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1.
Internet resource in Portuguese | LIS -Health Information Locator | ID: lis-LISBR1.1-46933

ABSTRACT

Mais de 140 mil pessoas no mundo morreram em decorrência do sarampo em 2018, de acordo com novas estimativas da Organização Mundial da Saúde (OMS) e dos Centros para Controle e Prevenção de Doenças (CDC) dos Estados Unidos. Essas mortes ocorreram em um momento em que os casos de sarampo aumentaram globalmente, com surtos devastadores em todas as regiões.


Subject(s)
Measles , Measles/mortality
2.
Epidemiol Infect ; 147: e319, 2019 12 11.
Article in English | MEDLINE | ID: mdl-31822310

ABSTRACT

A large-scale measles outbreak (11 495 reported cases, 60% aged ≥15 years) occurred in Georgia during 2013-2015. A nationwide, multistage, stratified cluster serosurvey for hepatitis B and C among persons aged ≥18 years conducted in Georgia in late 2015 provided an opportunity to assess measles and rubella (MR) susceptibility after the outbreak. Residual specimens from 3125 participants aged 18-50 years were tested for Immunoglobulin G antibodies against MR using ELISA. Nationwide, 6.3% (95% CI 4.9%-7.6%) of the surveyed population were seronegative for measles and 8.6% (95% CI 7.1%-10.1%) were seronegative for rubella. Measles susceptibility was highest among 18-24 year-olds (10.1%) and declined with age to 1.2% among 45-50 year-olds (P < 0.01). Susceptibility to rubella was highest among 25-29 year-olds (15.3%), followed by 18-24 year-olds (11.6%) and 30-34 year-olds (10.2%), and declined to <5% among persons aged ≥35 years (P < 0.001). The susceptibility profiles in the present serosurvey were consistent with the epidemiology of recent MR cases and the history of the immunization programme. Measles susceptibility levels >10% among 18-24 year-olds in Georgia revealed continued risk for outbreaks among young adults. High susceptibility to rubella among 18-34 year-olds indicates a continuing risk for congenital rubella cases.


Subject(s)
Measles/epidemiology , Rubella/epidemiology , Adolescent , Adult , Disease Outbreaks , Disease Susceptibility , Female , Georgia (Republic)/epidemiology , Humans , Male , Measles/blood , Measles/diagnosis , Measles/prevention & control , Middle Aged , Rubella/blood , Rubella/diagnosis , Rubella/prevention & control , Seroepidemiologic Studies , Young Adult
3.
Inquiry ; 56: 46958019894098, 2019.
Article in English | MEDLINE | ID: mdl-31823676

ABSTRACT

Since 2018 and currently in 2019, the United States and Canada experienced a rapidly spreading measles virus outbreak. The developing outbreak may be due to a lack of vaccination, an inadequate dosage of measles (MMR) vaccine, clusters of intentionally under-vaccinated children, imported measles from global travel, and from those who are immunocompromised or have other life-threatening diseases. The infection originated mainly from travelers who acquired measles abroad and has thus led to a major outbreak and health concern not only in the United States and Canada but also in other parts of the world. According to World Health Organization, from January 2019 through September 2019, 1234 cases of measles have been reported in the United States and 91 reported cases in Canada, while in 2018, 372 and 28 cases were reported in the United States and Canada, respectively. A potential driving factor to the increased cases maybe because fewer children have been vaccinated over the last number of years in both countries. This article is a narrative review of cases discussing the measles outbreak among partially vaccinated and unvaccinated children and adults in the United States and Canada in 2018 and 2019.

