Vaccines

Editorial

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2 pages, 117 KiB

Open AccessEditorial

Addressing the Dangerous Consequences of the Resurgence of Measles and Rubella: The Critical Need for a Global Target

by Jon Kim Andrus

Vaccines 2024, 12(6), 698; https://doi.org/10.3390/vaccines12060698 - 20 Jun 2024

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Abstract

I am delighted and honored to be Guest Editor of this Vaccines Special Issue on measles and rubella elimination [...] Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

Research

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13 pages, 1099 KiB

Open AccessArticle

On the Path to Measles and Rubella Elimination Following Rubella-Containing Vaccine Introduction, 2000–2023, Namibia

by Balcha G. Masresha, Messeret E. Shibeshi, Roselina de Wee, Nicholas Shapumba, Takudzwa Sayi, Susan E. Reef and James L. Goodson

Vaccines 2024, 12(9), 957; https://doi.org/10.3390/vaccines12090957 (registering DOI) - 23 Aug 2024

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Abstract

Introduction: The WHO Measles and Rubella Strategic Framework 2021–2030 within the Immunization Agenda 2030 includes both measles and rubella elimination goals and provides guidance to countries for planning and implementing the measles and rubella elimination strategies. Namibia has been implementing measles elimination strategies [...] Read more.

Introduction: The WHO Measles and Rubella Strategic Framework 2021–2030 within the Immunization Agenda 2030 includes both measles and rubella elimination goals and provides guidance to countries for planning and implementing the measles and rubella elimination strategies. Namibia has been implementing measles elimination strategies since 1997. Methods: We reviewed and described the implementation of measles and rubella elimination strategies and the programmatic and epidemiological situation in Namibia during 2000–2023. Namibia introduced a rubella-containing vaccine (RCV) in 2016 as a combined measles–rubella (MR) vaccine using a MR catch-up campaign, targeting a wide age range based on detailed analysis and triangulation of multiple key data sources including MR vaccination coverage, MR case-based surveillance, detailed measles outbreak investigations, and serosurveys. Results: In 2020, estimated MCV1 coverage in Namibia reached 90% and has been sustained at 91% in 2021 and 2022. MCV2 was introduced in 2016, and the estimated MCV2 coverage has steadily increased to 79% in 2022. Following the MCV2 introduction and the implementation of the wide age range MR catch-up campaign in 2016, annual measles and rubella incidence decreased substantially. During 2017–2023, the period following the implementation of the catch-up MR vaccination SIA in 2016, average annual measles incidence per million population in Namibia decreased by 97% from the average during 2010–2016. Similarly, the average annual rubella incidence decreased by 95% from 2010–2016 to 2017–2023. Discussion: Successful implementation of the 2016 wide age range campaign and maintaining high routine immunization coverage likely led to the significant reduction in measles and rubella incidence in Namibia. To sustain the reduction in measles and rubella incidence and attain the elimination targets, Namibia needs to attain and maintain high routine immunization coverage with both doses of the MR vaccine and implement timely and high-quality periodic MR follow-up SIAs. High-quality elimination-standard measles and rubella surveillance will help guide strategies and serve as the basis for the eventual verification of measles and rubella elimination in Namibia according to the WHO-recommended framework. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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14 pages, 419 KiB

Open AccessArticle

Tracking Measles and Rubella Elimination Progress—World Health Organization African Region, 2022–2023

by Balcha G. Masresha, Charles Shey Wiysonge, Reggis Katsande, Patrick Michael O’Connor, Emmaculate Lebo and Robert T. Perry

Vaccines 2024, 12(8), 949; https://doi.org/10.3390/vaccines12080949 (registering DOI) - 22 Aug 2024

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Abstract

Measles or rubella elimination is verified when endemic transmission of the corresponding virus has been absent for over 36 months in a defined area, in the presence of a well-performing surveillance system. This report updates the progress by 47 countries in the WHO [...] Read more.

Measles or rubella elimination is verified when endemic transmission of the corresponding virus has been absent for over 36 months in a defined area, in the presence of a well-performing surveillance system. This report updates the progress by 47 countries in the WHO African Region towards the goal of attaining verification of measles and rubella elimination in at least 80% of the countries of the region by 2030. We reviewed the WHO-UNICEF vaccination coverage estimates for the first and second doses of measles- and measles-rubella-containing vaccines, as well as the available coverage data for measles supplementary immunization activities, during 2022–2023. We also reviewed the measles-surveillance performance and analyzed the epidemiological trends of measles and rubella as reported in the case-based surveillance database. The WHO-UNICEF estimates of first measles vaccine dose (MCV1) and second measles vaccine dose (MCV2) coverage for the African Region for 2022 were 69% and 45%, respectively. Rubella-containing vaccines have been introduced in the routine immunization program in 32 of 47 (68%) countries as of the end of 2022, with no introductions during 2023. In 2022 and 2023, a total of 144,767,764 children were vaccinated in the region with measles or MR vaccines in 24 countries through 32 mass vaccination campaigns. The administrative coverage target of 95% was reached in only 15 (49%) of the 32 vaccination campaigns. In 2023, a total of 125,957 suspected cases of measles were reported through the case-based surveillance system, and 73,625 cases (58%) were confirmed to be measles, either by laboratory testing, by epidemiological linkage, or based on clinical compatibility. A total of 4805 confirmed rubella cases were reported, though this total represents substantial under-ascertainment. The regional incidence of measles was 60.3 cases per million population. Twenty-six countries (55%) met the targets for the two principal surveillance system performance-monitoring indicators. No country in the region has attained the verification of measles or rubella elimination as of the end of 2023. Addressing systemic problems with routine immunization and using tailored approaches to reach unvaccinated children can contribute to progress towards measles and rubella elimination. In addition, periodic and timely high-quality preventive SIAs remain a critical programmatic strategy to reach unvaccinated children. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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13 pages, 542 KiB

Open AccessArticle

Global Status Report for the Verification of Measles and Rubella Elimination, 2022

by Patrick O’Connor, Balcha Masresha, Desirée Pastor, Nasrin Musa, José Hagan, Sudhir Khanal, Chung-Won Lee and Natasha Crowcroft

Vaccines 2024, 12(8), 947; https://doi.org/10.3390/vaccines12080947 (registering DOI) - 22 Aug 2024

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Abstract

Since the World Health Assembly (WHA) in 2012 endorsed the Global Vaccine Action Plan (GVAP), which included regional measles and rubella elimination goals by 2020, global progress towards verification of measles and rubella elimination has been incremental. Even though the 2020 elimination goals [...] Read more.

