Neutralizing antibody titers against D8 genotype and persistence of measles humoral and cell-mediated immunity eight years after the first dose of measles, mumps, and rubella vaccine in Brazilian children.

OBJECTIVE: Assess the level of measles vaccine-induced neutralizing antibodies against the D8 genotype and the persistence of humoral and cell-mediated immunity in children who received their first dose of the measles, mumps, and rubella vaccine eight years previously. METHODS: Measles-specific IgG and neutralizing antibodies were determined in serum using ELISA and plaque reduction neutralization test, respectively. Cellular response was evaluated from peripheral blood mononuclear cells (PBMC). IFN-γ-secreting cells, memory B and T cells, and immunological mediators were assayed by ELISpot, flow cytometry, and multiplex liquid microarray assay, respectively. RESULTS: Antibody concentrations declined over time; however, the vaccine-induced neutralizing antibodies' effect against D8 and vaccinal genotypes persisted. PBMC stimulated with the vaccine virus exhibited specific IFN- γ-measles-secreting responses in most participants. Participants with high levels of neutralizing antibodies showed a higher proportion of activated B cells compared to participants with low levels of neutralizing antibodies, while proportions of memory CD4+ and CD8+ T cells were similar between these groups. PBMC supernatant cytokine levels showed a significant difference between stimulated and non-stimulated conditions for IL-2, TNF-α, IL-10, and CXCL10. CONCLUSION: Despite the decline in antibody concentrations over time, the participants still demonstrated neutralizing capacity against the measles D8 genotype five to eight years after the second dose of the measles, mumps, and rubella vaccine. Additionally, most of the enrolled children exhibited cell-mediated immunity responses to measles virus stimulation.

Sarampión en Latinoamérica: un análisis de tendencia y red de colaboración científica en los últimos 20 años / Measles in Latin America: a trend analysis and scientific collaboration network in the last 20 years

Con el objetivo de analizar la contribución científica de las publicaciones sobre sarampión y representar gráficamente las redes de colaboración entre países durante los últimos 20 años, se realizó un estudio bibliométrico entre 1999 y 2018 de revistas indexadas en Scopus. Se analizaron datos de producción anual y se representó gráficamente un análisis de co-ocurrencia de producción y colaboración entre países utilizando VOSviewer. Se registraron 587 documentos entre los 1999 y 2018, con tendencia estacionaria; el promedio de publicaciones anual fue de 29 documentos (rango 13-44), siendo el 72,4 por ciento artículos originales. Los países Brasil (53,3 por ciento ) y México (17,5 por ciento ) tuvieron mayor productividad y colaboración, principalmente con Estados Unidos y Reino Unido. La investigación sobre sarampión en Latinoamérica presenta una tendencia estacionaria. Brasil y México fueron los países con más publicaciones y tienen mayores redes de colaboración científica con Estados Unidos y Reino Unido(AU)

With the objective of analyzing the scientific contribution of measles publications and graphing the collaboration networks between countries during the last 20 years. A bibliometric study was conducted between 1999 and 2018 of journals indexed in Scopus. Annual production data were analyzed and a co-occurrence analysis of production and collaboration between countries using VOSviewer was plotted. 587 documents were registered between 1999 and 2018, with a steady trend, the average of annual publications was 29 documents (range 1-44), being 72.4 percent were original articles. The countries of Brazil (53.3 percent) and Mexico (17.5 percent) had greater productivity and collaboration mainly with the United States and the United Kingdom. Measles research in Latin America presents a stationary trend. Brazil and Mexico were the countries with more publications and have greater networks of scientific collaboration with the United States and the United Kingdom(AU)

["If there is a risk, I should have a choice:" Risk management and risk perception in Italian vaccine hesitancy movements]. / "Si hay un riesgo quiero poder elegir": gestión y percepción del riesgo en los movimientos de reticencia a la vacunación italianos.

In Italy, the passing of mandatory pediatric vaccinations in 2017 was a consequence of increasing vaccine hesitancy in the country, a phenomenon that has largely spread on social networks. This article examines risk management and risk perception regarding pediatric vaccinations through an analysis of online content shared by Italian vaccine hesitancy movements between December of 2019 and April of 2020. Results show that these movements carry out a reinterpretation of risk, scientific evidence, and parental responsibility, especially with regard to the alleged correlation between the measles vaccine and autism. The limitations of political decisions surrounding vaccines are due to the application of punitive measures such as administrative penalties and licensing bans for doctors who express "anti-vax" ideas, aspects which may increase distrust towards the political establishment and the medical profession.