5.
Am J Infect Control ; 2019 Dec 12.
Article in English | MEDLINE | ID: mdl-31839277

ABSTRACT

BACKGROUND: Patients with measles can precipitate outbreaks in health care facilities where they seek care. Rural critical-access hospitals (CAHs) may be at higher risk of outbreaks given their size and potentially limited infection prevention resources. METHODS: We surveyed CAHs in Idaho to ascertain their levels of preparedness for managing measles cases. A 25-item questionnaire was sent to infection preventionists at all 27 Idaho CAHs. The questionnaire covered organizational structure, resources for managing measles cases, and hospital policies for ensuring immunity among health care workers. RESULTS: A total of 22 (82%) CAHs responded, reporting varying availability of facilities and resources for managing measles cases and disparate procedures for testing clinical samples and providing vaccines to nonimmune, exposed staff. DISCUSSION: With measles incidence on the rise in the United States, our survey found that most of the responding hospitals had the basic organizational structure for facility-wide prevention and management efforts in case a patient with suspected or confirmed measles presented to that facility. Most of the hospitals also had at least some available resources to manage measles cases, as well as policies for ensuring immunity to measles among at least some groups of health care workers. CONCLUSIONS: This study provides initial perspectives on measles preparedness among Idaho CAHs, despite limited generalizability. Future studies should explore whether self-reported preparedness measures reflect the ability of the CAHs to control measles spread when cases present for care.

6.
JAMA Pediatr ; : e194515, 2019 Dec 09.
Article in English | MEDLINE | ID: mdl-31816033

ABSTRACT

Importance: The US population is experiencing a resurgence of measles, with more than 1000 cases during the first 6 months of 2019. Imported measles cases among returning international travelers are the source of most US measles outbreaks, and these importations can be reduced with pretravel measles-mumps-rubella (MMR) vaccination of pediatric travelers. Although it is estimated that children account for less than 10% of US international travelers, pediatric travelers account for 47% of all known measles importations. Objective: To examine clinical practice regarding MMR vaccination of pediatric international travelers and to identify reasons for nonvaccination of pediatric travelers identified as MMR eligible. Design, Setting, and Participants: This cross-sectional study of pediatric travelers (ages ≥6 months and <18 years) attending pretravel consultation at 29 sites associated with Global TravEpiNet (GTEN), a Centers for Disease Control and Prevention-supported consortium of clinical sites that provide pretravel consultations, was performed from January 1, 2009, through December 31, 2018. Main Outcomes and Measures: Measles-mumps-rubella vaccination among MMR vaccination-eligible pediatric travelers. Results: Of 14 602 pretravel consultations for pediatric international travelers, 2864 travelers (19.6%; 1475 [51.5%] males; 1389 [48.5%] females) were eligible to receive pretravel MMR vaccination at the time of the consultation: 365 of 398 infants aged 6 to 12 months (91.7%), 2161 of 3623 preschool-aged travelers aged 1 to 6 years (59.6%), and 338 of 10 581 school-aged travelers aged 6 to 18 years (3.2%). Of 2864 total MMR vaccination-eligible travelers, 1182 (41.3%) received the MMR vaccine and 1682 (58.7%) did not. The MMR vaccination-eligible travelers who did not receive vaccine included 161 of 365 infants (44.1%), 1222 of 2161 preschool-aged travelers (56.5%), and 299 of 338 school-aged travelers (88.5%). We observed a diversity of clinical practice at different GTEN sites. In multivariable analysis, MMR vaccination-eligible pediatric travelers were less likely to be vaccinated at the pretravel consultation if they were school-aged (model 1: odds ratio [OR], 0.32 [95% CI, 0.24-0.42; P < .001]; model 2: OR, 0.26 [95% CI, 0.14-0.47; P < .001]) or evaluated at specific GTEN sites (South: OR, 0.06 [95% CI, 0.01-0.52; P < .001]; West: OR, 0.10 [95% CI, 0.02-0.47; P < .001]). The most common reasons for nonvaccination were clinician decision not to administer MMR vaccine (621 of 1682 travelers [36.9%]) and guardian refusal (612 [36.4%]). Conclusions and Relevance: Although most infant and preschool-aged travelers evaluated at GTEN sites were eligible for pretravel MMR vaccination, only 41.3% were vaccinated during pretravel consultation, mostly because of clinician decision or guardian refusal. Strategies may be needed to improve MMR vaccination among pediatric travelers and to reduce measles importations and outbreaks in the United States.

