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The waning of maternal antibodies may cause infants to lose protection against measles before receiving measles-containing vaccine (MCV). The aim of this study is to investigate the changing characteristics and influencing factors of measles antibodies in preterm infants (PT), and to provide scientific basis for optimizing MCV vaccination strategy of the target population. Blood samples were collected from PT and full-term infants (FT) at the chronological age (CA) of 3, 6, and 12 months. Measles antibodies were quantitatively detected by enzyme-linked immunosorbent assay. Demographic and vaccination information were both collected. Kruskal-Wallis rank sum test was used to compare the measles antibodies among different gestation age (GA) groups, and multiple linear regression was performed to identify the correlative factors for the antibodies. Measles antibodies of PT decreased significantly with age increasing before MCV vaccination. The positive rates of antibodies of PT were 10.80% and 3.30% at the age of 3 and 6 months, respectively ( p  < .001). At 12 months, the measles antibodies and seropositive rate in the infants who received MCV vaccination increased sharply ( p  < .001). Regression analyzes showed that the younger the GA or the older the age, the lower the antibodies at 3 months(p < .001，p = .018); while the lower measles antibody levels at 3 months and older age predicted the lower antibodies at 6 months(p < .001, p  = .029). PT were susceptible to measles due to the low level of maternally derived antibodies before MCV vaccination. More efforts should be considered to protect the vulnerable population during their early postnatal life.

Objectives: Several countries have successfully eliminated measles, and China is making significant strides toward achieving this goal. This study focused on investigating the patterns of measles infections in Zhejiang Province, China, as well as control measures. The objective was to provide valuable insights that could contribute to the development of nationwide elimination strategies., Methods: We analyzed measles surveillance data from 2005 to 2022 in Zhejiang Province. We utilized a joinpoint regression model to examine trends in measles. Additionally, we employed SaTScan version 9.5 to identify spatial-temporal clusters. Finally, we used an age-period-cohort model to assess the effects of age, period, and cohort., Results: The age-standardized incidence rate (ASIR) of measles infection in Zhejiang Province from 2005 to 2022 was 5.24 per 100,000, showing a consistent and significant downward trend with an annual percentage change of -24.93% (p<0.05). After 2020, the ASIR for measles infection fell to below 0.1 per 100,000. The majority of measles cases occurred in individuals either without an immunization history or with an unknown immunization status, representing 41.06% and 41.40% of the cases from 2010 to 2022, respectively. According to data from the National Measles Surveillance System, the annual rate of discarded measles cases from 2009 to 2014, and the annual rate of discarded measles and rubella cases from 2015 to 2022, were both above 2 per 100,000, indicating the high sensitivity of the measles surveillance system., Conclusions: The significant reduction in measles incidence from 2005 to 2022 demonstrates substantial progress in Zhejiang Province towards the elimination of measles.

Background: Supplementary immunization activities (SIAs) have been demonstrated being effective in reducing measles incidence within a short period of time in China, but the effects are short-lived if there is no follow-up SIA with high routine immunization coverage., Objectives: To assess the change in measles seroprevalence from 2009 to 2013 after the launch of 2 large-scale SIAs within the period., Methods: Three population-based cross-sectional serologic surveys of measles antibodies were conducted in 2009, 2011 and 2013 in Zhejiang, a province in eastern China, with serologic samples collected from 1541, 896 and 1474 subjects, respectively. The serum levels of immunoglobulin G antibodies were measured by enzyme-linked immunosorbent assay., Results: We found that the seropositivity rate among infants 0-7 months of age, a group having no vaccination benefit, was below 80% throughout the study period. In addition, the seropositivity rate among adults 30-49 years of age decreased significantly from 96.0% (95% confidence interval: 93.7%-98.3%) in 2011 to 88.5% (95% confidence interval: 84.3%-92.8%) in 2013., Conclusion: We showed that large-scale SIAs were effective, but their effects were not long lasting. Given the drop in seropositivity among adults, their susceptibility should be carefully monitored. While older individuals could benefit from the immunization activities, children who were too young to be vaccinated still have a weak seropositivity profile and the optimal age for the administration of the first dose of vaccine should be reconsidered.

