scholarly journals 1611. Interventions to Decrease the Absolute Number of Individuals Not Immune to Measles at Princeton University (PU)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S588-S588
Author(s):  
Irini Daskalaki ◽  
Robin Maestripieri ◽  
Gayathri Ganesan ◽  
Jonathan Pletcher
Keyword(s):  
Community Intervention ◽  
Absolute Number ◽  
Secure Messaging ◽  
Blood Tests ◽  
Princeton University ◽  
Education Material ◽  
Measles Outbreak ◽  
Residential Staff ◽  
Measles Outbreaks ◽  
Number Of Individuals

Abstract Background PU’s dormitories house ~100% of undergraduate and ~70% of graduate students. MMR is required for all students by NJ law, allowing for medical and religious exemptions (RE). Information on immunization requirements is widely available and accessible. If a student is found not compliant, measures include monetary fines, class registration holds, and contact by residential staff. Visiting short-term students should submit immunization records, but, due to rolling matriculation dates, enforcement measures may not be applicable. In the fall of 2018, a measles outbreak was reported close to campus. We sought to engage all students not immune to measles with proactive messaging. Methods Starting on December 3, 2018, the electronic health record (EHR) was used to generate a weekly report of active students not immune to measles following the CDC’s immunity criteria. Notifications and education material were sent via secure messaging and/or email. Students with no immunization data were provided instructions on record submission. Reminders were sent to those due for second MMR. Students with RE were offered blood tests for measles immunity. Alerts were placed in the EHR of all non-immune students so every encounter would serve as reminder. Student travelers on PU sponsored trips were informed about measles outbreaks and, often, MMR became a trip requirement. Results On December 3, 2018, 84 students were measles non-immune: 2 with medical and 23 with RE; 59 lacking second MMR or with no immunization data.The 23 RE became 24 when a student in absentia returned. Since, 3 of the students with RE had blood tests revealing measles immunity; 2 received MMR to travel; 3 decided that their RE was not current. On 4/22/19, there were 18 students lacking second MMR or with no immunization data, most of them new visiting students. Overall, 57% reduction of absolute number of measles nonimmune students. Conclusion This community intervention shows that students who remained measles non-immune despite the regular immunization compliance activities, could become compliant through active messaging, education and continued engagement. Importantly, 8 of 24 students with RE, when engaged and provided with information and potential consequences of unimmunized status, were found either already immunized or not opposed to receiving immunizations. Disclosures All authors: No reported disclosures.

scholarly journals The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
C. N. Mburu ◽  
◽  
J. Ojal ◽  
R. Chebet ◽  
D. Akech ◽  
...  
Keyword(s):  
Vaccination Coverage ◽  
Herd Immunity ◽  
African Region ◽  
Population Immunity ◽  
Measles Outbreak ◽  
Increased Risk ◽  
Measles Vaccination ◽  
Serological Data ◽  
Measles Outbreaks ◽  
Measles Vaccination Coverage

Abstract Background The COVID-19 pandemic has disrupted routine measles immunisation and supplementary immunisation activities (SIAs) in most countries including Kenya. We assessed the risk of measles outbreaks during the pandemic in Kenya as a case study for the African Region. Methods Combining measles serological data, local contact patterns, and vaccination coverage into a cohort model, we predicted the age-adjusted population immunity in Kenya and estimated the probability of outbreaks when contact-reducing COVID-19 interventions are lifted. We considered various scenarios for reduced measles vaccination coverage from April 2020. Results In February 2020, when a scheduled SIA was postponed, population immunity was close to the herd immunity threshold and the probability of a large outbreak was 34% (8–54). As the COVID-19 contact restrictions are nearly fully eased, from December 2020, the probability of a large measles outbreak will increase to 38% (19–54), 46% (30–59), and 54% (43–64) assuming a 15%, 50%, and 100% reduction in measles vaccination coverage. By December 2021, this risk increases further to 43% (25–56), 54% (43–63), and 67% (59–72) for the same coverage scenarios respectively. However, the increased risk of a measles outbreak following the lifting of all restrictions can be overcome by conducting a SIA with ≥ 95% coverage in under-fives. Conclusion While contact restrictions sufficient for SAR-CoV-2 control temporarily reduce measles transmissibility and the risk of an outbreak from a measles immunity gap, this risk rises rapidly once these restrictions are lifted. Implementing delayed SIAs will be critical for prevention of measles outbreaks given the roll-back of contact restrictions in Kenya.