7.
Med Sci Monit ; 25: 9245-9254, 2019 Dec 04.
Article in English | MEDLINE | ID: mdl-31800568

ABSTRACT

BACKGROUND Measles morbidity and mortality were significantly reduced after the measles vaccine was introduced in China in 1965. However, measles outbreaks easily occur in densely populated areas, especially where there is no universal vaccination. The outbreak that occurred in Shenzhen, the Chinese city with the largest internal immigration, provides a lesson in measles virus mutation and measles prevention. The present study is a phylogenetic analysis of measles viruses and comparison of clinical signs between individuals with and without vaccination. MATERIAL AND METHODS We performed phylogenetic analysis of the nucleoprotein (N) genes of measles virus from 129 measles patients in Shenzhen from January 2015 to July 2019. Phylogenetic trees were constructed using the neighbor-joining method. RESULTS The phylogenetic analysis showed all viruses were classified into genotype H1. In addition, there is often a seasonal measles outbreak in July each year. The clinical data showed that patients who were unvaccinated were more likely to have coughing, chronic bronchitis, conjunctivitis, catarrh, Koplik spots, and diarrhea. Children of migrant workers and those living in mountainous and rural districts accounted for most measles cases. CONCLUSIONS Our results showed there was a seasonal measles outbreak in Shenzhen Children's Hospital. All the measles virus from 129 measles patients were H1 viruses. The clinical signs also showed a difference between unvaccinated and vaccinated patients. Moreover, most of the unvaccinated patients came from migrant worker families. We suggest there is a need for increased health promotion and vaccination programs for migrant workers and people living in remote villages.


Subject(s)
Measles virus/genetics , Measles/epidemiology , Child , Child, Preschool , China/epidemiology , Disease Outbreaks , Female , Genotype , Humans , Immunoglobulin M , Infant , Infant, Newborn , Male , Measles Vaccine , Measles virus/pathogenicity , Nucleoproteins/genetics , Phylogeny , Vaccination , Viral Proteins/genetics
9.
MMWR Morb Mortal Wkly Rep ; 68(48): 1105-1111, 2019 Dec 06.
Article in English | MEDLINE | ID: mdl-31805033

ABSTRACT

In 2010, the World Health Assembly (WHA) set the following three milestones for measles control to be achieved by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district, 2) reduce global annual measles incidence to less than five cases per 1 million population, and 3) reduce global measles mortality by 95% from the 2000 estimate* (1). In 2012, WHA endorsed the Global Vaccine Action Plan,† with the objective of eliminating measles§ in five of the six World Health Organization (WHO) regions by 2020. This report updates a previous report (2) and describes progress toward WHA milestones and regional measles elimination during 2000-2018. During 2000-2018, estimated MCV1 coverage increased globally from 72% to 86%; annual reported measles incidence decreased 66%, from 145 to 49 cases per 1 million population; and annual estimated measles deaths decreased 73%, from 535,600 to 142,300. During 2000-2018, measles vaccination averted an estimated 23.2 million deaths. However, the number of measles cases in 2018 increased 167% globally compared with 2016, and estimated global measles mortality has increased since 2017. To continue progress toward the regional measles elimination targets, resource commitments are needed to strengthen routine immunization systems, close historical immunity gaps, and improve surveillance. To achieve measles elimination, all communities and countries need coordinated efforts aiming to reach ≥95% coverage with 2 doses of measles vaccine (3).


Subject(s)
Disease Eradication , Global Health/statistics & numerical data , Measles/prevention & control , Adolescent , Adult , Child , Child, Preschool , Humans , Immunization Programs , Incidence , Infant , Measles/epidemiology , Measles/mortality , Measles Vaccine/administration & dosage , Young Adult
10.
MMWR Morb Mortal Wkly Rep ; 68(48): 1112-1116, 2019 Dec 06.
Article in English | MEDLINE | ID: mdl-31805034

