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Walekhwa AW, Musoke D, Nalugya A, Biribawa C, Nsereko G, Wafula ST, Nakazibwe B, Nantongo M, Odera DA, Chiara A, Boyce RM, Mulogo EM. Gaps in measles vaccination coverage in Kasese district, Western Uganda: results of a qualitative evaluation. BMC Infect Dis 2022; 22:589. [PMID: 35787247 PMCID: PMC9251590 DOI: 10.1186/s12879-022-07579-w] [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: 06/27/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the availability of a highly effective vaccine, measles remains a substantial public health problem in many countries including Uganda. In this study, conducted between June–August 2020 following a local outbreak, we sought to explore the factors that could affect measles vaccination coverage in rural western Uganda. Methods We conducted a descriptive study using qualitative data collection approaches in the Kasese district. The research team utilized purposive sampling to identify and select participants from the public health sector and district government. We conducted key informant interviews (KII) and one focus group discussion (FGD). Responses were recorded using portable electronic devices with the FGD and KII guide installed. Interviews were conducted at the health centre and district headquarters. Data was coded and analysed using ATLAS.ti version 8 software through deductive thematic analysis to identify key themes. Results Barriers to measles vaccination identified in this study were premised around six themes including: (i) availability of supplies and stock management, (ii) health worker attitudes and workload, (iii) financing of vaccination outreach activities, (iv) effectiveness of duty rosters (i.e., health workers’ working schedules), (v) community beliefs, and (vi) accessibility of healthcare facilities. Respondents reported frequent vaccine supply disruptions, lack of resources to facilitate transportation of health workers to communities for outreach events, and health centre staffing that did not adequately support supplemental vaccination activities. Furthermore, community dependence on traditional medicine as a substitute for vaccines and long distances traveled by caregivers to reach a health facility were mentioned as barriers to vaccination uptake. Conclusions Health system barriers limiting vaccination uptake were primarily logistical in nature and reflect inadequate resourcing of immunization efforts. At the same time, local beliefs favouring traditional medicine remain a persistent cultural barrier. These findings suggest an urgent need for more efficient supply management practices and resourcing of immunization outreaches in order to achieve the Uganda Ministry of Health’s targets for childhood immunization and the prevention of disease outbreaks. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07579-w.
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Affiliation(s)
- Abel Wilson Walekhwa
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda. .,School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda.
| | - David Musoke
- School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda
| | - Aisha Nalugya
- School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda
| | - Claire Biribawa
- School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda.,Ministry of Health, Uganda, P.O BOX 7272, Kampala, Uganda
| | | | - Solomon Tsebeni Wafula
- School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda
| | - Brenda Nakazibwe
- School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda
| | - Mary Nantongo
- School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda
| | - Doreen Awino Odera
- Department of Public Health, North Dakota State University, Fargo, ND, 58102, USA
| | - Achangwa Chiara
- Department of Public Health and Hygiene, University of Buea, Cameroon, P.O. Box 63, Buea, Cameroon
| | - Ross Mathew Boyce
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda.,Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Edgar Mugema Mulogo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
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Walekhwa AW, Ntaro M, Kawungezi PC, Achangwa C, Muhindo R, Baguma E, Matte M, Migisha R, Reyes R, Thompson P, Boyce RM, Mulogo EM. Measles outbreak in Western Uganda: a case-control study. BMC Infect Dis 2021; 21:596. [PMID: 34157990 PMCID: PMC8220759 DOI: 10.1186/s12879-021-06213-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measles outbreaks are prevalent throughout sub-Saharan Africa despite the preventive measures like vaccination that target under five-year-old children and health systems strengthening efforts like prioritizing the supply chain for supplies. Measles immunization coverage for Kasese district and Bugoye HC III in 2018 was 72 and 69%, respectively. This coverage has been very low and always marked red in the Red categorization (below the national target/poor performing) on the national league table indicators. The aim of this study was to assess the scope of the 2018-2019 measles outbreak and the associated risk factors among children aged 0-60 months in Bugoye sub-county, Kasese district, western Uganda. METHODS We conducted a retrospective unmatched case-control study among children aged 0-60 months with measles (cases) who had either a clinical presentation or a laboratory confirmation (IgM positivity) presenting at Bugoye Health Centre III (BHC) or in the surrounding communities between December 2018 and October 2019.. Caregivers of the controls (whose children did not have measles) were selected at the time of data collection in July 2020. A modified CDC case investigation form was used in data collection. Quantitative data was collected and analyzed using Microsoft excel and STATA version 13. The children's immunization cards and health registers at BHC were reviewed to ascertain the immunization status of the children before the outbreak. RESULTS An extended measles outbreak occurred in Bugoye, Uganda occured between December 2018 and October 2019. All 34 facility-based measles cases were documented to have had maculopapular rash, conjunctivitis, and cough. Also, the majority had fever (97%), coryza (94.1%), lymphadenopathy (76.5%), arthralgias (73.5%) and Koplik Spots (91.2%) as documented in the clinical registers. Similar symptoms were reported among 36 community-based cases. Getting infected even after immunized, low measles vaccination coverage were identified as the principal risk factors for this outbreak. CONCLUSION Measles is still a significant problem. This study showed that this outbreak was associated with under-vaccination. Implementing a second routine dose of measles-rubella vaccine would not only increase the number of children with at least one dose but also boost the immunity of those who had the first dose.
