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1.
Sci Prog ; 105(2): 368504221105172, 2022.
Article in English | MEDLINE | ID: covidwho-1909995

ABSTRACT

Despite the development and deployment of effective COVID-19 vaccines, many regions remain poorly covered. Seeking alternative tools for achieving immunity against COVID-19 remains to be of high importance. "Trained immunity" is the nonspecific immune response usually established through administering live attenuated vaccines and is a potential preventive tool against unrelated infections. Evidence regarding a possible protective role for certain live attenuated vaccines against COVID-19 has emerged mainly for those administered as part of childhood vaccination protocols. This review summarizes the relevant literature about the potential impact of Bacille Calmette-Guérin (BCG) and measles, mumps and rubella (MMR) vaccines on COVID-19. Existing available data suggest a potential role for BCG and MMR in reducing COVID-19 casualties and burden. However, more investigation and comparative studies are required for a better understanding of their impact on COVID-19 outcomes.


Subject(s)
COVID-19 , Mumps , Rubella , BCG Vaccine/therapeutic use , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Humans , Measles-Mumps-Rubella Vaccine/therapeutic use , Mumps/epidemiology , Mumps/prevention & control , Rubella/prevention & control , Vaccination , Vaccines, Attenuated/therapeutic use
2.
Vaccine ; 40(26): 3676-3683, 2022 06 09.
Article in English | MEDLINE | ID: covidwho-1852210

ABSTRACT

Vaccine-preventable diseases, such as measles, have been re-emerging in countries with moderate to high vaccine uptake. It is increasingly important to identify and close immunity gaps and increase coverage of routine childhood vaccinations, including two doses of the measles-mumps-rubella vaccine (MMR). Here, we present a simple cohort model relying on a Bayesian approach to evaluate the evolution of measles seroprevalence in Belgium using the three most recent cross-sectional serological survey data collections (2002, 2006 and 2013) and information regarding vaccine properties. We find measles seroprevalence profiles to be similar for the different regions in Belgium. These profiles exhibit a drop in seroprevalence in birth cohorts that were offered vaccination at suboptimal coverages in the first years after routine vaccination has been started up. This immunity gap is observed across all cross-sectional survey years, although it is more pronounced in survey year 2013. At present, the COVID-19 pandemic could negatively impact the immunization coverage worldwide, thereby increasing the need for additional immunization programs in groups of children that are impacted by this. Therefore, it is now even more important to identify existing immunity gaps and to sustain and reach vaccine-derived measles immunity goals.


Subject(s)
COVID-19 , Measles , Mumps , Rubella , Bayes Theorem , Belgium/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Child , Cross-Sectional Studies , Humans , Measles/epidemiology , Measles/prevention & control , Measles-Mumps-Rubella Vaccine , Mumps/prevention & control , Pandemics , Rubella/prevention & control , Seroepidemiologic Studies , Vaccination
3.
Front Public Health ; 9: 689458, 2021.
Article in English | MEDLINE | ID: covidwho-1775809

ABSTRACT

OBJECTIVE: This analysis examines governorate-level disease incidence as well as the relationship between incidence and the number of persons of concern for three vaccine-preventable diseases-measles, mumps, and rubella-between 2001 and 2016. METHODS: Using Iraqi Ministry of Health and United Nations High Commissioner for Refugees (UNHCR) data, we performed descriptive analyses of disease incidence and conducted a pooled statistical analysis with a linear mixed effects regression model to examine the role of vaccine coverage and migration of persons of concern on subnational disease incidence. RESULTS: We found large variability in governorate-level incidence, particularly for measles (on the order of 100x). We identified decreases in incident measles cases per 100,000 persons for each additional percent vaccinated (0.82, 95% CI: [0.64, 1.00], p-value < 0.001) and for every additional 10,000 persons of concern when incorporating displacement into our model (0.26, 95% CI: [0.22, 0.30], p-value < 0.001). These relationships were insignificant for mumps and rubella. CONCLUSIONS: National level summary statistics do not adequately capture the high geospatial disparity in disease incidence between 2001 and 2016. This variability is complicated by MMR vaccine coverage and the migration of "persons of concern" (refugees) during conflict. We found that even when vaccine coverage was constant, measles incidence was higher in locations with more displaced persons, suggesting conflict fueled the epidemic in ways that vaccine coverage could not control.