ABSTRACT

In 2005, the World Health Organization (WHO) Western Pacific Region countries, including China, resolved to eliminate measles by 2012 or as soon as feasible thereafter (1). As of 2018, nine* of the 37 Western Pacific Region countries or areas† had eliminated§ measles. China's Measles Elimination Action Plan 2006-2012 included strengthening routine immunization; conducting measles risk assessments, followed by supplementary immunization activities (SIAs) with measles-containing vaccine (MCV) at national and subnational levels; strengthening surveillance and laboratory capacity; and investigating and responding to measles outbreaks. Most recently, progress toward measles elimination in China was described in a 2014 report documenting measles elimination efforts in China during 2008-2012 and a resurgence in 2013 (2). This report describes progress toward measles elimination in China during January 2013-June 2019.¶ Measles incidence per million persons decreased from 20.4 in 2013 to 2.8 in 2018; reported measles-related deaths decreased from 32 in 2015 to one in 2018 and no deaths in 2019 through June. Measles elimination in China can be achieved through strengthening the immunization program's existing strategy by ensuring sufficient vaccine supply; continuing to improve laboratory-supported surveillance, outbreak investigation and response; strengthening school entry vaccination record checks; vaccinating students who do not have documentation of receipt of 2 doses of measles-rubella vaccine; and vaccinating health care professionals and other adults at risk for measles.


Subject(s)
Disease Eradication , Disease Outbreaks/prevention & control , Measles/prevention & control , Population Surveillance , Adolescent , Child , Child, Preschool , China/epidemiology , Disease Outbreaks/statistics & numerical data , Female , Humans , Immunization Programs , Incidence , Infant , Male , Measles/epidemiology , Measles/mortality , Measles Vaccine/administration & dosage
11.
Hum Vaccin Immunother ; : 1-9, 2019 Dec 10.
Article in English | MEDLINE | ID: mdl-31810408

ABSTRACT

Simultaneous administration of different vaccines is a strategy to increase the possibility to receive vaccines at appropriate age, safely and effectively, reducing the number of sessions and allowing a more acceptable integration of new vaccines into National Immunization Programs (NIPs). Co-administration can be performed when there are specific indications in the Summary of Product Characteristics (SmPC) of the vaccines; but, in absence of these indications, the practice is possible if there are no specific contraindications nor scientific evidence to discourage simultaneous administration.The aim of this work is to review the safety and efficacy of co-administration of the tetravalent measles, mumps, rubella, and varicella (MMRV) and the meningococcal C (Men C) conjugate vaccines after 12 months of age.Several studies demonstrated that MMRV and Men C conjugate vaccines can be administered concomitantly without a negative impact on the safety and immunogenicity of either vaccines, inducing highly immunogenic responses.

12.
Vaccines (Basel) ; 7(4)2019 Nov 28.
Article in English | MEDLINE | ID: mdl-31795157

ABSTRACT

Despite efforts to improve surveillance and vaccination coverage, measles virus (MeV) continues to cause outbreaks also in high-income countries. As the reference laboratory of the Veneto Region, Italy, we analyzed changes in population immunity, described measles outbreaks, investigated MeV genetic diversity, and evaluated cross-protection of measles vaccination against MeV epidemic strains. Like most European areas, the Veneto Region has suboptimal measles vaccination coverage and is facing a growing public mistrust of vaccination. A progressive decline of measles vaccine uptake was observed during the last decade in the Veneto Region, leading to immunity gaps in children and young adults. Measles outbreaks were caused by the same MeV genotype B3, D4, and D8 strains that were circulating in other European countries. Eleven cases of measles were observed in immunized subjects. These cases were not associated with particular MeV genotypes nor with mutations in epitopes recognized by neutralizing antibodies. Accordingly, sera from fully vaccinated subjects cross-neutralized epidemic MeV strains, including the genotypes B3, D4, and D8, with the same high efficiency demonstrated against the vaccine strain. In fully vaccinated subjects, high MeV IgG antibody titers persisted up to 30 years following vaccination. These results support the use of the current measles-containing vaccines and strategies to strengthen vaccination.

13.
BMJ Case Rep ; 12(12)2019 Dec 02.
Article in English | MEDLINE | ID: mdl-31796443

ABSTRACT

A 40-year-old British man presented to the emergency department for the second time in 10 days following a 2-week holiday in Thailand with malaise, bilateral conjunctivitis and a morbilliform rash. He had previously seen his general practitioner and ophthalmology and was diagnosed with conjunctivitis. We confirmed measles following RNA detection on a mouth swab. Four days after admission he developed abdominal pain and a CT abdomen demonstrated acute appendicitis with large appendicoliths. A perforated appendix was identified intraoperatively. Measles RNA was detected in the resected appendix. Preoperatively he developed hypoxia with right upper lobe changes seen on a CT pulmonary angiogram. Bronchoalveolar lavage performed in theatre isolated measles RNA at high level, consistent with measles pneumonitis. He required ventilatory support in the intensive care unit and was also treated with intravenous antibiotics. He made a complete recovery.