En Italia, la aplicación de la obligatoriedad de las vacunas infantiles en 2017 ha sido una consecuencia de la consolidación de la reticencia a la vacunación, un fenómeno que se ha difundido en mayor medida a partir del despliegue de las redes sociales. Este artículo plantea la gestión y percepción del riesgo sobre las vacunaciones infantiles a través del análisis de los contenidos online compartidos por parte de los movimientos de reticencia italianos, realizado entre diciembre de 2019 y abril de 2020. Los resultados señalan que estos movimientos actúan una reinterpretación del riesgo, de la evidencia científica y de la responsabilidad parental sobre todo a través de una presupuesta correlación entre vacuna antisarampión y autismo. Las limitaciones de las decisiones políticas en tema de vacunas se deben a la aplicación de estrategias de carácter punitivo, como sanciones administrativas y exclusión del registro de médicos, que expresan ideas "no vax", factores que pueden aumentar la desconfianza en la clase política y la medicina.

"Si hay un riesgo, quiero poder elegir": gestión y percepción del riesgo en los movimientos de reticencia a la vacunación italianos / "If there is a risk, I should have a choice": Risk management and risk perception in Italian vaccine hesitancy movements

RESUMEN En Italia, la aplicación de la obligatoriedad de las vacunas infantiles en 2017 ha sido una consecuencia de la consolidación de la reticencia a la vacunación, un fenómeno que se ha difundido en mayor medida a partir del despliegue de las redes sociales. Este artículo plantea la gestión y percepción del riesgo sobre las vacunaciones infantiles a través del análisis de los contenidos online compartidos por parte de los movimientos de reticencia italianos, realizado entre diciembre de 2019 y abril de 2020. Los resultados señalan que estos movimientos actúan una reinterpretación del riesgo, de la evidencia científica y de la responsabilidad parental sobre todo a través de una presupuesta correlación entre vacuna antisarampión y autismo. Las limitaciones de las decisiones políticas en tema de vacunas se deben a la aplicación de estrategias de carácter punitivo, como sanciones administrativas y exclusión del registro de médicos, que expresan ideas "no vax", factores que pueden aumentar la desconfianza en la clase política y la medicina.

ABSTRACT In Italy, the passing of mandatory pediatric vaccinations in 2017 was a consequence of increasing vaccine hesitancy in the country, a phenomenon that has largely spread on social networks. This article examines risk management and risk perception regarding pediatric vaccinations through an analysis of online content shared by Italian vaccine hesitancy movements between December of 2019 and April of 2020. Results show that these movements carry out a reinterpretation of risk, scientific evidence, and parental responsibility, especially with regard to the alleged correlation between the measles vaccine and autism. The limitations of political decisions surrounding vaccines are due to the application of punitive measures such as administrative penalties and licensing bans for doctors who express "anti-vax" ideas, aspects which may increase distrust towards the political establishment and the medical profession.

Caracterización epidemiológica y clínica de pacientes pediátricos hospitalizados con sarampión

