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Zimmermann BM, Paul KT, Janny A, Butt Z. Between information campaign and controversy: a quantitative newspaper content analysis about COVID-19 vaccination in Switzerland and Austria. Scand J Public Health 2024; 52:253-261. [PMID: 37646484 DOI: 10.1177/14034948231195388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
AIMS Because media portrayal reflects and shapes public opinion and health policy, investigating news coverage of public health issues is highly relevant for public health research and practice. Addressing a topical issue, this study investigated how newspaper coverage framed COVID-19 vaccines in Austria and German-speaking Switzerland and how it developed over time. METHODS A quantitative newspaper content analysis of six newspapers from Austria and German-speaking Switzerland published between January 1 and 31, 2022 was conducted. Frames were identified for each country separately through hierarchical cluster analysis (Ward's method) based on frame elements. RESULTS Four frames were identified in both countries: (1) Evaluating new vaccines, (2) Discussing mandates, (3) Promoting vaccination, (4) Mentioning vaccines. In Frames 1 (Switzerland 86.4%, Austria 93.3%) and 3 (Switzerland 92.7%, Austria 98.9%), most articles included vaccine-endorsing statements, with Swiss coverage including additional negative statements more often than Austrian coverage (43.2%/44.6% vs 4.0%/3.3%). Frame 2 was closely linked to vaccine skepticism only in Austria and contained more evaluative statements in Austrian newspapers (25.4% endorsing, 35.4% rejecting; in Switzerland 14.5%/18.1%). The Austrian tabloid Kronen Zeitung published most articles (497/1091, 45.6%). CONCLUSIONS The commercialized and comparatively high share of tabloid news coverage in Austria may have contributed to oversimplified and polarizing COVID-19 vaccine debates in this context. Insufficiently balanced and adequate information may contribute to a loss of public trust in vaccination and may therefore affect vaccination uptake. Authorities and public health professionals should consider this effect when designing information campaigns.
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Affiliation(s)
- Bettina M Zimmermann
- Institute for Biomedical Ethics, University of Basel, Switzerland
- Institute of History and Ethics in Medicine, School of Social Sciences, School of Medicine, Technical University of Munich, Germany
- Institute of Philosophy and Multidisciplinary Center for Infectious Diseases, University of Bern, Switzerland
| | - Katharina T Paul
- Department of Political Science, University of Vienna, Austria
- Research Platform Governance of Digital Practices (DigiGov), University of Vienna, Austria
| | - Anna Janny
- Department of Political Science, University of Vienna, Austria
| | - Zarah Butt
- Institute for Biomedical Ethics, University of Basel, Switzerland
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2
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Lackner C, Karbiener M, Faltner L, Farcet MR, Kreil TR. Feasibility of identifying plasma donors with high measles neutralizing antibody concentrations for the use of producing a measles hyperimmune globulin for postexposure prophylaxis. Immunol Res 2022; 70:365-370. [PMID: 35266077 PMCID: PMC8906519 DOI: 10.1007/s12026-022-09274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022]
Abstract
Immune globulin (IG) is administered as measles postexposure prophylaxis (PEP) in people with primary immunodeficiency disorders or individuals not eligible for live virus vaccination. However, measles virus (MeV) neutralizing antibody (nAb) levels in plasma for fractionation and IG products fractionated thereof have declined. Here, the feasibility of producing a measles hyperimmune globulin (HIG) for PEP of high-risk individuals was investigated. Plasma samples (n = 384) were selected based on donor self-identification for previous MeV infection or vaccination, to determine the MeV-nAb content and compare it to the potency of plasma pools (n = 13) from the current IG manufacture. Convalescent donors have higher mean MeV-nAb concentrations (3.9 IU/mL) than vaccinated donors (2.5 IU/mL), as previously reported. However, their selection would only result in a 1.4-fold elevated nAb concentration compared to current plasma pools, which is not sufficient for HIG production. Interestingly, thirty-two donors (8%) had a MeV-nAb concentration of ≥ 8 IU/mL. The selective use of these plasma donations would result in sixfold higher plasma pool concentrations, which should permit the manufacture of the measles HIG. Further, the longitudinal analysis of a subset of individuals who repeatedly donated plasma at a high frequency revealed only a minor decline (~ 30%) of MeV-nAb levels. Repeat donations of such high-potency donors would thus facilitate the production of the measles HIG. Due to its markedly raised MeV-nAb concentration compared to standard IG, such preparation could significantly shorten infusion time and thus improve the treatment experience for both physicians and patients, especially infants.
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Affiliation(s)
- Cornelia Lackner
- Global Pathogen Safety, Takeda Manufacturing Austria AG, Takeda, Benatzkygasse 2-6, 1221, Vienna, Austria
| | - Michael Karbiener
- Global Pathogen Safety, Takeda Manufacturing Austria AG, Takeda, Benatzkygasse 2-6, 1221, Vienna, Austria
| | - Lukas Faltner
- Global Pathogen Safety, Takeda Manufacturing Austria AG, Takeda, Benatzkygasse 2-6, 1221, Vienna, Austria
| | - Maria R Farcet
- Global Pathogen Safety, Takeda Manufacturing Austria AG, Takeda, Benatzkygasse 2-6, 1221, Vienna, Austria
| | - Thomas R Kreil
- Global Pathogen Safety, Takeda Manufacturing Austria AG, Takeda, Benatzkygasse 2-6, 1221, Vienna, Austria.
