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Ferrari C, Somma G, Treglia M, Pallocci M, Passalacqua P, Di Giampaolo L, Coppeta L. Questionable Immunity to Mumps among Healthcare Workers in Italy-A Cross-Sectional Serological Study. Vaccines (Basel) 2024; 12:522. [PMID: 38793772 PMCID: PMC11125717 DOI: 10.3390/vaccines12050522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/27/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Highly contagious diseases, such as mumps, are a global concern as new epidemics continue to emerge, even in highly vaccinated populations. The risk of transmission and spread of these viruses is even higher for individuals who are more likely to be exposed, including healthcare workers (HCWs). In healthcare settings, both HCWs and patients are at risk of infection during the care process, potentially leading to nosocomial epidemic outbreaks. Mumps is often underestimated compared with measles and rubella, despite being milder and less likely to spread. In fact, the risk of complications following mumps infection is extremely high, especially if the disease occurs in adulthood. The measles-mumps-rubella (MMR) vaccine has been shown to be an excellent preventive measure. Unfortunately, the mumps component appears to be less effective in inducing immunity than those for measles and rubella (two-dose effectiveness of 85%, 95% and 97%, respectively). The main aim of our study was to investigate the prevalence of detectable mumps antibodies (serum IgG antibodies) in a cohort of Italian and foreign HCWs in relation to personal and occupational factors. We included in the study 468 subjects who underwent health surveillance at the Occupational Medicine Unit of the Tor Vergata Polyclinic in Rome during the period from January 2021 to March 2023. In our study, the proportion of HCWs found to be unprotected against mumps was very high (8.3%), and those found to be immune are below the WHO threshold for herd immunity (95%). From our data, it seems essential that all occupational health services carry out an accurate screening with a dose of anti-mumps antibodies to assess serological protection before starting a job, regardless of an individual's vaccination history. This approach is proving to be beneficial, accurate, as it allows all serologically non-immune individuals to be vaccinated in the workplace, including those who would be protected by their vaccination history but have lost the antibody response.
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Affiliation(s)
- Cristiana Ferrari
- PhD Program in Social, Occupational and Medico-Legal Sciences, Department of Occupational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Roma, Italy
| | - Giuseppina Somma
- Department of Occupational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Roma, Italy; (G.S.); (M.T.); (L.C.)
| | - Michele Treglia
- Department of Occupational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Roma, Italy; (G.S.); (M.T.); (L.C.)
| | - Margherita Pallocci
- PhD Program in Applied Medical Surgical Sciences, Department of Surgical Sciences, University of Rome Tor Vergata, Viale Oxford 81, 00133 Roma, Italy;
| | - Pierluigi Passalacqua
- Department of Occupational Medicine, University of Rome La Sapienza, 00185 Roma, Italy;
| | - Luca Di Giampaolo
- Department of Occupational Medicine, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy;
| | - Luca Coppeta
- Department of Occupational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Roma, Italy; (G.S.); (M.T.); (L.C.)
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Anderson EM, Browne S, Moser CA, Feemster K. College health administrator's perceptions of the impacts of COVID-19 on college immunization programs. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 37713306 DOI: 10.1080/07448481.2023.2239364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 06/07/2023] [Accepted: 07/09/2023] [Indexed: 09/17/2023]
Abstract
College immunization policies vary. To evaluate the landscape of college immunization programs, we distributed a 45-item survey to college health administrators between July and September 2021. Items measured perceptions of institutionally recommended and required vaccines, enforcement strategies, barriers to vaccine uptake, and the impact of the COVID-19 pandemic. Of 566 invitations sent, only 66 college health administrators completed the survey (11.7% response rate). The majority of participating institutions (89%) required at least one vaccine, with measles-mumps-rubella (MMR) being the most commonly required (83%). Geographic region, school type, or size was not significantly correlated with immunization policies but state-level political leanings were. Common barriers to vaccine program implementation identified by respondents included student-based and institutional concerns. The COVID-19 pandemic was described as both exacerbating existing immunization program barriers and providing opportunities to strengthen programs. Future work will evaluate identified themes in a larger study population and monitor change in perceptions over time.