El sarampión en una enfermedad prevenible por vacuna cuya eficacia es de aproximadamente 95 %. La recomendación es vacunar al año de edad y entre 4 y 6 años. El resurgimiento ocurre en zonas con baja cobertura vacunal. Objetivo: Describir las características epidemiológicas y clínicas de pacientes pediátricos hospitalizados con sarampión. Métodos: Se realizó un estudio transversal, prospectivo y descriptivo incluyendo pacientes ingresados al Hospital de Niños "J.M. de los Ríos" (Caracas, Venezuela) en el primer cuatrimestre 2018 con evidencia clínica de sarampión. Se registraron datos epidemiológicos, manifestaciones clínicas y evolución. Resultados: Se incluyeron 46 pacientes. Los lactantes fueron los más afectados: mayores 41,3 % (n=19) y menores 30,4 % (n=14). El 56,5 % (n=26) procedía del municipio Libertador (Distrito Capital). El 94,7 % (n=18) de los pacientes mayores de un año no tenía vacuna y 65,2 % (n=30) desconocía la fuente de infección. El 93,5 % (n=43) recibió un promedio de seis meses de lactancia materna; 69,6 % (n=32) tenía nutrición normal. El 100 % tuvo evolución clínica dermatológica y respiratoria típica. La diarrea ocurrió en 47,8 % (n=22) y las manchas de Koplik en 23,9 % (n=11). Las complicaciones se presentaron en 87 % (n=40); la más frecuente fue neumonía 80,4 % (n=37). No hubo casos de encefalitis. Cuatro pacientes (8,7 %) requirieron cuidados intensivos, tres de los cuales fallecieron (6,5 %). El diagnóstico se realizó de forma clínica-serológica en 24 % (n=11) Conclusiones: El 94,7 % de pacientes mayores de un año no tenía vacuna. El 72 % fueron lactantes. El 69,6 % tenía estado nutricional normal. El 80,4 % presentó neumonía. La mortalidad ocurrió en el 6,5 %.

Measles in a disease preventable by vaccine whose efficacy is approximately 95 %. The recommendation is to vaccinate at one year of age and between 4 and 6 years. The resurgence occurs in areas with low vaccination coverage. Objective: To describe the epidemiological and clinical characteristics of pediatric patients hospitalized with measles. Methods: A cross-sectional, prospective and descriptive study was performed, including patients admitted to Children's Hospital "J.M. de los Ríos" (Caracas, Venezuela) in the first four-month period of 2018 with clinical evidence of measles. Epidemiological data, clinical manifestations and evolution were recorded. Results: 46 patients were included. Infants were the most affected: greater 41.3 % (n = 19) and lower 30.4 % (n = 14). 56.5 % (n = 26) came from the Libertador municipality (Capital District). 94.7 % (n = 18) of patients older than one year did not have a vaccine and 65.2 % (n = 30) did not know the source of infection. 93.5 % (n = 43) received an average of six months of breastfeeding; 69.6 % (n = 32) had normal nutrition. 100 % had typical dermatological and respiratory clinical evolution. Diarrhea occurred in 47.8 % (n = 22) and Koplik's spots in 23.9 % (n = 11). Complications occurred in 87 % (n = 40); the most frequent was 80.4 % pneumonia (n = 37). There were no cases of encephalitis. Four patients (8.7 %) required intensive care, three of whom died (6.5 %). The diagnosis was made clinically-serologically in 24 % (n = 11) Conclusions: 94.7 % of patients older than a year I did not have a vaccine. 72 % were infants. 69.6 % had normal nutritional status. 80.4 % had pneumonia. Mortality occurred in 6.5 %.

A correlation of measles specific antibodies and the number of plasmacytoid dendritic cells is observed after measles vaccination in 9 month old infants.

Measles virus (MeV) represents one of the main causes of death among young children, particularly in developing countries. Upon infection, MeV controls both interferon induction (IFN) and the interferon signaling pathway which results in a severe host immunosuppression that can persists for up to 6 mo after infection. Despite the global biology of MeV infection is well studied, the role of the plasmacytoid dendritic cells (pDCs) during the host innate immune response after measles vaccination remains largely uncharacterized. Here we investigated the role of pDCs, the major producers of interferon in response to viral infections, in the development of adaptive immune response against MeV vaccine. We report that there is a strong correlation between pDCs population and the humoral immune response to Edmonston Zagreb (EZ) measles vaccination in 9-month-old mexican infants. Five infants were further evaluated after vaccination, showing a clear increase in pDCs at baseline, one week and 3 months after immunization. Three months postvaccination they showed increase in memory T-cells and pDCs populations, high induction of adaptive immunity and also observed a correlation between pDCs number and the humoral immune response. These findings suggest that the development and magnitude of the adaptive immune response following measles immunization is directly dependent on the number of pDCs of the innate immune response.

