Economic evaluation of second measles containing vaccine (MCV) dose: a systematic review of available evidence.

INTRODUCTION: The global measles incidence has decreased from 145 to 49 cases per 1 million population from 2000 to 2018, but evaluating the economic benefits of a second measles-containing vaccine (MCV2) is crucial. This study reviewed the evidence and quality of economic evaluation studies to guide MCV2 introduction. METHODS: The systematic review of model-based economic evaluation studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search yielded 2231 articles, with 876 duplicates removed and 1355 articles screened, with nine studies included for final analysis. RESULTS: Six studies reported a positive benefit-cost ratio with one resulting in net savings of $11.6 billion, and two studies estimated a 2-dose MMR vaccination program would save $119.24 to prevent one measles case, and a second dose could prevent 9,200 cases at 18 months, saving $548.19 per case. The most sensitive variables were the discount rate and vaccination administration cost. CONCLUSIONS: Two MCV doses or a second opportunity with an additional dose of MCV were highly cost-beneficial and resulted in substantial cost savings compared to a single routine vaccine. But further research using high-quality model-based health economic evaluation studies of MCV2 should be made available to decision-makers. PROSPERO REGISTRATION: CRD42020200669.

A real-world study on the changing characteristics of measles antibodies in premature infants in China.

The waning of maternal antibodies may cause infants to lose protection against measles before receiving measles-containing vaccine (MCV). The aim of this study is to investigate the changing characteristics and influencing factors of measles antibodies in preterm infants (PT), and to provide scientific basis for optimizing MCV vaccination strategy of the target population. Blood samples were collected from PT and full-term infants (FT) at the chronological age (CA) of 3, 6, and 12 months. Measles antibodies were quantitatively detected by enzyme-linked immunosorbent assay. Demographic and vaccination information were both collected. Kruskal-Wallis rank sum test was used to compare the measles antibodies among different gestation age (GA) groups, and multiple linear regression was performed to identify the correlative factors for the antibodies. Measles antibodies of PT decreased significantly with age increasing before MCV vaccination. The positive rates of antibodies of PT were 10.80% and 3.30% at the age of 3 and 6 months, respectively (p < .001). At 12 months, the measles antibodies and seropositive rate in the infants who received MCV vaccination increased sharply (p < .001). Regression analyzes showed that the younger the GA or the older the age, the lower the antibodies at 3 months(p < .001，p = .018); while the lower measles antibody levels at 3 months and older age predicted the lower antibodies at 6 months(p < .001, p = .029). PT were susceptible to measles due to the low level of maternally derived antibodies before MCV vaccination. More efforts should be considered to protect the vulnerable population during their early postnatal life.

Descriptive Analysis of Measles Outbreak in Liberia, 2022.

Background: Liberia reported a large outbreak of measles involving all the counties in 2022. We conducted a descriptive analysis of the measles surveillance data to understand the trend of the outbreak and guide further policy action to prevent future outbreaks. Methods: We analyzed the measles surveillance data from Epi week 1 to 51, 2022. All the laboratory-confirmed cases, clinically compatible and epidemiologically linked cases were included in the analysis, the variables of interest included the patient's age, sex, place of residence, measles classification, measles vaccination status, and outcome. We cleaned and analyzed the data using R version 4.2.0 and Arc GIS Pro. The demographic characteristics of the cases were presented, the progression of the cases was presented in Epicurve and the spatial distribution and the case fatality rate (CFR) of the case were presented at the district level using the Arc GIS Pro. Results: The median age of the cases was 4 years (interquartile range: 2-8 years). Children under five years of age constituted 60% of the cases (4836/8127), and females accounted for 52% (4204/8127) of the cases. Only 1% (84/8127) of the cases had documentary evidence of receiving at least one dose of measles-containing vaccine (MCV). Only 3 out of 92 health districts in the country did not report a case of measles during the period under review. The overall cases fatality rate was 1% however CFR of up to 10% were reported in some districts. Conclusion: The outbreak of measles involved almost all the districts of the country, exposing a possible nationwide suboptimal immunization coverage for MCV. The high CFR reported in some districts needs further investigation.

Predictors for Uptake of Vaccines Offered during the Second Year of Life: Second Dose of Measles-Containing Vaccine and Meningococcal Serogroup A-Containing Vaccine, Ghana, 2020.

