Measles - United States, January 1, 2020-March 28, 2024.

Measles is a highly infectious febrile rash illness and was declared eliminated in the United States in 2000. However, measles importations continue to occur, and U.S. measles elimination status was threatened in 2019 as the result of two prolonged outbreaks among undervaccinated communities in New York and New York City. To assess U.S. measles elimination status after the 2019 outbreaks and to provide context to understand more recent increases in measles cases, CDC analyzed epidemiologic and laboratory surveillance data and the performance of the U.S. measles surveillance system after these outbreaks. During January 1, 2020-March 28, 2024, CDC was notified of 338 confirmed measles cases; 97 (29%) of these cases occurred during the first quarter of 2024, representing a more than seventeenfold increase over the mean number of cases reported during the first quarter of 2020-2023. Among the 338 reported cases, the median patient age was 3 years (range = 0-64 years); 309 (91%) patients were unvaccinated or had unknown vaccination status, and 336 case investigations included information on ≥80% of critical surveillance indicators. During 2020-2023, the longest transmission chain lasted 63 days. As of the end of 2023, because of the absence of sustained measles virus transmission for 12 consecutive months in the presence of a well-performing surveillance system, U.S. measles elimination status was maintained. Risk for widespread U.S. measles transmission remains low because of high population immunity. However, because of the increase in cases during the first quarter of 2024, additional activities are needed to increase U.S. routine measles, mumps, and rubella vaccination coverage, especially among close-knit and undervaccinated communities. These activities include encouraging vaccination before international travel and rapidly investigating suspected measles cases.

Temporal and spatial analysis of over 7,000 measles cases outbreak from 2018 to 2019 in the Brazilian Amazon.

OBJECTIVE: This study aimed to present a temporal and spatial analysis of the 2018 measles outbreak in Brazil, particularly in the metropolitan city of Manaus in the Amazon region, and further introduce a new tool for spatial analysis. METHODS: We analyzed the geographical data of the residences of over 7,000 individuals with measles in Manaus during 2018 and 2019. Spatial and temporal analyses were conducted to characterize various aspects of the outbreak, including the onset and prevalence of symptoms, demographics, and vaccination status. A visualization tool was also constructed to display the geographical and temporal distribution of the reported measles cases. RESULTS: Approximately 95% of the included participants had not received vaccination within the past decade. Heterogeneity was observed across all facets of the outbreak, including variations in the incubation period and symptom presentation. Age distribution exhibited two peaks, occurring at one year and 18 years of age, and the potential implications of this distribution on predictive analysis were discussed. Additionally, spatial analysis revealed that areas with the highest case densities tended to have the lowest standard of living. CONCLUSION: Understanding the spatial and temporal spread of measles outbreaks provides insights for decision-making regarding measures to mitigate future epidemics.

Recovery of measles-containing and HPV vaccine ordering post-COVID-19 pandemic: Trends by public vs. private funding source, urbanicity, and state - United States, January 2018 - December 2022.

OBJECTIVE: To assess recovery in childhood and adolescent vaccine ordering since initial declines in 2020 due to COVID-19 pandemic-related disruptions. METHODS: Using vaccine ordering data provided by Merck & Co., Inc., Rahway, NJ, USA, the number of measles-containing vaccine doses ordered each month in the U.S. during January 1, 2020-May 31, 2022 were compared to doses ordered during the corresponding month in 2018 and human papillomavirus (HPV) vaccine doses ordered during January 1, 2020-December 31, 2022 were compared to corresponding month in 2019. Differences stratified by public vs. private funding source and state and urbanicity of the county where the provider is located were examined. RESULTS: The cumulative deficit for measles-containing vaccines was 1,314,179 doses (-5.7%) as of May 2022 and 3,911,020 doses (-13.6%) for HPV vaccine as of December 2022. Deficits in publicly funded doses and HPV doses ordered in rural counties were greater than deficits in privately funded doses and HPV doses ordered in urban counties. CONCLUSIONS: Findings show that monthly measles-containing and HPV vaccine ordering has recovered; however, deficits remain. Greater deficits in publicly funded vaccine doses and HPV ordering in rural counties suggest varying level of recovery. To reduce gaps in deficits, health care providers are strongly encouraged to use every visit to recommend needed vaccines.

The decline of measles antibody titers in previously vaccinated adults: a cross-sectional analysis.