Since the World Health Assembly (WHA) in 2012 endorsed the Global Vaccine Action Plan (GVAP), which included regional measles and rubella elimination goals by 2020, global progress towards verification of measles and rubella elimination has been incremental. Even though the 2020 elimination goals were not achieved, commitment towards achieving measles and rubella elimination has been firmly established in the Immunization Agenda 2030 (IA2030) and the Measles and Rubella Strategic Framework (MRSF) 2021–2030. In 2023, the six Regional Verification Commissions for measles and rubella elimination (RVCs) reviewed data as of 31 December 2022 and confirmed that 82 (42%) Member States have been verified for measles elimination, and 98 (51%) Member States have been verified for rubella elimination. The six RVCs are composed of independent public health and immunization experts who are well-placed to support accelerating measles and rubella elimination. RVCs should be leveraged not only to review elimination documents but also to advocate for and champion public health programming that supports measles and rubella activities. The verification of elimination process is one of many tools that should be deployed to reinforce and accelerate efforts towards achieving a world free of measles and rubella. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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13 pages, 997 KiB

Open AccessArticle

The Global Measles and Rubella Laboratory Network Supports High-Quality Surveillance

by Paul A. Rota, Roger Evans, Myriam Corinne Ben Mamou, Gloria Rey-Benito, Lucky Sangal, Annick Dosseh, Amany Ghoniem, Charles R. Byabamazima, Maurice Demanou, Raydel Anderson, Gimin Kim, Bettina Bankamp, R. Suzanne Beard, Stephen N. Crooke, Sumathi Ramachandran, Ana Penedos, Vicki Stambos, Suellen Nicholson, David Featherstone and Mick N. Mulders

Vaccines 2024, 12(8), 946; https://doi.org/10.3390/vaccines12080946 (registering DOI) - 22 Aug 2024

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Abstract

With 762 laboratories, the Global Measles and Rubella Laboratory Network (GMRLN) is the largest laboratory network coordinated by the World Health Organization (WHO). Like the Global Polio Laboratory Network, the GMRLN has multiple tiers, including global specialized laboratories, regional reference laboratories, national laboratories, [...] Read more.

With 762 laboratories, the Global Measles and Rubella Laboratory Network (GMRLN) is the largest laboratory network coordinated by the World Health Organization (WHO). Like the Global Polio Laboratory Network, the GMRLN has multiple tiers, including global specialized laboratories, regional reference laboratories, national laboratories, and, in some countries, subnational laboratories. Regional networks are supervised by regional laboratory coordinators reporting to a global coordinator at WHO headquarters. Laboratories in the GMRLN have strong links to national disease control and vaccination programs. The GMRLN’s goal is to support member states in obtaining timely, complete, and reliable laboratory-based surveillance data for measles and rubella as part of the strategy for achieving measles and rubella elimination. Surveillance data are reported to the national program and are included in annual reports on the status of measles and rubella elimination to national verification committees for review by regional verification commissions. Quality within the GMRLN is ensured by monitoring performance through external quality assurance programs, confirmatory and quality control testing, accreditation, and coordination of corrective action and training where needed. The overall performance of the laboratories has remained high over the years despite many challenges, particularly the COVID-19 pandemic. The GMRLN is well-positioned to support high-quality laboratory-based surveillance for measles and rubella and to transition to supporting laboratory testing for other pathogens, including vaccine-preventable diseases. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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14 pages, 879 KiB

Open AccessArticle

Strengthening of Vaccine-Preventable Disease (VPD) Surveillance to Enhance National Health Capacity and Security: Perspective from India

by Arun Kumar, Ratnesh Murugan, Satishchandra Donkatti, Deepa Sharma, Nirmal Kaundal, Tigran Avagyan, Pawan Kumar, Sunil Bahl, Sudhir Khanal and Vinod Bura

Vaccines 2024, 12(8), 941; https://doi.org/10.3390/vaccines12080941 (registering DOI) - 22 Aug 2024

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Abstract

The Government of India, in collaboration with the World Health Organization (WHO), established the National Polio Surveillance Project (NPSP) in 1997 and initiated acute flaccid paralysis (AFP) surveillance to achieve the goal of polio eradication. The WHO South-East Asia Region, comprising of 11 [...] Read more.

The Government of India, in collaboration with the World Health Organization (WHO), established the National Polio Surveillance Project (NPSP) in 1997 and initiated acute flaccid paralysis (AFP) surveillance to achieve the goal of polio eradication. The WHO South-East Asia Region, comprising of 11 countries, including India, was certified as polio-free in March 2014. India was also validated to have eliminated maternal and neonatal tetanus in May 2015. Over the years, the surveillance of other vaccine-preventable diseases (VPDs) was integrated with AFP surveillance in the country. Outbreak-based measles–rubella (MR) surveillance was initiated in 2005 using AFP surveillance as a platform, case-based fever–rash (FR) surveillance started in 2021 as one of the strategies to achieve measles and rubella elimination in the country. The surveillance of diphtheria, pertussis, and neonatal tetanus was integrated with AFP surveillance in a phased manner during 2015–2022. The surveillance system for VPDs in India, supported by a laboratory network of 10 polio laboratories, 28 measles–rubella laboratories, and 20 diphtheria–pertussis laboratories, has enhanced the national health capacity and security. The setting up and expansion of the surveillance system in the country involved the important component of capacity building of personnel on various components of surveillance, including case identification, case investigation, sample collection and shipment, data analysis and public health response. These capacities have been used effectively during other emergencies, such as the recent COVID-19 pandemic, as well as during outbreaks of other diseases and natural calamities. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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14 pages, 1427 KiB

Open AccessArticle

Measles Population Immunity Profiles: Updated Methods and Tools

by Xi Li, James L. Goodson and Robert T. Perry

Vaccines 2024, 12(8), 937; https://doi.org/10.3390/vaccines12080937 (registering DOI) - 22 Aug 2024

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Abstract

Measles is a highly contagious disease and remains a major cause of child mortality worldwide. While measles vaccine is highly effective, high levels of population immunity are needed to prevent outbreaks. Simple but accurate tools are needed to estimate the profile of population [...] Read more.

Measles is a highly contagious disease and remains a major cause of child mortality worldwide. While measles vaccine is highly effective, high levels of population immunity are needed to prevent outbreaks. Simple but accurate tools are needed to estimate the profile of population measles immunity by age to identify and fill immunity gaps caused by low levels of vaccination coverage. The measles immunity profile estimates and visualizes the percentage of each birth cohort immune or susceptible to measles based on measles vaccination coverage. Several tools that employed this approach have been developed in the past, including informal unpublished versions. However, these tools used varying assumptions and produced inconsistent results. We updated the measles population immunity profile methodology to standardize and better document the assumptions and methods; provide timely estimates of measles population immunity; and facilitate prompt actions to close immunity gaps and prevent outbreaks. We recommend assuming that the second dose of the measles-containing vaccine (MCV2) and doses given during supplementary immunization activities (SIAs) first reach children who have been previously vaccinated against measles, so that previously unvaccinated children are reached only when the coverage of MCV2 or SIA is higher than the coverage achieved by all previous measles vaccination opportunities. This updated method provides a conservative estimate of immunization program impact to assess measles outbreak risk and to facilitate early planning of timely preventive SIAs to close population immunity gaps. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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9 pages, 1175 KiB

Open AccessArticle

Optimal Timing Regularly Outperforms Higher Coverage in Preventative Measles Supplementary Immunization Campaigns

by Katherine A. Rosenfeld, Kurt Frey and Kevin A. McCarthy

Vaccines 2024, 12(7), 820; https://doi.org/10.3390/vaccines12070820 - 22 Jul 2024

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Abstract

Measles threatens the lives and livelihoods of tens of millions of children and there are countries where routine immunization systems miss enough individuals to create the risk of large outbreaks. To help address this threat, measles supplementary immunization activities are time-limited, coordinated campaigns [...] Read more.