Who are the children at risk? Lessons learned from measles outbreaks

2011 ◽  
Vol 140 (9) ◽  
pp. 1578-1588 ◽  
Author(s):  
C. STEIN-ZAMIR ◽  
H. SHOOB ◽  
N. ABRAMSON ◽  
G. ZENTNER
Keyword(s):  
Immunization Coverage ◽  
Lessons Learned ◽  
Significant Shift ◽  
Risk Markers ◽  
Peak Incidence ◽  
Young Infants ◽  
Measles Outbreak ◽  
Baby Clinic ◽  
Measles Outbreaks ◽  
Control Study

SUMMARYWe investigated a measles outbreak in the Jerusalem district in 2007–2008 (992 cases). Most cases (72·6%) were aged <15 years, 42·9% aged <5 years, and 12·8% were infants aged <1 year. The peak incidence rate was in infants aged 6–12 months (916·2/100 000). This represents a significant shift from former outbreaks in 2003–2004, where the peak incidence was in the 1–4 years age group. Of children aged <5 years the proportion aged 6–12 months tripled (7·7% vs. 25·6%). In a case-control study (74 cases, 148 controls) children who developed measles were less likely to be registered in a well-baby clinic and had lower overall immunization coverage. The differences in proportions for registration, DTaP3 and MMR1 coverage were 35·1%, 48·6% and 80·8%, respectively (all P<0·001). Rising birth order of cases and their siblings was associated with non-registration and non-compliance with MMR immunization. The vulnerability of young infants and the risk markers noted above should be taken into account in planning intervention programmes.

scholarly journals Effective control measures limited measles outbreak after extensive nosocomial exposures in January-February 2008 in Gothenburg, Sweden

2008 ◽  
Vol 13 (30) ◽  
Author(s):  
P Follin ◽  
L Dotevall ◽  
M Jertborn ◽  
Y Khalid ◽  
J Å Liljeqvist ◽  
...  
Keyword(s):  
Vaccination Coverage ◽  
Control Measures ◽  
Effective Control ◽  
Imported Case ◽  
Measles Outbreak ◽  
Measles Outbreaks ◽  
Rubella Vaccination ◽  
And Control

In January-February 2008, one imported case of measles initiated a series of exposures with around 380 nosocomial secondary contacts. Susceptible individuals were traced early and control measures were initiated that managed to limit the consequences considerably. Only four secondary cases were identified by the end of March. This minor outbreak illustrates the importance and efficiency of early control measures as well as the fact that the risk of measles outbreaks still exists in a country that has high measles, mumps, rubella vaccination coverage among children.

scholarly journals ‘When you welcome well, you vaccinate well’: a qualitative study on improving vaccination coverage in urban settings in Conakry, Republic of Guinea

2020 ◽  
Author(s):  
Julita Gil Cuesta ◽  
Katherine Whitehouse ◽  
Salimou Kaba ◽  
Kassi Nanan-N’Zeth ◽  
Benoit Haba ◽  
...  
Keyword(s):  
Side Effects ◽  
Vaccination Coverage ◽  
Community Involvement ◽  
Health Workers ◽  
Urban Settings ◽  
Republic Of Guinea ◽  
Measles Outbreak ◽  
Sub Saharan ◽  
Measles Outbreaks ◽  
Vaccination Campaigns