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Austria's Digital Vaccination Registry: Stakeholder Views and Implications for Governance. Vaccines (Basel) 2021; 9:vaccines9121495. [PMID: 34960241 PMCID: PMC8706289 DOI: 10.3390/vaccines9121495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/20/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
In this study, we explore the recent setup of a digital vaccination record in Austria. Working from a social-scientific perspective, we find that the introduction of the electronic vaccination pass was substantially accelerated by the COVID-19 pandemic. Our interviews with key stakeholders (n = 16) indicated that three main factors drove this acceleration. The pandemic (1) sidelined historical conflicts regarding data ownership and invoked a shared sense of the value of data, (2) accentuated the need for enhanced administrative efficiency in an institutionally fragmented system, and (3) helped invoke the national vaccination registry as an indispensable infrastructure for public health governance with the potential to innovate its healthcare system in the long term.
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Vaccination Status and Attitude among Measles Cluster Cases in Austria, 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249377. [PMID: 33333819 PMCID: PMC7765158 DOI: 10.3390/ijerph17249377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 11/20/2022]
Abstract
On 21 January 2019, public health authorities of two neighboring Austrian provinces reported an increase in measles cases. We investigated this occurrence to identify clusters of epidemiologically linked cases and the associated vaccination status in order to generate hypotheses on those factors explaining the size of the measles clusters. Probable cases were residents of the provinces of Styria or Salzburg with clinical presentation of measles after 1 January 2019 who were linked to a confirmed case using RNA virus detection. We collected data on age, rash onset, certificate-based vaccination status and reasons for being unvaccinated. Contact history was used to identify chains of transmission. By 11 March, we identified 47 cases, with 40 (85.1%) in unvaccinated patients. A cluster of 35 cases with a median age of seven years (IQR: 1–11) occurred between 9 January and 20 February in the province of Styria due to one transmission chain with four case generations. Of 31 vaccine-eligible cases, 25 (80.6%) were unvaccinated, of which 13 refused vaccination. Between 10 January and 1 March, we identified 12 cases as part of five unlinked clusters in the province of Salzburg. Each of these five clusters consisted of two generations: the primary case and the successive cases (median age: 22 years, IQR: 11–35). Eleven of 12 cases occurred in unvaccinated patients, with none of the 11 having a vaccination-refusing attitude. An extended measles cluster in a vaccination-refusing community, compared to five short-lived clusters concurrently occurring in the neighboring province, illustrates how vaccine refusal may hamper control of transmission.
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Schober T. Effects of a measles outbreak on vaccination uptake. ECONOMICS AND HUMAN BIOLOGY 2020; 38:100871. [PMID: 32521477 DOI: 10.1016/j.ehb.2020.100871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/05/2019] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
This paper explores the effects of a measles outbreak on vaccination uptake in Austria, using administrative data with individual-level information on childhood vaccinations. I define a treatment group of children affected by the outbreak, and compare them with a control group of earlier-born children who are unaffected. Twelve months after the outbreak, the vaccination rate of the treatment group is 2.5 (first dose of the measles, mumps and rubella vaccine) and 4 (second dose) percentage points higher than the corresponding rates of the control group. The results do not indicate that families at increased risk respond more strongly, suggesting that the outbreak changed the perceived value of vaccinations across the whole population. Findings also reveal heterogeneity in the response of families based on the parents' level of education, indicating that parents with higher education levels absorb new information more rapidly.
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Affiliation(s)
- Thomas Schober
- Johannes Kepler University Linz, Department of Economics, Christian Doppler Laboratory for Aging, Health, and the Labor Market, Altenberger Straße 69, 4040 Linz, Austria.
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Hughes SL, Bolotin S, Khan S, Li Y, Johnson C, Friedman L, Tricco AC, Hahné SJM, Heffernan JM, Dabbagh A, Durrheim DN, Orenstein WA, Moss WJ, Jit M, Crowcroft NS. The effect of time since measles vaccination and age at first dose on measles vaccine effectiveness - A systematic review. Vaccine 2020; 38:460-469. [PMID: 31732326 PMCID: PMC6970218 DOI: 10.1016/j.vaccine.2019.10.090] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/16/2019] [Accepted: 10/27/2019] [Indexed: 12/04/2022]
Abstract
BACKGROUND In settings where measles has been eliminated, vaccine-derived immunity may in theory wane more rapidly due to a lack of immune boosting by circulating measles virus. We aimed to assess whether measles vaccine effectiveness (VE) waned over time, and if so, whether differentially in measles-eliminated and measles-endemic settings. METHODS We performed a systematic literature review of studies that reported VE and time since vaccination with measles-containing vaccine (MCV). We extracted information on case definition (clinical symptoms and/or laboratory diagnosis), method of vaccination status ascertainment (medical record or vaccine registry), as well as any biases which may have arisen from cold chain issues and a lack of an age at first dose of MCV. We then used linear regression to evaluate VE as a function of age at first dose of MCV and time since MCV. RESULTS After screening 14,782 citations, we identified three full-text articles from measles-eliminated settings and 33 articles from measles-endemic settings. In elimination settings, two-dose VE estimates increased as age at first dose of MCV increased and decreased as time since MCV increased; however, the small number of studies available limited interpretation. In measles-endemic settings, one-dose VE increased by 1.5% (95% CI 0.5, 2.5) for every month increase in age at first dose of MCV. We found no evidence of waning VE in endemic settings. CONCLUSIONS The paucity of data from measles-eliminated settings indicates that additional studies and approaches (such as studies using proxies including laboratory correlates of protection) are needed to answer the question of whether VE in measles-eliminated settings wanes. Age at first dose of MCV was the most important factor in determining VE. More VE studies need to be conducted in elimination settings, and standards should be developed for information collected and reported in such studies.