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Affiliation(s)
- Elizabeth M Anderson
- Vaccine Education Center at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Office of the Assistant Secretary for Health, Region 3, US Department of Health and Human Services, Philadelphia, Pennsylvania, USA
| | - Safa Browne
- Vaccine Education Center at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Charlotte A Moser
- Vaccine Education Center at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kristen Feemster
- Vaccine Education Center at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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3
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Kidokoro M, Shiino T, Yamaguchi T, Nariai E, Kodama H, Nakata K, Sano T, Gotou K, Kisu T, Maruyama T, Kuba Y, Sakata W, Higashi T, Kiyota N, Sakai T, Yahiro S, Nagita A, Watanabe K, Hirokawa C, Hamabata H, Fujii Y, Yamamoto M, Yokoi H, Sakamoto M, Saito H, Shibata C, Inada M, Fujitani M, Minagawa H, Ito M, Shima A, Murano K, Katoh H, Kato F, Takeda M, Suga S. Nationwide and long-term molecular epidemiologic studies of mumps viruses that circulated in Japan between 1986 and 2017. Front Microbiol 2022; 13:728831. [PMID: 36386684 PMCID: PMC9650061 DOI: 10.3389/fmicb.2022.728831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
In Japan, major mumps outbreaks still occur every 4–5 years because of low mumps vaccine coverage (30–40%) owing to the voluntary immunization program. Herein, to prepare for a regular immunization program, we aimed to reveal the nationwide and long-term molecular epidemiological trends of the mumps virus (MuV) in Japan. Additionally, we performed whole-genome sequencing (WGS) using next-generation sequencing to assess results from conventional genotyping using MuV sequences of the small-hydrophobic (SH) gene. We analyzed 1,064 SH gene sequences from mumps clinical samples and MuV isolates collected from 25 prefectures from 1986 to 2017. The results showed that six genotypes, namely B (110), F (1), G (900), H (3), J (41), and L (9) were identified, and the dominant genotypes changed every decade in Japan since the 1980s. Genotype G has been exclusively circulating since the early 2000s. Seven clades were identified for genotype G using SH sequence-based classification. To verify the results, we performed WGS on 77 representative isolates of genotype G using NGS and phylogenetically analyzed them. Five clades were identified with high bootstrap values and designated as Japanese clade (JPC)-1, -2, -3, -4, -5. JPC-1 and -3 accounted for over 80% of the total genotype G isolates (68.3 and 13.8%, respectively). Of these, JPC-2 and -5, were newly identified clades in Japan through this study. This is the first report describing the nationwide and long-term molecular epidemiology of MuV in Japan. The results provide information about Japanese domestic genotypes, which is essential for evaluating the mumps elimination progress in Japan after the forthcoming introduction of the mumps vaccine into Japan’s regular immunization program. Furthermore, the study shows that WGS analysis using NGS is more accurate than results obtained from conventional SH sequence-based classification and is a powerful tool for accurate molecular epidemiology studies.
