Boletim Sarampo nº 18 - 2024

O Sarampo é uma doença viral aguda, infectocontagiosa, altamente transmissível que atinge com mais severidade populações de baixo nível socioeconômico.

Boletim Sarampo nº 19 - 2024

O Sarampo é uma doença viral aguda, infectocontagiosa, altamente transmissível que atinge com mais severidade populações de baixo nível socioeconômico.

Hospital-acquired infections and unvaccinated children due to chronic diseases: an investigation of the 2017-2019 measles outbreak in the northern region of Vietnam.

BACKGROUND: Measles remains a major public health burden worldwide. Parents often hesitate to vaccinate children with chronic diseases. We investigated the association between the percentage of vaccination and chronic diseases and explore hospital infections' role in the 2017-2019 measles outbreak across northern Vietnam provinces. METHODS: A total of 2,064 children aged 0-15 years old admitted for measles to the National Children's Hospital during the outbreak were included in the study. Demographic information, clinical characteristics, vaccination statuses and laboratory examination were extracted from electronic medical records, vaccination records, or interviews with parents when other sources were unavailable. RESULTS: The incidence rate that provincial hospitals sent to the National Children's Hospital was proportional to the population density of their provinces of residence. Early nosocomial transmission of measles was observed before community-acquired cases emerged in many provinces. Among patients aged over 18 months, those with chronic diseases had a proportion of vaccination of 9.4%, lower than patients without chronic diseases at 32.4%. Unvaccinated patients had a higher proportion of hospital-acquired infections with aOR = 2.42 (1.65-3.65), p < 0.001 relative to vaccinated patients. The proportion of hospital-acquired infections was higher among children with chronic diseases compared to those without, with aOR = 3.81 (2.90-5.02), p < 0.001. CONCLUSION: Measles spread in healthcare settings prior to community cases that occurred in several provinces. We recommend enhancing hospital infection control by increasing staff training and improving early detection and isolation during non-outbreak periods. Measles patients with chronic diseases exhibited lower proportions of vaccination and faced a higher risk of hospital-acquired infections. It is crucial to establish comprehensive vaccination guidelines and enhance parental awareness regarding the significance and safety of measles vaccination to protect these vulnerable individuals.

Assessing the impact of COVID-19 non-pharmaceutical interventions and relaxation policies on Class B respiratory infectious diseases transmission in China.

This study investigates the incidence of Class B respiratory infectious diseases (RIDs) in China under the Coronavirus disease 2019 (COVID-19) epidemic and examines variations post-epidemic, following the relaxation of non-pharmaceutical interventions (NPIs). Two-stage evaluation was used in our study. In the first stage evaluation, we established counterfactual models for the pre-COVID-19 period to estimate expected incidences of Class B RIDs without the onset of the epidemic. In the second stage evaluation, we constructed seasonal autoregressive integrated moving average intervention (SARIMA-Intervention) models to evaluate the impact on the Class B RIDs after NPIs aimed at COVID-19 pandemic were relaxed. The counterfactual model in the first stage evaluation suggested average annual increases of 10.015%, 78.019%, 70.439%, and 67.799% for tuberculosis, scarlet fever, measles, and pertussis respectively, had the epidemic not occurred. In the second stage evaluation, the total relative reduction in 2023 of tuberculosis, scarlet fever, measles and pertussis were - 35.209%, - 59.184%, - 4.481%, and - 9.943% respectively. The actual incidence declined significantly in the first stage evaluation. However, the results of the second stage evaluation indicated that a rebound occurred in four Class B RIDs after the relaxation of NPIs; all of these showed a negative total relative reduction rate.

Immunological landscape of human lymphoid explants during measles virus infection.

In humans, lymph nodes are the primary site of measles virus (MeV) replication. To understand the immunological events that occur at this site, we infected human lymphoid tissue explants using a pathogenic strain of MeV that expresses GFP. We found that MeV infected 5%-15% of cells across donors. Using single-cell RNA-Seq and flow cytometry, we found that while most of the 29 cell populations identified in the lymphoid culture were susceptible to MeV, there was a broad preferential infection of B cells and reduced infection of T cells. Further subsetting of T cells revealed that this reduction may be driven by the decreased infection of naive T cells. Transcriptional changes in infected B cells were dominated by an interferon-stimulated gene (ISG) signature. To determine which of these ISGs were most substantial, we evaluated the proteome of MeV-infected Raji cells by mass spectrometry. We found that IFIT1, IFIT2, IFIT3, ISG15, CXCL10, MX2, and XAF1 proteins were the most highly induced and positively correlated with their expression in the transcriptome. These data provide insight into the immunological events that occur in lymph nodes during infection and may lead to the development of therapeutic interventions.

