A lesson from MMR: is choice of vaccine the missing link in promoting vaccine confidence through informed consent?

A recent study suggests that vaccine hesitancy amongst key demographics – including females, younger individuals, and certain ethnic groups – could undermine the pursuit of herd immunity against COVID-19 in the United Kingdom. At the same time, the UK Joint Committee on Vaccination and Immunization (JVCI) indicated that it will not facilitate the choice between available COVID-19 vaccines. This paper reflects upon lessons from the introduction of the UK's combined Measles, Mumps and Rubella (MMR) vaccine strategy of the 1980s when Member of Parliament Miss Julie Kirkbride argued that had parents been allowed to choose between vaccine variants, then the crisis of low herd immunity – and subsequent outbreaks – could have been avoided. This paper explores this argument, as applied to the COVID-19 vaccination strategy, by considering how three key elements of informed consent – disclosure of risk, benefit, and reasonable alternatives – may be employed to tackle vaccine hesitancy and build vaccine confidence.

Vaccines for the prevention of infections in adults with haematological malignancies

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the benefits and adverse effects of vaccines for the prevention of infections in adults with haematological malignancies.Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Adult Vaccination

Adult vaccination rates are low in the United States, despite clear benefits for reducing morbidity and mortality. Vaccine science is evolving rapidly, and family physicians must maintain familiarity with the most recent guidelines. The recommended adult immunization schedule is updated annually by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. All eligible patients should receive SARS-CoV-2 vaccines according to the current guidelines. Adults without contraindications should also receive an annual influenza vaccine. Hepatitis A vaccine is recommended for adults with specific risk factors. All pregnant patients, adults younger than 60 years, and those 60 years and older who have risk factors should receive a hepatitis B vaccine. A 15- or 20-valent pneumococcal conjugate vaccine is recommended for all patients who are 65 years and older. Patients who receive 15-valent pneumococcal conjugate vaccine should receive a dose of 23-valent pneumococcal polysaccharide vaccine one year later. Adults 19 to 64 years of age should receive a pneumococcal vaccination if they have medical risk factors. A single dose of measles, mumps, and rubella vaccine is recommended for adults without presumptive immunity, and additional doses are recommended for patients with HIV and postdelivery for pregnant patients who are not immune to rubella. A tetanus and diphtheria toxoids booster is recommended every 10 years. For pregnant patients and those in close contact with young infants, a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine should be administered. The human papillomavirus vaccine is recommended for all people through 26 years of age. Herpes zoster vaccine is indicated for all adults 50 years and older.Copyright © 2022 American Academy of Family Physicians.

Mitigating Vaccine Hesitancy and Building Trust to Prevent Future Measles Outbreaks in England.

Measles, a highly infectious respiratory viral infection associated with severe morbidity and mortality, is preventable when coverage with the highly effective measles, mumps and rubella vaccine (MMR) is ≥95%. Vaccine hesitancy is responsible for measles outbreaks in countries where measles had previously been eliminated, including in England, and is one of the ten threats to global public health identified by the World Health Organization (WHO). Official administrative 2012-2021 data on measles incidence and MMR coverage in England were reviewed alongside a scoping literature review on factors associated with MMR uptake in England. Whilst measles incidence has reduced significantly since 2012, sporadic measles outbreaks in England have occurred with geographic disparities and variations in MMR coverage. Over the last decade, MMR uptake has fallen across all regions with no area currently reaching the WHO target of 95% coverage of both doses of MMR necessary for herd immunity. Factors associated with MMR coverage overlap with the 3C (convenience, complacency and confidence) model of vaccine hesitancy. The COVID-19 pandemic has reinforced pre-existing vaccine hesitancy. Increasing MMR uptake by reducing vaccine hesitancy requires allocated funding for area-based and targeted domiciliary and community-specific immunisation services and interventions, public health catch-up campaigns and web-based decision aid tools.

