Epidemic trend of measles in Shandong Province, China, 1963-2005

Measles Epidemiology and Viral Nucleoprotein Gene Evolution in Shandong Province, China

Measles, caused by measles virus (MeV), has not been eradicated in many regions and countries, threatening human health. Thus, it is beneficial for measles elimination to understand measles epidemiology and molecular evolution of key viral genes, such as nucleoprotein (N) gene. Based on public data, measles epidemiological information and MeV N gene sequences reported in Shandong Province, China were comprehensively collected and systematically analyzed. The results showed a positive correlation between population density and measles incidence (r = + 0.31), while negative correlations were found between measles incidence and healthcare condition (r = - 0.21) as well as average routine vaccination rate (r = - 0.11). Additionally, the predominant lineage of MeV in Shandong was formed by genotype H1 strains, and the time of the most recent common ancestor of the N gene of MeV genotype H1 in Shandong traced back to 1987 (95% highest posterior density, 1984-1990) with relatively rapid evolution (mean rate, 1.267×10^-3 substitutions/site/year). The genetic diversity of MeV N gene increased with the substantial emergence of major divergent clades of genotype H1 before 2005 and then remained relatively stable. In summary, these findings provided a significant insight into the measles elimination. This article is protected by copyright. All rights reserved.

Analysis of spatial-temporal distribution of notifiable respiratory infectious diseases in Shandong Province, China during 2005-2014

BACKGROUND

Little comprehensive information on overall epidemic trend of notifiable respiratory infectious diseases is available in Shandong Province, China. This study aimed to determine the spatiotemporal distribution and epidemic characteristics of notifiable respiratory infectious diseases.

METHODS

Time series was firstly performed to describe the temporal distribution feature of notifiable respiratory infectious diseases during 2005-2014 in Shandong Province. GIS Natural Breaks (Jenks) was applied to divide the average annual incidence of notifiable respiratory infectious diseases into five grades. Spatial empirical Bayesian smoothed risk maps and excess risk maps were further used to investigate spatial patterns of notifiable respiratory infectious diseases. Global and local Moran's I statistics were used to measure the spatial autocorrelation. Spatial-temporal scanning was used to detect spatiotemporal clusters and identify high-risk locations.

RESULTS

A total of 537,506 cases of notifiable respiratory infectious diseases were reported in Shandong Province during 2005-2014. The morbidity of notifiable respiratory infectious diseases had obvious seasonality with high morbidity in winter and spring. Local Moran's I analysis showed that there were 5, 23, 24, 4, 20, 8, 14, 10 and 7 high-risk counties determined for influenza A (H1N1), measles, tuberculosis, meningococcal meningitis, pertussis, scarlet fever, influenza, mumps and rubella, respectively. The spatial-temporal clustering analysis determined that the most likely cluster of influenza A (H1N1), measles, tuberculosis, meningococcal meningitis, pertussis, scarlet fever, influenza, mumps and rubella included 74, 66, 58, 56, 22, 64, 2, 75 and 56 counties, and the time frame was November 2009, March 2008, January 2007, February 2005, July 2007, December 2011, November 2009, June 2012 and May 2005, respectively.

CONCLUSIONS

There were obvious spatiotemporal clusters of notifiable respiratory infectious diseases in Shandong during 2005-2014. More attention should be paid to the epidemiological and spatiotemporal characteristics of notifiable respiratory infectious diseases to establish new strategies for its control.