In China, children aged <8 months, who were expected to be protected by maternal antibodies before receiving the first dose of measles vaccine, were the age group with the greatest risk of infection in recent years. In this study, we evaluated whether infants yet to be age-eligible for measles vaccine had a sufficient seropositive level of maternal measles antibodies in 2009 and 2013. Blood samples were collected from infants aged <8 months through population-based serological surveys conducted in Zhejiang, China. Serum levels of immunoglobulin G measles antibodies were quantified using enzyme-linked immunosorbent assay. In 2013, the mean geometric mean titres (GMTs) of infants aged 4 to 8 months were below the seropositivity threshold (<200 mIU/mL), decreasing from 118.6 mIU/mL (95% confidence interval [CI] 83.0, 169.3 mIU/mL) at 4 months to 28.6 mIU/mL (95% CI 15.6, 52.3 mIU/mL) at 7 months. Antibody levels were significantly lower in 2013 than in 2009 starting from 5 months of age. In conclusion, infants aged 4 to 8 months are susceptible to measles due to low levels of maternal measles antibodies. It is thus suggested to provide infants with a supplementary dose on top of the routine schedule, and/or launch catch-up vaccination campaigns among young women.

Measles cases have occurred in individuals with histories of vaccination against the disease in Zhejiang Province, China. The purposes of this study were to determine the seroprevalence of immunoglobulin G (IgG) measles antibodies in vaccinated individuals, to explore the waning kinetics of measles antibody among children after receipt of a measles-containing vaccine, and to define high-risk groups in the population. A seroprevalence survey of measles antibody was conducted with 1900 randomly selected and age-stratified participants aged 6-14 years in Zhejiang province. In our study, seronegative persons accounted for 7.17% of study participants. A case-control study of participants who had received at least one dose of measles-containing vaccine was conducted, with 123 cases of immune failure and 1593 controls with immune success. Multivariate logistic regression analysis showed that age, and number of doses were the influencing factors for measles immunization failure. The older a participant (odds ratio [OR] = 1.164), the more likely that measles vaccine immunity failed. In addition, immune failure was more likely to occur after one dose of MCV than two doses (OR = 0.008) or three doses and more (OR = 0.047). In a univariate logistic regression analysis, we found that immune failure was more likely to occur with MCV vaccination beginning at 8 months than at 9-11 months (OR = 0.562) and the subjects whose registration residence was in other cities in Zhejiang province (OR = 3.527). However, these differences in seropositivity were not significant in the multivariate logistic regression analysis. The exponential regression equation of the attenuation model after measles immunization was y = 884.64e -0.057x (R 2  = 0.0521, p < 0.001), and results showed that the measles geometric mean concentration of IgG antibodies was approximately 884.64 mIU/ml after the last MCV vaccination and decreased with time since last vaccination., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the economic impact of the current measles vaccination program in Zhejiang Province, east China., Methods: A decision tree-Markov model with parameters from published literatures, government documents and surveys was developed and used to simulate over 40 years of a birth cohort in Zhejiang Province during the year 2014. The expected cost and effectiveness of the current measles vaccination program was compared against no vaccination. Costs were assessed from the payer's perspective. Benefits were defined as savings on the direct cost of measles treatment, and the effectiveness was measured according to the number of measles cases and deaths averted. The net present value (NPV), benefit-cost ratio (BCR) and incremental cost-effectiveness ratio (ICER) were also calculated. A threshold for cost-effectiveness of less than 3 times the Gross Domestic Product (GDP) per capita was used. One-way sensitivity analysis was performed to assess parameter uncertainties., Results: The total vaccination cost was estimated to be $2.52 million. The BCR of the current measles program was found to be 6.06 with a NPV of $73.38 million. It was also calculated that a total of 195,165 measles cases and 191 measles-related deaths would be prevented by vaccination. The ICER was approximately $12.91 per case averted and $13,213.43 per death averted, respectively, which was cost-effective. The models were proven to be robust., Conclusions: The current measles vaccination program appeared to be cost-effective and to offer substantial benefits. The results of this analysis sought to contribute to the justification of future investments to achieve the goal of measles elimination., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The target of eliminating measles has not been achieved, and measles has resurged in Zhejiang, China, since 2013. In this study, we hypothesized that population density and the proportion of the floating population were the potential causes of measles persistence in Zhejiang. Measles cases in Zhejiang from 2004 through 2017 were analyzed using data from the National Notifiable Diseases Reporting System (NNDRS). Reported measles incidence and annual incidence by age were described. Spearman correlation coefficients were used to assess correlations between measles incidence and population density and the proportion of floating population. A total of 48,648 measles cases were reported during the 14-year period. Two large measles epidemics occurred in 2005 (14,317 cases, incidence of 29.38/100,000) and 2008 (12,782 cases, incidence of 25.26/100,000). A higher proportion of cases occurred in young adults aged 20 to 34 years and infants under 1 year of age. A positive correlation was observed between measles incidence and either population density or proportion of inter-provincial floating populations. In general, Zhejiang suffers from a high incidence of measles partly because of its high population density and the low vaccination rates among inter-provincial floating populations. To meet the target of measles elimination, convincing susceptible young adults and migrant children to get vaccinated remains a critical issue.