Abstract Background Recurrent measles outbreaks followed by mass vaccination campaigns (MVCs) occur in urban settings in sub-Saharan countries. An understanding of the reasons for this is needed to improve future vaccination strategies. The 2017 measles outbreak in Guinea provided an opportunity to qualitatively explore suboptimal vaccination coverage within an MVC among participants through their perceptions, experiences and challenges. Methods We conducted focus group discussions with caregivers (n=68) and key informant interviews (n=13) with health professionals and religious and community leaders in Conakry. Data were audio-recorded, transcribed verbatim from Susu and French, coded and thematically analysed. Results Vaccinations were widely regarded positively and their preventive benefits noted. Vaccine side effects and the subsequent cost of treatment were commonly reported concerns, with further knowledge requested. Community health workers (CHWs) play a pivotal role in MVCs. Caregivers suggested recruiting CHWs from local neighbourhoods and improving their attitude, knowledge and skills to provide information about vaccinations. Lack of trust in vaccines, CHWs and the healthcare system, particularly after the 2014–2016 Ebola epidemic, were also reported. Conclusions Improving caregivers’ knowledge of vaccines, potential side effects and their management are essential to increase MVC coverage in urban settings. Strengthening CHWs’ capacities and appropriate recruitment are key to improving trust through a community involvement approach.

A US metropolitan county health department’s response to a measles outbreak in a childcare facility – challenges faced and lessons learned

2020 ◽  
pp. 175791392095520
Author(s):  
Diane Meyer ◽  
Marc Trotochaud ◽  
Lisa Ferguson ◽  
Jennifer Vines ◽  
Russell Barlow ◽  
...  
Keyword(s):  
Public Health ◽  
Health Department ◽  
Lessons Learned ◽  
Outbreak Response ◽  
Public Health Community ◽  
Local Public Health ◽  
Measles Outbreak ◽  
Health Community ◽  
Childcare Facility ◽  
Measles Outbreaks

Aims: In June 2018, the Multnomah County Health Department located in Portland, Oregon, US, responded to a measles exposure in a local childcare facility. This analysis describes lessons learned and challenges encountered during this measles response that may inform public health policy and help other local public health authorities prepare for measles outbreaks. These lessons will become increasingly important as measles cases continue to increase in both the US and abroad. Methods: A semi-structured videoconference interview was conducted with nine health department staff who were directly involved in the health department’s response to the measles outbreak. Interview notes were iteratively discussed between all authors to identify those outbreak response challenges and lessons learned that were generalizable to the broader public health community. Results: Some of the key challenges and lessons learned included the need for increased provider recognition and reporting of measles cases, difficulty in determining which staff and children to exclude from attending daycare during the 21-day postexposure monitoring period, determining who would be prioritized to receive immunoglobulin, and the need for childcare staff vaccine status requirements. Conclusion: Lessons from this response highlight important considerations for public health practitioners and policy makers. Given the relative severity of measles and the potential for spread in facilities that serve infants and young children, the public health community must continue to address key gaps through planning and policy.

#34: Measles Outbreak in Pediatric Oncology Patients in Hue Central Hospital, Vietnam

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S24-S24
Author(s):  
Nguyen Thi Kim Hoa ◽  
Tran Kiem Hao ◽  
Chau Van Ha
Keyword(s):  
Clinical Features ◽  
Pediatric Oncology ◽  
Laboratory Evaluation ◽  
Measles Vaccine ◽  
Central Hospital ◽  
Oncology Patients ◽  
Children With Cancer ◽  
Measles Outbreak ◽  
Liver Transaminases ◽  
Measles Outbreaks

Abstract Background Measles outbreaks in immunocompromised populations present a significant challenge, and to interrupt endemic transmission can be difficult. This study aimed to investigate measles in pediatric oncology patients at Hue Central Hospital, Vietnam to describe demographic, epidemiological, and clinical features. Methods Potential measles infections among children with cancer were prospectively identified between April 20 to July 10, 2019 at Hue Central Hospital. Measles diagnoses were based on both clinical features and IgM laboratory evaluation. Data were abstracted from patient medical records and analyzed in SPSS v.18.0 (IBM Corp., Armonk, NY, USA). Results From April 20 to July 10 in 2019, a total of 11 patients with malignancies were identified as having measles, with a median age of 4.0 years (range: 1 years to 9 years). Of these 11 patients, 2 (18.2%) had not received any dose of measles vaccine, 4 (36.4%) had received 1 dose of measles vaccine, and 5 (45.5%) had received the recommended 2 doses. All patients had fever with the median temperature of 39 degrees Celsius (range: 38.5–39.5), and median fever duration of 7 days. All patients had cough and rash, while 3 (27.3%) were complicated by pneumonia, and 2 (18.2%) had elevated liver transaminases. All patients had hospital visits or were hospitalized before measles onset, with the median length of stay of 10 days (range: 7–24 days). All patients were likely to exposed each other. 100% of these patients recovered. Conclusions Children with cancer are at extra risk of measles infection due to their immunocompromised status. Getting vaccinated is the best way to prevent measles, and improved infection control is critical for the prevention of measles in patients with malignancies. Following this measles outbreak, a designated outpatient area was established to separate the inpatient unit and limit hospital transmission.