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Affiliation(s)
- Minoru Kidokoro
- Department of Quality Assurance, Radiation Safety, and Information Management, National Institute of Infectious Diseases, Tokyo, Japan
- *Correspondence: Minoru Kidokoro,
| | - Teiichiro Shiino
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomohiro Yamaguchi
- Public Hygiene Division, Gifu Prefectural Tono Region Public Health Center, Tajimi, Japan
| | - Eri Nariai
- Department of Health and Food Safety, Ishikawa Prefectural Institute of Public Health and Environmental Science, Kanazawa, Japan
| | - Hiroe Kodama
- Department of Health and Food Safety, Ishikawa Prefectural Institute of Public Health and Environmental Science, Kanazawa, Japan
| | - Keiko Nakata
- Division of Virology, Osaka Institute of Public Health, Osaka, Japan
| | - Takako Sano
- Division of Microbiology, Kanagawa Prefectural Institute of Public Health, Chigasaki, Japan
| | - Keiko Gotou
- Division of Virology, Ibaraki Prefectural Institute of Public Health, Mito, Ibaraki, Japan
| | - Tomoko Kisu
- Virus Research Center, Clinical Research Division, Sendai National Hospital, Sendai, Japan
| | - Tomomi Maruyama
- Department of Infectious Diseases, Gifu Prefectural Research Institute for Health and Environmental Sciences, Kakamigahara, Japan
| | - Yumani Kuba
- Department of Medical Microbiology and zoology, Okinawa Prefectural Institute of Health and Environment, Uruma, Japan
| | - Wakako Sakata
- Kitakyushu City Institute of Health and Environmental Sciences, Kitakyushu, Japan
| | - Teruaki Higashi
- Kitakyushu City Institute of Health and Environmental Sciences, Kitakyushu, Japan
| | - Naoko Kiyota
- Department of Microbiology, Kumamoto Prefectural Institute of Public-Health and Environmental Science, Uto, Japan
| | - Takashi Sakai
- Department of Microbiology, Kumamoto Prefectural Institute of Public-Health and Environmental Science, Uto, Japan
| | - Shunsuke Yahiro
- Department of Microbiology, Kumamoto Prefectural Institute of Public-Health and Environmental Science, Uto, Japan
| | - Akira Nagita
- Department of Pediatrics, Mizushima Central Hospital, Kurashiki, Japan
| | - Kaori Watanabe
- Virology Section, Niigata Prefectural Institute of Public Health and Environmental Sciences, Niigata, Japan
| | - Chika Hirokawa
- Virology Section, Niigata Prefectural Institute of Public Health and Environmental Sciences, Niigata, Japan
| | | | - Yoshiki Fujii
- Division of Biological Science, Hiroshima City Institute of Public Health, Hiroshima, Japan
| | - Miwako Yamamoto
- Division of Biological Science, Hiroshima City Institute of Public Health, Hiroshima, Japan
| | - Hajime Yokoi
- Health Science Division, Chiba City Institute of Health and Environment, Chiba, Japan
| | - Misako Sakamoto
- Health Science Division, Chiba City Institute of Health and Environment, Chiba, Japan
| | - Hiroyuki Saito
- Department of Microbiology, Akita Prefectural Research Center for Public Health and Environment, Akita, Japan
| | - Chihiro Shibata
- Department of Microbiology, Akita Prefectural Research Center for Public Health and Environment, Akita, Japan
| | - Machi Inada
- Virology and Epidemiology Division, Nara Prefecture Institute of Health, Sakurai, Japan
| | - Misako Fujitani
- Virology and Epidemiology Division, Nara Prefecture Institute of Health, Sakurai, Japan
| | - Hiroko Minagawa
- Laboratory of Virology, Aichi Prefectural Institute of Public Health, Nagoya, Japan
| | - Miyabi Ito
- Laboratory of Virology, Aichi Prefectural Institute of Public Health, Nagoya, Japan
| | - Akari Shima
- Microbiology Division, Saga Prefectural Institute of Public Health and Pharmaceutical Research, Saga, Japan
| | - Keiko Murano
- Department of Virology III, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hiroshi Katoh
- Department of Virology III, National Institute of Infectious Diseases, Tokyo, Japan
| | - Fumihiro Kato
- Department of Virology III, National Institute of Infectious Diseases, Tokyo, Japan
| | - Makoto Takeda
- Department of Virology III, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shigeru Suga
- Department of Pediatrics, National Hospital Organization Mie National Hospital, Tsu, Japan
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4
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Lasher E, Fulkerson G, Seale E, Thomas A, Gadomski A. COVID-19 vaccine hesitancy and political ideation among college students in Central New York: The influence of differential media choice. Prev Med Rep 2022; 27:101810. [PMID: 35541216 PMCID: PMC9069981 DOI: 10.1016/j.pmedr.2022.101810] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/02/2022] Open
Abstract
News sources are central in predicting college students’ COVID-19 vaccine hesitancy. Conservative political ideology promotes the consumption of right wing media. Right wing media consumption is associated with COVID-19 vaccine hesitancy. Gender indirectly affects hesitancy through political ideology and news consumption.
