Elimination of endemic measles and rubella transmission in Oman.

Objectives: The main objective of the study is to describe the five lines of evidence of measles and rubella elimination in Oman. Methods: A descriptive record review of the national surveillance database of fever and rash illnesses (measles and rubella surveillance) to demonstrate elimination status. Results: A total of 532 and 73 cases of measles and rubella cases were reported during 2000-2022, respectively. Of the reported measles cases during 2000-2022, 106 were sporadic cases and 36 outbreaks (426 cases) were reported. The size of the outbreaks was largely small and the largest and the longest outbreak was in 2016-2017 involving the Dhofar-South Sharqiyah governorates with 90 cases due to genotype B3, which lasted for 32 weeks. Of the reported rubella cases during 2000-2022; all 73 were sporadic cases with no outbreaks. The vaccination coverage of Measles Mumps Rubella 2 is high (>98.0%) at the national and sub-national levels since 2008, thus maintaining the high population immunity. The absence of endemic genotype was proven through genetic sequencing of all the reported cases and outbreaks of measles and rubella. The high-performance indicators showed quality surveillance system. Conclusions: Oman fulfills the criteria for measles and rubella elimination. All the five lines of evidence were verified and Oman was certified to have eliminated measles and rubella in 2019. After 3 years of post-elimination, Oman has continued to maintain its elimination status successfully. High population immunity and quality surveillance resulted in sustaining the elimination during the post-elimination period.

Progress towards Measles and Rubella Elimination in the South-East Asia Region-2013-2023.

The South-East Asia (SEA) Region of the World Health Organization (WHO), through a Regional Committee resolution in 2013, adopted the goal of "measles elimination and rubella control by 2020". The goal was revised in 2019 to "measles and rubella elimination by 2023". Countries of the Region have made significant efforts to achieve the goal. Progress has been made in the Region, with five of the 11 countries of the Region having been verified for having eliminated measles and rubella. Surveillance and immunization program performance for measles and rubella has shown an improvement since 2013. This progress has been possible due to a high level of political and programmatic commitment in the countries of the Region, as well as due to the alliances and infrastructures established for disease elimination initiatives in the past, notably for polio, being utilized effectively to implement strategies for measles and rubella elimination. The unforeseen COVID-19 pandemic had a detrimental effect on the immunization and surveillance efforts, leading to a delay in the achievement of measles and rubella elimination in the Region. Challenges to achieve the goal remain; however, efforts are ongoing in countries to not only protect the gains made so far but also to make further progress towards the goal of measles and rubella elimination.

Acceptance of Rubella-Containing Vaccine and Factors Associated with Acceptance among Women of Reproductive Age in China: A Cross-Sectional Study.

Objectives: To investigate the acceptance and factors influencing acceptance of rubella-containing vaccine (RCV) among women of reproductive age in Guangdong, Henan, Hubei, Liaoning, Shanxi, Sichuan and Zhejiang provinces of China. Methods: Using a stratified sampling method, we selected one urban and one rural community health services center in each of two cities in seven provinces. From these centers, we recruited women 15-49 years of age to complete a questionnaire on their willingness to receive RCV and factors influencing willingness. The survey instrument was adapted from the behavioral and social drivers (BeSD) of vaccination survey tool developed by the World Health Organization. Results: Among 1286 participants, 981 (76.3%) were willing to receive RCV. Awareness of rubella ranged from 12.4% to 70.6%. Willingness to receive RCV differed significantly by region, occupation, vaccination history, and awareness. All latent variables of the structural equation model (SEM) were positively correlated with willingness, and all standardized paths were statistically significant (p < 0.001). Thinking and Feeling had direct positive effects on Social Processes (ß = 0.789) and Practical Issues (ß = 0.542), thereby indirectly affecting motivation. Conclusions: Women of reproductive age had high willingness to receive the rubella vaccination, but their general awareness of rubella was relatively low. It is necessary to strengthen the health education of women of reproductive age regarding rubella to improve RCV coverage.

Intrathecal immune reactivity against Measles-, Rubella-, and Varicella Zoster viruses is associated with cerebrospinal fluid inflammation in multiple sclerosis.

