‘I don’t know anybody who said, “oh great, let’s get measles”’: a qualitative study of responses to childhood vaccinations (MMRV) among Orthodox Jews in Jerusalem following the 2018-19 measles outbreaks

Measles outbreaks have emerged among religious minorities in the global north, which cross regional and national boundaries and raise implications for measles elimination targets. Yet, studies are ambiguous about the reasons that underlie non-vaccination in religious populations, and whether and how religious “beliefs” influence vaccine decision-making among populations with suboptimal vaccination coverage. In 2018-19, Israel experienced the largest measles outbreaks in a quarter century – the burden of which disproportionately affected Orthodox Jewish neighbourhoods in Jerusalem. The objective of this study was to explore how Orthodox Jewish households in Jerusalem responded to the measles outbreaks in their neighbourhoods and how they viewed childhood vaccination (MMRV) during a public health emergency.Research methods primarily consisted of 25 in-depth semi-structured interviews conducted with 23 household heads, and 2 public health professionals involved in planning and implementation of vaccination services. Thematic analysis generated five key themes, i) where the issue of sub-optimal vaccination uptake was perceived to be located; ii) how responsive people and services were to the measles outbreaks; iii) the sources of information used in vaccine decisions by religious parents; vi) whether vaccination was deemed a religious issue; and v) how vaccination influenced social relations within religious neighbourhoods.Results demonstrate parental investment in protecting child health, with decisions around vaccination reflecting vaccine efficacy and safety, and the risk of measles transmission. Household heads across all Orthodox Jewish backgrounds were not apathetic towards measles transmission. No religious “beliefs” were identified for non-vaccination among the household heads in this cohort. Rather than relegating suboptimal vaccination uptake among religious minorities and populations as an issue of religious “beliefs,” quality social science research should examine – and clearly convey – how religion influences vaccine decision-making. Such clarity can help to avoid stigmatizing religious minorities and populations, and to plan for appropriate vaccination programmes and promotion campaigns.

Spatial Clustering of Vaccine Exemptions on the Risk of a Measles Outbreak

OBJECTIVES Areas of increased school-entry vaccination exemptions play a key role in epidemics of vaccine-preventable diseases in the United States. California eliminated nonmedical exemptions in 2016, which increased overall vaccine coverage but also rates of medical exemptions. We examine how spatial clustering of exemptions contributed to measles outbreak potential pre- and postpolicy change. METHODS We modeled measles transmission in an empirically calibrated hypothetical population of youth aged 0 to 17 years in California and compared outbreak sizes under the observed spatial clustering of exemptions in schools pre- and postpolicy change with counterfactual scenarios of no postpolicy change increase in medical exemptions, no clustering of exemptions, and lower population immunization levels. RESULTS The elimination of nonmedical exemptions significantly reduced both average and maximal outbreak sizes, although increases in medical exemptions resulted in more than twice as many infections, on average, than if medical exemptions were maintained at prepolicy change levels. Spatial clustering of nonmedical exemptions provided some initial protection against random introduction of measles infections; however, it ultimately allowed outbreaks with thousands more infections than when exemptions were randomly distributed. The large-scale outbreaks produced by exemption clusters could not be reproduced when exemptions were distributed randomly until population vaccination was lowered by >6 percentage points. CONCLUSIONS Despite the high overall vaccinate rate, the spatial clustering of exemptions in schools was sufficient to threaten local herd immunity and reduce protection from measles outbreaks. Policies strengthening vaccine requirements may be less effective if alternative forms of exemptions (eg, medical) are concentrated in existing low-immunization areas.

Genetic Analysis of the Measles Virus From the Outbreaks in South Korea, 2019

Three genotypes (B3, D8, and H1) of the measles virus (MeV) have recently caused global outbreaks. In Korea, four measles outbreaks were reported during 2018–2019 and most patients were infants and health care workers in their 20s and 30s. To investigate the genetic characteristics and molecular epidemiology of the outbreaks, we analyzed the sequence of MeVs by targeting the N-450, MF-NCR, and/or H gene regions. Considering their phylogenetic relationships, besides the N-450 and MF-NCR sequences that are commonly used for genotyping MeVs, the MF-NCR-H sequence was related to the dynamics for identifying the transmission of MeVs. Phylogenetic clustering patterns reconstructed from the MF-NCR-H sequence set revealed that genotype D8 caused three of the four outbreaks, while B3 seemed to have induced the fourth outbreak. These results suggest that the MF-NCR-H sequence is useful for rapid confirmation of measles outbreaks and to identify the epidemiological routes of MeVs.