Measles threatens the lives and livelihoods of tens of millions of children and there are countries where routine immunization systems miss enough individuals to create the risk of large outbreaks. To help address this threat, measles supplementary immunization activities are time-limited, coordinated campaigns to immunize en masse a target population. Timing campaigns to be concurrent with building outbreak risk is an important consideration, but current programmatic standards focus on campaigns achieving a high coverage of at least 95%. We show that there is a dramatic trade-off between campaign timeliness and coverage. Optimal timing at coverages as low as 50% for areas with weak routine immunization systems is shown to outperform the current standard, which is delayed by as little as 6 months. Measured coverage alone is revealed as a potentially misleading performance metric. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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10 pages, 598 KiB

Open AccessArticle

“Anees Has Measles”: Storytelling and Singing to Enhance MMR Vaccination in Child Care Centers Amid Religious Hesitancy

by Therdpong Thongseiratch, Puttichart Khantee, Naphat Jaroenmark, Napatsaree Nuttapasit and Nithida Thonglua

Vaccines 2024, 12(7), 819; https://doi.org/10.3390/vaccines12070819 - 22 Jul 2024

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Abstract

This study explores the enhancement of MMR vaccination rates in the deep south of Thailand through a culturally tailored intervention that incorporates storytelling and singing, aligning with local cultural and religious values. The “Anees has Measles” intervention, developed with input from community stakeholders [...] Read more.

This study explores the enhancement of MMR vaccination rates in the deep south of Thailand through a culturally tailored intervention that incorporates storytelling and singing, aligning with local cultural and religious values. The “Anees has Measles” intervention, developed with input from community stakeholders including health workers, religious leaders, and parents, featured traditional melodies in its singing activities. The intervention comprised two main components: storytelling sessions and singing activities, both utilizing culturally resonant content and formats to effectively engage the community. Conducted from December 2019 to March 2020 across eight districts in five provinces, the study targeted children aged 18 months to 5 years in government child care centers. Results indicated a substantial increase in MMR vaccination coverage from 44.3% to 72.0% twelve months post-intervention, and further to 77.0% at 48 months post-intervention, representing a significant and sustained improvement (p < 0.001). This marked and continuous increase demonstrates the effectiveness of culturally adapted health education in areas with significant vaccine hesitancy. The findings highlight the importance of integrating culturally and religiously sensitive methods into public health strategies, significantly enhancing vaccine acceptance and coverage in diverse and conservative settings. This approach suggests a broader applicability for similar interventions in comparable contexts globally. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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17 pages, 2947 KiB

Open AccessArticle

A Cross-Sectional Study of Measles-Specific Antibody Levels in Australian Blood Donors—Implications for Measles Post-Elimination Countries

by Kirsten M. Williamson, Helen Faddy, Suellen Nicholson, Vicki Stambos, Veronica Hoad, Michelle Butler, Tambri Housen, Tony Merritt and David N. Durrheim

Vaccines 2024, 12(7), 818; https://doi.org/10.3390/vaccines12070818 - 22 Jul 2024

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Abstract

Passive immunisation with normal human immunoglobulin (NHIG) is recommended as post-exposure prophylaxis (PEP) for higher-risk measles contacts where vaccination is contraindicated. However, the concentration of measles-specific antibodies in NHIG depends on antibody levels within pooled donor plasma. There are concerns that measles immunity [...] Read more.

Passive immunisation with normal human immunoglobulin (NHIG) is recommended as post-exposure prophylaxis (PEP) for higher-risk measles contacts where vaccination is contraindicated. However, the concentration of measles-specific antibodies in NHIG depends on antibody levels within pooled donor plasma. There are concerns that measles immunity in the Australian population may be declining over time and that blood donors’ levels will progressively decrease, impacting levels required to produce effective NHIG for measles PEP. A cross-sectional study of Australian plasmapheresis donors was performed using an age-stratified, random sample of recovered serum specimens, collected between October and November 2019 (n = 1199). Measles-specific IgG antibodies were quantified by ELISA (Enzygnost anti-measles virus IgG, Siemens), and negative and equivocal specimens (n = 149) also underwent plaque reduction neutralisation testing (PRNT). Mean antibody levels (optical density values) progressively decreased from older to younger birth cohorts, from 2.09 [±0.09, 95% CI] to 0.58 [±0.04, 95% CI] in donors born in 1940–1959 and 1990–2001, respectively (p < 0.0001). This study shows that mean measles-specific IgG levels are significantly lower in younger Australian donors. While current NHIG selection policies target older donors, as younger birth cohorts become an increasingly larger proportion of contributing donors, measles-specific antibody concentrations of NHIG will progressively reduce. We therefore recommend monitoring measles-specific antibody levels in future donors and NHIG products in Australia and other countries that eliminated measles before the birth of their youngest blood donors. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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9 pages, 3277 KiB

Open AccessArticle

Congenital Rubella Syndrome Does Not Increase with Introduction of Rubella-Containing Vaccine

by Kurt Frey

Vaccines 2024, 12(7), 811; https://doi.org/10.3390/vaccines12070811 - 22 Jul 2024

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Abstract

Rubella infection is typically mild or asymptomatic except when infection occurs during pregnancy. Infection in early pregnancy can cause miscarriage, stillbirth, or congenital rubella syndrome. Only individuals that are still susceptible to rubella infection during child-bearing age are vulnerable to this burden. Rubella-containing [...] Read more.

Rubella infection is typically mild or asymptomatic except when infection occurs during pregnancy. Infection in early pregnancy can cause miscarriage, stillbirth, or congenital rubella syndrome. Only individuals that are still susceptible to rubella infection during child-bearing age are vulnerable to this burden. Rubella-containing vaccine (RCV) is safe and effective, providing life-long immunity. However, average age-at-infection increases with increasing vaccination coverage, which could potentially lead to increased disease burden if the absolute risk of infection during child-bearing age increases. The dynamics of rubella transmission were explored using EMOD, a software tool for building stochastic, agent-based infection models. Simulations of pre-vaccine, endemic transmission of rubella virus introduced RCV at varying levels of coverage to determine the expected future trajectories of disease burden. Introducing RCV reduces both rubella virus transmission and disease burden for a period of around 15 years. Increased disease burden is only possible more than a decade post-introduction, and only for contexts with persistently high transmission intensity. Low or declining rubella virus transmission intensity is associated with both greater burden without vaccination and greater burden reduction with vaccination. The risk of resurgent burden due to incomplete vaccination only exists for locations with persistently high infectivity, high connectivity, and high fertility. A trade-off between the risk of a small, future burden increase versus a large, immediate burden decrease strongly favors RCV introduction. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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20 pages, 1439 KiB

Open AccessArticle

Progress and Challenges in Measles and Rubella Elimination in the WHO European Region

by Mark Muscat, Myriam Ben Mamou, Catharina Reynen-de Kat, Dragan Jankovic, José Hagan, Simarjit Singh and Siddhartha Sankar Datta

Vaccines 2024, 12(6), 696; https://doi.org/10.3390/vaccines12060696 - 20 Jun 2024

Cited by 1 | Viewed by 956

Abstract

The elimination of both measles and rubella remains a priority for all 53 Member States of the World Health Organization (WHO) European Region. To provide an update on the epidemiological status of measles and rubella in the Region, we reviewed surveillance data on [...] Read more.