Assessment of impact of relaxation in lockdown and forecast of preparation for combating COVID-19 pandemic in India using Group Method of Data Handling

Ever since the outbreak of novel coronavirus in December 2019, lockdown has been identified as the only effective measure across the world to stop the community spread of this pandemic. India implemented a complete shutdown across the nation from March 25, 2020 as lockdown I and went on to extend it by giving timely partial relaxations in the form of lockdown II, III & IV. This paper statistically analyses the impact of relaxation during Lockdown III and IV on coronavirus disease (COVID) spread in India using the Group Method of Data Handling (GMDH) to forecast the number of active cases using time series analysis and hence the required medical infrastructure for the period of next six months. The Group Method of Data Handling is a novel self organized data mining technique with data driven adaptive learning capability which grasps the auto correlative relations between the samples and gives a high forecasting accuracy irrespective of the length and stochasticity of a time series. The GMDH model has been first validated and standardized by forecasting the number of active and confirmed cases during lockdown III-IV with an accuracy of 2.58% and 2.00% respectively. Thereafter, the number of active cases has been forecasted for the rest of 2020 to predict the impact of lockdown relaxation on spread of COVID-19 and indicate preparatory measures necessary to counter it.

Synthesis of Evidence to Characterize National Measles and Rubella Exposure and Immunization Histories

Population immunity depends on the dynamic levels of immunization coverage that countries achieve over time and any transmission of viruses that occur within the population that induce immunity. In the context of developing a dynamic transmission model for measles and rubella to support analyses of future immunization policy options, we assessed the model inputs required to reproduce past behavior and to provide some confidence about model performance at the national level. We reviewed the data available from the World Health Organization (WHO) and existing measles and rubella literature for evidence of historical reported routine and supplemental immunization activities and reported cases and outbreaks. We constructed model input profiles for 180 WHO member states and three other areas to support disease transmission model development and calibration. The profiles demonstrate the significant variability in immunization strategies used historically by regions and member states and the epidemiological implications of these historical choices. The profiles provide a historical perspective on measles and rubella immunization globally at the national level, and they may help immunization program managers identify existing immunity and/or knowledge gaps.

Cost of measles containment in an ambulatory pediatric clinic

BACKGROUND

Measles is highly infectious; prompt containment of illnesses is necessary to prevent spread. In August 2013, a 13-year-old male with measles exposed patients and employees in a pediatric clinic. We studied containment costs to identify avoidable costs.

METHODS

Measles exposure was defined as in-person contact with or presence in the same room <2 hours after the measles patient. Costs were calculated retrospectively using published costs of measles-mumps-rubella vaccine, cost-to-charge ratios for inpatient care in urban Washington State and local emergency department charges for post-exposure immunoglobulin (IG). Personnel costs were calculated by multiplying hourly wages by time for employees who worked on the response; overhead was excluded.

RESULTS

Fifty-two patients, 60 caretakers and 10 employees were exposed. Personnel time cost $1961. Exposed patients had a mean age of 9.6 years (range: 2 months-19 years); 34 (65%) were fully vaccinated, and 18 (35%) were <12 months of age and too young to be vaccinated. Five patients (10%) were <6 months of age and required IG; 13 infants (25%) 6-11 months of age required measles-mumps-rubella vaccination. Caretakers followed up with their physicians for evidence of immunity. One employee had documented evidence of immunity; 9 required measles antibody testing or vaccination. Management of exposed persons cost $3694; overall clinic costs were $5655.

CONCLUSION

Responding to 1 measles case cost the pediatric clinic more than $5000, despite isolating the patient promptly after examination. Documentation of employee immunity, vaccination of eligible patients and strict infection control precautions might reduce ambulatory costs associated with measles containment.

Difficulties in eliminating measles and controlling rubella and mumps: a cross-sectional study of a first measles and rubella vaccination and a second measles, mumps, and rubella vaccination

Background

The reported coverage of the measles–rubella (MR) or measles–mumps–rubella (MMR) vaccine is greater than 99.0% in Zhejiang province. However, the incidence of measles, mumps, and rubella remains high. In this study, we assessed MMR seropositivity and disease distribution by age on the basis of the current vaccination program, wherein the first dose of MR is administered at 8 months and the second dose of MMR is administered at 18–24 months.