BACKGROUND: Understanding the drivers of coverage for vaccines offered in the second year of life (2YL) is a critical focus area for Ghana's life course approach to vaccination. This study characterizes the predictors of vaccine receipt for 2YL vaccines-meningococcal serogroup A conjugate vaccine (MACV) and the second dose of measles-containing vaccine (MCV2)-in Ghana. METHODS: 1522 children aged 18-35 months were randomly sampled through household surveys in the Greater Accra Region (GAR), Northern Region (NR), and Volta Region (VR). The association between predictors and vaccination status was modeled using logistic regression with backwards elimination procedures. Predictors included child, caregiver, and household characteristics. RESULTS: Coverage was high for infant vaccines (>85%) but lower for 2YL vaccines (ranging from 60.2% for MACV in GAR to 82.8% for MCV2 in VR). Predictors of vaccination status varied by region. Generally, older, first-born children, those living in rural settlements and those who received their recommended infant vaccines by their first birthday were the most likely to have received 2YL vaccines. Uptake was higher among those with older mothers and children whose caregivers were aware of the vaccination schedule. CONCLUSIONS: Improving infant immunization uptake through increased community awareness and targeted strategies, such as parental reminders about vaccination visits, may improve 2YL vaccination coverage.

Demographical, clinical, and complication differences between vaccinated and unvaccinated hospitalized children with measles in mogadishu somalia: a hospital-based retrospective cohort study.

Measles is endemic in Somalia; recurrent outbreaks are reported annually. Under-five children are the most affected due to low immunization coverage, vitamin A deficiency, and malnutrition. The study aims to evaluate the demographical, clinical, and complication variations between vaccinated and unvaccinated hospitalized children with measles in the study hospital. Method: A hospital-based retrospective cohort study was implemented between 10 October and 10 November 2022 by reviewing case record files following a well-structured checklist of admitted clinical features, demographic characteristics, history of measles immunization, and measles complication status. Descriptive statistics were used by presenting frequency and percentage for categorical and the mean score for continuous variables. χ2 and Fisher's exact test at P =0.05 were used to identify the proportions differences between vaccinated and unvaccinated cases. Result: A total of 93 hospitalized measles children participated in the study. Over half were boys, the mean age in months was 20.9 (SD±7.28), and over two-thirds of the mothers/caregivers did not have formal education. Almost 9.7% of hospitalized measles children had one dose of the measles-containing vaccine, while none had two doses. The vaccinated cases had fewer ill with fewer complications than the unvaccinated cases. Fever, cough, rash, and Koplik's spots were clinical features associated with measles immunization status. Conclusion: Around one in ten hospitalized children had one dose of the measles vaccine. Vaccinated cases had fewer illnesses with few complications than unvaccinated cases. The paper highly emphasizes providing booster doses, improving vaccine logistics and storage, and following immunization schedules. In addition, conducting further multicentral high sample-size studies is highly required to identify whether vaccine inadequacy was due to host-related or vaccine-related factors.

Measles second dose vaccine utilization and associated factors among children aged 24-35 months in Sub-Saharan Africa, a multi-level analysis from recent DHS surveys.