scholarly journals A Review of Measles Outbreak Cost Estimates From the United States in the Postelimination Era (2004–2017): Estimates by Perspective and Cost Type

2020 ◽  
Vol 71 (6) ◽  
pp. 1568-1576
Author(s):  
Jamison Pike ◽  
Andrew J Leidner ◽  
Paul A Gastañaduy
Keyword(s):  
United States ◽  
Indirect Costs ◽  
Health Department ◽  
The United States ◽  
Public Health Department ◽  
Median Cost ◽  
Cost Estimates ◽  
Measles Outbreak ◽  
Measles Outbreaks ◽  
The Cost

Abstract Despite the elimination of measles in the United States (US) in the year 2000, cases continue to occur, with measles outbreaks having occurred in various jurisdictions in the US in 2018 and 2019. Understanding the cost associated with measles outbreaks can inform cost-of-illness and cost-effectiveness studies of measles and measles prevention. We performed a literature review and identified 10 published studies from 2001 through 2018 that presented cost estimates from 11 measles outbreaks. The median total cost per measles outbreak was $152 308 (range, $9862–$1 063 936); the median cost per case was $32 805 (range, $7396–$76 154) and the median cost per contact was $223 (range, $81–$746). There were limited data on direct and indirect costs associated with measles. These findings highlight how costly measles outbreaks can be, the value of this information for public health department budgeting, and the importance of more broadly documenting the cost of measles outbreaks.

scholarly journals ДИНАМІКА ВІКОВОЇ СТРУКТУРИ ПОПУЛЯЦІЇ CROCUS HEUFFELIANUS HERB. У ПРИРОДНОМУ ЗАПОВІДНИКУ "МЕДОБОРИ" ЗА ОСТАННЄ ДЕСЯТИРІЧЧЯ

2019 ◽  
Vol 75 (1) ◽  
pp. 8-12
Author(s):  
L. Ia. Kozyra ◽  
N. J. Semenovych
Keyword(s):  
Plant Density ◽  
Age Groups ◽  
Absolute Number ◽  
Entire Area ◽  
Left Handed ◽  
Beginning Of Flowering ◽  
Average Plant ◽  
Number Of Individuals

Based on the long-term observations of Crocus heuffelianus Herb., the Red Book species of "Medobory" Nature Reserve, growing on the boundary of the area, the dynamics of the population age structure has been analysed. The study of the population and phenology has been conducted since 1995 at the Botanical Experimental Area (BP-2), which is located in Viknianske forestry (square 32, board 7) and covers an area of 0.1925 hectares.The number and density of the cenopopulation have been studied. The ratio of the number of individuals to the area of the population is taken for the density, and the number of individuals in its entire area – for the absolute number. The number of species ranged from 347 to 753 individuals. The average plant density is 0.27 individuals per square meter. The highest index was in the years 2016 and 2018 – 0.39 and 0.38 individuals per square meter, and the lowest was in 2005 – 0.09 individuals per square meter.During the investigating over the past decade, surveys of plants of different ages (juvenile, virgin and generative), as well as phenological observations were conducted. Allocation of age groups was carried out in accordance with the classification of Melnyk V.I.The population of Crocus heuffelianus Herb in the Reserve is established as a full-fledged and left-handed. Only in 2011 it was intermediate.According to the results of phenological observations, the average long-term date of the vegetation onset is the 15th of March, the beginning of flowering – the 24th of March, the mass flowering – the 1st of April and the end - the 12th of April. The entire flowering cycle is 21 days on average.An important factor that has a significant impact on the state of the population of the species in the Reserve is the spring sowing of bulbs and tufts of plants by sultry European. It is pointed out almost every year, and evidenced by the presence of numerous fresh lanterns and ditches.