Subject(s)
Measles , Mumps , Rubella , Humans , Iraq/epidemiology , Measles/epidemiology , Measles/prevention & control , Measles-Mumps-Rubella Vaccine , Mumps/epidemiology , Mumps/prevention & control , Rubella/epidemiology , Rubella/prevention & control , Vaccination
4.
BMC Public Health ; 22(1): 221, 2022 02 03.
Article in English | MEDLINE | ID: covidwho-1707500

ABSTRACT

BACKGROUND: Following the 2015 earthquake, a measles-rubella (MR) supplementary immunization activity (SIA), in four phases, was implemented in Nepal in 2015-2016. A post-campaign coverage survey (PCCS) was then conducted in 2017 to assess SIA performance and explore factors that were associated with vaccine uptake. METHODS: A household survey using stratified multi-stage probability sampling was conducted to assess coverage for a MR dose in the 2015-2016 SIA in Nepal. Logistic regression was then used to identify factors related to vaccine uptake. RESULTS: Eleven thousand two hundred fifty-three households, with 4870 eligible children provided information on vaccination during the 2015-2016 MR SIA. Overall coverage of measles-rubella vaccine was 84.7% (95% CI: 82.0-87.0), but varied between 77.5% (95% CI: 72.0, 82.2) in phase-3, of 21 districts vaccinated in Feb-Mar 2016, to 97.7% (CI: 95.4, 98.9) in phase-4, of the last seven mountainous districts vaccinated in Mar-Apr 2016. Coverage in rural areas was higher at 85.6% (CI: 81.9, 88.8) than in urban areas at 79.0% (CI: 75.5, 82.1). Of the 4223 children whose caregivers knew about the SIA, 96.5% received the MR dose and of the 647 children whose caregivers had not heard about the campaign, only 1.8% received the MR dose. CONCLUSIONS: The coverage in the 2015-2016 MR SIA in Nepal varied by geographical region with rural areas achieving higher coverage than urban areas. The single most important predictor of vaccination was the caregiver being informed in advance about the vaccination campaign. Enhanced efforts on social mobilization for vaccination have been used in Nepal since this survey, notably for the most recent 2020 MR campaign.


Subject(s)
Measles , Rubella , Child , Humans , Immunization Programs , Infant , Measles/epidemiology , Measles/prevention & control , Measles Vaccine , Nepal/epidemiology , Rubella/prevention & control , Rubella Vaccine , Vaccination
5.
Vaccine ; 40(20): 2884-2893, 2022 05 03.
Article in English | MEDLINE | ID: covidwho-1701291

ABSTRACT

In 2020, National Immunization Programme (NIP) of Nepal implemented a measles outbreak response immunization (ORI) campaign, which was additional to an ongoing preventive measles-rubella SIA campaign. Both campaigns were implemented during ongoing COVID-19 transmission. By April, 220 measles cases and two deaths were confirmed from eight districts of Nepal. The NIP triangulated information from surveillance (measles and COVID-19), measles immunization performance and immunity profile, programme capacities and community engagement and applied a logical decision-making framework to the collated data to inform 'Go/No-Go' decisions for ORI interventions. This was reviewed by the National Immunization Advisory Committee (NIAC) for endorsement. Outbreak response with non-selective immunization (ORI), vitamin-A administration and case management were implemented in affected municipalities of four districts, while in the remaining districts outbreak response without ORI were undertaken. The structure and iterative application of this logical framework has been described. ORI was implemented without interrupting the ongoing measles-rubella vaccination campaign which had targeted children from 9 to 59 months of age. The age group for ORI was same as SIA in one sub-district area, while for the other three sub-district areas it was from 6 months to 15 years of age. More than 32,000 persons (97% coverage) were vaccinated in ORI response. Overall measles incidence decreased by 98% after ORI. The daily incidence rate of measles was 94 times higher (95% confidence interval: 36.11 - 347.62) before the ORI compared to two weeks after ORI until year end. Close attention to surveillance and other data to inform actions and seamless collaboration between NIP and core immunization partners (WHO, UNICEF), with guidance from NIAC were key elements in successful implementation. This was an example of feasible application of the global framework for implementation of a mass vaccination campaign during COVID-19 through application of a simple decision-making logical framework.