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Affiliation(s)
| | - Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Ye Li
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Andrea C Tricco
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan J M Hahné
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jane M Heffernan
- Centre for Disease Modelling, Department of Mathematics & Statistics, York University, Toronto, Ontario, Canada
| | - Alya Dabbagh
- Department of Immunisation, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - David N Durrheim
- Hunter New England Health, New Lambton Heights, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Public Health and Tropical Medicine, James Cook University, Queensland, Australia
| | - Walter A Orenstein
- Emory University School of Medicine, Emory University, Atlanta, GA, United States; Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - William J Moss
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Modelling and Economics Unit, Public Health England, London, United Kingdom
| | - Natasha S Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
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Schneider R, Reinau D, Schur N, Blozik E, Früh M, Signorell A, Heininger U, Schwenkglenks M, Meier CR. Coverage rates and timeliness of nationally recommended vaccinations in Swiss preschool children: A descriptive analysis using claims data. Vaccine 2019; 38:1551-1558. [PMID: 31791812 DOI: 10.1016/j.vaccine.2019.11.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/07/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Low vaccination coverage as well as incomplete and delayed vaccinations pose a risk for the individual and population protection from vaccine-preventable diseases. AIM To describe vaccination patterns for nationally recommended basic and supplementary vaccinations in Swiss preschool children. METHODS We performed a descriptive study based on administrative claims data from a large Swiss health insurer (Helsana), in cohorts of children born between January 2010 and December 2016. We assessed coverage rates of nationally recommended basic vaccinations (i.e., diphtheria, tetanus, acellular pertussis [DTaP], Haemophilus influenzae type b [Hib], poliomyelitis [IPV], measles, mumps, and rubella [MMR]) and supplementary vaccinations (i.e., pneumococcal conjugate vaccine [PCV] and meningococcal group C conjugate vaccine [MCV]) for each birth cohort at the age of 13, 25, and 37 months. Additionally, we analysed timeliness of vaccinations using inverse Kaplan-Meier curves. Results were extrapolated to the Swiss population. RESULTS The study population comprised 563,216 children. We observed continuously increasing coverage rates for all vaccinations until the 2015 birth cohort. Overall, up-to-date status for the first dose of studied vaccinations at 37 months was as follows: DTaP: 95.4%; Hib: 94.9%; IPV: 95.5%; MMR: 86.8%; PCV: 83.2%; and MCV: 66.7%. On average, however, only seven out of ten children had an up-to-date status for completed basic vaccinations; even less (six out of ten) were up-to-date for recommended supplementary vaccinations at 37 months of age. Moreover, 4% of all analysed children received none of the recommended vaccinations and there were substantial regional differences. Delays in vaccine administration were common. The most frequently postponed basic vaccination was MMR; 22.6% of children vaccinated with the first dose experienced delays relative to age-appropriate standards. CONCLUSION To avoid future outbreaks and transmission of vaccine-preventable diseases, vaccination coverage in Switzerland must be further improved. In addition, more emphasis should be placed on timely vaccination.
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Affiliation(s)
- Rahel Schneider
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland
| | - Daphne Reinau
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland
| | - Nadine Schur
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, CH-4056 Basel, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, CH-8600 Dübendorf, Switzerland
| | - Mathias Früh
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, CH-8600 Dübendorf, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, CH-8600 Dübendorf, Switzerland
| | - Ulrich Heininger
- University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology, and University of Basel Medical Faculty, Spitalstrasse 33, CH-4056 Basel, Switzerland
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, CH-4056 Basel, Switzerland
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland; Boston Collaborative Drug Surveillance Program, MA 11 Muzzey St, Lexington, MA 02421, USA.