The elimination of both measles and rubella remains a priority for all 53 Member States of the World Health Organization (WHO) European Region. To provide an update on the epidemiological status of measles and rubella in the Region, we reviewed surveillance data on both diseases for 2023 submitted monthly by national surveillance institutions. We analyzed the cases of measles and rubella for 2023 by age group, case classification, vaccination, hospitalization, and importation status and report on measles-related deaths. In 2023, 60,860 measles cases, including 13 fatal cases, were reported in 41 countries. Most cases (95%; n = 57,584) were reported by six countries: Azerbaijan, Kazakhstan, Kyrgyzstan, Romania, the Russian Federation, and Türkiye. Of the 60,848 cases with data on age, 19,137 (31%) were 1–4 years old and 12,838 (21%) were 5–9 years old. A total of 10,412 (17%) were 20 years and older. The genotypes identified in the Region were largely dominated by D8 variants (n = 1357) and the remainder were B3 variants (n = 221). In 2023, 345 rubella cases were reported by 17 countries, mostly from Poland, Kyrgyzstan, Tajikistan, Türkiye, and Ukraine. A total of 262 cases (76%) were classified as clinically compatible and 79 (23%) were laboratory-confirmed. To achieve the elimination of measles and rubella in the Region, political commitment needs to be revived to enable urgent efforts to increase vaccination coverage, improve surveillance and outbreak preparedness, and respond immediately to outbreaks. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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12 pages, 2248 KiB

Open AccessArticle

Breakthrough Measles among Vaccinated Adults Born during the Post-Soviet Transition Period in Mongolia

by José E. Hagan, Stephen N. Crooke, Nyamaa Gunregjav, Sun B. Sowers, Sara Mercader, Carole J. Hickman, Mick N. Mulders, Roberta Pastore, Yoshihiro Takashima, David N. Durrheim, James L. Goodson and Paul A. Rota

Vaccines 2024, 12(6), 695; https://doi.org/10.3390/vaccines12060695 - 20 Jun 2024

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Abstract

Mongolia experienced a nationwide measles outbreak during 1 March 2015–31 December 2016, with 49,077 cases reported to the WHO; many were among vaccinated young adults, suggesting a possible role of vaccine failure. Advanced laboratory methods, coupled with detailed epidemiological investigations, can help classify [...] Read more.

Mongolia experienced a nationwide measles outbreak during 1 March 2015–31 December 2016, with 49,077 cases reported to the WHO; many were among vaccinated young adults, suggesting a possible role of vaccine failure. Advanced laboratory methods, coupled with detailed epidemiological investigations, can help classify cases as vaccine failure, failure to vaccinate, or both. In this report, we conducted a study of cases to identify risk factors for breakthrough infection for a subset of laboratory-confirmed measles cases. Of the 193 cases analyzed, only 19 (9.8%) reported measles vaccination history, and 170 (88%) were uncertain. Measles-specific IgG avidity testing classified 120 (62%) cases as low IgG avidity, indicating no prior exposure to measles. Ten of these cases with low IgG avidity had a history of measles vaccination, indicating primary vaccine failure. Overall, sixty cases (31%) had high IgG avidity, indicating breakthrough infection after prior exposure to measles antigen through vaccination or natural infection, but the IgG avidity results were highly age-dependent. This study found that among young children aged 9 months–5 years, breakthrough infection was rare (4/82, 5%); however, among young adults aged 15–25 years, breakthrough infection due to secondary vaccine failure (SVF) occurred on a large scale during this outbreak, accounting for the majority of cases (42/69 cases, 61%). The study found that large-scale secondary vaccine failure occurred in Mongolia, which highlights the potential for sustained outbreaks in post-elimination settings due to “hidden” cohorts of young adults who may have experienced waning immunity. This phenomenon may have implications for the sustainability of measles elimination in countries that remain vulnerable to the importation of the virus from areas where it is still endemic. Until global measles elimination is achieved, enhanced surveillance and preparedness for future outbreaks in post- or peri-elimination countries may be required. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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Review

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14 pages, 9818 KiB

Open AccessReview

Using Regular High-Quality Serosurveys to Identify and Close National Immunity Gaps—Measles and Rubella Elimination in Japan

by Tomimasa Sunagawa, Yusuke Kobayashi, Yoshihiro Takashima, Hajime Kamiya, Tomoe Shimada, Kazutoshi Nakashima, Satoru Arai, Kiyosu Taniguchi, Keiko Tanaka-Taya and Nobuhiko Okabe

Vaccines 2024, 12(8), 939; https://doi.org/10.3390/vaccines12080939 (registering DOI) - 22 Aug 2024

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Abstract

In Japan, periodic measles outbreaks occurred mainly among young children under the routine immunization program with one dose of the measles-containing vaccine (MCV). A second dose of MCV was introduced in 2006. During a nationwide measles resurgence in 2007–2008, the most affected age [...] Read more.

In Japan, periodic measles outbreaks occurred mainly among young children under the routine immunization program with one dose of the measles-containing vaccine (MCV). A second dose of MCV was introduced in 2006. During a nationwide measles resurgence in 2007–2008, the most affected age group was teenagers. The national serological surveillance for vaccine-preventable diseases made it clear that there was a measles immunity gap among teenagers who had not received a second dose of MCV. To fill this immunity gap, nationwide non-selective supplementary immunization activities (SIAs) were carried out as a five-year program from April 2008 to March 2013 by providing an opportunity to be vaccinated with the measles and rubella vaccine during the first year of junior high school (12–13 years old) and the last year of high school (17–18 years old). The SIA was conducted with the strong involvement of local governments in charge of vaccination delivery and collaboration between the health and education sectors. Japan was verified as achieving measles elimination in 2015 and this has been sustained to date. The challenge of rubella elimination following a similar strategy of a serological diagnosis of an immunity gap and targeted vaccination is also discussed. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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9 pages, 2007 KiB

Open AccessReview

Building Quality Control for Molecular Assays in the Global Measles and Rubella Laboratory Network

by Bettina Bankamp, Raydel Anderson, Lijuan Hao, Elena Lopareva, Min-hsin Chen, Gimin Kim, R. Suzanne Beard, Yoshio Mori, Noriyuki Otsuki, Akihido Ryo and Paul A. Rota

Vaccines 2024, 12(8), 824; https://doi.org/10.3390/vaccines12080824 - 23 Jul 2024

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Abstract

More than 100 laboratories in the World Health Organization Global Measles and Rubella Laboratory Network (GMRLN) perform nucleic acid-based methods for case confirmation of measles or rubella infections and/or strain surveillance (genotyping). The quality of laboratory data is critical to ensure that diagnostic [...] Read more.