Measles and travel: an update for general practice nurses

Measles remains a risk for international travellers. The ongoing COVID-19 pandemic has interrupted many routine childhood vaccine schedules worldwide, resulting in an upsurge in measles cases. A travel consultation is an opportunity to offer measles, mumps and rubella (MMR) vaccine for both personal protection of individual travellers and as a public health intervention.

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 Universal immunization program and Integrated disease surveillance project reports. Spearman rank correlation 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. © The Authors retain the copyrights of this article, with first publication rights granted to Medsci Publications.

Vaccine Hesitancy to Vaccine Hope: Comparison of MR Vaccine and COVID Vaccine Trends in India

Social media played a major role during the distress in the era of Web 3.0 technologies. The use of social media for relief and rescue operations is common nowadays. But the Web 3.0 and its technologies have made the situation worse sometimes, especially in the healthcare sector. The measles-rubella (MR) vaccine campaign in India had a huge setback due to the social media. The World Health Organization (WHO) has observed that the misinformation in social media is one of the ten reasons for vaccine hesitancy. In the COVID-19 situation, the misinformation has increased tremendously but at the same time people were expecting a vaccine. The vaccine hesitancy depends on the severity of the cause of the disease and the cure of the disease. There were trends of vaccination hesitancy during the MR vaccination campaign and that has changed to vaccine hope during the COVID-19 in the social media. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

The epidemiological situation in Ukraine in terms of the implementation of preventive vaccinations according to the Protective Vaccination Program

The level of immunization of children and adolescents under the Protective Vaccination Program in Ukraine is lower than in Poland, and, due to the outbreak of the war in Ukraine, many people now live in conditions that are often unsanitary. Centers for refugees are also places of increased risk of outbreaks of infectious diseases. This risk is increased by the low percentage of the vaccinated, limited access to healthcare (including diagnostics) and overcrowding. The paper presents the state of vaccination in Ukraine against poliomyelitis, measles, diphtheria, tetanus and pertussis, the most important problems in the field of infectious diseases, as well as the resulting risks and the need to prevent them.

Understanding Childhood Immunisation Hesitancy in within Primary Care

Aims The success of the childhood immunisation programme depends on parental confidence in the efficacy of vaccines. Parental hesitancy because of lack of access to evidence based information alongside the misinformation available on social media contributes to the poor uptake of vaccinations. Reliance on herd immunity is compromised if increasing cohorts begin to decline vaccines. Combating misinformation and gaining an understanding of reasons for refusal and hesitancy behaviours enables the implementation of interventions to prevent declines. Our study attempted to understand reasons and personal characteristics influencing parental refusal in accepting immunisations. Methods Using a semi-structured interview, parents of children who had missed immunisation appointments were contacted. The parents were asked a series of open-ended questions about the reasons for their non-attendance to appointments. Results Out of the 47 patients contacted, 19 patients responded. Main reasons for vaccine refusal included misinformation, homoeopathy and religion. Parents expressed concerns over the vaccine components and the negative impacts vaccines had previously had on the child or other family members. Alongside this some parents expressed a concern over a link between autism and the MMR vaccine. A review of the records did not provide any valid information to support these claims which were more perceptual than factual. Furthermore, one parent expressed a lack of trust in the whole immunisation programme since the beginning of the COVID- 19 pandemic and the roll out of vaccines. Conclusion Parental beliefs and hesitancy are key to the effectiveness of the childhood immunisation programme. Unless we can fully understand and counsel parents with the correct, evidence- based information we will not be able to change parental behaviours and reduce hesitancy surrounding vaccines. Social media and the plethora of information has a large contribution to the varied messages and information available to parents. Our study adds to existing information around the misinformation of vaccines. Public health programmes cannot combat misinformation and implement interventions unless there are more robust information campaigns.

Viral exanthems Unravelling viral rashes

Common causes of viral exanthems in Australia include herpesviruses, enteroviruses, parvovirus B19, varicella, measles and rubella viruses and mosquito-borne alphaviruses. The cause can often be diagnosed clinically from the rash distribution and morphology, confirmed only when necessary with serological or PCR tests. Most viral exanthems are self-limiting, requiring supportive care alone.