The global reemergence of measles in 2018-2019 reinforces the relevance of high-coverage immunization to maintain the disease elimination. During an outbreak in the Sao Paulo State in 2019, several measles cases were reported in individuals who were adequately vaccinated according to the current immunization schedule recommends. This study aimed to assess measles IgG antibody seropositivity and titers in previously vaccinated adults. A cross-sectional study was conducted at CRIE-HC-FMUSP (Sao Paulo, Brazil) in 2019. It included healthy adults who had received two or more Measles-Mumps-Rubella vaccines (MMR) and excluded individuals with immunocompromising conditions. Measles IgG antibodies were measured and compared by ELISA (Euroimmun®) and chemiluminescence (LIASON®). The association of seropositivity and titers with variables of interest (age, sex, profession, previous measles, number of measles-containing vaccine doses, interval between MMR doses, and time elapsed since the last MMR dose) was analyzed. A total of 162 participants were evaluated, predominantly young (median age 30 years), women (69.8%) and healthcare professionals (61.7%). The median interval between MMR doses was 13.2 years, and the median time since the last dose was 10.4 years. The seropositivity rate was 32.7% by ELISA and 75.3% by CLIA, and a strong positive correlation was found between the tests. Multivariate analyses revealed that age and time since the last dose were independently associated with positivity. Despite being a single-center evaluation, our results suggest that measles seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose.

[Stratification of risk areas for measles transmission: a systematic reviewEstratificación de las zonas de riesgo de transmisión del sarampión: revisión sistemática]. / Estratificação de áreas de risco de transmissão de sarampo: uma revisão sistemática.

Objective: To perform a systematic review of scientific publications addressing the use of stratification methods to define risk areas for measles transmission. Method: Articles published in English, Portuguese, and Spanish in journals indexed in the SciELO, PubMed, and LILACS databases were selected. The search terms risk assessment AND measles were used without date limits. Editorials, opinion articles, individual-level observational studies, and publications that did not focus on the application of methods to stratify measles transmission risk areas were excluded. Year of publication, authorship, country where the study was performed, objective, geographic level of analysis, method used, indicators, and limitations were recorded in a data form. Results: Thirteen articles published between 2011 and 2022 in nine countries from the six World Health Organization (WHO) regions were selected. Of these, 10 referred to the Measles Risk Assessment Tool developed by the WHO/Centers for Disease Control and Prevention. Only one study adapted the tool to the local context. The risk stratification indicators used in the selected studies focused on a combination of the following dimensions: population immunity, quality of surveillance systems, and epidemiologic status. The systematic output of data with adequate quality and coverage was a noteworthy aspect hindering risk stratification. Conclusion: There seems to be limited dissemination of measles risk stratification strategies, especially at local levels. The need to train human resources to process and interpret risk analyses as part of the routine of surveillance services is emphasized.

Objetivo: Realizar una revisión sistemática de las publicaciones científicas en las que se han abordado experiencias de aplicación de métodos de estratificación para definir las zonas de riesgo de transmisión del sarampión. Métodos: Se seleccionaron artículos publicados en español, inglés o portugués en revistas indizadas en las bases de datos SciELO, PubMed y LILACS. En la búsqueda se utilizaron los descriptores "risk assessment" y "measles", sin limitaciones en la fecha de publicación. Se excluyeron editoriales, artículos de opinión, estudios de observación de pacientes individuales y publicaciones que no tratasen de la aplicación de métodos de estratificación de zonas de riesgo de transmisión del sarampión. Se empleó un formulario para extraer la información sobre año de publicación, autoría, país de realización del estudio, objetivo, escala geográfica, método utilizado, indicadores y limitaciones. Resultados: Se seleccionaron 13 artículos publicados entre el 2011 y el 2022 en nueve países de las seis regiones de la Organización Mundial de la Salud (OMS). En 10 de ellos se utilizó como referencia la herramienta de evaluación del riesgo de sarampión creada por la OMS y los Centros para el Control y la Prevención de Enfermedades de Estados Unidos. Solamente en un estudio se adaptó la herramienta al contexto local. Los indicadores utilizados para la estratificación del riesgo se basaron en una combinación de las dimensiones de inmunidad poblacional, calidad de los sistemas de vigilancia y situación epidemiológica. Entre las dificultades de la estratificación del riesgo se destaca la de generación sistemática de datos con una cobertura y calidad adecuadas. Conclusión: Las estrategias de estratificación del riesgo de transmisión del sarampión siguen sin estar, al parecer, muy extendidas, en especial a nivel local. Cabe reiterar la necesidad de fomentar la capacitación de recursos humanos para procesar e interpretar los análisis de riesgo en las operaciones habituales de los servicios de vigilancia.