More than 100 laboratories in the World Health Organization Global Measles and Rubella Laboratory Network (GMRLN) perform nucleic acid-based methods for case confirmation of measles or rubella infections and/or strain surveillance (genotyping). The quality of laboratory data is critical to ensure that diagnostic results and country reports to regional verification committees are based on accurate data. A molecular External Quality Assurance (mEQA) program was initiated by the US-CDC in 2014 to evaluate the performance of laboratories in the network. The inclusion of testing for measles and rubella viruses, with a focus on detection and genotyping, plus the diversity of assays and platforms employed required a flexible and comprehensive proficiency testing program. A stepwise introduction of new evaluation criteria gradually increased the stringency of the proficiency testing program, while giving laboratories time to implement the required changes. The mEQA program plays an important role in many processes in the GMRLN, including informing plans for the training of laboratory staff, access to reagents, and the submission of sequence data to global databases. The EQA program for Local Public Health Institutes in Japan is described as an example for national mEQA programs. As more laboratories initiate molecular testing, the mEQA will need to continue to expand and to adapt to the changing landscape for molecular testing. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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13 pages, 1004 KiB

Open AccessReview

Use of Measles and Rubella Rapid Diagnostic Tests to Improve Case Detection and Targeting of Vaccinations

by Audrey Rachlin, Lee M. Hampton, Paul A. Rota, Mick N. Mulders, Mark Papania, James L. Goodson, L. Kendall Krause, Matt Hanson, Jennifer Osborn, Cassandra Kelly-Cirino, Beth Evans, Antara Sinha, Lenesha Warrener, David Featherstone and David Brown

Vaccines 2024, 12(8), 823; https://doi.org/10.3390/vaccines12080823 - 23 Jul 2024

Viewed by 669

Abstract

Efforts to control and eliminate measles and rubella are aided by high-quality surveillance data—supported by laboratory confirmation—to guide decision-making on routine immunization strategies and locations for conducting preventive supplementary immunization activities (SIAs) and outbreak response. Important developments in rapid diagnostic tests (RDTs) for [...] Read more.

Efforts to control and eliminate measles and rubella are aided by high-quality surveillance data—supported by laboratory confirmation—to guide decision-making on routine immunization strategies and locations for conducting preventive supplementary immunization activities (SIAs) and outbreak response. Important developments in rapid diagnostic tests (RDTs) for measles and rubella present new opportunities for the global measles and rubella surveillance program to greatly improve the ability to rapidly detect and respond to outbreaks. Here, we review the status of RDTs for measles and rubella Immunoglobulin M (IgM) testing, as well as ongoing questions and challenges regarding the operational use and deployment of RDTs as part of global measles and rubella surveillance. Efforts to develop IgM RDTs that can be produced at scale are underway. Once validated RDTs are available, clear information on the benefits, challenges, and costs of their implementation will be critical for shaping deployment guidance and informing country plans for sustainably deploying such tests. The wide availability of RDTs could provide new programmatic options for measles and rubella elimination efforts, potentially enabling improvements and flexibility for testing, surveillance, and vaccination. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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17 pages, 2264 KiB

Open AccessReview

Challenges for Sustaining Measles Elimination: Post-Verification Large-Scale Import-Related Measles Outbreaks in Mongolia and Cambodia, Resulting in the Loss of Measles Elimination Status

by José Hagan, Otgonbayar Dashpagma, Ork Vichit, Samnang Chham, Sodbayar Demberelsuren, Varja Grabovac, Shafiqul Hossain, Makiko Iijima, Chung-won Lee, Anuzaya Purevdagva, Kayla Mariano, Roger Evans, Yan Zhang and Yoshihiro Takashima

Vaccines 2024, 12(7), 821; https://doi.org/10.3390/vaccines12070821 - 22 Jul 2024

Viewed by 570

Abstract

The Western Pacific Region’s pursuit of measles elimination has seen significant progress and setbacks. Mongolia and Cambodia were the first two middle-income countries in the Western Pacific to be verified as having eliminated measles by the Western Pacific Regional Verification Commission for Measles [...] Read more.

The Western Pacific Region’s pursuit of measles elimination has seen significant progress and setbacks. Mongolia and Cambodia were the first two middle-income countries in the Western Pacific to be verified as having eliminated measles by the Western Pacific Regional Verification Commission for Measles and Rubella Elimination, in March 2014 and 2015, respectively. However, both countries experienced large-scale or prolonged importation-related measles outbreaks shortly afterwards, leading to the re-establishment of endemic transmission. We describe the path to initial elimination in both countries and explore these outbreaks’ characteristics, factors contributing to the loss of elimination status, and implications for broader elimination efforts. Data sources include case-based epidemiological and laboratory surveillance reports, historical immunization coverage, genotype data, and published reports of in-depth outbreak investigations. In Mongolia, a single prolonged and large-scale outbreak revealed a hidden immunity gap among young adults and was driven in part by nosocomial transmission, leading to significant morbidity and mortality and loss of elimination status. Cambodia suffered multiple importations from neighboring endemic countries during the global measles resurgence in 2018–2019, complicated by cross-border mobility and significant nosocomial amplification, and the country was ultimately unable to sufficiently distinguish independent chains of transmission, leading to loss of elimination status. Our findings highlight the importance of broadening population immunity assessments beyond children to include adults and specific high-risk groups. Robust routine immunization programs, supplemented by tailored SIAs, are crucial for preventing and managing outbreaks. Additionally, strong outbreak preparedness plans, rapid response strategies, and cross-border collaboration and the global effort to prevent multiple resurgences and large-scale importation-induced outbreaks are vital for maintaining elimination status. The experiences of Mongolia and Cambodia underscore the challenges of sustaining measles elimination in the face of importation risks, shared borders with endemic countries, healthcare system gaps, and population movements. Strengthening the global coordination and synchronization of measles elimination activities is imperative to protect the gains achieved and prevent future setbacks. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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15 pages, 5425 KiB

Open AccessReview

Measles and Rubella Elimination in the Western Pacific Region in 2013–2022: Lessons Learned from Progress and Achievements Made during Regional and Global Measles Resurgences

by Yoshihiro Takashima, Syeda Kanwal Aslam, Roger Evans, Kayla Mae Mariano, Chung-won Lee, Xiaojun Wang, Varja Grabovac and David N. Durrheim

Vaccines 2024, 12(7), 817; https://doi.org/10.3390/vaccines12070817 - 22 Jul 2024

Viewed by 605

Abstract

Measles is the most contagious communicable disease, causing an estimated 5.5 million cases and more than 30,000 deaths in the Western Pacific Region (WPR) during 2000. Rubella infection in a pregnant woman can be devastating for the foetus, resulting in congenital rubella syndrome [...] Read more.