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Trobisch A, Klobassa DS, Gschiel H, Wassermann-Neuhold M, Zenz W. Analyse des Masernausbruches 2015 in der Steiermark. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-017-0340-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fournet N, Mollema L, Ruijs WL, Harmsen IA, Keck F, Durand JY, Cunha MP, Wamsiedel M, Reis R, French J, Smit EG, Kitching A, van Steenbergen JE. Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews. BMC Public Health 2018; 18:196. [PMID: 29378545 PMCID: PMC5789742 DOI: 10.1186/s12889-018-5103-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/19/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite effective national immunisation programmes in Europe, some groups remain incompletely or un-vaccinated ('under-vaccinated'), with underserved minorities and certain religious/ideological groups repeatedly being involved in outbreaks of vaccine preventable diseases (VPD). Gaining insight into factors regarding acceptance of vaccination of 'under-vaccinated groups' (UVGs) might give opportunities to communicate with them in a trusty and reliable manner that respects their belief system and that, maybe, increase vaccination uptake. We aimed to identify and describe UVGs in Europe and to describe beliefs, attitudes and reasons for non-vaccination in the identified UVGs. METHODS We defined a UVG as a group of persons who share the same beliefs and/or live in socially close-knit communities in Europe and who have/had historically low vaccination coverage and/or experienced outbreaks of VPDs since 1950. We searched MEDLINE, EMBASE and PsycINFO databases using specific search term combinations. For the first systematic review, studies that described a group in Europe with an outbreak or low vaccination coverage for a VPD were selected and for the second systematic review, studies that described possible factors that are associated with non-vaccination in these groups were selected. RESULTS We selected 48 articles out of 606 and 13 articles out of 406 from the first and second search, respectively. Five UVGs were identified in the literature: Orthodox Protestant communities, Anthroposophists, Roma, Irish Travellers, and Orthodox Jewish communities. The main reported factors regarding vaccination were perceived non-severity of traditional "childhood" diseases, fear of vaccine side-effects, and need for more information about for example risk of vaccination. CONCLUSIONS Within each UVG identified, there are a variety of health beliefs and objections to vaccination. In addition, similar factors are shared by several of these groups. Communication strategies regarding these similar factors such as educating people about the risks associated with being vaccinated versus not being vaccinated, addressing their concerns, and countering vaccination myths present among members of a specific UVG through a trusted source, can establish a reliable relationship with these groups and increase their vaccination uptake. Furthermore, other interventions such as improving access to health care could certainly increase vaccination uptake in Roma and Irish travellers.
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Affiliation(s)
- N. Fournet
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - L. Mollema
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- National Institute for Public Health and the Environment, Epidemiology and Surveillance Unit, P.O. Box 1 (internal P.O. Box 75), 3720 BA Bilthoven, the Netherlands
| | - W. L. Ruijs
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - I. A. Harmsen
- Municipal Health Service (GGD) Amsterdam, Amsterdam, The Netherlands
| | - F. Keck
- Laboratoire d’anthropologie sociale - Centre National de la Recherche Scientifique, Paris, France
| | - J. Y. Durand
- Centre for Research in Anthropology, Universidade do Minho (CRIA - UMinho), Braga, Portugal
| | - M. P. Cunha
- Centre for Research in Anthropology, Universidade do Minho (CRIA - UMinho), Braga, Portugal
| | - M. Wamsiedel
- Department of Public Health at Xi’an Jiaotong-Liverpool University, Suzhou, China
| | - R. Reis
- Leiden University Medical Centre, Leiden, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
- The Children’s Institute, University of Cape Town, Cape Town, South Africa
| | - J. French
- Strategic Social Marketing, Liphook, UK
- Brighton University Business School, Brighton, UK
| | - E. G. Smit
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - A. Kitching
- Department of Public Health, Health Service Executive, St Finbarr’s Hospital, Cork, Republic of Ireland
| | - J. E. van Steenbergen
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Centre for Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
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Santibanez S, Hübschen JM, Ben Mamou MC, Muscat M, Brown KE, Myers R, Donoso Mantke O, Zeichhardt H, Brockmann D, Shulga SV, Muller CP, O'Connor PM, Mulders MN, Mankertz A. Molecular surveillance of measles and rubella in the WHO European Region: new challenges in the elimination phase. Clin Microbiol Infect 2017; 23:516-523. [PMID: 28712666 DOI: 10.1016/j.cmi.2017.06.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND The WHO European Region (EUR) has adopted the goal of eliminating measles and rubella but individual countries perform differently in achieving this goal. Measles virus spread across the EUR by mobile groups has recently led to large outbreaks in the insufficiently vaccinated resident population. As an instrument for monitoring the elimination process and verifying the interruption of endemic virus transmission, molecular surveillance has to provide valid and representative data. Irrespective of the country's specific situation, it is required to ensure the functionality of the laboratory surveillance that is supported by the WHO Global Measles and Rubella Laboratory Network. AIMS To investigate whether the molecular surveillance in the EUR is adequate for the challenges in the elimination phase, we addressed the quality assurance of molecular data, the continuity and intensity of molecular monitoring, and the analysis of transmission chains. SOURCES Published articles, the molecular External Quality Assessment Programme of the WHO, the Centralized Information System for Infectious Diseases of the WHO EUR and the WHO Measles and Rubella Nucleotide Surveillance databases served as information sources. CONTENT Molecular proficiency testing conducted by the WHO in 2016 has shown that the expertise for measles and rubella virus genotyping exists in all parts of the EUR. The analysis of surveillance data reported nationally to the WHO in 2013-2016 has revealed some countries with outbreaks but not sufficiently representative molecular data. Long-lasting supranational MV transmission chains were identified. IMPLICATIONS A more systematic molecular monitoring and recording of the transmission pattern for the whole EUR could help to create a meaningful picture of the elimination process.