BACKGROUND/OBJECTIVES: We aimed to determine in multiple sclerosis (MS) whether intrathecal immunoglobulin G (IgG) production against measles- (M), rubella- (R), and varicella zoster (Z) viruses, which is called MRZ reaction (MRZR) and considered the most specific soluble biomarker for MS, is associated with demographic and basic cerebrospinal fluid (CSF) parameters reflecting inflammation. METHODS: We analyzed the presence of positive MRZR and associations with demographic and clinical routine CSF parameters in 513 patients with MS and 182 non-MS patients. RESULTS: Comparing MS patients versus non-MS patients, positive MRZR (38.8% versus 2.2%; specificity 97.8%; positive likelihood ratio, PLR 17.7) had a better specificity and PLR for MS than CSF-specific OCB (89.5% versus 22.0%; specificity 78.0%; PLR 4.1). A positive MRZR in MS patients was associated with female sex (p = 0.0001), pleocytosis (p < 0.0001), higher frequency of presence of plasma cells in CSF (p = 0.0248), normal CSF/serum albumin ratio (p = 0.0005), and intrathecal production of total IgG or CSF-specific OCB (both p < 0.0001), but not with intrathecal production of total IgA or IgM. CONCLUSIONS: This study confirms the MRZR as a highly specific marker of MS and shows that MRZR-positive MS patients more frequently are female and show inflammatory changes of basic CSF parameters than MRZR-negative MS patients.

Predictors of measles-rubella vaccination status in the Savannah Region, Ghana: A cross-sectional study among caregivers of children aged 18-59 months.

Introduction: Savannah Region witnessed a decline in measles-rubella (MR) vaccination coverage prior to the measles outbreak in 2022. This study aimed to assess contributory factors of the low routine MR vaccination coverage and proffer recommendations to improve vaccination uptake. Methods: A cross-sectional study was conducted in two districts (Bole and Central Gonja) of Savannah Region from December 2022 to June 2023. Caregivers of children 18-59 months were randomly selected and interviewed using a structured questionnaire. Bivariate and multivariate logistic regression were performed to assess predictors of MR vaccination status. Results: Children of caregivers with inadequate knowledge of MR vaccination (AOR = 0.58, 95 %CI: 0.47-0.72), travelled more than five km to access health services (AOR = 0.48, 95 %CI: 0.39-0.59), described health workers attitude as poor (AOR = 0.44, 95 %CI: 0.26-0.74), and those who sought treatment for adverse events following immunization (AEFI) from the pharmacy (AOR = 0.65, 95 %CI: 0.51-0.84) were less likely to complete MR vaccination. On the contrary, children of female sex (AOR = 1.27, 95 %CI: 1.05-1.53), aged 24-59 month (AOR = 2.56, 95 %CI: 1.05-1.53), caregivers with primary or secondary education (AOR = 1.43, 95 %CI: 1.11-1.84; and AOR = 2.23, 95 %CI: 1.64-3.03 respectively), and those who did not experience rescheduling of vaccination sessions (AOR = 1.61, 95 % CI: 1.25-2.01) were more likely to complete routine MR vaccination schedule. Conclusion: Inadequate caregiver knowledge, poor geographical access to health services, poor healthcare worker attitude, and non-institutional management of AEFI significantly contributed to the low MR vaccination uptake in the Savannah Region. Adopting tailored approaches to addressing these factors could improve vaccination coverage.

Data on recent measles cases at the Jalal-Abad city of Kyrgyzstan.

Measles caused by the virus is highly infectious and sometimes fatal, but it is prevented through vaccination. In Kyrgyzstan, measles cases were initially documented in September 2023, with a notable escalation observed between November and December of the same year. Children aged 3-5 years and 1-2 years exhibited the highest prevalence rates, followed by infants under one year old. Unvaccinated children constituted the majority of cases, with schoolchildren and kindergarten attendees also affected. Surprisingly, a significant proportion of measles cases occurred in vaccinated children, primarily those who received the MMR or Rubella-measles vaccine. Doctors identified 22 recent measles outbreaks and none of the 75 contacts recorded in these outbreaks acquired the disease. Therefore, it is of interest to report an analysis of measles outbreak spike at Jalal-Abad city of Kyrgyzstan in 2023.

Effects of Simulation on Nursing students' Knowledge and Learning Related to Measles Vaccine and Vaccine Hesitancy: A Mixed Method Study.