The Effect of House Ventilation and Floor Type on the Event of Measles in Jember District

Measles is a disease caused by the measles virus from the Paramyxovirus family, genus Morbilivirus. Measles is one of the communicable disease and one of the main causes of death in children under five. Jember Regency is one of the contributors to measles cases which is quite high, namely in 2015 there were 109 cases, in 2016 there were 266 cases. From 2017 to July there were 342 cases of measles. The incidence is very high compared to 2016. The purpose of the study was to analyze the effect of house ventilation and floor type on the incidence of measles in Jember Regency. The type of research is observational analytic using a Case Control approach which was carried out in the work area of ​​the Jember District Health Center where measles outbreaks occurred in 2017 namely Silo 2 Health Center, Rambi Puji Health Center, Arjasa Health Center, Panti Health Center, Sabrang Health Center, Jelbuk Health Center and Sukorambi Health Center. Samples taken were 100 respondents consisting of 50 case respondents and 50 control respondents. Research data sourced from primary and secondary data, research data collection using questionnaires and documentation studies. Processing and analyzing data using Logistics Regression test with a significance level of 5% (α=0.05). The results showed that house ventilation (p value = 0.005) had an effect on the incidence of measles in Jember Regency. Home ventilation has an effect on the incidence of measles because some respondents live in homes with inappropriate ventilation and most of them live in homes with ventilation 10% of the floor area.

Catch-up immunization for adolescents and young adults during pre-travel consultation in Japan

Rubella and measles outbreaks in adults occur because of unimmunized or partially immunized status. Travel clinics play an important role in catch-up measles, rubella, mumps, and varicella immunization for adults. We evaluated the need for catch-up measles, rubella, mumps, and varicella immunization by young adults at our travel clinic. This retrospective observational study was conducted at the National Center for Global Health and Medicine from June 1, 2017 to May 31, 2018. Adults aged 16–49 years who received pre-travel consultation and had childhood immunization records were included. Individuals who fully or partially received planned measles, rubella, mumps, and varicella catch-up immunization were classified as “immunized.” We calculated the proportion of “immunized” individuals and analyzed the factors associated with catch-up measles, rubella, mumps, and varicella immunization at pre-travel consultation using logistic regression analysis. Overall, 3,456 individuals received pre-travel consultations during the study period; 827 (336 men, median age 22 years) had childhood immunization records. The most common trip purposes were study (33%) and tourism (24%). The most common destination was Asia (39%). Catch-up immunization of any measles, rubella, mumps, and varicella vaccine was needed by 755 individuals. After consultation, 20–46% of these participants who needed catchup immunization received at least one dose of immunization. Factors that are negatively associated with measles, rubella, mumps, and varicella catch-up immunization were tourism (odds ratio 0.37 to 0.58), yellow fever vaccination (0.45 to 0.50) (excluding varicella), and each disease history (0.13 to 0.40) (excluding rubella and varicella). Further studies are needed to identify barriers to catch-up immunization.

Direct sequencing of measles virus complete genomes in the midst of a large-scale outbreak

Measles outbreaks escalated globally despite worldwide elimination efforts. Molecular epidemiological investigations utilizing partial measles virus (MeV) genomes are challenged by reduction in global genotypes and low evolutionary rates. Greater resolution was reached using MeV complete genomes, however time and costs limit the application to numerous samples. We developed an approach to unbiasedly sequence complete MeV genomes directly from patient urine samples. Samples were enriched for MeV using filtration or nucleases and the minimal number of sequence reads to allocate per sample based on its MeV content was assessed using in-silico reduction of sequencing depth. Application of limited-resource sequencing to treated MeV-positive samples demonstrated that 1–5 million sequences for samples with high/medium MeV quantities and 10–15 million sequences for samples with lower MeV quantities are sufficient to obtain >98% MeV genome coverage and over X50 average depth. This approach enables real-time high-resolution molecular epidemiological investigations of large-scale MeV outbreaks.

Small-molecule polymerase inhibitor protects non-human primates from measles and reduces shedding

Measles virus (MeV) is a highly contagious pathogen that enters the human host via the respiratory route. Besides acute pathologies including fever, cough and the characteristic measles rash, the infection of lymphocytes leads to substantial immunosuppression that can exacerbate the outcome of infections with additional pathogens. Despite the availability of effective vaccine prophylaxis, measles outbreaks continue to occur worldwide. We demonstrate that prophylactic and post-exposure therapeutic treatment with an orally bioavailable small-molecule polymerase inhibitor, ERDRP-0519, prevents measles disease in squirrel monkeys (Saimiri sciureus). Treatment initiation at the onset of clinical signs reduced virus shedding, which may support outbreak control. Results show that this clinical candidate has the potential to alleviate clinical measles and augment measles virus eradication.

The Burden of Communicable Diseases in Lebanon: Trends in the Past Decade

The present study aims to review the main communicable diseases that experienced an upsurge in the past decade in Lebanon and to highlight the reasons behind this increase. Data of reported communicable diseases from 2010 till 2019 were obtained from the Lebanese Ministry of Public Health (LMOPH) epidemiological surveillance database. Tuberculosis, measles, mumps, leishmaniasis, and hepatitis A were the main communicable diseases that showed a sharp increase in the past 10 y. Measles outbreaks occurred in 2013 and 2018, leishmaniasis outbreak in 2013, and mumps and hepatitis A outbreaks in 2014. The highest percentages of reported diseases were from Beqaa and North governorates. The massive influx of Syrian refugees to Lebanon, together with the poor water management system, poor sanitation, deprived living conditions, and limited health-care access in rural areas might have contributed to the upsurge of communicable diseases. Although the LMOPH succeeded in containing the outbreaks, further efforts are needed to improve the identified gaps to avoid future outbreaks.