Subject(s)
Appendicitis/diagnosis , Measles/diagnosis , Pneumonia, Viral/etiology , Adult , Appendicitis/microbiology , Appendicitis/surgery , Appendicitis/virology , Contact Tracing/methods , Delayed Diagnosis , Humans , Male , Measles/complications , Measles/genetics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/therapy , Respiration, Artificial , Salmonella/isolation & purification
14.
Rev. peru. med. exp. salud publica ; 36(4): 610-619, oct.-dic. 2019. tab, graf
Article in Spanish | LILACS-Express | ID: biblio-1058769

ABSTRACT

RESUMEN Objetivos . Estimar la cobertura y determinar los factores asociados a la vacunación contra el sarampión en Perú. Materiales y métodos . Realizamos un estudio de fuente secundaria utilizando la Encuesta Demográfica y de Salud Familiar (ENDES) del 2017, la unidad informante fue una mujer en edad fértil de 15 a 49 años; la unidad de análisis fue un niño de 12 a 59 meses (para la primera dosis) o niño de 18 a 59 meses (para la dosis de refuerzo) y que contaba con datos de vacunación. Los datos de cobertura fueron obtenidos de la tarjeta de vacunación. Resultados . Según la tarjeta de vacunación, la cobertura para la primera dosis fue del 70,2% (IC95%: 68,8-71,6), para la dosis de refuerzo del 52,0% (IC95%: 50,5-53,6). Los niños de 24-35 meses tuvieron más probabilidades de ser vacunados para la primera dosis (OR: 1,59; IC95%: 1,28-1,97) y dosis de refuerzo (OR:2,04; IC95%: 1,62-2,56) comparado con los niños de 12-23 meses y 18-23 meses respectivamente. Los niños cuyo control de crecimiento y desarrollo fue en el sector privado tuvieron menores probabilidades de ser vacunados para la primera dosis (OR: 0,30; IC95%: 0,21-0,43) y dosis de refuerzo (OR: 0,26; IC95%: 0,17-0,40) comparado con los que se controlaron en el sector público. Conclusiones . Según la ENDES 2017, Perú y ninguna de sus regiones alcanzó una cobertura del 95,0% para la primera dosis y su refuerzo. El control de crecimiento y desarrollo en establecimientos del sector público está asociado con la vacunación de sarampión en su primera dosis y refuerzo.


ABSTRACT Objectives . To estimate coverage and determine factors associated with measles vaccination in Peru. Materials and Methods . We conducted a secondary source study using the 2017 Demographic and Family Health Survey (ENDES). The reporting unit was a woman of childbearing age, 15 to 49 years; the unit of analysis was a child, 12 to 59 months (for the first dose), or a child, 18 to 59 months (for the booster dose) who had vaccination information. Coverage data were obtained from the vaccination card. Results . According to the vaccination card, coverage for the first dose was 70.2% (95% CI: 68.8-71.6); for the booster dose, 52% (95% CI: 50.5-53.6). Children aged 24-35 months were more likely to be vaccinated for the first dose (OR 1.59, 95% CI: 1.28-1.97) and booster dose (OR 2.04, 95% CI: 1.62-2.56), compared with children aged 12-23 months and 18-23 months respectively. Children with growth and development check-ups performed in the private sector were less likely to be vaccinated for the first dose (OR 0.30, 95% CI: 0.21-0.43) and booster dose (OR 0.26, 95% CI: 0.17-0.40), compared to those being monitored in the public sector. Conclusions . According to ENDES 2017, Peru and none of its regions achieved 95.0% coverage for the first and booster doses. Growth and development monitoring in public sector facilities is associated with measles vaccination in terms of first and booster doses.

