Measles vaccine coverage and factors related to uncompleted vaccination among 18-month-old and 36-month-old children in Kyoto,Japan

Background  

Due to low vaccine coverage, Japan has not only experienced outbreaks of measles but has also been exporting it overseas. This study aims to survey measles vaccine coverage and the factors uncompleted vaccination among community-living children.     

The pre-vaccination regional epidemiological landscape of measles in Italy: contact patterns, effort needed for eradication, and comparison with other regions of Europe

Background  

Strong regional heterogeneity and generally sub-optimal rates of measles vaccination in Italy have, to date, hampered attainment of WHO targets for measles elimination, and have generated the need for the new Italian National Measles Elimination Plan. Crucial to success of the plan is the identification of intervention priorities based upon a clear picture of the regional epidemiology of measles derived from the use of data to estimate basic parameters. Previous estimates of measles force of infection for Italy have appeared anomalously low. It has been argued elsewhere that this results from Italian selective under-reporting by age of cases and that the true measles force of infection in Italy is probably similar to that of other European countries. A deeper examination of the evidence for this conjecture is undertaken in the present paper.     

Following in the footsteps of smallpox: can we achieve the global eradication of measles?

Background  

Although an effective measles vaccine has been available for almost 40 years, in 2000 there were about 30 million measles infections worldwide and 777,000 measles-related deaths. The history of smallpox suggests that achieving measles eradication depends on several factors; the biological characteristics of the organism; vaccine technology; surveillance and laboratory identification; effective delivery of vaccination programmes and international commitment to eradication.     

Measles outbreaks in displaced populations: a review of transmission, morbidity and mortality associated factors

Background  

Measles is a highly contagious infectious disease with a significant public health impact especially among displaced populations due to their characteristic mass population displacement, high population density in camps and low measles vaccination coverage among children. While the fatality rate in stable populations is generally around 2%, evidence shows that it is usually high among populations displaced by disasters. In recent years, refugees and internally displaced persons have been increasing. Our study aims to define the epidemiological characteristics and risk factors associated with measles outbreaks in displaced populations.     

Effectiveness assessment of vaccination policy against measles epidemic in Japan using an age–time two-dimensional mathematical model

Objectives  

In 2007, measles prevailed among the youth and young adult population in Japan, creating in a serious social problem. Among the developed countries, Japan has a relatively high incidence of measles. The objective of this study was to assess the effect of improvements in the vaccination policy against measles through simulations.     

Impact of measles national vaccination coverage on burden of measles across 29 Member States of the European Union and European Economic Area, 2006–2011

Background

Challenges in reaching good vaccination coverage against measles emerged in several European Union/European Economic Area Member States (EU/EEA MS) leading to progressive accumulation of susceptible individuals and outbreaks. The Burden of Communicable Diseases in Europe (BCoDE) project developed a methodology for measuring the burden of communicable diseases expressed in Disability-Adjusted Life Years (DALYs) in the EU/EEA MS. The aim of this study was to compare national vaccination coverage and burden of measles across EU/EEA MS.

Methods

Country-specific data on measles national vaccination coverage 2006–2011 from 29 EU/EEA MS (MCV1) were retrieved from Centralized Information System for Infectious Diseases (CISID). DALYs were calculated for each country separately using a disease progression model with a single input parameter (annual measles incidence, adjusted for under-estimation). A software application was used to compute estimated DALYs according to country-specific and year-specific population age-distributions (data retrieved from Eurostat). Log-linear mixed-effect regression modeling approach was used to investigate a linear relation between natural logarithm-transformed DALYs and coverage.

Results

The reported annual vaccination coverage ranged from 72.6% to 100%. The estimated national annual burden ranged from 0 to 30.6 DALYs/100,000. Adjusting for year, there was a significant negative relationship between coverage and burden. For a given country there was a decrease in log-transformed DALYs/100,000 of 0.025 (95% confidence interval: −0.047 to −0.003) for every percentage increase in vaccination coverage. The largest effect of calendar time on estimated burden of measles was observed for the year 2011, the smallest was for the year 2007.