Vaccine hesitancy is a persistent, global public health concern that community health nurses are well-positioned to manage. Simulations involving standardized patients are effective experiential learning on managing vaccine hesitancy for other allied health disciplines. A pretest-posttest design, with a mixed-methods, one-group, quasi-experimental approach, was used to examine the effectiveness of a simulation on nursing students' knowledge of measles, mumps, and rubella vaccine hesitancy, as well as their attitudes toward the intervention. The study was completed with 61 participants. After participation in the simulation, pretest/posttest data showed a mean increase in participants' knowledge of the measles, mumps, and rubella vaccine. There was a significant improvement in the test scores from 62.62 ± 14.82 to 69.50 ± 15.75; z = -3, 897 (1-17 days) (p = 0.001). A postintervention questionnaire revealed participants most appreciated the direct interaction with a live person, the opportunity to observe classmates' performance and share feedback, multistage structure, and safety. Drawbacks included stress from being observed by peers, time constraints, and the necessity of sharing the nursing role with a partner during the scenario. Another drawback is the simulation's inability to effectively prepare participants for hesitancy in clinical settings as they needed to assess natural clinical settings. Simulations incorporating vaccine hesitancy education and standardized patients can effectively prepare nursing students for situations related to vaccine hesitancy in community clinical settings.

A Comparative Study of the Efficacy of Intralesional Measles Mumps Rubella (MMR) Vaccine and Auto Implantation for the Treatment of Periungual and Palmoplantar Warts: A Randomized Controlled Trial.

Background: Warts are benign epidermal proliferations, caused by infection of keratinocytes with human papillomavirus (HPV). Auto implantation and intralesional mumps, measles, and rubella (MMR) vaccine are novel methods of immunotherapy for treating periungual and palmoplantar warts. They act by stimulating the patient's immune system; this clears not only the local warts but also distant warts with lesser side effects. Objective: We conducted this study to compare the efficacy and safety of both methods in treating periungual and palmoplantar warts. Materials and Methods: A total of 160 patients were randomly allocated into two groups of 80 patients. Group A was treated with 0.3 mL of intralesional MMR vaccine at an interval of 3 weeks or for a maximum of three sittings, and Group B was treated with auto implantation. Results: At the end of therapy, the result was better in group A (MMR vaccine) as 86% of cases yielded an excellent response as compared to 71% in group B (auto implantation). The recurrence rate was 5% in group A and 4% in group B. There were no serious side effects in both groups with pain during injection (70%) in group A and swelling at the recipient site (8%) in group B being the most common side effect. Conclusion: Both MMR and auto implantation had significant response rates. But MMR was faster and better.

Rubella seroprevalence among unvaccinated school-aged children in Jos, North Central, Nigeria.

Introduction: rubella poses a significant public health threat, particularly in developing countries, where congenital rubella remains a preventable concern. This cross-sectional study examined rubella seroprevalence among children aged 10 and under from May to September 2016 in Jos, Nigeria. Methods: using a multistage sampling method, eligible participants who had not been vaccinated against the rubella virus and consented to participate in the study were recruited across schools in the city. Rubella-specific IgG and IgM antibodies were detected from eluted serum collected from the participants using the enzyme-linked immunosorbent assay (ELISA). Data analysis and visualization was done using the R software version 4.3.1. Results: of the 405 participants investigated in this study, 336 (82.96%) tested positive for rubella IgG, while 9 (2.22%) tested positive for rubella IgM. Factors such as age ≥ 5 years and lack of Western education showed significant associations with rubella seropositivity. Conclusion: this study highlights the seroprevalence of rubella IgG and IgM antibodies among children aged 10 and under in Jos, Nigeria. The significant associations between rubella seropositivity and factors such as age ≥ 5 years and lack of Western education underscore the necessity for an effective rubella vaccination program to prevent congenital rubella syndrome (CRS).

Rubella epidemiology in Lesotho after vaccine introduction: a five-year review, 2018-2022.