Estratificação de áreas de risco de transmissão de sarampo: uma revisão sistemática

[RESUMO]. Objetivo. Realizar uma revisão sistemática de publicações científicas que abordaram experiências de aplicação de métodos de estratificação para definir áreas de risco de transmissão de sarampo. Método. Foram selecionados artigos publicados nos idiomas inglês, português e espanhol em periódicos indexados nas bases SciELO, PubMed e LILACS. A busca utilizou os descritores risk assessment AND measles, sem delimitação de período. Foram excluídos editoriais, artigos de opinião, estudos observacionais de nível individual e publicações que não tratavam da aplicação de métodos de estratificação de áreas de risco de transmissão de sarampo. As informações de ano de publicação, autoria, país de realização do estudo, objetivo, escala geográfica, método utilizado, indicadores e limitações foram extraídas por meio de formulário. Resultados. Foram selecionados 13 artigos publicados entre 2011 e 2022 em nove países das seis regiões da Organização Mundial da Saúde (OMS). Desses, 10 tiveram como referência a ferramenta Measles Risk Assessment Tool desenvolvida pela OMS/Centers for Disease Control and Prevention. Apenas um estudo adaptou a ferramenta ao contexto local. Os indicadores utilizados para a estratificação de risco enfocaram uma combinação das dimensões imunidade populacional, qualidade dos sistemas de vigilância e situação epidemiológica. Como dificuldades para a estratificação de risco, destaca-se a produção sistemática de dados com cobertura e qualidade adequadas. Conclusão. As estratégias de estratificação do risco de transmissão de sarampo parecem ser ainda pouco difundidas, especialmente na escala local. Reitera-se a necessidade de estímulo à capacitação de recursos humanos para processamento e interpretação das análises de risco nas rotinas dos serviços de vigilância.

[ABSTRACT]. Objective. To perform a systematic review of scientific publications addressing the use of stratification methods to define risk areas for measles transmission. Method. Articles published in English, Portuguese, and Spanish in journals indexed in the SciELO, PubMed, and LILACS databases were selected. The search terms risk assessment AND measles were used without date limits. Editorials, opinion articles, individual-level observational studies, and publications that did not focus on the application of methods to stratify measles transmission risk areas were excluded. Year of publication, authorship, country where the study was performed, objective, geographic level of analysis, method used, indicators, and limitations were recorded in a data form. Results. Thirteen articles published between 2011 and 2022 in nine countries from the six World Health Organization (WHO) regions were selected. Of these, 10 referred to the Measles Risk Assessment Tool developed by the WHO/Centers for Disease Control and Prevention. Only one study adapted the tool to the local context. The risk stratification indicators used in the selected studies focused on a combination of the following dimensions: population immunity, quality of surveillance systems, and epidemiologic status. The systematic output of data with adequate quality and coverage was a noteworthy aspect hindering risk stratification. Conclusion. There seems to be limited dissemination of measles risk stratification strategies, especially at local levels. The need to train human resources to process and interpret risk analyses as part of the routine of surveillance services is emphasized.

[RESUMEN]. Objetivo. Realizar una revisión sistemática de las publicaciones científicas en las que se han abordado experiencias de aplicación de métodos de estratificación para definir las zonas de riesgo de transmisión del sarampión. Método. Se seleccionaron artículos publicados en español, inglés o portugués en revistas indizadas en las bases de datos SciELO, PubMed y LILACS. En la búsqueda se utilizaron los descriptores "risk assessment" y "measles", sin limitaciones en la fecha de publicación. Se excluyeron editoriales, artículos de opinión, estudios de observación de pacientes individuales y publicaciones que no tratasen de la aplicación de métodos de estratificación de zonas de riesgo de transmisión del sarampión. Se empleó un formulario para extraer la información sobre año de publicación, autoría, país de realización del estudio, objetivo, escala geográfica, método utilizado, indicadores y limitaciones. Resultados. Se seleccionaron 13 artículos publicados entre el 2011 y el 2022 en nueve países de las seis regiones de la Organización Mundial de la Salud (OMS). En 10 de ellos se utilizó como referencia la herramienta de evaluación del riesgo de sarampión creada por la OMS y los Centros para el Control y la Prevención de Enfermedades de Estados Unidos. Solamente en un estudio se adaptó la herramienta al contexto local. Los indicadores utilizados para la estratificación del riesgo se basaron en una combinación de las dimensiones de inmunidad poblacional, calidad de los sistemas de vigilancia y situación epidemiológica. Entre las dificultades de la estratificación del riesgo se destaca la de generación sistemática de datos con una cobertura y calidad adecuadas. Conclusiones. Las estrategias de estratificación del riesgo de transmisión del sarampión siguen sin estar, al parecer, muy extendidas, en especial a nivel local. Cabe reiterar la necesidad de fomentar la capacitación de recursos humanos para procesar e interpretar los análisis de riesgo en las operaciones habituales de los servicios de vigilancia.