COVID-19 vaccine hesitancy is context specific and highly dynamic in the United States. The objective of this study was to examine the underlying causes of COVID-19 vaccine use and hesitancy among students at two colleges in Central New York (USA) in order to better understand how to promote vaccination in this demographic. A Knowledge, Attitudes, Beliefs & Behaviors survey was designed to measure the relationship between gender, political ideology, media consumption, beliefs, mental health and anxiety, and pandemic-related behaviors. The survey was distributed by email to students in April 2021. Of 8,894 eligible respondents, 627 students completed the survey. Structural Equation Modeling was utilized to explore both direct and indirect relationships. Modeling suggests that the effect of political ideology (being more conservative) is to promote the consumption of right wing news, which in turn tends to increase vaccine hesitancy. Conservative political ideology does not directly lead to vaccine hesitancy, but it does encourage the consumption of news from sources that promote fear and hesitation about the vaccines. News sources significantly contribute to vaccine attitudes among this demographic.
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5
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Shah M, Ferra G, Fitzgerald S, Barreira PJ, Sabeti PC, Colubri A. Containing the spread of mumps on college campuses. ROYAL SOCIETY OPEN SCIENCE 2022; 9:210948. [PMID: 35116142 PMCID: PMC8790351 DOI: 10.1098/rsos.210948] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
College campuses are vulnerable to infectious disease outbreaks, and there is an urgent need to develop better strategies to mitigate their size and duration, particularly as educational institutions around the world adapt to in-person instruction during the COVID-19 pandemic. Towards addressing this need, we applied a stochastic compartmental model to quantify the impact of university-level responses to contain a mumps outbreak at Harvard University in 2016. We used our model to determine which containment interventions were most effective and study alternative scenarios without and with earlier interventions. This model allows for stochastic variation in small populations, missing or unobserved case data and changes in disease transmission rates post-intervention. The results suggest that control measures implemented by the University's Health Services, including rapid isolation of suspected cases, were very effective at containing the outbreak. Without those measures, the outbreak could have been four times larger. More generally, we conclude that universities should apply (i) diagnostic protocols that address false negatives from molecular tests and (ii) strict quarantine policies to contain the spread of easily transmissible infectious diseases such as mumps among their students. This modelling approach could be applied to data from other outbreaks in college campuses and similar small population settings.
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Affiliation(s)
| | | | | | | | - Pardis C. Sabeti
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Harvard School of Public Health, Boston, MA, USA
| | - Andrés Colubri
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Program in Bioinformatics and Integrative Biology, University of Massachusetts Medical School, Worcester, MA, USA
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6
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Cataldi JR, O'Leary ST, Marlow MA, Beaty BL, Hurley LP, Crane LA, Brtnikova M, Gorman C, Pham HT, Lindley MC, Kempe A. Pediatricians' Knowledge and Practices Related to Mumps Diagnosis and Prevention. J Pediatr 2021; 239:81-88.e2. [PMID: 34453916 PMCID: PMC10207028 DOI: 10.1016/j.jpeds.2021.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess pediatricians' mumps knowledge and testing practices, to identify physician and practice characteristics associated with mumps testing practices, and to assess reporting and outbreak response knowledge and practices. STUDY DESIGN Between January and April 2020, we surveyed a nationally representative network of pediatricians. Descriptive statistics were generated for all items. The χ2 test, t tests, and Poisson regression were used to compare physician and practice characteristics between respondents who would rarely or never versus sometimes or often/always test for mumps in a vaccinated 17-year-old with parotitis in a non-outbreak setting. RESULTS The response rate was 67% (297 of 444). For knowledge, more than one-half of the pediatricians responded incorrectly or "don't know" for 6 of the 9 true/false statements about mumps epidemiology, diagnosis, and prevention, and more than one-half reported needing additional guidance on mumps buccal swab testing. For testing practices, 59% of respondents reported they would sometimes (35%) or often/always (24%) test for mumps in a vaccinated 17-year-old with parotitis in a non-outbreak setting; older physicians, rural physicians, and physicians from the Northeast or Midwest were more likely to test for mumps. Thirty-six percent of the pediatricians reported they would often/always report a patient with suspected mumps to public health authorities. CONCLUSIONS Pediatricians report mumps knowledge gaps and practices that do not align with public health recommendations. These gaps may lead to underdiagnosis and underreporting of mumps cases, delaying public health response measures and contributing to ongoing disease transmission.
