Search Results (63)

Background/Objectives: Measles, mumps, and rubella (MMR) continue to pose a significant public health challenge due to insufficient immunization coverage. This study aimed to provide the first seroprevalence data against MMR and to explore self-reported immunity among future healthcare workers (HCWs) in Serbia, including women of childbearing age. Methods: We included 1296 future health care workers (HCWs) aged 19 to 29, born in Serbia. All HCWs supplied a blood sample for serology and filled in a questionnaire. Antibodies were measured using an enzyme immunoassay against measles, mumps, and rubella (MMR). Results: Anti-measles, -mumps, and -rubella seronegativity rates were 25.6%, 26.5%, and 4.4%, respectively, among future HCWs in Serbia. The mumps seronegativity rate was significantly higher in the oldest (27–29-year) age group, accompanied by significantly lower anti-mumps IgG GMCs in the same age group compared to younger participants (p = 0.035 and p < 0.001, respectively). Anti-mumps seronegativity also increased significantly across birth cohorts, from the youngest to the oldest (p = 0.004). Furthermore, anti-mumps IgG antibody GMCs were significantly higher among females, those who attended nursery/kindergarten, and unvaccinated individuals (p = 0.050, p = 0.020, and p = 0.005, respectively). Finally, older age and unvaccinated status were identified as independent factors associated with anti-measles and anti-mumps seronegativity among future HCWs in Serbia. Conclusions: The cross-sectional seroprevalence data revealed insufficient seroprotection in this population of particular importance, i.e., future HCWs, and women of childbearing age. These results strongly support the national recommendations for the mandatory vaccination of these populations. Identified immunity gaps should be closed promptly by strategic, targeted serologic screening, followed by vaccination of those lacking MMR antibodies. Full article

Background/Objectives: In the Republic of Serbia, measles vaccination was first introduced in 1971, while combined vaccination (measles, mumps, rubella) was made mandatory in 1996 as part of the national vaccination program. Reported prevalence values for 2023 were <0.75 cases per 100K population for measles, 0.09 cases per 100K for mumps, and no cases of rubella. Methods: This cross-sectional study was performed in May, 2024 as part of the project “Herd Immunity to Vaccine-Preventable and Other Relevant Infections in the Belgradian Population.” It focused on assessing herd immunity to measles, mumps and rubella (MMR) among residents insofar as these remain a public concern despite the availability of vaccines. A total of 2533 subjects were distributed across nine age groups, covering those aged 1–70⁺ years and various professional groups residing in Belgrade. Participants were stratified by age and activity. Upon obtaining individual information by online questionnaire and receiving a signed statement of informed consent, blood samples were obtained for IgG antibody testing (ELISA) to determine MMR serological status. The results were compared to national and international immunization standards to evaluate herd immunity levels. Results: Our results indicate varying levels of immunity for each virus, with specific demographic groups showing different immunity levels. Total measles seroprevalence during this study was 74.7%, with significant variation across all age groups. While high seropositivity was observed in both children (90.7%) and elder age groups (98.4%), middle-aged individuals in the age group 30–49 years showed significantly lower IgG levels. Between 2021 and 2023, there were no registered cases of rubella detected in Serbia, which indicates a high level of immunity. This was confirmed here with consistently high IgG levels across all age groups, with an average seropositivity of 94.8%. Average mumps seropositivity across all age groups was 85.1%. The lowest value was in the young child (1–5 years) age group (76.1%); the highest was in the elderly group (92.6%). Conclusions: The current findings suggest that the Belgradian population has strong overall immunity to MMR, yet with some concerns regarding measles immunity in middle-aged adults, suggesting a potential need for catch-up vaccinations. While rubella status indicates strong herd immunity and minimal risk of outbreaks, mumps immunity in some groups (children, middle-aged adults) is below the protective threshold. While it is still sufficient to prevent widespread transmission, it should be closely observed. To our knowledge, this study is the first of its kind to provide data about MMR seroprevalence in Belgrade. Findings indicate the need for constant surveillance and revaccination of vulnerable/seronegative groups. Full article

