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

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

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

Chronic Hydrocephalus Following Mumps Encephalitis: Neuropathological Correlates and Review.

Hydrocephalus is a rare and devastating complication of mumps encephalitis. The histopathological correlates of mumps infection in central nervous system tissues are not well-characterized. We present the case of a 54-year-old patient who suffered long-term neuropsychiatric sequelae and hydrocephalus as a consequence of a childhood mumps infection. Brain autopsy revealed significant dilation of the lateral and third ventricles. Aqueductal stenosis was not observed on premortem imaging or on gross examination. Histology revealed loss of ependymal epithelium throughout the aqueduct and ventricular system. Macrophage conglomerates were identified within the cerebral aqueduct at the level of the pons in addition to subjacent periaqueductal gliosis and scattered Rosenthal fibers. Together, these findings support primary ependymal injury as a pathophysiological mechanism in the development of chronic hydrocephalus following mumps infection. Finally, we review the existing literature and discuss potential mechanisms of disease.

[The knowledge about measles, mumps and rubella among parents in the county of Roskilde]. / Viden om maeslinger, fåresyge og røde hunde hos foraeldre i Roskilde Amt.

INTRODUCTION: The aim was to determine how much knowledge parents have of MMR diseases and the side effects of the vaccine, and what influence this has on acceptance of the vaccination programme. MATERIALS AND METHODS: Sampling three districts of Roskilde County was done by the distribution of 1867 questionnaires to the parents of children aged 0-15 years in 22 institutions and schools (1 January to 28 February 2000). RESULTS: Of the 878 (47%) replies, 825 (94%) had followed the vaccination programme. There was no difference between those who had followed the programme and those who had not with respect to reports of complications to the diseases, but the latter group reported more complications to the vaccine. In the vaccinated group, there were significantly more who stated that the doctor's opinion of the vaccine was positive, and acceptance of the remaining vaccination programme was also greater in this group. More children in the non-vaccinated group were involved in the decision about vaccination. DISCUSSION: Though knowledge of the diseases does not seem to influence the decision about vaccination, the responses raise the question of how information is to reach the general public. An open debate is needed on vaccination complications, as it is these or uncertainty about them that seem to influence the parents' choice. For 70% of parents, the doctor is their source of information, and it is therefore important for acceptance of the MMR vaccine that doctors have a positive view and are able to communicate this view to the parents.

[Diagnosis and approaches to therapy of emotional disorders in patients with infectious diseases]. / Diagnostika i podkhody k terapii émotsional'nykh narushenii u bol'nykh s infektsionnoi patologiei.

AIM: To examine psychological and emotional disorders in patients with infectious diseases, to specify indications for their pharmacological correction. MATERIAL AND METHODS: Clinicopsychological, clinicofunctional and laboratory tests were made to examine 30 patients with infectious mononucleosis (19 females and 11 males) and 30 patients with serous meningitis (16 females and 14 males) aged 16-35 admitted to hospital on the disease day 2-14. RESULTS: Shmishek's questionnaire revealed various types of personality accentuations with dominating hyperthymic (30%) and cyclothymic (20%). According to the data of the clinical scale SCL-90, the greatest number of cases with values over normal was in patients with serous meningitis. Beck's questionnaire revealed clinical depression in 12 patients (40%) with acute serous meningitis, subdepression in 14(46.7%) patients, severe depression in 6(20%) patients with infectious mononucleosis. In convalescence, emotional disorders persisted in 4 patients with serous meningitis. CONCLUSION: Affective disorders in the above patients require consultation of the psychiatrist to decide on psychopharmacotherapy inclusion in combined treatment of infectious diseases to prevent lingering course.