#Mandatory #Measles #Vaccination in #NYC — Reflections on a Bold Experiment (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]

Mandatory Measles Vaccination in New York City — Reflections on a Bold Experiment

Julie D. Cantor, M.D., J.D.

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Though a vaccine has been available for more than 50 years, measles has recently reemerged as a public health threat in the United States. Outbreaks have arisen where vaccination rates have waned, and local governments have responded.

In Detroit, officials and religious leaders of an affected community collaborated, encouraging vaccination to control an outbreak. Los Angeles quarantined people exposed to the virus. New York City and Rockland County have seen the most cases, and their extensive vaccination efforts have included free clinics, meetings with community leaders, and email messages to clinicians. They also issued orders restricting the liberty of people who neither had nor were exposed to the virus.

(…)

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Disclosure forms provided by the author are available at NEJM.org.

This article was published on June 5, 2019, at NEJM.org.

Author Affiliations: From the UCLA School of Law, Los Angeles.

Keywords: Measles; USA; NYC; Society.

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#Measles #resurgence in the #USA: how #international #travel compounds vaccine resistance (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Summary, edited.]

Measles resurgence in the USA: how international travel compounds vaccine resistance

Sahotra Sarkar,  Aleksa Zlojutro, Kamran Khan, Lauren Gardner

Published: May 09, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30231-2

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Hotez and colleagues{1} recent article highlights the increasing frequency of vaccine-preventable disease cases in Europe and the USA caused by very visible anti-vaccine movements.{2}

The most troubling aspect of this development is the global increase in measles cases. From Jan 1, 2019, to April 26, 2019, the USA reported 704 confirmed measles cases spanning 22 states, compared with 372 reported cases in 2018, 120 in 2017, 86 in 2016, 188 in 2015, and 667 in 2014.{3}

Therefore, only 4 months into 2019 the number of cases reported is already the highest since measles was declared officially eliminated in the US in 2000.{3}

(…)

We declare no competing interests.

Keywords: Measles; USA.

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Immunogenicity and #Efficacy of a #Measles Virus-vectored #Chikungunya Vaccine in #NHP (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Immunogenicity and Efficacy of a Measles Virus-vectored Chikungunya Vaccine in Nonhuman Primates

Shannan L Rossi, Jason E Comer, Eryu Wang, Sasha R Azar, William S Lawrence, Jessica A Plante, Katrin Ramsauer, Sabrina Schrauf, Scott C Weaver

The Journal of Infectious Diseases, jiz202, https://doi.org/10.1093/infdis/jiz202

Published: 03 May 2019

 

Abstract

Background

Chikungunya virus (CHIKV) infection can result in chikungunya fever (CHIKF), a self-limited acute febrile illness that can progress to chronic arthralgic sequalae in a large percentage of patients. A new Measles virus-vectored vaccine was developed to prevent CHIKF and we tested it for immunogenicity and efficacy in a nonhuman primate (NHP) model.

Methods

Nine cynomolgus macaques were immunized and boosted with the Measles virus-vectored chikungunya vaccine or sham-vaccinated. Sera were taken at multiple times during the vaccination phase to assess antibody responses against CHIKV. Macaques were challenged with a dose of CHIKV previously shown to cause fever and viremia, and core body temperature, viremia and blood cell and chemistry panels were monitored.

Results

The vaccine was well tolerated in all macaques, and all seroconverted (high neutralizing antibody [PRNT80 titers 40-640] and ELISA titers) after the boost. Furthermore, the vaccinated primates were protected against viremia, fever, elevated WBC counts and CHIKF-associated cytokine changes following challenge with the virulent La Reunion CHIKV strain.

Conclusions

These results further document the immunogenicity and efficacy of a Measles-vectored chikungunya vaccine that shows promise in Phase I-II clinical trials. These findings are critical to human health because no vaccine to combat CHIF is yet licensed.