Cutaneous warts caused by human papillomavirus (HPV) are among the most common dermatological conditions, affecting the quality of life of numerous people. Although they are widespread, effective and reliable treatment alternatives are limited, emphasizing the necessity for novel treatment options. Intralesional immunotherapy has emerged as a promising alternative, aiming to stimulate the host immune response to achieve the clearance of both treated and distant lesions. This review explores the immunopathogenesis of cutaneous warts and provides an in-depth analysis of intralesional therapies including measles–mumps–rubella (MMR) vaccine, purified protein derivative (PPD), Bacillus Calmette–Guérin (BCG), Candida antigen, Mycobacterium w vaccine (MWV), vitamin D3, and autoinoculation. We provide a comprehensive analysis of the most promising modalities, highlighting their mechanism of action, outcomes, advantages, and limitations. Although initial data indicate that intralesional immunotherapy offers advantageous efficacy and tolerability, there is a lack of standardized treatment protocols and randomized controlled trials to endorse its broad application. Nevertheless, considering its potential to address local and distant lesions with minimal adverse effects, intralesional immunotherapy may represent a transformative approach to managing cutaneous warts. Full article

Background/Objective: Variations in measles vaccine antibody response by age and HIV status have been reported. This study assessed measles pre-vaccination status and compared humoral response durability over the first five years of life among HIV-infected (HI) children on early treatment, HIV-exposed uninfected (HEU), and HIV-unexposed uninfected (HUU) children within the ANRS 12225—Pediacam III cohort in Cameroon. Methods: Measles vaccine (MCV) was administered at 6 and 9 months for HIV-exposed infants and at 9 months for HIV-unexposed infants, followed by a measles-mumps-rubella (MMR) dose at 15 months for all. Measles antibody titers were measured pre-vaccination, 1–6 months post-MCV doses, and annually until age 5 using ELISA (Enzygnost, Dade Behring). Results: A total of 496 children were included: 143 HI (median age at cART initiation: 4.2 months, (IQR: 3.2–5.6)), 180 HEU, and 173 HUU. Of these, 456 children were tested pre-vaccination (median age: 6.1 months, IQR: 5.6–6.8), with 6.1% (95% CI: 4.1–8.6) seropositive to measles antibodies, with differences across groups. At 18.4 months (IQR: 18.1–19.9), seropositivity rates were 96.7% (59/61) in HI, 96.8% (90/93) in HEU, and 100% (111/111) in HUU groups. For children following the 6 + 9 + 15-month or 9 + 15-month MCV schedules, seropositivity at 18, 36, 48, and 60 months was 96%, 89%, 87%, and 88%, respectively, with no significant differences between groups. Conclusions: Early cART initiation in HI children may result in a robust initial measles antibody response, with comparable persistence of antibody titers across all groups up to five years. Full article

Objectives: Our objectives were to evaluate the safety of the simultaneous vaccination of Japanese encephalitis attenuated live vaccine (JEV-L) and measles, mumps, and rubella combined attenuated live vaccine (MMR) in children and to provide a reference for the implementation of the strategy of simultaneous vaccination with the two vaccines. Methods: The data of adverse events following immunization (AEFI) and vaccination for JEV-L and MMR from 2020 to 2023 were extracted through the Guangdong Province Vaccine Distribution and Vaccination Management Information System and the Chinese National AEFI Information System (CNAEFIS). The inclusion criteria were that children were born after 1 October 2019, and received the first dose of JEV-L or MMR after 1 June 2020, in accordance with the starting age for vaccination (8 months). The study used the number of vaccine doses as the denominator to calculate and compare the reporting rates of cases and calculated the relative risk (RR) of adverse reactions and the 95% confidence interval (CI). Results: In Guangzhou, a total of 214,238 doses of JEV-L were administered to children. JEV-L and MMR were co-administered in 464,009 doses, and MMR was administered separately in 241,150 doses. The overall reporting incidence rates of AEFI (per 100,000 doses) for JEV-L, the simultaneous vaccination group, and MMR were 11.20, 53.02, and 60.96, respectively. Among children aged 8 months in Guangzhou, 57.98% (463,512/799,423) received the simultaneous administration of JEV-L and MMR. In the reported AEFI events, general reactions accounted for 87.50% in the JEV-L group, 88.21% in the simultaneous vaccination group, and 89.80% in the MMR separate group. The incidence rates of common adverse reactions were 9.80, 46.7, and 54.74, respectively. The incidence rates of rare adverse reactions were 0.93, 3.88, and 2.90, respectively. The reporting incidence rates of fever ≥38.6 °C after vaccination were 4.20, 16.16, and 17.83 for the JEV-L separate group, simultaneous vaccination group, and MMR separate group, respectively. There was a significant difference between the simultaneous vaccination group and the JEV-L separate group (RR = 3.848, 95% CI = 1.927, 7.683), while no significant difference was found compared with the MMR separate group (RR = 0.906, 95% CI = 0.623, 1.318). The simultaneous vaccination group showed no significant differences in the reporting incidence rates of local redness and induration compared with the two separate vaccination groups (RR = 1.385, 95% CI = 0.144, 13.315; RR = 0.390, 95% CI = 0.087, 1.743; RR = 0.520, 95% CI = 0.033, 8.314). No significant differences were found in the incidence rates of rare adverse reactions such as maculopapular rash, urticaria, and thrombocytopenic purpura. Conclusions: The AEFI reporting incidence rate for the first dose of the simultaneous vaccination of JEV-L and MMR in 8-month-old children in Guangzhou is between the rates of the two separate groups. Compared with the MMR separate group, the simultaneous vaccination group does not increase the risk of adverse reactions. Full article