BACKGROUND: The rubella virus is a major contributor to birth defects globally and is preventable by vaccination. In 2020, the world was supposed to be free of both rubella and Congenital Rubella Syndrome (CRS) however this goal has yet to be realized with only 93 out of 194 WHO member states confirmed rubella-free in 2020. METHODS: A retrospective measles and rubella case-based surveillance data record review was conducted from 2018 to 2022 to document rubella epidemiology after the introduction of rubella vaccination in Lesotho and progress toward elimination. All samples submitted for surveillance purposes and tested for rubella were considered but only filtered according to inclusion and exclusion criteria. Descriptive statistics were used to analyse the data. RESULTS: Of the 1041 samples that were tested for rubella between 2018 and 2022, 10 (1%) were confirmed measles positive and were excluded from further analysis. The median age of the respondents was 6.0 (IQR 4.0-8.0.) years. About 643 (62.4%) of respondents were in the age category of 5 - <13 years. Rubella prevalence was 1% (95% CI; 0.5 -1.8%). The non-measles, non-rubella rash illness rate of 2 per 100 000 population was obtained at the national level each year of the study period but by only 2 of the country's 10 districts in 2021. CONCLUSIONS: The study showed low rubella prevalence. Rubella infection was predominant in those aged 5 - < 13 years. Failure to meet surveillance targets at certain time points during the study period may have led to an underestimation of rubella cases. There is a need to improve the quality of measles and rubella surveillance in Lesotho. Supplementary immunization activities would also be useful in closing immunity gaps, limiting outbreaks, and advancing rubella and CRS elimination in Lesotho.

Report from the World Health Organization's immunization and vaccines-related implementation research advisory committee (IVIR-AC) ad hoc meeting, 28 June - 1 July 2024.

The World Health Organization's Immunization and Vaccines-related Implementation Research Advisory Committee (IVIR-AC) serves to independently review and evaluate vaccine-related research to maximize the potential impact of vaccination programs. From 28 June - 1 July 2024, IVIR-AC was convened for an ad hoc meeting to discuss new evidence on criteria for rubella vaccine introduction and the risk of congenital rubella syndrome. This report summarizes background information on rubella virus transmission and the burden of congenital rubella syndrome, meeting structure and presentations, proceedings, and recommendations.

Estimates of Potential Demand for Measles and Rubella Microarray Patches.

Global measles vaccine coverage has stagnated at approximately 85% for over a decade. By simplifying vaccine logistics and administration, the measles and rubella microarray patch (MR-MAP) may improve coverage. Clinical trials have demonstrated similar safety and immunogenicity in 9-month-old infants for MR-MAPs compared with syringe-and-needle vaccination. To aid commercialization, we present estimates of MR-MAP demand. We created a spreadsheet-based tool to estimate demand for MR-MAPs using data from 180 WHO countries during 2000-2016. Five immunization scenarios were analyzed: (1a) Supplementary Immunization Activities (SIAs) in Gavi, the Vaccine Alliance (Gavi)-eligible countries and (1b) WHO countries where preventive SIAs are routinely conducted; (2) SIAs and outbreak response immunization in all WHO countries; (3) routine immunization (RI) and SIAs in six high-burden measles countries (the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, and Pakistan); (4) RI and SIAs in six high-burden countries and Gavi-eligible countries; and (5) hard-to-reach populations. MR-MAP demand varied greatly across scenarios. Forecasts for 2025-2034 estimate from 137 million doses in hard-to-reach populations (scenario 5) to 2.587 billion doses for RI and SIAs in six high-burden countries and Gavi-eligible countries (scenario 4). When policymakers and manufacturers assess MR-MAP demand, they may consider multiple scenarios to allow for a complete consideration of potential markets and public health needs.

Exploring Important Attributes, the Potential Use Cases and Feasibility of Introduction of Measles and Rubella Microarray Patches (MR-MAPs): Insights from Nine Countries.