Measles virus, chikungunya virus, vaccine, non-human primate

Topic: fever – macaca  – primates – vaccination – vaccines – viremia – measles – viruses – chikungunya virus vaccine – immunogenicity

Issue Section: Major Article

This content is only available as a PDF.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: Chikungunya fever; Measles; Vaccines; Animal models.

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Type I #Interferon receptor signaling drives selective permissiveness of #astrocytes and #microglia to #measles virus during #brain #infection (J Virol., abstract)

[Source: Journal of Virology, full page: (LINK). Abstract, edited.]

Type I Interferon receptor signaling drives selective permissiveness of astrocytes and microglia to measles virus during brain infection

Jeremy Charles Welsch, Benjamin Charvet, Sebastien Dussurgey, Omran Allatif, Noemie Aurine, Branka Horvat, Denis Gerlier, Cyrille Mathieu

DOI: 10.1128/JVI.00618-19

 

ABSTRACT

Fatal neurological syndromes can occur after Measles virus (MeV) infection of the brain. The mechanisms controlling MeV spread within the central nervous system (CNS) remain poorly understood. We analyzed the role of type I interferon (IFN-I) receptor (IFNAR) signaling in the control of MeV infection in a murine model of brain infection. Using organotypic brain cultures (OBC) from wild-type and IFNARko transgenic mice ubiquitously expressing the human SLAM (CD150) receptor, the heterogeneity of the permissiveness of different CNS cell types to MeV infection was characterized. In the absence of IFNAR signaling, MeV propagates significantly better in explant slices. In OBC from IFNAR competent mice, while astrocytes and microglia were infected on the day of explant preparation, they became refractory to infection with time, in contrast to neurons and oligodendrocytes that remained permissive to infection. This selective loss of permissiveness to MeV infection was not observed in IFNARko OBC. Accordingly, the development of astrogliosis related to the OBC procedure was exacerbated in the presence of IFNAR signaling. In the hippocampus, this astrogliosis was characterized by a change in astrocyte phenotype and by an increase of IFN-I transcripts. A proteome analysis showed the up-regulation of 84 out of 111 secreted proteins. In the absence of IFNAR, only 27 secreted proteins were up-regulated, none of which were associated with antiviral activities. Our results highlight the essential role of the IFN-I response in astrogliosis and in the permissiveness of astrocytes and microglia that could control MeV propagation throughout the CNS.

 

Importance:

Measles virus (MeV) can infect the central nervous system (CNS) with dramatic consequences. The mechanisms controlling MeV invasion of the CNS remain ill defined since most previous data were obtained from post mortem analysis. Here, we highlight for the first time the crucial role of the type 1 interferon (IFN-I) response not only in the control of CNS invasion but also in the early permissiveness of glial cells to Measles virus infection.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Measles; Encephalitis; Neuroinvasion; Interferons.

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Early #measles #vaccination during an #outbreak in The #Netherlands: reduced short and long-term #antibody responses in children vaccinated before 12 months of age (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Early measles vaccination during an outbreak in The Netherlands: reduced short and long-term antibody responses in children vaccinated before 12 months of age

Iris D Brinkman, Jelle de Wit, Gaby P Smits, Hinke I ten Hulscher, Maria C Jongerius, Taymara C Abreu, Fiona R M van der Klis, Susan J M Hahné, M P G Koopmans, Nynke Y Rots, Debbie van Baarle, Robert S van Binnendijk

The Journal of Infectious Diseases, jiz159, https://doi.org/10.1093/infdis/jiz159

Published: 11 April 2019

 

Abstract

Background

The majority of infants will not be protected by maternal antibodies until their first measles vaccination between 12-15 months of age. This provides incentive to reduce the age of measles vaccination, but immunological consequences are insufficiently understood and long-term effects are largely unknown.

Methods

Infants who received early measles vaccination between 6-12 months and a second dose at 14 months of age (n=79) were compared with a control group who received one dose at 14 months of age (n=44). Measles-neutralizing antibody concentrations and avidity were determined up to 4 years of age.