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Affiliation(s)
- Abel Wilson Walekhwa
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda.
| | - Moses Ntaro
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Peter Chris Kawungezi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Chiara Achangwa
- Department of Public Health and Hygiene, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Rabbison Muhindo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Emmanuel Baguma
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Michael Matte
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Richard Migisha
- Department of Physiology, Faculty of Medicine, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Raquel Reyes
- Department of Medicine, Division of Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Ross M Boyce
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Edgar M Mulogo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
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Jamrozik E, Heriot G, Bull S, Parker M. Vaccine-enhanced disease: case studies and ethical implications for research and public health. Wellcome Open Res 2021; 6:154. [PMID: 34235275 PMCID: PMC8250497 DOI: 10.12688/wellcomeopenres.16849.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 11/20/2022] Open
Abstract
Vaccination is a cornerstone of global public health. Although licensed vaccines are generally extremely safe, both experimental and licensed vaccines are sometimes associated with rare serious adverse events. Vaccine-enhanced disease (VED) is a type of adverse event in which disease severity is increased when a person who has received the vaccine is later infected with the relevant pathogen. VED can occur during research with experimental vaccines and/or after vaccine licensure, sometimes months or years after a person receives a vaccine. Both research ethics and public health policy should therefore address the potential for disease enhancement. Significant VED has occurred in humans with vaccines for four pathogens: measles virus, respiratory syncytial virus, Staphylococcus aureus, and dengue virus; it has also occurred in veterinary research and in animal studies of human coronavirus vaccines. Some of the immunological mechanisms involved are now well-described, but VED overall remains difficult to predict with certainty, including during public health implementation of novel vaccines. This paper summarises the four known cases in humans and explores key ethical implications. Although rare, VED has important ethical implications because it can cause serious harm, including death, and such harms can undermine vaccine confidence more generally – leading to larger public health problems. The possibility of VED remains an important challenge for current and future vaccine development and deployment. We conclude this paper by summarising approaches to the reduction of risks and uncertainties related to VED, and the promotion of public trust in vaccines.
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Affiliation(s)
- Euzebiusz Jamrozik
- The Ethox Centre & Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK.,Monash Bioethics Centre, Monash University, Melbourne, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - George Heriot
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Susan Bull
- The Ethox Centre & Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Michael Parker
- The Ethox Centre & Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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Takeuchi N, Egawa G, Kuwai T, Kaku Y, Kabashima K. Lichenoid eruptions accompanied by fever and pneumonia after measles vaccination. J Dermatol 2020; 48:e126-e127. [PMID: 33368574 DOI: 10.1111/1346-8138.15735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/12/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Nao Takeuchi
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Gyohei Egawa
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takumi Kuwai
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yo Kaku
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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[Is it necessary to change the measles case definition?]. Aten Primaria 2020; 52:805-807. [PMID: 32376054 PMCID: PMC8054288 DOI: 10.1016/j.aprim.2019.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/05/2019] [Indexed: 11/22/2022] Open
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Kohlmaier B, Schweintzger NA, Zenz W. Measles recognition during measles outbreak at a paediatric university hospital, Austria, January to February 2017. ACTA ACUST UNITED AC 2020; 25. [PMID: 31992389 PMCID: PMC6988273 DOI: 10.2807/1560-7917.es.2020.25.3.1900260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recognition of measles is crucial to prevent transmissions in the hospital settings. Little is known about the level of recognition of measles and possible causes of not recognising the disease by physicians in the post-vaccine era. We report on a measles outbreak in a paediatric hospital in Austria in January to February 2017 with strikingly high numbers of not recognised cases. The extent and course of the outbreak were assessed via retrospective case finding. Thirteen confirmed measles cases were identified, two with atypical clinical picture. Of eight cases with no known epidemiological link, only one was diagnosed immediately; four were recognised with delay and three only retrospectively. Eleven typical measles cases had four ‘unrecognised visits’ to the outpatient clinic and 28 on the ward. Two atypical cases had two ‘unrecognised visits’ to the outpatient clinic and 19 on the ward. Thirteen clinicians did not recognise typical measles (atypical cases not included). Twelve of 23 physicians involved had never encountered a patient with measles before. The direct and indirect costs related to the outbreak were calculated to be over EUR 80,000. Our findings suggest the need to establish regular training programmes about measles, including diagnostic pitfalls in paediatric hospitals.