Quantifying the Declining Rate of Measles, Mumps, and Rubella Vaccine Administration in Harris County Due to the COVID-19 Pandemic and Analyzing the Vaccination Gaps by Racial Stratification of Patients

Background: Despite vaccines being attributed to the eradication of smallpox and prevention of many possibly fatal diseases, public confidence in vaccines has been on the decline, and the COVID-19 pandemic has further increased the vaccination gap across the world. A study done by the Michigan Care Improvement Registry compared age-recommended vaccination rates for patients from the years of 2016-2019 and the year 2020. The study showed that in the 16-month age cohort, children obtaining measles vaccine coverage declined from 76.1% in May 2019 to 70.9% in May 2020. An analysis by Scientific American showed only 44.7% of the number of vaccines administered in March 2019 were administered in March 2020 in the state of Texas. Methods: The Quality Improvement sector of the Health Technology department at the UT Health Science Center approved the project and collected data across UT Health primary pediatric care clinics in Harris County. The data points included all the pediatric appointments of patients who were eligible for the MMR 1 and 2 vaccines in 2019 and 2020. The data displayed which eligible patients for the MMR 1 and 2 vaccines received the vaccine at their appointment. The data was analyzed for overall trends of Harris County, and then subdivided by patient racial groups. Results: From 2019 to 2020, the MMR1 vaccination rate decreased from 52.15% to 43.55%, and the MMR2 vaccination rate decreased from 55.70% to 45.57%. Combining years 2019 and 2020, the percentage of eligible patients who did not receive the MMR1 vaccine consisted of 28.04% Caucasian, 22.05% African American, 17.11% Hispanic, Latino, or Latin American, 1.34% Asian or Pacific Islander, and 31.46% Other. The percentage of eligible patients in 2019 and 2020 who did not receive the MMR2 vaccine consisted of 28.05% Caucasian, 16.25% African American, 21.76% Hispanic, Latino, or Latin American, 1.75% Asian or Pacific Islander, and 32.18% Other. The demographic labeled “other” consisted of not answered and not specified patients. Conclusion: Overall, there was a clear decline in the rate of MMR vaccinations to eligible patients from 2019 to 2020. This indicates that the COVID-19 pandemic is potentially playing an even greater role in public health than previously thought due to increasing the possibility of a measles epidemic occurring in Harris County. Stratifying the data by race demonstrated which demographics were more prone to vaccination gaps. Patients who selected not answered/not specified and Caucasian patients were the most likely to experience a gap in vaccine administration leading to an increased chance of measles outbreaks in these groups of patients. This is valuable knowledge for providers to be aware of which groups are more predisposed to vaccine gaps, so the healthcare team can help close the gap through a targeted approach of care.

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.

Factors Predicting Rubella Vaccination and Antibody in Pregnant Women in Japan: A Report from Pregnant Women Health Initiative.

This study aimed to identify the factors predicting rubella vaccination status based on self-reported data and the presence of sufficient rubella antibody titers in pregnant women in Japan. We used the results of the nationwide questionnaire survey conducted at obstetric facilities in the Pregnant Women Health Initiative Project (PWHI), with 23 participating hospitals recruiting pregnant women from June 2018-November 2019. We extracted age, the number of deliveries, educational level, household income, pre-pregnancy smoking, and knowledge of rubella from questionnaires and medical records. We analyzed the association of rubella vaccination status and antibodies with each of these factors. We found that the number of previous deliveries, educational level, annual household income, smoking before pregnancy, and knowledge of rubella were factors predicting self-reported rubella vaccination status, while age and the number of previous deliveries were identified as factors predicting the presence of sufficient rubella antibody titers (32 folds or higher). Women considering pregnancy should be immunized against rubella to prevent congenital rubella syndrome in the future. Furthermore, social policies are needed to strongly encourage vaccination, especially for all citizens who were not given the opportunity or missed the chance to be vaccinated against rubella.

