to the COVID-19 outcomes. The analysis of countries according to an age-group partition reveals that the strongest correlation is attributed to the coverage in BCG vaccination of the young population (0-24 years). Furthermore, a strong correlation and statistical significance are associated with the degree of BCG coverage for the most recent 15 years, but no association was observed in these years for other broadly used vaccination protocols for measles and rubella. We propose that BCG immunization coverage, especially among the most recently vaccinated population, contribute to attenuation of the spread and severity of the COVID-19 pandemic.

Vaccinomics and Adversomics in the Era of Precision Medicine: A Review Based on HBV, MMR, HPV, and COVID-19 Vaccines.

Precision medicine approaches based on pharmacogenomics are now being successfully implemented to enable physicians to predict more efficient treatments and prevention strategies for a given disease based on the genetic background of the patient. This approach has already been proposed for vaccines, but research is lagging behind the needs of society, and precision medicine is far from being implemented here. While vaccinomics concerns the effectiveness of vaccines, adversomics concerns their side effects. This area has great potential to address public concerns about vaccine safety and to promote increased public confidence, higher vaccination rates, and fewer serious adverse events in genetically predisposed individuals. The aim here is to explore the contemporary scientific literature related to the vaccinomic and adversomic aspects of the three most-controversial vaccines: those against hepatitis B, against measles, mumps, and rubella, and against human Papilloma virus. We provide detailed information on the genes that encode human leukocyte antigen, cytokines and their receptors, and transcription factors and regulators associated with the efficacy and safety of the Hepatitis B and Measles, Mumps and Rubella virus vaccines. We also investigate the future prospects of vaccinomics and adversomics of a COVID-19 vaccine, which might represent the fastest development of a vaccine ever.

Vaccine repurposing approach for preventing COVID 19: can MMR vaccines reduce morbidity and mortality?

The coronavirus disease (COVID-19) is resulting in millions of infected individuals with several hundred thousands dead throughout the world. Amidst all the havoc, one interesting observation in the present COVID-19 pandemic is the negligible symptoms in the young; particularly children below 10 years of age. We assume the extensive pediatric vaccination with MMR vaccines followed globally could have resulted in innate immune responses, e.g., induction of interferons (IFNs) and activated natural killer (NK) cells, thereby offering natural immunity against SARS-CoV-2 in the young population. Possible cross-protective innate immunity offered by MMR vaccination prompted us to suggest repurposing MMR vaccination for immuno-prophylaxis against COVID-19.