Laboratory diagnosis of measles infection using molecular and serology during 2019-2020 outbreak in Brazil.

INTRODUCTION: Laboratory diagnosis of measles can be challenging, and the reintroduction of the measles virus in Brazil has brought about new issues. The aim of this study was to analyze the qPCR results of swab and urine samples and compare them with those of immunological methods for the diagnosis of measles. METHODS: This was a cross-sectional study based on a retrospective analysis of 3,451 suspected cases using laboratory test surveillance databases for qPCR (respiratory swabs and urine) and serologic tests for IgM and paired IgG. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and agreement through kappa and adjusted kappa coefficients (PABAK) were calculated using different diagnostic strategies. RESULTS: The swab and urine samples obtained using real-time qPCR were equivalent. Samples collected simultaneously and the combined samples showed moderate agreement between IgM ELISA and real-time qPCR; however, 48.9 % of the IgM ELISA analyses did not demonstrate detectable qPCR concentrations during simultaneous collections and 43.9 % of combined collections. The paired analysis of IgG showed an accuracy of 67.5 % for IgM and 90.7 % for real-time qPCR. CONCLUSIONS: Diagnosis based on IgM presents detection delimitation in samples collected early (1-5 days), suggesting that these individuals satisfy at least two criteria. In addition to qPCR, paired analysis of IgG using ELISA can be used to increase the sensitivity and specificity of laboratory diagnoses.

Estratificação de áreas de risco de transmissão de sarampo: uma revisão sistemática / Stratification of risk areas for measles transmission: a systematic review / Estratificación de las zonas de riesgo de transmisión del sarampión: revisión sistemática

RESUMO Objetivo. Realizar uma revisão sistemática de publicações científicas que abordaram experiências de aplicação de métodos de estratificação para definir áreas de risco de transmissão de sarampo. Métodos. Foram selecionados artigos publicados nos idiomas inglês, português e espanhol em periódicos indexados nas bases SciELO, PubMed e LILACS. A busca utilizou os descritores risk assessment AND measles, sem delimitação de período. Foram excluídos editoriais, artigos de opinião, estudos observacionais de nível individual e publicações que não tratavam da aplicação de métodos de estratificação de áreas de risco de transmissão de sarampo. As informações de ano de publicação, autoria, país de realização do estudo, objetivo, escala geográfica, método utilizado, indicadores e limitações foram extraídas por meio de formulário. Resultados. Foram selecionados 13 artigos publicados entre 2011 e 2022 em nove países das seis regiões da Organização Mundial da Saúde (OMS). Desses, 10 tiveram como referência a ferramenta Measles Risk Assessment Tool desenvolvida pela OMS/Centers for Disease Control and Prevention. Apenas um estudo adaptou a ferramenta ao contexto local. Os indicadores utilizados para a estratificação de risco enfocaram uma combinação das dimensões imunidade populacional, qualidade dos sistemas de vigilância e situação epidemiológica. Como dificuldades para a estratificação de risco, destaca-se a produção sistemática de dados com cobertura e qualidade adequadas. Conclusão. As estratégias de estratificação do risco de transmissão de sarampo parecem ser ainda pouco difundidas, especialmente na escala local. Reitera-se a necessidade de estímulo à capacitação de recursos humanos para processamento e interpretação das análises de risco nas rotinas dos serviços de vigilância.

ABSTRACT Objective. To perform a systematic review of scientific publications addressing the use of stratification methods to define risk areas for measles transmission. Method. Articles published in English, Portuguese, and Spanish in journals indexed in the SciELO, PubMed, and LILACS databases were selected. The search terms risk assessment AND measles were used without date limits. Editorials, opinion articles, individual-level observational studies, and publications that did not focus on the application of methods to stratify measles transmission risk areas were excluded. Year of publication, authorship, country where the study was performed, objective, geographic level of analysis, method used, indicators, and limitations were recorded in a data form. Results. Thirteen articles published between 2011 and 2022 in nine countries from the six World Health Organization (WHO) regions were selected. Of these, 10 referred to the Measles Risk Assessment Tool developed by the WHO/Centers for Disease Control and Prevention. Only one study adapted the tool to the local context. The risk stratification indicators used in the selected studies focused on a combination of the following dimensions: population immunity, quality of surveillance systems, and epidemiologic status. The systematic output of data with adequate quality and coverage was a noteworthy aspect hindering risk stratification. Conclusion. There seems to be limited dissemination of measles risk stratification strategies, especially at local levels. The need to train human resources to process and interpret risk analyses as part of the routine of surveillance services is emphasized.