BACKGROUND: Although a safe and effective vaccine is available, measles remains an important cause of mortality and morbidity among young children in Sub-Saharan Africa (SSA). The WHO and UNICEF recommended measles-containing vaccine dose 2 (MCV2) in addition to measles-containing vaccine dose 1 (MCV1) through routine services strategies. Many factors could contribute to the routine dose of MCV2 coverage remaining far below targets in many countries of this region. This study aimed to assess the prevalence of MCV2 utilization among children aged 24-35 months and analyze factors associated with it by using recent nationally representative surveys of SSA countries. METHODS: Secondary data analysis was done based on recent Demographic and Health Surveys (DHS) data from eight Sub-Saharan African countries. In this region, only eight countries have a record of routine doses of measles-containing vaccine dose 2 in their DHS dataset. The multilevel binary logistic regression model was fitted to identify significantly associated factors. Variables were extracted from each of the eight country's KR files. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤ 0.05 in the multivariable model were used to declare significant factors associated with measles-containing vaccine dose 2 utilization. RESULT: The pooled prevalence of MCV2 utilization in SSA was 44.77% (95% CI: 27.10-62.43%). In the multilevel analysis, mothers aged 25-34 years [AOR = 1.15,95% CI (1.05-1.26), mothers aged 35 years and above [AOR = 1.26, 95% CI (1.14-1.41)], maternal secondary education and above [AOR = 1.27, 95% CI (1.13-1.43)], not big problem to access health facilities [AOR = 1.21, 95% CI (1.12-1.31)], four and above ANC visit [AOR = 2.75, 95% CI (2.35-3.24)], PNC visit [AOR = 1.13, 95% CI (1.04-1.23)], health facility delivery [AOR = 2.24, 95% CI (2.04-2.46)], were positively associated with MCV2 utilization. In contrast, multiple twin [AOR = 0.70, 95% CI (0.53-0.95)], rural residence [AOR = 0.69, 95% CI (0.57-0.82)] and high community poverty [AOR = 0.66, 95% CI (0.54-0.80)] were found to be negatively associated with MCV2 utilization. CONCLUSIONS AND RECOMMENDATIONS: Measles-containing vaccine doses 2 utilization in Sub-Saharan Africa was relatively low. Individual-level factors and community-level factors were significantly associated with low measles-containing vaccine dose 2 utilization. The MCV2 utilization could be improved through public health intervention by targeting rural residents, children of uneducated mothers, economically poor women, and other significant factors this study revealed.

Predictors of exceeding emergency under-five mortality thresholds using small-scale survey data from humanitarian settings (1999 - 2020): considerations for measles vaccination, malnutrition, and displacement status.

BACKGROUND: Quantifying the effect of measles containing vaccine (MCV) coverage and the prevalence of global acute malnutrition (GAM) on mortality levels in populations of displaced and crisis-affected resident children is important for intervention programming in humanitarian emergencies. METHODS: A total of 1597 surveys containing data on under-five death rate, population status (internally displaced, refugee, or crisis-affected resident), measles containing vaccine coverage, and global acute malnutrition were extracted from the Complex Emergency Database (CE-DAT). Under-five mortality rates were dichotomized to those exceeding critical levels or otherwise. A Bayesian multivariable mixed-effect logistic regression model was used to assess the association between an under-five death rate (U5DR) exceeding this threshold and population status (i.e., internally displaced, refugees or residents), GAM prevalence (proxy for food security), and MCV coverage. RESULTS: The prevalence of GAM, MCV and U5DR were higher in internally displaced children (IDC) with values of 14.6%, 69.9% and 2.07 deaths per 10 000 per day, respectively. Refugee populations had lower average under-five mortality rate (0.89 deaths per 10 000 per day), GAM of 12.0% and the highest measles containing vaccine coverage (80.0%). In crisis-affected residents the prevalence of GAM, MCV and average U5DR are 11.1%, 65.5% and 1.20 deaths per 10 000 per day respectively. In mixed-effect logistic model taking 2 deaths per 10 000 children less than five years old per as emergency threshold (Model III); MCV (AOR = 0.66, 95% Highest Density Interval (HDI): 0.57, 0.78), GAM (AOR = 1.79, 95% HDI: 1.52, 2.12) were associated with a reduction of the odds of U5DR exceeding critical level accounting for country-specific levels of variability. The odds of U5DR exceeding critical level (2/10000/day) in crisis-affected resident children and refugees were 0.36 (95% HDI: 0.22, 0.58) and 0.25(95% HDI: 0.11, 0.55) less than amongst IDP children adjusting for GAM and MCV. In considering country specific yearly median U5DR (model IV) the odds of U5DR exceeding twice the median U5DR were associated with MCV (AOR = 0.72, 95% HDI: 0.64, 0.82), GAM (AOR = 1.53, 95%HDI: 1.34, 1.76). The odds of U5DR exceeding critical level in crisis-affected resident children was 0.30(95% HDI: 0.20, 0.45) less than IDP children, after adjusting for MCV and GAM. We found no difference between the odds of U5DR exceeding twice the country level median U5DR in the refugee population compared to the IDPs. CONCLUSIONS: In this study vaccination coverage and global acute malnutrition (proxy for food security) were associated with U5DR exceeding critical level. The emergency threshold for IDPs and affected residents is significantly different and consistent across the different outcomes, whereas the result is inconsistent for IDPs and refugees. Continued improvement in measles vaccination coverage and reduction of malnutrition in humanitarian emergencies have the potential to minimize the deterioration of mortality level amongst children in emergency settings. To generate a robust understanding of the critical level of child mortality in displaced and affected resident populations, studies accounting for the impact of the duration of displacement, contextual factors in humanitarian settings, and the level of humanitarian assistance provided are needed.