Medical factors associated with caregiver intention to vaccinate their children against COVID-19.

OBJECTIVE: To describe medical factors that are associated with caregiver intention to vaccinate their children against COVID-19. METHODS: We conducted a cross-sectional study of families receiving primary care in a mid-Atlantic pediatric healthcare system, linking caregiver-reported data from a survey completed March 19 to April 16, 2021 to comprehensive data from the child's EHR. RESULTS: 513 families were included (28% Black, 16% Hispanic, 44% public insurance, 21% rural, child age range 0-21 years). 44% of caregivers intended to vaccinate their children against COVID-19, while 41% were not sure and 15% would not. After adjusting for socio-demographics, the only medical factors that were associated with caregiver COVID-19 vaccine hesitancy were caregiver COVID-19 vaccination status at the time of the survey (aOR 3.0 if the caregiver did not receive the vaccine compared to those who did, 95% CI 1.7-5.3) and child seasonal influenza immunization history (aOR 3.3 if the child had not received the influenza vaccine in the 2020-2021 season compared to those who did, 95% CI 2.0-5.4). Other medical factors, including family medical experiences with COVID-19, other child immunization history, child health conditions like obesity and asthma, and family engagement with the healthcare system were not associated with caregiver intention to vaccinate their children against COVID-19. CONCLUSIONS: This study highlights important factors, such as general attitudes towards vaccines and understanding of COVID-19 morbidity risk factors, that healthcare providers should address when having conversations with families about the COVID-19 vaccine.

Acute Disseminated Encephalomyelitis Secondary to Rubeola Infection Masquerading as New Onset Multiple Sclerosis in an Elderly Woman: Case Report

Introduction: Following an alarming surge of measles cases from declining immunization rates, it is important that clinicians recognize measles as a possible cause of otherwise unexplained symptoms, especially in patients with uncertain immunological status. Case: Over a 4-month period, a 76-year-old woman with a history of treated breast cancer experienced rapidly progressive and fluctuating focal weakness and numbness primarily affecting her lower extremities. Initially complaining of vague gastrointestinal symptoms upon returning from an extended stay in Florida, she was found to have active demyelinating lesions of her brain, cervical, and thoracic cord on MRI. This was initially thought to be new onset multiple sclerosis. CSF analysis showed critically high protein and, upon repeat analysis, positive rubeola and herpes IgM, which were elevated despite high dose steroid infusions and a steroid taper. Alternative diagnoses were ruled out, including: other infectious etiologies;endocrine/metabolic disorders;drug toxicity;malignancy;paraneoplastic disorders;transverse myelitis;multifocal cord infarction;stroke;seizure;and others. Repeat images displayed improvement of lesions and the patient was discharged to acute rehab with close neurological follow-up without steroids. Discussion: Acute disseminated encephalomyelitis is more likely in children, though cases are rare. This case of disseminated measles underscores the critical need for continued vaccination of at-risk populations, especially in those who are elderly or immunocompromised. Previous titers for immunity were not known, a potential limitation. Recent evidence demonstrates measles' ability to cause immune system "amnesia," potentially explaining this patient's concomitant herpes. As COVID-19 cases continue to present, recent evidence has linked the protective effect of the MMR vaccine against COVID-19's spread and severity. Conclusion: It is imperative that measles and other severe, preventable diseases continue to be closely monitored. Clinicians should assess benefits of proactively measuring rubeola titers in patients of all ages or in those who have previously received extensive immunosuppressive therapy.

Number of doses of Measles-Mumps-Rubella vaccine applied in Brazil before and during the COVID-19 pandemic.