Measles is the most contagious communicable disease, causing an estimated 5.5 million cases and more than 30,000 deaths in the Western Pacific Region (WPR) during 2000. Rubella infection in a pregnant woman can be devastating for the foetus, resulting in congenital rubella syndrome (CRS) in 90% of rubella infections in early pregnancy. It was estimated that approximately 9000 CRS cases occurred in the WPR in 2010. World Health Organization (WHO) Member States in the WPR decided in 2003 to eliminate measles and in 2014 to eliminate rubella from the region. While the WPR successfully attained historically low measles incidence in 2012, it experienced a region-wide measles resurgence in 2013–2016. During the regional resurgence, WHO and Member States accumulated greater knowledge on the epidemiology of measles and rubella in the WPR and strategies to maintain gains. The implementation of the resulting new regional strategy and plan of action from 2018 has proven that measles and rubella elimination is achievable and sustainable under the pressure of multiple importations of measles virus during the world-wide measles resurgences in 2018–2019. This article discusses this progress and achievements towards achieving the global eradication of measles and rubella. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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18 pages, 1231 KiB

Open AccessReview

Serosurveillance for Measles and Rubella

by Allison M. Brady, Elina El-Badry, Eriko Padron-Regalado, Nicole A. Escudero González, Daniel L. Joo, Paul A. Rota and Stephen N. Crooke

Vaccines 2024, 12(7), 816; https://doi.org/10.3390/vaccines12070816 - 22 Jul 2024

Viewed by 731

Abstract

Measles and rubella remain global health threats, despite the availability of safe and effective vaccines. Estimates of population immunity are crucial for achieving elimination goals and assessing the impact of vaccination programs, yet conducting well-designed serosurveys can be challenging, especially in resource-limited settings. [...] Read more.

Measles and rubella remain global health threats, despite the availability of safe and effective vaccines. Estimates of population immunity are crucial for achieving elimination goals and assessing the impact of vaccination programs, yet conducting well-designed serosurveys can be challenging, especially in resource-limited settings. In this review, we provide a comprehensive assessment of 130 measles and rubella studies published from January 2014 to January 2024. Methodologies and design aspects of serosurveys varied greatly, including sample size, assay type, and population demographics. Most studies utilized enzyme immunoassays for IgG detection. Sample sizes showed diverse sampling methods but favored convenience sampling despite its limitations. Studies spanned 59 countries, predominantly including adults, and revealed disparities in seroprevalence across demographics, regions, and notably among migrants and women. Age-related declines in antibodies were observed, particularly among infants, and correlations between vaccination status and seropositivity varied. We conclude with an outlook on measles and rubella serosurveillance, emphasizing the need for proper survey design and the advantages of standardized, multiplex serology assays. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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16 pages, 810 KiB

Open AccessReview

Possible Paths to Measles Eradication: Conceptual Frameworks, Strategies, and Tactics

by Amy K. Winter and William J. Moss

Vaccines 2024, 12(7), 814; https://doi.org/10.3390/vaccines12070814 - 22 Jul 2024

Viewed by 883

Abstract

Measles elimination refers to the interruption of measles virus transmission in a defined geographic area (e.g., country or region) for 12 months or more, and measles eradication refers to the global interruption of measles virus transmission. Measles eradication was first discussed and debated [...] Read more.

Measles elimination refers to the interruption of measles virus transmission in a defined geographic area (e.g., country or region) for 12 months or more, and measles eradication refers to the global interruption of measles virus transmission. Measles eradication was first discussed and debated in the late 1960’s shortly after the licensure of measles vaccines. Most experts agree that measles meets criteria for disease eradication, but progress toward national and regional measles elimination has slowed. Several paths to measles eradication can be described, including an incremental path through country-wide and regional measles elimination and phased paths through endgame scenarios and strategies. Infectious disease dynamic modeling can help inform measles elimination and eradication strategies, and all paths would be greatly facilitated by innovative technologies such as microarray patches to improve vaccine access and demand, point-of-contact diagnostic tests to facilitate outbreak responses, and point-of-contact IgG tests to identify susceptible populations. A pragmatic approach to measles eradication would identify and realize the necessary preconditions and clearly articulate various endgame scenarios and strategies to achieve measles eradication with an intensified and coordinated global effort in a specified timeframe, i.e., to “go big and go fast”. To encourage and promote deliberation among a broad array of stakeholders, we provide a brief historical background and key considerations for setting a measles eradication goal. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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14 pages, 538 KiB

Open AccessReview

The Problem with Delaying Measles Elimination

by Natasha S. Crowcroft, Anna A. Minta, Shelly Bolotin, Tania Cernuschi, Archchun Ariyarajah, Sébastien Antoni, Mick N. Mulders, Anindya S. Bose and Patrick M. O’Connor

Vaccines 2024, 12(7), 813; https://doi.org/10.3390/vaccines12070813 - 22 Jul 2024

Viewed by 868

Abstract

Measles is a highly infectious disease leading to high morbidity and mortality impacting people’s lives and economies across the globe. The measles vaccine saves more lives than any other vaccine in the Essential Programme of Immunization and is also the most cost-effective vaccine, [...] Read more.

Measles is a highly infectious disease leading to high morbidity and mortality impacting people’s lives and economies across the globe. The measles vaccine saves more lives than any other vaccine in the Essential Programme of Immunization and is also the most cost-effective vaccine, with an extremely high return on investment. This makes achieving measles elimination through vaccination a key child health intervention, particularly in low-income countries, where the overwhelming majority of measles deaths continue to occur. All countries and regions of the world have committed to achieving measles elimination, yet many have faced challenges securing political commitment at national and global levels and predictable, timely, and flexible support from global donors, and experienced setbacks during the COVID-19 pandemic. This has happened against a backdrop of stagnant measles vaccination coverage and declining enthusiasm for vertical programmes, culminating in a World Health Organization Strategic Advisory Group of Experts (WHO SAGE) review of the feasibility of measles eradication in 2019. Sustaining the elimination of measles long term is extremely difficult, and some countries have lost or nearly lost their measles elimination status in the face of ongoing importation of cases from neighbouring or closely connected countries in which elimination had been delayed. Thus, a widening equity gap in measles immunisation coverage creates challenges for all countries, not just those facing the greatest burden of measles morbidity and mortality. Delaying elimination of measles in some countries makes it cumulatively harder for all countries to succeed for three principal reasons: increased inequity in measles immunisation coverage makes outbreaks more likely to happen and to be larger; political will is very difficult to sustain; and immunity may wane to a point that transmission is re-established. New strategies are needed to support countries and regions in their vision for a world without measles, including ways to galvanise domestic, regional and global resources and ignite the political will that is essential to make the vision a reality. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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10 pages, 224 KiB

Open AccessReview

Vaccination Week in the Americas: An Ongoing Initiative to Strengthen and Sustain Measles and Rubella Elimination in the Region

by Alba Maria Ropero, Hannah Kurtis, Lauren Vulanovic, Pamela Bravo-Alcántara, Maite Vera Antelo and Margherita Ghiselli

Vaccines 2024, 12(7), 812; https://doi.org/10.3390/vaccines12070812 - 22 Jul 2024

Viewed by 485

Abstract

Vaccination Week in the Americas (VWA) is a yearly regional initiative that promotes the benefits of vaccination to all persons in the region. In its 22-year history, more than 1.15 billion people have been reached under the framework of VWA across more than [...] Read more.