Conclusions

This study shows that the degree of success of national measles vaccination programs, when measured by the coverage obtained, is significantly associated with overall impact of measles across EU/EEA MS. In EU/EEA MS each percentage point increase in national vaccination coverage seems to lead to early significant reduction of overall burden of measles.     

The potential for measles transmission in England

Background  

Since the schools vaccination campaign in 1994, measles has been eliminated from England. Maintaining elimination requires low susceptibility levels to keep the effective reproduction number R below 1. Since 1995, however, MMR coverage in two year old children has decreased by more than 10%.     

Association between social capital and second dose of measles vaccination in Japan: Results from the A-CHILD study

Background and Objectives

Measles vaccination is important to prevent outbreak, and social capital can be an important preventive factor. However, there have been very few studies that investigated the association between social capital and measles vaccination, especially the second dose, which is more likely to be suboptimal. This study aimed to investigate the association between social capital and second dose of measles vaccine.

Vaccination coverage of healthcare professionals in an infectious diseases department

Objectives

The study's objective was to evaluate with a standardized questionnaire the knowledge of healthcare workers (HCWs) regarding occupational vaccinations and their vaccination coverage.

Population and Methods

This cross-sectional survey was conducted in the department of infectious diseases of a 1796 bed-teaching hospital in Dijon, France.

Results

Fifty-seven (93%) out of 61 HCPs completed the questionnaire. Vaccination against HVB was the most frequently mentioned vaccination (79%), followed by BCG (66%), and combine vaccine against diphteria, tetanus, and polio (DTP) (66 %). Influenza was the most often quoted among recommended vaccinations (70%), followed by measles (61%), pertussis (39%), and varicella (14%). The number of correct answers was significantly correlated with age of participants, being a physician, and having had courses on vaccination. Almost all HCPs were up to date for mandatory vaccinations. In 2009 to 2010, vaccination rates against seasonal flu and H1N1 flu reached 88%. Only 52% of HCPs knew about their pertussis immunization and only a third of those born before 1980 had been tested for measles.

Conclusions

HCPs knowledge of mandatory vaccinations is adequate but more limited for recommended vaccinations. Information on influenza vaccination has significantly improved its perception among HCPs resulting in a better adhesion to vaccination.     

Girls may have lower levels of maternal measles antibodies and higher risk of subclinical measles infection before the age of measles vaccination

Background

Previous studies have suggested that girls may have lower maternal measles antibody levels than boys. Girls might therefore be more likely to contract measles infection before the normal age of measles vaccination at 9 months of age.

Methods

In connection with a clinical trial of different measles vaccination strategies, we collected pre-measles vaccination blood samples at 4.5 months of age from two subgroups of children. Samples from these children were used to assess possible differences in maternal antibody levels for boys and girls. At 9 months of age another subgroup of children was sampled before the normal measles vaccination; these samples were used to assess the frequency of subclinical measles infection among boys and girls.

Results

We determined measles-specific antibody levels for 812 children at 4.5 months of age and for 896 children at 9 months of age. At 4.5 months of age girls were less likely to have protective maternal antibody levels, the male–female ratio for protective antibody level being 1.23 (1.00–1.51). Among children sampled at 9 months of age, girls were more likely to have protective levels, the female–male ratio for having protective antibody levels being 1.65 (0.98–2.78) (p = 0.054) and the geometric mean titre was significantly higher for girls (p = 0.007). Children who lived in houses with known measles cases were more likely to have protective levels at 9 months of age even though they had not reported measles infection. Since we had excluded children with known measles infection, girls may have been more likely to have had subclinical measles infection. Combining clinical and possible subclinical measles infection, girls tended to be more likely than boys to contract measles infection before 9 months of age, the RR being 1.36 (0.97–1.90).

Conclusions

Girls lost maternal measles antibodies more rapidly than boys and well before 9 months of age. They may be more likely to contract subclinical measles infection before the current age of measles vaccination.     