[Analysis of serum IgM antibody and viral nucleic acid test results in measles and rubella cases in China from 2014 to 2023].

Objective: To analyze the results of serum IgM antibody and viral nucleic acid testing in measles and rubella cases in China from 2014 to 2023. Methods: Surveillance data on measles and rubella during 2014-2023 were obtained from the Chinese Disease Prevention and Control Information System, and cases that underwent measles/rubella IgM antibody testing and viral nucleic acid testing were included in the study. Information on the number of cases, vaccination status, and laboratory test results was collected, and laboratory test results were compared among cases with different times of rash or onset and different doses of vaccination. Results: From 2014 to 2023, the total number of measles and rubella surveillance cases was 581 746, and the number of measles and rubella cases that underwent both IgM antibody and viral nucleic acid testing was 39 124 and 21 766, respectively, with a double-positive rate of IgM antibody and viral nucleic acid testing of 63.73% (for measles) and 41.68% (for rubella). The single-positive rate for IgM antibody was 21.12% (for measles) and 27.15% (for rubella). The single-positive rate for viral nucleic acid tests was 13.84% (for measles) and 28.19% (for rubella). According to different days of rash or onset (0-3, 4-5, 6-10 and >10), samples of 24 629 (62.95%) measles cases and 15 785 (72.52%) rubella cases were from within 3 days of rash or onset, and the single positive rate of viral nucleic acid detection was 16.90% (for measles) and 32.07% (for rubella). The single positive rate of IgM antibody increased gradually with the time of onset (measles: χ2trend=314.098, P<0.001, rubella: χ2trend=763.846, P<0.001), and reached 31.66% (for measles) and 53.12% (for rubella) after 10 days of rash or onset. Depending on the number of vaccination doses (1, 2,≥3), the single positive rate of viral nucleic acid detection ranged from 12.93% to 20.29% (for measles) and from 25.30% to 27.88% (for rubella). The single positive rate of IgM antibody detection ranged from 36.89% to 47.47% (for measles) and from 22.81 to 41.15% (for rubella). Conclusions: Combined testing of serum IgM antibody and viral nucleic acids could facilitate laboratory confirmation of measles and rubella cases and was also important for measles and rubella elimination efforts.

Spatio-temporal modeling of co-dynamics of smallpox, measles, and pertussis in pre-healthcare Finland.

Infections are known to interact as previous infections may have an effect on risk of succumbing to a new infection. The co-dynamics can be mediated by immunosuppression or modulation, shared environmental or climatic drivers, or competition for susceptible hosts. Research and statistical methods in epidemiology often concentrate on large pooled datasets, or high quality data from cities, leaving rural areas underrepresented in literature. Data considering rural populations are typically sparse and scarce, especially in the case of historical data sources, which may introduce considerable methodological challenges. In order to overcome many obstacles due to such data, we present a general Bayesian spatio-temporal model for disease co-dynamics. Applying the proposed model on historical (1820-1850) Finnish parish register data, we study the spread of infectious diseases in pre-healthcare Finland. We observe that measles, pertussis, and smallpox exhibit positively correlated dynamics, which could be attributed to immunosuppressive effects or, for example, the general weakening of the population due to recurring infections or poor nutritional conditions.

Measles in the Modern Era: A Review.