Background/Objectives: This study analyzed data on the actual timing of the first and second doses of the Measles, Mumps, and Rubella (MMR) vaccination in Slovakia according to the vaccination schedule. Methods: Histograms were constructed using immunological survey data on MMR vaccination conducted in Slovakia in 2018. Results: For the first dose (2560 individuals), 83.4% of them were vaccinated timely (15th–18th month, mostly in the 16th month), while 13.8% of them were delayed. For the second dose (1061 individuals), 72.7% of vaccinations were timely (11th year), and 23.2% were delayed. There was a bimodal distribution of the timing of the administration of the second dose, with peaks at the beginning of the 11th year and at the turn of the 11th and 12th year. Conclusions: The unexpected shape of the histograms suggests that ambiguous interpretations of the vaccination schedule may be one of the causes of vaccination delays. Full article

Background: This paper investigates the long-term effects of the measles, mumps, and rubella (MMR) vaccine on healthcare, education, and economic outcomes using a novel dataset from the Copenhagen School Health Records Register. Methods: To address potential endogeneity, we use within-sibling variation in vaccination status induced by different periods of vaccine availability in Denmark. Results: Our findings reveal that, prior to the establishment of herd immunity, vaccinated cohorts experienced substantial protection against hospitalizations related to MMR. During the same period, we also observe modest improvements in educational outcomes and positive—though statistically insignificant—estimates for labor market outcomes among siblings with discordant vaccination status. We find no impact of vaccination on hospitalizations, education, or economic outcomes for cohorts born after herd immunity was established, a period when everyone benefited from herd protection regardless of individual vaccination status. Conclusions: MMR vaccination, before herd immunity, reduced hospitalization due to Measles, Mumps, and Rubella. The impact on later outcomes, such as education, income, and employment lacks statistical precision at conventional levels. Evidence suggest positive self-selection in vaccination among families with high socioeconomic status. Full article

Specific prevention of measles, mumps, and rubella (MMR) is the main prerequisite for a radical reduction in the incidence of these infections in the Kyrgyz Republic (KR). An increase in the number of seronegative individuals observed in recent years has led to an increase in measles incidence. This is directly related to a decrease in collective immunity, which provides protection for the population only in conditions of a high density of immunized individuals and their uniform distribution in the population. The only way to estimate the number of immunized individuals is by conducting serological surveys of collective immunity. Aim of the study: The aim was to study the level of collective immunity to the MMR viruses in the KR. Materials and methods: This study involved a cohort of 6617 residents (volunteers) aged 1 to 70⁺ years, formed in accordance with the Rospotrebnadzor program “Assessment of collective immunity to vaccine-preventable and other relevant infections” and stratified by age and region of residence. During the study, participants filled out a questionnaire and gave venous blood samples to determine IgG antibodies to MMR viruses (ELISA using certified Russian test systems). Results: In December 2023, collective immunity ensured epidemiological well-being only with respect to rubella. The volunteer seropositivity was 94.2% (95% CI: 93.7–94.8). The average measles seropositivity was 78.9% (95% CI: 77.9–79.9). It was significantly lower in children aged 1–17 years and significantly higher than the cohort average in individuals aged ≥18 years. The average mumps seropositivity was 76.4% (95% CI: 75.3–77.4), with the minimum level noted among individuals aged 12–29 years (63.8%; 95% CI: 61.4–66.2). The maximum levels of mumps seropositivity were noted among children aged 6–11 years and older adults who had likely experienced mumps (50–70⁺ years). Seroprevalence distributions by activity correlated with age distributions (all infections). Conclusions: The system of targeted prophylaxis of vaccine-preventable infections adopted in the KR has contributed to the formation of a high level of rubella collective immunity and, to a lesser extent, measles and mumps immunity. The recent trend towards increases in measles and mumps incidence in the KR requires additional efforts to increase collective immunity to these infections. Full article