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Affiliation(s)
- Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Nina A Schweintzger
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
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Pulmonary measles disease: old and new imaging tools. Radiol Med 2018; 123:935-943. [PMID: 30062499 DOI: 10.1007/s11547-018-0919-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 07/09/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Measles virus can cause lower respiratory tract infection, so that chest radiography is necessary to investigate lung involvement in patients with respiratory distress. PURPOSE To assess measles pneumonia imaging during the measles outbreak occurred in 2016-2017 in Italy. MATERIAL AND METHODS We retrospectively observed adult patients with a serological diagnosis of measles, who underwent chest-X rays for suspected pneumonia. If a normal radiography resulted, the patient underwent unenhanced CT. A CT post processing software package was used for an additional quantitative lung and airway involvement analysis . RESULTS Among 290 patients affected by measles, 150 underwent chest-X ray. Traditional imaging allowed the pneumonia diagnosis in 114 patients (76%). The most frequent abnormality at chest X-rays was bronchial wall thickening, observed in 88.5% of the cases; radiological findings are faint in the 25% of the cases (29/114 patients). In nine subjects with a normal chest X-ray, unenhanced CT with a quantitative analysis was performed, and depicted features consistent with constrictive bronchiolitis. CONCLUSION Measles may produce bronchiolitis and pneumonia. In the cases in which involvement of pulmonary parenchyma is not sufficient to result in radiological abnormalities, CT used with a dedicated postprocessing software package, provides an accurate lungs and airways analysis, also determining the percentage of lung involvement.
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Abstract
Measles (rubeola) continues to be endemic and epidemic in many regions of the world. Measles is primarily a disease of childhood, but it can also affect adult populations, and therefore it is important that both adult and pediatric hospitalist physicians be able to recognize it. Although the disease is rarely encountered in the United States, measles infection can spread rapidly across vulnerable populations. In addition, infected adults can develop complications that may require hospitalization for treatment. This review summarizes the typical clinical course and complications of measles infection, along with recommendations for diagnosis and management for both adult and pediatric hospitalists. Journal of Hospital Medicine 2017;12:472-476.
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Affiliation(s)
- Ketino Kobaidze
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Gregory Wallace
- Epidemiology Branch, Division of Viral Disease, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia
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Relevance of the Measles Virus Expression in Cancer - an Update. Pathol Oncol Res 2016; 22:661-6. [PMID: 27287391 DOI: 10.1007/s12253-016-0080-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
Evidence of an association between classical Hodgkin lymphoma and the measles virus has previously been presented by our group. Arguments held against our thesis were reevaluated. Substantiation of a relationship between the measles virus and additional solid tumors was submitted. Moreover, a pathogenic pathway was suggested to support a possible contribution of the measles virus to the development of classical Hodgkin lymphoma. We have chosen to exclude a discussion of measles virotherapy, since this carries distinct implications. We now add new evidence regarding the expression of the measles virus phosphoprotein in a few cancers. We also suggest a role in this context for atypical measles syndrome in malignant tumors. Last, we propose a collaboration which may make the best, on the one hand of our cohort of classical Hodgkin lymphoma, half of which carry the measles virus expression in their tumor cells. The planned study will also look into the patients vaccination records and into a previous history of the measles disease. On the other hand, cohorts of patients diagnosed with late onset measles will be assessed for the eventual diagnosis of atypical measles syndrome and will be followed up for the subsequent development of a malignant tumor.
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