MMR vaccine effectiveness in an outbreak that involved day-care and primary schools |
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Authors: | Barrabeig Irene Rovira Ariadna Muñoz Pilar Batalla Joan Rius Cristina Sánchez Josep Anton Domínguez Àngela |
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Affiliation: | a Epidemiological Surveillance Unit of Barcelona-Zona Sud. Department of Health, Generalitat of Catalonia, Barcelona, Spain b CIBER Epidemiología y Salut Pública (CIBERESP), Spain c Dept. of Statistics and Operations Research, University Politècnica de Catalunya (UPC), Barcelona, Spain d Vaccine Service, Department of Health, Generalitat of Catalonia, Barcelona, Spain e Epidemiology Service of Public Health Agency of Barcelona, Barcelona, Spain f Department of Public Health, School of Medicine, University of Barcelona, Spain |
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Abstract: | ObjectiveIn 2006, a large measles outbreak occurred in Catalonia (Spain), where the immunization schedule included two doses of MMR vaccine at 15 months and 4 years. The aim of this study was to investigate the vaccine effectiveness (VE) of MMR in children attending day-care and pre-school centres and to estimate the number of cases that would have been avoided by administering the first dose of MMR at 12 months.MethodsA retrospective cohort study was carried out between October 2006 and January 2007 in day-care and pre-school centres with confirmed measles cases. VE was calculated in children aged ≥15 months without previous measles infection. Cases avoided by advancing the first dose of MMR to 12 months were estimated by calculating the basic and effective reproduction number in centres where transmission outside the class was observed.ResultsFifteen centres and 1394 children were included. There were 77 confirmed cases (attack rate = 5.5%). Vaccination coverage of the 1121 children aged ≥15 months was 91.6% and VE was 96% (95%CI 89-98%).There were 33 (41%) cases in the 81 children aged 12-14 months. Advancing the first dose to 12 months would have prevented 74 cases (91.5%) and lowered the attack rate from 41% to 8.6%.ConclusionsOver 90% of cases in children aged 12-14 months would have been avoided by MMR administration at 12 rather than 15 months. We strongly recommend advancing the first dose of MMR to 12 months in order to reduce the risk of measles outbreaks. |
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Keywords: | R0, basic reproduction number MMR, measles mumps and rubella vaccine VE, direct effectiveness of vaccination RR, relative risks ARv, attack rate in vaccinated children ARu, attack rate in unvaccinated children CI, confidence interval R, effective reproduction number EUVAC, European surveillance network for vaccine-preventable diseases |
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