Results

Infants with a first measles vaccination administered before 12 months of age show long-term reduced measles-neutralizing antibody concentrations and avidity compared to the control group. For 11.1% of children with a first dose before 9 months of age, antibody levels had dropped below the cutoff for clinical protection at 4 years of age.

Conclusions

Early measles vaccination provides immediate protection in the majority of infants, but long-term neutralizing antibody responses are reduced compared to infants vaccinated at a later age. Additional vaccination at 14 months of age does not improve this. Long-term, this may result in an increasing number of children susceptible to measles.

antibody response, timing of vaccination, protection, antibody avidity

Issue Section: Major Article

This content is only available as a PDF.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: Measles; Vaccines.

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Increase in #Infant #Measles #Deaths during a Nationwide Measles #Outbreak — #Mongolia, 2015–2016 (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Increase in Infant Measles Deaths during a Nationwide Measles Outbreak — Mongolia, 2015–2016

Christopher T Lee, MD, Jose E Hagan, MD, Baigalmaa Jantsansengee, MD, Oyun-Erdene Tumurbaatar, MPH, Samdan Altanchimeg, MD, Buyanjargal Yadamsuren, MSc(Med), Sodbayar Demberelsuren, MSc(Med), Chinbayar Tserendorj, MD, Oyungerel Munkhtogoo, MD PhD, Darmaa Badarch, MD PhD, Nyamaa Gunregjav, MS, Bolortuya Baatarkhuu, MD, Chimedsuren Ochir, PhD, LaShondra Berman, PhD, Raydel Anderson, MS, Minal K Patel, MD, Christopher J Gregory, MD, James L Goodson, MPH

The Journal of Infectious Diseases, jiz140, https://doi.org/10.1093/infdis/jiz140

Published: 29 March 2019

 

Abstract

Background

Surveillance data from a large measles outbreak in Mongolia suggested an increased case fatality ratio (CFR) in the second of two waves. To confirm the increase in CFR and identify risk factors for measles death, we enhanced mortality ascertainment and conducted a case-control study among infants hospitalized for measles.

Methods

We linked national vital records with surveillance data of clinically- or laboratory-confirmed infant (aged <12 months) measles cases with rash onset during March–September 2015 (wave 1) and October 2015–June 2016 (wave 2). We abstracted medical charts of 95 fatal cases and 273 nonfatal cases hospitalized for measles, matched by age and sex. We calculated adjusted matched odds ratios (amORs) and 95% confidence intervals (CIs) for risk factors.

Results

Infant measles deaths increased from 3 among 2,224 cases (CFR: 0.13%) in wave 1 to 113 among 4,884 cases (CFR: 2.31%) in wave 2 (p<0.001). Inpatient admission, 7–21 days before measles rash onset, for pneumonia or influenza (amOR: 4.5; CI 2.6–8.0), but not other diagnoses, was significantly associated with death.

Discussion

Measles infection among children hospitalized with respiratory infections likely increased deaths due to measles during wave 2. Preventing measles virus nosocomial transmission likely decreases measles mortality.

measles, mortality, Mongolia, healthcare-associated infection, case fatality

Topic: disease outbreaks – infant – mongolia – measles – mortality – case fatality rate

Issue Section: Major Article

This content is only available as a PDF.

Published by Oxford University Press for the Infectious Diseases Society of America 2019. This work is written by (a) US Government employee(s) and is in the public domain in the US.

This work is written by (a) US Government employee(s) and is in the public domain in the US.

Keywords: Measles; Nosocomial outbreaks; Mongolia.