Measles is a viral illness considered eliminated in the United States; however, outbreaks still occur even in this modern era where vaccines are readily available for every child under government-sponsored financing programs. The most recent measles outbreak was reported in March 2024 in Chicago, Illinois. Many of these patients were children younger than age 5 years with unvaccinated or unknown vaccine status, and this outbreak was associated with a migrant shelter. Measles bears a resemblance to other exanthemic diseases of childhood. In populations where there is high vaccine coverage, measles is less likely to be in the differential diagnosis for most physicians; however, cases of vaccine failure have been described, and populations have risk factors for developing complications associated with measles. Therefore, this quick review aims to describe an illustrative case, followed by epidemiology, clinical manifestations, complications, diagnosis, and vaccines associated with measles. By the end of this article, clinicians should be able to recognize a potential measles case, select the most appropriate test to confirm the diagnosis, and thus, prevent the spreading of this highly contagious disease. [Pediatr Ann. 2024;53(9):e345-e350.].

Multifaceted activation of STING axis upon Nipah and measles virus-induced syncytia formation.

Activation of the DNA-sensing STING axis by RNA viruses plays a role in antiviral response through mechanisms that remain poorly understood. Here, we show that the STING pathway regulates Nipah virus (NiV) replication in vivo in mice. Moreover, we demonstrate that following both NiV and measles virus (MeV) infection, IFNγ-inducible protein 16 (IFI16), an alternative DNA sensor in addition to cGAS, induces the activation of STING, leading to the phosphorylation of NF-κB p65 and the production of IFNß and interleukin 6. Finally, we found that paramyxovirus-induced syncytia formation is responsible for loss of mitochondrial membrane potential and leakage of mitochondrial DNA in the cytoplasm, the latter of which is further detected by both cGAS and IFI16. These results contribute to improve our understanding about NiV and MeV immunopathogenesis and provide potential paths for alternative therapeutic strategies.

Epidemiology of measles outbreaks, incidence and associated risk factors in Ethiopia from 2000 to 2023: a systematic review and meta-analysis.

BACKGROUND: Although a universal vaccine is available and Ethiopia is working outstandingly towards measles elimination, a recurrent measles outbreak has occurred each year in different parts of the country. Therefore, understanding the epidemiology of measles cases, the incidence of confirmed measles virus cases and related risk factors is crucial. Here, we conducted a systematic review and meta-analysis to summarize information regarding the epidemiology, measles incidence rate and risk factors for national measles infections occurring in the past two decades, from 2000 to 2023. METHODS: Data from electronic databases, including PubMed, African Journal Online, WHO databases and Google Scholars, were searched to identify studies describing measles outbreaks, incidence rates and associated factors in Ethiopia that occurred between 2000 and 2023. Important basic information was extracted in an Excel spreadsheet and imported into Comprehensive Meta-analysis Software version 3 to evaluate the associations between measles outbreaks and different risk factors. We pooled the odds ratios (ORs) and 95% confidence intervals (CIs) for every included risk factor to evaluate the associations with measles outbreaks. RESULTS: We included 36 studies involving 132,502 patients with confirmed measles cases in Ethiopia. The results of this systematic review and meta-analysis revealed that measles outbreaks were more frequently reported in the Oromia region (73,310 (33.1%)), followed by the Southern Nation Nationalities of Ethiopia region (29,057 (13.4%)). The overall pooled analysis indicated that the prevalence of measles susceptibility was 67.5% (95% CI: 67.3-67.8%), with an I2 of 99.86% and a p value for heterogeneity < 0.0001. The non-vaccinated status of the children, their contact history with measles cases, their travel history, the presence of cases in family or neighbors, and malnourished patients were identified as factors associated with the high prevalence and recurrent measles infections in Ethiopia. CONCLUSION: The results of this systematic review and meta-analysis indicated that the pooled prevalence of measles infection was high, which is a public health concern in Ethiopia. Thus, strengthening healthcare services, regular vaccination campaigns, and the integration of health education activities with other services may decrease the incidence rate.