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Affiliation(s)
- S Santibanez
- WHO European Regional Reference Laboratory for Measles and Rubella, Robert Koch-Institut, Berlin, Germany.
| | - J M Hübschen
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg
| | - M C Ben Mamou
- Vaccine-preventable Diseases and Immunization, WHO Regional Office for Europe, Copenhagen, Denmark
| | - M Muscat
- Vaccine-preventable Diseases and Immunization, WHO Regional Office for Europe, Copenhagen, Denmark
| | - K E Brown
- WHO Global Specialized Laboratory for Measles and Rubella, Virus Reference Department, Public Health England, London, UK
| | - R Myers
- WHO Global Specialized Laboratory for Measles and Rubella, Virus Reference Department, Public Health England, London, UK
| | - O Donoso Mantke
- INSTAND e.V. - Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien e.V., Düsseldorf, Germany
| | - H Zeichhardt
- INSTAND e.V. - Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien e.V., Düsseldorf, Germany; Institut für Virologie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Germany; Institut für Qualitätssicherung in der Virusdiagnostik - IQVD, Berlin, Germany
| | - D Brockmann
- Epidemiological Modelling of Infectious Diseases, Robert Koch-Institut, Berlin, Germany; Institute for Theoretical Biology, Department of Biology, Humboldt University of Berlin, Berlin, Germany
| | - S V Shulga
- WHO European Regional Reference Laboratory for Measles and Rubella, Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - C P Muller
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg
| | - P M O'Connor
- Vaccine-preventable Diseases and Immunization, WHO Regional Office for Europe, Copenhagen, Denmark
| | - M N Mulders
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - A Mankertz
- WHO European Regional Reference Laboratory for Measles and Rubella, Robert Koch-Institut, Berlin, Germany
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11
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Thompson KM, Odahowski CL, Goodson JL, Reef SE, Perry RT. Synthesis of Evidence to Characterize National Measles and Rubella Exposure and Immunization Histories. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1427-1458. [PMID: 26249328 DOI: 10.1111/risa.12454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
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.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | | | - James L Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan E Reef
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Alonso WJ, Rabaa MA, Giglio R, Miller MA, Schuck-Paim C. Modeling the Impact of Alternative Immunization Strategies: Using Matrices as Memory Lanes. PLoS One 2015; 10:e0141147. [PMID: 26509976 PMCID: PMC4624994 DOI: 10.1371/journal.pone.0141147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/04/2015] [Indexed: 11/19/2022] Open
Abstract
Existing modeling approaches are divided between a focus on the constitutive (micro) elements of systems or on higher (macro) organization levels. Micro-level models enable consideration of individual histories and interactions, but can be unstable and subject to cumulative errors. Macro-level models focus on average population properties, but may hide relevant heterogeneity at the micro-scale. We present a framework that integrates both approaches through the use of temporally structured matrices that can take large numbers of variables into account. Matrices are composed of several bidimensional (time×age) grids, each representing a state (e.g. physiological, immunological, socio-demographic). Time and age are primary indices linking grids. These matrices preserve the entire history of all population strata and enable the use of historical events, parameters and states dynamically in the modeling process. This framework is applicable across fields, but particularly suitable to simulate the impact of alternative immunization policies. We demonstrate the framework by examining alternative strategies to accelerate measles elimination in 15 developing countries. The model recaptured long-endorsed policies in measles control, showing that where a single routine measles-containing vaccine is employed with low coverage, any improvement in coverage is more effective than a second dose. It also identified an opportunity to save thousands of lives in India at attractively low costs through the implementation of supplementary immunization campaigns. The flexibility of the approach presented enables estimating the effectiveness of different immunization policies in highly complex contexts involving multiple and historical influences from different hierarchical levels.
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Affiliation(s)
- Wladimir J. Alonso
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- Origem Scientifica, Epidemiology and Modeling, Sao Paulo, Sao Paulo, Brazil
| | - Maia A. Rabaa
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- Clinical Research Unit, Oxford University, Ho Chi Minh City, Vietnam
| | - Ricardo Giglio
- Department of Economics, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Mark A. Miller
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
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Leuridan E, Maertens K, Wautier M, Hutse V, Theeten H. Susceptibility to measles, mumps, and rubella in 5-year-old children in Flanders, Belgium. Eur J Pediatr 2015; 174:925-32. [PMID: 25579232 DOI: 10.1007/s00431-014-2481-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/28/2014] [Accepted: 12/12/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED The second dose of an MMR vaccine is a catch up for persons who did not receive the first dose or for primary vaccine failures. Catch up doses can be scheduled according to convenience into the program of the country. The second MMR dose is often administered at the age of 5 years, before school entry. Some countries chose to implement the second dose at the age of 10-13 years, as is the case for Belgium. The here presented long-term follow-up of a cohort of children, set up originally to analyze maternal antibodies against vaccine preventable diseases, offers a unique opportunity to evaluate ad interim the current long-interval MMR vaccination schedule in Belgium. After 1 MMR dose at 12 months of age, rubella immunity is almost intact at 5 years of age (94.5 % is seropositive), measles seropositivity scores 86.8 %, and mumps 32 %, measured with ELISA. A seroneutralization (SN) test for mumps antibodies reveals much higher seropositivity rates (88 %). Using a regression model on the log (IgG) titer for all antigens, no influence was found from any of the studied variables, except for girls who had a significantly higher rubella IgG titer (p=0.002) compared to boys. CONCLUSION The data show considerable susceptibility to mumps and measles in 5-year-old children, confirming a previously conducted seroprevalence study (2006). Both advantages and disadvantages of shortening or enlarging the vaccine schedule are discussed.