Background: Microarray patches (MAPs) are innovative, needle-free vaccine delivery systems, suitable for administration by minimally trained health care workers or trained community health workers. Their introduction may transform immunization programmes, particularly for vaccines where high coverage is required for population immunity, such as measles, and where vaccine delivery is challenging, such as in low- and middle-income countries. Recognizing the need to understand how best to tailor these products to reflect country priorities, workshops on measles and rubella MAPs (MR-MAPs) were conducted in multiple regions to collect insights on needs and preferences from relevant stakeholders at country level. Methods: The CAPACITI Innovation Framework was used to structure stakeholder discussions in nine countries in the period from August 2022 to July 2023. The discussions, building on the findings from a situation analysis on the barriers related to measles and rubella vaccine delivery, followed the four-step process outlined in the framework. Results: Key barriers hindering delivery of measles and rubella vaccines across the countries were in the categories of human resource management, service delivery, and demand generation. MR-MAP attributes that stakeholders believed would reduce or eliminate these barriers included ease of preparation and administration, improved thermostability, fewer (ancillary) components, and single-dose presentation. Some attributes such as the site of administration, wear time, and storage volume could exacerbate certain barriers. Based on an understanding of key barriers, product attributes, and underserved populations, stakeholders identified several potential use cases for MR-MAPs: (i) delivery at a fixed health post, (ii) delivery through outreach sessions conducted by health workers, and (iii) administration by community health workers. To enable robust national decision making about the introduction of MR-MAPs and successful implementation, global and national evidence on feasibility and acceptability of MR-MAPs should be generated. To prepare for the potential introduction of MR-MAPs, immunization programmes should evaluate their immunization policies based on their preferred use cases and modify them if needed, for example, to enable community health workers to administer vaccines, along with making programmatic adjustments to waste management and training. Conclusions: MR-MAPs have the potential to reduce key barriers to MR delivery. Yet, their future impact depends on the ability of global stakeholders to steer the development of MR-MAPs to be responsive to country needs and preferences. The generation of evidence to enable robust decision making, timely modification of vaccine policies, and addressing programmatic considerations will be key to successful uptake.

Care of children with congenital rubella syndrome (CRS) in Indonesia.

INTRODUCTION: Congenital rubella syndrome (CRS) is associated with severe birth defects, that lead to disability in later life. Hence, early detection and intervention are needed to prevent permanent disability and mortality in children with CRS. We evaluated the time to diagnosis or correction intervention related to survival rate using survival analysis. METHODOLOGY: A retrospective cohort study was conducted to evaluate the follow-up of CRS-confirmed cases from 2011-2018 at a national referral hospital in Jakarta, Indonesia. Parents of eligible children who registered in the national CRS registry as laboratory-confirmed CRS cases were contacted through phone calls or home visits and interviewed about the current situation of their child's health. We also obtained clinical data from the medical records. RESULTS: Fifty children, age 4 to 14 years, identified with laboratory-confirmed CRS were included in this study. Half (54%) of these children were female. All were born from mothers with no previous rubella vaccination history. Ophthalmic abnormalities such as congenital cataracts (88%) were the most common birth defect. Multiple congenital abnormalities including congenital heart disease, ocular abnormalities, and auditory defects were identified in 52% of the children. Based on Kaplan-Meier analysis, 50% of children were diagnosed at four months. Ophthalmic corrections such as cataract surgery were performed earlier than heart or auditory correction, with 50% of children undergoing eye correction one month after the diagnosis. CONCLUSIONS: There is a vital need to implement CRS surveillance in Indonesia to know the burden of CRS and reinforce the preventive actions, including vaccination against rubella.

On the Path to Measles and Rubella Elimination Following Rubella-Containing Vaccine Introduction, 2000-2023, Namibia.

INTRODUCTION: The WHO Measles and Rubella Strategic Framework 2021-2030 within the Immunization Agenda 2030 includes both measles and rubella elimination goals and provides guidance to countries for planning and implementing the measles and rubella elimination strategies. Namibia has been implementing measles elimination strategies since 1997. METHODS: We reviewed and described the implementation of measles and rubella elimination strategies and the programmatic and epidemiological situation in Namibia during 2000-2023. Namibia introduced a rubella-containing vaccine (RCV) in 2016 as a combined measles-rubella (MR) vaccine using a MR catch-up campaign, targeting a wide age range based on detailed analysis and triangulation of multiple key data sources including MR vaccination coverage, MR case-based surveillance, detailed measles outbreak investigations, and serosurveys. RESULTS: In 2020, estimated MCV1 coverage in Namibia reached 90% and has been sustained at 91% in 2021 and 2022. MCV2 was introduced in 2016, and the estimated MCV2 coverage has steadily increased to 79% in 2022. Following the MCV2 introduction and the implementation of the wide age range MR catch-up campaign in 2016, annual measles and rubella incidence decreased substantially. During 2017-2023, the period following the implementation of the catch-up MR vaccination SIA in 2016, average annual measles incidence per million population in Namibia decreased by 97% from the average during 2010-2016. Similarly, the average annual rubella incidence decreased by 95% from 2010-2016 to 2017-2023. DISCUSSION: Successful implementation of the 2016 wide age range campaign and maintaining high routine immunization coverage likely led to the significant reduction in measles and rubella incidence in Namibia. To sustain the reduction in measles and rubella incidence and attain the elimination targets, Namibia needs to attain and maintain high routine immunization coverage with both doses of the MR vaccine and implement timely and high-quality periodic MR follow-up SIAs. High-quality elimination-standard measles and rubella surveillance will help guide strategies and serve as the basis for the eventual verification of measles and rubella elimination in Namibia according to the WHO-recommended framework.