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Affiliation(s)
- Jessica R Cataldi
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Mariel A Marlow
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brenda L Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Laura P Hurley
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Division of General Internal Medicine, Denver Health, Denver, CO
| | - Lori A Crane
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Michaela Brtnikova
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Carol Gorman
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Huong T Pham
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Megan C Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
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7
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Moncla LH, Black A, DeBolt C, Lang M, Graff NR, Pérez-Osorio AC, Müller NF, Haselow D, Lindquist S, Bedford T. Repeated introductions and intensive community transmission fueled a mumps virus outbreak in Washington State. eLife 2021; 10:66448. [PMID: 33871357 PMCID: PMC8079146 DOI: 10.7554/elife.66448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/15/2021] [Indexed: 12/20/2022] Open
Abstract
In 2016/2017, Washington State experienced a mumps outbreak despite high childhood vaccination rates, with cases more frequently detected among school-aged children and members of the Marshallese community. We sequenced 166 mumps virus genomes collected in Washington and other US states, and traced mumps introductions and transmission within Washington. We uncover that mumps was introduced into Washington approximately 13 times, primarily from Arkansas, sparking multiple co-circulating transmission chains. Although age and vaccination status may have impacted transmission, our data set could not quantify their precise effects. Instead, the outbreak in Washington was overwhelmingly sustained by transmission within the Marshallese community. Our findings underscore the utility of genomic data to clarify epidemiologic factors driving transmission and pinpoint contact networks as critical for mumps transmission. These results imply that contact structures and historic disparities may leave populations at increased risk for respiratory virus disease even when a vaccine is effective and widely used.
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Affiliation(s)
- Louise H Moncla
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, United States
| | - Allison Black
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, United States.,Department of Epidemiology, University of Washington, Seattle, United States
| | - Chase DeBolt
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, United States
| | - Misty Lang
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, United States
| | - Nicholas R Graff
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, United States
| | - Ailyn C Pérez-Osorio
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, United States
| | - Nicola F Müller
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, United States
| | - Dirk Haselow
- Arkansas Department of Health, Little Rock, United States
| | - Scott Lindquist
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, United States
| | - Trevor Bedford
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, United States.,Department of Epidemiology, University of Washington, Seattle, United States
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8
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Bartelme RR. Anthroposophic Medicine: A Short Monograph and Narrative Review-Foundations, Essential Characteristics, Scientific Basis, Safety, Effectiveness and Misconceptions. Glob Adv Health Med 2020; 9:2164956120973634. [PMID: 33457106 PMCID: PMC7783888 DOI: 10.1177/2164956120973634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Anthroposophic medicine is a form of integrative medicine that originated in Europe but is not well known in the US. It is comprehensive and heterogenous in scope and remains provocative and controversial in many academic circles. Assessment of the nature and potential contribution of anthroposophic medicine to whole person care and global health seems appropriate. METHODS Because of the heterogenous and multifaceted character of anthroposophic medicine, a narrative review format was chosen. A Health Technology Assessment of anthroposophic medicine in 2006 was reviewed and used as a starting point. A Medline search from 2006 to July 2020 was performed using various search terms and restricted to English. Books, articles, reviews and websites were assessed for clinical relevance and interest to the general reader. Abstracts of German language articles were reviewed when available. Reference lists of articles and the author's personal references were also consulted. RESULTS The literature on anthroposophic medicine is vast, providing new ways of thinking, a holistic view of the world, and many integrating concepts useful in medicine. In the last ∼20 years there has been a growing research base and implementation of many anthroposophical concepts in the integrated care of patients. Books and articles relevant to describing the foundations, scientific status, safety, effectiveness and criticisms of anthroposophic medicine are discussed. DISCUSSION An objective and comprehensive analysis of anthroposophic medicine finds it provocative, stimulating and potentially fruitful as an integrative system for whole person care, including under-recognized life processes and psychospiritual aspects of human beings. It has a legitimate, new type of scientific status as well as documented safety and effectiveness in some areas of its multimodal approach. Criticisms and controversies of anthroposophic medicine are often a result of lack of familiarity with its methods and approach and/or come from historically fixed ideas of what constitutes legitimate science.