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Affiliation(s)
- E Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium,
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14
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Santibanez S, Hübschen JM, Muller CP, Freymuth F, Mosquera MM, Mamou MB, Mulders MN, Brown KE, Myers R, Mankertz A. Long-term transmission of measles virus in Central and continental Western Europe. Virus Genes 2015; 50:2-11. [DOI: 10.1007/s11262-015-1173-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 01/16/2015] [Indexed: 12/18/2022]
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Klomp JH, van Lier A, Ruijs WL. Vaccination coverage for measles, mumps and rubella in anthroposophical schools in Gelderland, The Netherlands. Eur J Public Health 2014; 25:501-5. [DOI: 10.1093/eurpub/cku178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Byström E, Lindstrand A, Likhite N, Butler R, Emmelin M. Parental attitudes and decision-making regarding MMR vaccination in an anthroposophic community in Sweden – A qualitative study. Vaccine 2014; 32:6752-7. [DOI: 10.1016/j.vaccine.2014.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 11/16/2022]
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Increased measles–mumps–rubella (MMR) vaccine uptake in the context of a targeted immunisation campaign during a measles outbreak in a vaccine-reluctant community in England. Vaccine 2014; 32:1147-52. [DOI: 10.1016/j.vaccine.2014.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 12/20/2013] [Accepted: 01/02/2014] [Indexed: 11/18/2022]
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Bonačić Marinović AA, Swaan C, Wichmann O, van Steenbergen J, Kretzschmar M. Effectiveness and timing of vaccination during school measles outbreak. Emerg Infect Dis 2013; 18:1405-13. [PMID: 22931850 PMCID: PMC3437694 DOI: 10.3201/eid1809.111578] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Implementing a vaccination campaign during an outbreak can effectively reduce the outbreak size.
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Affiliation(s)
- Axel Antonio Bonačić Marinović
- Center for Infectious Disease Control, National Institute for Public Health and the Environment-RIVM, PO Box 1, 3720 BA Bilthoven, the Netherlands.
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Leuridan E, Sabbe M, Van Damme P. Measles outbreak in Europe: susceptibility of infants too young to be immunized. Vaccine 2012; 30:5905-13. [PMID: 22841972 DOI: 10.1016/j.vaccine.2012.07.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 07/08/2012] [Accepted: 07/16/2012] [Indexed: 10/28/2022]
Abstract
As women vaccinated against measles transfer low amounts of antibodies, an increasing number of infants lack early protection through maternal antibodies until being immunised themselves. This paper reviews the literature on disease burden of measles in the population too young to be immunized according to the respective national recommendations during recent outbreaks in EU and EEA/EFTA countries. In addition, specific control strategies adopted to protect this young population are reviewed. Pubmed, Unbound Medline, Web of Knowledge and the Eurosurveillance database were searched using MESH terms: measles and epidemiology, measles and infants, prevalence of measles, measles and outbreaks and measles and epidemic. Additionally, data from Euvac.net and ECDC were consulted. Databases were searched from January 2001 to September 2011. Fifty-three papers were included in the analysis. The percentage of all measles cases during outbreaks affecting young infants ranged from 0.25% to 83.0%. Specific control strategies were adopted: e.g. administration of the first or second vaccine dose earlier than recommended. Infants younger than 12 months are often involved in measles outbreaks, and advancing the first vaccine dose could reduce the burden of disease. However, immunization before 9 months of age is not systematically recommended because of dysmature humoral immune responses of infants. High coverage and timely administration of the recommended series of vaccines are the most important measures to decrease measles incidence and measles circulation and protect vulnerable infants from infection.
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Affiliation(s)
- E Leuridan
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Universiteitsplein, 1, 2610 Wilrijk, Belgium.
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Mollema L, Wijers N, Hahné SJM, van der Klis FRM, Boshuizen HC, de Melker HE. Participation in and attitude towards the national immunization program in the Netherlands: data from population-based questionnaires. BMC Public Health 2012; 12:57. [PMID: 22264347 PMCID: PMC3298495 DOI: 10.1186/1471-2458-12-57] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 01/20/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Knowledge about the determinants of participation and attitude towards the National Immunisation Program (NIP) may be helpful in tailoring information campaigns for this program. Our aim was to determine which factors were associated with nonparticipation in the NIP and which ones were associated with parents' intention to accept remaining vaccinations. Further, we analyzed possible changes in opinion on vaccination over a 10 year period. METHODS We used questionnaire data from two independent, population-based, cross-sectional surveys performed in 1995-96 and 2006-07. For the 2006-07 survey, logistic regression modelling was used to evaluate what factors were associated with nonparticipation and with parents' intention to accept remaining vaccinations. We used multivariate multinomial logistic regression modelling to compare the results between the two surveys. RESULTS Ninety-five percent of parents reported that they or their child (had) participated in the NIP. Similarly, 95% reported they intended to accept remaining vaccinations. Ethnicity, religion, income, educational level and anthroposophic beliefs were important determinants of nonparticipation in the NIP. Parental concerns that played a role in whether or not they would accept remaining vaccinations included safety of vaccinations, maximum number of injections, whether vaccinations protect the health of one's child and whether vaccinating healthy children is necessary. Although about 90% reported their opinion towards vaccination had not changed, a larger proportion of participants reported to be less inclined to accept vaccination in 2006-07 than in 1995-96. CONCLUSION Most participants had a positive attitude towards vaccination, although some had doubts. Groups with a lower income or educational level or of non-Western descent participated less in the NIP than those with a high income or educational level or indigenous Dutch and have been less well identified previously. Particular attention ought to be given to these groups as they contribute in large measure to the rate of nonparticipation in the NIP, i.e., to a greater extent than well-known vaccine refusers such as specific religious groups and anthroposophics. Our finding that the proportion of the population inclined to accept vaccinations is smaller than it was 10 years ago highlights the need to increase knowledge about attitudes and beliefs regarding the NIP.