This study aimed to figure out the economic burden of measles patients and explore the associated factors for total cost in measles cases that occurred in the year 2015 from Jiaxing, Jinhua, and Taizhou cities in Zhejiang Province, China. Direct interviews were conducted to collect information on patient expenses during treatment, including outpatient expenses, hospitalization expenses, self-treatment fees, productivity loss, and transportation fees. Descriptive epidemiological methods and chi-square tests were used to assess the direct and indirect cost of measles patients. Ordinal logistic regression was applied to explore the possible factors contributing to cost. A total of 136 measles cases were investigated and the average direct cost, indirect cost, and total cost were #747.14, #520.12, and #1,267.26, respectively. Direct cost accounted for 58.96% of the total cost, which was significantly higher than the indirect cost (P < 0.001). In 2015, 1,386 confirmed cases were reported in the Zhejiang Province, and the overall direct, indirect, and total economic burden reached #1.04 million, #0.72 million, and #1.76 million, respectively. Quality-adjusted life years for measles patient were calculated to be 76.06 in Zhejiang, 2015. Hospitalization, occupation, complication, disease duration, age, and site had a significant influence on the total cost according to ordinal logistic regression, with the maximum contribution from hospitalization. Measles resulted in heavy economic burdens, and local public health departments or community health service centers should spare no effort to maintain a high rate of vaccination coverage and protect susceptible populations.

Objective: To determine measles antibody levels and influencing factors among children aged 6 to 15 years in Zhejiang province., Methods: Blood samples were collected from 2069 children aged 6 to 15 years in Changxing county (Huzhou) and Liandu district (Lishui) of Zhejiang province. Serum level of measles IgG antibody was measured using ELISA, and 800 mIU/mL was applied as the cut-off point of high antibody level. Chi-square or trend Chi-square test was used to analyze difference in positive rates of high antibody level among children with different characters, and the factors related to high antibody level in the vaccinated children were analyzed using multivariate logistic regression., Results: Among 2069 subjects, positive rate of high measles antibody level was 36.06% (746/2069). Multivariate logistic regression showed that the high measles antibody level was significantly associated with age of children and the age of first measles vaccine inoculation. The positive rate of high measles antibody level decreased with age( OR =0.866, 95% CI :0.830-0.904, P <0.01), and the positive rate in children whose first vaccination at ≥ 12 months of age was higher than those whose first vaccination at 8 months of age( OR =0.633, 95% CI :0.498-0.805, P <0.01)., Conclusions: In order to obtain high measles antibody level and to maintain high levels of population immune barrier, it is suggested that first dose of vaccination can be appropriately delayed in low epidemic areas, and elder children should have timely catch-up vaccination.

In 2006, China targeted measles for elimination by 2012, but the goal was not achieved. In line with this goal, the timeliness of measles laboratory reporting should be evaluated to improve efficiency in implementing control measures. Laboratory-confirmed suspected measles cases reported to the measles surveillance system in Zhejiang Province, China, from 2009 to 2015 were collected. Three reporting periods were defined: transport duration (period from serum collected to serum received in lab), analysis duration (period from serum received to the result being reported), and total reporting duration. The median was calculated for each period. Associations between total reporting delay and other factors were accessed using logistic regression model. A total of 18,518 laboratory-confirmed suspected measles cases were collected. For transport duration, the median was within 1 day, and no variation was observed among different years. For analysis duration, the median decreased from 3 days in 2009 to 1 day in 2015. For total reporting duration, the median decreased from 5 days in 2009 to 2 days in 2015. The median of total delay was 13 days during the 7 years. The proportion of cases notified within the time limit was found to increase, indicating a tendency toward more efficient laboratory reporting. Moreover, timeliness was influenced by various external factors: reporting from CDC, reporting from counties with higher economic status, and reporting in spring were the variables associated with shorter delays. Timeliness of measles laboratory reporting has increased annually in China. Health administration departments need to pay more attention to measles laboratory surveillance in counties with lower economic status.