Computational Analysis of a Marine-Derived Drug From Rhizophora mucronata Against the Capsid Protein of Rubella Virus.

Background Rubella, commonly known as German measles, is caused by a single-stranded RNA genome. Vaccination is currently the most effective method for preventing rubella and its complications. Molecular docking, a computer-based technique used in drug discovery and development, is used to investigate the interactions between potential drug candidates and their target proteins. It predicts the binding interactions between small molecules (ligands) and the target protein. In this study, we examined a marine-derived drug from Rhizophora mucronata for its potential antiviral properties against the rubella capsid virus. Our objective was to identify the active inhibitory sites of the capsid virus. Materials and methods Protein and ligand molecules were retrieved from Protein Data Bank (PDB) and PubChem databases. The Lamarckian genetic algorithm was used to calculate molecular docking using Autodock Tools 1.5.7. The docking parameters used for each docked molecule were determined from 100 separate docking experiments with a maximum of 2.5×10-6 energy and a mutation rate of 2.0 and mass over ratio of 0.8. The results were recorded as docking parameter files (DPF). PyMOL was used to view and investigate the interactions between ligand fragments and rubella capsid protein. Results This approach plays a crucial role in the development of structure-based drugs. The results of the molecular docking suggest that Rhizophorin has the potential to bind with the rubella capsid protein. The strong binding affinity of -6.05 kcal/mol between the ligand and the protein further supports the potential of Rhizophorin as a therapeutic agent. The formation of hydrogen bonds between the ligand and amino acid residues Glu79, Arg82, and Thr118 indicates the significance of electrostatic interactions in the binding process. Furthermore, the hydrophobic interactions between the ligand and residues Ala81, Val84, Leu87, and Ile119 suggest the role of non-polar interactions in stabilizing the complex. The identified amino acid residues involved in these binding interactions could serve as potential targets for drug development. In future studies, experimental validation of the predicted interactions could provide further insights into the potential of Rhizophorin as an antiviral agent. Conclusion According to the findings of this study, the in silico investigation successfully identified a target for inhibiting the rubella virus (RuV) capsid receptor molecule. Future investigations on these compounds will require in vitro and in vivo studies using models that are more relevant to the medicinal potential of the capsid protein molecule.

Building Quality Control for Molecular Assays in the Global Measles and Rubella Laboratory Network.

More than 100 laboratories in the World Health Organization Global Measles and Rubella Laboratory Network (GMRLN) perform nucleic acid-based methods for case confirmation of measles or rubella infections and/or strain surveillance (genotyping). The quality of laboratory data is critical to ensure that diagnostic results and country reports to regional verification committees are based on accurate data. A molecular External Quality Assurance (mEQA) program was initiated by the US-CDC in 2014 to evaluate the performance of laboratories in the network. The inclusion of testing for measles and rubella viruses, with a focus on detection and genotyping, plus the diversity of assays and platforms employed required a flexible and comprehensive proficiency testing program. A stepwise introduction of new evaluation criteria gradually increased the stringency of the proficiency testing program, while giving laboratories time to implement the required changes. The mEQA program plays an important role in many processes in the GMRLN, including informing plans for the training of laboratory staff, access to reagents, and the submission of sequence data to global databases. The EQA program for Local Public Health Institutes in Japan is described as an example for national mEQA programs. As more laboratories initiate molecular testing, the mEQA will need to continue to expand and to adapt to the changing landscape for molecular testing.

A Serological Survey of Measles and Rubella Antibodies among Different Age Groups in Eastern China.