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Affiliation(s)
- Liesbeth Mollema
- Centre for Infectious Disease Control Netherlands, RIVM, Bilthoven, The Netherlands
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control Netherlands, Epidemiology and Surveillance Unit, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Nancy Wijers
- Centre for Infectious Disease Control Netherlands, RIVM, Bilthoven, The Netherlands
- Department of Earth and Life Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Susan JM Hahné
- Centre for Infectious Disease Control Netherlands, RIVM, Bilthoven, The Netherlands
| | | | - Hendriek C Boshuizen
- ICT/Expertise Centre for Methodology and Information Service, RIVM, Bilthoven, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control Netherlands, RIVM, Bilthoven, The Netherlands
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Lang P, Zimmermann H, Piller U, Steffen R, Hatz C. The Swiss National Vaccination Coverage Survey, 2005-2007. Public Health Rep 2011; 126 Suppl 2:97-108. [PMID: 21812174 DOI: 10.1177/00333549111260s212] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We described the results from the Swiss National Vaccination Coverage Survey (SNVCS) 2005-2007, a survey designed to monitor immunization coverage of children and adolescents residing in Switzerland in each canton within a three-year period. METHODS The SNVCS is a cross-sectional survey using a two-stage sampling design targeting children aged 2, 8, and 16 years. Families of selected children were contacted by mail and telephone. Coverage was determined via vaccination cards or vaccination summary forms. RESULTS A total of 25 out of 26 cantons participated in the survey, with 8,286 respondents for children aged 24-35 months, 10,314 respondents for children aged 8 years, and 9,301 respondents for teenagers aged 16 years. Compared with data from 1999-2003, coverage estimates for toddlers remained unchanged for diphtheria, tetanus, pertussis, poliomyelitis, and Haemophilus influenzae type b vaccines at three doses, but increased five percentage points to 86%-87% for measles-mumps-rubella at one dose and was 71% at two doses. Coverage for measles, mumps, and rubella were 89%-90% at one dose and 75% at two doses for 8-year-olds, and 94% and 76% for the two dosages, respectively, for 16-year-olds. Linguistic region and nationality were highly correlated with being vaccinated against measles for the two younger age groups. CONCLUSION Despite the increase in vaccine coverage, measles vaccination is still low, and the World Health Organization goal to eliminate measles by 2010 was not achieved in Switzerland. More efforts are needed by the cantons and the central government to increase vaccination coverage.
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Affiliation(s)
- Phung Lang
- University of Zurich, Institute of Social and Preventive Medicine, Division of Epidemiology and Prevention of Infectious Diseases, Zurich, Switzerland.
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Mankertz A, Mulders MN, Shulga S, Kremer JR, Brown KE, Santibanez S, Muller CP, Tikhonova N, Lipskaya G, Jankovic D, Khetsuriani N, Martin R, Gavrilin E. Molecular genotyping and epidemiology of measles virus transmission in the World Health Organization European Region, 2007-2009. J Infect Dis 2011; 204 Suppl 1:S335-42. [PMID: 21666182 DOI: 10.1093/infdis/jir101] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2002, the World Health Organization (WHO) adopted a goal to eliminate measles in the European Region by 2010. Measles elimination is defined as the interruption of indigenous measles virus (MV) transmission. The molecular epidemiology of MV transmission in the WHO European Region was studied through the investigation of reported cases and outbreaks to monitor the region's progress toward its measles elimination goal. METHODS National and regional laboratories performed molecular characterization of MV detected between 2007 and 2009 in the WHO European Region. To document indigenous transmission and importations into the region, we analyzed genotyping results and epidemiological data on measles outbreaks reported by the member states. RESULTS Since 2007, MV genotype D6 has not been reported in the WHO European Region, suggesting that its chains of transmission have been interrupted, whereas several other MV genotypes are still circulating. Although several European countries have already interrupted indigenous MV transmission, genotyping showed that 3 endemic MV transmission chains have been reestablished in other countries. CONCLUSIONS The WHO European Region 2010 goal will not be met, as indigenous transmission of MV has not been interrupted. As the region begins to document its process of elimination verification to monitor progress toward the goal, countries will need to ensure that genotyping is performed in all measles outbreaks.
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Affiliation(s)
- Annette Mankertz
- National Reference Centre for Measles, Mumps, and Rubella/World Health Organization European Regional Reference Laboratory, Robert Koch-Institute, Division of Viral Infection, Berlin, Germany.