Introduction: Endemic measles persists in China, despite >95% reported coverage of two measles-containing vaccine doses and nationwide campaign that vaccinated more than 100 million children in 2010. In 2011, almost half of the 9943 measles cases in China occurred in children eligible for measles vaccination. We conducted a case-control study during 2012-2013 to identify risk factors for measles infection in children aged 8 months-14 years., Methods: Children with laboratory-confirmed measles were age- and neighborhood-matched with three controls. We interviewed parents of case and control infants on potential risk factors for measles. We calculated adjusted matched odds ratios and 95% confidence intervals of risk factors. We calculated attributable fractions for risk factors that could be interpreted as causal and vaccine efficacy (VE) for the measles containing vaccine (MCV) used in the Chinese immunization program., Results: In all, 969 case-patients and 2845 controls were enrolled. In multivariable analysis, lack of measles vaccination both overall (mOR 22.7 [16.6, 31.1] and when stratified by region (east region, mOR 74.2 [27.3, 202]; central/western regions mOR 17.4 [12.5, 24.3]), hospital exposure (mOR 63.0, 95% CI [32.8, 121]), and migration among counties (overall mOR 3.0 [2.3, 3.9]) were significant risk factors. The calculated VE was 91.9-96.1% for a single dose of MCV and 96.6-99.5% for 2 doses., Conclusions: Lack of vaccination was the leading risk factor for measles infection, especially in children born since the 2010 supplementary immunization activity. Reducing missed vaccination opportunities, improving immunization access for migrant children, and strengthening school/kindergarten vaccine checks are needed to strengthen the routine immunization program and maintain progress toward measles elimination in China., (Copyright © 2016. Published by Elsevier Ltd.)

Objective: To study the spatial-temporal dynamical features of measles in Zhejiang province., Methods: Data was from the China Disease Surveillance Information System and China Immunization Program Information Management System. Power-law method on spatial-temporal-multicomponent model was used to analyze the epidemic characteristics of measles in the districts of Zhejiang province., Results: The incidence of measles in Zhejiang province was 2.72/100 000 (1 494 cases) in 2013. Compared to the first order adjacent matrix, Power-law method showed a lower value of Akaike information criterion. The follow-up impact from the previous measles epidemic was strong to the Keqiao, Xiaoshan and Yuecheng districts with the autoregressive component as 1.39, 0.88 and 0.77, respectively. Local risk of measles seemed high in Keqiao, Qujiang and Xiaoshan districts with the endemic component as 4.06, 3.74 and 3.55, respectively. Impact of the epidemic to the nearby districts was large in Keqiao, Shangyu districts and Jiande city with epidemic components as 3.08, 2.54 and 2.21, respectively., Conclusion: The spatial-temporal feature of measles in several districts of Zhejiang province appeared heterogeneous, suggesting the specific strategies should be taken to control the epidemics of measles.

Background: The reported coverage of the measles-rubella (MR) or measles-mumps-rubella (MMR) vaccine is greater than 99.0% in Zhejiang province. However, the incidence of measles, mumps, and rubella remains high. In this study, we assessed MMR seropositivity and disease distribution by age on the basis of the current vaccination program, wherein the first dose of MR is administered at 8 months and the second dose of MMR is administered at 18-24 months., Methods: Cross-sectional serological surveys of MMR antibodies were conducted by collecting epidemiological data in Zhejiang province, China in 2011. In total, 1015 participants were randomly selected from two surveillance sites. Serum MMR-specific immunoglobulin G levels were tested by enzyme-linked immunosorbent assay. The geometric mean titers and seroprevalence with 95% confidence intervals (CIs) were calculated by age and gender. Proportions of different dose of vaccine by age by vaccine were also identified. Statistically significant differences between categories were assessed by the Chi-square test., Results: Over 95% seroprevalence rates of measles were seen in all age groups except <7 months infants. Children aged 5-9 years were shown lower seropositivity rates of mumps while elder adolescences and young adults were presented lower rubella seroprevalence. Especially, rubella seropositivity was significantly lower in female adults than in male. Nine measles cases were unvaccinated or unknown vaccination history. Among them, 66.67% (6/9) patients were aged 20-29 years while 33.33% (3/9) were infants aged 8-12 months. In addition, 57.75% (648/1122) patients with mumps were children aged 5-9 years, and 50.54% (94/186) rubella cases were aged 15-39 years., Conclusions: A timely two-dose MMR vaccination schedule is recommended, with the first dose at 8 months and the second dose at 18-24 months. An MR vaccination speed-up campaign may be necessary for elder adolescents and young adults, particularly young females.