RESUMEN Objetivo. Realizar una revisión sistemática de las publicaciones científicas en las que se han abordado experiencias de aplicación de métodos de estratificación para definir las zonas de riesgo de transmisión del sarampión. Métodos. Se seleccionaron artículos publicados en español, inglés o portugués en revistas indizadas en las bases de datos SciELO, PubMed y LILACS. En la búsqueda se utilizaron los descriptores "risk assessment" y "measles", sin limitaciones en la fecha de publicación. Se excluyeron editoriales, artículos de opinión, estudios de observación de pacientes individuales y publicaciones que no tratasen de la aplicación de métodos de estratificación de zonas de riesgo de transmisión del sarampión. Se empleó un formulario para extraer la información sobre año de publicación, autoría, país de realización del estudio, objetivo, escala geográfica, método utilizado, indicadores y limitaciones. Resultados. Se seleccionaron 13 artículos publicados entre el 2011 y el 2022 en nueve países de las seis regiones de la Organización Mundial de la Salud (OMS). En 10 de ellos se utilizó como referencia la herramienta de evaluación del riesgo de sarampión creada por la OMS y los Centros para el Control y la Prevención de Enfermedades de Estados Unidos. Solamente en un estudio se adaptó la herramienta al contexto local. Los indicadores utilizados para la estratificación del riesgo se basaron en una combinación de las dimensiones de inmunidad poblacional, calidad de los sistemas de vigilancia y situación epidemiológica. Entre las dificultades de la estratificación del riesgo se destaca la de generación sistemática de datos con una cobertura y calidad adecuadas. Conclusión. Las estrategias de estratificación del riesgo de transmisión del sarampión siguen sin estar, al parecer, muy extendidas, en especial a nivel local. Cabe reiterar la necesidad de fomentar la capacitación de recursos humanos para procesar e interpretar los análisis de riesgo en las operaciones habituales de los servicios de vigilancia.

Temporal and spatial analysis of over 7,000 measles cases outbreak from 2018 to 2019 in the Brazilian Amazon

ABSTRACT Objective: This study aimed to present a temporal and spatial analysis of the 2018 measles outbreak in Brazil, particularly in the metropolitan city of Manaus in the Amazon region, and further introduce a new tool for spatial analysis. Methods: We analyzed the geographical data of the residences of over 7,000 individuals with measles in Manaus during 2018 and 2019. Spatial and temporal analyses were conducted to characterize various aspects of the outbreak, including the onset and prevalence of symptoms, demographics, and vaccination status. A visualization tool was also constructed to display the geographical and temporal distribution of the reported measles cases. Results: Approximately 95% of the included participants had not received vaccination within the past decade. Heterogeneity was observed across all facets of the outbreak, including variations in the incubation period and symptom presentation. Age distribution exhibited two peaks, occurring at one year and 18 years of age, and the potential implications of this distribution on predictive analysis were discussed. Additionally, spatial analysis revealed that areas with the highest case densities tended to have the lowest standard of living. Conclusion: Understanding the spatial and temporal spread of measles outbreaks provides insights for decision-making regarding measures to mitigate future epidemics.

[Maintaining measles elimination status in Colombia during outbreak control, 2019Manutenção do status de eliminação do sarampo na Colômbia durante o controle de surtos, 2019]. / Mantenimiento del estatus de eliminación del sarampión en Colombia durante el control de brotes, 2019.

Objective: Describe measles outbreaks caused by importation of multiple cases, and the corresponding control interventions. Methods: Descriptive study of measles outbreaks caused by the importation of multiple cases to Colombia in 2018-2019. Case definitions, classification of source of infection, collection of biological specimens, searches for suspected cases, case identification, and contact tracing were employed. Vaccination records were obtained from vaccination cards or from the Colombian information system. Nationality was determined from records found in the public health surveillance system. The incident command system was used, and response teams and action plans were activated to control outbreaks. Results: In March 2018, the first case of measles imported from Venezuela was confirmed. Measles incidence in 2018 was 0.2 cases per 100 000 population, and it was 0.3 per 100 000 in 2019. The case fatality rate in 2019 was 0.4%. A total of 214 cases were confirmed in the Venezuelan population (91% with no vaccination history); and 69 outbreaks with no epidemiological link were studied. The MVi/Hulu Langat.MYS/26.11[D8] lineage was identified. Endemic circulation was prevented through innovative interventions such as infection surveillance and control, immediate notification, prioritization of field visits, and transmission risk level criteria. Conclusions: Colombia controlled measles outbreaks that resulted from imported cases, and it prevented endemic circulation, thereby maintaining certification of measles elimination in the country.