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Uzicanin A, Zimmerman L. Field Effectiveness of Live Attenuated Measles-Containing Vaccines: A Review of Published Literature. J Infect Dis 2011; 204 Suppl 1:S133-48. [DOI: 10.1093/infdis/jir102] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rota PA, Brown K, Mankertz A, Santibanez S, Shulga S, Muller CP, Hübschen JM, Siqueira M, Beirnes J, Ahmed H, Triki H, Al-Busaidy S, Dosseh A, Byabamazima C, Smit S, Akoua-Koffi C, Bwogi J, Bukenya H, Wairagkar N, Ramamurty N, Incomserb P, Pattamadilok S, Jee Y, Lim W, Xu W, Komase K, Takeda M, Tran T, Castillo-Solorzano C, Chenoweth P, Brown D, Mulders MN, Bellini WJ, Featherstone D. Global Distribution of Measles Genotypes and Measles Molecular Epidemiology. J Infect Dis 2011; 204 Suppl 1:S514-23. [DOI: 10.1093/infdis/jir118] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wadl M, Siedler A, Krämer W, Haindl ME, Gebrande S, Krenn-Lanzl I, Mankertz A, Hautmann W. Measles transmission from an anthroposophic community to the general population, Germany 2008. BMC Public Health 2011; 11:474. [PMID: 21676265 PMCID: PMC3132164 DOI: 10.1186/1471-2458-11-474] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 06/15/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Germany, measles vaccination coverage with two doses is not yet sufficient to prevent regional outbreaks. Among the 16 German federal states, vaccination coverage was lowest in Bavaria with 85% in 2008. From March to mid-April 2008, four neighbouring Bavarian counties reported 55 measles-cases mostly linked to an ongoing measles outbreak in an anthroposophic school in Austria. We investigated this outbreak to guide future public health action. METHODS We applied the German national case-definition for measles and collected data using the national surveillance system and a questionnaire. Measles cases with disease onset a maximum of 18 days apart and spatial contact (e.g. same household, same school) were summed up in clusters. Two different interventions, which were implemented in schools and kindergartens in Bavaria, were compared by their impact on the size and duration of measles clusters. Susceptible persons were excluded from schools or kindergartens either with the first (intervention A) or second (intervention B) measles case occurring in the respective institution. RESULTS Among the 217 Bavarian measles cases identified from March-July 2008, 28 (13%) cases were attendees of the anthroposophic school in Austria. In total, vaccination status was known in 161 (74%) cases and 156 (97%) of them were not vaccinated. The main factor for non-vaccination was "fear of vaccine-related adverse events" (33%). Twenty-nine (18%) of 161 cases suffered complications. Exclusively genotype D5 was detected. Overall, 184 cases could be epidemiologically grouped into 59 clusters. Of those, 41 clusters could be linked to households and 13 to schools or kindergartens. The effect of intervention A and B was analysed in 10 school or kindergarten clusters. Depending on the respective intervention A or B, the median number of cases per cluster was 3 versus 13 (p = 0.05), and the median duration of a cluster was 3 versus 26 days (p = 0.13). CONCLUSIONS Introduction of measles virus into a pocket of susceptible persons (e.g. vaccination opponents or sceptics) may lead to large outbreaks in the general population, if the general population's vaccination coverage is below the WHO recommended level. Education on the safety of measles vaccine needs to be strengthened to increase measles vaccination coverage. Early intervention may limit spread in schools or kindergartens. Suspected measles has to be reported immediately to the local health authorities in order to allow intervention as early as possible.
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Affiliation(s)
- Maria Wadl
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Anette Siedler
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | | | | | | | - Annette Mankertz
- National Reference Centre for Measles, Mumps and Rubella, Robert Koch- Institute, Berlin, Germany
| | - Wolfgang Hautmann
- Bavarian Health and Food Safety Authority, Department for Epidemiology, Oberschleissheim, Germany
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Epidemiological and molecular assessment of a measles outbreak in a highly vaccinated population of northeast Italy. Epidemiol Infect 2011; 139:1727-33. [PMID: 21396148 DOI: 10.1017/s095026881100032x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Two distinct measles outbreaks, unrelated from the epidemiological point of view but caused by genetically related strains, occurred in the Friuli Venezia Giulia region of northeastern Italy. Forty-two cases were reported during the period April-May 2008. In the first outbreak the index case was a teacher who introduced the virus into the Pordenone area, involving eight adolescents and young adults. The other concomitant outbreak occurred in the city of Trieste with 33 cases. The containment of the epidemics can be explained by the high MMR vaccine coverage in an area where the first dose was delivered to 93·4% and the second dose to 88·3% of the target children. Phylogenetic analysis of 14 measles virus strains showed that they belonged to a unique D4 genotype indistinguishable from the MVs/Enfield.GBR/14.07 strain, probably introduced from areas (i.e. Piedmont and Germany) where this genotype was present or had recently caused a large epidemic.
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Evaluating measles surveillance: comparison of sentinel surveillance, mandatory notification, and data from health insurance claims. Epidemiol Infect 2010; 139:516-23. [DOI: 10.1017/s095026881000244x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYInadequate notification is a recognized problem of measles surveillance systems in many countries, and it should be monitored using multiple data sources. We compared data from three different surveillance sources in 2007: (1) the sentinel surveillance system mandated by the Act on Prevention of Infectious Diseases and Medical Care for Patients Suffering Infectious Diseases, (2) the mandatory notification system run by the Aichi prefectural government, and (3) health insurance claims (HICs) submitted to corporate health insurance societies. For each dataset, we examined the number of measles cases by month, within multiple age groups, and in two categories of diagnostic test groups. We found that the sentinel surveillance system underestimated the number of adult measles cases. We also found that HIC data, rather than mandatory notification data, were more likely to come from individuals who had undergone laboratory tests to confirm their measles diagnosis. Thus, HIC data may provide a supplementary and readily available measles surveillance data source.
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