BACKGROUND: Measles and rubella are vaccine-preventable diseases targeted for elimination in most World Health Organization regions, and China is considered to have momentum towards measles elimination. Therefore, this study aimed to assess the population immunity levels against measles and rubella in Zhejiang Province in China in order to provide valuable insights for informing future public health measures and contributing to the ongoing global campaign against these diseases. MATERIALS AND METHODS: A cross-sectional serological survey was conducted in 2022. A total of 2740 blood samples were collected from healthy individuals spanning the age range of 0-59 years, representing diverse demographic strata across 11 prefectures in Zhejiang Province in China. The sera were tested for measles and rubella IgG antibodies to determine positivity rates and geometric mean concentrations (GMCs). RESULTS: The overall positivity rate for the measles IgG antibody was 85.3%, with a GMC of 588.30 mIU/mL. The positivity rate for the rubella IgG antibody was 70.9%, and the GMC was 35.30 IU/mL. Measles IgG antibody positivity rates across the 0-11 months, 12-23 months, 24-35 months, 3-5 years, 6-9 years, 10-14 years, 15-19 years, 20-29 years, and 30-59 years age groups were 63.1%, 92.5%, 97.0%, 94.0%, 85.8%, 77.3%, 86.9%, 84.9%, and 88.7%, respectively (trend χ2 = 118.34, p < 0.001). Correspondingly, rubella antibody positivity rates for these same age brackets were 55.9%, 87.9%, 94.7%, 88.2%, 69.9%, 54.2%, 72.6%, 67.5%, and 74.3% (trend χ2 = 199.18, p < 0.001). Both univariate and multivariate analyses consistently demonstrated that age, immunization history, and differing economic levels were significant factors contributing to variations in antibody levels. CONCLUSIONS: The seroprevalence of measles and rubella was lower than that required for herd immunity. Periodic vaccination campaigns should be launched to increase immunity.

Using Regular High-Quality Serosurveys to Identify and Close National Immunity Gaps-Measles and Rubella Elimination in Japan.

In Japan, periodic measles outbreaks occurred mainly among young children under the routine immunization program with one dose of the measles-containing vaccine (MCV). A second dose of MCV was introduced in 2006. During a nationwide measles resurgence in 2007-2008, the most affected age group was teenagers. The national serological surveillance for vaccine-preventable diseases made it clear that there was a measles immunity gap among teenagers who had not received a second dose of MCV. To fill this immunity gap, nationwide non-selective supplementary immunization activities (SIAs) were carried out as a five-year program from April 2008 to March 2013 by providing an opportunity to be vaccinated with the measles and rubella vaccine during the first year of junior high school (12-13 years old) and the last year of high school (17-18 years old). The SIA was conducted with the strong involvement of local governments in charge of vaccination delivery and collaboration between the health and education sectors. Japan was verified as achieving measles elimination in 2015 and this has been sustained to date. The challenge of rubella elimination following a similar strategy of a serological diagnosis of an immunity gap and targeted vaccination is also discussed.

The Global Measles and Rubella Laboratory Network Supports High-Quality Surveillance.

With 762 laboratories, the Global Measles and Rubella Laboratory Network (GMRLN) is the largest laboratory network coordinated by the World Health Organization (WHO). Like the Global Polio Laboratory Network, the GMRLN has multiple tiers, including global specialized laboratories, regional reference laboratories, national laboratories, and, in some countries, subnational laboratories. Regional networks are supervised by regional laboratory coordinators reporting to a global coordinator at WHO headquarters. Laboratories in the GMRLN have strong links to national disease control and vaccination programs. The GMRLN's goal is to support member states in obtaining timely, complete, and reliable laboratory-based surveillance data for measles and rubella as part of the strategy for achieving measles and rubella elimination. Surveillance data are reported to the national program and are included in annual reports on the status of measles and rubella elimination to national verification committees for review by regional verification commissions. Quality within the GMRLN is ensured by monitoring performance through external quality assurance programs, confirmatory and quality control testing, accreditation, and coordination of corrective action and training where needed. The overall performance of the laboratories has remained high over the years despite many challenges, particularly the COVID-19 pandemic. The GMRLN is well-positioned to support high-quality laboratory-based surveillance for measles and rubella and to transition to supporting laboratory testing for other pathogens, including vaccine-preventable diseases.