The purpose of this study was to evaluate the effectiveness and immunogenicity of the measles–mumps–rubella (MMR) vaccine against SARS-CoV-2 in healthcare workers at one medical institution. The effectiveness of the MMR vaccine against SARS-CoV-2 was evaluated in overall healthcare workers (HCWs). In addition, neutralizing antibodies to SARS-CoV-2 were measured according to the subjects’ measles immunity status with serum samples collected before the coronavirus disease 2019 pandemic period. The effectiveness of the MMR vaccine for SARS-CoV-2 in all HCWs and measles IgG-positive subjects was 34% (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI] = 0.53–2.70) and 34% (aOR = 0.66, CI = 0.38–18.4), respectively. The neutralizing antibody levels for SARS-CoV-2 were low in all groups regardless of the measles immune status. The MMR vaccine alone may not provide sufficient protection against SARS-CoV-2. Full article

In 2015, the 62nd session of the Regional Committee [RC] of the Eastern Mediterranean Region [EMR] endorsed the Eastern Mediterranean Vaccine Action Plan 2016–2020 (EMVAP) that included postponement of the measles elimination target to before 2020. However, the EMR does not have a regional rubella control or elimination goal. We reviewed the progress of measles and rubella surveillance in context of measles elimination in the Eastern Mediterranean Region during 2019–2022. We compiled data on coverage, reported cases, surveillance indicators, incidence, and genotypes. We conducted an age-cohort analysis to estimate the size of the susceptible population using coverage and SIAs coverage data. We reviewed the dossiers of countries that applied to the Regional Verification Commission [RVC] for the verification of measles and rubella elimination. Between 2019 and 2022, the regional coverage of the vaccine against measles and rubella was stable at 83% for the first dose [MCV1] and increased from 75% to 78% for the second dose [MCV2] after a dip during COVID-19. In the EMRO, eighteen countries are using MR (measles–rubella) and/or measles–mumps–rubella (MMR) vaccines and four are using measles vaccines. The reported regional measles incidence per 1,000,000 was 23.3 in 2019, decreased to 7.4 in 2020, and re-increased to 50 in 2022, with two main genotypes–D8 and B3–in circulation. Both genotypes are considered to be actively circulating in eighteen countries, with different circulating variants of each genotype. There were no genotyping data available from four countries. Measles and rubella surveillance indicators deteriorated in the region. The number of susceptible individuals exceeded one birth cohort in nine of the 22 countries. In 2019–2022, Bahrain, Egypt, Iran, and Oman were verified to have eliminated measles and rubella. While four countries eliminated measles and rubella and another five progressed toward measles and rubella elimination, however, immunity gaps and reported incidence increased in eleven countries. Countries approaching elimination need to prepare verification dossiers, while others need to increase their routine coverage, conduct follow-up campaigns, and improve surveillance. Submission of progress reports to the RVC will measure progress toward the goal. Full article

People living with HIV (PLHIV) are at greater risk of illness and death from vaccine-preventable diseases. This study aimed to identify the predictors associated with the recommended vaccination schedule for this group. This was a single-center cross-sectional study conducted in a large Brazilian municipality, evaluating the vaccination statuses of 645 PLHIV for nine immunizers. The primary outcome was the adequacy of the vaccination schedule. The vaccination status was assessed for the diphtheria/tetanus, hepatitis B, hepatitis A, measles/mumps/rubella, yellow fever, 13- and 23-valent pneumococcal, meningococcal C, and HPV vaccines. Those who had received all of the recommended vaccinations in accordance with the schedule established by the government at the time of the assessment, without any delays, were classified as having received an “adequate schedule”. The independent variables included sociodemographic, clinical–epidemiological, and social vulnerability factors, analyzed by multiple logistic regression with adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Only 47 individuals (7.3%) had an adequate vaccination schedule for all vaccines. The vaccines with the highest adequacy rate were diphtheria and tetanus (533; 82.6%), and the one with the lowest rate was measles/mumps/rubella (MMR) (243; 37.7%). The main predictors of a complete vaccination schedule were the age group, place of clinical follow-up, and where they received their last doses of vaccines. Educational interventions for PLHIV and health professionals are needed to improve the vaccination coverage in this group. Full article