Protocolo para o uso da ferramenta de monitoramento do Programa Ampliado de Imunização nacional

Nos últimos 10 anos, a cobertura de vacinação contra todas as doenças diminuiu na Região das Américas. Mais recentemente, como consequência da pandemia de COVID-19, o declínio acelerou para uma cobertura preocupante de 80% com a terceira dose da vacina contra difteria, coqueluche e tétano (DTP3) e a terceira dose da vacina contra poliomielite para cada uma dessas vacinas em 2021. Essas são as estimativas de cobertura mais baixas na Região desde a erradicação da poliomielite nas Américas em 1994. Da mesma forma, os indicadores de qualidade para a vigilância de doenças evitáveis por vacinação (VDPDs), como poliomielite, sarampo e rubéola, também foram afetados. As notificações de paralisia flácida aguda (PFA) e erupção cutânea diminuíram em praticamente todos os países em 2020 e 2021. Considerando as tendências na cobertura e vigilância de VPE em conjunto com a situação global, é importante concentrar esforços para revitalizar os programas de imunização da Região e garantir sua melhoria contínua. Em julho de 2021, o Grupo Técnico Assessor (GTA) da OPAS sobre VPE fez um forte apelo por ações efetivas para melhorar o desempenho dos serviços de imunização na Região. No início deste ano, o 59º Conselho Diretor da OPAS aprovou a política “Revitalização da imunização como um bem público para a saúde universal”, que estabelece o roteiro estratégico para o Programa Ampliado de Imunização (PAI) da Região para os próximos anos, alinhado com a Agenda 2030 para Imunização (AI2030). A região enfrenta grandes desafios na área de imunização. Portanto, é necessário examinar o desempenho dos programas de imunização, analisar as razões por trás das quedas na cobertura observadas nos últimos 10 anos e procurar integrar efetivamente as operações de vacinação de resposta à pandemia e a vacinação regular do programa.

Directiva sanitaria que establece las disposiciones para el barrido contra el sarampión y la poliomielitis - 2024. Directiva sanitaria N° 160-MINSA/DGIESP-2024 / Health directive establishing provisions for sweeping against measles and polio - 2024. Health Directive No. 160-MINSA/DGIESP-2024

El documento contiene las disposiciones necesarias para el barrido contra el sarampión y la poliomielitis en el país en el año 2024.

Epidemic in the time of the COVID-19 pandemic: News media framing of the MMR vaccination controversy in Serbia.

Rising vaccine hesitancy is often related to negative vaccination media coverage. It is generally accepted that the media played a great role in spreading the MMR (measles, mumps, and rubella) childhood vaccination scare first in the UK and then worldwide. During the COVID-19 pandemic, the MMR vaccination rate dropped further in some countries. This paper examines the Serbian news media framing of the MMR vaccination controversy in the period 2019-2023 (periods of declining MMR vaccination rate, rising COVID-19 vaccine hesitancy and the 2023 measles outbreaks). Furthermore, the paper questions whether the COVID-19 pandemic influenced the MMR vaccine narrative in the newspapers. For this reason, quality content analysis of the press in combination with framing approaches (diagnostic-prognostic-motivational framing tasks and responsibility framing) were used. In total, 122 articles dealing with the MMR vaccine and measles epidemics were analysed. According to the press, the most significant cause of the declining MMR rate is anti-vaccination campaigns and conspiracy theories by the "anti-vax lobby" (diagnostic frames). The pandemic was the other significant cause for the intake drop. Achieving herd immunity through vaccine uptake is offered as the best solution (prognostic frames). Finally, MMR vaccination campaigns and penalties for non-compliant parents and vaccine refusers are proposed as calls to action (motivational frames). During this period, the press did not publish any "sensational anti-vax stories". Considering the low MMR vaccine numbers in Serbia in this period, positive media messages did not have a significant influence on improving the vaccination rate. Thus, I suggest that Serbian parents distrust vaccination information presented by the dominant news, including the advice of health experts.

Onward transmission of measles virus among vaccinated cases in a large community outbreak in Auckland, New Zealand, 2019.