Subject(s)
COVID-19 , Measles , Rubella , COVID-19/epidemiology , COVID-19/prevention & control , Child , Disease Outbreaks/prevention & control , Humans , Immunization , Measles/epidemiology , Measles/prevention & control , Nepal/epidemiology , Rubella/prevention & control
6.
BMJ Glob Health ; 6(12)2021 12.
Article in English | MEDLINE | ID: covidwho-1591304

ABSTRACT

INTRODUCTION: Despite gains in global coverage of childhood vaccines, many children remain undervaccinated. Although mass vaccination campaigns are commonly conducted to reach these children their effectiveness is unclear. We evaluated the effectiveness of a mass vaccination campaign in reaching zero-dose children. METHODS: We conducted a prospective study in 10 health centre catchment areas in Southern province, Zambia in November 2020. About 2 months before a national mass measles and rubella vaccination campaign conducted by the Ministry of Health, we used aerial satellite maps to identify built structures. These structures were visited and diphtheria-tetanus-pertussis (DTP) and measles zero-dose children were identified (children who had not received any DTP or measles-containing vaccines, respectively). After the campaign, households where measles zero-dose children were previously identified were targeted for mop-up vaccination and to assess if these children were vaccinated during the campaign. A Bayesian geospatial model was used to identify factors associated with zero-dose status and measles zero-dose children being reached during the campaign. We also produced fine-scale zero-dose prevalence maps and identified optimal locations for additional vaccination sites. RESULTS: Before the vaccination campaign, 17.3% of children under 9 months were DTP zero-dose and 4.3% of children 9-60 months were measles zero-dose. Of the 461 measles zero-dose children identified before the vaccination campaign, 338 (73.3%) were vaccinated during the campaign and 118 (25.6%) were reached by a targeted mop-up activity. The presence of other children in the household, younger age, greater travel time to health facilities and living between health facility catchment areas were associated with zero-dose status. Mapping zero-dose prevalence revealed substantial heterogeneity within and between catchment areas. Several potential locations were identified for additional vaccination sites. CONCLUSION: Fine-scale variation in zero-dose prevalence and the impact of accessibility to healthcare facilities on vaccination coverage were identified. Geospatial modelling can aid targeted vaccination activities.


Subject(s)
Measles , Rubella , Bayes Theorem , Child , Humans , Immunization Programs , Measles/epidemiology , Measles/prevention & control , Prospective Studies , Rubella/prevention & control , Vaccination , Zambia/epidemiology
7.
Expert Rev Vaccines ; 20(7): 811-826, 2021 07.
Article in English | MEDLINE | ID: covidwho-1258699

ABSTRACT

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.


Subject(s)
Measles-Mumps-Rubella Vaccine/administration & dosage , Measles/prevention & control , Mumps/prevention & control , Rubella/prevention & control , Vaccination Coverage/methods , Vaccination/methods , Disease Outbreaks/prevention & control , Humans , Measles/epidemiology , Measles/psychology , Mumps/epidemiology , Mumps/psychology , Rubella/epidemiology , Rubella/psychology , Vaccination/psychology , Vaccination Refusal/psychology
8.
J Prim Care Community Health ; 12: 21501327211005902, 2021.
Article in English | MEDLINE | ID: covidwho-1169941