Objetivo: Descrever os surtos de sarampo gerados por múltiplas importações de casos e as intervenções de controle. Métodos: Estudo descritivo de surtos devido a múltiplas importações de casos para a Colômbia entre 2018 e 2019. Foram utilizadas definições de caso, classificação da fonte de infecção, coleta de amostras biológicas, rastreamento de casos suspeitos, identificação e seguimento de contatos. O histórico de vacinação foi obtido do cartão de vacinação ou do sistema de informações da Colômbia. A nacionalidade foi definida de acordo com o registro no sistema de vigilância em saúde pública. O sistema de comando de incidentes foi usado, com equipes de resposta e planos de ação para controlar os surtos. Resultados: O primeiro caso de sarampo importado da Venezuela foi confirmado em março de 2018. Nesse ano, a incidência foi de 0,2 casos por 100 mil habitantes e, em 2019, de 0,3 casos por 100 mil habitantes. A taxa de letalidade em 2019 foi de 0,4%. Um total de 214 casos foi confirmado na população venezuelana (91% sem histórico de vacinação). Foram estudados 69 surtos sem vínculo epidemiológico. Foi identificado o genótipo D8, cepa MVi/Hulu Langat.MYS/26.11. A circulação endêmica foi evitada por meio de intervenções inovadoras, como vigilância e controle de infecções, notificação "superimediata", priorização de visitas de campo e critérios para níveis de risco de transmissão. Conclusões: A Colômbia controlou os surtos de sarampo decorrentes de casos importados e impediu a circulação endêmica a fim de manter a certificação da eliminação do vírus do sarampo no país.

Mumps vaccine effectiveness of a 3rd dose of measles, mumps, rubella vaccine in school settings during a mumps outbreak -- Arkansas, 2016-2017.

Objectives: The largest mumps outbreak in the United States since 2006 occurred in Arkansas during the 2016-17 school year. An additional dose (third dose) of measles-mumps-rubella vaccine (MMR3) was offered to school children. We evaluated the vaccine effectiveness (VE) of MMR3 compared with two doses of MMR for preventing mumps among school-aged children during the outbreak. Study design: A generalized linear mixed effects model was used to estimate the incremental vaccine effectiveness (VE) of a third dose of MMR compared with two doses of MMR for preventing mumps. Methods: We obtained school enrollment, immunization status and mumps case status from school registries, Arkansas's immunization registry, and Arkansas's mumps surveillance system, respectively. We included students who previously received 2 doses of MMR in schools with ≥1 mumps case after the MMR3 clinic. We used a generalized linear mixed model to estimate VE of MMR3 compared with two doses of MMR. Results: Sixteen schools with 9272 students were included in the analysis. Incremental VE of MMR3 versus a two-dose MMR regimen was 52.7% (95% confidence interval [CI]: -3.6%‒78.4%) overall and in 8 schools with high mumps transmission it was 64.0% (95% CI: 1.2%‒86.9%). MMR3 VE was higher among middle compared with elementary school students (68.5% [95% CI: -30.2%‒92.4%] vs 37.6% [95% CI: -62.5%‒76.1%]); these differences were not statistically significant. Conclusion: Our findings suggest MMR3 provided additional protection from mumps compared with two MMR doses in elementary and middle school settings during a mumps outbreak.

Mantenimiento del estatus de eliminación del sarampión en Colombia durante el control de brotes, 2019 / Maintaining measles elimination status in Colombia during outbreak control, 2019 / Manutenção do status de eliminação do sarampo na Colômbia durante o controle de surtos, 2019