Willingness to receive measles-containing vaccine among healthcare workers / 预防医学

Objective@#To investigate the willingness to receive measles-containing vaccine (MCV) and its influencing factors among healthcare workers in the Yangtze River Delta region, so as to provide the evidence for improving the measles-containing vaccination rate@*Methods@#Healthcare workers were sampled from 19 medical institutions in each of Shanghai Municipality, Jiangsu Province, Zhejiang Province and Anhui Province for questionnaire surveys using a multi-stage stratified convenience sampling methods from July 2020 to March 2021. Participants' gender, age, educational level, professional title, measles-containing vaccination, awareness of MCV and willingness to receive MCV were collected, and the factors affecting the willingness to receive MCV were identified among healthcare workers using a multivariable logistic regression model. @*Results@#Totally 1 403 questionnaires were allocated, and 1 394 valid questionnaires were recovered, with an effective recovery rate of 99.36%. The respondents included 327 men and 1 067 women, with a male to female ratio of 1∶3.26, and 64.35% (897) were at ages of 31 to 50 years. There were 1 005 respondents with a bachelor degree (72.09%), 765 with middle and senior professional titles (54.88%), 676 with a history of measles-containing vaccination (48.49%), 1 176 with willingness to receive MCV (84.36%) and 218 without willingness to receive MCV due to convenience of vaccination (30.73%) and cost (19.27%). Multivariable logistic regression analysis showed that region (Zhejiang, OR=1.613, 95%CI: 1.054-2.470; Anhui, OR=2.058, 95%CI: 1.259-3.363), and no history of measles (OR=2.219, 95%CI: 1.302-3.781) were factors improving the willingness to receive MCV among healthcare workers, and hospital level (secondary, OR=0.483, 95%CI: 0.306-0.763; tertiary, OR=0.251, 95%CI: 0.160-0.394), history of measles-containing vaccination (no, OR=0.262, 95%CI: 0.172-0.399; unknown, OR=0.386, 95%CI: 0.266-0.559), and unawareness of MCV knowledge (OR=0.208, 95%CI: 0.081-0.536) were factors inhibiting the willingness to receive MCV among healthcare workers.@*Conclusions@#The willingness to receive MCV correlates with region, history of measles, hospital level, history of measles-containing vaccination and awareness of MCV knowledge among healthcare workers in the Yangtze River Delta region.

Seroepidemiological investigation of measles among residents in Quzhou City / 预防医学

Objective@#To investigate the measles antibody level among residents in Quzhou City, Zhejiang Province in 2018, so as to provide the evidence for improving the measles control strategy.@*Methods@#The permanent residents aged 0 to 59 years were randomly sampled from 10 townships ( streets ) in Kecheng District and Changshan County of Quzhou City. Residents' demographics and vaccination of measles-containing vaccine ( MCV ) were collected, and serum anti- measles IgG antibody was detected using enzyme-linked immunosorbent assay ( ELISA ). The positive rate, protective rate and geometric mean concentration (GMC) of anti-measles antibody were estimated. @*Results@#A total of 606 residents were tested, with a male to female ratio of 0.83∶1. The subjects had a median age ( interquartile range ) of 17.36 ( 29.07 ) years, and 399 residents ( 65.84% ) had a vaccination history of MCV. The positive rate, protective rate and GMC of anti-measles IgG antibody were 94.88%, 48.68%, and 784.51 ( 95%CI: 731.14-841.40) mIU/mL, respectively. The positive rate of anti-measles IgG antibody was higher in men than in women ( 97.08% vs. 93.07%, χ2=4.968, P=0.026 ), and the protection rate was lower in men than in women ( 44.16% vs. 52.41%, χ2=4.089, P=0.043 ). The protective rate and GMC of anti-measles IgG antibody showed a“U”-shaped distribution with age, and a low protective rate was seen in residents aged 10 to 39 years ( 23.53% to 46.67% ), which the GMC of anti-measles IgG antibody that did not reach the protective level. A total of 233 residents at age of 15 years and below had with a history of two-dose MCV vaccination, and the positive rate ( χ2trend=7.260, P=0.007 ), protective rate ( χ2trend=12.756, P<0.001 ) and GMC ( rs=-0.289, P<0.001 ) of anti-measles IgG antibody presented a tendency towards a reduction with time <1 to 11 years after vaccination of the last dose of MCV.@*Conclusions@#A high positive rate of anti-measles antibody was detected among residents in Quzhou City in 2018; however, the protection rate of anti-measles antibody was low among residents at ages of 10 to 39 years. The coverage of MCV vaccination is recommended to be improved among residents at ages of 10 to 39 years in Quzhou City.