Vaccination Week in the Americas (VWA) is a yearly regional initiative that promotes the benefits of vaccination to all persons in the region. In its 22-year history, more than 1.15 billion people have been reached under the framework of VWA across more than 40 countries and territories. This review examines multiple PAHO and WHO data points, documents and reports related to measles/rubella vaccination coverage and VWA since its inception. Its goal is to document the impact that the VWA has had in maintaining and accelerating measles and rubella disease elimination, in the context of PAHO’s Disease Elimination Initiative. The results suggest that VWA’s contributions to measles and rubella elimination have been substantial. Every year, VWA promotes (a) renewed political commitment to the immunization program from the highest political authorities of Member States; (b) vaccination operations to close immunity gaps, recover under-vaccinated persons, and reach chronically underserved populations; and (c) the dissemination of messages on the benefits of vaccination through regional and national communications campaigns. VWA will continue to be an important contributor to disease elimination efforts in the Americas, even as new targets are set in response to the evolving epidemiological landscape. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

13 pages, 6688 KiB

Open AccessReview

Global Update on Measles Molecular Epidemiology

by Bettina Bankamp, Gimin Kim, Derek Hart, Andrew Beck, Myriam Ben Mamou, Ana Penedos, Yan Zhang, Roger Evans and Paul A. Rota

Vaccines 2024, 12(7), 810; https://doi.org/10.3390/vaccines12070810 - 22 Jul 2024

Cited by 1 | Viewed by 615

Abstract

Molecular surveillance of circulating measles variants serves as a line of evidence for the absence of endemic circulation and provides a means to track chains of transmission. Molecular surveillance for measles (genotyping) is based on the sequence of 450 nucleotides at the end [...] Read more.

Molecular surveillance of circulating measles variants serves as a line of evidence for the absence of endemic circulation and provides a means to track chains of transmission. Molecular surveillance for measles (genotyping) is based on the sequence of 450 nucleotides at the end of the nucleoprotein coding region (N450) of the measles genome. Genotyping was established in 1998 and, with over 50,000 sequence submissions to the Measles Nucleotide Surveillance database, has proven to be an effective resource for countries attempting to trace pathways of transmission. This review summarizes the tools used for the molecular surveillance of measles and describes the challenge posed by the decreased number of circulating measles genotypes. The Global Measles and Rubella Laboratory Network addressed this challenge through the development of new tools such as named strains and distinct sequence identifiers that analyze the diversity within the currently circulating genotypes. The advantages and limitations of these approaches are discussed, together with the need to generate additional sequence data including whole genome sequences to ensure the continued utility of strain surveillance for measles. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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12 pages, 236 KiB

Open AccessReview

Measles and Rubella Diagnostic and Classification Challenges in Near- and Post-Elimination Countries

by Thomas D. Filardo, Stephen N. Crooke, Bettina Bankamp, Kelley Raines, Adria D. Mathis, Tatiana M. Lanzieri, R. Suzanne Beard, Ludmila Perelygina, David E. Sugerman and Paul A. Rota

Vaccines 2024, 12(6), 697; https://doi.org/10.3390/vaccines12060697 - 20 Jun 2024

Viewed by 602

Abstract

Measles and rubella are vaccine-preventable viral diseases and can be prevented by safe, highly effective vaccination with measles- and rubella-containing vaccines. Given the myriad causes of febrile exanthems, laboratory surveillance for both measles and rubella is important to document the incidence of these [...] Read more.

Measles and rubella are vaccine-preventable viral diseases and can be prevented by safe, highly effective vaccination with measles- and rubella-containing vaccines. Given the myriad causes of febrile exanthems, laboratory surveillance for both measles and rubella is important to document the incidence of these diseases and to track the progress and maintenance of elimination in near- and post-elimination settings. Diagnostic challenges can hinder effective surveillance and classification challenges can hinder efforts to demonstrate achievement or maintenance of elimination. In this report, we review diagnostic and classification challenges for measles and rubella in near- and post-elimination settings. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

18 pages, 590 KiB

Open AccessReview

A World without Measles and Rubella: Addressing the Challenge of Vaccine Hesitancy

by David M. Higgins and Sean T. O’Leary

Vaccines 2024, 12(6), 694; https://doi.org/10.3390/vaccines12060694 - 20 Jun 2024

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Abstract

The worldwide elimination of measles and rubella is feasible, but not without overcoming the substantial challenge of vaccine hesitancy. This challenge is complicated by the spread of misinformation and disinformation fueled by rapidly progressing technologies and evolving forms of online communication. The recent [...] Read more.

The worldwide elimination of measles and rubella is feasible, but not without overcoming the substantial challenge of vaccine hesitancy. This challenge is complicated by the spread of misinformation and disinformation fueled by rapidly progressing technologies and evolving forms of online communication. The recent COVID-19 pandemic has only added further complexity to this challenge. However, considerable progress has been made in understanding the scope of the problem and the complex factors that influence vaccine hesitancy. Our understanding of evidence-based strategies for addressing vaccine hesitancy has grown significantly, including evidence for effective communication and behavioral interventions. In this article, we review measles and rubella vaccines and vaccine hesitancy. We then provide an overview of evidence-based strategies for addressing vaccine hesitancy, including communication strategies and behavioral interventions. This article is relevant to healthcare professionals, health system leaders, public health professionals, policymakers, community leaders, and any individuals who have a role in addressing vaccine hesitancy in their communities. Finally, we review future directions and major areas of research need. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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12 pages, 499 KiB

Open AccessReview

Sustaining the Elimination of Measles, Rubella and Congenital Rubella Syndrome in the Americas, 2019–2023: From Challenges to Opportunities

by Gloria Rey-Benito, Desirée Pastor, Alvaro Whittembury, Regina Durón, Carmelita Pacis-Tirso, Pamela Bravo-Alcántara, Claudia Ortiz and Jon Andrus

Vaccines 2024, 12(6), 690; https://doi.org/10.3390/vaccines12060690 - 20 Jun 2024

Cited by 1 | Viewed by 714

Abstract

This report reviews national data from all Member States on measles, rubella, and congenital rubella syndrome (CRS) elimination in the Region of the Americas during 2019–2023. It includes an analysis of compliance with vaccination coverage, surveillance indicators, and measles outbreaks, as well as [...] Read more.