In 2014, the Expanded Program on Immunization of Thailand changed the timing of the second dose of the measles–mumps–rubella (MMR) vaccine from 4–6 years to 2.5 years, while maintaining the first dose at 9 months of age. This study aimed to examine the dynamics and durability of immune responses induced by the two-dose MMR vaccine in a group of 169 Thai children from 4 to 7 years of age (4.5 years after the second MMR dose). We followed a cohort of healthy children from a clinical trial (ClinicalTrials.gov NCT02408926) where they were administered either the Priorix vaccine (GlaxoSmithKline Biologicals, Rixensart, Belgium) or M-M-RII (Merck & Co., Kenilworth, NJ, USA) at 9 months and 2.5 years of age. Blood samples were collected annually from ages 4 to 7 years. Anti-measles, -mumps, and -rubella IgG levels were evaluated using the enzyme-linked immunosorbent assay (EUROIMMUN, Lubeck, Germany). A total of 169 children completed this study. Over the 4.5 years following the two-dose MMR vaccination, we observed a decline in the seroprotection rates against measles and mumps, but not rubella. Longitudinal monitoring of antibody persistence, among other strategies, will help predict population-level immunity and inform public health interventions to address potential future outbreaks. Full article

Highly contagious diseases, such as mumps, are a global concern as new epidemics continue to emerge, even in highly vaccinated populations. The risk of transmission and spread of these viruses is even higher for individuals who are more likely to be exposed, including healthcare workers (HCWs). In healthcare settings, both HCWs and patients are at risk of infection during the care process, potentially leading to nosocomial epidemic outbreaks. Mumps is often underestimated compared with measles and rubella, despite being milder and less likely to spread. In fact, the risk of complications following mumps infection is extremely high, especially if the disease occurs in adulthood. The measles–mumps–rubella (MMR) vaccine has been shown to be an excellent preventive measure. Unfortunately, the mumps component appears to be less effective in inducing immunity than those for measles and rubella (two-dose effectiveness of 85%, 95% and 97%, respectively). The main aim of our study was to investigate the prevalence of detectable mumps antibodies (serum IgG antibodies) in a cohort of Italian and foreign HCWs in relation to personal and occupational factors. We included in the study 468 subjects who underwent health surveillance at the Occupational Medicine Unit of the Tor Vergata Polyclinic in Rome during the period from January 2021 to March 2023. In our study, the proportion of HCWs found to be unprotected against mumps was very high (8.3%), and those found to be immune are below the WHO threshold for herd immunity (95%). From our data, it seems essential that all occupational health services carry out an accurate screening with a dose of anti-mumps antibodies to assess serological protection before starting a job, regardless of an individual’s vaccination history. This approach is proving to be beneficial, accurate, as it allows all serologically non-immune individuals to be vaccinated in the workplace, including those who would be protected by their vaccination history but have lost the antibody response. Full article

Perceptions of the complete eradication of vaccine-preventable diseases such as measles, mumps, and rubella (MMR) may foster complacency and compromise vaccination efforts. Decreased measles vaccination rates during the COVID-19 pandemic have heightened the risk of outbreaks, even in adequately vaccinated populations. To address this, we have aligned with ECDC recommendations, leveraging previous cross-border sero-epidemiological assessments between Pécs, Hungary, and Osijek, Croatia, to identify latent risk groups and uncover potential parallels between our nations. Testing 2680 Hungarian and 1764 Croatian serum samples for anti-MMR IgG via ELISAs revealed anti-measles seropositivity ratios below expectations in Croatian cohorts aged ~20–30 (75.7%), ~30–40 (77.5%) and ~40–50 years (73.3%). Similarly, Hungarian samples also showed suboptimal seropositivity ratios in the ~30–40 (80.9%) and ~40–50 (87.3%) age groups. Considering mumps- and rubella-associated seropositivity trends, in both examined populations, individuals aged ~30–50 years exhibited the highest vulnerability. Additionally, we noted congruent seropositivity trends across both countries, despite distinct immunization and epidemiological contexts. Therefore, we propose expanding research to encompass the intricate dynamics of vaccination, including waning long-term immunity. This understanding could facilitate targeted interventions and bolster public awareness. Our findings underscore persistent challenges in attaining robust immunity against measles despite vaccination endeavors. Full article

Measles, mumps, rubella (MMR), and varicella incidence rates have increased due to the delayed vaccination schedules of children secondary to the COVID-19 pandemic. Decreased herd immunity creates a risk for immunocompetent children and immunocompromised individuals in the community. Historically, live-attenuated vaccines (MMR and varicella) were recommended before solid organ transplants. The amount of time before transplant when this is appropriate is often debated, as is the utility of vaccine titers. MMR and varicella vaccines previously were not recommended in immunocompromised patients post-solid organ transplant due to the undue risk of transmission and posed infection risk. The new literature on live-attenuated vaccines in post-transplant pediatric patients provides more insight into the vaccines’ safety and efficacy. The present article aims to provide guidance on live-attenuated vaccines (MMR and varicella) in the pre-transplant and post-operative solid organ transplant phases of care in pediatric patients. Full article