Serum anti-measles antibody levels among residents in Zhejiang Province / 预防医学

Objective@#To investigate the serum levels of anti-measles antibody among residents in Zhejiang Province in 2018, so as to provide insights into measles control.@*Methods@#Permanent residents aged 0 to 59 years were recruited using the stratified multistage random sampling method in Zhejiang Province in 2018, and subjects' demographic features, medical history of measles and history of immunization with measles-containing vaccine (MCV) were collected using a questionnaire survey. The serum level of anti-measles IgG antibody was detected, and the geometric mean concentration (GMC) of anti-measles IgG antibody was estimated. The seroprevalence, protective rate and GMC of anti-measles IgG antibody were compared among residents at different age groups and regions.@*Results@#A total of 4 189 residents were enrolled, including 1 939 males and 2 250 females, with a male to female ratio of 1∶1.16. There were 3 858 residents positive for anti-measles IgG antibody, with seroprevalence of 92.10%, and there were 2 072 residents with protective antibodies against measles, with a protective rate of 49.46%. The median GMC of anti-measles IgG antibody was 798.33 (interquartile range, 1 024.06) mIU/mL, and the protective rate of anti-measles IgG antibody appeared a tendency towards a decline with age ( χ2trend=18.067, P<0.001 ). There were significant differences in the seroprevalence ( χ2=45.090, P<0.001 ), protective rate ( χ2=57.432, P<0.001 ) and GMC of anti-measles IgG antibody (χ2=88.624, P<0.001 ) among residents at different regions, with the lowest seroprevalence of anti-measles IgG antibody in Ningbo City ( 85.19% ), the lowest antibody-protective rate (38.98%) and the lowest GMC [632.89 ( 909.04 ) mIU/mL] in Zhoushan City, the highest seroprevalence ( 95.16% ), antibody-protective rate (58.48%) and GMC [1 035.84 ( 1 301.77 ) mIU/mL] in Huzhou City.@*Conclusions@# The protective rate of anti-measles antibody was low and appeared a tendency towards a decline among residents in Zhejiang Province in 2018. There was a region-specific serum level of anti-measles antibody in Zhejiang Province in 2018.

Measles epidemiology and vaccination coverage in Oromia Region, Ethiopia: Evidence from surveillance, 2011-2018.

Despite a reported high coverage of measles-containing vaccine (MCV), low-income countries including, Ethiopia, have sustained high measles transmission with frequent outbreaks. We investigated the distribution of measles infection and vaccination in Oromia Regional State, Ethiopia. According to the World Health Organization (WHO) and the Ethiopian measles case classification guidelines, measles cases were classified as laboratory-confirmed, clinically compatible, and epidemiologically linked. We derived measles vaccination coverage estimates using reported measles vaccine efficacy and, the proportion of measles cases vaccinated with measles vaccine at least once from the surveillance data. We calculated measles effective reproduction number (Re) in the region. Almost twenty-five thousand measles cases were reported through the surveillance system, with more than 50% of the suspected and confirmed measles cases reported in 2015. Measles had sustained and high transmission rate with uneven distribution among the zones. Children between 1 and 4 years of age and MCV unvaccinated individuals were the most affected groups. In all the zones, the average surveillance-estimated MCV coverage among both infants and under-five children was significantly lower than the WHO recommended minimum 90% threshold herd-immunity. With this level of vaccination coverage, an infected case can transmit to more than four individuals. Nevertheless, the administrative coverage reports for the concurrent period were consistently above 90%. The estimated MCV coverage across the Oromia region was well below the recommended herd-immunity threshold. It partly explains the apparent mismatch of sustained measles transmission and outbreaks despite the very high administrative coverage estimates. Oromia regional health bureau, in collaboration with key stakeholders, should make a concerted effort to increase the effective-coverage of MCV to at least 90%. Additionally, multiple-dose MCV has to be scaled-up and accompanied with appropriate geographic and age targeting using evidence from surveillance data. Immediate programmatic action is needed to improve the quality of measles surveillance.