scholarly journals Public health practitioner perspectives on dealing with measles outbreaks if high anti-vaccination sentiment is present

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Penelope Robinson ◽  
Kerrie Wiley ◽  
Chris Degeling
Keyword(s):  
Public Health ◽  
Vaccination Schedule ◽  
Health Practitioner ◽  
Vaccine Preventable Diseases ◽  
Vaccination Rates ◽  
Modified Delphi ◽  
Global Pandemic ◽  
Measles Outbreak ◽  
High Level ◽  
Measles Outbreaks

Abstract Background Communities with low vaccination rates are at greater risk during outbreaks of vaccine preventable diseases. Most Australian parents support vaccines, but some refuse and are often judged harshly by their community, especially during an outbreak. We sought the perspectives of Australian public health experts on the key issues faced when managing a measles outbreak in an area with high anti-vaccination sentiment. Methods A measles outbreak scenario formed the basis of a 3-round modified Delphi process to identify key practitioner concerns in relation to parents/carers who don’t follow the recommended vaccination schedule. We surveyed a range of professionals in the field: policymakers, infectious disease experts, immunisation program staff, and others involved in delivering childhood vaccinations, to identify key priorities when responding to an outbreak in a community with low vaccination coverage. Results Findings indicate that responses to measles outbreaks in communities with high anti-vaccination sentiment are motivated by concerns about the potential for a much larger outbreak event. The highest operational priority is to isolate infected children. The two most highly ranked practical issues are mistrust from non-vaccinating members of the local region and combatting misinformation about vaccines. Trying to change minds of such individuals is not a priority during an outbreak, nor is vaccinating their children. Using media and social media to provide information about the outbreak and measures the public can take to limit the spread of the disease was a focus. Conclusions Our findings provide a deeper understanding of the challenges faced during an outbreak and priorities for communicating with communities where there is a high level of anti-vaccination sentiment. In the context of a global pandemic, the results of this study also have implications for managing public health responses to community transmission of SARS-CoV-2, as COVID-19 vaccines becomes widely available.

Spatial Clustering of Vaccine Exemptions on the Risk of a Measles Outbreak

PEDIATRICS ◽  
2021 ◽  
Vol 149 (1) ◽  
Author(s):  
Ashley Gromis ◽  
Ka-Yuet Liu
Keyword(s):  
Large Scale ◽  
Spatial Clustering ◽  
Vaccine Coverage ◽  
Herd Immunity ◽  
The United States ◽  
Vaccine Preventable Diseases ◽  
Measles Outbreak ◽  
Measles Outbreaks ◽  
Lower Population ◽  
Local Herd

OBJECTIVES Areas of increased school-entry vaccination exemptions play a key role in epidemics of vaccine-preventable diseases in the United States. California eliminated nonmedical exemptions in 2016, which increased overall vaccine coverage but also rates of medical exemptions. We examine how spatial clustering of exemptions contributed to measles outbreak potential pre- and postpolicy change. METHODS We modeled measles transmission in an empirically calibrated hypothetical population of youth aged 0 to 17 years in California and compared outbreak sizes under the observed spatial clustering of exemptions in schools pre- and postpolicy change with counterfactual scenarios of no postpolicy change increase in medical exemptions, no clustering of exemptions, and lower population immunization levels. RESULTS The elimination of nonmedical exemptions significantly reduced both average and maximal outbreak sizes, although increases in medical exemptions resulted in more than twice as many infections, on average, than if medical exemptions were maintained at prepolicy change levels. Spatial clustering of nonmedical exemptions provided some initial protection against random introduction of measles infections; however, it ultimately allowed outbreaks with thousands more infections than when exemptions were randomly distributed. The large-scale outbreaks produced by exemption clusters could not be reproduced when exemptions were distributed randomly until population vaccination was lowered by &gt;6 percentage points. CONCLUSIONS Despite the high overall vaccinate rate, the spatial clustering of exemptions in schools was sufficient to threaten local herd immunity and reduce protection from measles outbreaks. Policies strengthening vaccine requirements may be less effective if alternative forms of exemptions (eg, medical) are concentrated in existing low-immunization areas.

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