This report reviews national data from all Member States on measles, rubella, and congenital rubella syndrome (CRS) elimination in the Region of the Americas during 2019–2023. It includes an analysis of compliance with vaccination coverage, surveillance indicators, and measles outbreaks, as well as an analysis of the response capacity of the laboratory network and a country case study that meets all indicators. The sources of information were the integrated epidemiological surveillance system for measles and rubella of the Pan American Health Organization (PAHO)/World Health Organization (WHO) and the Joint Reporting Form (eJRF), among others. From 2020 to 2022, regional coverage with first (MMR-1) and second doses (MMR-2) decreased to rates below 90%. The regional suspected case notification rate was maintained above the minimum expected 2.0 suspect cases per 100,000 population, except in 2021. During 2019 to 2023, 18 countries experienced outbreaks, with two of the outbreaks resulting in re-established endemic transmission. In conclusion, two countries in the Americas have not maintained measles elimination, but by the end of 2023 no country showed endemic measles transmission. One of the countries that lost its certification of elimination in 2018 managed to be reverified in 2023; the other is pending reverification. All countries maintained rubella elimination. Despite these challenges, the sustainability of the elimination of these diseases remains a health priority in the Region. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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22 pages, 583 KiB

Open AccessCommentary

Accelerating Global Measles and Rubella Eradication—Saving Millions of Lives, Preventing Disability, and Averting the Next Pandemic

by David N. Durrheim, Jon K. Andrus, Shahina Tabassum, David Githanga, Mira Kojouharova and Nadia Talab

Vaccines 2024, 12(6), 699; https://doi.org/10.3390/vaccines12060699 - 20 Jun 2024

Cited by 1 | Viewed by 850

Abstract

No vaccine has been more effective in reducing disease burden, especially in preventing child deaths, than measles-containing vaccine. The return on investment makes measles-containing vaccine one of the most cost-effective public health measures available. Exhaustive reviews of biological, technical, economic and programmatic evidence [...] Read more.

No vaccine has been more effective in reducing disease burden, especially in preventing child deaths, than measles-containing vaccine. The return on investment makes measles-containing vaccine one of the most cost-effective public health measures available. Exhaustive reviews of biological, technical, economic and programmatic evidence have concluded that measles can and should be eradicated, and by including rubella antigen in measles-containing vaccine, congenital rubella syndrome will also be eradicated. All World Health Organisation Regions have pledged to achieve measles elimination. Unfortunately, not all countries and global partners have demonstrated an appropriate commitment to these laudable public health goals, and the negative impact of the COVID-19 pandemic on coverage rates has been profound. Unsurprisingly, large disruptive outbreaks are already occurring in many countries with a global epidemic curve ominously similar to that of 2018/2019 emerging. The Immunization Agenda 2030 will fail dismally unless measles and rubella eradication efforts are accelerated. Over half of all member states have been verified to have eliminated rubella and endemic rubella transmission has not been re-established in any country to date. In 2023, 84 countries and areas were verified to have sustained elimination of measles. However, without a global target, this success will be difficult to sustain. Now is the time for a global eradication goal and commitment by the World Health Assembly. Having a galvanising goal, with a shared call for action, will demand adequate resourcing from every country government and global partners. Greater coordination across countries and regions will be necessary. Measles, rubella and congenital rubella syndrome eradication should not remain just a technically feasible possibility but rather be completed to ensure that future generations of children do not live under the shadow of preventable childhood death and lifelong disability. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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7 pages, 190 KiB

Open AccessCommentary

Evolution and Contribution of a Global Partnership against Measles and Rubella, 2001–2023

by Peter Strebel, Mark Grabowsky, Edward Hoekstra, Andrea Gay and Stephen Cochi

Vaccines 2024, 12(6), 693; https://doi.org/10.3390/vaccines12060693 - 20 Jun 2024

Cited by 1 | Viewed by 853

Abstract

This article describes the arc of global measles and rubella elimination since 2000 from the perspective of the founding partners of the Measles Initiative. The Measles Initiative was formed in 2001 as a partnership among the American Red Cross, the Centers for Disease [...] Read more.

This article describes the arc of global measles and rubella elimination since 2000 from the perspective of the founding partners of the Measles Initiative. The Measles Initiative was formed in 2001 as a partnership among the American Red Cross, the Centers for Disease Control and Prevention, UNICEF, the United Nations Foundation, and the World Health Organization with the aim to reduce measles deaths in low-income countries. Recognizing rubella as the leading infectious disease cause of congenital abnormalities globally and achievement of measles and rubella elimination in the region of the Americas, the partnership was renamed the Measles and Rubella Initiative (MRI) in 2012. The goals of the MRI were at least a 95% reduction in global measles mortality and elimination of measles and rubella in at least five of the six WHO regions. In January 2023, the membership of the partnership was expanded to include the Bill and Melinda Gates Foundation (BMGF) and Gavi the Vaccine Alliance, and its name changed to the IA2030 Measles and Rubella Partnership. We describe the role the partnership has had in measles partner effectiveness and its impact on measles and rubella disease burden, including how the partnership has strategically adapted to the evolving immunization landscape. We conclude with lessons learned regarding the role global partnerships can play in furthering the impact of disease control programs within the current global immunization environment. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

7 pages, 226 KiB

Open AccessCommentary

The Case for Assessing the Drivers of Measles Vaccine Uptake

by Jessica Kaufman, Ashleigh Rak, Sophia Vasiliadis, Navrit Brar, Eeman Atif, Jennifer White, Margie Danchin and David N. Durrheim

Vaccines 2024, 12(6), 692; https://doi.org/10.3390/vaccines12060692 - 20 Jun 2024

Viewed by 859

Abstract

Global measles cases are on the rise following disruptions to routine immunisation programs during the COVID-19 pandemic, with devastating consequences. According to the World Health Organization, the behavioural and social drivers of vaccination include what people think and feel about vaccines, social processes, [...] Read more.

Global measles cases are on the rise following disruptions to routine immunisation programs during the COVID-19 pandemic, with devastating consequences. According to the World Health Organization, the behavioural and social drivers of vaccination include what people think and feel about vaccines, social processes, motivation to vaccinate and practical barriers to vaccination. However, the drivers of measles vaccine uptake are not necessarily the same as those for other childhood vaccines, and we lack data on how these drivers specifically have changed during and since the COVID-19 pandemic. Without accurately measuring the behavioural and social drivers for measles vaccination, and ideally measuring them serially over time, countries cannot design, target and implement interventions that effectively increase and sustain measles vaccine coverage. This paper outlines what is and is not known about the behavioural and social drivers of measles vaccination and provides recommendations for improving their post-pandemic assessment. Full article

(This article belongs to the Special Issue A World without Measles and Rubella: Meeting the Regional Elimination Targets on the Path to Global Eradication)

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