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Affiliation(s)
- Ricardo R Bartelme
- Department of Family Medicine, University of Michigan Medical
School, Ann Arbor, Michigan
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9
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Connell AR, Connell J, Leahy TR, Hassan J. Mumps Outbreaks in Vaccinated Populations-Is It Time to Re-assess the Clinical Efficacy of Vaccines? Front Immunol 2020; 11:2089. [PMID: 33072071 PMCID: PMC7531022 DOI: 10.3389/fimmu.2020.02089] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/31/2020] [Indexed: 01/05/2023] Open
Abstract
History illustrates the remarkable public health impact of mass vaccination, by dramatically improving life expectancy and reducing the burden of infectious diseases and co-morbidities worldwide. It has been perceived that if an individual adhered to the MMR vaccine schedule that immunity to mumps virus (MuV) would be lifelong. Recent mumps outbreaks in individuals who had received two doses of the Measles Mumps Rubella (MMR) vaccine has challenged the efficacy of the MMR vaccine. However, clinical symptoms, complications, viral shedding and transmission associated with mumps infection has been shown to be reduced in vaccinated individuals, demonstrating a benefit of this vaccine. Therefore, the question of what constitutes a good mumps vaccine and how its impact is assessed in this modern era remains to be addressed. Epidemiology of the individuals most affected by the outbreaks (predominantly young adults) and variance in the circulating MuV genotype have been well-described alluding to a collection of influences such as vaccine hesitancy, heterogeneous vaccine uptake, primary, and/or secondary vaccine failures. This review aims to discuss in detail the interplay of factors thought to be contributing to the current mumps outbreaks seen in highly vaccinated populations. In addition, how mumps diagnoses has progressed and impacted the understanding of mumps infection since a mumps vaccine was first developed, the limitations of current laboratory tests in confirming protection in vaccinated individuals and how vaccine effectiveness is quantified are also considered. By highlighting knowledge gaps within this area, this state-of-the-art review proposes a change of perspective regarding the impact of a vaccine in a highly vaccinated population from a clinical, diagnostic and public perspective, highlighting a need for a paradigm shift on what is considered vaccine immunity.
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Affiliation(s)
- Anna R Connell
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland
| | - Jeff Connell
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - T Ronan Leahy
- Children's Health Ireland, Dublin, Ireland.,Department of Pediatrics, University of Dublin, Trinity College, Dublin, Ireland
| | - Jaythoon Hassan
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland.,National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
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10
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Abstract
Another large outbreak of mumps occurred in Lothian from October 2017, which coincided with the commencement of the higher education term. During this period 324 cases were notified, most of whom were aged 18–22 years old. Although previous outbreaks had a focus in student populations, 43% of current cases reported that they were not a student. There has been increases in private student housing where students from all universities live, which may have contributed to the wide spread of the outbreak and complicated outbreak control. Information on vaccination status was available for 244 cases (75%), of whom the majority (75.8%) reported having two MMR doses. To investigate potential waning vaccine immunity the mean length of time since last mumps containing vaccine was calculated as 14.3 years. The outbreak was declared over in May 2018 after case numbers returned to background levels. This outbreak highlighted that mumps outbreaks occur cyclically coinciding with new cohorts of susceptible students entering the Lothian population. The lessons from this outbreak are to encourage students to have two MMR doses and also be prepared for mumps outbreaks in the near future. In future outbreaks the utility of a third MMR for outbreak control could be examined.