[RESUMEN]. Objetivo. Describir los brotes de sarampión generados por la múltiple importación de casos y las intervenciones de control. Métodos. Estudio descriptivo de brotes por múltiple importación de casos a Colombia entre 2018-2019. Se utilizaron las definiciones de caso, clasificación de fuente de infección, recolección de muestras biológicas, rastreo de casos sospechosos, identificación y seguimiento de contactos. El antecedente vacunal se obtuvo del carné o del sistema de información de Colombia. La nacionalidad se definió de acuerdo con el registro en el sistema de vigilancia en salud pública. Se empleó el sistema de comando de incidente con equipos de respuesta y planes de acción para controlar los brotes. Resultados. En marzo de 2018 se confirmó el primer caso de sarampión importado de Venezuela. La incidencia en 2018 fue 0,2 casos por 100 000 habitantes y en 2019 fue 0,3. La letalidad en 2019 fue de 0,4%. Se confirmaron 214 casos en población venezolana (91% sin antecedente vacunal). Se estudiaron 69 brotes sin vínculo epidemiológico. Se identificó el genotipo D8 linaje MVi/Hulu Langat.MYS/26.11. Se evitó la circulación endémica a través de intervenciones innovadoras tales como, la vigilancia y control de infecciones, notificación super inmediata, priorización de visitas de campo y criterios de niveles de riesgo de transmisión. Conclusiones. Colombia controló los brotes de sarampión que se presentaron por la importación de casos e impido la circulación endémica para conservar la certificación de la eliminación del virus de sarampión en el país.

[ABSTRACT]. Objective. Describe measles outbreaks caused by importation of multiple cases, and the corresponding con- trol interventions. Methods. Descriptive study of measles outbreaks caused by the importation of multiple cases to Colombia in 2018–2019. Case definitions, classification of source of infection, collection of biological specimens, sear- ches for suspected cases, case identification, and contact tracing were employed. Vaccination records were obtained from vaccination cards or from the Colombian information system. Nationality was determined from records found in the public health surveillance system. The incident command system was used, and response teams and action plans were activated to control outbreaks. Results. In March 2018, the first case of measles imported from Venezuela was confirmed. Measles incidence in 2018 was 0.2 cases per 100 000 population, and it was 0.3 per 100 000 in 2019. The case fatality rate in 2019 was 0.4%. A total of 214 cases were confirmed in the Venezuelan population (91% with no vaccination history); and 69 outbreaks with no epidemiological link were studied. The MVi/Hulu Langat.MYS/26.11[D8] lineage was identified. Endemic circulation was prevented through innovative interventions such as infection surveillance and control, immediate notification, prioritization of field visits, and transmission risk level criteria. Conclusions. Colombia controlled measles outbreaks that resulted from imported cases, and it prevented endemic circulation, thereby maintaining certification of measles elimination in the country.

[RESUMO]. Objetivo. Descrever os surtos de sarampo gerados por múltiplas importações de casos e as intervenções de controle. Métodos. Estudo descritivo de surtos devido a múltiplas importações de casos para a Colômbia entre 2018 e 2019. Foram utilizadas definições de caso, classificação da fonte de infecção, coleta de amostras biológicas, rastreamento de casos suspeitos, identificação e seguimento de contatos. O histórico de vacinação foi obtido do cartão de vacinação ou do sistema de informações da Colômbia. A nacionalidade foi definida de acordo com o registro no sistema de vigilância em saúde pública. O sistema de comando de incidentes foi usado, com equipes de resposta e planos de ação para controlar os surtos. Resultados. O primeiro caso de sarampo importado da Venezuela foi confirmado em março de 2018. Nesse ano, a incidência foi de 0,2 casos por 100 mil habitantes e, em 2019, de 0,3 casos por 100 mil habitantes. A taxa de letalidade em 2019 foi de 0,4%. Um total de 214 casos foi confirmado na população venezuelana (91% sem histórico de vacinação). Foram estudados 69 surtos sem vínculo epidemiológico. Foi identificado o genótipo D8, cepa MVi/Hulu Langat.MYS/26.11. A circulação endêmica foi evitada por meio de intervenções inovadoras, como vigilância e controle de infecções, notificação “superimediata”, priorização de visitas de campo e critérios para níveis de risco de transmissão. Conclusões. A Colômbia controlou os surtos de sarampo decorrentes de casos importados e impediu a circulação endêmica a fim de manter a certificação da eliminação do vírus do sarampo no país.

Measles epidemiological surveillance system before and during the COVID-19 pandemic in Pernambuco, Brazil, 2018-2022: a descriptive evaluation.