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#Immunogenicity and #safety of #measles- #rubella #vaccine co-administered with attenuated Japanese #encephalitis SA 14–14–2 vaccine in infants aged 8 months in #China: a non-inferiority RCT (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Immunogenicity and safety of measles-rubella vaccine co-administered with attenuated Japanese encephalitis SA 14–14–2 vaccine in infants aged 8 months in China: a non-inferiority randomised controlled trial

Yan Li, MD, Susan Y Chu, PhD, Chenyan Yue, MD, Kathleen Wannemuehler, PhD, Shuyun Xie, MD, Fubin Zhang, MD, Yamin Wang, MD, Yuxi Zhang, MD, Rui Ma, MD, Yumin Li, MD, Zhiping Zuo, MD, Lance Rodewald, MD, Qiyou Xiao, MD, Zijian Feng, MD, Huaqing Wang, MD, Zhijie An, MD

Published: March 01, 2019 / DOI: https://doi.org/10.1016/S1473-3099(18)30650-9

 

Summary

Background

In China, measles-rubella vaccine and live attenuated SA 14–14–2 Japanese encephalitis vaccine (LJEV) are recommended for simultaneous administration at 8 months of age, which is the youngest recommended age for these vaccines worldwide. We aimed to assess the effect of the co-administration of these vaccines at 8 months of age on the immunogenicity of measles-rubella vaccine.

Methods

We did a multicentre, open-label, non-inferiority, two-group randomised controlled trial in eight counties or districts in China. We recruited healthy infants aged 8 months who had received all scheduled vaccinations according to the national immunisation recommendations and who lived in the county of the study site. Enrolled infants were randomly assigned (1:1) to receive either measles-rubella vaccine and LJEV simultaneously (measles-rubella plus LJEV group) or measles-rubella vaccine alone (measles-rubella group). The primary outcome was the proportion of infants with IgG antibody seroconversion for measles 6 weeks after vaccination, and a secondary outcome was the proportion of infants with IgG antibody seroconversion for rubella 6 weeks after vaccination. Analyses included all infants who completed the study. We used a 5% margin to establish non-inferiority. This trial was registered atClinicalTrials.gov ( NCT02643433).

Findings

1173 infants were assessed for eligibility between Aug 13, 2015, and June 10, 2016. Of 1093 (93%) enrolled infants, 545 were randomly assigned to the measles-rubella plus LJEV group and 548 to the measles-rubella group. Of the infants assigned to each group, 507 in the measles-rubella plus LJEV group and 506 in the measles-rubella group completed the study. Before vaccination, six (1%) of 507 infants in the measles-rubella plus LJEV group and one (<1%) of 506 in the measles-rubella group were seropositive for measles; eight (2%) infants in the measles-rubella plus LJEV group and two (<1%) in the measles-rubella group were seropositive for rubella. 6 weeks after vaccination, measles seroconversion in the measles-rubella plus LJEV group (496 [98%] of 507) was non-inferior to that in the measles-rubella group (499 [99%] of 506; difference −0·8% [90% CI −2·6 to 1·1]) and rubella seroconversion in the measles-rubella plus LJEV group (478 [94%] of 507) was non-inferior to that in the measles-rubella group (473 [94%] of 506 infants; difference 0·8% [90% CI −1·8 to 3·4]). There were no serious adverse events in either group and no evidence of a difference between the two groups in the prevalence of any local adverse event (redness, rashes, and pain) or systemic adverse event (fever, allergy, respiratory infections, diarrhoea, and vomiting). Fever was the most common adverse event (97 [19%] of 507 infants in the measles-rubella plus LJEV group; 108 [21%] of 506 infants in the measles-rubella group).

Interpretation

The evidence of similar seroconversion and safety with co-administered LJEV and measles-rubella vaccines supports the co-administration of these vaccines to infants aged 8 months. These results will be important for measles and rubella elimination and the expansion of Japanese encephalitis vaccination in countries where it is endemic.

Funding

US Centers for Disease Control and Prevention, US Department of Health and Human Services; China–US Collaborative Program on Emerging and Re-emerging Infectious Diseases.

Keywords: Measles; Rubella; Japanese encephalitis; Vaccines; China.

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