ABSTRACT

OBJECTIVES: The purpose of this cohort study was to evaluate measles, mumps, rubella (MMR), and varicella immunity among a population of adult employees receiving primary care in an employer-sponsored health center. METHODS: Participants were eligible for MMR and varicella immunity screening if they were an employee receiving primary care in an employer-sponsored health center between January 1, 2019 and November 1, 2020 who could not provide proof of immunization and 1) had it recommended by their provider, 2) specifically requested immunity testing (often because they had heard of measles outbreaks in their country of origin), or 3) were seen for an immigration physical for their Green Card application. RESULTS: Overall, 3494 patients were screened for their MMR immunity. Of these, 3057 were also screened for varicella immunity. Among these patients, 13.9% lacked measles immunity, 0.83% lacked immunity to all 3 components of MMR, and 13.2% lacked varicella immunity. Among the 262 patients who presented specifically for immunity screening, the rates of lacking immunity were higher for all conditions: 22.7% lacked measles immunity and 9.2% lacked varicella immunity. CONCLUSION: Given declines in immunizations during the COVID-19 pandemic, there is reason to be concerned that measles and varicella-associated morbidity and mortality may rise. Employers, especially those with large foreign-born populations or who require international travel may want to educate their populations about common contagious illnesses and offer immunity validation or vaccinations at no or low cost.


Subject(s)
COVID-19 , Chickenpox , Measles , Mumps , Pandemics , Rubella , Vaccination Coverage , Adult , Antibodies, Viral , California , Chickenpox/immunology , Chickenpox/prevention & control , Cohort Studies , Disease Outbreaks , Female , Humans , Male , Mass Screening , Measles/immunology , Measles/prevention & control , Mumps/immunology , Mumps/prevention & control , Occupational Health Services , Primary Health Care , Rubella/immunology , Rubella/prevention & control , SARS-CoV-2 , Vaccination
11.
Int J Environ Res Public Health ; 18(1)2020 12 22.
Article in English | MEDLINE | ID: covidwho-1011508

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted essential health services. Simultaneously, it has created opportunities for citizens to raise awareness of personal hygiene, mask wearing, and other preventive measures. This brief report aims to clarify the epidemiological trends of measles and rubella in Japan and to explore future challenges for controlling these diseases during and after the COVID-19 pandemic. Although Japan eliminated measles in 2015, the number of measles patients has gradually increased since then, and reached 744 in 2019. In the 2010s, Japan experienced two large rubella epidemics, and the majority of the patients were reported in Tokyo and other metropolitan areas. While the transmission of measles and rubella seems to be suppressed during the COVID-19 pandemic, closing the gap in routine childhood vaccination will be challenging in any country. Moreover, supplementary immunization campaigns for adults have also been disrupted, and they must be invigorated. While the pandemic has a devastating effect on a global scale, it should be utilized as a good opportunity to regain faith in vaccines, implement an evidence-based vaccination policy, and strengthen international cooperation.


Subject(s)
COVID-19 , Immunization Programs , Measles , Pandemics , Rubella , Adult , Child , Humans , Japan/epidemiology , Measles/epidemiology , Measles/prevention & control , Rubella/epidemiology , Rubella/prevention & control , Vaccination
12.
Vaccine ; 38(51): 8185-8193, 2020 12 03.
Article in English | MEDLINE | ID: covidwho-997580

ABSTRACT

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.


Subject(s)
Immunity, Humoral , Measles-Mumps-Rubella Vaccine/immunology , Rubella/immunology , Adolescent , Adult , Antibodies, Neutralizing/immunology , B-Lymphocytes/immunology , Female , Humans , Immunoglobulin G/blood , Male , Measles-Mumps-Rubella Vaccine/pharmacology , Rubella/prevention & control , Time Factors , Vaccination , Young Adult
13.
Vaccine ; 38(50): 7897-7904, 2020 11 25.
Article in English | MEDLINE | ID: covidwho-912658

ABSTRACT

INTRODUCTION: Rubella virus (RV) was eliminated in the United States in 2004, although a small portion of the population fails to develop long-term immunity against RV even after two doses of the measles-mumps-rubella (MMR) vaccine. We hypothesized that inherent biological differences in cytokine and chemokine signaling likely govern an individual's response to a third dose of the vaccine. METHODS: Healthy young women (n = 97) were selected as study participants if they had either low or high extremes of RV-specific antibody titer after two previous doses of MMR vaccine. We measured cytokine and chemokine secretion from RV-stimulated PBMCs before and 28 days after they received a third dose of MMR vaccine and assessed correlations with humoral immune response outcomes. RESULTS: High and low antibody vaccine responders exhibited a strong pro-inflammatory cellular response, with an underlying Th1-associated signature (IL-2, IFN-γ, MIP-1ß, IP-10) and suppressed production of most Th2-associated cytokines (IL-4, IL-10, IL-13). IL-10 and IL-4 exhibited significant negative associations with neutralizing antibody titers and memory B cell ELISpot responses among low vaccine responders. CONCLUSION: IL-4 and IL-10 signaling pathways may be potential targets for understanding and improving the immune response to rubella vaccination or for designing new vaccines that induce more durable immunity.