OBJECTIVE: To evaluate the measles epidemiological surveillance system, before and during the COVID-19 pandemic in Pernambuco, Brazil. METHODS: This was a descriptive evaluation of the quality (duplicity; completeness; consistency), timeliness and usefulness attributed, classified as excellent ≥ 90.0%, regular ≥ 70.0% and < 90.0%, and poor (< 70.0%). Data from the Notifiable Health Conditions Information System and Laboratory Environment Management System were used, before (03/11/2018-03/10/2020) and during (03/11/2020-03/10/2022) the pandemic. RESULTS: 1,548 suspected measles cases were registered (1,469 before and 79 during the pandemic). In the two periods studied, there were 11 and 1 duplicate records, average completeness in filling out the variables was 99.2% and 95.7%, while average consistency was 96.7% and 97.5%, respectively. Timeliness (receipt of samples, 16.2% and 33.0%. Release of results, 1.3% and 1.3%) and usefulness (43.5% and 24.4%) were poor. CONCLUSION: Quality was classified as excellent in the periods studied, timeliness and usefulness were classified as poor, signaling non-compliance with the purpose of the system. MAIN RESULTS: The quality of data from the measles epidemiological surveillance system in Pernambuco was excellent, while its timeliness and usefulness were poor during both periods. IMPLICATIONS FOR SERVICES: The limited timeliness and, therefore, the low usefulness of the measles epidemiological surveillance system must be discussed in the three government spheres of health service management, with the aim of training the professionals involved, as well as monitoring and evaluating the system. PERSPECTIVES: Systematic monitoring and evaluation generates evidence that supports health service managers and workers in the timely identification of gaps that compromise the full fulfillment of the objectives proposed.

Modeling vaccination coverage during the 2022 central Ohio measles outbreak: a cross-sectional study.

Background: Of the eight large (>50 cases) US postelimination outbreaks, the first and last occurred in Ohio. Ohio's vaccination registry is incomplete. Community-level immunity gaps threaten more than two decades of measles elimination in the US. We developed a statistical model, VaxEstim, to rapidly estimate the early-phase vaccination coverage and immunity gap in the exposed population during the 2022 Central Ohio outbreak. Methods: We used reconstructed daily incidence (from publicly available data) and assumptions about the distribution of the serial interval, or the time between symptom onset in successive measles cases, to estimate the effective reproduction number (i.e., the average number of secondary infections caused by an infected individual in a partially immune population). We estimated early-phase measles vaccination coverage by comparing the effective reproduction number to the basic reproduction number (i.e., the average number of secondary infections caused by an infected individual in a fully susceptible population) while accounting for vaccine effectiveness. Finally, we estimated the early-phase immunity gap as the difference between the estimated critical vaccination threshold and vaccination coverage. Findings: VaxEstim estimated the early-phase vaccination coverage as 53% (95% credible interval, 21%-77%), the critical vaccination threshold as 93%, and the immunity gap as 42% (95% credible interval, 18%-74%). Interpretation: This study estimates a significant immunity gap in the exposed population during the early phase of the 2022 Central Ohio measles outbreak, suggesting a robust public health response is needed to identify the susceptible community and develop community-specific strategies to close the immunity gap. Funding: This work was supported in part by the National Institute of General Medical Sciences, National Institutes of Health; the UK Medical Research Council (MRC); the Foreign, Commonwealth and Development Office; the National Institute for Health Research (NIHR) Health Protection Research Unit in Modelling Methodology; Imperial College London, and the London School of Hygiene & Tropical Medicine, Community Jameel; the EDCTP2 programme, supported by the EU; and the Sergei Brin Foundation.

Why Parents Say No to Having Their Children Vaccinated against Measles: A Systematic Review of the Social Determinants of Parental Perceptions on MMR Vaccine Hesitancy.

Ongoing outbreaks of measles threaten its elimination status in the United States. Its resurgence points to lower parental vaccine confidence and local pockets of unvaccinated and undervaccinated individuals. The geographic clustering of hesitancy to MMR indicates the presence of social drivers that shape parental perceptions and decisions on immunization. Through a qualitative systematic review of published literature (n = 115 articles; 7 databases), we determined major themes regarding parental reasons for MMR vaccine hesitancy, social context of MMR vaccine hesitancy, and trustworthy vaccine information sources. Fear of autism was the most cited reason for MMR hesitancy. The social drivers of vaccine hesitancy included primary care/healthcare, education, economy, and government/policy factors. Social factors, such as income and education, exerted a bidirectional influence, which facilitated or hindered vaccine compliance depending on how the social determinant was experienced. Fear of autism was the most cited reason for MMR hesitancy. Vaccine hesitancy to MMR and other childhood vaccines clustered in middle- to high-income areas among mothers with a college-level education or higher who preferred internet/social media narratives over physician-based vaccine information. They had low parental trust, low perceived disease susceptibility, and were skeptical of vaccine safety and benefits. Combating MMR vaccine misinformation and hesitancy requires intersectoral and multifaceted approaches at various socioecological levels to address the social drivers of vaccine behavior.