Knowledge synthesis of benefits and adverse effects of measles vaccination: the Lasbela balance sheet

Background

In preparation for a cluster-randomized controlled trial of a community intervention to increase the demand for measles vaccination in Lasbela district of Pakistan, a balance sheet summarized published evidence on benefits and possible adverse effects of measles vaccination.

Methods

The balance sheet listed: 1) major health conditions associated with measles; 2) the risk among the unvaccinated who contract measles; 3) the risk among the vaccinated; 4) the risk difference between vaccinated and unvaccinated; and 5) the likely net gain from vaccination for each condition.

Results

Two models revealed very different projections of net gain from measles vaccine. A Lasbela-specific combination of low period prevalence of measles among the unvaccinated, medium vaccination coverage and low vaccine efficacy rate, as revealed by the baseline survey, resulted in less-than-expected gains attributable to vaccination. Modelled on estimates where the vaccine had greater efficacy, the gains from vaccination would be more substantial.

Conclusion

Specific local conditions probably explain the low rates among the unvaccinated while the high vaccine failure rate is likely due to weaknesses in the vaccination delivery system. Community perception of these realities may have had some role in household decisions about whether to vaccinate, although the major discouraging factor was inadequate access. The balance sheet may be useful as a communication tool in other circumstances, applied to up-to-date local evidence.

     

Durchimpfung und Prävalenz von IgG-Antikörpern gegen Masern bei Kindern und Jugendlichen in Deutschland

Background

Measles is a vaccine-preventable disease that could be eliminated by global vaccination strategies with two-dose measles vaccination. The World Health Organization (WHO) European Region aims at achieving measles elimination by 2015. Target control is mainly based on verification of 95?% vaccination coverage. In Germany, target verification cannot be based on data from centrally collected registers on vaccination and seroprevalence of measles-specific antibodies.

Objective

This paper provides an overview of measles vaccination coverage and the timeliness of measles vaccination in birth cohorts 1989–2008. In addition, factors associated with vaccination gaps are described.

Methods

Primary data on vaccination coverage (annual school entrance health examination) and on vaccination coverage and immune status (population-based German Health Interview and Examination Survey for Children and Adolescents – KiGGS) and secondary data (insurance refund claim data) are described and discussed.

Results and conclusion

The measles immunization coverage (two doses) obtained in the 2010 school entrance examinations was 91.5?%. The range was 87.6–95.3?% between Federal States. Regional differences were even more pronounced between districts. The timeliness of the two-dose measles immunization increased from 41?% (birth cohorts 2001/2002) to 66?% (birth cohorts 2006/2008). Despite progress in recent years, measles vaccination coverage is still inadequate in adolescents, young adults, and young children. The German Standing Committee on Vaccination (STIKO) recommends a combined MMR vaccination of adults who were born after 1970 and who were not fully vaccinated against measles during childhood. Successful implementation of this recommendation is crucial just as it is important to step up efforts to improve the timeliness of measles vaccination in young children. Regional vaccination gaps and susceptible clusters defined by age or sociodemographic parameters are of particular importance to the epidemiology of measles disease. Knowledge of the factors associated with nonimmunization should be used to tailor vaccination strategies.     

Explaining variation in the uptake of HPV vaccination in England

Background  

In England, two national programmes of HPV vaccination for girls have been instituted, a routine programme for 12- and 13-year-olds and a catch-up programme for 17- and 18-year-olds. Uptake rates across the country have been far from uniform, and this research sought to identify factors explaining the variation in uptake by locality.     

Sero-epidemiology of measles-specific IgG antibodies and predictive factors for low or missing titres in a German population-based cross-sectional study in children and adolescents (KiGGS)

Background and objective

In the European Region, measles elimination is now targeted to 2015. To measure progress towards elimination age-group specific susceptibility targets have been defined. Age-specific measles susceptibility in children and adolescents was evaluated in Germany. Taking into account a broad range of socio-demographic, health- and vaccination status related variables, populations for vaccination campaigns were identified.

Method

We analysed data from children aged 1-17 years in the representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Measles immunoglobulin G antibodies were measured in 13,977 participants by enzyme immunoassay (ELISA). Bivariate and multivariate logistic regression analyses were used to determine parental and infant related factors associated with measles susceptibility.