Effects of measles-containing vaccination in children with severe underlying neurologic disease.

BACKGROUND: Measles outbreaks pose significant risk for those unvaccinated. PATIENTS AND METHODS: Measles-containing vaccine was offered to unvaccinated children with severe neurologic diseases during a measles outbreak. Vaccination adverse events were reported by parents 30 days following vaccination. Long term effects were evaluated 12 months post vaccination. RESULTS: Twenty-seven children were vaccinated (36 doses given). Half of parents (51.8%) reported no adverse events following immunization. Adverse events included afebrile seizures (6/36), fever alone (5/36) and febrile seizures (5/36). Two children required hospitalization. Quadrivalent measles-containing vaccine combined with varicella was associated with febrile seizures (p = 0.04). No child needed adjustment of the anti-epileptic treatment or exhibited developmental regression. CONCLUSION: Ina series of children with prior severe neurologic disease, the safety-tolerability profile ofvaccines containing a measles vaccine component suggests that vaccination is justified. Main side effect was seizure aggravation in children with known epileptic disease.

Surveillance of adverse events following immunization with measles-containing vaccines in Shanghai， 2011-2018 / 上海预防医学

Objective:To analyze the safety of measles-containing vaccines （MCV） in Shanghai city. Methods:Adverse event following immunization cases related to measles attenuated live vaccine （MV）， measles and rubella combined attenuated live vaccine （MR） and measles， mumps and rubella combined attenuated live vaccine （MMR） vaccination in Shanghai during 2011—2018 were collected from the National AEFI Surveillance System for epidemiological analysis. Results:A total of 15 055 MVC-related AEFI cases were reported， for an incidence of 139.74 per 100 000 doses. Among all MVC-related AEFI cases， the male to female ratio was 1.17∶1， and 12 068 （111.70 per 100 000 doses） were common reactions， with 1 050 from MV（64.66 per 100 000）， 5 484 from MR（134.36 per 100 000）and 5 534 from MMR（108.60 per 100 000. Most of common reactions were fever （96.01 per 100 000）， but 2 939 （27.20 per 100 000） were rare reactions， with 408 from MV （25.12 per 100 000）， 1 983 from MR （48.59 per 100 000） and 548 from MMR （10.75 per 100 000）. Most of rare reactions were allergic rash （25.00 per 100 000）. Conclusion:MCV has a good safety profile but we should continue to strengthen MCV-related AEFI surveillance.

Cost analysis of supplemental immunization activities to deliver measles immunization to children in Anambra state, south-east Nigeria.

BACKGROUND: Measles immunization is critical for reducing the societal burden of the disease, especially among children. However, the costs of the measles supplemental immunization activities, which are the main vaccine deployment strategy, are usually high and financing such immunization activities is a serious challenge in Nigeria. In Nigeria, little or no information exists on the costs of measles supplemental immunization activity for planning and sustenance of immunization programmes. This study aimed to determine the cost per child immunized and cost structure of a follow-up supplemental immunization activity (SIA) for measles immunization to children. METHOD: Data on costs and outputs of SIA were collected from six Local Government area (LGAs) immunization offices in Anambra state, southeast Nigeria. The ingredient approach was used for costing, based on the providers' perspective. The sample results were extrapolated to state estimates using volume weighted mean method. The major indicator considered was cost per child immunized. Two-way sensitivity analysis was used to test the robustness of the results. RESULT: The cost per child immunized through SIA was $1.37 and the cost per child for operational cost only was $0.81. The total cost of the SIA for the sample was $345,069.35 and the operational cost was $204,969.46. The cost of personnel (43.99%) and vaccine (36.22%) contributed the highest percentage to the total cost of SIA. The cost of personnel and transportation took the first (74.6%) and second (7.10%) highest percentages of the operational cost for the sample. The estimated total and operational costs of measles SIA for the state were $1,279,127.84 and $759,795.52 respectively. CONCLUSION: The cost per child immunized with measles containing vaccine through SIA is relatively high in Nigeria. There is a need to review the activities with SIA, so as to ensure that resources are efficiently allocated and used for different activities of the programme.