Factors affecting compliance with the measles vaccination schedule in a Brazilian city / Fatores que afetam a adesão ao calendário de vacinação contra o sarampo numa cidade brasileira

CONTEXT AND OBJECTIVE: The success of vaccination campaigns depends on the degree of adherence to immunization initiatives and schedules. Risk factors associated with children's failure to receive the measles vaccine at the correct age were studied in the city of São Paulo, Brazil. DESIGN AND SETTING: Case-control and exploratory study, in the metropolitan area of São Paulo. METHODS: The caregivers of 122 children were interviewed regarding their perceptions and understanding about the measles vaccination and the disease. RESULTS: The results showed that age, region of residence, marital status and education level were unrelated to taking measles vaccines adequately. Most individuals remembered being informed about the last annual vaccination campaign by television, but no communication channel was significantly associated with vaccination status. The answers to questions about knowledge of the disease or the vaccine, when analyzed alone, were not associated with taking measles vaccinations at the time indicated by health agencies. The results showed that, when parents felt sorry for their children who were going to receive shots, they delayed the vaccination. Most of the children did not take the measles vaccination on the exactly recommended date, but delayed or anticipated the shots. CONCLUSION: It is clear that there is no compliance with the government's recommended measles vaccination schedule (i.e. first dose at nine and second at 15 months of age, as recommended in 1999 and 2000). Feeling sorry for the children receiving shots can delay vaccination taking.

CONTEXTO E OBJETIVO: O sucesso das campanhas de vacinação depende da adesão às iniciativas e ao calendário de imunização. Fatores de risco associados com não tomar a vacina contra o sarampo na idade recomendada foram estudados na cidade de São Paulo. TIPO DE ESTUDO E LOCAL: Estudo caso-controle e exploratório, realizado na área metropolitana de São Paulo. MÉTODO: Cuidadores de 122 crianças foram entrevistados sobre sua percepção e compreensão sobre a vacina contra o sarampo e sobre a doença. RESULTADOS: Os resultados mostraram que idade, região de residência, status marital ou nível educacional não se relacionaram com a tomada adequada das vacinas contra o sarampo. A maioria dos indivíduos lembrou-se de ter sido informada sobre a última campanha nacional de vacinação na televisão, mas nenhum canal de comunicação se associou significativamente com o status vacinal. As respostas às questões sobre conhecimentos a respeito da doença e da vacina, quando analisadas em separado, não se associaram à tomada das vacinas nas datas indicadas pelas instituições de saúde. Os resultados mostraram que quando os pais sentiam dó ao verem os filhos tomando as injeções, eles atrasavam a vacinação por pelo menos 20 dias. A maioria das crianças não toma a vacina contra o sarampo exatamente no dia recomendado, mas atrasa ou antecipa as injeções. CONCLUSÃO: Esta claro que não há aderência ao calendário governamental recomendado de vacinação contra o sarampo (i.e. primeira dose aos 9 e segunda dose aos 15 meses de idade, como recomendado em 1999 e 2000). Sentir pena de ver a criança recebendo uma injeção pode atrasar a tomada da vacina.

Reacciones tempranas en escolares vacunados con antisarampionosa en aerosol / Early reactions in vaccinated scholastics, with anti-measles by aerosol

A raíz de la epidemia de sarampión que afectó al país, se tomó la decisión de ampliar la cobertura de vacunación a grupos etáreos escolares, los más afectados en dicha epidemia. La vacunación con técnica en aerosol, permitió optimizar la vacuna, el tiempo de aplicación y los recursos humanos. En Tabasco se vacunaron 208 045 niños; y se realizó una encuesta en la jurisdicción de Jalpa de Méndez a 6 738 niños vacunados, para conocer las reacciones postvacunales una semana después de haber inhalado la vacuna. En los resultados encontrados, en 1844 niños hubo diversos signos y síntomas, que no representan un riesgo para la aplicación de la técnica en aerosol.

In view of the measles epidemic that affected the country, a resolution was taken to enlarge the extent of vaccination range in school age groups, which were the most affected in such epidemic. The vaccination with the aerosol method, allowed the optimization of the vaccine, the aplication time, and the human resources. There were 208 045 scholastics vaccinated in Tabasco, a survey was per­formed in the jurisdiction of Jalpa de Mendez with 6 738 vaccinated children in orden to find out the postvaccina­tion reactions a week after the vaccine was inhalated. It was found in 1 844 children, that there were different signs and symptoms that did not represent a risk for the application of the aerosol method.