BACKGROUND: Isolation of cases and quarantining of non-immune contacts are the mainstay of measles outbreak management in elimination settings. Serology testing of exposed contacts may not be feasible in large outbreaks; therefore, vaccination history is used as a proxy for determining immunity to measles and thus prevention of onward virus transmission. This study sought to investigate the risk of measles virus transmission from individuals with a history of one or two doses of measles-containing vaccine (MCV). METHODS:  Retrospective analysis of data from measles cases reported to Auckland Regional Public Health Service during the 2019 Auckland region measles outbreak. Vaccination history was verified using patient records and the New Zealand National Immunisation Register. Onward transmission was determined through case interviews and assessment of exposed contacts. RESULTS:  1451 measles cases were assessed as eligible for vaccination at the time of measles outbreak. Of these, 1015 (70.0%) were unvaccinated, 220 (15.2%) had unknown vaccination status, 139 (9.6%) had received only one dose of MCV and 77 (5.3%) had received two doses of the vaccine. Compared to unvaccinated cases, the odds of onward transmission were lower among those with one dose only (OR 0.41, 95% CI: 0.20-0.75) or two doses of MCV (OR 0.44, 95% CI: 0.17-0.95). Median time since vaccination was longer among those with onward transmission compared to those without onward transmission for one and two doses of the vaccine, suggesting a potential effect of waning immunity among this cohort. CONCLUSION:  These findings support the hypothesis that measles cases with a history of prior vaccination are less likely to transmit the virus to others compared to unvaccinated cases. Such information can be used to support decisions around quarantine requirements for vaccinated contacts in future measles outbreaks.

Measles Outbreak Investigation in Aneded District, Northwest Ethiopia: A Case-Control Study.

BACKGROUND: Between 2000 and 2018, global measles deaths decreased by 73%, but the disease remains prevalent in many developing countries, especially in Africa and Asia. Although Ethiopia was attempting to eliminate the measles, it still ranks fourth in the world in terms of the number of cases. The aim of the investigation was to describe the outbreak and identify its determinants in the Aneded district. METHODS: Between March 3, 2020, and April 2, 2020, the 89 patients and 178 controls participated in a case-control study. Data were gathered by means of in-person interviews with household leaders. The attack and case fatality rates were determined. In multivariable logistic regression analysis, variables having a p-value of less than 0.05 were considered statistically significant cut-off points. RESULTS: An investigation was conducted on a total of 89 measles cases, with 3 deaths and 178 controls. In total, there were 1.65 attacks per 1000 people, or 3.4% of the case fatality rate. There were 155 days of outbreak duration. The disease was significantly associated with being female [adjusted odds ratios (AOR) = 2.66; 95% confidence interval (CI) = 1.38-5.11], under 5 years old [AOR = 7.24; 95% CI = 2.58-20.31], positive in attitude [AOR = 0.22; 95% CI = 0.11-0.42], and having a contact history [AOR = 3.19; 95% CI = 1.67-6.10]. CONCLUSION: The measles outbreak, with its higher attack and case fatality rate, has been influenced by factors like household attitudes, age, sex, contact and travel history and needs to be reduced through early detection, active surveillance, and fostering favorable attitudes towards disease prevention and control.

Host WD repeat-containing protein 5 inhibits protein kinase R-mediated integrated stress response during measles virus infection.

Some negative-sense RNA viruses, including measles virus (MeV), share the characteristic that during their infection cycle, cytoplasmic inclusion bodies (IBs) are formed where components of the viral replication machinery are concentrated. As a foci of viral replication, how IBs act to enhance the efficiency of infection by affecting virus-host interactions remains an important topic of investigation. We previously established that upon MeV infection, the epigenetic host protein, WD repeat-containing protein 5 (WDR5), translocates to cytoplasmic viral IBs and facilitates MeV replication. We now show that WDR5 is recruited to IBs by forming a complex with IB-associated MeV phosphoprotein via a conserved binding motif located on the surface of WDR5. Furthermore, we provide evidence that WDR5 promotes viral replication by suppressing a major innate immune response pathway, the double-stranded RNA-mediated activation of protein kinase R and integrated stress response. IMPORTANCE: MeV is a pathogen that remains a global concern, with an estimated 9 million measles cases and 128,000 measles deaths in 2022 according to the World Health Organization. A large population of the world still has inadequate access to the effective vaccine against the exceptionally transmissible MeV. Measles disease is characterized by a high morbidity in children and in immunocompromised individuals. An important area of research for negative-sense RNA viruses, including MeV, is the characterization of the complex interactome between virus and host occurring at cytoplasmic IBs where viral replication occurs. Despite the progress made in understanding IB structures, little is known regarding the virus-host interactions within IBs and the role of these interactions in promoting viral replication and antagonizing host innate immunity. Herein we provide evidence suggesting a model by which MeV IBs utilize the host protein WDR5 to suppress the protein kinase R-integrated stress response pathway.