Classification of measles cases from 2014 to 2018: Implications for progress towards measles elimination in China.

Measles incidence has decreased dramatically in China due to the implement of measles-containing vaccine (MCV). However, a measles epidemic caused resurgence recently, even among vaccinated individuals. To evaluate the effectiveness of current immunization programs and discuss initiatives for the next step in measles elimination in mainland China, the characteristics of 121,969 laboratory-confirmed measles cases reported in the measles surveillance system (MSS) during 2014-2018 were analyzed according to the vaccination status of the cases in this study. Children under 2 years of age without MCV vaccination (44,424, 36.42% of all cases) and adults over 20 years of age with an unknown vaccination history (37,564, 30.80% of all cases) accounted for the majority of measles cases from 2014 to 2018. 42,425 (34.78%) of the 77,384 cases with available vaccination information were categorized as programmatically preventable. 38,840 (91.55%) of the 42,425 cases were aged ≥8 months without the MCV vaccination history. 34,959 (28.66%) cases were categorized as programmatically non-preventable, of whom 22,611 (64.68%) were too young to receive their first MCV dose, 6857 (19.61%) received their first dose and were too young to receive their second dose, 5491 (15.71%) received at least two doses of MCV. 15,933 (13.06%) of the 121,969 cases had a history of MCV vaccination. Measles virus infection in cases with an MCV vaccination history mainly occurred within the first month after MCV vaccination, especially in those who received a one-dose measles vaccination. MCV vaccination could reduce the frequencies of clinical symptoms and complications of measles cases. Our study confirmed that the current measles immunization programs used in mainland China is effective in reducing the measles incidence in China. Unvaccinated infants/children aged 8-23 months and high risk susceptible adults over 20 years of age with unknown vaccination histories should be the focus groups of measles immunization activities in China in the future.

Age-appropriate vaccination coverage and its determinants for the polio containing vaccine 1-3 and measles-containing vaccine doses in Zhejiang province, China: A community-based cross-sectional study.

Background: This study aimed to evaluate the age-appropriate coverage and its associated risk factors for the primary vaccination of Polio containing vaccine (PCV) and measles-containing vaccine (MCV) through the secondary use of the 2018 Zhejiang provincial coverage survey among children aged 12-23 months. Methods: Data were collected through structured pre-tested Chinese version questionnaire by face-to-face interview among 770 mothers whose children aged 12-23 months. Age-appropriate vaccination coverage was measured using Chinese vaccination schedule recommendation. Bivariate and multivariate logistic regression models were adopted to identify determinants of the age-inappropriate vaccination. Results: The age-appropriate vaccination coverage of PCV1, PCV2, PCV3, and MCV was 88.8%, 80.8%, 73.6%, and 75.7%, respectively. The risk factors associated with the age-inappropriate vaccination of PCV 1-3 dose and MCV included child's gender, birthplace, living area, maternal education level, immigration status, monthly household income, participation of the pregnant women's seminar, antenatal care follow-up, knowledge on vaccination. Conclusion: The proportions of age-appropriate vaccination coverage were low compared with the up-to-date coverage. Modifiable factors were associated with age-inappropriate vaccinations. Vaccination interventions should consider identified modifiable factors to improve age-appropriate vaccination coverage.

Reported measles cases, measles-related deaths and measles vaccination coverage in Myanmar from 2014 to 2018.

BACKGROUND: There is a global resurgence of measles, consequent upon worldwide stagnating measles vaccination coverage. The study aim was to document trends and characteristics of reported cases of measles, measles-related deaths, and measles vaccination coverage (MCV1-first dose of measles-containing vaccine and MCV2-second dose of measles-containing vaccine) at national and sub-national level in Myanmar over a five year period between 2014 and 2018. METHODS: This was a descriptive study using routine data collected and submitted to the Expanded Programme on Immunization. RESULTS: Between 2014 and 2018, there were 2673 measles cases of which 2272 (85%) occurred in 2017 and 2018. Five adjacent regions in lower Myanmar were the most affected: in 2017 and 2018, these regions reported 1647 (73%) of the 2272 measles cases in the country. Overall, 73% of measles cases were laboratory confirmed, 21% were epidemiologically linked, and 6% were clinically compatible (clinical diagnosis only), with more laboratory confirmed cases in recent years. Annual measles-related deaths were either zero or one except in 2016 when there were 21 deaths, all occurring in one remote village. In the recent years, the most commonly affected age groups were 0-8 months, 9 months to 4 years, and ≥ 15 years. Among 1907 measles cases with known vaccination status, only 22% had been vaccinated and 70% of those had only received one dose of vaccine. Annual MCV1 coverage nationally varied from 83 to 93% while annual MCV2 coverage nationally varied from 78 to 87%, with no clear trends over the years. Between 2014 and 2018, a high proportion of the 330 townships had MCV coverage < 95%. Over 80% of measles cases were reported from townships that had MCV coverage < 95%. CONCLUSION: There have been a large number of measles cases in recent years associated with sub-optimal measles vaccine coverage. Myanmar has already conducted supplemental immunization activities in October and November, 2019. Myanmar also needs to improve routine immunization services and targeted responses to measles outbreaks.