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McNall RJ, Wharton AK, Anderson R, Clemmons N, Lopareva EN, Gonzalez C, Espinosa A, Probert WS, Hacker JK, Liu G, Garfin J, Strain AK, Boxrud D, Bryant PW, George KS, Davis T, Griesser RH, Shult P, Bankamp B, Hickman CJ, Wroblewski K, Rota PA. Genetic characterization of mumps viruses associated with the resurgence of mumps in the United States: 2015-2017. Virus Res 2020; 281:197935. [PMID: 32194138 DOI: 10.1016/j.virusres.2020.197935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/07/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
Despite high coverage with measles, mumps, and rubella vaccine in the United States, outbreaks of mumps occur in close contact settings such as schools, colleges, and camps. Starting in late 2015, outbreaks were reported from several universities, and by the end of 2017, greater than 13,800 cases had been reported nation-wide. In 2013, the CDC and the Association of Public Health Laboratories contracted four Vaccine Preventable Diseases Reference Centers (VPD-RCs) to perform real-time reverse transcription PCR (RT-qPCR) to detect mumps RNA in clinical samples and to determine the genotype. Twelve genotypes of mumps virus are currently recognized by the World Health Organization, and the standard protocol for genotyping requires sequencing the entire gene coding for the small hydrophobic (SH) protein. Phylogenetic analysis of the 1862 mumps samples genotyped from 2015 through 2017 showed that the overall diversity of genotypes detected was low. Only 0.8 % of the sequences were identified as genotypes C, H, J, or K, and 0.5 % were identified as vaccine strains in genotypes A or N, while most sequences (98.7 %) were genotype G. The majority of the genotype G sequences could be included into one of two large groups with identical SH sequences. Within genotype G, a small number of phylogenetically significant outlier sequences were associated with epidemiologically distinct chains of transmission. These results demonstrate that molecular and epidemiologic data can be used to track transmission pathways of mumps virus; however, the limited diversity of the SH sequences may be insufficient for resolving transmission in all outbreaks.
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Affiliation(s)
- Rebecca J McNall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam K Wharton
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Raydel Anderson
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nakia Clemmons
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elena N Lopareva
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Alex Espinosa
- California Department of Public Health, Richmond, CA, USA
| | | | - Jill K Hacker
- California Department of Public Health, Richmond, CA, USA
| | - Gongping Liu
- Minnesota Department of Health, St Paul, MN, USA
| | - Jacob Garfin
- Minnesota Department of Health, St Paul, MN, USA
| | | | - David Boxrud
- Minnesota Department of Health, St Paul, MN, USA
| | - Patrick W Bryant
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Kirsten St George
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Timothy Davis
- Wisconsin State Laboratory of Hygiene, Madison, University of Wisconsin, WI, USA
| | - Richard H Griesser
- Wisconsin State Laboratory of Hygiene, Madison, University of Wisconsin, WI, USA
| | - Peter Shult
- Wisconsin State Laboratory of Hygiene, Madison, University of Wisconsin, WI, USA
| | - Bettina Bankamp
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carole J Hickman
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kelly Wroblewski
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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12
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Decreased humoral immunity to mumps in young adults immunized with MMR vaccine in childhood. Proc Natl Acad Sci U S A 2019; 116:19071-19076. [PMID: 31481612 DOI: 10.1073/pnas.1905570116] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In the past decade, multiple mumps outbreaks have occurred in the United States, primarily in close-contact, high-density settings such as colleges, with a high attack rate among young adults, many of whom had the recommended 2 doses of mumps-measles-rubella (MMR) vaccine. Waning humoral immunity and the circulation of divergent wild-type mumps strains have been proposed as contributing factors to mumps resurgence. Blood samples from 71 healthy 18- to 23-year-old college students living in a non-outbreak area were assayed for antibodies and memory B cells (MBCs) to mumps, measles, and rubella. Seroprevalence rates of mumps, measles, and rubella determined by IgG enzyme-linked immunosorbent assay (ELISA) were 93, 93, and 100%, respectively. The index standard ratio indicated that the concentration of IgG was significantly lower for mumps than rubella. High IgG avidity to mumps Enders strain was detected in sera of 59/71 participants who had sufficient IgG levels. The frequency of circulating mumps-specific MBCs was 5 to 10 times lower than measles and rubella, and 10% of the participants had no detectable MBCs to mumps. Geometric mean neutralizing antibody titers (GMTs) by plaque reduction neutralization to the predominant circulating wild-type mumps strain (genotype G) were 6-fold lower than the GMTs against the Jeryl Lynn vaccine strain (genotype A). The majority of the participants (80%) received their second MMR vaccine ≥10 years prior to study participation. Additional efforts are needed to fully characterize B and T cell immune responses to mumps vaccine and to develop strategies to improve the quality and durability of vaccine-induced immunity.
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