Background: A prolonged measles epidemic occurred in Wenzhou City, China after a nationwide measles mass immunization campaign (MMIC) in 2010. We conducted an investigation to identify factors contributing to this epidemic and to provide evidence-based recommendations for measles elimination strategies in China., Methods: Measles was diagnosed using the national standard case-definitions. We estimated the population vaccination coverage based on the proportion of measles patients that had been vaccinated. In a case-control investigation, all measles patients who received treatment in The Second Affiliated Hospital of Wenzhou Medical College (Hospital S) during November 1 to December 31, 2010 served as cases; controls were randomly selected among all other patients who received treatment in Hospital S during the same time period, frequency matched by month of hospital visit. We reviewed medical records of case- and control-patients to compare their exposure history at Hospital S and to its intravenous rehydration room (IV room) during the incubation period (7-21 days before their illness onset)., Results: The attack rate of measles in Wenzhou City was 3.3/100,000 during September 1, 2010 to January 11, 2011. Children aged 8-11 m had the highest attack rate (171/100,000) of all age groups. In children not age-eligible for the MMIC but should have been routinely vaccinated after the MMIC, the vaccination rate was only 52%. In the case-control investigation, 60% (25/42) of case-patients compared with 21% (35/168) of control-patients had visited Hospital S (adjusted ORM-H = 5.5, 95% CI = 2.7-11). Among unvaccinated children who had received treatment in Hospital S, 84% (21/25) of case-patients compared 38% (11/29) of control-patients had visited the IV room (adjusted ORM-H = 9.2, 95% CI = 1.5-59)., Conclusion: Relaxed routine measles vaccination among children after the MMIC was the main factor responsible for this epidemic. Exposure in the IV room at Hospital S facilitated the epidemic. To reach the goal of measles elimination, the Chinese public health authorities should make greater efforts to improve timely routine measles vaccination, and to reduce nosocomial transmission.

The increasing proportions of adult cases were observed in the recent measles outbreaks in Zhejiang Province, China. In order to identify the high-risk age groups of measles for targeted intervention, a seroprevalence survey of measles antibody was conducted among 1961 participants aged 0-60 years randomly selected by age-stratified purpose sampling, and the effect of revaccination program in secondary school was evaluated in Zhejiang Province. The adjusted overall seropositivity rate of measles was 88% (95% confidence interval [CI]: 86-89%) with geometric mean titers (GMT), 976±86 mIU/ml. The seropositivity rate of measles was significantly lower in subjects aged 15-19 years than aged 5-9 years (90% vs 96%, χ(2)=5.21, p=0.022). Both seropositivity rate and GMT level of measles were higher in participants aged 10-14 years with ≥2 doses MCV than those with only 1 dose (95% vs 81%, 1276 mIU/ml vs 666 mIU/ml). The seropositivity rate increased from 91% to 100% after revaccination with MCV among 184 secondary school students. The proportions of measles cases aged ≥15 years were reduced gradually (χ(2)=55.47, p=0.000) from 2009 to 2011 after implementing the revaccination campaign on secondary school students since 2008. Our findings strongly suggested that a revaccination opportunity with MCV for adolescents helps to improve the population immunity, and it can be conducted effectively and practically in secondary school students., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Measles and rubella are vaccine-preventable diseases targeted for elimination in most World Health Organization regions, and China is considered to have momentum towards measles elimination. Therefore, this study aimed to assess the population immunity levels against measles and rubella in Zhejiang Province in China in order to provide valuable insights for informing future public health measures and contributing to the ongoing global campaign against these diseases. Materials and methods: A cross-sectional serological survey was conducted in 2022. A total of 2740 blood samples were collected from healthy individuals spanning the age range of 0–59 years, representing diverse demographic strata across 11 prefectures in Zhejiang Province in China. The sera were tested for measles and rubella IgG antibodies to determine positivity rates and geometric mean concentrations (GMCs). Results: The overall positivity rate for the measles IgG antibody was 85.3%, with a GMC of 588.30 mIU/mL. The positivity rate for the rubella IgG antibody was 70.9%, and the GMC was 35.30 IU/mL. Measles IgG antibody positivity rates across the 0–11 months, 12–23 months, 24–35 months, 3–5 years, 6–9 years, 10–14 years, 15–19 years, 20–29 years, and 30–59 years age groups were 63.1%, 92.5%, 97.0%, 94.0%, 85.8%, 77.3%, 86.9%, 84.9%, and 88.7%, respectively (trend χ2 = 118.34, p < 0.001). Correspondingly, rubella antibody positivity rates for these same age brackets were 55.9%, 87.9%, 94.7%, 88.2%, 69.9%, 54.2%, 72.6%, 67.5%, and 74.3% (trend χ2 = 199.18, p < 0.001). Both univariate and multivariate analyses consistently demonstrated that age, immunization history, and differing economic levels were significant factors contributing to variations in antibody levels. Conclusions: The seroprevalence of measles and rubella was lower than that required for herd immunity. Periodic vaccination campaigns should be launched to increase immunity. [ABSTRACT FROM AUTHOR]