Subject(s)
Immunity, Cellular , Immunity, Humoral , Measles-Mumps-Rubella Vaccine/administration & dosage , Measles-Mumps-Rubella Vaccine/immunology , Rubella/immunology , Adult , Chemokines/immunology , Chemokines/metabolism , Cytokines/immunology , Cytokines/metabolism , Female , Humans , Immunization Schedule , Leukocytes, Mononuclear/immunology , Leukocytes, Mononuclear/metabolism , Middle Aged , Rubella/prevention & control , Young Adult
14.
PLoS Comput Biol ; 16(10): e1008292, 2020 10.
Article in English | MEDLINE | ID: covidwho-874143

ABSTRACT

The lack of effective vaccines for many endemic diseases often forces policymakers to rely on non-immunizing control measures, such as vector control, to reduce the massive burden of these diseases. Controls can have well-known counterintuitive effects on endemic infections, including the honeymoon effect, in which partially effective controls cause not only a greater initial reduction in infection than expected, but also large outbreaks during control resulting from accumulation of susceptibles. Unfortunately, many control measures cannot be maintained indefinitely, and the results of cessation are poorly understood. Here, we examine the results of stopped or failed non-immunizing control measures in endemic settings. By using a mathematical model to compare the cumulative number of cases expected with and without control, we show that deployment of control can lead to a larger total number of infections, counting from the time that control started, than without any control-the divorce effect. This result is directly related to the population-level loss of immunity resulting from non-immunizing controls and is seen in a variety of models when non-immunizing controls are used against an infection that confers immunity. Finally, we examine three control plans for minimizing the magnitude of the divorce effect in seasonal infections and show that they are incapable of eliminating the divorce effect. While we do not suggest stopping control programs that rely on non-immunizing controls, our results strongly argue that the accumulation of susceptibility should be considered before deploying such controls against endemic infections when indefinite use of the control is unlikely. We highlight that our results are particularly germane to endemic mosquito-borne infections, such as dengue virus, both for routine management involving vector control and for field trials of novel control approaches, and in the context of non-pharmaceutical interventions aimed at COVID-19.


Subject(s)
Communicable Disease Control/methods , Endemic Diseases/prevention & control , Immunization Programs , Animals , Basic Reproduction Number , COVID-19 , COVID-19 Vaccines , Coronavirus Infections/prevention & control , Culicidae , Dengue Vaccines/therapeutic use , Health Policy , Humans , Insect Vectors , Models, Theoretical , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Public Health , Rubella/prevention & control , Rubella Vaccine/therapeutic use , Seasons , Severe Dengue/prevention & control , Viral Vaccines/therapeutic use
15.
Euro Surveill ; 25(19)2020 05.
Article in English | MEDLINE | ID: covidwho-259289

ABSTRACT

Using electronic health records, we assessed the early impact of coronavirus disease (COVID-19) on routine childhood vaccination in England by 26 April 2020. Measles-mumps-rubella vaccination counts fell from February 2020, and in the 3 weeks after introduction of physical distancing measures were 19.8% lower (95% confidence interval: -20.7 to -18.9) than the same period in 2019, before improving in mid-April. A gradual decline in hexavalent vaccination counts throughout 2020 was not accentuated by physical distancing.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus , Disease Outbreaks/prevention & control , Measles-Mumps-Rubella Vaccine , Pandemics , Pneumonia, Viral/epidemiology , Vaccination/statistics & numerical data , Betacoronavirus , COVID-19 , Child, Preschool , England , Health Services Accessibility , Humans , Infant , Measles/prevention & control , Mumps/prevention & control , Quarantine , Rubella/prevention & control , SARS-CoV-2
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