Results

The overall prevalence of seronegativity in children tested for measles IgG aged 1-17 years was 10.0% (95% CI 9.4-10.7). The prevalence of seronegativity in the German population was below the WHO targets for measles elimination in children aged 2-9 year-olds but exceeded the target for 10-17 year-olds. Age differences in the level of seronegativity were found to be mainly due to differences in vaccination coverage. A higher level of susceptibility was observed if parents did not comply with the request to present the child's vaccination card. In vaccinated children, immigration, male gender, very young age at first vaccination and a longer time period since last vaccination were associated with a higher level of susceptibility.

Conclusion

Further increase of the two-dose vaccination coverage is necessary in order to achieve the WHO targets. Catch up vaccination campaigns should focus on adolescents and immigrants.     

Early loss of measles antibodies after MMR vaccine among HIV-infected adults receiving HAART

Objective

: The objective of the study was to evaluate the immune response to measles vaccine of HIV-infected adults in comparison to HIV non-infected adults.

Design

We conducted a cross-sectional study to identify adults lacking measles antibodies. 26 HIV-infected patients and 22 controls found to be measles seronegative in the cross-sectional study, received the MMR vaccine. We prospectively followed patients and measured measles antibodies, and cellular proliferative responses against measles antigens. We registered all adverse events at baseline, 3 and 12 months after vaccination.

Methods

We determined measles antibodies by ELISA and cellular proliferative response in PBMC's at baseline, and repeated measurements at 3 and 12 months after vaccination.

Results

The humoral immune response to the vaccine between HIV-infected adults and the HIV-uninfected group was not statistically different at 3 months (81% vs. 86% respectively). One year after vaccination, a higher proportion of HIV-infected adults had lost measles antibodies in contrast to controls. The cellular response was not statistically different between the groups at baseline, 3 and 12 months after immunization despite the waning of antibodies at 12 months. No severe adverse events were observed. Most patients were receiving HAART and had a mean CD4+ cell count of 496 cells/mL.

Conclusions

The initial humoral immune response to measles vaccine was not different between HIV-infected adults and HIV-uninfected adults. However, HIV-infected adults have a rapid decline of measles antibodies despite their high CD4+ cell count and sustained cellular proliferative response.     

Why children are not vaccinated against measles: a cross-sectional study in two Nigerian States

Background

Childhood vaccination rates in Nigeria are among the lowest in the world and this affects morbidity and mortality rates. A 2011 mixed methods study in two states in Nigeria examined coverage of measles vaccination and reasons for not vaccinating children.

Methods

A household survey covered a stratified random cluster sample of 180 enumeration areas in Bauchi and Cross River States. Cluster-adjusted bivariate and then multivariate analysis examined associations between measles vaccination and potential determinants among children aged 12-23 months, including household socio-economic status, parental knowledge and attitudes about vaccination, and access to vaccination services. Focus groups of parents in the same sites subsequently discussed the survey findings and gave reasons for non-vaccination. A knowledge to action strategy shared findings with stakeholders, including state government, local governments and communities, to stimulate evidence-based actions to increase vaccination rates.

Results

Interviewers collected data on 2,836 children aged 12-23 months in Cross River and 2,421 children in Bauchi. Mothers reported 81.8% of children in Cross River and 42.0% in Bauchi had received measles vaccine. In both states, children were more likely to receive measles vaccine if their mothers thought immunisation worthwhile, if immunisation was discussed in the home, if their mothers had more education, and if they had a birth certificate. In Bauchi, maternal awareness about immunization, mothers’ involvement in deciding about immunization, and fathers’ education increased the chances of vaccination. In Cross River, children from communities with a government immunisation facility were more likely to have received measles vaccine. Focus groups revealed lack of knowledge and negative attitudes about vaccination, and complaints about having to pay for vaccination. Health planners in both states used the findings to support efforts to increase vaccination rates.