15.
Acta Med Port ; 2019 Sep 12.
Article in English | MEDLINE | ID: mdl-31851892

ABSTRACT

Rubella is a vaccine preventable infection, and congenital rubella the most feared complication of this disease. Although young adult women are at greatest risk of post-vaccine rubella, this is also the group who potentially benefits the most from vaccine protection. Since post-vaccine disease has a mild and self-limited course, the benefit clearly exceeds the risk. During a measles outbreak in the north of Portugal, a 38-year-old woman presented with cervical posterior lymphadenopathies, fever and a maculo-papular rash one week after the administration of the measles, mumps and rubella vaccine. Measles was discarded and rubella viremia was demonstrated. Symptoms of rubella are non-specific and laboratory confirmation is essential. This is particularly relevant during a measles outbreak.

16.
J Pharm Pract ; : 897190019895437, 2019 Dec 26.
Article in English | MEDLINE | ID: mdl-31875758

ABSTRACT

Vaccine hesitancy has been identified as a top threat to global health by the World Health Organization. The current measles outbreak in the United States places even greater emphasis on the relevance of this topic. Vaccination is one of the most cost-effective methods to avoid preventable disease and associated complications. Safety concerns and lack of education commonly contribute to vaccination refusals. By providing patients evidence-based facts and education, pharmacists have the opportunity to address common misconceptions influencing the antivaccination movement and prevent future outbreaks of vaccine-preventable diseases.

17.
Rev Med Chil ; 147(5): 650-657, 2019 May.
Article in Spanish | MEDLINE | ID: mdl-31859898

ABSTRACT

BACKGROUND: There is always a risk of importing infectious diseases when travelling abroad. AIM: To estimate the effective risk of a Chilean of acquiring measles during a travel by countries where measles outbreaks have been reported, considering the present level of immunity in the country. MATERIAL AND METHODS: Previously established mathematical models using differential equations were applied to calculate the risk of acquiring measles of people traveling to endemic areas. RESULTS: The probability of acquiring measles of a voyager is 8.11 x 10-8. CONCLUSIONS: These estimations help decision making about preventive measures for travelers to endemic measles areas.


Subject(s)
Measles/transmission , Models, Theoretical , Risk Assessment/methods , Travel-Related Illness , Chile/epidemiology , Disease Outbreaks , Humans , Measles/epidemiology , Measles/prevention & control , Measles Vaccine , Probability , Risk Factors , Time Factors , Vaccination
18.
Wiad Lek ; 72(11 cz 1): 2145-2148, 2019.
Article in English | MEDLINE | ID: mdl-31860862

ABSTRACT

OBJECTIVE: Introduction: During last year's, Ukraine and other European countries are facing outbreaks of well-known and emergency infections. Particularly alarming is the increase in the incidence of measles, which may be the result of a sharp decline of immunization that leads to the accumulation of susceptible individuals in the population. The aim was to assess the incidence of measles and the vaccination coverage for measles during last 5 years among children of Sumy region of Ukraine and factors due to which it is unable to be reached the required level of MMR-vaccination.. RESULTS: Review: Statistical data shown the vaccination coverage rates was dangerously low in Sumy region of Ukraine last 5 years. It began to decrease starting from 2013 year. measles vaccination coverage in 2013 was below 50%, reaching a staggering minimum of ~ 30 % in 2014 and 20 % in 2015. According to our research (questioning), the targeted vaccination coverage for measles was unable to be reached due to several factors, such as the active refusal of parents to vaccinate their children or partly the lack of sufficient vaccine supplies. CONCLUSION: Conclusions: MMR-vaccination uptake in Sumy Region is still below World Health Organization target. In the period 2014-2016, the level of children immunization was critically low and the concept of herd immunity was lost. This is the main reason for the ongoing measles outbreak in 2018. It is of the utmost importance that all medical professionals, physicians, researchers, educators, and governments of Ukraine unite to combat the anti-vaccination movement.