Study on factors associated with seroprotection after measles vaccination in children of 6-14 years in Eastern China.

Measles cases have occurred in individuals with histories of vaccination against the disease in Zhejiang Province, China. The purposes of this study were to determine the seroprevalence of immunoglobulin G (IgG) measles antibodies in vaccinated individuals, to explore the waning kinetics of measles antibody among children after receipt of a measles-containing vaccine, and to define high-risk groups in the population. A seroprevalence survey of measles antibody was conducted with 1900 randomly selected and age-stratified participants aged 6-14 years in Zhejiang province. In our study, seronegative persons accounted for 7.17% of study participants. A case-control study of participants who had received at least one dose of measles-containing vaccine was conducted, with 123 cases of immune failure and 1593 controls with immune success. Multivariate logistic regression analysis showed that age, and number of doses were the influencing factors for measles immunization failure. The older a participant (odds ratio [OR] = 1.164), the more likely that measles vaccine immunity failed. In addition, immune failure was more likely to occur after one dose of MCV than two doses (OR = 0.008) or three doses and more (OR = 0.047). In a univariate logistic regression analysis, we found that immune failure was more likely to occur with MCV vaccination beginning at 8 months than at 9-11 months (OR = 0.562) and the subjects whose registration residence was in other cities in Zhejiang province (OR = 3.527). However, these differences in seropositivity were not significant in the multivariate logistic regression analysis. The exponential regression equation of the attenuation model after measles immunization was y = 884.64e-0.057x (R2 = 0.0521, p < 0.001), and results showed that the measles geometric mean concentration of IgG antibodies was approximately 884.64 mIU/ml after the last MCV vaccination and decreased with time since last vaccination.

Assessing measles vaccine failure in Tianjin, China.

Despite increasing global measles vaccination coverage, progress toward measles elimination has slowed in recent years. In China, children receive a measles-containing vaccine (MCV) at 8 months, 18-24 months, and some urban areas offer a third dose at age 4-6 years. However, substantial measles cases in Tianjin, China, occur among individuals who have received multiple MCV doses. This study describes the vaccination history of measles cases 8 months - 19 years old. Data came from measles cases in Tianjin's reportable disease surveillance system (2009-2013), and from a case control study (2011-2015). Twenty-nine percent of those in the surveillance dataset and 54.4% of those in the case series received at least one dose of MCV. The minimum and median time-to-diagnosis since vaccination revealed an increase in time since vaccination for incremental doses. Considerable measles cases in Tianjin occur in vaccinated children, and further research is needed to understand the reasons for vaccine failure.

Measles vaccination in an increasingly immunized and developed world.

Increased measles immunization has led to a significant decline in measles incidence and mortality. During 2016 it is estimated that fewer than 100,000 died from measles for the first time in recorded history. In highly immunized countries measles epidemiology has changed. Threats to national elimination goals and public health include aging cohorts of naïve people that exist from imperfect vaccination rates during the early years of immunization programs. This may be complemented by some loss of immunity in vaccinated populations. While childhood immunization must remain a focus for control efforts, due to higher mortality in the very young, these naïve adolescents and adults also accumulate as they age and add to the pool of susceptible people, perhaps beyond the view of those that are focused on childhood immunization. Here, features of measles epidemiology and control in highly immunized populations are reviewed, providing global data where necessary, to highlight why countries with high immunization coverage are still threatened by measles outbreaks and how changing dynamics may alter disease control.