Conclusion

Measles vaccination remains sub-optimal, particularly in Bauchi. Efforts to counter negative perceptions about vaccination and to ensure vaccinations are actually provided free may help to increase vaccination rates. Parents need to be made aware that vaccination should be free, including for children without a birth certificate, and vaccination could be an opportunity for issuing birth certificates. The study provides pointers for state level planning to increase vaccination rates.

     

Was there a disparity in age appropriate infant immunization uptake in the theatre of war in the North of Sri Lanka at the height of the hostilities?: a cross-sectional study in resettled areas in the Kilinochchi district

Background

It was long speculated that there could be under-immunized pockets in the war affected Northern part of Sri Lanka relative to other areas. With the cessation of hostilities following the military suppression of the rebellion, opportunities have arisen to appraise the immunization status of children in areas of re-settlement in former war ravaged districts.

Methods

We conducted a cross-sectional study to describe the coverage and age appropriateness of infant vaccinations in a former conflict district during the phase of re-settlement. The target population comprised all children of re-settled families in the age group of 12 – 23 months in the district. We selected a study sample of 300 children from among the target population using the WHO’s 30 cluster EPI survey method. Trained surveyors collected data using a structured checklist. The infant vaccination status was ascertained by reviewing vaccination records in the Child Health Development Record or any other alternative documentary evidence.

Results

The survey revealed that the proportion of fully vaccinated children in the district was 91%. For individual vaccines, it ranged from 92% (measles) to 100% (BCG, DPT/OPV1). However, the age appropriateness of vaccination was less than 50% for all antigens except for BCG (94%). The maximum number of days of delay of vaccinations ranged from 21 days for BCG to 253 days for measles. Age appropriate vaccination rates significantly differed for DPT/OPV1-3 and measles during the conflict and post-conflict stages while it did not for the BCG. Age appropriate vaccination rates were significantly higher for DPT/OPV1-3 during the conflict while for the measles it was higher in the post conflict stage.

Conclusions

Though the vaccination coverage for infant vaccines in the war affected Kilinochchi district was similar to other districts in the country, it masked a disparity in terms of low age-appropriateness of infant immunizations given in field settings. This finding underscores the need for investigation of underlying reasons and introduction of remedial measures in the stage of restoring Primary Health Care services in the ex-conflict zone.

     

The average cost of measles cases and adverse events following vaccination in industrialised countries

Background  

Even though the annual incidence rate of measles has dramatically decreased in industrialised countries since the implementation of universal immunisation programmes, cases continue to occur in countries where endemic measles transmission has been interrupted and in countries where adequate levels of immunisation coverage have not been maintained. The objective of this study is to develop a model to estimate the average cost per measles case and per adverse event following measles immunisation using the Netherlands (NL), the United Kingdom (UK) and Canada as examples.     

Wissen und Einstellungen zur Masernimpfung bei Medizinstudierenden

Background

Insufficient immunization rates among health care personnel and general public cause recurring measles outbreaks. To achieve higher immunization rates, a profound knowledge and positive attitude concerning vaccinations are needed, as well as confident vaccination consultations provided by a treating physician. As medical students in future are main contact persons for patients regarding vaccination, we analysed their attitudes towards and the knowledge about measles immunization in Munich and Dresden in order to take into account possible influences of different vaccination policies.

Materials and methods

In summer term 2015, we invited medical students in their last three years of the studies (5th–10th semester) during compulsory and voluntary courses at the Technische Universität München (TUM) and Technische Universität Dresden (TUD) to participate in our study.

Results

In all, 508 students of the TUM and 216 students of the TUD could be included in our study. On average, 46.7% of the knowledge items were answered correctly at both study sites. The age of the participants seemed to have the strongest influence on the knowledge. The attitudes towards measles vaccinations were very positive at both study sites (93.1% approval on average). Neither the study site, nor the state of origin of the participants, or a previous medical education showed a significant influence on the attitude towards measles vaccination.

Conclusions

The knowledge of the study participants seemed to be insufficient, although their attitudes towards measles vaccination were positive. It is important that medical students are confronted more with the topic vaccination during their studies.