Subject(s)
Measles , Child , Disease Outbreaks , Europe , Humans , Measles/epidemiology , Measles Vaccine , Ukraine , Vaccination
19.
Tohoku J Exp Med ; 249(4): 265-273, 2019 12.
Article in English | MEDLINE | ID: mdl-31852852

ABSTRACT

In Japan, some measles outbreaks were initiated by a tourist from oversea and foreign workers recently. Moreover, rubella outbreak emerged since July 2018 mainly in the South Kanto, and the outbreak is currently ongoing in 2019. It is important to maintain a high measles-rubella combined vaccine (MR) coverage for measles-rubella control. Vaccination coverage for the second dose of MR (MR2) is 90.8% in Tokyo in 2016, which was the third worst among all prefectures in Japan. The purpose of this study was to clarify determinant factors of vaccination coverage for MR2 in Tokyo. Data were obtained for 49 wards and cities in Tokyo in 2016. We regressed vaccination coverage of MR2 on the times of notification by mail, the proportion of households receiving welfare payments, and the proportion of non-Japanese elementary school students. In addition to the simplest specification, five factors were included separately as explanatory variables: the proportion of public health nurses; the ratio of the number of pediatric medical facilities to the number of preschool and elementary school children; the moving-in rate; the proportion of households with a single parent; and the proportion of households with husband and wife both working. Results show that a high proportion of households receiving welfare payments, notification by two or more letters, and moving-in rate or a lower proportion of non-Japanese elementary school students improve coverage. In conclusion, the health authorities can exert efforts to reduce burden of time spent for vaccination and provide sufficient information to improve coverage.


Subject(s)
Measles Vaccine/immunology , Rubella Vaccine/immunology , Vaccination Coverage , Child , Child, Preschool , Dose-Response Relationship, Immunologic , Humans , Time Factors , Tokyo
20.
PLoS One ; 14(12): e0226513, 2019.
Article in English | MEDLINE | ID: mdl-31841530

ABSTRACT

INTRODUCTION: In the WHO European Region, endemic transmission of measles and rubella had been interrupted by 37 and 42 of the 53 member states (MSs), respectively, by 2018. Sixteen MSs are still endemic for measles, 11 for rubella and nine for both diseases, the latter including Italy. Elimination is documented by each country's National Verification Committee (NVC) through an annual status update (ASU). OBJECTIVE: By analysing data used to produce the ASUs, we aimed to describe the advances made by Italy towards elimination of measles and rubella. Moreover, we propose a set of major interventions that could facilitate the elimination process. METHODS: A total of 28 indicators were identified within the six core sections of the ASU form and these were evaluated for the period 2013-2018. These indicators relate to the incidence of measles/rubella; epidemiological investigation of cases; investigation of outbreaks; performance of the surveillance system; population immunity levels; and implementation of supplemental immunization activities (SIAs). RESULTS: From 2013 to 2018, epidemiological and laboratory analyses of measles cases in Italy improved substantially, allowing timely investigation in 2017 and 2018 of most outbreak and sporadic cases and identification of the majority of genotypic variants. Moreover, since 2017, vaccination coverage has increased significantly. Despite these improvements, several areas of concern emerged, prompting the following recommendations: i) improve outbreak monitoring; ii) strengthen the MoRoNet network; iii) increase the number of SIAs; iv) reinforce vaccination services; v) maintain regional monitoring; vi) design effective communication strategies; vii) foster the role of general practitioners and family paediatricians. CONCLUSIONS: The review of national ASUs is a crucial step to provide the NVC with useful insights into the elimination process and to guide the development of targeted interventions. Against this background, the seven recommendations proposed by the NVC have been shared with the Italian Ministry of Health and the Technical Advisory Group on measles and rubella elimination and have been incorporated into the new Italian Elimination Plan 2019-2023 as a technical aid to facilitate the achievement of disease elimination goals.


Subject(s)
Disease Eradication/trends , Measles/prevention & control , Rubella/prevention & control , Adolescent , Adult , Child , Child, Preschool , Disease Eradication/methods , Disease Eradication/organization & administration , Disease Outbreaks/prevention & control , Female , Humans , Incidence , Infant , Infant, Newborn , Italy/epidemiology , Male , Measles/epidemiology , Measles Vaccine/therapeutic use , Middle Aged , Population Surveillance , Pregnancy , Quality Indicators, Health Care , Rubella/epidemiology , Vaccination/methods , Vaccination/trends , Vaccination Coverage/methods , Vaccination Coverage/trends , World Health Organization , Young Adult
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