Methods

Cross-sectional serological surveys of MMR antibodies were conducted by collecting epidemiological data in Zhejiang province, China in 2011. In total, 1015 participants were randomly selected from two surveillance sites. Serum MMR-specific immunoglobulin G levels were tested by enzyme-linked immunosorbent assay. The geometric mean titers and seroprevalence with 95% confidence intervals (CIs) were calculated by age and gender. Proportions of different dose of vaccine by age by vaccine were also identified. Statistically significant differences between categories were assessed by the Chi-square test.

Results

Over 95% seroprevalence rates of measles were seen in all age groups except <7 months infants. Children aged 5–9 years were shown lower seropositivity rates of mumps while elder adolescences and young adults were presented lower rubella seroprevalence. Especially, rubella seropositivity was significantly lower in female adults than in male. Nine measles cases were unvaccinated or unknown vaccination history. Among them, 66.67% (6/9) patients were aged 20–29 years while 33.33% (3/9) were infants aged 8–12 months. In addition, 57.75% (648/1122) patients with mumps were children aged 5–9 years, and 50.54% (94/186) rubella cases were aged 15–39 years.

Conclusions

A timely two-dose MMR vaccination schedule is recommended, with the first dose at 8 months and the second dose at 18–24 months. An MR vaccination speed-up campaign may be necessary for elder adolescents and young adults, particularly young females.

Spatiotemporal analysis of infant measles using population attributable risk in Shandong province, 1999-2008

BACKGROUND

Reduction of measles incidence and mortality has been encouraging in China. However, it remains an important public health concern among infants. This study aimed to examine the space-time distribution pattern of infant measles occurrence for the period of 1999-2008 in Shandong, China.

METHODS AND FINDINGS

Measles cases among infants aged younger than 1 year were obtained from the national infectious diseases reporting information system. A spatiotemporal analysis using population attributable risk percent (PAR%) was used to distinguish between multiple geographic clusters of potential interest. The analysis detected 29 statistically significant space-time clusters with the most likely cluster in Zaozhuang City from 2006 to 2008. Of the 28 secondary clusters, 22 were found in 2008. The map of PAR%, relative risk (RR) and space-time cluster analysis indicated that the clusters were generally unchanged, and were found south-west and north-west of Shandong. The Lanshan District in Linyi had the highest PAR%, while highest RR was in the Yicheng District in Zaozhuang.

CONCLUSION

There were significant space-time clusters of infant measles in Shandong over the study period. PAR% is an effective way to analyze multiple clusters from their application like RR. Interrupting measles circulation and maintaining routine coverage over 95% may be the only effective strategy to achieve measles elimination.

A 60-year review on the changing epidemiology of measles in capital Beijing, China, 1951-2011

BACKGROUND

China pledged to join the global effort to eliminate measles by 2012. To improve measles control strategy, the epidemic trend and population immunity of measles were investigated in 1951-2011 in Beijing.

METHODS

The changing trend of measles since 1951 was described based on measles surveillance data from Beijing Centre of Disease Control and Prevention (CDC). The measles vaccination coverage and antibody level were assessed by routinely reported measles vaccination data and twenty-one sero-epidemiological surveys.

RESULTS

The incidence of measles has decreased significantly from 593.5/100,000 in 1951 (peaked at 2721.0/100,000 in 1955), to 0.5/100,000 in 2011 due to increasing vaccination coverage of 95%-99%. Incidence rebounded from 6.6/100,000 to 24.5/100,000 since 2005 and decreased after measles vaccine (MV) supplementary immunization activities (SIAs) in 2010. Measles antibody positive rate was 85%-95% in most of years since 1981. High-risk districts were spotted in Chaoyang, Fengtai and Changping districts in recent 15 years. Age-specific incidence and proportion of measles varied over time. The most affected population were younger children of 1-4 years before 1978, older children of 5-14 years in 1978-1996, infant of <1 years and adults of ≥15 years in period of aim to measles elimination.

CONCLUSION

Strategies at different stages had a prevailing effect on the epidemic dynamics of measles in recent 60 years in Beijing. It will be essential to validate reported vaccination coverage, improve vaccination coverage in adults and strengthen measles surveillance in the anticipated elimination campaign for measles.