BACKGROUND: Due to the social isolation measures adopted in an attempt to mitigate the risk of transmission of SARS-CoV-2, there has been a reduction in vaccination coverage of children and adolescents in several countries and regions of the world. OBJECTIVE: Analyze the number of doses of vaccine against Measles-Mumps-Rubella (MMR) applied before and after the beginning of mitigation measures due to COVID-19 pandemic in Brazil. METHODS: The data collected refer to the number of doses of the MMR vaccine applied monthly to the target population residing in Brazil: cahildren, aged 12 months (first dose) and children, aged 9 years (second dose), from April 2019 to December 2020. Differences in MMR vaccine doses from April 2019 to March 2020 (before the start of mitigation measures) and April 2020 to September 2020 (after the start of the mitigation measures) were evaluated. Spatial analysis identified clusters with a high percentage of reduction in the median of applied doses no Brazil. RESULTS: There was a reduction in the median of doses applied in the Regions North (- 33.03%), Northeast (- 43.49%) and South (- 39.01%) e nos Estados Acre (- 48.46%), Amazonas (- 28.96%), Roraima (- 61.91%), Paraíba (- 41.58%), Sergipe (- 47.52%), Rio de Janeiro (-59.31%) and Santa Catarina (- 49.32) (p < 0.05). High-high type spatial clusters (reduction between 34.00 and 90.00%) were formed in the five regions of Brazil (Moran's I = 0.055; p = 0.01). CONCLUSION: A reduction in the number of MMR vaccine doses was evidenced as a possible effect by the restrictive actions of COVID-19 in Brazil.

Pneumococcal and Influenza Vaccination Rates and Pneumococcal Invasive Disease Rates Set Geographical and Ethnic Population Susceptibility to Serious COVID-19 Cases and Deaths.

This study examines the relationship of pneumococcal vaccination rates, influenza, measles-mumps-rubella (MMR) diphtheria-tetanus-pertussis vaccinations (DTP), polio, Haemophilus influenzae type B (Hib), and Bacillus Calmette-Guerin (tuberculosis) vaccination rates to COVID-19 case and death rates for 51 nations that have high rates of COVID-19 testing and for which nearly complete childhood, at-risk adult and elderly pneumococcal vaccination data were available. The study is unique in a large number of nations examined, the range of vaccine controls, in testing effects of combinations of vaccinations, and in examining the relationship of COVID-19 and vaccination rates to invasive pneumococcal disease (IPD). Analysis of Italian regions and the states of the United States were also performed. Significant positive correlations were found between IPD (but not lower respiratory infections) and COVID-19 rates, while significant negative correlations were found between pneumococcal vaccination and COVID-19 rates. Influenza and MMR vaccination rates were negatively correlated with lower respiratory infection (LRI) rates and may synergize with pneumococcal vaccination rates to protect against COVID-19. Pneumococcal and influenza vaccination rates were independent of other vaccination rates. These results suggest that endemic rates of bacterial pneumonias, for which pneumococci are a sentinel, may set regional and national susceptibility to severe COVID-19 disease and death.

Durability of humoral immune responses to rubella following MMR vaccination.

BACKGROUND: While administration of the measles-mumps-rubella (MMR-II®) vaccine has been effective at preventing rubella infection in the United States, the durability of humoral immunity to the rubella component of MMR vaccine has not been widely studied among older adolescents and adults. METHODS: In this longitudinal study, we sought to assess the durability of rubella virus (RV)-specific humoral immunity in a healthy population (n = 98) of adolescents and young adults at two timepoints: ~7 and ~17 years after two doses of MMR-II® vaccination. Levels of circulating antibodies specific to RV were measured by ELISA and an immune-colorimetric neutralization assay. RV-specific memory B cell responses were also measured by ELISpot. RESULTS: Rubella-specific IgG antibody titers, neutralizing antibody titers, and memory B cell responses declined with increasing time since vaccination; however, these decreases were relatively moderate. Memory B cell responses exhibited a greater decline in men compared to women. CONCLUSIONS: Collectively, rubella-specific humoral immunity declines following vaccination, although subjects' antibody titers remain well above the currently recognized threshold for protective immunity. Clinical correlates of protection based on neutralizing antibody titer and memory B cell ELISpot response should be defined.